OPEN ENROLLMENT WORKSHOP Kelsey Leckinger - Benefits Coordinator - - PowerPoint PPT Presentation

2018 CALENDAR YEAR OPEN ENROLLMENT WORKSHOP

Kelsey Leckinger - Benefits Coordinator (State Attorney) Amy Maros - Benefits Coordinator (Public Defender, Criminal

Conflict and Civil Regional Counsel, Guardian ad Litem, Capital Collateral Regional Counsel and Justice Administrative Commission)

Open Enrollment

• Open Enrollment - 10/16/2017 - 11/03/2017
• Correction period - 11/06/2017 - 11/17/2017
• OE summary inserts in Benefits Packages
• Mailing Starts 10/02/17
• Benefits Guide - available on the myBenefits

website in October

• myBenefits Website - Open Enrollment Page
• Open Enrollment page will change week of October 2

to 2018 Plan Year page to capture all changes for the upcoming plan year

• QSC Matrix

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Important Notices

Notices will be in the Open Enrollment Insert sent to employees

Women’s Health and Cancer Rights Act (WHCRA)

• State Employees’ PPO and HMO Plan booklets and Benefits Documents provide

benefits for mastectomy-related services

Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIPRA)

• Employees eligible for Medicaid or CHIP and who are eligible for health

coverage from your employer may be eligible for a premium assistance program

• Contact your State Medicaid or CHIP office for information about premium

assistance

Medicare D Notice

• Medicare D Notice is also available on myBenefits site

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Stay Informed

My Benefits Website

• Benefits Guide
• Learn about changes
• Read about plans
• Use Cost Estimators
• Insurance Company Contact Info
• http://mybenefits.myflorida.com/

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Address Verification Process

Address Verification

• Ensure employees log into the People First system and update address
• information. Address Information in People First is used for numerous

purposes, including:

• Open Enrollment Benefits Statements
• Insurance Cards
• Important Notices
• Division of State Group Insurance notices regarding changes in

insurance plans

• Information regarding FSA and HSA
• 1095-C

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Additional Notification Options

Phone Number

• Employees have the opportunity to provide both a primary and secondary phone

number within the address verification process

• Provides the employer, insurance provider, People First, and Division of State

Group Insurance an additional method of contact during an emergency or inquiry

Personal Email Address

• The notification email address provided is used to send important information

throughout the year, such as notice regarding benefits and retirement

• If the employee uses a work email address instead of a personal email address,

they risk not receiving these important notices if they change jobs

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Returned Mail

• Any undeliverable Open Enrollment Packets will be sent to

JAC’s Human Resources Office

• If returned mail is received, please be sure Open Enrollment

Packet is forwarded to the employee as soon as possible

• Please ensure employees update their address in People

First

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What’s New for 2018?

• HMO changes
• Dental plan changes
• New Dental Plans
• Vision premium increase
• FSA changes
• HSA contribution increase
• Dependent Eligibility Verification,
• ngoing
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Health & Prescription Plan Changes

HMO Contracted Service Areas

• HMO Coverage Area by County:
• Four HMO’s available for 2018 Plan Year- Capital Health Plan, Aetna,

United Healthcare, and AvMed

• Each county now has only one HMO available
• Home or work county for HMO election
• Participants enrolled in an HMO that is no longer available in their

county will default to the one HMO available in their home county of record according to the employee’s address in People First

• Participants with 2 available HMOs—meaning their work and home

county have different HMO options—will default into the HMO available in home county

• Participants must specifically elect the HMO in their work county;
• therwise they will be defaulted to the HMO in their home county
• 2018 Plan Year- HMO enrollment will show on Annual Benefit Statement

included in the Open Enrollment packet

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Covered Services Change

Occupational Therapy:

Services are a covered benefit beginning January 1, 2018. Services must be for conditions resulting from a physical or mental illness, injury, or impairment. PPO:

• Limited to 21 treatment days during any six-month period

HMO:

• Limited to 60 visits per injury

Maximum applies to all out-patient Occupational Therapy treatments, regardless of location of services

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Medication Synchronization(Med Sync)

• Allows all prescriptions to be synchronized so they can be

refilled on the same day

• Optional and only allowed once per calendar year
• Ineligible Medications:
• All controlled substances
• Any drugs dispensed in unbreakable

packaging from the manufacturer

• Multi-dose unit of medication
• Co-payment prorated for shorter-day supply
• Any short-supply or sync prescriptions of maintenance drugs

will count as one of three refills of maintenance medications allowed at a retail pharmacy

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Dental Plan Changes

Dental Changes

Dental Plans No Longer offered starting 2018 Plan Year:

