2012 Employee Benefits Meeting Presented to: Presented by: Mardi - - PowerPoint PPT Presentation

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2012 Employee Benefits Meeting

Presented by:

Mardi Burns, CHC

Senior Vice President, Senior Benefits Consultant

Lana Hitner, HIA

Account Executive

Presented to:

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Housekeeping Items

• Please make sure you have the Anthem

brochure

• Please hold questions until the end of

the presentation

• If you have a personal question, you

may talk with someone one on one after the presentation

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Today’s Agenda

• Short Term Disability
• Long Term Disability
• Health Care Reform Overview
• Review Changes with the Health Plan
• Introduction of Independent Clinic

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Sheboygan Area School District Long and Short Term Disability (LTD & STD)

Corporate Office: 250 South Executive Drive, Suite 300 Brookfield, WI 53005 800.627.3660 www.NISBenefits.com

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National Insurance Services (NIS)

• Working with state’s schools, cities and

counties since 1969

• Corporate headquarters is in WI
• Currently insures 1,566 public sector

groups in 20 states

• NIS does business with approximately

45% of school districts in the state

• Endorsed by CESA 7

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Short Term Disability Benefits (STD)

• Active employees only
• Employee paid
• Match in current benefits
• Benefits begin 1st day of Accident and 4th day of Sickness
• Maximum Benefit Duration is 90 consecutive calendar days
• Can collect short term disability benefit PLUS sick leave or

workers’ compensation

• Benefits are paid over the summer months
• Maternity is covered
• 12/12 pre-ex applies

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Short Term Disability Benefits (STD)

• Benefit is not taxable (as long as NOT put through flex

plan)

• Benefit is designed to dovetail with the LTD
• If you are currently enrolled, you will be enrolled at the

same benefit level. No additional paperwork needed.

• Pick up an enrollment packet after the presentation if

you are interested in enrolling in STD

• One time open enrollment now through May 31st
• Return forms to Payroll by May 31st

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Long Term Disability (LTD)

• Active employees only
• SASD pays for this benefit
• Benefit covers up to 66 2/3% of your salary
• Maximum monthly benefit is $8,000
• 90 consecutive calendar day elimination period
• Mental Illness/Substance Abuse covered same as any illness
• Enhanced Definition of Disability

 No gap in coverage (LTD plan will continue LTD coverage until claimant is eligible for Social Security Disability (SSDI))  After claimant is eligible for SSDI, the LTD plan will coordinate benefits  Current plan provides coverage for up to 24 months in order to continue long term disability

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Health Care Reform – What is it?

Patient Protection and Affordable Care Act

• Signed into law on March 23, 2010
• Commonly referred to as the Health Care Reform bill
• Regulations in the bill started to take effect at the

beginning of the first plan year after September 23, 2010

Goals:

• Improve access
• Stabilize cost
• Reform insurance products

Core Component = Mandated Coverage

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Health Care Reform Impact

• Cost shifting to private payors due to

less reimbursement from government programs

• Insurance exchanges
• Magnet plan risk
• Cadillac tax in 2018

– Estimated $1.6 million

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Health Care Reform Upcoming changes for January 1, 2013

– Health Care Flexible Spending Account (FSA) limit reduced to $2,500 – Health care premiums to be reported on employee’s W-2 (2012 data) – Fees (transitional fee, comparative effectiveness research fee)

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Why are Health Care Costs Rising?

• Aging population
• Technological advancements
• Direct advertisement from

pharmaceutical companies to consumers

• Over-use, under-use and misuse
• f healthcare resources
• Personal desires and wants driving

services without knowledge of the costs

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SASD Health Plan Facts

• Medical costs are currently over 20 million annually
• Pharmacy costs are currently over four million

annually

• 42% of plan members incurred $1,000 or less in

charges

• 15% of plan members accounted for 75% of all plan

costs

• At a trend of 8%, costs are expected to reach 35

million by 2018

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SASD Cost Containment

• Disease management programs
• Provider network

– Access – Discounts

• Anthem online tools

– Care Compare

• Preventive care
• Wellness
• Plan design changes
• Pharmacy cost containment programs
• Independent Clinic

