Open Enrollment for the 2015 Plan Year

Craig J. Nichols, Secretary

Open Enrollmentfor the 2015 Plan Year

2:00 p.m. Eastern TimeAugust 27, 2014: Betty Easley 152

August 28, 2014: Conference CallDial-in: 888-670-3525

Passcode: 766-565-3066#

2

Agenda

• Benefit Changes for 2015– Pharmacy Benefits

Manager– 90-Day Maintenance at

Retail– Vision– Supplemental Plan

Premiums– HSA Contribution Limits

• Eligibility Changes– Definitions– Changing Employee

Status– Jury Duty, Military Leave

and FMLA Leave– Rehired Retirees

• System Enhancements– Key Dates Screen– Reports

• Communications– Open Enrollment– Helpful Documents– Wellness Wire

2

3

Benefit Changes for 2015

4

Pharmacy Benefits Manager

• CVS/caremark– Contact Info:

• caremark.com – user account Jan. 1• Caremark.com/sofrxplan – plan info• 888-766-5490 – 24/7

– Welcome letter– Preferred Drug List and Maintenance Drug List– Transferring Mail Order Prescriptions– PPO Members Maintenance Medications

5

90-Day Maintenance at Retail

• HMO and PPO Plan Members• All CVS Retail Pharmacies• 90-Day Maintenance at Retail Pharmacies• Mail Order Copays

6

Vision

• New Contract Awarded to Humana • One Vision Plan for 2015: Exam Plus Materials

– Similar or Better Benefits

• Materials Only Plan Ends 12/31/14– Notices to Current Members– Must Enroll during OE for Vision Coverage

7

Supplemental Plan Premium Changes

• Dentals– Assurant Freedom Advance– CIGNA Prepaid– Humana Network Plus– Humana Preferred

• Humana Exam Plus Materials Vision• CIGNA Hospitalization

8

HSA Contribution Limits

• Includes the state’s contribution:– Single: $3,350– Family: $6,650

9

Eligibility Changes

10

Periods

• New Hire Measurement Period – the period of 12 consecutive months starting the first of the month following the initial hire date and ending the last day of the twelfth month

• Open Enrollment Measurement Period – the period of 12 consecutive months from October 3 through the following October 2 of each year

• Stability Period – the period of 12 consecutive months starting from the first day of enrollment (or possible enrollment if coverage waived) in health insurance

11

Break in Service

• Termination of employment or unpaid leave that exceeds 13 consecutive weeks (26 weeks for employees of academic institutions); or a break between four weeks and 13 weeks (26 weeks for employees of academic institutions) if the period of service prior to the break is less than the period of the break.

• Applies to ALL Employees– Termination after Full Calendar Month QSC Event No

Longer Applies

12

Salary to OPS and OPS to Salary

• All salaried or OPS appointments are considered when determining the employee’s measurement and stability periods.

• If no 13/26 week break in service, measurement period determined based on initial start date in a position, regardless of type.

• Stability period based on whether employee is in the new hire measurement period or the open enrollment measurement period. – If the employee was employed for more than 12 months

and was measured as a new hire, the employee is thereafter in the open enrollment stability period (January through December).

13

FT Salaried to FT Salaried

• FTE 0.75 to 1.00• Must have a 13/26-week break in service to be

treated as a new hire for insurance election purposes.

14

FT Salaried/OPS Eligible to PT Salaried

• Affordable health coverage guaranteed for 12 months starting from date of enrollment, so coverage continues as if PT salaried is full-time for remainder of the stability period (i.e., FT employer contribution continues).• Appointment date in the initial salaried position

generates the measurement period start date. Employee is then measured to determine eligibility to continue full-time rate for the next stability period.

• Life insurance rolls and PT employee pays prorated premium.

• All other elections roll.• If OPS eligible, allowed to enroll in only optional life

and/or MRA/LPMRA.

15

Caution: PT Salaried FTE

Please do not use FTEs less than 0.75 but allow employees to work 0.75 or more.

