plan year january 1 through december 31, 2012 2012 benefit options presentation 1
TRANSCRIPT
Plan Year January 1 through December 31, 2012
2012 Benefit Options
Presentation
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The Employee BenefitOptions Guide
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How to access the Guide:
• View the Guide on the OSEEGIB website at www.sib.ok.gov or www.healthchoiceok.com
• Complete the online request• Contact your Insurance Coordinator• Contact OSEEGIB Member Services
• 2012 Plan Changes• Health Plans• Dental Plans• Vision Plans• HealthChoice Life Insurance Plan• Eligibility
Topics
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• 2012 Employee Benefit Options Guide• Frequently Asked Questions at
www.sib.ok.gov or www.healthchoiceok.com
• Your Insurance Coordinator • OSEEGIB Member Services• Plan websites and customer service
representatives
For More Information
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Index
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•2012 Plan Changes•HealthChoice Health Plans•Dental Plans•Vision Plans•HealthChoice Life Insurance Plan•Eligibility•End
Click the link below to access a particular section of this presentation.
2012 PLAN CHANGES
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Eligibility Changes
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There are no eligibility changes for plan year 2012.
High and Basic Plans
• Must submit the HealthChoice High and Basic Plans Tobacco-Free Attestation for Plan Year 2012 by November 15, 2011, or enroll in the High or Basic Alternative Plan
• The Attestation is available online, by calling HealthChoice Member Services, or from your Insurance Coordinator
HealthChoice Plan Changes
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Two new plans: High Alternative and Basic Alternative Plans
• Plan costs for tobacco use are approximately $52 million annually
• High Alternative has a $750 individual/ $2,250 family deductible• $3050 ind/yearly maximum
• Basic Alternative has a $750 individual/$1,500 family deductible• $5750 ind/yearly maximum
HealthChoice Plan Changes
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High and Basic Plans
You may still be eligible without the Attestation if you provide a letter:
• Showing you/your dependent has enrolled in the quit tobacco program
• Showing you/your dependent has completed the quit tobacco program
• From your doctor indicating it is not medically advisable for you/your dependent to quit using tobacco
HealthChoice Plan Changes
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All HealthChoice Plans
• Specific preventive procedures covered at 100% when using a Network Provider; refer to your Employee Benefit Options Guide
• Non-Network emergency room services will be paid as Network; deductibles and balance billing may apply
• Speech therapy no longer requires certification for patients 18 and older
HealthChoice Plan Changes
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High Plan
• Family out-of-pocket limit of $8,400 for Network and $9,900 for non-Network
Basic Plan
• Well child care visits covered at 100% when using a Network Provider
HealthChoice Plan Changes
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S-Account Plan
• Out-of-pocket limits are being lowered to $3,000 for an individual and $6,000 for a family
• Well child care visits have no copay and do not apply to the deductible
• Proof of enrollment in an HSA is no longer required
HealthChoice Plan Changes
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S-Account Plan
• To make enrollment easier and more convenient, HealthChoice has contracted with American Fidelity Health Services Administration to provide an HSA or you can enroll in an HSA through the financial institution of your choice
HealthChoice Plan Changes
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Prescription Plan Benefits• Prescriptions can be filled at a retail
pharmacy or through the mail-order pharmacy
• Retail pharmacy fills are limited to a 30-day supply or less for one copay
• Mail-order pharmacy fills are limited to a 90-day supply for one copay
• Prescription tobacco cessation products covered at 100%
HealthChoice Plan Changes
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Dental Plan Changes
There are no changes to the dental plan benefits for 2012.
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Vision Plan ChangesSuperior Vision
• With a network provider, there is a $25 fitting copay for standard and specialty fitting for contact lenses, then plan pays 100% for standard fitting and up to $50 for specialty fitting
• Plan offers savings of 20-50% on LASIK surgery
• Fitting fee not covered with a non-network provider
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Vision Plan ChangesUnitedHealthcare Vision
• With network provider, the UV coating and tint lens options are covered in full
Vision Service Plan (VSP)
• With network provider, the contact lens exam is covered in full after up to $60 copay
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HealthChoice Life Insurance Plan
• You can now purchase up to $500,000 of supplemental life insurance coverage with an approved Life Insurance Application, regardless of salary
• You can no longer purchase $20,000 of life insurance coverage without a Life Insurance Application during Option Period
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HEALTHCHOICE HEALTH PLANS
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Available Plans
• HealthChoice High• HealthChoice High Alternative• HealthChoice Basic • HealthChoice Basic Alternative• HealthChoice S-Account• HealthChoice USAUsing a HealthChoice Network Provider will lower your out-of-pocket costs.
