Presentation on theme: "The content of this presentation is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage."— Presentation transcript:
The content of this presentation is designed only for communication purposes and is not to be considered a contract, nor does it guarantee or imply coverage. Consult your Benefit Administrator for questions.
FRENSHIP ISD Benefit Open Enrollment Plan Overview
Online Benefit Access 24/7 Visit for all of your benefit needs. Review the Employee Benefit Guide. Find important links to all benefit carriers. Find enrollment times and locations for your campus.
Section 125 Cafeteria Plan There are special rules and requirements to receive the pre-tax benefit election plan privileges: Cedar Hill ISD must set a plan year. The districts plan year is September 1 - August 31 of each year. Open Enrollment will be held July 26 through August 26. Although coverage is voluntary, every employee is required to review their personal information, make elections/waive as desired, by completing the CHISD on-line enrollment. Any pre-tax elections will remain in effect unless you have a qualified event change in family status. Qualifying event benefit changes must be made within 31 days of the event and changes must be consistent with the event. Qualifying Event Examples: Marriage, Divorce, Birth or Adoption, Death, Change in Dependent Eligibility Status, etc.
CIGNA PPO Dental Insurance CIGNA offers two PPO plan options: PPO plans allow the freedom to choose any dentist, however, if you go to a network provider, benefits will be based on a reduced fee schedule. Utilizing a network provider gives you more bang for your buck. If you choose to go to an out-of-network provider, PPO plan Option 2 has less out of pocket cost / balance billing versus Option 1. Base DPPO Plan – $1,000 annual maximum, $50 Deductible. Orthodontics for children to age 19: $1,000 lifetime maximum. Out-of-Network Reimbursement is based on the in-network fee schedule. High DPPO Plan – $1,000 annual maximum, $50 Deductible. Orthodontic for children to age 19: $1,000 lifetime maximum. Out-of-Network Reimbursement at 90% UCR. PPO In-Network Benefits: 100% Preventive services, 80% Basic services, 50% Major services and 50% Orthodontics (for child to age 19). PPO dental network: CORE network.
CIGNA Dental Monthly Premiums CIGNA Dental DPPO Plans Base Plan Employee Only $23.34 Employee + One Dependent $45.47 Employee + Family $68.50 High Plan Employee Only $32.96 Employee + One Dependent $65.20 Employee + Family $99.42
Superior Vision Insurance Superior Vision Insurance In-Network Benefits: $10 Exam and $25 Materials co-pay Prescription Lenses – once every 12 months One Frame (up to $125) – once every 24 months OR y OR you may choose contacts instead of lenses Contacts (up to $120) – once every 12 months Extra Discounts and Savings 10% to 30% savings on additional purchases of eyewear and contact lenses.
Superior Vision Monthly Premiums Superior Vision Monthly Premiums Vision Monthly Premium Employee Only$ 7.10 Employee + One Dependent$13.78 Employee + Family$20.24
Hartford Educator Select Disability Coverage is guaranteed issue up to $7,500 monthly benefit (based on income). New coverage and increased coverage is subject to a 12-month pre-existing condition exclusion. However, there is a four week benefit paid. Benefits can last while you are under a doctors care to age 65 due to illness or injury. You may choose waiting periods in days of: 0/7, 14/14, 30/30, 60/60, 90/90, and 180/180, based on your need. Waiting period is waived if you elect a 30 day elimination or less plan, and you are hospitalized. Telephonic Claims for faster, easier processing
TransAmerica Cancer Insurance. This is a supplemental plan designed to help cover out of pocket expenses not covered by your medical plan and pays benefits directly to you. Coverage is available for employees age 18 or over, and their spouse and unmarried, dependent children up to age 25. This coverage is offered to employees who have not been diagnosed with cancer, or who have been cancer and treatment free for the last 10 years. Annual Cancer Screening Benefit - $50 per calendar year Hospital Indemnity Benefit - $100 a day Radiation/Chemotherapy – options of $5,000 or $15,000 per 12 month period Lodging Benefit – Up to $50 a day for non-local treatment up to 50 days First Occurrence benefit- $1000 or $2000 Intensive Care Optional Rider - $300 or $600
Dearborn National Group Life Insurance New Employees can enroll within the first 30 days of employment for the lesser of $200,000 or 7-times your annual salary and 50% of employee amount up to $50,000 for your spouse and up to $10,000 for your dependent child(ren) without a statement of health (must meet actively at work requirements). Employee must cover themselves to cover a spouse or dependent child. Employees cannot be enrolled as both an employee and a spouse. If both parents are employees, only one may elect coverage on dependent children. Premiums are age-banded.
