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2012 Benefit Options Presentation. Plan Year January 1 through December 31, 2012. The Employee Benefit Options Guide. How to access the Guide: View the Guide on the O SEEGIB website at www.sib.ok.gov or www.healthchoiceok.com Complete the online request Contact your Insurance Coordinator
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2012 Benefit Options Presentation Plan Year January 1 through December 31, 2012
The Employee BenefitOptions Guide • How to access the Guide: • View the Guide on the OSEEGIB website at www.sib.ok.gov or www.healthchoiceok.com • Complete the online request • Contact your Insurance Coordinator • Contact OSEEGIB Member Services
Topics • 2012 Plan Changes • Health Plans • Dental Plans • Vision Plans • HealthChoice Life Insurance Plan • Eligibility
For More Information • 2012 Employee Benefit Options Guide • Frequently Asked Questions at www.sib.ok.gov or www.healthchoiceok.com • Your Insurance Coordinator • OSEEGIB Member Services • Plan websites and customer service representatives
Index Click the link below to access a particular section of this presentation. • 2012 Plan Changes • HealthChoice Health Plans • Dental Plans • Vision Plans • HealthChoice Life Insurance Plan • Eligibility • End
Eligibility Changes There are no eligibility changes for plan year 2012.
HealthChoice Plan Changes • High and Basic Plans • Must submit the HealthChoice High and Basic Plans Tobacco-Free Attestation for Plan Year 2012 by November 15, 2011, or enroll in the High or Basic Alternative Plan • The Attestation is available online, by calling HealthChoice Member Services, or from your Insurance Coordinator
HealthChoice Plan Changes • Two new plans: High Alternative and Basic Alternative Plans • Plan costs for tobacco use are approximately $52 million annually • High Alternative has a $750 individual/ $2,250 family deductible • $3050 ind/yearly maximum • Basic Alternative has a $750 individual/$1,500 family deductible • $5750 ind/yearly maximum
HealthChoice Plan Changes • High and Basic Plans • You may still be eligible without the Attestation if you provide a letter: • Showing you/your dependent has enrolled in the quit tobacco program • Showing you/your dependent has completed the quit tobacco program • From your doctor indicating it is not medically advisable for you/your dependent to quit using tobacco
HealthChoice Plan Changes • All HealthChoice Plans • Specific preventive procedures covered at 100% when using a Network Provider; refer to your Employee Benefit Options Guide • Non-Network emergency room services will be paid as Network; deductibles and balance billing may apply • Speech therapy no longer requires certification for patients 18 and older
HealthChoice Plan Changes • High Plan • Family out-of-pocket limit of $8,400 for Network and $9,900 for non-Network • Basic Plan • Well child care visits covered at 100% when using a Network Provider
HealthChoice Plan Changes • S-Account Plan • Out-of-pocket limits are being lowered to $3,000 for an individual and $6,000 for a family • Well child care visits have no copay and do not apply to the deductible • Proof of enrollment in an HSA is no longer required
HealthChoice Plan Changes • S-Account Plan • To make enrollment easier and more convenient, HealthChoice has contracted with American Fidelity Health Services Administration to provide an HSA or you can enroll in an HSA through the financial institution of your choice
HealthChoice Plan Changes • Prescription Plan Benefits • Prescriptions can be filled at a retail pharmacy or through the mail-order pharmacy • Retail pharmacy fills are limited to a 30-day supply or less for one copay • Mail-order pharmacy fills are limited to a 90-day supply for one copay • Prescription tobacco cessation products covered at 100%
Dental Plan Changes • There are no changes to the dental plan benefits for 2012.