16

PT Salaried to FT Salaried

• All elections roll• Significant cost decrease QSC event to enroll in

or increase health coverage• Auto enrolled in basic life

17

PT Salaried to PT Salaried

• All elections roll• Potentially a significant cost increase or

decrease QSC event to change health coverage• Appointment date in the initial salaried position

generates the measurement period start date – Employee is measured at the end of the new hire

measurement period to determine eligibility for full-time benefits for the next 12 months

– Subsequently measured again during open enrollment to determine eligibility for full-time benefits for the next plan year.

18

FT Salaried to OPS

• Appointment date in FT salaried position generates the measurement period start date.

• Employee is guaranteed health benefits as OPS, regardless of the expected hours as OPS, for remainder of stability period.

• All benefits roll except optional life and MRA/LPMRA.

19

PT Salaried to OPS

• OPS appointment drives eligibility– If OPS appointment is at least 30 hours, benefits

continue for remainder of stability period. – If OPS appointment is less than 30 hours, benefits

are terminated.

• Optional life and MRA/LPMRA end.

20

OPS Eligible to FT Salaried

• All elections roll.• Auto enrolled in basic life• Employee allowed to enroll only in optional life

and/or MRA/LPMRA.• Employee is treated as salaried for all future QSC

events and open enrollment.

21

OPS Eligible to OPS

• Affordable health coverage guaranteed for 12 months starting from date of enrollment, so coverage continues for remainder of the stability period (i.e., FT employer contribution continues), regardless of the expected hours for the new OPS appointment.

22

OPS Not Eligible to OPS Eligible

• Must be in the new hire measurement period and experience one of the following:– Increase hours to at least 30 per week– Move from short-term to regular status– Move from seasonal to regular status

• Allowed to enroll in coverage.– The effective date of coverage can be the first day of

the third month following and including the status change or the first day of the second month following the new hire measurement period, whichever is earlier.

23

Jury Duty – OPS Employees

• For hours the OPS employee would have worked if not called to jury duty:– Agencies: use 0031 (Administrative Leave – Jury

Duty) on the timesheet.– JAC, SCS, universities and BENOS: record hours

type 2024 on the alternate time entry screen.

24

Military Leave – OPS Employees

• Starting in November, submit military leave for OPS employees using action code 11, reason code 83.

• When the employee returns from military leave, use return from leave action code 36, with reason code 00.

25

FMLA Leave – OPS Employees

• Starting in November, submit FMLA leave for OPS employees using action code 11, reason code 49.

• When the OPS employee returns from FMLA, use return from leave action code 36, with reason code 00.

• OPS employees on FMLA and enrolled in health insurance are only eligible for the state contribution up to 12 weeks.– Return the employee from FMLA or terminate the

employee at the end of 12 weeks; otherwise, the state contribution will continue and it should not.

26

Rehired Retirees

• Benefits automatically moved from the retiree ID to the salaried or OPS eligible employee record upon hire.– To continue retiree health and life (and lose eligibility

for state health contribution and all other state group insurance benefits), employee must call service center to elect retiree coverage.

• Benefits will automatically be moved each open enrollment if eligible for employee coverage – required to offer affordable coverage.

27

System Enhancements

28

Key Dates Screen

• New screen that will include measurement dates, hours measured and other information specific to OPS employees.

29

Reports

• New OPS Employee Report will include all OPS employees for the agency and their eligibility status for benefits.

• OPS Leave of Absence Report will show the time period the OPS employees are on Military Leave, FMLA leave or Academic Break.

30

Communications

31

Open Enrollment

• OE summary inserts in benefits packages– Mailing starts 10/06/14

• Benefits guide• OE communication kits• myBenefits website• CVS/caremark welcome letter• Humana vision letter (materials only ending)

32

Helpful Documents

• QSC Event Matrix• Employee Eligibility for State Group Insurance• MA 14-003

– Be a member of and retire under one of the following retirement options:

• Early retirement • Disability Retirement• FRS Pension Plan• FRS Investment Plan• State University System Optional Retirement Program

(SUSORP) • Senior Management Service Optional Annuity Program

(SMSOAP)

33

The Wellness Wire

34

Thanks for all you do!