Presentation on theme: "Georgia Military College Health and Flexible Benefits Description"— 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 When am I eligible for benefits? 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 1st of the next effective month. See next slide for examples.
3 When am I eligible for benefits? 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 3rd, the next opportunity you had to start your benefits was the 1st 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?” Health and Medical BenefitsDepartment of Community HealthFlexible BenefitsState Personnel AdministrationChoice between Cigna and United Healthcare as insurance carriersChoice between an HRA and HDHP (both PPO options)The option to add dependentsElections are made through State Health Benefits, managed by Department of Community HealthDentalVisionSpecified IllnessShort and Long Term DisabilityLife InsuranceSpending AccountsLegal InsuranceAccidental Death and DismembermentLong-Term CareElections are made through Georgia Breeze, managed by the 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 SHBP Health Reimbursement Account How does the hra work?SHBP Health Reimbursement Account
7 Features of the HRA Plan Lower employee premiumsSHBP 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 expensesYou do not pay co-pays under this plan but co-insurance whether it is for your prescription drugs, office visits or surgeryAny dollars not used at the end of the year roll over to the next year100 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 requiredSuggest that you designate a PCPCost for certain asthma, diabetes and cardiac drugs may be waivedMust be enrolled and compliant with disease management programThe employee and spouse can also each earn $125 (total of $250)Must complete a health assessment and get an annual physical
9 How an HRA Works—Single Coverage Health CoverageSHBP pays 85/60%up to $3,000Out-of-pocket maximum*HRA credits, deductibles and out-of-pocket maximums change on an annual basis, please refer to the decision guide for new annual limits.Preventive Care---1,100 Deductible---(reduced by $500 Contribution)$800 MemberResponsibility$500 Health Reimbursement Account – funded by SHBPHow an HRA Works—Single CoverageThe 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.
10 HRA the SECOND year you are enrolled Health CoverageSHBP pays 85/60%up to $3,000Out-of-pocket maximumMember only had $200of non-preventive careMedical expenses inYear 1$300 of non-used HRAdollars rolls over toYear 2SHBP credits another$500 to HRAHRA balance at beginningof Year 2 is $800Member responsibility to meet deductible is now only $500Preventive Care---1,300 Deductible---(Assume the deductible increases year 2)($500 MemberResponsibility$800 Health Reimbursement Account$500 funded by SHBP in Year 2+$300 rolled over from Year 1HRA the SECOND year you are enrolledThis 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.
11 SHBP High Deductible Health Plans How would I use an hdhp?SHBP High Deductible Health Plans
12 High Deductible Health Plans Lower premiumsHigher Deductible than the HRAAll first-incurred expenses are covered out-of-pocket until you reach the deductibleWhat 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 RewardsLower premiumsLower out-of-pocket costs through co-payments, coinsurance, deductibles and out-of-pocket maximumsIf 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 www.asicorporation.com ASI is honored to offer the TRICARE Supplement Plan to TRICARE eligible employees and their families from the State Health Benefit Plan of GA.Plan featuresNo pre-existing condition limitationsGuaranteed renewable coverage100% reimbursement on covered services (under TRICARE Standard/Extra)No referrals requiredPrompt claims processing days or less in most casesWorldwide coverageYoung Adult coverage (eligible dependents up to 26th birthday)Plan benefitsReimbursement of:Co-pays (including prescriptions)Cost sharesDeductibleCharges in excess* of those covered by TRICAREExpand Your Healthcare ChoicesASI 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.
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 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.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.
17 Go forth and enroll in benefits! “The road to health is paved with good intestines!”--Sherry A. RogersGo forth and enroll in benefits!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
18 State Health Regulations for Qualifying Events After I have enrolled, what happens if I have a life event/family status change?State Health Regulations for Qualifying EventsState 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 ProcessEmployees 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 Flexible Benefit Regulations for Qualifying Events After I have enrolled, what happens if I have a life event/family status change?Flexible Benefit Regulations for Qualifying EventsFlexible 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.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.
20 Being a State of Georgia Employee has perks! 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: