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2014 OPEN ENROLLMENT
Overview November 4 - 22, 2013
Welcome
Important Notes:
• There will be a Q&A session following the presentation. Please hold questions for the end of the presentation.
• You can always email [email protected] or call 954-357-6700 for personalized assistance.
Welcome ! Thank you for joining us today!
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Agenda
• Health Care Reform Update and Changes
• New Benefits for 2014
• New Plan High Deductible Health Plan (HDHP) with Health Savings Account (HSA)
• Open Enrollment Overview
• Online Enrollment
• Q&A’s
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What is Health Care Reform (HCR)?
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What is Health Care Reform (HCR)?
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Americans not covered under a government plan (Medicaid, Medicare, TRICARE) will have two options for health insurance in 2014:
1. Get coverage through their Employer,
2. Buy an individual market health plan
through either:
• The individual market exchange, or
• The off-exchange or private exchange market
The Big Picture – Basics of 2014 HCR
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Broward County Healthcare Increases 2014
• As a result of Health Care Reform taxes and
fees, and member utilization, our rates
increased by approximately $4 million for 2014.
• The County is absorbing approximately $2
million, or half of the increase. Employees will
see an increase in their payroll deduction the first time in four years – CDH Plans only.
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What Does this Mean?
If we stay
on our current path,
premiums will
continue to increase By 2018, we will
incur Large
Employer Taxes
We need to prepare
Now!
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1. A new lower costing High Deductible Health Plan (HDHP) paired with a Health Savings Account (HSA) at lower premium cost to employees.
2. Waiver of Health coverage requires proof of other insurance coverage – Employees waiving must provide proof of other insurance coverage to receive annual $3,100 Waiver Credit.
Employees electing to enroll in Health Care Exchanges will not be eligible for the Waiver Credit
What’s New for 2014?
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Waiver Credit remains for 2014:
• Full-time = $3,100 annually ($119.23 biweekly)
• PT20 = $1,550 annually ($59.62 bi-weekly)
2014 Waiver Credit Recap
IMPORTANT – MUST WAIVE ONLINE OR FORFEIT WAIVER CREDIT! – PROOF OF HEALTH COVERAGE REQUIRED BY DECEMBER 23, 2013.
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3. A Working Spouse/Domestic Partner Surcharge of $20 bi- weekly for spouses who have insurance available under their employer’s plan.
– We recognize the value of insuring spouses and domestic partners and significantly subsidize to keep it affordable.
– Many employers have stopped covering spouses/domestic partners with access to other health coverage.
– The County will continue to provide coverage however, if other coverage is available there will be a $20 per pay period surcharge to offset the increase in costs to the county.
What’s New for 2014?
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• All employees enrolling a spouse or domestic partner in health coverage will be required to complete a Spousal/Domestic Partner Surcharge Affidavit online indicating whether their spouse or domestic partner have access to group health coverage by virtue of their employment.
• If yes, the member will incur a $20 per paycheck surcharge.
Recap - New for 2014! Spousal/Domestic Partner Surcharge
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Our plans are designed to encourage healthy lifestyle choices.
• During enrollment, employees must electronically acknowledge whether they and/or any of their insured dependents age 18+ have used tobacco products within the last one hundred twenty (180) days.
• All employees enrolling in health coverage are required to
complete a Tobacco Use Affidavit indicating whether
they or someone they insure over age 18 uses or
has used tobacco products in the past 180 days.
• If yes, the member will incur a $20 per paycheck
surcharge.
Tobacco Surcharge
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2014 Health Plans – Consumer Driven Health Plans (CDH)
3 Consumer Driven Health Plans (same as 2013):
• CDH Low - Lower payroll deduction, higher deductible, fewer services for a set copay
• CDH High - Higher payroll deduction, lower deductible, more services for a set copay
• CDH Out-of-Network – Most expensive and most flexible to go out of network
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Other Benefit Programs Life Insurance & Voluntary Long Term Disability
• Broward County Employee Benefits will be
conducting an additional Life Insurance and
Long Term Disability Open Enrollment in the
1st quarter of 2014.
• Additional information regarding the selected
carriers for Life and Long Term Disability Plans
will be forthcoming in early 2014.
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• No changes to Employer contribution HRA, deductibles, co-insurance, co-pays, out of pocket maximums for CDH High, CDH Low, and Out-of Network Plans.
• Preventative Mammogram and Colonoscopy: For CDH Plans, a member’s first mammogram and first colonoscopy each calendar year will be at no cost to the member when test is performed at an in-network facility.
• Hearing Exams: free hearing exams beginning January 1, 2014. Coverage limited up to an annual maximum of $1,500.00 per insured member.
