Presentation is loading. Please wait.

Presentation is loading. Please wait.

Celebrate …2008. Celebrate … Your health.  New Principal Wellness program  Additional resources within health plans Your valuable benefit plans.  Two.

Similar presentations


Presentation on theme: "Celebrate …2008. Celebrate … Your health.  New Principal Wellness program  Additional resources within health plans Your valuable benefit plans.  Two."— Presentation transcript:

1 Celebrate …2008

2 Celebrate … Your health.  New Principal Wellness program  Additional resources within health plans Your valuable benefit plans.  Two new and improved consumer health plans  Valuable plans at affordable cost in a market where costs continue to rise at rapid rates from year to year Your resources.  Enhanced tools available from Anthem  New Schurz Choice communication portal Your choice.  Continue year after year to have many options available

3 Meeting Highlights New or Changing for 2008  Wellness Program  Medical Plan Options  Flexible Spending Accounts  Dental  Dependent Supplemental Life Options  Schurz Choice Communication portal  ADP Employee Self Service portal No Changes for 2008  Vision  Group Life andAD&D  Long Term Disability  Employee Supplemental Life Options

4 2008 Benefit Overview BenefitAdministrator Change Benefit/Plan Change Cost ChangePositive Impact vs. Negative Impact Wellness ProgramNEW- PrincipalNEWNEW- No Cost!Positive MedicalNoYes Positive for most DentalNoYes Positive VisionNo No Change PCA (Health Reimbursement Account) Yes n/aPositive for most Flexible Spending Accounts Yes n/aPositive Group Life InsuranceNo No Change Long Term DisabilityNo No Change Dependent Life InsuranceNoYes Positive

5 Schurz Choice Principal Wellness Plan

6 What is Wellness? Worksite wellness programs are proactive, organized programs that provide lifestyle and medical assistance that assist employees and their family members to promote and maintain good health Wellness doesn’t just involve your physical health, it involves emotional, spiritual, occupational, social, and intellectual dimensions too

7 Wellness Makes $ ense Most employees (83%) are in the low and medium cost categories of healthcare spending Each risk factor avoided (such as high cholesterol or high blood pressure) can save a company an average of $304 per risk factor per year By keeping these employees out of the high-cost category, employees lead better lives and employers can potentially save thousands of dollars To better compare the cost savings, look at a low-risk employee vs. a high risk employee. The difference between low- and high-risk categories is $2,882 per year, per employee No. of Risk FactorsAverage Total Cost Per Year 0-2$1,397 5 or more$4,279

8 Benefits of the Wellness Program Better health for you and your family Reduction in health insurance premiums for participation Increased knowledge about your health and well-being Culture of wellness in the workplace Lower health care costs in the future

9 Wellness Program Onsite health screenings for employees that include immediate results of a cholesterol panel, glucose, blood pressure, body composition, and a health risk analysis (HRA) Quarterly “Words of Wellness” newsletters sent to employees’ homes Proven health coaching to high-risk individuals through email or phone Trusted health information available to employees through Principal’s website

10 Important Information about Wellness Principal Wellness program is open to all medical plan eligible employees  Regardless of whether someone: Elects medical coverage with Schurz Choice or not Elects Core or Alternate medical plan All components are confidential- screening process, screening results, any health coaching discussions, calls, etc. Reduced medical plan costs of $25 per month if you participate in the wellness program To qualify for the premium incentive credit:  Must complete the Principal screening (onsite or physician packet) and complete the health questionnaire which is included in the Principal screening packet

11 How do I elect to participate Go through the ADP ESS enrollment process- elect one of the following options: PARTICIPATING: in the Principal Wellness program for 2008. Reduced premiums take effect January 1, 2008 (premium incentive credit) As long as you complete the Principal screening process in 2008, you will pay the reduced premiums for medical coverage. NOT PARTICIPATING: in the Principal Wellness Program for 2008. Increased, non-wellness premiums take effect January 1, 2008 and continue through December 31, 2008 - UNLESS If you choose at the time of screening to go through the Principal Wellness screening process, Schurz will retroactively credit you the reduced premiums for medical coverage.

