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Ambercare AMBERCARE Open Enrollment Webinar 2015 October 24, 2014 Patricia A. Cole Principal Phoenix – 2325 East Camelback Today’s Agenda • Introduction • What’s new for 2015 • Affordable Care Act (ACA) • Core Benefits – Medical – Blue Cross Blue Shield of New Mexico – Health Savings Account – HSA Bank – Dental – Delta Dental of New Mexico – Vision – Vision Care Direct – Basic Life & AD&D – UNUM – Voluntary Life – UNUM • Voluntary Benefits with Aflac – Accident – Critical Accident – Short Term Disability MERCER May 25, 2017 1 What’s New for 2015 • Benefits now available to all full-time employees working an average of 30 hours per week • Passive Enrollment • No changes to medical or Rx plans • No changes to life, dental or vision benefits • Slight increase in medical and dental contributions (continue the same percentage split) • No change in vision contributions MERCER May 25, 2017 2 Affordable Care Act (ACA): Individual Mandate Pay penalty All individuals must have health coverage MERCER OR 2015 Greater of $325 (single) | $975 cap (family) or 2% of household income By 2016 Greater of $695 (single) | $2,085 cap (family) or 2.5% of household income 3 Public Programs in 2014 201 Medicaid and Public Exchanges Medicaid Expansion Expanded to anyone below 138% federal poverty line. Not all states have agreed to expand coverage, (NM has). • In these states, federal subsidies may be available for certain people to buy coverage. • Those ineligible for Medicaid or federal subsidies may have no option for subsidized coverage other than employer plan (if available). MERCER Single individual Public Exchanges Insurance plan options available on exchanges that are operated by states or federal government (or a state/federal partnership). • Exchanges will conduct open enrollment: Oct 1, 2013 to Mar 31, 2014. • If household income is between 100%/138% and 400% of federal poverty level – and individual does not have access to affordable employer coverage that provides minimum value– federal government will provide subsidies to buy insurance on exchanges. % of FPL** Family of four Annual household income Household income >400% of FPL not eligible for subsidy through marketplace 400% $45,960 $94,200 300% $34,470 $70,650 200% $22,980 $47,100 150% $17,235 $35,325 138% $15,856 $32,499 100% $11,490 $23,550 * Not all States have agreed to expand Medicaid to 138% of FPL ** Based on 2013 FPL 4 Welcome to Open Enrollment 2015 Ambercare Home Health MERCER May 25, 2017 bcbsnm.com 5 Blue PPO • No referrals required • Choose your own provider locally, nationally and internationally • Participating providers accept covered charges as their maximum fee and will file claims • Nonparticipating Providers, do not have contractual agreements with Blue Cross Blue Shield, therefore member will be responsible for charges above the BCBS allowable fee • Deductible and Coinsurance apply to almost all services • Some services only require copayments MERCER May 25, 2017 6 Understanding your PPO or HSA Plan • Copay – A set dollar amount you will pay • Deductible – A specific dollar amount which must be met by a member before the Plan begins to pay • Coinsurance – A percentage of a covered service that you are responsible for paying after the deductible has been met • Out-of-Pocket Maximum – The maximum amount of coinsurance, per year, you are required to pay out of your own pocket after the deductible is met. The deductible and copays for both medical and pharmacy will apply toward meeting the out-of-pocket maximum. MERCER May 25, 2017 7 PPO Benefits Member’s Share Benefits PPO In-Network PPO Out-of-Network Deductible $2,000 Individual $4,000 Family $6,000 Individual $12,000 Family Out-of-Pocket Maximum $3,000 Individual $6,000 Family $9,000 Individual $18,000 Family $20 Copay Primary Provider Office Visit (deductible waived) 40%* Preventive Care/Well Visits No Charge 40%* Inpatient Admission 20%* 40%* Emergency Room 20%* 40%* Urgent Care 20%* 40%* Lab/X-Ray/MRIs 20%* 40%* Outpatient Services 20%* 40%* *After deductible MERCER May 25, 2017 8 High Deductible