Spring 2020 Presenters VACORP Stephanie Heintzleman, Member - - PowerPoint PPT Presentation
Hybrid Disability Boot Camp Spring 2020 Presenters VACORP Stephanie Heintzleman, Member Services Director OneDigital Nancy Grasso, Regional Vice President Business Development Carrie Bartlett, Senior Client Executive Anthem Michael
Hybrid Disability Boot Camp Spring 2020
Presenters
VACORP Stephanie Heintzleman, Member Services Director OneDigital Nancy Grasso, Regional Vice President Business Development Carrie Bartlett, Senior Client Executive Anthem Michael D’Achille – Director Specialty Sales, Virginia Alex Balasco – Specialty Sales Executive
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What We’re Going to Discuss
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VACORP.org/hybrid-disability
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Continued Training & Additional Resources
⎻ Each month, a popular question or important information is included on the monthly billing statement from VACORP. A repository of these questions is housed on the VACORP website and is updated quarterly.
⎻ Boot Camps provide basic training on the Hybrid Disability plan. Perfect for new hires involved with Hybrid Plan administration, for entities with little exposure to Hybrid claims, and for groups that haven’t attended a Regional Workshop or had a training session with the Anthem account specialist.
⎻ The Anthem account specialist is available for personalized training, either by conference call or in
Camp or Regional Workshop, or with turnover in key HR positions. Training sessions last one to two hours and may be customized to focus on the specific training needs of an employer.
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Hybrid Disability Contacts
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Short-Term Disability Claims Manager Short-Term Disability Claims Team Lead Dottie Tieslau - Interim Ton Albritton Dorothy.Tieslau@anthem.com Tondelayo.Albritton@anthem.com O: 404-682-9267 O: 800-232-0113 ext. 102 135 5075 Groups A-C Groups D-N Nicole Timmons, STD Case Manager James Perryman, STD Case Manager Nicole.Timmons@anthem.com James.Perryman@anthem.com O: 800-232-0113 ext. 102 135 5090 O: 800-232-0113 ext. 102 135 6033 Groups O-R Groups S-Z Vanessa Hayes, STD Case Manager Paige Blakely, STD Case Manager Vanessa.Hayes@anthem.com Paige.Blakely@anthem.com O: 800-232-0113 ext. 102 135 6640 O: 800-232-0113 ext. 102 135 6761
OUT UNTIL FURTHER NOTICE
Sian Ramsey – Specialty Account Manager vacorpservice@anthem.com
Communication with VACORP & OneDigital
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Best Practices
sender list
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When Mailing Payment
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When paying by ACH
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Claims Update
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STD Claims Submitted in 2019
before absence
Days – Average claim decision time
Average days out for STD Claims
into medical information*
referred to medical
5 year rate guarantee
*Not all entities or employees are covered by Anthem medical. This percentage includes non-Anthem covered entities.
Top 10 STD Claims for VACORP Hybrid Disability
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Diagnostic Category VACORP Claims IBI Claims Pregnancy 47.5% 21.0% Musculoskeletal 13.8% 22.9% Neoplasm (cancer) 8.6% 6.4% Injury and Poisoning 5.9% 12.0% Digestive System 5.4% 7.0% Mental Disorders 4.7% 7.3% Respiratory System 3.0% 2.6% Genitourinary System (reproductive and urinary system) 2.9% 5.2% Circulatory System 2.9% 4.9% Nervous System 2.7% 3.0%
SIC code
Virginia, established in the Code of Virginia.
the regulations as presented in the legislation.
has some enhancements to the mandated benefits.
2024
program, including rate information do not affect this program
Hybrid History
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Hybrid Disability Program Review
depending on VRS tenure
coverage
Disability
Short Term Disability
benefit
Long Term Disability
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Short Term Disability
Non-occupational disabilities are covered on the day following the completion of 12 months of continuous service with the employer as long as the employee is capable
Benefits begin on the first work day after a 7 Calendar Day waiting period and are payable for up to 125 work days, based upon the nature of the disability. What is the benefit? For Non-Occupational Disabilities
Months of Continuous Participation Work days of 100% Replacement of Creditable Compensation Work days of 80% Replacement of Creditable Compensation Work days of 60% Replacement of Creditable Compensation Fewer than 12 12-59 125 60-119 25 25 75 120-179 25 50 50 180 or more 25 75 25
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1. Many ways to submit claim: email, mail, fax, submit online, or by phone 2. Telephonic or Online claims are preferred for maximum efficiency and quickest adjudication!
