Open Enrollment 2012
Employee Benefits
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Faith HitesSenior Account Manager, Group
BenefitsRaffa Financial Services, Inc.
Brady J. FosterBroker, Group BenefitsHMBS Group Insurance, LLC.
Moderator
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Open Enrollment Means…
You may enroll in coverage
You may add or drop dependents
You may change benefit plans – Medical, Dental, Vision
If you are utilizing the Flexible Spending Account (FSA), you Must elect new contributions to your Medical Expense and Dependent Care Plans
You Must re-elect your taxation choice on your Short and Long-Term Disability benefits by completing the paper form
Open Enrollment
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Important Information
Open enrollment begins December 5, 2011.
All Open Enrollment Elections Must be Made by December 16, 2011 – No Exceptions!
Medical, Dental, and Vision Open Enrollment Elections are completed online through Benefit Mall. Instructions to log onto Benefit Mall are available in your open enrollment packet.
If no changes are to be made to your Medical, Dental, and Vision benefits, then you do not need to log onto Benefit Mall. Your benefits from 2011 will renew automatically in 2012.
Paper forms will be provided for the FSA (Medical & Dependent care) election, your HRA Acknowledgement, and your STD / LTD taxation election. These forms Must be filled out and submitted during Open Enrollment. 4
What’s New With Benefits…
New POS Low Cost Medical Benefit Option for Local (VA, DC, or MD) and Out of Area Employees (all other states). Look for additional details on plan deductibles, co-pays, etc… on the Medical Analysis page in your open enrollment packet.
Both the CareFirst HMO and POS plans from last year have been eliminated in favor of a new Lower Cost POS Plan.
The Dental Plan changed from Humana to Guardian
Introduction
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What’s Not Changing This Year…
CareFirst PPO plan
Reliance Standard for Life, Short-Term and Long-Term Disability
FSA (Medical & Dependent Care ) and HRA administration with The 125 Company
Introduction
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Discussion Topics…
CareFirst Medical Plans (PPO vs. POS)
HRA Card, Prescription & Vision Plans
Guardian Dental Plan
Reliance Standard Life & Disability Plans
Flexible Spending Accounts (Medical & Dependent Care)
Benefit Review
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CareFirst Health Plan Options for Local and Out of Area Employees…
Option 1: Open Access POS (New!)
Option 2: Blue Preferred PPO
Medical Plan Introduction and Pricing
PPO Blue Preferred NEW! POS
2012 cost 2012 Cost
Employee $167.27 $112.80
Employee & Child $317.81 $240.11
Employee & Spouse
$393.08 $296.98
Family $459.99 $347.53
• All premiums are shown as monthly employee costs.• To find your bi-monthly premium cost, divide the above amount by 2.
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Medical Benefits Terminology
Networks
Local includes employees located in VA (excluding Dalgren), DC, & MD
Out of Area includes all other BCF employees
In Network includes doctors participating in the Blue Cross Blue Shield Network
Out of Network includes all doctors not participating in the Blue Cross Blue Shield Network
Terms
Deductible the amount an individual must pay for health care expenses before co-pays & co-insurance begins to cover your medical costs. BCF covers this expense by issuing you an HRA card.
Co-insurance refers to the percentage of money that an individual is required to pay for services, after a deductible has been paid, up to the annual out of pocket max.
Co-pay a predetermined (flat) fee that an individual pays for health care services. For example, the POS plan requires a $30 copayment for each office visit.
Out of Pocket Maximum a predetermined amount that an individual must pay, annually, before health care expenses will be covered at 100% by Blue Cross Blue Shield. 9
CareFirst Open Access POS Health Plan
Local POS plan is part of the Regional CareFirst Blue Choice Network (you
must use this network locally!) Out of Area POS plan is part of the National Blue Preferred / Blue Card
Network. All out of area employees may utilize the same network of doctors
for both the POS & PPO plans.
A Point of Service (POS) Plan is a hybrid between an HMO and PPO plan offering the features of both plan types.
A Point of Service (POS) Plan is a hybrid between an HMO and PPO plan offering the features of both plan types.