• Humana
• Humana Network Plus—Prepaid dental plan (4004)
• Humana Preferred Plus—PPO dental plan (4054)
• United Solstice
• UnitedHealthcare Solstice S700—Prepaid dental plan (4014)
• Ameritas
• Preventive Plus (4064)
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Dental Changes

New procured Dental Plans Available 2018 Plan Year:

• Ameritas
• Indemnity w/PPO (4021)
• Standard PPO (4022)
• Preventative PPO (4023)
• MetLife
• Indemnity w/PPO (4031)
• Standard PPO (4032)
• Preventative PPO (4033)
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Dental Changes

Employees enrolled in a plan that will no longer be available for the 2018 plan year must actively elect a new plan. They will NOT be moved into a comparable plan.

• Employees who are currently enrolled in a plan that will

not be offered in 2018 will show no coverage on their Annual Benefits Statement

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All Dental Options for 2018 Plan Year

Ameritas:

• Indemnity w/PPO (4021)
• Standard PPO (4022)
• Preventative PPO (4023)

MetLife:

• Indemnity w/PPO (4031)
• Standard PPO (4022)
• Preventative PPO (4033)

Cigna:

• Cigna Dental (4034) – Prepaid Dental plan

Sun Life (formerly Assurant):

• Sun Life Freedom Advance (4074) - Indemnity PPO
• Sun Life Prepaid (225) - Prepaid Dental Plan

Humana:

• Humana schedule B (4084) - Indemnity Dental Plan
• Humana Select 15 (4044) - Prepaid Dental Plan

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Questions

Supplemental Plan Changes

Vision Premium Increase

Humana Vision Exam plus Materials

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Monthly Premium New premium amounts 2018 plan year

Employee Only $6.96 (Increase of $.64) Employee + Spouse $13.74 (Increase of $1.26) Employee + Child(ren) $13.60 (Increase of $1.26) Family (Spouse + Children) $21.36 (Increase of $1.98)

Healthcare FSA and Limited Purpose FSA $500 Carryover

Healthcare FSA and Limited Purpose FSA:

• Carryover up to $500 into the next plan year
• Funds over $500 will be forfeited the next plan year
• Annual maximum can still be elected when rolling over prior year funds
• $500 carryover added to annual election
• 90-day grace period for the following year is eliminated
• Plan year contributions must be used by Dec. 31
• Claims can be submitted through April 15 of next plan year
• Grace period will continue for the 2017 plan year
• Total amount of plan year election with carryover amount will be shown on

Chard Snyder Portal -- not in People First

• If an employee has up to $500 of carryover funds and does not elect a

healthcare FSA the following plan year, their funds will continue to carry over year to year until the funds are depleted. The Benny Card will continue to be active and the balance of funds will be available on the Chard Snyder Portal

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Healthcare FSA and Limited Purpose FSA $500 Carryover

Example: On Jan. 1, 2019, Mary has $475 remaining in her 2018 healthcare FSA. The $475 will carry over to the 2019 plan year. Mary can file claims for services received in 2018 through April 15, 2019. Any services received in 2018 will be deducted from the $475. If the services rendered in 2018 are more than the $475, she will not be able to dip into 2019 money. Example: On Jan. 1, 2019, John has $600 remaining in his 2018 healthcare FSA. John has one service for $50 that he filed a claim for prior to the April 15, 2019 deadline. The $50 will be deducted from the $600 remaining balance. However, only $500 will be carried over for services rendered in 2019. In this instance, John would lose $50. Example: During open enrollment, for the 2019 plan year, Fred decides that he no longer wishes to have an healthcare FSA. On Jan. 1, 2019, Fred has $500 remaining in his 2018 healthcare FSA. Fred can continue to use this money for qualifying expenses until the funds are exhausted, even though he does not have an FSA plan for the 2019 plan year.

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Dependent Care FSA

• $500 Carryover does NOT apply to Dependent Care FSA
• Dependent Care FSA will continue to have the grace period
• Grace period allows additional time after the plan year to use funds

for services up to March 15 of the following year

• All claims must be filed by April 15

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Health Savings Account (HSA) Contribution Increase

HSA contribution limit (employee and employer):

Annual maximum

• Individual—$3,450 (increase of $50)
• Family—$6,900 (increase of $150)
• Employer contribution remains the same
• $41.66/month for individual up to $500/year
• $83.33/month for family up to $1,000/year

Annual maximum out-of-pocket for High Deductible Health Plans

• Individual—$6,650 (increase of $100)
• Family—$13,300 (increase of $200)

Minimum deductible limit for High Deductible Health Plans

• Individual—$1,350 (increase of $50)
• Family—$2,700 (increase of $100)

