Open Enrollment Presentation 2014

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  • Riverside has confirmed that all plan designs comply with required benefits according to the Affordable Care Act as well as ensuring that our plans meet the affordability standard (cannot exceed 9.5% of employees pay).
    Vision increases very minimal = 9 cents for single... 24 cents for family.
  • Good news- first two bullets
    Explain specialty drugs – typically high cost unique drugs requiring special dispensing conditions. See the drug list available on the enrollment site, RiverNet or Humana.com for details. The employee will have more of a cost share for these specialty meds.
  • A list of the generic preventative drugs is available on the benefit enrollment site, RiverNet and at Humana.com

Transcript

  • 1. 2014 Benefits Riverside Healthcare Choices and Advantages for Riverside Employees
  • 2. Open Enrollment  Benefit Enrollment Timeline  November 4-24: Open Enrollment  Nov 4 – Benefit and Wellness Mini Fair  Rounding to Hospital Departments–10pm to Midn.  Nov 5 – Benefit and Wellness Fair  Riverside Lobby from 11:00 am to 3:00 pm  Nov 4-14: Benefit meetings and Q&A sessions  Nov 24: Enrollment period ends  Dec 3: Confirmation of benefit elections will be mailed to employees’ homes 2
  • 3. Open Enrollment  Confirm your benefit elections and make any necessary changes.  It’s important to confirm your enrollment if you…   would like to make changes to your existing elections have NEW dependents to add to your plan(s) (you will need to submit proof of eligible status)  Opt Out of health insurance (you must supply proof of insurance each year)  want to continue your Flexible Spending Account (the IRS prohibits the automatic rollover of FSA elections from year to year)  want to avoid the spousal surcharge (if your spouse is not eligible for benefits with their employer, you must complete the exemption form)  want to avoid the tobacco surcharge (if you are enrolled in health insurance, you must indicate your tobacco status for yourself and each dependent enrolled in your plan) 3
  • 4. Enrollment Process  Log on to the BenefitsTalk™ website at www.benefitstalk.com/riverside  Review online plan information  Review your current elections  Process your enrollment for 2014  Benefit Call Center representatives are available toll free at (866) 932-6851  Monday through Friday from 7AM-6PM 4
  • 5. Benefits are part of Total Compensation  To continue managing costs in 2014 while providing competitive benefits, premium adjustments have occurred for health insurance.   Rates can be viewed online during enrollment at www.benefitstalk.com/riverside or by calling the Benefit Center. Riverside continues to pay 80% of the total cost of healthcare coverage for employees.  There are no premium increases for dental, life insurance, or long term disability; however there is a 2% increase on vision premiums.  After enrollment, employees will receive a confirmation statement that details employee’s total compensation including Riverside’s contributions to benefits costs. 5
  • 6. PPO Changes See Benefit Booklet Plan Summaries for complete details  Preferred Plus Medical Plan no longer available  If you are currently enrolled in the Preferred Plus Plan, you must elect another plan. If you fail to elect another plan, you will be defaulted into the Gold PPO (Preferred) Plan.  New Names  Preferred Plan ($1500 Deductible) is “Gold PPO”  Basic Plan ($3000 Deductible) is “Silver PPO” 6
  • 7. PPO Plan Design Changes See Benefit Booklet Plan Summaries for complete details  Co-Pays accumulate to annual max out of pocket (except for Rx co-pays)  Riverside In-Network Providers Primary office visit co-pay decreased to $20  Prescription Specialty Drugs - Co-pay $100  Out-of-Network expenses do not count toward In-Network deductibles and max out of pocket and vice versa.  Gold Plan - increased max out of pocket for Tier 2 and increased deductible and max out of pocket for Tier 3 7
  • 8. New Plan – HDHP Silver HSA Qualified Plan  For services other than preventive care, you are responsible for       paying out-of-pocket until your deductible is met. No co-pays for office visits or ER visits and prescriptions. Deductible $2500 at Riverside (tier 1) and Humana (tier 2); $5000 out of network (tier 3). Co-Insurance 90% at Riverside, 70% at Humana, 40% out of network. Max out-of-pocket (up to two per family) $3500 at Riverside, $6000 at Humana, and $12000 out of network. Once you meet the out of pocket maximum, services will be covered in full (for any covered benefit) up to the allowable amount. Preventive services are covered in full at the first two tiers. Generic preventative drugs not subject to deductible at tier 1 8
