Open Enrollment OverviewCity of Clearwater

2015 Plan Year

Insurance Renewal Background

• The City has a Benefits Committee that is comprised of representatives from each employee group and the retiree group.  The benefits committee evaluates the best options available based on the claims experience and the City’s budget for healthcare and they determine what is a viable and cost effective option for their employee group.  Fire, Police, CWA ,SAMP, and Retirees are all under one insurance policy, so the benefits committee must work together to find the best plan that will minimize increases in employee premiums and out-of pocket expenses.

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Benefits Committee

• CWA: Steve Sarnoff, Steve Finney, Mike Head, Matt McCombs, Roberta Gluski, Alternates: Phil Hughes & Todd Voigt

• FOP Officers: Jonathan Walser, Christopher Precious • FOP Supervisors: Sgt. Joel Morley • IAFF: Lt. John Klinefelter; Matt Schad • SAMP: Susan Chase; Sandy Clayton; Jim Donnelly (Newly

added SAMP 4-6 Rep); Jay Ravins (Mgt.)

• Retirees: Karen Dombrowski (contact info on www.myclearwater.com)

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Insurance Renewal Background

• For 2015, the City was faced with an increase of almost 2 million dollars to keep the current OAP plan.   Since the City currently pays 100% for employee only coverage; 75% for employee plus 1 and 68% for employee plus family, a 2 million dollar increase to keep the current plan would not be financially feasible.  It would have also been an approximate 12% increase to the employee premiums, which the benefits committee thought was too much of an increase for their members. 

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Insurance Renewal Background

• Cigna gave us a proposal for a new network that would increase costs for the City by approximately $900,000 and for employees by only $130,000.  This new “Local Plus Network” is a network of Cigna’s highest performing doctors. This was the most affordable option and although it may result in employees having to change physicians, it still offers a network of qualified physicians, Cigna’s most qualified physicians, as an alternative without changing the schedule of benefits.

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Insurance Renewal Background

• Cigna provided the Benefits Committee a “disruption report” encompassing the physicians that our employees used between August 2013 and August 2014 and Local Plus Network has a 90% match to the doctors that were utilized during that time frame.

• Based on the affordable cost and no changes to the current schedule of benefits, the benefits committee voted unanimously for the Local Plus Network.

• Human Resources staff is not a voting member of the benefits committee and we are simply here to make sure we educate you on the benefits being offered in 2015.

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Facts to consider:

• The Health Center is helping! Since 2009, primary care visit claims through Cigna 50%, which means those claims have shifted from Cigna to the health center.

• Last year, catastrophic claims (any claim over $50,000) 21%. These conditions cannot be treated or prevented at the Health Center, but the Health Center can facilitate early detection. (average claim was approximately $125,000). It’s a balancing act: Similar to car insurance…you have claims, you pay more. (on top of normal inflation).

• 2 million dollar increase to keep the same plan with no changes. Benefits Committee also reviewed a zero increase plan, but the copays/coinsurance/deductibles increased drastically. 7

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Benefits Committee unanimously voted to:

Continue self-funding and remain with Cigna.Continue self-funding and remain with Cigna.

Adopt new “Local Plus Network” with 6% Adopt new “Local Plus Network” with 6% increase, rather than a 12% increase to increase, rather than a 12% increase to remain with OAP plan.remain with OAP plan.

Keep same schedule of benefits as 2014. Keep same schedule of benefits as 2014.

Same premiums for PHA and Base options, Same premiums for PHA and Base options, difference is in schedule of benefitsdifference is in schedule of benefits..

Local Plus Network –What does it mean?

Network of highest performing doctors throughout the US, who have proven results proven results in quality, care and cost-efficiencyin quality, care and cost-efficiency.

Local Plus Network has a 90% match to the Local Plus Network has a 90% match to the doctors being utilized in our current plan.doctors being utilized in our current plan.

