Presentation on theme: "Garnett-Powers & Associates (GPA)"— Presentation transcript:
1 Garnett-Powers & Associates (GPA) The University ofSouthern CaliforniaPostdoctoral ScholarBenefit ProgramOpenEnrollmentPlan YearJune 25th through July 18th , 2014Presented byGarnett-Powers & Associates (GPA)
2 Agenda The Role of GPA and the Insurance Carriers Review of all Benefits, Rates and PlanDesignsExplanation of Online Open EnrollmentProcessQ & A
3 The Role of GPA and the Insurance Carriers GPA is the broker/administrator andcustomer service provider.We design, market, implement andadminister benefit programs forPostdoctoral Scholars at many campusesthroughout the United States.We are not the insurance carrier.The insurance carrier provides the actualbenefits, access to the providers and paysthe claims associated with your care.
4 What is Open Enrollment? Open Enrollment is an annual period of time designated to allow currentenrollees the opportunity to make changes to their coverage that areotherwise not allowed throughout the rest of the year, unless youexperience a qualifying life event.Open Enrollment also allows those postdocs who initially waived coverageto now enroll, including dependents.Examples of qualifying life events are:MarriageDivorceBirth of a childDeath of a dependentAdoption or placement of adoption of a childLoss of coverageDependent arrival in the U.S.Dependent loss of eligibility due to attainment of age 26.
5 What is Open Enrollment? (Continued) All postdocs currently enrolled in the USC Postdoctoral Scholar Benefit Program have the option of making the following changes during the Open Enrollment Period from June 25th – July 18th, 2014:Change from the HMO Medical and/or Dental plan tothe POS Medical and/or Dental plan, or vice versa.Enroll in the voluntary vision plan if previouslywaived.If you previously waived either yourself and/or yourfamily members, you/they may enroll in the program atthis time.All changes will be effective August 1st, 2014.If you are not changing your current enrollment, noaction is necessary.
6 Postdoctoral Scholar Benefit Program Eligibility for thePostdoctoral Scholar Benefit ProgramThe program is mandatory for the following Postdoc job codes:Postdoctoral Fellows in job codePostdoctoral Scholar - Fellowship Trainees in jobcodePostdoctoral Scholar – Teaching Fellows in jobcodePostdoctoral Scholar – Research Associates in jobcodeIf you are in one of the above job titles/job codes and youwish to waive coverage for this program, you must provideproof of comparable coverage.Please either fax or your coverage documentation tothe fax number or address listed on the GPA website.
7 Benefits Offered Through the Postdoctoral Scholar Benefit Program Plan NameInsurance TypeCompanyHMOMedicalPOSDentalPPOVision (Voluntary)Life and AD&DLifeSTD and LTDDisability
8 Benefit Plan/Rate Changes for Plan Year 2014/2015The Aetna medical HMO and POS plan rates willincrease by 5%.The dental HMO/POS, voluntary vision, life anddisability plan rates will remain the same.The HMO medical plan annual out-of-pocketmaximum has been enriched to include pharmacyexpenses effective 8/1/2014, as mandated by healthcare reform.The POS medical plan annual out-of-pocketmaximum has been enriched to include thedeductible, copayments and pharmacy expenseseffective 8/1/2014, as mandated by health carereform.
10 What is an HMO Plan?Under the HMO model, the member must choose a PrimaryCare Physician (PCP) contracted with the HMO plan at thetime of enrollment (provider directory links are available on theGPA website).Each family member may have a different PCP, who acts asyour healthcare “gatekeeper”.You may change your HMO PCP once a month if you arenot satisfied with your current choice.If the member is in need of treatment from a Specialist or is inneed of an In-Patient or Out-Patient procedure, he/she mustobtain a referral from their PCP prior to any type ofconsultation or treatment (except in the case of an emergency).If the referral is not obtained, no benefits will be paid.There is no Out-of-Network benefit (except in the case of anemergency).
11 New HMO ID CardsBeginning 8/1/2014, current HMO members will start to receive new HMO ID cards as part of the plan’s migration to a new, simpler platform.The new HMO ID card will include:– New member number beginning with a ‘W’.– Member Services phone number and claims mailing address.– Health plan product name and group number (controlnumber) will be on the front of the ID card.Future member Explanation of Benefits (EOBs) will have a new look making it easier for members to understand claim activity.
