State Employee Health Plan

State Employee Health Plan
Open Enrollment 2015 Welcome to Open Enrollment for the State Employee Health Plan. We are glad you could attend this presentation to learn about your health plan offerings for Plan Year (PY) 2015.

Changes for PY 2015 Plan B will no longer be offered
Members will need to select Plan A or C for 2015 Coventry was purchased by Aetna We will be offering Aetna for 2015 UnitedHealthcare will no longer be offered Members will need to select Aetna or BCBS Salary tiers for employee premiums were eliminated Open Enrollment will be on a new website: Regent employees – Check with HR for instructions There are also some changes for Plan Year (PY) 2015. You will have the option of Plans A or C next year. Plan B is being discontinued due to declining enrollment. Coventry was purchased by Aetna so the plans will now be available from Aetna. UnitedHealthcare will not be offered next year so you will have the option of selecting Plan A or C with Aetna or BCBS of Kansas. The plan member contribution will no longer be by salary tier. Everyone will pay the same rates. Open enrollment this year will not be done in Employee Self Service but rather done in the Membership Portal known as MAP. The address is on the screen. Regent employees single sign on may be available to you. You should follow the instructions provided by your HR office to access the system.

Changes for PY 2015 Plan A Combined Medical & Pharmacy Out Of Pocket (OOP) Maximum Single: $4,750/ Family: $9,500 2014 2015 Medical Deductible $300/$600 Coinsurance 20% OOP Max $2,000/$4,000 Medical Deductible $300/$600 Coinsurance 20% Pharmacy Coinsurance 20%/35%/60% This year the Plan A medical and pharmacy programs have separate out of pocket maximums. For an individual it is $2,000 medical and $2,750 pharmacy. For Plan Year 2015, there will be a combined into one out of pocket maximum for network medical and pharmacy claims of $4,750 for an individual and $9,500 for a family. Pharmacy Coinsurance 20%/35%/60% OOP Max $2,750/$5,500 Combined OOP Max Medical & Pharmacy $4,750/$9,500

Changes for 2015 I.R.S requirements for HDHP deductibles increased
Plan C’s new deductible and OOP Max is: $2,600 single/$5,200 family 2014 Network 2015 Network Deductible $2,500/$5,000 Coinsurance 0% Out of Pocket Max Deductible $2,600/$5,200 Coinsurance 0% Out of Pocket Max The I.R.S. has increased the minimum High Deductible Health Plan deductible so the Plan C deductible must be increased to $2,600 and $5,200 to remain in compliance.

Changes for 2015 Plan C members that are ineligible for a Health Savings Account (HSA) may now elect a Health Reimbursement Account (HRA) Members who could elect the HRA include: Members eligible for Medicare Members who have VA or military benefits Anyone else not eligible for an HSA State contributes the same amounts as for the HSA Plan C members currently have a Health Savings Account but there are rules on who can have an HSA. For those members that don’t qualify for an HSA, next year they can have a Health Reimbursement Account instead. The State will contribute the same amount of funds into an HRA for these members. The account works a little different than an HSA so lets take a closer look at the HRA……….

Health Reimbursement Accounts (HRAs) - Vs
Health Reimbursement Accounts (HRAs) - Vs. - Health Savings Accounts (HSAs) HRA HSA Member Eligibility Requirements: Self-employed persons are not eligible for an HRA Must meet IRS eligibility guidelines Who Contributes: Employer Only Employee & Employer Who Owns the Money: Employer Employee Carryover Funds: No Yes Coverage Period: Plan Year Doesn’t apply Expense Documentation: Substantiation is required by a third party subject to IRS substantiation requirements Employee responsible for maintaining documentation Portable: With an HRA, the eligibility is much more open and only the self employed are excluded from having an HRA. HRA is an account that only the employer deposits funds into for the employee. The account works similar to an Flexible Spending Account in that: The money does not roll over from year to year. Unspent funds are forfeited at the end of the year. You will have to submit a claim for reimbursement to US Bank along with documentation to access the funds. The funds are not portable.

