Your 2017 Employee Benefits Zach Peterson, Senior Account Specialist, IBAMS Chipasha Kashoki, Account Specialist, IBAMS
October 27th, 2016 Diocese of Texas
Introduction
Why are YOU here today?
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Why Are You Here Today? You received a memo from Cornelio telling you to show up — at this time — in this room You told your spouse there was an Open Enrollment meeting and s/he said you had to be here You were hoping for free food! Because you have questions To learn about your healthcare benefits and how to use them to stay healthy 3
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Introduction
Why are we here today?
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Why are we here Today? We received a memo from Cornelio telling me to show up – at this time – in this room We think employees tend to become anxious when they hear benefits are changing and we want to help reduce your anxiety We will have ANSWERS to many of your questions Because CPG really does want you to know how to make the most of your new benefits
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Agenda Open Enrollment Medical Trust Plan Array Update Looking Ahead to 2017
2017 Plan Benefits CDHP/HSAs: The Basics Important Open Enrollment Information and Dates Getting Help Q&A 6
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About Your Benefits
What should I know about Open Enrollment?
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Open Enrollment Held each fall for current plan enrollees All renewing members will receive a letter from the Medical Trust, including: • The Open Enrollment (OE) period for your group • Instructions for using the online OE website to make your healthcare benefit selections for 2017
Open Enrollment Please note that the Open Enrollment website should be accessed using Firefox, Safari, and Internet Explorer 8 or 9. Please use one of these browsers to access the website. You can download Firefox for Mac or PC using this link: download Firefox (https://www.mozilla.org/en-US/firefox/new/)
Don't have an account? In order to access Open Enrollment and other applications, you will have to create an account. Create an Acc ount
Sign In Sign in by entering your username and password. You can enter your username, personal email address or client number in the Username box. *Username *Password
Forgot us ername? Forgot pas sword?
Show typing
D on' tInhave an ac count? Sign
* Denotes a required field. Need Help? Please contact Client Services at (855) 594-2201, Monday - Friday, 8:30AM - 8:00PM ET (excluding holidays).
You will log in to the OE website with your MyCPG Account user name and password Know your plan selections when you go online • Remember to include your plan and eligible dependents when you enroll
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The Importance of Open Enrollment Open Enrollment provides an opportunity to select health plans that best meet your needs for the coming year • How much coverage do you and your family really need? • Have you experienced changes in the past year which may impact your coverage needs? Be sure to verify and make any necessary corrections to your personal and dependent information If your current plan will no longer be offered, you will need to actively select another plan option during Open Enrollment 9
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Timeline for Active Open Enrollment 2017 September
October
9/9
10/12
November
Last Week
December
Renewal Release Date
Letter generation and mailing
Identification cards mailed
Letter will specify assigned OE session
9/9 – 10/17 Administrator Plan Selections
10/24 – 11/9 (Session 1)* OE site will be open for member enrollment 10
Partners on Your Journey to Health and Wellness
HEARING HEALTH CARE
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2017 Retiree Open Enrollment
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2017 Retiree Open Enrollment 2017 Retiree Member OE Timeline
October 13 – December 7
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2017 Retiree Rates Medicare Supplement
Comprehensive
Plus
Premium
2017 Per Person, Per Month
$340
$465
$540
Dollar Amount
$10
$15
$20
Percentage
3.1%
3.4%
3.9%
Increase versus 2016
Dental
Dental and Orthodontia
Basic Dental
Preventive Dental
2017 Per Person, Per Month
$85
$69
$45
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Medical Trust Plan Array Update
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The Episcopal Church Medical Trust Mission: Provide access to high-quality benefits and consistent service, balancing compassionate benefits with financial stewardship
