Presentation on theme: "2011 Open Enrollment Carleton College. Open Enrollment Period 2 Our 2011 Open Enrollment period begins October 11, 2010 and concludes November 15, 2011."— Presentation transcript:
2011 Open Enrollment Carleton College
Open Enrollment Period 2 Our 2011 Open Enrollment period begins October 11, 2010 and concludes November 15, Employees will access the on-line tool (benefitsCONNECT) on the Human Resources website.Human Resources website Be sure to review the refresher regarding your username and password; passwords will remain the same for 2011 as they are in This is a “passive” enrollment year, which means that unless you request a plan change, your current plans in 2010 (along with your corresponding dependents) will remain active for 2010.
The Hartford: Voluntary Life Insurance 3 Carleton College is pleased to announce that effective January 1, 2011, The Hartford will offer a guaranteed life insurance increase to those non-union employees with existing voluntary group term life coverage. The new amount of this guaranteed issue is $150,000, which is an increase from the $90,000 offered since Please note: For those employees with amounts in excess of this, no change will be possible. Employees with current Voluntary Life coverage of any amount can increase their election to $150,000 without completing medical underwriting. Employees who do not have current VL coverage can enroll in up to $80,000 with out completing medical underwriting. In order to increase your coverage, you will need to indicate the change on benefitsCONNECT. For specifics regarding the Voluntary Group-Term Life Insurance plan, please visit the Human Resources website.
Flex Spending Starting Jan. 1, 2011, you can no longer be reimbursed from an FSA for over-the-counter (OTC) drugs or medicines without a prescription. –Many OTC supplies, such as bandages, will still be eligible for FSA reimbursement without a prescription. We expect to have a new Third Party Administrator for our Flex plans by January 1, In order to reduce confusion, we encourage employees to exhaust their 2010 accounts by the end of the year. The new provider will offer a VISA debit card which will reduce errors. Additionally, they offer daily claims processing. 4
2011 Medical Insurance Options Options Blue (Aware) Aware PPO Accord HRA
Medical Premiums Medical InsuranceMonthly PremiumBi-Weekly Premium Aware PPO Employee$122.59$56.58 Employee +1$259.02$ Family$408.93$ Options Blue (Aware Network) Employee$84.23$38.88 Employee +1$172.39$79.56 Family$260.63$ Accord HRA Employee$74.69$34.47 Employee +1$152.39$70.33 Family$230.06$106.18
2011 Plan Design Changes Options Blue & Accord HRA: Unlimited Preventive services (previously capped at $500) No lifetime maximum (previously 5MM) PPO No lifetime maximum (previously 5MM) Lab, x-ray, and allergy related services now covered at 80% after deductible (previously covered at 100%) 8
Options Blue (Aware) HEALTH PLANIn-networkOut-of-network DeductibleIndividual$1,000 2-Party/Family$1,500/$2,000 Out-of-pocket maximum Individual$1,900 2-Party/Family$2,550/$3,800 Coinsurance80% Lifetime maximumUnlimited HRAContribution$500 Individual, $750 2-Party, $1000 Family Rollover Covered expenses Health Plan Eligible Expenses
Options Blue (Aware) Cont’d. Preventive care Routine cancer screening 100% Routine physical exams 100% Routine hearing exams Lab and x-ray services Immunizations Routine vision exams Well-child care (up to age 6) 100%80% after deductible Immunizations (up to age 18) 100%80% after deductible
Options Blue (Aware) Cont’d. Covered servicesIn-networkOut-of-network Services received Inpatient care Facility services 80% after deductible Professional services 80% after deductible Outpatient care Facility services 80% after deductible Professional services 80% after deductible Lab and x-ray services 80% after deductible Physician’s office Office visits for illness 80% after deductible In-office surgery 80% after deductible Allergy-related services 80% after deductible Urgent care 80% after deductible Lab and x-ray services 80% after deductible Emergency room care Emergency room 80% after deductible Physician services 80% after deductible Ambulance services80% after deductible
Options Blue (Aware) Two-party and family plans are subject to individual deductibles and out-of-pocket maximums. An individual can meet their own deductible and out-of-pocket maximum before other family members. Individuals within the family may have claims processed at different levels of coverage. Total expenses will not exceed plan deductibles and out-of-pocket maximums. $1,000 deductible $1,500 deductible $2000 deductible
Aware PPO cont’d.