Great News For Our Employees in 2014
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• No changes in plan design or premium for Dental Plans for Open Enrollment, HOWEVER:
• We will be conducting an additional Dental Open Enrollment in the 1st quarter of 2014.
• Additional information regarding the selected carriers and Dental Plans will be forthcoming in early 2014.
Important Information About 2014 Dental Benefits !
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NEW PLAN for 2014 - High Deductible Health Plan (HDHP) paired with and Health Savings Account (HSA) – Lowest payroll deductions, highest employer
contribution!
• Health savings accounts (HSAs) were first authorized by the 2003 Medicare Modernization Act. HSAs are intended to be used in conjunction with qualified high-deductible health plans (HDHPs).
• The number of people with HSA/HDHP coverage rose to nearly 15.5 million in January 2013, up from 13.5 million in January 2012 and 11.4 million in January 2011; an annual growth rate of approximately 15 percent over the last several years.
• The share of HSA/HDHP covered lives enrolled in large group plans jumped from 59 percent in January 2012 to
68 percent in January 2013.
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HDHP and HSAs Facts
1. Your deductible – Employee: $2,100
– Employee & Dependents: $4,200
2. Your coverage - Coinsurance – Employee: $1,500
– Employee & Dependents: $3,000
3. Your out-of-pocket maximum – Employee: $3,600
– Employee & Dependents: $7,200
How the HDHP Plans Works:
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1. Your deductible – Employee: $2,100
Employee & Dependents: $4,200
• You will pay the contracted cost for your health and pharmacy expenses until you meet your deductible.
• You can choose to pay for health care from your HSA or you can pay another way and let your HSA grow.
• Preventive care is covered 100% in network.
How the HDHP Plans Works:
1. Your deductible
EE=$2,100,
EE & Dep=$4,200
You choose to pay out
of your pocket OR with
your HSA
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How the HDHP Plans Works:
2. Your coverage—Coinsurance Employee Only: $1,500,
Employee & Dependents $3,000
• Once the deductible is met, the plan pays 70% of your eligible expenses including prescription drugs.
• You pay the rest (30%) coinsurance up to a maximum of $1,500 for Employee Only, $3,000 for Employee & Dependents
2. Your coverage after
deductible is met:
EE=$1,500
EE & Dep = $3,000
Your plan pays 70 %
You pay 30%
COINSURANCE
1. Your deductible
EE=$2,100,
EE & Dep=$4,200
You choose to pay out
of your pocket OR with
your HSA
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How the HDHP Plans Works:
3. Your out-of-pocket maximum — Employee only: $3,600,
Employee & Dependents: $7,200
2. Your coverage after
deductible is met:
EE=$1,500
EE & Dep = $3,000
Your plan pays 70 %
You pay 30%
COINSURANCE
You choose to pay out
of your pocket OR with
your HSA
• Your deductible and coinsurance payments apply to your out-of-pocket maximum.
• Once your out-of-pocket maximum is met, you are fully protected from covered medical and pharmacy expenses. This is the most you will have to pay.
3. Your out-of-pocket
Maximum: EE=$3,600,
EE & Dep = $7,200
You are protected
When you reach your out-of-pocket
maximum, the plan pays 100%.
• The plan will then pay 100% of all remaining covered expenses for the rest of the plan year.
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1. Your deductible
EE=$2,100,
EE & Dep=$4,200
Rules • When you receive health services or prescriptions not on the preventive list, you
will pay 100 percent of the contracted rate until you meet your annual deductible (Employee Only Tier $2,100, Employee + Dependents Tiers $4,200).
• Under a HDHP, all services received during an office visit are billed individually. There are no copays under the HDHP.
• All health care services including Lab Work, X-rays, Scans, Diagnostic Tests, Emergency Room and Urgent Care visits, Out Patient and In Patient Hospitalization are all subject to the deductible. After the deductible is met, then coinsurance (30%), and when out-of-pocket maximum is met, 100% coverage – employee has no out of pocket expenses for covered services.
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General HDHP Rules
Recap-How the HDHP Plans Works:
Your plan pays 70 %
You pay 30%
COINSURANCE
You choose to pay out
of your pocket OR with
your HSA
Your coverage — After deductible is met, the plan pays 70% of your eligible expenses, you pay 30% coinsurance. Employee Only: $1,500, for Employee & Dependents: $3, 000
You are protected
When you reach your out-of-pocket
maximum, the plan pays 100%.
1 Your deductible — You will pay the contracted cost for your health and pharmacy expenses until you meet your deductible. Employee Only: $2,100 Employee & Dependents: $4,200
2
3 Your out-of-pocket maximum — When you reach the out-of-pocket maximum, the Plan pays 100% of eligible expenses. You are fully protected from out of pocket medical expenses. — Employee only: $3,600, Employee & Dependents: $7,200
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1. Your deductible
EE=$2,100,
EE & Dep=$4,200
2. Your coverage after
deductible is met:
EE=$1,500
EE & Dep = $3,000
3. Your out-of-pocket
Maximum: EE=$3,600,EE
& Dep = $7,200
• No Co-pays - Designated Preventive Drugs*are payable at 100%,
• All prescriptions are subject to deductible and when deductible is met, co-insurance at 30% of discounted rate.