claim submission OR emailed to LDClaims mailbox
completion
Anthem will gather the rest!
advance
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Eligibility Template
Please send the following eligibility information: PLEASE ONLY RESPOND TO THOSE QUESTIONS THAT ARE HIGHLIGHTED
number of hours worked on date last worked: ____________________________
Hybrid Disability Plan offered by Anthem Life: yes or no
If yes, please provide contract dates below: Current contract start date: ________________________________________ Current contract end date: _________________________________________
10. Standard work week hours:__________________________________________ 11. Please provide the employee’s normal “days off” during the week - highlight the off days: Monday Tuesday Wednesday Thursday Friday Saturday Sunday 12. Is claim work related: yes or no
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Short-Term Disability: Submit a claim
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Submit Claim ✓ Employees submits a claim ✓ Human Resources emailed automatically upon claim notification Receive Claim Packet ✓ A welcome letter ✓ A Release of Information form (STD) ✓ Resource Advisor brochure ✓ Employer-specific information Designated Disability Case Manager Assigned The Disability Case Manager develops ongoing relationship with employees and human resources staff to create custom action plans and explore return-to-work opportunities. Customer Service
Filing a Claim: By Phone
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Filing a Claim: Online
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Employer Portal
✓ View Claims and Status ✓ Upload documentation with initial claim submission ✓ Claims uploaded and available for status view within 24 hours ✓ ASO Reports available ✓ Custom reports available
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Advice to Pay Report for Client Name
KIA MOTORS MANU
Client Number
GA1986
Period:
09/12/2019 through 10/02/2019
Sub Group Name
KIA MOTORS MANU
Sub Group Number
0000GL0000
Generated:
10/02/2019 9:07:28 AM Group Number Subgroup Number CLASS Class Description Claim Number Employee SSN EMPLOYEE ID Claimant Last Name Claimant First Name First Day Absent Date Claim Incurred Benefit Start Date Authorization Date Reversal Date GA1986 0000GL0000 01 Salaried Team Members ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Members ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Members ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Members ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Members ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019 GA1986 0000GL0000 01 Salaried Team Members ST00756638 344234214 123456 BLACKBURN MAGGIE 07/15/2019 07/14/2019 07/15/2019 09/23/2019
PAYREVSTATUS Pay From Pay Thru Authorization Type Authorization Stat Case Status Remaining Time Benefit End Date RTW Authorized Thru Date N 09/16/2019 09/19/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 09/09/2019 09/15/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 09/02/2019 09/08/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 08/26/2019 09/01/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 08/19/2019 08/25/2019 Medical APPROVED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019 N 07/14/2019 08/18/2019 Medical DENIED OPEN 3 WEEKS 2 DAYS 10/12/2019 09/19/2019
Advice to Pay Report SAMPLE
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Claim Report SAMPLE
If blank…
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Long Term Disability
review so the employer or employee doesn’t need to
⎻ SSNRA if less than age 60 ⎻ 5 years ages 60-64 ⎻ To age 70 if 65-68 ⎻ 12 months if age 69 or greater
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No claim form
✓
Long Term Disability – 1% Pension Contribution to VRS
has been approved for Social Security Disability, Anthem calculates the additional benefit due for the Pension Benefit Rider
Benefit (including any retroactive benefit in the first payment)
entity
⎻ notifies the LTD claimant of the additional benefit made payable to the entity on their behalf to be applied to their VRS Pension account ⎻ indicates the amount and the anticipated duration of the monthly Pension Benefit ⎻ explains the amount of any retroactive payment, as applicable ⎻ directs the claimant to contact the entity for details on how/when the payment is applied to their VRS account
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DELIVERING COMPLIANCE CONFIDENCE
FMLA is a federal law that requires employers to grant leave for family and medical circumstances and to reinstate the employee in the same or an equivalent position upon conclusion of the leave. Employee may use up to 12 weeks of FMLA leave in a 12-month period. (480 hours) Employee may use up to 26 weeks in a single 12-month period for if military personnel active duty (current or pending).
An employee is eligible for FMLA leave when:
❑ he or she has been employed by a covered employer for at least 12 months; ❑ has worked at least 1,250 hours during the 12 months before the start of FMLA leave; and ❑ is employed at a worksite where 50 or more employees work within 75 miles of that worksite.
