Open Enrollment OverviewCity of Clearwater

2016 Plan Year

Open Enrollment OverviewCity of Clearwater

2016 Plan Year

Benefits Committee• CWA: Steve Sarnoff, Steve Finney, Mike Head, Matt McCombs, Roberta

Gluski, Alternates: Phil Hughes & Todd Voigt

• FOP Officers: Jonathan Walser, Christopher Precious • FOP Supervisors: Sgt. Joel Morley • IAFF: Stephen Colbert; Matt Schad • SAMP: Susan Chase; Sandy Clayton; Jim Donnelly; Jay Ravins (Mgt.)

• Retirees: Karen Dombrowski (contact info on www.myclearwater.com)

Are there any Benefit Committee Members present today?

What’s Driving Clearwater’s Health Care Costs for 2016?

• Medical claim costs are down 6% with Local Plus Network Implementation. Local Plus Network is working! Amount of physician visits didn’t decrease, but the costs associated with them did.

• Catastrophic claims rose by $25K from last year and that accounted for 68% of our medical claims costs.

• Pharmacy claim costs are up 36% driven by specialty medications. Example: Hep C curable meds introduced in 4th Qtr of 2014 costs $1,000 per pill with a 90 day treatment plan.

(Specialty meds for: Hepatitis C, Cancer, Multiple Sclerosis, Arthritis)

• 2016 premiums increased by 7.7%.

OPEN ENROLLMENT 2016

Benefits Committee Voted To:Benefits Committee Voted To:• Continue self-funding and remain with CignaContinue self-funding and remain with Cigna

• Continue with “Local Plus Network”Continue with “Local Plus Network”

• Adopt Open Access Plus (OAP) “PHA Buy-Up” plan with Adopt Open Access Plus (OAP) “PHA Buy-Up” plan with larger network larger network

• PHA incentive: Local Plus PHA plan or Open Access Plus PHA incentive: Local Plus PHA plan or Open Access Plus (OAP) “Buy-up” Plan(OAP) “Buy-up” Plan

OPEN ENROLLMENT 2016• Open Enrollment Period – Wednesday October 28th - Friday, November 20th at 11:59 P.M

•Benefit Plan Year: January 1 to December 31, 2016

• During Open Enrollment, you may change plans, add/drop dependents, elect FSA, and enroll/drop other benefits

• Changes are not allowed outside Open Enrollment–unless having Qualifying Event (Page 5)

• Effective date of changes made during open enrollment is January 1, 2016

EMPLOYEE BENEFITS HIGHLIGHTS HANDBOOK

• Available in hardcopy as well as electronically on the City’s Intranet site.

• Handbook contents: o Carrier and Benefits Administrator contact informationo Qualifying event and dependent eligibility guidelineso Available benefitso Rates for premium payroll deductions

OPEN ENROLLMENT 2016ALL EMPLOYEES ARE REQUIRED TO LOG INTO BENTEK THIS YEAR (Even if you are not making changes)

• Acknowledge the Federal Healthcare Notices

• Review and/or make changes to benefit elections for 2016

• Enroll in the 2016 Flexible Spending Account if you would like it for 2016. FSAs do not roll automatically roll over – must enroll annually!

City Premium Payment Plan• As an employee, you are automatically enrolled in the City IRS

Section 125 qualified Premium Payment Plan when you elect eligible benefits such as medical, dental, vision and supplemental insurance.

• Premiums are deducted pre-tax from your paycheck.

• Changes to elections may not be made outside of open enrollment except for qualifying events. (30 days to notify HR of Qualifying Event, per IRS Section 125)

Domestic Partners are a post tax deduction as they do not qualify under the Section 125 plan.

Medical Insurance for 2016Pages 7-11

Three Cigna Medical Plan OptionsCigna Local Plus PHA Plan Cigna Local Plus Base Plan Cigna Open Access Plus (OAP) “Buy-Up” Plan

(New!)

