faculty open enrollment november 2, 2015 – november 20, 2015 coverage effective january 1, 2016
TRANSCRIPT
Faculty Open Enrollment• November 2, 2015 – November 20, 2015• Coverage Effective January 1, 2016
Topics for Discussion
• CHEIBA Trust and Mines• Eligibility• Benefits Plan Changes• 2016 Rates• Affordable Care Act• Enrollment Process
CHEIBA Trust
• Mines is part of a multi-university benefits trust• The Trust provides comprehensive benefits to all
member schools• Mines faculty obtain insurance through the school’s
membership in the trust• Health, Dental, LTD, Basic Life and Business Travel
(Employer Paid)• Vision, Optional Life and Accidental Death and
Dismemberment (Employee Paid)
Eligibility
• Employee, legal spouse, or partners joined in a Civil Union
• Dependent child(ren), civil union partners, qualified step child(ren), or qualified foster child(ren), married or unmarried and regardless of tax status until the end of the month in which they turn 26
• Employee’s child(ren) of any age who are medically certified as disabled
Domestic Partner Eligibility
• No Domestic Partners may be added to trust benefits after December 31, 2015
• Existing Domestic Partners enrolled in Trust benefits will be grandfathered for 2016
• All Domestic Partner benefits will end December 31, 2016
Civil Unions
• Recognized for insurance purposes January 1, 2014• Requirements– Photocopy of Civil Union Certificate– Joint bill or statement dated within the last 60
days
Eligibility Documentation
• The CHEIBA Trust requires eligibility documents for all new plan participants including copies of registered marriage certificates and birth certificates
• Documentation requirements are posted on the CSM Benefits webpage and available in the Human Resources Office.
Health Insurance
• Five Plan Designs– Blue Advantage Point of Service– Blue Priority PPO (Formerly Blue Prime PPO)– Custom Plus (Closed to New Enrollment)– Blue Priority HMO– Lumenos HSA 2500 (High Deductible Health Plan)
• The following information is based on in-network benefits only. Some plans have an out-of-network option. Please see the 2016 Benefits Book for details
Definitions
• Deductible: The amount you pay out of pocket for your health care expenses before the plan makes payments for eligible expenses
• Copayment: A flat dollar amount you pay for services regardless of the cost of those services
• Co-Insurance: The percentage of the eligible expenses you are responsible for paying
Blue Advantage HMO/POSPCP Requirement Yes
In-Network Deductible $0
Out of Pocket Maximum $2,000/$4,000
Preventive Care No Cost
Primary Care Office Visits $20 co-pay
Specialist Office Visits $20 co-pay
Emergency Room $100 co-pay
Inpatient Hospital $400 co-pay
Urgent Care $50 co-pay
Out-Patient Surgery $85/$65 co-pay
Retail Rx – 30 Day Supply $15/$30/$45 co-pay
Mail Order Rx – 90 Day Supply $15/$60/$90 co-pay
Specialty Pharmacy – 30 Day Supply 30% to a maximum of $125
Blue Priority PPOPCP Requirement Yes
In-Network Deductible $400/$800
Out of Pocket Maximum $750/$1,500
Preventive Care No Cost
Primary Care Office Visits Tier 1 $10 co-pay Tier 2 15% co-insurance
Specialist Office Visits Tier 1 $10 co-ay Tier 2 15% co-insurance
Emergency Room 15% co-insurance
Inpatient Hospital 15% co-insurance
Urgent Care 15% co-insurance
Out-Patient Surgery 15% co-insurance
Retail Rx – 30 Day Supply $15/$30/$45 co-pay
Mail Order Rx – 90 Day Supply $15/$60/$90 co-pay
Specialty Pharmacy – 30 Day Supply 30% to a maximum of $125
Blue Priority PPO
• Name Change – Formerly Blue Prime PPO• Members must designate a Tier 1 Primary Care
Physician (PCP)• Use a Tier 1 PCP or Specialist for a $10 copayment• You still have access to all physicians in the PPO
Network including non-Tier 1 PCP’s• Anthem will assign a PCP to members who do not
designate one
Blue Priority HMO New OptionPCP Requirement Yes – Limited Network
In-Network Deductible $2,000/$6,000
Out of Pocket Maximum $4,000/$10,000
Preventive Care No Cost
Primary Care Office Visits $20 co-pay
Specialist Office Visits $60 co-pay
Emergency Room $250 co-pay
Inpatient Hospital $250 co-pay plus 20% after deductible
Urgent Care $60 co-pay
Out-Patient Surgery $250 co-pay
Retail Rx – 30 Day Supply $200/$400 (Tier 2 & 3) $15/$40/$60
Mail Order Rx – 90 Day Supply $200/$400 (Tier 2 & 3) $15/$80/$120
Specialty Pharmacy – 30 Day Supply 30% to a maximum of $250
Lumenos 2500 HSA New OptionPCP Requirement No
In-Network Deductible $2,500/$5,000
Out of Pocket Maximum $2,500/$5,000
Preventive Care No Cost
Primary Care Office Visits $0 after deductible
Specialist Office Visits $0 after deductible
Emergency Room $0 after deductible
Inpatient Hospital $0 after deductible
Urgent Care $0 after deductible
Out-Patient Surgery $0 after deductible
Retail Rx – 30 Day Supply $0 after deductible
Mail Order Rx – 90 Day Supply $0 after deductible
Specialty Pharmacy – 30 Day Supply $0 after deductible
Health Savings Account (HSA)
• The Lumenos 2500 HSA is a high deductible health plan and HSA qualified
• An HSA is a tax-favored savings account that, when paired with a qualified high deductible health plan (HDHP), allows you to pay for qualified medical expenses, or leave funds invested in the account for future medical expenses tax-free
• An HSA can be set-up through your local bank or credit union
All Health Plans
• New!• A routine vision exam for a $15 copayment
will be covered under all Mines health plans• Enrollment is automatic you do not need to
do anything• Anthem Blue View Vision Network
Pharmacy Reminders
• All Asthma and Diabetic medications are available at no cost
• Use the Express Scripts Mail Order Pharmacy for significant cost savings
• A 90 day supply of generic medication is available through the mail order pharmacy for a $15 copayment
Dental Plans (Anthem Dental)
• Two Plan Options– Dental PPO Plus– Dental PPO
• There are no changes for 2016
New! Anthem Blue View Vision
• A routine vision exam is now covered under your health insurance
• Two Plan Options– Materials Only – For members and dependents covered
under Mines health insurance– Materials plus Exam – Only for members not covered
under Mines health insurance• In order to start or continue vision coverage you must enroll
in one of the 2016 coverage options• Coverage under VSP will end December 31, 2015
New! Anthem Blue View VisionIn- Network
Eyeglass Frames $130 Allowance 20% discount on balance
Eyeglass Lenses Standard plastic single vision Standard plastic lined bifocal Standard plastic lined trifocal
$15 co-pay$15 copay$15 co-pay
Contact Lenses (In lieu of eyeglasses)Once every 12 months Elective conventional lenses Elective disposable lenses Non-elective contact lenses Contact Lens exam (fitting & evaluation)
$130 allowance 15% discount on balance$130 allowanceCovered in fullCopayment up to $55
New! Anthem Blue View VisionIn-Network (Member Cost)
Eyeglass Lens Upgrades Transitions (Adults) Polycarbonate (Adults) UV Coating Progressive Lenses Anti-Reflective Coating Other Add on Services
$75 co-pay$40 co-pay$15 co-pay$65-$110 co-pay$45-$68 co-pay20% off Retail Price
• Out-of-network benefits paid on a schedule – See the 2016 Benefits Book• Members are not eligible for glasses and contacts in the same benefits period• Purchase materials through your provider, or retail locations including Lens Crafters,
Pearl Vision, Target, JC Penny and Sears• Discounts on Lasik• Low vision benefit
New! Anthem Blue View Vision2016 Premiums Materials Only
Employee Only $6.36
Employee + Spouse $11.92
Employee + Children $11.92
Employee + Family $17.31
2016 Premiums Material plus Exam
Employee Only $8.80
Employee + Spouse $16.49
Employee + Children $16.49
Employee + Family $23.95
Identification Cards
• Due to the change in Health plan options and the addition of Anthem Blue View Vision everyone will be issued a new ID card for 2016
• Health, Dental, and Vision will all be on one card
• If you have moved please drop by Human Resources GH110 to update your information
Long Term Disability Insurance
• Income replacement in case of a long term disability
• 90 day waiting period• The Standard Insurance Company• Mines pays all premiums for this plan• No plan changes for 2016
Voluntary Accidental Death & Dismemberment (AD&D)
• Coverage for Accidental Death or Dismemberment
• Mutual of Omaha• No plan changes for 2016
Travel Accident Insurance
• Provides coordination of care while traveling on school business
• Provides an accidental death and dismemberment benefits while traveling on school business
• Mines pays all premiums for this plan• No changes for 2016
Basic Life Insurance Employee Coverage:
Under age 65 -- 2X annual salary; benefit capped at $500,000
Age 65 – 69 -- 2X annual salary; benefit capped at $50,000
Age 70 + -- flat amount of benefit of $10,000
Dependent Coverage included at $2000
Employee’s legal spouse under age 70 and any married or unmarried child(ren) regardless of tax status and between 14 days and 26 years of age
Mines pays all premiums for this plan Domestic Partners and children of domestic partners are not eligible for Dependent Coverage
Optional Life InsuranceAnthem Life
• Optional employee paid life insurance• Coverage up to $300,00 for employee and/or spouse
– An Application including a medical questionnaire is required during open enrollment
• Voluntary Dependent Child Coverage - $5,000• Dependents may be insured through the month in which they
turn 26• No health screening is required for children
2016 Flexible Spending Account
• Healthcare Flexible Spending– Pre-tax deductions for healthcare expenses for you and
your qualified dependents to cover items such as co-pays, deductibles, medical supplies, eye glasses/contact lenses, and dental care
• Dependent Care Flexible Spending– Pre-tax deductions for day care expenses for qualified
dependents. Tuition beyond preschool is not covered.• Participants save anywhere from 15%-30% or more• Expenses must be incurred during the plan year to qualify for
reimbursement. Funds not used are forfeited!