Vision Plan Changes • Superior Vision • With a network provider, there is a $25 fitting copay for standard and specialty fitting for contact lenses, then plan pays 100% for standard fitting and up to $50 for specialty fitting • Plan offers savings of 20-50% on LASIK surgery • Fitting fee not covered with a non-network provider
Vision Plan Changes • UnitedHealthcare Vision • With network provider, the UV coating and tint lens options are covered in full • Vision Service Plan (VSP) • With network provider, the contact lens exam is covered in full after up to $60 copay
HealthChoice Life Insurance Plan • You can now purchase up to $500,000 of supplemental life insurance coverage with an approved Life Insurance Application, regardless of salary • You can no longer purchase $20,000 of life insurance coverage without a Life Insurance Application during Option Period • Return to Index
View plan changes for 2012 • Available Plans • HealthChoice High • HealthChoice High Alternative • HealthChoice Basic • HealthChoice Basic Alternative • HealthChoice S-Account • HealthChoice USA • Using a HealthChoice Network Provider will lower your out-of-pocket costs.
High • When using a Network Provider: • $30 copay for PCP office visits • $50 copay for specialist office visits • Annual deductible $500/individual or $1,500/family • Plan pays 80%/member pays 20% of Allowed Charges up to the out-of-pocket limit of $2,800/individual or $8,400/family
High Alternative • When using a Network Provider: • Benefits same as High Option except deductibles and out-of-pocket limit • Annual deductible $750/individual or $2,250/family • Plan pays 80%/member pays 20% of Allowed Charges up to the out-of-pocket limit of $3,050/individual or $9,150/family
Basic • When using a Network Provider: • Office visit copays do not apply • Plan pays first $500 then member pays next $500 as deductible; $1,000 deductible for a family of two or more • Plan then pays 50% until $5,500/ individual or $11,000/family out-of-pocket limit is met • Plan then pays 100% of Allowed Charges
Basic Alternative • When using a Network Provider: • Office visit copays do not apply • Plan pays first $250 then member pays next $750 as deductible; $1,500 deductible for family of two or more • Plan then pays 50% until $5,750/individual or $11,500/family out-of-pocket limit is met • Plan then pays 100% of Allowed Charges
S-Account • Designed for a Health Savings Account (HSA) • When using a Network Provider: • Combined $1,500 deductible/individual and $3,000/family • Entire deductible must be met before claims are paid (including prescriptions) • $50 copay for office visits • The calendar year out-of-pocket limit is $3,000/individual or $6,000/family • American Fidelity Health Service Administration
USA • For members who live and work outside of Oklahoma and Arkansas for more than 90 consecutive days • Benefits are the same as the HealthChoice High Plan • Members have access to the USA Plan’s nationwide provider network
Network Pharmacy Benefits • Prescriptions can be filled at retail pharmacies or through mail-order • Benefits are the same for all plans; S-Account members must meet the plan deductible before benefits are paid • You are responsible for the cost difference when choosing a brand-name if a generic is available
Network Pharmacy Benefits • When using a retail pharmacy: • Up to 30-day supply • For generics, maximum copay of $10 • For Preferred brand-name, maximum copay of $30 • For non-Preferred brand-name, maximum copay of $60
Network Pharmacy Benefits • When using the mail-order pharmacy: • Up to 90-day supply • For generics, maximum copay of $25 • For Preferred brand-name, maximum copay of $60 • For non-Preferred brand-name, maximum copay of $120 • 90-day supply does not apply to drugs with quantity or dosage limits
Network Pharmacy Benefits • Certain prescription tobacco cessation medications for a $0 copay • A calendar year pharmacy out-of-pocket limit of $2,500 (does not apply to S-Account Plan) • Specialty medications must be filled through Accredo Health, the HealthChoice specialty care, delivery service pharmacy • Return to Index
Dental Plans Available • Assurant Heritage Plus with SBA Prepaid • Assurant Heritage Secure Prepaid • Assurant Freedom Preferred • CIGNA Dental Care Plan Prepaid • Delta Dental PPO – Choice • Delta Dental PPO • Delta Dental Premier • HealthChoice Dental There are no changes to the dental plan benefits for 2012.
