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1 Health Insurance and Flexible Benefits Annual Open Enrollment May 1 – May 23, 2014 presented by Employment & Benefits Department of Human Resources.

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Presentation on theme: "1 Health Insurance and Flexible Benefits Annual Open Enrollment May 1 – May 23, 2014 presented by Employment & Benefits Department of Human Resources."— Presentation transcript:

1 1 Health Insurance and Flexible Benefits Annual Open Enrollment May 1 – May 23, 2014 presented by Employment & Benefits Department of Human Resources

2 Health Insurance and Flexible Benefits 2014 Open Enrollment Open Enrollment Options Changes for July 1, 2014 Deadlines & Effective Dates Benefits at a Glance  COVA Care  COVA HealthAware  COVA High Deductible Health Plan (HDHP)  TRICARE Voluntary Supplement Premiums Effective July 1, 2014  Reflected on July 16 pay date 2

3 Health Insurance and Flexible Benefits 2014 Open Enrollment Types of Membership Eligible Dependents Making Changes Outside Open Enrollment Flexible Spending Accounts  over-the-counter drug/medical expenses How to Enroll/Make Changes Resources and Questions 3

4 4 Open Enrollment Options Health Care Coverage enroll in or change your health plan keep your current plan consider optional buy-ups add or remove eligible family members waive health care coverage Premium Rewards enroll or remain in COVA Care or COVA HealthAware to qualify Flexible Spending Accounts (FSAs) enroll in a health or dependent care FSA

5 Changes for July 1, 2014 New Premiums for all plans except COVA HDHP & TRICARE voluntary supplement COVA Care prescription drug copay tiers 2-4 increase $5 retail and $10 for home delivery COVA HealthAware two new “do rights” for the HRA COVA Care & COVA HealthAware Asthma/COPD and hypertension incentive programs added to MyActiveHealth COVA Care, COVA HealthAware & COVA HDHP Residential treatment centers added to behavioral health services Flexible Spending Accounts (FSAs) Period to file claims changes if your account ends before 06/30/15 5

6 COVA Care & COVA HDHP Overview administered by Anthem & Delta Dental COVA Care is a preferred provider organization (PPO) Pay copayments or coinsurance Must meet deductible for certain services COVA HDHP is a high deductible health plan Must meet deductible and then pay 20% coinsurance for service up to the out of-pocket limit Allows member to set up a Health Savings Account (HSA) to help you pay for health care expenses or save towards retirement Must set up HSA through local bank or financial institutio n 6

7 COVA Care & COVA HDHP Overview administered by Anthem & Delta Dental COVA Care & COVA HDHP includes; all doctors & hospitals in the Anthem BC/BS PPO network for medical, behavioral health and pharmacy services in Virginia and; the BlueCare PPO & BlueCard Worldwide programs for coverage outside of VA Both plans include an Employee Assistance Program (EAP) Optional Buy-up are available for an additional premium 7

8 COVA Care & COVA HDHP Overview administered by Anthem & Delta Dental Dental benefits are through the Delta Dental network employee is responsible for co-pays and deductible if services are through the DD network if services are outside the network, DD will pay the allowable charge and employee may be balanced billed by the provider Consider your dental needs carefully basic plan covers only routine exams and cleaning expanded dental provides basic dental plan coverage plus coverage for primary, complex restorative and orthodontic services 8

9 COVA HealthAware administered by Aetna Plan includes an employer paid HRA employee/retiree only = $600 employee/retire + spouse = $1200 Coverage paid at 100 % for in-network preventive medical, dental, vision, and hearing exams Provides out-of-network coverage Optional benefits (additional premium): expanded dental expanded dental & vision Initial contribution to your HRA Opportunity to earn more HRA contributions by completing “do rights” 9

10 COVA HealthAware administered by Aetna Earn “Do Rights” to Get More HRA Dollars receive $50 in your HRA for each “do right” up to $150 for 3 activities spouse also eligible for up to $150 for completing 3 “do rights” total of up to $300 for both employee and spouse Eligible “Do Rights” routine annual physical exam routine dental exam routine vision exam (new) annual flu shot MyActiveHealth health tracker usage MyActiveHealth coaching module completion (new) Unused HRA funds roll over into the new plan year with no limit as long as you stay in the plan 10

11 MyActiveHealth COVA Care, COVA HDHP and COVA HealthAware Participants MyActiveHealth allows you to access your health information 24/7 Go to Health information in one place Personalized health action items Easy-to-use health tips, tools, and trackers Programs include: Health Insights to help manage chronic conditions Free prescription drugs & supplies when requirements are met Diabetes management Asthma and COPD (new) Hypertension (new) Depending on Plan, hospital co-pay waiver or HRA contribution when requirements are met Bariatric surgery education 11