12 Postdoctoral Scholar Benefit Program Aetna HMO Medical Plan Medical Benefits In-Network Postdoc Pays Physician Office Visit $20 Copay Specialist Office Visit $20 Copay Hospitalization: Inpatient $250 Copay per admission Outpatient $100 Copay per visit Pregnancy $250 Copay per admission Prescription Drugs: Tier 1 $10 Copay Tier 2 $20 Copay Tier % Copay Emergency Room Visits $100 Copay Urgent Care $50 Copay Routine Physical Exam $0 Routine Gynecological Exams $0 Routine Mammograms $0 Mental Health Outpatient $20 Copay Inpatient $250 Copay per admission Annual Out-of-Pocket Maximum* $1,000 Individual *includes pharmacy expenses eff. 8/1/14 $3,000 Family Deductible: Individual n/a Family n/a Lifetime Maximum Unlimited For more detailed plan design information go to:
13 What is a POS Plan?The Point of Service (POS) plan offers more flexibility andchoice than the HMO plan due to the In-Network and Out-of-Networkselection you make at the time you seek services.The Plan offered through Aetna functions exactly like a PPOplan, but offers the opportunity of selecting a PCP for In-Networkservices.The In-Network benefits (copays/coinsurance) will be covered ata higher level than the Out-of-Network benefits.At the time of service, you have the ability to seek carefrom a Specialist, without having to obtain a referral from a PCP.The contractual agreement between the POS Plan and the In-Network Provider is on a “discounted fee for service” basis.You will pay more out-of-pocket when you seek services Out-of-Network because those physicians are not providing thecontracted discounts as the In-Network physicians.
14 Postdoctoral Scholar Benefits Program Aetna POS Medical Plan Medical Benefits In-Network Out-of-Network Postdoc Pays Postdoc Pays Physician Office Visit $10 Copay 50% Specialist Office Visit $10 Copay 50% E-Visits to PCP/Specialists 1 $10 Copay 50% Walk-in Clinics 2 $10 Copay 50% Hospitalization: Inpatient 10% $500 Copay + 50% Outpatient 10% 50% Pregnancy 10% $500 Copay + 50% Prescription Drugs: Tier 1 $10 Copay $10 Copay + 50% Tier 2 $25 Copay $25 Copay + 50% Tier 3 50% Copay 50% Copay Emergency Room Visits $100 Copay + 10% $100 Copay + 10% Urgent Care $50 Copay $50 Copay Routine Physical Exam $0 50% Routine Gynecological Exam $0 50% Routine Mammograms $0 50% Mental Health Outpatient $10 Copay 50% Inpatient 10% $500 Copay + 50% For more detailed plan design information go to:
15 Postdoctoral Scholar Benefits Program Aetna POS Medical Plan (continued) Annual Out-of-Pocket Maximum* $1,000 Individual $10,000 Individual $3,000 Family $30,000 Family Deductible: Individual n/a n/a Family n/a n/a Lifetime Maximum Unlimited Unlimited *Includes deductible, copayments & pharmacy expenses eff. 8/1/ – An E-visit is an online internet consultation between a physician (with the technical capability) and an established patient about a non-emergency healthcare matter. 2 – Walk-in Clinics are network, free-standing health care facilities typically found within preferred pharmacies like Walgreens and CVS. They are an alternative to a physician's office visit for treatment of unscheduled, non-emergency illnesses and injuries and the administration of certain immunizations. It is not an alternative for emergency room services or the ongoing care provided by a physician. Neither an emergency room, nor the outpatient department of a hospital, shall be considered a Walk-in Clinic For more detailed plan design information go to:
16 Summaries of Benefits and Coverage The PPACA requires that you be notified that theSummaries of Benefits and Coverage for yourmedical plans will be available on our websiteno later than June 25th , 2014.The Summaries of Benefits and Coverage followthe recommended guidelines of PPACA in astandardized format to make them easier to readand comprehend to better serve you in makingyour plan selections.You may request a paper copy at no charge bycalling the toll-free number on your new ID card.You may also print a copy directly off of the GPAwebsite.
