2/8/2016

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Agenda

1. PEEHIP Overview2. Wellness Program review3. 3-1 Rule and the Employer Portal4. New employee procedures5. Premium rates and open enrollment6. Medicare/Retiree procedures7. New reporting requirements from ACA

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PEEHIP Overview• Total healthcare spending around $1.2 billion per plan year• Forecasted deficits reaching hundreds of millions in future

years• PEEHIP is constantly working to reduce cost to keep the

plan affordable while remaining a quality benefit• Drug formulary changes• Medical policy changes i.e. carryover• Copay and premium changes

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PEEHIP OverviewWhat can PEEHIP members do to help control costs?• Obtain a primary care physician and seek care from them when appropriate

instead of an ER or Urgent Care facility.• Ask your doctor about the medications you are taking to see if any lower

cost alternatives such as generics are available.• Ask your doctor and BCBS about any treatments you may need or

medications that may have to be administered for you by a physician. Different facilities have greatly different costs to the plan.

• Take advantage of the PEEHIP Team Up for Health Wellness Program to achieve better health and reduce both your out-of-pocket costs and the costs of potentially avoidable healthcare spending by the plan.

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Wellness Program ReviewWhat PEEHIP members are saying:

Numerous accounts of members:◦ Losing weight◦ Lowering A1C◦ Quitting smoking◦ Making dietary changes◦ Increasing physical activities◦ Improved member-physician

relationships

This program is a "lifeline that bridges the gap with the doctor.“

Member stated that this is a “phenomenal program.” “I have learned so much

just by visiting the website (MyActiveHealth).” The health screening “changed my life!”

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Wellness Program Review Who is Required to Participate?

• Required if enrolled in PEEHIP BCBS hospital/medical plan (group #14000) and: Active members and their covered spouses Non-Medicare-eligible retirees Covered non-Medicare-eligible spouses of retirees COBRA, Leave of Absence, Surviving Spouses

• NOT required to participate: Medicare-eligible retirees Medicare-eligible spouses on retired contracts Children Members who are only enrolled in VIVA, Optional Plans, Supplemental Medical –

(Must be enrolled in group #14000 hospital/medical plan to be required to participate)

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Wellness Program ReviewEarn a Waiver of the Monthly Wellness Premium

•$50 monthly wellness premium applied separately to subscribers and spouses effective October 1 who do not participate or complete their annual wellness program requirements by August 31 each year

•PEEHIP does not want anyone to incur the additional $50 monthly wellness premium

•Wellness premium can be removed prospectively during the plan year after requirements completed

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1. Complete a Wellness ScreeningOne screening available every year restarting every August 1. For screenings obtained at your doctor, only 1 is covered per calendar year.

2. Complete the Health QuestionnaireYearly restart date is October 1Health Questionnaire (HQ) available online at www.MyActiveHealth.com/PEEHIPTelephonic HQ available at 855.294.6580

*Newly enrolled members and spouses with coverage effective 6/2 – 8/31 have until August 31st of the following year to complete requirements.

Wellness Program Review

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Wellness Program Review3. Participate in Wellness Coaching/Disease Management

Yearly restart date is October 1 and minimum requirement is 1 phone call or 100heartbeat units of online coaching credit unless otherwise noted*ActiveHealth Certified Wellness Coach works to reduce health risk and coach members tomanage weight, get moving, manage stress, eat healthier & moreActiveHealth Nurse Coach helps with self examination, adherence to medication, knowingwhen to seek treatment, etc.The 5 Chronic disease states identified for disease management are asthma, diabetes,coronary artery disease, congestive heart failure, COPD

*Some PEEHIP members will be identified as candidates for a higher level of care than regular Disease Management. These members will be required to complete at least 4 telephonic Health Coaching calls before August 31, 2016 in order to earn the wellness premium waiver.

ActiveHealth nurses and coaches will contact candidates or can be reached at 855.294.6580 from 8:00am – 8:00pm, Monday-Friday; 8:00am – 1:00pm, Saturdays

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Wellness screenings travel from doctor’s offices or from the schools to ADPH, then toActiveHealth, then to PEEHIP

Screenings through each Wednesday are sent to ActiveHealth the following Thursday ActiveHealth uploads screenings and sends to PEEHIP the following Monday or Tuesday The total processing time is 5 – 13 days depending on if the screening missed the weekly cut-off

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Midfield Elementary Midfield, AL

Onsite Team (from L to R)◦ Lisa Hoffman, Onsite Coach◦ Tilusha Adams, Wellness Director◦ Lindsey Lee, Onsite Coach

Wellness Program Review

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PEEHIP 3-1 Rule

Full-Time Active Employee

In pay status at least ½ the working days of the month (16th of month)

For every 3 months earned, accrue 1 additional month of coverage

Applies to September - September

Works the same for 9, 10, 11, and 12 month employees

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PEEHIP 3-1 Rule (Cont’d)

Terminated Employee Hired Back Before Extra Months Exhausted

Coverage stays the same as before termination

Not treated as a new employee

Enrollment changes only during Open Enrollment

FMLA The 3-1 Rule applies even when a member is granted FMLA.

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Employer contributions: Sep, Oct, Nov, DecAccrues: Jan

Date of Hire: August 12Date of Termination: January 8 15

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Employer contributions: Oct, Nov, Dec, Jan, Feb, MarAccrued: Apr and May

Date of Hire: September 21Date of Termination: April 15 16

Employer contributions: Nov Accrued: None

Date of Hire: October 5Date of Termination: December 11 17

Employer contributions: Jan, Feb, Mar, Apr, May Accrue: June

Date of Hire: Dec 16Date of Termination: May 20 18

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12 month employee terminates Oct. 9th

No October Employer Contribution Due3-1 Rule applied Sep - Sep

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The employer’s notification to PEEHIP of an employee’s eligibility for coverage.

Entries must be done in a timely manner. Enrollment period = 30 days

Entries must be accurate.

Portal uses the 16th of the month in determining if an employer contribution is due for that month.

Invoices reflect portal entries.

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Resignations and Retirements

• Terminations: Enter 30 days ahead

• Retirements: Enter 60 days ahead

• PEEHIP cannot decide portal dates

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FMLAEnter a “Hire” date for an employee who is on FMLA and has not exhausted all 12 weeks. Enter an “FMLA” date if they remain on FMLA in the new school term. If they do not return after using all 12 weeks, enter a “LOA” date in the portal until they return to active status.

This enables the portal to accurately apply the 3-1 Rule.

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Required for all new hires

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New Employee Enrollment

New employees MUST enroll within 30 days of date of hire.

Enroll through Member Online Service (MOS) • Receive a confirmation

Submit a New Enrollment and Status Change form to PEEHIP

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Effective Dates of Coverage

Date of hire

First of the month following date of hire

OR

October 1 (if hired during Open Enrollment)

Family coverage can begin 60 days from the date of hire but MUST be requested within 30 days of the date of hire.

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Other Enrollment PeriodsOpen Enrollment: July 1 – September 10 (72 days)

Online enrollment deadline: September 10Paper enrollment deadline: August 31Flex enrollment deadline: September 30

All Open Enrollment changes/enrollments become effective: October 1

Qualifying Life Events (QLE’s)Enrollment must be submitted to PEEHIP within 45 days of a QLE

Examples of a QLE:Birth of a childAdoption/Legal custody of a childMarriage/divorce (of subscriber)Medicaid/Medicare entitlementSpouse/dependent loss of coverage (eligibility)

NEW - Spouse’s OE different from PEEHIP’s OE

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PEEHIP Supplemental Medical

• The Supplemental Medical plan is a supplement to other primary coverage.

• Does not pay the cost of services excluded by the other primary plan.

• Covers the copayment, deductible, and/or coinsurance of the other primary

insurance plan.

• Members with deductibles greater than $1450 (single) or $2700 (family)

are not eligible for PEEHIP Supplemental Medical.

• Medicare-eligible retirees, PEEHIP VIVA members, and members covered

by an exchange plan are not eligible for PEEHIP Supplemental Medical.

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PEEHIP Flex Spending Account

• Health Care Flexible Spending Account (Health FSA) maximum $2550

• Dependent Care Flexible Spending Account (DCA) maximum $5000

• Members cannot exceed these limits even if they enroll in other plans.