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Health Plan Changes Effective July 1, 2012

Applies to all employees except Hearing Interpreters

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Deductible

Deductible Tier Current Effective 7/1/12 Current Effective 7/1/12 Single $200 $500 $200 $1,000 Employee plus Spouse OR Child(ren) $400 $1,000 $400 $2,000 Family $400 $1,000 $400 $2,000 Network Non-Network

Network and non-network deductibles cross reduce. This means any network deductible satisfied will also apply to the non- network deductible and non-network deductible will satisfy the network deductible until each limit is reached. Deductibles currently met will be credited to the new deductible. Deductibles will start over January 1, 2013.

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Coinsurance

Network – Plan pays 90%; Employee pays 10% Non-Network – Plan pays 70%; Employee pays 30% Network and non-network coinsurance cross reduce. Coinsurance means the insured person and the insurer share a set percentage of the hospital and medical expenses after the deductible has been met.

Coinsurance Tier Current Effective 7/1/12 Current Effective 7/1/12 Single N/A $500 $400 $1,000 Employee plus Spouse OR Child(ren) N/A $1,000 $1,000 $2,000 Family N/A $1,000 $1,000 $2,000 Network Non-Network

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Coinsurance Example

It will take $5,500 of allowable charges to satisfy the deductible and coinsurance for one person.

Allowable Charges $5,500 Subtract Member Deductible

• 500

Remaining Balance $5,000 Subtract 10% Member Coinsurance

• 500

Health Plan Pays $4,500

Assumes a Network provider is utilized.

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Maximum Out-of-Pocket

Maximum out-of-pocket also referred to a out-of-pocket maximum is the total amount of deductible and coinsurance the covered person will pay. Accumulates on an single and family level. The family out-of-pocket maximum is the combined total for all family members. Emergency room copays and pharmacy copays and coinsurance do not apply toward the out-of-pocket maximum. Maximum Out-of-Pocket Tier Current Effective 7/1/12 Current Effective 7/1/12 Single N/A $1,000 $400 $2,000 Employee plus Spouse OR Child(ren) N/A $2,000 $1,000 $4,000 Family N/A $2,000 $1,000 $4,000 Network Non-Network

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Emergency Room

• $100 copay(waived if admitted); then

deductible and coinsurance

• Benefit is the same whether you see an

Network or Non-Network provider

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Prescription Drugs

• Implementing a formulary
• Four tier levels

– Tier 1 – Generic - $10 copay – Tier 2 – Preferred Brand - $25 copay – Tier 3 – Non-Preferred Brand - $50 copay – Tier 4 – Specialty - 25% up to $150 per month one month supply

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What is a Formulary?

• List of prescription drugs approved for the

use and/or coverage by a benefit plan

• What do the tiers represent?

– Determined by several factors

• Cost of drug
• Cost of drug in comparison to other drugs used

for the same treatment

• Availability of over the counter options
• Other clinical and cost factors

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Days Supply

• Retail Pharmacy

– Members will receive a 30-day supply for one copay – May get up to a 90-day supply, but you will have to pay a three copays

• Mail Order Pharmacy

– Members will receive a 90-day supply for two copays – Save one copay every three months by using mail

• rder (See page 43 for mail order form)

– Once you have established an account, ordering refills is safe, easy, and convenient – Prompt delivery to members’ homes – Free shipping

* Anthem’s home delivery pharmacy sent more than 8 million prescriptions to members in 2011.

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Getting Started w ith Home Delivery

Members call or visit their health plan website to provide medication and profile information. Home Delivery Pharmacy contacts physician to

• btain a

prescription. Prescription is filled by licensed pharmacists and checked for accuracy. Prescription is delivered directly to the member.

