2017 PEBTF Active Open Enrollment Employee contribution changes Get - - PowerPoint PPT Presentation

2017 PEBTF Active Open Enrollment

• Employee contribution changes
• Get Healthy changes
• Plan changes 2018
• Medical plan options
• Prescription drug benefits
• Other benefits
• Making the right decision for you and

your family

• Enrollment
• Additional Information

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• Full‐time Employees

– You pay the health care contribution through payroll deductions

• 2.25% of your gross base pay – January 1 thru June 30, 2018; 2.50% beginning July

1, 2018*

– If you were hired on or after August 1, 2003

• You pay the health care contribution
• Basic PPO and Custom HMO plans are offered at no additional cost (except when

covering dependents during your first 6 months of employment)

• Choice PPO has a biweekly buy‐up – $8.85 for single coverage/$23.08 for family

coverage

• You may purchase prescription drug coverage for the first six months of service

3 *Refer to your collective bargaining agreement for details

• Part‐time Employees

– You pay the health care contribution through payroll deductions.

• 2.25% of your gross base pay – January 1 thru June 30, 2018; 2.50% beginning July

1, 2018*

– Plus the cost for your plan selection

• Refer to the rate information on page 11 of the Open Enrollment Newsletter

4 *Refer to your collective bargaining agreement for details

Get Healthy Know Your Numbers Program

Current Employee Contribution Effective January 1, 2018 Effective July 1, 2018

Employee Completed a Wellness Screening in 2016

If you complete a wellness screening by 12/31/17: You will pay 2.5% of gross base salary

You are currently paying 2.25% of gross base salary You will continue to pay 2.25% of gross base salary Employee Did Not Complete a Wellness Screening in 2016 You are currently paying 2.25% of gross base salary, plus a surcharge of $62.19 biweekly You will pay 2.25% of gross base salary plus a surcharge of $63.62 biweekly

If you do NOT complete a wellness screening by 12/31/17: You will pay 2.5% of gross base pay, plus a surcharge of $63.62 biweekly

Wellness screenings are offered to employees enrolled in PEBTF benefits. Spouses/domestic partners are not required to complete a wellness screening in 2017. 5

• PPO annual deductibles increase
• PPO copays increase
• PPO lab services

– Lab copay if you do not use Quest Diagnostics or LabCorp

• Plan buy‐up for Choice PPO

– For employees hired on/after 8/1/2003

• Prescription drug plan copays increase

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Employees hired prior to 8/1/2003 do not have a buy-up

Medical Plan Options

PPO Option Custom HMO Narrow Network Choice PPO (Aetna) Basic PPO (Highmark) Regional (Aetna or Geisinger)  Annual deductible  Annual deductible  No annual deductible & low copays  In‐network and out‐of‐ network benefit  In‐network and out‐of‐ network benefit  In‐network only – IMPORTANT to look at the network before making a decision; www.pebtf.org  Plan buy‐up for employees hired on or after 8/1/03  No buy‐up for employees hired on or after 8/1/03  No buy‐up for employees hired on or after 8/1/03

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• Choice PPO (Aetna)

– Offered in all regions

• Basic PPO (Highmark)

— Offered in all regions

• Flexible

– In‐network and out‐of‐network benefits

• You receive greater benefits when you use in‐network providers

– A referral is not required to see a specialist or to receive care outside of the network

• Preventive care covered at 100%*
• Very important that you take a look at the plan’s network of providers and

facilities to ensure that your primary care physician and other providers (ie hospitals, physical therapists, urgent care) are in‐network before enrolling in either plan

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*Refer to Summary Plan Description available at www.pebtf.org for a list of covered services

• PPO copays are the same for both plans

PPO Options effective January 1, 2018

PCP Copay $20 Specialist Copay $45 (increase for 2018) Urgent Care $50 Emergency Room (waived if admitted) $200 (increase for 2018)

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• If you use Quest Diagnostics or LabCorp, there is no cost to you for covered lab

tests.

• If you do NOT use Quest Diagnostics or LabCorp, you will have a $30 lab copay.

– This is a change. In 2017, the cost of the lab test was applied to your annual deductible.

• If you visit your doctor for the blood draw, the office visit copay will still apply.

– The Open Enrollment Newsletter has some examples of what you will pay under different scenarios. Check it out for more info!

