Presentation on theme: "Raytown School District Open Enrollment"— Presentation transcript:
1Raytown School District Open Enrollment 2010-2011
2All Active Employees Must Enroll or Waive Health BenefitsDental BenefitsVision BenefitsBasic 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 MailRetirees 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)
3ALL EMPLOYEES MUST COMPLETE ONLINE ENROLLMENT EVEN IF WAIVING COVERAGE, RETIREES MUST COMPLETE PAPER ENROLLMENT FORMS, ALL ENROLLMENTS MUST BE COMPLETED BY MAY 9TH.
4New Medical Insurance Carrier BlueCross BlueShield of Kansas City
5Welcome 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, 2010.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.
6Before We Get Started…. Health Care Reform Pre-Existing Waiting Period 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 QuestionsPre-Existing Waiting PeriodPre-Existing Waiting Period will not apply:Members currently enrolled in HumanaMembers currently enrolled in another Group Health PlanDeductible CreditYou will receive credit for the Deductible/OOP Maximum expenses you have incurred on your Humana plan from January 1st, 2010 through June 30th, 2010.
72010 Medical Plans PPO Health Plans Preferred-Care Blue – PPO (Preferred Provider Organization)No selection of PCP (Primary Care Physician)No referrals to SpecialistsIn and Out of Network CoveragePay lower out of pocket expenses by using network ProvidersNational and International CoverageThree PPO Plan Options$2,000 Deductible Base Plan$1,000 Deductible Buy-Up Plan$500 Deductible Buy-Up Plan
8Medical Premiums Effective July 1, 2010 * RATES EFFECTIVE 07/01/2010 BEGINNING WITH JUNE, 2010 PAYCHECKTOTAL COSTEMPLOYEE WORKS:$2,00030 HRS OR MORE20 HRS & UNDER 3015 HRS & UNDER 2010 HRS & UNDER 15Base PlanDISTRICTEMPLOYEEDEDUCTION CODEPAYSEMPLOYEE ONLY$$$$$$$$$EMPLOYEE / SPOUSE$$$$$EMPLOYEE / CHILDREN$$$$$FAMILY$$$$$$1,000Buy Up Plan$$$$$$$$$$$$$$$$ ,072.44$$$$$500$$$$$$$$$$$$$$$$ ,144.94$$$$1,043.73NOTE TO COBRA PARTICIPANTS:YOU WILL PAY THE MONTHLY AMOUNT LISTED IN THE "TOTAL COST" COLUMNPLUS AN ADDITIONAL 2% OF YOUR HEALTH PREMIUM ADMINISTRATION FEE
9Preferred-Care Blue PPO Visit for a complete list of Providers53 Hospitals, 4,858 PhysiciansCenterpoint Medical CenterChildren’s MercyKU HospitalLee’s Summit HospitalMenorah Medical CenterNorth Kansas City HospitalOlathe Medical CenterOverland Park RegionalResearch HospitalsSaint Luke’s HospitalsShawnee Mission Medical Center(Liberty, St. Joseph, St. Mary’s and Truman Hospitals are not in the Preferred-Care Blue Network)
10Travel 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.
11Preferred-Care Blue PPO $2,000 Deductible Base Plan In-NetworkOut-of-NetworkDeductible: The portion the covered person must pay each calendar year before BCBSKC will provide benefits.Individual DeductibleFamily Deductible$2,000$6,000$2,750$8,250Coinsurance: 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 MaximumIndividual MaximumFamily Maximum$3,000$9,000$18,000Out-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.
12Preferred-Care Blue PPO $1,000 Deductible Buy-Up Plan In-NetworkOut-of-NetworkDeductible: The portion the covered person must pay each calendar year before BCBSKC will provide benefits.Individual DeductibleFamily Deductible$1,000$3,000$1,250$3,750Coinsurance: 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 MaximumIndividual MaximumFamily Maximum$4,000$12,000$24,000Out-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.
13Out-of-Pocket Maximum Preferred-Care Blue PPO $500 Deductible Buy-Up PlanIn-NetworkOut-of-NetworkDeductible: The portion the covered person must pay each calendar year before BCBSKC will provide benefits.Individual DeductibleFamily Deductible$500$1,500$750$2,250Coinsurance: 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 MaximumIndividual MaximumFamily Maximum$3,500$10,500$7,000$21,000Out-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.