12 Why Participate in Wellness You save $300 annually in medical plan premiums! The on-site screening is valued at over $200. You have the opportunity to improve or maintain your health status by being engaged in your health. In order for Schurz to continue offering valuable health plans, your participation, understanding and advocacy for your health is key

13 Schurz Choice Anthem Medical Plans

14 Medical Both plans are PPO plans- meaning you will receive the best benefit by utilizing Anthem BC/BS network providers (same as today) Both plans have new tools available through Anthem Lumenos Core 1200 Plan = Lumenos 1200 Core Plan  Health Reimbursement Account included Alternate 500 Plan = Lumenos 500 Alternate Plan  Health Incentive Account included Both plans have unlimited in-network preventive care that does not apply towards the deductible or out of pocket maximum NEW Healthy Rewards program is available on both plans Allows you to earn dollars to be used for eligible medical expenses Dollars earned either go into your HRA (core plan) or HIA (alternate plan)

15 Anthem Lumenos 1200 Core Plan

16 Core 1200 Plan- Single Coverage $500 HRA Dollars $700 Bridge Coinsurance / Traditional Coverage 100% Preventive Care 100% Coverage $1,200 Deductible $2,500 In-Network Out of Pocket Maximum

17 Anthem Lumenos 1200 Core Plan In NetworkOut of Network HRA Allocation from Schurz$500 Individual Coverage Individual Bridge (deductible) -applies to those with single coverage only $700 (combined deductible for in and out of network) Member Coinsurance20%40% Individual Out of Pocket Maximum -applies to those with single coverage only $2,500$5,000 Preventive Care100% as outlinedDeductible & Coinsurance Colonoscopies (both preventive & diagnostic) 100%Deductible & Coinsurance Retail /Mail Order PrescriptionDeductible & Coinsurance Earn extra dollars toward your HRA through the Healthy Rewards program

18 Core 1200 Plan- Employee +Dependent(s) Coverage $1,400 HRA Dollars $1,000 Bridge Coinsurance / Traditional Coverage 100% Preventive Care 100% Coverage $2,400 Deductible $5,000 In-Network Out of Pocket Maximum

19 Anthem Lumenos 1200 Core Plan In NetworkOut of Network HRA Allocation from Schurz$1,400 Family Coverage (employee plus one or more dependents) Family Bridge (deductible) -applies to anyone electing to cover 1 or more dependents $1,000 (combined deductible for in and out of network) Member Coinsurance20%40% Family Out of Pocket Maximum -applies to anyone electing to cover 1 or more dependents $5,000$10,000 Preventive Care100% as outlinedDeductible & Coinsurance Colonoscopies (both preventive & diagnostic) 100%Deductible & Coinsurance Retail /Mail Order PrescriptionDeductible & Coinsurance Earn extra dollars toward your HRA through the Healthy Rewards program

20 What is considered Preventive Care? School and sports physicals also covered in full Colonoscopies will also continue to be covered in full for in-network providers whether routine or diagnostic.

21 Key Components of Core Plan No Copays for any services To pay for bridge and coinsurance expenses –  Use roll-over PCA credits  Use HCFSA  Use your own cash All medical plan expenses go towards Out of Pocket Maximum (HRA, Bridge and Coinsurance) Mail order no longer has the buy 2 get 1 free  90 day supply is available for 90 day price If you have dependents on the plan –  Schurz HRA allocation = $1,400  Bridge = $1,000  Out of Pocket Maximum = $5,000  There is no individual bridge or deductible.

22 Health Reimbursement Account Details Annual Schurz Contribution to HRA Employee Only Coverage $500 Employee + One or more Dependents $1,400 Administered by Anthem First dollar payment  No deductible to be satisfied first  HRA will pay before FSA Any unused PCA balances will transfer from WageWorks to Anthem Unused balances are intended t0 carry over from year-to-year and intended to be available for Retiree Health Premium Fund Direct payment to providers (hospital and physicians) vs. employees Pharmacy will know if HRA dollars available and charge patient appropriately

23 Anthem’s Lumenos 1200 Core Plan Stay healthy with Preventive Care coverage Your employer makes an annual allocation to your account Use your account dollars to pay for medical care and prescription drugs Earn more dollars to your HRA through Healthy Rewards Incentive After HRA funds are spent, you pay an out of pocket amount to satisfy your bridge Your 2008 HRA + Bridge = Deductible Traditional Health Coverage then covers additional expenses Deductible + Traditional Coverage = OOPM