3 Medical Options for 2016

1. PHA Local Plus Plan – Must have a Personal Health Assessment (PHA) completed between January 1, 2015 and Friday, November 20, 2015.

2. Base Local Plus Plan – No PHA required.

The biweekly rates will be the same for both plan options, the difference is in the schedule of benefits.

The PHA plan has lower office visit co-payments, co-insurance, deductibles, and out-of-pocket limits.

3 Medical Options for 2016 3. Open Access Plus (OAP) “Buy-Up” Plan (New!)

• To be eligible, must have a PHA completed between January 1, 2015 and November 20, 2015.

• Larger network of physicians.• Schedule of benefits same as the Local Plus Base

Plan.

Medical Insurance 2016Personal Health Assessment (PHA) is a requirement to participate in either:

• Local Plus PHA Plan with the better schedule of benefits • New Open Access Plus (OAP) “Buy Up” Plan with the larger

network.• Police and Fire personnel who have completed their Lifescan

prior to November 20, 2015 can use that result as their PHA credit.

The Local Plus Base Plan is an option for those employees who do not want to complete a personal health assessment. (Base plan has higher co-pays, deductible, out of pocket maximum.)

How to Complete a Personal Health Assessment

• Personal Health Assessments must be completed between January 1, 2015 – November 20, 2015 (Friday before Thanksgiving)

• Employee Health Center re-opened on November 2nd

• Call 727-298-1788 to make an appointment • Remember to fast eight (8) hours prior to your appointment • If you are unsure when you had your last PHA, log into the Care

ATC patient portal at patients.careatc.com. If you do not have your username or password, please call the Patient Access Center at 800-993-8244

Medical Insurance 2016Summary of Differences

Local Plus Base and Local Plus PHA Plan Open Access Plus Buy-Up

PlanDeductible $2,000/$4,000 $3,000/$6,000Out-of-pocket limit $3,500/$7,000 $4,000/$8,000Co-Insurance 10% 20%PCP Copayment $40 $50Specialist Copayment $60 $75

Biweekly deductions are the same for the Local Plus PHA and Base Plans.

Biweekly deductions are higher for Open Access Plus Buy Up Plan.

Medical Insurance 2016

No changes to the current schedule of benefits:

• $500 inpatient ($300 outpatient) hospital admission charge, then subject to deductible and applicable co-insurance.

• $150 co-payment per visit for emergency room services and $75 co-payment per visit for urgent care services.

Medical Insurance 2016No changes to the current schedule of benefits:

• Prescription co-payments of $30 for generic, $40 for preferred brand, and $60 for non-preferred brand (30 day retail); mail order (90-day supply) at 2X the 30-day co-payment.

• Advanced imaging services (MRI, CAT/PET scans) at hospital-affiliated facilities subject to deductible and applicable co-insurance; no charge for advanced imaging at freestanding facilities (West Coast, Rose, etc.)

Preventive Care

Take Care of Yourself with Preventive Care.

Preventive exams and other routine health screenings can help keep you healthy by detecting early warning signs of a more

serious issue. These exams are covered at 100% without a co-pay applying.

Preventive Care Cigna participants can have the following services done as well

care/preventive care at no cost:• Well Exam• Well Woman Exam• Mammogram• Pap Test• Colonoscopy – initial physician’s visit co-pay applies & the

actual procedure will be done at no cost• PSA Test

Medical Insurance 2016How Deductible and Co-Insurance Works (refer to page 9)

• For services requiring a co-payment, you pay only the amount of the co-payment each time you receive the service.

• For services requiring co-insurance, (anything with a % listed), you pay the full cost of services up to the deductible amount, and you then pay a percentage of the remaining cost of services up to your out-of-pocket limit.

• Once you reach your out-of-pocket limit, the plan pays the full cost of any services.

• Only services requiring co-insurance go toward satisfying the deductible. All services, including co-payments and co-insurance, will go toward satisfying the out-of-pocket limit. Prescription Drugs now go towards the out-of-pocket limit.

Medical Insurance 2016

The City continues to subsidize employee & dependent coverage for the Local Plus plans as follows:

Employee Only Coverage - City pays 100 % of the cost

Employee + One dependent - City pays 75% of the cost

Employee + Family – City pays 68% of the cost

Local Plus Plans 2016 Employee

Pays CityPays

Total monthly Premium

Increase from 2015

Employee Only $0 $661.78/month

100% of Premium

$ 661.78 $0

Employee Plus One Dependent

$141.74 biweekly($283.48/

month)

$850.45/month75% of

Premium

$1,133.93 $10.15 increase

Per Pay from 2015

Employee + Family $297.70biweekly($595.40/

month)

$1,265.23/month68% of

Premium

$1,860.63 $21.31 increase

Per Pay from 2015

Dual Coverage $0 $1,860.53100% of

Premium

$1,860.63 $0

Cigna Open Access Plus (OAP) Buy-Up Plan 2016

Employee

Pays CityPays

Total monthly Premium

Increase from 2015

Employee Only $25.48 biweekly($50.96/month)

$661.78/month93% of

Premium

$ 712.74 $25.48 Per Pay

Employee Plus One Dependent

$185.40 biweekly($370.80/

month)

$850.45/month70% of

Premium

$1,221.24 $53.81 per pay increase from

2015 LP +1 coverage

Employee + Family $369.34biweekly($738.68/

month)

$1,265.21/month63% of

Premium

$2,003.89 $92.95 per pay increase from

2015 LP Family coverage

Dual Coverage $71.63 biweekly($143.26/

month)

$1,860.63/month93% of

Premium

$2003.89 $71.63 per pay increase

Benefit: Larger network

Cost: $611.52 annually for employee only

How many times will you use the physician that is in the OAP network? Is it worth the biweekly deduction?

Cigna Open Access Plus (OAP) Buy-Up Plan 2016Consider benefit versus cost

Medical Insurance 2016Retiree Premiums, no City subsidy

Local Plus PHA or Local Plus Base Plans

• Retiree only $661.78 ($47.31 increase per month)

• Retiree + One $1,133.93 ($81.07 increase per month)

• Retiree + family $1,860.63 ($133.03 increase per month)

Medical Insurance 2016Retiree Premiums, no City subsidy

New PHA “Buy-up” Plan

• Retiree Only $712.74 ($50.96 increase per month)

• Retiree + One $1,221.24 ($107.62 increase per month)

• Retiree + Family $2,003.89 ($185.89 increase per month)

Cigna On-Site Representative

Stacy Lambert Stacy.lambert@myclearwater.com

Municipal Services BuildingThird Floor• Hours:

Monday and Wednesday 8:30 a.m. – 5:00 p.m.Tuesday, Thursday & Friday 8:00 a.m. – 4:30 p.m.

• Direct phone: (727) 562-4503

City Employee Health Center (page 6) • Must be enrolled in the City’s Medical Insurance to be eligible - No

other requirement• Reopened November 2nd and managed by Cigna On-Site Health • Staffed with 1 Physician, 1 Nurse Practitioner, 1 Health Coach, and 2

Medical Assistants• No cost for ANY services:

o Primary and urgent care office visito Labso Radiologyo Prescription drugs• All services must be authorized by the EHC physician.

Employee Assistance Program (pg 12)• Effective January 1, falls under medical insurance: Cigna Behavioral Health - EAP

and Mental Health/Chemical Dependency provider.

• Entitled to five free EAP visits annually per issue, $10 per visit co-pay after five visits or if diagnosed during 5 free visits, the copay applies.

• National network of providers and no limit to the number of visits.

• Co-pays for services go toward satisfying Cigna Out-of-Pocket Maximum.

EAP can help to resolve issues with family, personal, financial, marital, job, and substance abuse.

• Completely Confidential!