14Deductible and Out-of-Pocket Maximum Credit Deductible CreditYou will receive credit for the Deductible/OOP Maximum expenses you incur from January 1st, 2010 through June 30th , 2010.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.January 1 , 2011 – December 31, 2011The full Deductible and Out-of-Pocket Maximum will apply January 1, 2011.
15Preferred-Care Blue PPO $2,000 Base Plan$1,000 Buy-Up Plan$500 Buy-Up PlanPhysicians Office VisitsPCP (Internal Medicine, General Practitioner, Family Practitioner, Pediatrician)Specialists (Allergists, OB/Gyn, ENT)$25* copay$50* copay$20* copay$40* copay*Office Visit Copay includes Office Charge and Lab services in Physician’s office, or Independent LabConsistent with your previous plans, copays do not apply to deductible or OOP MaxChiropractic CareApplicable Specialist Copay(Includes office visit, lab and x-ray)Skeletal manipulations are subject to deductible and coinsuranceUrgent Care(includes CVS Minute Clinics; Walgreen’s Take-Care Centers)$40* CopayEmergency Services(Copay waived if admitted to a network hospital)$100 copay then Deductible then CoinsuranceLab services performed in a Hospital or Outpatient setting and all Radiology Services subject to Coinsurance
16Routine Preventive Care Mandated Routine ServicesPaid at 100%PSA TestsPelvic Exams and Pap SmearsMammogramsChildhood ImmunizationsLead TestingColorectal Cancer ExamsNewborn Hearing ScreeningOther Covered Routine ServicesPaid at 100%$50O Calendar Year Maximum (applies to network and non-network services)Physician ExaminationsCBC Metabolic ScreeningUrinalysisGlucose ScreeningThyroid Stimulating Hormone ScreeningLipid Cholesterol PanelHIV ScreeningHPV ScreeningChest X-rayEKGVision Care(Applicable Office Visit Copay)One routine eye exam per calendar year
17Prescription 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-MartRetail (up to a 34-day supply)Tier 1$10 copayTier 2$25 copayTier 3$50 copayConsistent with your previous plans, Rx Copays DO NOT go towards Deductible or Out-of-Pocket MaximumExpress Scripts - Mail Order Prescription ProgramLong Term Maintenance DrugsMail-Order (up to a 102-day supply)Tier 1$30 copayTier 2$75 copayTier 3$150 copayTo get started on EXPRESS SCRIPTSget a NEW Prescription from your Doctor!Please see Benefits/Payroll for Rx Prior Authorization Forms
18Prescription 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
19Key Differences (In-Network Services) $2,000 Base Plan$1,000 Buy-Up Plan$500 Buy-Up PlanAnnual Deductible$2,000 individual$6,000 family$1,000 individual$3,000 family$500 individual$1,500 familyNetwork CoinsuranceMember 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$3,500 individual /$10,500 familyOffice Visits$25 PCP copay*$50 Specialist copay*$20 PCP copay*$40 Specialist copay*ChiropracticServices$50 copay*Deductible + Coinsurance$40 copay*Routine CareUrgent Care(office visit/lab only)Emergency Care$100 copay* then deductible then coinsurancePrescription Drugs$10/$25/$50*$30/$75/$150**Copays do not apply to deductible or OOP maximum
20Each transition of care is evaluated on a case by case basis. General InformationTransition of CareIf 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 trimesterCurrent confinement in hospital or treatment facilityScheduled surgeryOngoing treatment of illnessEach transition of care is evaluated on a case by case basis.Please see Benefits/Payroll for Transition of Care Assistance Forms or Rx Prior Authorization Forms
21Finding a Provider is Easy…. Kansas City Metro AreaFind Blue KC Doctors, Hospitals, PharmaciesSELECT A PROVIDER DIRECTORYLocal BlueKC Provider DirectoryMY INSURANCE PLANSelect Your PlanPreferred-Care Blue NetworkSELECT A PROVIDER TYPEDoctorsHospitalsPharmacies, Facilities, LabsDentalUrgent Care and Retail Health CentersMental HealthOther ProvidersClick CONTINUEAll Other AreasFind Blue KC Doctors, Hospitals, PharmaciesSELECT A PROVIDER DIRECTORYBlueCard Provider DirectoryCONTINUESelect Guest TabChoose ProductPPO/EPOFIND PROVIDERSPhysiciansHospitalsBehavioral HealthAll Types
22Enrollment Process For Medical, Dental, Vision and Life Your BluesEnroll Account will be active Monday, April 26th 2010.On the Internet, go toLogin ID is (your first name) (First initial of your last name) (last four digits of your SSN) ValerieS0570Password is your nine-digit SSN without spaces or dashesYou will be asked to change your passwordCall BluesEnroll toll free help line at Monday through Friday, 8:00 AM to 5:00 PM CSTOn-line Enrollment must be completed by 11:59 p.m. onSunday, May 9, 2010
25BluesEnroll On-Line Instructions Complete step-by-step on-line instructions are available on the district’s intranet and web site.
