1. CITY OF TYLER 2016 HEALTH PLAN OPEN ENROLLMENT FOR EMPLOYEES/RETIREES
Welcome to the City of Tyler Benefits review presentation. The benefits presented in this presentation will become effective on January 1, As of November 2, 2015 all forms are available for distribution from your insurance representative. Let’s begin!

2. What’s New for 2016
What’s New for 2016?

3. Major Benefits Highlights
One plan offered
Buy up Plan (eliminated)
Core Plan
Beginning January 1, 2016 the City of Tyler will offer one Medical plan. The buy up plan will be eliminated and the core plan will have some modifications. If you are currently on the buy-up plan all charges incurred through December 31, 2015 will be processed under the buy-up plan provisions. Any charges incurred after that date will be processed under the new plan design. Every employee will be required to complete new enrollment documents.

4. Major Benefits Highlights Adjustment to Employee Contribution
$20.00 per month per tier increase or $10.00 Bi-Weekly (24 pay periods)
Other adjustments include a premium increase of $20.00 per month or $10.00 Bi-Weekly for 24 pay periods.

5. Rates Effective January 1, 2016
Core Plan
Rates Effective January 1, 2016
Employee
Retiree
Bi-Weekly Rates
Monthly Rates
Current
New
Employee Only
$5.15
$15.15
$10.30
$30.30
Employee/Spouse
$75.71
$85.71
$151.42
$171.42
Employee/Child(ren) (Cost for up to 3 children – Add $15.15 for each additional child bi-weekly or $30.30 monthly)
$62.21
$72.21
$124.42
$144.42
Employee/Family (Cost for up to 3 children – Add $15.15 for each additional child bi-weekly or $30.30 monthly)
$91.93
$101.93
$183.86
$203.86
Here are the new rates for the Core Plan, effective January 1, This graph shows the Bi-Weekly rates for employees as well as the Monthly rates for Retirees hired before January 1, Again this shows an increase of $10 bi-weekly which would be $20 per month. The premiums shown include the cost for up to 3 children. An additional premium of $15.15 bi-weekly or $30.30 per month will be added for each additional child.

6. Core Plan Non-Medicare Retirees Hired After January 1, 1997
Rates Effective January 1, 2016
Retiree
Monthly Rates
Current
New
Employee Only
$476.08
$496.08
Employee/Spouse
$756.25
$776.25
Employee/Child(ren)
(Cost for up to 3 children – Add $30.30 monthly for each additional child)
$668.12
$688.12
Employee/Family
$900.44
$920.44
These are the rates for Non-Medicare Retirees hired after January 1, The rate for Employee/Children and Employee Family coverage includes up to 3 children. An additional premium of $30.30 will be added for each additional child.

7. Major Benefits Highlight
No out of network coverage will be available without prior approval or in the event of an emergency.
You must use doctors and clinics that are In-Network. No out of network coverage will be available without prior approval or in the event of emergency.

8. Major Benefits Highlight
Office visit co-pay reduction in cost –
$40 co-pay to a $30 co-pay
An office visit co-pay is currently $40. Effective January 1, This cost will reduce to a $30 .

9. Accidental Injury and Emergency Care $200 copay then 100%
Emergency Room
Accidental Injury and Emergency Care
$200 copay then 100%
If you are admitted to the hospital the copay is waived.
Non Emergency Care in the Emergency Room
In Network
In Network/Other Counties
70% after you have met your deductible
Accidental Injury and Emergency Care emergency room visit copay is $200. If you go to the Emergency Room and are then admitted to the hospital the copay is waived. Non Emergency Care through the emergency room is a $200 copay then it pays 100% In Network. For In Network Other Counties the plan will pay 70% after you have met your deductible. Reminder: For minor emergencies you can use Tyler Urgent Care on Old Jacksonville Hwy, across the street from the Brookshires Museum. The co-pay at that location is the same as a doctor’s office co-pay which will be $30.

10. Major Benefits Highlight
Reduction in cost -
Individual Maximum Out-of-Pocket
$6, $5,500
Family Maximum Out-of-Pocket
$12,400 $11,000
There will be a Reduction in cost for out of pocket maximums. The individual maximum out of pocket expense is currently $6,200 but will reduce to $5,500 on January 1, The current Family out of pocket maximum is $12,400 but will reduce to $11, The out of pocket maximums now include prescription and office visit copays.

11. Core Plan Major Benefit Highlight Preventative Care Covered 100%
The Core Plan will cover a set of preventive services at no cost to you.
The preventive services include but are not limited to:
Routine Physicals
Well Women Exams
Well Baby Care
Immunizations
Health Screenings (i.e. Prostate Screenings etc.)
It is important to know that these services are free only when delivered by a doctor or other provider that is In-Network.
Preventative Care Covered 100% - The Core Plan will cover a set of preventive services at no cost to you. The preventive services include but are not limited to: Routine Physicals, Well Women Exams, Well Baby Care, Immunizations and Health Screenings. It is important to know that these services are free only when delivered by a doctor or other provider that is In-Network.