The highlighted areas reflect plan coverage changes effective January 1, 2011.
Accord HRA Summary of Providers not included in Accord: Mayo Clinic Providers –Mayo Clinic –St. Mary’s Rochester –Rochester Methodist –Kasson Mayo Family Practice (contracted under Mayo Clinic) –Kenyon Mayo Family Practice (contracted under Mayo Clinic) Hazelden Providers –Hazelden –Hazelden OP CD Treatment –Youth and Family & extended residential CD treatment –Mental health clinics Note: All Mayo Health System clinics (Faribault, Northfield, Owatonna, etc.) are in the Accord network
Accord HRA cont’d.
Accord HRA cont’d. Covered services In-networkOut-of-network Services received Inpatient care Facility services 80% after deductible60% after deductible Professional services 80% after deductible60% after deductible Outpatient care Facility services 80% after deductible60% after deductible Professional services 80% after deductible60% after deductible Lab and x-ray services 80% after deductible60% after deductible Physician’s office Office visits for illness 80% after deductible60% after deductible In-office surgery 80% after deductible60% after deductible Allergy-related services 80% after deductible60% after deductible Urgent care 80% after deductible60% after deductible Lab and x-ray services 80% after deductible60% after deductible Emergency room care Emergency room 80% after deductible60% after deductible Physician services 80% after deductible60% after deductible Ambulance services80% after deductible60% after deductible
Accord HRA Two-party and family plans are subject to individual deductibles and out-of-pocket maximums. An individual can meet their own deductible and out-of-pocket maximum before other family members. Individuals within the family may have claims processed at different levels of coverage. Total expenses will not exceed plan deductibles and out-of-pocket maximums. $1,000 deductible $1,500 deductible $2000 deductible
Prescription Drugs Prescription drugs Generic Feature: If a brand name is selected when a generic is available, the member will pay the higher copay plus the difference between the cost of the brand and the generic. The difference amount does not accumulate toward the OOPM. Step Therapy Classes: Antidepressants, Cholesterol Lowering, Diabetic Monitors & Strips, Proton Pump Inhibitors. Retail pharmacy (31-day supply) $15 Generic Drugs $35 Brand Name Formulary Drugs $55 Brand Name Non-formulary Drugs Prescription Drug Out of pocket maximum: $750 Individual $1,000 Family $15 Generic Drugs $35 Brand Name Formulary Drugs $55 Brand Name Non-formulary Drugs Prescription Drug Out of pocket maximum: $750 Individual $1,000 Family 90dayRx (retail or mail) $30 Generic Drugs $70 Brand Name Formulary Drugs $110 Brand Name Non-formulary Drugs Prescription Drug Out of pocket maximum: $750 Individual $1,000 Family $30 Generic Drugs $70 Brand Name Formulary Drugs $110 Brand Name Non-formulary Drugs Prescription Drug Out of pocket maximum: $750 Individual $1,000 Family
Prescription Drug Out of pocket maximum: Options Blue (Aware) $750 Individual $1,000 Family Accord HRA$750 Individual $1,000 Family Aware PPO$500 per person
2011 Group Renewal Bulletin The 2011 Group Renewal Bulletin outlines benefit clarifications, process modifications and other recommended health plan changes that may affect members. As we embark on a new era of health care reform, it’s important to know that this bulletin includes the first wave of changes required by new federal health care reform legislation – including both the Patient Protection and Affordability Act signed in March and the second reconciliation bill that followed. As health care reform continues, you can count on Blue Cross Blue Shield of Minnesota to be your trusted guide in navigating the changing health care landscape, providing you the information and guidance you need to effectively manage your health care benefits.
