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COPRA MeetingMay 19, 2011

• What is Open Enrollment• When is Open Enrollment• Premiums• Medical Co-Pays• Covering Children up to Age 26• New Pharmacy Management Vendor• Optional Life Insurance

– New Maximums– Add up to $50,000 with no health history!

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Helpful Reminders

You may re-enroll in City retiree medical coverage during Open Enrollment if you have

CONTINUOUS, COMPARABLE COVERAGE

since the date you dropped the City’s coverage.

Evidence of continuous, comparable coverage is required.

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Open Enrollment Communication

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FORMS DOCUMENTS WEBSITE LINKS UPDATES

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Medical – Dental

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• Provider networks are leased.– Provider reimbursement levels are set

• City pays a monthly fee to process claims and provide other services.

• City is billed for the amount paid to each doctor, hospital, lab, etc.– This is paid from the Health Care Benefits Trust

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The total projected cost for medical and pharmacy coverage in the 2011 – 12 Plan Year– Employees & Retirees– 99.06% is spent directly on

claims

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• The City issued RFPs in late 2010 for– Medical, Dental, & Pharmacy Management– The last time these RFPs were issued: 2004

• Responses were received from– 5 medical vendors– 9 dental vendors– 9 pharmacy management vendors

• Selection committees reviewed RFP responses and interviewed finalists.

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• Vendors were evaluated on– Ability to meet current and future plan designs– Customer service and support– Cost

OUTCOME • Medical and Dental Plans: No change

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CIGNA Pharmacy Management replaces CVS/Caremark on August 1st

Tuesday, May 31to

Wednesday, June 29at 5 p.m. sharp

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• Medical Premiums – CIGNA 0%– BCBS HMO 0%

– BCBS PPO ↑ 8.8%

• Dental Premiums– DHMO 0%– DPPO 0%

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Retiree and Dependent

Status

2011-2012 Monthly Retiree Medical Premiums

 

Code 

CIGNA HMO 

BCBS HMO 

BCBS PPO

  0% change 0% change 8.8% increase

Single – Retiree or survivor not on Medicare A $640.87 $562.04 $581.82

was $526.42Family – Retiree and 1 or more dependents not on Medicare B $1,774.61 $1,547.42 $1,604.39

was $1,444.73Family – Retiree not on

Medicare, all dependents on Medicare

C $1,187.07 $1,034.13 $1,072.44was $964.97

Single – Retiree or survivor on Medicare D $547.76 $480.35 $497.29

was $449.92Family – Retiree with Medicare, any dependent not on Medicare E $1,071.41 $932.27 $966.99

was $869.23Family – Retiree and all

dependents on Medicare F $1,040.54 $905.72 $939.52was $844.78

 Retiree and Dependent Status

    

Code

Full Premiumand 

PEHP Premium 

  

Qualified City Contribution Amount 

 

Single – Retiree or survivor         not on Medicare

ACIGNA: $745.87

BCBS HMO: $667.04BCBS PPO: $686.82

$105

Family – Retiree and 1 or more dependents not on Medicare

BCIGNA: $ 2,149.61

BCBS HMO: $1,922.42BCBS PPO: $1,979.39

$375

Family – Retiree not on Medicare, all dependents on Medicare

CCIGNA: $1,447.07

BCBS HMO: $1,294.13BCBS PPO: $1,332.44

$260

Single – Retiree or survivor         on Medicare

DCIGNA: $637.76

BCBS HMO: $570.35BCBS PPO: $587.29

$90

Family – Retiree with Medicare, any dependent not on Medicare

ECIGNA: $1,316.41

BCBS HMO: $1,177.27BCBS PPO: $1,211.99

$245

Family – Retiree and all dependents on Medicare

FCIGNA: $1,275.54

BCBS HMO: $1,140.70BCBS PPO: $1,174.52

$235

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Total Monthly Premium

Dental PPO  

Single $34.08Retiree +1 $75.72

Family $110.75Dental HMO  

Single $18.36Retiree +1 $33.17

Family $58.46Deduction automatically taken from monthly pension check.

