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Embracing a Healthy Lifestyle through the State Health Plan New Plan Options and Incentives for 2014. Why Are W e Making C hanges for 2014?.

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Embracing a Healthy Lifestyle through the State Health PlanNew Plan Options and Incentives for 2014

why are w e making c hanges for 2014
Why Are We Making Changes for 2014?
  • More choice for members. The Treasurer conducted a listening tour and the Plan conducted focus groups and surveys. The message was clear, members want more options.
  • Encourage members to become more engaged in their health and take steps to live a healthier life.
  • An engaged membership will help ensure that the State Health Plan remains financially stable in the years ahead.
open enrollment 2014
Open Enrollment 2014

Open Enrollment will be conducted

October 1 – 31, 2013.

You must complete enrollment—otherwise, you and your covered family members will be enrolled in the Traditional 70/30 Plan effective January 1, 2014.

health plan options for 2014
Health Plan Options for 2014

Traditional 70/30 Plan

Enhanced 80/20 Plan

NEW: Consumer-Directed Health Plan (CDHP) with HRA

  • The current Standard 80/20 Plan with a new name to match the new features
  • $0 ACA Preventive Services
  • $0 ACA Preventive Medications
  • New Wellness Incentives
  • Reduced medical copay opportunities
  • The current Basic 70/30 Plan with a new name
  • No incentives available
  • No $0 ACA (Affordable Care Act) Preventive Services/ Medications
  • A new health plan option
  • A high-deductible medical plan
  • A Health Reimbursement Account (HRA) to help offset the deductible
  • 85/15 Coinsurance
  • $0 ACA Preventive Services/Medications
  • CDHP Preventive Medication List ($0 deductible)
  • New wellness incentives
    • Additional HRA funds for visiting certain providers
a new focus on wellness
A New Focus On Wellness

Enhanced 80/20 Plan

NEW: Consumer-Directed Health Plan (CDHP) with HRA

Traditional 70/30 Plan

  • Wellness premium credits when:
  • Subscriber completes a Health Assessment
  • Subscriber attests for him/herself and spouse (if applicable) to not smoking
  • Selecting a Primary Care Provider (PCP) for self and dependents
  • Additional wellness incentives
  • No incentives available
  • No $0 ACA Preventive Services
  • No $0 ACA Preventive Medications
  • Wellness premium credits when:
  • Subscriber completes a Health Assessment
  • Subscriber attests for him/herself and spouse (if applicable) to not smoking
  • Selecting a Primary Care Provider (PCP) for self and all dependents
  • Additional wellness incentives
the traditional 70 30 plan
The Traditional 70/30 Plan
  • Traditional 70/30 Plan – There are no changes to the Plan’s benefits for 2014
  • Copays and Deductibles – There will be no opportunities for copay reductions on the Traditional 70/30 Plan.
  • Network Services – Members may visit any provider, but they will pay less when they go to a BCBSNC network provider
  • Preventive Services – Copays still apply to preventive services.
monthly premiums traditional 70 30plan
Monthly Premiums—Traditional 70/30Plan

Reminder: Wellness premium credits are not offered under the Traditional Plan.

the enhanced 80 20 plan
The Enhanced 80/20 Plan
  • New incentives to encourage members to manage their health and lower their health care costs
    • Preventive Care – No copays on Affordable Care Act (ACA ) preventive services or preventive medications.
    • Primary Care Provider (PCP) – $15 PCP copay reduction.
      • If PCP is not available at the time of the appointment, the member may visit any provider in the same practice and still receive the copay reduction
        • If a member wants to change PCPs, they can go to their enrollment portal and select a new PCP. The PCP change must be made before visiting the new PCP.
      • Specialists – $10 Specialist copay reduction, choose a Blue Options Designated provider
      • Hospitals – $233 Inpatient Hospital copay avoidance (Blue Options)
who can be a primary care provider
Who can be a Primary Care Provider?
  • A Primary Care Provider can practice:
    • General / Family Medicine
    • Internal Medicine
    • Pediatrics, or
    • Obstetrics and Gynecology
  • A Primary Care Provider can be:
    • Licensed Nurse Practitioners
    • Physician’s Assistants
  • Specialty Providers cannot be selected as a PCP.
monthly premiums enhanced 80 20 plan
Monthly Premiums—Enhanced 80/20 Plan

