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Overview of Charter School Health Plan Enrollment and Benefits for 2014

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This document outlines the critical processes and requirements related to the State Health Plan (SHP) for charter schools, including group setup, electronic enrollment, eligibility and premium structures for the 2014 plan year. Key elements include irrevocable election processes, the necessity for electronic enrollment, and benefits attached to various health plans including the Enhanced 80/20 Plan and the Consumer-Directed Health Plan (CDHP). Additionally, it details effective dates, required employee notifications, and wellness incentives aimed at promoting health and reducing premiums.

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Overview of Charter School Health Plan Enrollment and Benefits for 2014

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  1. New Charter Schools December 16 , 2013

  2. Topics • Legislation • Group Setup • Electronic Enrollment • Eligibility • Rates • Plans • Effective Dates • Benefits • Group Premiums

  3. Legislation • § NCGS 135-48.54 • Charter School Board of Directors must make election in writing • Election must be made no later than 30 days after charter signed • Send to the SHP Executive Administrator and the State Board of Education • Election is irrevocable • Shall notify each employee of the election in writing • Each employee shall acknowledge receipt

  4. New Group Setup • Contact at State Health Plan (SHP) Rita Sandoval Rita.Sandoval@nctreasurer.com • Complete group setup form and submit to SHP • Order new employee kits • State Health Plan website www.shpnc.org • Electronic enrollment setup – free (required) • Benefitfocus – electronic enrollment vendor

  5. Electronic Enrollment • The State Health Plan is paperless and enrollment is only available electronically. • No paper applications are accepted • Following receipt of Group Setup form, a Benefitfocus Representative will be assigned to implement the new group onto the eEnroll System.

  6. Eligibility • Full-time employees • 30 or more hours per week • Part-time employees – pay full premium • 20-29 hours • Dependents – employees pay 100% of premium • Legal spouse • Natural, stepchild, adopted, foster and legal guardian up to age 26

  7. Plans for 2014 Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan • The current Standard 80/20 Plan with a new name to match the new features • $0 Affordable Care Act (ACA) Preventive Services • $0 ACA Preventive Medications • New Wellness Incentives • Reduced copays • A newhealth plan option • A high-deductible medical plan • A Health Reimbursement Account (HRA) to help offset the deductible • 85/15 Coinsurance • $0 Affordable Care Act (ACA) Preventive Services • $0 ACA Preventive Medications • CDHP Preventive Medication List ($0 deductible) • New wellness incentives • Additional HRA funds for visiting certain providers • The current Basic 70/30 Plan with a new name • No incentives available • No $0 Affordable Care Act (ACA) Preventive Services • No $0 ACA Preventive Medications Third Party Claims Administrator - Blue Cross Blue Shield of North Carolina

  8. Focus on Wellness Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan • Wellness premium credits when: • Subscriber completes a Health Assessment • Subscriber attests for him/herself and spouse (if applicable) to not smoking...or to being in a smoking cessation program • Selecting a Primary Care Provider (PCP) for self and all dependents • Additional wellness incentives • $15 copay reduction for utilizing the PCP (or someone in that practice) listed on the ID card • $10 specialist copay reduction for utilizing a Blue Options Designated Specialist • $0 inpatient hospital copay for utilizing a Blue Options Designated Hospital • Wellness premium credits when: • Subscriber completes a Health Assessment • Subscriber attests for him/herself and spouse (if applicable) to not smoking...or to being in a smoking cessation program • Selecting a Primary Care Provider (PCP) for self and dependents • Additional wellness incentives • $15 added to the HRA when the PCP (or someone in that practice) listed on the ID card is seen • $10 added to the HRA when a Blue Options Designated Specialist is seen • $50 added to the HRA when a Blue Options Designated Hospital is utilized for inpatient services • No incentives available • No $0 ACA Preventive Services • No $0 ACA Preventive Medications

  9. Monthly Premium – Enhanced 80/20 Plan *Assumes completion of three wellness activities Employer Share $448.12

  10. Monthly Premium – CDHP *Assumes completion of three wellness activities Employer Share $448.12

  11. Monthly Premium – 70/30 Plan Reminder: Wellness premium credits are not offered under the Traditional Plan. Employer Share $448.12

  12. Effective Dates • Effective date is the first of the month or first of the second month following date of hire • Dependents must be added at time of hire or due to a qualifying event • Dependents must be enrolled within 30 days of the qualifying event or added at annual enrollment

  13. Group Premiums • Prepaid Plan • Billed monthly for the next month • i.e., June bill is for July • Bills are generated in the middle of the month • Premium is due by the 5th of the next month and must be paid as billed • If premium is not paid by the due date, claims are held • Premiums not received by the fifteenth day of the month following the due date shall be charged 1 ½% interest of the amount due the Plan, per month beginning with the sixteenth day of the month following the due date. (NCGS 135-48.55) • eBilling offers paperless invoices, electronic one-time and recurring payments, on-demand and scheduled reporting

  14. Thank You!

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