Healthcare Plan 2011

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  • This slide will need to be customized based on the HRA plan design(s) offered, as well as the tiers recognized by the customer.

    If you have information about how this compares with other options, you can discuss on this slide.
  • This slide will need to be customized based on the HRA plan design(s) offered, as well as the tiers recognized by the customer.

    If you have information about how this compares with other options, you can discuss on this slide.
  • This slide will need to be customized based on the HRA plan design(s) offered, as well as the tiers recognized by the customer.

    If you have information about how this compares with other options, you can discuss on this slide.
  • This slide will need to be customized based on the HRA plan design(s) offered, as well as the tiers recognized by the customer.

    If you have information about how this compares with other options, you can discuss on this slide.

  • Please note that there is a Core 5 deck in the appendix section of this deck that may be used as appropriate
    There are 8 Well Aware programs that together cover over 35 conditions in order to give customers the flexibility to purchase the conditions they want/need.

    Conditions like HIV, ESRD and CKD are better handled via case/medical management, as they are more complex and require more coordination of care and guidance.

    Likewise, Oncology and Maternity incorporate elements from disease management and case management but are managed through different programs, since the program designs are modified slightly to address the specific needs of those touch by these conditions. The program names are Healthy Pregnancies, Healthy Babies® and Cancer Support Program.

  • CIGNA’s Service call centers have received J.D. Power and Associates certification for providing “An Outstanding Customer Service Experience” for the third consecutive year. Only a few select service firms in the country have obtained this recognition three years in a row. Plus, we’re the first health plan to offer live customer service 24 hours a day, 7 days a week.
  • Healthcare Plan 2011