Health Plan (HDHP) Member’s Share Benefits In-Network Out-of-Network Deductible Individual $2,000 $6,000 Family $4,000 $12,000 Individual $6,250 $18,750 Family $12,500 $37,500 Preventive Care/Well Visits No Charge 50%* Inpatient Admission 20%* 50%* Emergency Room 20%* 20%* Urgent Care 20%* 50%* Lab/X-Ray/MRIs 20%* 50%* Retail Pharmacy Care 20%* Not Covered Out-of-Pocket Maximum *After deductible MERCER May 25, 2017 9 Prescription Drug Benefit In-Network Pharmacy Costs Retail Pharmacy Generic Preferred Brand Non-Preferred PPO $5 $20 $40 HSA* 25% 50% 50% Home Delivery (Mail Order) $187 (Up to a 90-day supply) Generic Preferred* Brand Non-Preferred PPO $10 $40 $80 HSA 25% 50% 50% $21 *Deductible must be met first MERCER May 25, 2017 10 More Doctors. More Hospitals. More than 96% of hospitals and 91% of doctors Over 22,000 contracted in New Mexico nationwide network more Nationwide coverage when traveling or living outside of home state providers more than 5,300 hospitals Worldwide® coverage when traveling in more than 195 countries MERCER May 25, 2017 11 How to Find a Provider Log on: bcbsnm.com Click on ‘Find A Doctor” Call Customer Service Toll-free 1-800-432-0750 OR Contact your Call BlueCard Access 24/7 800-810-BLUE (-2583) MERCER May 25, 2017 physicians and ask if they belong to the BCBS PPO Network 12 More Benefits. More Resources. bcbsnm.com MERCER May 25, 2017 13 Self Service Blue Access® for Members Claims and Customer Service Members can: • Check status of claims • View explanations of benefits • Communicate with Customer Advocates through e-mail • View provider selections • Order new ID cards or print temporary copy • Link to wellness site (Well onTarget) MERCER May 25, 2017 14 Member Liability Estimator • View Costs for 102 High Volume, High Price Variability Procedures • Amount is Episodic (includes facility and professional components) • Amount Displayed is Based on BCBS Contracts • Information Available Nationally • Number of Procedures Represents Blue Cross Members Only MERCER Integrated Provider Finder Demographics • More Demographics Information • Website Design Consistent with other Search Engine Sites • Ability To Compare Three Facilities Side By Side • Combines Cost, Quality and Member Feedback for a ‘One Stop Shop’ for Patient Needs • Connects Members and Providers Together Online MERCER Integrated Provider Finder Cost • View Costs for 102 High Volume, High Price Variability Procedures • Amount is Episodic (includes facility and professional components) • Amount Displayed is Based on BCBS Contracts • Information Available Nationally • Number of Procedures Represents Blue Cross Members Only MERCER Our new wellness is for Everyone • Integrated Health Assessment • Life Points Reward Program • Online Workplace Competitions • Certified Wellness Coaching – stress management, nutrition and physical activity • Personalized Wellness Communication MERCER May 25, 2017 18 BlueExtrasSM Discounts Just for Being a Member! Vision Care and Eyewear – Discounts Weight Management – on eyewear, contact lenses and laser vision correction surgery Discounts at Jenny Craig®´ on membership and food Nutrition – Discounts on Hearing Aids – Discounts Seattle Sutton’s Healthy Eating®´ meal plans; national home delivery program on hearing aids for members, parents and grandparents Complementary Alternative Medicine – Just for being a Member! Discounts on acupuncture, health clubs, chiropractic, naturopaths, spas, massage therapy, vitamins and supplements, and more Under the My Coverage tab MERCER May 25, 2017 19 24/7 Nurseline Advice anytime. Round-the-clock health and the wellness advice from licensed professionals Advice isn’t just needed from 9 to 5. Our 24/7 Nurseline is here to help. • Nurses provide health advice and information, help you to identify warning signs and administer self-care, 24 hours a day • Audio health library on 1,200 topics such as first aid, kicking the smoking habit, fevers, sprains and more 24/7 MERCER 1-800-973-6329 Available in English and Spanish May 25, 2017 20 What if I Have Questions? Personalized Service Call your customer service team for: • • • • • • • • Claim questions/status 1-800-432-0750 Network provider information Toll-free Membership and eligibility Customer Service Medical coverage questions Inquiries (telephone and email) Transition of Care information ID card requests Help with online tools MERCER May 25, 2017 21 Why Blue Cross and Blue Shield? 