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1
COPRA MeetingMay 19, 2011
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• 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!
employee.phoenix.gov/hr 2
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employee.phoenix.gov/hr 3
Helpful Reminders
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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.
employee.phoenix.gov/hr 4
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Open Enrollment Communication
employee.phoenix.gov/hr 5
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employee.phoenix.gov/hr 6
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employee.phoenix.gov/hr 7
FORMS DOCUMENTS WEBSITE LINKS UPDATES
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8
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Medical – Dental
employee.phoenix.gov/hr 9
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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
employee.phoenix.gov/hr 10
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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
employee.phoenix.gov/hr 11
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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.
employee.phoenix.gov/hr 12
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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
employee.phoenix.gov/hr 13
CIGNA Pharmacy Management replaces CVS/Caremark on August 1st
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Tuesday, May 31to
Wednesday, June 29at 5 p.m. sharp
employee.phoenix.gov/hr 14
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• Medical Premiums – CIGNA 0%– BCBS HMO 0%
– BCBS PPO ↑ 8.8%
• Dental Premiums– DHMO 0%– DPPO 0%
employee.phoenix.gov/hr 15
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16
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
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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
17
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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.
employee.phoenix.gov/hr 18
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Medical Co-Pays
employee.phoenix.gov/hr 19
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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
employee.phoenix.gov/hr 20
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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
employee.phoenix.gov/hr 21
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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
employee.phoenix.gov/hr 22
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Eligibility for Children
up to Age 26
employee.phoenix.gov/hr 23
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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.
employee.phoenix.gov/hr 24
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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.
employee.phoenix.gov/hr 25
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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.
employee.phoenix.gov/hr 26
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CIGNA Pharmacy Management Replaces CVS/Caremark
employee.phoenix.gov/hr 27
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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.
employee.phoenix.gov/hr 28
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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
employee.phoenix.gov/hr 29
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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
employee.phoenix.gov/hr 30
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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.
employee.phoenix.gov/hr 31
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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 .
employee.phoenix.gov/hr 32
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eCHRIS Self-Service
employee.phoenix.gov/hr 33
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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
employee.phoenix.gov/hr 34
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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
employee.phoenix.gov/hr 35
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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.
employee.phoenix.gov/hr 36
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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
employee.phoenix.gov/hr 37
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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
employee.phoenix.gov/hr 38