Dental Insurance 2016 (pages 13-14)Assurant and Humana remain as 2016 Dental Providers.

• Assurant Dental Plan: No plan changes or increases in premiums

• Humana CS150 Dental Plan: No plan changes but will have slight increases in premiums

– Employee Only: $9.25 per pay ($.49 cent increase from 2015)– Employee + 1: $17.21 per pay ($.90 cent increase from 2015)– Employee + Family: $22.40 per pay ($1.17 increase from 2015)

Dental Insurance 2016 (page 13-14)• Humana Advantage Dental Plan- No plan changes but slight

increase in 2016 premiums

– Employee Only: $13.93 per pay ($.70 cent increase from 2015)– Employee + 1: $25.95 per pay ($1.36 increase from 2015)– Employee + Family: $33.78 per pay ($1.77 increase from 2015)

• Humana Elite Preferred Dental Plan - No changes

Vision Insurance (page 15)

• Offered by Humana Vision

• No changes to benefits

• No changes to premiums

Supplemental Insurance (pages 16-17)•Administered by

Aflac• Accident Advantage• Short Term Disability• Hospital Advantage• Cancer Care Plan• Critical Care & Recovery• Dental

You must meet with an Aflac representative to add, drop, or make changes to Aflac insurance elections.

Flexible Spending Accounts (page 18)• Administered by Aflac through WageWorks.

• Flexible Spending Account limits will be $2,550 for unreimbursed medical and $5,000 for dependent care.

• A debit card will be issued for FSAs – no need to submit forms for reimbursement. If you did not keep your FSA debit card, you can request a new one online through the EBC.

• FSA requires a new online enrollment each year, it does not roll over!!

Dependent Eligibility (page 3)• An eligible dependent is defined as your legal spouse, domestic

partner or dependent child of you or your spouse/domestic partner: o Natural child, stepchild, legally adopted child, foster child, or a

child for whom legal guardianship has been awarded to you or your spouse/domestic partner.

• Documentation verifying dependent eligibility will be required from all employees covering a dependent that was not covered in 2015.

• Documentation examples include marriage certificate, affidavit for domestic partnership, birth certificate, guardianship court order.

Dependent Eligibility• Medical coverage for eligible dependents is provided to the

end of the calendar year in which the child turns age 26. Dental and vision coverage is provided through the end of the month in which the child turns age 26.

• Dependent children may continue to be covered for Medical only from age 27 to the end of the calendar year in which the child reaches age 30 if they meet the following criteria: o Unmarried with no dependents

ANDo A Florida resident OR full-time or part-time student

ANDo Otherwise uninsured and not entitled to Medicare

BENTEK-Employee Benefits CenterMandatory This Year!

Tips for a Successful Online Open Enrollment

Mandatory ALL EMPLOYEES MUST LOG INTO BENTEK!

• Review and/or make changes to benefit elections for 2016• Acknowledge the Federal Healthcare Notices• Enroll in the 2016 Flexible Spending Account (if you would

like it for 2016)• If waiving medical insurance coverage, you must provide

proof of other coverage for yourself only and complete a waiver form.

Tips for a Successful Online Open Enrollment• You must meet with an Aflac representative if you are adding,

dropping, or making changes to your supplemental insurance elections.

• You must click on “I Agree” and then hit “submit” on the final page. Hitting submit acknowledges that the received the federal healthcare notices through Bentek and can access them in Bentek at any time. It also saves your elections. If you exit before clicking “SUBMIT,” your changes will not be saved.

• You can print a confirmation statement or HR will provide confirmation statements in December.

Thank You!Don’t Forget ….

All election changes must be completed online no later than 11:59pm on November 20, 2015 (Friday before Thanksgiving).

www.mybentek.com/clearwater

PHAs must have been completed between January 1, 2015 and November 20, 2015

to qualify for the Local Plus PHA Plan or Open Access Plus Buy-Up Plan.

Contact the Employee Health Center 727-298-1788 to make an appointment for a PHA