*Assumes completion of three wellness activities

the consumer directed health plan cdhp with hra a different kind of health plan with two components
The Consumer-Directed Health Plan (CDHP) with HRAA different kind of health plan with two components

2

1

Health Reimbursement Account (HRA)

High-Deductible Health Plan

  • The Plan funds the members’ Health Reimbursement Accounts (HRA) annually
    • $500 for employee only
    • $1,000 for employee + 1
    • $1,500 for employee + 2 or more dependents
  • When HRA is depleted, the member must pay the remaining deductible & coinsurance
  • Unused HRA funds roll to the following year
  • Covers the same services as other Plan options through the same PPO network
  • In-network: Deductible
  • $1,500 Individual/ $4,500 Family
  • Out-of-Network: Deductible $3,000 Individual/ $9,000 Family
  • After the deductible is met, 15% coinsurance
  • The deductible applies to both Pharmacy and Medical expenses
example cdhp office visit and prescription
Example: CDHP Office Visit and Prescription

Present HRA ID Card at Office Visit. Total office visit $175 submitted to BCBSNC by provider.

  • Member picks up prescription at pharmacy and pays $65 because deductible has not been met.
  • Claim automatically rolls over to HRA for adjudication - $175 remitted to provider-
  • Pharmacy claim automatically submitted to HRA. Member reimbursed $65.
  • Claim processes in primary claims system and applies towards $1,500 deductible – EOB/EOP issued.
  • At end of the month, $15 credited to member’s HRA for visiting PCP on ID Card.
monthly premiums cdhp
Monthly Premiums—CDHP

*Assumes completion of three wellness activities

completing open enrollment
Completing Open Enrollment
  • Action must be taken during Open Enrollment:
    • Choose a health plan
    • Decide whom to cover
    • Complete wellness activities
  • Remember, NC Flex Benefits enrollment in Oct. also.
  • Online enrollment only – https://shp-login.hrtintouch.com
  • Effective January 1, 2014 through December 31, 2014

If you do not complete your enrollment by October 31, 2013, you, and any currently covered family members will be enrolled in the Traditional 70/30 Plan effective Jan. 1, 2014.

enrollment instructions
Enrollment Instructions

eEnroll

  • All changes need to be done through the eEnroll system by logging in to the system at https://shp-login.hrintouch.com
  • For assistance in navigating eEnrollmembers can call Benefitfocus Customer Service at 855-859-0966.
nc flex new vision benefit
NC FLEX – NEW Vision Benefit
  • Core Wellness Exam
  • Annual Comprehensive Eye Exam
  • $20 copay
  • In-network providers only
  • Discounts on materials
  • No premium – but MUST enroll
nc flex new group term life option
NC FLEX – NEW Group Term Life Option
  • Employee and Spouse Coverage
    • Rates based on age of employee
  • Employee and Child(ren) Coverage
    • Flat rate for child(ren) coverage
  • If elected, premiums for Employee and Dependent(s) will be after-tax.
nc flex flexible spending accounts
NC Flex - Flexible Spending Accounts
  • MUST re-enroll each year.
  • Employee-only contribution to reimburse yourself for eligible expenses
  • Does not roll over
  • Not to be confused with HRA
    • (Health Reimbursement Account)
resources for members
Resources for Members
  • Please READ your mail!

There will be 4 mailers sent to you to assist you in your decision.

  • SHP Website
    • There will be 4 instructional videos posted to the Plan’s website.
    • Premium Rate Calculator tool available online
important numbers
Important Numbers
  • www.shp-login.hrintouch.com
  • ELIGIBILITY AND ENROLLMENT for eEnroll855-859-0966
  • BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and HRA) 888-234-2416