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Medical Co-Pays

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Service Current Co-Pay

Primary Care Physician Office Visit, Convenience Care Clinic $15

Specialist Office Visit $35

Lab, Radiology $0

Routine Physicals $0

Behavioral Health Office Visits $10

Eye Exam $5

Inpatient Hospitalization $100/day, max. $300

Generic Medication $10

Preferred Brand Name Medication $25

Non-Preferred Brand Name Medication $40

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Service Current Co-Pay Co-Pay as of 8/1/11

PCP Office Visit $15 $20

Eye Exam $5 $10

Urgent Care $40 $45

Emergency Room $125 $140

Outpatient Surgery $75 $80

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Prescription Co-Pays 

TierRetail Co-Pay

30 Day Supply

Mail Order Co-Pay

90 Day Supply

90 Day Fill at Retail

Generic $10 / 30 day supply $20 / 90 day supply $30

Preferred Name Brand $25 / 30 day supply $50 / 90 day supply $75

Non-Preferred Name Brand $40 / 30 day supply $80 / 90 day supply $120

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Eligibility for Children

up to Age 26

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• The term “child” includes a biological child, adopted child, child placed for adoption, stepchild, qualified domestic partner’s child, or a child living with you for whom you have either permanent legal custody.

• Student status is not required.

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Medical – Dental •Beginning August 1, 2011 the maximum age for eligible children changes from age 23 to age 26.

•Eligibility for Coverage– Cannot have access to other group coverage, for

example, through their employer or their spouse’s employer.

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• Children who were removed from City coverage at age 23 will NOT be automatically re-enrolled. The employee must take action during Open Enrollment.

• It is always the retiree’s responsibility to know when a child no longer qualifies for coverage.

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CIGNA Pharmacy Management Replaces CVS/Caremark

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• Takes effect on August 1st

• For CIGNA and BlueCross/BlueShield plans.

• If you are impacted by this change you will receive information in the mail. Please open and read it.

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CVS/Caremark

• 60,000 pharmacies nationally– Walgreens– CVS– Walmart– Target– Costco– Safeway– Fry’s– Bashas’

CIGNA Pharmacy Mgmt.

• 60,000 pharmacies nationally– Walgreens– CVS– Walmart– Target– Costco– Safeway– Fry’s – Bashas’– CIGNA Medical Group

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CVS/Caremark

• Customer Service– 24/7

• Mail Order• 90 Day Fill at Retail

– Large chain stores– 3 co-pays

• Onsite Representative• Online support

CIGNA Pharmacy Mgmt.• Customer Service

– 24/7

• Home Delivery

• 90 Day Fill at Retail – Large chain stores

– 3 co-pays

• Onsite Representative

• Online support at mycigna.com

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• Everyone will receive new medical ID cards.

• Everyone will receive new Pharmacy ID cards.

• You will receive new ID cards in the mail

in late July.

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• Continue to use your CVS/Caremark pharmacy ID card through July 31st .

• Give your pharmacist your CIGNA Pharmacy Management ID card the first time you fill a prescription on or after August 1st .

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eCHRIS Self-Service

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“I’m not sure what I’m enrolled in.”

• Go to eCHRIS Self-Service• Log in• Go to Benefits• Click Current Benefits Summary

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“I want to make a change.”

• Use eCHRIS Self-Service– Log in– Go to Benefits– Click Benefits Enrollment– Make Change(s)– SUBMIT

Changes must be submitted by 5:00 p.m. on Wednesday, June 29th

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• If you have a computer, but eCHRIS seems overwhelming, ask the HR Center or the Benefits Office for help.

• If you are unable to use eCHRIS and would like to make a change, contact the Benefits Office before 5 p.m. on June 29th.

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• HR Center– (602) 262-6608– Located on the 1st floor of the Personnel Building.

• Benefits Office– (602) 262-4777– Located on the 4th floor of the Personnel Building.

• Password Help– Call (602) 534-4357

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“I don’t want to change anything.”

• Do nothing, and your current benefits will continue August 1, 2011 – July 31, 2012

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