Open Enrollment Presentation Plan Year 2018 Tammy Gill Assistant - - PowerPoint PPT Presentation

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Open Enrollment Presentation Plan Year 2018

Tammy Gill Assistant Director, Human Resources

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Agenda

• Important Dates to Remember
• PEIA Changes for Plan Year 2018

– Healthy Tomorrows – iSelectMD – Prescription Changes for PY 2018 – Rx Savings Solutions – Facility Fee Limit Changes for PY 2018

• Mountaineer Flexible Benefits (FBMC)

Changes for Plan Year 2018

• Things to Consider/Reminders

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Reminder

• Open Enrollment is your opportunity

to review all benefit elections to determine what is best for you and your family!

• Please take time to review all

available benefit options and information provided.

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Important Dates To Remember

• Open Enrollment period: 4/2/17 –

midnight on 5/15/17; changes are effective 7/1/17)

• Plan Year 2018 is 7/1/17 – 6/30/18
• Healthy Tomorrows Reporting Form and

Primary Care Physician designation are due 5/15/17 (PPB Plan policyholders only)

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PEIA Plan Changes

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Active State Employees

Coinsurance Structure Changes

In West Virginia Outside West Virginia with Approval from HealthSmart Outside West Virginia without Approval from HealthSmart Plan A 80/20 70/30 60/40 Plan B 70/30 65/35 50/50 Plan C High Deductible No Change No Change No Change Plan D 80/20 70/30 n/a *This includes network providers in contiguous counties of surrounding

• states. Members may still use those providers without prior approval, but

will pay the higher coinsurance amount for services. **** Emergencies Included on the higher amount if it is not pre-certified

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Increase deductible and out-of-pocket maximum amounts in PEIA PPB Plans A, B, and D

• Increase deductible by $200 single/

$400 family

• Increase out-of-pocket maximum by

$1,000 single/$2,000 family

Active State Employees

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Prescription changes:

• Implement mandatory 90-day prescription fill for

all maintenance medications

Example 1: Generic: Drug A Your cost is $20 (2 x $10 copayment for 90 day supply) Example 2: Preferred brand: Drug B Your cost is $50 (2 x $25 copayment for 90 day supply) Example 3: Non-preferred brand: Drug C costs $500 for 90 day supply Your cost is $500 x .75 = $375 Drugs on the maintenance medication list would not be covered in anything less than a 90-day supply.

Active State Employees

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Comprehensive Care Partnership

• CCP – Comprehensive Care Partnership

– program pairs members with primary care clinics around the state – CCP members pay reduced or no copayments for specified services at their chosen CCP provider – CCPs provide primary care, reminders about needed screenings, coordination with specialists, and patient management – Some CCPs also provide specialist services and labs

• CCP Assignments

– Starting March 1, if a member uses a CCP provider more than any other provider, but they haven’t chosen that provider as their CCP, PEIA will be automatically enrolling them as a member of the CCP, unless they

• pt out.

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2018 PEIA Healthy Tomorrow’s

• Plan Year 2018 (Phase 3) – due by May 15, 2017

– Chose a provider and meet measurement goals or have the waiver box signed by the doctor

• BP <140/90
• Cholesterol <245
• Glucose <125
• Waist Circumference (report only) Men <40,
• Women <35
• Additional $500 deductible for non-compliance.
• Biometrics collected between 4/2/16 – 5/15/17

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• PEIA Manage My

Benefits Login page

• First time users click

“Need to Register” to set up an account.

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Check Status of Healthy Tomorrows Form

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Plan Year 2019

• Begins 7/1/18
• Policyholders must submit Healthy

Tomorrows form for biometrics collected between 4/2/17 – 5/15/18

• If policyholders do not comply they will

face increased monthly premiums

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PEIA Partners with iSelectMD Telehealth

• Members connect with a physician via phone or video chat when they

have a non-emergent medical condition that needs treatment

• A physician will call back generally within 30 minutes
• iSelectMD physicians treat many non-emergent conditions, including:

– Sinus Infections – Bronchitis – Cold & Flu – Ear Infections – Urinary Tract Infections – Gastroenteritis – Sore Throat – Pink Eye and much more

• iSelectMD physicians can prescribe certain medicines, as needed

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iSelectMD for PPB Members

• Services

– For consultation with a state licensed/Board Certified Physician call 1-877-775-3006; $40 co-pay – WV Code is: WV1144 – Available anytime and anywhere 24/7 – Encourages everyone to have a PCP and does not replace an existing PCP. – Requires a Medical History Disclosure to be completed prior to the first consultation. This may be completed online at www.iSelectMD.com or by calling customer care at 1-877-775-3006 x3.

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Rx Savings Solutions

• New service is available April 1, 2017
• Website that members can use to save money on

prescriptions

• Rx Savings Solutions tracks prescription prices by

pharmacy, and can let members know when they can save money by choosing a different pharmacy

• The software analyzes data to find lower cost alternative

drugs that could save the member money

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Rx Savings Solutions is…

• Easy

– Clear cost comparisons – Basic healthcare terms – Phone, email or text notifications – Certified pharmacy tech support

• Safe

– Pharmacist designed and validated – Clinically trustworthy – HIPAA-compliant – Drug interaction awareness

• This service is available to members in PEIA PPB

Plans A, B, C and D.

