Presentation on theme: "Raytown School District Open Enrollment 2010-2011."— Presentation transcript:
Raytown School District Open Enrollment
2 Health Benefits Dental Benefits Vision Benefits Basic Life (must designate beneficiary) Flex Spending/Cafeteria 125 Benefits (Active Employees Includes Individuals Retiring 2010) Retirees prior to 2010 will be provided Enrollment Packet via United States Mail Retirees or Individuals on Cobra are not to complete the electronic version for Open Enrollment. If you have not received your packet by April 23, please contact Benefits Office/Payroll Office, (816) All Active Employees Must Enroll or Waive
3 ALL EMPLOYEES MUST COMPLETE ONLINE ENROLLMENT EVEN IF WAIVING COVERAGE, RETIREES MUST COMPLETE PAPER ENROLLMENT FORMS, ALL ENROLLMENTS MUST BE COMPLETED BY MAY 9TH.
New Medical Insurance Carrier BlueCross BlueShield of Kansas City
5 Welcome to Blue Cross and Blue Shield of Kansas City! Welcome to your new Blue Cross and Blue Shield health benefit program! Your new coverage will be effective July 1, Please be sure to show your new Blue Cross ID card for services received on or after July 1, You should receive your Blue Cross ID card towards the end of June. Each enrolled family member will receive their own ID card. Your SSN is not used as an identifying number on the ID card. Show your BCBSKC ID card to your provider and at the pharmacy each time you receive services on or after July 1, 2010.
6 Before We Get Started…. Health Care Reform What’s covered now? And what’s covered in the future? –The health care reform bill that passed is very complex, and full of moving parts, however, some elements have become clearer. In the next several months, some changes will occur, and we will be ready to make these changes for plan years after September 23, In the meantime – your Blue Cross plans are consistent and secure and you will receive exceptional service. –BlueKC.com will provide current information and Frequently Asked Questions Pre-Existing Waiting Period –Pre-Existing Waiting Period will not apply: –Members currently enrolled in Humana –Members currently enrolled in another Group Health Plan Deductible Credit –You will receive credit for the Deductible/OOP Maximum expenses you have incurred on your Humana plan from January 1st, 2010 through June 30th, 2010.
Medical Plans PPO Health Plans Preferred-Care Blue – PPO (Preferred Provider Organization) No selection of PCP (Primary Care Physician) - No referrals to Specialists In and Out of Network Coverage –Pay lower out of pocket expenses by using network Providers National and International Coverage Three PPO Plan Options $2,000 Deductible Base Plan $1,000 Deductible Buy-Up Plan $500 Deductible Buy-Up Plan
8 Medical Premiums Effective July 1, 2010 * RATES EFFECTIVE 07/01/2010 BEGINNING WITH JUNE, 2010 PAYCHECK TOTAL COSTEMPLOYEE WORKS: $2, HRS OR MORE20 HRS & UNDER 3015 HRS & UNDER 2010 HRS & UNDER 15 Base PlanDISTRICTEMPLOYEEDISTRICTEMPLOYEEDISTRICTEMPLOYEEDISTRICTEMPLOYEE DEDUCTION CODE PAYS EMPLOYEE ONLY $ $ $ 9.72 $ $ $ $ $ $ EMPLOYEE / SPOUSE $ $ $ $ $ $ $ $ $ EMPLOYEE / CHILDREN $ $ $ $ $ $ $ $ $ FAMILY $ $ $ $ $ $ $ $ $ EMPLOYEE WORKS: $1, HRS OR MORE20 HRS & UNDER 3015 HRS & UNDER 2010 HRS & UNDER 15 Buy Up PlanDISTRICTEMPLOYEEDISTRICTEMPLOYEEDISTRICTEMPLOYEEDISTRICTEMPLOYEE DEDUCTION CODE PAYS EMPLOYEE ONLY $ $ $ $ $ $ $ $ $ EMPLOYEE / SPOUSE $ $ $ $ $ $ $ $ $ EMPLOYEE / CHILDREN $ $ $ $ $ $ $ $ $ FAMILY $ 1, $ $ $ $ $ $ $ $ EMPLOYEE WORKS: $ HRS OR MORE20 HRS & UNDER 3015 HRS & UNDER 2010 HRS & UNDER 15 Buy Up PlanDISTRICTEMPLOYEEDISTRICTEMPLOYEEDISTRICTEMPLOYEEDISTRICTEMPLOYEE DEDUCTION CODE PAYS EMPLOYEE ONLY $ $ $ $ $ $ $ $ $ EMPLOYEE / SPOUSE $ $ $ $ $ $ $ $ $ EMPLOYEE / CHILDREN $ $ $ $ $ $ $ $ $ FAMILY $ 1, $ $ $ $ $ $ $ $1, NOTE TO COBRA PARTICIPANTS: YOU WILL PAY THE MONTHLY AMOUNT LISTED IN THE "TOTAL COST" COLUMN PLUS AN ADDITIONAL 2% OF YOUR HEALTH PREMIUM ADMINISTRATION FEE
