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Benefits Choice Information FY 2015

Benefits Choice Information FY 2015

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Benefits Choice Information FY 2015

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  1. Benefits Choice Information FY 2015

  2. FY 2015 Changes • Changes(listed on page 4 of the Benefits Choice book and page 2 of the flyer): • Deductibles and plan year deductible caps • Coinsurance • OAP out-of-pocket maximum • Vision lens benefit frequency • Retiree premiums 2

  3. FY 2015 Changes • Remaining the same: • Employee premiums • Employee premium annual salary bands • QCHP deductible salary bands • Life insurance rates • Dental rates 3

  4. Out-of-Pocket Maximum • The following do not count toward the out-of-pocket maximum: • Amounts over allowable charges for the plan • Non-covered services • Charges for services deemed to be not medically necessary • Penalties for failing to pre-certify/provide notification • Prescription deductibles and copayments (see Coventry HMO exception) 4

  5. Out-of-Pocket Maximum • Effective 7/1/14, Coventry HMO will count prescription deductibles and copayments towards the out-of-pocket maximum. Therefore, once the out-of-pocket maximum has been met, prescription charges will be covered at 100% for the rest of the plan year. • In FY 2016, prescriptions will apply to all health plan out-of-pocket maximums. 5

  6. Out-of-Pocket Maximum • Eligible charges from Tiers I and II will be added together when calculating the out-of-pocket maximum. • Tier III will no longer have an out-of-pocket maximum. 6

  7. FY 2015 Benefit Changes Quality Care Health Plan (QCHP) * Salary bands for QCHP deductibles did not change this year. 7

  8. QCHP Deductibles 8

  9. QCHP Benefit Levels Note: Percentages are based on the allowable charge for covered services. 9

  10. QCHP Prescriptions 10

  11. HMO Health Plans 11

  12. Open Access Plans – Tier I 12

  13. Open Access Plans – Tier II 13

  14. Open Access Plans – Tier III 14

  15. HMO and OAP Prescriptions 15

  16. Vision 16

  17. Dental 17

  18. If you have questions… If you have questions, please contact Benefits staff by calling 650-2190. Or review the Benefits Choice Options booklet on the CMS website at: http://www2.illinois.gov/cms/Employees/benefits/StateEmployee/Pages/BenefitsBooks.aspx. Thank you! 18