2018 UpdateWOOD COUNTY EMPLOYEE HEALTH BENEFITS PLAN

Keeping a pulse on your health

YOU MATTER!

NO RATE INCREASE FOR 2018

START HERE!

• Available every three years

• Lower cost option to get datafor physical

• Free, confidential

• Review recommended screenings based on age and health status

Wood County is committed to wellness!Screenings have been offered to employees since 1993.

What is your current health status?

I expect ____ years in good or better health.Excellent

I expect ____ years free of limitation of activity.Average

I expect ___ years free of chronic disease. Poor

Where do you see your health status in five to 10 years?

Age

TimeBoth age and time are working against us.

Maintaining our current health status is actually considered as improvement.

Tips to maintaining your current health status from the American Heart Association: Life’s simple 7

Stop SmokingCigarette smokers have a higher risk of developing cardiovascular disease. If you smoke, quitting is the best thing you can do for your health.

Eat BetterA healthy diet is one of your best weapons for fighting cardiovascular disease. When you eat a heart-healthy diet, you improve your chances for feeling good and staying healthy – for life!

Get ActiveLiving an active life is one of the most rewarding gifts you can give yourself and those you love. Simply put, daily physical activity increases your length and quality of life.

Lose WeightWhen you shed extra fat and unnecessary pounds, you reduce the burden on your heart, lungs, blood vessels and skeleton. You give yourself the gift of active living, you lower your blood pressure and you help yourself feel better, too.

Manage Blood PressureHigh blood pressure is a major risk factor for heart disease and stroke. When your blood pressure stays within healthy ranges, you reduce the strain on your heart, arteries, and kidneys which keeps you healthier longer.

Control CholesterolHigh cholesterol contributes to plaque, which can clog arteries and lead to heart disease and stroke. When you control your cholesterol, you are giving your arteries their best chance to remain clear of blockages.

Reduce Blood SugarMost of the food we eat is turned into glucose (or blood sugar) that our bodies use for energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves.

Reward Yourself for Being Engaged in Your Health

▪ Earn Wellness Warrior status and earn a special reward▪ Complete all 12 monthly wellness

challenges*

▪ Benefit Eligible Employees can:▪ Earn a Deductible Credit for

Participating in Wellness Programs▪ Receive 1 challenge credit for each of the

following completed programs:▪ Monthly Challenge ▪ Wellness Screening conducted in 2018▪ Fitness Program▪ Nutrition for Life Program▪ Tobacco Termination▪ Summer Swim

Wellness Reward Level

Challenge Credits Needed

$50 Credit 5

$100 Credit 10

Wellness Warrior

12*

Refer to the Summary Plan Description for program details.

Items to Note for Reimbursement Programs

▪ Plan will reimburse for gym memberships, fitness classes and other programs listed in the Summary Plan Description

▪ Plan will not reimburse for:▪ Food/Beverages▪ Child Care Services▪ Sports programs unless part of a regular facility membership▪ Supplies▪ Tanning and other ancillary services

▪ Detailed receipts are required▪ Contracts may be requested if receipts do not provide adequate information

for auditing purposes

▪ Deadlines for Forms

Some things can’t be preventedNEXT STEPS IF YOU NEED CARE

Know Your Plan

▪ ER visit for non-emergency may not be covered by the Plan

▪ Falcon Health bills at the doctor office rate, which is lower than an urgent care facility

▪ Have a primary care physician▪ Wood County Community Health

and Wellness Center is taking new patients▪ Offers Sliding Fee Schedule even for

those with insurance coverage▪ Provides access to the Prescription

Savings Program

Primary Care

Acute Issues Monitoring

Urgent Care

After Hours Non Life Threatening

Emergency Room

Life Threatening Medical Emergency

Know Your Plan

In-Network

Professional Co-Payment (Office Visit)

$15

ER Co-Payment

$45

Deductible $150 Single/ $450 Family

Out-of-Network

Professional Co-Payment (Office Visit)

$15

ER Co-Payment

$45

Deductible $300 Single/ $900 Family

Out-of-Network Applies to

In-Network Only

No carryover

Choose Quality Network Providers

www.frontpathcoalition.com

You wouldn’t trust just anyone to watch your kids or remodel your house. Would you?

Doesn’t your health deserve the same considerations?

See your Group Representative for username and password.

Pipeline

▪ CarePoints ® : A severity-adjusted episode of illness evaluation system which measures physician resource utilization.

