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Faculty Open Enrollment
November 2, 2015 – November 20, 2015 Coverage Effective January 1, 2016
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Topics for Discussion CHEIBA Trust and Mines Eligibility
Benefits Plan Changes 2016 Rates Affordable Care Act Enrollment Process
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CHEIBA Trust Mines is part of a multi-university benefits trust
The Trust provides comprehensive benefits to all member schools Mines faculty obtain insurance through the school’s membership in the trust Health, Dental, LTD, Basic Life and Business Travel (Employer Paid) Vision, Optional Life and Accidental Death and Dismemberment (Employee Paid)
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Eligibility Employee, legal spouse, or partners joined in a Civil Union Dependent child(ren), civil union partners, qualified step child(ren), or qualified foster child(ren), married or unmarried and regardless of tax status until the end of the month in which they turn 26 Employee’s child(ren) of any age who are medically certified as disabled
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Domestic Partner Eligibility
No Domestic Partners may be added to trust benefits after December 31, 2015 Existing Domestic Partners enrolled in Trust benefits will be grandfathered for 2016 All Domestic Partner benefits will end December 31, 2016
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Civil Unions Recognized for insurance purposes January 1, 2014
Requirements Photocopy of Civil Union Certificate Joint bill or statement dated within the last 60 days
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Eligibility Documentation
The CHEIBA Trust requires eligibility documents for all new plan participants including copies of registered marriage certificates and birth certificates Documentation requirements are posted on the CSM Benefits webpage and available in the Human Resources Office.
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Health Insurance Five Plan Designs Blue Advantage Point of Service
Blue Priority PPO (Formerly Blue Prime PPO) Custom Plus (Closed to New Enrollment) Blue Priority HMO Lumenos HSA 2500 (High Deductible Health Plan) The following information is based on in-network benefits only. Some plans have an out-of-network option. Please see the 2016 Benefits Book for details
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Definitions Deductible: The amount you pay out of pocket for your health care expenses before the plan makes payments for eligible expenses Copayment: A flat dollar amount you pay for services regardless of the cost of those services Co-Insurance: The percentage of the eligible expenses you are responsible for paying
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Blue Advantage HMO/POS
PCP Requirement Yes In-Network Deductible $0 Out of Pocket Maximum $2,000/$4,000 Preventive Care No Cost Primary Care Office Visits $20 co-pay Specialist Office Visits Emergency Room $100 co-pay Inpatient Hospital $400 co-pay Urgent Care $50 co-pay Out-Patient Surgery $85/$65 co-pay Retail Rx – 30 Day Supply $15/$30/$45 co-pay Mail Order Rx – 90 Day Supply $15/$60/$90 co-pay Specialty Pharmacy – 30 Day Supply 30% to a maximum of $125
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Blue Priority PPO PCP Requirement Yes In-Network Deductible $400/$800
Out of Pocket Maximum $750/$1,500 Preventive Care No Cost Primary Care Office Visits Tier 1 $10 co-pay Tier 2 15% co-insurance Specialist Office Visits Tier 1 $10 co-ay Tier 2 15% co-insurance Emergency Room 15% co-insurance Inpatient Hospital Urgent Care Out-Patient Surgery Retail Rx – 30 Day Supply $15/$30/$45 co-pay Mail Order Rx – 90 Day Supply $15/$60/$90 co-pay Specialty Pharmacy – 30 Day Supply 30% to a maximum of $125
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Blue Priority PPO Name Change – Formerly Blue Prime PPO
Members must designate a Tier 1 Primary Care Physician (PCP) Use a Tier 1 PCP or Specialist for a $10 copayment You still have access to all physicians in the PPO Network including non-Tier 1 PCP’s Anthem will assign a PCP to members who do not designate one
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Blue Priority HMO New Option
PCP Requirement Yes – Limited Network In-Network Deductible $2,000/$6,000 Out of Pocket Maximum $4,000/$10,000 Preventive Care No Cost Primary Care Office Visits $20 co-pay Specialist Office Visits $60 co-pay Emergency Room $250 co-pay Inpatient Hospital $250 co-pay plus 20% after deductible Urgent Care Out-Patient Surgery Retail Rx – 30 Day Supply $200/$400 (Tier 2 & 3) $15/$40/$60 Mail Order Rx – 90 Day Supply $200/$400 (Tier 2 & 3) $15/$80/$120 Specialty Pharmacy – 30 Day Supply 30% to a maximum of $250
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Lumenos 2500 HSA New Option PCP Requirement No In-Network Deductible
$2,500/$5,000 Out of Pocket Maximum Preventive Care No Cost Primary Care Office Visits $0 after deductible Specialist Office Visits Emergency Room Inpatient Hospital Urgent Care Out-Patient Surgery Retail Rx – 30 Day Supply Mail Order Rx – 90 Day Supply Specialty Pharmacy – 30 Day Supply
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Health Savings Account (HSA)
The Lumenos 2500 HSA is a high deductible health plan and HSA qualified An HSA is a tax-favored savings account that, when paired with a qualified high deductible health plan (HDHP), allows you to pay for qualified medical expenses, or leave funds invested in the account for future medical expenses tax-free An HSA can be set-up through your local bank or credit union
