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2010 MIIS Health and Wellness Benefits

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2010 MIIS Health and Wellness Benefits 2010 MIIS Health and Wellness Benefits Presentation Transcript

  • Middlebury College Health & Welfare Benefit Plan Monterey 2010 Employee Health/Dental/FSA Plan Open Enrollment © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 1
  • Today’s Presentation: Today we’ll provide a brief introduction to CBA Blue and review: - What’s new. - High level review of your plans. - The current open enrollment period. - What you should expect next. - What may be required of you. We’ll save time for a question and answer session at the conclusion of the meeting. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 2
  • Who is CBA Blue? - CBA Blue is a Third Party Administrator located in South Burlington, Vermont. - We are an affiliate of Blue Cross and Blue Shield of Vermont. - We are your new Health, Dental, and FSA Plan Administrator effective January 1, 2010. - We utilize the national BlueCard® network to provide our members access to inpatient, outpatient, and professional healthcare providers around the country. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 3
  • BlueCard® PPO Network - BlueCard® is a national program that enables members of one Blue company to obtain healthcare services while traveling or living in another Blue company's service area. - PPO Access in 50 states: 482,120 PCPs 828,414 Specialists 5,752 Hospital - No Claim Forms - No billing hassles © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 4
  • What’s new? - New Customer Service phone number - New Claims Submission Address - New Website – www.cbabluevt.com - New Health Plan PPO Network – BlueCard® - Plan Changes, we’ll review…. - New ID Card(s) © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 5
  • Customer Service & Claims New Customer Service information: - Our hours of operation are M-F 8 am to 7 pm ET (5 am to 4 pm PT) - (888) 222-9206 - AT&T Language Line available. - IVR system 7 days a week, 24 hours a day. New Claims Submission address: - CBA Blue P.O. Box 2365 South Burlington, Vermont 05407-2365 © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 6
  • Website www.cbabluevt.com From our Member Page you can: Locate a Network Provider. Register for secure member access to view your claim’s history, locate and print copies of your EOBs and view your plan details. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 7
  • Locate a Network Provider Follow link from our Member Page, then: Choose Guest Tab Select PPO/EPO as your plan type , click continue. Enter the city, state and radius you are willing to travel Once you have your ID card, you will use the BlueCard® Provider Finder as a Member, by entering the first three alpha characters of your ID Number. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 8
  • High Level Health Plan Review Benefit BlueCard® PPO Network Deductible Individual $300 Two-person $600 Family $900 Out-of-Pocket Maximum Individual $1100 Two-person $2200 Family $3300 Employee Coinsurance 20% Plan Coinsurance 80% Office Visits (including services rendered at time of No Deductible, Plan Pays 80% visit), Well Adult & Well Child Care, Outpatient Mental Health and Substance Abuse. Member pays 20% All other covered services (See Summary) Subject to Deductible, Then Plan Pays 80% Member pays Deductible, Then 20% Until Out-of-Pocket Maximum is Satisfied © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 9
  • Health Plan Pre-certification Your Health Plan Requires that the following scheduled services are pre-certified prior to delivery or within 48 hours after an emergency, or Benefits may be reduced (call 1-800-204-5990): - Inpatient Hospitalizations © 2007 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 10
  • Care Management (Outreach) Your Health Plan also contains a nurse staffed Confidential outbound coaching program called HealthReach®. The program is designed to reach out to high risk individuals and educate those individuals on how to make better health decisions. In this program, a Registered Nurse works one on one with the member to identify and implement important lifestyle and treatment modifications. © 2007 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 11
  • Retail Prescription Benefits Your prescription drug plan provides you access to a pharmacy network managed for Middlebury College by RESTAT. Retail (30 day) co-payments: Drug Category Co-payment Generic $10 Preferred Brand $25 Non-Preferred Brand $40 To locate a network pharmacy or access the RESTAT formulary, go to www.restat.com . 12
  • Mail Order Prescription Benefits Your prescription drug plan provides you access to a mail order program (90 day supply) managed for Middlebury College by NEMOP: Drug Category Co-payment Generic $20 Preferred Brand $50 Non-Preferred Brand $80 To learn more about the Mail Order Program go to www.nemoprx.com . 13