DELIVERING COMPLIANCE CONFIDENCE
Qualifying for FMLA For the birth of a child and to care for the newborn child For placement of a child for adoption or foster care To care for spouse, child or parent with a serious health condition An employee’s serious health condition Qualifying exigency from the employee’s spouse, child or parent, a military member covered active duty
(including notification of an impending call
To care for a covered service member with a serious injury
*DISABILITY BENEFIT*
DELIVERING COMPLIANCE CONFIDENCE
Qualifying for FMLA
to perform the functions of the employee’s job (up to 12 weeks of leave in a 12-month period):
involves inpatient care or continuing treatment by a health care provider which may include:
medical care facility.
in a period of incapacity and needed follow-up treatment
visits must take place at least twice a year
DELIVERING COMPLIANCE CONFIDENCE
Time Period
Calendar Year Any Fixed 12- Month Leave Period 12-Month Period Starting
Employee’s First FMLA Leave Rolling 12- Month Period Preceding Date Employee Uses Any FMLA Leave
You Choose: Intermittent FMLA Leave
FMLA may be taken intermittently or
for events Requiring Employer Approval: Birth or placement for adoption or foster care of a child *Closed Holidays – do not count towards days unless scheduled to work
DELIVERING COMPLIANCE CONFIDENCE
Chronic Conditions – disease or disorder:
periods of incapacity;
lifetime; and
complications from treatments or medications.
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Mercer Survey on Absence and Disability Management, 2013 Survey Report. HR Daily Advisor; Powered by BLR: https://hrdailyadvisor.blr.com/2014/02/26/chronic-conditions-frustrating-annoying-yes-but-you-must-accommodate/
DELIVERING COMPLIANCE CONFIDENCE
Examples of Chronic Conditions that are likely Disabilities
arthritis, fybromyalgia, or lupus)
episodic)
term usage of prescribed medications)
complications)
medications taken for a long term for chronic conditions)
severe acid reflux)
products
fluctuations (physical or emotional)
latex, etc.)
(bipolar or schizophrenia)
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HR Daily Advisor; Powered by BLR: https://hrdailyadvisor.blr.com/2014/02/26/chronic-conditions-frustrating-annoying-yes-but-you-must-accommodate/
Partial Disability
unable to earn 80% of predisability earnings
disability
⎻ Physician will provide parameters (days per week, hours per day, etc)
⎻ If the injury or illness results in additional absence after 45 days of working, a new claim will be filed and the elimination period starts over again even if it is the same condition/illness. ⎻ If the injury or illness results in additional absence before 45 days of working, the claim will continue.
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Leave Without Pay (LWOP)
compensation.
during the time in which they are on leave UNLESS the employee is on FMLA, STD or approved leave without pay that is shorter than 30 days.
you should include them on your VRS report/snapshot and include them in the numbers submitted on the VACORP monthly self-report remittance.
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Workers Compensation & Disability
benefit.
submitted an STD claim and it was approved. What do we do?
⎻ The disability claim may be approved, but because of the offset, no STD benefit should be paid.
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Workers Compensation & Disability
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Example: Sandra was hired 1/1/2014. She has 74 months of service and her first 85 days are paid at 100%.
