2015 Annual Enrollment Info for SHBP & FLEX

2015 Annual Enrollment Info

for SHBP & FLEX

Presented by: Beth [email protected]

SHBP Annual EnrollmentAGENDA

• Annual Enrollment Dates and Miscellaneous Info• 2015 Plan Options• HMO Plan and Rates• HRA Plan and Rates• HDHP Plan and Rates• Pharmacy Benefits for BCBSGa and UHC• Enhanced Benefits• 2015 Wellness• Tricare Supplement/PeachCare For Kids• Making your 2015 Election• Contact Information

Annual Enrollment dates are October 27, 2014 through November 14, 2014.

The SHBP website (www.mySHBPga.adp.com) will open at 12:01 AM on 10/27/14 and close at 5:00 PM on 11/14/14.

You will need to make your 2015 elections on-line.

NOTE: You should not wait until the last minute to make your election as there may be heavy traffic.

SHBP Annual Enrollment

SHBP Enrollment PortalYour password expires every 45 days. Login to the SHBP Enrollment Portal to set up your new password.

Login using your current password If it’s been over 45 days since the last

time you logged in, you’ll be prompted to create a new password (which will expire every 45 days)

If you do not know your current User Name or Password:

Click the Forgot User ID? or Forgot Password? from the login page

Links are located to the right of the User Name and Password blocks.

2015 Active Employee Decision Guide

• Will not be printed, available on-line at www.dch.georgia.gov/shbp.

• The Active Employee Decision Guide is also available on the DNR Intranet at http://dnrnet.dnr.state.ga.us/hr/benefits. • Please read the Decision Guide booklet so you will know

what is changing and what effect the changes will have on your benefits, options, rates, etc. before making your

election for the 2015 Plan Year.

SHBP Annual Enrollment

• You should go online to make your HI selection. You will not be allowed to make a change in the coverage until the next Annual Enrollment period unless you have a qualifying event that allows a change.

• You may go online as many times as you like – but the last election confirmed at the time AE closes will be your election for the 2015 Plan Year.

• You should print and keep a copy of the confirmation page which will contain a confirmation number. Once AE is closed, you will be able to go online at www.mySHBPga.adp.com and view your 2015 election.

SHBP Annual Enrollment

When making your benefit election, you should:• Make sure you have selected the correct option.• Confirm you have added all eligible dependents for coverage.• Confirm you have answered the Surcharge question

correctly.• Click “Confirm” and Print the Confirmation page.

NOTE: You must answer the Surcharge question EACH TIME YOU LOG ON TO THE WEBSITE.

NOTE: The last selection made when the website closes at 5:00 PM on 11/14/14 will be the Plan you are placed in for the 2015 Plan Year.

SHBP Annual Enrollment

New Plan Vendors and Options

BlueCrossBlueShield of GA•Health Maintenance Organization (HMO)•Health Reimbursement Arrangement (HRA)

United Healthcare•Health Maintenance Organization (HMO)•High Deductible Health Plan (HDHP)

Kaiser Permanente•Health Maintenance Organization (HMO)•Metro Atlanta Service Area/In-Network only plan

Statewide Health Maintenance Organization (HMO)

An HMO allows you to receive covered medical services from in-network providers only (except for emergency care.) It is important to verify your current provider is in-network when selecting an HMO Plan Option. This option is available with Blue Cross Blue Shield of Ga (BCBSGa) and United Healthcare.

Plan Features•Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventive care.” •Certain services are subject to a deductible and co-insurance•You are not required to obtain referrals to see a Specialist (SPC), but are encouraged to select a Primary Care Physician (PCP) to help coordinate your care.•The medical and pharmacy out-of-pocket maximums are combined•Co-payments count toward your out-of-pocket maximum•Certain drug costs are waived if SHBP is primary and you actively participate in one of the Disease Management Programs for diabetes, asthma and/or coronary artery disease.

