Pike County School Corporation 2019 Medical Benefits Open Enrollment
2 2019 MEDICAL OPEN ENROLLMENT Welcome to Open Enrollment We understand that balance must be individualized. What is right for one person may not be appropriate for another. It is our goal to offer choices allowing you to tailor your benefits plan specifically to what is best for you and your family members. Who is Eligible Full time employees who work 30 hours per week are eligible for benefits. Spouses and/or children of employees are also eligible for medical coverage, when the employee elects coverage.
3 2019 MEDICAL OPEN ENROLLMENT When to Enroll Medical benefits chosen are in effect from January 1, 2019 – December 31, 2019. Open enrollment for medical benefits for 2019 is Monday, November 5 th – Friday, November 16 th . Election forms must be returned to Chelsea Yon by 5pm. on Friday, November 16 th . If election form is not received, current medical and vision coverage elections will carry over from 2018. Once you have made your elections, you will not be able to change them unless you have a qualified change in status. • Qualified changes in status include: marriage, divorce, legal separation, birth or adoption of a child, change in child’s dependent status, death of spouse, child or other qualified dependent, commencement or termination of adoption proceedings, or change in spouse’s benefits or employment status.
4 WHAT DETERMINES PREMIUMS? • As with any insurance CLAIMS affect future premiums • Our claims come from: • Office (dr) visits • Hospital charges/surgeries/lab work • Tests • Drugs • These claims are influenced by: • Age • Lifestyle • Physical Condition • Use of coverage (ER vs. After hours) • High Priced drugs • Inflation • Future expectations of our use & inflation trends
5 CHANGING / NOT CHANGING What Isn’t Changing? • Saying with Anthem (same network) • Same plans • Preventive Care Covered at 100% • Vision is still with VSP • No rate increase for employees
6 TWO PLANS TO CHOOSE FROM HDHP Plan Copay Plan Services In Network In Network Deductible $3,000 $750 ● Individual $6,000 $2,250 ● Family Co-Insurance 100% / 0% 80% / 20% (Plan / Employee) Out of Pocket Max $4,000 $3,000 ● Individual $8,000 $6,000 ● Family Physician Visit Deductible $30 Copay Specialist Visit Deductible $50 Copay Preventive Care Paid at 100% Paid at 100% Emergency Room Deductible $250 Copay then 20% Urgent Care Deductible $75 Copay Prescription Drugs Retail Mail Order Retail Mail Order ● Tier 1 $10 Copay $10 Copay $10 Copay $10 Copay ● Tier 2 $30 Copay $75 Copay $30 Copay $75 Copay ● Tier 3 $60 Copay $180 Copay $60 Copay $180 Copay ● Tier 4 20% w/ $200 max 25% up to $250 25% up to $150 25% up to $150
7 HEALTH SAVINGS ACCOUNT (HSA) Can ONLY be paired with a CDHP (Core) Owned by YOU! Can be funded by the employee AND the employer You can contribute up to $3,450 single or $6,900 for a family PRE-TAX – You may change the amount during the year Funds automatically rollover to the next plan year…it’s your money! All healthcare, vision and dental expenses are reimbursable. Qualified expenses determined by IRS. Automatic Enrollment annually after initial enrollment. Can use as a secondary source of retirement savings. (IF you use for something other than medical expenses, you get charged taxes + a 20% penalty)
8 HEALTH SAVINGS ACCOUNT (HSA) IRS 213(d) services qualify for tax-exempt distributions from an HSA. This includes items that are qualified under a Flexible Spending Account. • Deductibles • OTC Medication** * Items are eligible for reimbursement even if they • Lab work • Contact Lenses* are not eligible to be applied • Surgeries • Ambulance to the Qualified Health Plan Deductible. • Prescriptions • Chiropractor ** With a prescription only • Vision services* • Hearing Aids * • Dental services* • Orthodontia* • Bandages** • Wigs
