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2014 Health Benefits Open Enrollment May 1 – 23, 2014
Commonwealth of Virginia Health Benefits Program 2014 Health Benefits Open Enrollment May 1 – 23, 2014 Highlights for July 1, 2014 April 2014
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Customize based on your needs
Enroll, change or keep your health plan Consider buy-up options: COVA Care, COVA HealthAware & COVA HDHP Add or remove eligible family members Waive coverage Enroll in a Flexible Spending Account
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Your Health Plan Choices
Plans Offered Available Administrator COVA Care Statewide Anthem Blue Cross and Blue Shield Delta Dental of Virginia COVA HealthAware Aetna COVA HDHP Anthem Delta Dental Kaiser Permanente HMO Regional, primarily in Northern Virginia Kaiser Permanente TRICARE supplement Association and Society Insurance Corporation (ASI)
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COVA Care and COVA HDHP Administered by Anthem and Delta Dental
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for Dental Anthem administers: Medical Behavioral Health
Employee Assistance Program (EAP) Prescription Drug Delta Dental partners with Anthem for Dental
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COVA Care and COVA HDHP Behavioral Health
Change Effective 7/1/2014 Residential Treatment Centers Approved in-network behavioral health services
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www.AnthemEAP.com Workplace issues Mental health Finance/Legal
Health and Wellness Mental health Parenting and child care Marriage & relationship concerns
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COVA Care – Prescription Drugs
Tier Retail Home Delivery 1 Generic drugs (no change) $15 $30 2 Lower cost preferred brands $60 3 Higher cost brands $45 $90 4 High cost Specialty brand $55 COVA Care – Prescription Drugs Change for 7/1/2014 Drug copayments increase for tiers 2-4 $5 retail/$10 mail $ 60 $110
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Home Delivery only two copays online at anthem.com or by phone
Three month supply for only two copays Easy to get started online at anthem.com or by phone Delivered safely to your doorstep
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Optional Buy-Ups • Expanded Dental (Delta Dental)
◦ • Expanded Dental (Delta Dental) Out-of-Network Expanded Dental (Delta Dental) Routine Vision/ Hearing
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COVA Care – Vision and Hearing
Blue View Vision Eye exam Eyeglasses and contact lenses Frames Discounts on accessories Hearing Routine hearing exam Hearing aids COVA Care – Vision and Hearing ◦
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Commonwealth employees at anthem.com/cova
Go to urgent care centers instead of emergency rooms $25 PCP/$40 Specialist copay for Urgent Care vs. $150 copay the ER at Call 24/7 NurseLine Access to a registered nurse day or night Download the Mobile App on your smartphone Find Doctor &Urgent Care Centers, View ID Card and Estimate Your Costs Use the “Estimate Your Cost” tool Find cost ranges for services and quality reviews for doctors Bookmark your dedicated website for Commonwealth employees at anthem.com/cova Anthem Tips and Resources ◦
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More on Dental Benefits
Administered by Delta Dental of Virginia The COVA Care and COVA HDHP dental benefits will continue to be administered by Delta Dental. We’ll review the benefits in more detail over the next few slides.
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Delta Dental of Virginia will continue to administer the dental benefits for COVA Care and COVA HDHP
IMPORTANT PLAN FEATURES: Diagnostic & Preventive services are covered at 100% for all members when they see a participating provider. COVA Care Basic and COVA HDHP members have 100% coverage for diagnostic and preventive services such as routine exams and cleanings, as well as sealants and fluoride for children. These services are exempt from the deductible and annual maximum. Some frequency limitations apply such as two cleanings in a plan year. Refer to your COVA Care or COVA HDHP handbook for details. Please remember if you and your family need coverage for any dental services other than Diagnostic & Preventive you will need to elect the Expanded Dental benefits during Open Enrollment. With the Expanded benefits you will also have 80% coverage for Primary Services such as fillings and root canals, 50% coverage for Complex Restorative Services such as crowns and bridges, and 50% coverage for Orthodontics. Please refer to your handbook for more details, or contact Delta Dental’s dedicated Commonwealth of Virginia customer service team.
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Expanded Dental optional buy-up includes
Primary Care – such as fillings, extractions, root canals Complex Restorative - dentures, bridges and implants Orthodontic services COVA Care Basic and COVA HDHP members have 100% coverage for diagnostic and preventive services such as routine exams and cleanings, as well as sealants and fluoride for children. These services are exempt from the deductible and annual maximum. Some frequency limitations apply such as two cleanings in a plan year. Refer to your COVA Care or COVA HDHP handbook for details. Please remember if you and your family need coverage for any dental services other than Diagnostic & Preventive you will need to elect the Expanded Dental benefits during Open Enrollment. With the Expanded benefits you will also have 80% coverage for Primary Services such as fillings and root canals, 50% coverage for Complex Restorative Services such as crowns and bridges, and 50% coverage for Orthodontics. Please refer to your handbook for more details, or contact Delta Dental’s dedicated Commonwealth of Virginia customer service team.