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• Annual deductible amounts will increase for 2018

Choice PPO (Aetna) Basic PPO (Highmark) In‐network $350 single/$700 family* (on certain services) $1,200 single/$2,400 family* (on certain services) Out‐of‐network $700 single/$1,400 family * $2,400 single/$4,800 family*

*Each individual is responsible for his/her single deductible; see limit above for the most a family would have to pay in deductibles.

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• The amount a member owes for health care services before the

plan begins to pay

– The PPO plans have an in‐network and out‐of‐network deductible – The HMO plan has no deductible; if you go out of network, you pay 100%

• f costs
• PPO in‐network deductible applies to all services except

– Preventive care – Primary care physician and specialist office visits and outpatient therapy copays – Emergency room and urgent care copays – Covered diagnostic lab services

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Yes No

Primary Care Physician (Regardless of Diagnosis)  Specialist  Immunizations  Preventive Care  Annual Physical/Well Visit  Inpatient Facility/Surgical  Outpatient Facility/Surgical  Diagnostic Imaging (X‐Ray, MRI, CAT‐Scan, PET)  Lab (bloodwork NOT at Quest or LabCorp)  Lab (bloodwork at Quest or LabCorp) 

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Examples include, but are not limited to:

• You have outpatient surgery at a PPO in‐network hospital

– You pay the in‐network deductible and then the plan pays 100%

• Choice PPO – $350 single/$700 family (increase for 2018)
• Basic PPO – $1,200 single/$2,400 family (increase for 2018)
• You get an MRI at a network facility

– You pay the in‐network deductible and then the plan pays 100%

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Examples include, but are not limited to:

• You visit your primary care physician (PCP; your family doctor) for a

sore throat

– No deductible – pay PCP office visit copay of $20

• You visit an orthopedic surgeon

– No deductible – pay the specialist office visit copay of $45 (increase for 2018)

• Blood test at Quest Diagnostics

– Covered 100% – you pay no copay or deductible

• Blood test at an in‐network hospital

– You pay a $30 lab copay (change for 2018)

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• Regional HMO networks:

– PEBTF Custom HMO Southeast – Aetna – PEBTF Custom HMO Central – Aetna – PEBTF Custom HMO West – Aetna – PEBTF Custom HMO Northeast – Geisinger

• Smaller network of providers
• Low copays and no annual deductible

(no changes for 2018)

• PCP referral is required for all services
• Only in‐network benefits
• Preventive care covered at 100%

(see SPD)

PEBTF Custom HMO – effective January 1, 2018

PCP Copay $5 Specialist Copay $10 Urgent Care Copay $50 Emergency Room (waived if admitted) $150 Annual deductible $0

IMPORTANT You must check the Custom HMO network to verify your doctor participates. Visit www.pebtf.org. If you’re selecting a new doctor, you should verify they are accepting new patients.

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• In‐network benefit only
• You must choose an in‐network Primary Care Physician (PCP) at

time of enrollment

– Your PCP must refer you for all in‐network services

• Networks are limited to help keep costs low

– Very important that you take a look at the plan’s network of providers and facilities to ensure that your primary care physician and other providers (e.g., hospitals, physical therapists, urgent care) are in‐network before enrolling in the plan – A customized network for PEBTF members is used for this plan – visit www.pebtf.org > 2017 Open Enrollment

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Buy‐Up Amounts for Choice PPO In 2017, Post 8/1/03 employees pay In 2018, Post 8/1/03 employees will pay

• $11.54 per pay – single coverage
• $23.08 per pay – family coverage
• $8.85 per pay – single coverage
• $23.08 per pay – family coverage
• Employees hired on or after 8/1/2003 pay a plan buy‐up for the

Choice PPO

– Deducted from biweekly pay

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• For PPOs and PEBTF Custom HMO

– You visit your network PCP for your annual physical

• You pay $0

– You get your annual preventive mammogram

• You pay $0

– Your child has a well‐child visit and gets a covered immunization

• You pay $0

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• For PPOs and PEBTF Custom HMO

– You visit your in‐network PCP for an earache

• $20 copay (PPOs)
• $5 copay (HMO)

– You visit an in‐network specialist

• $45 copay (PPOs)
• $10 copay (HMO) – referral required

– You get outpatient physical therapy (in‐network provider)

