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Published byDaniella Harrington Modified over 9 years ago
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Annual Enrollment What’s Not Changing What’s Changing & New MetLife Hospital Indemnity Plan MetLife Defender Terms and Definitions 2015 Health Renewal Humana Health Benefits 2015 Health Plan Payroll Deductions 2 AGENDA Humana Vitality Humana On-Line Resources Humana Resources Flexible Spending Accounts (FSA) Reminders Questions & Answers
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Annual Enrollment October 15 thru October 27, 2014 ** 2 WEEK WINDOW!! ** Coverage Begins: January 1, 2015 Deductions begin: 12/5/14 – Support 12/12/14 – Instructional/Administrative/PTS 2015 Flexible Spending Account and & MetLife Legal deductions begin: 1/2/15 - Support 1/9/15 -Instructional/Admin/PTS 3
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What’s Not Changing ? Humana Dental – No change in benefits or deductions. Met Life Dental – No change in benefits or deductions. Eye Med Vision - No change in benefits or deductions. Prudential Life – No change in benefits or deductions. All new or increased levels of coverage subject to medical underwriting approval. Spouse coverage amount may not exceed employee’s coverage amounts (Board life and/or optional term life). Corporate Care Works EAP Plan – No changes. (Employee Assistance Plan) 4
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What’s Changing & New Humana Health Plans – Changes to Out of Pocket Max and National Point of Service (NPOS) Deductible. Payroll deduction changes. New employee + child/ren Tier. RX Benefits – Co-pay changes. Assurant Disability Insurance – No change in benefits or deductions. All increases subject to medical underwriting. HIP Plan has been discontinued. New MetLife Programs – Hospital Indemnity Plan Defender Identity Theft Plan 5
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MetLife HOSPITAL INDEMNITY 6 Covered Benefits: Hospital Admission - $500 Hospital Confinement - $250 per day, 30 day maximum Inpatient Rehabilitation Unit - $100 per day, 15 day maximum – Accident only Payroll Costs: Employee Only - $8.00 Employee + Spouse - $13.00 Employee + Child(ren) - $17.00 Employee + Family - $21.00 Employees may use board credits if not enrolled in health plan. Preexisting conditions apply 12/12. (See certificate for full list of exclusions and limitations.)
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MetLife Defender Benefits ID Theft Monitoring Personal Identity Monitoring and Security Patented Peer-to-Peer Network Monitoring Junk Mail Removal Health Data Protection Financial Data Protection On-Line Child Safety Payroll Deduction Employee Only - $9.00 Employee + Spouse - $15.00 Employee + Children - $12.00 Employee + Family - $18.00 Enrollment any time during the year through: 1-800-Get Met 8 (438-6388) 7
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Terms and Definitions Deductible - the amount of covered services that the member must pay per year before Humana pays benefits for covered services. Co-payment - the specified dollar amount that the member must pay for a covered service. Co-insurance - the % amount of a covered service that the member must pay. Example: An 80%/20% coinsurance means that Humana will pay 80% of the allowable charge and the member will pay 20%. Medical Out-of-pocket limit - the most a member would have to pay per calendar year before the Humana pays 100% of the in network cost. Excludes RX costs. 8
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2015 Health Renewal Proposed 2015 health renewal was 11.6%. Final renewal after negotiations and plan design changes was approximately 5%. Projected 2015 premium -$117.8M; $5.5 premium increase. Overall the District will pay approximately 80% and employees will pay 20% of total premium. New Five Tier Enrollment structure – Employee, Employee + Child(Children); Employee + Spouse, Family and Two Board Family. New Humana Vitality Program 9
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Staff HMO Key Features & Changes Staff Network with a limited number of physicians. Referrals to Specialists limited by PCP Choice. No Out-of-Network Benefit, except for emergencies. Service areas Pinellas, Pasco, Hillsborough, Manatee, Polk, Sarasota, Hernando & Citrus. Co-pays for all services; preventive services covered at 100 % Hospital co-pay $500 per day, 5 day maximum. Out of Pocket Maximum - $3,500 (employee) and $7,000 (family). 10 Please confirm participation with Humana’s toll free customer service or website –NOT Doctor’s Office !
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NPOS Plan Key Features & Changes Deductible: $300/individual $600/family Hospital co-pay -$500 per day, 5 day maximum. 80/20% co-insurance for physician visits, outpatient services, lab and x-rays. Out of Pocket Maximum - $3,500 (employee) and $7,000 (family). 11 Broad National Point of Service (NPOS) Network – open access. No Specialist referrals. In-Network and Out-of- Network benefits. ++ Good option For Out of Area Retirees & Studen ts.