2011 Group Renewal Bulletin (Cont.) The Group Renewal Bulletin provides a summary of changes that will be implemented with our health plan renewal effective January 1, The summary of changes involve: Blue Distinction Centers ® for spine surgery and for knee and hip replacement Creditable coverage disclosure for pharmacy benefits Emergency Care Medical equipment, prosthetics and supplies Notification requirements Skilled nursing facility language update Legislative update: Federal health care reform, Mental Health Parity, and state of Minnesota legislative mandates.
2011 Group Renewal Bulletin (Cont.) Blue Distinction Centers for Spine Surgery and for Knee and Hip Replacement Customer service representatives will encourage all members to use the new Blue Distinction Centers. These Blue Distinction specialty care facilities have been selected after a rigorous evaluation of clinical data that provided insight into the facility’s structures, processes and outcomes of care. Members must use a Blue Distinction provider to obtain the highest level of benefits. The Blue Distinction benefit design is as follows: Highest level for Blue Distinction Centers Reduced benefit for non Blue Distinction participating providers No coverage for nonparticipating providers *Note: The benefit differential option and soft steerage for Blue Distinction Centers are NOT available for groups on the Accord, Value, BluePlus or other alternative networks. Creditable coverage disclosure for pharmacy benefits There are two disclosures relating to creditable coverage: 1) disclosure to Medicare-eligible members; and 2) disclosure to Centers for Medicare and Medicaid Services (CMS). Member notification of creditable coverage status is due each year on November 14, upon member request, upon plan design change, or upon termination of coverage. Member notification is the employer’s responsibility. Employers must also disclose creditable coverage status to CMS, which includes information relating to the prior disclosure to members. The CMS disclosure must be provided within 60 days after the beginning date of the plan year for which the entity is providing the disclosure to CMS. Emergency Care Fully insured groups who previously elected copayments on outpatient facility fees will now process as follows: –Outpatient hospital/facility charges will be paid at 100% after copayment. –Outpatient professional charges will be paid at 100% and are NOT subject to copayment or a deductible. Health plans with coverage for emergency services subject to the deductible and overall coinsurance will not be impacted by this change.
2011 Group Renewal Bulletin (Cont.) 27 Medical equipment, prosthetics and supplies Durable medical equipment and supplies (DME) on the Aware PPO or CMM product now process according to the benefit plan’s overall deductible and coinsurance. Notification requirements Effective January 1, 2011, for all renewing fully-insured groups, notification requirements have been revised. The language has changed from “Recommended” to “Required” for an approved prior authorization, preadmission notification, preadmission certification, and/or emergency admission notification. This revision aligns contract language with Blue Cross’ review of inpatient services and health care industry standards. Blue Cross reviews services to verify that they are medically necessary and that the treatment provided is the proper level of care. Skilled nursing facility language update The fully insured certificate of coverage (COC) description for skilled nursing facility (SNF) have been updated. The following language has been removed, as access to skilled nursing facilities locally and nationally is no longer an issue. "If you are unable to obtain a bed in an in-network skilled nursing facility within a 50-mile radius of your home due to full capacity, you may be eligible to receive services at an out-of-network skilled nursing facility at the in-network level of coverage.“ Legislative Update: Federal Health Care Reform All group health plans must implement a number of rules. This is true regardless if their plan(s) was in existence prior to the enactment of the law, their funding type (self or fully-insured), and/or if their plan is subject to a collectively bargained agreement. There are no exceptions or special provisions in the enactment. All group plans must include: No lifetime limits on coverage for essential benefits for all plans. Plus an enrollment period for those who have met the plan’s LTM and are still otherwise eligible for enrollment. Note: Interim Final Rules on “essential benefits” are still pending. Extension of parents’ coverage to young adults under 26 years old regardless of residence, student status, marital status, financial dependency, or employment status (grandfathered plans may exclude children who have other employment-based coverage until 2014). Plus an enrollment period for those eligible to enroll who lost coverage or were ineligible but are now under age 26. No coverage exclusions for enrollees (under age 19) with pre-existing conditions No annual limits may be applied to essential benefits.