Changes for PY 2015 The Autism benefit had to be modified to comply with HB 2744 Annual dollar limits removed Applied Behavior Analysis (ABA) services for children are the only services with an annual limit: Under age 7 will be limited to 1,300 hours per calendar year Children between age 7 but less than 19 years of age, Applied Behavior Analysis (ABA) services will be limited to 520 hours per calendar year HB 2744 was passed by the 2014 legislature and as a result there are some changes to the Autism rider. The annual dollar limits have been removed. Only Applied Behavior Analysis services are limited to a set number of hours based upon the age of the child.

Changes for 2015 The Health Care FSA plan for Plan Year (PY) 2015 will have a carry over provision instead of a grace period New rules allow up to a maximum of $500 in unused funds to be rolled over to the following plan year Rollover funds can be used to pay for health care any time during the entire year Employees can contribute up to $2,500 into an HCFSA during that same plan year Members enrolled this year (2014) in an HCFSA or Limited still have a grace period for unspent funds Beginning in 2015, members with Health Care Flexible Spending Accounts (HCFSAs) can roll over up to $500 of their election into the next plan year. This will replace the current grace period option that limits the time in which you can spend your HCFSA funds. Grace period funds can be spent at any time during the year. If you roll over $500 into 2016, you will still be able to set aside the maximum in 2016 of $2,500 for an HCFSA. For members enrolled in an HCFSA this year (2014) you will still have a grace period like we have had in prior years. That means: You have to have your funds spent by March 15, 2015 and claimed by April 30, 2015. If you are planning to move to Plan C for 2015, you will need to have your HCFSA account dollars spent by 12/31/14 or you will not be eligible for the full January employer contribution into your Health Savings Account (HSA).

Changes for PY 2015 Coverage of wheelchairs has been enhanced to allow for medically necessary motorized wheelchairs Coverage for prosthetics has been modified to allow for medically necessary prosthetics with electronic components or processors The limited coverage for eyeglasses for children with certain eye disorders has been modified to remove the dollar cap Compounded medication costing over $300 will require prior authorization from Caremark Coverage has been enhanced to include medically necessary motorized wheelchairs. Prior authorization is recommended. Coverage for prosthetics has been enhanced to allow for electronic components or processors when medically necessary. Again prior authorization by the health plan is recommended. The dollar limit on eyeglasses for children with apakia, pseudophakia or corneal transplants has been removed. This coverage is limited to only children with these specific eye conditions and should not be confused with the Superior Vision Plan coverage. As a result of recent changes in the market, medications that are being compounded by pharmacies for members that are over $300 must be prior authorized by Caremark.

Performance Drug List The Performance Drug List has been updated to reflect recent generic drug launches Applies to both Plans A & C Three drug classes on the Performance Drug List: ACE/ARBs – Blood pressure lowering HMGs – Cholesterol lowering PPIs – Stomach acid reducers Must try a Generic before using a Non Preferred Brand Name Drug Generic and Preferred Brands not affected The Performance Drug List that has been in place for several years now has been updated to reflect changes in the pharmacy market. The change is in how Non Preferred brand name drugs in three specific classes of prescription drugs are processed. Those three (3) classes of prescription drugs include: cholesterol lowering medications (HMGs), proton pump inhibitors (PPIs, which reduce the production of acid in the stomach), and high blood pressure medications (ACE/ARBs). These three classes of drugs include a large selection of lower costing generic drug options. Before you can purchase a Non Preferred product in these classes, you have to have tried a generic in the class. The system will automatically check your history. There are a large number of generics available in these classes. You will continue to have access to preferred brand name medications and generics.

Performance Drug List Preferred HMGs Generic Preferred Brands
Cholesterol Lowering Agents Performance Drug List HMG-CoA Reductase Inhibitors (HMGs or Statins)/Combinations Preferred HMGs Generic amlodipine-atorvastatin atorvastatin (generic Lipitor) fluvastatin lovastatin pravastatin simvastatin Preferred Brands Crestor Simcor Vytorin Non Preferred HMGs Advicor Altoprev Liptruzet Livalo HMGs are the cholesterol lowering products. The performance drug list will only affect You if You try to purchase a non preferred brand name drug listed on the right. Before you can fill a prescription for one of the Non Preferred products on the right side of the screen, the member would have to have tried one of the generic products in the left side column. The Caremark claims system will review your claims history to see if you have previously purchased a generic in the drug class first. If this is no record of a generic in your history during the preceding 24 months, the pharmacy will receive a message that the claim cannot be processed since the member has not tried the generic first. If your history shows that you have tried a generic previously, the claim will process without delay. You still be responsible for paying the non preferred drug coinsurance of 60%.

