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2010 Insurance Orientation Employee Insurance Program 803-734-0678 (Greater Columbia area) 888-260-9430 (Toll-free outs PowerPoint Presentation
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2010 Insurance Orientation Employee Insurance Program 803-734-0678 (Greater Columbia area) 888-260-9430 (Toll-free outs

2010 Insurance Orientation Employee Insurance Program 803-734-0678 (Greater Columbia area) 888-260-9430 (Toll-free outs

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2010 Insurance Orientation Employee Insurance Program 803-734-0678 (Greater Columbia area) 888-260-9430 (Toll-free outs

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  1. 2010 Insurance Orientation Employee Insurance Program 803-734-0678 (Greater Columbia area) 888-260-9430 (Toll-free outside the Columbia area)

  2. Disclaimer BENEFITS ADMINISTRATORS AND OTHERS CHOSEN BY YOUR EMPLOYER WHO MAY ASSIST WITH INSURANCE ENROLLMENT, CHANGES, RETIREMENT OR TERMINATION AND RELATED ACTIVITIES ARE NOT AGENTS OF THE EMPLOYEE INSURANCE PROGRAM AND ARE NOT AUTHORIZED TO BIND THE EMPLOYEE INSURANCE PROGRAM.THIS PRESENTATION CONTAINS AN ABBREVIATED DESCRIPTION OF INSURANCE BENEFITS. THE PLAN OF BENEFITS DOCUMENTS AND BENEFITS CONTRACTS CONTAIN COMPLETE DESCRIPTIONS OF THE HEALTH AND DENTAL PLANS AND ALL OTHER INSURANCE BENEFITS. THEIR TERMS AND CONDITIONS GOVERN ALL HEALTH BENEFITS OFFERED BY THE STATE. IF YOU WOULD LIKE TO REVIEW THESE DOCUMENTS, CONTACT YOUR BENEFITS ADMINISTRATOR OR THE EMPLOYEE INSURANCE PROGRAM.THE LANGUAGE USED IN THIS PRESENTATION DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE AGENCY. THIS PRESENTATION DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS PRESENTATION, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.

  3. Important Information This overview is not meant to serve as a comprehensive description of the benefits offered by the Employee Insurance Program. For more detailed information, have the 2010 Insurance Benefits Guide handy as you review this presentation.

  4. Insurance Orientation EIP Benefit Programs • Health Plans • Dental Plans • Vision Plan • Life Insurance • Long Term Disability • Long Term Care • MoneyPlu$ (Pre-tax programs)

  5. Insurance Orientation Eligibility

  6. Eligibility Active Employee • Must be employed in permanent, full-time position • Work at least 30 hours per week unless • Employed as a part-time teacher (only eligible for health, dental, vision and MoneyPlu$) • Employed by employer who allows coverage for 20-hour employees

  7. Eligibility Retired Employee • Must meet certain requirements to continue coverage in retirement • Refer to 2010 Insurance Benefits Guide for retiree eligibility information

  8. Eligibility Eligible Spouse • Spouse or former spouse* if coverage is court-ordered • Cannot cover spouse who is eligible for benefits through EIP as active employee or funded retiree * Documentation required to cover a former spouse

  9. Eligibility Children • Natural child • Step-child • Adopted child* • Foster child* • Child for whom employee has legal custody* * Documentation required at time of enrollment

  10. Eligibility Eligible Children • Under age 19, or until 25, if full-time student* • Unmarried, not employed with benefits and principally dependent on employee • Reside with employee or employee is court-ordered* to cover • Approved for incapacitation* * Documentation required at time of enrollment

  11. Eligibility Survivors • Dependents covered at time of employee’s or retiree’s death may continue health, dental and vision coverage • Spouse eligible until remarriage • Children remain eligible as long as eligible dependent • If all coverage is canceled cannot re-enroll as survivor

  12. Insurance Orientation Enrollment and Coordination of Benefits

  13. Enrollment Enroll • Within 31 days of • Hire or retirement date • Special eligibility situation • During open enrollment as late entrant