2016 Flexible Spending Account• 24Hour Flex – New Plan Administrator January 1, 2016 www.24hourflex.com 1-800-651-4855• Healthcare $2,550 per employee annual maximum• Dependent Care $5,000 per family annual maximum• CSM pays the $3.75 administrative fee• File claims online or using by using the 24Hour Flex mobile app• You must enroll during the open enrollment period to start or continue
this benefit (IRS regulations)• Claims for expenses incurred in 2015 should be filed with PayFlex!• Participation for Domestic Partners/Civil Unions partners and/or children
of Domestic Partners/Civil Union partners is limited to tax qualified dependents
24Hour Flex Visa Card (Benny Card)
• You will automatically be issued a Debit Card• Use to pay for co-pays, prescriptions, qualified dental
treatments, medical supplies and other qualified expenses
• Keep your Documentation! You may be required to provide documentation to 24Hour Flex, or to the IRS in case of an audit
• You are not required to use the debit card. You may still file regular electronic claims
2016 Premium InformationHealth Insurance
• Mines pays 100% of your health and dental premiums
• Health premiums increased 6.1% this year
• New four tier premium structure
• HMO/POS, Blue Priority PPO, and Custom Plus
MedicalPremiums
2015 2016
EmployeeOnly
$601.00 $637.52
Employee +Spouse
N/A $1,528.84
Employee +Children
N/A $1,401.84
Family +Family
$1,568.00 $1,759.13
2016 Premium InformationHealth Insurance
Blue Priority HMO2016
Employee Only $586.52
Employee + Spouse $1,406.84
Employee + Children
$1,289.84
Employee + Family $1,619.13
Lumenos 2500 HSA2016
Employee Only $573.52
Employee + Spouse $1,376.84
Employee + Children
$1,216.84
Employee + Family $1,584.13
2016 Premium Information
• No increase in dental premiums
• New four tier premium structure
Dental Premiums 2015
Employee Only $39.00
Employee + Spouse $90.00
Employee + Children
$86.00
Employee + Family $102.00
Value Of Your Coverage(Health, Dental, Life, LTD, Travel)
Assume salary of $60,000Employee only coverage, under age 65
CSM Pays: $8,170With PERA included, CSM pays: $19,660
Employee with family coverage, under age 65CSM Pays: $22,385With PERA included, CSM pays: $33,874
Assume a salary of $100,000Employee with family coverage, under age 65
With PERA included, CSM pays: $41,5692016 Employer (CSM) PERA Contribution rate is 19.15%(10.15% Employer Contribution plus 9% AED/SAED)
Open Enrollment
• Enrollment is REQUIRED for those who:– Wish to participate in a Flexible Spending Account– Wish to participate in the vision plan– Wish to add, drop, or change coverage– Wish to add or drop dependents. Reminder: Dependents
may be insured through the month in which they turn 26 regardless of, student, tax, or marital status
– Forms are due in the Human Resources Office no later than Friday November 20th at 5:00pm. Early submission is greatly appreciated!
Open Enrollment
• You DO NOT need to complete new enrollment forms if you DO NOT wish to:– Enroll in a Flexible Spending Account– Start or continue Vision Coverage– Change dependent coverage
• Your benefits will continue unchanged
Qualifying EventsREMINDER: • Your benefits elections will be in effect for the entire 2016
calendar year unless a “qualifying event” occurs • You must notify, and provide Human Resources with
documentation within 31 days of an eligible qualifying event • Examples are marriage, divorce, birth, overage dependents,
spouse loses coverage etc. • Failure to do so means that you must wait until the next open
enrollment period (IRS regulations)• Reference your Benefits Book or contact HR for further details
Voluntary Tax Deferred Options
• PERA 401(k) Plan• PERA 457 Deferred Compensation Plan• 403(b) Tax-Deferred Annuity Plan• Roth 403(b) Post-Tax
• You may enroll in these plans at anytime!• Detailed plan information is available in
Human Resources
Affordable Care Act (PPACA) Update
• Individual Mandate– Most individuals will be required to carry minimum value (60% actuarial value) coverage
or face a possible financial penalty
• Employer Mandate– Employers are required to provide minimum value coverage to 95% (70% for 2015) of
employees working 30 or more hours per week or face a financial penalty– Starting in January of 2016 employers and insurance companies will be reporting offers
of coverage and enrollment information to the IRS for calendar year 2015– Many employees will receive a Form 1095-C Form from their employer outlining offers
of coverage and enrollment information for calendar year 2015 by January 31, 2016– Stay tuned for more information on this topic
Participant Advocate Link
• You have a P.A.L.!• The participant advocate is available to assist you
with benefits issues such as billing problems, reimbursement issues, and denied services
• The participant advocate is an employee of Gallagher Benefits Services and works only for you!
• (303) 889-2790 or (800) 943-0650