12 MyActiveHealth COVA Care, COVA HDHP and COVA HealthAware Participants Healthy Beginnings for expectant moms Helps moms be healthier so their babies will be too Includes incentives when you have certain conditions that qualify Depending on Plan, hospital co-pay waiver or HRA contribution when requirements are met Healthy Lifestyles For those generally healthy but need help staying on track Includes coaching on : nutrition, exercise, stress management and quiting tobacco 12

13 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Deductible – per plan year -One person -Two or more persons $225 $450 $1,500 $3,000 $1,750 $3,500 Out-of-pocket expense -limit – per plan year -One person -Two or more persons $1,500 $3,000 $6,000 $5,000 $10,000 Doctor’s visits -Primary Care Physician -Specialist $25 $40 20% after deductible

14 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Hospital Services -Inpatient -Outpatient $300 per stay $125 per visit 20% after deductible 20% after deductible Emergency Room Visits $150 per visit (waived if admitted) 20% after deductible Ambulance Travel 20% after deductible 14

15 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Outpatient diagnostic, laboratory, tests, shots and x- rays 20% after deductible Infusion services (includes IV or injected chemotherapy) 20% after deductible Outpatient therapy visits -Occupational, physical and speech therapy -Chiropractic (30-visit plan year limit per member) $25 PCP/$35 specialist $35 20% after deductible 20% after deductible 20% after deductible 15

16 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Applied behavior analysis (ABA) for autism spectrum disorder – ages 2 through 6 -$35,000 annual limit $25 per service 20% after deductible 20% after deductible Behavioral Health Visits Medical & non-medical prof visits Inpatient residential treatment Intensive outpatient treatment (IOP) $25 $300 per stay $125 per episode of care 20% after deductible Employee Assistance Program (EAP) Up to 4 visits per incident $0 $0 $0 16

17 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Prescription drugs – mandatory generic Retail Pharmacy Home Delivery Pharmacy Up to 34-day supply $15/$30/$45/$55 Up to 90-day supply $30/$60/$90/$110 Up to 34-day supply 20% after deductible Up to 90-day supply 20% after deductible Up to 34-day supply 20% after deductible Up to 90-day supply 20% after deductible Dental Services Diagnostic & preventive$0 Annual Routine Vision ExamNot Available$0Not Available Annual Routine Hearing ExamNot Available$0Not Available 17

18 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay 18 Wellness & preventive services $0 $0 $0 Office visits at specified intervals, immunizations, lab and x-rays Annual check-up visit (primary care physician or specialist), immunizations, lab and x-rays Routine gynecological exam, Pap test, mammography screening, prostate exam (digital rectal exam), prostate specific antigen (PSA) test, and colorectal cancer screening

19 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Expanded Dental *Maximum benefit – per member Deductible Primary (basic) care Complex restorative (inlays, onlays, crowns, dentures, bridgework) Orthodontic - Lifetime maximum benefit Optional Benefit $2000 $50/$100/$150 20% after deductible 50% after deductible 50% no deductible $2000 Optional Benefit $2000 $50/$100/$150 20% after deductible 50% after deductible 50% no deductible $2000 Optional Benefit $2000 $50/$100/$150 20% after deductible 50% after deductible 50% no deductible $

20 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Routine Vision (once every 12 months) Routine eye exam Optional Benefit $40 Optional Benefit Included in basic plan Not Available Eyeglass frames Lenses -Eyeglass lenses (standard plastic, single, bifocal or trifocal) or -Contact lenses – *Conventional or *disposable *non-elective 20% off balance after plan pays first $100 $20 15% off balance after plan pays first $100 Balance after plan pays $250 20% off balance after plan pays first $100 $20 15% off balance after plan pays first $100 Balance after plan pays $250 20

21 2014 Benefits at a Glance In-Network Benefits COVA Care You Pay COVA HealthAware* You Pay COVA HDHP You Pay Routine Hearing (once every 48 months) Routine hearing exam Optional Benefit $40Included in basic planNot Available Hearing aids and other hearing-aid related services Benefit maximum Balance after plan pays $1,200 $1,200 Not Available Out-of-NetworkOptional Benefit Plan payment reduced by 25%. Provider may balance bill for amount above allowable charge Additional deductible out- of-pocket limits apply. 40% coinsurance after deductible. Provider may balance bill for amount above allowable charge. Not Available 21

22 22 Health Plan Monthly Premiums Effective 07/01/2014 SinglePlus OneFamily COVA Care (with preventive dental) $75$171$230 COVA Care + Out-of-Network $89$190$256 COVA Care + Expanded Dental $100$219$303 COVA Care + Out of Network + Expanded Dental $114$238$329 COVA Care + Expanded Dental + Vision & Hearing $115$244$337 COVA Care + Out of Network + Expanded Dental + Vision & Hearing $129$263$363

