H b id Di Hybrid Disability bilit Boot Camp Fall 2019 Fall 2019 - PowerPoint PPT Presentation

H b id Di Hybrid Disability bilit Boot Camp Fall 2019 Fall 2019

Presenters VACORP Stephanie Heintzleman, Member Services Director OneDigital Nancy Grasso, Regional Vice President Business Development Carrie Bartlett Senior Client Executive Carrie Bartlett, Senior Client Executive Anthem Michael D’Achille – Director Specialty Sales, Virginia p y , g Sian Ramsey - Specialty Account Manager Kim Herrick – Manager, Business Projects and Support Alex Balasco – Specialty Sales Executive p y 2

What We’re Going to Discuss • The first 90 days Th fi t 90 d  What we learned and how we responded • Program Review • Claims submission • Claims submission  Submission best practices  How to view  Tools and communication expectations • Claims Determination  Timing  Communication  Employer and Employee Responsibility p y p y p y • Billing and Remittance • OneDigital  Survey  Leave implications  Plan 1 & 2 Legacy Coverage 3

4 The First 90 days

• Anthem has received 336 claims as of 9/23/19 • There were 14 claims submitted prior to the effective Issue: date of 7/1/19 Delay in Claims • 170 of these were submitted prior to the Date of Decisions Disability ⎻ While Anthem reviewed the claims as they were received, the claim decision was not made until the date of disability, after confirming the surgery or delivery. ⎻ As this was not the same process as The Standard, this led to a perceived delay in processing 5

1. Requirements for additional medical support to Analysis: validate disability After reviewing the After reviewing the 2. Claims filed prior to the Date of Disability – claims, we found 3 decision was not made until date of disability reasons for delays in the 3. Eligibility Template – was sent to Employer decision time decision time Contacts once claim was received, resulting in delays Solution: Expedited Claim Processing Procedures as of 9/13/19 6

Improved Claims Process Improved/Expedited Process Improved/Expedited Process Initial Process Initial Process • Out of Work Notice or APS is • Medical Records Required for acceptable Approval • Early notice claims are • Early Notice Claim Decisions upon y p pre approved pre-approved Date of Disability • Eligibility Template is • Eligibility Template sent for completion uploaded/sent with original claim submission upon notice of claim 7

Please send the following eligibility information: PLEASE ONLY RESPOND TO THOSE QUESTIONS THAT ARE HIGHLIGHTED 1. Date last worked:__________________________________________________ number of hours worked on date last worked: ____________________________ 2. First day absent from work: y ___________________________________________ Eligibility 3. Estimated or actual return to work date:_________________________________ 4. Date of hire:______________________________________________________ Template 5. Please advise if the employee is currently eligible and enrolled in the VACORP Hybrid Disability Plan offered by Anthem Life: yes or no 6. Does the employee have LTD : yes or no 7. Insurance Effective date:____________________________________________ 8. Is this person a contract employee: yes or no If yes, please provide contract dates below: Current contract start date : ________________________________________ Current contract end date : _________________________________________ 9. Occupation:______________________________________________________ 10. Standard work week hours:__________________________________________ 11. Please provide the employee’s normal “days off” during the week - highlight the off days: the off days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday 12. Is claim work related: yes or no 8

9 VACORP.org/hybrid-disability

VACORP Website: Your One Stop Shop for all information/manuals/webinars: http://www vacorp org/hybrid disability/ http://www.vacorp.org/hybrid-disability/ Your Anthem Resources Employer Portal Handbook : http://www.vacorp.org/wp-content/uploads/2019/09/EMPLOYER- Manual-Online-Claims-Reporting.pdf Manual Online Claims Reporting.pdf Employee Portal Handbook : http://www.vacorp.org/wp- content/uploads/2019/07/EMPLOYEE-Manual-Online-Claims- Reporting.pdf Filing a Claim By Phone : http://www.vacorp.org/wp- content/uploads/2019/07/Telephonic-claims-reporting.pdf 10

Disability Claims Process Guide : http://www.vacorp.org/wp- content/uploads/2019/07/VACORP-Disability-Claims- content/uploads/2019/07/VACORP Disability Claims Your Anthem Resources Process-Presentation-Slides.pdf Disability Plan Employee Handbook : http://www.vacorp.org/wp- htt // / content/uploads/2019/06/VACORP-Hybrid-Disability- Plan-Employee-Booklet.pdf FAQ’s : http://www.vacorp.org/wp- content/uploads/2019/07/2019-VACORP-Hybrid- Disability-Program-Claims-Review-FAQs.pdf 11

