1. Paulding County School District
2015 Benefits open enrollment review

2. ShawHankins
Service Center- can answer questions on all benefits, including state health
Available extended hours 8:30 am – 7:00 pm during open enrollment
Oct 27 – Nov 14
Benefit website- shawhankinsbenefits.net/pcsd

3. SHBP Changes for 2015-Carrier Options
3 carriers to choose from: BCBS of GA, United Healthcare, & Kaiser Permanente.
BCBS of Georgia: 3 levels of HRA- Gold, Silver & Bronze and statewide HMO
United Healthcare: High Deductible Health Plan (HDHP) and statewide HMO
Kaiser Permanente: Regional HMO available to members who work or live in the 27 metro Atlanta counties.

4. SHBP Changes for 2015- Plan Highlights
Health Reimbursement Arrangement (HRA)
Copays will no longer apply to medical and pharmacy expenses. All services will be subject to the plan deductible and/or co-insurance.
Health Maintenance Organization (HMO)
Members now have the choice of enrolling in statewide or regional HMO plan that offers co-payments for certain services
High Deductible Health Plan (HDHP)
Members now have the option of enrolling in an HDHP. With an HDHP you are also eligible to start a Health Savings Account (HSA) to set aside pre-tax dollars for medical expenses.
Out of Pocket Maximums
The medical and pharmacy out of pocket maximums will now be combined
Co-payments count toward the out of pocket maximums for the HMO plans

5. How the HRA Plans Works
Bronze, Silver and Gold options with different levels of coverage
All services are subject to the plan deductible and/or coinsurance, no copays apply for 2015
SHBP contributes HRA credits to your HRA account based on the plan option and tier of coverage you choose
These credits provide first dollar coverage for medical and pharmacy expenses
HRA credits left at the end of the year will roll over to the next plan year, if you remain enrolled in an HRA option
If you enroll in an HMO or HDHP plan, you will forfeit any remaining 2014 credits

6. HRA Plan Features Preventive services covered at 100%
After you meet your annual deductible, you pay a percentage of the cost, called co-insurance
You are not required to obtain referrals from a PCP to see a Specialist
The credits in your HRA account are used to help meet your deductible and out of pocket max
The medical and pharmacy out of pocket maximum are combined
Certain drug costs are waived if you participate in one of the DM programs- diabetes, asthma, or coronary artery disease

9. How the HDHP Works Low monthly premium
Must satisfy high deductible ($3,500 individual, $7,000 family) for all medical and pharmacy expenses (except preventive care)
If you have more than single coverage, the entire family deductible ($7,000) must be met before benefits are payable for any family member
Eligible to establish a Health Savings Account (HSA) to set aside tax-free dollars to pay for eligible health care expenses.

10. HDHP Plan Features Preventive services covered at 100%
You pay co-insurance (70% in-network, 50% out of network) after you meet the plan deductible for all medical and pharmacy expenses, until you meet the out of pocket maximum ($6,450/$12,900)
Medical and pharmacy out of pocket maximums are combined
No co-pays apply
Eligible to contribute to Health Savings Account
Contributions will not be taken through payroll deductions

13. How the Statewide HMO Works
Available through BCBS or UHC
Rates differ between the 2 carriers
Receive covered services through in-network providers only (except emergency care)
Be sure to confirm your providers are participating in the BCBS or UHC network
Co-payments apply to certain services- office visits, urgent care, emergency room and prescriptions
Co-payments count toward your out of pocket maximum, but not deductible
Preventive services covered at 100%

16. How the Regional HMO Works
Services only available through Kaiser HMO network
Must select a PCP
Preventive services covered at 100%
Plan available for members that live or work in one of the 27 metro Atlanta counties:
Barrow
Coweta
Gwinnett
Paulding
Bartow
Dawson
Haralson
Pickens
Butts
DeKalb
Heard
Pike
Carroll
Douglas
Henry
Rockdale
Cherokee
Fayette
Lamar
Spalding
Clayton
Forsyth
Meriwether
Walton
Cobb
Fulton
Newton

19. Wellness
Healthways will continue as the Wellness vendor for the BCBS and UHC plan options with well-being resources and incentive programs
All health actions must be completed between January 15, 2015 and December 15, to earn well-being incentive credits
If you choose one of the HRA plans, the well-being credits will be deposited into your HRA account
If you choose a statewide HMO, well-being credits will be placed into incentive accounts
If you choose the HDHP plan, well being credits will be placed into an incentive account
You must pay $1,300 toward your individual deductible or $2,600 toward family deductible prior to accessing these credits

20. Earning Wellness Credits

21. Wellness-Kaiser Permanente
Resources Available
Total Health Assessment
Biometric screenings
Online and onsite healthy living classes
Sign up at my.kp.org/shbp and complete at least one health action to be entered in monthly drawing for an iPad and a Fit Bit:
Completed biometric screening
Completed online Total Health Assessment
Get support to meet goals with KP wellness coach
Complete one online health education class
Get your annual flu shot
Received a preventive Cancer Screening- Colorectal Cancer, Breast Cancer or Cervical Cancer

22. Tobacco Cessation Tobacco surcharges are included in all SHBP options
Surcharge applies if you are not tobacco-free or do not complete tobacco cessation coaching program
If you do not make an indication for 2015 on your tobacco usage, you will continue to be assessed the surcharge.

