2017 – Employer Group Programshumanresources.brevardschools.org/Shared Documents... · out-of-network, with the best savings received from in-network providers. When you have the

2017 – Employer Group Programs

Consortium Formed as outlined by F.S. 163

Provide a common service “Retiree Benefits for over age 65 School District Retirees”

Board of Directors, FEA, FASA, FASS, FSBA, FERMA and Retirees

3

Part “A” Part “B”Must Pay Premium

Hospital CareSkilled Nursing Facility Nursing

Home CareHome Health Services

Hospice

Preventive ServicesMedical Necessary Services

Lab TestsDoctor VisitsAmbulance

Premium Usually $0 Premium Starts at $121.80Based on income

You pay: $1,288 deductibleDays 61-90: $322Days 91-150 $644

Beyond lifetime reserve days: all costs

$166 per year deductibleTypically pay 20% of the Medicare-approved amount for most doctor,

outpatient therapy, and durable medical equipment

Possible 15% above approved amount

NO DRUGS!

5

Benefit Under 65 Retiree UHC LowPremium

UHCComprehensive

UHCPremier

Medical CIGNA National PPO National PPO National PPO

Annual Deductible $1,500 $400 $250 $0Annual OOP $4,000 $6,700 $6,700 $2,500Hospital Admit $DED +$600 +20%

$210/Day to 7 Days

$230/Day to 7 Days $175

Office Visits $30/$50 $25/$45 $20/$30 $5/$15Emergency Care $DED +$250 +20% $65 $65 $65Outpatient Surgery TBD 20% $15

Rx

Tier 1 $10 25% $7 $5Tier 2 $30 25% $40 $30Tier 3 $50 25% $90 $60Tier 4 25% $90 $80CoverageGap No Gap Yes Gap No Gap No Gap

MonthlyPremium $572.58 $10.00 $152.79 $246.34

6Plan design and/or rate varies by County of residence

Benefit Under 65 Retiree Health First Health First Health First

Medical CIGNA Rewards Group A HMO Group HMO POS

Annual Deductible $1,500 $0 $0 $0Annual OOP $4,000 $4,500 $2,000 $3,000Hospital Admit $DED +$600 +20%

$200/Day to 8 Days $250 $150 5 Days

Office Visits $30/$50 $0/$40 $0/$20 $0/$25Emergency Care $DED +$250 +20% $75 $50 $50Outpatient Surgery TBD $225 $125 $150

Rx

Tier 1 $20 $5 $5 $5Tier 2 $30 $15 $15 $15Tier 3 $50 $45 $25 $45Tier 4 $90 $45 $90Tier 5 33% $90 33%Tier 6 $0 $0 $0CoverageGap No Gap Yes Gap No Gap GAP 3,4,5MonthlyPremium $572.58 $0 $148.00 $169.00 7

Medigap Benefits Plan A Plan F Plan NPart A Coinsurance and Hospital Costs √ √ √Medicare Part B Coinsurance or Copayment √ √

Plan N pays 100% of the Part B coinsurance, except for a

copayment of up to $20 for some office visits and up to a

$50 copayment for an emergency room visit that

does not result in an inpatient admission

Blood (First 3 Pints) √ √ √Part A Hospice Care Coinsurance or Copayment √ √ √

Skilled Nursing Facility Care Coinsurance √ √

Medicare Part A Deductible √ √Medicare Part B Deductible √Medicare Part B Excess Charges (15%) √Foreign Travel Emergency (To Limits) √ √Non-Smoker 65 in Zip Code 32177 127.86 175.47 126.85

8

` Rx BenefitAARP Medicare RX

Saver PlusAARP Medicare

RX PreferredComprehensive Premier

Initi

alCo

vera

ge

Perio

d

Deductible $360 $0 $0 $0

Tier 1 $1-$8 $2-$10 $10 $7Tier 2 $2-$15 $6-$20 $45 $30Tier 3 $17 - $45 $32-$47 $75 $60

Tier 4 29% – 40% 35% - 50% 33% $75

Tier 5 25% 33% N/A N/A

GAP

Tier 1 51% 51% $10 $7Tier 2 51% 51% 40% $30Tier 3 40% 40% 40% $60Tier 4 40% 40% 40% $75Tier 5 40% 40% N/A N/A