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Rx Savings Solutions

• Access Rx Savings Solutions by logging into your

HealthSmart account at myhealth.healthsmart.com. Select Rx Savings Solutions from the menu.

• Need help with a prescription or the website?

The Rx Savings Solutions' Member Services department is available to answer questions M - F, 7am to 8pm CST. Email: info@rxsavingssolutions.com Phone: 1-800-268-4476

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Medical Benefit Changes Active State Employees

• Increased the number of outpatient procedures

subject to Facility Fee Limits. If the member chooses an out-of-state facility that charges more than the PEIA facility fee limit, the member will be responsible for the difference between PEIA’s payment and the facility’s charge.

• This will include bordering counties.

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Outpatient Procedures Subject to Maximum Facility Fees

See complete list in PEIA Shopper’s Guide

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The Health Plan

• PPO Plan C will ONLY cover generic

drugs at a $10 co-pay

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PEIA Reminders

• Changes only enrollment
• Submit changes online at

www.peia.wv.gov, click on “Manage My Benefits” or call PEIA to request a Transfer Form at 1-877-676-5573

• Check your tobacco status – update online
• r over the phone

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Mountaineer Flexible Benefits (FBMC)

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Mountaineer Flexible Benefits

• Open Enrollment Dates:

April 2, 2017 – May 15, 2017

• Changes Only Enrollment
• Enroll online via Premier Enroll

at MyFBMC.com or via FBMC paper enrollment form

• Benefit effective date July 1,

2017

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Mountaineer Flexible Benefits

• Dental
• Vision
• Short-Term Disability
• Long-Term Disability
• Hearing Plan
• Legal Plan
• Flexible Spending Accounts (Health Care & Dependent Care)

** DCFSA: Coverage extends to age 13, unless disabled

• Health Savings Account (HSA) (Must be enrolled in PEIA Plan C)
• Limited Health Care FSA (Must be enrolled in HSA)

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What’s New for Plan Year 2018

• If you do not make changes, your benefits will roll over and your

premiums will be adjusted to reflect any new rates.

• The dental rates for the Routine and Assistance Plans are slightly
• increasing. The Basic and Enhanced Plans are remaining the

same.

• The Hearing Plan rates are slightly increasing and the benefit

allowance is now $500 per ear per device.

• The Health Care FSA, Dependent Care FSA, Health Savings

Account and Limited Health Care FSA are now administered by PayFlex.

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What’s New for Plan Year 2018

• The Health Care FSA & Limited Health Care FSA minimum annual

contribution is now $150 and the maximum annual contribution increased to $2,600.

• Mountaineer Flexible Benefits will maintain the grace and run-out

period.

• Individual HSA contribution limit is $3,400 per year.
• The HSA custodian fee will decrease to $2.50.
• Employees should exhaust their FSA balance with WageWorks by

the end of the grace period (September 15, 2017).

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Enrollment Form

 Open Enrollment  New Hire  Transfer  Change in Status

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MyFBMC.com Registration

• Employees that have not previously enrolled on

Premier Enroll will need to register as a new user

• Employees should use their SSN for the first

registration

• An email will be sent to participants to

validate registration

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Online Enrollment Confirmation Statement

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Things to Consider/ Reminders

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Long Term Disability – Things to Consider

• Premiums are based on age and salary of

employee.

• Premiums increase every 5 years (as age

and salary increase).

• LTD insurance is not a lifetime benefit.

Benefits end as of age 70.

• Do you know how much you are paying

each month?

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TIAA - Things to Consider

• If you haven’t looked at your retirement

investments in the last 5 -10 years, please take the time to do so!

• Life Cycle Funds became available

approximately 7 years ago.

• This product uses targeted retirement dates

to direct investments in a diversified portfolio.

• Changes can be completed online or by

calling TIAA at 800-842-2273.

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Reminder – Beneficiary Designations

• Please remember to keep your beneficiary

designation(s) current!

• Life events may affect how you want your

benefits paid.

• If you can’t remember, it is always best to

complete a new form/go online, as information is likely outdated.

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Reminder – Beneficiary Designations

• Designations should be made for Basic and

Optional Life Insurance.

• Primary Beneficiary(ies) – The person or

persons named will receive the proceeds.

• Contingent (Secondary) Beneficiary(ies) – At

the time of your death, if the primary beneficiary(ies) is no longer living, the benefit is paid to this person or persons.

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Reminder – Beneficiary Designations

• Default Beneficiary(ies) – If a beneficiary is not

named, proceeds will be paid in the following

• rder:

– to a spouse, if living, if not; – to child(ren), if living, if not; – to parent(s), if living, if not; – to siblings, if living, if not; – to your estate

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Beneficiary Changes

• Two options for updating beneficiary

information with PEIA:

– Go to www.peia.wv.gov and select “Manage My Benefits” – Complete Basic and/or Optional Life Beneficiary Change paper form

• Remember to update beneficiaries with

your retirement vendor (TIAA or Empower)

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Questions?