23. State Health Open Enrollment
Open enrollment is from October 27th – November 14th
myshbpga.adp.com
If you do not login to enroll or make changes, you will be defaulted to your current HRA plan (without copays), coverage tier and tobacco status. If you are not currently covered and do not enroll, you will continue with no coverage.

24. State Health Open Enrollment
When making your benefit election make sure you have selected the correct option.
Verify your coverage tier (you only, you + spouse, you + child(ren) or you + family)
Confirm you have added all eligible dependents you wish to be included under your coverage.
Confirm you have answered the tobacco question correctly.
Review/Confirm your elections and click “Finish”. NOTE: If Finish is NOT clicked, your enrollment process has not been completed.
Print or save a copy of your confirmation page for your records.

25. Ancillary Benefits

26. Bswift Enrollment Portal
Will make all non-medical plan elections through the Bswift portal
Open Enrollment October 27 – November 14
Pauldingschools.bswift.com
User Name: First Initial, Last Name, Last 4 digits of SSN
Password: Last 4 digits of SSN

27. Dental MetLife will be the dental carrier for 2015
Expansive national network, superior service
All members will receive a new ID card
Continue to have a Low and High plan option

28. MetLife Employee Employee + 1 Family Low Plan High Plan
Plan Option 1- Low Plan
Plan Option 2 – High Plan
Coverage Type
In-Network
Out-of- Network
Out-of-Network
Type A – Diagnostics & Preventative
100% of Negotiated Fee*
100% of R&C Fee**
100% of Negotiated Fee*
Type B – Basic
40% of Negotiated Fee*
40% of R&C Fee**
80% of Negotiated Fee*
80% of R&C Fee**
Type C – Major
25% of Negotiated Fee*
25% of R&C Fee**
50% of Negotiated Fee*
50% of R&C Fee**
Type D – Orthodontia
N/A
Deductible†
Individual
$50.00
Family
$150.00
Annual Maximum Benefit:
Per Person
$500.00
$1,000
Orthodontia Lifetime Maximum
1,000
MetLife
Employee
Employee + 1
Family
Low Plan
$ 16.30
$ 45.77
$65.34
High Plan
$ 24.40
$68.51
$97.81

29. Vision Davis Vision will continue as the vision carrier for 2015
No change in plan coverage or rates

31. Basic Life with AD&D
PCSD provides basic life coverage at no cost to you
This includes a life and accidental death and dismemberment benefit
$30,000 for all Full Time Administrators & Technical Professional Employees
$15,000 for all Other Full Time Employees
Coverage available for dependents
$5,000 for Spouse
$3,000 for Children
$1.65 to cover all dependents

32. Supplemental Life with AD&D

33. Short Term Disability No changes to STD benefit
All sick leave must be exhausted prior to STD benefits beginning
Late entrants or employees that wish to increase their level of coverage must submit an Evidence of Insurability Form and be approved before coverage is effective

34. Long Term Disability
Late entrants or employees that wish to increase their level of coverage must submit an Evidence of Insurability Form and be approved before coverage is effective

35. Flexible Spending Accounts
Two separate accounts- Medical Spending Account and Dependent Care Spending Account
Allows you to set aside pre-tax dollars to spend on qualified expenses, saving on your taxable income
Must make new elections for 2015
If enrolling in the HDHP medical plan, you are not eligible to contribute to FSA
TASC will administer FSA account for 2015
You will receive a new debit card

36. Flexible Spending Accounts
Medical Spending Account
Maximum contribution of $2,500
Some eligible expenses- Deductibles, copayments, dental expense, vision services and materials
Dependent Care Spending Account
$5,000 for married couple filing joint income tax returns, $2,500 if unmarried or married and filing separate income taxes
Some eligible expenses- any care of a dependent that allows you and your spouse to work: day care, after school program, in-home care, camps
New! You may rollover up to $500 left at the end of the 2014 plan year to use in 2015 for your Medical Spending Account

37. Whole Life Benefit never decreases, premiums never increase
You own the policy

38. Critical Illness Coverage
Pays a lump sum benefit to you at the time of diagnosis of a covered illness.
Benefit Choice: From $5,000 to $25,000
Able to cover you and your family
Some covered illnesses: Heart Attack, Stoke, Coronary Artery Bypass, Major Organ Transplant, End Stage Renal Failure
Wellness Benefit: Pays you $50 benefit when you have a annual preventive screening: Ex) colonoscopy, EKG, Stress Test, Mammogram, PSA

39. Questions?