Good morning/afternoon. Thank you for coming to an Annual Change presentation for the 2013 plan year. Let’s go over a few housekeeping items: Handouts and give-aways are available on table(s). If you would like to return any of the handouts, please do and we’ll take them with us! Books were handed out to employees by your agency HR or Payroll contacts. They are also available online. We have a VERY few copies with us, so if you borrow one for the presentation, we’d love it if you left it with us when you leave! Speaking of the books! You may have noticed 16 pages at the beginning of the books called Summary of Benefits and Coverage. These pages are part of Health Care Reform that, if included in the AC books, must be placed towards the front of the book. Our benefits information for 2013 starts on p. 22. We have a ‘low-vision’ copy of the presentation if you should need it. Please just raise your hand and I will get to you. With me today I have _______from Cigna, ______ from Delta, and (if in Helena) _____ from the Montana Health Center We will have time for questions at the end of the presentation, and all resources will be available to you afterward.THANK YOU FOR ATTENDING TODAY! Let’s get started!!
The theme of our presentation as you will soon see, is “CHOICES”What are YOUR choices? For Medical – you have the Choice Plan (formerly Managed Care) and the Classic Plan (formerly Traditional). If you are on the Managed Care plan and don’t make an election, you default to the Choice plan. If you are on Traditional and do not make an election, you default to Classic. For Dental – you now have the Premium (formerly our full Dental Benefits Plan) and the Basic (NEW!) Plans. Anyone who does not select a plan during Annual Change defaults to the Premium plan. You can use dentists in both the PPO and Premier networks. The PPO network gives the greatest savings, and the Premier network gives some savings. You do not have to choose PPO or Premier for 2013 – whatever network your dentist is in is the network you use. As members our own health choices can impact our out-of-pocket costs – what we eat, how much we exercise, how we manage stress. For Wellness – You have the Montana Health Center, Cigna, Delta Dental, and Health Care & Benefits (HCBD) to CHOOSE from – or choose them all! You often have choices with our prescription medications – talk with your health care provider or HCBD about options. Providers you see – Are you using In-Network providers (CIGNA & DELTA DENTAL) whenever possible?All of these choices help to determine your out-of-pocket costs!!
The book….We cannot read it for you or TO you! We make sure EVERYONE has access to a book. They were mailed to retirees on Sept 14th. HCBD provides books to each agency to the HR/Payroll staff. If you are an employee and do not have your book, please contact your HR or Payroll staff. Some agencies opt not to give out books; they prefer you to print your own copy from the online version on our website. Regardless….you should HAVE a book in some format.Read it…it’s good stuff!
Even if you have never, ever, ever logged in to make benefit changes, you really SHOULD do it this year! There are PLENTY of good reasons to do so!You NEED to choose a medical plan – Choice or Classic (if you do not choose a plan, those on Blue Choice default to the Choice plan, and those on Traditional default to the Classic plan)You NEED to choose a dental plan - Premium or Basic (no selection defaults to the Premium planIF you want Vision plan, you MUST elect it! If not, saying “NO” is required. Just because you have it this year does not mean you have it next year.IF you want to put money aside for Flexible Spending accounts, you MUST enroll or RE-ENROLL!! You may not move to the next step until you elect or waive flexible spending – both medical and dependent (even if you don’t have kids)It keeps your online sign active!Walk through the steps! Pictures or go to live web if you can.
Read bulletsRemember, what you do this year 2012 applies to 2013. During 2013, we will be offering you more opportunities to save in 2014. Tobacco-free is just the start. Stay informed via our newsletter, the website, and other announcements so you know you are doing everything to save the most you can!