17 Prescriptions – Mail Order Pharmacy You can order maintenance medications through Aetna’sRx Home Delivery for chronic conditions as asthma,arthritis, diabetes, high cholesterol and heart conditions.Under the HMO Plan, this service provides you up to a 90 day supplyof these medications after a copay of $20 for generic, $40 forbrand-name, and 50% for non-formulary brand namedrugs.Under the POS plan, this service provides you up to a 90 day supply ofthese medications after a copay of $20 for generic, $50 for brand-name, and 50% for non-formulary brand name drugs.Please click on Aetna RX Home Delivery/Order Form onthe website for more information, as well as directions onhow to order your prescriptions.Please visit forimportant information regarding the prescriptioncoverage.
18 Wellness ProgramsAetnaNavigator - This is an online member portal that allowsyou to view your medical visits and claims status, printtemporary ID cards and gain access to more importantinformation.Once you have your member ID, you may registerfor access to this site. There will be instructions on the website toassist you.Beginning Right – Provides a pregnancy risk survey and awealth of information to assist you with when either you or yourspouse become pregnant.GlobalFit – Offers discounts to a nationwide network of fitnessclubs.Health Connections – Discounts are offered through thisprogram for spas, health foods and fitness clothing.Stress Management – Information available for better mentaland physical health.
19 Urgent Care The hospital emergency room is to be used only if the situation is life threatening.The Urgent Care Center should be used as often aspossible to avoid additional charges.The Urgent Care Center is open 24 hours and isavailable to treat most non-life threateningemergencies, as broken bones (not multiple fractures),wounds not bleeding profusely, fevers and flusymptoms.The copay is less: HMO Plan - $100 copay foremergency room vs $50 copay for urgent care.POS Plan - $100 copay +10% for emergency room vs $50 copay for urgent care.There are 10 Urgent Care Centers within 10 miles of the University Park Campus in the HMO network, and 18 Urgent Care Centers in the POS network within 10 miles of the University Park Campus.
20 Walk-In Clinics The Walk-In Clinic is an in-network, free-standing health care facility that is an alternative to aphysician’s office for treatment of unscheduled, non-emergency illnesses and injuries and administrationof certain immunizations.It is not an alternative for the emergency room or theoutpatient department of a hospital.It is generally found in a retail location as CVS orWalgreens.If you use a Walk-In Clinic on the Medical POS plan,you will pay $10 in-network.There are 3 Walk-In Clinics within 10 miles of campus in the POS network.Walk-In Clinics are not covered under the HMO plan.
21 Health Care ReformThe Patient Protection and Affordable Care Act (ACA) wassigned into law on March 23, 2010.The ACA requires that most people that are either citizens orlegal residents to have health insurance coverage, or to pay a taxbeginning in 2014 if they do not.The intent of the ACA is to make health care coverage available to the millions that are uninsured in the U.S.All states are required to offer a Health Care Exchange, eitherthrough the federal government, on their own or through apartnership between the state and the federal government.California has its own exchange called Covered California.U.S. citizens and most legal residents are eligible for plans onthe exchange.
22 Health Care Reform (Continued) There are differing levels of coverage and cost, as well as several insurance carriers offering the plans.In order to be eligible for the Premium Tax Credit, also known as a subsidy, a person must meet certain eligibility requirements:The employer offers coverage where the plandesign does not meet the coverage requirementsof the ACA.Certain poverty-level income conditions are met.The cost of employee-only coverage exceeds 9.5%of an employee’s W-2 wages.
