Presentation on theme: "Forsyth County Schools Online Enrollment and Benefit Plan Information for January 1, 2012 through December 31, 2012."— Presentation transcript:
Forsyth County Schools Online Enrollment and Benefit Plan Information for January 1, 2012 through December 31, 2012
2012 Open Enrollment This years OE dates will be October 11-November 10, Members will make their election online at the new website You should not wait until the last minute to make your election as there may be heavy traffic You will need to register on the new website before you can make your 2012 election 3
2012 Open Enrollment You may go online as many times as you like - but the last election confirmed at the time OE closes will be your election for the 2012 Plan Year You should print and keep a copy of the confirmation page which will contain a confirmation number -once OE is closed, you will be able to go online at and view your 2012 election, (including your plan choice, answers to surcharge questions and more) 4
2012 Benefit and Plan Changes All Plan Options –Certain Tobacco Cessation Medications Covered when prescribed as part of a Tobacco Cessation Program Contact each vendor for specifics –Bariatric Surgery Bariatric (weight loss) surgery will no longer be covered under any plan options. 5
2012 Benefit and Plan Changes Eligibility Changes Spousal Surcharge Verification –SHBP will request verification from all members not paying the spousal surcharge who cover a spouse who is actively working. Documentation/affidavit will be required that the spouse is not eligible for health coverage through employer –If your spouse does not work, SHBP will require a copy of the most current federal tax return 7
2012 Benefit and Plan Changes PeachCare FOR KIDS ® Federal law has changed and now allows the PeachCare for Kids ® program to enroll children of members covered under SHBP PeachCare will be offered as a voluntary program to children eligible for SHBP coverage who meet the PeachCare for Kids ® requirements Benefits under PeachCare include dental, vision and health insurance at low premiums and low co-payments There will be a link to the PeachCare website which will include an eligibility calculator to aid employees in determining if their children may qualify Employees may complete an application on-line or may call and request a paper application be mailed to you by calling PeachCare for Kids 8
2012 Benefit and Plan Changes PeachCare FOR KIDS ® Information is available at GA-PEACH ( ) and If your child loses eligibility for PeachCare for Kids coverage you will have 60 days from the loss of coverage to enroll in SHBP coverage. Failure to pay is not a loss of eligibility for coverage If PeachCare for Kids denies coverage for your child(ren) denial is not a qualifying event to allow enrollment in SHBP coverage NOTE: Children enrolled in PeachCare for Kids cannot be dually enrolled in SHBP. Earliest an employee can apply is
2012 Benefit and Plan Changes New Tricare Supplement TRICARE Coverage –Voluntary, member-pay-all supplemental health benefit –Available to SHBP eligible individuals who are also eligible for TRICARE, the military health benefit program –Ends when you turn 65 DEERS Number –Members must provide a Defense Enrollment Eligibility Reporting System (DEERS) number No Split Option –Everyone covered under the contract must be in Tricare 10
2012 Benefit and Plan Changes New Tricare Supplement (continued) Eligibility for Children - Must be single - Age must be a full-time student or if under age 26 if enrolled in the TRICARE Young Adult Program Loss of eligibility for Tricare Supplement while actively working -Is a qualifying event to select another option if you make the request within 31 days COBRA - Members who lose eligibility for SHBP coverage while covered by Tricare supplement will not be offered COBRA For additional information call or on the website at 11
2012 Benefit and Plan Changes New Wellness Plans Include HRA, HMO and HDHP Plan Options Wellness Plan Promise: - Members and covered spouses -Each must Complete an online health assessment -Each must Obtain biometric screening* between July 1, 2011 and June 30, 2012 from their physician. (*Body Mass Index, Blood Pressure, Blood Glucose, Cholesterol) -Biometric screening results MUST be received by your health care vendor by June 30, 2012 – Forms available after January 1,
2012 Benefit and Plan Changes New Wellness Plans (contd) Rewards received for Wellness Plan Options –Lower premiums –Lower out-of-pocket costs through co-payments, coinsurance, deductibles and out-of-pocket maximums Note: If a member or his/her covered spouse does not honor their promise the Wellness plan will not be offered as an option the following year 13
