School Employees Benefit Board (SEBB) Fall 2019 Upcoming Health - - PowerPoint PPT Presentation

School Employees Benefit Board (SEBB)

Fall 2019

Upcoming Health Benefit Changes

• Medical
• Dental
• Vision
• Long-term disability (LTD)
• The School Employees Benefits Board (SEBB) of the Washington State Health

Care Authority (HCA) will manage the program

• Districts are required to be part of SEBB and are no longer able to offer their
• wn benefit plans
• Districts may offer limited optional supplemental benefits
• SEBB coverage begins January 1, 2020

The State will now manage health benefits for all school districts, ESDs and Charter Schools

• Flexible spending accounts (FSA)
• Dependent care assistance program (DCAP)
• Life and Accidental Death &

Dismemberment (AD&D)

Why SEBB?

• Standardize benefits, rules, and costs
• Transparency and accountability in state

expenditures for school employee benefits

• Provide health benefits to more people
• Reduce the cost of health benefits for school

employees

• Consolidate collective bargaining for school

employee benefits

Am I Eligible?

• Employees will be eligible on 1/1/20 if:
• They have a 630-hour or more contract with the Pasco School

District.

• If not initially eligible as listed above, employees will be

eligible when:

• They reach 630 work hours (hours worked accumulate

beginning 9/1/19)

• Letters will be sent to each employee stating their

anticipated eligibility status

Medical Plans

Amounts will be withheld from your paycheck starting January 31, 2020 District pooling and benefit allotments end as of 12/31/19 Employee Cost

Employee Employee & Spouse Employee & Child(ren) Full Family

Kaiser Permanente WA Core 1

$13.00 $26.00 $23.00 $39.00

Kaiser Permanente WA Core 2

$19.00 $38.00 $33.00 $57.00

Kaiser Permanente WA Core 3

$89.00 $178.00 $156.00 $267.00

Premera High PPO

$70.00 $140.00 $123.00 $210.00

Premera Standard PPO

$22.00 $44.00 $39.00 $66.00

UMP Achieve 1

$33.00 $66.00 $58.00 $99.00

UMP Achieve 2

$98.00 $196.00 $172.00 $294.00

UMP High Deductible

$25.00 $50.00 $44.00 $75.00

Surcharges* Tobacco Surcharge

$25.00 $25.00 $25.00 $25.00

Spousal Surcharge

$50.00 $50.00 $50.00 $50.00 *Employees may be subject to the above surcharges

Plans shown are those available in Benton and Franklin Counties

Core 1 Core 2 Core 3

Provider Network

Core HMO Core HMO Core HMO

Deductible Individual $1,250 $750 $250 Family $3,750 $2,250 $750 Coinsurance 20% 20% 20% Medical Out-of-pocket Maximum Individual $4,000 $3,000 $2,000 Family $8,000 $6,000 $4,000 Primary Care/Specialty Care $30 / $40 Copay $25 / $35 Copay $20 / $30 Copay Diagnostic Lab & Imaging 20% over $500 20% over $500 20% After Deductible Inpatient Services 20% After Deductible 20% After Deductible 20% After Deductible Ambulance 20% After Deductible 20% After Deductible 20% After Deductible Emergency Room $150 + 20% After Ded. $150 + 20% After Ded. $150 + 20% After Ded. Urgent Care $30 Copay $25 Copay $20 Copay Spinal Manipulations $30 Copay $25 Copay $20 Copay Mental Health Office Visit $30 Copay $25 Copay $20 Copay Outpatient Rehab (PT,OT,ST) $40 Copay $35 Copay $30 Copay Prescription Drugs RX Deductible (Individual/Family) $0 /$0 $0 /$0 $0 / $0 RX Out of Pocket Maximum Combined w/ Medical Combined w/ Medical Combined w/ Medical Value NA NA NA Generic $5 Copay $10 Copay $10 Copay Preferred Brand $25 Copay $25 Copay $25 Copay Non-preferred Brand $50 Copay $50 Copay $50 Copay Specialty 50% up to $150 50% up to $150 50% upto $150

Kaiser Permanente Medical Plans

(True HMO Plan, Requires Referrals from PCP, No Out of Network Benefits)

This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board. TRIOS is out of Network for this provider.

This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board. Kadlec, Lourdes, & TRIOS are in network for these plans.