23 Health Care Reform (Continued) Important ACA Information Specifically for Enrollees in the USC-PBP:All of the USC-PBP plans meet or exceed the legal requirements of the ACA.To the best of our knowledge, the cost of single coverage for the HMO does not exceed 9.5% of an eligible postdoc’s wages/stipend.It is highly unlikely that anyone enrolled in the USC-PBP medical coverage will be eligible for a subsidy through the exchange.For more information, please visit the Covered California site at
25 Postdoctoral Scholar Benefit Program California Dental HMO Plan Annual Maximum: UnlimitedIn-NetworkPostdoc PaysCalendar Year Deductible NoneDiagnostic and Preventive Care-Routine Exams No Charge-Teeth Cleanings No Charge-X-Rays No ChargeBasic Procedures-Fillings $0 - $65 Copay-Endodontics $0 - $200 Copay-Periodontics $20 - $275 Copay-Oral Surgery $0 - $100 CopayMajor Procedures-Crowns $75 - $300 Copay-Bridgework $100 - $600 Copay-Dentures $100 - $600 CopayOrthodontia-Adolescent $1,775 Copay-Adult $1,975 CopayFor more detailed plan design information go to:
26 Accessing the POS Network The Principal POS (Point of Service) plan offers comprehensive coverage,adding an additional tier of benefits as an option for your care, called theEPO Tier.EPO indicates “Exclusive Provider Organization”.A POS plan incorporates three tiers for delivery of care and you choose thetier you desire at the time of service:The EPO Tier: There are no deductibles in this tier, with preventive covered at 100%, basic covered at 90% and major covered at 60%. This tier offers you the maximum amount of savings when you seek dental care. EPO dentists are generally PPO dentists.2. The PPO Tier: This tier offers you the flexibility of seeking servicefrom a PPO dentist, at a higher out-of-pocket cost than the EPO tier.3. Non-Network Tier: This tier allows you to seek care from any non-network provider.
27 Postdoctoral Scholar Benefit Program Principal Financial Group Dental POS Plan EPO NetworkPostdoc PaysNone0%10%40%50%PPO NetworkPostdoc Pays$50 per individual*$150 per family*0%20%40%50%*Deductible waived for Preventive careOut-of-NetworkPostdoc Pays$50 per individual$150 per family0%20%40%50%Annual Maximum $1,500 per personCalendar Year DeductibleDiagnostic and Preventive Care-Routine Exams-Teeth Cleanings-X-RaysBasic Procedures-Fillings-Endodontics-Periodontics-Oral SurgeryMajor Procedures-Crowns-Bridgework-DenturesImplant Benefits-$1,000 Lifetime MaximumFor more detailed plan design information go to:
28 Accessing the Out-of-Network Tier An example of how seeking out-of-network services canimpact your out-of-pocket costs:Porcelain Crown on a molar - We will estimate that the usual, customaryand reasonable charge is considered $800.Per the out-of-network benefit structure, you will pay 40% (yourcoinsurance) toward that crown, which would be $320.In addition, if the out-of-network dentist performing your crown servicescharges more than what is considered usual, customary and reasonable,you will pay the $320 PLUS any additional amount that the dentist wishes tocharge. So, if the dentist charged $900 for the crown in total, you would paya total of $420 for the crown, which includes the extra $100 that the dentistcharged above what is considered usual, customary and reasonable.Using the out-of-network tier costs you more because the dentists do notdiscount their services per a provider contract, whereas those contracts doreduce your out-of-pocket costs in the EPO and in-network PPO tier.When you access care out-of-network, you and the insurance carrierincur more costs, consequently affecting the overall pricing of the plan.Principal has a robust EPO and PPO network.
30 Postdoctoral Scholar Benefit Program Voluntary EyeMed PPO Vision Plan Vision Benefits In-Network Out-of-Network Postdoc Pays Postdoc Pays Eye Exam (every 12 months) $10 Copay up to $30 Allowance Frames (every 24 months) $130 Allowance up to $65 Allowance (20% off remaining balance) Lenses (every 12 months) Single $0 Copay up to $25 Allowance Bifocal $0 Copay up to $40 Allowance Trifocal $0 Copay up to $63 Allowance Contact Lenses (materials only) $130 Allowance up to $104 Allowance (15% off remaining balance) For more detailed plan design information go to:
31 LIFE/AD&D, SHORT-TERM DISABILITY and LONG-TERM DISABILITY INSURANCE Provided by
32 Postdoctoral Scholar Benefit Program Life and Accidental Death & Dismemberment Insurance The plan pays $10,000 in the event of a death.An additional benefit of $10,000 is paid for AD&D if thedeath is due to an accident.Postdoctoral Scholars holding J-1 Visa status will have the$10,000 medical evacuation and $7,500 of repatriation ofmortal remains coverage necessary to fulfill the visarequirements included in their Life and AD&D policy.In addition, family members holding J-2 Visa status will alsobe covered for the medical evacuation and repatriation, evenif the Postdoctoral Scholar waives medical and/or dentalcoverage.