HRA Medical Benefits Network Provider

Deductible*

You $1,300 You + Child(ren) or Spouse $1,950You + Family $2,600

Plan Pays 80% after deductibleMember Pays 20% after deductible

ACA Preventive Care 100%

Out-of-Pocket Limit You $4,000 You + Child(ren) or Spouse $6,500 You + Family $9,000

Co-Pay

Physician $35Specialist $45

Statewide Health Maintenance Organization (HMO)

HRA

Pharmacy Benefits

Tier 1 Co-pay $20

Tier 2 Co-pay $50

Tier 3 Co-pay $90

Participating 90-day Voluntary Mail Order or Retail 90-day Network

Tier 1 Co-pay $50

Tier 2 Co-pay $125

Tier 3 Co-pay $225

Prescription costs do not apply to your deductible.

Statewide Health Maintenance Organization (HMO)

Kaiser Permanente HMOThe Kaiser Permanente HMO Plan Option is available to SHBP eligible members who live or work in one of the 26 counties within the defined Metro Atlanta Service Area.*

Plan Features•Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventative care.”•KP administers the benefits for medical, pharmacy and wellness•No deductibles•The medical and pharmacy out-of-pocket maximums are combined•Co-payment only option

*Metro Atlanta Service Area includes the counties of:Barrow, Bartow, Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Haralson, Henry, Lamar, Meriwether, Newton, Paulding, Pickens, Pike, Rockdale, Spalding, Walton

SHBP HMO Rates

NOTE: An additional $80.00 will be added to the monthly premium shown above, if you or your covered dependents use Tobacco products.

Active Employee YOU YOU +

Child(ren) YOU + Spouse YOU + Family

BCBS of Ga $130.74 $240.88 $333.06 $443.18

UHC $181.32 $326.86 $439.26 $584.80

Kaiser $145.78 $266.44 $364.64 $485.30

Health Reimbursement Arrangement (HRA)

The HRA provides first-dollar coverage for eligible medical and pharmacy expenses and is funded by SHBP. When going to the doctor, you will not pay a co-payment. Instead, you pay the applicable deductible and co-insurance. If you have remaining credits in your current HRA account, those credits will roll over to the next Plan Year as long as you remain enrolled in an HRA option.

Plan Features•Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventive care.” You must meet separate in-network and out-of-network deductibles and out-of-pocket maximums.•You are not required to select a Primary Care Physician (PCP) or obtain referrals to a Specialist (SPC)•The credits in your HRA Account are used to help meet your deductibles and out-of-pocket maximums•The medical and pharmacy out-of-pocket maximums are combined•Certain drug costs are waived if SHBP is primary and you actively participate in one of the Disease Management Programs for diabetes, asthma and/or coronary artery disease.

HRA Gold Plan Silver Plan Bronze Plan

Network Provider Out-of-Network Network Provider Out-of-Network Network Provider Out-of-Network

Medical Benefits

Deductible*

You $1,500 $3,000 $2,000 $4,000 $2,500 $5,000

You + Child(ren) or Spouse $2,250 $4,500 $3,000 $6,000 $3,750 $7,500

You + Family $3,000 $6,000 $4,000 $8,000 $5,000 $10,000

Plan Pays 85% 60%* 80% 60%* 75% 60%*

ACA Preventive Care 100% Not covered 100% Not covered 100% Not covered

Out-of-Pocket Limit*

You $4,000 $8,000 $5,000 $10,000 $6,000 $12,000

You + Child(ren) or Spouse $6,000 $12,000 $7,500 $15,000 $9,000 $18,000

You + Family $8,000 $16,000 $10,000 $20,000 $12,000 $24,000

Base HRA Contribution

You $400 $200 $100

You + Child(ren) or Spouse $600 $300 $150

You + Family $800 $400 $200

Pharmacy Benefits

Tier 1 15%, Min $20, Max $50 15%, Min $20, Max $50 15%, Min $20, Max $50

Tier 2 25%, Min $50, Max $80 25%, Min $50, Max $80 25%, Min $50, Max $80

Tier 3 25%, Min $80, Max $125 25%, Min $80, Max $125 25%, Min $80, Max $125

* See ACA Glossary of Health Coverage and Medical Terms for definition

This is a high level plan design summary.

