2019 open enrollment informational session for hro - hawaii...2019/04/01 · employer-union health...

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2019 Open Enrollment Informational Session

For Human Resource and County Personnel Officers

Hawaii Employer-Union Health Benefits Trust Fund

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Employer-Union Health Benefits Trust Fund

State of Hawaii

Open EnrollmentImportant dates, form submission

deadlines and EUTF website resources

Enrollment FormCompleting and submitting forms for

open enrollment

Premiums and ContributionsNew premiums, Information on collective

bargaining and employer/employee contributions

Health Plan SelectionKnow what to consider when

selecting a health plan

Health & WellnessIdentify ways to reduce healthcare

cost and improve your health

Changes for 2019Benefit changes and new life

insurance carrier

Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment FormOpen Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment Form

Open Enrollment

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Important Dates Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment FormOpen Enrollment

IMPORTANT DATES

APRIL MAY JUNE JULY JUNE

*Do not expect extensions this year*

Election PeriodApril 1, 2019 - April 30, 2019

Submission Deadline April 30, 2019*

Employees who wish to enroll or make changes must complete and submit an EC-1 or EC-1H enrollment form and any required proof documents on or before the submission deadline to their HRO, CPO, EBU office or enrollment designee. For employees who do not want to make changes, no action is needed.


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IMPORTANT DATES


*Do not expect extensions this year*


Submission Deadline April 30, 2019*

Submission deadline for enrollment forms and proof documents to the EUTF by Human Resource Officers, County Personnel Officers and DOE-EBU is May 7th 2019 by mail or courier only. (No fax) Other non-OE related enrollment forms maybe faxed to the EUTF.

Submission DeadlineHRO/CPO/EBU

May 7, 2019

Enrollment forms received on or before the deadline will be processed during the months of May and June. Once the enrollment is processed, a confirmation notice will be mailed to the employee. If employees do not receive a confirmation notice by the end of June, please have them contact the EUTF. If they are not enrolling or making changes during the election period, they will not receive a confirmation notice.


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IMPORTANT DATES


Processing PeriodMay – June, 2019



Confirmation NoticeReceived by end of June


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IMPORTANT DATES


Processing PeriodMay – June, 2019 July 1, 2019 – June 30, 2020

New Plan YearElection PeriodApril 1, 2019 - April 30, 2019


Processing PeriodMay – June, 2019

New premiums deducted from paycheck

State EmployeesJuly 20, 2019 through July 5, 2020

County EmployeesJuly 15, 2019 through June 30, 2020

The New Plan Year for active employees begins July 1st and continues until June 30th of the following year. All changes made during open enrollment will take effect July 1st. All changes made during open enrollment, including new premiums and contributions, will take effect July 1st.

EUTF Online Resources


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Website: eutf.hawaii.gov

• Open Enrollment



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• Open Enrollment

o Open Enrollment Informational Session Schedule



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• Open Enrollment

o Open Enrollment Informational Session Schedule

o Open Enrollment Checklist



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• Learning Center Tab

o HRO OE Training

o LWOP, Premium Deductions, Shortages and Cancelations

o New Hire and Birth


• Active Employee Tab



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• Premium Calculator



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• Plan Finder

• Events Calendar



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• Plan Finder



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• Plan Finder



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• Plan Finder

• Events Calendar



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Changes For 2019

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Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment FormChanges for 2019

HMSABenefits Effective 7/1/2019 In-Network Provider Members Affected Note

Advance Care Planning No chargeNot subject to 75/25 deductible

EUTF PPO, HMO and HSTA VBProvided during a physicians visit or ER physician visit

Genetic CounselingStandard plan

benefits*EUTF PPO, HMO and HSTA VB -

Annual Preventive Health Exam No chargeNot subject to 75/25 deductible

EUTF PPO and HMO Replaces Routine Physical Exam benefit

Chlamydia and Gonorrhea Screenings for Men

No chargeNot subject to 75/25 deductible

EUTF PPO, HMO and HSTA VB -

Diabetes Prevention Program No chargeNot subject to 75/25 deductible

HSTA VBLimited to once per lifetime. Previously added for EUTF plans eff. 7/1/18.

Dr. Ornish’s Program for Reversing Heart Disease

$20 Copayment Per session

HSTA VBLimited to once per lifetime. Previously added for EUTF plans eff. 1/1/16.

Supportive Care No charge HSTA VBLimited to 90 calendar days in a 12-month period. Previously added for EUTF plans eff. 7/1/17.

*For more information about your coinsurance or copayment, see your HMSA Guide to Benefits.


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Kaiser Permanente

Benefits Effective 7/1/2019 Description Benefit Members Affective

Diabetes Prevention ProgramMembers with pre-diabetes will have access to a facility-based (through YMCA) and digital-based (through Omada) Diabetes Prevention Program.