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COVA HealthAware Administered by Aetna Plan logo here
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Comprehensive Plan Benefits and Coverage
Medical Behavioral Health Pharmacy Basic Dental Routine Vision Exam Routine Hearing Exam Includes a Health Reimbursement Account (HRA) Expanded Dental and Vision benefits for an additional premium
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Changes for 7/1/2014 Residential treatment centers added to behavioral health benefits. More healthy activities to choose for “Do Right” contributions to the HRA.
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What is a Health Reimbursement Arrangement (HRA)?
Account that automatically pays eligible out-of-pocket expenses as long as funds are available Medical Behavioral health Pharmacy Funds paid automatically from HRA towards eligible expenses for any covered member Unused HRA funds roll over into future plan years with no limit if enrollment in the plan continues
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COVA HealthAware HRA The initial HRA contribution for 7/1/2014:
Employee/Retiree $ 600 Employee/Retiree + Spouse $1,200 HRA contribution is prorated for new enrollments or QME changes during the plan year. The HRA proration chart may be found on
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How the Plan Works COVA HealthAware is an open access, point-of-service (POS) plan with a large national network. HRA Contribution Employee/ Retiree only Employee/Retiree + Spouse Do Right HRA Incentives In-Network Out-of-Network Deductible One person $1,500 $3,000 Two or more persons $6,000 Out-of-pocket Max $12,000 Coinsurance Preventive 100% 60% Diagnostic 80% earn up to $300 $600 $1,200 earn up to $150
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HRA “Do Rights” Employees/Retirees and enrolled spouses
Additional $50 HRA contribution for up to three “Do Rights” Up to $150 per employee/retiree Up to $150 per enrolled spouse “Do Rights” include Annual routine physical exam Routine dental exam Annual routine vision exam (new!) Annual flu shot Active Health Management Health Tracker Active Health Management Coaching Module (new!)
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Pharmacy Benefits Integrated with the medical benefit
Combined deductible and out-of-pocket maximum Mandatory Generic plan Specialty pharmacy available Members can compare drug costs in advance on their member website
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Dental Benefits Diagnostic and preventive dental services
Included with the basic plan Covered at 100% in-network Expanded Dental: Optional Buy-Up Primary procedures: fillings, extractions, root canals Complex restorative procedures: crowns, dentures, bridges, implants Orthodontia
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Vision Benefits Routine annual vision exam included with basic plan and covered at 100% Expanded Vision: Optional Buy-Up Materials benefit for eyeglasses and contact lenses Discounts for eyewear and accessories Network includes private practice providers plus participating national chains
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Employee Assistance Program (EAP) Aetna Resources For LivingSM
Available to participants and members of their household Confidential resource to address and resolve personal and workplace challenges Provides up to 4 visits per incident per plan year at no cost Additional legal and financial guidance
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Member tools and resources
Aetna Navigator Secure member website for 24/7 plan access and answers to questions Member Payment Estimator Provides real-time, personalized cost estimates for members based on their specific health plan and balances iTriage Mobile app to help members make better healthcare decisions and improve healthcare delivery CarePass Digital health and wellness tool to combine all leading health, wellness, and nutrition apps in one place Aetna Mobile Access to Aetna Navigator from a smartphone
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Finding answers is easy!
Have a question about any COVA HealthAware Benefit? One-stop, concierge-style service: Dedicated website:
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MyActiveHealth Total Population Health Program
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ActiveHealth Management:
Provides coaching services as part of the COVA health management program Partners with Anthem and Aetna to deliver services promoting healthy lifestyles and chronic condition management. Posters, flyers, postcards and communications provide program information.
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Customized Health Portal
All eligible adult members may access their own customized portal Complete their health assessment Schedule biometric screening The portal is enhanced with online coaching and web tools Digital coaching Interactive trackers, games and more
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Healthy Lifestyles - Lifestyle Coaching with Five Tracks
Smoking Cessation Weight Management Stress Management Nutrition Exercise Healthy Insights - Disease and Chronic Condition Management for Conditions Such As: Heart Disease Diabetes Healthy Beginnings - Maternity Care
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Incentives - COVA Care and COVA HealthAware
Healthy Insights Diabetes management Hypertension (new July 1, 2014) COPD & Asthma (new July 1, 2014) Bariatric Surgery Coaching Program Healthy Beginnings for expectant moms
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Administered by Kaiser Permanente
Kaiser Permanente HMO Administered by Kaiser Permanente
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New for July 1, 2014 Pediatric Vision Eyewear up to age 19
No cost to members One pair of frames per year from select group, and Certain single vision or bifocal lenses, or Up to three months supply of contact lenses from selected list
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The Power of kp.org
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Administered by Association and Society Insurance Corporation (ASI)
TRICARE SUPPLEMENT Administered by Association and Society Insurance Corporation (ASI)
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TRICARE SUPPLEMENT Voluntary supplemental health benefit option
Available to employees and their dependents who are eligible for: TRICARE, the military health benefit program, and The State Health Benefits Program Eligible employees who enroll in the plan are responsible for 100% of the monthly premium amounts Monthly premium payments are made with pre-tax dollars through payroll deduction
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Premium Reward For employee, retiree and/or enrolled spouse
Employee/Retiree or spouse can save $17/month Together can save $34/month
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Already Earning a Premium Reward?