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View plan changes for 2012
When using a Network Provider:• $30 copay for PCP office visits• $50 copay for specialist office visits• Annual deductible $500/individual or
$1,500/family• Plan pays 80%/member pays 20% of
Allowed Charges up to the out-of-pocket limit of $2,800/individual or $8,400/family
High
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High AlternativeWhen using a Network Provider:• Benefits same as High Option except
deductibles and out-of-pocket limit• Annual deductible $750/individual or
$2,250/family• Plan pays 80%/member pays 20% of
Allowed Charges up to the out-of-pocket limit of $3,050/individual or $9,150/family
When using a Network Provider:• Office visit copays do not apply• Plan pays first $500 then member pays
next $500 as deductible; $1,000 deductible for a family of two or more
• Plan then pays 50% until $5,500/ individual or $11,000/family out-of-pocket limit is met
• Plan then pays 100% of Allowed Charges
Basic
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When using a Network Provider:• Office visit copays do not apply• Plan pays first $250 then member pays
next $750 as deductible; $1,500 deductible for family of two or more
• Plan then pays 50% until $5,750/individual or $11,500/family out-of-pocket limit is met
• Plan then pays 100% of Allowed Charges
Basic Alternative
Designed for a Health Savings Account (HSA)When using a Network Provider:• Combined $1,500 deductible/individual
and $3,000/family • Entire deductible must be met before
claims are paid (including prescriptions)• $50 copay for office visits• The calendar year out-of-pocket limit is
$3,000/individual or $6,000/family• American Fidelity Health Service
Administration
S-Account
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• For members who live and work outside of Oklahoma and Arkansas for more than 90 consecutive days
• Benefits are the same as the HealthChoice High Plan
• Members have access to the USA Plan’s nationwide provider network
USA
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Network Pharmacy Benefits
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• Prescriptions can be filled at retail pharmacies or through mail-order
• Benefits are the same for all plans; S-Account members must meet the plan deductible before benefits are paid
• You are responsible for the cost difference when choosing a brand-name if a generic is available
Network Pharmacy Benefits
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When using a retail pharmacy:• Up to 30-day supply• For generics, maximum copay of $10• For Preferred brand-name, maximum
copay of $30• For non-Preferred brand-name,
maximum copay of $60
Network Pharmacy Benefits
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When using the mail-order pharmacy:• Up to 90-day supply• For generics, maximum copay of $25• For Preferred brand-name, maximum
copay of $60• For non-Preferred brand-name,
maximum copay of $120• 90-day supply does not apply to drugs
with quantity or dosage limits
Network Pharmacy Benefits
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• Certain prescription tobacco cessation medications for a $0 copay
• A calendar year pharmacy out-of-pocket limit of $2,500 (does not apply to S-Account Plan)
• Specialty medications must be filled through Accredo Health, the HealthChoice specialty care, delivery service pharmacy
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DENTAL PLANS
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Dental Plans Available
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• Assurant Heritage Plus with SBA Prepaid
• Assurant Heritage Secure Prepaid• Assurant Freedom Preferred• CIGNA Dental Care Plan Prepaid• Delta Dental PPO – Choice• Delta Dental PPO• Delta Dental Premier• HealthChoice DentalThere are no changes to the dentalplan benefits for 2012.
Dental Benefits
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All the dental plans have the same core benefits which are divided into four different classes:
• Preventive Care includes cleanings, bitewing x-rays, and routine oral exams
• Basic Care includes fillings, extractions, root canals, endodontics, and periodontics
*HealthChoice and Assurant Freedom Preferred have a 12-month waiting period for orthodontic care unless you provide proof of prior group dental coverage.
