2019-20 Benefits Open Enrollment Boulder Valley School District Why - - PowerPoint PPT Presentation

2019-20 Benefits Open Enrollment

Boulder Valley School District

Why are we making changes?

• BVSD’s healthcare goals are to improve our members’ quality & satisfaction,

control costs and improve the overall health of our members

• Colorado’s Rising Cost of Healthcare
• http://www.bellpolicy.org/2018/12/17/health-care-brief/
• https://coloradosun.com/2019/01/03/colorado-health-care-costs-explained/
• https://www.civhc.org/2018/11/08/colorados-health-care-costs-continue-to-rise-above-other-states/
• Cost of benefits to BVSD taxpayers $34 million/year
• BVSD is balancing providing comprehensive benefits with escalating costs
• Options considered
• Implement employee only premium
• Increase deductibles, copays, out of pocket maximums
• Reduce plan benefits (e.g., eliminate coverage of services or procedures)
• Bundled pricing (e.g., The Zero Card)

What’s changing?

• The district contribution is increasing from $613 to $644 per month.
• BVSD’s Self-funded
• Medical plan is changing to UMR from Cigna.
• Prescription plan is moving to Rx Benefits from Cigna.
• Employees on Cigna will be moved to equivalent plans unless you make

changes during open enrollment.

• Dependent premiums on all medical and dental plans are increasing.
• A few changes will affect UMR & Kaiser Permanente plans.
• Deductibles & out-of-pocket maximums are unchanged on all plans.

What’s changing? (cont.)

• VSP will maintain the same rates; there are a couple of plan enhancements.
• The Zero Card is offered at no charge to UMR members.
• Voluntary benefits will be offered for the first time through Aflac:
• Accident Insurance
• Critical Illness Insurance
• Refer to the BVSD 2019-2020 Benefits Guide for specific information.

What do I need to do?

• Review 2019-2020 BVSD benefits guide.
• If you want to change elections, complete the Google OE form by April 30

(sent via email or at https://www.bvsd.org/benefits/Pages/OPEN%20ENROLLMENT.aspx)

• Open enrollment is only available online (no paper forms)
• Review the new offering from Aflac and fill out the application if you’d like to enroll.
• Familiarize yourself with the new websites, mobile applications, and phone numbers

if you’re enrolled with UMR/RxBenefits. Also, be sure to check out the benefits of using a Zero Card provider.

UMR

Medical

Your member ID number Your medical provider network Your pharmacy benefits information Family members covered under your plan Your group health plan number

How to read your ID card

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Signing up for umr.com

Visit umr.com on your desktop computer or tablet device Click Login/Register to sign up

Helpful hints

• Have your UMR member ID card handy
• Spouses and adult children must create

their own online account

• You must provide a valid email address
• Select a username and password you can remember

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With umr.com you can:

See your benefits information anytime, anywhere

• View My taskbar, your personalized

to-do list

• Check your benefits and

see what’s covered

• Look up what you owe and

how much you’ve paid

• Find a doctor in your network
• Learn about medical conditions and your

treatment options

• Use UMR’s Cost Estimator to compare

prices of quality providers (replaces Health Care Blue Book).

The Zero Card

Medical Bundling

Meet the Zero Card

Say goodbye to deductibles, copays and coinsurance

Healthcare for FREE

Boulder Valley School District has made this program available to employees and dependents covered by the self-funded plan (UMR) to keep you in the BEST health possible. You Pay $0 for covered services and never have to worry about copays or deductibles.

Your doctor recommends a specific service or surgery. We will take care of all the details and you pay $0.

How easy is it?

Call, email or chat live with your own Zero Card Personal Health Assistant. You can search for a provider at www.thezerocard.com, call, email or chat live with one of The Zero Card’s Personal Health Assistants.

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How to find care

Cards

The Zero Card Contact The Zero Card at 855-816-0001 prior to scheduling appointments & procedures. You do not need a card for Zero Card services outside of labs. The Zero Card contracts with Lab Card for lab services. Save card, show it at Quest facilities and utilize it only for Lab Services.

RxBenefits

Pharmacy

• Advocacy. Expertise. Service.

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RxBenefits is your Pharmacy Benefit Administrator (PBA).

• We partner with the country’s largest Pharmacy Benefit Managers (PBMs) to bring greater discounts,

enhanced access, and improved Member Services to our clients and their employees.

