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This presentation is a summary of information and does not purport to present the complete details of all of the plan options offered by the Office of Group Benefits. For complete information on each plan option individuals should read the plan documents carefully and also consult other Office of Group Benefits and plan administrators’ publications.
Presentation Will Cover… • Eligibility • Plan Overview • Life Insurance • Invoicing • Flexible Benefits
Eligibility... • Eligibility same for all plans • Participation schedule not affected when changing plans
Eligibility... Dependents of Full Time Active Employees • Legal Spouse • Never married children under 21 that you support • Never married children up to 24 that are full time students (proof of full time status required within 30 days of each semester start)
Eligibility... Children include… • Legally adopted children • Children placed in home for adoption (claimed on taxes) • Children in home under your legal guardianship (claimed on taxes) • Grandchildren dependent on you, parent is your covered dependent
Eligibility... Over-Age Dependents • Incapable of self-sustaining employment prior to age 21 • Covered dependent prior to age 21 • Program must be notified prior to dependent’s 21st birthday
Pre-Existing ConditionsNew Hires or Re-Hires • If diagnosed or treated within 6 months prior to enrollment date • Then that condition is pre-existing and no benefits payable for that condition in first 12 months of coverage • Must complete enrollment form within 30 days for a new dependent otherwise pre-existing condition applies • May be exempt from PEC if continuously covered within 63 days of enrollment date
Eligibility... Retirees • Coverage must be in effect prior to retirement date • Participation schedule applies to … • Employees who joined program on or after 1/1/02 • Dependents who joined program on or after 7/1/02
Timely ProcessingRetirement Documents • When an employee retires the agency must do one of the following: • Enter the termination information in ISIS; OR • Enter the termination information in e-Enrollment, AND… TO AVOID A BREAK IN THE EMPLOYEE’S HEALTH/DRUG COVERAGE: • A GB-01 MUST be completed and immediately forwarded to OGB
Special Enrollments – HIPAAEmployees or Dependents • Loss of eligibility through separation, divorce, termination of employment, reduction in hours, or death of the Participant Employee • Cessation of Participant Employer contributions, unless the contributions ceased for cause or for failure of the Employee to make contributions
Special Enrollments – HIPAAEmployees or Dependents Acquired Dependents • Special enrollment will be permitted for Employees or Dependents when the Employee acquires a new Dependent by marriage, birth, adoption, or placement for adoption • A special enrollment application must be made within 30 days of either the termination of the prior coverage or the date the new Dependent is acquired.
Security…e-Enrollment • February 1, 2007, began the first year of tightened security for use of e-Enrollment • This new policy was implemented as a result of inappropriate use of IDs and passwords • Sub-users using Master Users’ ID to access e-Enrollment • Master Users not being timely updated • Sub-users inadequately trained (OGB offers training classes each month and one-on-one training is available upon request)
Changes in 2007-2008 TOP 5…All Plans • Total health care lifetime maximum of $5.0 million per person including prescription drugs • All plans have the same prescription drug benefit program through Catalyst Rx • All plans have the same mental health/substance abuse program offered by United Behavioral Health • Premiums have changed for all plans • Directory of providers replaced by web site listing... www.groupbenefits.org “2007 Annual Enrollment Information”
Providers? • Is my doctor/doctors in the plan? • Is my preferred hospital in the plan? • Check Website for most current information
Restrictions? • Out of State vs. In State • Cost of going Out of Network • Members in primary Medicare A and B can go out of network in all plans except in Humana HMO.
Take Action…Control Premium Costs • Married couples • If both are state or school employees • If both are eligible for coverage • May save money by splitting coverage • Retirees • If plan to retire after 7/1/07 • Check retiree premiums on plans • Some plans have higher member costs for retirees
Take Action Control Out of Pocket Costs… Six Critical Questions…Pre-Procedure • Is the procedure covered by my plan? • Is the doctor, lab and anesthesiologist in the network? • Is a referral to a specialist or pre-cert required? • Is there a deductible requirement? • Is there a co-pay or % of eligible charges payment? • Is this procedure meeting requirements in the plan document?
Sources of Information • OGB – 1-800-272-8451 • Catalyst - 1-866-358-9530 • Humana - 1-888-393-6765 • Humana Medicare Advantage Plans - 1-866-396-8810 • United Behavioral Health - 1-866-492-7143 • United (current members) - 1-866-336-9374 • United (prospective members) - 1-866-336-9374 Option 1 • ASI (TRICARE Supp'l) - 1-800-638-2610 ext 255
OGB Keeps Administrative Costs Low Administrative costs are 3% of total costs
Key Points • Active and retirees who are not changing plans do not have to file an enrollment/Scantron form • Active employees who are changing plans should follow e-Enrollment procedure with the HR department at their agency • Retired employees who are changing plans should fill out a Scantron form and mail it to the OGB address on the form • FARA (MCO) and Vantage (HMO) plan members must select a new plan or they will be placed in the PPO plan
Key Points • Can only make the decision once a year • Must consider any possible changes through the year • Child going to college out of state • Possible job transfer out of state • Travel a lot out of state • Use of medical specialists • Balance costs, benefits and restrictions
Medicare D…Why Decline? • OGB plans offer more than standard Medicare plan • Prescription drug coverage is part of your OGB plan • OGB will continue health and prescription coverage for retirees
Plan Overview…All PlansMental Health and Substance Abuse CoverageMember Out of Pocket Expenses
More Choices for Active and Retired Employees TRICARE Supplement Plan by ASI • Voluntary health benefit option • Available to active and retired OGB plan members and their dependents who are eligible for TRICARE—the military’s health benefit program • Plan members voluntarily elect to transfer from PPO, EPO and HMO
More Choices for Active and Retired Employees More information on TRICARE Supplemental Plan on OGB website www.groupbenefits.org
More Choices for Retirees on Medicare • Medicare Advantage Private Fee for Service • Nationwide • Medicare Advantage HMO • Offered in Baton Rouge, New Orleans and Shreveport • Must complete Medicare Advantage application AND OGB form
More Choices for Retirees on Medicare Medicare Advantage Private Fee for Service • Offered by Humana, available nationwide • Significant savings on premiums/co-pays • Retiree and spouse must be in Medicare A and B • Can see any doctor, hospital or provider that accepts Medicare and the plan payment terms
More Choices for Retirees on Medicare Medicare Advantage HMO • Offered by Humana • Significant savings on premiums/co-pays • Available in Baton Rouge, New Orleans and Shreveport • Retiree and spouse must be enrolled in Medicare A and B • MUST utilize Humana Medicare HMO Network Providers
Life Insurance Life Insurance Plan will be Offered Vendor Selection is in Process
Reduce Taxes and Increase Spendable Income Current Salary - Flexible Benefit Deduction (s) = Taxable Salary Amount
