Flexible Benefits Enrollment 2009-2010 Plan Year
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Flexible Benefits Flexible Benefits
Enrollment Enrollment
2009-2010 Plan Year2009-2010 Plan Year
Employee Benefits
Outline of PresentationOutline of Presentation
• Plan Year Highlights• Core Benefits• Benefit Choices• Life Events• Employee Contributions• Questions
Employee Benefits
Plan Year HighlightsPlan Year Highlights• Flexible Benefits Budget
– $2,700/year ($112.50/pay)– June 15, 2009
• Medical Insurance– No Plan Design Changes– Employee Contributions will remain the same.
• Dental Insurance– No Plan Design Changes– Decrease in Employee Contribution
Employee Benefits
Plan Year Highlights cont…Plan Year Highlights cont…
• Vision Insurance– No Plan Design Changes– Increase in Employee Contributions
• Flexible Spending Accounts– Loomis to AmeriFlex
• Life Insurance– AIG to SunLife– Special “Guaranteed Issue” Open Enrollment
Employee Benefits
Core BenefitsCore Benefits
• Core Life Insurance/ Core Accidental Death and Dismemberment (AD&D) Insurance– SunLife – $50,000 Core Life Insurance Benefit – $50,000 AD&D Insurance Benefit
• Long Term Disability– Provides 60% Of Monthly Base Pay ($4,500 Monthly Max)– Benefit Begins Following 180 Days of Continuous Disability– One-year services requirement
Employee Benefits
Core Benefits cont…Core Benefits cont…• Long Term Disability
– Provides 60% Of Monthly Base Pay ($4,500 Monthly Max)– Benefit Begins Following 180 Days of Continuous Disability– One-year services requirement
• Employee Assistance Program (EAP)
• Flexible Benefits Budget– $2,700/year ($112.50/pay)
Employee Benefits
Core Benefits Cont…Core Benefits Cont…• Tuition Remission
– Wilkes University– King’s College– Misericordia University
• Paid Holidays
• Vacation/Sick/Personal Leave
• 403(b) Retirement Savings Plan
• Bookstore Discount
• Wilkes-Barre YMCA
Employee Benefits
Benefit ChoicesBenefit Choices
• Medical Insurance• Prescription Plan• Dental Insurance• Vision Insurance• Voluntary Term Life Insurance• Voluntary AD&D Insurance• Flexible Spending Accounts
Employee Benefits
Medical InsuranceMedical InsuranceThree medical plan options:
• Blue Care HMO
• Blue Care HMO Plus – (formerly Blue Care POS)
• Blue Care PPO
www.bcnepa.com
Employee Benefits
Blue Care HMOBlue Care HMO
Benefits– Benefit Period : Calendar Year– Deductible: None– PCP Office Visit: $15 Co-pay– Specialist Office Visit: $30 Co-pay
Preventive Services– Immunizations: $15 Co-pay– Routine pediatric/adult and well child care: $15 Co-pay– Routine gynecological exam: $30 Co-pay– Mammography Screening/diagnostics: No Charge
Employee Benefits
Blue Care HMOBlue Care HMO
Emergency and Urgent Care– Emergency Room: $100 Co-pay– Urgent Care through your PCP: $15 Co-pay
Inpatient Services– Inpatient hospital services, including maternity: $100 per admission– Skilled Nursing Care (60 days per benefit period): $100 per admission
Mental Health– Inpatient services (30 days /benefit period): $100 per admission– Outpatient services (60 visits/benefit period): $30 per visit
Employee Benefits
Blue Care HMOBlue Care HMO
Outpatient Services– Chemotherapy, dialysis, or radiation: No Charge– High-tech Imaging (MRI, MRA, CT scans, pet scans, nuclear cardiology): $75
Co-pay– Diagnostic testing (lab tests, x-rays, etc.): No Charge– Maternity Care: $30 initial visit– Outpatient Surgery: $100 Co-pay
Other Services– Chiropractic Care (12 treatments/benefit period; ages 13+): $30 Co-pay– DME: $5,000 maximum/benefit period
Employee Benefits
Blue Care HMOBlue Care HMO
Substance Abuse– Outpatient Services (30 visits/benefit period; 120 visits/lifetime):
No Charge– Detoxification (7days/admission; 4 admissions/lifetime): $100 per
admission– Inpatient non-hospital residential treatment (30 visits/benefit
period; 90 days/lifetime): No Charge for Initial Visit; 50% Subsequent Visits
Employee Benefits
Blue Care HMO PlusBlue Care HMO Plus
Two Network Options– FPH Network
• Blue Care HMO Benefit Plan Design