2012 Benefit and Plan Changes New Wellness Plans –During the 2012 Open Enrollment, if you drop a spouse because he/she did not complete the promise, you will still not be able to enroll in the Wellness Plan in 2013 –Disease Management Pharmacy Co- Payment/Co-Insurance waiver program will be available for members enrolled in the Wellness HMO and Wellness HRA plan options. Contact CIGNA or UnitedHealthcare for details. 14
2012 Benefit and Plan Changes New Standard Plans Includes the HRA, HMO and HDHP Plan Options –Covers the same services as the Wellness Plans EXCEPT No Promise (i.e., no biometric requirements) Higher premiums Higher out-of-pocket expenses through co-payments, coinsurance, deductibles and out-of-pocket maximum No preventive incentive for the HRA ($125 credit) No DSM pharmacy copay waiver 15
2012 Benefit and Plan Changes HRA Wellness and Standard Plans SHBP HRA Contributions Comparison Wellness HRA ContributionStandard HRA Contribution You $ 500 You + Spouse $ 1,000 You + Child(ren) $ 1,000 You + Family $ 1,500 You $ 375 You + Spouse $ 650 You + Child(ren) $ 650 You + Family $1,000 16
2012 Benefit and Plan Changes HRA Wellness and Standard Plans Prescription Drug Coverage The Pharmacy benefit will be the same under the Wellness and Standard HRA Plans Pharmacy costs will no longer apply to the deductible or out-of- pocket limit (Starting day one member will always pay coinsurance amounts) HRA dollar credits may be used for prescription drug, but will no longer help to offset your deductible or out-of-pocket limit The benefit will change to a 3 Tier structure with a minimum and maximum out-of-pocket Please note: UnitedHealthcare (UHC) members will need to provide a separate Health Care Spending Card to access HRA dollar credits for their pharmacy expenses. Additionally, UHC members will still need to present their UnitedHealthcare ID cards with any prescriptions at the pharmacy. No separate card is required for CIGNA members at the pharmacy. 17
2012 Benefit and Plan Changes HRA Wellness and Standard Plans UnitedHealthcare Pharmacy Health Care Spending Card –How does it work and what happens at the pharmacy? Activate your card as soon as you receive it by calling the number on the back of your card. Your card must be activated 1 business day prior to use. When you use your card, payment is transferred directly from your card to the pharmacy. Once HRA funds are no longer available transactions will be denied. This card can only be used for covered prescription expenses (not for medical or dental). Unauthorized transactions will be denied. 18
2012 Benefit and Plan Changes HRA Wellness and Standard Plans Prescription Coverage Examples – Drug A is Tier 1 If the cost of the drug is less than the minimum amount for Tier 1 drugs –For a 31-day supply the usual and customary price is $15 –The minimum for Tier 1 is $20 –The SHBP Member pays $15 Cost of the drug when coinsurance applies for Tier 1 drugs –For a 31-day supply the contracted price is $100 –The Coinsurance is 15% and the minimum amount for Tier 1 is $20 –15% of $100 is $15 –The SHBP Member pays $20 Note: The $4 generics from $4 Generic Programs offered by some pharmacies will be $4 20
2012 Benefit and Plan Changes HRA Wellness and Standard Prescription Coverage Examples – Drug B is Tier 2 If the cost of the drug is less than the minimum amount for Tier 2 drugs –For a 31-day supply the usual and customary price is $35.79 –The minimum for Tier 2 is $50 –The SHBP Member pays $35.79 Cost of the drug when coinsurance applies for Tier 2 drugs –For a 31-day supply the contracted price is $350 –The Coinsurance is 25% and the maximum amount for Tier 2 is $80 –25% of $350 is $87.50 –The SHBP Member pays $80 21
2012 Benefit and Plan Changes HMO Wellness and Standard Type of ServiceWellness HMO Co-payment Standard HMO Co-payment Primary Care Physician$35$45 Specialist$45$55 The deductibles and out of pocket maximum did not change The $200 annual vision benefit for glasses and contacts will no longer be offered Pharmacy 90- day Voluntary Mail Order Tier 1- $ 50 Tier 2- $125 Tier 3- $225 HMO Plan Changes 22
2012 Benefit and Plan Changes High Deductible Health Plan Wellness and Standard DeductibleWellness HDHP (In/Out of Network) Standard HDHP (In/Out of Network) You You + Spouse You + Child(ren) You + Family $1500/$3000 $3000/$6000 $1750/$3500 $3500/$7000 Out-of-Pocket (In/Out-of-Network) Wellness HDHPStandard HDHP You You + Spouse You + Child(ren) You + Family $2400/$5300 $4100/$9800 $2650/$5800 $4600/$10800 HDHP Deductible and Out-of-Pocket Comparison 23