• Your pharmacy benefits coverage will be with Express Scripts.
• Your benefits are provided by Express Scripts. RxBenefits administers the services for a more personal and

manageable approach. Contact RxBenefits at 800.334.8134 with any pharmacy-related questions. What’s New? You have access to our Member Services Team, available Monday through Friday, 7 a.m.-8 p.m. Central Time. Our knowledgeable representatives can assist you with questions such as:

Who is RxBenefits?

Can you assist me with my benefits questions? Is my drug covered? What will it cost? Is my pharmacy in the network? Can you help transition my mail

• rder scripts?

Are there lower cost alternatives?

• Advocacy. Expertise. Service.

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What to Expect

For questions or concerns, members can contact RxBenefits Member Services at 800.334.8134 Monday through Friday 7 a.m.-8 p.m. Central or emailing RxHelp@RxBenefits.com

• Effective July 1, your pharmacy coverage

with Express Scripts will be administered by RxBenefits.

• As part of your new pharmacy benefits plan,

you will receive:

• New combo ID card (Medical & Rx)
• Summary of Benefits
• Access to concierge-level service
• Access to Express-Scripts.com to review

medication tiers, drug pricing, local pharmacies, plan details and ways to maximize benefits. New members will need to create an account. There are more than 68,000 pharmacies in the Express Scripts network, including most national chains and many independent stores

• Advocacy. Expertise. Service.

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Member services

If you had any questions, or issues, you would call the PBM 800#. You used your old insurance card. Your pharmacy provider was direct with the PBM. You will receive a new ID card that lists contact details for RxBenefits Member Services You will have access to high-touch, superior service. Present your new ID card at the pharmacy on or after July 1. Questions? Call the RxBenefits Member Services number listed on your new ID card. It’s that simple!

RxBenefits Member Services

Service as it is meant to be

Friendly and knowledgeable live representatives who are:

• Committed to following the issue to

resolution

• Focused on serving members, not

rushing them

Now Before

• Advocacy. Expertise. Service.

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The Express Scripts app

• Register your account from your mobile device
• Transfer eligible maintenance medications

to Express Scripts Pharmacy

• Select and schedule prescription refills and enroll

eligible prescriptions in auto refills

• Check Express Scripts Pharmacy order shipping

information

• Locate a nearby pharmacy using GPS
• Access DrugDigest database for information,

uses, possible side effects, etc.

• Set a reminder for medication doses

For Members on the Go

• Advocacy. Expertise. Service.

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Frequently asked questions

Q: Are my drugs covered? A: You can access a copy of the most current Performance Drug List at www.Express-Scripts.com or by contacting RxBenefits Member Services at 800.334.8134. Your medications may not be in the same tier level under Express Scripts as they were under Cigna, so please review the performance drug list since it may provide lower cost alternatives for your medications. Also, discussing generics with your physician could save you money. Q: Can I still use my same ID card?! A: No. Please use your new UMR medical/pharmacy ID when you fill your prescriptions on or after July 1, 2019. Q: If my coverage is with Express Scripts, why do I need to call RxBenefits? A: Your benefits are being provided by Express Scripts, but RxBenefits administers the services for a more personal, manageable approach. Contact RxBenefits for any pharmacy-related questions. Q: What happens if my questions require contact with Express Scripts? A: RxBenefits Member Services reps have access to Express Scripts systems. If RxBenefits needs to contact Express Scripts to resolve an issue, they will stay on the line, explain the issue, and monitor your problem until it is resolved.

Kaiser Permanente

Medical/Pharmacy

Plan changes effective 07/01/2019

Service New Benefit

Emergency Room Copay Increasing from $200 to $250 Urgent Care Copay Increasing from $75 to $100 Brand Name Drug Copay Increasing from $60 to $75 Out of Area Dependent Benefit Outpatient generic, brand, specialty, and non-preferred drugs will be 50% coinsurance. Mail order is not available

At Kaiser Permanente, our goal is to get you the care you need to stay healthy, when – and where – you need it.

