Insurance Group Representative Update 2014 Program Year November 7, - - PowerPoint PPT Presentation

1

Wood County Employee Health Benefits Plan

Insurance Group Representative Update 2014 Program Year

November 7, 2013

Presented By: Pamela Boyer, HR & Benefits Manager Janese Diem, Personnel Coordinator Cheryl Albrecht, Benefits Coordinator

2

Wood County Employee Health Benefits Plan

Big Picture

• Wood County Employee Health Benefits Plan
• Board of County Commissioners: Trustees
• Agreement extends to other elected officials and appointing

authorities

−

Same benefits for all

• Wood County Plan Document: Subscriber Booklet

−

Summary Plan Description (SPD)

−

Standard Eligibility Rules, Schedule of Benefits, etc.

• Trustees Establish Annual Funding Rates

−

Self‐insured Plan with Trust Fund Agreement

−

Rates Uniformly applied

• Change of Consultant

−

Mercer: Jason Beaver

3

2012 Rate Comparison

% of Single Average Employer Monthly Average Average Co-payment Report PEPY Funding Premium Deductible Coinsurance Dr/Spec/ER

County $ 9,888 85% $ 59.52 $150 $ 250 $10/$10/$35 Mercer $10,460 78% $111 $500 $2,250 $23/$38/$100 SERB $12,401 87% $ 63 $500-1,199 $2,000

2014 County $ 10,907

• Per Employee Per Year (PEPY) is a method of measuring plan costs, includes health &

prescription only

• Deductible, Coinsurance and Co‐payments are based on averages for single contact in‐

network

• Mercer Survey based on large national employers of 500+ employees. PEPY based on PPO

Midwest region, $10,346 for all PPO plans. Schedule of benefits based on PPO plan.

• State Employee Relations Board (SERB) based on Counties of similar population as Wood
• County. PEPY based on self‐insured plans, $12,888 for all PPO plans. Schedule of benefits

based on all lines of coverage

4

Positive Performance

• Excellent Plan Design

−

Low financial participation features to eliminate barrier for care while instilling some skin in the game

−

Deep discounts using FrontPath Health Network & lower tier drugs

• Invested in Employee Wellness since 1989

−

Employee base is long term investment: employee retention

−

“Pay now or pay later”

−

Manage at low cost

• Engaged Employees

−

Share information upon hire and ongoing

−

Teamwork when using the trust – it is our money

• Informed Trustees

−

Fair & consistent application

−

Value & support recommendations from EHBC & Consultant

• Centralized Administration

−

Work with EHBC meeting to keep all informed

−

Eligibility audits

−

Excellent network of insurance group representatives

−

Understand Health Care Reform and affects on Plan

5

2014 Health Care Reform Changes Health & Prescription Only

• Removal of Pre‐existing Conditions on adults
• Removal of Lifetime Limits on Essential Health Benefits
• Change in Dependent Eligibility Rules

−

Cannot condition eligibility on dependent’s eligibility in other employer sponsored group health plan

• Continue Grandfathered Health Plan Status

−

All reforms do not affect the plan

• Plan meets Minimum Value & Essential Health Coverage
• Requires Communicating Marketplace Notice to All Employees

−

Full (upon hire) & Part Time employees (within 14 days)

• Postponed Shared Responsibility until 2015

−

Track hours for Measurement Period to determine eligibility

−

Report new part‐time hires and terminations

6

Centralized Administrative Functions Roles & Responsibilities

• Coordinate Countywide Enrollment and Funding

−

Check reports/applications & enter into data base

−

Generate funding based on enrollment

• Code, Payroll Deductions & Trust Fund

−

Report information to TPA

• Enrollment & Administrative Fees

−

Confirm changes to employees

• Individual Enrollment Verification forms

−

Balance Monthly Payroll Deductions & Funding

• Public Record: Official File in BCC

−

Office maintains working file (not part of personnel file)

• HIPAA Training

−

Notification requested if transferring duties to new person

7

• Distributed Information to All Employees Nov. 1, 2013

−

2014 Summary Plan Description (SPD)

−

2014 Exchange Notification

−

Individual Enrollment Verification (IEV)

• On‐line Access

−

Updated HIPAA Privacy Practices and forms

−

2014 Summary of Benefits and Coverage (SBC) & Glossary of Health Coverage and Medical Terms

• Minimum Essential Coverage and Minimum Value
• Wellness Programs Waiver and Release
• Signature of Receipt due by November 15