Prescription costs do not apply to your deductible.Pharmacy Benefits are the same across the board regardless of plan option.

Benefits of an HRA

• Your HRA is funded by SHBP. Any unused funds roll over for future health expenses.

• HRA credits can assist you in paying health expenses that go towards your deductible.

• Initial HRA credits vary depending on the option/tier chosen.

• Any remaining HRA credits from previous years will rollover in March 2015, this allows a 2014 plan runout to pay late claims for 2014.

• If you do not enroll in an HRA Plan Option in 2015, any remaining HRA credits from 2014 are forfeited. Also, if you experience a Qualifying Event during the Plan Year that results in a Plan Option change to HMO or HDHP then your HRA credits will be forfeited.

SHBP HRA Rates

NOTE: An additional $80.00 will be added to the monthly premium shown above, if you or your covered dependents use Tobacco products.

Active Employee YOU YOU +

Child(ren) YOU + Spouse YOU + Family

HRA Gold $166.08 $300.38 $405.52 $539.84

HRA Silver $108.64 $202.74 $284.90 $379.00

HRA Bronze $66.28 $130.74 $195.96 $260.40

High Deductible Health Plan (HDHP)The HDHP offers in-network and out-of-network benefits and has a low monthly premium. However, you must satisfy a high deductible that applies to all covered medical and pharmacy expenses. (except preventive care.) If you have any dependents, the entire family deductible must be met before benefits are payable for any family member. Also, you may qualify for a Health Savings Account (HSA) to set aside tax-free dollars to pay for eligible health care expenses.

Plan Features•Plan pays 100% of covered services provided by in-network providers that are properly coded as “preventive care.”•Before you can use well-being incentive credits, members must meet a threshold ($1,300 – individual; $2,600 other tiers)•You must meet separate in-network and out-of-network deductibles and out-of-pocket maximums•You pay co-insurance after meeting the entire deductible for covered medical and pharmacy expenses•The medical and pharmacy out-of-pocket maximums are combined•The HSA cannot be combined with a Flexible Spending Account (FSA)•There are no co-payments

SHBP HDHP Rates

NOTE: An additional $80.00 will be added to the monthly premium shown above, if you or your covered dependents use Tobacco products.

Active Employee YOU YOU +

Child(ren) YOU + Spouse YOU + Family

UHC $53.02 $108.74 $169.84 $225.56

Blue Cross Blue Shield of GA and United Healthcare Elections

Pharmacy Benefits•Express Scripts administers the prescription drug pharmacy benefits for members who choose BCBSGa and UnitedHealthcare. Express Scripts provides benefits for retail prescription drug products, mail order, home delivery and specialty pharmacy services.•Get up to a 90-day supply of your maintenance medication either through Express Scripts home delivery pharmacy services or at a participating 90-day retail pharmacy.•Express Scripts offers several programs for managing your prescriptions:

– The My RX Choices Prescription Savings Program lowers out-of-pocket prescription costs

– The Worry-Free Fills Program offers automatic refills for long-term medications and will be automatically shipped to you

– The Extended Payment Program extends home delivery payments over three installments

Applied Behavior Analysis (ABA) for Autism•Effective January 1, 2015, SHBP will provide limited coverage for medically necessary ABA treatment of Autism Spectrum Disorder•Maximum benefit of $35,000 per year per approved member (through age 10)•Co-payments, deductibles and/or co-insurance may apply

Bariatric Pilot•The GA Legislature has established a pilot program to provide benefit coverage for certain bariatric surgical procedures for the treatment and management of obesity and related conditions.•Effective January 1, 2015, the pilot program is limited to 75 non-Medicare Advantage members for the 2015 Plan Year.•Qualified applicants will be randomly selected by the vendors for which you are enrolled. Please contact your vendors for more information.