Dental Benefits • All the dental plans have the same core benefits which are divided into four different classes: • Preventive Care includes cleanings, bitewing x-rays, and routine oral exams • Basic Care includes fillings, extractions, root canals, endodontics, and periodontics
Dental Benefits • Major Care includes dentures, bridgework, crowns, and implants • Orthodontic Care* is covered for members under age 19 and members age 19 or older with temporomandibular joint dysfunction (unless otherwise noted) *HealthChoice and Assurant Freedom Preferred have a 12-month waiting period for orthodontic care unless you provide proof of prior group dental coverage.
Heritage Plus Dental Plan with SBA • No deductibles or maximum annual benefit • You must select a Primary Care Dentist for each covered person • Preventive Care is covered at 100% • Copay schedule applies to other services • The SBA (Special Benefit Amendment) provides an additional discount for network specialists
Heritage Secure Dental Plan • No deductibles or maximum annual benefit • You must select a Primary Care Dentist for each covered person • Preventive Care is covered at 100% • A copay schedule applies to other services, including specialist care
Freedom Preferred Dental Plan • Preventive Care is covered at 100% • A $25 deductible applies to Basic and Major Care. • After the deductible: • Basic Care is covered at 85% • Major Care is covered at 60% • Orthodontic Care is covered at 60%; maximum lifetime benefit of $2,000 • All other services have a combined $2,000 maximum annual benefit
Prepaid Dental Plan • No deductible or maximum annual benefit • You must select a Primary Care Dentist for each covered person • After routine cleanings, x-rays, and evaluations are covered at 100%; a $5 copay applies • A copay schedule applies to other services, including specialist care • Orthodontia benefits for adults
Delta Dental PPO - Choice • You must select a Primary Care Dentist for each covered person • No deductible for Preventive or Basic Care • A $100 deductible for Major Care • A copay schedule for all other services • A $2,000 maximum annual benefit for Preventive, Basic, and Major Care • Orthodontic Care has a maximum lifetime benefit of $1,800
DeltaDental Premier • A $50 combined deductible applies to Preventive, Basic, and Major Care • Preventive Care is covered at 100% • Basic Care is covered at 70% • Major Care is covered at 50% • Orthodontic Care is covered at 60% with a lifetime maximum of $2,000 • $3,000 maximum annual benefit
Delta Dental PPO • Preventive Care is covered at 100% • $25 annual deductible for Basic and Major Care • After deductible: • Basic Care is covered at 85% • Major Care is covered at 60% • Orthodontic Care is covered at 60% $2,000 maximum • $2,500 maximum annual benefit for other services
Dental • When using a Network Provider: • Preventive Care is covered at 100% • A $25 deductible applies to Basic and Major Care • Basic Care is covered at 85% • Major Care is covered at 60% • Orthodontic Care is covered at 50% —no lifetime maximum • A $2,000 calendar year maximum applies to all other services • Return to Index
Vision Plans Available • Humana/CompBenefits Vision Care Plan • Primary Vision Care Services (PVCS) • Superior Vision Plan • United Healthcare Vision • Vision Service Plan (VSP)
Vision Plans Overview • Each vision plan has its own provider network • The toll-free number and website address of each plan is listed in the Employee Benefit Options Guide • Contact each vision plan for specific benefit questions
Humana/CompBenefits • A $10 copay for an annual eye exam • A $25 copay for lenses and frames — one pair per year • Discounts are available for other vision services and lens options • Contact lenses are available instead of glasses
Primary Vision Care Services • There is no copay or limit on the number of eye exams • Lenses and frames are sold at wholesale cost • There is no limit on the number of pairs of glasses • Benefits available for contact lenses
Superior Vision • A $10 copay applies to eye exams — one per year • A $25 copay for lenses and frames —one pair per year • Contact lenses – available instead of glasses; $25 copay/standard fitting then plan pays 100% or $25 copay/specialty fitting then plan pays up to $50 • Discounts available for other vision services and lens options
UnitedHealthcare Vision • A $10 copay for eye exams — one exam per year • A $25 copay for lenses and frames — one pair per year • Discounts are available for other vision services and lens options • Lens UV coating and tints are covered in full • Contact lenses are available instead of glasses