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

H b id Di bilit Hybrid Disability 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

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What We’re Going to Discuss

Th fi t 90 d

• The first 90 days
• 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

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The First 90 days

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Issue:

• Anthem has received 336 claims as of 9/23/19
• There were 14 claims submitted prior to the effective

Delay in Claims Decisions

date of 7/1/19

• 170 of these were submitted prior to the Date of

Disability

⎻ While Anthem reviewed the claims as they were received, the claim decision was not made until the date

• f 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

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Analysis:

After reviewing the

1. Requirements for additional medical support to validate disability

After reviewing the claims, we found 3 reasons for delays in the decision time

2. Claims filed prior to the Date of Disability – decision was not made until date of disability 3. Eligibility Template – was sent to Employer

decision time

Contacts once claim was received, resulting in delays Solution: Expedited Claim Processing Procedures as of 9/13/19

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Improved Claims Process

Initial Process Improved/Expedited Process

• Medical Records Required for

Approval

• Early Notice Claim Decisions upon

Initial Process

• Out of Work Notice or APS is

acceptable

• Early notice claims are

pre-approved

Improved/Expedited Process

y p Date of Disability

• Eligibility Template sent for completion

upon notice of claim pre approved

• Eligibility Template is

uploaded/sent with original claim submission

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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:

Eligibility Template

y ___________________________________________

• 3. Estimated or actual return to work date:_________________________________
• 4. Date of hire:______________________________________________________
• 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

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VACORP.org/hybrid-disability

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VACORP Website: Your One Stop Shop for all information/manuals/webinars:

http://www vacorp org/hybrid disability/

Your Anthem Resources

http://www.vacorp.org/hybrid-disability/ 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

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Disability Claims Process Guide: http://www.vacorp.org/wp- content/uploads/2019/07/VACORP-Disability-Claims-

Your Anthem Resources

content/uploads/2019/07/VACORP Disability Claims Process-Presentation-Slides.pdf Disability Plan Employee Handbook: htt // / http://www.vacorp.org/wp- 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

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Hybrid Disability Contacts

Short‐Term Disability Claims Manager Short‐Term Disability Claims Team Lead Tanya Lestage Ton Albritton Tanya Lestage Ton Albritton Tanya.Lestage@anthem.com Tondelayo.Albritton@anthem.com O: 404‐682‐9333 O: 800‐232‐0113 ext. 102 135 5075 G A C G D N Groups A‐C Groups 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 O R G S Z Groups O‐R Groups 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

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Hybrid Disability Hybrid Disability Program Review

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• The plan is mandated by the Commonwealth of Virginia

Hybrid History

The plan is mandated by the Commonwealth of Virginia, established in the Code of Virginia.

• The Plan must be comparable and comply with the

regulations as presented in the legislation.

Hybrid History

• 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

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Hybrid Disability Program Review

• Codified
• Self Insured

Short Term Disability

• Codified
• Insured Through Anthem

Long Term Disability

• Self Insured
• 7 day waiting period
• 125 workday day benefit
• Insured Through Anthem
• 125 workday waiting period
• Social Security Normal Retirement

f

• Interaction with Sick leave
• Interaction with FMLA
• Code requirements

benefit

• 1% retirement benefit
• Code requirements

(Health Insurance)

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Who is eligible for Hybrid Disability benefits AFTER 12 months?

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

• f Active Work on that day

For Non-Occupational Disabilities

• f 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?

Months of Continuous Participation Work days of 100% Replacement of Creditable Compensation Work days of 80% Replacement of Creditable Compensation Work days of 60% Replacement of Creditable Compensation p Compensation Compensation Fewer than 12 12-59 125 60-119 25 25 75 120 179 25 50 50 120-179 25 50 50 180 or more 25 75 25

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Who is eligible for Hybrid Disability benefits in the first 12 months?

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. For Occupational Disabilities What is the Benefit?

M th f C ti W k d f 100% W k d f 80% W k d f 60% Months of Continuous Participation Work days of 100% Replacement of Creditable Compensation Work days of 80% Replacement of Creditable Compensation Work days of 60% Replacement of Creditable Compensation F th 60 125 Fewer than 60 125 60-119 85 25 15 120 or more 85 40

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Who is eligible for Hybrid Disability benefits in the first 12 months?

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 Occupational Disabilities are covered from the first day of Hybrid employment claim should be filed along with the Workers Compensation (WC) claim

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Who is eligible for Hybrid Disability benefits in the first 12 months?