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CDHP – Key Features & Changes HMO Premier Network which is a larger Tampa Bay area network than the Staff HMO Network. Network includes: Pinellas, Pasco, Hillsborough and several other Florida counties as well as a limited number of states outside of Florida. NO Out-of-Network benefits If you move to another plan for 2015, any remaining PCA funds will be forfeited as of December 31, 2014. $ 1,500 (employee) and $3,000 (family) deductible with a $500 (employee) and $1,000 (family) allowance. 80%/20% In–Network Co- insurance once deductible has been met. Out of Pocket Maximum - $3,500 (employee) and $7,000 (family) 12 ++ For Out of Area Retirees & Students, you may wish to consider the NPOS plan.
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Pharmacy Benefits No deductible on Tier 1 Drugs - $20 copay Deductible ($250 Single/$500 Family) on Tier 2 & Tier 3 Drugs. After deductible: Tier 2 -$55 co-pay Tier 3 -$95 co-pay Preferred Retail Pharmacy Network – Sam’s Club, Walmart, and CVS. Non-Preferred Network – available with additional 30% coinsurance after applicable deductible and copay. Three month supply for two co-pays still available (after applicable deductible) at retail locations. Right Source Mail Order still available. RightSourceRx
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Tier/PlanConsumer Directed Health Plan Staff HMONational Point of Service (NPOS) Employee$30$48$63 Employee + Spouse $120$158$182 Employee + Child/Children $115$151$175 Family$178$230$262 2 Board Family$85$137$169 14 2015 Health Plan Deductions
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Humana Vitality For Employees & Dependents enrolled in Humana Health Plan. On Line Wellness Plan. Complete Vitality Check & HRA. Provides Personalized Plan. Access to tools and resources to meet your goals. Earn Points to Receive Prizes. Reach “Silver Status”, receive payroll credit in 2016. Improve your health and well-being. 15
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What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana: 1.Visit www.MyHumana.com 2.Have your Humana ID card handy 3.Go to Humana.com 4.Click “Register for MyHumana” 5.Follow the easy steps to register 16 24 Hour Humana Online Resources
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Humana PCS Resources Heather Keegan, RN – Patient Advocate Assists employees with medical and provider issues. Coordinated Diabetes Care Program. Advocates for employees. Jody Lowry, RN – Health & Wellness Specialist Facilities wellness and health education programs, enrolls members in disease management, clinical programs and Vitality. Janet Lang - On Site Claims Representative Assists employees with eligibility, claims and coverage issues. 17
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Flexible Spending Account (FSA) FSA Plan Deductions are taken pre-tax over 20 pays. You save Social Security and Income Tax – you increase your take home pay. Reimbursed for Dependent Day Care (Dependent Care FSA) Up to $5000 for two working parents Pretax savings for day care expenses Children up to age 13 Reimbursed for eligible Medical Expenses (Medical FSA) : Medical, dental, vision co-pays, co-insurance & deductibles Prescription drug costs Contact Lenses & Prescription Eyeglasses Lasik & other vision improvement surgery 18
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Flexible Spending Account Flexible Spending Account You decide how much to contribute: Health Care FSA: $200 - $2500 Dependent Day Care FSA: $200 - $5000 Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31. Receive a debit card – for Health Care Expenses. Not for Dependent Day Care. Amount available for Health Care Expenses on Jan. 1, 2015. Use for deductibles, co-pays, co-insurance and other eligible expenses. Look for Humana Access Visa cards last week in December – plain envelope.
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Reminders Changes through Web only October 15 thru 27th. Confirmation notices available on line for employees to print. Review health plan options and new enrollment tiers. Review new MetLife offerings – Hospital Indemnity Plan and Defender Identity Theft Protection. Make sure your life insurance beneficiaries are current. Make sure you have enrolled only eligible dependents. Humana will mail everyone new ID Cards. Please make sure your address on Employee Self Service is correct. Enroll in MyHumana so that you can participate in the Humana Vitality Program. 20
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Questions Visit our web site for current information, including full Beneflex Guide, enrollment and benefit module videos, CDHP & FSA flyers at www.pcsb.org/annual-enrollment.www.pcsb.org/annual-enrollment Call the Humana Hot Line - 888-393-6765, 8:00 am – 8:00 pm, Monday thru Friday. Call the PCS Benefits Help Line for enrollment assistance - 588-6197, 8:00 am – 4:30 pm, Monday thru Friday. Email us at houckc@pcsb.orghouckc@pcsb.org 21
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