2011 Group Renewal Bulletin (Cont.) 28 Preventive Care For groups that have followed our recommended preventive care benefits, services covered will not significantly change with Health Care Reform as the majority of the recommendations are already included. New preventive care services have been added. Examples of these are: Screening, counseling and behavioral interventions for obesity in adults Screening for major depressive disorders in adolescents Counseling for tobacco use To comply with Health Care Reform and to ensure the preventive care benefit is easy to understand, Blue Cross has consolidated preventive care, prenatal and well-child services into one Preventive Care Package. Detailed information on what is included in our Preventive Care Package is available for review at Update to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (the Act) On February 2, 2010, the Internal Revenue Service and the U.S. Departments of Labor and Health and Human Services issued interim final regulations (IFR) that expand the criteria to determine if health plans meet mental health and substance use disorder parity standards. The IFR applies to health plans offered by employers with 51 or more employees and takes effect generally with plan years that begin on or after July 1, (Alternate effective dates may apply for health plans subject to collectively bargained agreements.) Blue Cross and Blue Shield of Minnesota (“Blue Cross”) has done extensive parity assessments on the benefit plans we administer. Additionally, Blue Cross contracted with an independent actuarial evaluation, and they largely confirmed our results.
2011 Group Renewal Bulletin (Cont.) 29 State of Minnesota Legislative Mandates Oral Oncology Parity Effective August 1, 2010 the Minnesota State Legislative requires that fully insured health plans provide oral chemotherapy to members at a cost sharing that is at parity with cost sharing for intravenous and injected chemotherapy. Private Duty Nursing Effective July 1, 2010 the Minnesota State Legislature requires fully-insured health plans to provide private duty nursing to certain individuals who are also covered under Medical Assistance (MA). Coordination of Benefits (COB) Primacy Rules Blue Cross and Blue Shield of Minnesota administers coordination of benefits (COB) primacy rules based on the National Association of Insurance Commissioner's (NAIC) guidelines. Minnesota's previous regulations allowed an individual non-group health plan to always be the secondary payer if the other insurance was a group health plan. Minnesota recently amended the law to coincide with the current NAIC model in which a non-group health plan is now regarded in the same way as a group health plan for primacy purposes. This allows group health plans the possibility to benefit from coordination of benefits savings as the group health plan will no longer automatically be made to pay as the primary plan. Effective immediately, Blue Cross is administering the new COB rules for all groups. We anticipate that only a minimal number of our members will be directly affected by this change. Provider Collection of Deductibles and Coinsurance Effective 08/01/2010 a new state law allows providers to collect a patient's anticipated deductible and coinsurance amount prior to the claims submission. This applies to Minnesota providers and their patients, regardless of where the patient resides and regardless of the participation status of the provider. Providers may not withhold a service for a member based on a patient's failure to pay a deductible or coinsurance at or prior to the time of service. Overpayments by patients to providers must be returned to the patient by the provider by check or electronic payment within 30 days of the date in which the claim adjudication is received by the provider. Please visit the Human Resources to access the 2011 Group Renewal Bulletin and more information on Health Care Reform in detail.
Health Care Reform 30 Highlights of Health Care Reform include: Breaks for Nursing Mothers: Adequate, non-bathroom space is provided to nursing mothers to express breast milk. Whistleblower Protections: Employees who exercise rights granted by, report alleged violation of, or participate in legal proceedings related to health care reform cannot be subject to discrimination in employment. Report Value of Employer-Provided Health Coverage on W2 No OTC (Over-the-Counter) Drug Reimbursements for Health FSAs/HRAs.