Hearing Aids•Benefit allowance for hearing aids has increased for children up to age 19 from $1,500 to $3,000 every five years

Enhanced Benefits

Blue Cross Blue Shield of GA and United Healthcare Elections

2015 Wellness• Healthways will remain the vendor for the wellness program

• Health actions must be completed between January 15, 2015 and December 15, 2015 in order to earn the well-being incentive credits.

• Members will have access to a variety of Healthways’ tools, activities and services such as the Well-Being Assessment, wellness incentives, Well-Being Coaching, Biometric Screenings, and on-site activities.

• Healthways will also administer 2015 wellness incentives that will allow you to earn credits for offsetting certain health care costs.

• Members can earn up to 480 well-being incentive credits toward medical expenses, plus an additional 480 for a covered spouse (total of 960 per household)

2015 Wellness Incentives for BCBSGa and UHC

What to DO What you EARN

1. Assess Your Health Complete your 2015 Healthways Well-Being Assessment® (WBA), a confidential, online questionnaire that will take about 20 minutes.

Complete both and earn$240

(WBA must be completed before HRA dollars can be

earned)2. Know Your Numbers

Complete a 2015 biometric screening and submit results (body mass index, blood pressure, cholesterol, glucose). The biometric screening must be completed at an SHBP sponsored screening event or by your physician; your results must be submitted appropriately on the 2015 Physician Screening Form.

3. TAKE Action It’s your choice! Complete the coaching pathway, online pathway or a combination of both.

Telephonic Coaching Pathway Create your Well-Being Plan. Actively engage in telephonic coaching.

Online Pathway Complete your WBA and: Record 5 online well-being activities within four consecutive weeks and earn up to 40 well-being incentive credits.

Earn up to$240

(WBA must be completed before HRA dollars can be

earned)

Kaiser Permanente (KP) Elections

2015 Wellness• Members that elect KP will have access to a variety of tools, activities

and services such as the Total Health Assessment, Biometric Screenings and Online and On-site Healthy Living Classes

• As a part of the KP Wellness Program, if you sign up on kp.org and complete at least one of the identified health actions (e.g. getting your annual flu shot, completing one online health education class,) you will be entered into a monthly drawing for an iPad and a Fit Bit to help you manage your health.

• For details on the KP Wellness Program, contact Kaiser Permanente at www.my.kp.org/shbp or call 1-855-512-5997.

Other Health Care Options Available to Qualified Employees

TRICARE Coverage• Voluntary, member-pay-all supplemental health benefit. • Available to SHBP eligible individuals who are also eligible for

TRICARE, the military health benefit program.• Ends when you turn 65.• Everyone covered under the contract must be in Tricare.

PEACHCARE FOR KIDS

As state or public school employees, you could be eligible to enroll your children in PeachCare for Kids.

Visit www.peachcare.org or call 877-427-3224 for information. Children cannot be enrolled in both SHBP and PeachCare.

Patient Protection and Affordable Care Act (ACA)

The Department of Community Health which administers the State Health Benefit Plan states that all entities involved in the State Health Benefit Plan may assume that “all options meet the affordability and minimum value requirements of the Patient Protection and Affordable Care Act.” For this reason and others DNR is in compliance with the ACA.

Employees of the DNR office of Human Resources (OHR) are not qualified to accurately answer any questions regarding this federal program. Therefore, employees are encouraged to direct their questions regarding the ACA to the federal government website www.Healthcare.gov or call 1-800-318-2596.

Making Your 2014 Benefit Election

Online ElectionEmployees must make their health election on-line at www.mySHBPga.adp.com

Website Open & Close DatesWebsite opens at 12:01 a.m. on October 27, 2014.Website closes at 5:00 p.m. on November 14, 2014.