9 PAYROLL DEDUCTIONS Medical Semi-Monthly Rates for 2019 Plan Type Employee Only Employee & Family Core Plan (HDHP) $18.40 $41.81 Buy-Up Plan (PPO) $87.45 $230.68 Per Pay Difference $69.05 $188.87 Annual Difference $1,657.20 $4,532.88 Potential HSA Funding $1,657.20 $4,532.88
10 ANTHEM.COM / MOBILE APP • Personalized Account Summary • View Plans and Benefits • Research Conditions • Access Discount Programs • Search for Providers • Access Express Scripts • View ID Cards
11 ANTHEM PROGRAMS 24/7 NurseLine Offers members access to trained registered nurses any time of the day or night. Toll-free at 1- 888-279-5449 to get information & support when you need it MyHealth@Anthem Provides access to tools such as the Health Risk Assessment & Personal Health Record to help members take charge of their own health ConditionCare Addresses chronic conditions such as asthma, COPD, diabetes, and so on with coaching & self- management tools ComplexCare Proactively engages members with multiple health issues to maximize the member’s health & reduce hospitalizations & costs associated with illness Future Moms Provides individualized support to expectant moms to achieve healthier pregnancies & deliveries
12 LIVE HEALTH ONLINE See a doctor from the comfort of your home: • A vailable in most states, including D.C.* • A vailable 24 hours a day, 7 days a week, 365 days a year • A vailable anywhere you have a computer or mobile device with Internet access(at home, in the office or on the go) • Provides access to in -network, board-certified doctors and licensed behavioral health professionals • Allows doctors to ePrescribe utilizing local pharmacies • Takes member payments via Visa, MasterCard, American Express and Discover • Is secure, convenient and easy to use
13 VITALS SMART SHOPPER Earn money for procedures that you were already planning. SmartShopper pays incentives for completing procedures , such as: Lab work SAMPLE INCENTIVES Mammograms Colonoscopies Bone Density Scans Hip Replacement MRI CT Scan MRI = $150 Knee Surgery = $250 Ultrasound CT Scan = $150 Upper GI exam … and more
14 VITALS SMART SHOPPER How fast can you earn up to $500? How about less than 5 minutes? Visit vitalssmartshopper.com (you‘ll need your Anthem ID card) or call 1.800.824.9127
15 RX HELP CENTERS Announcing a New Health Benefit Designed To Help You Save on Prescriptions….A Concierge Prescription Drug Advocacy Service called RX Help Centers. • Does not replace your current Rx Plan • Helps save on high cost brand and specialty medications • No cost to members on the health plan • You will receive a link customized to PCSC in late December Example: Current Out of With RxHC Savings Pocket Cost Assistance Jack $1,607 $884 45% Jill $2,424 $1,690 30% Joe $4,500 $0 Can’t beat FREE rxhelpcenters.com / (866)478-9593
16 CONSUMER TIP Shop online for medication pricing options at Goodrx.com
17 VOLUNTARY VISION BENEFIT Services In-Network Benefits* Frequency Vision Exam $10 Copay Every 12 months Lenses (Single, Bifocal, $25 Copay Every 12 months Trifocal, Lenticular) Frames $25 Copay Every 24 months Elective Contact Lenses Up to $130 benefit in lieu of glasses Every 12 months *Copay applies to a complete pair of glasses or to frames, whichever is selected Your Cost Per Pay Employee $4.22 Employee/Spouse $9.10 Employee/Child(ren) $7.36 Family $12.24 * - VSP Network
18 CONSUMER TIP Vision – zennioptical.com Glasses as low as $6.95 • Upload your prescriptions • Upload a photo •
19 NEXT STEPS Complete Your Election Form Open enrollment for medical benefits for 2019 is Monday, November 5 th – Friday, November 16 th . Election forms must be returned to Chelsea Yon by 5pm. on Friday, November 16 th .
20 QUESTIONS? Beth Hancock Phone: (812) 461-9023 Email: tamika.wilson@onirisk.com Ben Schmitt Phone: (812) 464-1444 Email: ben.schmitt@onirisk.com Calvin Conerly Phone: (317) 706-9512 Email: calvin.conerly@onirisk.com
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