No charge Active EUTF and HSTA VB

Contact a Kaiser Permanente lifestyle coach at 808-432-2260 to get started.


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CVS/caremark

Benefits Effective 7/1/2019 Description Benefit Notes

Two-Trial Step Therapy

Members will be required to try two generic medications before certain brand-name medications will be covered.

Applies to the following drug classes:

ACE/ARB (treats high blood pressure)COX 2 Inhibitors/NSAIDs (treats pain)Proton Pump Inhibitors (treats acid reflux)Urinary Antispasmodics (treats urinary incontinence).

For ACE/ARB and COX 2 Inhibitors; existing members will not be required to try a second generic

75/25 Maximum Out-of-Pocket (MOOP)

EUTF 75/25 PPO drug plan calendar year MOOP will increase.

Currently: $2,350/$4,700(Individual/Family)

Eff. July 1, 2019:$2,900/$5,800(Individual/Family)

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Specialty Maximum Out-of-Pocket (MOOP)

The specialty calendar year MOOP will increase.

Currently: $2,000 MOOP

Eff. July 1, 2019:$2,500 MOOP

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Specialty Tiered Copayments

Addition of tiered specialty copayments.

Current benefit: 20% of eligible charges; Up to $250 maximum per fill; $2,000 out-of-pocket maximum per calendar year; $30 copay oral oncology specialty medications

Specialty Generic 10% ($200 max)

Specialty Preferred 20% ($300 max)

Specialty Non-Preferred 30% ($400 max)


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Hawaii Dental Service (HDS)Benefits Effective 7/1/2019 Description Benefit Members Affective

Total Health Plus Total Health Plus is a supplemental set of benefits that provides 100% coverage of additional cleanings and fluoride treatments for high risk patients.

See below.Active EUTF and

HSTA VB

Medical Condition or Diagnosis Benefit Frequency

Diabetes Cleanings Two additional per year

CancerCleaningsFluoride Treatments

Two additional per yearTwo additional per year

Oral CancerCleaningsFluoride Treatments

Two additional per yearFour additional per year

Sjögren’s Syndrome CleaningsFluoride Treatments

Two additional per yearFour additional per year

Stroke Cleanings Two additional per year

Heart Attack, Congestive Heart Failure Cleanings Two additional per year

Kidney Failure Cleanings Two additional per year

Organ Transplants Cleanings Two additional per year

Pregnancy Cleanings One additional per year

Medical Risk for Cavities Fluoride Treatments Three additional per year


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Vision Service Plan (VSP)Benefits Effective 7/1/2019 Description Benefit

Standard Progressive LensesStandard progressive lenses (no-line multi-focal lenses) excluding any lens option ad-ons.

Covered at 100% through VSP Providers.(Currently not a benefit)

New Network ProvidersWal-Mart & Sam’s Club have been added to the VSP Network for EUTF

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FramesStandard frame benefit available at all VSP Providers (Costco, Wal-Mart & Sam’s Club)

$120 allowance every other plan year.(Current benefit $65 allowance every other plan year)

NOTE: Impacts all active employees

Effective July 1, 2019


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Life Insurance

Securian Financial (Securian) has been chosen as the new carrier for your Group Life Insurance.

Reduced Benefits After 65 Participants age

$25,028 Age 65 through 69



$7,701 Age 80 and over

New 2019 Benefit Participants age

$38,505 Under age 65

The accelerated death benefit will be up to 100% of your life insurance benefit. The accelerated death benefit allows a terminally ill participant with a life expectancy of 12 months or less to request early payment of their life insurance benefit.

Reduced Benefits 65 and Over:

Premiums and Contribution

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What is collective bargaining?


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Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment Form

Collective Bargaining

The portion of premiums paid by the employer are negotiated within the collective bargaining

process. The Employer portion of health premiums is not subject to arbitration and is described in

the collective bargaining agreements.

If settlement on employer contributions to EUTF/HSTA VB plans has not been completed timely,

employers will continue their July 1, 2018 to June 30, 2019 monthly contributions until an

agreement is reached.

Please visit the EUTF website at eutf.hawaii.gov for premium amounts and updated

employee/employer contribution amounts once collective bargaining agreements are reached.

Premiums and Contribution

Health Plan Selection

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Things to Consider

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Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment FormHealth Plan Selection

PREMIUMS

DEDUCTIBLE

The monthly amount paid for your health insurance shared between the employer and employee.

Does not apply to all plans or all services and cannot be paid in advance. Must be paid each calendar year on a claim-by-claim basis before benefits subject to the annual deductible become available.

