 Annual Enrollment  What’s Not Changing  What’s Changing & New  MetLife Hospital Indemnity Plan  MetLife Defender  Terms and Definitions  2015.

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Presentation transcript:

 Annual Enrollment  What’s Not Changing  What’s Changing & New  MetLife Hospital Indemnity Plan  MetLife Defender  Terms and Definitions  2015 Health Renewal  Humana Health Benefits  2015 Health Plan Payroll Deductions 2 AGENDA  Humana Vitality  Humana On-Line Resources  Humana Resources  Flexible Spending Accounts (FSA)  Reminders  Questions & Answers

Annual Enrollment  October 15 thru October 27, 2014 ** 2 WEEK WINDOW!! **  Coverage Begins: January 1, 2015  Deductions begin: 12/5/14 – Support 12/12/14 – Instructional/Administrative/PTS  2015 Flexible Spending Account and & MetLife Legal deductions begin: 1/2/15 - Support 1/9/15 -Instructional/Admin/PTS 3

What’s Not Changing ?  Humana Dental – No change in benefits or deductions.  Met Life Dental – No change in benefits or deductions.  Eye Med Vision - No change in benefits or deductions.  Prudential Life – No change in benefits or deductions. All new or increased levels of coverage subject to medical underwriting approval. Spouse coverage amount may not exceed employee’s coverage amounts (Board life and/or optional term life).  Corporate Care Works EAP Plan – No changes. (Employee Assistance Plan) 4

What’s Changing & New  Humana Health Plans – Changes to Out of Pocket Max and National Point of Service (NPOS) Deductible. Payroll deduction changes. New employee + child/ren Tier.  RX Benefits – Co-pay changes.  Assurant Disability Insurance – No change in benefits or deductions. All increases subject to medical underwriting. HIP Plan has been discontinued.  New MetLife Programs –  Hospital Indemnity Plan  Defender Identity Theft Plan 5

MetLife HOSPITAL INDEMNITY 6  Covered Benefits:  Hospital Admission - $500  Hospital Confinement - $250 per day, 30 day maximum  Inpatient Rehabilitation Unit - $100 per day, 15 day maximum – Accident only  Payroll Costs:  Employee Only - $8.00  Employee + Spouse - $13.00  Employee + Child(ren) - $17.00  Employee + Family - $21.00 Employees may use board credits if not enrolled in health plan. Preexisting conditions apply 12/12. (See certificate for full list of exclusions and limitations.)

MetLife Defender Benefits  ID Theft Monitoring  Personal Identity Monitoring and Security  Patented Peer-to-Peer Network Monitoring  Junk Mail Removal  Health Data Protection  Financial Data Protection  On-Line Child Safety Payroll Deduction  Employee Only - $9.00  Employee + Spouse - $15.00  Employee + Children - $12.00  Employee + Family - $18.00 Enrollment any time during the year through: Get Met 8 ( ) 7

Terms and Definitions  Deductible - the amount of covered services that the member must pay per year before Humana pays benefits for covered services.  Co-payment - the specified dollar amount that the member must pay for a covered service.  Co-insurance - the % amount of a covered service that the member must pay. Example: An 80%/20% coinsurance means that Humana will pay 80% of the allowable charge and the member will pay 20%.  Medical Out-of-pocket limit - the most a member would have to pay per calendar year before the Humana pays 100% of the in network cost. Excludes RX costs. 8

2015 Health Renewal  Proposed 2015 health renewal was 11.6%. Final renewal after negotiations and plan design changes was approximately 5%.  Projected 2015 premium -$117.8M; $5.5 premium increase.  Overall the District will pay approximately 80% and employees will pay 20% of total premium.  New Five Tier Enrollment structure – Employee, Employee + Child(Children); Employee + Spouse, Family and Two Board Family.  New Humana Vitality Program 9

Staff HMO Key Features & Changes  Staff Network with a limited number of physicians.  Referrals to Specialists limited by PCP Choice.  No Out-of-Network Benefit, except for emergencies.  Service areas Pinellas, Pasco, Hillsborough, Manatee, Polk, Sarasota, Hernando & Citrus.  Co-pays for all services; preventive services covered at 100 %  Hospital co-pay $500 per day, 5 day maximum.  Out of Pocket Maximum - $3,500 (employee) and $7,000 (family). 10 Please confirm participation with Humana’s toll free customer service or website –NOT Doctor’s Office !