Cata

stro

phic

Tier 1 $3.30 or 5% $3.30 or 5% $3.30 or 5% $3.30 or 5%

Tier 2 $3.30 or 5% $3.30 or 5% $3.30 or 5% $3.30 or 5%

Tier 3 $8.25 or 5% $8.25 or 5% $8.25 or 5% $8.25 or 5%Tier 4 $8.25 or 5% $8.25 or 5% $8.25 or 5% $8.25 or 5%Tier 5 $8.25 or 5% $8.25 or 5% N/A N/A

Monthly Premium $32.90 $72.00 $115.00 $304.239

Medigap/Supplement Plan With Drug PlanDrug Plan Low Value EGWP/Gap EGWE/no GAPPlan A $152.76 $189.06 $225.27 $374.61Plan F $200.75 $237.05 $273.26 $422.60Plan N $152.75 $189.05 $225.26 $374.61

Medicare Advantage PlansPlans Comprehensive $152.79 Premier $319.11

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Group Dental Insurance Plans◦ PPO Plans ◦DHMO Plans ◦Group Vision Insurance Plan ◦ Identity Theft Protection Plan

IT Tech Support Program VPI Pet Insurance Ameritas Hearing - New PetAssure Rx - New

11

Did you know. . . .1 in 3 age 65-74 have hearing loss1 in 2 over age 75

Untreated hearing loss leads to:Irritability NegativismDepression LonelinessReduced alertness Anger

Source: WebMD, BetterHearing.org and (John) HopkinsMedicine.org

My hearing is not bad.Most wait 10 years after hearing loss to seek help.

Wearing hearing aids means I am old.Connecting with others will help your brain stay

younger and keep you involved with life.

I don’t like how hearing aids look.Hearing aids are smaller and less conspicuous today.

It is difficult to adjust to wearing hearing aids, and they are hard to use.New, easier to use technology allows frequencies to be adjusted to meet your specific hearing needs.

Hearing aids cost too much.61% of people pay retail at an average of $1,675 per ear. Insurance benefits significantly reduces your out of pocket expense.

5 Hear Aid Myths . . .

SoundCare®Exclusively for members of the Florida School Retiree Benefits Consortium

• Largest ENT and Audiologist network in the country• No claims to be filed by member• 30-60% discounts for all major hearing aid

technology manufacturer• Hearing wellness program• Customer service available 9:00 am – 9 pm ET• Leasing program available

Hearing exams Hearing aids Hearing aid maintenance

100% covered through EPIC providers

100% up to $40 per benefit year

Batteries, repairs, service contracts and ear molds

Year 2 Year 3Year 1

30-60% EPIC

discount

30-60% EPIC

discount

30-60% EPIC

discount

50% up to $400 per ear, per

benefit period for

any provider

50% up to $800 per ear, per

benefit period for

any provider

Contact your SoundCarecustomer service representative at 877-359-8346.

• Select the provider of your choice• Make an appointment with your provide• Visit obtain a claim form• Take your claim form to your appointm• Complete & send in claim form

how to use your benefits

• Hearing health counselor will coordinate yo• Appointment• Care• Ordering hearing devices• Filing claim forms

how to use your benefits

Monthly Rates: Effective thru 12/31/2017Member only $ 8.00

Member + Spouse $16.00

Member + Child(ren) $12.00

Member + Family $20.00

2017

Florida School Retiree Benefit Consortium

Dental Benefits Guide

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A Healthy Mouth = A Healthy You

• Oral health is not just about teeth It's about the whole body

• The extraordinary prevalence of periodontal disease makes its impact on systemic health very important

• Cumulative healthcare costs were 21 percent higher for patients with severe periodontal disease than those with no periodontal disease

• Early detection is the key to treating the disease and preventing potentially serious health conditions

26

Dental Options

Florida Schools Retiree Benefits Consortium (FSRBC) is pleased to offer you four choices of dental coverage during Open Enrollment Period (OEP). The plans are through Humana. Select the plan that best suits your needs:

• Low DHMO Plan (HD205)• High DHMO Plan (HS195)• Low PPO Plan • Medium PPO Plan• High PPO Plan

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Dental DHMO

A copay-based network-only offering that requires selection of a primary care dentist. Each family member on your plan can choose their own dentist. Because services are prepaid, you have clear upfront costs. There are no yearly maximums, no deductibles, and no waiting periods.