• Major Care includes dentures, bridgework, crowns, and implants
• Orthodontic Care* is covered for members under age 19 and members age 19 or older with temporomandibular joint dysfunction (unless otherwise noted)
Dental Benefits
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• No deductibles or maximum annual benefit
• You must select a Primary Care Dentist for each covered person
• Preventive Care is covered at 100%• Copay schedule applies to other
services• The SBA (Special Benefit Amendment)
provides an additional discount for network specialists
Heritage Plus Dental Plan
with SBA
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• No deductibles or maximum annual benefit
• You must select a Primary Care Dentist for each covered person
• Preventive Care is covered at 100%• A copay schedule applies to other
services, including specialist care
Heritage Secure Dental Plan
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• Preventive Care is covered at 100%• A $25 deductible applies to Basic and
Major Care. After the deductible:• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care is covered at 60%;
maximum lifetime benefit of $2,000 • All other services have a combined
$2,000 maximum annual benefit
Freedom Preferred Dental Plan
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• No deductible or maximum annual benefit
• You must select a Primary Care Dentist for each covered person
• After routine cleanings, x-rays, and evaluations are covered at 100%; a $5 copay applies
• A copay schedule applies to other services, including specialist care
• Orthodontia benefits for adults
Prepaid Dental Plan
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• You must select a Primary Care Dentist for each covered person
• No deductible for Preventive or Basic Care
• A $100 deductible for Major Care• A copay schedule for all other services • A $2,000 maximum annual benefit for
Preventive, Basic, and Major Care• Orthodontic Care has a maximum
lifetime benefit of $1,800
Delta Dental PPO - Choice
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• A $50 combined deductible applies to Preventive, Basic, and Major Care
• Preventive Care is covered at 100%• Basic Care is covered at 70%• Major Care is covered at 50%• Orthodontic Care is covered at 60%
with a lifetime maximum of $2,000• $3,000 maximum annual benefit
DeltaDental
Premier
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• Preventive Care is covered at 100% • $25 annual deductible for Basic and
Major CareAfter deductible:• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care is covered at 60%
$2,000 maximum• $2,500 maximum annual benefit for
other services
Delta Dental PPO
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When using a Network Provider:• Preventive Care is covered at 100%• A $25 deductible applies to Basic and
Major Care• Basic Care is covered at 85%• Major Care is covered at 60%• Orthodontic Care is covered at 50% —
no lifetime maximum• A $2,000 calendar year maximum
applies to all other services
Dental
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VISION PLANS
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Vision Plans Available
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• Humana/CompBenefits VisionCare Plan
• Primary Vision Care Services (PVCS)• Superior Vision Plan• United Healthcare Vision• Vision Service Plan (VSP)
• Each vision plan has its own provider network
• The toll-free number and website address of each plan is listed in the Employee Benefit Options Guide
• Contact each vision plan for specific benefit questions
Vision Plans Overview
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• A $10 copay for an annual eye exam• A $25 copay for lenses and frames —
one pair per year• Discounts are available for other vision
services and lens options• Contact lenses are available instead of
glasses
Humana/CompBenefits
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• There is no copay or limit on the number of eye exams
• Lenses and frames are sold at wholesale cost
• There is no limit on the number of pairs of glasses
• Benefits available for contact lenses
Primary Vision Care Services
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• A $10 copay applies to eye exams — one per year
• A $25 copay for lenses and frames —one pair per year
• Contact lenses – available instead of glasses; $25 copay/standard fitting then plan pays 100% or $25 copay/specialty fitting then plan pays up to $50
• Discounts available for other vision services and lens options
Superior Vision
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• A $10 copay for eye exams — one exam per year
• A $25 copay for lenses and frames — one pair per year
• Discounts are available for other vision services and lens options
• Lens UV coating and tints are covered in full
• Contact lenses are available instead of glasses
UnitedHealthcare Vision
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• A $10 copay for eye exams — one exam per year
• A $25 copay for lenses and frames —one pair per year
• Discounts are available for glasses and other vision benefits
• Up to $60 copay for contact lens exam with network provider
• Contact lenses are available instead of glasses
VSP
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Life Insurance Plan
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Basic and Supplemental Life for You
• First $20,000 of life coverage (Basic Life)
• All additional coverage is known as Supplemental Life
• Basic Life and the first $20,000 of Supplemental Life include Accidental Death and Dismemberment (AD&D) benefits
Employee Life
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During initial enrollment:
• Guaranteed Issue (two times your annual salary) can be elected without completing a Life Insurance Application
• Amounts above Guaranteed Issue require an approved Life Insurance Application
Employee Life
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During Option Period:
• You can purchase up to $500,000 of supplemental life insurance coverage with an approved Life Insurance Application, regardless of your annual salary
• HealthChoice no longer offers the $20,000 of life insurance annually without an approved Life Insurance Application
Employee Life
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• Keep your beneficiary designation up-to-date
• Beneficiaries can be changed at any time• Review your beneficiaries if you have a
change such as a marriage, divorce, death of a family member, or birth of a child
• Beneficiary Designation Forms are available online, from your Insurance Coordinator, or by calling OSEEGIB Member Services
Beneficiary Designation
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All three options offer $1,000 of coverage for dependents under six months of age.