Active Employee Health Plan Decision GuideAvailable on the website at www.dch.georgia.gov/shbp.

No printed hardcopies.

Employee Responsibilities

• Read and make sure you understand the plan materials posted at www.dch.georgia.gov/shbp and other information provided by DNR and take the required actions.

• Confirm that you answered the Tobacco Surcharge question appropriately

• Check your payroll deduction to verify that the correct deduction amount has been made. If you are not being charged the correct amount, immediately contact HR.

• Notify SHBP whenever you have a change in covered dependents (within 31 days of a Qualifying Event.)

What Happens If No Action Is Taken?

• Members who do not make an election, either through the web portal or by calling the SHBP Member Services Center, will be defaulted to the Blue Cross Blue Shield HRA option previously selected for 2014, without co-payments.

• If you do not make an election and are currently paying the Tobacco Surcharge, your coverage will default and the Tobacco Surcharge you were paying in 2014 will continue to apply.

• If you do not make an election and are currently enrolled in TRICARE Supplement in 2014, you will be enrolled in TRICARE Supplement in 2015.

Contact InformationBlue Cross Blue Shield of GA - www.bcbsga.com/shbp855-641-4862

UnitedHealthcare – www.welcometouhc.com/shbp888-364-6352

Kaiser Permanente – www.my.kp.org/shbp855-512-5997

Healthways - www.BeWellSHBP.com888-616-6411

Express Scripts – www.express-scripts.com/georgiaSHBP 877-841-5227

SHBP Call Center800-610-1863

Tricare Supplement – www.asicorporation.com/ga_shbp866-637-9911

PeachCare For Kids – www.peachcare.org877-427-3224

Important Notice

• The information provided in this presentation is a summary of changes for the 2015 Plan Year. It is intended only to highlight principal benefits.

• Please refer to the Active Employee Decision Guide for more details.

FLEX Annual Enrollment

AGENDA• Annual Enrollment Dates and Miscellaneous Information• 2015 Flexible Benefit Changes• Specified Illness Plan Information• Spending Accounts Plan Information • Dental Plan Information• Life Insurance Plan Information• Reminders for AE 2015• Contact Information

FLEX Annual Enrollment

Annual EnrollmentDates for Annual Enrollment:

Starts: 1:00 AM on October 27th

Ends: Midnight on November 14th

Two Options to make benefit selections and/or update dependent information for Plan Year 2015:

• Accessing the GaBreeze website: www.GaBreeze.ga.gov • Contacting the GaBreeze Benefits Call Center:

1-877-342-7339

Employees will be allowed to have multiple confirmations online during the Annual Enrollment period.

Flexible Benefit Changes

Specified Critical Illness Plan – Aflac/CAICPlan Changes

Spending Accounts – SHPS/ADPPlan Changes

Dental Plans – Cigna HMOPlan Changes

Legal Plans – HyattPlan Changes

Specified Illness Plan InfoSpecified Illness Plan – Aflac/CAIC

Rate decrease to the Select and Select Plus Options

Coverage levels added to the Spouse Specified Illness for the Select/Select Plus options ($20,000, $30,000,$40,000,$50,000)

Spouse Specified Illness guaranteed issue level will be $30,000

• EOI required for Spouse enrolling in $40,000 or $50,000 levels

• If denied, coverage will default to the current level for PY 2014

Reminder: Coverage for Spouse Specified Illness cannot exceed coverage level for Employee Specified Illness and cannot be of a different plan.

Specified Illness Plan InfoSpecified Illness Plan – Aflac/CAIC

Additional enhancements effective January 1, 2015:

• Benefits no longer reduce by 50% at age 70

• New Waiver of Premium Benefit included in 2015

Additional and Re-Occurrence benefits, other than Cancer, will only require a 90 day interval between diagnosis (previously six months to a year between diagnois)

Waiting periods for the purchase of additional coverage have been waived from the plan

The current vendor will be changing its branding to Aflac/CAIC

Spending Accounts Plan InfoSpending Accounts – ADP

Relation to the Health Saving Account

• Employees who enroll in the High Deductible Health Plan AND enroll in a Health Savings Account (HSA) will NOT be eligible to enroll in a Health Care Spending Account.