Axis AD&D Insurance This plan is designed to help provide you with peace of mind against the risk of covered accidental death or dismemberment. Coverage is available for employee or family. The amount of insurance you select is called the Principal Sum. Employee principal sum can be elected for $200,000, $100,000 or $50,000. Spouse and child coverage is a percentage of principal sum of employee coverage.
Texas Life Individual Life Insurance to age 121 Offers guaranteed level coverage to age 121; premium stays level for a significant period of time. You and your family continue coverage without loss of benefits or increase in costs should you terminate your employment. Policies can be purchased on spouse, children and grandchildren through age 18 without employee coverage. Contact FBS at for an application.
FSA Administrator – National Benefit Services The Cedar Hill ISD Flexible Spending Account (FSA) Plan Year- September 1, 2013 to August 31, 2014 Plan Maximum- $2,500 each plan year – MUST be re-elected each year. Services must be incurred in plan year. Participants have a 90 day grace period to file claims following plan year. FSA accounts can be used for all IRS Classified Dependents. FSA accounts are Use it or lose it – plan contributions carefully!
Healthcare Reimbursement Flex Card The flex card is Broker paid for CHISD employees The NBS Flex Card makes using your FSA quick and easy – just swipe it as a payment for your eligible expenses (doctors visits, prescriptions, etc.) and the funds are automatically deducted from your FSA. All participating employees will receive 2 NBS flex cards; additional cards may be ordered for family members for $5.00. Keep your cards, flex cards are valid for four years. Cards are reloaded on September 1. Always keep your receipts! In the event of an audit an itemized receipt may be required for substantiation of expenses. There is a $5 replacement fee for lost/stolen cards.
Healthcare Reimbursement Account Examples Are: Doctor office co-pays Prescription co-pays Dental Expenses Vision – Glasses, Contacts, Etc. TAX FREE ACCOUNT FOR OUT-OF-POCKET MEDICAL EXPENSES on a PRE-LOADED VISA CARD
Dependent Care Reimbursement Account Tax Free Account for eligible Dependent/Child Care Expenses Tax Free Deduction via payroll vs. deduction on income tax Annual Maximum - $5,000 Must be re-elected every year
How to file a claim with NBS: Visit & click forms to download Reimbursement Claim Formwww.mybenefitshub.com/cedarhillisd Claim Form may be Faxed, Mailed or ed to National Benefit Services You may receive your reimbursement via check or direct deposit Claims may be viewed on your benefit website
MEDlink® – Example of Savings INPATIENT HOSPITAL EXAMPLE: Illness: $11,000 In-hospital Cost – Emp. Only Age 45 Plan 2 Plan 1-HD Deductible $ 1,000 $ 2, % co-insurance $ 2,000 $ 1,720 EE out of pocket $ 3,000 $ 4,120 MEDlink® pays $ 2,500 Total Out of Pocket $ 500 $ 1,620 MedLink Gap Premium/Monthly $ TRS Medical Premium $ $ TRS with MedLink Monthly cost $ $ Annual Premium Savings AC2 vs AC1HD $ 2,448
For complete benefit information and enrollment instructions log on to: Contact FBS at if you have questions or need enrollment assistance. any questions.
Health Coverage for You and Your Family
PPO Plan Overview ActiveCare 1-HD, 2 and 3 Plans Plan Year
PPO Plan Overview (Network Level of Benefits) 23 ActiveCare 1-HDActiveCare 2ActiveCare 3 Deductible $2,400 employee only $4,800 family $1,000 individual $3,000 family $300 individual $900 family Out-of-Pocket Maximum (does not include copays or deductibles) $3,850 employee only $4,200 family $4,000 individual $8,000 family $1,000 per individual Coinsurance (Plan pays/ participant pays) 80% / 20% Office Visit Copay20% after deductible $30 for primary $50 for specialist $20 for primary $30 for specialist Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians. All other physicians are specialists.
