St Stat ate of Indi diana Emp Employee e Hea Health th Ben - - PowerPoint PPT Presentation

St Stat ate of Indi diana Emp Employee e Hea Health th Ben enefits

Jennifer Peschke Benefits Manager Indiana State Personnel Department

State of

• f In

Indiana A Anthem Be Benefit C Comp

• mparison

Sum ummary of

• f Be

Benefits f for

• r 2017

17

Wellness CDHP CDHP 1 CDHP 2 Traditional PPO In-Network Out of Network In- Network Out of Network In- Network Out of Network In-Network Out of Network Deductible Single $2,500 $2,500 $1,500 $750 $1,500 Family $5,000 $5,000 $3,000 $1,500 $3,000 Out-of-Pocket Maximum Single $4,000 $4,000 $3,000 $3,000 $6,000 Family $8,000 $8,000 $6,000 $6,000 $12,000

• individual embedded

$7,150 $7,150 not applicable not applicable Office Visit 20% 40% 20% 40% 20% 40% 30% 50% Inpatient 20% 40% 20% 40% 20% 40% 30% 50% Emergency Room 20% 20% 20% 20% 20% 20% 30% 30% Urgent Care 20% 20% 20% 20% 20% 20% 30% 30% Wellness and Prevention 0% 40% 0% 40% 0% 40% 0% 50%

(no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible)

Prescription Dr Drug g Su Summar ary

Retail Mail Retail Mail Retail Mail Retail Mail (up to 30 days) (up to 90 days) (up to 30 days) (up to 90 days) (up to 30 days) (up to 90 days) (up to 30 days) (up to 90 days) Preventive (mandated by the ACA) $0 $0 $0 $0 $0 $0 $0 $0

(no deductible) (no deductible) (no deductible) (no deductible)

Generic $10 copay $20 copay $10 copay $20 copay $10 copay $20 copay $20 copay $40 copay Brand, Formulary 20% 20% 20% 20% 20% 20% 30% 30% Min $30 Min $60 Min $30 Min $60 Min $30 Min $60 Min $40 Min $80 Max $120 Max $50 Max $100 Max $50 Max $100 Max $50 Max $100 Max $60 Brand, 40% 40% 40% 40% 40% 40% 50% 50% Non-Formulary Min $50 Min $100 Min $50 Min $100 Min $50 Min $100 Min $70 Min $140 Max $180 Max $70 Max $140 Max $70 Max $140 Max $70 Max $140 Max $90 Specialty 40% 40% 40% 50% Min $75, Max $150 Min $75, Max $150 Min $75, Max $150 Min $100, Max $175 (30 day supply) (30 day supply) (30 day supply) (30 day supply)

2017 17 Rate tes

Plan Coverage Minimum Bi-weekly Employee Rate Maximum Bi-weekly Employer Rate Bi-weekly Rate Minimum Monthly Employee Rate Maximum Monthly Employer Rate Monthly Rate Minimum Annual Employee Rate Maximum Annual Employer Rate Annual Total Rate

Wellness Single $50.30 $195.48 $245.78 $108.98 $423.54 $532.52 $1,307.80 $5,082.48 $6,390.28 Family $83.84 $591.36 $675.20 $181.65 $1,281.28 $1,462.93 $2,179.84 $15,375.36 $17,555.20 Wellness Single $15.30 $195.48 $210.78 $33.15 $423.54 $456.69 $397.80 $5,082.48 $5,480.28 W/ Non-Tobacco Use Incentive Family $48.84 $591.36 $640.20 $105.82 $1,281.28 $1,387.10 $1,269.84 $15,375.36 $16,645.20 CDHP 1 Single $64.10 $205.08 $269.18 $138.88 $444.34 $583.22 $1,666.60 $5,332.08 $6,998.68 Family $124.16 $610.56 $734.72 $269.01 $1,322.88 $1,591.89 $3,228.16 $15,874.56 $19,102.72 CDHP 1 Single $29.10 $205.08 $234.18 $63.05 $444.34 $507.39 $756.60 $5,332.08 $6,088.68 W/ Non-Tobacco Use Incentive Family $89.16 $610.56 $699.72 $193.18 $1,322.88 $1,516.06 $2,318.16 $15,874.56 $18,192.72 CDHP2 Single $148.64 $220.56 $369.20 $322.05 $477.88 $799.93 $3,864.64 $5,734.56 $9,599.20 Family $364.46 $641.52 $1,005.98 $789.66 $1,389.96 $2,179.62 $9,475.96 $16,679.52 $26,155.48 CDHP 2 Single $113.64 $220.56 $334.20 $246.22 $477.88 $724.10 $2,954.64 $5,734.56 $8,689.20 W/ Non-Tobacco Use Incentive Family $329.46 $641.52 $970.98 $713.83 $1,389.96 $2,103.79 $8,565.96 $16,679.52 $25,245.48 Traditional PPO Single $361.34 $243.60 $604.94 $782.90 $527.80 $1,310.70 $9,394.84 $6,333.60 $15,728.44 Family $964.28 $687.60 $1,651.88 $2,089.27 $1,489.80 $3,579.07 $25,071.28 $17,877.60 $42,948.88 Traditional PPO Single $326.34 $243.60 $569.94 $707.07 $527.80 $1,234.87 $8,484.84 $6,333.60 $14,818.44 W/ Non-Tobacco Use Incentive Family $929.28 $687.60 $1,616.88 $2,013.44 $1,489.80 $3,503.24 $24,161.28 $17,877.60 $42,038.88

Rate te His History

Sc School l Member ersh ship

What Can an B Be Customize ized

Eligibility ty

• School corporations can define eligible employees as full-time, part-time or minimum

number of hours/week.