  • Mail Order Split-Pill Incentive With the split pill incentive program, you’re provided with pills/tablets that are double the prescribed dose. You receive 90 day supplies for one co-pay: Drug Category Co-payment Generic $10 Preferred Brand $25 Non-Preferred Brand $40 You will need to split the pill/tablet in half to receive the correct dose. We will not send you any medication that should not or cannot be split. 14
  • Prescription Benefits Your prescription drug includes an out-pocket- maximum (including both retail and mail). Once met the Plan will pay prescriptions at 100%. Enrollment Level Maximum Out-of-Pocket Individual $400 Two-Person $800 Family $1200 • The Plan’s prescription program utilizes a Step Therapy Program. In some cases the health plan may require that you have tried a “first-step” drug, before approving a second-level drug. 15
  • High Level Dental Plan Review Benefit Calendar Year Deductible $25 Per Individual Applies to Class 2, 3, & 4 Class One: Diagnostic Care Plan Pays 100% Oral Exams, Cleanings, etc. Class Two: Basic Care Plan Pays 80% Fillings, Periodontics, Extractions, Oral Surgery, X-rays, etc. Class Three: Major Care Plan Pays 80% Dentures, Crowns, Bridges, Inlays, Onlays, Implants, etc. Class Four: Orthodontic Care Plan Pays 80% ($2000 per Member Lifetime Maximum) Study Models, Appliances, etc. Calendar Year Maximum $2,000 Applies to Class 1, 2, and 3 © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 16
  • Flexible Spending Accounts Eligible Employees may elect to enroll in the Middlebury College Flexible Spending Program (FSA). • A Health Care Account allows you to save money from your paycheck on a tax-free basis to cover certain medical (including some OTC expenses) and dental expenses not otherwise covered by your health plan. • A Dependent Care Account affords you tax-free savings to cover certain costs associated with providing your dependent care while you are at work. Remember, estimate wisely, any money that is left unspent at the end of the plan year is forfeited. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 17
  • Flexible Spending Accounts Category Without FSA With FSA Gross Monthly Salary $2500.00 $2500.00 Qualifying Health Care Expenses $0.00 $200.00 Qualifying Dependent Care Expenses $0.00 $350.00 Total Qualifying Expenses $0.00 $550.00 Gross Taxable Income $2500.00 $1950.00 Income Tax @20% plus FICA @7.65% $691.25 $539.18 Net Spendable Income $1808.75 $1420.82 Post-Tax Health Care Expenses $200.00 $0.00 Post-Tax Dependent Care Expenses $350.00 $0.00 Total Post-Tax Expense $550.00 $0.00 Net Spendable Income $1258.75 $1410.82 Increase in Monthly Spending Income N/A $152.07 Increase in Annual Spending Income N/A $1824.84 © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 18
  • Flexible Spending Accounts Members who enroll in the Middlebury College Flexible Spending Program will receive a Benefits Card. The Card can be used at both healthcare and non- healthcare merchants who have an industry standard healthcare inventory approval (IIAS) system in place. • A listing of IIAS merchants can be found at www.cbabluevt.com Remember to keep your receipts. For some expenses, we may need to verify the eligibility of the expense. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 19
  • Flexible Spending Accounts How to use your card for medical/dental/OTC expenses: 1. Prescriptions/OTC- present your medical ID card to the pharmacist first, next present your FSA card to pay the applicable co-payment at point-of-sale. 2. Medical- present only your medical card at time of service. Wait until you have received an Explanation of Benefits from CBA Blue and a balance forward statement from your physician. Make sure they match and then write your card number on the statement and remit as payment. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 20
  • Open Enrollment Now is the time to: - Join the plan(s)! - Change your current elections. - Change your enrollment level (i.e. single to family). - Add or delete dependents from your coverage. * Should you wish to enroll or make changes, please complete your electronic enrollment process by November 15 to ensure new ID card delivery in time for January 1, 2010. 21
  • What should I expect next? Arriving in your mailbox soon…. - New CBA Blue Medical/Dental Identification Card(s) arriving prior to the 1st of January. Be sure to present your new card to your providers beginning Jan 1. - New Mastercard® Benefits Card for those who enroll in FSA also arriving prior to the 1st of January. - Remember, claims incurred prior to Jan 1. should be sent to your previous administrator…claims incurred Jan 1. and forward should be sent to CBA Blue. © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 22
  • Open Forum Questions and Answers © 2009 CBA Blue An Independent Licensee of the Blue Cross Blue Shield Association. All Rights Reserved. 23