    1. 1. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 1 Saint Michael’s College Plan year: 1/1/2011-12/31/2011 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    2. 2. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 2 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA We are easy to work with.
    3. 3. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Statement of Principles  Saint Michael’s College is committed to providing competitive and comprehensive healthcare benefits to its faculty and staff  The healthcare design should promote healthy choices and encourage informed use of plan features  The College will continually investigate new and contemporary plan designs and market changes  The College and employees will share in the cost of the plan
    4. 4. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA What will we cover today?  Review the new Choice Fund HRA plan effective 1/1/2011 - What portion of expenses do you pay under the new Health Plan? - How does the Health Reimbursement Account (HRA) work with the new Health Plan? - The Healthy Award Account; Additional ways you can earn $ to help with your medical expenses  Resources available to help you with your questions and your health - Pre-enrollment - After the effective date (1/1/2011)  What will it cost you to enroll in the new Choice Fund HRA plan?  Next steps and future communication topics  Most importantly! Answer your questions
    5. 5. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Highlights of the new plan  100% coverage for Preventive Care  100 % coverage for routine eye exam when you use a CIGNA participating provider  Employer funded Health Reimbursement Account to help you with some of your out of pocket medical costs  Opportunities to earn additional dollars by voluntarily participating in Healthy activities  Unused funds may rollover for use in later years  Access to Customer Service 24/7/365  Access to CIGNA’s National Provider Network  Out of Network coverage  Transition/Continuation of care  Primary Care Physician recommended but not required  Extensive resources to help you improve your physical and financial health 5
    6. 6. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA New Terms to Familiarize Yourself With  Calendar Year Medical Plan Deductible: Amount you pay before the plan reimburses you for your medical expenses you incur  Medical Plan Coinsurance: % of expenses paid by the plan after you satisfy the deductible  Calendar Year Medical Plan Out of Pocket Maximum (OOP): A Cap on the $ amount you pay in deductibles + coinsurance. Once you meet the OOP maximum, the plan reimburses you for 100% of eligible expenses.  Health Reimbursement Account (HRA): $ made available to you by Saint Michael’s to help you offset your medical out of pocket (deductible/coinsurance) expenses  Healthy Awards Account (HAA): Additional $ you can earn to help you offset your medical out of pocket expenses. 6
    7. 7. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA  After you pay your deductible you pay the following coinsurance for services until you meet your Out of Pocket Maximum (OOP):  Service In-Network Coinsurance PCP Office Visit you pay 20%, plan pays 80% Specialist Office Visit you pay 20%, plan pays 80% Inpatient Hospital Care you pay 20%, plan pays 80% Outpatient Hospital Care you pay 20%, plan pays 80% Emergency Room Visit you pay 20%, plan pays 80% Lab and X-Ray you pay 20%, plan pays 80%  The Deductible does not apply to Certain Services! - Preventive Care covered at 100% (including preventive lab work) - Prescription Drug coverage (more on that later) - Annual Eye Exam (more on that later) Coverage begins after you meet your deductible for most services
    8. 8. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Components of your Out of Pocket Maximum (OOP) * Note: under 2-person and family coverage each individual has their own deductible, coinsurance and OOP maximum. Amounts above shown to illustrate your financial responsibility if multiple family members meet their per person maximum. Under family coverage this could mean that a family of five could meet their $1500 maximum deductible without any one person meeting the $500 per person deductible (5 x $300 = $1500 = family maximum deductible met.) 8 Deductible Your 20% Coinsurance Your OOP Maximum Per Person: $500 $1000 $1500 Maximum for 2 person coverage: $1000 $2000 $3000 Maximum for family (3+ coverage): $1500 $3000 $4500 + =
    9. 9. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA How your HRA and HAA help you with your deductible or OOP Maximum Maximum Family Deductible SMC Provided HRA $ You can earn in your HAA Your Share of Deductible Employee only: $500 $250 $275 $0 - You have $25 to help with coinsurance Employee + 1: $1000 $500 $400 $100 Family (3+): $1500 $650 $525 $325 9 After a person meets their deductible the member pays 20%, plan 80% until you meet your maximum out of pocket. Maximum Family Out of Pocket SMC Provided HRA $ You earn in your HAA Your Share of Out of Pocket Max* Employee only: $1500 $250 $275 $975 Employee + 1: $3000 $500 $400 $2100 Family (3+): $4500 $650 $525 $3325 * This really assumes a worst case scenario. Remember each family member has their own deductible, coinsurance, OOP Max! However any family members deductible coinsurance expenses can be reimbursed from the families HRA or HAA – we will show an example later. - - - - = =
    10. 10. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Prescription Benefits Medical Plan Deductible does not apply to Pharmacy costs Retail Pharmacy  Generic …20% up to a maximum of $10  Preferred …25% up to a maximum of $30  Non-preferred …30% up to a maximum of $50 CIGNA Home Delivery Prescriptions  Generic …20% up to a maximum of $25  Preferred …25% up to a maximum of $75  Non-preferred …30% up to a maximum of $125 Prescription out of pocket maximums are: $1,500 per person (new financial protection feature) *You cannot use your Health Reimbursement Funds for Prescription drug costs
    11. 11. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 11 Vision Plan Highlights Benefit In Network Out of Network Examination Copay $0 n/a Exam Covered in full $75 allowance Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA For In-Network coverage you need to use a CIGNA Vision Participating Provider. Find Providers at Mycigna.com
    12. 12. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 12 Healthy Awards Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA
    13. 13. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 13 Earn Additional dollars with Healthy Awards Voluntarily Participate in activities to improve health Earn $ in a Healthy Awards Account Use $ to help pay for eligible claim expenses What’s eligible? Expenses related to: • Medical Deductible and Coinsurance you pay Unused money “rolls over” to next year – you don’t lose it.
    14. 14. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 14 Healthy Awards: Eligible Activities and Awards ACTIVITY AWARD Complete Health Assessment (Employee) $125 Complete Biometric Screenings (Employee) $150 Complete Health Assessment (Spouse) $125 Complete routine care visit (Children) $125 This enables the following potential for the year •Employee $275 •Employee & Spouse $400 •Employee & Child $400 •Employee & Children or Employee & Spouse & Child(ren) $525 Unused money “rolls over” to next year – you don’t lose it. * More information will be provided about the Healthy Incentives during November and December! Funds will be made available in your account once activities have been completed. Within 10 business days for: Health Assessment Within 5 business days for: Employer activities reported via myCIGNA.com Within 2-3 weeks for: Employer activities reported via paper form
    15. 15. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Health Reimbursement Account vs. Healthy Awards Account What is the difference?? Health Reimbursement Account  Automatically funded each year by Saint Michael’s  Only a portion of unused funds roll over year to year - $125 for Employee - $300 for Employee + 1 - $550 for Family  These dollars are utilized toward services covered on the medical plan that are subject to the deductible or coinsurance. Healthy Awards Account  You earn dollars by participating in health and wellness programs  All of your unused funds roll over year after year  These dollars are utilized toward services covered on the medical plan that are subject to the deductible or coinsurance. Both are components of a Health Reimbursement Arrangement
    16. 16. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 16 I’ve heard that I don’t have to pay at the time of service. How are my medical claims paid? Medical Claim Payment Process CIGNA updates quarterly Health Statement; sends email alert or mails to your home, based on preference setting CIGNA provides an Explanation of Benefits (your receipt) showing: • Doctor fee, CIGNA discount, amount billed, amount deducted from HRA-HAA, amount paid to doctor, remaining HRA-HAA balance. CIGNA subtracts payment owed from your HRA -HAA balance and pays doctor. $200 deducted from HRA-HAA and sent to doctor and Updates claim and account information on myCIGNA.com. Doctor bills CIGNA $200. CIGNA determines your payment responsibility: You owe $200 Show CIGNA Choice Fund ID card. Pay nothing at visit. Doctor discounted CIGNA fee: $200 Sick visit to an in-network doctor/hospital/facility. Doctor standard fee: $250 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA Preventive visits are covered at 100%
    17. 17. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 17 My life is busy. How does CIGNA help me understand and track my health care expenses? Explanation of Benefits • Available by mail or online at myCIGNA.com • Based on your preference, either mailed to your home or you're alerted by email after each claim is processed and posted to myCIGNA.com • Clearly shows how and when claims were paid, and how the plan and account(s) paid toward claims Quarterly Health Statement • Available by mail or online at myCIGNA.com • Based on your preference, either mailed to your home or you're alerted by email after each statement is posted to myCIGNA.com • Shows year-to-date deductibles, all claim activity and out-of-pocket expenses for that quarter Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    18. 18. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 18 End of Year 1 100%PreventiveCare (in-network) HRA $280 Carlos’ Share $220 ($250 - $30) Health Plan 80% 100% after $1,500 (in-network)100%PreventiveCare (in-network) Deductible Out-of-PocketMax HRA $250 Carlos’ Share $250 Health Plan 80% 100% after $1,500 (in-network) Year 1 Year 2 Carlos Single, 35 yrs. old Works hard, plays hard Healthy; occasional sport injury $300 preventive care exam Covered 100% by Plan; No cost to Carlos + $ 70 urgent care doctor visit $150 sports medicine visit $220 total medical expenses How Expenses Are Paid $220 paid from HRA ($300 Preventive Covered by Plan) $520 paid by Plan $0 paid by Carlos $300 preventive exam Covered 100% by Plan; No cost to Carlos + $200 specialist visits (2) $ 25 prescription coinsurance expense (not eligible for HRA reimbursement) $225 total expenses How Expenses Are Paid $200 HRA ($300 covered by Plan) $500 paid by Plan $25 paid by Carlos End of Year 2 $80 HRA Balance; Rolls over to next year’s HRA $30 HRA Balance; Rolls over to next year’s HRA Remember, Carlos could also earn extra dollars through the Healthy Awards Account
    19. 19. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 19 The Coopers Active family of 6 Spouse has diabetes 100%PreventiveCare (in-network) Deductible Out-of-PocketMax HRA $650 Cooper’s Share $850 Health Plan 80% 100% after $4,500 (in-network) Year 1 $1,500 annual exams (5) Covered 100% by Plan; No cost to the Coopers + $1,600 Endocrinologist visits (10) $1,500 Doctor visits (12) $3,100 total medical expenses $1200 in Drug costs (her coinsurance averages 20%) $5,800 Total How Expenses Are Paid $ 500 for Mrs. Cooper’s deductible $ 520 Coopers’ coinsurance -$650 (Available HRA not counting HAA) $370- Net cost to the Coopers* $ 240 Cooper’s portion of drug cost $ $610 Cooper’s total responsibility* The total Medical Expense was $5800 The Coopers paid $610 or about 10% The Plan paid $5,090 or about 90% *If the Coopers earned Healthy award $ they could offset an additional $370 of their Cost Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    20. 20. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 20 The Davidsons Late 50s, Empty nesters Husband in severe auto accident 100%PreventiveCare (in-network) Deductible Out-of-PocketMax HRA $500 Davidson’s Share $500 Health Plan 80% 100% after $3,000 (in-network) Year 1 $600 annual exams (2) Covered 100% by Plan; No cost to the Davidsons + $25,000 Hospitalization $ 2,500 Radiology $ 2,500 Specialist visits (10) $ 2,500 Rehabilitation (10) Total = $32,500 medical expenses $1,500 in drug costs (their coinsurance averages 20%) Total with Preventive = $34,600 How Expenses Are Paid $500 for Mr. Davidsons’ deductible $1,000 Mr. Davidsons’ Coinsurance (he has met his OOP Maximum) -$500 (available HRA not counting HAA) $1,000 (Net Cost to Davidsons* $ 300 Davidson’s portion of drug cost $1,300 Davidson’s Total Responsibility Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA The total Medical Expense was $34,600 The Davidson’s paid $1,300 or about 4% The Plan paid $33,300 or about 96% *If the Davidson’s earned Healthy award $ they could offset an additional $400 of their Cost