9 Preferred-Care Blue PPO Visit for a complete list of Providers 53 Hospitals, 4,858 Physicians Centerpoint Medical Center Children’s Mercy KU Hospital Lee’s Summit Hospital Menorah Medical Center North Kansas City Hospital Olathe Medical Center Overland Park Regional Research Hospitals Saint Luke’s Hospitals Shawnee Mission Medical Center (Liberty, St. Joseph, St. Mary’s and Truman Hospitals are not in the Preferred-Care Blue Network)
10 Travel with Your PPO Health Plans As a Blue Cross Blue Shield Member, you can take your healthcare benefits with you across the country and around the world. The BlueCard PPO Program gives you access to over 6,000 hospitals and 800,000 physicians around the country, giving you the peace of mind that you can take charge of your health, wherever you are. Visit our website at click BlueCard Provider Directory, click Continue. Login using the ID number on the front of your BCBSKC ID Card. or call (800) 810-BLUE (2583) to receive a complete list of network of hospitals and physicians.
11 Preferred-Care Blue PPO $2,000 Deductible Base Plan In-NetworkOut-of-Network Deductible: The portion the covered person must pay each calendar year before BCBSKC will provide benefits. Individual Deductible Family Deductible $2,000 $6,000 $2,750 $8,250 Coinsurance: Portion of covered charges paid by BCBSKC after you satisfy your deductible. CoinsuranceMember pays: 10% BCBSKC pays: 90% Member pays: 30% BCBSKC pays: 70% Out-of-Pocket MaximumIn-NetworkOut-of-Network Individual Maximum Family Maximum $3,000 $9,000 $6,000 $18,000 Out-of Pocket Maximum: Total of deductible and coinsurance that members pay each calendar year toward covered services before BCBSKC pays 100%. Emergency Services received in a network facility – Copay + Network Deductible and Network Coinsurance. Emergency Services received in a non-network facility – Copay + Non-network Deductible and Non-network Coinsurance.
12 Preferred-Care Blue PPO $1,000 Deductible Buy-Up Plan In-NetworkOut-of-Network Deductible: The portion the covered person must pay each calendar year before BCBSKC will provide benefits. Individual Deductible Family Deductible $1,000 $3,000 $1,250 $3,750 Coinsurance: Portion of covered charges paid by BCBSKC after you satisfy your deductible. CoinsuranceMember pays: 10% BCBSKC pays: 90% Member pays: 40% BCBSKC pays: 60% Out-of-Pocket MaximumIn-NetworkOut-of-Network Individual Maximum Family Maximum $4,000 $12,000 $24,000 Out-of Pocket Maximum: Total of deductible and coinsurance that members pay each calendar year toward covered services before BCBSKC pays 100%. Emergency Services received in a network facility – Copay + Network Deductible and Network Coinsurance. Emergency Services received in a non-network facility – Copay+ Non-network Deductible and Non-network Coinsurance.
13 Preferred-Care Blue PPO $500 Deductible Buy-Up Plan In-NetworkOut-of-Network Deductible: The portion the covered person must pay each calendar year before BCBSKC will provide benefits. Individual Deductible Family Deductible $500 $1,500 $750 $2,250 Coinsurance: Portion of covered charges paid by BCBSKC after you satisfy your deductible. CoinsuranceMember pays: 20% BCBSKC pays: 80% Member pays: 40% BCBSKC pays: 60% Out-of-Pocket MaximumIn-NetworkOut-of-Network Individual Maximum Family Maximum $3,500 $10,500 $7,000 $21,000 Out-of Pocket Maximum: Total of deductible and coinsurance that members pay each calendar year toward covered services before BCBSKC pays 100%. Emergency Services received in a network facility – Copay + Network Deductible and Network Coinsurance. Emergency Services received in a non-network facility – Copay + Non- network Deductible and Non-network Coinsurance.