Blood Pressure Lowering ACE/ARBs
Performance Drug List ACE = Angiotensin Converting Enzyme Inhibitors ARB = Angiotensin II Receptor Antagonists and Direct Renin Inhibitors & Combinations Preferred Generic amlodipine-benzazepril benazepril & benazepril HCT candesartan/candesartan HCTZ captopril & captopril HCTZ enalapril & enalapril HCTZ eprosartan fosinopril & fosinopril HCTZ irbesartan/irbesartan HCTZ lisinopril & lisinopril HCTZ losartan/losartan HCTZ moexipril & moexipril HCTZ quinapril & quinapril HCTZ ramipril telmisartan HCTZ trandolapril trandolapril-verapamil ext HCTZ valsartan &valsartan HCTZ Preferred Brands Benicar & Benicar HCT Micardis & Micardis HCT Non Preferred ARBs This slide is a little busy because there are so many generic options in the ACE/ARB categories to treat high blood pressure. The definitions for ACE and ARB are listed as well for you. You can see that there are many generic options as well as two preferred products to choose from. If you and your provider elect the three on the lower right side of the screen, you will have to have tried one of the generics first. Remember generics have the lowest member coinsurance of 20% and preferred brands are 35%. The non preferred products cost you the most out of your pocket with a 60% coinsurance. Edarbi Edarbyclor Teveten HCT

Proton Pump Inhibitors (PPIs)
Stomach Acid Reducers Performance Drug List Proton Pump Inhibitors (PPIs) Preferred PPIs Generic esomeprazole lansoprazole omeprazole omeprazole – sodium bicarb pantoprazole rabeprazole Preferred Brand Dexilant Non Preferred PPIs Prilosec Packets Protonix Packets Zegerid powder for oral susp For PPIs which are long lasting stomach acid reducers, the Non Preferred brand name drugs are highlighted on the right. The preferred and generic are on the left side of the screen. There are also a number of quality over the counter products available that may be less expensive then the prescription products and provide the same results. Talk to your doctor about what will work for you.

Upcoming Generic Releases
Abilify ODT Oxytrol Abilify Tabs Patanol Aggrenox Protopic Aloxi Relenza Axert Teveten HCT Baraclude Welchol Susp Doribax Welchol Tabs Gleevec Zyvox Injection Namenda Zyvox Susp Ortho Tri-Cyclen Lo Zyvox Tabs These are just a few of the drugs scheduled to go generic next year. We encourage members to switch to generic as soon as they are released. Generic drugs save you and the plan money. A full list is posted on the SEHP web site for those interested.

Selecting Your Health Plan
Pick a plan design (A or C) Which plan design provides the coverage you and your family need? What is the total plan cost? Premiums + Deductible & OOP = ? Review the Provider Networks Each of the medical vendors uses a different provider network Open Enrollment is your opportunity to decide how you want to finance your healthcare for the upcoming year. We encourage you to review the plan design options. Look at the coverage and the out of pocket cost of each plan design and select an option, A or C. Each of our health plan vendors offers their own unique provider networks. Being a network provider means that the health care professional has agreed to accept the vendor’s allowed charge as payment in full. The provider agrees to write off any difference between what they charge and what the health plan allows. You are free to use any provider that you wish; however, if you use a provider that is not part of your health plan’s networks, it will cost you more out of your pocket. Non network providers do not have to accept the health plan’s allowed charge and can bill you for the difference. Make sure you review the networks before deciding on a medical vendor.