Low DHMO Plan (HD205)

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• You choose your Primary Care Dentist• No deductibles or coinsurance• Unlimited annual maximum• No referrals required• Most preventive services available at no charge• Schedule of member copays for non specialist services• Specialist services (endodontic, oral surgery) may be

provided at up to a 25% discount (not included in the co-pay arrangement)

High DHMO Plan (HS195)

• You choose your Primary Care Dentist• No deductibles or coinsurance• Unlimited annual maximum• No referrals required• Most preventive services available at no charge• Schedule of member copays• Specialist covered as any other provider at copay level• Orthodontic Coverage

29

30

Dental PPO

A coinsurance-based plan that offers higher coverage in-network than out-of-network, with the best savings received from in-network providers. When you have the Dental PPO plan, our in-network dentists provide dental services at a negotiated discounted rate. You’ll have lower out-of-pocket costs for services received from in-network dentists.

Low PPO Plan

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• No referrals required• In-Network providers offer benefits at a lower out of

pocket cost• Members can also choose to go out-of-network and

choose their own provider • Nationwide network• Annual maximum per person on the plan: $800• Most preventive services available at no charge• Prosthetics, Extractions, and Root Canals covered at

Major service level• Non-Par reimburses dentist at the standardized fee

schedule

Medium PPO Plan

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• No referrals required• In-Network providers offer benefits at a lower out of

pocket cost• Members can also choose to go out-of-network and

choose their own provider • Nationwide network• Annual maximum per person on the plan: $1,250• Most preventive services available at no charge• Prosthetics, Extractions, and Root Canals covered at

Basic services level• Non-Par reimburses dentist at the standardized fee

schedule

High PPO

• No referrals required• Members can choose to go out-of-network and choose

their own provider• In-Network and Out-of-Network benefits paid at same co-

insurance• Nationwide Network• Annual maximum per person on the plan: $2,000• Most preventive services covered at 100%• Prosthetics, Extractions, and Root Canals covered at the

Major service level• Non-Par reimbursement dentist at the 80th percentile

33

34

Dental Plans Comparison

HD205 HS195 Low PPO Medium PPO High PPO

Deductible (In/Out of Network)

n/a n/a $50/$150 (In)$100/$300 (Out)$25/$75 (In)

$50/$150 (Out)$50/$150 (In)

$50/$150 (Out)

Office Visit $5 $0 100% 100% 100%

X-rays $0 $0 100% 100% 100%

Fillings $30-$90 $0-$65 70% After Deductible80%

After Deductible80%

After Deductible

Periodontal Maintenance $45 $40

50%After Deductible

80% After Deductible

50%After Deductible

Orthodontia 18 25% Discount

$1,850$1,850

20% Discount

20% Discount

20%Discount

Implants Not covered Not covered Not covered Not covered No covered

Annual Max Unlimited Unlimited $800 $1,250 $2,000

35

Thank you!

**CONFIDENTIAL & PROPRIETARY**Not for distribution outside of Davis Vision and client/broker/consultant relationship

Florida School Retiree Benefit Consortium Open Enrollment for January 1, 2017


The Survey Says…

37

Source: Jobson Optical’s 2012 Consumer Perception Report

Chart1

Medical/Health

Dental

Vision

Importance of Benefits - Rated as Somewhat or Very Important

Importance of Voluntary Benefits Consumers Rated Benefits asSomewhat or Very Important

0.945

0.915

0.929

Sheet1

Importance of Benefits - Rated as Somewhat or Very Important

Medical/Health94.5%

Dental91.5%

Vision92.9%

To resize chart data range, drag lower right corner of range.


*One-year eyeglass breakage warranty included


$570+ Savings with Davis Vision

Service & Materials AverageRetail Cost With Davis Vision

Eye ExaminationBifocal Spectacle Lenses (uncoated plastic)

$98$55

$10 Copay$15 Copay

Frame (Fashion or Designer Frame from Davis Vision Collection) $175 $0

Premium Progressives (Varilux®, etc.) $240 $90Tint $20 $0Scratch-Resistant Coating $40 $0Standard Anti-Reflective (AR) Coating $62 $35One-Year Breakage Warranty $30+ $0

Total: $720+ $150

39


For more details about the Davis Vision plan, just log on to the Open Enrollment section of the Member site at: www.davisvision.com

or Call 1.877.923.2847

and enter Client Code: 4951

http://www.davisvision.com/


THANK YOU

Plan Features Premium UltimateRestoration services Yes YesLost wallet assistance Yes YesIdentity safety resource center Yes YesInternet surveillance monitoring and alerts Yes Yes

Social security monitoring and alerts Yes YesChange of address monitoring and alerts Not Available YesCourt/criminal monitoring and alerts Not Available YesSex offender monitoring and alerts Not Available YesAnti-Virus, anti-spyware protection Not Available YesAnti-phishing, anti spam protection Not Available YesJunk mail-list removal Not Available YesMonthly RatesRetiree $7.00 $10.50Retiree + Family $15.00 $22.50