• $20 copay (PPOs)
• $5 copay (HMO)

– You sprain your ankle, are treated and released

• At urgent care, $50 copay (PPOs & HMO)
• At the emergency room,

– $200 copay (PPOs) – $150 copay (HMO)

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• For PPOs and PEBTF Custom HMO

– MRI

• PPO – covered 100% after you meet the annual deductible
• HMO – covered 100% in‐network (referral required, no deductible)

– Inpatient surgery – in‐network facility

• PPO – covered 100% after you meet the annual deductible
• HMO – covered 100% (referral required, no deductible)

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• Continues to be administered by CVS Caremark
• Continues to have a formulary, which is a list of the preferred drugs

– 30 day supplies – network pharmacy – 90 day supplies

• Mail order
• CVS pharmacy
• Rite Aid pharmacy

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Your Copay Today Your Copay Effective January 1, 2018 Prescriptions at a Network Pharmacy Up to a 30 Day Supply Tier 1: Generic drug $10 $12 Tier 2: Preferred brand‐name drug $20* $30* Tier 3: Non‐Preferred brand‐name drug $40* $60* CVS ‐ Retail Maintenance & Mail Order Up to a 90 Day Supply Tier 1: Generic drug $15 $18 Tier 2: Preferred brand‐name drug $30* $45* Tier 3: Non‐Preferred brand‐name drug $60* $90* Retail Maintenance at a Rite Aid Pharmacy Up to 90 Day Supply Tier 1: Generic drug $20 at Rite Aid $24 at Rite Aid Tier 2: Preferred brand‐name drug $40 at Rite Aid* $60 at Rite Aid* Tier 3: Non‐Preferred brand‐name drug $80 at Rite Aid* $120 at Rite Aid*

*plus the cost difference between the brand and the generic, if one exists

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• Optum continues to administer the mental health and

substance abuse benefits

– Benefits mirror the medical plan option you choose

• Outpatient mental health office visit copay

– $20 – if enrolled in the PPO – $5 – if enrolled in the PEBTF Custom HMO (in‐network only; no out‐of‐network benefits if enrolled in the Custom HMO)

– DMEnsion continues to administer the durable medical equipment (DME) prosthetics, orthotics, medical and diabetic supply benefit

• Vision, dental and hearing aid benefits continue with no

changes

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• 1. Take a look at the plans available in your region
• 2. Check the plan’s network of doctors, providers and facilities to see if

they participate in the network

• Important if you are considering the PEBTF Custom HMO because it has a

limited network

• PEBTF Custom HMO offers lowest copays, no annual deductible and you need a

referral for specialist care

• 3. Determine if you would like an out‐of‐network benefit – both PPOs
• ffer that
• 4. Both PPOs have annual deductibles on certain services
• 5. Consider the buy‐up for the Choice PPO –employees hired on/after

8/1/2003 only

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• During Open Enrollment – October 16 – November 3

– Follow the instructions in the open enrollment newsletter mailed to your home in early October or view online at www.pebtf.org – If you want to change plans for 2018

• Use employee self service or contact the commonwealth’s HR Service Center
• Call your local HR office if your agency is not supported by the commonwealth’s

HR Service Center

• All enrollments or changes must be done by November 3

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• Review the Open Enrollment Newsletter
• Visit www.pebtf.org

– FAQs – Links to medical plans online directories – Recorded webinar

• Contact the PEBTF with questions

– 717‐561‐4750 – 800‐522‐7279 – Email: openenrollment@pebtf.org

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• Visit www.pebtf.org
• Contact the PEBTF with questions

717-561-4750 800-522-7279 Email: openenrollment@pebtf.org

• Medical Plans:

Choice PPO ‐ Aetna 1‐800‐991‐9222 www.aetna.com/dse/custom/pebtf Basic PPO – Highmark 1‐888‐301‐9273 https://provdir.highmarkblueshield.com/; Select PPOBlue PEBTF Custom HMO: West – Aetna 1‐800‐991‐9222 Central – Aetna 1‐800‐991‐9222 Southeast – Aetna 1‐800‐991‐9222 www.aetna.com/dse/custom/pebtf Northeast – Geisinger 1‐800‐504‐0443 https://www.geisinger.org/pebtf