  • 9. New Plan – HDHP Bronze HSA Qualified Plan  For services other than preventive care, you are responsible for      paying out-of-pocket until your deductible is met. No co-pays for office or ER visits and prescriptions. Deductible $4000 at Riverside and Humana; $6000 out of network. Co-Insurance 80% at Riverside, 60% at Humana, 40% out of network. Out-of-pocket annual limit (up to two per family) $5000 at Riverside, $6350 at Humana, and $12000 out of network. Once you meet the out of pocket maximum, services will be covered in full (for any covered benefit) up to the allowable amount. Preventive services are covered in full at the first two tiers 9
  • 10. Choices Available  In order to be eligible to choose from any insurance plan Riverside offers during Open Benefit Enrollment, employees must complete the following by December 1st    On-line Health Assessment Screening Lab Work Physician Wellness Visit  Those who do not complete these criteria will only be eligible for the HDHP Bronze Plan. 10
  • 11. Health Savings Account (HSA)  You must be in a HDHP to contribute to a HSA  You can contribute in a lump-sum or in any amount and frequency that     you wish. You can elect a certain amount for payroll deduction per pay period during your online benefit enrollment. There is a limit to how much you can contribute to your HSA each year. The maximum is $3,330 for single coverage and $6,350 for family. Over age 55 are eligible for additional $1000 catch-up contributions. There will be instructions for setting up your HSA thru PNC Bank. A Direct Deposit from you paycheck will go into your HSA account. Pay qualified medical expenses with your PNC Health Savings Account Visa® debit card, by transfer of money from your PNC HSA to a personal bank account, reimbursement via check request or by HSA check. If you are enrolled in HDHP HSA account AND want to contribute to a Flexible Spending Account (FSA), you will only be able to enroll in a Limited FSA that allow eligible expenses only for dental and vision 11
  • 12. Medical Insurance Premium Discounts  Employees with an FTE of .5 or greater who take Riverside Insurance can earn an additional $20 per pay period by completing: On-line Health Assessment  Screening Lab Work  Physician Wellness Visit  Coaching (if required)  Flu Shot  Mammogram (gender/age based)  100 Healthy Habit Points  For more information go to http://www.riversidemc.net/reach  12
  • 13. Riverside In-Network Physicians  For a better level of coverage, employees should choose physicians on the Riverside In-Network Physician List.  PPO Plans:  $20 co-pay per office visit  $40 co-pay for specialists  90% coverage (after deductible) for inpatient visits at Riverside  HDHP: Must meet deductible first then co-insurance starts  This list of physicians is subject to change from time to time, depending on the hospital affiliations of the physician, relocation and other criteria.  An updated list is available…  online at www.benefitstalk.com/riverside  on RiverNet (in the Benefit Folder under Human Resources)  or from Human Resources 13
  • 14. FastCare  Riverside's FastCare clinic offers convenient health care for minor conditions and non-emergency illnesses. For Details, go to www.riversidemc.net/fastcare  If you are enrolled in one of the PPO Plans, you will only pay a $10 Co-Pay  If you are enrolled in a HDHP, you will pay the entire cost of all visits until you have met your deductible, then the visit is covered in full. (Currently $59 per visit.) 14
  • 15. PPO Prescription Coverage      $10 co-pay for generics $40 co-pay for formulary brand names $60 co-pay for brand names and injectibles $100 co-pay for Specialty Medications Use Riverside Family Pharmacy and get a three month supply of maintenance drugs (excluding specialty drugs) for…     TWO co-payments in the Gold (Preferred) Plan ONE co-payment in the Silver (Basic) Plan Detailed information about prescription drug coverage is available at www.benefitstalk.com/Riverside. Its important to confirm coverage of any prescriptions drugs you currently fill to see if there are changes in the formulary that may affect limits, prior authorization, or step therapy. 15
  • 16. HDHP Prescription Coverage  Silver HDHP       Generic Preventative – 100% Not Subject to Deductible Generic Drug – 100%, after Deductible Formulary – 80%, after Deductible Non-Formulary - 80%, after Deductible Specialty - 80%, after Deductible Then covered at 100% after meet max out of pocket  Bronze HDHP      Generic Drug – 100%, after Deductible Formulary – 80%, after Deductible Non-Formulary - 80%, after Deductible Specialty - 80%, after Deductible Then covered at 100% after meet max out of pocket 16
  • 17. Flexible Spending Accounts (FSA)  FSA’s are a way to save money by paying for certain health and dependent expenses with before tax dollars. (Max: $2,500 for Health FSA’s and $5,000 for Dependent Care FSA’s)  You must elect your contribution amount each year (the IRS prohibits the automatic rollover of FSA elections from year to year)  If you are in an HSA, you will be eligible for a “Limited FSA” only  Go to the BenefitsTalk™ website to access balances and view recent transactions  Grace period extends thru March 15, 2014 to incur expenses.  Deadline to submit 2013 claims is April 15, 2014, to WestLake.   Use-It-Or-Lose-It Rule still applies Manual claims processed within 48 hours  You will also have the option to use the Debit Card. Approved expenses are automatically deducted from your pre-tax account.  You may continue to use the same card from last year 17
