Presentation Transcript

1. Commonwealth of Virginia Health Benefits Program

   2014 Health Benefits Open EnrollmentMay 1 – 23, 2014

   Highlights for July 1, 2014 April 2014

2. Customize based on your needs

   Enroll, change or keep your health plan Consider buy-up options: COVA Care, COVA HealthAware & COVA HDHP Add or remove eligible family members Waive coverage Enroll in a Flexible Spending Account

3. Your Health Plan Choices

4. COVA Care and COVA HDHP

   Administered by Anthem and Delta Dental
5. Anthemadministers: Medical BehavioralHealth EmployeeAssistanceProgram(EAP) PrescriptionDrug DeltaDentalpartners withAnthem forDental
6. COVA Care and COVA HDHP Behavioral Health Change Effective 7/1/2014 Residential Treatment Centers Approved in-network behavioral health services
7. www.AnthemEAP.com Workplaceissues Finance/Legal Health and Wellness Mentalhealth Parentingand childcare Marriage&relationshipconcerns
8. COVA Care – Prescription Drugs Change for 7/1/2014 Drug copayments increase for tiers 2-4 $5 retail/$10 mail Retail Tier Home Delivery $15 1 Generic drugs(nochange) $30 $ 60 2 Lowercost preferred brands $30 $45 $90 $60 3 Highercost brands $55 4 HighcostSpecialtybrand $110
9. HomeDelivery Threemonthsupplyfor onlytwocopays Easytogetstarted onlineatanthem.com or byphone Deliveredsafelytoyour doorstep
10. Optional Buy-Ups • ExpandedDental (Delta Dental) Out-of-Network ExpandedDental (Delta Dental) ◦ ◦ ◦ RoutineVision/ Hearing
11. COVA Care – Vision and Hearing BlueViewVision Eyeexam Eyeglassesandcontactlenses Frames Discountsonaccessories ◦ ◦ ◦ Hearing Routinehearingexam Hearingaids
12. Anthem Tips and Resources Go tourgentcare centersinsteadof emergency rooms $25PCP/$40SpecialistcopayforUrgentCarevs.$150copay theER  at Call24/7NurseLine Accesstoaregisterednursedayornight  Download the Mobile App on your smartphone Find Doctor &Urgent Care Centers, View ID Card and Estimate Your Costs ◦ ◦ ◦  Usethe“EstimateYour Cost” tool Findcostrangesforservicesandqualityreviewsfordoctors  Bookmark yourdedicatedwebsite for Commonwealth employeesat anthem.com/cova 

13. More on Dental Benefits

    Administered by Delta Dental of Virginia
14. Delta Dental of Virginia will continue to administer the dental benefits for COVA Care and COVA HDHP IMPORTANT PLAN FEATURES: Diagnostic & Preventive services are covered at 100% for all members when they see a participating provider.
15. Expanded Dental optional buy-up includes Primary Care – such as fillings, extractions, root canals Complex Restorative - dentures, bridges and implants Orthodontic services

16. COVA HealthAware

    Administered by Aetna Plan logo here

17. Comprehensive Plan

    Benefits and Coverage Medical Behavioral Health Pharmacy Basic Dental Routine Vision Exam Routine Hearing Exam Includes a Health Reimbursement Account (HRA) Expanded Dental and Vision benefits for an additional premium

18. Changes for 7/1/2014

    Residential treatment centers added to behavioral health benefits. More healthy activities to choose for “Do Right” contributions to the HRA.

19. What is a Health Reimbursement Arrangement (HRA)?

    Account that automatically pays eligible out-of-pocket expenses as long as funds are available Medical Behavioral health Pharmacy Funds paid automatically from HRA towards eligible expenses for any covered member Unused HRA funds roll over into future plan years with no limit if enrollment in the plan continues

20. COVA HealthAware HRA

    The initial HRA contribution for 7/1/2014: Employee/Retiree $ 600 Employee/Retiree + Spouse $1,200 HRA contribution is prorated for new enrollments or QME changes during the plan year. The HRA proration chart may be found on www.COVAHealthAware.com
21. HRA Contribution Employee/ Retiree only $600 Employee/Retiree + Spouse $1,200 Do Right HRA Incentives Employee/ Retiree only earn up to $150 Employee/Retiree + Spouse earn up to $300 In-Network Out-of-Network Deductible One person $1,500 $3,000 Two or more persons $3,000 $6,000 Out-of-pocket Max One person $3,000 $6,000 Two or more persons $6,000 $12,000 Coinsurance Preventive 100% 60% Diagnostic 80% 60% How the Plan Works COVA HealthAware is an open access, point-of-service (POS) plan with a large national network.