▪ Top tier physician report by specialty.

▪ Continue to add reports to the portal.

Know Your Plan

▪ Vision coverage calendar resets on 1/1/18 ▪ Submit claims within 90 days ▪ Detailed receipts and invoices are

required ▪ Wal-Mart register receipt alone does not

provide required information

▪ No coordination of benefits

General Reminder

Understand Your Plan’s Rules!

• Coordination of Benefits

• High Deductible with HSA

• Special Enrollment Rights and Reporting Timelines

Know Your Plan

Prescription Formulary

Retail Co-Payment AmountCo-payments double for mail order

Select OTC $0

Tier 1 $5

Tier 2 $20 plus 20% of AWP$45 maximum

Tier 3 $20 plus 20% of AWP$85 maximum

Prescription Savings Program

▪ Up to a 90 day supply* = $5 co-payment

▪ Must transfer primary care services to Center which grants access to the pharmacy

▪ Payable as primary (does not coordinate benefits)

*Some restrictions apply

How to Access the Wood County Community Health and Wellness Center

It’s Easy!▪ Sign-off on a Release of

Information to transfer information from current primarycare provider to the Community Health & Wellness Center

▪ Schedule an appointment ▪ Call 419.354.9049

▪ Can keep your specialist!▪ Reverse referral process for

prescriptions

Center offers:▪ Health care services for your entire

family▪ Pharmacy services for Center patients▪ Reproductive health services▪ Social work services▪ Financial assistance/sliding fee scale

for those who qualify (even those with insurance)

▪ Evening appointments

Benefits of Switching: Rx Savings Program

Select OTC

Tier 1

Tier 2

Tier 3

Medical Review*

* Some restrictions apply – Not all medications are available through this program

Save money from both your pockets

Payment of ClaimsEmployee

15%

Employer85%

Our Health Benefits Trust

Benefits of Switching: Rx Savings Program

90 Day Supply Comparison (3 – 30 day fills at Pharmacy v. 1 – 90 day fill with Rx Savings Program)

Employee saves $130

Plan saves $593

Benefits of Switching: Rx Savings Program

Employee pays

$20 for a year’s worth of medication.

A savings of $520 annually.

Annual Costs

Plan pays $200 less per month.

That’s a savings of approximately

$2,400 a year.

Savings under RX Savings Program

If five people made the switch, the Plan could experience a savings

of $12,000.

Remember, the Plan’s money is your money too!

Employee Health Benefits Status Report

Plan Expenses 2013 to 2017 (as of 9/30/17)Note: Board of DD entered Plan 1/1/17

$0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000

2013

2014

2015

2016

2017

Health Prescription Vision Dental Life Wellness Administration

$7,992,908

$9,072,546

$9,946,784

$10,187,703

$8,060,242

How Does our Plan Compare? 2016 SERB Report: Cost of Health Insurance for Ohio’s Public Sector

•Statewide: $582 Single $1,526 Family•Counties: $627 Single $1,680 Family•Wood County: $609 Single $1,584 Family

AverageMedical & Rx

Premiums

•Statewide: $13,928•Counties: $13,164•Wood County: $10,741

Average Annual Cost

(H, Rx, V, D)

•Statewide: $2,000 Single $4,000 Family•Counties: $2,500 Single $5,000 Family•Wood County: $400 Single $1,200 Family

Medical In-Network Out-of-Pocket Maximums (H)

Challenges Ahead

▪ Compare your plan to others using the Summary of Benefits and Coverage ▪ 2018 Revised Version available on employee website

▪ Formulary Change ▪ Enroll in Rx EOB for Therapeutic Alternatives▪ Review Drug Tier Changes

▪ Plan’s intent is to comply with current and future Federal regulations regarding Health Care coverage

▪ The Plan reserves the right to develop and/or modify eligibility rules

Don’t ForgetFRIENDLY REMINDERS

OPEN ELECTION

▪ Review Your Individual Enrollment Summary▪ Notify group rep of needed changes ▪ May require an updated Universal Application

▪ Report Changes within 30 days of event

▪ Pre-certify as required▪ Notify family members

▪ Complete a release to share HIPAA protected information with family members▪ Required on an annual basis

▪ With no insurance rate increase, remember it’s never too early to save for retirement▪ Deferred Compensation Programs

Nov. 15 to Dec. 15

Jan. 1 effective date

Time to StretchTHANK YOU FOR ATTENDING TODAY’S MEETING!