CALENDAR YEAR PLAN YEAR

MAXIMUM

OUT-OF-POCKET

IN-NETWORKOUT-OF-NETWORK

COINSURANCECOPAYMENT

Jan 1st to Dec 31st - Includes medical and prescription drug benefits.July 1st to Jun 30th - Includes dental and vision benefits.

The maximum amount in deductibles, coinsurance and copayments you will pay for covered medical and prescription drug cost within a calendar year.

Coinsurance is your out-of-pocket cost based on a percentage of the in-network negotiated or eligible charge. Copayment is your out-of-pocket fixed dollar amount.

Physicians, hospitals, pharmacies and other providers contracted with your health plan. Providers that are not contracted with your health plan.

Calendar Year -Plan Year -

In-network -Out-of-network -


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Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment FormHealth Plan Selection

Maximum Out-of-Pocket (MOOP)

• Financial protection• All covered coinsurance, copayments and deductibles apply towards MOOP• Insurance company keeps track of out-of-pocket• When MOOP is reached – 100% coverage• Member is still responsible for taxes• Resets every calendar year

EUTF 90/10 PPO Plan HMSA$2,000/$4,000 (medical)

$4,350/$8,700(CVS prescription drug)



EUTF HMO Comprehensive Kaiser$2,000/$6,000

(medical and prescription drug)



EUTF HMO Standard Kaiser$2,500/$7,500

(medical and prescription drug)

EUTF HMO HMSA$1,500/$3,000 (medical)


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HMSA 80/20HMSA 90/10 HMSA 75/25HMSA PPO Plan Comparison for Self-only

Total Estimated Annual Cost:

Annual Employee Premium Contribution* $4,786 $3,180

Rick anticipates 4 doctor visits during the calendar year. His doctors charge $100 per

visit before insurance pays. Total $400**

Coinsurance 10%$40

Coinsurance 20%$80

$0 $0$4,786 $3,180

Calendar Year Maximum Out-Of-Pocket (MOOP)

Coinsurance less than

$2,500 MOOP

Rick is considering enrolling in either the 90/10, 80/20 or 75/25 Self-only plan

(Low dollar example)

$988

Coinsurance 25%$100


$5,000 MOOP

$4,826 $3,260

$0$0Calendar Year Plan Deductible


$2,000 MOOP

$0$988$1,088

The HMSA 75/25 PPO Plan for Self-only offers Rick the most savings in this scenario

$300$300

*Based on employer contribution from July 1, 2018 through June 30, 2019** Examples do not include any out-of-network and non-covered services or any applicable taxes

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HMSA 80/20HMSA 90/10 HMSA 75/25HMSA PPO Plan Comparison for Self-only


Annual Employee Premium Contribution* $4,786 $3,180

Rick anticipates $19,100 in covered in-network medical expenses (with $300

subject to the 75/25 deductible) from January 2019 - April 2019**

Coinsurance 10%$1,910


$0 $0$4,786 $3,180


Coinsurance exceeds

$2,500 MOOP

Rick is considering enrolling in either the 90/10, 80/20 or 75/25 Self-only plan

(High dollar example)

$988

Coinsurance 25%

Coinsurance + deductible reaches

$5,000 MOOP


$6,696 $7,000$5,680

$18,800X 25%$4,700


$0$0 $300Calendar Year Plan Deductible


$2,000 MOOP

$0$988$5,988

The HMSA 80/20 PPO Plan for Self-only offers Rick the most savings in this scenario


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Standard PlanComprehensive PlanKaiser HMO Plans


Annual Employee Premium Contribution* $3,066 $725

Malia will undergo surgery and was told the cost before insurance could be $50,000 at an in-network Kaiser facility this year.**

No ChargeCoinsurance 15%

$7,500

$0 $0$3,066 $725$3,225


$2,000Not met

$2,500Met

Malia is considering enrolling in the Kaiser Comprehensive or Standard plan

Total estimated annual savings under the Kaiser Comprehensive plan: $159



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Supplemental Plan Option

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EUTF HMSA 80/20 PPO CVS Prescription Drug Plan

$9,904 Coinsurance of Primary Plan(Up to the eligible charge)

EUTF Secondary Coverage Options

Employees who are covered under a non-EUTF group sponsored medical and prescription drug plan may enroll in an EUTF medical and prescription drug plan.

Non-EUTF HMSA 80/20 Medical & Prescription Drug Plan

Family MOOP$7,500 – Medical

Employee is considering enrolling in either an EUTF HMSA 80/20 PPO plan with CVS Prescription Drugs or the EUTF Supplemental Medical & Prescription Drug Plan offered through HMA.