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 Occupational Disabilities are covered from the first day of Hybrid employment claim should be filed along with the Workers Compensation (WC) claim

$1,102

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Continued Training & Additional Resources

Q ti f th M th

• Question of the Month

Each month, a popular question or important information is included on the monthly billing statement from

• VACORP. A repository of these questions is housed on the VACORP website and is updated quarterly.
• Boot Camps - Spring and Fall - annually

Boot Camps provide basic Beginner training on the Hybrid Disability plan. Perfect for new hires involved with Hybrid Plan administration, for entities with little exposure to Hybrid claims, and for groups that haven’t attended a Regional Workshop or had a training session with the VACORP account specialists.

• Regional Training Workshops - Summer - annually

g g p y Workshops are held throughout the Commonwealth from May through August, and focus on complex claims issues, common questions, process changes and upcoming plan changes. Attendance of a Boot Camp session or a personalized training session is recommended prior to attending a Regional Workshop.

• Personalized Training

e so a ed a g The VACORP account specialists are available for personalized training, either by conference call or in

• person. This is a great alternative for an entity with a large HR staff, unable to attend a Boot Camp or

Regional Workshop, or with turnover in key HR positions. Training sessions last one to two hours and may be customized to focus on the specific training needs of an employer. Contact Sian.Ramsey@anthem.com to arrange personalized training.

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Employee

Dear Hybrid Plan Employee: VACORP H b id Di bilit Pl ff d b A th Lif id i t ti if ’t

Employee Electronic Documents T l t

VACORP Hybrid Disability Plan offered by AnthemLife provides some income protection if you can’t work because of physical disease, mental disorder, injury or pregnancy. You are enrolled in this program because your employer opted out of the state disability program. The VACORP Hybrid Disability Plan offered by AnthemLife is comparable and meets all requirements of Title 51.1 of the Code of Virginia. The hyperlinks provided below will take you directly to important documents regarding your VACORP

Template

Suggested Methods of

The hyperlinks provided below will take you directly to important documents regarding your VACORP Hybrid Disability Plan, including an Employee Handbook, FAQ and Certificates of Coverage. We encourage you to save this email that includes the hyperlinks so you will have direct access to current contractual information. If you have questions, please contact your Benefit Administrator

Suggested Methods of Distribution:

• New Hire Orientation
• Intranet

VACORP Hybrid Disability Coverage Document Name Click Below for Document Employee Handbook Employee Handbook Employee FAQ Employee FAQ STD Benefits at a Glance STD Benefits at a Glance

Intranet

• e-mail
• Thumb drive
• Binder/folder

STD Benefits at a Glance STD Benefits at a Glance STD Certificate of Coverage STD Certificate of Coverage LTD Benefits at a Glance LTD Benefits at a Glance LTD Certificate of Coverage LTD Certificate of Coverage Reporting Claims Via Phone Reporting Claims Via Phone R ti Cl i O li R ti Cl i O li

• Binder/folder

Reporting Claims Online Reporting Claims Online Employee Assistance Anthem Resource Advisor Benefits Perks at Anthem

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Claims Submission

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1. Anthem accepts telephonic, paper or online claims 2. Telephonic or Online claims are preferred for i ffi i d i k t dj di ti ! maximum efficiency and quickest adjudication!

• Eligibility Template can be uploaded with initial

claim submission OR emailed to LDClaims mailbox mailbox

• Online Claim Submission does not require full

completion

• Complete what information is available –

Complete what information is available Anthem will gather the rest!

• Submit anticipatory claims about 30 days in

advance

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 View Claims and Status

Employer Portal

 Upload documentation with initial claim submission  Claims uploaded and available for status view within 24 hours  ASO R t il bl  ASO Reports available  Custom reports available

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Advice to Pay Report SAMPLE

Advice to Pay Report for Client Name

KIA MOTORS MANClient Number GA1986

Period:

09/12/2019 through 10/02/2019

Sub Group Name

KIA MOTORS MANSub Group Number 0000GL0000

Generated:

0/02/2019 9:07:28 AM Group Number Subgroup Number CLASS Class Description Claim Number Employee SSN EMPLOYEE ID Claimant Last Name Claimant First Name First Day Absent Date Claim Incurred Benefit Start Date Authorization Date Reversal Date GA1986 0000GL0000 01 Salaried Team Membe ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Membe ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Membe ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Membe ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Membe ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Membe ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019

PAYREVSTATUS Pay From Pay Thru Authorization Type Authorization Stat Case Status Remaining Time Benefit End Date RTW Authorized Thru Date Stat Thru Date N 09/16/2019 09/19/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 09/09/2019 09/15/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 09/02/2019 09/08/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 08/26/2019 09/01/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 08/19/2019 08/25/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 07/14/2019 08/18/2019 Medical DENIED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019

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N 07/14/2019 08/18/2019 Medical DENIED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019

Claims Determination

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• Refreshed process

Claims Determination

• Maternities - best practice
• Timing expectation

g p

• What does the HR team need to do?
• What does the employee need to do?