– Blue Card Network (www.bcbs.com)• Additional Costs
Employee Benefits
Blue Care HMO PlusBlue Care HMO Plus
Benefits– Benefit Period : Calendar Year– Deductible: $250.00 (Maximum 3 per family)– Coinsurance: 20%– Coinsurance (Maximum 3 per family): $1,000– Lifetime Maximum: $1,000,000– PCP Office Visit: 20%– Specialist Office 20%
Employee Benefits
Blue Care HMO PlusBlue Care HMO Plus
Coinsurance (20%) Applies To:• Preventive Services• Urgent Care through your PCP• Inpatient Services• Outpatient Services• Mental Health (50% for
Outpatient Services)• Substance Abuse (50% for
Inpatient Subsequent Visits)
Employee Benefits
Blue Care PPOBlue Care PPO
Two Network Options
– Preferred (www.bcbs.com)
– Non-Preferred • Additional Costs
Employee Benefits
Blue Care PPOBlue Care PPO
Benefits Preferred Non-Preferred
- Benefit period- Deductible (Maximum 3 separate deductibles per family) $300 $600
- Coinsurance (Insured responsibility) None 20% of allowable charge- Coinsurance maximum (Maximum 3 separate coinsurance maximums per family) None $3,000
- Lifetime maximum Unlimited $500,000- Precertification penalty (facility) None $500
Preventive Services - Childhood Immunizations (not subject to deductible; copay applies for office visits) No charge 20%
- Routine gynecological exam and pap smear (one per benefit period; not subject to deductible) $30 20%
- Routine mammography (one per benefit period, limited to age 40+; not subject to deductible) No charge 20%
Insured Responsibility
Calendar Year
Employee Benefits
Blue Care PPOBlue Care PPO
Emergency and Urgent Care Services- Outpatient emergency room visit (not subject to deductible; copay waived if admitted to hospital) $100 copay $100 copay
Inpatient Services - Inpatient hospital services (unlimited days per benefit period) No charge 20% - Skilled nursing care (60 days per benefit period) No charge 20%
Outpatient Services- Chemotherapy, dialysis or radiation No charge 20% - High-tech imaging (MRI, MRA, CT scans, pet scans, nuclear cardiology) $75 copay (after deductible) 20% - Diagnostic testing (lab tests, x-rays, etc) No charge 20% - Physical (20 visits per benefit period), speech (12 visits per benefit period), or occupational therapy (12 visits per benefit period)
$30 (after deductible) 20%
- Cardiac rehabilitation (36 visits/benefit period) No charge 20% - Pulmonary therapy (18 visits/benefit period) No charge 20% - Respiratory therapy (18 visits/benefit period) No charge 20%
Employee Benefits
Blue Care PPOBlue Care PPO
Other Services- Allergy extract/injections No charge 20% - Chiropractic care (18 treatments per benefit period ages 13 and up) $30 (after deductible) 20% - Durable medical equipment/prosthetics/orthotics No charge 20%
- Home health services (100 visits/benefit period) $30 (after deductible) 20% - Home infusion services $30 (after deductible) 20% - Hospice care (180-day lifetime maximum) No charge 20% - Surgery No charge 20% - Maternity services (physician office visits) $30 initial visit 20%
- Primary Care Physician office visits (preferred not subject to deductible). Unlimited visits. $15 copay 20% - Specialty Physician office visits (preferred not subject to deductible). Unlimited visits. $30 copay 20%
$5,000 benefit period maximum
Employee Benefits
Blue Care PPOBlue Care PPO
Mental Health - Inpatient services (30 days/benefit period) No charge 20%
- Outpatient services (60 visits/benefit period) 50% 50%Substance Abuse- Outpatient services (30 visits/benefit period; 120 visits/lifetime) No charge 20% - Detoxification (7 days/admission; 4 admissions/lifetime) No charge 20%
- Inpatient non-hospital residential treatment (30 days/benefit period; 90 days/lifetime) No charge 1st course; 50% 2nd & subsequent courses
20% 1st course; 50% 2nd and subsequent courses
Employee Benefits
Prescription Drug CoveragePrescription Drug Coverage
• BCNEPA
• National Pharmacy Network - Express Scripts Inc. https://member.express-scripts.com
• Based off of a formulary listing which includes all therapeutic categories.