Plan A Medical Coverage
Network Non Network Medical Deductible $300/$600 Coinsurance 20% Medical Deductible $500/$1,500 Coinsurance 50% OOP Max Medical $4,750/$9,500 Pharmacy Coinsurance 20%/35%/60% Lets take a closer look at the Plans offered. Lets begin with Plan A. Plan A has a $300 per person and $600 per family network deductible. A higher deductible applies to Non Network services. After the Deductible, Coinsurance applies to most services and network office visits are subject to Copays. The maximum amount of out of pocket expenses for Network medical and pharmacy services in a year are $4,750 for an individual and $9,500 for a family. You will incur additional out of pocket expense if you also use both Network and Non Network providers, as the Non Network benefit accumulates separately from the Network benefits. Combined OOP Max Medical & Pharmacy $4,750/$9,500

Plan A Prescription Drug Plan
Drugs Coverage Level Generic 20% Coinsurance Preferred Brand Name Drugs 35% Coinsurance Special Case Medications 25% Coinsurance to a Max of $75 per 30 day supply Non Preferred Brand Name Drugs 60% Coinsurance Discount Tier You pay 100% of discount cost. Do not count toward your OOP There are no changes to the coverage tiers under the Plan A pharmacy program. On Plan A, your prescription drugs are subject to Coinsurance. Generic drugs are your best buy and have the lowest OOP cost. Members should review the preferred drug list options with their providers to find the most cost effective options. You may also want to use the new transparency tools from Castlight and Rx Savings to help you reduce your pharmacy spend.

Plan C Medical Coverage
2015 Network 2015 Non Network Deductible $2,600/$5,200 Coinsurance 0% Combined Medical and Pharmacy OOP Deductible $2,600/$5,200 Coinsurance 20% Out of Pocket Max $4,100/$8,200 The Plan C Deductible was increased this year due to a change in the IRS requirements for High Deductible Health Plans with Health Savings Accounts. The Plan C deductible is now $2,600 for one person and a maximum of $5,200 for the family. Once you meet your network deductible, additional covered medical or pharmacy services are covered in full for the remainder of the calendar year. Benefits for Network and Non Network providers are subject to separate deductibles and out of pocket requirements.

Plan C Prescription Drug Plan
4/15/2017 Plan C Prescription Drug Plan Covered drugs are subject to the Network Plan C Deductible After the Deductible, the plan pays covered prescription drugs at 100% of allowed charge Uses same Preferred Drug List as Plans A Plan C is a creditable drug plan Discount Tier drugs are Not Covered drugs Only eligible for Caremark’s negotiated discount Do not count toward OOP Max On Plan C, prescription drugs are subject to the overall plan deductible and then paid at 100% once the deductible has been satisfied. The Preferred Drug List is the same as the one used for Plans A. It is available on Caremark.com. Discount Tier drugs are not considered covered drugs and are only eligible for the discount. These will always be paid for 100% by the member – even after the deductible is satisfied. Plan C is creditable coverage and should not pose an issue for those getting close to Medicare eligibility.

Plan Comparison Example:
After work on January 15th, Jill fell injuring her wrist Jill went to an urgent care center. They x-rayed it, gave her prescription & a splint She was advised it was broken & to follow up with an orthopedic doctor the next day The orthopedic doctor sent her for a MRI & then placed the wrist in a cast for 6 weeks When the cast came off, she went to occupational therapy Jill starts receiving bills for services in February with the last of the therapy charges billed in April The following is a real life example of your health plan benefits in action. Jill has an accident early in the year and has claims that will be submitted for several months. Jill falls on January 15th and immediately knows that her wrist injury is going to require medical attention. She heads to the local urgent care and has her wrist examined, x-rayed and splinted. It’s broken. She is told to follow up with an Orthopedic doctor the next day. The orthopedic doctor reviews the x-rays and orders an MRI because of concerns about the break. Cast is put on the arm for 6 weeks and then OT to regain range of motion.

Jill’s Claims on Plan A Service Actual Charge Allowed Charge
Deductible Copay or Coins Plan Paid Member Owes Urgent care Facility $279.50 $50.00 $229.50 Urgent Care Doctor $108.25 $90.04 Specialist Office visits (4) $276.50 $258.13 $180.00 $78.13 MRI $1,375.93 $556.74 $209.96 $69.36 $277.42 $279.32 Xrays (4) $370.00 $200.61 $40.12 $160.49 Pharmacy (1) $14.38 $2.88 $11.50 Therapy visits (6) $2,595.77 $ $499.96 $919.84 Total $5,020.33 $2,819.20 $300.00 $842.32 $ $ Jill is a Plan A member and only used network providers. She must meet the $300 deductible and then her services are paid at 80% and she owes 20% plus any office visit copays. So, when she completes her care in April, she will owe the providers $1, and the plan will have paid $1, to the providers.