Occupational Disabilities
Benefits begin on the first work day after a 7 Calendar Day waiting period and are payable for up to 125 work days, based upon the nature of the disability. What is the Benefit? Short Term Disability
Months of Continuous Participation Work days of 100% Replacement of Creditable Compensation Work days of 80% Replacement of Creditable Compensation Work days of 60% Replacement of Creditable Compensation Fewer than 60 125 60-119 85 25 15 120 or more 85 40
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Occupational Disabilities
During the employee’s first 60 Months of Continuous Participation, several questions need to be asked in order to determine if a Short Term Disability (STD) claim should be filed along with the Workers Compensation (WC) claim Occupational Disabilities are covered from the first day of Hybrid employment
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Occupational Disabilities
During the employee’s first 60 Months of Continuous Participation, several questions need to be asked in order to determine if a Short Term Disability (STD) claim should be filed along with the Workers Compensation (WC) claim Occupational Disabilities are covered from the first day of Hybrid employment
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$1,102
COVID-19 / Coronavirus
⎻ Must have documentation by physician ⎻ Employee must meets the seven day waiting period ⎻ Disability could include a doctor-ordered quarantine
⎻ Order of isolation from a state or federal government public health official or agency
⎻ Disability benefits would not be applicable
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Employee Electronic Documents Template
Suggested Methods of Distribution:
Dear Hybrid Plan Employee: VACORP Hybrid Disability Plan offered by AnthemLife provides some income protection if you can’t work because of physical disease, mental disorder, injury or pregnancy. You are enrolled in this program because your employer opted out of the state disability program. The VACORP Hybrid Disability Plan offered by AnthemLife is comparable and meets all requirements of Title 51.1 of the Code of Virginia. The hyperlinks provided below will take you directly to important documents regarding your VACORP Hybrid Disability Plan, including an Employee Handbook, FAQ and Certificates of Coverage. We encourage you to save this email that includes the hyperlinks so you will have direct access to current contractual information. If you have questions, please contact your Benefit Administrator VACORP Hybrid Disability Coverage Document Name Click Below for Document Employee Handbook Employee Handbook Employee FAQ Employee FAQ STD Benefits at a Glance STD Benefits at a Glance STD Certificate of Coverage STD Certificate of Coverage LTD Benefits at a Glance LTD Benefits at a Glance LTD Certificate of Coverage LTD Certificate of Coverage Reporting Claims Via Phone Reporting Claims Via Phone Reporting Claims Online Reporting Claims Online Employee Assistance Anthem Resource Advisor Benefits Perks at Anthem
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Resource Advisor Program
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Valuable extras for members, at no additional cost
Counseling and consultations › Online thru LiveHealth Online › 24/7 toll-free phone consultations › Three face-to-face counseling sessions › Unlimited legal and financial consultations Resource Finder › Online provider database for child and elder care › College locator › Library of practical information Online services, tools and resources › Identity theft services › Debt and credit management › Investment planning › State-specific and living wills
Perks at Work
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Discounts on goods and services you use every day like:
ClassPass, Active & Fit, GlobalFit and more
Watchers and more
1 800 Contacts, and LasikPlus
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Can you relate?
† Gallup. “2018 Survey of K-12 School DistrictSuperintendents” 2018.
83% of superintendents say they struggled with recruiting and retaining good teachers last year… Managing productivity and finding qualified talent are top concerns for public sector employers.
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*Aflac 2018 Public Sector Workforce Report.
Why offer a disability plan to all employees?
Disparity between new and tenured employees:
injured, they must utilize all saved sick and vacation
must go without pay, count on sick bank donations from
reason, they would have their income replaced at 60%- 100% for STD and 60% for LTD, after applicable waiting periods.
Hybrid Employees vs. Plan 1 & 2 Employees
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Best Practices
anniversary with you.
months?
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Plan 1 & 2 Legacy Pricing with Anthem
like Hybrid)
Plan 1 and 2 employees
claims process
population decreases Includes: Sample Demographic Analysis
Demographic data is based on most current census provided to OneDigital (census run Apr-19). It is for illustrative purposes only. Any new-hire activity or terminations will alter projected figures. 1 Generational Groups based on parameters set by the Pew Research Center.GENDER AGE GROUPS
Age Band # % Under 21 0.0% 40 to 49 58 27.5% 30 to 39 50 23.7% 21 to 29 38 18.0% % 60 to 64 25 11.8% 65 and Over 7 3.3% 50 to 59 33 15.6%GENERATIONAL GROUPS1
YEARS OF SERVICE
17.1% Total 211 100% 16 to 20 Years 36 17.1% 0 to 5 Years 71 33.6% 6 to 10 Years 36 17.1%ANNUAL SALARY
Salary Band # % Less than $25k 8 3.8% 21+ Years 36 0% 18% 24% 27% 16% 12% 3% Under 21 21 to 29 30 to 39 40 to 49 50 to 59 60 to 64 65 and Over 59% 41% Males Females 1% 24% 37% 37% 1% Greatest Boomers Gen X Millennials Gen Z 4% 69% 20% 4% 3% Less than $25k $25k to $49k $50k to $74k $75k to $99k $100k or More 34% 17% 15% 17% 17% 0 to 5 Years 6 to 10 Years 11 to 15 Years 16 to 20 Years 21+ Years56
access to participate and get a customized report!
systems – private sector is not eligible
visit this site:
Local Government and School System Benchmarking Study
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