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Office of Group Benefits Annual Enrollment 2012 PowerPoint Presentation
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Office of Group Benefits Annual Enrollment 2012
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  1. Office of Group Benefits Annual Enrollment 2012 FOR ACTIVE EMPLOYEES & RETIREES WITHOUT MEDICARE

  2. Welcome This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan option, individuals should read plan documents carefully and also consult other OGB and plan administrators’ publications.

  3. Welcome This presentation will cover: • Ways to Save • Eligibility • Overview of Health Plans • Life Insurance • Flexible Benefits

  4. Office of Group Benefits OGB serves state agencies, universities and school boards Prescription Drug Benefits 21.9% Administrative Costs 3.5% Mental Health Benefits 1% Medical Benefits 71.4% Life Insurance 2.2% OGB’s administrative costs are only 3.5% of total costs (June 30, 2011)

  5. Annual Enrollment Timeline Annual Enrollment ends Deadline for employees to submit health plan enrollment forms to HR (if changing plans) Annual Enrollment begins Flexible Benefits Annual Enrollment ends Deadline for employees to submit Flexible Benefits forms to HR (may be earlier for some agencies) 2012 plan year begins

  6. Ways to Save

  7. Your Health: Our Premium Priority7 Ways to Save • Choose the right health plan for you • Out-of-state coverage differs by plan • Out-of-state dependent? Job transfer? Travel? • Are your providers in the plan’s network? • All plans accessible through OGB website 1 2 • Stay in your health plan’s provider network • Avoid balance billing 3 • Request generic drugs • Same active ingredients and big savings • Preferred drug list at

  8. Your Health: Our Priority7 Ways to Save • Get preventive (wellness) exams • Prevention • Early diagnosis 4 5 • Use Flexible Benefits (active employees) • Pre-tax deduction saves money • More take-home pay • Sign up for Diabetic Sense program (PPO & HMO plans) • Get test supplies free • Free glucometer • Provided by Catalyst Rx through Liberty • 1-888-341-8582 6 • Sign up for Living Well Louisiana program (PPO & HMO plans) • Access to health coaches 24 hours a day, 7 days a week • Prescription drug incentive for active LWL participants • Lower co-pays • 1-800-383-0115 7

  9. Prescription Cost Comparison

  10. Living Well Louisiana Health Management Program For PPO and HMO Plans Free health management program for active employees, retired employees without Medicare and rehired retirees without Medicare who are diagnosed with 1 or more of these 5 ongoing health conditions: • Diabetes • Heart disease • Heart failure • Asthma • Chronic obstructive pulmonary disease (COPD) Living Well Louisiana is not available to individuals who have Medicare as primary coverage

  11. Living Well Louisiana Health Management Program For PPO and HMO Plans • Once enrolled, you have access to... • Health coaches – 24 hours a day, 7 days a week • Online health information and resources • Reduced co-payments to eligible LWL participants for prescription drugs used to treat these 5 chronic conditions When Medicare Part A and/or B become primary, you are no longer eligible for LWL program

  12. Living Well Louisiana Health Management Program For PPO and HMO Plans • Active participation requires: • Initial assessment by phone • Follow-up contacts by phone, mail or email • Ongoing relationship with LWL health coaches (contact at least once every 3 months) If plan member fails to maintain contact with health coaches, or if Medicare becomes plan member’s primary health coverage, participant is no longer eligible to participate in LWL program or receive reduced co-pay on applicable prescription drugs

  13. Premium Cost-Saving Strategies Married Couples If both are state or schoolemployees... • Both eligible? • May save if split coverage

  14. Eligibility

  15. Eligibility – Same for All Plans Full-Time Employees and Dependents • Legal spouse Louisiana does not recognize same-sex marriages regardless of other states’ laws • Children up to age 26 – regardless of child’s student, marital or tax status No one can be enrolled simultaneously as both an employee and a dependent in OGB health plans or life insurance No dependent can be covered by more than one employee Dependent verification required

  16. Eligibility – Children • Natural child of you or your legal spouse • Legally adopted child • Child placed in home for adoption • Child in home under legal guardianship or custody • Grandchild dependent on you whose parent is your covered dependent

  17. Dependent Verification • Plan member must provide proof of the legal relationship of each dependent within 30 days of date of application for coverage • Proof: Official documents • Marriage certificate • Birth certificate • Other court records or legal documents

  18. Eligibility Change – Newborns Effective July 1, 2011, OGB must receive child’s birth certificate within 6 months of birth • Birth letter will suffice for first 6 months only – if received within 30 days of DOB • OGB will send reminder letter 90 days after birth date

  19. Over-Age Dependents Covered child under age 26 who is or becomes incapable of self-sustaining employment is eligible to continue coverage as an overage dependent • OGB must receive required medical records before dependent reaches age 26 • Definition of incapacity broadened – now includes both mental and physical incapacity

  20. Pre-Existing Condition Limitation forNew Hires and Late Applicants Must complete enrollment form (GB-01) within 30 days for new dependent … otherwise, pre-existing condition limitation (PEC) applies • If diagnosed or treated within 6 months prior to enrollment date, condition is pre-existing ... no benefits are payable for that condition in first 12 months of coverage • PEC limitation does not apply to anyone under age 19 • May be exempt from pre-existing condition limitation if continuously covered without 63-day break in coverage prior to enrollment date