22. HRA “Do Rights”

    Employees/Retirees and enrolled spouses Additional $50 HRA contribution for up to three “Do Rights” Up to $150 per employee/retiree Up to $150 per enrolled spouse “Do Rights” include Annual routine physical exam Routine dental exam Annual routine vision exam (new!) Annual flu shot Active Health Management Health Tracker Active Health Management Coaching Module (new!)

23. Pharmacy Benefits

    Integrated with the medical benefit Combined deductible and out-of-pocket maximum Mandatory Generic plan Specialty pharmacy available Members can compare drug costs in advance on their member website
24. Dental Benefits Diagnostic and preventive dental services Included with the basic plan Covered at 100% in-network Expanded Dental: Optional Buy-Up Primary procedures: fillings, extractions, root canals Complex restorative procedures: crowns, dentures, bridges, implants Orthodontia

25. Vision Benefits

    Routine annual vision exam included with basic plan and covered at 100% Expanded Vision: Optional Buy-Up Materials benefit for eyeglasses and contact lenses Discounts for eyewear and accessories Network includes private practice providers plus participating national chains

26. Employee Assistance Program (EAP)Aetna Resources For LivingSM

    Available to participants and members of their household Confidential resource to address and resolve personal and workplace challenges Provides up to 4 visits per incident per plan year at no cost Additional legal and financial guidance

27. Member tools and resources

    Aetna Navigator Secure member website for 24/7 plan access and answers to questions Member Payment Estimator Provides real-time, personalized cost estimates for members based on their specific health plan and balances iTriage Mobile app to help members make better healthcare decisions and improve healthcare delivery CarePass Digital health and wellness tool to combine all leading health, wellness, and nutrition apps in one place Aetna Mobile Access to Aetna Navigator from a smartphone

28. Finding answers is easy!

    Have a question about any COVA HealthAware Benefit? One-stop, concierge-style service: 1-855-414-1901 Dedicated website: www.COVAHealthAware.com

29. MyActiveHealthTotal Population Health Program

30. ActiveHealth Management: Provides coaching services as part of the COVA health management program Partners with Anthem and Aetna to deliver services promoting healthy lifestyles and chronic condition management. Posters, flyers, postcards and email communications provide program information.
31. Customized Health Portal www.myactivehealth.com/cova All eligible adult members may access their own customized portal Complete their health assessment Schedule biometric screening The portal is enhanced with online coaching and web tools Digital coaching Interactive trackers, games and more
32. Healthy Lifestyles - Lifestyle Coaching with Five Tracks Smoking Cessation Weight Management Stress Management Nutrition Exercise Healthy Insights - Disease and Chronic Condition Management for Conditions Such As: Heart Disease Diabetes Healthy Beginnings - Maternity Care
33. Incentives - COVA Care and COVA HealthAware Healthy Insights Diabetes management Hypertension (new July 1, 2014) COPD & Asthma (new July 1, 2014) Bariatric Surgery Coaching Program Healthy Beginnings for expectant moms

34. Kaiser Permanente HMO

    Administered by Kaiser Permanente

35. New for July 1, 2014

    Pediatric Vision Eyewear up to age 19 No cost to members One pair of frames per year from select group, and Certain single vision or bifocal lenses, or Up to three months supply of contact lenses from selected list

36. The Power of kp.org

37. TRICARE SUPPLEMENT

    Administered by Association and Society Insurance Corporation (ASI)
38. TRICARE SUPPLEMENT Voluntary supplemental health benefit option Available to employees and their dependents who are eligible for: TRICARE, the military health benefit program, and The State Health Benefits Program Eligible employees who enroll in the plan are responsible for 100% of the monthly premium amounts Monthly premium payments are made with pre-tax dollars through payroll deduction

39. Premium Reward

    For employee, retiree and/or enrolled spouse Employee/Retiree or spouse can save $17/month Together can save $34/month

40. Already Earning a Premium Reward?

    Remain in COVA Care or COVA HealthAware Reward will continue through June 30, 2015 No additional actions required New! Confirm your reward status on EmployeeDirect
41. Earn Premium Rewards – COVA Care and COVA HealthAware Eligible members enrolled from July 1, 2013–March 1, 2014 Health assessment and biometric screening must be completed and submitted by May 31, 2014. Eligible members enrolled effective April 1–July 1, 2014 Health assessment and biometrics must be completed and submitted byAugust 31, 2014. Health assessment and biometric registration are available atwww.MyActiveHealth.com/covaor by telephone at 1-866-938-0349

42. Flexible Spending Accounts

    Administered by Anthem
43. Flexible SpendingAccounts HealthcareFSA Set asideupto $2,500per year,pre-tax, for eligible health expenses DependentcareFSA Set asideupto $5,000per year,pre-tax, for dependent day care expenses UsetheEliteBenefitCardforeligible Health FSA expenses
44. FSA Change for 7/1/2014 You must file claims within the three months after your coverage period ends Including any documentation required to validate an outstanding FSA card transaction. For Example, if your coverage period ends on 4/30/15, you must file by July 31, 2015.
45. All Participants Should Register Online: Account Balances Direct Deposit Account Activity Statements Online Payments Important Information about your FSA: Participants must enroll each plan year in order to participate. If you enroll in COVA HealthAware, the HRA pays first. See Spotlight on Benefits for website and contact information.

46. ALEX is back!

    ALEX is your online interactive assistant. He can advise you on what plan may be best for you. The final decision is still yours. Take a look at www.alexforcova.com

47. Get More Details

    Find information: Spotlight or Retiree notification booklet www.dhrm.virginia.gov Your agency Benefits Administrator Contact the plans

48. Make Your Election!

    Visit http://edirect.virginia.gov Login and select “Health Benefits Enrollment and Information” Or submit an enrollment form to your agency benefits office Final answer due May 23!

49. Remember, It’s Your Call!

    Consider what’s best for you and your family Choose your health coverage Premium reward Employees - Flexible Spending Account

50. Important Dates

    •Last day of Open Enrollment - May 23 •Last Day to Key RC 56 – May 29 •Last Day to Key RC 47 – June 30

51. Premium Rewards

    Current Premium Rewards will continue until June 30, 2015 as long as members remain in COVA Care or COVA HealthAware. No additional action required!
52. EmployeeDirect: Health Benefits Enrollment and Information Bulletin Board Confirm your premium rewards: Select “View Current Health Benefits Profile”, then look at Section 3: Health Care Coverage Election for “Reward Earned”. PSBREW – New Premium Reward Activity Screen - Check the status of the reward activities Confirm the end date of the Premium Reward Numbered Memo 14-01

    Premium Reward Status

53. The Spotlightnewsletter will be: mailed to the employee’s home providedelectronically to all employees with emails in BES Summary of Benefits and Coverage(SBC) required by the Affordable Care Act (ACA) If currently enrolled, employees will receive a plan specific SBC If not currently enrolled, a notice on how to obtain a copy of the SBCs. Annual CHIP notice required by the Department of Labor HIPAA Special Enrollment Notice

    Employee Mailing

54. Need Help? EmployeeDirect login/password issues or HuRMan access:Email: support@dhrm.virginia.gov General Open Enrollment questions: Email: openenrollment@dhrm.virginia.gov EmployeeDirect Health Benefits and Enrollment issues, keying BES, or content of a BES report: Email: ohb@dhrm.virginia.gov Policy and eligibility questions: Email: ohb@dhrm.virginia.gov Fax: (804) 371-0231