14 Deductible and Out-of-Pocket Maximum Credit Deductible Credit You will receive credit for the Deductible/OOP Maximum expenses you incur from January 1 st, 2010 through June 30 th, January 1, 2011 – December 31, 2011 The full Deductible and Out-of-Pocket Maximum will apply January 1, If you have satisfied all or a portion of your Deductible with Humana, you will receive credit for the Deductible with BCBSKC. If you have satisfied all or a portion of your OOP Maximum with Humana, you will receive credit for the OOP Maximum with BCBSKC. If you receive your EOB after July 1, 2010 and if you have any BCBSKC claims – we will reprocess your claim to give you credit for the deductible/out-of-pocket maximum on your BCBSKC plan.
15 Preferred-Care Blue PPO Lab services performed in a Hospital or Outpatient setting and all Radiology Services subject to Coinsurance $2,000 Base Plan $1,000 Buy-Up Plan $500 Buy-Up Plan Physicians Office Visits PCP (Internal Medicine, General Practitioner, Family Practitioner, Pediatrician) Specialists (Allergists, OB/Gyn, ENT) $25* copay $50* copay $20* copay $40* copay $25* copay $50* copay *Office Visit Copay includes Office Charge and Lab services in Physician’s office, or Independent Lab Consistent with your previous plans, copays do not apply to deductible or OOP Max Chiropractic CareApplicable Specialist Copay (Includes office visit, lab and x-ray) Skeletal manipulations are subject to deductible and coinsurance Urgent Care (includes CVS Minute Clinics; Walgreen’s Take-Care Centers) $50* copay$40* Copay$50* copay Emergency Services (Copay waived if admitted to a network hospital) $100 copay then Deductible then Coinsurance
16 Routine Preventive Care Mandated Routine Services Paid at 100% PSA Tests Pelvic Exams and Pap Smears Mammograms Childhood Immunizations Lead Testing Colorectal Cancer Exams Newborn Hearing Screening Other Covered Routine Services Paid at 100% $50O Calendar Year Maximum (applies to network and non-network services) Physician Examinations CBC Metabolic Screening Urinalysis Glucose Screening Thyroid Stimulating Hormone Screening Lipid Cholesterol Panel HIV Screening HPV Screening Chest X-ray EKG Vision Care (Applicable Office Visit Copay) One routine eye exam per calendar year
17 Prescription Drugs Retail and Mail-Order Frequently Used Pharmacies Include: Costco, CVS, Hen House, Hy-Vee, K-Mart, Price Chopper, Sam’s Club, Sun Fresh, Target, Walgreen’s, Wal-Mart Retail (up to a 34-day supply) Tier 1 $10 copay Tier 2 $25 copay Tier 3 $50 copay Express Scripts - Mail Order Prescription Program Long Term Maintenance Drugs Mail-Order (up to a 102-day supply) Tier 1$30 copay Tier 2$75 copay Tier 3$150 copay To get started on EXPRESS SCRIPTS get a NEW Prescription from your Doctor! Consistent with your previous plans, Rx Copays DO NOT go towards Deductible or Out-of-Pocket Maximum Please see Benefits/Payroll for Rx Prior Authorization Forms
18 Prescription Drug Coverage Generics First Program For some medication classes, multiple generic medication alternatives now exist. Members will be required to try a generic medication before initiating therapy with a brand name medication. This will apply to the following medication classes: NSAIDs: (Anti-Inflammatory medications for Arthritis and pain) Calcium Channel Blockers: (CCB for hypertension) ACE Inhibitors/ARBs: (Medications for hypertension) Statins: (Medications for cholesterol) SSRIs/NDRIs: (Medications for Depression) Nasal Steroids: (Medications for Allergies) Sedative Hypnotics: (Medications for Sleep) Proton Pump Inhibitors (PPIs): (Medications for gastroesophageal reflux disease [GERD] or stomach acid) The Generics First Program will be implemented 90 days after July 1, Any member currently taking a Name Brand drug can continue. Any new prescription request after the 90-day waiting period will be subject to the Generics First Program. Generics First Program is Effective 10/1/10
19 Key Differences (In-Network Services) *Copays do not apply to deductible or OOP maximum $2,000 Base Plan$1,000 Buy-Up Plan$500 Buy-Up Plan Annual Deductible $2,000 individual $6,000 family $1,000 individual $3,000 family $500 individual $1,500 family Network Coinsurance Member pays: 10% BCBSKC pays: 90% Member pays: 10% BCBSKC pays: 90% Member pays: 20% BCBSKC pays: 80% Out-of – Pocket Maximum $3,000 individual / $9,000 family (Includes Deductible + Coinsurance) $4,000 individual / $12,000 family (Includes Deductible + Coinsurance) $3,500 individual / $10,500 family (Includes Deductible + Coinsurance) Office Visits$25 PCP copay* $50 Specialist copay* $20 PCP copay* $40 Specialist copay* $25 PCP copay* $50 Specialist copay* Chiropractic Services $50 copay* Deductible + Coinsurance $40 copay* Deductible + Coinsurance $50 copay* Deductible + Coinsurance Routine Care$25 PCP copay* $50 Specialist copay* $20 PCP copay* $40 Specialist copay* $25 PCP copay* $50 Specialist copay* Urgent Care$50 copay* (office visit/lab only) $40 copay* (office visit/lab only) $50 copay* (office visit/lab only) Emergency Care $100 copay* then deductible then coinsurance Prescription Drugs $10/$25/$50* $30/$75/$150* $10/$25/$50* $30/$75/$150* $10/$25/$50* $30/$75/$150*
20 General Information Transition of Care If you or a covered dependent is under the care of a physician that is NOT a BCBSKC provider for a continuing medical condition, we can provide assistance in your transition to network providers. Pregnancy in third trimester Current confinement in hospital or treatment facility Scheduled surgery Ongoing treatment of illness Please see Benefits/Payroll for Transition of Care Assistance Forms or Rx Prior Authorization Forms Each transition of care is evaluated on a case by case basis.