33 Postdoctoral Scholar Benefit Program Short-Term Disability Insurance (STD) Postdoctoral Scholars – Fellowship Trainees in job codeand Postdoctoral Scholar – Teaching Fellows injob code are eligible and automatically enrolled inthe STD.The Short-Term Disability plan will provide a weeklybenefit of 70% of your pre-disability earnings.The maximum weekly benefit will not exceed $1,500.If approved, benefits for an accident or sickness (non-work related) will become payable after you have beencontinuously disabled for 8 days.The maximum benefit period for benefits to be payable is52 weeks.
34 Postdoctoral Scholar Benefit Program Long-Term Disability Insurance (LTD) All postdocs are eligible and automatically enrolled in theLTD.The Long-Term Disability plan will provide a weeklybenefit of 66.67% of your pre-disability earnings.The maximum monthly benefit will not exceed $5,000.If approved, benefits for an accident or sickness (non-work related) will become payable after you have beencontinuously disabled for 365 days.The maximum benefit period for benefits to be payable isage 65 or Social Security Normal Retirement Age.
35 2014 / 2015 Monthly Rates and Contributions Total Monthly CostInstitutional CostPostdoc CostPostdoc IncreaseHealth Plan HMOPostdoc$343.76$274.14$69.62$3.31Postdoc + Child(ren)$639.41$509.91$129.50$6.17Postdoc + Spouse/Partner$718.46$572.95$145.51$6.93Postdoc + Spouse/Partner + Child(ren)$1,017.54$811.46$206.09$9.82Health Plan POS$486.03$387.60$98.44$4.69$904.02$720.92$183.09$8.71$1,015.81$810.08$205.74$9.80$1,438.66$1,147.28$291.38$13.88Dental HMO$14.44$9.67$4.77$0.00$26.67$13.33$13.34$24.44$12.22$37.78$12.85$24.93Dental POS$51.71$34.65$16.60$106.32$53.15$51.74$103.73$51.86$50.47$163.77$55.69$105.18Vision$8.06NA$16.11$15.31$23.69DISABILITY - LONG & SHORT TERM PLANS$31.10LIFE INSRUANCE (10K)$1.45
36 The Open Enrollment Process Go to the Garnett-Powers & Associates websiteat and click on “Open Enrollment”.Next, click on the “Open Enrollment Form Instructions” link and printthem out for assistance with completing the open enrollmentform properly.Once the instructions are in hand, go directly to the “Open EnrollmentForm Login” link. This will take you to a login page where under “Returning User” you will provide your address and your previously created unique password.You will be taken to the Postdoc Dashboard where you will be able to view your current enrollment and also complete your Open Enrollment Form with any desired benefit changes.Please check all plans in which you wish to be enrolled for Plan YearOnce complete, you will click “Submit and Create PrintableEnrollment Form” which will send your form to our secure database andalso allow you to print a copy of your enrollment form for your records.
37 The Open Enrollment Process (Continued) If you choose or switch to the Aetna Medical HMO, you must select aPrimary Care Physician (PCP) for all participating familymembers. Provider directory links are available on the GPAwebsite. Please enter the 6-digit PCP number for yourself and allenrolling family members.If you choose or switch to the California Dental DHMO, you mustselect a Primary Care Dentist for you and your enrolling familymembers. Please enter the 4-digit number for yourself and allAn will be sent no later than July 30th, 2014 confirmingyour new enrollment status.ID cards for any new coverage will be mailed to your home directly fromthe Insurance Carriers (Aetna Medical , California Dental, PrincipalDental and EyeMed Vision).
40 Family Member Eligibility Family member eligibility requirements are the same as the family member eligibility requirements for theUniversity of Southern California faculty/staff plans.The Major Family Member Categories Are:SpouseNatural or adopted children to age 26 regardless of studentstatus.Stepchildren may be included if they live with the Postdoc andare supported at more than 50% and claimed as a taxdependent.Same-sex domestic partner. The required Declaration ofDomestic Partnership form, found on the GPA website, must becompleted, notarized, signed and forwarded to Garnett-Powers& Associates.
41 Garnett-Powers & Associates, Inc. Information SourcesFor general inquiries and customer service regardingenrollment, benefit questions and ID cards, you shouldcontact:Garnett-Powers & Associates, Inc.Website:Toll Free Phone:Fax #:Address: