Download presentation
Presentation is loading. Please wait.
1
Flexible Benefits Enrollment 2009-2010 Plan Year Flexible Benefits Enrollment 2009-2010 Plan Year
2
Employee Benefits Outline of Presentation Plan Year Highlights Core Benefits Benefit Choices Life Events Employee Contributions Questions
3
Employee Benefits Plan Year Highlights Flexible Benefits Budget –$2,700/year ($112.50/pay) –June 15, 2009 Medical Insurance –No Plan Design Changes –Employee Contributions will remain the same. Dental Insurance –No Plan Design Changes –Decrease in Employee Contribution
4
Employee Benefits Plan Year Highlights cont… Vision Insurance –No Plan Design Changes –Increase in Employee Contributions Flexible Spending Accounts –Loomis to AmeriFlex Life Insurance –AIG to SunLife –Special “Guaranteed Issue” Open Enrollment
5
Employee Benefits Core Benefits Core Life Insurance/ Core Accidental Death and Dismemberment (AD&D) Insurance –SunLife –$50,000 Core Life Insurance Benefit –$50,000 AD&D Insurance Benefit Long Term Disability –Provides 60% Of Monthly Base Pay ($4,500 Monthly Max) –Benefit Begins Following 180 Days of Continuous Disability –One-year services requirement
6
Employee Benefits Core Benefits cont… Long Term Disability –Provides 60% Of Monthly Base Pay ($4,500 Monthly Max) –Benefit Begins Following 180 Days of Continuous Disability –One-year services requirement Employee Assistance Program (EAP) Flexible Benefits Budget –$2,700/year ($112.50/pay)
7
Employee Benefits Core Benefits Cont… Tuition Remission –Wilkes University –King’s College –Misericordia University Paid Holidays Vacation/Sick/Personal Leave 403(b) Retirement Savings Plan Bookstore Discount Wilkes-Barre YMCA
8
Employee Benefits Benefit Choices Medical Insurance Prescription Plan Dental Insurance Vision Insurance Voluntary Term Life Insurance Voluntary AD&D Insurance Flexible Spending Accounts
9
Employee Benefits Medical Insurance Three medical plan options: Blue Care HMO Blue Care HMO Plus –(formerly Blue Care POS) Blue Care PPO www.bcnepa.com
10
Employee Benefits Blue Care HMO Benefits –Benefit Period : Calendar Year –Deductible: None –PCP Office Visit: $15 Co-pay –Specialist Office Visit: $30 Co-pay Preventive Services –Immunizations: $15 Co-pay –Routine pediatric/adult and well child care: $15 Co-pay –Routine gynecological exam: $30 Co-pay –Mammography Screening/diagnostics: No Charge
11
Employee Benefits Blue Care HMO Emergency and Urgent Care –Emergency Room: $100 Co-pay –Urgent Care through your PCP: $15 Co-pay Inpatient Services –Inpatient hospital services, including maternity: $100 per admission –Skilled Nursing Care (60 days per benefit period): $100 per admission Mental Health –Inpatient services (30 days /benefit period): $100 per admission –Outpatient services (60 visits/benefit period): $30 per visit
12
Employee Benefits Blue Care HMO Outpatient Services –Chemotherapy, dialysis, or radiation: No Charge –High-tech Imaging (MRI, MRA, CT scans, pet scans, nuclear cardiology): $75 Co-pay –Diagnostic testing (lab tests, x-rays, etc.): No Charge –Maternity Care: $30 initial visit –Outpatient Surgery: $100 Co-pay Other Services –Chiropractic Care (12 treatments/benefit period; ages 13+): $30 Co-pay –DME: $5,000 maximum/benefit period
13
Employee Benefits Blue Care HMO Substance Abuse –Outpatient Services (30 visits/benefit period; 120 visits/lifetime): No Charge –Detoxification (7days/admission; 4 admissions/lifetime): $100 per admission –Inpatient non-hospital residential treatment (30 visits/benefit period; 90 days/lifetime): No Charge for Initial Visit; 50% Subsequent Visits
14
Employee Benefits Blue Care HMO Plus Two Network Options –FPH Network Blue Care HMO Benefit Plan Design –Blue Card Network (www.bcbs.com)www.bcbs.com Additional Costs
15
Employee Benefits Blue Care HMO Plus Benefits –Benefit Period : Calendar Year –Deductible: $250.00 (Maximum 3 per family) –Coinsurance: 20% –Coinsurance (Maximum 3 per family): $1,000 –Lifetime Maximum: $1,000,000 –PCP Office Visit: 20% –Specialist Office 20%
16
Employee Benefits Blue Care HMO Plus Coinsurance (20%) Applies To: Preventive Services Urgent Care through your PCP Inpatient Services Outpatient Services Mental Health (50% for Outpatient Services) Substance Abuse (50% for Inpatient Subsequent Visits)
17
Employee Benefits Blue Care PPO Two Network Options –Preferred (www.bcbs.com)www.bcbs.com –Non-Preferred Additional Costs
18
Employee Benefits Blue Care PPO Benefits PreferredNon-Preferred - Benefit period - Deductible (Maximum 3 separate deductibles per family)$300$600 - Coinsurance (Insured responsibility)None20% of allowable charge - Coinsurance maximum (Maximum 3 separate coinsurance maximums per family)None$3,000 - Lifetime maximumUnlimited$500,000 - Precertification penalty (facility)None$500 Preventive Services - Childhood Immunizations (not subject to deductible; copay applies for office visits)No charge20% - Routine gynecological exam and pap smear (one per benefit period; not subject to deductible)$3020% - Routine mammography (one per benefit period, limited to age 40+; not subject to deductible)No charge20% Insured Responsibility Calendar Year
19
Employee Benefits Blue Care PPO
20
Employee Benefits Blue Care PPO
21
Employee Benefits Blue Care PPO
22
Employee Benefits Prescription Drug Coverage BCNEPA National Pharmacy Network - Express Scripts Inc. https://member.express-scripts.com https://member.express-scripts.com Based off of a formulary listing which includes all therapeutic categories. Co-pay will depend on what tier the prescription drug is categorized. Formulary:http://www.bcnepa.com/PDF/RxFormulary3.pdf.http://www.bcnepa.com/PDF/RxFormulary3.pdf
23
Employee Benefits Prescription Drug Coverage
24
Employee Benefits Prescription Drug Coverage Three Ways to Save Money on your Prescription Drug Costs: Tier 0 (Zero) Request Generic Medications Utilize the Mail Order Pharmacy Program
25
Employee Benefits Prescription Drug Coverage Tier 0 (Zero) July 1, 2008 65 Generic Drugs Co-pay Free List of Drugs www.bcnepa.com www.bcnepa.com
26
Employee Benefits Dental Insurance Provider: United Concordia Two Dental Plans –Basic –Enhanced Flexibility Maximum Allowable Charge (MAC) Website Functions
27
Employee Benefits Dental Insurance
28
Employee Benefits Dental Insurance
29
Employee Benefits Vision Insurance Provider: Davis Vision Inc. Plan: Fashion Excellence Gold
30
Employee Benefits Vision Insurance
31
Employee Benefits Voluntary Term Life Employee Coverage – Increments of $10,000 to the lesser of 5X salary or $300,000. Guaranteed Issue amount of $150,000 when first eligible for coverage and during this open enrollment period. Spouse Coverage – Increments of $10,000 up to a maximum benefit of $100,000. Guaranteed Issue amount of $30,000 when first eligible for coverage and during this open enrollment period. Dependent Child(ren) Coverage – Increments of $2,500 up to a maximum benefit of $10,000. All Dependant Child(ren) coverage is a guarantee issue.
32
Employee Benefits Voluntary Term AD&D Employee Coverage – Increments of $10,000 up to a maximum benefit of $500,000. Spouse Coverage – Increments of $10,000 up to a maximum benefit of $250,000. Dependent Child(ren) Coverage – Increments of $2,000 up to a maximum benefit of $50,000.
33
Employee Benefits Flexible Spending Accounts Medical Spending Accounts –$3,000/Plan Year –Use It Or Lose It Provision Dependent Care Spending Accounts –$5,000/Plan Year –Use It Or Lose It Provision
34
Employee Benefits Flexible Spending Accounts cont… PY 2008-2009 –Loomis: prior to 06/01/2009 –Human Resources: after 06/01/2009 PY 2009-2010 –AmeriFlex Special Open Enrollment Sessions –Monday, April 6 th and Thursday, April 9th
35
Employee Benefits Flexible Spending Accounts If you are currently enrolled in a Flexible Spending Account, you must re-enroll for the new plan year. You will not be automatically enrolled.
36
Employee Benefits Additional Benefit Choices Legal Services Plan Long Term Care Insurance
37
Employee Benefits Life Events Change In Status Spouse’s or Dependent’s Open Enrollment Dependent Care Changes Cost or Coverage Changes Within The Employer’s Plan HIPAA Special Enrollment Rights Judgment, Decree Or Court Order Enrollment/Ceasing To Be Enrolled In Medicare Or Medicaid (does not apply to CHIP) Family Medical Leave Act (FMLA) Special Requirements
38
Employee Benefits Please Note: The benefit change must be consistent with the Life Event. You may add or delete dependents during the plan year, when you experience a Life Event. You must contact the Human Resources Development Office within 30 days of the Life Event, and provide the required documentation, or the change will not take place until the next Open Enrollment.
39
Employee Benefits Employee Contributions Medical Insurance Deductions- SAME Dental Insurance Deductions-Decrease Vision Insurance Deductions- Slight Increase Rate Sheet- HR Website- Ben Info & Forms
40
Employee Benefits Wellness Programs YMCA Membership Wilkes Fitness Facilities Weight Watchers at Work College Town Challenge Lunch & Learns
41
Employee Benefits Open Enrollment Procedures Review all Open Enrollment information. If you are not making any changes to your benefit elections or do not wish to enroll or continue to participate in a Flexible Spending Account, no further action is needed on your part. If you are making any benefit changes or participating in a Flexible Spending Account, you must return all paperwork to Brigid Peet, Benefits Coordinator (x4644) by Friday May 1, 2009.
42
Employee Benefits Questions
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.