21 Finding a Provider is Easy…. Kansas City Metro Area Find Blue KC Doctors, Hospitals, Pharmacies SELECT A PROVIDER DIRECTORY Local BlueKC Provider Directory MY INSURANCE PLAN Select Your Plan Preferred-Care Blue Network SELECT A PROVIDER TYPE oDoctors oHospitals oPharmacies, Facilities, Labs oDental oUrgent Care and Retail Health Centers oMental Health oOther Providers Click CONTINUE All Other Areas Find Blue KC Doctors, Hospitals, Pharmacies SELECT A PROVIDER DIRECTORY BlueCard Provider Directory CONTINUE Select Guest Tab Choose Product PPO/EPO FIND PROVIDERS oPhysicians oHospitals oBehavioral Health oAll Types
22 Enrollment Process For Medical, Dental, Vision and Life On-line Enrollment must be completed by 11:59 p.m. on Sunday, May 9, 2010 Your BluesEnroll Account will be active Monday, April 26 th On the Internet, go to Login ID is (your first name) (First initial of your last name) (last four digits of your SSN) ValerieS0570 Password is your nine-digit SSN without spaces or dashes You will be asked to change your password Call BluesEnroll toll free help line at Monday through Friday, 8:00 AM to 5:00 PM CST
25 BluesEnroll On-Line Instructions Complete step-by-step on-line instructions are available on the district’s intranet and web site.
26 AFTER BENEFIT “Open” ENROLLMENT MAY 9TH NO CHANGES WILL BE ALLOWED UNLESS YOU HAVE A “QUALIFYING EVENT” IN YOUR LIFE AS DEFINED BY INSURANCE REGULATIONS. QUALIFYING EVENT CATEGORIES: CHANGE IN MARITAL STATUS CHANGE IN NUMBER OF DEPENDENTS CHANGE IN EMPLOYMENT STATUS CHANGE IN ELIGIBILITY STATUS
New Voluntary Dental Carrier Assurant Employee Benefits
28 Dental Insurance Premiums are 100% Employee Paid 3 Plans Offered –Prepayment Plan –Freedom Basic Low PPO Plan –Freedom Preferred High PPO Plan Freedom Preferred High PPO increase in benefits from 80% to 100% for Type II In-Network Services If you are currently enrolled in the Humana dental plans, there are no waiting periods for services in the Assurant plans You must re-enroll or you will lose coverage To locate a provider:
29 Voluntary Dental Benefit Summary General Plan InformationAssurant PrePaid Plan Assurant Freedom Basic PPO (Low Plan) Assurant Freedom Preferred PPO (High Plan) Annual Deductible/Individual N/A$50 Annual Deductible/FamilyN/A $50 each family member Waived for PreventiveN/AYes Waiting Period for Major Services N/A 6-12 months Annual Plan MaximumN/A$1,250 Out-of-Network BenefitsAvailable Lifetime Orthodontia Plan Maximum N/A Covered Services Preventive Procedures (In-Network) $10 office visit copay plus fee schedule 100% Basic Services (In- Network) $10 office visit copay plus fee schedule 100% Major Services (In- Network) $10 office visit copay plus fee schedule N/A50% Orthodontia Services Dependent ChildrenN/A AdultsN/A
Voluntary Vision Insurance Plan Vision Service Plan (VSP)
32 Using Your VSP Plan Locate a VSP Preferred Provider –www.vsp.com or Call and make an appointment Say you have VSP –Provider will handle the rest Important- no i.d. cards nor prior authorizations
33 VSP Preferred Provider Network 40,000 National Access Points 334 Access Points in Greater KC Area All have dispensaries on site 88% of VSP locations offer extended hours
34 Vision Insurance Premiums are 100% employee paid Provides both in and out-of-network coverage $10 copay for exams
35 VSP Signature Plan Frequency –12 months on Exam –12 months on Lenses –24 months on Frame –12 months on Contact Lenses (in lieu of glasses-lenses and frame) Copays –$10 copay on exam –$25 copay on glasses
36 VSP Preferred Provider Coverage Exam covered after $10 copay Lenses covered after $25 copay –Single Vision, Lined Bifocal, Lined Trifocal, Lenticular lenses. –Polycarbonate lenses for dependent children Frame: $130 allowance toward any frame, 20% discount on any overage costs Non-covered lens options: Cost controlled discounts on all non-covered lens options (i.e. progressives, anti-reflective coating, scratch resistant coating, etc.). Avg. savings 35 to 40%.