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Tax Favored Accounts

• Medical Reimbursement

– Standard HMO and PPO Members – Maximum Annual Contribution

• $2,600 per year or $216.66 per month
• Limited Purpose Medical Reimbursement Account

– Only for Employees Enrolled in the High Deductible HMO or PPO Health plan. – Maximum Annual Contribution

• $2,600 per year or $216.66 per month

– Can only be used for preventative care expenses not covered by health plan, dental, and vision

• Dependent Care Reimbursement Account

– Maximum Annual Contribution

• $5,000 per year or $416.00 per month

For more information employees should contact Chard Snyder at 855-824-9284

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Eligible Variable Hour (OPS) Employees

• Any state employee working an average of 30 hours or more per week

will be eligible for: – Health Insurance: same premiums as Career Service – Basic life: employee must enroll and pay $3.58 monthly premium – Eligible for spouse and child life. Must be enrolled in Basic life coverage. – Dental, vision and other supplemental plans – Dependent Care Reimbursement Account – If enrolled into a High Deductible HMO or PPO they are eligible for HSA contribution – New for 2018: OPS employees are eligible for the Healthcare FSA and Limited Purpose FSA in the 2018 plan year

• Not eligible for optional life

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Dependent Eligibility Verification Audit & other Legislative Changes

Dependent Eligibility Verification Audit

SB 2508 (Ch. 2017-127, L.O.F.) requires the Division of State Group Insurance (DSGI) to conduct a full Dependent Eligibility Verification Audit (DEVA). DSGI will continue to conduct a monthly quality assurance review (QA Process) to confirm that dependents are eligible for insurance coverage under the program. Phase I: (QA Process)

• May to Nov. 30, 2017 – DSGI performs a quality assurance review of at least 10%
• f qualifying status change (QSC) events on a monthly basis

Phase II: (DEVA)

• Sept. 1 to Nov. 30, 2017 – Amnesty Period. Enrollees can remove ineligible

dependents

• Dec. 1, 2017 to May 2018 – 100% audit by a third party vendor

Phase III: (QA Process)

• June 2018 and beyond: DSGI will continue audit of QSCs
• DSGI will start review of new hires through the QA Process

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Dependent Eligibility Verification Audit

http://mybenefits.myflorida.com/health/dependent_eligibility_verification

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Dependent Eligibility Verification Phase I - QA Process Request for Documentation:

• Initial request sent according to notification election in People First (email,
• r regular mail)
• 50-day Human Resource notice—sent via email to Human Resource Office
• 60-day letter / 2nd request—sent according to notification election in

People First

• Final Notice—Sent regular and certified mail
• Along with Final Notice, employees are contacted by telephone and an

additional email is sent to the Human Resource Office

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Dependent Eligibility Verification Phase I - QA Process Documentation Submission:

• Documentation submitted to verify eligibility may be an original or

photocopy

• Employees should redact any information on a document which is not

necessary to verify eligibility

• Employees may email a cell phone picture of documents, send scanned

copies to DSGI.QATeam@dms.myflorida.com, fax to 850-488-0252, or mail documentation to Division of State Group Insurance, P.O. Box 5450, Tallahassee, FL 32314

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PLEASE DO NOT SEND DOCUMENTATION TO THE PEOPLE FIRST SERVICE CENTER

Dependent Eligibility Verification Phase I

Coverage Termination

• Employees who do not provide requested documentation within the allotted time frame
• r their documents do not prove dependent eligibility
• Ineligible dependents in question will be removed from coverage prospectively, the

first day of the month following ineligibility determination

• Ineligible dependents dropped from coverage are not eligible for COBRA coverage,
• nly dependents who are eligible for coverage may continue insurance through

COBRA for health, dental and vision coverages

• If employees do not agree with the determination they may submit a level II appeal to

DSGI by following the process outlined in the determination letter

Questions About Dependent Eligibility Verification

• Employees can read our Frequently Asked Questions at www.mybenefits.myflorida.com

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Dependent Eligibility Verification Phase II - DEVA

Phase II: 100% audit conducted by third party vendor

• Amnesty period – Members who remove dependents by Nov. 30, 2017, will be held

harmless for past claims of ineligible dependent(s)

• Members can remove ineligible dependents at any time during the amnesty period by

calling the People First Service Center at 866-663-4735 or online during Open Enrollment

• Audit will begin December 1, 2017
• Applies to nearly 93,000 members, with approximately 193,000 dependents
• Enrollees will be required to provide requested documentation to verify the eligibility of their

dependents

• If documentation is not sent timely, or if documentation does not prove dependent eligibility,

the coverage for ineligible dependents will be prospectively terminated

• Many communications will be sent regarding audit, including direct mail, emails and

Management Advisories

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Dependent Eligibility Verification Phase II Communications

• Sept. 1, 2017 - Postcard mailed to approximately 180,000 members

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Dependent Eligibility Verification Phase II Communications

Management Advisory 17-007

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Dependent Eligibility Verification Phase III - QA Process

Phase III:

• DSGI will start review of new hires through the Quality

Assurance Process

• QSCs that add dependents
• Ongoing after May 2018

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SB 7022 (Ch. 2017-88, L.O.F.)