Family Deductible Illustration Amy covers spouse and three dependents 24 $4,800 $1,000$800 $400 AmySue Chris TedBob Sue ActiveCare 1-HD with $4,800 family deductible The family deductible may be met by one or more people Plan pays benefits once entire $4,800 is met ̶ there is no individual deductible to meet ActiveCare 2 with a $1,000 individual deductible and a $3,000 family deductible Plan pays benefits for an individual as his/her deductible is met Everyone helps to meet the family deductible, but no one person pays more than the individual amount Bob $600 Amy Ted $200 Chris
Out-of-Pocket (OOP) Maximum Illustration Amy covers spouse and three dependents 25 $4,200 $4,000$2,000 $600 AmySue Chris TedBob Sue ActiveCare 1-HD with $4,200 family OOP maximum The family out-of-pocket maximum may be met by one or more people Plan pays benefits once entire $4,200 is met ̶ there is no individual amount to meet ActiveCare 2 with a $4,000 individual and $8,000 family OOP maximum Plan pays benefits for an individual as his/her OOP maximum is met Everyone helps to meet the family OOP maximum, but no one person pays more than the individual amount Bob $1,000 Amy Ted $400 Chris
PPO Plan Overview (Network Level of Benefits) 26 Preventive Care Clarification ServicesActiveCare 1-HDActiveCare 2ActiveCare 3 Preventive Care Plan pays 100% (deductible waived) Plan pays 100% (no copay required) Routine eye exam (one per plan year) Hearing exam 20% after deductible $30 for primary $50 for specialist $20 for primary $30 for specialist 100% coverage for certain age- and gender-specific preventive care services when network providers are used Must be billed by provider as preventive care
PPO Plan Overview (Network Level of Benefits) 27 Benefits (continued) ServicesActiveCare 1-HDActiveCare 2ActiveCare 3 High-tech Radiology (CT scan, MRI, nuclear medicine) 20% after deductible $100 copay per service, plus 20% after deductible Inpatient Hospital20% after deductible $150 copay per day, plus 20% after deductible ($750 max copay per admission; $2,250 max/year) $150 copay per day, plus 20% after deductible ($750 max copay per admission; $2,250 max/year) Emergency Room20% after deductible $150 copay, plus 20% after deductible (copay waived if admitted) $150 copay, plus 20% after deductible (copay waived if admitted) Outpatient Surgery20% after deductible $150 copay per visit, plus 20% after deductible
28 New!! Effective Sept. 1, 2013 MRIs CAT or CT Scans Endoscopy procedures Colonoscopy procedures Back or spinal surgery Knee surgery Shoulder surgery Hip or joint replacement surgery Bariatric surgery Benefits Value Advisor Real-time access to current cost and quality transparency Appointment scheduling Clinical decision support tools Understanding benefits and how to best use them Referrals to condition management programs Preauthorization coordination Help get benefits information and find network providers for: One-Call Solution: Customer Service
Your Prescription Drug Plan 29 Express Scripts administers your prescription drug plans on behalf of TRS –ActiveCare 1-HD, 2, and 3 plans Benefit includes both a retail and mail component Express Scripts has its own mail-order pharmacy where specialist pharmacists focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.* Express Scripts buys medication from the most reputable suppliers *Express Scripts mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is % accurate and is 23 times more accurate than a retail pharmacy Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice; Nov. 2007, Pharmacology, a peer-reviewed journal of the American College of Clinical Pharmacy
Prescription Drug Benefits – Network Level 30 * If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information. FeaturesActiveCare 1-HDActiveCare 2ActiveCare 3 Drug Deductible (per person, per plan year) Subject to plan year deductible $0 generic; $200 brand $75 Retail Short-Term (up to 31-day supply) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand) 20% coinsurance after deductible $20 $40* $65* $15 $35* $60* Retail Maintenance (after first fill, up to 31-day supply) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand) $25 $50* $80* $20 $45* $75* Mail Order and Retail-Plus (up to 90-day supply) Tier 1 (Generic) Tier 2 (Preferred Brand) Tier 3 (Non-Preferred Brand) $45 $105* $180* $45 $105* $180* Specialty Medications (retail or mail) 20% coinsurance after deductible $200 per fill
Information Resources TRS Website – –Pharmacy Benefit Highlights –List of maintenance medications –FAQs –Download forms Express Scripts Participant Website – –Prior authorization list –Formulary information –Locate a participating pharmacy –Generics Rx Advantage –My Rx Choices® / Price a Medication –Health and wellness information –Mobile App –Check prescription status –Order mail order refills –Download forms –Express Scripts widget Customer Service – Benefits Booklet 31
Who is Eligible to Enroll? To be eligible for TRS-ActiveCare coverage, you must: Be employed by a participating district/entity and –Be an active, contributing TRS member or –Be employed 10 or more regularly scheduled hours each week 32 Health care coverage for public school employees and their families
Employees NOT Eligible to Enroll State of Texas employees or retirees Higher education employees or retirees TRS retirees, receiving or who declined coverage under TRS-Care 33 These individuals are not eligible to enroll for TRS-ActiveCare coverage as employees, but they can be covered as a dependent of an eligible employee.