• Co-pay will depend on what tier the prescription drug is categorized.
• Formulary:http://www.bcnepa.com/PDF/RxFormulary3.pdf .
Employee Benefits
Prescription Drug CoveragePrescription Drug Coverage
Express Scripts Network Pharmacy Retail Copay (30-day supply) Tier 1 $15.00 Tier 2 $30.00 Tier 3 $50.00 Home Delivery Copay (90-day supply) Tier 1 $30.00 Tier 2 $70.00 Tier 3 $150.00
Employee Benefits
Prescription Drug CoveragePrescription Drug Coverage
Three Ways to Save Money on your Prescription Drug Costs:
• Tier 0 (Zero)
• Request Generic Medications • Utilize the Mail Order Pharmacy Program
Employee Benefits
Prescription Drug CoveragePrescription Drug Coverage
Tier 0 (Zero)
• July 1, 2008
• 65 Generic Drugs
• Co-pay Free
• List of Drugs www.bcnepa.com
Employee Benefits
Dental InsuranceDental Insurance• Provider: United Concordia
• Two Dental Plans– Basic – Enhanced
• Flexibility
• Maximum Allowable Charge (MAC)
• Website Functions
Employee Benefits
Dental InsuranceDental InsuranceBenefits/Services Basic EnhancedDiagnostic and Preventive 100% MAC* 100% MAC*Basic Services 100% MAC* 100% MAC* After DeductibleMajor Services Not Covered 50% MAC* After DeductibleOrthodontics (Dependent Children to Age 19) Not Covered 50% MAC* After DeductibleDeductible N/A $50 Individual/$150 Family
PredeterminationPlan Maximums (Dental) $1,000 PP/CY $1,200 PP/CYPlan Maximums (Orthodontia) N/A $1,000/Chld/Lifetime
Required for treatment plans of $150 or more, or the extraction of 6 or more teeth.
Employee Benefits
Dental InsuranceDental Insurance
Provider Charge 45.00$ 45.00$ Allowable Charge 30.00$ 30.00$ Member Responsibility -$ 15.00$ Payment to Provider 30.00$ 45.00$
Routine Examination (Maximum Allowable Charge Example)Network Dentist Out-of-Network Dentist
Provider Charge 45.00$ 45.00$ Allowable Charge 30.00$ 30.00$ Member Responsibility -$ 15.00$ Payment to Provider 30.00$ 45.00$
Routine Examination (Maximum Allowable Charge Example)Network Dentist Out-of-Network Dentist
Employee Benefits
Vision InsuranceVision Insurance
Provider: Davis Vision Inc.