The R he Rate e Split

• School corporations shall not pay more than the State; the school corporation

employees shall pay at least the amount paid by a State employee.

Contributi tions t s to an HSA

• Your school can decide if you will contribute, how much you will contribute and which

financial institution(s) you will use.

Example of State of Indiana employer contributions to State employee HSAs for 2017

What Can annot B Be Chan anged

Pla lan Des Design

• Plan designs are set by the State.
• You must offer all plans to all benefit eligible employees.

Inclus lusion ion

• All benefit eligible employees in your school corporation must be included.

You cannot split out employees by classifications/groups.

Dependent t Defin finit ition ion

• Definition of dependent is set by the State.

Eligib ligible le De Dependents

“Dependent” means: (a) Spouse of an employee; (b) Any children, step-children, foster children, legally adopted children of the employee or spouse, or children who reside in the employee’s home for whom the employee or spouse has been appointed legal guardian or awarded legal custody by a court, under the age of twenty- six (26). Such child shall remain a “dependent” for the entire calendar month during which he

• r she attains age twenty-six (26).

In the event a child: i) was defined as a “dependent”, prior to age 19, and ii) meets the following disability criteria, prior to age 19: (I) is incapable of self-sustaining employment by reason of mental or physical disability, (II) resides with the employee at least six (6) months of the year, and (III) receives 50% of his or her financial support from the parent such child’s eligibility for coverage shall continue, if satisfactory evidence of such disability and dependency is received by the State or its third party administrator in accordance with disabled dependent certification and recertification procedures. Eligibility for coverage of the “Dependent” will continue until the employee discontinues his coverage or the disability criteria is no longer

• met. A Dependent child of the employee who attained age 19 while covered under another Health Care policy and met the

disability criteria specified above, is an eligible Dependent for enrollment so long as no break in Coverage longer than sixty-three (63) days has occurred immediately prior to enrollment. Proof of disability and prior coverage will be required. The plan requires periodic documentation from a physician after the child’s attainment of the limiting age.

Fees

Informati ation Fe Fee

• Similar to a monthly premium

COBRA Administr trati ation

• $0.35 per enrolled member per month

Plan lan Administra trati tion

• n

Sta tate

• Notify school of any changes to plans (including Open Enrollment)
• Sample communications

Insuran ance C e Carriers

• Send billing inquiries and adjustments.
• Administer COBRA

School C

• ol Corpora
• ration

ion

• Administration of HIPAA
• Administration of FMLA
• Comply with ACA Reporting Requirements

Benefit it Eligib ligibilit ility

Open Enrollm rollmen ent

• Occurs at the same time as Open Enrollment for State employees
• Benefit changes will be effective on January 1st

New E Employee ees

• Benefits effective on the first day of the month following their date of hire.

Terminat ated Employees

• Benefits terminate on the last day of the month in which they separate

employment.

Sc School l Benefit it C Coordin inator R Role le

Communicati ations

• Communicate benefit options and open enrollment information for

current and new employees.

Enrollm rollmen ent

• Complete enrollment of current and new employees on medical plans.
• Paper applications or Anthem Employer Access

Carrier rrier N Not

• tif

ific ication ion

• Update carriers with eligibility and plan enrollment information

Payroll

• ll
• Inform school payroll of benefit adjustments and verify correct deductions

for employees

Addi diti tion

• nal Benefit

its

Anthem 360˚ Health program:

• 24/7 NurseLine: 888-279-5449
• Condition Care - assisting members in managing symptoms related to

the most frequently diagnosed conditions.

• Complex Care - reaching out to members with multiple health care

issues to offer support and assistance.

• Case Management – working with members to achieve health goals

designed for specific circumstances, such as a recent hospital stay.

Addit itional B al Benefit its

Go365

• An online tool for employees to manage their well-being.
• Employees can qualify for the 2018 Wellness CDHP by reaching an Earned

Status of Silver in Go365 by August 31, 2017. This means all points must be processed and posted to your Go365 account by the August 31 deadline.

• The quickest path to Silver status within the program includes completing

the: 1) Health Assessment 2) Vitality Check 3) Action Items recommended within Go365 to take charge of your health.

Addit itional B al Benefit its

Ca Castl tlight

• A healthcare cost transparency tool for employees to find the highest

quality, lowest cost providers in their area.

• Features:
• Up to date deductible and out-of-pocket maximum status.
• Step-by-step explanations of past medical spending.
• Comparing nearby doctors, medical facilities and healthcare services.
• Personalized cost estimates.

Getting St Started ed

Bi Binder Agreements

• Term of three (3) years.
• Must be signed no later than 30 days prior to the start of the effective

date of the school corporation.

Plan I Informati ation

• Provide current plan and enrollment information to State Personnel.
• Determine your rate split prior to employee education sessions. (this will

also need to be done prior to each open enrollment period)

Enrollm rollmen ent

• Employee education sessions held no more than 30 days prior to effective

date.

• Benefit applications or electronic enrollment must be submitted to the

carrier no later than 30 days prior to the effective date.

Conta ntacts cts

Jennifer P Peschke

Benefits Manager Indiana State Personnel Department 317-234-7265 jpeschke@spd.in.gov

Chris risty T y Tittle le

Benefits Director Indiana State Personnel Department 317-232-3241 ctittle@spd.in.gov

Addi diti tion

• nal R

Resou

• urce

ces

We Websites

Interested School Corporations http://www.in.gov/spd/2755.htm Participating School Corporations http://www.in.gov/spd/2756.htm

Ema Email

BenefitingSchools@spd.in.gov