37 VSP Preferred Provider Coverage Contact Lenses (in lieu of glasses) –$ allowance towards fitting evaluation and materials. –VSP offers a contact lens care program through its providers for additional savings. Additional VSP Discounts –30% discount off additional pairs of prescription glasses or non-prescription sunglasses if purchased on same day as exam. Otherwise 20% discount.
38 VSP Preferred Provider Coverage Laser Corrective Surgery Discounts –Avg. Savings 15 to 20% –Should VSP contracted surgery center offers a promotional price to public, VSP members receive 5% off the promotional price. –Members who are interested please visit vsp.com or contact VSP at
39 Non-Preferred Provider Coverage Member responsible for payment of services to a non-preferred provider. Remit itemized paid receipt to VSP within six months from date of service. Reimbursed the below allowances (copays do apply) –Exam- Up to $45 –Single Lenses- Up to $45 –Bifocals- Up to $65 –Trifocals- Up to $85 –Frame- Up to $47 –Contact Lenses- Up to $105
42 District Sponsored Basic Life Insurance No benefit changes –Benefit level based upon hours worked Must designate a new beneficiary using the BluesEnroll system
Flexible Spending Account / Dependent Care Account Tri-Star Systems
44 Flexible Spending Accounts Program Highlights A great way to plan ahead and save money over the course of the year is to participate in the Flexible Spending Account (FSA) program. These accounts allow you to redirect a portion of your salary on a pre-tax basis into reimbursement accounts. Money from these accounts is then used to pay medical expenses, which are not covered by your medical plan. Services provided by Tri-Star Systems.
45 Flexible Spending Accounts Program Highlights Two ways to maximize your pre-tax savings: –Health Care Reimbursement Account: This account reimburses you for eligible health care expenses not covered by insurance. The maximum amount you can contribute to this account is $2,400. –Dependent Care Reimbursement Account: Through regular payroll deductions, you can set aside part of your income to pay for daycare expenses for eligible children and adults. Qualified expenses for reimbursement include adult and child daycare centers, preschools and before/after school care. Employees can make up to $5,000 ($2,500 for married couples filing separately) a year in pre-tax contributions to a dependent care FSA
46 Flexible Spending Accounts Program Highlights Important rules: –You are responsible for filing claims for reimbursement. –Carefully review your estimated expenses, as any funds remaining in the account at the end of the year are forfeited. –The money you contribute to each account for the plan year can only be used for eligible expenses you incur during the year. –You must enroll or waive for the 2010 plan year via the Tri-Star Systems web site.
47 MANDATORY ONLINE OPEN ENROLLMENT Enrollment website: Click on the action button Tri-Star Systems On-Line Enrollment Process
48 To Login you will need your social security number AND the Open Enrollment letter from Tri-Star that provided you with your password. This is a secure site.
49 You must click on “I Agree” to continue the Open Enrollment process.
50 Tri-Star Systems On-Line Enrollment Complete Tri-Star step-by-step instructions are available on the district’s intranet and web site.
51 BluesEnroll, printed confirmation of enrollment in the following: –Blue Cross and Blue Shield of Kansas City Health Insurance –Assurant Dental Insurance –VSP Vision Care –US Able Life Insurance Beneficiary Designation Tri-Star Systems Flexible Spending (FSA) –Printed confirmation of enrolled or waived Keep for your Records the Above Documents Completed Enrollment?