42

Remote Support via Internet, Live Chat, Telephone◦ 24/ 7/ 365

Assistance With Various Devices Including:◦ Computers (PC and MAC)◦ Smartphones◦ Cameras◦ Printers and Scanners◦ Modems ◦ Gaming Consoles

Computer Protection Software Self Help Database for Assistance With Technology Issues Secure Data Back Up Data Protection Onsite Support Available at $80 per Hour

43

Unlimited Support Unlimited Support with Data Backup $10.00 per Household $14.00 per Household

Veterinary Pet Insurance® is the leading pet insurance provider of pet health insurance.◦ Nation’s largest & oldest provider◦ VPI is wholly owned by Nationwide Mutual Insurance Co.◦ Plans are completely portable◦ Discounts (5% core policies / 10% for 2-3 pets)◦ Available plans Major Medical Plan – Comprehensive covers accidents, illnesses & hereditary conditions Pet Wellness Basics – Economical Covers Accidents & Illnesses Major Medical Plan with Pet Wellness

◦ Easy Enrollment FSRBC specific web page for enrollment at www.petinsurance.com/fsrbc, or Retirees can call 877-PETS-VPI and mention FSRBC to receive their 5% discount.

44

http://www.petinsurance.com/fsrbc

PETplus is a wholesale pricing club. You save on:

Rx medications Flea and Tick Preventatives Heartworm Preventatives Supplements and Vitamins Dietary and Specialty Foods

Brand name products pets need Savings guaranteed!

1. Enroll with FBMC and you’ll receive account activation instructions.

2. Shop online or call a pet care specialist to order the products you need.

3. Have your order shipped right to your door for FREE or pick it up at your local pharmacy (over 50,000 locations nationwide).

If you don't have a prescription, we contact your vet for you.

Included with PETplus at no additional cost Call, chat, email or text Access U.S. based certified veterinarian or veterinary

technician at any time Help reduce unnecessary vet visits

Dr. Aimee, D.V.M. Dr. Anna, D.V.M. Nicole Rogers, CVT Tamar, L.V.T. Dr. Dawn, D.V.M.

20% off ALL orders from Savings on:o SuppliesoTreatso BedsoGrooming itemso Furniture oAnd much more!

All dogs and cats can be enrolled – no exclusions

Single Pet Plan is $4.50/month Unlimited Pet Plan is $8.50/ month

I have probably saved over $1000/year versus purchasing meds via my vet.

-PETplus Member

Third Party Administrator◦ Manage Enrollment◦ Collect Premiums◦ Remit Premiums to Carriers◦ Maintain Records◦ Develop Program Communications◦ Maintain Customer Call Center

53

FBMC receives eligibility file from Brevard FBMC notifies Medicare Carriers of eligibility FBMC send packet Medicare Providers Send Material Retiree Enrolls by phone and paper

application based on carrier and products purchased

Confirmation sent to Retiree from Carriers and FBMC

FBMC Collects Premium from FRS, ACH or DB

54

Florida School Retiree Benefits Consortium �Who is Florida School Retiree Benefits Consortium FSRBCWho is Florida School Retiree Benefits Consortium FSRBCMedicare.govMedicareMedicare Advantage- BREVARD1 Medicare Advantage- BREVARD 2 Medicare Supplement Benefit OptionsMedicare Pharmacy Part D UHCPlan CostsNon-Medical Benefit Plan �Options AvailableSlide Number 12Slide Number 13Slide Number 14Slide Number 15no deductibleshearing examhearing aid maintenancehearing aidshow to use your benefitsnon EPIC providerEPIC provider��For more information about �how to enroll for this hearing benefit, �please contact:�� FBMC Benefits ManagementFlorida School Retiree Benefit Consortium��Dental Benefits GuideA Healthy Mouth = A Healthy You Slide Number 26Dental DHMO Low DHMO Plan (HD205)High DHMO Plan (HS195)Dental PPOLow PPO PlanMedium PPO PlanHigh PPODental Plans ComparisonThank you!Slide Number 36The Survey Says…Slide Number 38Slide Number 39Slide Number 40Slide Number 41Identity Theft ProtectionIT Technical Support Veterinary Pet Insurance What’s New?�PETplus Brand Name ProductsHow does it Work? Average Savings with 24/7 Ask-a-Vet HelplineMore Savings!How to EnrollYour pets will thank you!Who is FBMC Benefits ManagementHow Enrollment Works