Employee Benefit Plan Effective April 1, 2014 Presented by: AND - PowerPoint PPT Presentation

Employee Benefit Plan Effective April 1, 2014 Presented by: AND

April 2014 Open Enrollment What to expect for April 2014 Open Enrollment Medical Remaining with CHP Adding a new Low Cost Plan Option – 3 Plans Dental Slight increase to the current rates due to Health Care Reform Same plan design No provider disruption Vision No increase to the current rates Same plan design No provider disruption 2

April 2014 Open Enrollment NEW BENEFITS AVAILABLE THIS YEAR! Voluntary Hospital Indemnity Voluntary Accident NES/Colonial representative will introduce these products. 3

Medical Plan Options Low Plan Basic Plan Premium Plan TYPE OF SERVICE IN-NETWORK ONLY OUT-OF- OUT-OF- IN-NETWORK IN-NETWORK NETWORK NETWORK DEDUCTIBLE: $3,000 / $2,000 / $6,000 / $1,000 / $2,250 $4,000 / $12,000 Single/Family $6,000 $4,000 $18,000 COINSURANCE 50% 70% 50% 80% 60% PERCENTAGE OUT OF POCKET $6,350 / $6,350 / $12,700 / MAXIMUM $3,000 / $6,000 $12,000 / $36,000 $12,700 $12,700 $38,100 Single/Family Deductible & Deductible & OFFICE VISITS Deductible & Coinsurance $35 copay $25 copay Coinsurance Coinsurance SPECIALISTS OFFICE Deductible & Deductible & Deductible & Coinsurance $50 copay $40 copay VISITS Coinsurance Coinsurance Deductible & Deductible & PREVENTIVE CARE Paid at 100% Paid at 100% Paid at 100% Coinsurance Coinsurance EMERGENCY ROOM VISIT Deductible & Coinsurance $250 copay $250 copay $250 copay $250 copay URGENT CARE CENTER Deductible & Deductible & Deductible & Coinsurance $50 copay $40 Copay VISIT Coinsurance Coinsurance IN-PATIENT HOSPITAL Deductible & Deductible & Deductible & Deductible & Deductible & Coinsurance CONFINEMENT Coinsurance Coinsurance Coinsurance Coinsurance OUT-PATIENT HOSPITAL Deductible & Deductible & Deductible & Deductible & Deductible & Coinsurance VISIT Coinsurance Coinsurance Coinsurance Coinsurance $25/$45/50% 90 Day Mail Order – $25/$45/50% $25/$45/50% PRESCRIPTION DRUG 2 times copay 90 Day Mail Order – 2 times copay 90 Day Mail Order – 2 times copay COPAYMENTS MANDATORY MAIL MANDATORY MAIL ORDER MANDATORY MAIL ORDER ORDER 4

Aetna Dental Plan Dual Option Plan  Can switch between the DMO and the PPO plans during open  enrollment. DMO is an In-Network only plan  PPO provides both In-Network and Out-of-Network benefits.  There are no benefit changes for 2014  Aetna Navigator™ – easy-to-use member self-service website  where you can check claims status, obtain claim forms, locate a participating dentist… Or call Aetna Member Services at 1-877-238-6200  Prompt 1 (Dental Plan Member) 5

Empire Vision Plan There are no benefit changes for 2013  How to find a Blue View Vision provider: 1. Go to empireblue.com 2. Select “Blue View Vision” 3. Enter 6

Senior Med Employee Page 7

PPO Network  Magnacare PPO  Over 80,000 providers in New York & New Jersey  500,000 providers throughout the U.S.  www.magnacare.com  Easy-to-use provider search tool Name  Practice type/Specialty  Location  Language  8

Utilization Review  Hines & Associates  URAC Accredited  Streamlined Precertification process  Pre-cert requirements can be found in Summary Plan Description 9

Emergency or Urgent Care? Know The Difference! Urgent Care Emergency Explanation: Medical care for a Explanation: a sudden, serious condition that needs illness or accidental injury that immediate attention to is either life threatening or minimize severity and prevent would result in severe physical complications but is not a damage if not treated medical emergency. immediately (for example, appendicitis) Average ER Facility cost: $800 Average provider cost: $250 Example: Sprained ankle Example: Appendicitis  Premium Plan - $40 copay  Premium Plan - $250 copay  Basic Plan - $50 copay  Basic Plan - $250 copay  Low Plan – Contracted Fee  Low Plan - Much higher Contracted fee 10

Prescription Drug Discount Programs You can find the listings of discounted drugs on the vendor’s web sites. Please note that these lists are updated periodically and are subject to change at anytime, Walmart http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf Target http://sites.target.com/site/en/health/generic_drugs.jsp?sort=alph CVS http://www.cvs.com/CVSApp/promoContent/promoLandingTemplate.jsp?promoLandingId=1046 Rite Aide http://www.riteaid.com/pharmacy/rx_savings.jsf Costco http://www.envisionrx.com/pdfs/CMPPDrugList.pdf Walgreens http://www.walgreens.com/images/psc/pdf/11PM0109_30_90day_4_15.pdf ShopRite http://www.shoprite.com/cnt/Pharmacy.html In addition, the below web site is the ultimate pharmacy search engine for discounted generic drug programs available at pharmacies throughout the U.S. http://www.medtipster.com 11

Maximize Your Benefits!  Network doctors - Use network providers for lower out of pocket expenses  When possible, go to an Urgent Care Center instead of an Emergency Room.  Utilize the Mail order prescription drug benefit to reduce copayments  Use generic medications when possible  Utilize Prescription Drug Discount Programs 12

Voluntary Plans  Accident Insurance  Hospital Indemnity You DO NOT have to participate in the Health Plan to enroll in a Voluntary plan. 13

Accident Insurance Plan pays lump sum dollar amount to you in the event of  accidental injury, reimburses for emergency room visits, hospitalization, ambulance services, fractures, dislocations, and many other accident related benefits 24 hour coverage  Benefit pays $50 annually, per covered insured, for specific  preventative health screening tests. Tests include: mammogram, pap smear, colonoscopy, chest X-ray and several others Employee, employee/spouse, one parent family and two parent  family coverage available Coverage is portable 

Hospital Indemnity Insurance  Plan pays insured directly, $1,000 or $2,000, depending on level coverage chosen, upon hospital admission  Pays $165/day to the insured for each day you are hospitalized up to 60 days per confinement  Pays $150 for Emergency Room admission  Plan pays up to $1,000, depending on level of coverage, for outpatient surgery and $250 for diagnostic procedure benefit  Employee, employee/spouse, one parent family and two parent family coverage available

What we need you to do Medical, Dental and Vision • Complete the Employee Election Form. • If you want to add or remove dependents, please complete an Enrollment From for the appropriate carrier. CHP – Medical Empire – Vision Aetna - Dental • Please return the complete forms to your Administrator by March 21st. Voluntary Hospital and Accident •Meet with a Representative. One-on-one meetings will be held on 3/17 at Crown and 3/18 and 3/19 at Lakeview and Oak Hollow. 16

Questions? Thank you!