Let’s talk about some of your CHOICES!1st – Rupert….(read example)
Changes to our Benefits -One of the goals the Governor gave HCBD for 2013 was to keep the increase to members’ per paycheck benefits payments at zero or as close to zero as possible. We made adjustments to deductibles and out-of-pocket maximums. We even had to make the tough decision to discontinue some benefits – not to penalize some members but rather to keep costs down for the majority of our members. The lower maximum rate of $2,500 for medical flexible spending is part of healthcare reform. This is a federal decision, not one from HCBD. GOOD NEWS! Choice plan office copay is STILL $15. Coinsurance for in- and out-of-network has been simplified to 25% and 35%. AND! Also part of healthcare reform, select preventive services outlined on p. 28 of your book are covered at 100% - no out-of-pocket cost to you. Check it out! It’s a true BENEFIT!
You may notice wellness coming at you from more than one direction. We have more choices for 2013. Our members have access to HCBD’s Wellness program including the Employee Assistance Program, Weight Watchers $75 reimbursement, and Lunch ‘N’ Learn;Cigna’s extensive wellness programs (including weight management, tobacco cessation, disease management, prenatal support, and more); CareHere’s programs available through the Montanan Health CentersDelta Dental wellnessSo why all the fuss over wellness? If you attended one of our presentations this spring, you may remember the slide that showed we (the State health plan) spent $132 million on health care in 2011. Up over 10% from the year before. Estimates vary – between 60% and 90% of health care costs are due to preventable diseases, diseases that wellness programs can control or eliminate. AGAIN! It’s your CHOICE and you can choose one or all!
Specialty medications have become the treatment trend. The specialty copay for 2013 is either $150 or $250. If you have trouble paying for your specialty medication, contact HCBD. There are programs to help people pay for specialty medications. You may think the copay is expensive, but these medications ARE expensive. Fore example; Rheumatoid Arthritis medications such as Simponi, Enbrel and Humira can cost $2,000-$4,000 per injection. Cancer and M.S. medications which may fall into specialty categories can be upwards of $10,000 per administration.Bottom line, ask your provider, talk with an HCBD Benefits Specialist, discuss your options, and become a savvy shopper with your healthcare dollars.
Remember, we are a self-funded plan. HCBD is responsible for setting the rates, determining the benefits, and overseeing the plan. Cigna AND Delta Dental administer our plan(s) as we write them. Cigna & Delta do not set our rates, and our rates did not go up because we switched to new administrators. Our rates are going up because of the rising cost of health care. Unless we as members make changes in our health, rates will continue to rise. You will now hear from our vendors and, in Helena, from our Montana Health Center staff. Now I’ll turn this over to ____ from Cigna to talk about our medical benefits, followed by _____ from Delta Dental and (if in Helena) ____ from MHC.
Are you interested in losing weight, quitting smoking, or learning tips on how to deal with stress better? You can enroll in one of Cigna’s Lifestyle Management Programs – work with a coach either online or over the phone.
Starting in January, the State will offer members two dental benefit options, the Basic Plan and the Premium Plan. Let’s take a look at the at the two options. The Premium Plan covers treatments similar to the current dental plan, including Types A, B, and C Services; however, there are a few enhancements to the benefits.First, Type A services now have their own annual maximum - $600 per member per calendar year.Second, Amalgam (silver-colored) fillings are now considered a Type A Service so they are covered at 100% of the allowed fee.Third, Type B and C Services will have a separate $1,200 calendar year benefit per member. What this means is that members covered under the Premium Plan will now be eligible for up to $1,800 in benefits each calendar year.The Basic Plan, will provide members the opportunity to reduce their monthly benefits payments and receive some important oral health benefits. The Basic Plan will give members up to $600 per calendar year toward Type A services, including Amalgam fillings – all covered at 100% of the allowed charge. The Basic Plan does not cover Type B or Type C Services. Type A Services under both plans will not be subject to a deductible. For more information regarding your dental benefits, see your Annual Change book, the Health Care and Benefits Division web site, or the Summary Plan Description.And for clarification, whether you select the Basic or Premium plan, you can use dentists from both networks – PPO and Premier. Or you can see an out-of-network dentists, though your out-of-pocket costs will be higher.