Uniform Medical Plans – Regence Blue Shield

(Largest PPO Network)

Achieve 1 Achieve 2 High Deductible UMP Plus**

Provider Network

Regence Blue Shield Regence Blue Shield Regence Blue Shield Regence Blue Shield

Deductible-Medical Yakima Co. ONLY Individual $750 $250 $1,400 $125 Family $2,250 $750 $2,800 $375 Coinsurance 20% 15% 15% 15% Medical Out-of-pocket Maximum Individual $3,500 $2,000 $4,200 $2,000 Family $7,000 $4,000 $8,400 $4,000 Primary Care/Specialty Care 20% After Deductible 15% After Deductible 15% After Deductible $0 Copay/15% After Ded. Diagnostic Lab & Imaging 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible Inpatient Services $200 / Day to $600+20% $200 / Day to $600+ 15% 15% After Deductible $200 / Day to $600 + 15% Ambulance 20% After Deductible 20% After Deductible 20% After Deductible 20% After Deductible Emergency Room $75 + 20% After Ded. $75 + 15% After Ded. 15% After Deductible $150 + 15% After Ded. Urgent Care 20% After Ded. 15% After Ded. 15% After Deductible 15% After Deductible Spinal Manipulations 20% After Ded. 15% After Ded. 15% After Deductible 15% After Deductible Mental Health Office Visit 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible Outpatient Rehab (PT,OT,ST) 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible Prescription Drugs RX Deductible(Individual/Family) $250 / $750* $100 / $300* Combined w/ Medical $0 / $0 RX Out-of-Pocket Maximum $2,000 / $4,000 $2,000 / $4,000 Combined w/ Medical $2,000 / $4,000 Value 5% up to $10 5% up to $10 15% After Deductible 5% up to $10 Generic 10% up to $25 10% up to $25 15% After Deductible 10% up to $25 Preferred Brand 30% up to $75 30% up to $75 15% After Deductible 30% up to $75 Non-preferred Brand NA NA NA NA Specialty 30% up to $75 30% up to $75 15% After Deductible 30% up to $75

* Prescription Deductible waived for Generics ** UMP Plus Requires referrals from a PCP and has no out of network benefits for non-emergency care.

This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board.

High PPO Standard PPO Provider Network PRIME PRIME Deductible Individual

$750 $1,250

Family

$1,875 $3,125

Coinsurance

25% 20%

Medical Out-of-pocket Maximum Individual

$3,500 $5,000

Family

$7,000 $10,000

Primary Care/Specialty Care

$20 / $40 Copay $20 / $40 Copay

Diagnostic Lab & Imaging

25% After Ded. 20% After Ded.

Inpatient Services

25% After Deductible 20% After Deductible

Ambulance

25% After Deductible 20% After Deductible

Emergency Room

$150 + 25% After Ded. $150 + 20% After Ded.

Urgent Care

25% After Ded. 20% After Ded.

Spinal Manipulations

25% After Ded. 20% After Ded.

Mental Health Office Visit

$20 Copay $20 Copay

Outpatient Rehab (PT,OT,ST)

$40 Copay $40 Copay

Prescription Drugs RX Deductible (Individual/Family)

$125 / $312 $250 / $750*

RX Out of Pocket Maximum

Combined w/ Medical Combined w/ Medical

Value

NA NA

Generic

$7 Copay $7 Copay

Preferred Brand

$30 Copay 30%

Non-preferred Brand

30% 50%

Specialty

$50 Copay 40%

* RX Deductible is waived for Generic Drugs

Premera Blue Cross Medical Plans

(Kadlec Hospital is out of network)

Dental Plans

This is a summary, and is not inclusive of all covered services. Figures shown are subject to legislative funding and final decisions by the SEB Board. Benefit Uniform Dental Delta Care Willamette Annual Maximum $1,750 No Maximum No Maximum Annual Deductible $50 Ind / $150 Family $0 $0 Preventive Visits 0% 0% 0% Basic Services Fillings 20% $10 - $50 Copay $10 - $50 Copay Root Canals 20% $100 - $150 Copay $100 - $150 Copay Oral Surgery 20% $10 - $50 Copay $10 - $50 Copay Major Services Crowns 50% $100 - $175 Copay $100 - $175 Copay Orthodontia 50% of $1,750; Then remainder of cost over $1,750 $1,500 per case $1,500 per case

Vision Plans

This is a summary, and is not inclusive of all covered services. Figures shown are subject to legislative funding and final decisions by the SEB Board.