  14. Enrollment Pre-existing Condition Exclusion • Applies to health, Basic and Supplemental Long Term Disability • Waiting period • 12 months • 18 months (late entrant) • May be reduced by creditable coverage

  15. Enrollment October Enrollment Periods • Annual Enrollment (Every year) • Change health plans • Enroll in or drop State Vision Plan • Enroll or re-enroll in MoneyPlu$ programs • Open Enrollment (Odd-numbered years, i.e., 2011, 2013) • Enroll in or drop health, dental or Dental Plus • Add or drop eligible dependents

  16. Coordination of Benefits Health and Dental • Plan that covers person as employee is primary to plan that covers person as dependent • Children – Plan of parent whose birthday occurs earliest in year is primary • Deductible and coinsurance linked for married EIP subscribers enrolled in same health plan

  17. Insurance Orientation Health Plans

  18. Insurance Orientation Health Plan Options • State Health Plan • Standard Plan • Savings Plan • HMO • BlueChoice HealthPlan • CIGNA HMO

  19. Insurance Orientation Before you choose a health plan: • Read the plan overviews listed in the 2010 Insurance Benefits Guide • Review the exclusions and limitations listed for each plan • Determine if your doctor is in the network • Ask questions – contact EIP, your BA or the plan administrator for assistance

  20. State Health Plan State Health Plan (SHP) Administered by BlueCross BlueShield of South Carolina

  21. State Health Plan Standard Plan and Savings Plan Common to Both • Worldwide coverage • In- and out-of-network benefits • Pharmacy network • Online access available www.SouthCarolinaBlues.com

  22. State Health Plan Standard Plan and Savings Plan Preauthorization • Refer to 2010 Insurance Benefits Guide for information regarding • Medi-Call • National Imaging Associates • APS (mental health and substance abuse services) • Medco

  23. State Health Plan Standard Plan and Savings Plan Provider Network • Provider files claims and accepts allowable charges as payment in full • Subscriber pays deductibles and coinsurance

  24. State Health Plan Standard Plan and Savings Plan Out-of-network • Subscriber • May have to file claims • Can be balance billed • Pays higher coinsurance • No benefits paid for out-of-network prescription drugs

  25. State Health Plan Standard Plan and Savings Plan Limited Preventive Benefits* • Routine mammogram • Pap test • Well child care • Routine colonoscopy * Refer to the 2010 Insurance Benefits Guide for plan guidelines

  26. State Health Plan Standard Plan SHP Standard Plan

  27. Annual Deductible • $350 individual • $700 family • In-network Coinsurance • Plan pays 80% • Subscriber pays 20% • Coinsurance Maximum • $2,000 individual • $4,000 family • Out-of-network Coinsurance • Plan pays 60% • Subscriber pays 40% • Coinsurance Maximum • $4,000 individual • $8,000 family Standard Plan Deductibles and Coinsurance

  28. Standard Plan • Per-occurrence Deductibles • $10 Office visit • $75 Outpatient facility service • $125 Emergency room visit

  29. Network Retail Pharmacy* (up to 31-day supply) $ 9 Tier 1 $ 30 Tier 2 $ 50 Tier 3 Medco Mail Order* (up to 90-day supply) $ 22 Tier 1 $ 75 Tier 2 $125 Tier 3 Retail Maintenance Network Standard Plan Prescription Drug Benefits $2,500 maximum copayment per person

  30. State Health Plan Savings Plan SHP Savings Plan

  31. Savings Plan • Annual Deductible • $3,000 individual • $6,000 family • In-network Coinsurance • Plan pays 80% • Subscriber pays 20% • Coinsurance Maximum • $2,000 individual • $4,000 family • Out-of-network Coinsurance • Plan pays 60% • Subscriber pays 40% • Coinsurance Maximum • $4,000 individual • $8,000 family Deductibles and Coinsurance

  32. Savings Plan Rules • Subscriber pays 100% of • Allowable charges in-network • Actual charges out-of-network • Allowable charges at network pharmacies • After deductible is met, Plan will reimburse subscriber 80% of allowable charges