−

Lauren Schall @ BCC

2014 Centralized Employee Communication

8

Insurance Group Representatives Role & Responsibilities

• Primary Responsibilities
• 1. Communicate Plan Design & Eligibility to Employees
• Notification of All New Hires – Full & Part Time
• Initial Eligibility & Wellness Screening
• Ongoing
• 2. Report Enrollment & Funding
• Interaction with payroll officer
• Determine those on FMLA or other leave status
• Document on monthly insurance reports to BCC
• 3. Distribute & Collect Information/Signatures
• One of Many Job Responsibilities

− 30 Individual Group Representatives

9

• Uniform Eligibility Rules & Plan Design

− Plan Document & SPD

• Utilize Insurance Checklists

− Part Time Employees – New Process

• Must provide information within 14 days of employment
• Use new part‐time form – employee must sign

− Full Time Employees

• Must provide information within 30‐day Enrollment Period
• Conduct Insurance Orientation within FIRST DAY of employment
• Use Universal Application Checklist
• Signed Checklist provides enrollment in Life Insurance but forfeits

enrollment eligibility in other benefits if Application and other requirements are not met within 30‐day Enrollment Period – New Process

• 1. Communicate Plan Design

10

• Review

Checklist with New Part Time Employees hired after 10/18/13

• Report on

monthly insurance report

11

• Communicate Due Dates in Writing (See Checklist)

− Full Time Hire date October 14

• 30‐day enrollment period starts October 14
• Materials due from employee by November 12
• Schedule Wellness Screening & Follow Up within 30‐day

Enrollment Period

− Required for all Employees & Spouses seeking coverage − Insubordination for employee if employer schedules/advises − Charge for missed appointments w/o 24 hr advanced notice − Spouse does not attend = No coverage

• 1. Communicate Plan Design

Oc t 14 

 No v 12 De c 2

Hire Date Comple te App, F

• r

ms & We llne ss Sc r e e nings E nd of 30 Day E nr

• llme nt Pe riod

30 Day E nr

• llme nt Pe r

iod Monthly Insur anc e R e por t Due with F

• r

ms

12

• Review Checklist

with New Full Time Employees hired on 11/1/13 forward

• Be sure all areas

are reviewed and due dates are communicated

• Mark dates on

your calendar to follow up

13

• Conduct Exit Interview

− Completion of COBRA Personnel Action Report − Check COBRA eligibility − 60‐day election period

• Serves as a safety net between coverages

− 45‐day grace period for initial premium payment after election

• Following payments 30‐day grace period (claims pended)

− Same Schedule of Benefits & Funding

• 102% of total premium self‐paid by enrollee
• Share deductible/co‐insurance in same calendar year
• 1. Communication of Plan

Aug 1 Aug 15 Oc t 15 No v 1

Cove r age te r minate s COBR A mailing se nt E le c tion pe r iod e nds If no e le c tion made 60 day e le c tion pe r iod 45-day initial payme nt pe r iod COBR A e ff. Aug 1 E le c tion r e c e ive d & payme nt made

14

• Certificate of Creditable Coverage

− Still required in 2014 by ACA − Documents continuous coverage − Pre‐exiting Condition Period waived in new coverage

• 63‐day break or less between coverages

− Provided in COBRA Notification mailing

• Life Insurance Options for Terminal Illness

− Medical Waiver of Premium

• Disabled before age 60

− Accelerated Death Benefit

• 1. Communication of Plan

15

• Monthly Insurance Reports

− Due Monday @ 4:29 p.m. following last pay date of month − Electronic Monthly Insurance Report Template available − Plan for delivery time if using currier – plan ahead − Follow up from previous month changes including:

• Individual Enrollment Verifications
• Terminations of Part‐Time Employees
• Changes in funding status, self‐pay to payroll deduction

− Add current changes

• Any new or terminated part time employees

− Make notation on future reports for ongoing issues − Review applications and forms to ensure information is

complete, legible & signed

• 2. Enrollment & Funding

16

17

• Greater Review of Eligibility due to ACA

− No pre‐existing conditions − Unlimited coverage − Stop loss coverage will inquire on hits

• Health & Prescription combined in 2014
• Ensure Completion of Appropriate Forms Based
• n Eligibility