In late December, you will receive two dental plan ID cards. These ID cards will be separate from your medical plan ID card. The dental plan ID cards will be in the name of the employee or retiree.Important note: Only the primary member’s name will appear on the card. If you have dependents covered on dental, their card will have only your name on it. They are still covered and will be identified as having coverage if a dentist’s office calls to verify eligibility.
A self-managed resource to assist in the prevention of dental illness and management of medical outcomes.In addition to the broad array of oral health and wellness resources available through our web site, Delta Dental recently launched a new SmileWaySM Wellness Program. Members determine their own level of participation in the program which includes reviewing habits, getting educated, and staying informed. SmileWay utilizes website features, Facebook, Twitter, and customized communications to participants based on their results through our cavity and periodontal risk assessment quizzes.
We are excited about the new Health Center and those soon to open! Since opening the Montana Health Center in Helena, every single day has been booked solid. The Health Center is already looking at increasing the number of health care providers. And feedback has been awesome! People appreciate having at least 20 minutes with their health care provider. They appreciate not waiting long times for their appointment. Those who have used the Health Center so far love having no out-of-pocket costs for services there. Work is already underway to determine where the next Health Center will open.
The professionals available to work with you include: Read bullets.Those not in Helena or those preferring not to go in person may meet with health coaches by phone and online. Members outside Helena can use coaching by phone. Using wellness benefits has never been easier!
Everyone must register individually at CareHere.com to use the Health Center.
To stay connected with wellness, you can sign up for CareHere Connect. This online system gives you one centralized place to track all your healthy choices. And it gives you recommendations for taking your health to the next level.
Your vision benefits are listed on p. 33 of (both) booklets. You can “SEE” the benefits remain the same. Don’t forget if you are in the Rural out of network (50 miles from nearest in-network provider) you can view your benefits as “RURAL OUT OF NETWORK” for your vision benefit.This is a benefit you can set aside some flexible spending dollars to cover your out of pocket costs.
Counseling services for the Employee Assistance Program are automatically processed through Cigna. Members and covered dependentscan get four counseling sessions with no copay or no coinsurance if using an in-network provider. After the initial four counseling sessions, the regular medical benefits apply. It’s important to understand your benefits if you use more than the four counseling sessions with no copay. For example, under EAP, you may have four sessions of marriage counseling. However, marriage counseling is NOT covered on the medical plan, so there are no benefits for marriage counseling once you have used the four sessions. If you have any questions about the EAP benefit, call HCBD and talk with a Benefits Specialist.
This year is not an open enrollment year, so as usual members may add dependents only to the dental and vision plans during Annual Change. To add a dependent to the medical plan requires a qualifying event. See page 44 in the Employee book (page 40 in the Retiree book) for a definition and list of qualifying events.
Read bullets.On line renewals may click a box to elect a change to current status. Retirees do NOT have this option.Plan will always default to the pre-tax option if you do not make a selection.