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All Health Plans New! A routine vision exam for a $15 copayment will be covered under all Mines health plans Enrollment is automatic you do not need to do anything Anthem Blue View Vision Network
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Pharmacy Reminders All Asthma and Diabetic medications are available at no cost Use the Express Scripts Mail Order Pharmacy for significant cost savings A 90 day supply of generic medication is available through the mail order pharmacy for a $15 copayment
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Dental Plans (Anthem Dental)
Two Plan Options Dental PPO Plus Dental PPO There are no changes for 2016
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New! Anthem Blue View Vision
A routine vision exam is now covered under your health insurance Two Plan Options Materials Only – For members and dependents covered under Mines health insurance Materials plus Exam – Only for members not covered under Mines health insurance In order to start or continue vision coverage you must enroll in one of the 2016 coverage options Coverage under VSP will end December 31, 2015
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New! Anthem Blue View Vision
In- Network Eyeglass Frames $130 Allowance 20% discount on balance Eyeglass Lenses Standard plastic single vision Standard plastic lined bifocal Standard plastic lined trifocal $15 co-pay $15 copay Contact Lenses (In lieu of eyeglasses) Once every 12 months Elective conventional lenses Elective disposable lenses Non-elective contact lenses Contact Lens exam (fitting & evaluation) $130 allowance 15% discount on balance $130 allowance Covered in full Copayment up to $55
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New! Anthem Blue View Vision
In-Network (Member Cost) Eyeglass Lens Upgrades Transitions (Adults) Polycarbonate (Adults) UV Coating Progressive Lenses Anti-Reflective Coating Other Add on Services $75 co-pay $40 co-pay $15 co-pay $65-$110 co-pay $45-$68 co-pay 20% off Retail Price Out-of-network benefits paid on a schedule – See the 2016 Benefits Book Members are not eligible for glasses and contacts in the same benefits period Purchase materials through your provider, or retail locations including Lens Crafters, Pearl Vision, Target, JC Penny and Sears Discounts on Lasik Low vision benefit
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New! Anthem Blue View Vision
2016 Premiums Materials Only Employee Only $6.36 Employee + Spouse $11.92 Employee + Children Employee + Family $17.31 2016 Premiums Material plus Exam Employee Only $8.80 Employee + Spouse $16.49 Employee + Children Employee + Family $23.95
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Identification Cards Due to the change in Health plan options and the addition of Anthem Blue View Vision everyone will be issued a new ID card for 2016 Health, Dental, and Vision will all be on one card If you have moved please drop by Human Resources GH110 to update your information
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Long Term Disability Insurance
Income replacement in case of a long term disability 90 day waiting period The Standard Insurance Company Mines pays all premiums for this plan No plan changes for 2016
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Voluntary Accidental Death & Dismemberment (AD&D)
Coverage for Accidental Death or Dismemberment Mutual of Omaha No plan changes for 2016
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Travel Accident Insurance
Provides coordination of care while traveling on school business Provides an accidental death and dismemberment benefits while traveling on school business Mines pays all premiums for this plan No changes for 2016
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Basic Life Insurance Employee Coverage: Under age X annual salary; benefit capped at $500,000 Age 65 – X annual salary; benefit capped at $50,000 Age flat amount of benefit of $10,000 Dependent Coverage included at $2000 Employee’s legal spouse under age 70 and any married or unmarried child(ren) regardless of tax status and between 14 days and 26 years of age Mines pays all premiums for this plan Domestic Partners and children of domestic partners are not eligible for Dependent Coverage
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Optional Life Insurance Anthem Life
Optional employee paid life insurance Coverage up to $300,00 for employee and/or spouse An Application including a medical questionnaire is required during open enrollment Voluntary Dependent Child Coverage - $5,000 Dependents may be insured through the month in which they turn 26 No health screening is required for children
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2016 Flexible Spending Account
Healthcare Flexible Spending Pre-tax deductions for healthcare expenses for you and your qualified dependents to cover items such as co-pays, deductibles, medical supplies, eye glasses/contact lenses, and dental care Dependent Care Flexible Spending Pre-tax deductions for day care expenses for qualified dependents. Tuition beyond preschool is not covered. Participants save anywhere from 15%-30% or more Expenses must be incurred during the plan year to qualify for reimbursement. Funds not used are forfeited!