2012 Benefit and Plan Changes High Deductible Health Plan (HDHP) Wellness and Standard HDHP Co-Insurance and Pharmacy Comparison Type of ServiceWellness HDHPStandard HDHP Co-Insurance90% IN or 60% OON80% IN or 60% OON Pharmacy 90-Day Voluntary Mail Order (this is not a change) 80% ($25 min/ $250 max) 24 IN = In Network OON = Out of Network
Making Your 2012 Benefit Election - Considerations Determine if healthcare provider is in-network Carefully review the 2012 Decision Guide available at or in your open enrollment packet. Compare the benefits in relation to the premiums Check the Preferred Drug Lists for each plan and healthcare vendor as the formulary varies between plans and vendors 25
Making Your 2012 Benefit Election Online Election - Employees must make their health election at Website Open & Close Dates - Website opens at 4 a.m. on October 11, Website closes at 4:30 p.m. on November 10,
Making Your 2012 Benefit Election – Did You? Remember to: Make sure you have selected the correct option Confirm you have added all eligible dependents you wish to be covered Confirm you have answered the surcharge questions correctly Click Confirm and always Print your Confirmation (this WILL include a confirmation number) 27
Making Your 2012 Benefit Election – If You Dont If you dont go online and make a 2012 election Your coverage will default To the Standard HRA, HMO or HDHP Option with your current vendor The tobacco and spousal surcharges (if you cover your spouse) will apply for the 2012 Plan Year 28
Questions or Additional Information CIGNA - HMO, HRA, HDHP UnitedHealthcare - HMO, HDHP HRA Refer to or to access additional informationwww.myshbp.ga.gov 36
Flexible Benefits Plan Option I: Healthcare Reimbursement: You may contribute $25 per month not to exceed $2,500 per plan yr. Option II: Dependent Daycare Reimbursement: Max per calendar yr. is the lesser of: 1.) $5,000 for married filing jointly or; 2.) your spouses total amt. compensation or; 3.) ½ your total compensation. If you are single the max. is $5,000. Option III. Pre-Tax Insurance Premium: If you agree to have your health insurance premiums payroll deducted before taxes you will save money. Even if youre not participating in the Healthcare or Dependent Daycare Reimbursement plans you must complete Option III of the participation form.
Changes to FSA Changes have been made to the FSA due to Health Care Reform: Beginning January 1, 2012, the maximum Healthcare Reimbursement available will be $2,500 annually. Please remember as of last year, January 1, 2011, a doctors prescription is required in order for you to receive reimbursement of expenses incurred when purchasing certain over-the-counter medicines. Because the new law requires a prescription for these types of items before the FSA can reimburse you from your account, you still are no longer able to make these over the counter purchases using your FSA debit card.
Dental Plans The Dental Plans are remaining the same for the new plan year. Please review carefully the benefit summaries provided in your enrollment booklet. NOTE: The Late Entrant Penalty Still Applies to the Core and Buy-Up Plans: If you do not currently have dental coverage for yourself and/or dependents and you elect coverage for the new plan year you and/or your dependents are considered a late entrant. Therefore, the following Late Entrant Penalty will be applied to your coverage for the first 12 months: Only routine exams & routine cleanings will be covered. If you are a late entrant we highly recommend you take the CORE plan for the new plan year as the penalty will be applied regardless of the plan you choose.
MetLife Core Dental Plan Calendar Year Deductible $50.00 on Individual $ on Family (deductible waived on Preventive) Calendar Year Maximum Is $1,000 Pays 100% of UCR charges on Preventive Services (Type A) Pays 50% of UCR charges on Basic Services (Type B) Major & Orthodontics NOT covered on Core Plan Payroll Deductions: Employee Only : No Cost Employee + 1 : $30.25 Employee + Family: $63.42
MetLife Buy Up Dental Plan Payroll Deductions: Employee Only : $20.99 Employee + 1 : $57.50 Employee + Family: $ Calendar Year Deductible $50.00 on Individual $ on Family (deductible waived on Preventive). Calendar Year Maximum $2,000 Pays 100% of UCR on Preventive Services (Type A). Pays 80% of UCR on Basic Services (Type B) Major & Child Orthodontics Covered at 50% (Type C/D). Lifetime Maximum on Orthodontics is $1,500 NOTE: Dependents are only eligible for orthodontic benefits through age 18 regardless of full-time student status.