When employees renewing this benefit the MUST make a positive or negative (Enroll or waive) election when renewing or the process will not let them complete. Health Care Reform effect for 2013 – Medical Flex accounts decrease to a maximum of $2,500. Dependent Care will remain the same.Flex plan notes: Payroll Deduction - Elect up to $2,500 tax-free for health FSA, Elect up to $5,000 tax-free for dependent care FSA - Be careful! Use it or Lose itServices/items for which you can use your medical FSA:Medical: Benefit plan deductibles, copays, non-covered expensesDental: Eligible expenses not covered by benefit planVision: Eligible expenses not covered by benefit planOver the counter drugs require a prescription from your health care provider starting in 2012Dependent Care FSA Kids twelve years old and youngerAny tax dependent living in your home that is unable to care for themselvesTo be reimbursed: Medical FSA Reimbursement If covered by benefit plan, send with claim form: Explanation of Benefits (EOB)Not Covered by benefit plan, send with claim form: Itemized Bill or ReceiptDependent Care FSA Reimbursement Send Allegiance one of the following with a completed claim form:Provider May Sign Reimbursement Request, Bill or Receipt from Provider, Day Care Contract
Read the top paragraph. You can add this benefit ANY time, not just during Annual ChangeFor rates see the Unum website www.unum.com
Read through bullets.Plan C – Employees may add $10,000 annually WITHOUT Evidence of Insurability (EOI).Plan D – Spouses may add a “ONE-TIME” $10,000 WITHOUT EOI. If you’ve already done this, you can’t do again (w/o EOI). You of course, may add more spouse life; they will just have to pass a health statement. Remember, your spouse cannot have more than the amount YOU as the employee have in Plan C!EOI means, evidence of insurabilityWhen is Evidence of Insurability Required? After your initial 31 days of becoming a member, or outside the 60 days of a Qualifying Event, or If you elect an amount higher than $10,000 during those time periods or If you enroll outside of those time periods you are subject to evidence of insurability.During the Annual Change you (the employee) may elect up to $10,000 additional coverage under Plan C without submitting evidence of insurability. Dependents on life insurance may stay covered until they reach age 26; then they are no longer eligible for life insurance under your plan.
MEDEX Travel Assist from The Standard provides pre-trip, medical, travel, and legal assistance—and more. They can even fly you home if you have a medical emergency. All Plan members have this benefit!
Long Term Disability pays a monthly benefit in the event you cannot work because of a covered injury or illness. This benefit replaces a portion of your income, helping you meet your financial commitments. Long-term disability may cover costs of training and education, family care, job search, and other job related expenses. For more information about LTD, view the Long-Term Disability booklet on the HCBD website.
We’ve talked about your choices for 2013. Let’s go over the key points. Read bullets.October 26, 2012 is the deadline. For retirees and legislators, confirmation statements being postmarked by 10/26/12 is OK!
The take home message is that the choices you make this year during Annual Change will impact your out-of-pocket costs. If you are not sure what choices to make, if you need help reviewing your health care needs and the plans available, call HCBD during business hours or Cigna’s pre-enrollment line (available 24 hours/day) for help. We are now open for questions! We will ALL be around afterward as well, in case there is a question you prefer not to ask in group setting.THANK YOU FOR ATTENDING!!!
Annual Change 2013 MT Employees
STATE OF MONTANAAnnual Change 2013Employees
What Are My Choices?• The Choice or Classic Plan for Medical• The Premium or Basic Plan for Dental – choose a plan• I can use PPO and Premier dentists with both plans• Wellness Programs• Prescriptions I Take• Providers I See (In- or Out-of-Network) As a member, the choices I make determine my out-of-pocket costs
Read the Book!• Every State employee and every retiree gets an Annual Change book.• If you are an employee and have not received a book, contact your HR or Payroll person. They distribute the books. Employees make their elections online.• Retirees books were mailed 9/14. Chances are the book has your answers.
How To Do Elections Online• Needed: MINE site login (ask payroll for help)• Go to Employee Self Service• Click on Benefits Enrollment• You must say YES or NO to Vision, Medical Flex, and Dependent Flex• Read the email you receive after hitting SUBMIT.
Rates for 2013• State share stays at $733• Choice rates (formerly Managed Care) went up a little• Classic rates (formerly Traditional) went up more than Choice• Save $5 - $10/month for attending a health screening• In 2014 you can save more by being tobacco-free!
