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City of Plano Retiree Non-Medicare Open Enrollment Plan Year 2010.

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Presentation on theme: "City of Plano Retiree Non-Medicare Open Enrollment Plan Year 2010."— Presentation transcript:

1 City of Plano Retiree Non-Medicare Open Enrollment Plan Year 2010

2 Health Plan Overview City absorbed most of the medical cost increases from 2004 - 2008 In 2006 - City along with Hay Group developed a strategic approach and organization philosophy - a long term strategic plan for management of its benefit programs. The philosophical position will establish a basis upon which future benefit plan designs will be developed. Claims incurred January 1, 2008 – December 31, 2008 -1.1% of membership drove 42% of medical cost -Total claims for medical and RX rose 33% in 2008 -September 2008 – funded GASB moving $15.5 million from health claims fund -Additional 13% City contribution was added to medical rates beginning March 19,2009 to cover the excess claims.

3 Medical – Core Plan with UHC  No Plan Design Changes –Lifetime Maximum of $2,000,000 –Deductible of $1,000 –Out of Pocket Maximum of $3,000 –Coinsurance 80%  No Dental Plan Design Changes  Vision Plan Enhancement -Polycarbonate lenses coverage -$150 contact lenses allowance for 6 boxes – in lieu of glasses

4 Pharmacy – CVS/Caremark  17.1% increase in cost - attributed to member utilization, mix of drugs, drug price increases, marketing costs  2008 to 2009 Member cost share decreased - from 26.1% to 18.5%  Net effect is an estimated 29% increase in the City’s annual drug cost

5 Pharmacy – CVS / Caremark 2010 Plan Design Tier 4 for Specialty Drugs - $120 Co-pay with limit of 30 days $100 Family Deductible reinstated Minimum Co-pays reinstated Maximum Out of Pocket increased to $2500

6 Pharmacy – CVS / Caremark Family Deductible - $100 $2500 Max. OOP/Person Retail (30 Day Supply)CoinsuranceMinimumMaximum Tier 1 - Generic15%$6$15 Tier 2 - Brand Preferred25%$30$45 Tier 3 - Brand Non Preferred40%$45$60 Tier 4 - SpecialtyNA$120 Mail (90 Day Supply) Tier 1 - Generic15%$12$30 Tier 2 - Brand Preferred25%$60$90 Tier 3 - Brand Non Preferred40%$90$120 Tier 4 - SpecialtyNA

7 Consumerism Rx – use generics when possible –This may require that you talk to your doctor about alternative drugs and take the drug list with you to your visit Medical – use in-network providers –Ask the provider to ensure they are in-network or call UHC to verify or check myuhc.com –Taking card doesn’t mean they are in-network, it only means they will file the claim –Use Premium rated (****) doctors and facilities when selecting – these provide proven high quality (better outcomes) at reasonable costs Dental – ask for pre-determinations so you will know your financial responsibility up front You are the purchaser of your own health care – Purchase health care just like you would any other product.

8 New Question at Enrollment “Does your spouse have access to health insurance through their employer?” Will not be able to proceed with enrollment until question is answered Question only – NO surcharge being applied and NO spouse will be taken off plan

9 Important Dates Enrollment opens October 1, 2009 Enrollment closes October 21, 2009 Enroll through PeopleSoft Vendor Brochures and Hospital Gap Paper Enrollment Form Available online

10 Other Changes Hospital Gap -form required if enrolling for first time or making change to coverage Enrolling Dependents -eligible dependents can now be added during open enrollment or at the time of a qualifying event -“Alert Message” when adding dependents during open enrollment

11 Confirmation Statements Confirmation Statements will be sent out mid-November CORRECTIONS Only – send to HR Check on-line through PeopleSoft at Employee Self Service to review your elections at any time Premiums can be debited from your checking account


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