A Primary Care Physician (PCP) must be selected. You DO NOT need referrals
to see a specialist. Instructions on how to find a doctor can be found in your
enrollment package.There is a deductible that needs to be met with coverage.HRA cards WILL BE used to cover deductible expenses up to the in-network
deductible $ amount.After you meet your deductible, a co-payment is charged for all medical
services. HRA cards DO NOT cover co-payments.
POS Networks
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CareFirst PPO Health Plan
The BCF Solutions VA Blue Preferred PPO plan has not changed.
All Local and Out of Area employees are eligible to elect the PPO plan option.
The PPO is part of the National Blue Preferred / Blue Card Network. This means you are eligible to use any Blue Cross Blue Shield doctor from their nationwide network without a referral.
After you meet your deductible, the PPO plan does not have a co-pay associated with regular doctor visits.
Just as last year, your HRA card will cover your in-network PPO deductible.
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CareFirst – How to Find a Doctor
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Click to find a Provider
CareFirst – How to Find a Doctor
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POS – Local and Out of Area
PPO
All CareFirst BCBS Health Plans are HRA’s…
CareFirst Health Plans
The $ amount on the HRA debit card is equal to your In-Network
deductible.
BCF management elected to cover all in-network employee medical
deductible expenses through the HRA debit card.
The HRA debit card can ONLY be used to pay for services that are subject
to the Medical Deductible, this includes:
Inpatient and Outpatient hospitalization services or surgeries
Emergency Services (Ambulance, Emergency Room, or Urgent Care)
Visits to your Primary Care Doctor or a Specialist
Lab and X-Ray Fees
Mental/Nervous or Substance Abuse hospitalizations or physician visits* Please note this is not a complete and comprehensive list.
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All CareFirst BCBS Health Plans are HRA’s…
CareFirst Health Plans
Below are some examples of what the HRA debit card
CANNOT BE USED FOR.
Prescription Drug Co-Pays
Cosmetic Surgery
Vision Care
All Dental Expenses
All POS Co-Payments (after the deductible is met)
Any expense related to co-insurance after the deductible has
been met
* Please note this is not a complete and comprehensive list.
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Additional HRA Information
HRA Website: www.125Company.com
How to use the HRA
Monitor your account
Upload “Explanation of Benefits/Receipts” to the website
Explanation of Benefits are mailed from BCBS and can also be found on
the CareFirst website
Don’t pay for your appointment while at the doctor’s office.
The doctor needs to first submit a claim to BCBS and then send you a bill.
Wait for the bill to be mailed to you.
If your HRA card is not accepted by the doctor you have two options
1. You can pay for it out of pocket and then submit a reimbursement claim
(form on the BCF website)
2. You can submit the reimbursement form with your EOB to 125 Company
(form on the BCF website) and once you receive the money, pay the bill.
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Prescription Drug Plan
Drug Benefit Description $15 Generic Drugs
$35 Preferred Brand prescription or refill. Preferred Brand is designated by CareFirst
$60 Non Preferred Brand prescription or refill
If you use a Non Preferred Brand name drug and a
Generic is available, you will pay the difference in the
cost of the drugs.
Injectables – you pay 50% up to a $100 Co-pay
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Prescription Drug Plan
All $ amounts are co-pays. The co-pay is Not covered by the
HRA card.
Maintenance medications are eligible for the Mail Order
Program, where you can get 3 months of medication for only 2
co-payments. Forms and information can be found online at
www.carefirst.com
If the cost of the drug is less than the listed co-pay, the
employee will only have to pay the cost of the drug at the time
the prescription is filled.
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CareFirst Plan Comparison – All Employees
Medical Benefit (All are HRA Plans)
Open Access POSBlue Preferred
PPOIn - Network Out of Network In - Network Out of Network
Deductible (Individual)
$1,400 $2,800 $2,000 $4,000
Deductible (Family) $2,800 $5,600 $4,000 $8,000
Co-Insurance 100% 70% 100% 80%
Out-Of Pocket Maximum
$2,800 / $5,600 $5,600 / $11,200 $7,000 / $14,000 $15,000 / $15,000
Maximum Benefit Unlimited Unlimited Unlimited Unlimited
Inpatient Hospital Ded then $300 Ded then 70% Ded then 100% Ded then 80%
Outpatient ServicesDed then /$30 Dr
$300 facilityDed then 70% Ded then 100% Ded then 80%
Lab & X-Ray Ded then $30 Ded then 70% Ded then 100% Ded then 80%
Emergency Room Ded then $300 Ded then $300 Ded then $100 Ded then $100
Physician/Specialist Ded then $30 Ded then 70% Ded then 100% Ded then 80%
Prescription Drugs $15/$35/$60 $15/$35/$60 $15/$35/$60 $15/$35/$60
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Plan is Administered by CareFirst and Davis Vision
Network – Davis Vision
Providers Can Be Located On-Line at https://idoc.davisvision.com/davis/member/adv_doc_locate_v2.asp
CareFirst Blue Vision Plus Plan
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Vision Plus2012 cost
Employee $3.58
Employee & Child $6.60
Employee & Spouse
$8.21
Family $10.18
• All premiums are shown as monthly employee costs.• To find your bi-monthly premium cost, divide the above amount by 2.
