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Open Enrollment for 2017 Benefits
- 1. Duke University &Health System Oct. 24 – Nov. 4, 2016 Open Enrollment for 2017 Benefits
- 2. 2 Duke’s medical insuranceplans Duke offers 4 plans: –Duke Basic (HMO administered by Aetna with Triangle network primarily of Duke physicians) –Duke Select (HMO administered by Aetna with Triangle network primarily of Duke physicians) –Blue Care (BCBS HMO with statewide network) –Duke Options (BCBS PPO plan with international network)
- 3. 3 Duke’s medical insuranceplans Five tiers of coverage –Employee –Employee & Spouse –Employee & Child –Employee & Children –Family
- 4. 4 Medical insurance premiums •Premium increases will again be less than the projected increases nationally $648$606$141$132Duke Options $656$613$147$137Blue Care $461$445$78$75Duke Select $292$282$31$30Duke Basic 2017201620172016 FamilyIndividual
- 5. 5 What if youhad to be hospitalized
- 6. 6 Medical Plan Changes •Coventry is now Aetna, and new member ID cards for January • Inpatient hospitalization copay increase: – From $450 to $600 for Duke Select, Blue Care, and Duke Options at Duke hospitals – Options and Blue Care copay for non-Duke In-Network hospitals will move to $700, Out-of- Network hospitals under Options will move to $900. • Outpatient Surgery copay increase from $200 to $250 for Duke Select and Blue Care • Out-of-Network annual deductible for Duke Options: – from $500 to $650 for individuals, and from $1,500 to $1,950 for family • Duke Options Out-of-Network coinsurance maximum: – from $3,000 to $4,000 for an individual and from $9,000 to $12,000 for family • Specialty Drug dispensing limited to Accredo (Express Scripts) or Duke Pharmacies unless medication is required immediately • Coverage added to Duke Options for ABA Therapy (Applied Behavioral Analysis) an intensive, early intervention program for children with Autism Spectrum Disorder when medically necessary and by a certified provider. – Details on www.hr.duke.edu • Dollar maximum for transgender surgery will be eliminated from Duke Options
- 7. 7 Tobacco Surcharge • In2017, tobacco use surcharge will increase from $40 to $50 per month for health insurance • The surcharge does not apply to dependents • Surcharge will be removed if employee successfully completes a tobacco cessation program available at no charge through Live for Life
- 8. 8 PHARMACY PLAN Open Enrollmentfor 2017
- 9. 9 Pharmacy Usage Trends Each1% increase in Generic Dispensing Rate = reduces plan costs $1m
- 10. 10 *Participants in theDuke Basic plan have a $100 deductible for all prescription drugs, including generic, mail order and on- site Duke Pharmacies. Retail pharmacy Express Scripts Mail order or on-site Duke Pharmacy Up to a 34-day supply Up to a 90-day supply First 3 purchases of any medication After 3rd purchase of long- term medication Anytime Generic (no deductible)* $15 (or cost of drug if less) 50%* Min. $15, Max. $30 (or cost of drug if less) $25 (or cost of drug if less) Brand ($100 per person annual deductible applies. No deductible for mail order or on-site Duke pharmacies.)* $50 50%* Min. $70, Max. $165 $130 Non-formulary ($100 per person annual deductible applies. No deductible for mail order or on-site Duke pharmacies.)* $70 50%* Min. $85, Max. $180 $180
- 11. 11 Pharmacy Plan • Increasein co-pays (up to 34 day supply) for: • Generic from $10 to $15 for up to 34-day supply • Formulary drugs by from $45 to $50 • Non-formulary drugs from $65 to $70 • Increases in Mail Order 90-day supply* co-pays for: • Generic from $20 to $25 • Brand from $120 to $130 • Non-Formulary from $155 to $180 *obtained via mail order or on-site Duke Pharmacies • Specialty medications available through Duke Pharmacy or Accredo only, unless STAT medication
- 12. 12 VISION PLAN Open Enrollmentfor 2017
- 13. 13 Duke’s vision planfor 2017 Individual Employee & Child Employee & Children Employee & Spouse Family $9.66 $18.49 $19.46 $18.50 $29.97 • No changes to premiums for 2017 • Increase in frame allowance from $130 to $150 once every 24 months
- 14. 14 DENTAL PLAN Open Enrollmentfor 2017
- 15. 15 Dental Premiums for2017 • PPO Plan: Modest increase in premium • Dental Plan A: Modest increase in premium • Dental Plan B: No premium increase Individual Family 2016 2017 2016 2017 PPO $38.44 $39.21 $116.46 $118.79 Dental Plan A $42.11 $44.13 $127.55 $133.67 Dental Plan B $12.18 $12.18 $45.24 $45.24
- 16. 16 Dental Late Entrant •If you or a dependent are planning to enroll for 2017 but are not currently enrolled for dental coverage at Duke – Coverage will only include two preventive care exams (not including X-rays), two cleanings, and one fluoride application (for children under age 19) for the first 12 months
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- 18. 18 Save with reimbursementaccounts • Pre-tax savings is about 30 percent of every dollar you put in the accounts • Health Care Reimbursement Account: $2,550 maximum • Health Care Reimbursement Account allows for up to $500 to be carried over from one plan year to the next plan year • Dependent Care Reimbursement Account: $5,000 combined household maximum (carry over not allowed)
- 19. 19 Managing Your Account •WageWorks Health Care Card • App for iPhones, Androids and Blackberries • Website • Paper forms (fax/mail)
- 20. 20 Summary for 2017 •No increase in co-pay for Primary Care Physician (PCP) or Specialist office visit • Moderate premium increase for health plan, significantly less than national average • Modest increase in pharmacy co-pays • Increase in inpatient admission and outpatient surgery copays • No premium increases to vision • No premium increases to Dental Plan B, moderate increase to Dental Plan A and Dental PPO
- 21. 21 Open enrollment: Oct.24 - Nov. 4 1. Enroll online through the Duke@Work Self-Service website Or 2. By phone at 919-684-5600
- 22. 22 What’s next? When What Sep13 HR Forum Oct. 3 Manager Memo/Presentation: Open enrollment changes for 2017 benefits Oct. 6 Guide: Print guide mailed home. Oct. 10 Article: Open enrollment for 2017 benefits Oct. 24 Open Enrollment Period Begins Oct. 24 Email: Open enrollment period begins Oct. 31 Article: Reminder about deadline Nov. 3 Email: Reminder about deadline Nov. 4 Open Enrollment Period Ends
- 23. Duke University &Health System Questions?
Editor's Notes
- #6 But when looking at costs, you have to also consider the coverage and what you would pay if you had to use the benefit. For example, if you had to be hospitalized, your out-of-pocket costs would be significantly lower through Duke than at most of our peers.
- #23 More information about specific changes for benefits will be communicated next month as part of the annual open enrollment process. Articles and events are planned throughout the next few months to help provide context and set expectations about changes for 2011. Here are a few of the highlights of what you can expect to see.