1. OPEN ENROLLMENT 2012
OPEN ENROLLMENT 2014

2. Filice Insurance Agency Nina Gardner, Melanie ruiz
Nina Gardner, J.D. – Your Employee Benefits Consultant – strategic benefit planning
Melanie Ruiz – Your Account Manager – day-to-day administration – questions, plan design inquiries, claims and coverage issues, billing questions, etc.
CRLA’s Customized Website – Your Own Intranet

3. Employee Benefits app

4. ID Cards app

5. Open enrollment
Open Enrollment is a once-a-year opportunity to make election changes
Change plans
Add or drop coverage for yourself
Add or drop coverage for your dependents
Update life insurance beneficiaries

6. Mid-year qualifying events
What changes can I make outside of Open Enrollment?
If you do not make changes during open enrollment, the only time you can make an election or enrollment change is if you experience an eligible qualifying event.
Common examples of qualifying events include, but are not limited to the following:
Marriage or domestic partner union
Divorce or legal separation
Birth or adoption
Gain or loss of coverage

7. IMPORTANT THINGS TO KNOW
MEDICAL COVERAGE
Changes you make to your elections are effective 8/1/2014
Plan year 8/1/14 – 7/31/15
Deductibles and out of pocket maximums are calendar year for medical. Deductible and maximum are plan year for the dental plan. Vision is calendar year.

8. Employee benefits overview
Anthem Blue Cross
Classic PPO 250/20/10
Value HMO 20/40/250/3 day
Kaiser
HMO 10
Dental – Direct Dental
Vision – Anthem Blue Cross
Disability (LTD) – employer paid & buy-up – Mutual of Omaha
Employer-paid Life Insurance and Voluntary Life Insurance – Mutual of Omaha
Employee Assistance Program
Travel Assistance
FSA
Commuter Plan

9. Medical Kaiser – No Changes Anthem Blue Cross – No Changes
Kaiser: Must use Kaiser facility
Kaiser has a number of free resources!
24 hour nurse line
your doctor
Make or change appointments online
Managing health issues (such as quitting smoking or losing weight)
Anthem Blue Cross: More flexibility in choosing providers
Use Anthem network whenever possible
Identify local urgent care clinics for assistance after hours when not an emergency
24/7 Nurse Line
Future Moms Maternity Program
Condition Care: Asthma, diabetes, heart disease, coronary artery disease

10. Tips – Stretching your dollars
Use the mail order pharmacy
Ask for generic drugs
Compare prices at different pharmacies
Go to Urgent Care instead of the Emergency Room
Make sure your doctor, lab, hospital or pharmacy is in-network
Get your annual routine physical exam and recommended screenings
Inquire about the cost of services in advance
Anthem care comparison: quality and costs for medical procedures at hospitals and other medical facilities

11. Preventative Care vs. Diagnostic care
What is the Difference?
Preventive = Deductible does not apply
When you have no symptoms with no reason to think you aren't healthy and you get a service or test listed in the Preventive Health Care Guidelines, it's a "preventive service.”
Carriers pay 100% for preventive services.
Examples of Preventative Services:
Well Woman, Well Man, Well Child Annual Check Up
In association with the Affordable Care Act Schedule of Care
Immunizations, Blood Pressure, Cholesterol, Diet Counseling for Adults at Risk for Chronic Disease, Type 2 Diabetes Screening for adults with high blood pressure, Tobacco use & Cessation Intervention.
For a more detailed list please visit:

12. Preventive Care for Women
New Preventive care Guidelines for Women cover the following services (covered at 100% without cost sharing):
Well-women visits
Gestational diabetes screening
HPV DNA Testing for women 30 and older
Sexually Transmitted infection counseling; HIV screening and counseling
FDA approved contraception methods and counseling
Breastfeeding support, supplies, and counseling
Domestic Violence support, supplies, and counseling
For additional details

13. Summary of Benefits and Coverage (SBC)
Available on Filice Website
Paper copies available from HR upon request

14. Balanced meal

15. exercise
Walking is one of the easiest ways to get the exercise you need to stay healthy.
Experts recommend at least 2� hours of moderate activity (such as brisk walking, brisk cycling, or yard work) a week. It's fine to walk in blocks of 10 minutes or more throughout your day and week.