Primary care and Specialists are subjected to Primary care and Specialists are subjected to the Local Plus directory; hospitals and the Local Plus directory; hospitals and ancillaries (such as free standing radiology, ancillaries (such as free standing radiology, surgery centers, dialysis centers, etc) are surgery centers, dialysis centers, etc) are not; employees can use any hospital or not; employees can use any hospital or ancillary that accept Cigna OAP.ancillary that accept Cigna OAP.

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Local Plus Network –What does it mean?

Employees can access the Local Plus Network in any area in the country where one exists.

In service areas where the Local Plus Network is not available, employees can access doctor’s and hospitals in the Open Access Plus Network and receive coverage at the in-network benefit.

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Open Enrollment 2015

• Open Enrollment: Oct 29th to Nov. 26, 2014.

• Benefit Plan Year: Jan. 1 to Dec. 31, 2015.

• During Open Enrollment, you may change plans, add/drop dependents, elect FSA, and enroll/drop other benefits.

• Changes are not allowed after the Open Enrollment period unless you experience an eligible qualifying event. (Examples on page 4)

• Effective date of changes made during open enrollment is Jan. 1, 2015.

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Employee Benefit Highlights Handbook

• Available in hardcopy as well as electronically on the city’s Intranet site.

• Handbook contents: o Carrier and Benefits Administrator contact informationo Qualifying event and dependent eligibility guidelineso Available benefitso Rates for premium payroll deductions

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City Premium Payment Plan – page 4

• As an employee, you are automatically enrolled in the City IRS Section 125 qualified Premium Payment Plan when you elect eligible benefits such as medical, dental, vision and supplemental insurance.

• Premiums are deducted pre-tax from your paycheck.

• Changes to elections may not be made outside of open enrollment except for qualifying events.

• Qualifying events are listed on page 4 in the Employee Benefit Highlights Booklet.

• Exception: Domestic Partners are a post tax deduction as they do not qualify under the Section 125 plan.

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Medical Insurance for 2015 pages 5-7

• Same two Cigna plan options, a “Base” plan and a “PHA” plan.

• The plan you are enrolled in will depend on whether or not you have completed 2 Health Assessments. One biometric PHA with the Health Center Staff and the Cigna online Health Assessment. Both must be complete between January 1, 2014 and November 26, 2014.

• The rates will be the same for both plan options, the difference will be in the schedule of benefits.

• The PHA plan will have lower deductibles, out-of-pocket limits, co-insurance, and office visit co-payments.

• See pages 5-7 in the Employee Benefit Highlights Booklet.

How to complete the Personal Health Assessments?

Requirement #1 Cigna online Health Assessment:

• Go to www.mycigna.com and take the online health assessment. HR Staff assisting at all PHA onsite locations.

Requirement # 2 Person Health Assessment Biometric Screening

• Make an appointment online at www.careatc.com . Dedicated PHA appointments from 7:00 a.m. to 10:00 a.m. daily at the EHC.

• CareATC staff will be onsite from 7:00 a.m. to 10:00 a.m. at various departments during the month of November. See the schedule of locations on the City intranet.

Medical Insurance

Cigna OAP Base plan

You will be enrolled in this plan if you have not completed both Personal Health Assessments, one through the City’s Employee Health Center staff and the other through www.mycigna.com (Cigna online health assessment) between January 1, 2014 and November 26, 2014.

Cigna OAP PHA plan

To be enrolled in this plan, you must have completed both Personal Health Assessments, one through the City’s Employee Health Center staff and the other through www.mycigna.com (Cigna online health assessment) between January 1, 2014 and November 26, 2014.

Medical Insurance

Summary of Differences

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Possible Incentive!

• Potential Shared Savings Incentive: Cigna projects 6% Potential Shared Savings Incentive: Cigna projects 6% savings from moving to the Local Plus Network Plan. savings from moving to the Local Plus Network Plan. Any savings will be shared with the employees who Any savings will be shared with the employees who complete complete bothboth the PHA and Cigna’s online Health the PHA and Cigna’s online Health Assessment. 50% of savings will be placed in an HRA at Assessment. 50% of savings will be placed in an HRA at the end of 2015 and the other 50% will be used to the end of 2015 and the other 50% will be used to possibly fund another HRA in 2016.possibly fund another HRA in 2016.