1 in 3 Americans is covered by a Blue Cross and Blue Shield plan More doctors and hospitals to choose from nationwide and around the world The best in personalized customer service for questions, inquiries, claims or help with online tools Online technology helps you access and manage your health and wellness information Coverage everywhere you go – in the U.S. and around the world MERCER May 25, 2017 22 It’s about helping members live more healthy and productive lives. bcbsnm.com MERCER May 25, 2017 23 Considering a Health Savings Account (HSA)? MERCER May 25, 2017 24 HSA Eligibility To be an eligible individual and qualify for an HSA you: • Must be enrolled in an HSA-compatible HDHP • May not have other first dollar medical coverage (other types of medical insurance) • May not be claimed as a dependent on another person's tax return • May not be enrolled in Medicare – An individual can be Medicare eligible and have an HSA. However, once enrolled in Medicare contributions to the HSA account must stop. The individual can keep any funds in the account prior to enrolling in Medicare and use those funds to pay for qualified medical expenses tax-free HSA contributions: • The IRS determines the maximum annual contribution amounts. The amounts are adjusted annually for inflation. Employee, employer or any third party may make contributions on behalf of an eligible individual MERCER May 25, 2017 25 Basic HSA Plan Concept Part I: High Deductible Health Plan 2015 HSA Concept Single Family Min. Deductible $1,250 $2,500 Max. Out of Pocket $6,350 $12,700 Part II: Health Savings Account Max. Contribution Single Family For 2015 $3,350 $6,650 Covers illness or injury after the deductible, and certain preventive care services at no cost to you Pays for Qualified Medical Expenses not covered by the health plan • Out-of-pocket includes deductible & co-insurance • Qualifying deductible ranges are limited by the maximum out-of-pocket. MERCER May 25, 2017 26 Basic HSA Concept • Compare to an IRA HSA Tax-Deferred Growth Earnings Contributions Contributions Tax-Deductible/Pre-Tax Contributions Tax-Free Distributions (For Qualified Medical Expenses) Normal Tax (NON-qualified expenses if you are 65 or older) MERCER May 25, 2017 27 Who is eligible for an HSA? Individuals who are covered by an HSA-compatible health plan are qualified if they are: • Not covered by any other non HSA-compatible health plan • Not claimed as a dependent on another person’s tax return (excluding spouses per Internal Revenue Code) • Not enrolled in Medicare MERCER May 25, 2017 28 Advantages of an HSA • Funds roll over from year to year – No “use it or lose it” philosophy • Tax benefits on contributions, earnings and distributions – Contributions are either pre-tax (via paycheck) or tax-deductible • Portability – Funds follow you – Tax-free withdrawals for Qualified Medical Expenses even if qualifying coverage ends • Long-term investment opportunities – (Not FDIC insured) • Control over healthcare dollars MERCER May 25, 2017 29 Tax Savings Example Contribution $3,000 per year for 25 years Annual Medical Expenses $500 per year Tax Bracket 28% (Federal) Average Interest Rate 2% TAX SAVINGS ON CONTRIBUTIONS = $17,500.00 TAX SAVINGS ON DEFERRED GROWTH = $4,921.21 ACCOUNT BALANCE AT THE END OF 25 YEARS = $80,075.75 For illustrative purposes only. Actual savings may vary. Visit www.hsabank.com and click on Calculate Savings for a personalized estimate. MERCER May 25, 2017 30 Online Calculation Tools Is an HSA Right for Me? Allows you to compare a traditional health plan and an HSA qualified plan to determine potential savings http://hsabank.com/hsabank/Education/HSA_Right_For_Me.aspx MERCER May 25, 2017 31 Calculation Tools Determine Healthcare User Type • Shows you how you can maximize the advantages of an HSA