The Medical Trust Serving the Church Financial Sustainability
• • • • • • •
High-quality health plans that provide robust benefits Advocacy for employers and employees Competitive rating and stability High levels of client service and satisfaction Proactive case/risk management Cost reduction and mitigation Stable and adequate reserving 16
January – August
In Partnership With Our Clients, Our Commitment is to Provide Members…
Pre-Open Enrollment
Meaningful Choices Right Choices 17
A Smarter Healthcare Program
January – August Pre-Open Enrollment
Consistent member experience Enables members to make informed and optimal healthcare decisions so they may: • Access the right care — at the right place — at the right time Ensures quality, effective outcomes • Creates better ways to spend and contain costs • Streamlines medical necessity review and promotes evidence-based decisions on value and quality 18
6
January – August
Meaningful Choice, Delivered Better
Pre-Open Enrollment
Concentration
Modernization
Simplification
• Purposeful
• Continuous
• Provide
attention to key program elements
evaluation to keep overall program relevant
meaningful choice and consistent experience
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Transitioning Towards 2018 2015 20 plans: • 17 Platinum • 2 Gold • 1 Silver • 0 Bronze
2016 and 2017
• • •
Strategic communications plan Consolidation opportunities Additional plans to provide meaningful choice
2018 6 core plan designs: • 1 Platinum • 2 Gold • 2 Silver • 1 Bronze
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Looking Ahead to 2017
7
Plan Offering Changes for 2017 National Plans
Regional Plans — Kaiser
• Eliminated: Aetna HMO • Eliminated: Aetna Choice POS II • Eliminated: Aetna Select EPO • Eliminated: UnitedHealthcare
•
New: Consumer-Directed Health Plan / Health Savings Account
•
New: EPO High
Choice EPO
– Network only – Merger of current High
Plan Name Change
• High Deductible (HDHP) will now be Consumer-Directed (CDHP)
and Mid Option plans
• •
Eliminated: High Option Eliminated: Mid Option 22
What is Not Changing for 2017 Core Health Plan Benefits
• Pharmacy with Express Scripts • Cigna Behavioral Health • Underlying
plan coverage and exclusions
Additional Benefits
• EyeMed Vision Care • Cigna Employee Assistance Program (EAP)
• Health Advocate • Amplifon Hearing Discounts • UnitedHealthcare Global
Cigna Dental
Assistance Travel Assistance
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Summary of Plan Array Strategy Our shared goal is an overall smarter healthcare program
• Meaningful choice, delivered more cost-effectively 2016 and 2017 = transition period
• Simplification, clarification, and modernization lead the way Focus on healthcare consumerism and program changes
• Requires enhanced member education, communications, and engagement 24
8
2017 Plan Benefits
Your 2017 Medical Plan Choices Network & Out-of-Network Plans Cigna Open Access Plus
Network Only Plans
Anthem BCBS EPO 80*
Anthem BCBS PPO 90/70* (New) Anthem BCBS PPO 75/50* Anthem BCBS PPO 70 SLV* Cigna CDHP-20/HSA Anthem BCBS CDHP-40/HSA
* Available for Medicare Secondary Payer (MSP) 26
Medical Expense Terms Defined What is a Deductible? An amount you could owe during a coverage period (usually a calendar year) for covered health care services before your plan begins to pay What is a Copayment? A fixed amount you pay for a covered health care service, usually when you receive the service What is Coinsurance? Your share of a covered health care service, calculated as a percentage of vendor-negotiated costs What is the Maximum Out-Of-Pocket Limit? Maximum yearly amount set as the most each individual or family can be required to pay for covered services
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Health Benefits Roadmap: Summary of Benefits and Coverage High level overview of your benefits • Multi-paged • Comprehensive • Not exhaustive Topics addressed • Deductibles • Maximum out-of-pockets • Out-of-pocket costs – –
• •
Copayments Coinsurances
Exclusions Limitations 28
Anthem BCBS EPO 80 Individual (in-network) Annual Deductibles Medical: Prescription (retail): Out-of-pocket limits Medical: Pharmacy:
$350 $50 per person
Individual and Family (in-network)
$
$
Annual Deductibles Medical: Prescription (retail):
$700 $50 per person
$4,700 $5,000
$2,350 $2,500
Out-of-pocket limits Medical: Pharmacy:
Physician visits Preventive: Office visit: Specialist visit:
No copay $25 $25
Physician visits Preventive: Office visit: Specialist visit:
No copay $25 $25
Emergency room
$100
Emergency room
