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Board Employee Insurance Program Open Enrollment 2005

South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

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Page 1: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

South Carolina Budget and Control Board

Employee Insurance Program

Open Enrollment 2005

Page 2: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Changes for 2005

Health

Dental & Dental Plus

MONEYPLU$MONEYPLU$

Optional Life/ Dependent Life

Supplemental Long Term Disability

Page 3: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

During the 2005 open enrollment you can:

Change from one health plan to another

Enroll in or drop coverage

Add or drop dependents

Health Plans

Page 4: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Network Providers Out-of-Network

Benefits BlueCard Program Preventive

Benefits

Rx Network Providers

Mental Health and Substance Abuse coverage

Medi-Call/APS Precertification Requirements

State Health Plan Standard Plan and Savings Plan

Page 5: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Implementation of Tobacco Cessation Benefit

Administered by APS

Free service for State Health Plan employees and covered dependents effective January 1, 2006

For assistance contact, Free & Clear at:

1-866-QUIT-4-LIFE

Or 1-866-784-8454

State Health Plan Standard Plan and Savings Plan

Page 6: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Coinsurance In-Network: Plan Pays 80% You Pay

20%

Out-of-Pocket Maximum $2,000 individual $4,000 family

Coinsurance Out-of-Network: Plan Pays 60% You Pay 40%

Out-of-Pocket Maximum $4,000 individual $8,000 family

$1 million lifetime benefits

State Health Plan Standard Plan

Annual Deductible $350 individual $700 family

Page 7: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Per-Occurrence Deductibles $125 emergency room visit (waived if admitted) $75 out patient hospital service (some

exceptions apply) $10 per office visit

Per-occurrence deductibles do not apply toward annual deductibles or out-of-pocket maximums

State Health Plan Standard Plan

Page 8: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Participating Retail Rx(up to 31-day supply)

$10 Generic $25 Preferred Brand $40 Non-Preferred Brand

Home Delivery Mail-Order(up to 90-day supply)

$25 Generic $62 Preferred Brand $100 Non-Preferred Brand

Pay the difference Annual out-of-pocket maximum of $2,500 per person Coordination of benefits

State Health Plan Standard PlanPrescription Drugs

Page 9: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Designed for subscribers who:

Are willing to take greater responsibility for their healthcare

Want lower premiums

Appreciate the opportunity to save for major medical expenses through a Health Savings Account

State Health Plan Savings Plan

Page 10: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Coinsurance In-Network: Plan Pays 80% You Pay

20%

Out-of-Pocket Maximum $2,000 individual $4,000 family

Coinsurance Out-of-Network: Plan Pays 60% You Pay 40%

Out-of-Pocket Maximum $4,000 individual $8,000 family

$1 million lifetime benefits

State Health Plan Savings Plan

Annual Deductible $3,000 individual $6,000 family (no embedded deductible) You pay 100% of SHP allowable charges

for Medical and Rx

Page 11: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Benefits No Per-Occurrence Deductibles Reimbursement for Annual Flu Shot Annual Physical to include Specific

Services Eligible to Contribute to a Health Savings

Account (HSA)

State Health Plan Savings Plan

Page 12: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Restrictions Cannot be enrolled in Medicare

Chiropractic payments limited to $500 per person (after deductible)

Prescription exclusions:

Non-sedating antihistamines

Drugs for erectile dysfunction

State Health Plan Savings Plan

Page 13: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

They are tax-sheltered investment accounts used to pay qualified medical expenses

They are portable

Contributions can be made only when participating in a High Deductible Health Plan (i.e., SHP Savings Plan)

Cannot be covered by another health plan

Facts about Health Savings Accounts

Page 14: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Facts about Health Savings Accounts

If direct deposited, contributions can be deducted on federal income tax return

Annual contributions are limited to $2,650 for 2005 for individuals; $5,250 maximum contribution for family

Catch-up provisions for individuals age 55 and older are $700 for 2006 increasing by an additional $100 each year until a total of $1,000 in 2009

Page 15: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Spouse and dependent do not have to be covered by the SHP Savings Plan or other high deductible health plan

Keep all receipts If used for non-qualified medical

expenses, amount is included in income and penalty applies, unless: Subscriber dies or becomes disabled Subscriber becomes enrolled in

Medicare Visit IRS at www.irs.gov

Facts about Health Savings Accounts

Page 16: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Health Saving Account Payroll deducted, tax-free for qualified medical

expenses Interest is earned VISA check card available from NBSC – unlimited use $20/year or $2/month Checks provided - $.50 fee per check written Carries forward from year to year Does NOT advance money “Limited Use” – Medical Spending Account (up to

$5,000) for Vision/Dental

Fringe Benefits Management CompanyMONEYPLU$

Page 17: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

My Insurance Manager allows you to: Review claim status View and print a copy of your Explanation of

Benefits See how much you have paid toward your annual

deductible and coinsurance maximum Ask customer service a question through

secured e-mail Review the provider directory (updated nightly) Request a new ID card

BCBS of South Carolinawww.southcarolinablues.com

Page 18: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

You must choose a primary care physician (PCP)