The information provided here is only a summary. Upon enrollment, your Evidence of Coverage will contain a description

• f your coverage, including benefits, exclusions, and limitations. Your Evidence of Coverage will prevail over this or any other plan summary.
• 1. These features are available when you receive care at Kaiser Permanente medical offices.
• 2. Phone visits may have a charge if you seek care with an affiliated provider (including RNs).
• 3. Check with your doctor’s office to see if video visits are appropriate and available to you.
• 4. There are no charges for preventive care services.
• 5. Estimated costs are not subject to deductible.

Reminders

• Medical Advice / 24-hour nurse advice line: 303-338-4545
• Member Services: 303-338-3800
• New Member Connect Team: 1-844-639-8657
• Clinical Pharmacy Call Center: 303-338-4503
• Kaiser Permanente Mail Order Pharmacy:
• Automated mail-order refills: 1-866-938-0077
• General mail order questions: 1-866-523-6059
• Away from home Travel Line: 951-268-3900
• International Travel Clinic: 303-283-2650
• Chat with a Doctor now on Mobile application
• 7 a.m.-10 p.m., 7 days a week, 365 days a year
• On kp.org only - Can chat with a Pharmacist or Financial Counselor Mon. thru Fri. 8 a.m-5 p.m. (Not on the

Mobile app yet!)

• Urgent Care:
• Longmont Medical Offices Mon.–Fri., noon–8 p.m. Sat.–Sun., 8 a.m.–4 p.m.
• Westminster Medical Offices Mon.–Fri., 10 a.m.–8 p.m. Sat.–Sun. 8 a.m.–6 p.m.
• NextCare Urgent Care 2144 Main St., Suite 8 Longmont, CO 80501 303-772-0041
• Children’s Hospital Colorado North Campus, Broomfield Urgent and Outpatient Specialty Care

469 W. State Highway 7 Broomfield, CO 80023 720-777-1340

• Chiropractic and Acupuncture-Covered Benefit – Baseline and Westminster Medical Offices

(consult kp.org or mobile app for additional Urgent, Chiropractic and Acupuncture locations)

Delta Dental

Delta Dental – No Changes

PPO Premier Non-Participating* Deductible None None $100 per lifetime for

• rthodontia only

Annual maximum $1500 (July 1 – June 30) Preventive/Diagnostic 100% 75% 75% Basic 80% 75% 75% Major 60% 50% 50% Orthodontia 60% (child only – to age 19) 50% (child only - to age 19) 50% (child only - to age 19) Ortho Lifetime Max $1,250 per person TMJ 50% to a $1000 Lifetime Max

• Non-Participating providers are not contracted and can balance bill you for difference between the allowed amount and the billed amount.
• Delta Dental recommends members obtain a pre-determination of benefits for services $400 or more.

Aflac

Voluntary Benefits

Aflac Accident Insurance

An Accident insurance plan provides benefits to help cover the costs associated with unexpected bills that are the result of an accident.

• 24 Hour coverage on or off the job.
• Does not offset or coordinate with any other coverage you may have.
• All benefits are paid directly to your home address.
• No claim limits or dollar limits as plan will continue to pay for all accidents.
• The policy will provide a cash benefit for the treatments you receive as the

result of an accident.

• The included $50 Wellness Benefit pays for preventive testing once per

person per calendar year.

• Coverage is available for you, your spouse, and dependent children.
• Coverage is guaranteed-issue and fully portable; same rates/same

coverage.

Aflac Critical Illness

A Critical Illness plan provides a lump – sum benefit if you are diagnosed with a critical illness.

Cancer Heart Attack Stroke Major Organ Transplant Kidney Failure Bone Marrow Transplant Coronary Artery Bypass Surgery Skin Cancer Alzheimer’s / Parkinson’s Plus 11 other conditions

• The employee may elect $10,000, $15,000 or $20,000 lump – sum benefit. Spouse may

elect the same amount of coverage as the employee. Each dependent child is covered at 50% of the employee amount free of charge.

• The included $50 Health Screening benefit for any one covered health screening test per

calendar year for a covered employee and spouse.

• Guaranteed Issue up to full $20,000 for 2019. No medical questions required, fully

portable same rates/same coverage. (Underwriting required beyond initial enrollment period.)

• Rates are locked in at your enrollment age and do not increase as you get older.

Other Voluntary Benefits

• Defined Contribution Retirement Plans through
• Empower
• PERA
• Security Benefit
• EcoPass
• Supplemental Life through The Standard
• VSP (vision plan)