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GEORGIA MILITARY COLLEGE HEALTH AND FLEXIBLE BENEFITS DESCRIPTION A general overview of the benefits available to you for health and flexible benefits.

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Presentation on theme: "GEORGIA MILITARY COLLEGE HEALTH AND FLEXIBLE BENEFITS DESCRIPTION A general overview of the benefits available to you for health and flexible benefits."— Presentation transcript:

1 GEORGIA MILITARY COLLEGE HEALTH AND FLEXIBLE BENEFITS DESCRIPTION A general overview of the benefits available to you for health and flexible benefits

2 All full-time employees are eligible for benefits after they have been on payroll for a full working month as a full-time employee. Benefits must commence on the 1 st of the next effective month. See next slide for examples. When am I eligible for benefits?

3 Benefits commence after being employed for a full month— How does that work? EXAMPLE 1: If the first working day of the month was Monday, February 2, and that was the day you started full-time employment, your benefits would be effective March 1(the following month). EXAMPLE 2: If the first working day of the month was Monday, February 2, and you started full-time employment February 3, your benefits would start April 1. You did not start the first working day of the month, so you did not work the “full” working month in which you started. Since you completed working your first full month on March 3 rd, the next opportunity you had to start your benefits was the 1 st of the following month, which is April. This would be the case if you started employment any day after the first working day of the month.

4 What are my options for “health benefits?”  Choice between Cigna and United Healthcare as insurance carriers  Choice between an HRA and HDHP (both PPO options)  The option to add dependents  Elections are made through State Health Benefits, managed by Department of Community Health  Dental  Vision  Specified Illness  Short and Long Term Disability  Life Insurance  Spending Accounts  Legal Insurance  Accidental Death and Dismemberment  Long-Term Care  Elections are made through Georgia Breeze, managed by the State Personnel Administration Health and Medical Benefits Department of Community Health Flexible Benefits State Personnel Administration

5 Health Plans Available to New Hires As a new hire, you are eligible for the Standard Plan for the Health Reimbursement Arrangement (HRA) or the High Deductible Health Plan (HDHP). You will be enrolled in this plan until December 31 of the current plan year. During Open Enrollment (which is held during Oct-Nov of your current plan year), you will be able to make elections for the NEXT plan year to commence on the following January. Example, if you were hired April 15, 2013, you would enroll in the Standard Plan for the program of your choice (HRA or HDHP). You will be enrolled in that plan until December 31, 2013, but during open enrollment, Oct Nov. 2013, you can choose to enroll in the Wellness Plan of the program of your choosing. That insurance will commence Jan

6 HOW DOES THE HRA WORK? SHBP Health Reimbursement Account

7 Features of the HRA Plan Lower employee premiums SHBP credits dollars each year that pay for covered initial charges, whether medical or pharmacy expenses. These dollars also reduce your deductible and maximum out-of-pocket expenses You do not pay co-pays under this plan but co-insurance whether it is for your prescription drugs, office visits or surgery Any dollars not used at the end of the year roll over to the next year 100 percent coverage for preventive care and the cost of these services do not come out of your HRA dollars

8 Features of the HRA Plan No primary care physician designation or specialist referrals required  Suggest that you designate a PCP Cost for certain asthma, diabetes and cardiac drugs may be waived  Must be enrolled and compliant with disease management program The employee and spouse can also each earn $125 (total of $250)  Must complete a health assessment and get an annual physical

9 The Yellow box on the side of the house shows preventive care benefits. There is no cost to you when you receive your annual physical from a participating provider AND you don’t use your HRA dollars to pay for this benefit! The Green section of the house reflects the dollars in your HRA account (provided by the State.) These dollars will be used for your medical expenses i.e. prescriptions or Dr. visits. Once these dollars have been exhausted YOU must satisfy the rest of your deductive before more benefits are paid. This is the blue box. The true deductible is $1,100, but because SHBP provides $500, your out-of-pocket costs or “Member Responsibility” is only $600. How an HRA Works—Single Coverage Health Coverage SHBP pays 85/60% up to $3,000 Out-of-pocket maximum (reduced by $500 Contribution) $800 Member Responsibility $500 Health Reimbursement Account – funded by SHBP Preventive Care ---1,100 Deductible--- *HRA credits, deductibles and out-of-pocket maximums change on an annual basis, please refer to the decision guide for new annual limits.

10 This member has unused HRA account dollars that have rolled over to the next year, which is added to the new deposit of HRA dollars for the next plan year. This reduces the amount of out-of-pocket dollars the member pays for non-preventive expenses until they reach their deductible. HRA the SECOND year you are enrolled ---1,300 Deductible--- (Assume the deductible increases year 2) Health Coverage SHBP pays 85/60% up to $3,000 Out-of-pocket maximum ( $500 Member Responsibility $800 Health Reimbursement Account $500 funded by SHBP in Year 2+$300 rolled over from Year 1 Preventive Care Member only had $200 of non-preventive care Medical expenses in Year 1 $300 of non-used HRA dollars rolls over to Year 2 SHBP credits another $500 to HRA HRA balance at beginning of Year 2 is $800 Member responsibility to meet deductible is now only $500

11 HOW WOULD I USE AN HDHP? SHBP High Deductible Health Plans

12 High Deductible Health Plans Lower premiums Higher Deductible than the HRA All first-incurred expenses are covered out-of-pocket until you reach the deductible What are the benefits? Lower premiums: The biggest benefit is lower premium costs, making them much more affordable on a monthly basis than traditional insurance. Wellness benefits: The State Health HDHP offers wellness benefits that cover yearly check-ups, mammograms, child well visits and immunizations. If you have kids, this alone could save you thousands! Contracted rate: While you’re paying “out of pocket” for doctor’s visits, you are still paying the rate that the insurance company has negotiated with your doctor. For some procedures, this could be 70-80% less than the rate they would bill someone without insurance! Permits an HSA: The State Health HDHP allows you to open a health savings account, where you can put away tax-advantaged money to use for your health care expenses. Flexibility: Because you’re paying out-of-pocket for expenses, you have a lot more freedom in the type of care you choose. While it still pays to stay “in-network,” you can choose alternatives that may not have been available before.