24 Meet Mary Jones – 1200 Core Plan Single Coverage HRA $500 funded by annual employer allocation Plus Additional dollars available through Healthy Rewards Preventive Care 100% In Network Traditional Health Plan Coverage 80% Network Provider 60% Non-Network Provider $700 Bridge (Deductible equals $1,200 minus $500 HRA allocation) Mary Jones’ Lumenos PPO Core Plan $500 Year 1 allocation plus $50 reward for completing Health Assessment via anthem.com $550 Expenses:Ob/Gyn visit & lab tests – $350 Office Visit– $150 $500 Paid by Preventive Care benefit at 100%$350 Paid from HRA & applied to deductible$150 HRA Rollover to Year 2$400

25 Meet The Smiths – 1200 Core Plan Family Coverage The Smiths’ Lumenos PPO Core Plan $1,400 Year 1 allocation plus $50 reward for completing Health Assessment via anthem.com $1,450 Expenses:Preventive visits & lab tests – $500 Physical therapy - $800 Prescription drugs – $200 $1,500 Paid by Preventive Care benefit at 100%$500 Paid from HRA & applied to deductible$1,000 HRA Rollover to Year 2$450 HRA $1,400 funded by annual employer allocation Plus Additional dollars available through Healthy Rewards Preventive Care 100% In Network Traditional Health Plan Coverage 80% Network Provider 60% Non-Network Provider $1,000 Bridge (Deductible equals $2,400 minus $1,400 HRA allocation) Year 1

26 Meet The Smiths- 1200 Core Plan Family Coverage The Smiths’ Lumenos PPO Core Plan HRA Balance: $1,400 Year 2 allocation plus $450 roll-over from Year 1 plus $50 reward for completing Health Assessment and $300 reward for enrolling and graduating from Personal Health Coach program for a diabetes condition $2,200 Expenses:Preventive visits & lab tests – $300 Hospital and surgery - $10,000 Prescription drugs – $500 $10,800 Paid by Preventive Care benefit at 100%$300 Deductible paid from Year 2 HRA allocation plus Year 1 Roll-over and Healthy Rewards program $2,200 Remaining deductible to be satisfied by Smiths$200 Charges paid by Traditional Health Coverage (80% x $8,300 = $6,640)$6,640 Smiths pay coinsurance under Traditional Health Coverage (20% x $8,300 = $1,660)$1,660 Total amount paid by HRA (applied to deductible)$2,200 Total amount Smiths pay (remaining deductible & coinsurance)$1,860 Year 2

27 Anthem Lumenos 500 Alternate Plan

28 Alternate 500 Plan- Single Coverage $500 Bridge /Deductible Coinsurance / Traditional Coverage 100% Preventive Care 100% Coverage $1,000 Out of Pocket Maximum OOPM does not include any prescription drug copays

29 Anthem Lumenos 500 Alternate Plan In NetworkOut of Network Individual Deductible (Bridge) - applies to those with single coverage only $500 (combined in and out of network deductible) Member Coinsurance20%40% Individual Out of Pocket Maximum -applies to those with single coverage only $1,000$2,000 Preventive Care100%Deductible & Coinsurance Colonoscopies (both preventive & diagnostic) 100%Deductible & Coinsurance Pharmacy benefits shown on following slide Earn dollars into a Health Incentive Account by participating in Healthy Rewards

30 What is considered Preventive Care? School and sports physicals also covered in full Colonoscopies will also continue to be covered in full for in-network providers whether routine or diagnostic.

