Presentation on theme: "City of Pasadena Open Enrollment Meeting For 2012 Benefits."— Presentation transcript:
City of Pasadena Open Enrollment Meeting For 2012 Benefits
City of Pasadena 2012 Plan Overview Beginning January 1, 2012, Allegiance will be the new Third Party Administrator for the City of Pasadena. The provider network will be Cigna Open Access. Prescription Drugs: both Retail and Mail Order will be administered by CIGNA Two Medical Plans ~ Plan A and Plan B Two Dental Plans 1) Self-Funded PPO administered by Allegiance ~ the calendar year maximum remains $1,500 2) Fully Insured DHMO through CIGNA ~ there are no changes to the DHMO Dental plan Voluntary Life Insurance – Changes may be made with evidence of insurability. EAP Provided by Cigna Your Open Enrollment period is October 3 rd through November 4 th.
Transition of Care Transition of Care allows you to continue to receive services for specified medical conditions for a defined period of time with health care professionals who do not participate in the CIGNA Network. You must apply for Transition of Care during Open Enrollment. Conditions that may qualify for Transition of Care: Pregnancy in the second or third trimester High Risk Pregnancy Transplant Candidates Newly diagnosed or relapsed Cancer Customer Service: If you feel that you may meet conditions for Transition of Care, you must apply during Open Enrollment.
Employee Assistance Program Employee Assistance Program Cigna will provide the EAP for the City of Pasadena The EAP is a free, confidential resource. Toll-free phone number: Available 24 hours a day, 7 days a week Available to all employees and their household members. Services Include: Counseling Legal Assistance Financial Assistance Child, elder, and pet care resources and referrals Identity theft consultation or login to access your benefits link and enter your Member ID in lowercase letters with no spaces
Allegiance Resources Ask Allegiance - Member Website – Look up providers – Download claim forms – Find a doctor or facility – Research prescription drugs – View claims activity Contacting Allegiance Member Services On-line at
Welcome to the Allegiance Website
Provider Search - from the online services menu
The home page presents multiple options each giving you access to various types of information AskAllegiance Home Page
Access to View and Print EOBs Click on the blue claim number to view your EOB
Plan A No deductible In-network hospital expenses (in-patient & out-patient) are paid at 80% All other services (excluding physician office visits) pays at 70% All out-of-network services are paid at 50%, subject to reasonable and customary Office Visit Co-pays ~ $35 Primary Care / $50 Specialist Wellness Benefit – 100% Retail prescription (30 day supply) the greater of 30% or $5 for Generic or $25 for Brand with a deductible of $50 Mail order co-pays (90 day supply) $25 Generic and $65 Brand Out-of-Pocket maximum $4,000 Individual and $7,000 Family (family out-of-pocket maximum will accumulate for all family members) Out-of-Network charges will not apply to out-of-pocket maximum
Plan B $1,000 Deductible for Individual / $2,000 for Family Once the deductible is met, all in-network services, including both in-patient and out-patient hospital, are paid at 80% All out-of-network services are paid at 60%, subject to reasonable and customary. (Out-of-network costs do not count toward the deductible.) Office Visit co-pays ~ $35 Primary Care / $50 Specialist Wellness Benefit – 100%, not subject to deductible or co-pay Retail prescription (30 day supply) the greater of 30% or $5 for Generic or $25 for Brand with a $50 deductible Mail order co-pays (90 day supply) $25 Generic and $65 Brand Out-of-pocket maximum $4,000 Individual and $7,000 Family (family out-of-pocket maximum will accumulate for all family members). Amounts used to satisfy deductibles do not count toward the out-of-pocket maximum. Out-of-network charges will not apply to out-of-pocket maximum and will not count toward satisfying the deductible
2012 Medical Plan Rates With PHA Plan AEmployee Monthly Cost EE$79.00 EE + Spouse$ EE + Child(ren)$ EE + Family$ Plan BEmployee Monthly Cost EE$0 EE + Spouse$ EE + Child(ren)$56.00 EE + Family$152.00