Jill’s Claim on Plan A Jill has now met her $300 Deductible & $ in Coinsurance & Copays A total of $1, is credited toward her Network Out Of Pocket (OOP) max of $4,750 If she needs additional services or prescriptions this year, she will have additional Coinsurance and Copays to pay Jill will need to pay the providers $1,142.32 If she has a health care flexible spending account, she could use those dollars to pay the bills Otherwise she will need to come up with this whole amount out of her pocket So Jill will have met $1, of her annual OOP max. If she needs additional medical care or prescription drugs, she will have additional out of pocket expenses to pay. As a Plan A member unless Jill has signed up for a Health Care Flexible Savings Account (HCFSA) to use pre-tax money for health services, she will have to come up with the full amount out of her pocket. Using an HCFSA would at least allow her to use pre-tax funds for part of her care.

Jill’s Claims on Plan C Service Actual Charge Allowed Charge
Deductible Plan Paid Member Owes Urgent care Facility $279.50 Urgent Care Doctor $108.25 $90.04 Specialist Office visits (4) $276.50 $258.13 Cat Scan $1,375.93 $556.74 Xrays (4) $370.00 $200.61 Pharmacy (1) $14.38 Therapy visits (6) $2,595.77 $1,419.80 $1,200.60 $219.20 Total $5,020.33 $2,819.20 $2,600.00 If Jill is enrolled in Plan, the member deductible applies first. After all the claims are processed she will have the $2,600 deductible for network medical or pharmacy services and the plan will have begun to pay for her medical pharmacy claims in full. But there is more to the story than just the member out of pocket….

Jill’s Claim on Plan C Jill has an HSA that the SEHP deposited $750 into in January that she can use to pay the providers Using pre-tax dollars she contributes $30 per pay period If she started the year with $0, her HSA would have: by May 1, $1,065 available by July 1, $1,955 available If she hadn’t spent any, by Dec $2,340 Jill has no more out of pocket for the rest of the year Covered network medical and pharmacy services will be paid at 100% for the rest of the plan year Jill has a Health Savings Account and her employer, the State, has already deposited $750 into her account in January. She will get another $750 in July that she can use to pay her claims. In addition, she is setting aside $30 pre-tax from each of her paychecks. That reduces her taxable income and saves her money and also provides her with additional funds to use to pay her claims. By May, she would have over $1,000 to use to pay the providers. By July, $1,955 would have been set aside to help her pay her medical expenses. Now if Jill hadn't had this claim and used none of her money, she would start off next year with over $2,300 already in the account to use for any future health care services she might need. One other point, Jill has now met the OOP max for Plan C and any other covered network services would be paid in full by the plan for the remainder of the calendar year.

Plan C Health Saving Account
An employee-owned bank account for saving money to use to pay for your current or future medical expenses Account administered by US Bank Unspent HSA funds roll over and accumulate year to year and can be invested Portable - The account and the money belong to you HSA funds can be used to pay expenses of your tax qualified dependents Plan C includes a Health Savings Account (HSA). As Jill found out this is a great way to set aside funds to pay for health care services. The HSA is an employee-owned bank account. Unlike a Flexible Spending Account, an HSA is a permanent account where funds roll over from year to year if not spent. You can only contribute to an HSA while you are enrolled in a qualified high deductible health plan. Members can invest their HSA funds in a variety of investment options. The account and the funds in it belong to the employee and go with you if you leave State service or if you switch to another health plan at a future open enrollment. This is your account and your funds. As long as the money is spent on healthcare for you or your qualified dependents, the money is not taxable to you. You can set aside funds using pre-tax payroll deduction for additional tax savings.

HSA Eligibility Requirements
The following Employees are eligible to have an HSA: You must be covered by Plan C a High Deductible Health Plan (HDHP) You have no other health coverage that isn’t an HDHP except what is permitted under “Other Coverage” defined by the IRS You are not enrolled in Medicare or TRICARE You cannot be claimed as a dependent on someone else’s tax return IRS guidelines identify employees that are eligible to have and make contributions into an HSA account. The rules for spouses and dependents are different. Additional information is available on the SEHP website, the US Bank website and on the Treasury Department website.