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Billing and Billing and Remittance

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Best Practices

• Add email address: billing-hybriddisability@riskprograms.com to safe

sender list

• Create email alias for your organization to receive Hybrid information

y g y

• If Zero VRS Hybrid Plan employees:
• reply “no Hybrid Plan employees”
• indicate entity name

indicate entity name

• Update contact info as staff changes
• resignations

t d d l

• extended leave
• new staff
• email address changes
• Share Question of the Month with others

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When Mailing Payment

• New Rates as of July 1, 2019
• Checks in ONE envelope
• Please do not combine with payments for other VACORP coverages

Please do not combine with payments for other VACORP coverages

• Do not staple checks
• Include ONE completed invoice
• Adjustments
• Adjustments
• Include VRS Hybrid Plan Info
• Snapshot (screenshot)

ONLY h H b id Pl dit bl ti d b f li

• ONLY show Hybrid Plan creditable compensation and number of lives
• OR your system report matching data provided to VRS
• Do not send personally identifiable information

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When paying by ACH

• Email VACORP
• accounting@riskprograms.com AND
• billing-hybriddisability@riskprograms.com
• Include ONE completed invoice
• Adjustments
• Include VRS Hybrid Plan Info

y

• Snapshot (screenshot)
• ONLY show Hybrid Plan creditable compensation and number of lives
• OR your system report matching data provided to VRS

y y p g p

• Payment amount
• Please do not combine with payments for other VACORP coverages
• Date payment will be received

p y

• Do not send personally identifiable information

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Communication with VACORP

• Billing questions
• billing hybriddisability@riskprograms com
• billing-hybriddisability@riskprograms.com
• 844-986-2705
• ask for Hybrid Disability
• Coverage questions
• Sian Ramsey – Anthem Life Specialty Account Manager
• Office:540 853 5073
• Office:540-853-5073
• Mobile:540-988-2390
• Sian.Ramsey@anthem.com

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Frequently Asked Questions

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Commonly A k d

• Taxation / W-2s

Asked Questions:

Taxation / W-2s

• When to start counting waiting period?
• Can people use sick leave if they don’t

t t fil l i ? want to file a claim?

• Payroll timing and claim approval
• Police Officers/Fire/EMTs
• Irregular schedules/shift workers
• Partial Disability/Part-time employment
• Employees Transferring from Entity to
• Employees Transferring from Entity to

Entity

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Schools:

A. Active Work Days F l l ti f th b fit ⎻ For your calculation of the benefit a) Stipends for summer school or coaching b) Short Term Disability benefit calculation and Cred Comp B C t t / N C t t D B. Contract / Non-Contract Days a) Short Term Disability occurring during non-contract period. b) Counting 125th Workday during Contract/Non-Contract

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OneDigital OneDigital

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OneDigital will be performing a study

• OneDigital will be performing a study
• If you participate, you’ll get a customized

report!

Local

• Specific to local governments and school

systems – private sector is not eligible

• What are we studying?

Local Government and School System

• Sick leave data – accumulations and payouts
• Leave policy adjustments
• Benefit program and cost management
• Other employee perks

y Study

• Other employee perks
• When: later this month and will be open for 3-4

weeks

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Can you relate?

40% higher number of resignations in state and local governments in 2016 relative to g 2014 83% of superintendents th t l d ith say they struggled with recruiting and retaining good teachers last year…

† Gallup. “2018 Survey of K-12 School District

Superintendents” 2018.

† NACO. “Managing County Workers” Report. 2017

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Why offer a disability plan to all employees?

• Hybrid employees (those hired after 1/1/14) are all automatically provided employer paid STD &

LTD coverage.

• Plan 1 & 2 employees (those hired prior to 1/1/14) have no disability coverage
• Disparity between new and tenured employees

–

Today and going forward, if an Plan 1 or Plan 2 employee were to become ill or injured, they must utilize all sick and vacation time. Once this time has been utilized, the employee must go without pay or count on sick bank donations from other employees without pay or count on sick bank donations from other employees.

–

If a Hybrid employee were to go out for the same reason, they would have their income replaced at 60%-100% for STD and 60% for LTD, after applicable waiting periods.