26AFTER 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 STATUSCHANGE IN NUMBER OF DEPENDENTSCHANGE IN EMPLOYMENT STATUSCHANGE IN ELIGIBILITY STATUS
28Dental Insurance Premiums are 100% Employee Paid 3 Plans Offered Prepayment PlanFreedom Basic Low PPO PlanFreedom Preferred High PPO PlanFreedom Preferred High PPO increase in benefits from 80% to 100% for Type II In-Network ServicesIf you are currently enrolled in the Humana dental plans, there are no waiting periods for services in the Assurant plansYou must re-enroll or you will lose coverageTo locate a provider:
29Voluntary Dental Benefit Summary General Plan InformationAssurant PrePaid PlanAssurant Freedom Basic PPO (Low Plan)Assurant Freedom Preferred PPO (High Plan)Annual Deductible/IndividualN/A$50Annual Deductible/Family$50 each family memberWaived for PreventiveYesWaiting Period for Major Services6-12 monthsAnnual Plan Maximum$1,250Out-of-Network BenefitsAvailableLifetime Orthodontia Plan MaximumCovered ServicesPreventive Procedures (In-Network)$10 office visit copay plus fee schedule100%Basic Services (In-Network)Major Services (In-Network)50%Orthodontia ServicesDependent ChildrenAdults
31Voluntary Vision Insurance Plan Vision Service Plan (VSP)
32Using Your VSP PlanLocate a VSP Preferred ProviderorCall and make an appointmentSay you have VSPProvider will handle the restImportant- no i.d. cards nor prior authorizations
33VSP Preferred Provider Network 40,000 National Access Points334 Access Points in Greater KC AreaAll have dispensaries on site88% of VSP locations offer extended hours
34Vision InsurancePremiums are 100% employee paidProvides both in and out-of-network coverage$10 copay for exams
35VSP Signature PlanFrequency12 months on Exam12 months on Lenses24 months on Frame12 months on Contact Lenses (in lieu of glasses-lenses and frame)Copays$10 copay on exam$25 copay on glasses
36VSP Preferred Provider Coverage Exam covered after $10 copayLenses covered after $25 copaySingle Vision, Lined Bifocal, Lined Trifocal, Lenticular lenses.Polycarbonate lenses for dependent childrenFrame: $130 allowance toward any frame, 20% discount on any overage costsNon-covered lens options: Cost controlled discounts on all non-covered lens options (i.e. progressives, anti-reflective coating, scratch resistant coating, etc.). Avg. savings 35 to 40%.
37VSP Preferred Provider Coverage Contact Lenses (in lieu of glasses)$ allowance towards fitting evaluation and materials.VSP offers a contact lens care program through its providers for additional savings.Additional VSP Discounts30% discount off additional pairs of prescription glasses or non-prescription sunglasses if purchased on same day as exam. Otherwise 20% discount.
38VSP Preferred Provider Coverage Laser Corrective Surgery DiscountsAvg. 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
39Non-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 $45Single Lenses- Up to $45Bifocals- Up to $65Trifocals- Up to $85Frame- Up to $47Contact Lenses- Up to $105
42District Sponsored Basic Life Insurance No benefit changesBenefit level based upon hours workedMust designate a new beneficiary using the BluesEnroll system
43Flexible Spending Account / Dependent Care Account Tri-Star Systems
44Flexible 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.
45Flexible 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
46Flexible 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.
47Tri-Star Systems On-Line Enrollment Process MANDATORYONLINE OPEN ENROLLMENTEnrollment website:Click on the action button
48To 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.
49You must click on “I Agree” to continue the Open Enrollment process.
50Tri-Star Systems On-Line Enrollment Complete Tri-Star step-by-step instructions are available on the district’s intranet and web site.
51Completed Enrollment?BluesEnroll, printed confirmation of enrollment in the following:Blue Cross and Blue Shield of Kansas City Health InsuranceAssurant Dental InsuranceVSP Vision CareUS Able Life Insurance Beneficiary DesignationTri-Star Systems Flexible Spending (FSA)Printed confirmation of enrolled or waivedKeep for your Records the Above Documents