Plan: Fashion Excellence Gold
Employee Benefits
Vision InsuranceVision InsuranceFREQUENCY OF SERVICE Eye Exams, Frames, Lenses, Contacts 12 Months Each
IN-NETWORK OUT-OF-NETWORK
BENEFITS
Amount Covered
Amount Reimbursed
Eye Exam (Optometrist or Ophthalmologist)
100% $40
Standard Lenses (Pair) – Single Vision – Bifocal – Trifocal – Lenticular / Aphakic
100% 100% 100% 100%
$30 $40 $60 $80
Frames Fashion level Designer Level Premier Level Retail Allowance
100% $20 $40
Up to $100
Up to $30 Up to $40 Up to $60 Up to $80
Contacts (In lieu of glasses) – Standard (Hard/Soft Daily Wear Spherical) – Specialty (e.g. Disposables, Gas Permeables)
100%
$75 Off Provider Charge
$48
$48
Employee Benefits
Voluntary Term LifeVoluntary Term Life• Employee Coverage – Increments of $10,000 to the lesser of 5X
salary or $300,000. Guaranteed Issue amount of $150,000 when first eligible for coverage and during this open enrollment period.
• Spouse Coverage – Increments of $10,000 up to a maximum benefit of $100,000. Guaranteed Issue amount of $30,000 when first eligible for coverage and during this open enrollment period.
• Dependent Child(ren) Coverage – Increments of $2,500 up to a maximum benefit of $10,000. All Dependant Child(ren) coverage is a guarantee issue.
Employee Benefits
Voluntary Term AD&DVoluntary Term AD&D• Employee Coverage – Increments of $10,000 up to a maximum
benefit of $500,000.
• Spouse Coverage – Increments of $10,000 up to a maximum benefit of $250,000.
• Dependent Child(ren) Coverage – Increments of $2,000 up to a maximum benefit of $50,000.
Employee Benefits
Flexible Spending AccountsFlexible Spending Accounts
• Medical Spending Accounts– $3,000/Plan Year– Use It Or Lose It Provision
• Dependent Care Spending Accounts– $5,000/Plan Year– Use It Or Lose It Provision
Employee Benefits
Flexible Spending Accounts Flexible Spending Accounts cont…cont…
• PY 2008-2009 – Loomis: prior to 06/01/2009– Human Resources: after 06/01/2009
• PY 2009-2010 – AmeriFlex
• Special Open Enrollment Sessions– Monday, April 6th and Thursday, April 9th
Employee Benefits
Flexible Spending AccountsFlexible Spending Accounts
If you are currently enrolled in a Flexible Spending Account, you must re-enroll for the new plan
year. You will not be automatically enrolled.
Employee Benefits
Additional Benefit ChoicesAdditional Benefit Choices
Legal Services Plan
Long Term Care Insurance
Employee Benefits
Life EventsLife Events• Change In Status Spouse’s or Dependent’s Open Enrollment
• Dependent Care Changes
• Cost or Coverage Changes Within The Employer’s Plan
• HIPAA Special Enrollment Rights
• Judgment, Decree Or Court Order
• Enrollment/Ceasing To Be Enrolled In Medicare Or Medicaid (does not apply to CHIP)
• Family Medical Leave Act (FMLA) Special Requirements
Employee Benefits
Please Note: Please Note:
• The benefit change must be consistent with the Life Event.
• You may add or delete dependents during the plan year, when you experience a Life Event.
• You must contact the Human Resources Development Office within 30 days of the Life Event, and provide the required documentation, or the change will not take place until the next Open Enrollment.
Employee Benefits
Employee ContributionsEmployee Contributions
• Medical Insurance Deductions- SAME
• Dental Insurance Deductions-Decrease
• Vision Insurance Deductions- Slight Increase
• Rate Sheet- HR Website- Ben Info & Forms
Employee Benefits
Wellness ProgramsWellness Programs
• YMCA Membership
• Wilkes Fitness Facilities
• Weight Watchers at Work
• College Town Challenge
• Lunch & Learns
Employee Benefits
Open Enrollment ProceduresOpen Enrollment Procedures
• Review all Open Enrollment information. • If you are not making any changes to your benefit elections or do
not wish to enroll or continue to participate in a Flexible Spending Account, no further action is needed on your part.
• If you are making any benefit changes or participating in a Flexible Spending Account, you must return all paperwork to Brigid Peet, Benefits Coordinator (x4644) by Friday May 1, 2009.
Employee Benefits
QuestionsQuestions
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