in any stage in life. If you’re using Internet Explorer, click here for the demo. If you’re using other browsers, click here. MERCER May 25, 2017 32 How to Contribute Who Makes Contributions? • Accountholder • Employer • Third Party Contributions from all sources count toward the annual maximum. Annual IRS Maximum How Are They Made? • Through your employer Payroll deductions may be an option Year Individual Family Online through Internet Banking 2015 $3,350 $6,650 – • – • • (regardless of deductible) One-time or recurring from an external account Checks Transfers or rollovers – MERCER Individuals and/or their spouses, over the age of 55 and not enrolled in Medicare can make an additional $1,000 catch-up contribution annually. (HSA, IRA) May 25, 2017 33 Distribution Options • Debit card from Visa® • Reimbursement from Internet Banking to an external account • HSA checks • Withdrawal Form – Mail to HSA Bank MERCER May 25, 2017 34 Qualified Medical Expenses A Qualified Medical Expense is incurred to maintain the health of the accountholder or the accountholder’s spouse or dependents. The following are included: • • • • • Doctor and hospital visits Medical equipment Dental care, braces, dentures Vision care, glasses, contacts Medications, (over-the-counter items with a Rx stating medical condition) • Medical related transportation *A list of Qualified Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, over-the-counter medications are considered Qualified Medical Expenses for HSA purposes. MERCER May 25, 2017 35 Other Qualified Medical Expenses • Premiums for long-term care insurance – Limited to amount listed in 213(d)(10) of the Internal Revenue Code • Premiums for COBRA • Premiums for coverage while receiving unemployment compensation • Premiums for individuals over age 65 – Retirement health benefits – Medicare premiums MERCER May 25, 2017 36 Investment Options HSA Bank offers a unique opportunity to invest HSA funds in self-directed investment accounts. HSA Bank offers: • TD AMERITRADE investment accounts • Mutual Fund Selection investment accounts **Investment products are not FDIC insured, are not a deposit or other obligation of or guaranteed by the bank, and are subject to investment risks including possible loss of principal amount invested. MERCER May 25, 2017 37 Service and Support • Toll-free Bankline 24-hour account access via touch tone phone (800)-565-3512 • Toll-free Client Assistance Center (800)-357-6246 7 a.m. – 9 p.m., CT, Monday – Friday • Toll-free Spanish Language Assistance Line (866)-357-6232 7 a.m. – 9 p.m., CT, Monday – Friday MERCER May 25, 2017 38 What does Your Future Hold? For more information, please visit: www.hsabank.com MERCER May 25, 2017 39 Dental, Vision and Life Insurance MERCER May 25, 2017 40 Delta Dental of New Mexico Dental Plan Details • Diagnostic and Preventive Service – 100% benefit - Includes: exams, fluoride, x-rays, sealants for children (to age 15), routine or periodontal cleanings * - *People with specific at-risk health conditions may be eligible for additional cleanings or fluoride treatment. The patient should talk with his or her dentist about treatment. • Basic Services – 80% benefit - Includes: filings, root canals, gum disease, extractions, oral surgery • Major Services – 50% benefit - Includes: crowns, bridges, dentures, implants • Orthodontic Services (children up to age 19) – 50% benefit MERCER May 25, 2017 41 Dental Plan Details • PPO Dental plan In-Network - The lowest cost of care applies when services are received from Delta Dental PPO dentist. These dentists will not bill patients for any amount over Delta Dental Approved Fees. Out-of-Network – Delta Dental Premier or Non-participating dentists may balance bill patients for amounts over Delta Dental approved fees and or any other amount disallowed by Delta Dental. Deductible – $50 per person with a maximum of $150 per family – Does not apply to preventive services or orthodontic services • Maximum – $1,500 annual per person • Orthodontic Maximum – $1,500 lifetime MERCER May 25, 2017 42 VisionCare Direct • 12/12/24 Benefit – Eye Exam benefit every 12 