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Annual Enrollment 2011-2012 Plan Summaries. A&M Care Plan Scott & White Health Plan (in some areas) Graduate Plan A&M System Health Plans (Employees)

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Presentation on theme: "Annual Enrollment 2011-2012 Plan Summaries. A&M Care Plan Scott & White Health Plan (in some areas) Graduate Plan A&M System Health Plans (Employees)"— Presentation transcript:

1 Annual Enrollment Plan Summaries

2 A&M Care Plan Scott & White Health Plan (in some areas) Graduate Plan A&M System Health Plans (Employees)

3 A&M Care Plans A&M Care 65 PLUS Scott & White Health Plan (in some areas) A&M System Health Plans (Retirees)

4 A&M Care Plan: $700 deductible Coinsurance: Plan pays 70%, Member Pays 30% Office Visit Copayments: $30 PCP; $45 Specialist A&M Care

5 A&M Care Plan: $700 deductible 65 PLUS: $500 deductible A&M Care (Retirees)

6 Network benefitsLive in a network area and use a network provider Out-of-Network benefitsLive in a network area and use an out-of- network provider Non-Network benefitsLive outside a network area or have Medicare A&M Care

7 Network Office visit: $30 for PCP; $45 for specialist, PCP referral not required Hospital services: A&M Care: 30% after plan-year deductible A&M Care: What You Pay

8 Out-of-Network Office visit: 50% after plan-year deductible Hospitalization: 50% after plan-year and hospital deductibles A&M Care: What You Pay

9 Non-Network Most services: 30% after plan-year deductible A&M Care: What You Pay

10 Must live or work in an eligible ZIP code to enroll Office visit copayment $30 PCP $45 Specialist $350 Deductible 80/20 Coinsurance Health Maintenance Organizations (HMOs) Scott & White Health Plan

11 Some vision and hearing coverage available with Requires selection of a primary care physician Must use HMO doctors/hospitals except in emergency Health Maintenance Organizations (HMOs) The Scott & White Health Plan

12 A&M Dental DeltaCare USA Dental HMO Vision Basic Life/Basic AD&D Alternate Basic Life Optional Life Dependent Life Other A&M System Benefits Optional AD&D Long-Term Disability Long-Term Care Flexible Spending Accounts American Hearing Aid Associates Marsh Optional Benefits GMS Relocation Services

13 Preventive: 100%; no deductible Basic: 80% after deductible Major: 50% after deductible Orthodontia: 50% after deductible Delta PPO and Premier Network dentists charges lower than non- network dentists Maximum allowable limits apply A&M Dental

14 Deductible: $75/person, $225/family per plan year Maximum benefits: $1,500/person per plan year Maximum orthodontic benefits: $1,500/person per lifetime A&M Dental

15 Must use DeltaCare USA general dentist General dentist must refer to specialist No deductible or maximum benefit Orthodontia: Max 24 mos of treatment You pay set fee for other services $ 5 copay for cleanings and $8 copay for amalgam fillings through a network dentist DeltaCare USA Dental HMO

16 Eye exam: Network: You pay $10 Non-Network: Plan pays up to $50 Eyeglasses: Network: You pay $15 for lenses every plan year and frames every other plan year, plus any frames cost over the frames allowance Non-Network: Limited benefits Vision

17 Contact lenses: Network: Up to $150 every plan year Non-Network: Up to $150 every plan year Surgery: Network: 15% discount off retail cost and 5% off promotional cost Non-Network: No benefit Additional Material Discount Program 40% Discount on an additional pair of glasses for participating providers Vision

18 Basic Life/Basic AD&D Alternate Basic Life Optional Life Dependent Life Optional Accidental Death and Dismemberment (AD&D) Beneficiaries Living Access benefit Life Insurance

19 $7,500 life coverage on you $5,000 life coverage on your eligible dependent children $5,000 AD&D coverage on you Included with all A&M System health plans Basic Life/Basic AD&D

20 Alternate Basic Life Can purchase only if no A&M System health coverage, but certify other coverage Can use the employer contribution Cannot elect if you buy Optional Life

21 Alternate Basic Life Employees: $50,000 or 7 times your pay, whichever is less, in coverage on you Retirees: $50,000 or your Optional Life amount, whichever is less, in coverage on you – reduces to $30,000 at age 80 $5,000 life coverage on your eligible dependent children $5,000 AD&D coverage on you

22 Employees: Coverage of ½, 1, 2, 3, 4, 5 or 6 times annual salary on you Maximum is $1 million Retirees When you retire your Optional Life amount is reduced to $100,000 Reduction at age 70 to $60,000 and to $30,000 at age 80. Optional Life

23 Cost is based on age and tobacco use Evidence of good health required to increase coverage or enroll in coverage Cannot elect if have Alternate Basic Life Optional Life