• When Out-of Pocket maximum is met, Rx benefits payable at 100% of discounted rate.
• List of 100% Covered Preventative Drugs will be listed on the Catamaran and Broward County Employee Benefits websites.
*Preventive medications are defined as those prescribed to prevent the occurrence
or recurrence of a chronic disease or condition, such as high blood pressure, high
cholesterol, diabetes, asthma, osteoporosis, and heart disease.
HDHP Pharmacy Benefits – Catamaran
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WHAT IS A HEALTH SAVINGS ACCOUNT
(HSA)?
• Health Savings Accounts are like a medical IRA … a way to save for retirement.
• Under federal law, HSAs were created to help individuals save for qualified medical and retiree health expenses on a tax-free basis
• Can only be paired with a HDHP • Can be funded by Employer and Employee on a pre-tax
basis (Employee Only $3,300/Family $6,550) • Employee owns account making it fully portable after
retirement or separation from the County
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Benefits of an HSA
• Funds roll over from year to year
– No “use it or lose it” philosophy
– Eliminates need for a Flexible Spending Account
• Employees retain control and make choices about how to spend their health care dollars
• Covers expenses such as dental and vision
• Tax-free withdrawals for “Qualified Medical Expenses” even if health coverage ends
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Benefits of an HSA
Broward County will fund the HSA=$1,000 Single/$2,000 Employee plus Dependents. You can also fund the HSA to pay the plan deductible and out-of-pocket expenses (qualified health care costs) – or you can let your account grow. Humana Access HSA accounts in UMB Bank will be available via link to MyHumana.com
HSA* Banker: UMB
Bank
It’s yours even if you switch jobs or plans
Tax savings
Pay for today’s $ or save for tomorrow’s
Use for qualified expenses
Use it for retirement
HSAs are designed to help you save and pay for your health care now and for retirement
*Health Savings Account can only be established in conjunction with the High Deductible Health plan
offering
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An HSA is not health insurance
What You Should Know About The HSA
Can be funded by employer and employee
No “use it or lose it” requirement
HSA is owned by you – Visa Debit Card issued by UMB Bank
Used to pay/reimburse qualified expenses
An HSA is not health insurance
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See Humana “My
HSA handbook”
Common Questions About HSAs
• Enroll during your Open Enrollment period
through on-line enrollment How do I enroll?
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• Yes. Funds belong to you even if you leave your job, change health plans or retire.
• Yes. Anyone can contribute to your HSA. Keep in mind that annual contribution limits above 2014 limits are subject to income taxes and a penalty.
• Use your HSA debit card-UMB Bank
• Pay by check, cash or credit card and reimburse yourself later from your HSA
Can I take the funds in my HSA with me if I leave the County?
2
Can others contribute to my HSA?
3
How do I access the funds in my account?
4
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• IRS Rules do not allow transfers from and HRA to an HSA. For 2014, if an employee with an HRA account balance elects to enroll in the 2014 High Deductible Health Plan with new HSA, the county plans to vest any unused $ in your HRA.
• Upon retirement or separation from the County funds will be rolled over into a Health Retirement Savings Account (HRSA) at ICMA.
What Happens to my Health Reimbursement Account (HRA)?
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• It is the employee’s responsibility to keep up with their receipts, banking accounts, etc.
• The employee is responsible for how they spend their HSA money within the IRS guidelines.
• Must report all HSA spending on taxes.
• No use it or lose it - it's the employee's money.
• Medicare eligible employees enrolling in the High Deductible Health Plan will have the equal County-funded HSA amount deposited into their Health Reimbursement Account (HRA) through WageWorks.
• FSAs are not offered if enrolled in an HSA. HSA
funds may be used for qualified medical, dental
and vision expenses.
• The annual HSA amount is prorated for new hires and
newly benefit eligible employees based on effective
date in plan.
Things to Remember About HSAs
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It is recommended that you bank some, or all, of your HRA or HSA so that your accounts build up and can cover more costly services when needed.
Health Reimbursement Account (HRA) and Health Savings Account (HSA)
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– Freedom of Choice
No PCP Selection
• All plans are Open Access which means you are not required to select a PCP.
• For the CDH Plans: When using a physician designated as Primary Care/ Family Medicine, your copay will be at the PCP rate. All other physicians will be at the Specialist rate.