2012 Medical Plan Rates Without PHA Plan AEmployee Monthly Cost EE$ EE + Spouse$ EE + Child(ren)$ EE + Family$ Plan BEmployee Monthly Cost EE$50.00 EE + Spouse$ EE + Child(ren)$ EE + Family$252.00
City of Pasadena Non- Grandfathered Retiree Rates effective A.Retiree with 25 years of service with the City of Pasadena or Retiree whose age and years of service with the City of Pasadena equal to 65 or greater. Plan APlan B Employee Only $253.00$ Employee/Spouse$644.00$ Employee/Child(ren)$536.00$ Employee/Family$953.00$ B.Retiree with years of service with the City of Pasadena and Retiree whose age and years of service with the City of Pasadena is less than 65. Employee Only$340.50$ Employee/Spouse$769.00$ Employee/Child(ren)$648.50$ Employee/Family$ $ C.Retiree with less than 20 years of service with the City of Pasadena and Retiree whose age and years of service with the City of Pasadena is less than 65. Employee Only$428.00$ Employee/Spouse$894.00$ Employee/Child(ren)$761.00$ Employee/Family$ $
Retirees 65+ Effective the City of Pasadena will contribute $ to the Medical Supplement Plan. The current Plan effective will cost retirees $47.11 a month. There will be a new option which will have Reduced Benefits and no monthly cost. We will have more information to the 65+ Retirees in the next few weeks.
2012 DHMO Rates Employee Monthly Cost Retiree Monthly Cost Employee/Retiree $0.23$12.42 Employee/Retiree plus Spouse $11.18$23.07 Employee/Retiree plus Child(ren) $9.56$21.45 Employee/Retiree plus Family $23.47$35.36
2012 PPO Dental Rates Employee Monthly Cost Retiree Monthly Cost Employee/Retiree $2.52$22.68 Employee/Retiree plus Spouse $24.93$45.09 Employee/Retiree plus Child(ren) $24.05$44.21 Employee/Retiree plus Family $42.88$63.05
Flexible Spending What is a Flex Spending Account (FSA)? A special non-taxed account designed to save you money on medical and dependent care (Day Care) expenses. These are two separate accounts. How do you participate? Select an annual amount to contribute to your account(s), these funds are automatically transferred from your paycheck (before taxes) into your FSA.
Flexible Spending How do I access the money? 1. Pay for eligible expenses out of your pocket and then submit your receipts to Allegiance. A check will be sent to you in the mail. 2. You will be provided with a Allegiance Card that works just like any credit card. See example of this card on the following page. Use this card to pay for eligible expenses. Save your receipts, you may need to verify your expenses.
Flexible Spending Substantiation For expenses other than medical or prescription co-pays, you may be required to provide a copy of the receipt for the charge. Allegiance will send a letter asking for the additional information. If you do not supply the receipt, your card will be suspended until the issue is resolved. SAVE YOUR RECEIPTS
Flexible Spending What can I use the money for? You can use Medical FSA money on any eligible unreimbursed medical expense. Just to List a Few Things: Co-Pays, Deductible, Prescriptions, Dental services, Eye Exams, Glasses, Contacts, Medical Supplies, Over the Counter Medications with a prescription, Hearing Exams, Chiropractic services, Mental Health services. Specific information is available in the handout materials. SAVE YOUR RECEIPTS
Flexible Spending How long do I have to use the money? The IRS allows 14 ½ months to use the money in your FSA. You may incur expenses from January 1, 2012 through March 15, You have until March 31, 2013 to file for a reimbursement of eligible expenses.
Flexible Spending What happens if I do not use the money? If you do not spend all the money in the FSA, it will be forfeited after March 15, 2013.
Flexible Spending For the Plan Year 2012, the City will once again set up a Medical Flex Spending Account for each eligible employee. The City will deposit $ in the account to use for unreimbursed eligible medical expenses. Employees may contribute up to an additional $4,500.
Flexible Spending Account Transition Run out will be handled by Allegiance. Any remaining funds of $ or less in the account as of December 31, 2011 will be up transferred to Allegiance. Reimbursement for 2011 claims after December 31, 2011 will need to be filed with Allegiance by paper submission.