A referral is required for most specialty care

You must live or work in the HMO service area

Provide emergency service out of service area

Read HMO materials carefully before making a health plan selection

No out-of-network benefits

Health Maintenance Organizations(HMOs)

Page 19: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Annual Deductible $250 individual $500 family

90% after $200 inpatient hospital copay $75 outpatient hospital copay $100 emergency copay

Coinsurance Maximum (excludes deductibles and copays)

$1,500 individual $3,000 family

BlueChoice Health PlanAvailable in all South Carolina counties

Page 20: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

$15 PCP and OB-GYN copay

$30 specialist copay

$35 urgent care copay

BlueChoice Health PlanAvailable in all South Carolina counties

Page 21: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Retail Pharmacy (up to 31-day supply)

$ 8 generic $ 30 preferred brand $ 50 non-preferred brand $ 75 specialty pharmaceuticals

Home Delivery/Mail Order (up to 90-day supply)

$ 16 generic $ 60 preferred brand $100 non-preferred brand

BlueChoice Health PlanAvailable in all South Carolina counties

Page 22: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Annual Deductible: None

80% after $500 inpatient hospital copay $250 outpatient hospital copay $100 emergency copay

Coinsurance Maximum (includes deductibles, copays and coinsurance)

$3,000 individual $6,000 family

CIGNA HMOAll South Carolina counties except: Abbeville, Aiken, Barnwell,

Edgefield, Greenwood, Laurens, McCormick, and Saluda

Page 23: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

$20 primary care physician copay

$40 specialist, OB-GYN copay

CIGNA HMOAll South Carolina counties except: Abbeville, Aiken, Barnwell,

Edgefield, Greenwood, Laurens, McCormick, and Saluda

Page 24: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Retail Pharmacy (up to 30-day supply)

$ 7 generic $ 25 preferred brand $ 50 non-preferred brand

Home Delivery/Mail Order (up to 90-day supply)

$ 14 generic $ 50 preferred brand $100 non-preferred brand

CIGNA HMOAll South Carolina counties except: Abbeville, Aiken, Barnwell,

Edgefield, Greenwood, Laurens, McCormick, and Saluda

Page 25: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

You must choose a primary care

physician (PCP)

A referral is required to higher

level of benefits; self-referrals are also allowed

You must live or work in the POS service area

Out-of-network benefits are available at a lower benefits level

Read POS materials carefully before making a health plan selection

HMO with Point of Service(POS) Option

Page 26: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

In-network No deductible $300 inpatient hospital copay $100 emergency and

outpatient hospital copay $15-PCP and OB-GYN copay $25 specialist copay $45 specialist copay w/o

referral,$35 urgent care RX: $7-generic, $25 preferred

brand, $50 non-preferred brand

Mail order available for a 90 day supply $14-generic, $50 preferred, $100 non-preferred

Out-of-network Deductibles

$300 single $900 family

60% of allowance Copay

$100 emergency care Coinsurance

$3,000 single $9,000 family

(excludes deductibles) No preventive care benefits No prescription benefits

MUSC OptionsThese South Carolina counties only: Berkeley, Charleston, Colleton, Dorchester

Page 27: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Available to: TRICARE eligible employees (and their eligible

dependents) who are not Medicare eligible (coverage ends upon Medicare entitlement)

Provides TRICARE eligible subscribers additional coverage that pays 100 percent of the member’s out-of-pocket costs

TRICARE Supplement is provided at no cost to the subscriber

TRICARE Supplement(administered by ASI)

Page 28: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Employees who change from the SHP or an HMO to the TRICARE Supplement plan must notify TRICARE

The DEERS eligibility record for each

family member must be current

Upon enrollment, subscribers will receive a packet from ASI with their certificate of insurance, identification card, claim forms and instructions on how to file

TRICARE student eligibility begins at 21 and ends at 23

TRICARE Supplement

Page 29: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

SHP

Savings Plan

SHP Standard

Plan

BlueChoice HMO

Employee only $ 9.28 $ 93.46 $125.30 Employee/spouse $ 72.56 $237.50 $365.72 Employee/children $ 20.28 $142.46 $268.46 Full family $108.56 $294.58 $540.18

CIGNA HMO

MUSC Options

Employee only $127.00 $119.24 Employee/spouse $365.18 $335.28 Employee/children $267.12 $223.56 Full family $536.98 $431.82 Optional employer

premiums may vary

SHP

Savings Plan

SHP Standard

Plan

BlueChoice HMO

Employee only $ 9.28 $ 93.46 $125.30 Employee/spouse $ 72.56 $237.50 $365.72 Employee/children $ 20.28 $142.46 $268.46 Full family $108.56 $294.58 $540.18

CIGNA HMO

MUSC Options

Employee only $127.00 $119.24 Employee/spouse $365.18 $335.28 Employee/children $267.12 $223.56 Full family $536.98 $431.82 Optional employer

premiums may vary

2006 Active Employee Monthly Health Premiums

Page 30: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

State Dental Planand

Dental Plus

Page 31: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

State Dental Plan and Dental Plus

During the 2005 open enrollment you can: Enroll in or drop dental coverage Add or drop dependents from dental

coverage Enroll in or drop Dental Plus

Page 32: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

State Dental Plan and Dental Plus

Administered by BlueCross BlueShield of S.C.