    21. 21. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 21 Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA Helping you be well and live well.
    22. 22. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 22 Help when you need it! Help with coordinating care if you’re admitted to the hospital Compare prescription drug costs – preferred brand vs. generic, retail vs. at-home delivery online drug- interaction checker helps you keep track of prescription medications and avoid interactions Easy-to-use, confidential health assessment gives you an overall health “score” and a personalized report Online coaching programs to help you maintain a healthy lifestyle Save money on health and wellness products and services like fitness clubs, eyewear, massage therapy and more A personal health advocate to help you prepare for office visits, improve your lifestyle and reduce your health risks, explore and choose treatment options, and answer health and coverage questions Healthy pregnancy education programs with March of Dimes helps every baby get a healthy start. Well Aware disease management program to help you with chronic conditions Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    23. 23. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 11 conditions addressed in 5 Well Aware programs COPD Emphysema Chronic Bronchitis Diabetes Type 1 Diabetes Type 2 Diabetes Heart Disease Heart Failure Cardiomyopathy Coronary Artery Disease Acute Myocardial Infarction Angina Asthma Low Back Pain 23 Participation in these programs is voluntary  Claims  Medical ,Pharmacy  Health Assessment  Referral from other programs • Case Management • Lifestyle Improvement • Health Advisor  Self-Referral  Health Care Professional Identify Activate Support
    24. 24. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Communications Ongoing nurse outreach by phone 24/7 access to registered nurses Routine preventive care reminders Education Materials including: • Program Workbook • Quarterly Newsletters Online tools and resources • Goal Tracker • Program Alerts • Symptom Checker mywellaware.com 24
    25. 25. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 25 • Quality rankings let you compare doctors and hospitals • Online resources let you check for dangerous drug interactions • Alerts sent to you and your doctor if we see or anticipate possible gaps or errors in care • Support from our care coordinators if you are hospitalized with a serious illness Features • Quickly compare cost and quality using 1-3 star rating system • Ratings for 29 conditions • Ratings based on Healthshare plus CIGNA data 1 – 3 star rating system Find CIGNA Centers of Excellence Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA What is CIGNA doing to make sure I’m getting quality care?
    26. 26. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 26 How can I reach CIGNA when I need help? • Call us anytime day or night – live, 24/7 customer service • Find information when you need it at myCIGNA.com • We speak many languages For J.D. Power and Associates Certified Call Center ProgramSM information, visit www.jdpower.com. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    27. 27. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 27 My life is busy. How can CIGNA save me time? • 24/7 online and phone assistance to find doctors, specialists, hospitals, labs and pharmacies close to home or when you are traveling • Talk to a trained nurse with questions when you can’t reach your doctor – day or night • Self-service through myCIGNA.com lets you:  Print forms or print/order ID cards  Check your coverage  Track claims, payments and deductibles  View, print and download your explanation of benefits and health statements  Access articles and health education resources, and sign up for online coaching programs  Keep track of your health history and records with a secure online database • Award-winning decision support tools  Learn about common health problems and options for treatment  Find doctors, hospitals, specialist and labs  Compare treatment and procedure costs • Switch a prescription to CIGNA Home Delivery Pharmacy with one easy phone call and have your medications delivered to your door at no extra cost Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    28. 28. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 28 • Voted 2009 Best Employee Assistance Program as ranked by readers of Business Insurance • Winner of “Innovation in Multicultural Health Care” Award from independent National Committee for Quality Assurance (NCQA) • Top industry rankings for Effectiveness of Care by NCQA • Our customer call centers are certified by J.D. Power and Associates* for providing “an outstanding customer service experience” • Doctors and hospitals ranked us #1 and #2 respectively on our payment, accuracy and efficiency in the annual survey by AthenaHealth • CIGNA’s Explanation of Benefits is one of only three to earn “Excellent” designation for clarity, content and design from Dalbar • Earned #1 ranking for Best Innovation in customer intimacy across all industries for cost and quality tools on myCIGNA.com from Information Week 500 • Gold medal for “exemplary customer strategy and excellence in customer experience.” Everyone says they are the best. Why should I trust CIGNA? *For J.D. Power and Associates Certified Call Center ProgramSM information, visit www.jdpower.com. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    29. 29. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA Important Dates • Enrollment packets to home addresses week of October 18, 2010. • Forms due to Human Resources by November 17, 2010. Questions about the new plan? • Call the toll-free hotline 24/7/365 – 1.800.401.4041
    30. 30. Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA 30 "CIGNA", “CIGNA HealthCare”, "myCIGNA.com" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), CIGNA Health and Life Insurance Company (CHLIC), Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. All models are used for illustrative purposes only. 838558 08/10 © 2010 CIGNA Some content provided under license.

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