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Pharmacy Programs

• Step Therapy (see Page 10)

– Offers a step-by-step approach to determine the medications that are right for you – Plan members who are already taking a drug in the Step Therapy program, may continue taking their current drug

• Quantity Limits (see Page 14)

– Members impacted by this program will notice this change January 1, 2012. Anthem will send out letters to the impacted plan members after July 1st

• Preferred Generic (see page 25)

– When doctor prescribes a brand name drug with a generic available, the pharmacy will fill the prescription with the generic drug

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Specialty Medications

• Tier 4 benefit will be 25% up to $150 per month one

month supply

• Members will be allowed up to two fills at the retail

pharmacy during this transition

• Must be obtained through mail order only through

Curascript (Anthem’s Mail Order Pharmacy)

– Offers treatment for health conditions that require complex medications – Provides personalized support from a team of specialized care professionals – Medications are sent to employees homes or doctors’ offices at no additional cost

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Need More Info…Go to anthem.com. Logging in is Easy !

After you’ve registered, simply enter your username and password, and click the Log In button. Your personalized site at anthem.com is available for you 24/7 to help you, and those you care about, stay healthy and get the best care possible.

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You will need your: Member ID First name Last name Date of birth To register for the first time.

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Medical Plan Premiums

• Premium rates restructured to three tiers

1. Employee Only 2. Employee plus Spouse or Child(ren) 3. Family = Employee, Spouse and Child(ren)

• If both employee and spouse work at SASD, you can

each choose an employee only plan

• Payroll will automatically make the adjustments based

upon current plan enrollment

• Contact payroll before May 31st if you want to make any

changes

• Information on the premiums employees will be paying

will be sent to employees by May 18th

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Coming Soon!

Wellness & Clinics

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Sheboygan County InHealth Clinic

• 615 Pennsylvania Ave., Sheboygan
• Current Providers
• Nurse Practitioner
• Medical Assistant
• Chiropractor (Sheboygan County only)
• Adding for the School District:
• Nurse Practitioner
• Medical Assistant

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Sheboygan County InHealth Clinic

• 615 Pennsylvania Ave., Sheboygan
• Current Providers
• Nurse Practitioner
• Medical Assistant
• Chiropractor (Sheboygan County only)
• Adding for the School District:
• Nurse Practitioner
• Medical Assistant

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• Improved accessibility
• Shorter wait times for care
• Better coordination of care
• More quality time with provider
• More personalized service
• Focus on acute care, prevention and wellness
• No cost to employees and their family members

who are enrolled in the health plan

How does the clinic benefit employees?

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• A provider with advanced level of medical training and

education (Masters Degree)

– allows them to diagnose and treat medical problems

• Capable of performing similar services as a primary

care physician including

– diagnosing and treating patients, – writing prescriptions, and – referring patients to specialists.

What is a Nurse Practitioner?

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Primary & Preventive Care

– Routine Physicals (excluding pre-operative exams) – Well Child Visits – Immunizations – Preventative Screenings – Lab Testing/Ordering of Diagnostics – Prescriptions

Current Clinic Services

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Urgent Care

– Cold and flu symptoms – Sore throats/Strep tests – Ear infections – Rashes – Urinary tract infection

Current Clinic Services

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Management of Chronic Health Conditions

– Diabetes – High Blood Pressure – High Cholesterol – Asthma/Allergies – Hypothyroidism

Current Clinic Services

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Minor Procedures

– Ear irrigation – Suture removals – Wart evaluation and treatments – Skin tag removal (non-suspicious)

Current Clinic Services

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Patient Education

– Chronic Health Condition Management – InHealth Coaching – Lifestyle Management Education – Assistance with Smoking Cessation

Current Clinic Services

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Practitioner Motive

Interra Health provides work in the best interest of the patient and are always conscious of overall cost Providers do not receive incentives based on services performed or revenue generated thus preventing unnecessary services

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More to Come

Once the clinic staffed to accommodate the needs of SASD’s employees and their families, employees will receive an announcement in the mail and can begin to use the clinic at that time.

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Stay Tuned for More Information…

• Medical plan premiums
• New ID cards for the Medical plan
• Independent clinic opening
• Health Risk Assessment dates
• Back to School Bash – August 21st
• Remember to turn Short Term Disability

enrollment form into Payroll by May 31st

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Questions?

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