Remain in COVA Care or COVA HealthAware Reward will continue through June 30, 2015 No additional actions required New! Confirm your reward status on EmployeeDirect
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COVA Care and COVA HealthAware
Earn Premium Rewards – COVA Care and COVA HealthAware Eligible members enrolled from July 1, 2013–March 1, 2014 Health assessment and biometric screening must be completed and submitted by May 31, 2014. Eligible members enrolled effective April 1–July 1, 2014 Health assessment and biometrics must be completed and submitted by August 31, 2014. Health assessment and biometric registration are available at or by telephone at
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Employee Premium with Rewards
MONTHLY PREMIUMS Employee Only Employee Plus One Employee Plus Two Or More Health Care Plan Reward Earner Employee Employee or Spouse Employee and Employee or Employee and COVA Care Employee Premium $75 $171 $230 Rewards -$17 -$34 Employee Premium with Rewards $58 $154 $137 $213 $196 COVA HealthAware $26 $81 $96 $9 $64 $47 $79 $62
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Flexible Spending Accounts
Administered by Anthem
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Flexible Spending Accounts
Health care FSA Set aside up to $2,500 per year, pre-tax, for eligible health expenses Dependent care FSA Set aside up to $5,000 per year, pre-tax, for dependent day care expenses Use the Elite Benefit Card for eligible Health FSA expenses
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FSA Change for 7/1/2014 You must file claims within the three months after your coverage period ends Including any documentation required to validate an outstanding FSA card transaction. For Example, if your coverage period ends on 4/30/15, you must file by July 31, 2015.
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All Participants Should Register Online:
Account Balances Direct Deposit Account Activity Statements Online Payments Important Information about your FSA: Participants must enroll each plan year in order to participate. If you enroll in COVA HealthAware, the HRA pays first. See Spotlight on Benefits for website and contact information.
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ALEX is back! ALEX is your online interactive assistant. He can advise you on what plan may be best for you. The final decision is still yours. Take a look at
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Get More Details Find information:
Spotlight or Retiree notification booklet Your agency Benefits Administrator Contact the plans
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Make Your Election! Visit http://edirect.virginia.gov
Login and select “Health Benefits Enrollment and Information” Or submit an enrollment form to your agency benefits office Final answer due May 23!
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Remember, It’s Your Call!
Consider what’s best for you and your family Choose your health coverage Premium reward Employees - Flexible Spending Account
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Important Dates •Last day of Open Enrollment - May 23
•Last Day to Key RC 56 – May 29 •Last Day to Key RC 47 – June 30
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Coverage Effective on: Activities Completed by: Premium Reward Begins:
Premium Rewards Coverage Effective on: Activities Completed by: Premium Reward Begins: July 1, 2013 May 31, 2014 July 1, 2014 August 1, March 1, 2014 April 1, 2014 – June 1, 2014 June 30, 2014 April 1, July 1, 2014 July 31, 2014 August 1, 2014 April 1, 2014 – July 1, 2014 August 31, 2014 September 1, 2014 Current Premium Rewards will continue until June 30, 2015 as long as members remain in COVA Care or COVA HealthAware. No additional action required!
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Premium Reward Status PSBREW – New Premium Reward Activity Screen -
EmployeeDirect: Health Benefits Enrollment and Information Bulletin Board Confirm your premium rewards: Select “View Current Health Benefits Profile”, then look at Section 3: Health Care Coverage Election for “Reward Earned”. PSBREW – New Premium Reward Activity Screen - Check the status of the reward activities Confirm the end date of the Premium Reward Numbered Memo 14-01 PSB305: EmployeeDirect No Reward None Par Only You Only Spouse Only Par&Spouse You and Spouse
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Employee Mailing The Spotlight newsletter will be:
mailed to the employee’s home provided electronically to all employees with s in BES Summary of Benefits and Coverage(SBC) required by the Affordable Care Act (ACA) If currently enrolled, employees will receive a plan specific SBC If not currently enrolled, a notice on how to obtain a copy of the SBCs. Annual CHIP notice required by the Department of Labor HIPAA Special Enrollment Notice
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Need Help? General Open Enrollment questions:
EmployeeDirect login/password issues or HuRMan access: General Open Enrollment questions: EmployeeDirect Health Benefits and Enrollment issues, keying BES, or content of a BES report: Policy and eligibility questions: Fax: (804)
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