16. Wellness resources Anthem Online resources: Kaiser resources:
Weight Loss: Jenny Craig, Weight Watchers, Lindora
Fitness Clubs: Curves, Bally’s, Gold’s
Family & Home: Health- and wellness-related books and products, elder-care services, baby-proofing products
Vision, Hearing, Dental: Prescription glasses, sunglasses, laser vision, contact lenses, audio logical services and testing, dental-related products
Kaiser resources:
Weight Loss
Smoking Cessation
Health Risk Assessment
Classes and Programs

17. Kaiser and Wellness
Kaiser Permanente encourages our members to live healthy and thrive. Get active and take control of these healthy resources.
For more information, visit or call Member services at
English TTY for the hearing/speech impaired
Health classes at Kaiser Permanente facilities. (Many classes are free.)
Healthy lifestyle programs help you
lose weight
eat healthy
manage diabetes
reduce stress
quit smoking
live with ongoing conditions
reduce pain
manage depression
get a good night’s sleep
Discounts on additional health care services give you more options
acupuncture
massage therapy

18. Good health on the go
Mobile apps
Use your Smartphone or mobile device to fit wellness into your schedule.
Manage your care, find nearby facilities, and more
Stay fit with the free Every Body Walk! app— a fun, interactive tool to help you create and maintain a daily walking routine
Just download our free apps from the App StoreSM or Google Play*
*App Store is a service mark of Apple Inc.

19. Maximize your health
Wellness coaches
Experienced coaches are available by phone, at no cost to members.
Your coach will work one-on-one with you to help you set goals to improve your health
Get a personalized plan to help you lose weight, quit smoking, manage stress, eat right, and more
Coaching is available in English and Spanish and no referral is needed

20. Common Insurance Term: Deductible
Deductible: The amount the insured person has to pay before the insurance company starts to pay its portion of costs for a covered health service
Out of Pocket Maximum: The most you will pay in a year except for prescription drug copays. Prescription drug copays continue after the out of pocket maximum has been met.
Co-insurance: The portion of the charges that you pay after you have met the deductible.
Co-pays: Fixed amounts you pay for prescription drugs, office visit or x-rays.

21. Anthem classic PPO 250/20/20 Plan Features In-Network Out-of-Network
Deductible
Per Member
Per Family
Out of Pocket Max
$250 (combined)
$750 (combined)
$2,500 (includes ded.)
$5,000 (includes ded.)
$6,500 (includes ded.)
$13,000 (includes ded.)
Preventive Care
$0 (deductible waived)
30% after deductible
Office Visits
$20 (ded. waived)
Diagnostic Lab & X-ray
10% after deductible
Hospital Services
Emergency Services
$ % after ded.
Prescription Medication
No deductible
Generic
Brand Formulary
Brand Non-Formulary
Specialty
$10
$30
$50
30% to $150/fill ($3,500 max)
50% + copay

22. Anthem blue cross value HMO 20/40/250/3 day
Plan Features
In-Network Only
Deductible
Per Member
Per Family
Out of Pocket Max
Per Person $0
$3,000
$6,000
Preventive Care
Office Visits
$20/$40
Diagnostic Lab & X-ray
No charge
In-Patient Hospital Services
$250/day, up to 3 day max
Out-Patient Hospital Services
$125/admit
Emergency Services
$150
Prescription Medication
Generic
Brand Formulary
Brand Non-Formulary
Specialty
None
$15
$30
$50
30% to $150/fill ($3,500 annual max)

23. Kaiser – HMO 10 Plan Features In-Network Only Deductible Per Member
Per Family
Out of Pocket Max
None
$1,500
$3,000
Preventive Care
Routine exam, screenings $0
Office Visits
$10
Diagnostic Lab & X-ray
No Charge
Hospital Services
Outpatient Surgery
$10/procedure
Emergency Services
$50
Prescription Medication
Generic
Brand and Specialty
$10 (100 day supply)
$25 (100 day supply)

24. Medication Assistance Program
If you are taking a medication that is for a chronic illness or disease and cannot afford to pay your portion, there may be help.
The Partnership for Prescription Assistance Program is designed to help individuals, like YOU save money without affecting your prescription drug need.
Not all medications will qualify, but most drugs manufacturers provide low\free medicine for:
HIV- \
Diabetes- \
Asthma- \
Depression- \
Other conditions and medications may qualify.
Please contact Kryz Novotnaj at (925) at Filice Insurance if you need assistance with other conditions not listed above.

