Benefits begin July 1, 2008 By Paul Bogumill, Director of Benefits, Montana University System (406) 444 - 0329 1 WELCOME!
2 Howd That Happen…………………….. Rates are by 7% for Active Employees Rates will be for Retirees
3 1) Our Plan Projectory had sharply increased. 2)We attacked the problem by identifying cost drivers and implementing more aggressive risk management activities.
4 We need to address the cost drivers in our Prescription Plan. These changes will be applied in our upcoming benefit year beginning July 1, 2008. We made changes to our Medical/ Dental/Vision Plans and these changes worked.
5 Good Consumerism – We are a self funded plan. Good Benefit Design – We design our benefits package Good Communication – IUBC, Campus Benefit Reps We cannot assume that the in premiums is a trend, but a reflection of good consumerism/benefit design/communication And, we must continue this style of management to keep benefits affordable for all of us in the years to come. So: here are the Benefit Plan Changes for the upcoming year that we want you to be aware of……
6 Deductible Co-insurance Co-payment Co-insurance Max No Change All Plans Managed by MUS Plan APlan BNew WestAllegiance MC PEAK Blue Choice Traditional Managed Care Pg 5
7 Plan B Plan B Broadest / Most Inclusive Network Plan A Plan A Steerage For Elective Services Billings – St. Vincent Missoula – St. Patrick Bozeman – Bozeman Deaconess Out of State – travel network Plan A Plan A - Elective services to Out of Network Facilities/Provider - 35% co-insurance (in network is 25%) - separate deductible - separate ACM - subject yourself to Balance Billing Well Child Care through age 7* (was through age 2) Immunization Benefit $500* (was $250 for ages 8-18/$75 for ages 19+, and $50 pneumonia/flu) *Best benefit for Prevention Care services, is in our Managed Care Plans Pg 7-12
8 Continue to perform Well Large movement into managed care last year 6,682 Traditional Plan Policy Holders 3,153 shift to Managed Care Last Year Good outcomes / satisfaction Prenatal $0 co-pay if enrolled in StarBaby Program Clarification of $15 Office Visit Professional services only Labs / x-ray / apply to deductible and coinsurance Preventative Labs through Well Checks Pg 7-12
New West Health Services THE choice for the Montana University System Employees In state customer service to give you personal attention Expanded Network – Facilities and Providers High Quality Healthcare High Quality Healthcare –Preventive Care –Local Nurse Case Managers Consistently competitive rates year after year Consistently competitive rates year after year Out-of-State Network
Locally based and owned Full service health plan with proven record Extensive provider participation Self referral to any PEAK provider Extended statewide and national network with referral by any PEAK physician NEW! Healthy AIM health improvement assistance services
A LLEGIANCE F A M I L Y O F C O M P A N I E S Spring 2008 Allegiance Means Value Allegiance Means Service Access to a broad provider network that serves all MUS campuses & affiliated centers. Access to superior national provider network & centers of excellence Access to knowledgeable medical staff to help you manage your health care. A Customer Service Team dedicated to the needs of MUS. Quick and accurate claims turnaround. Responsive customer service. Claims access and Eligibility information available 24/7 via the web or IVR (phone based). Knowledgeable & helpful professionals.
Why Choose Blue? An advanced degree of savings, service, and security. Were proud to offer you: The lowest rates. A comprehensive benefits package. The second largest national provider network. Unparalleled stability. As Montanas oldest and largest health insurance provider, we can give you the kind of security you wont find elsewhere. And were right next-door. Theres never been a better time to go Blue.
13 Scheduled Benefit Design You Choose the Provider Use Delta Dental providers - if you want pre-negotiated fees No Change All Plans Managed by MUS BasicPremium Pg 15
14 Enhanced Out of Network Benefit for members in areas without access (50 mile radius) to a network provider. Pg 21
15 Retail deductible was $100/$200 $100/$300 Maximum out of pocket was $1200/person, $2400/family $800/$1600 – excludes mail orderIncludes mail order costs PPI Coverage Change OLD DEDUCTIBLES NEW DEDUCTIBLES No matter what Medical Plan you choose We are all on ONE Prescription Plan Administered by CVS/Caremark Pg 13
16 Coverage Reminder Coverage for Proton Pump Inhibitors (PPI) such as Aciphex, Nexium, Prevacid, and Protonix are available under the prescription drug plan as long as they are filled at a retail pharmacy. Because of the availability of an over-the-counter alternative (Prilosec and its generic Omeprazole), PPI drugs are not available through the mail order facilities.
17 Two mailing notices of account balances per year. NO ADMIN FEE to employee. *Reminder – Flex Plan choices need to be re-elected every year Pg 26
WellAwards Introducing WellAwards Reward program for those currently practicing healthy lifestyle behaviors and to encourage those who wish to improve Participants get credit for healthy activities earn a $100 cash award Available Fall 2008 – employees and spouses See May Wellness Newsletter for more details… Pg 28-29
19 Employee Assistance Program (EAP) – counseling services (previously APS Healthcare) Recovering from Depression Program Online Work-Life documents and tools Legal Services Financial Services Pg 30