NPOS Plan Key Features & Changes  Deductible: $300/individual $600/family  Hospital co-pay -$500 per day, 5 day maximum.  80/20% co-insurance for physician visits, outpatient services, lab and x-rays.  Out of Pocket Maximum - $3,500 (employee) and $7,000 (family). 11  Broad National Point of Service (NPOS) Network – open access.  No Specialist referrals.  In-Network and Out-of- Network benefits. ++ Good option For Out of Area Retirees & Studen ts.

CDHP – Key Features & Changes  HMO Premier Network which is a larger Tampa Bay area network than the Staff HMO Network.  Network includes: Pinellas, Pasco, Hillsborough and several other Florida counties as well as a limited number of states outside of Florida.  NO Out-of-Network benefits If you move to another plan for 2015, any remaining PCA funds will be forfeited as of December 31,  $ 1,500 (employee) and $3,000 (family) deductible with a $500 (employee) and $1,000 (family) allowance.  80%/20% In–Network Co- insurance once deductible has been met.  Out of Pocket Maximum - $3,500 (employee) and $7,000 (family) For Out of Area Retirees & Students, you may wish to consider the NPOS plan.

Pharmacy Benefits  No deductible on Tier 1 Drugs - $20 copay  Deductible ($250 Single/$500 Family) on Tier 2 & Tier 3 Drugs. After deductible: Tier 2 -$55 co-pay Tier 3 -$95 co-pay  Preferred Retail Pharmacy Network – Sam’s Club, Walmart, and CVS.  Non-Preferred Network – available with additional 30% coinsurance after applicable deductible and copay.  Three month supply for two co-pays still available (after applicable deductible) at retail locations.  Right Source Mail Order still available. RightSourceRx

Tier/PlanConsumer Directed Health Plan Staff HMONational Point of Service (NPOS) Employee$30$48$63 Employee + Spouse $120$158$182 Employee + Child/Children $115$151$175 Family$178$230$262 2 Board Family$85$137$ Health Plan Deductions

Humana Vitality  For Employees & Dependents enrolled in Humana Health Plan.  On Line Wellness Plan.  Complete Vitality Check & HRA.  Provides Personalized Plan.  Access to tools and resources to meet your goals.  Earn Points to Receive Prizes.  Reach “Silver Status”, receive payroll credit in  Improve your health and well-being. 15

What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana: 1.Visit 2.Have your Humana ID card handy 3.Go to Humana.com 4.Click “Register for MyHumana” 5.Follow the easy steps to register Hour Humana Online Resources

Humana PCS Resources  Heather Keegan, RN – Patient Advocate Assists employees with medical and provider issues. Coordinated Diabetes Care Program. Advocates for employees.  Jody Lowry, RN – Health & Wellness Specialist Facilities wellness and health education programs, enrolls members in disease management, clinical programs and Vitality.  Janet Lang - On Site Claims Representative Assists employees with eligibility, claims and coverage issues. 17

Flexible Spending Account (FSA)  FSA Plan Deductions are taken pre-tax over 20 pays.  You save Social Security and Income Tax – you increase your take home pay.  Reimbursed for Dependent Day Care (Dependent Care FSA)  Up to $5000 for two working parents  Pretax savings for day care expenses  Children up to age 13  Reimbursed for eligible Medical Expenses (Medical FSA) :  Medical, dental, vision co-pays, co-insurance & deductibles  Prescription drug costs  Contact Lenses & Prescription Eyeglasses  Lasik & other vision improvement surgery 18

Flexible Spending Account Flexible Spending Account  You decide how much to contribute:  Health Care FSA: $200 - $2500  Dependent Day Care FSA: $200 - $5000  Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31.  Receive a debit card – for Health Care Expenses. Not for Dependent Day Care.  Amount available for Health Care Expenses on Jan. 1, Use for deductibles, co-pays, co-insurance and other eligible expenses.  Look for Humana Access Visa cards last week in December – plain envelope.

Reminders  Changes through Web only October 15 thru 27th.  Confirmation notices available on line for employees to print.  Review health plan options and new enrollment tiers.  Review new MetLife offerings – Hospital Indemnity Plan and Defender Identity Theft Protection.  Make sure your life insurance beneficiaries are current.  Make sure you have enrolled only eligible dependents.  Humana will mail everyone new ID Cards. Please make sure your address on Employee Self Service is correct.  Enroll in MyHumana so that you can participate in the Humana Vitality Program. 20

Questions  Visit our web site for current information, including full Beneflex Guide, enrollment and benefit module videos, CDHP & FSA flyers at  Call the Humana Hot Line , 8:00 am – 8:00 pm, Monday thru Friday.  Call the PCS Benefits Help Line for enrollment assistance , 8:00 am – 4:30 pm, Monday thru Friday.  us at 21