31 Anthem Lumenos 500 Alternate Plan Retail= 30 day supplyIn NetworkOut of Network Retail- Generic$10 Copay Retail- Brand Name Preferred or Formulary $25 Copay Retail- Brand Name Non-Preferred or Non- Formulary $50 Copay Retail- Injectible Drugs (Tier 4)25% Cost Share; Up to maximum of $1,000 Mail Order= 90 day supplyIn NetworkOut of Network Mail order- Generic$20 Copay Mail order- Brand Name Preferred or Formulary $50 Copay Mail order- Brand Name Non-Preferred or Non-Formulary $100 Copay Mail order- Injectible Drugs (Tier 4)25% Cost Share; Up to maximum of $1,000 None of the above shown copays track towards the deductible or out-of-pocket maximum

32 Alternate 500 Plan- Family Coverage $1,000 Bridge /Deductible Coinsurance / Traditional Coverage 100% Preventive Care 100% Coverage $2,000 Out of Pocket Maximum OOPM does not include any prescription drug copays

33 Anthem Lumenos 500 Alternate Plan In NetworkOut of Network Family Deductible (Bridge) - applies to those with famil coverage only $1,000 (combined in and out of network deductible) Member Coinsurance20%40% Individual Out of Pocket Maximum -applies to those with family coverage only $2,000$4,000 Preventive Care100% as outlinedDeductible & Coinsurance Colonoscopies (both preventive & diagnostic) 100%Deductible & Coinsurance Same pharmacy copays for family Earn dollars into a Health Incentive Account by participating in Healthy Rewards

34 Key Components of Alternate Plan Copays for prescription drugs do not apply to Out of Pocket Maximum Mail Order copays continue to be buy 2 get 1 free

35 Health Incentive Account Details Administered by Anthem Any PCA balance will not transfer from Wage Works into HIA Unused balances are intended t0 carry over from year-to-year but are not available for Retiree Health Premium Fund Direct payment to providers (hospital and physicians) vs. employees Cannot use Health Incentive Account dollars for prescription copays

36 Meet Mary Jones- PPO 500 Alternate Plan Single Coverage No HRA available Members are eligible for Healthy Incentive Account Program Preventive Care 100% In Network Traditional Health Plan Coverage 80% Network Provider 60% Non-Network Provider $500 Deductible Mary Jones’ Lumenos PPO Alternate Plan Expenses:Ob/Gyn visit & lab tests – $350 Prescription drugs – $150 $500 Paid by Preventive Care benefit at 100%$350 Copay paid by member- not applied to the deductible$50

37 Meet The Smiths – PPO 500 Alternate Plan Family Coverage The Smiths’ Lumenos PPO Alternate Plan Expenses:Preventive visits & lab tests – $500 Physical therapy - $800 Prescription drugs – $200 $1,500 Paid by Preventive Care benefit at 100%$500 Paid by member & applied to deductible*$800 Copays paid by member- not applied to deductible$60 No HRA available Members are eligible for Healthy Incentive Account Program Preventive Care 100% In Network Traditional Health Plan Coverage 80% Network Provider 60% Non-Network Provider $1,000 Deductible If the there are dollars available in the Healthy Incentive Account, which would be earned through the Healthy Rewards program, the HIA dollars could be used towards the deductible.

38 PPO 1200 Core Plan Cost MONTHLY COSTWellness ParticipationNon-Wellness Participation Employee Only$37.29$62.29 Employee + Spouse$97.34$122.34 Employee + Child(ren)$67.13$92.13 Employee + Family$127.17$152.17 BI-WEEKLY COSTWellness ParticipationNon-Wellness Participation Employee Only$17.21$28.75 Employee + Spouse$44.93$56.46 Employee + Child(ren)$30.98$42.52 Employee + Family$58.69$70.23 WEEKLY COSTWellness ParticipationNon-Wellness Participation Employee Only$8.61$14.37 Employee + Spouse$22.46$28.23 Employee + Child(ren)$15.49$21.26 Employee + Family$25.35$35.12

39 PPO 500 Alternate Plan Cost MONTHLY COSTWellness ParticipationNon-Wellness Participation Employee Only$100.48$125.48 Employee + Spouse$193.72$218.72 Employee + Child(ren)$143.38$168.38 Employee + Family$304.11$329.11 BI-WEEKLY COSTWellness ParticipationNon-Wellness Participation Employee Only$46.38$57.92 Employee + Spouse$89.41$100.95 Employee + Child(ren)$66.17$77.71 Employee + Family$140.36$151.90 WEEKLY COSTWellness ParticipationNon-Wellness Participation Employee Only$23.19$28.96 Employee + Spouse$44.70$50.47 Employee + Child(ren)$33.09$38.86 Employee + Family$70.18$75.95