Transparency, Bundled Services, and Shared Savings offered in 2018

• Access to comprehensive pricing for surgeries and other health care services
• Allows enrollees to shop for health care services and providers
• Rewards enrollees by sharing savings generated by enrollee’s choice of service provider

Additional Benefit Offerings

• Prepaid limited health plans and Discount medical plans
• Prepaid health clinics
• Service contacts offered by licensed providers, hospitals and clinics
• Bundled arrangements offered by service networks, group practices, and professional

associations Metal Tiers

• We will not have any information regarding metal tiers until plan year 2019.

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Helpful Information

Dependent Eligibility Certification for Open Enrollment

These steps must be completed before benefits changes will be processed

• Verify Dependent Information

– Dependent Name – Social Security Number – Date of Birth

• Removing Dependent Outside Open Enrollment

– Must have a Qualifying Status Event Change – Must provide documentation to People First

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Danger Zones

• Open Enrollment changes are made entirely online.

However, supplemental plans may still require additional paper forms to be completed.

• Employees must complete their own enrollments online;

however, you can assist the employee if needed.

• Please do not use employee’s People First number to

enroll as the employee.

• Remind employees to print confirmation for their records.
• Dependent Social Security numbers and information

must be accurate; IRS penalty can result.

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Waiving Coverage

• Employees are not required to enroll in

coverage

– If they have no other coverage, they may be subject to the individual tax penalty

• Use a waiver form

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Tips

• Encourage employees to review their

current Benefits Statement

• Contact JAC or you can print the Benefit

Statement if an employee does not receive the statement in the mail

• Encourage employees to look at their pay

warrants at the end of January 2018 to make sure the correct premiums pulled

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Weight Management Pilot

DSGI will initiate a pilot program for members enrolled in the PPO and HMO plans to provide coverage for the treatment and management of obesity and related conditions during the 2018 plan year. Criteria shall include, but not be limited to the following:

• Participation limited to 2,000 members- employees and dependents
• Must be a member of the PPO Plan or a self-insured HMO – ( Florida Blue, Aetna, AvMed and United

Health Care)

• Must complete of a health risk assessment
• Must consent to provide personal and medical information to DSGI
• Must be referred by and supervised by a participating physician
• Must be enrolled in a DSGI-approved wellness program during the 2018 plan year
• Coverage provided all Federal Drug Administration-approved medications for chronic weight management
• Participating member will be responsible for all applicable copayments, coinsurance, deductibles, and
• ther out-of-pocket expenses.

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Wellness Wire

• The Wellness Wire provides calendars of events hosted by providers of

Florida State Group Insurance and tips to improve your health and emotional well-being

• Share with your employees
• http://www.dms.myflorida.com/content/download/132676/825562/file/The

%20Wellness%20Wire%20September%202017.pdf

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Contact Information

Chard Snyder

Live Chat Feature

• New Live Chat feature is available in the FSA &

HSA Information portal in People First.

• Now with a click of your mouse, you can chat with

a Chard Snyder customer service representative. Anything that you might call in or email about, you can also take care of using Live Chat.

• Representatives are available to chat Monday

through Friday, 8am – 5pm Eastern time.

Toll Free: 1-(855)-824-9284

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Pharmacy Benefits Manager

• CVS/Caremark

– Health Insurance Plans – https://www.caremark.com/wps/portal – http://info.caremark.com/sofrxplan – 888-766-5490

• Exception: Retirees with Medicare

Advantage Plan

• Capital Health Plan (CHP)
• Florida Health Care Plan (FHCP)
• CVS, Winn-Dixie, Wal-Mart, Publix – check

with your local pharmacy

• Walgreens – still Non-Provider

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My Florida & People First Contact Information

www.myflorida.com/mybenefits/

People First Service Center, Flexible Spending Accounts, Customer Service Representatives are available Monday – Friday 8:00 a.m. – 6:00 p.m. (ET).

Toll Free: 1-(866)-663-4735 Fax: 1-(800)-422-3128

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JAC Benefits Staff

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benefits@justiceadmin.org