AVESIS Vision – Low Plan Payroll Deductions: Employee Only : $5.83 Employee + 1 : $10.18 Employee + Family: $15.14 In Network Benefits Eye Exam: $10 copay Contact Lenses Fit & Follow up Exams: $110 Allowance $100 Frame Allowance Standard Plastic Lenses (Single, Bifocal, Trifocal) $20 copay 12/12/24 Plan
AVESIS Vision – High Plan Payroll Deductions: Employee Only : $6.60 Employee + 1 : $11.56 Employee + Family: $17.17 In Network Benefits Eye Exam: $10 copay Contact Lenses Fit & Follow up Exams: $130 Allowance Frames: $150 Allowance Standard Plastic Lenses (Single, Bifocal, Trifocal) $25 copay 12/12/24 Plan
Short Term Disability Payroll Deductions Based on your salary and age as of 1/1/2011. Deductions will be calculated online at the time of enrollment. Your Short Term Disability Benefits Elimination Period for Accident or Sickness is 14 days or the period for which you receive sick leave, whichever is longer. Late Entrant Penalty (Physical Disease, Pregnancy, Mental Disorders: EP= 60 days for first 12 mos. of coverage.) Benefit Amount: 60% of Your Basic Weekly Salary to a maximum of $1,500 per week. Max. Benefit Duration is 15 weeks
Long Term Disability Payroll Deduction None Required Long Term Disability Benefits Benefits begin after the 120 th day of disability Benefit Amount 60% of Your Basic Monthly Salary Maximum Benefit Period-SSNRA Maximum Monthly Benefit Amount $7,000
Board Paid Life Insurance Payroll Deduction: No Contributions are Required Forsyth County Schools provides $30,000 of Life and AD&D for every eligible full-time Employee
Voluntary Life Insurance Payroll Deduction Based on your tobacco status and age as of 01/01/2012. Deductions will be calculated online. Guarantee Issue:$220,000 or 5X Salary Whichever is Less Spouse Guarantee Issue: $25,000 Dependent Guarantee Issue: $10,000 If you currently have coverage you may increase coverage by $10,000 up to the guarantee issue amount at each annual enrollment with no E of I.
Voluntary Life Information Employee Coverage If you did not elect Employee Voluntary Life insurance when initially eligible you may do so now but will be required to complete an Evidence of Insurability (E of I) form for any amount of coverage. If you did elect Employee Voluntary Life insurance when initially eligible you may increase your coverage by $10,000 without Evidence of Insurability as long as the total amount does not exceed the Guarantee Issue (GI) amount of $220,000. Any increases over $10,000 or over the GI amount will require an Evidence of Insurability form be completed. Spouse Coverage Employees are allowed to add up to $30,000 of voluntary spouse life coverage without adding additional voluntary life on themselves. Guarantee issue for spouse is $25,000. However, E of I will be required for any amount of coverage if you did not elect coverage on your spouse initially. Also, if you are electing to increase coverage on your spouse E of I will be required for any increased amount. Dependent Coverage Employees are allowed to add up to $10,000 of voluntary dependent life coverage without adding additional voluntary life on themselves. However, E of I will be required for any amount of coverage if you did not elect coverage on your dependent initially. Also, if you are electing to increase coverage on your dependent E of I will be required for any increased amount.
Long Term Care Your Long Term Care Policy is Portable Coverage is available for you, your spouse, your adult children, parents, grand- parents or in-laws Facility & Professional Home Care Benefit Benefit Options: $1,000 up to $8,000 monthly Benefit Duration Options: 3 yrs., 6 yrs. or Unlimited Competitive Rates You can calculate your cost and obtain your enrollment applications for Long Term Care via the link available in the enrollment website under My Benefits. Or you can log directly into the Unum Long Term Care informational site at w3.unum.com/enroll/Forsyth and follow the prompts to the enrollment applications. Please contact ShawHankins at if you have any questions in regards to Long Term Care Insurance.
Log in to access benefits Go to Username: First letter of your first name, your last name, and the last four digits of your SS# (ex. jdoe4567) Default Password: The last four digits of your SS# (ex. 4567) You will then be prompted to create a permanent password. At the bswift website enter your Username and Default Password.
On the Home Page you will find under My Benefits direct links to the State Health Enrollment Website, the AFLAC enrollment website, as well as the Flexible Benefit Plan Participation form. Navigating the Website Note: If you access these sites from the bswift home page please remember to return to the home page in order to continue your enrollment.
To begin the enrollment process for dental, vision, life and disability click on the Change My Elections button located on the home page. How to Enroll in your benefits Note: You are not required to change your elections. However, you are required to verify your personal data, family info, and review beneficiaries for your Life Insurance.
Please remember… 1. To review carefully all coverage options available to you and your family before making your elections for the new plan year. 2. The State Health enrollment is mandatory. 3. You are required to go to the Forsyth bswift online enrollment portal in order to verify your personal & dependent data as well as re-assign your Beneficiaries for Life Insurance even if you are not making changes to your dental, vision, life or disability coverage. 4. To complete Option III of the Flexible Benefits Participation Form and return to the Forsyth County Benefits Office. 5. Your deadline to enroll is 4:30 p.m. on November 10, There is a link to this presentation available under the Finance Department Web page as well as under the My Benefits tab located in the Forsyth bswift enrollment portal. If you have any questions please contact the ShawHankins Contact Center at