Dependent Eligibility 34 Spouse, including common law spouse A child under age 26: a natural child, an adopted child (or a child who is lawfully placed for legal adoption), foster child, or child under legal guardianship of the employee Any other child under the age of 26 (unmarried) in a regular parent-child relationship with the employee – Must meet residency and support criteria A grandchild under age 26 Unmarried disabled dependent (age 26+) – Must live with employee A dependent does not include a brother or sister of an employee unless the sibling is an unmarried individual under 26 years of age who is either: (1) under the legal guardianship of the employee, or (2) in a regular parent- child relationship with the employee and meets the any other child criteria Parents and grandparents of the covered employee do not meet the definition of an eligible dependent
Special Eligibility Situations If employee and spouse both work for a participating district/entity: –A spouse may be covered as an employee or as a dependent of an employee –Only one parent can cover dependent children A child (under age 26) employed by a district/entity and a contributing TRS member cannot be covered as a dependent –The child must be covered as an employee –If the child is not a contributing TRS member, the child may be covered as a dependent 35
Making Changes/Special Enrollment Events 36 Enrollees may be able to enroll for coverage, change plan options, or change the dependents he or she covers during the plan year within 31 days after a special enrollment event occurs New dependent –Marriage, birth, adoption or placement for adoption –Special rules apply to newborns Loss of other coverage Changing districts/entities is not considered a special enrollment event
Newborns Covered first 31 days if employee has coverage –Does not apply to newborn grandchildren Must add newborn within 60 days after the date of birth or up to one year after the date of birth if: –Employee has employee and family or employee and child(ren) coverage at the time of birth and at the time of enrollment Plan changes must be made within 31 days after the newborns date of birth Not necessary to wait for newborns Social Security number –Submit application without SSN to enroll –Re-submit another form after SSN is issued 37
Application to Split Premium 40 Married couples working for different participating entities may pool funds Optional Requires an Application to Split Premium form to be completed by both employees and employers Form available online
ID Cards (mailed to your home) PPO plans (ActiveCare 1-HD, 2 and 3) –Separate cards for medical and prescription drugs Blue Cross and Blue Shield of Texas Express Scripts 41
42 Enrollment Info Blue Access for Members
Blue Access for Members SM 43 Online member management tool Research health conditions View claims history and print Explanation of Benefits (EOB) statements Locate a network doctor or hospital Order additional ID cards, or print a temporary ID Take a confidential health assessment Send secure messages to BCBSTX Customer Advocates Monday thru Friday 7 a.m. to 10 p.m. (CT) EOBs are available online; you must log in and elect to receive paper copies
Blue Access Mobile SM 44 Public Site – No log-in required Health Care 101 Find a Doctor or Hospital Blue Access for Members Log-in Contact Information Provider Finder App For iPhone ® and Android ® phones Blue Access for Members SM Secure Site – Log-in Required ID Card My Coverage – Benefits / Eligibility Visits and Claims Health and Wellness – Diabetes, Obesity, Nutrition, Fitness, Metabolic Syndrome, Maternity Care, Member Care Profile User Profile Register for Blue Access for Members Text Messaging Static – One-Way SMS Messaging Diabetes Management, Claim Status Notification Alerts Dynamic – Two-Way Messaging member initiates text with keyword (ID Card Management)
What if I Have Questions? Call TRS-ActiveCare customer service for: –Claim questions/status –Network provider information –Membership and eligibility –Medical and Rx coverage questions –Inquiries (telephone and ) –ID card requests –Transition of care information –Help with online tools! 45 Customer Service Personalized Service
Questions Thank you for attending
TRS-ActiveCare is administered by Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Texas provides claims payment services only and does not assume any financial risk or obligation with respect to claims. Prescription drug benefits for ActiveCare 1-HD, 2 and 3 plans are administered by Express Scripts, Inc. HMO plans provided by: SHA, L.L.C. dba FirstCare Health Plans, Scott and White Health Plan, and Valley Baptist Insurance Company dba Valley Baptist Health Plans.