Health Care Reform (Cont.) 31 All group health plans must implement a number of rules including: 1.No lifetime limits on coverage for essential benefits for all plans (e.g. ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorder services including behavioral health treatments, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, pediatric services including oral and vision care). 2.No rescissions of coverage except for fraud or intentional misrepresentation. 3.Extension of parents’ coverage to young adults under 26 years of age regardless of residence, student status, marital status, financial dependency, or employment status. This change will also allow employees to reimburse medical expenses of their adult children from the Health FSA/HRA account.
Health Care Reform (Cont.) No coverage exclusions for children (under age 19) with pre-existing conditions. 5.No “restricted” annual limits (e.g. annual dollar-amount limits on coverage for essential benefits below $750,000 in 2011). 6.Additional benefits: **Guaranteed access to pediatricians and OB-GYNs **Emergency Services must be provided without prior authorization requirements and non-participating providers must be covered at the same benefit and cost-sharing level as services provided for participating providers.
Medical/Dependent Care Flexible Spending Medical Flex Spending Limit= $5,000 Dependent Care Flex Spending Limit = $5,000 Both accounts have risk of forfeiture. Please be conservative when making your election.
OTC Medicines, FSAs & Health Care Reform 34 Health care reform legislation passed by Congress and signed by President Obama in March, 2010 changed the rules for health care flexible spending account (FSA) benefit plans. Starting Jan. 1, 2011, you can no longer be reimbursed from an FSA for over-the-counter (OTC) drugs or medicines without a prescription. Many OTC supplies, such as bandages, will still be eligible for FSA reimbursement without a prescription.
OTC Medicines, FSAs & Health Care Reform (Cont.) 35 What this means to you? Decide how much to contribute to your health care FSA with the new law in mind. If you use OTC drugs or medicines recommended by your doctor to treat a medical condition, you may want to ask your doctor for a prescription. You will purchase these drugs or medicines by paying for them yourself. Then, you can submit a claim, a receipt and a copy of the prescription to OptumHealth Financial Services to be reimbursed from your FSA.
OTC Medicines, FSAs & Health Care Reform (Cont.) 36 Following are examples of OTC items that will require a prescription for FSA reimbursement as of Jan. 1, 2011: Acid controllers Acne medicine Aids for indigestion Allergy and sinus medicine Anti-diarrheal medicine Baby rash ointment Cold and flu medicine Eye drops Feminine anti-fungal or anti-itch products Hemorrhoid treatment Laxatives or stool softeners Lice treatments Motion sickness medicines Nasal sprays or drops Ointments for cuts, burns or rashes Pain relievers, such as aspirin or ibuprofen Sleep aids Stomach remedies
OTC Medicines, FSAs & Health Care Reform (Cont.) 37 Examples of OTC items that may continue to be reimbursed from an FSA without a prescription: Bandages Birth control Braces and supports Catheters Contact lens solution and supplies Crutches Denture cleaners and adhesives Diagnostic tests and monitors (such as blood glucose monitors) Elastic bandages and wraps First-aid supplies Insulin Ostomy products Reading glasses Walkers, wheelchairs and canes
OTC Medicines, FSAs & Health Care Reform (Cont.) 38 Grace Periods: The rule covering OTC drugs and medicine applies to all purchases that take place on or after January 1, If you file claims for eligible 2010 FSA expenses after January 1, 2011 (during the “Grace Period”), you will not have to provide prescriptions for purchases of eligible OTC medicines that happened in If you want to use your FSA dollars for OTC medicine, you will need to pay out-of-pocket and submit a prescription with your claims.
Resources Enrollment resources are available on HR web site BlueCross and BlueShield web site – BlueCross and BlueShield Customer Service – (866) One-on-one appointments can be scheduled with Kerstin or Andrea during the open enrollment period.