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Best Practices

• Sick Leave:
• Recommend that Hybrid employees accumulate 60-90 days
• Allow Hybrid employees to accrue at the same rate as the Plan 1 and Plan 2
• Adjust Plan 1 & 2 accumulation if offering disability, will help offset retirement payouts

Si k B k

• Sick Bank:
• Only allow Hybrid participation for the first year
• Individual vs. Family considerations
• Have you done an assessment?
• Payout provisions:
• Leave vs. retirement; Implement limits/caps
• Can lead to continued growth of unfunded liability

H b id E l Y 1

• Hybrid Employees – Year 1
• Non-occupational disabilities are not covered until after the employee has celebrated their 12 month

anniversary with you.

• How do you cover Hybrid employees for non-occupational disabilities for that first year?
• Sick Leave? Voluntary coverages like AFLAC or Colonial? Do you limit those plans to just the first twelve

months?

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Plan 1 & 2 Legacy Pricing with Anthem

• Reduced Hybrid pricing ($0.01 on the

Hybrid rate) Includes: Sample Demographic Analysis

GENDER AGE GROUPS

Age Band # % Under 21 0.0% 30 to 39 50 23.7% 21 to 29 38 18.0% 124 41.0

Males

Count

• Avg. Age

0% 18% % 12% 3% Under 21 21 to 29 30 to 39 41%

• Resource Advisor & Perks at Work (just

like Hybrid)

• Telephonic claim intake

40 to 49 58 27.5% 60 to 64 25 11.8% 65 and Over 7 3.3% 50 to 59 33 15.6%

GENERATIONAL

• Avg. Age = 43.7

47.9 Total 211 100% 86 Count 13.6 $44,638 $48,351 10.7

YEARS OF SERVICE

• Avg. Age
• Avg. Years of Service
• Avg. Salary

g g

• Avg. Years of Service
• Avg. Salary

Females

24% 27% 16% 40 to 49 50 to 59 60 to 64 65 and Over 59% 41% Males Females 17%

• 1 login for claims management for Hybrid,

Plan 1 and 2 employees

• If you have Anthem Medical – expedited

l i

%

GROUPS1

• Avg. Tenure = 11.8 Years

Born between 1945 and 1964 50 23.7% Born before 1945 1 0.5% 11 to 15 Years 32 15.2%

SERVICE

17.1% Total 211 100% 16 to 20 Years 36 17.1% 0 to 5 Years 71 33.6% 6 to 10 Years 36 17.1% Tenure Band # Greatest / Silent Generation Baby Boomers Generation Generation X

ANNUAL

21+ Years 36 1% 24% 37% 1% 4% 4% 3% 34% 17% 15% 17% 0 to 5 Years 6 to 10 Years 11 to 15 Years 16 to 20 Years 21+ Years

claims process

• Pooled stability for Plan 1 and 2 as

population decreases

Demographic data is based on most current census provided to OneDigital (census run Apr‐19). It is for illustrative purposes only. Any new‐hire activity or terminations will alter projected figures.

i l G b d b h h C

Born after 1996 3 1.4% Born between 1981 and 1996 78 37.0% Born between 1965 and 1980 79 37.4% 43 Total 211 100%

• Avg. Salary = $46,787

$75k to $99k 8 3.8% $100k or More 6 2.8% $25k to $49k 146 69.2% $50k to $74k Generation Z / Post Millennials Millennial Generation 20.4%

U SALARY

Salary Band # % Less than $25k 8 3.8%

37% Greatest Boomers Gen X Millennials Gen Z 69% 20% Less than $25k $25k to $49k $50k to $74k $75k to $99k $100k or More

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Who is OneDigital?

Founded in 2000 and headquartered in Atlanta, Georgia, OneDigital powers your people with exceptional employee benefits and HR,

• ffering employers a sophisticated combination of strategic benefit advisory services and personalized solutions to companies of all sizes.

NATIONAL FOOTPRINT

70 locations

WHO WE SERVE

44,000 clients

THE ONEDIGITAL TEAM

1,500 employees

Buzzworthy

OneDigital is leading the headlines for our exceptional growth, our talented leaders and our energetic culture.

Nancy Grasso helped create the VACORP VLDP Opt-Out Program in 2013 when the original legislation was passed. Along with Carrie Bartlett, they manage this program. Nancy and Carrie have a strong expertise in the public sector working with many l l t d h l t th t t th OneDigital‘s Mid-Atlantic team

in 40 states across the globe and growing

150 employees 4,000 clients

local governments and school systems across the state over the last two decades. Nancy Grasso: 804-762-7076 Carrie Bartlett: 804-249-5152

employees

SERVING OVER

clients

across Virginia, Maryland, and DC OFFICES IN: Richmond, Charlottesville, Reston, Fairfax, Winchester, Roanoke, and Chevy Chase, MD.

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Questions?

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