13 What will the benefit be to enroll in a Wellness Plan next year? If you enroll in the Wellness Plan for the following year, you and your covered spouse (if applicable) will be required to uphold a Wellness Plan Promise. This entails completing a Health Education module online, completing an online health assessment and obtaining a biometric screening. Wellness Plan Rewards Lower premiums Lower out-of-pocket costs through co- payments, coinsurance, deductibles and out-of- pocket maximums If a member or his/her covered spouse does not honor their promise the Wellness plan will not be offered as an option the following year

14 Tricare Supplemental Plan features No pre-existing condition limitations Guaranteed renewable coverage 100% reimbursement on covered services (under TRICARE Standard/Extra) No referrals required Prompt claims processing days or less in most cases Worldwide coverage Young Adult coverage (eligible dependents up to 26th birthday) Plan benefits Reimbursement of: Co-pays (including prescriptions) Cost shares Deductible Charges in excess* of those covered by TRICARE Expand Your Healthcare Choices ASI has been working with employers to offer TRICARE supplement plans to their employees for many years. In that time we have provided thousands of families with the freedom to choose an alternative to their employer sponsored health plan. The TRICARE Supplement Plan is offered on a pretax basis to GA employees through a convenient voluntary payroll deduction under your section 125 cafeteria plan. The TRICARE Supplement Plan was designed to wrap around TRICARE, your primary health benefit. It pays the balance of covered services that would otherwise be your obligation after TRICARE has paid. ASI is honored to offer the TRICARE Supplement Plan to TRICARE eligible employees and their families from the State Health Benefit Plan of GA.

15 Flexible Benefits  Dental (Delta Dental)  Vision (Spectera)  Life Insurance (Minnesota Life)  Accidental Death and Dismemberment (Minnesota Life)  Disability (The Standard)  Specified Illness (Continental American Insurance Co.)  Long Term Care (Unum)  Legal Insurance (Hyatt Legal Plans)  Flexible Spending Accounts (ADP)

16 For a full description of the flexible benefits plans and how they can be used to benefit you and your family, please visit Click on the link that names the benefit for the description of the current years’ plan details.http://hr.gmc.cc.ga.us Visit the Human Resources website for full plan information, details and descriptions for Medical and Flexible Benefits! This is a quick view of how the HR Benefits Webpage appears.

17 On the website for new hires, there are directions on how you must enroll in your benefits. There are two separate places to enroll in your benefits. You must complete the SHBP form for medical and health benefits and return the form and supporting dependent documentation to Human Resources. You must complete online enrollment for flexible benefits with Georgia Breeze at Go forth and enroll in benefits! “The road to health is paved with good intestines!” --Sherry A. Rogers

18 After I have enrolled, what happens if I have a life event/family status change? State Health Regulations for Qualifying Events State Health Benefits must be notified within 30 days of MOST but not ALL Life Events. A Life Event is something that you experience during the year that changes your eligibility for insurance coverage. These include, Marriage, Divorce, Birth or Adoption, a child turning 26 and the loss or gain of other coverage. For information on how to notify State Health Benefits of these occurrences, and what supporting documentation the Department of Community Health requires, please read through the statement below about qualifying events. *PLEASE NOTE: Qualifying Events with State Health Benefits are handled differently than Flexible Benefits and the change in status must be reported to both Georgia Breeze for Flexible Benefits and Department of Community Health for State Health Benefits. State Health Qualifying Event Process Employees are not allowed to increase or decrease coverage, or to add or delete coverage except under limited Qualifying Life Event (Qualifying Event) conditions as outlined in Chapter in the Regulations of the Board. If a change in family status, employment status or change in insurance coverage occurs, any change made by the employee must be because of and consistent with such change. The intent of allowing change is to protect the employee and their family from loss of health coverage. A Qualifying Event is defined as a change in family status, employment status or change in insurance coverage. When a qualifying event has occurred, the employee must report the change to his/her employing entity within 31 days of the qualifying event. Enrollment in or changes to the current health benefit selection that are not received by SHBP within 31 days of the Qualifying Event will not be allowed.

19 After I have enrolled, what happens if I have a life event/family status change? Flexible Benefits must be notified within 30 days of MOST but not ALL Life Events. A Life Event is something that you experience during the year that changes your eligibility for insurance coverage. These include, Marriage, Divorce, Birth or Adoption, a child turning 26 and the loss or gain of other coverage. All qualifying event changes should be completed through Georgia Breeze.Georgia Breeze For information on how to notify Flexible Benefits of these occurrences, and what supporting documentation the State Personnel Administration requires, please click on the following for more information about each individual event. *PLEASE NOTE: Qualifying Events with Flexible Benefits are handled differently than State Health and the change in status must be reported to both Georgia Breeze for Flexible Benefits and Department of Community Health for State Health Benefits. Flexible Benefit Regulations for Qualifying Events

20 Because you are a State of Georgia Employee, you have access to many benefits and discounts with select vendors. To view the entire list visit as well as The State of Georgia Member ID for the working advantage Program is: Being a State of Georgia Employee has perks!


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