25. open access plan
Direct Dental PPO – You can see any dentist, but you pay less in the network.
$1,500 annual (plan year) maximum benefit
Child Ortho: $1,500 lifetime maximum benefit
$50/individual; $150/family annual (plan year) in-network deductible
4 cleanings and 2 exams per year
Maximum Rollover: $700 Threshold, $350 in-network maximum rollover, $1,250 maximum rollover account limit (must be on plan for an entire year)
Tip: Always get a pre-determination of benefits from your provider for services over $300.
Plan design co-insurance levels
In Out
Preventative 100% 100%
Basic 90% 80%
Major 60% 50%
Ortho 50% 50%

26. in network only Plan
Direct Dental – Only Access to In-Network Providers
$1,500 annual (plan year) maximum benefit
Child Ortho: $1,500 lifetime maximum benefit
$25/individual; $75/family annual (plan year) in-network deductible
2 cleanings and 2 exams per year
Tip: Always get a pre-determination of benefits from your provider for services over $300.
Plan design co-insurance levels In
Preventative 100%
Basic 90%
Major 60%
Ortho 50%

27. Anthem Vision PPO Plan Anthem Blue View Vision BV B1 Co-Pay: $15
Exams: Every 12 months
Lenses: Every 12 months
Frames: Every 24 months (up to $ % off remaining balance) OR
Contact Lens Care: Every 12 months (up to $130)

28. disability Long Term Disability – Mutual of Omaha
Benefit: 50% of salary – maximum benefit of $1,500/month
90 day elimination period
Own Occupation Period: 24 Months
Buy-up Option – Mutual of Omaha
Benefit: 60% of salary – maximum benefit of $7,500/month
Maximum Covered Payroll: $12,500 monthly
Buy-up Rate: $0.13 per $100 monthly covered payroll
Example: John Doe earns $2,500 per month
$2,500 X = $3.25 (monthly)
$2,500 X = $1.50 (bi weekly)

29. Life insurance $25,000 Employer-Paid Life Insurance $25,000 AD&D
Accelerated Death Benefit:
You can withdraw a percentage of your life benefit if terminally ill.
75% of the amount of the life insurance benefit is available if terminally ill, not to exceed $18,750
Conversion: In case of termination of employment, you can convert to an individual life policy within 31 days of termination.

30. Voluntary Life
Employee: $10,000 increments up to 5 times annual salary to a maximum of $300,000
Spouse: $5,000 increments up to 100% of employee elected amount to a maximum of $150,000
Dependent: $10,000 child: 14 days to 21 (to age 25 if full-time student)
Guarantee Issue Amount for new hires only: $150,000 (employee)/ $30,000 (spouse)/ $10,000 (child)
AD&D: Optional. Benefit equal to life amount.
Accelerated Death Benefit: 75% to a max of $225,000

31. Employee assistance Program
24/7 online resources and confidential telephonic consultation with licensed EAP consultants who provide assistance and guidance on:
Family, relationship and parenting issues
Emotional and stress-related issues
Conflicts at home or work
Alcohol and drug dependencies
Financial issues
Depression
Parenting
On-line resources and tools
Up to 3 in-person counseling sessions every 6 months with a licensed mental health professional.

32. Worldwide emergency Travel assistance
The need for emergency travel assistance is growing.
Whether your travel is for business or personal reasons, our worldwide emergency travel assistance program goes with you when you travel to a foreign country or just 100 miles or more from home.
If you, your spouse or your dependent children need immediate assistance anywhere in the world.

