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 2

• 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 *Refer to your collective bargaining agreement for details 3

• 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 *Refer to your collective bargaining agreement for details 4

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 are currently paying 2.25% of You will continue to pay 2.25% of gross You will pay 2.5% of gross base salary gross base salary base salary Employee Did Not Complete a Wellness Screening in 2016 You are currently paying 2.25% of You will pay 2.25% of gross base salary If you do NOT complete a wellness gross base salary, plus a surcharge of plus a surcharge of $63.62 biweekly screening by 12/31/17: $62.19 biweekly 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 Employees hired prior to 8/1/2003 do not have a buy-up 6

Medical Plan Options PPO Option Custom HMO Narrow Network Choice PPO Basic PPO Regional (Aetna) (Highmark) (Aetna or Geisinger)  Annual deductible  Annual deductible  No annual deductible & low copays  In ‐ network and out ‐ of ‐  In ‐ network and out ‐ of ‐  In ‐ network only – network benefit network benefit IMPORTANT to look at the network before making a decision; www.pebtf.org  Plan buy ‐ up for employees  No buy ‐ up for employees  No buy ‐ up for employees hired on or after 8/1/03 hired on or after 8/1/03 hired on or after 8/1/03 7

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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 *Refer to Summary Plan Description available at www.pebtf.org for a list of covered services 9

• 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 $200 admitted) (increase for 2018) 10

• 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! 11

• Annual deductible amounts will increase for 2018 Choice PPO Basic PPO (Aetna) (Highmark) In ‐ network $350 single/$700 family* $1,200 single/$2,400 family* (on certain services) (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. 12

• 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% of 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 13

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) 14

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% 15

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) 16

• Regional HMO networks: IMPORTANT – PEBTF Custom HMO Southeast – Aetna You must check the – PEBTF Custom HMO Central – Aetna Custom HMO network to – PEBTF Custom HMO West – Aetna verify your doctor participates. – PEBTF Custom HMO Northeast – Geisinger Visit www.pebtf.org. • Smaller network of providers If you’re selecting a new • Low copays and no annual deductible doctor, you should verify (no changes for 2018) they are accepting new patients. • PCP referral is required for all services • Only in ‐ network benefits PEBTF Custom HMO – effective January 1, 2018 • Preventive care covered at 100% PCP Copay $5 (see SPD) Specialist Copay $10 Urgent Care Copay $50 Emergency Room (waived if admitted) $150 Annual deductible $0 17

• 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 18

• Employees hired on or after 8/1/2003 pay a plan buy ‐ up for the Choice PPO – Deducted from biweekly pay Buy ‐ Up Amounts for Choice PPO In 2017, In 2018, Post 8/1/03 employees pay Post 8/1/03 employees will pay • $11.54 per pay – single coverage • $8.85 per pay – single coverage • $23.08 per pay – family coverage • $23.08 per pay – family coverage 19

• 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 20

• 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) 21

• 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) 22