23 23 Health Plan Monthly Premiums Effective 07/01/2014 SinglePlus OneFamily COVA HealthAware (with preventive dental) $26$81$96 COVA HealthAware + Expanded Dental $51$129$169 COVA HealthAware + Expanded Dental & Vision $59$143$188 COVA HDHP (with preventive dental) $0 COVA HDHP + Expanded Dental $25$48$73 TRICARE Voluntary Supplement $61$120$161

24 Premium Rewards Already earning a Premium Reward? keep it through 06/30/15 as long as you stay in COVA Care or COVA HealthAware How to Earn a Premium Reward be enrolled in COVA Care or COVA HealthAware complete and submit both a Health Assessment and a Biometric Screening by May 31, 2014 go to to beginwww.myactivehealth.com/cova if you do not have access to the Internet or need help call ActiveHealth at

25 Premium Rewards Health Assessment go to the health assessment link to answer the questions click “complete and save” you or your spouse need to register separately and complete your own health assessment Biometric Screening go to the biometric screening link print either a: Biometric Screening Physician Form and take it to your doctor or Lab Corp authorization to take to a location convenient for you follow all instructions on the form or authorization 25

26 Premium Rewards New to COVA Care or COVA HealthAware on July 1, 2014? Follow the steps in the Spotlight to receive the rewards Complete both requirements by July 31, 2014 premium rewards begins August 1, 2014 Complete both requirements by August 31, 2014 premium rewards begin September 1,

27 27 Types of Membership Employee Single – employee only Employee Plus One – employee plus one eligible family member (spouse or child) Family Coverage - employee and two or more eligible family members

28 28 Eligible Dependents Legally married spouse Natural and adopted children, stepchildren, children placed for adoption under age 26 Unmarried children in the court-ordered sole, permanent custody of the employee Must reside full-time with the employee Employee provides more than half of dependent’s support Court ordered custody must be awarded prior to the child’s 18 th birthday Disabled children

29 Eligibility Documentation Legally Married SpousePhotocopy of marriage certificate and top portion of first page of employee’s recent Federal tax return Natural or Adopted ChildrenPhotocopy of birth certificate showing employee’s name or photocopy of legal adoptive or pre- adoptive agreement StepchildrenPhotocopy of birth certificate showing employee’s spouse’s name and photocopy of marriage certificate and photocopy of top portion of first page of employee’s recent Federal tax return Unmarried children in court-ordered sole, permanent custody of employee Photocopy of birth certificate and photocopy of Final Court Order with presiding judge’s signature 29

30 30 Flexible Spending Accounts Plan Year FSA available to all eligible employees Save on health care out-of-pocket costs Pay for eligible medical or dependent care expenses with pre-tax dollars FSA Open Enrollment concurrent with Health Insurance Open Enrollment July 1, 2014 Effective Date for New Accounts FSAs are use it or lose it so don’t overestimate expenses If you take no action, you will have no FSA

31 Flexible Spending Accounts Plan Year Maximum Contributions: Health FSA: up to $2,500 Dependent Care FSA: up to $5,000 depending on tax filing status Minimum Contribution: $10 per pay period Administrative Fee: $3.65 monthly on a pre-tax basis for one or both FSA accounts If enrolled in COVA HealthAware, the HRA pays health expenses first If enrolled in FSA for only part of plan year you must file for claims within three months after coverage period ends (new) If account ends 06/30/15 you still have until 09/3015 to file for reimbursement 31

32 32 Flexible Spending Accounts FSA Benefit Card Annual contribution available on July 1, 2014 Will automatically receive an Elite VISA Benefit card when you enroll in Medical FSA instructions on using the new card will be provided with the card – read carefully Card accepted when: used with a provider, i.e., doctor or hospital, and the charge is equal to the co-pay amount Over-the-counter and prescriptions purchases only accepted at IIAS certified merchants IIAS = inventory information approval system

33 ALEX is Back and ALEX can Help! ALEX is an online interactive assistant designed to help you decide which plan may be the most cost-effective for you. Visit and follow the prompts. ALEX will: ask questions about your individual needs; explain the plans offered; estimate the lowest cost plan option for you; and provide a plan comparison. The final decision is yours! 33

34 34 Open Enrollment How to Enroll/Make Changes Enroll on-line Go to Click on the Employee Direct link and register a new account. Must use your 7-digit Employee Number Number is included in the ID number used in Payline and is also within the ID number on the HI card Date of Birth entered as (MM/DD/YYYY) Valid state or personal Address Employee Direct available 24/7 Enroll using paper forms Drop by Human Resources No Appointment Necessary Deadline Friday, May 23, 2014 at 5:00 p.m.

35 2014 Open Enrollment Department of Human Resources 314B Tyler Place, 2 nd Floor Larry Ashby, Mgr, Employment & Benefits Carmella Carter, HR Generalist Alicia Dials, HR Generalist Jack Wright, Sr. HR Generalist 35


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