• If an employee does enroll in a HCSA in error, it will be necessary for them to contact the GaBreeze Call Center and request an Appeal Form to submit to DOAS. The form will be received and reviewed by DOAS

GaBreeze will be notified of the final determination regarding the Spending Account

NO REFUNDS WILL BE GIVEN

Spending Accounts Plan InfoSpending Accounts – ADP

If an employee has a current contribution for 2014, it will NOT automatically rollover into the new plan year.

Employees MUST make an election to continue contributions in the FSA Plans for 2015 (Dependent Care & Health Care).

Employees will be required to make an election amount in order to keep their Health Care and/or Dependent Care Spending Account active.

The last deduction for Spending Accounts will be November 30th unless a new election for 2015 is made.

There will still be a grace period to make claims.

Dental Plan InfoDental Plans – Cigna (HMO Option)

New Features for PY 2015:

• TMJ diagnosis and treatment, including custom mouthpiece or bite plate therapy

• Athletic mouth guards

• Cone beam CT X-rays, where applicable

• Expanded coverage for periodontal maintenance

• Lower teeth whitening co-pay

• Additional applications of fluoride and fluoride varnish at a minimal co-pay

• Coverage for same-day, in-office CAD/CAM services for crowns, inlays, onlays, post and cores

• Veneers

Legal Plan InfoLegal Plans - Hyatt

Select Plus Plan – new services for PY 2015:

• Security deposit assistance (for tenants)

• Protection from domestic violence

Network of attorneys has increased nationwide to 13,000 with over 450 attorneys within the State of Georgia

New Hyatt mobile app for plan members available on Android phones and on Google Play

Life Insurance Plan InfoLife Insurance – MetLife

• Current employees electing Life insurance for the first time OR wishing to increase their current level of coverage will be required to complete the online Statement of Health (SOH) No paper form will be issued by Metlife

• Employees wishing to enroll in Spouse Life or increase the current level of spouse coverage will be required to complete the online Statement of Health (SOH)

Employees are required to pre-register their spouse on the GaBreeze website.

Spouse will receive an e-mail from Metlife with instructions for completing the SOH online; no paper form.

GaBreeze ConfirmationGaBreeze Confirmation Number

Employees will receive a Confirmation Number upon successful completion of their online Annual Enrollment on the Completed Successfully page on the GaBreeze website.

Additional changes will be permitted online during the remainder of the Annual Enrollment period.

- Employees will retain the same Confirmation Number

- Date/Time Stamp will update to reflect the most recent completion

Employees SHOULD PRINT A COPY of the Confirmation Number for their records.

2015 Enrollment Materials from DOAS/HRA

• You Decide! Booklet• Benefits At-a-Glance Brochure• What’s New for 2015?

Information available on-line at: http://doas.ga.gov/StateLocal/HRA/Benefits/pages/home.aspx

Please read the information provided so you will know what is changing and what effect the changes will have on your benefits, options, rates, etc. before making your election for the 2015 plan year.

Flex Annual Enrollment

Reminders for AE 2014

• Log onto the GaBreeze website to verify and/or update User ID and Password.

• Update email addresses on the “Personal Information” section of the “Your Profile” page to ensure quicker response time to receive password updates from GaBreeze.

• Link to the DCH Annual Enrollment site will be on GaBreeze.

Contact Information

GaBreeze

Website: www.GaBreeze.ga.gov

Toll Free: 1-877-3GBreez or 1-877-342-7339

GaBreeze Representatives available Monday – Friday, 8:00 am – 5:00 pm ET

(excluding holidays)

Contact Information

Office of Human Resources

Beth Findlay(404) 656-2697

[email protected]