Your CareFirst Medical plan does have vision coverage that will cover most vision related needs. You will have to pay a copayment at the time of your visit for an eye exam on both PPO and POS plans. There are discounts for eyeglasses and contacts.
All eye injuries and eye related diseases are covered through your CareFirst medical plan.
The Vision Plus benefit is for those individuals who need extra vision coverage.
All in-network Vision Plus plan participants receive an annual eye exam, frames, lens, and contacts with no copayments. All out of network participants are required to pay a portion of your vision services as illustrated on the next page.
CareFirst Blue Vision Plus Plan
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CareFirst Blue Vision Plus Plan
Vision Benefits Davis Vision Network
Exam Frequency 1 per 12 Months
Lenses Frequency 1 per 12 Months
Frame Frequency 1 per 12 Months
Co-Pays Davis Vision Provider Other Provider
Vision Exams $0 Co-Pay Plan Reimburses $45
Lenses (Single Vision) $0 Co-Pay Plan Reimburses $52 - $181
depending on lens type
Lenses (Bifocals) $0 Co-Pay
Lenses (Trifocals) $0 Co-Pay
Frames
$0 Co-Pay for Tower Collection; Plan
Allowance of $45 for Non-Tower Collection
Plan Reimburses $45
Contacts (Medically Necessary)
$0 Co-Pay Plan Reimburses $285
Overview of Vision Benefits…
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Guardian Dental Plan
Plan is Administered by Guardian Dental
Network – PPO / Traditional Preferred
TX and GA employees have state mandated benefits
Providers can be located online at www.guardiananytime.com/fpapp/FPWeb/home.process
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Guardian Dental
2012 cost
Employee $12.78
Employee & Child $24.56
Employee & Spouse
$29.03
Family $41.31• All premiums are shown as monthly employee costs.• To find your bi-monthly premium cost, divide the above amount by 2.
Overview of Dental Benefits…
Guardian Dental Plan – Non TX or GA
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GuardianDental Benefits
Guardian Choice Plan
PPO Value Plan (Fee Schedule) PPO NAP Plan (90% UCR)
In - Network Out of Network In - Network Out of Network
Deductible (Individual) $50 Combined $50 $50
Deductible (Family) $150 Combined $150 $150
Preventive Care100% (No Deductible)
100% (No Deductible)
100% (No Deductible)
100% (No Deductible)
Basic Services100% After Deductible
100% After Deductible
80% After Deductible
80% After Deductible
Major Services60% After Deductible
60% After Deductible
50% After Deductible
50% After Deductible
Annual Maximum $2,500 with Rollover $2,500 with Rollover
Overview of Dental Benefits…
Guardian Dental Plan – TX and GA
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Guardian Guardian PPO NAP Plan (90% UCR)
In Network Out of Network
Deductible (Individual) $50 Combined
Deductible (Family) $150 Combined
Preventive Care 100% (No Deductible) 100% (No Deductible)
Basic Services 80% After Deductible 80% After Deductible
Major Services 50% After Deductible 50% After Deductible
Annual Maximum $2,500 with Rollover
*Due to State Mandates al TX and GA employees must be on this plan
Benefits are Staying the Same…
Three (3) Employer-Paid Plans
Group Short-Term Disability Insurance
Group Long-Term Disability Insurance
Group Term Life Insurance
Reliance Standard Benefits
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STD/LTD Benefits Terminology
Tax Choice Option
Payment on Premium you can opt to pay the initial taxes on the premium payments to avoid paying taxes on your disability income benefits once you are receiving them.