40 New Anthem Lumenos Tools Health Advocates available to employees (888) 523-5898 Online access to health information  Cost estimator tools  Hospital ranking tools  Health Reimbursement Account balance information  Claim status Healthy Rewards program to earn additional dollars either into Health Reimbursement Account (Core Plan) or Health Incentive Account (Alternate Plan)  $50 reward for completing health questionnaire (one per family)  $100 reward for participating in health coaching program  $200 reward for successful completion of the health coaching program  $50 reward for successful completion of the smoking cessation program and/or weight management program Healthy Reward dollars = money into either your HRA or HIA, in turn money you can use for eligible medical plan expenses

41 Importance of Knowing Cost Will allow your dollars, whether it’s the HRA/HIA or your own money, to stay in your pocket or last longer Will allow you to be a good consumer of healthcare, in turn keeping costs level over time 41

42 Where to find additional cost info Call Anthem customer service Talk to your physician or pharmacist Use the Anthem Lumenos website instructions included in your packet

43 Prescription Drug Cost Info Review prescription drug costs for retail and mail order View alternatives, including generics and over-the-counter Find information on drug interactions

44 Using Your Anthem Plan When you visit a network doctor: Show your new Lumenos ID card Take advantage of discounts provided A claim is filed for you Payments from your HRA (if enrolled in Core plan and have available balance) and from your Traditional Health Coverage made directly to your doctor When you visit a doctor that is not in the network: Show your ID card Pay for the services received File a claim HRA applies to Core Plan Only

45 Anthem Reminders You will receive a new ID card from Anthem To view your 2008 plan information or claim information, you will need to re-register on the Anthem website- www.anthem.com on or after January 1 stwww.anthem.com This is where you will view your medical plan and HRA balance To view your 2007 plan or claim information, continue using your current log on information Same network you have today January 1 st is when the new plans take effect and you can start accessing the new programs available with Anthem Lumenos

46 How to decide Estimate your medical expenses Use the resources available to you Consider your current PCA dollars PCA dollars only roll-over to Core Plan with HRA Add up the annual cost of the plans Core plan much more affordable 46

47 Schurz Choice Anthem Flexible Spending Account Plans

48 What is a flexible spending account Your pre-tax money set aside for healthcare or dependent care expenses Healthcare = medical, dental, vision, prescriptions and over the counter items Dependent care = care for a dependent up to age 13 or older if they are not able to care for themselves (could be child or spouse)

49 Changes to FSA plans for 2008 Anthem will be the new administrator Single point of contact for Medical, Health Reimbursement Account, Vision and Flexible Spending Accounts Schurz $100 matching contribution for Health Care FSA option is no longer available No auto claims roll-over feature available  Anthem & Met Life will substantiate expenses so no receipts will need to be submitted when debit card used  Employees must maintain receipts in the event Anthem or the plan requests a copy

50 Annual Maximums Increase in Health Care Maximum  $3,500 Same Dependent Care Maximum  $5,000 or $2,500 if married filing separately

51 2007 Flexible Spending Claims You have until March 31 st 2008 to file claims for 2007 Any 2007 claims should continue to be submitted to Wage Works for reimbursement

52 Anthem Flexible Spending Debit Card New debit cards will be issued to all Anthem FSA participants You must keep your receipts according to IRS guidelines

53 Employee Access

54 To View Balance and Claim Information Click on: Spending Accounts, Claims, and Account Balances Spending Accounts, Claims, and Account Balances

55 Direct Deposit Employees may elect to enroll in the ACH Direct Deposit option with Anthem FSA Log on to anthem.com once enrolled to complete the process

56 Schurz Choice Met Life Passive PPO Dental Plan

57 Dental Two year lock period removed  No longer required to stay in the dental plan for two years. New four tier rate structure  Employee only  Employee + Spouse  Employee + Child(ren)  Employee + Family Slight increase to dental cost for 2008

58 Metlife Passive PPO Dental Plan Summary Member Out of Pocket Individual Deductible$25 Family Maximum Deductible$100 Preventive Care20% Restorative20% Major Restorative50% Orthodontics50% Annual Maximum Benefit per Person $1,500 Lifetime Orthodontic Maximum Benefit per Person (separate from annual maximum) $1,500 You may continue to see the dentist of your choice. If you use a Metlife dentist, you may receive a discount.