months – Lenses every 12 months – Frame allowance every 24 months • $15 copay for exam and materials • Frame allowance up to $130 • Elective contact lenses allowance up to $130 (in lieu of lenses and frames) • Necessary contact lenses allowance up to $250 • Non-member provider benefit provided at reduced benefits MERCER May 25, 2017 43 UNUM Life Insurance Details • Group Term Life Insurance and Accidental Death & Dismemberment – $25,000 benefit – $25,000 additional for accidental death – Additional benefits for an accidental dismemberment such as a loss of foot, loss of sight, loss of speech or hearing – Benefit is provided to all eligible full-time employees • 100% paid by Ambercare • Benefits reduce at age 65 MERCER May 25, 2017 44 UNUM Voluntary Term Life Insurance Details • Purchase in $10,000 increments to a maximum of 5x salary, not to exceed $500,000 • Guaranteed issue amounts for New Hires and those who enroll during this enrollment: – Employee: $120,000 – Spouse guarantee issue is $20,000 – Life insurance can be purchased on children (to age19 or up to age 23 FT student) - Benefit $10,000 • If you are currently enrolled in supplemental life, you can increase your election up to $120,000 with no medical questions. If you waived coverage previously and are elected coverage now, you are subject to medical evidence of insurability (EOI) • Benefits are portable if you leave Ambercare • Rates are based on your attained age MERCER May 25, 2017 45 Voluntary Aflac Benefits MERCER May 25, 2017 46 What is Voluntary Insurance? • Voluntary insurance plans are not designed to replace insurance you already have. • • Voluntary insurance enhances your existing benefits package. MERCER Benefits can be used to help pay expenses that other insurance plans don’t cover. 47 Features of Aflac Plans • Fast Claims Payment—Most claims are processed in about four days. • Unlimited Claims—There is no limit on the number of claims a certificateholder can file. • Payroll Deduction—Premiums are paid by convenient payroll deduction. • Portable Coverage—Employees can continue through bank draft or direct billing as long as the master policy stays in force. MERCER 48 Products Offered The following products will be offered during your enrollment: • Group Accident Insurance • Group Critical Illness insurance • Group Disability MERCER 49 Accident Insurance Group Accident Insurance from Aflac helps pay for out-of-pocket costs that arise when you have a covered accident such as fractures, dislocations and lacerations. More than 50 benefits are payable including the following: • Emergency treatment • Hospital admission • Intensive care unit • Ambulance transportation • Wellness testing Nonoccupational coverage is available. MERCER 50 Critical Illness Insurance Group Critical Illness Insurance from Aflac provides cash benefits if you’re diagnosed with or treated for a covered critical illness, such as cancer, a heart attack, or a stroke. More importantly, the plan helps you focus on recuperation instead of the distraction and stress over the costs of medical and personal bills. Guaranteed Issues amounts: • $20,000 for employee coverage • $10,000 for spouse coverage MERCER 51 Disability Insurance Group Disability Insurance from Aflac helps pay a portion of your income so that you can focus on taking care of yourself instead of your bills. Benefits include: • Total Disability • Partial Disability • Waiver of Premium MERCER 52 Open Enrollment • This is your opportunity to make changes: – Enroll in or drop benefits – Enroll or drop dependents – Change medical plan options • After 11/14/14, you cannot change your election until 1/1/2016 unless you have a “qualifying event” MERCER 53 What do I need to do? • If you are not making any changes to your current election, you do not need to do anything • If you want to make a change to your current election, you must go into Day Force Benefit Enrollment. Make sure you submit your election • If you want to check your current benefits, go into Day Force Benefit Summary (not Benefit Enrollment) • Open enrollment ends on by Friday November 14th MERCER 54 Questions?