Use My Insurance Manager at

www.southcarolinablues.com to: Review claim status View and print a copy of your Explanation of Benefits Review Dental Plus participating providers

Dental Plus rates:Employee $18.52Employee/spouse $35.06Employee/children $38.26Full family $54.80

Page 33: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

During the 2005 open enrollment:

Active employees must enroll or re-enroll in spending accounts

Must be continuously employed for one year (by January 1) to be eligible for the Medical Spending Account

Fringe Benefits Management Company MONEYPLU$

Page 34: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Pre-tax Health, Dental, Dental Plus and Optional Life premium $.12 per month administrative fee

Dependent Care Account $5,000 maximum amount $2.50 per month administrative fee

Fringe Benefits Management Company MONEYPLU$

Page 35: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Fringe Benefits Management Company MONEYPLU$

Medical Spending Account $5,000 maximum amount $2.50 per month administrative fee EZ REIMBURSE® MasterCard® available Must be employed by a participating employer

continuously for one year to participate

New Grace Period Can incur expenses through March 15, 2006 provided

your account is active December 31, 2005. Applies to medical spending account and limited

medical spending account Deadline for filing all claims is March 31, 2006

Page 36: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Medical Spending Account – EZ REIMBURSE® MasterCard ®

Providers must have EZ REIMBURSE® MasterCard ®

terminal

Eligible medical expenses such as copays and deductibles are subtracted at point of sale (substantiation of claims may be required)

FBMC mails EZ REIMBURSE® MasterCard ® to your home (unless currently enrolled)

$20.00 annual fee deducted from Medical Spending Account

Over-the-Counter and mail order Rx NOT deducted from EZ REIMBURSE® MasterCard ®

Fringe Benefits Management Company MONEYPLU$

Page 37: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Get more out of your paycheck

Claims can be faxed

Direct deposit

Internet or Integrated Voice Response available 24-hours-a-day, seven days a week

“Use It-or-Lose It”

Fringe Benefits Management Company MONEYPLU$

Page 38: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Optional Life Lower rates effective January 1, 2006 Active employees can enroll in or increase their

coverage in $10,000 increments up to $30,000, without providing medical evidence of good health

Subscribers who wish to increase coverage more than $30,000 may do so in $10,000 increments, up to a $500,000 maximum, by providing medical evidence of good health

Must be actively at work January 1, 2006 for coverage or increase to become effective

Optional Life Insurance(The Hartford)

Page 39: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Dependent Life Insurance(The Hartford)

Dependent Life - Spouse Enroll in increments of $10,000 or $20,000

without medical evidence of insurability Increase in increments of $10,000 or

$20,000 - not to exceed 50% of employee’s benefit amount or $100,000, whichever is less

Suicide exclusion applies Employee must be actively at work

January 1, 2006 for coverage or increase to become effective

Dependent Life – Child $10,000 per child - $1.24 per month

Page 40: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Supplemental Long Term Disability(The Standard)

SLTD coverage is an affordable way for employees to protect more of their income

New, lower rates effective September 1, 2005

Pay premiums through convenient payroll deductions

Benefit calculated at 65% of your monthly pre disability earnings – Maximum of $8,000 monthly

Minimum benefit of $100.00

Page 41: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Supplemental Long Term Disability(The Standard)

Lifetime Security Benefit

This valuable coverage feature extends SLTD benefits indefinitely for disabled employees who:

Suffer severe impairments - who are unable to perform two or more activities of daily living – bathing, dressing, continence, toileting, transferring and eating

Page 42: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Supplemental Long Term Disability(The Standard)

Enrolling for SLTD is simple. There is no medical evidence of insurability required!

To enroll, you must:

Select SLTD on your Notice of Election (NOE)

Choose either a 90-day or 180-day benefit waiting period

If enrolled, you can change from 180-day to 90-day benefit waiting period

Page 43: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

Open Enrollment is October 1-31, 2005Open Enrollment is October 1-31, 2005

You are responsibleYou are responsiblefor your benefitsfor your benefits

Nothing is automaticNothing is automatic

Changes made during open enrollment will be effective Changes made during open enrollment will be effective

January 1, 2006January 1, 2006

To contact EIP:To contact EIP:803-734-0678 (Greater Columbia Area) 803-734-0678 (Greater Columbia Area)

or 888-260-9430 (toll-free outside Columbia Area)or 888-260-9430 (toll-free outside Columbia Area)www.eip.sc.govwww.eip.sc.gov

Page 44: South Carolina Budget and Control Board Employee Insurance Program Open Enrollment 2005

The information in this overview is not meant to serve as a comprehensive description of the benefits offered by the Employee Insurance Program. Please consult your Insurance Benefits Guide and literature from the various HMOs offered in your service area for additional information.