State HSA Funding Single Family Employer (ER) Contribution * $1,500/$2,250 $750 & $750 $1,125 & $1,125 State’s HSA contribution will be made in two payments: Second pay period in January & First pay period in July 2014 Plans A & B members, if moving to Plan C in 2015: Your Health Care FSA must have a $0 balance by 12/31/14 If HCFSA funds remain on 1/1/15, the Employer HSA contribution is reduced & will not be made in April 2015 The State will make two (2) equal contributions into the employee’s HSA: The first half of the employer payment will be deposited into your account the second pay period in January. The second half of the employer payment will be deposited into your account the first pay period in July. If you are currently in enrolled in Plans A or B and have a Health Care Flexible Spending account, you must have spent all your money by 12/31/14 in order to received the full employer contribution into your HSA in January If HCFSA funds remain during the FSA grace period, the HSA will be funded after the grace period ends on March 15, 2015, and the employer contribution will be reduced. * Contributions amounts shown are for full time employees

Plan C HSA Contributions
HSA Account Single Family Total Annual HSA Maximum Contribution $3,350 $6,650 ER Maximum HSA Contribution $750 & $750 $1,125 & $1,125 EE Minimum $25 Contribution Annually $600 Available Employee (EE) Contributions* $25 to $77.08 $25 to $183.32 Additional over age 55 “Catch up” amount $1,000 The total annual maximum amount is the total amount that you and your employer can set aside each year into an HSA. The State is going to put a total of $1,500 into your Health Savings Account for single coverage over the course of the year ($2,250 if you choose family coverage). You will be asked to set aside a minimum of $25 per pay period by payroll deduction. Over the course of the year your contribution will result in $600 being added to your account. You can elect to contribute more to your HSA, but the total contribution to the HSA by the State and by you cannot exceed the maximum allowed by the IRS of $3,350 for a single plan and $6,650 for a family plan. Members over age 55 may use the “Catch Up” provision to set aside an additional $1,000 per year into their HSA. You will be able to elect this in the Open Enrollment Portal. Based on full time employees with 24 pay period deductions.

Health Reimbursement Account (HRA)
Available for Plan C members not eligible for an HSA The HRA is 100% employer funded No employee contributions are allowed HRA members may have a Health Care FSA HRAs are not portable Unused funds do not roll from year to year Cannot be converted to cash Cannot be assigned to a beneficiary New for 2015 for employees who are not eligible for an HSA, we will be offering a Health Reimbursement Account. HRAs are 100% employer funded - No employee contributions are allowed Employees with an HRA may have a Health Care FSA HRAs are not portable: Unused funds do not roll from year to year Cannot be converted to cash Unused funds cannot be assigned to a beneficiary

State HRA Funding Single Family Employer (ER) Contribution* $1,500/$2,250 $750 & $750 $1,125 & $1,125 State’s HRA contribution will be made in two payments: Second pay period in January First pay period in July State will pay HRA funding in two (2) equal contributions: The first half of the employer payment will be deposited into your account the second pay period in January. The second half of the employer payment will be deposited into your account the first pay period in July. HRAs may be used in conjunction with a healthcare flexible spending account so you can have funds in the grace period. * Contributions amounts shown are for full time employees

Quest Diagnostics Preferred Lab Benefit
Plan A - 100% coverage of eligible outpatient lab tests Plan C – Discount on eligible outpatient lab services Statewide & nationwide preferred lab vendor Your doctor can draw the sample and send to Quest You can visit Quest’s website for collection sites Services must be performed and billed by Quest Online appointment scheduling available All Plan A & C members can use Quest Use Your Quest ID card or medical ID card Quest Diagnostics is the statewide preferred lab vendor for Plans A and C. For Plan A, when you have covered outpatient lab work performed and billed by Quest, the plan pays 100 percent of the cost of the services. The plan can pay the additional amounts due to the negotiated discounts with Quest. Plan C members receive discounts on services until the Plan C deductible is satisfied and then covered services are paid at 100 percent. Any provider may use the Quest lab service by calling Quest to pick up the sample. You and your provider will decide whether or not to do so. Visit Quest’s website for a complete list of Quest collection sites.