Surplus Range HRA Account Funding1.25% - 2.24% ________$1002.25% - 3.49% ________$2003.5% - 4.49% ________$3004.5% - 5.99% ________$400>6% ___$500

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SAME outline of benefits as 2014:

• $500 inpatient ($300 outpatient) hospital admission charge, then subject to deductible and applicable co-insurance.

• Advanced imaging services (MRI, CAT/PET scans) at hospital-affiliated facilities subject to deductible and applicable co-insurance; no charge for advanced imaging at freestanding facilities (West Coast, Rose, etc.).

• $150 co-payment per visit for emergency room services and $75 co-payment per visit for urgent care services.

• Out of network benefit available if you don’t want to use the Local Plus Network.

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Medical Insurance

SAME outline of benefits as 2014

• Prescription co-payments of $30 for generic, $40 for preferred brand, and $60 for non-preferred brand (30 day retail); mail order (90-day supply) at 2X the 30-day copayment.

• No charge for Preventive Care after PCP or Specialist office visit co-payment (well-person exams, inoculations, colonoscopy, mammogram, etc.)

• Hospitals and Ancillaries (such as free standing radiology, surgery centers, dialysis centers, etc) are all included and not subjected to Local Plus directory. As long as they take Cigna OAP, they are in network. Pharmacy is not affected by Local Plus either.

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Medical Insurance

Medical Insurance

How the Deductible and Co-Insurance Works• For services requiring a co-payment, you pay only the

amount of the co-payment each time you receive the service.• For services requiring co-insurance, you pay the full cost of

services up to the deductible amount, and you then pay a percentage of the remaining cost of services up to your out-of-pocket limit.

• Once you reach your out-of-pocket limit, the plan pays the full cost of any services.

• Only services requiring co-insurance go toward satisfying the deductible. All services, including co-payments and co-insurance, will go toward satisfying the out-of-pocket limit. Prescription Drugs now go towards the OOP max.

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Medical Insurance

• The city continues to subsidize coverage for the Base and PHA plans at 100 percent of the cost for employee-only, 75 percent of the cost for employee plus one dependent, and 68 percent of the cost for employee plus family.

• There will be an increase of 6% in premiums. Rates are on page 7 of the employee benefits highlights book.

• Employee +1 increased $6.91 per pay

• Employee + family increased $14.96 per pay

• Retiree only increased $30.65 per month

• Retiree + 1 increased $55.47 per month

• Retiree + family increased $93.66 per month22

Cigna On-site Representative

Stacy Lambert Stacy.lambert@myclearwater.com

Municipal Services BuildingThird Floor

• Hours:Monday and Wednesday 8:30 a.m. – 5:00 p.m.Tuesday, Thursday & Friday 8:00 a.m. – 4:30 p.m.

• Direct phone # (727) 562-4503

City Employee Health Center – Page 8

• Must be enrolled in city’s medical insurance to be eligible - no other requirement.

• Completely confidential.

• Three physicians and four medical assistants on staff.

• No cost for ANY services:o Primary and urgent care office visito Labso Radiologyo Prescription drugs• All services must be authorized by an EHC physician.• See page 8 of Employee Benefit Highlights handbook.

Employee Assistance Program- Page 9

EAP and Mental Health/Chemical Dependency Coverage

• MHNet is now known as Resources for Living.

• Resources for Living will continue to administer our EAP Services.

• EAP can help to resolve issues with family, personal, financial, marital, job, and substance abuse.

• Mental health/chemical dependency benefit will be offered through the Cigna medical plan, but will maintain the $10 co-pay.

Employee Assistance Program

• Entitled to five free EAP visits annually.

• $10 per visit co-pay after five visits or if diagnosed.

• No limit to the number of visits.

• Co-pays for services go toward satisfying Cigna Out-of-Pocket Maximum.

• National network of providers.• See page 9 of Employee Benefit Highlights handbook.