• For HDHP Plan: All physician visits, other than preventative care will first be applied to your deductible; once deductible is met, 30% coinsurance applies.
• No Out-of-Network Benefit!!!!
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No PCP Selection
Counties in the network: Alachua, Baker, Bradford, Broward, Charlotte, Citrus, Clay, Collier, Columbia, Dixie, Duval, Flagler, Gilchrist, Hernando, Hillsborough, Indian River, Lake, Lee, Levy, Manatee, Marion, Martin, Miami-Dade, Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, St. Lucie, Union, Volusia
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2013-2014 Employee Plans & Rates
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Employee Considerations
CDH Plans •Higher payroll deduction •Some health copays •Rx copays •Lower out of pocket max
HDHP •Lower payroll deduction •First $ health and Rx payment at carrier negotiated rates (no copays) •Higher out of pocket max
What is a better value?
• Consider all the costs of each plan:
– Bi-weekly premiums – Deductible – Copays and/or coinsurance – Rx costs (no copays) – Your health care utilization
• HDHP with HSA or CDH with HRA?
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Member Aids for Cost Management and Education
• Quarterly “Smart Summary” from Humana
• Explanation of Benefits available for services since 1/1/2012 on Humana.com website
• Cost Comparison Tool available on Humana.com website
• On-site Humana Representatives
• Consumer Cost Lookup websites such as – Fair Health Educational Site (fairhealthconsumer.org)
– Healthcare Blue Book (healthcarebluebook.com)
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SmartSummary Mailed Quarterly, Available on-line
Humana SmartSummary Mailed Quarterly, Available On-line
Member # 1
Member # 2
Member # 3
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• Dental Plans – Compbenefits/Humana DHMO and The Standard PPO
• Vision Plan – United HealthCare
• Flexible Spending Account (FSA) – WageWorks
• Pre-paid Legal Plan – U.S. Legal
• Life Insurance – Employee Optional Life, Spousal Life and Dependent Life Insurance –The Standard
• Long Term Disability – The Standard
• Long Term Care – CNA
• Personal Income and Protection Plans - AFLAC
2014 Voluntary Benefit Options
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• Sign up ONLY on-line during
Open Enrollment!!!
• Opportunity to enroll in a legal benefit
plan that works the way you expect it to…
one that actually pays your attorneys’ fees!
• With the Family Defender, you and your family (dependents up to age 26) are covered for all your personal legal needs. It’s like having your own “Attorney on Retainer”, 24 hours a day, 7 days a week!
Other Voluntary Benefit Programs
Legal Insurance
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Wellness Program: Pharmacy Copay Waiver Incentive for enrolled employees and eligible spouses/domestic partners:
1. Enroll in Humana Vitality online wellness program
2. Complete the Vitality Check (Finger Stick screening for cholesterol, blood sugar)
3. Complete the online Vitality Health Risk Assessment
4. Participate in Disease Management Coaching through Humana (if applicable)
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Wellness Incentive
The Pharmacy copay waiver program will cover generic and preferred (formulary) medications through 12/31/14 and for the following disease states: • Asthma • Diabetes • Cardiovascular Disease (Coronary Artery Disease-CAD, Chronic
Obstructive Pulmonary Disease-COPD, Congestive Heart Failure-CHF, Hypertension)
• Chronic Kidney Disease
Note: Only drugs that are classified in the drug therapeutic class for the eligible disease state will be covered.
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Wellness Incentive
What is Open Enrollment? Open Enrollment 2014
• Annual opportunity to make plan selection and family status changes
• Must enroll or waive coverage online between November 4 and November 22, 2013
• Must Complete Tobacco Affidavit
• Must Complete Spousal/DP Surcharge Affidavit
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STEP 1: Online Enrollment (November 4 –
November 22, 2013)
STEP 2: Review, Print and Save Your Confirmation Statement
STEP 3: First Paycheck Deduction Review (January 10, 2014)
Open Enrollment - A Three Step Process
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HOW TO ACCESS THE ON-LINE ENROLLMENT SYSTEM (NOVEMBER 4 – NOVEMBER 22)
• From inside the County network:
– Access BC-Net, and then click Open Enrollment 2014 from the Hot Picks section.
• From outside the County network:
– Go to broward.org/benefits, and then click on Open Enrollment 2014.
• Read the information on the screen and then click the I Acknowledge the Employee Statement button.
• Populate the login fields with your login information and employee ID.
• Click Log In.
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ONLINE ENROLLMENT
ONLINE ENROLLMENT
If you have problems with your password, please call your agency Help Desk, or you may call the ETS Service Desk at 954-357-8600. Staff is available to assist with passwords.
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Note: Your Broward County Login ID
and Password are the same
credentials that you use to log in to
your Broward County computer or
BrowardEmployee.org site.
Thank You!!! Questions????