Payment on Benefit you will pay taxes on any disability income benefits you receive.
Terms
Waiting Period or Elimination Period the period of time that must lapse from the onset of a disability, before you are eligible to receive weekly or monthly benefits.
Benefit Percentage the amount payable to you, based on a percentage of the your income prior to disability. The proceeds are limited to an overall maximum amount.
Duration of Benefits the amount of time you are able to collect disability income
Benefit Maximums the maximum amount of disability income you are allowed to receive based on your salary at the time of injury. Amounts are paid weekly for STD and monthly for LTD
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Waiting Period (0 Days Accident/7 Days Sickness)
Benefit Percentage (60%)
Duration of Benefits (13 Weeks)
Benefit Weekly Maximum ($1,500)
You Must re-elect your taxation choice on your Short-Term Disability benefits by completing the paper form
Tax Choice Option – Payment on Premium or Benefit
Short-Term Disability Insurance
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Waiting Period (90 days)
Benefit Percentage (60%)
Duration of Benefits to Age 65 / Social Security Normal Retirement Age (SSNRA)
Benefit Monthly Maximum is ($7,500)
You Must re-elect your taxation choice on your Long-Term Disability Benefits by completing the paper form
Tax Choice Option– Payment on Premium or Benefit
Long-Term Disability Insurance
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Procedure
Employees seeking to use BCF’s disability insurance are required to provide notice to their Supervisor of the need to utilize their STD or LTD benefits. Employee requests are submitted via the BCF Leave Request Form (found on the BCF Website).
To receive disability benefits, a claim form must be submitted. The Reliance STD Claim Form can be found on the BCF website. Please return this form to HR. Supervisors will forward the Leave Request Form to HR. If an employee is uncomfortable discussing or providing information on a medical condition, the employee may contact HR directly. In this case, HR will notify the Supervisor and inform them of the request and decision. Every effort will be made to maintain employee privacy regarding the medical condition.
Disability Insurance
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Two (2) Times Annual Salary
Class I: Maximum Benefit of $200,000
Maximum Benefit Without Medical Questionnaire
In the event that something should happen to you, your beneficiary will need to contact your direct manager who will start the claims process with the HR Manager.
Group Life Insurance
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Class I - Regular Benefit Class II - Tax Relief Benefit
2 x Salary to $200,000 2 x to $50,000. Employees who elect Class II do so to avoid paying tax on the amount over $50,000
Pre-Tax Contributions for Eligible Out of Pocket Medical expenses…
FSA – Medical Expenses
Up to $3,000 can be set aside to pay for eligible medical expenses for plan year 2012
Full amount elected can be accessed immediately
An FSA can be used to pay for medical, dental, vision, or prescription expenses.
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Pre-Tax Contributions for Eligible Dependent Care Expenses…
FSA - Dependent Care Account
Up to $5,000 can be set aside to pay for eligible Dependent Care expenses for plan year 2012
Expenses are reimbursable as contributions become available through your payroll deductions. Reimbursement form is located on the BCF website
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Reminder - Important Information
All Open Enrollment Elections Must be Made by December 16, 2011 – No Exceptions!
Medical, Dental, and Vision Open Enrollment Elections are completed online through Benefit Mall. Instructions to log onto Benefit Mall are available in your open enrollment packet.
There will still be paper forms that must be filled out for the FSA (Medical Expense & Dependent Care) election, HRA Acknowledgement, and your STD / LTD taxation election.
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Reminder - Important Information
Forms to be filled out and submitted to HR:
FSA – Medical and Dependent Care STD / LTD Taxation Election HRA Acknowledgement
These forms MUST be returned even if you are not making changes!
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Thank You For Your Participation…
Questions
Who can I call with Additional Questions?
BCF Human Resources Department PMA/S4 – Sunita Gupta; 703-817-9475;
[email protected] Defense & Space – Dina Johns; 703-717-9937;
[email protected] Triad – Mike Parker; 626-793-7314; [email protected]
Angela Fitzpatrick, Raffa Financial ServicesBCF’s Dedicated Customer Service Representative240-403-2546
Brady J. Foster, HMBS Group Insurance, BCF’s Dedicated Insurance Broker949-630-2523, cell 949-244-6421; [email protected]
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