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INSURANCE COORDINATOR 2014 OPTION PERIOD MEETING

INSURANCE COORDINATOR 2014 OPTION PERIOD MEETING. WELCOME THANK YOU! HOUSEKEEPING AGENDA. MDIS #2940. Important Dates. Web Enrollment Opens: 9/23/2013 HC Tobacco Attestation Opens : 9/23/2013 Paper OP Forms due : 11/1/2013 Life Ins. Applications due : 11/15/2013

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INSURANCE COORDINATOR 2014 OPTION PERIOD MEETING

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  1. INSURANCE COORDINATOR 2014 OPTION PERIOD MEETING • WELCOME • THANK YOU! • HOUSEKEEPING • AGENDA MDIS #2940

  2. Important Dates • Web Enrollment Opens: 9/23/2013 • HC Tobacco Attestation Opens: 9/23/2013 • Paper OP Forms due: 11/1/2013 • Life Ins. Applications due: 11/15/2013 • HC Tobacco Attestation or Reasonable Alternative Due: 11/15/2013 • Web Enrollment Closes: 11/15/2013

  3. Resources For Members • Employee Benefit Options Guide (EBOG) 2014 • Online by choosing Member, Handbooks atwww.sib.ok.gov • By phone or email to your Member Services Representative • Option Period Materials • Personalized Enrollment Packet • Summary of Benefits and Coverage (SBC)

  4. Resources For Members • OP Banner, and FAQ at www.sib.ok.gov • OP CD • You • EGID Member Services: 1-800-752-9475

  5. Additional Resources for You • Web User’s Newsletter • IC Manual • OP Materials Request at www.sib.ok.gov • Your Member Services Representative

  6. Who is eligible? • Your Employee (Member) • Education: participates in TRS and working at least 4 hours per day or 20 hours per week • Local Government: working at least 1,000 hours per year, not temporary or seasonal • Eligible Dependents • Other Dependent Children, with approval • Common-law spouses • Adoptions: 1st of month in which member obtains physical custody • National Support Orders or other Court Orders

  7. Eligibility Change 1/1/2014: For all plans, newborns must be enrolled the first day of the birth month and applicable premium must be paid, if enrolling. • HC Plans: If newborn not enrolled, coverage for a routine delivery only. • HMOs: If newborn not enrolled, 31 days of coverage only.

  8. Health Plans(no change from 2013) EGID Indemnity Plans • HealthChoice High and High Alternative • HealthChoice Basic and Basic Alternative • HealthChoice S-Account • HealthChoice USA HMOs • CommunityCare • GlobalHealth

  9. HealthChoice High Network Benefits • Office Visit Copay: $30 or $50 • Deductible: $500 Individual - $1,500 Family • Coinsurance: 80/20% • Out-of-Pocket Maximum (OOP): $3,300 Individual- $8,400 Family • Office visit and ER copays now apply to OOP

  10. High Alternative Network Benefits • Office Visit Copay: $30 or $50 • Deductible: $750 Individual - $2,250 Family • Coinsurance: 80/20% • Out-of-Pocket Maximum (OOP): $3,550 Individual - $8,400 Family • Office visit and ER copays now apply to OOP

  11. HealthChoice Basic Network Benefits • No copays • HC Pays first $500 of Allowed Charges • Deductible: $500 • Coinsurance: 50% • Out-of-Pocket Maximum (OOP):$5,500 Individual - $11,000 Family

  12. Basic Alternative Network Benefits • No copays • HC Pays first $250 of Allowed Charges • Deductible: $750 • Coinsurance: 50% • Out-of-Pocket: $5,750 Individual - $11,500 Family

  13. HealthChoice S-Account Network Benefits • Deductible: $1,500 Individual - $3,000 Family (includes coinsurance and Network Pharmacy copays) • Office Visit Copay: $30 or $50 • Coinsurance: 80/20% • Out-of-Pocket Maximum (OOP): $3,000 Individual - $6,000 Family • Copays apply to OOP

  14. HealthChoice USA Network Benefits • Same design as HealthChoice High • Nationwide Network, www.choicecarenetwork.com • Must live or work outside of Oklahoma/Arkansas for at least 90 days

  15. HealthChoice Health Plan Changes(All Plans) • Clinical Trials • July 1, 2013: Immunizations now covered under health or pharmacy at 100%, including administration • Immunization Promotion: It’s Never Too Late to Vaccinate!