Benefit Davis Vision EyeMed MetLife

Routine Eye Exam

(1 Per Calendar Year)

$0 $0 $0 Lenses

(Every 24 Months)

$0 $0 $0 Progressive Lenses

(Every 24 Months)

$50 - $140 $55 - $175 $0 - $175 Conventional Contacts $0 of First $150; Then 85%. $0 of First $150; Then 85%. $0 of First $150; Then 100%. Disposable Contacts Up to 4 Boxes $0 of First $150; Then 100%. $0 of First $150; Then 100%. Frames

(Every 24 Months)

$0 of First $150; Then 80%. $0 of First $150; Then 80%. $0 of First $150; Then 80%.

Employer Paid Life MetLife Basic Benefit $35,000 Accidental Death & Dismemberment $5,000 Benefit Employee Spouse Child

Employee Paid Supplemental Life Benefit Increments $10,000 $5,000 $5,000 Benefit Maximum $1,000,000 Up to 50% of Employee Election $20,000 Guarantee Issue – No Health Questions (Children from 2 weeks old to age 26) $500,000 $100,000 $20,000 Employee Paid Supplemental AD&D Benefit Increments $10,000 $10,000 $5,000 Benefit Maximum $250,000 $250,000 $25,000 Guarantee Issue $250,000 $250,000 $25,000 * Supplemental Life and AD&D Rates are based on age and tobacco use.

SEBB Life and Supplemental Life Insurance

MetLife

SEBB Long-term Disability

Standard Insurance

Employer Paid Basic Long Term Disability Standard

Benefit Elimination Period 90 Days or when Family/Medical Leave Ends (Whichever is longer) Maximum Monthly Benefit $400 Benefit Duration Based on Age when Disability Begins

Employee Paid Supplemental Long Term Disability Standard

Monthly Benefit 60% of Pre-disability Earnings Maximum Monthly Benefit $10,000 (60% of $16,667 of Earnings) * Supplemental Long Term Disability Rates are based on your age as of January 1, 2020.

Which plan is right for me?

ALEX will:

• Ask questions about how you use benefits
• Based on your responses*, ALEX will make suggestions about

which plans might be best for you to consider

• Help you understand your benefits
• Be available October 3rd

*Your responses to ALEX are private and confidential

SEBB has purchased an online benefits advisor tool called ALEX.

Default Enrollment

• If you don’t enroll during open enrollment SEBB will

default you to the following selections:

• Employee enrolled as a single subscriber with:
• Uniformed Medical Plan Achieve 1
• Uniform Dental Plan
• MetLife vision
• Basic Life and AD&D
• Basic LTD
• Tobacco use premium surcharge incurred ($25)
• Total cost to employee $33 + $25 = $58

Default Enrollment

• An employee who defaults will not be allowed to:
• Enroll dependents
• Select Medical Flexible Spending Arrangement (FSA)
• Select Dependent Care Assistance Program (DCAP)
• Make plan selection changes until:
• Next annual open enrollment
• Or experiences a Special Open Enrollment (SOE)

event

Waiving Enrollment

• A school employee may waive SEBB medical if enrolled in:
• Other employer – based group medical insurance
• TRICARE
• Medicare
• A school employee who waives enrollment in SEBB medical

must enroll in:

• Dental
• Vision
• Basic life & AD&D
• Basic LTD
• You can not waive medical if enrolled in Medicaid
• To waive medical you must do so in the SEBB My Account
• nline system

Eligible Dependents

• Legal spouse
• State-registered domestic partner (SRDP)

Defined in RCW 26.60.020 (1)

• Child(ren) up to age 26

Child, step child, legally adopted child, etc.

• Extended dependents

Grandchild, niece, nephew, etc. with legal custody or guardianship

• Disabled dependents

Children age 26 or older – Disability occurred before age of 26 (if you have already filled out this paper within the last few years, you can work with the payroll office so you don’t have to redo the paperwork)

Required Forms & Dependent Verification

Spouse

Most recent year’s Federal Tax Return, or Marriage Certificate, and Proof of common residence, or Proof of financial interdependency

Children up to age 26

Most recent year’s Federal Tax Return, or Birth Certificate

State-registered Domestic Partner

Certificate of state-registered domestic partnership, and Proof of common residence, or Proof of financial interdependency

Extended Dependent

Extended Dependent Certificate form, and Court order Serves as DV Dependent must reside with subscriber

Disabled Dependent

Certificate of a Child With a Disability form

ALL dependent documentation must be verified by PSD no later than November 15th

Additional Resources

WE ARE PASCO!

• School Employee Initial Enrollment Guide
• SEBB My Account Introduction Video
• Pasco School District SEBB Webpage
• Pasco School District Benefits App
• Washington Health Care Authority Website

PSD’s Benefits App

Text “Pasco” to 36260 to get the App!

Questions?

WE ARE PASCO!