  • 18. Health Flex Spending Account Claims Automatically Processed  WestLake (Riverside’s FSA administrator) and Humana have come together to automate the FSA claims process.    Humana provides WestLake with a weekly listing of claims paid for RMC participants with an FSA eligible balance due. WestLake will automatically process the balance from your FSA account for any FSA eligible amount (charges that went to your deductible, co-pay or coinsurance). You may elect to opt out of automatic processing by calling the Benefit Center. 18
  • 19. Dependent Eligibility Verification (DEV)  Employees who are adding new dependents to their medical, dental, or vision plan, are required to submit proof of eligible status to the Benefit Center by December 14.  Documents that are acceptable include, birth certificates, marriage certificates, tax returns, etc. A full list of acceptable documents is available online.  Please remember to put your name and employee ID number on anything you send to the benefit center. 19
  • 20. Spousal Surcharge  Employees who choose to cover their spouse in Riverside’s group medical plan and whose spouse is eligible for medical coverage with their employer will pay a $50 surcharge per pay period, in addition to the health insurance premium.  The Spousal Surcharge will be waived if:     Your spouse does not have medical coverage available through his/her employer Your spouse is unemployed, self employed, or retired Your spouse is covered by Medicare Your spouse is also employed by Riverside Medical Center  If your spouse meets one of the criteria above, you must complete the exemption form electronically at www.benefitstalk.com/Riverside 20
  • 21. Tobacco Surcharge The purpose of the Tobacco Surcharge Program is to provide additional motivation to encourage healthy lifestyles in our workplace environment. In addition to promoting healthy lifestyles, the surcharge will help cover additional health plan expenses generated by smoking and other tobacco related health problems.  The surcharge applies only to employees enrolled in health insurance.  $15 per pay period for each covered family member who uses or has used tobacco products within the past six months.  To avoid the surcharge, you must enroll online at www.benefitstalk.com/riverside or contact the Benefit Call Center at (866) 932-6851 and indicate your tobacco-free status. 21
  • 22. Quit Smoking Help  Riverside would like to help make it easier for you to quit by reimbursing you and your dependents the cost of the smoking cessation program  Freedom From Smoking: Cost $30.00 (refunded to you upon completion) - American Lung Association program - 8 week series of weekly sessions at Riverside Medical Center.  Reimburse up to $100 for out-of-pocket expenses for quit smoking aids, such as medications, gum, patches, etc. Bring your receipts to Employee Health for reimbursement. 22
  • 23. Opt Out Information  If an employee has health insurance coverage elsewhere, they may OPT OUT of health insurance at Riverside and receive a benefit credit every pay period.  To receive this credit, you must…  Provide proof of insurance each year.    Fax or mail a copy of your insurance card to the Benefit Center (Fax: 866-932-6838) Please remember to put your name and employee ID number on anything you send to the benefit center. Participate in the REACH Employee Wellness Program to get the full credit.   Full Time Employees who Opt Out must participate in the REACH wellness program to receive the full $45 opt out credit. If you do not participate, you will receive a partial opt out credit of $25. Part Time Employees who Opt Out must participate in the REACH wellness program to receive the full $20 opt out credit. 23
  • 24. Riverside Health Fitness Center  Riverside will continue to offer employees monthly membership at half price with a reduced enrollment fee of $50 for new employee members.  Riverside will pay 50% of monthly membership for the first family member (i.e. spouse or dependent) and the enrollment fee will be $75.  This also applies if the second family member is enrolling in the Fitness Island Membership program  To receive discounts, employees must pay through payroll deduction, commit to a one year membership, and be a 0.5 FTE or greater 24
  • 25. Enrollment Process  Log on to the BenefitsTalk™ website at www.benefitstalk.com/riverside  Review online plan information  Review your current elections  Process your enrollment for 2014 by Nov 24  Benefit Call Center representatives are available toll free at (866) 932-6851  Monday through Friday from 7AM-6PM 25