24 Three plans: Plan A, Plan B or Plan C Plan A covers: Spouse amounts of: $25,000, $50,000, $75,000, $100,000, $150,000, or $200,000 Each child: $10,000 Plan B covers spouse and each child: $5,000/life; $5,000 AD&D Plan C covers: Spouse: 50% of your Alternate Basic Life Each child: 10% of your Alternate Basic Life Dependent Life

25 Life Enhancements Travel Assistance Legal Services Beneficiary Financial Counseling

26 Coverage for yourself/yourself & family Employees: Multiples of $10,000 Up to $250,000, regardless of pay Up to 10 times pay or $800,000 maximum Retirees: Multiples of $10,000 Up to $200,000 if younger than 70 Up to $60,000 if 70 or older Optional AD&D

27 Dependents: Percentage of your coverage amount Spouse: 50% and Children: 10% Spouse only: 60% Children only: 15% Optional AD&D

28 Pays benefits for death or certain injuries resulting from an accident. Pays full coverage amount or a percentage depending on the extent of loss. Optional AD&D

29 Education benefit Felonious assault benefit Child care benefit Medical continuation Coma benefit

30 Pays a benefit of 65% of your pay, reduced by other benefits you receive Reduced by Social Security, workers compensation, Federal Civil Service and most other group disability benefits Reduced by TRS or ORP benefits if you receive payment Long-Term Disability

31 Maximum monthly benefit is $8,000 Minimum monthly benefit is $100 or 10% of your benefit before deductions Benefits for partial disability Benefits begin after 90 days of disability Benefits continue until the greater of the Benefit Duration or Social Security Normal retirement Age Mental health limited to 24 months No Evidence of Good Health Required Long-Term Disability

32 Workplace accommodation benefit Cost based on pay, tobacco use Pre-existing condition definition: A sickness/ injury for which you have received treatment, care, services, or taken medication during the 90 days before LTD coverage begins. To receive coverage for a pre-existing condition, you must be in the plan 12 months or go 90 days after coverage begins without receiving care/medication. Long-Term Disability

33 Long-Term Care You choose from five maximum benefit levels $100/day $150/day $200/day $250/day $300/day Waiting period: 90 days/nursing facility;15 days/other care

34 Long-Term Care To receive benefits, you must be: unable to perform at least 2 activities of daily living without assistance require supervision due to a severe cognitive impairment Six activities of daily living: bathing, continence, dressing, eating, using a toilet and transferring

35 Eligible persons: Employees and retirees Spouses Parents and parents-in-law Grandparents Children 18 and older Portability Cost depends on age Long-Term Care

36 M ust re-enroll each year Can set aside before-tax dollars to pay health and dependent day care costs Separate health/day care accountsno transfers Can change elections only if you have a Change in Status Must use it or lose it No monthly administrative fee Flexible Spending Accounts

37 Can be used for health care expenses not paid by health, dental or vision plan Can pay medical, dental, vision and hearing expenses even if you dont have insurance. Can pay deductibles, coinsurance and copayments Annual maximum: $4,800 Monthly minimum: $20 Money available at start of plan year Health Care Account

38 If you elect to use the debit card, it costs $9/year Money comes right out of the Health Care Flexible Spending Account No paper claims Keep receipts Debit Card

39 Can be used to pay for: Care of a child 12 or younger Care of an older person with physical or mental disability Only care that allows you to work Annual maximum: $5,000 Monthly minimum: $40 Money available as you contribute to plan from paychecks Dependent Day Care Account

40 File health claims with your health and dental plans first if you have health/dental insurance Cannot use for over-the-counter medications, unless prescribed by a doctor. Cannot take both tax credit/deduction and use Spending Accounts Flexible Spending Accounts

41 American Hearing Aid Associates 30% hearing aid discounts or $250 discount at AHAA providers Hearing aid price includes: Testing, fitting and routine maintenance Quarterly cleanings and adjustments Yearly audiometric screenings Yearly hearing aid evaluations First-year warranty Repair/loss and damage replacement Batteries for life of instrument

42 American Hearing Aid Associates Show A&M System identification No premiums or forms Spouse, children, parents and grandparents are eligible or (800)

43 Global Mobility Solutions Home sale assistance Van line assistance Home finding assistance Special mortgage program Temporary housing assistance

44 GMS Relocation Network Web site relocation tools: Relocation coach – Lori Herbert Call (800) Ext. 8850

45 Marsh PersonalPlans Besides the core benefits available to you, Marshs PersonalPlans offers additional services that may be of interest. Auto Insurance Homeowners/renters insurance Identity Theft Pet Insurance Health Insurance Mart

46 Marsh PersonalPlans Marsh PersonalPlans provides: A broad selection of products and services from highly rated providers Personalized help from licensed insurance professionals Free, no obligation quotes by phone or on-line An information rich web-site Strict security standard Visit the or call for more

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