Non-EUTF Coverage

Type Health Plan Maximum Out-of-Pocket for Medical Health Plan Selection

Example

*Examples do not include prescription drug maximum out-of-pocket comparisons**Reimbursements do not include non-covered services or taxes

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HMA Supplemental***

Medical & Prescription Drug Plan$378

Coinsurance of Primary PlanAll Services: $2,750 per person, including

Sublimit for Prescription Drugs: $250 per person

Health Plan Options Annual EUTF Premiums Reimbursement**Annual Member

Cost Benefit

***Plan does not coordinate with Medicare or MedQuest

-$2,404

$7,122

Enrollment Form

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EC-1 Enrollment Form

• Please ensure you have the correct formthen complete all sections of the EC-1

• Attach any applicable proof documents

• Submit forms on or before the April 30th deadline to your:

o Human Resource Officero County Personnel Officeo EBU Office (DOE)o Enrollment Designee

Enrollment Form

Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment FormEnrollment Form

(Except the Coverage Start Date section)

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Employee Data


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Who We Are Health Plan Options Premiums and Contribution Health Plan Selection Making ChangesEnrollment

Leave this section blank

Coverage Start Date

Check the box of each plan you wish to enroll in. You may enroll in only one medical/prescription drug plan.

A spouse/partner and/or dependent child may enroll in the same plans as the employee, but may not enroll in health plans on their own.

Life insurance is 100% employer-paid and is available for the employee only.

Plan Selection & Contribution

Complete all applicable fields. Check the box labeled “Open Enrollment” and complete all line items under this section.

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Dependent Information


List all eligible dependents, including your spouse or partner, you wish to enroll in plans. Complete all line items associated with each dependent.

If this is your first time enrolling your spouse or partner and/or dependents in EUTF plans, please submit the following proof documents.


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Proof Documents

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Enrollment Type Required Proof Documents

SELF PLANS No proof documents required

ADDING A SPOUSE/PARTNER Marriage certificate Domestic partnership documents

(available at eutf.hawaii.gov)

ADDING A DEPENDENT CHILD Birth Certificate (if child has a last name different

than the employee) Guardianship Decree (if legal guardian) Adoption Decree (if child is placed for adoption or

adopted)

DEPENDENT CHILDREN AGE 19 – 23 WHO ARE FULL-TIME STUDENTS AND ENROLLING IN DENTAL & VISION PLANS

Student Certification Letter(A letter from school’s registrar or verification certificate from the National Clearinghouse. Transcripts are not accepted)


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Other Insurance Information


If you or any of your dependents are covered under a non-EUTF health plan, provide the type of plan, name of the plan, subscriber’s name, and name of the dependents enrolled. This helps to ensure that you receive the full benefit of your EUTF and non-EUTF plans by reducing your share of the costs.

Employee’s Signature

Read the statement and if you agree, sign and date the form.

Enrollment forms must be submitted to your human resource officer, personnel office, EBU (DOE employees) or open enrollment designee

on or before April 30, 2019.

All proof documents must be received in order to process enrollment changes.

Form Submission

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Submission deadline for enrollment forms and proof documents to the EUTF by Human Resource Officers, County Personnel Officers

and DOE-EBU is May 7th 2019 Submit forms to the EUTF by mail or courier only. (NO FAX)

EUTF201 Merchant Street, Suite 1700Honolulu, Hawaii 96813

All non-OE related enrollment forms maybe faxed to the EUTF.

Employer Form Submission


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Confirmation Notice

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Employees who submit their completed form and proof documents on or before the enrollment deadline will have their forms processed during the months of May and June.

If employees do not receive a confirmation notice by the end of June, please have them contact the EUTF. If they are not enrolling or making changes during the election period, they will not receive a confirmation notice.

Employees will use the corrective action form provided with the confirmation notice to notify the EUTF of any EUTF errors.

Only employees who submit an enrollment form will receive a confirmation notice.


Health and Wellness

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Tips on how to save money

Mail Order VS Retail

Generic Drugs VS Brand Name Drugs

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Urgent Care, online care, minute clinic, and calling

your physicianVS Emergency Room

Annual Physical & Screening

Tobacco Cessation Products & Programs Disease Management Programs

Health Coaching

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Reminders

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Deadline for employees to submit EC-1/EC-1H forms is April 30, 2019.

All proof documents must be received in order to process enrollment changes.

Deadline for employers to submit forms to EUTF isMay 7, 2019.

Open enrollment forms and related proof documents must be mailed or couriered to the EUTF.

Please visit the EUTF website at eutf.hawaii.gov for more information on open enrollment and updates for employee/employer contribution amounts once collective bargaining agreements are reached.

Open Enrollment Premiums and ContributionChanges for 2019 Health Plan Selection Health & WellnessEnrollment Form

Mahalo

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