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2016 Flexible Spending Account
24Hour Flex – New Plan Administrator January 1, 2016 Healthcare $2,550 per employee annual maximum Dependent Care $5,000 per family annual maximum CSM pays the $3.75 administrative fee File claims online or using by using the 24Hour Flex mobile app You must enroll during the open enrollment period to start or continue this benefit (IRS regulations) Claims for expenses incurred in 2015 should be filed with PayFlex! Participation for Domestic Partners/Civil Unions partners and/or children of Domestic Partners/Civil Union partners is limited to tax qualified dependents
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24Hour Flex Visa Card (Benny Card)
You will automatically be issued a Debit Card Use to pay for co-pays, prescriptions, qualified dental treatments, medical supplies and other qualified expenses Keep your Documentation! You may be required to provide documentation to 24Hour Flex, or to the IRS in case of an audit You are not required to use the debit card. You may still file regular electronic claims
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2016 Premium Information Health Insurance
Mines pays 100% of your health and dental premiums Health premiums increased 6.1% this year New four tier premium structure HMO/POS, Blue Priority PPO, and Custom Plus Medical Premiums 2015 2016 Employee Only $601.00 $637.52 Employee + Spouse N/A $1,528.84 Children $1,401.84 Family + Family $1,568.00 $1,759.13
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2016 Premium Information Health Insurance
Blue Priority HMO Lumenos 2500 HSA 2016 Employee Only $586.52 Employee + Spouse $1,406.84 Employee + Children $1,289.84 Employee + Family $1,619.13 2016 Employee Only $573.52 Employee + Spouse $1,376.84 Employee + Children $1,216.84 Employee + Family $1,584.13
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2016 Premium Information No increase in dental premiums
New four tier premium structure Dental Premiums 2015 Employee Only $39.00 Employee + Spouse $90.00 Employee + Children $86.00 Employee + Family $102.00
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Value Of Your Coverage (Health, Dental, Life, LTD, Travel)
Assume salary of $60,000 Employee only coverage, under age 65 CSM Pays: $8,170 With PERA included, CSM pays: $19,660 Employee with family coverage, under age 65 CSM Pays: $22,385 With PERA included, CSM pays: $33,874 Assume a salary of $100,000 With PERA included, CSM pays: $41,569 2016 Employer (CSM) PERA Contribution rate is 19.15% (10.15% Employer Contribution plus 9% AED/SAED)
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Open Enrollment Enrollment is REQUIRED for those who:
Wish to participate in a Flexible Spending Account Wish to participate in the vision plan Wish to add, drop, or change coverage Wish to add or drop dependents. Reminder: Dependents may be insured through the month in which they turn 26 regardless of, student, tax, or marital status Forms are due in the Human Resources Office no later than Friday November 20th at 5:00pm. Early submission is greatly appreciated!
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Open Enrollment You DO NOT need to complete new enrollment forms if you DO NOT wish to: Enroll in a Flexible Spending Account Start or continue Vision Coverage Change dependent coverage Your benefits will continue unchanged
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Qualifying Events REMINDER:
Your benefits elections will be in effect for the entire 2016 calendar year unless a “qualifying event” occurs You must notify, and provide Human Resources with documentation within 31 days of an eligible qualifying event Examples are marriage, divorce, birth, overage dependents, spouse loses coverage etc. Failure to do so means that you must wait until the next open enrollment period (IRS regulations) Reference your Benefits Book or contact HR for further details
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Voluntary Tax Deferred Options
PERA 401(k) Plan PERA 457 Deferred Compensation Plan 403(b) Tax-Deferred Annuity Plan Roth 403(b) Post-Tax You may enroll in these plans at anytime! Detailed plan information is available in Human Resources
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Affordable Care Act (PPACA) Update
Individual Mandate Most individuals will be required to carry minimum value (60% actuarial value) coverage or face a possible financial penalty Employer Mandate Employers are required to provide minimum value coverage to 95% (70% for 2015) of employees working 30 or more hours per week or face a financial penalty Starting in January of 2016 employers and insurance companies will be reporting offers of coverage and enrollment information to the IRS for calendar year 2015 Many employees will receive a Form 1095-C Form from their employer outlining offers of coverage and enrollment information for calendar year 2015 by January 31, 2016 Stay tuned for more information on this topic
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Participant Advocate Link
You have a P.A.L.! The participant advocate is available to assist you with benefits issues such as billing problems, reimbursement issues, and denied services The participant advocate is an employee of Gallagher Benefits Services and works only for you! (303) or (800)
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Questions? Monica Gutierrez (303) 384-2522 mgutierrez@mines.edu
Ann Hix, (303)
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