Premier OptionSpouse $20,000Child $10,000
Standard OptionSpouse $10,000Child $5,000
Low OptionSpouse $6,000Child $3,000
Dependent Life
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You must be enrolled in Basic Life coverage in order to enroll your eligible dependents in Dependent Life.
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ELIGIBILITY
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An education employee must be:• Currently employed, eligible for TRS,
and working at least four hours a day/20 hours a week
A local government employee must be:• Currently employed, regularly
scheduled to work 1,000 hours or more per year, and cannot be listed as a temporary or seasonal employee
Eligible Employees
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• If you insure one dependent under any benefit, you must insure all eligible dependents
• Eligible dependents can be excluded if on group insurance of the same type
• You can exclude dependents that do not reside with you, are married, or are not financially dependent on you for support
• A spouse can be excluded by signing the Spouse Exclusion Certification statement on the back of the form
Dependent Eligibility
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Eligible dependents include:
• Your legal spouse (including common-law)
• Your daughter, son, stepdaughter, stepson, eligible foster child, adopted child or child legally placed with you for adoption up to age 26, whether married or unmarried
• Disabled dependents over age 26 with approved documentation
Eligible Dependents
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Other Dependent Children
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• Other unmarried dependent children up to age 26, upon completion of an Application for Coverage for Other Dependent Children
• Guardianship papers or a tax return showing dependency may be provided in lieu of the application
Certain qualifying events may allow you to make a midyear change, examples include:
• Marriage• Divorce• Adoption• Death• Childbirth• Gain or loss of other group insurance
Notify your Insurance Coordinator within 30 days
of the event or wait until the next annual Option Period.
Midyear Qualifying Events
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Option Period Enrollment/Change Form:• Your Insurance Coordinator will
provide the deadlineInsurance Enrollment Form:• Return your form to your Insurance
Coordinator within 30 daysInsurance Change Form:• Return your form to your Insurance
Coordinator within 30 days of a qualifying event
Deadlines for Forms
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Attestation:• Must be completed online or returned
to your Insurance Coordinator by November 15
HRA for HMO Wellness Alternative Plus Plans:• Must be completed online and
confirmation of your completion provided to your Insurance Coordinator
• New employees enroll in the HMO Alternative Plan and have 30 days to complete the HRA
Deadlines for Forms
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• OSEEGIB mails you a Confirmation Statement when your form is received
• If your Confirmation Statement is incorrect, contact your Insurance Coordinator immediately
• If you do not make changes during the annual Option Period, no Confirmation Statement will be sent; keep your enrollment form as verification of coverage
Confirmation Statements
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• You cannot enroll in dental or life coverage unless you have group health insurance
• If excluding or adding common-law spouse, your spouse must sign your form
• You must sign and date your form• Return your form to your Insurance
Coordinator by the set deadline• Notify your Insurance Coordinator if
you have a change of address
Reminders
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• The 2012 Employee Benefit Options Guide
• Plan websites and toll-free numbers available in your Option Period packet
• The FAQ section of the OSEEGIB website
• OSEEGIB Member Services at 1-405-717-8780 or toll-free 1-800-752-9475 TDD users call 1-405-949-2281 or toll-free 1-866-447-0436
• Your Insurance Coordinator
Questions?
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