59 Met Life Dental Plan Cost MONTHLY Employee Only$5.15 Employee + Spouse$10.31 Employee + Child(ren)$10.82 Employee + Family$15.98 BI-WEEKLY Employee Only$2.38 Employee + Spouse$4.76 Employee + Child(ren)$4.99 Employee + Family$7.38 WEEKLY Employee Only$1.19 Employee + Spouse$2.38 Employee + Child(ren)$2.50 Employee + Family$3.69

60 Schurz Choice Sun Life Supplemental Dependent Life Plan

61 Dependent Life Insurance Spouse only benefit  10K, 20K, 40K Child only benefit  5K, 10K, 20K  Child benefit may not exceed the spouse benefit if both are elected If electing for the first time during open enrollment- must complete evidence of insurability on spouse

62 Schurz Choice Web Communication Portal

63 Schurz Choice Communication Portal

64 Communication Portal Does not replace ADP Employee Self Service  Link from ADP Employee Self Service portal  Employees can link to ADP from this site- Click on General benefit, health and wellness information posted here Links to various administrator websites Access to claim forms

65 ADP Enrollment via ESS Open Enrollment Period  October 29 – November 9 Single sign on this year through ESS Link to current benefits elected Link to election process Option to request 2008 Medical Summary Plan Documents from Anthem

66 What Happens Next You will receive a confirmation statement in the mail Review the statement for errors If something is listed incorrectly, please notify your local HR Representative immediately.

67 No Changes for 2008 Vision  Remains with Anthem Blue Vision/EyeMed  Must elect medical coverage in order to have vision benefits  May not use Health Reimbursement Account dollars for vision expenses Group Life and AD&D  Hourly employees= 1 x annual earnings up to $150,000  Salary employees = 2 x annual earnings up to $150,000 Long Term Disability  The benefit begins after 180 days of a continuous disability.  If you elect this coverage, Schurz will pay the premium for the first $18,000 of covered earnings. You pay the premium on earnings above $18,000. Employee Supplemental Life and AD&D Options

68 Schurz Choice Anthem Vision Plan

69 Anthem Vision In NetworkOut of Network Exam Limited to one per member every 12 months (from date of service) $10 CopayReimbursement up to $35 Lenses - Limited to one set of lenses per member every 12 months Single Vision Lenses$20 CopayReimbursement up to a maximum of $25 Bifocal Vision Lenses$20 CopayReimbursement up to a maximum of $40 Trifocal Vision Lenses$20 CopayReimbursement up to a maximum of $55 Lenticular Vision Lenses$20 CopayReimbursement up to a maximum of $80 Progressive LensesCovered up to Bifocal amount less copay Reimbursement up to a maximum of $40 Frames - Limited to one set of frames per member every 12 months Covered up to $120 retail value before $20 Copay Reimbursement up to a maximum of $45 Contact Lenses – in lieu of lenses and frames $20 Copay; $105 Plan MaximumReimbursement up to a maximum of $105

70 Employee Supplemental Life and AD&D Options Employee = 1-4 x annual earnings Single or Family Coverage Evidence of Insurability is not required Employees pays all of premium via payroll

71 Enrolling in Supplemental Life If you are enrolling for the first time and you are not a new hire you will be required to complete an Evidence of Insurability form.  www.schurzchoice.essbenefits.com www.schurzchoice.essbenefits.com  Complete and return the form to your HR Representative by January 22nd

72 What Happens Next Between now and November 9 th  You review benefit information on ADP Employee Self Service portal & Schurz Choice web communication portal  Make any benefit election changes online Mid- December  You will receive a confirmation statement in the mail outlining the benefits you are enrolled in for 2008  If you elect:  Medical- You will receive a new Anthem Lumenos ID card  Flexible Spending- You will receive a new Anthem FSA debit card

73 Questions?


Download ppt "Celebrate …2008. Celebrate … Your health.  New Principal Wellness program  Additional resources within health plans Your valuable benefit plans.  Two."

Similar presentations


Ads by Google