Stormont-Vail Preferred Lab Benefit
Regional Preferred Lab vendor in NE Kansas Plan A - 100% coverage for eligible outpatient lab services Plan C – Discounts on eligible outpatient lab services All Plan A &C members may use the Stormont-Vail draw site locations Labs drawn at other Cotton-O’Neil locations may be included if by network providers Show your medical ID Card to access benefit Stormont-Vail HealthCare is a regional preferred lab vendor for Plans A and C. On Plan A, when you have covered outpatient lab work performed and billed by Stormont-Vail, the plan pays 100 percent of the cost of the services. The plan can pay the additional amounts due to the negotiated discounts. Plan C members receive discounts on services until the Plan C deductible is satisfied and then covered services are paid at 100 percent.

Allowed amount covered in
4/15/2017 Dental Coverage Plan pays in full for 2 exams & cleanings Annual benefit maximum: $1,700 per person per year Benefit Level PPO Premier Non Network Preventive Services Covered in full Covered in full Allowed amount covered in full Basic Benefit Basic Restorative 50% Enhanced Benefit 20% 40% The annual dental benefit of $1,700 is unchanged. The plan continues to cover two preventive cleanings per person per year. Members that have had a cleaning or exam in the prior 12 months and need basic restorative care will be at the Enhanced benefit level. Members who haven’t had a cleaning or exam will be at the Basic benefit level. Orthodontic coverage is available and is limited to $1,000 per person per lifetime. The annual maximum benefit paid per person per year is unchanged at $1,700.

Vision Benefits Basic Vision Enhanced Vision Materials Copay
Office Visit Copay $25 $50 Frame Allowance $100 Lenses: single vision, standard bifocal, trifocal or lenticular 100% Contact lenses & fitting fee $150 $35 Covers everything in the Basic Plan PLUS Frame Allowance $150 High Index or Polycarbonate lenses Up to $116 Progressive lenses Up to $165 Scratch & UV coating Covered in full We offer two vision plans through Superior Vision: Basic and Enhanced. Vision is a separate offering, so you may elect a different coverage level than you have for medical coverage. The Basic plan covers a basic pair of glasses or contact lenses. The Enhanced plan covers everything that Basic covers, plus a $150 frame allowance and additional lens options.

FSA Vendor Free FSA Debit Card - Pay for your qualified FSA expenses
NueSynergy Mobile allows for on-the-go access to account balances & plan details Submit claims by taking a picture of your receipts with your smart phone allows members to easily access their account 24/7. Check your balance, submit claims, and learn more about your FSA. FSA Options: Healthcare FSA - Limited to $2,500 Limited FSA (Plan C) - dental & vision expenses $2,500 limit Dependent Care FSA - child care expenses $5,000 limit NueSynergy, our flexible spending account administrator, offers a debit card to members enrolled in health care, limited or dependent care FSAs with no monthly fees. NueSynergy has a free mobile app available to make using your account easier. Their user friendly website includes a benefit calculator to help you determine the proper amount to set aside in your account as well as tools to manage your FSA account. The maximums you can set aside this year into a flexible spending account are: HealthCare and Limited FSA $2,500 Dependent Care is limited to $5,000

HCFSA & Limited FSA Carry Over
Reminder: PY 2014 HCFSA and Limited FSA have a grace period to spend your funds Beginning with PY 2015, you will be able to carry over up to $500 into the next plan year If you are enrolled in a Healthcare or Limited FSA this year, you will have a grace period in which to spend any remaining funds in your account. Beginning in 2015, you will be able to roll over up to $500 of your unspent Healthcare or Limited FSA funds into the next plan year to spend

Employee Assistance Program
Focus is on EAP, work-life, & wellness services All calls are answered 24/7 by a masters level clinician Fully integrated counseling, work-life, legal, and financial services available Unlimited telephonic financial, legal, and family support Up to 8 in-person counseling sessions at no cost Referrals to local attorneys with free 30-minute consultation & 25% discount on fees Beginning January 1, 2014, ComPsych took over as the new Employee Assistance Program vendor. ComPsych offers members a comprehensive program for work-life, legal and financial services. This includes up to eight in person counseling sessions per topic per year with no member out of pocket cost. The EAP is open to all benefits eligible employees whether or not they are covered under the SEHP, their household members and children.