Hybrid Disability Contacts Short ‐ Term Disability Claims Manager Short ‐ Term Disability Claims Team Lead Tanya Lestage Tanya Lestage Ton Albritton Ton Albritton Tanya.Lestage@anthem.com Tondelayo.Albritton@anthem.com O: 404 ‐ 682 ‐ 9333 O: 800 ‐ 232 ‐ 0113 ext. 102 135 5075 G Groups A ‐ C A C G Groups D ‐ N D N Nicole Timmons, STD Case Manager Monique Minervini, STD Case Manager Nicole.Timmons@anthem.com Monique.Minervini@anthem.com O: 800 ‐ 232 ‐ 0113 ext. 102 135 5090 O: 800 ‐ 232 ‐ 0113 ext. 104 126 0025 G Groups O ‐ R O R G Groups S ‐ Z S Z Vanessa Hayes, STD Case Manager James Perryman, STD Case Manager Vanessa.Hayes@anthem.com James.Perryman@anthem.com O: 800 ‐ 232 ‐ 0113 ext. 102 135 6640 O: 800 ‐ 232 ‐ 0113 ext. 102 135 6033 Sian Ramsey – Specialty Account Manager Sian.Ramsey@anthem.com O: 540 ‐ 853 ‐ 5073 M: 540 ‐ 988 ‐ 2390 12

13 Hybrid Disability Hybrid Disability Program Review

• The plan is mandated by the Commonwealth of Virginia The plan is mandated by the Commonwealth of Virginia, Hybrid History Hybrid History established in the Code of Virginia. • The Plan must be comparable and comply with the regulations as presented in the legislation. • This plan is a comparable plan and has some enhancements to the mandated benefits. • Pricing advantage – rates guaranteed to July 1, 2024 • Notices from VRS concerning the State’s VLDP program, including rate information do not affect this program 14

Hybrid Disability Program Review Short Term Disability Long Term Disability • Codified • Codified • Self Insured • Self Insured • Insured Through Anthem • Insured Through Anthem • 7 day waiting period • 125 workday waiting period • 125 workday day benefit • Social Security Normal Retirement benefit f • Interaction with Sick leave • 1% retirement benefit • Interaction with FMLA • Code requirements • Code requirements (Health Insurance) 15

Who is eligible for Hybrid Disability benefits AFTER 12 months? For Non-Occupational Disabilities For Non-Occupational Disabilities Non-occupational disabilities are covered on the day following the completion of 12 months of continuous service with the employer as long as the employee is capable of Active Work on that day of Active Work on that day. Benefits begin on the first work day after a 7 Calendar Day waiting period and are payable for up to 125 work days, based upon the nature of the disability. What is the benefit? What is the benefit? Work days of 80% Work days of 60% Work days of 100% Replacement of Replacement of Months of Continuous Replacement of Participation Creditable Creditable Creditable Compensation p Compensation Compensation Compensation Compensation Fewer than 12 0 0 0 12-59 0 0 125 60-119 25 25 75 120 179 120-179 25 25 50 50 50 50 180 or more 25 75 25 16

Who is eligible for Hybrid Disability benefits in the first 12 months? For Occupational Disabilities For Occupational Disabilities Benefits begin on the first work day after a 7 Calendar Day waiting period and are payable for up to 125 work days, based upon the nature of the disability. What is the Benefit? Months of Continuous M th f C ti W Work days of 100% k d f 100% Work days of 80% W k d f 80% Work days of 60% W k d f 60% Participation Replacement of Replacement of Replacement of Creditable Creditable Creditable Compensation Compensation Compensation Fewer than 60 F th 60 0 0 0 0 125 125 85 25 15 60-119 120 or more 85 40 0 17

Who is eligible for Hybrid Disability benefits in the first 12 months? Occupational Disabilities are covered from the first day of Hybrid employment Occupational Disabilities are covered from the first day of Hybrid employment During the employee’s first 60 Months of Continuous Participation, several questions need to be asked in order to determine if a Short Term Disability (STD) claim should be filed along with the Workers Compensation (WC) claim claim should be filed along with the Workers Compensation (WC) claim 18

Who is eligible for Hybrid Disability benefits in the first 12 months? Occupational Disabilities are covered from the first day of Hybrid employment Occupational Disabilities are covered from the first day of Hybrid employment During the employee’s first 60 Months of Continuous Participation, several questions need to be asked in order to determine if a Short Term Disability (STD) claim should be filed along with the Workers Compensation (WC) claim claim should be filed along with the Workers Compensation (WC) claim $1,102 19