  33. Savings Plan Added benefits • Annual flu shot • Annual physical that includes specific services • Eligibility to contribute to Health Savings Account (HSA)

  34. HMOs Health Maintenance Organizations (HMOs)

  35. HMOs Requirements • Must live or work in HMO service area • Must choose Primary Care Physician (PCP) in network and receive referrals before seeing specialist • Only out-of-network benefit is emergency care

  36. BlueChoice HealthPlan (Available in all South Carolina counties) BlueChoice HealthPlan Available in all South Carolina Counties

  37. BlueChoice HealthPlan(Available in all South Carolina counties) • Annual Deductible • $250 individual • $500 family • Network Coinsurance • Plan pays 85% • Subscriber pays 15% Deductibles and Coinsurance • Coinsurance Maximum • $2,000 individual • $4,000 family

  38. BlueChoice HealthPlan(Available in all South Carolina counties) Copays Provider: • $15 PCP • $15 OB-GYN • $40 specialist • $35 urgent care Plan pays 100% after copay Facility: • $100 outpatient • $125 ER • $200 inpatient • Plan pays 85% • after copay

  39. Network Retail Pharmacy (up to 31-day supply) $ 8 Lower-cost generic $ 15 Higher-cost generic $ 35 Preferred brand $ 55 Non-preferred brand $ 80 Preferred brand specialty pharmaceuticals $125 Specialty pharmaceuticals Mail Order (up to 90-day supply) $ 20.00 Lower-cost generic $ 37.50 Higher-cost generic $ 87.50 Preferred brand $137.50 Non-preferred brand BlueChoice HealthPlan (Available in all South Carolina counties)

  40. CIGNA HMO CIGNA HMO Available in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

  41. CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda • Annual Deductible None • In-network Coinsurance • Plan pays 80% • Subscriber pays 20% Deductibles and Coinsurance • Coinsurance Maximum • $2,000 individual • $4,000 family

  42. CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda Copays Hospital • $250 outpatient • $500 inpatient • Plan pays 80% • after copay Provider • $15 PCP • $15 OB-GYN • $30 specialist • $100 ER Plan pays 100% after copay

  43. Mail-Order (up to 90-day supply) $ 14 generic $ 50 preferred brand $100 non-preferred brand Network Retail Pharmacy (up to 30-day supply) $ 7 generic $25 preferred brand $50 non-preferred brand CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

  44. Insurance Orientation Active Employee Health Premiums

  45. 2010 Active Employee Monthly Health Premiums SHP SHP Savings Standard Plan Plan $ 9.28 $ 93.46 Employee only Employee/spouse $ 72.56 $237.50 Premiums for local subdivisions may vary Employee/children $ 20.28 $142.46 Full family $108.56 $294.58 CIGNA Blue Choice HMO HMO $251.94 $185.56 Employee only $608.42 $508.78 Employee/spouse $518.08 $382.66 Employee/children $930.84 $741.22 Full family

  46. Tobacco Surcharge Tobacco Surcharge • $25 per month for tobacco users • Automatically charged unless certify no one uses tobacco • May certify by completing paper Certification Regarding Tobacco Use form

  47. Tobacco Surcharge Avoid the Surcharge • Must be tobacco free for 6 months to certify as non-tobacco user • All health plans offer free tobacco cessation program • Refer to 2010 Insurance Benefits Guide for detailed information

  48. Insurance Orientation State Dental Plan Administered by BlueCross BlueShield of South Carolina

  49. State Dental Plan Features Free to choose dentist No pre-existing condition exclusions Two year plan – may not drop or change until next open enrollment $1,000 maximum benefit

  50. State Dental Plan • Class III* • Prosthodontics • 50% of fee schedule Class IV • Orthodontics (only children younger than 19; $1,000 lifetime maximum) Class I • Preventive services • 100% of fee schedule Classes of Services • Class II* • Basic services • 80% of fee schedule • *$25 Combined Deductible for Classes II and III