12. Schedule of Benefits Go = Go Yellow = Caution Red = Stop
Core Plan Schedule of Benefits. Just like a traffic light signal=, green means go, yellow, caution and red stop. The green column represents doctors and clinics that are in the Platinum acess direct network. In Smith county and most of the surrounding counties. We will refer to this as In-Network. The yellow column represents doctors and clinics that are in network but are located in other counties. We will refer to this section as Other Counties. Red means stop, don’t go there , you will have no coverage. Let’s review the schedule of benefits. Concentrating on the green and yellow zone as there is no coverage for out of network services which would represent the red zone. There is an unlimited maximum benefit. Coinsurance is 80% coverage in-network and 70% for other counties. There is no annual decuctible if your stay in the green zone. The annual deductible for other counties is $600 for an individual and $1,800 for family. The out of pocket maximum is $5,500 for an individual and $11,000 for family. For other counties after you have paid your deductible the out of pocket maximum is $6,200 for an individual and $12,400 for a family. You have a $30 copay for a physician’s office visit thhen 80% for other services if going to an in-network doctor. You pay 70% after your deductible for in network other counties in the yellow zone. Preventive care is covered at 100% if you use a Platinum access Direct doctor. A preventive care is not covered in other counties. Use DRL lab and 100% of your lab work is covered. If you use some other lab you have 80% coverage the green zone and 70% coverage in the yellow zone. An In-Network emergency room copay is $200 if you are then admitted to the hospital the copay is waived. If you are in other counties a ER visit is 70% after deductible. In patient and Out Patient Hospital and Physician Services are covered at 80% In Network and 70% after deductible is met in Other Counties. Prescription drug benefits – If you use one of our preferred pharmacies a generic drug is $8, Preferred brand is $45, Name brand $60 and Specialty is $70. All other retail pharmacies a Generic is $8, Preferred Brand is $60, Name Brand is $70 and a Specialty drug is $90. If you use the mail order prescription service you can get up to a 90 day supply for 2 copays.
Red = Stop

13. All other Retail Pharmacies
Retiree RX Plan 2016
BENEFITS
Prescription Plan
PLATINUM
IN-NETWORK
OTHER COUNTIES
OUT-OF-
NETWORK
Prescription Drug
Benefits
Preferred Pharmacies
All other Retail Pharmacies
Retail Copays
Specialty
$70 / 100%
$95 / 100%
N/A
Name Brand
$60 / 100%
Preferred Brand
$45 / 100%
Generic
$8 / 100%
Mail Order Copay
Up to 90 Day Supply Max
2 Copays
There will be no changes to the Retiree Prescription Drug plan in 2016
All cost and benefits will remain the same.

14. Paperwork
&
Deadlines
Paperwork & Deadlines

15. Forms You Will Need To Complete Your Insurance Rep Will Provide Forms
2016 Employees’ Open Enrollment
All Employees must complete new enrollment forms
Employee/Only
1) Open Enrollment Form (Page 1 – 2)
3. Employee/Children
Open Enrollment Form (Page 1 – 2)
Verification of Dependent Eligibility Form for each child covered (Required to Submit Birth Certificate For Each Child Added)
All Employees must complete new enrollment forms. If you have employee/only coverage you will need to complete the 2 page enrollment form. If you have Employee/Children coverage you will need to complete the 2 page enrollment form, a verification of dependent eligibility form for each child covered and a copy of a certified birth certificate.
Your Insurance Rep Will Provide Forms

16. Forms You Will Need To Complete Your Insurance Rep Will Provide Forms
2016 Employees’ Open Enrollment
4. Employee/Spouse
1) Open Enrollment Form (Page 1 – 2)
(Required to Submit Marriage Licenses)
If you are covering your spouse on your insurance you will need to complete an open enrollment form and submit a copy of your marriage license. The insurance representative in your department will provide the required forms. Please complete the forms, attach any required documentation and turn it to your insurance representative by Wednesday, December 9, 2015.
Your Insurance Rep Will Provide Forms

17. WAYS OF HELPING TO REDUCE OVERALL COST
1) Get your Preventive Care Check Up EVERY year.
2) Use DRL Labs only (City Pays 100% - You Pay 0%).
3) Use Preferred Pharmacies
4) Utilize TriaHealth
We are all concerned with the cost of health care. Here are some ways to help reduce overall cost. Be sure to find an In Network Primary Care physician and get your preventive care check ups each year. Notify your doctor that you want your lab work sent to a DRL lab. Make sure that the pharmacy you frequent is one of our preferred pharmacies. Contact TriaHealth for assistance with finding a lower cost option for your prescription drugs.

18. Access Direct Platinum Network
It is important for City of Tyler employees to use doctors and clinics that are in network so that cost can be contained. Not only does it save the plan money but your out of pocket expenses are significantly less.
Keeping cost down by using in-network doctors and clinics and preferred pharmacies can help us control the rise to employee premiums.
Doctors and Clinics that are In-Network have signed a contract stating they will give us deep discounts. That is why it is important to utilize In-Network physicians.
It is important for City of Tyler employees to use doctors and clinics that are in network so that cost can be contained. Not only does it save the plan money but your out of pocket expenses are significantly less.
Keeping cost down by using in-network doctors and clinics and preferred pharmacies can help us control the rise to employee premiums.
Doctors and Clinics that are In-Network have signed a contract stating they will give us deep discounts. That is why it is important to utilize In-Network physicians.
A current list of in-network providers is available on the City of Tyler P drive under 2015 benefits.
FOR CURRENT INFORMATION ON NETWORK PROVIDERS
Call Direct: Toll Free:
or visit our website at:

19. Paperwork Deadline
Deadline To Employee’s Insurance Representative or Retiree to Human Resources - Wednesday, December 9, 2015
You must have your open enrollment paperwork turned in to your department Insurance Representative no later than Wednesday, December 9, 2015.

20. Questions?