If I Make the Right Choices… Choice PlanRupert + spouse and kids $947Health screenings for Rupert and spouse - $10State share $733Rupert’s monthly payment $204 Classic PlanRupert + spouse and kids $987No health screenings - $0State share $733Rupert’s monthly payment $254
Benefits Changes• Medical Flexible Spending max drops to $2,500 (federal law)• Office copays still $15 for the Choice plan• Coinsurance for both plans is 25% in-network and 35% out- of-network• Discontinued benefits include bariatric surgery, infertility treatment, and foot orthotics• Increased wellness options
WellnessWe have wellness options from:• HCBD – EAP, Lunch ‘N’ Learn, Weight Watchers;• Cigna – Management for weight, stress, and disease; tobacco cessation, prenatal support; and• CareHere – Dietitian, RN, Exercise Physiologist, Coaches for Behavioral Health and Tobacco CessationCigna, CareHere, and two of the HCBDwellness programs have no out-of-
URx • We still have Urx • Some Specialty drug copays will increase • Your best deal on a drug may be through mail order • Need help finding the most cost effective drug? Call and talk to our Benefits Specialists or Nurses.Call HCBD if you have trouble paying for your specialty drugs – help may be available
Our Health Plan• Our benefit plan is SELF-FUNDED! HCBD – sets rates, determines benefits, & oversees the plan• Rates NOT set by Cigna or Delta• Benefits NOT set by Cigna or Delta Rates are increasing because of the rising cost of healthcare and, in part, lifestyle choices.
YOUR MEDICALPLAN OPTIONSPlan year: 2013STATE OF MONTANA
Annual Change News forState of Montana Dental Benefits
Delta Dental Dual Network Offering Two dentist networks – You don’t have to select just one! Freedom of Choice – State of Montana members may visit: A Delta Dental PPOSM dentist (most savings) A Delta Dental Premier® dentist (some savings), or A non-participating dentist (no savings)
Statewide Network Growth 38 new PPO dentists in 2012 13 new Premier dentists in 2012Overall Network Counts Jan May Sept(Unique Dentists) 2012 2012 2012 PPO 123 127 148 Premier 256 257 276Additional contracts received but not processed PPO 5 Premier 0
State of Montana Dental Benefit Options Effective January 1, 2013Benefits and Covered Services Basic Plan Premium Plan Primary member, spouse, and eligible dependentWho’s Eligible children up to age 26Deductibles - Per Calendar Year $50 per person / No Deductible - Applies only to Type B and C Services $150 per familyAnnual Maximum – Type A Services $600 $600 per calendar year per calendar yearAnnual Maximum – Type B & C Services Not Covered $1,200 per calendar yearType A Services -- Oral examinations, cleanings, x- 100% 100%rays, fluoride treatment, sealants, and amalgam fillingsType B Services– Extractions, endodontics, Not Covered 80%periodontics, oral surgery, non-amalgam fillingsType C Services – Crowns, bridges, initial dentures Not Covered 50%See the HCBD website or the SPD for a full list of Type A, B, and C services, limitations, and exclusions Benefits illustrated above are not intended for use as a comprehensive description of the Plan. Please consult your benefit booklet for complete details, including limitations and exclusions.
Pre-treatment estimate / Pre-determination of benefits Lets a member to find out in advance what the member will have to pay Recommended for any treatment expected to be $300 or more in cost
State of Montana Dental Plan ID Card Two ID cards mailed to each employee/retiree Attached to bottom of letter Separate ID card for dental plan ID cards will be in name of employee/retiree Claims address State of MT Customer Service toll-free phone number Delta Dental specific alternate ID number Custom State of MT web site
deltadentalins.com/stateofmontanaWeb Capabilities Mobile Apps Socialize with Us Dentist directory View the website Facebook Member online Find a dentist services Log in to view Benefits and eligibility eligibility, benefits, cl Twitter information aims, ID cards Claim status Fee finder Printable ID card YouTube.com Electronic EOB’s MySmileKids Extensive dental health Google+ section and videos
SmileWaySM Wellness Program Includes a three-part Oral Health Challenge: Review habits: Take a quiz and sign up for targeted email messages Get educated: Take advantage of our dental health library, videos, and children’s oral health site Stay informed: Subscribe to our e-newsletter, connect through Facebook, or follow us on Twitter
Thank you!www.deltadentalins.com/stateofmontanaCustomer Service – (866) 496-2370 We keep you smiling®
Montana Health Center For employees covered on the health plan and theirdependents age two and older also covered on the planWhat can I receive at the Health Center?• Primary care• Same day services by appointment• Health screenings• Health coachingOpen now in Helena, coming to more towns in Montana soon!