  16. HealthChoice Health Plan Changes(All Plans) • Expansive list of preventive services covered at 100% • Simplified $200 wellness initiative continues • Electronic Funds Transfer (EFT)

  17. HealthChoice Pharmacy Changes • $4,000 Family OOP Maximum Established(High, High Alternative, Basic, Basic Alternative & USA) • Generic and Preferred Brand Apply to OOP Maximum • Copay restructure (all HealthChoiceplans)Cost up to:

  18. HealthChoice Tobacco Attestation • New Hires/New from HMO: One Year Grace Period; attestation not required until the next Option Period • Otherwise, due to EGID by 11/15/2013: • Attestation, or • Enroll at and complete three coaching sessions, or • Letter from Doctor

  19. Changes: • Combined Medical - Prescription Out-of-Pocket Maximum: $4,000 individual - $8,000 family • Inpatient Hospital Copay per Admission: $750 • Outpatient Hospital Copay per Visit: $500 • Custom website, state.ccok.com

  20. Changes: • Outpatient Hospital Copay per Visit: $250 Freestanding - $750 Hospital Facility • Advanced Imaging: $250 Copay Freestanding - $750 Copay Hospital Facility • Emergency Room Copay: $300 (waived if admitted) • Extended prescription supply available at certain pharmacies

  21. Dental Plans(no change from 2013) • HealthChoice Dental Plan • Assurant • Freedom Preferred • Heritage Plus with SBA (Prepaid) • Heritage Secure (Prepaid) • CIGNA Dental Care Plan (Prepaid) • Delta Dental • PPO • PPO Plus Premier • PPO – Choice

  22. HealthChoice Dental Plan Changes • Fluoride covered twice per year for all ages • Orthodontic Waiting Period: benefits only after 12 months continuous HealthChoice coverage • Sealants: Covered for molars only, age 16 and under; reapplication covered after 36 consecutive months • Preventive Resin: Covered for molars only, age 16 and under; reapplication covered after 60 consecutive months

  23. Vision Plans

  24. HealthChoice Life Insurance • Dependent Life Insurance simplified to two categories • Spouse • Child • Supplemental age-rated Life Insurance rates modified slightly, ages 50 and older

  25. Affordable Care Act (ACA) Updates • Information recently shared with Coordinators: • Critical lists • PCORI letter • Availability notices • Government websites • Marketplace Notification • COBRA General Notice Change • As your partner, we will continue to share critical information with you as we receive it from ACA sources • Check the EGID Calendarfor upcoming ACA Meetings

  26. Reminders • Deadlines • Ordering OP materials • 2013 IC Manual • SBCs for all plans • HealthChoice Tobacco Attestation • Life Insurance Applications • Use only current form • Medical records

  27. Reminders • Former Employees • If retiring during OP, contact EGID • OP Deadline, including Attestation for Former, Pre-Medicare members, is 12/7/2013 • Note new email addresses: first.last@omes.ok.gov • We will come to you! • Please let us know of any situation before you or your employee considers it a problem

  28. THANK YOU! • This publication was printed by the Office of Management and Enterprise Services as authorized by Title 62, Section 34. 1,100 copies have been printed at a cost of $66.00. A copy has been submitted to Documents.OK.gov in accordance with the Oklahoma State Government Open Documents Initiative (62 O.S. § 34.11.3). This work is licensed under a Creative Attribution-NonCommercial-NoDerivs 3.0 Unported License.

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