Exceeding the limits puts the PEEHIP plan in jeopardy by violating IRS

regulations.

• Does your system have controls to ensure your employees do not

exceed the limits?

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Premium PaymentsPremiums are payroll deducted at the end of each month to pay for the following month of coverage.

New employees do not have a paycheck from which to deduct their initial premium so the initial premium is due at the time of enrollment through MOS.

• Payment can also be made to PEEHIP by mailing a check or money order payable to PEEHIP.

Accounts will be placed on HOLD until PEEHIP receives the first month’s premium.

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2015-2016 $25

2016-2017 $50

2017-2018 $75

Blue Cross Blue Shield or VIVA Hospital/Medical Plans

Single $ 15

Family without Spouse $ 177

Family with Spouse* (includes spousal surcharge) $ 202

Does not apply to spouses who are independently eligible for PEEHIP.Surcharge to be phased in over 3 years (see below)

Single $ 444

Family without Spouse $ 1,131

Family with Spouse* (includes spousal surcharge) $ 1,156

LOA/COBRA Hospital/Medical Premiums

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Cancer, Indemnity, and Vision Single or Family $38 per plan

Dental Single $38

Dental Family $50

Southland Optional Coverage Plans

Tobacco PremiumMember $ 50

Spouse $ 50

Wellness PremiumMember $ 50

Spouse $ 50

PEEHIP Supplemental Medical PlanSingle or Family $ 0

Single or Family (Member on LOA/COBRA) $ 164

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Medicare Enrollment

• Medicare eligibility can be due to disability or starting the first of the month that a member turns 65

• Must have Part A and B to have adequate coverage

• 3 enrollment periods: Initial, Special, General

• Medicare Part B – An employee must enroll to be effective the date he or she retires. Enroll early (2-3

months)

• A Medicare-eligible (ME) spouse covered on an active contract must also enroll in Part B effective the

date the subscriber retires.

• If you are retired and approaching 65 years old (Medicare eligibility), unless you are already drawing

social security benefits, you must contact your local SS office 2-3 months prior to turning age 65

• A ME active member covered on a PEEHIP retiree contract must be enrolled in Parts A and B.

• Medicare Part D – ME retirees and ME covered spouses are automatically enrolled in the Medicare

GenerationRX Part D Prescription Drug Plan (PDP) offered by PEEHIP.

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Retiree Employment Verification

Retired on or after October 1, 2005 - Required to verify retiree employment information

Under PEEHIP Law, if a member retired on or after October 1, 2005, and is employed by another employer that provides at least 50% of the cost of single health insurance coverage, and the member is eligible for other coverage, the retiree cannot be insured on the PEEHIP Hospital Medical plan.

If required to enroll in the other employer’s coverage, the member can obtain the PEEHIP Supplemental Medical Plan at NO COST or two Optional Plans at NO COST.

PEEHIP will request this form to be completed at the appropriate time. DO NOT SEND the form in advance of this request.

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NEW Reporting

Employee Benefit Statement (Act 2015-82)

• Issued each year by January 31

• Includes all employee benefits (salary, annual and sick leave, holidays, insurance, retirement, etc.)

• Includes total amount paid to TRS and PEEHIP for retirement and health insurance; the percentage that amount is of the total appropriations from the Education Trust Fund (ETF); and the funding ratio of TRS

• State Department of Education will issue the statements for all K-12 employees; the Universities for their employees; Post-secondary Department for post-secondary employees; and RSA will issue for all retirees

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FORM 1095 – C -- Employer

This form will be completed for employees who are determined to be full time at least one month in calendar 2015. It should be mailed to each employee before January 31, 2016.

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FORM 1095 – B -- PEEHIP

FILLED OUT BY PEEHIP

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FORM 1095 – B -- PEEHIP

►As the issuer of coverage, PEEHIP will complete this form for all covered members

►This will be mailed by PEEHIP to each PEEHIP member by March 31, 2016

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The PEEHIP ADVISOR includes important information!

VERY IMPORTANT: Please make sure your address, phone numbers and email addresses are updated with RSA/PEEHIP so that you receive important information

The PEEHIP ADVISOR is a part of the RSA ADVISOR.

PEEHIP Advisor

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