  21. Retirement • Coverage must be in effect prior to retirement date • Participation schedule applies to... • Employees who joined an OGB health plan on or after January 1, 2002 • Dependents who joined an OGB health plan on or after July 1, 2002 • Prior OGB health plan coverage as a spouse qualifies in computing years of participation

  22. Retiree Participation Schedule Schedule not affected when you change OGB health plans

  23. Medicare and OGB Coverage If you reached age 65 on or after July 1, 2005, AND are retired AND are eligible for Medicare Part A premium-free, then… • You MUST enroll in Medicare Part B to receive OGB health plan benefits for medical expenses covered by Medicare Part B • You must submit Social Security verification to OGB: • If eligible – submit copy of Medicare card • If not eligible – submit letter from Social Security This also applies to your covered spouse If you are not yet retired, this will apply when you retire

  24. Overview of Health Plans

  25. OGB Health Plans for 2012 * CDHP-HSA plan is not available to retirees; other plans are available to all employees and retirees

  26. Key Points • Can change health plans during Annual Enrollment • Compare costs, benefits and restrictions when choosing a plan • Active employees and retirees who choose to keep same plan do not have to fill out a form • Active employees who want to change plans must notify your HR office

  27. Key Points Retirees who want to change plans must… • Fill out an OGB enrollment form … or • Write a letter to OGB that includes: • Your plan choice • Your name and address • Your date of birth • Your daytime phone number • Sign form or letter and mail it to ... OGB Eligibility Division P.O. Box 66678 Baton Rouge, LA 70896 ... or visit any OGB Agency Services office

  28. Plan Member Out-of-Pocket Expenses

  29. Plan Member Out-of-Pocket Expenses

  30. Plan Member Out-of-Pocket Expenses • * Plan member owes deductible, co-pay, co-insurance and balance of billed charges • ** No out-of-pocket maximum for non-network providers

  31. Mental Health & Substance Abuse Treatment Benefit 1 Subject to plan year deductible and/or co-insurance 2Pre-authorization required

  32. Prescription Drug BenefitPPO and HMO (Administered by Catalyst Rx) * OGB’s open formulary means EVERY FDA-approved prescription drug is covered by PPO and HMO health plans

  33. Prescription Drug BenefitRegional HMO (Administered by VHP’s Catalyst Rx) *Prescription drugs not on Vantage’s formulary list may be available at higher out-of-pocket cost

  34. Prescription Drug BenefitMedical Home HMO (Administered by VHP’s Catalyst Rx) * Vantage Health Plan’s open formulary means prescription drugs not on the Vantage formulary list may be available at higher out-of-pocket expense

  35. Prescription Drug BenefitCDHP-HSA (Administered by UHC’s PrescriptionSolutions)

  36. Life Insurance

  37. Life Insurance Prudential Insurance Co. of America • Group term life insurance policy • State pays half of premium for employees and retirees • Employee pays full premium for dependent life insurance • 25% reduction in coverage and appropriate reduction in premiums on July 1 after plan member reaches age 65 and age 70

  38. Life Insurance

  39. Life Insurance

  40. Life Insurance • Accidental Death and Dismemberment (AD&D) benefits available to all active and retired employees covered under Basic or Basic Plus plan • Retirees over age 70 not eligible for AD&D ALL inquiries and changes in life insurance must be made through your agency’s HR office

  41. Sources of Information • OGB website with links to all health plans….. • OGB (PPO)…..1-800-272-8451 • Blue Cross and Blue Shield of La. (HMO)….. 1-800-392-4089 • Vantage Health Plan (Medical Home & Regional HMO)…..1-888-823-1910 • UnitedHealthcare (CDHP-HSA)…..1-866-336-9374 • Catalyst Rx…..1-866-358-9530 • Living Well Louisiana Program…..1-800-383-0115 • Diabetic Sense Program…..1-888-341-8582 • ValueOptions…..1-866-492-7143 • DataPath Administrative Services….1-877-685-0655

  42. Flexible Benefits

  43. Flexible Benefits Options – Why Enroll?

  44. Flexible Benefits – More Take-Home Pay

  45. Premium Conversion

  46. More Take-Home Pay – Example

  47. Premium Conversion (Free Participation) Eligible Payroll Deductions • OGB health plan premium • OGB life insurance premium (Prudential) • Employee portion only • Some miscellaneous/statewide insurance premiums • Cancer insurance deduction* • Dental insurance deduction • Hospital indemnity insurance deduction • Intensive care insurance deduction • Vision insurance deduction * Policy cannot have a cash value or a return-of-premium rider

  48. Health Savings Account (HSA)

  49. OGB Health Savings Account (HSA) • You cannot participate in OGB HSA option if you have: • General-Purpose (Health Care) FSA – or your spouse has General-Purpose (Health Care) FSA • Medical coverage under a non-CDHP • TRICARE or TRICARE for Life coverage • Used any VA benefits within previous 3 months • Medicare Part A or Part B coverage • You must participate in OGB Consumer Driven Health Plan (CDHP) to participate in Health Savings Account (HSA) option

  50. Health Savings Account (HSA) You can use your HSA to pay these eligible expenses: • Office visits (including deductibles and co-insurance) • Chiropractic services • Prescription drugs • Over-the-counter medications with a prescription • Dental expenses • Eye glasses, contact lenses and solutions • Eye surgery (including Lasik) • Lab fees • COBRA, Medicare and qualified long-term care premiums