33. Flexible Spending Accounts
Benefit Resource, Inc.
FSAs help you pay eligible health care and dependent care expenses on a pre-tax basis
Tax advantage: When you save pre-tax dollars in your FSA, you’ll also lower your overall taxable income.
There are three components of the FSA that you can take advantage of:
Health care FSA - employees can elect pre-tax deductions of up to $2,000 annually to use towards eligible medical, Rx, dental and vision expenses
Dependent care FSA – employees can elect pre-tax deductions of up to $5,000 annually to use towards eligible child (12 and under) and adult day care expenses. $2,500 if married and filing separately.
Pre-tax Premiums
Use-it-or-lose-it forfeiture rule: unused dollars are not returned to you!
Submit your receipts by November 15 for expenses incurred during the benefit year. 33

34. Tax savings example
Medical FSA

35. How To Use Beniversal® for Medical Expenses
Use at qualified merchants (pharmacy, doctor, dentist, vision, etc.)
If prompted at the point of sale, choose credit not debit
Always retain your receipts

36. Substantiation Process
If we cannot match the charge to your plan summary, we may require substantiation.
If so, you will receive an from BRI asking for a receipt or an Explanation of Benefits (EOB)
You can send it to us by Fax, uploading it online, or from your smart phone with the BRI app

37. Cash Reimbursement Claims
Submit reimbursement claims for all Dependent Care expenses and those Medical expenses for which you could not use your Beniversal® card
Reimbursement is available in two ways:
A check mailed to your home address
Direct deposit into your checking/savings account (you can set up direct deposit via your online account or by mailing or faxing the direct deposit authorization form)

38. BRI Mobile app

39. Website login

40. Enter your Company Code = CRLA Member ID = Social Security Number
Password = Home Zip Code
(unless previously changed)

41. Your Home Page
Your home page allows you to resolve receipt requests, view a table of eligible expenses, review your account balance and transaction detail, submit claims, set up direct deposit and obtain any forms you may need.

42. Important Dates
Make your election by July 12 for the 2014/2015 plan year.
Payroll deductions will occur in equal amounts from each biweekly paycheck beginning in August 2014
You should receive your Beniversal® cards by the middle of August unless you already have a card. Any charges eligible 8/1 should be submitted via claim form until you get your card.
Eligible services must have been provided during the plan year or during the 2 ½ month grace period following the end of the plan year. The grace period ends October 15, You have until November 15, 2015 to submit claims.
Expenses have to be incurred inside the plan year and before the end of the grace period. Continue to use your card for expenses incurred during the 2014/2015 plan year until the new plan year starts and your grace period ends.

43. Receiving Beniversal® Cards
Cards are mailed
to employees’
homes after
enrollment
Beniversal® Cards are activated
via a toll-free phone call

44. Customer Service Go online: www.benefitresource.com
Call BRI Participant Services:
(5 am – 5pm PST)

45. Commuter Benefit
Commuter Benefits is a federal transportation benefit program that allows employees to save on their transit costs by deducting their commute expenses pre-tax from their paycheck each months.
You can deduct $130 per month from your paycheck on a pre-tax basis for transit, and an additional $245 per month for parking at your transit or carpool pick-up location.
This plan is managed by CRLA. 45

46. Enrollment instructions
OE period to make enrollments, changes, or terminations to your benefits, will be from 6/27/14 to 7/13/14.  Changes can only be made during this time period.
To enroll, you will no longer be using paper enrollment forms, you will be using the new Paycom Benefits Administration system.  Although we are no longer using enrollment forms, all employees are required to complete the Rate Sheet, located on the benefits website.  Please fill out the correct Rate Sheet.  There is one for those who make 40k or more annually and one for those who make under 40k annually.  Also, if you are electing voluntary or buy-up coverage greater than the guarantee issue amount, you will need to fill out an Evidence of Insurability form, also located on the benefits website.  These two forms must be submitted to HR no later than 7/13/14.
You will be making your OE elections through Paycom Benefits Administration in Paycom Employee Self Service.  Please be sure to attend your Paycom Benefits Administration Training today at 1:00 PM, or view the recording, before using Benefits Administration.  The recording will be on the benefits website, along with the OE webinar recording, by Monday morning.  Even though you may not want to make changes to your benefits for the 2014 to 2015 plan year, you will still need to confirm your benefit elections, enter your dependent information, and confirm your contact information on Benefits Administration. 
If you have any benefits questions, please contact Melanie Beranek.  For any Paycom Benefits Administration questions after the training, please contact your HR Department.” 46

47. Questions? ?