$100
Referral for specialist No
Referral for specialist No 29
Anthem BCBS PPO 90/70 Individual (in-network) Annual Deductibles Medical: Prescription (retail):
$250 $50 per person
Out-of-pocket limits Medical: Pharmacy:
Individual and Family (in-network) Annual Deductibles Medical: Prescription (retail):
$500 $50 per person
$1,750 $2,500
Out-of-pocket limits Medical: Pharmacy:
$3,500 $5,000
Physician visits Preventive: Office visit: Specialist visit:
No copay $25 $25
Physician visits Preventive: Office visit: Specialist visit:
No copay $25 $25
Emergency room
$100
Emergency room
$100
Referral for specialist No
$
$
Referral for specialist No 30
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Cigna Open Access Plus PPO Individual (in-network) Annual Deductibles Medical: Prescription (retail):
$500 $50 per person
Out-of-pocket limits Medical: Pharmacy:
Individual and Family (in-network) Annual Deductibles Medical: Prescription (retail):
$1,000 $50 per person
$2,500 $2,500
Out-of-pocket limits Medical: Pharmacy:
$5,000 $5,000
Physician visits Preventive: Office visit: Specialist visit:
No copay $25 $25
Physician visits Preventive: Office visit: Specialist visit:
No copay $25 $25
Emergency room
$100
Emergency room
$100
$
$
Referral for specialist No
Referral for specialist No 31
Anthem BCBS PPO 75/50 Individual (in-network) Annual Deductibles Medical: Prescription (retail): Out-of-pocket limits Medical: Pharmacy:
$900 $50 per person
Individual and Family (in-network)
$
$
Annual Deductibles Medical: Prescription (retail):
$1,800 $50 per person
$8,200 $5,000
$4,100 $2,500
Out-of-pocket limits Medical: Pharmacy:
Physician visits Preventive: Office visit: Specialist visit:
No copay $35 $45
Physician visits Preventive: Office visit: Specialist visit:
No copay $35 $45
Emergency room
$100
Emergency room
$100
Referral for specialist No
Referral for specialist No 32
Cigna Consumer-Directed Health Plan-20/HSA Individual (in-network) Annual Deductibles Medical/Pharmacy:
$2,700
Out-of-pocket limits Medical/Pharmacy:
Individual and Family (in-network) Annual Deductibles Medical/Pharmacy:
$5,450
$4,200
Out-of-pocket limits Medical/Pharmacy:
$8,450
Physician visits Preventive: Office visit: Specialist visit:
No cost share 20% coinsurance 20% coinsurance
Physician visits Preventive: Office visit: Specialist visit:
No cost share 20% coinsurance 20% coinsurance
Emergency room
20% coinsurance
Emergency room
20% coinsurance
Referral for specialist No
$
$
Referral for specialist No 33
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Anthem BCBS PPO 70 SLV Individual (in-network) Annual Deductibles Medical: Prescription (retail):
$3,000 $50 per person
Out-of-pocket limits Medical: Pharmacy:
Individual and Family (in-network) Annual Deductibles Medical: Prescription (retail):
$6,000 $50 per person
$4,000 $2,500
Out-of-pocket limits Medical: Pharmacy:
$8,000 $5,000
Physician visits Preventive: Office visit: Specialist visit:
No copay $35 $45
Physician visits Preventive: Office visit: Specialist visit:
No copay $35 $45
Emergency room
$150 copay
Emergency room
$150 copay
$
$
Referral for specialist No
Referral for specialist No 34
Prescription Medications — Express Scripts
Where to fill your prescription
What drugs are covered
• Participating retail
• Understand
•
•
•
pharmacy Non-participating retail pharmacy (file own claim for reimbursement) Home delivery
What does it cost
• $50 deductible at retail
• Copay amounts • Out of pocket limits
the formulary Generic, preferred brand, non-preferred brand
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Rx Benefits in Comparison: Traditional Plans* Standard Plan Retail
Home Delivery
Annual Prescription Deductible
$50 per person**
None
Annual Out-of-Pocket Limit
$2,500 individual/$5,000 family in-network (accumulates separately from the medical benefit***)
Copays/Coinsurance Tier 1: Generic
Up to $10
Up to $25
Copays/Coinsurance Tier 2: Preferred
Up to $35
Up to $90
Copays/Coinsurance Tier 3: Non-preferred
Up to $60
Up to $150
Dispensing Limits per Copayment
Up to a 30-day supply
Up to a 90-day supply
*For Anthem and Cigna CDHP Rx benefits, see next table slide in this presentation
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Rx Benefits in Comparison: CDHPs Consumer-Directed Health Plan: 20/HSA (Cigna)
Consumer-Directed Health Plan: 40/HSA (Anthem)
Retail & Home Delivery Annual Prescription Deductible
$2,700 per person/ $5,450 per family in-network (combined with medical)
$3,500 per person/ $7,000 per family in-network (combined with medical)
Annual Out-of-Pocket Limit
$4,200 individual/ $8,450 family in-network
$6,000 individual/ $12,000 family in-network
Tier 1: Generic
Coinsurance: You pay 15% after deductible
Tier 2: Preferred
Coinsurance: You pay 25% after deductible
Tier 3: Non-preferred
Coinsurance: You pay 50% after deductible
Dispensing Limits per Copayment
Up to a 30-day supply (retail) or 90-day supply (mail order)
37
What to Expect with Express Scripts Express-Scripts.com/Activate Express Scripts mobile app Make sure the drug is covered Coverage Management • ESI will contact you, your pharmacist, or your physician if necessary Home delivery
38
Mental Health/Substance Abuse Benefits Provided through Cigna Behavioral Health* • Individual, family, couples, group therapy • Medical management • Applied Behavioral Analysis • Colleague Group Benefits • Inpatient Benefits Copayments/coinsurance
*Members enrolled in Anthem CDHPs receive these benefits through Anthem. Members enrolled in Kaiser plans receive these benefits through Kaiser.
39
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How to Access Mental Health/Substance Abuse Benefits Find a network provider or facility* • Contact Cigna Behavioral Health at 866-395-7794, 24/7 • Log into www.cignabehavioral.com Preauthorization is required for inpatient services and some extensive outpatient services
*Members enrolled in Anthem CDHPs receive these benefits through Anthem. Members enrolled in Kaiser plans receive these benefits through Kaiser.
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Anthem CDHPs — Mental Health/Substance Abuse Benefits Provided through Anthem BCBS • Individual, family, couples, group therapy • Applied Behavioral Analysis • Colleague Group Benefits • Inpatient Benefits Copayments/coinsurance
41
Anthem CDHPs — How to Access Mental Health/Substance Abuse Benefits Find a network provider or facility • Contact Anthem at the number on your ID card, 24/7 • Log into www.anthem.com • Preauthorization is required for inpatient services and some extensive outpatient services EAP provided through Cigna Behavioral Health
42
14
CDHPs/HSAs: The Basics
CDHP/HSA Consumer-Directed Health Plan* • Traditional PPO or EPO Plan • Designed to be partnered with a Health Savings Account (HSA) Health Savings Account • Tax advantaged account for qualified healthcare expenses CDHP/HSA Fact Sheet — www.cpg.org/mtdocs
$ *Formerly referred to as High Deductible Health Plan
44
All Additional Benefits Included in CDHPs! EyeMed Employee Assistance Program (through Cigna Behavioral Health) Health Advocate UnitedHealthcare Global Assistance Amplifon Hearing Health Care
45
15
Health Savings Accounts — The Details
Who is Eligible to Have a Health Savings Account Must be enrolled in a qualifying CDHP Cannot be covered by other medical insurance, including Medicare, with limited exceptions: • Can have AFLAC-type coverage • Can have separate dental or vision coverage • Can have disability coverage Cannot contribute to a Health Savings Account while using a regular Flexible Spending Account (FSA) • Instead, enroll in a “limited purpose” FSA (if available)
47
Setting Up the Health Savings Account When you enroll in a CDHP, an HSA will be set up automatically for you with our HSA trustee, HealthEquity • You will receive a Welcome Kit with up to three Visa HSA Debit cards usable for healthcare expenses at the point of service • The Medical Trust will pay the set-up and monthly maintenance fees • New for 2017: Employer contributions are made through HealthEquity’s online portal
48
16
Setting Up the Health Savings Account (cont’d) Remember to designate a death beneficiary on the account • If spouse, account balance not taxable on your death and your spouse can continue to use the funds as a tax-advantaged health savings account • If anyone else, or if you fail to designate a beneficiary, the account will be closed, the balance will be taxed, and the money distributed to your designated non-spouse beneficiary or, if none, your heirs
49
Contributing to the Account Employer contributions Employee payroll deductions Direct deposits by employee or anyone IRS 2017 contribution maximums are $3,400 (individual) and $6,750 (family)* • Excess contributions are taxable to you and you pay a 6% penalty (for each year the excess remains in the HSA) You can make additional contributions, or withdraw excess contributions and associated interest, until the tax filing deadline – generally April 15 – each year *These amounts are the total contribution allowed from both the employee and the employer. An additional $1,000 is allowed if the account holder is age 55+. **The deadline is extended for any extensions to your tax return.
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Contributing to the Account (cont’d) Special Rules for Spouses/Families
Partial/Last Month Rule
•
•
• •
If all are enrolled in CDHPs, the maximum contribution is the family limit, which can be split evenly or as the parties decide Only the age 55+ account holder can make the extra $1,000 contribution Each covered individual, except IRS dependents, is eligible for and can open a separate account
•
You may make proportionate contributions only for the portion of the year you are eligible However, under a special rule, if you are not eligible for the entire year, but are eligible on December 1, you can make a contribution up to the full annual limit for the year, provided you remain HSA eligible until the end of the next calendar year
51
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Distributions From the Account You do not have to use the money in any particular year You can continue to use the money even when you are no longer eligible to contribute to the account • Not enrolled in a CDHP • Enrolled in Medicare You are not taxed on the amount distributed from the account if you use it for qualifying healthcare expenses • IRS Publication 502 • Includes dental and vision out of pocket expenses • Includes prescription medications – no OTC products If used for non-qualifying expenses, you will pay federal income tax and a 20% excise tax as a penalty • If you are age 65+, you don’t pay the penalty
52
Who Can Use Your Health Savings Account? Yourself Your spouse (even if the spouse is not on your CDHP) Your dependents that you can claim on your tax return (even if not on your CDHP)
53
Additional Paperwork Remember to keep track of how much is contributed
• • •
The trustee bank will send IRS Form 5498-SA to show the amount of contributions made to the account Your employer will enter the amount it contributed, including your contributions made through payroll deduction, in Box 12 of your W-2 If over the maximum, you have until the tax filing deadline, generally April 15 each year (or the date of any extension to your return), to withdraw the excess plus any interest earned on the excess
Remember to keep track of how each distribution is used
• •
The trustee will send IRS Form 1099-SA Must have receipts to show used for qualifying healthcare expenses for audit purposes
Filing your tax return
•
IRS Form 8889 54
18
How to use your HSA
Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc. Confidential and proprietary. Reproduction without express written consent is prohibited.
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Convenient Access •
Convenient access – – – –
•
Debit card Online Using our free mobile app By telephone
Use your HealthEquity account to – – – – – –
Check your balance Review transactions Review claims Submit new claims or documents Send payments and reimbursements Access tax documents
Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc. Confidential and proprietary. Reproduction without express written consent is prohibited.
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Options for Paying your Medical Expenses HSAs give participants the choice to pay using any method they like! • Use the HealthEquity HSA Debit Card — funds will come directly out of your HSA balance
• Use the HealthEquity member portal to pay the provider directly from HSA — visit the claims listing
• Pay out of pocket — you can choose to keep saving your HSA dollars or reimburse yourself from your HSA at a later date
• Link a personal bank account to the HealthEquity Member Portal and pay the provider directly from your bank account — you always have the option to reimburse yourself from your HSA at a later date
Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc. Confidential and proprietary. Reproduction without express written consent is prohibited.
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HSA How To: Doctors’ Visits
1
Go to the doctor
No copays
2
Doctor sends insurance carrier the bill
Insurance carrier adjusts price based on discounts
3
Optional: Enter claim in member portal
Pay doctor from HSA funds, if funds are available. Pay out of pocket if funds aren’t available and reimburse yourself later.
*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.
Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc. Confidential and proprietary. Reproduction without express written consent is prohibited.
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HSA How To: Pharmacy Prescriptions
1
Go to pharmacy
Show your Health Plan ID card
2
Pharmacy applies discount
Pay with your HSA card
3
Pharmacy sends claim to insurance carrier
Insurance carrier applies amount to your deductible— no paperwork needed
*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.
Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc. Confidential and proprietary. Reproduction without express written consent is prohibited.
59
HealthEquity mobile app Convenient, powerful tools: • On-the-go access for all account types • Take a photo of documentation with phone and link to claims and payments • Send payments and reimbursements from HSA • Manage debit card transactions • View claims status Available FREE for iOS and Android Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc. Confidential and proprietary. Reproduction without express written consent is prohibited.
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Additional Benefits
EyeMed Vision Care Annual eye exam with $0 copay when using network providers* Annual allowance for contacts or frames; discounts on amounts in excess of allowance when using network provider. Additional eyewear purchases at 40% off Non-prescription sunglasses at 20% off 20% off remaining balances beyond plan coverage limits
•
Savings on prescription eyeglasses or contact lenses
Discounted pricing for LASIK or PRK surgical procedures *Additional charges may apply for contact lens fit and follow-up.
62
Using Your EyeMed Benefits In-network benefits
Out-of-network benefits
•
There are two ways to locate an in-network provider and schedule your exam
•
– –
•
By telephone, call: (866) 723-0513 Online: www.eyemedvision.care.com
•
Consult Summary of Benefits for information on reimbursement for covered services Mail an itemized bill from your provider with the claim form to EyeMed
–
Claim form on: www.cpg.org
Claims processing may take 3-4 weeks
63
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Benefits of the Employee Assistance Program (EAP) Face-to-face sessions Confidential No cost share Unlimited telephonic consultation Available 24 hours a day, 7 days a week Household benefit Work/life support, such as eldercare, childcare, and pet care Financial services Legal services 64
When You Call Face-to-face visit
Individual calls EAP
Personal Advocate helps you access appropriate service
Informational services Telephonic support
65
How to Access Online EAP Resources Go to www.cignabehavioral.com Under the “Members” section click on “Login” to access your benefits • Enter your Employer ID: episcopal (lower case) • On left hand side, click on desired topic • Click on “Accept” for the privacy policy 66
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Health Advocate Private, confidential assistance for healthcare concerns Helps employees use benefits offered by employer • Find a doctor and schedule an appointment • Resolve claim issues Services available to employee, spouse, dependents as well as parents and parents-in-law Personalized assistance with clinical and administrative issues Service provided by experienced healthcare professionals Provides continuity of care via single point of contact 67
Accessing Your Health Advocate Benefit
Take a look at the member video www.Health Advocate.com/mem bers
Pick up the phone and call (866) 695-8622
Send an email answers@ HealthAdvocate.com
68
UnitedHealthcare Global Assistance Assistance when traveling outside the United States • Referrals for and scheduling medical treatment • Providing insurance information and medical records • Replacing prescriptions, eyeglasses or medical devices • Replacing lost or stolen travel documents • Emergency travel funds • Emergency medical evacuation Available 24 hours a day, 7 days a week UHC Global Assistance is not responsible for medical costs while you are traveling
69
23
Accessing UHC Global Assistance
Visit www.uhcglobal. com/global-assistance/
Call (800) 527-0218
Outside the United States? • Contact the Emergency Response Center – (410) 453-6330 (Collect call) – Email: Assistance@ uhcglobal.com
70
Amplifon Benefits Episcopal Church Medical Trust members receive: • Hearing aid low price guarantee: if you find the same product at a lower price, Amplifon will beat the local quote by 5% • 40% off hearing testing and diagnostics and average of 25% savings on hearing aids • Risk-free 60-day trial:100% money-back guarantee if you’re not satisfied with the hearing aids • 1-year free follow-up care • 3-year warranty: one of the longest in the industry • Free batteries: a two-year supply (max. 160 cells per hearing aid, an approximate $150 value) • Convenient hearing clinics near you • No enrollment fees: access to the hearing program is available at no cost 71
Access Your Benefits
HEARING HEALTH CARE (866) 349-9055 www.amplifonusa.com 72
24
Cigna Dental
Dental Plan Options — Preventive Plan Individual Annual Deductible Medical:
Member Costs Preventive Services: Basic Restorative Services: Major Restorative Services: Orthodontia Services:
Individual and Family $0
$
$
0% 20% 99% 99%
Annual Deductible Medical:
$0
Member Costs Preventive Services: Basic Restorative Services: Major Restorative Services: Orthodontia Services:
0% 20% 99% 99%
74
Dental Plan Options — Basic Plan Individual
Individual and Family
Annual Deductibles DPPO Advantage: DPPO & Out of Network:
$0 $50
Member Costs Preventive Services: Basic Restorative Services: Major Restorative Services: Orthodontia Services:
0% 15% 50% 100%
$
$
Annual Deductibles DPPO Advantage: DPPO & Out of Network:
$0 $150
Member Costs Preventive Services: Basic Restorative Services: Major Restorative Services: Orthodontia Services:
0% 15% 50% 100%
75
25
Dental Plan Options — Dental & Orthodontia Plan Individual Annual Deductibles DPPO Advantage: DPPO & Out of Network: Member Costs Preventive Services: Basic Restorative Services: Major Restorative Services: Orthodontia Services: (up to the $1,500 separate lifetime maximum)
Individual and Family $0 $25
$
$
Annual Deductibles DPPO Advantage: DPPO & Out of Network: Member Costs Preventive Services: Basic Restorative Services: Major Restorative Services: Orthodontia Services: (up to the $1,500 separate lifetime maximum)
0% 15% 15% 50%
$0 $75
0% 15% 15% 50%
76
Getting Help
Replacing a Lost ID Card If you lose your ID card, you can get a replacement card from your health plan vendor. Follow the instructions on the vendor’s website:
• • •
Anthem Cigna EyeMed
anthem.com cigna.com eyemedvisioncare.com
78
26
CPG Client Services We are here to serve our members
Best sequence for problem resolution
Monday through Friday (excluding holidays):
1st: Call Vendor for most benefit-related issues
• •
2nd: Call Health Advocate
•
7:30am to 7:00pm CST Telephone Direct Toll Free 1800-480-9967 Email:
[email protected]
3rd: Call Medical Trust
79
The Medical Trust Website www.cpg.org Our website is open 24/7/365 for members to: • Access and print forms, handbooks, and other information and documents • Access updated information relating to plans • Access a wide variety of information and resources other than healthcare related
80
Getting Help: Contacts Anthem Blue Cross and Blue Shield • (844) 812-9207 • www.anthem.com Cigna Medical and Dental • (800) 244-6224 • www.cigna.com
81
27
Getting Help: Contacts (cont’d) Express Scripts • (800) 282-2881 • www.express-scripts.com Cigna Behavioral Health (& EAP) • (866) 395-7794 • www.cignabehavioral.com EyeMed Vision Care • (866) 723-0512 (general customer service) • www.eyemedvisioncare.com 82
Getting Help: Contacts (cont’d) Health Advocate • (866) 695-8622 • www.healthadvocate.com UnitedHealthCare Global Assistance • (800) 527-0218 • www.uhcglobal.com/global-assistance/ Amplifon • (866) 349-9055 • www.amplifonusa.com 83
Important Notice Please note that this document is provided for informational purposes only and should not be viewed as an offer of coverage, legal, medical, tax or other advice. Please consult with your own professional advisor for further guidance. In the event of a conflict between this document and the official plan documents, the official plan documents will govern. The Church Pension Fund and its affiliates retain the right to amend, terminate or modify the terms of any benefit plans described in this document at any time, for any reason and unless required by law, without notice.
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Questions & Answers
Thank You For your participation and feedback! Please take a moment to complete a brief online survey. We value your input to assure sessions like this are truly helpful. Here is the survey link: cpg.org/ibamslearn
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Appendix Slides
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Plan Array Strategy
Clients Want High-Quality Health Benefits that are Cost-Effective
Meeting clients’ unique needs with high-value plans
January – August Pre-Open Enrollment
Cost-effectively
89
External Forces Require Us to Explore Different Solutions Highly Valued Benefits
January – August Pre-Open Enrollment
Challenges
• Comprehensive benefit levels
• Cost pressures
• Broad access
• Affordable Care Act
• Compassionate member advocacy
• Healthcare system in flux
• Cost containment
• Local market variation • Aging population
• Health engagement
90
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Medical Trust Plans Have Higher Coverage Levels, Customized Member Advocacy, and Broader Access Bronze 60%
Silver 70%
Gold 80%
2016 Health Insurance Exchange Norm: 90% enrolled in Silver or Bronze
January – August Pre-Open Enrollment
Platinum 90%
2016 Prevailing Medical Trust Plans: 82% enrolled in Platinum or Gold 91
Healthcare Exchanges — Market Overview Public (Individual or SHOP)
Private
• • •
• •
• •
Continued instability Carriers are losing money Platinum and Gold plans are disappearing in markets Greater emphasis on narrow networks Transitional Reinsurance ends in 2017
• • •
January – August Pre-Open Enrollment
Growth is slowing Savings is primarily through cost shifting Lower paid employees migrate to “Bronze” type plans Multiple players (Brokers and Health Plans) Solutions include non-medical voluntary plans (e.g., critical illness) 92
January – August
In Partnership With Our Clients, Our Commitment is to Provide Members…
Pre-Open Enrollment
Meaningful Choices Right Choices 93
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January – August
A Smarter Healthcare Program
Pre-Open Enrollment
Consistent member experience Enables members to make informed and optimal healthcare decisions so they may: • Access the right care — at the right place — at the right time Ensures quality, effective outcomes • Creates better ways to spend and contain costs • Streamlines medical necessity review and promotes evidence-based decisions on value and quality 94
January – August
Meaningful Choice, Delivered Better
Pre-Open Enrollment
Concentration
Modernization
Simplification
• Purposeful
• Continuous
• Provide
attention to key program elements
evaluation to keep overall program relevant
meaningful choice and consistent experience
95
January – August
Concentration
Pre-Open Enrollment
Purposeful attention to key program elements Management and administration
• Drive consistency in •
member experience Perform rigorous claims audits and analysis
Benefits provided
• Evaluate all benefits •
provided (coverage, exclusions, visit limits) Guide medical management program deployment (plan requirements, prior authorization, disease management)
Promote benefits education and engagement
96
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January – August
Modernization Broader range of cost share options (i.e., member out-ofpocket costs)
Pre-Open Enrollment
A new definition of what good healthcare and benefits means
Focus on outcomes and personal accountability
Emerging possibilities from a changing marketplace
• Centers of
• Additional
excellence
• Accountable
accountbased plans
care
• Narrow networks
• Telemedicine 97
Simplification: What Might a 2018 Plan Array Look Like? Level Type Platinum
Gold
Gold
Silver
Silver
Bronze
PPO
PPO
PPO
PPO
PPO
PPO
HSA Eligible
No
Yes
No
No
Yes
Yes
New in 2016
No
Yes
No
Yes
No
Yes
Embedded
NonEmbedded
Embedded
Embedded
Embedded
NonEmbedded
Network Coinsurance
10%
15%
25%
30%
20%
40%
Network Individual Deductible
$500
$1,400
$900
$3,500
$3,000
$4,000
$1,000
$2,800
$1,800
$7,000
$6,000
$8,000
Primary Care
$25
15%
$35
$35
20%
40%
Specialist
$25
15%
$45
$45
20%
40%
Plan Type
Deductible Type
Network Family Deductible
98
Ongoing Preparation for 2017 Plan Year Vendors and Plans Pharmacy Benefit Manager CBA RFP - ESI confirmed Kaiser Funding and design impact Aetna relationship and Plans going away • Monitor Anthem/Cigna Merger • MSP SEE program redesign
Benefits • Specialty Rx Considerations • Clinical Programs • Sleep Management • Centers of Excellence • Second Opinion Services • Telemedicine • Anthem Integrated Health Model 99
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Open Enrollment Held each fall for current plan enrollees All renewing members will receive a letter from the Medical Trust, including: • The Open Enrollment (OE) period for your group • Instructions for using the online OE website to make your healthcare benefit selections for 2017
Open Enrollment Please note that the Open Enrollment website should be accessed using Firefox, Safari, and Internet Explorer 8 or 9. Please use one of these browsers to access the website. You can download Firefox for Mac or PC using this link: download Firefox (https://www.mozilla.org/en-US/firefox/new/)
Don't have an account? In order to access Open Enrollment and other applications, you will have to create an account. Create an Acc ount
Sign In Sign in by entering your username and password. You can enter your username, personal email address or client number in the Username box. *Username *Password
Forgot us ername? Forgot pas sword?
Show typing
D on' tInhave an ac count? Sign
* Denotes a required field. Need Help? Please contact Client Services at (855) 594-2201, Monday - Friday, 8:30AM - 8:00PM ET (excluding holidays).
You will log in to the OE website with your MyCPG Account user name and password Know your plan selections when you go online • Remember to include your plan and eligible dependents when you enroll
100
Open Enrollment
101
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