Dental & Vision Insurance – Page 10-12

• Assurant and Humana remain as 2015 dental providers o No plan changeso No premium increases

• Humana Vision benefit remains the same for 2015o No plan changeso No premium increase

See pages 10-12 of Employee Benefit Highlights handbook

Supplemental Insurance

• Administered by Aflac• Hospital Confinement Indemnity

• Group Accident

• Dental

• Disability

• Critical Care

• Cancer

• You must meet with an Aflac representative to add, drop, or make changes to Aflac insurance elections.

• See pages 13-14 of Employee Benefit Highlights handbook

Flexible Spending Accounts

• Administered by Aflac through WageWorks.

• Flexible Spending Account limits will be $2,550 (increased) for unreimbursed medical and $5,000 for dependent care.

• A debit card will be issued for FSAs – no need to submit forms for reimbursement. If you did not keep your FSA debit card, you can request a new one online through the EBC.

• FSA requires a new online enrollment each year!• See pages 15-16 of Employee Benefit Highlights handbook.

Dependent Eligibility – Page 3

• An eligible dependent is defined as your legal spouse, domestic partner or dependent child of you or your spouse/domestic partner: o Natural child, stepchild, legally adopted child, foster

child, or a child for whom legal guardianship has been awarded to you or your spouse/domestic partner.

• Documentation verifying dependent eligibility will be required from all employees covering a dependent that was not covered in 2014.

• Documentation examples include marriage certificate, affidavit for domestic partnership, birth certificate, guardianship court order.

Dependent Eligibility – Page 3

• Medical coverage for eligible dependents is provided to the end of the calendar year in which the child turns age 26. Dental and vision coverage is provided through the end of the month in which the child turns age 26.

• Dependent children may continue to be covered for Medical only from age 27 to the end of the calendar year in which the child reaches age 30 if they meet the following criteria: o Unmarried with no dependents

ANDo A Florida resident OR full-time or part-time student

ANDo Otherwise uninsured and not entitled to Medicare

Domestic Partner Benefits

• A domestic partner and any eligible dependent(s) will be provided the same benefits afforded to all employees or retirees and their eligible dependents excluding Aflac & FMLA.

• Must meet all eligibility requirements listed in policy and provide proof of eligibility.

• Must submit affidavit of domestic partnership.

• The City will subsidize the premium cost consistent with the same subsidies afforded to all eligible employees.  Retiree’s medical premium costs are not subsidized.

• Premium deductions will be post-tax. 32

BENTEK-Employee Benefits Center

• Open enrollment is available 24 hours/7 days a week through the online Employee Benefits Center – no forms.

• Go to www.mybentek.com/clearwater

• Enter your username and password. (forgot username/forgot password links available).

• Bentek Contact information located on the inside cover of Employee Benefits Highlights Book.

• Here you can:• Make changes to current benefits

• Add or remove dependents

• Enroll or re-enroll in FSA

• Update beneficiaries

• Your medical insurance election will be defaulted to the BASE plan with the tier of coverage (employee only, employee plus one, or employee plus family) that you have elected for the current plan year. You are not required to go into Bentek unless you are:

– changing your tier of coverage– opting out of the city’s insurance and were insured in 2014– Enrolling or re-enrolling in FSA

• Once open enrollment is over, all those who have completed both PHAs will be automatically placed in the PHA plan.

• If waiving medical insurance coverage, you must provide proof of other coverage for yourself only and complete a waiver form.

Tips for a Successful Online Open Enrollment

• You must meet with an Aflac representative if you are adding, dropping, or making changes to your supplemental insurance elections.

• If you made changes, you must hit “submit” on the final page. If you exit before clicking “SUBMIT,” your changes will not be saved.

• After you submit your elections, you can print a confirmation but one will be provided to you by Human Resources at the end of open enrollment.

Tips for a Successful Online Open Enrollment

Thank You!

Don’t Forget ….

All election changes must be completed onlineno later than 11:59pm on November 26,2014.

www.mybentek.com/clearwater

BOTH PHAs must have been completed between January 1, 2014 and November 26, 2014

to qualify for the PHA Plan.www.careatc.com or 800-993-8244

www.mycigna.com