− Mandatory Life Insurance – uses checklist − Utilize Eligibility Guide − Sept. – Dec. Enrollees must complete current (2013)

and future year (2014) certifications

• Spousal Certification
• Dependent Certifications
• 2. Enrollment & Funding

18

19

20

• 2. Enrollment & Funding
• Eligibility

− Permanent full‐time employee, and

• 40 hours per week

− Must have full eight hours of active pay status the first

scheduled working day of each month, and

− Active pay status thirty (30) days prior or following the

first working day of the month

• Initial Offer

− Currently provided based on current eligibility

• Delayed Offer – Effective January 1, 2015

− Shared Responsibility requires hours tracked in 2014 − Additional training forthcoming in spring of 2014

21

• Requires Interaction with Payroll Officer
• Ensure Payroll Deduction Status

− Check for approved unpaid LOA, FMLA w/o pay,

disciplinary actions without pay

− Verify sufficient wages for 1st & 2nd payroll of month via

payroll deductions

• Self‐Pay: Premium or Payroll Deduction

− Total Premium = code + payroll deduction + trust − Notification from employee to continue due 5 days prior

to month of coverage

− Payment due the last day of the month prior to coverage

• Payment for December coverage due by November 30th
• No grace period provided for non‐FLMA

− Report, collect & submit with insurance report

• 2. Enrollment & Funding

22

• FMLA without Pay

− Self‐pay payroll deduction follows due date rules − 30‐Day Grace Period

• Dec. coverage due Nov. 30, plus grace period = Dec. 30

− Required Termination Notice

• Payment not received by Nov. 30 for Dec. coverage
• Provide written notice 15 days prior to termination for

failure to make payment by due date

• Notify on Dec. 15 if payment is not received by Dec. 30

will result in termination of coverage Dec. 1

− COBRA may be available

• Qualified non‐returning reason

− Communicate to BCC

• 2. Enrollment & Funding

23

Insert Timeline

24

• Monthly Insurance Report

− Reformatted to include Part Time Employees

• Report new hires and terminations

− Added a funding component to note Self‐Pay Status − May be submitted electronically, followed by paper − Retain a copy for future reference

• BCC retains official record
• Vision Report

− Separated from Monthly Reporting − Documents: employee, claimant, amount − Retain a copy for future reference

• BCC retains official record
• 2. Enrollment & Funding

25

26

• Distribute & Collect Various Forms

− Ensure signature before returning − Return signed Individual Enrollment Verifications with

next monthly report

• 2014 Individual Enrollment Verifications only for those

making changes 1/1/14 ‐ Due Jan. 27

− Notify employees of updated Focus Formulary

• Look for release of generic drugs
• Assist with Claim Issues Based on Plan Document

− Confidential HIPAA information

• Provide Paper Copies of Requested Documents

− Within 7 days (as required by law) for those with no

electronic access

• 3. Distribution/Collection of Information

27

Spousal Eligibility Exceptions for Primary Coverage

• Rules Posted on Website

− Spouse must complete an initial Spousal Eligibility

determination prior to requesting an Exception

− Employee signature required to acknowledge determination − If Exception granted, employee must report ANY change in

income within 30 days of change

• Retroactive Review of Approved Exceptions

− Plan reviews all approved Exception to ensure income was

properly reported

− 2013 Exceptions reviewed during the 2014 Annual Eligibility

Verification Process

− If change in income not reported a penalty is applied

28

Plan Reminders

• Pre‐certification Required

− Babies stay beyond mother’s discharge − Responsibility of Subscriber

• Accelerated Death Benefit Offering

− Contact BCC for assistance if employee ill

• Items Not Covered by the Plan

− Non‐diagnostic genetic testing − Birth control

• Special Enrollment Rights

− Employees and dependents increased review due to ACA − Spousal wellness screenings required

• Application changed to remind spouses

29

Use County Website: www.co.wood.oh.us

• Current Plan Document (Subscriber Booklet)
• Summary Plan Description (SPD)

−

Includes Plan Administrator Information

• Summary of Benefits & Coverage (SBC)

−

Uniform Glossary of Benefits

• Marketplace Notification
• Download Forms – updated HIPAA, etc.
• Universal Application is available electronically

−

Check data to ensure information is printed using final application not preview screen

• Wellness Program Information

−

Universal Waiver for 2013 Plan Year

−

Facebook posting available after hours for families

• Links to Networks
• Power Point Presentations

30

Wrap Up

• New Part‐time Employee Packets

− Light blue

• Annual Meetings

− Encourage employees to attend

− Schedule posted in SPD

− Group Representatives also encouraged to attend

− Different information that presented at this training

− Wellness incentives provided

• Additional Training in 2014

− Spring offering for the Shared Responsibility requirements

• n eligibility
• We Appreciate Your Role as Group Representatives!
• Questions?????