You Aren’t Alone on the Path to Better Health & Wellness Registered Dietitian Registered Nurse No out-of- pocket cost Exercise Physiologist & Private Behavioral Health Coach Tobacco Cessation Coach
Schedule Your Get to Know Me Appointment Montana Health Center in Helena first time access code: MHA2 CareHere (406) 444-9930 (877) 423-1330 www.carehere.com
Better Health Step by Step with CareHere Connect
Vision• No changes for 2013 www.eyemedvisioncare.comWhile making online benefits changes,you must ELECT or WAIVE vision – Nomoving on to the next step until you do…Honest, we don’t do this just to annoy you.
Employee Assistance Program• Four counseling sessions with no copay or coinsurance with in-network providers (Choice or Classic)• EAP sessions may include counseling services not covered under the medical plan
Dependent Changes• As always, add a spouse and/or child to dental and vision only (to add to medical requires a qualifying event)
Pre-Tax Plan• You can change it online during Annual Change• If you have a Flexible Spending Account (FSA), you must be enrolled in the Pre-Tax plan• May affect your Social Security if you are close to retirement "A dog who thinks he is a mans best friend is a dog who obviously has never met a tax lawyer." - Fran Lebowitz
Flexible Spending Accounts (FSA)Medical FSA Dependent FSALike vision, you have to elect You have to elect or waiveor waive medical FSA to move dependent FSA to move to theto the next step next step (yes! even if you don’t have a kid!)The new maximum for medicalFSAs is $2,500. This is part of The maximum for dependenthealthcare reform. FSAs is still $5,000. Cigna will be offering the option of automatic processing of claims soon for the medical FSA
Long-Term CareImportant notice regarding Long-Term Care:Unum Life Insurance Company announced it is discontinuing the sales of new grouplong-term care contracts as of February 7, 2012. While they realize there is a needfor this type of product, current economics, pricing, and risk factors make itimpossible for them to meet their financial and risk management objectives. Unum will continue to accept enrollees on existing policies. They will continue toprovide high quality service to existing policyholders and claimants throughout thelife of the group policy and as long as premiums are paid. This change will notimpact Unum’s current relationship with existing customers. Cost based on: Benefit chosen - care type, monthly benefit, & duration Age at purchase Inflation Protection Details on UNUM’s website www.unum.com
Life Insurance• Plan A – Basic Life $14,000, part of core benefits• Plan B – Dependent Life $2,000 for spouse, $1,000 for children• Plan C – Optional Life = 1X your salary rounded to the next $5,000 (May choose extra in $5K increments up to $500K)• Plan D – Spouse Supplemental Life (spouse life amount may not exceed Plan C amount)• Plan E – AD&D for employee only or employee and dependents
MEDEX Travel Assist Repatriation – Traveling 200 miles+ away from home and die, this will pay…to bring your remains home Accelerated Benefit – Terminally ill? You may qualify for up to 75% of your life insurance Portability – Separate from the State, you may port your Life insurance to a Term Life policy Conversion – separate from the State, you may convert your Life insurance to a Whole Life policy Call (800) 527-0218 for more information
Long-Term Disability Rehabilitation Plan – May provide vocational or educationaltraining to help you get back to work Survivors Benefit - If you die while receiving this, 3X your benefitgoes to your surviving spouse or children If you can’t do the work you used to do…http://benefits.mt.gov/ltd.mcpx
Choices MUST Be Made by 10/26!• Choice or Classic medical plan • Deductibles and out-of-pocket max are increasing• Basic or Premium dental plan • Both plans allow you to use both networks – PPO and Premier• Say yes or no to Flex • Medical ($2,500 max) and dependent ($5,000 max)• Say yes or no to Vision• Adding extra life coverage?• Health Care Advocates may be contacting you!• Be ready for Tobacco-free discount in 2014!