HealthQuest (HQ) Rewards
The earning period is being extended to 11/15/2014 The new year will be 11/16/2014 – 11/15/2015 This change means that during Open Enrollment an employee can see if they have earned the HQ Reward incentive discount or not If they have not, they still will have to time to earn it by 11/15/2014 Preventive Appointment Grace Period 8/1/2014 –11/16/2014 You must wait until after Nov. 15, 2014 to report well person, dental and eye appointments for credit next year Complete the self report Kansashealthquest.com The new HealthQuest Rewards program began on August 1. Members have until July 31 to complete the health assessment questionnaire (worth 10 credits) and earn 20 additional credits. New this year, members with cholesterol, glucose or blood pressure values in the ideal range will automatically receive 1 point for each ideal value.

HealthyKIDS Apply for HealthyKIDS Families at 250% of poverty level
4/15/2017 HealthyKIDS Apply for HealthyKIDS Families at 250% of poverty level State pays 90% of children’s healthcare premium Enroll at: Enroll between October 1 – 31, 2014 Coverage effective January 1, 2015 HealthyKIDS is the program for low income state families whereby the SEHP pays 90% of the children's health insurance contribution. To qualify, employees must be at 250 percent of the federal poverty level. To apply, you go online and complete the application during this open enrollment period. If you qualify, the HealthyKIDS discount will begin on January 1, 2015.

New Open Enrollment Website
New SEHP Membership Administrative Portal (MAP): I Open Enrollment website available October 1 – 31, 2014 You will need to attach electronic copies of birth certificates and marriage licenses if you are adding dependents during OE in MAP Scans Photos You will be able to update your information & mailing address Address changes are for the health plan information only MAP Questions:

MAP Questions: SEHPMembership@kdheks.gov
Registering for MAP Because MAP contains your Protected Health Information (PHI) it is a HIPAA compliant site All of your information is encrypted for security Once registered, you will set up a unique password for future authentication Because MAP contains your Protected Health Information (PHI) the site is fully HIPAA compliant Information you submit is encrypted for added security Once you authenticate in the system, you will set up a unique user name and password to use for future site visits. MAP Questions:

MAP Questions: SEHPMembership@kdheks.gov
Welcome To MAP This is a look at the new Member Portal in MAP. You will all need to register the first time to authenticate yourself in MAP. After the initial registration, you will set up a user name and password. If you wish to re-enter the portal, you would sign in using the user name and password you have created. MAP Questions:

4/15/2017 Identification Cards Aetna, BCBSKS and Delta Dental will send new cards to everyone Caremark, Superior Vision and Quest will only send cards to new members or members making changes Aetna, BCBS of Kansas and Delta are sending everyone new ID cards. Caremark and Superior will only send new cards to those individuals who are making plan or coverage changes. Reminders: If you lose your ID card or want additional cards, contact the vendors directly.

Transparency Tools Rx Savings Solutions is a pharmacy transparency tool to help save you money on your prescription drugs Available now at: Castlight, a transparency tool for medical and prescription drugs, will launch for Castlight’s website allows you to search your health plan’s providers and compare prices. You can pre-register beginning October 1 More information to come soon. We are offering employees two new tools to help them manage their health care spending. Rx Savings provides you with information on your prescription drugs and ways to save money. You can contact their customer service and speak to a pharmacist or pharm tech for assistance. Launching later this year will be the Castlight Health website. Castlight provides you with access to health care prices, quality information and health care information to assist you in making your health care decisions. More information on this will be sent out once the site is launched.

Email ?’s to SEHP: benefits@kdheks.gov
Questions? ?’s to SEHP:

State Employee Health Plan

Similar presentations

Presentation on theme: "State Employee Health Plan"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

State Employee Health Plan

Similar presentations

Presentation on theme: "State Employee Health Plan"— Presentation transcript:

Similar presentations

About project

Feedback