RISK MANAGEMENT & INSURANCEOCTOBER, 2015

BENEFLEX 2016

ANNUAL ENROLLMENT

Annual Enrollment

2016 Health Renewal

Terms and Definitions

Humana Health Plan Changes

Rx4 Traditional Prescription Plan

2016 Health Payroll Deductions

Humana Vitality

Dental Plan Rate Changes2

Eye Med Vision Changes

Short and Long Term Disability

Flexible Spending Accounts (FSA)

Humana Resources

Reminders

Questions & Answers

AGENDA

Annual Enrollment

October 14 thru October 26, 2015

Coverage Begins: January 1, 2016

Deductions begin: 12/4/15 – Support 12/11/15 – Instructional/Administrative/PTS

2016 Flexible Spending Account and MetLife Legal deductions begin: 1/15/16 - Support 1/8/16 -Instructional/Administrative/PTS

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2016 Health RenewalProposed 2016 health renewal was 9.3% over 2015

plan costs. After plan design changes , the increase was reduced to 6.5%

Projected 2016 premium is $121M; which equates to a $7.4M premium increase

Overall the District will pay approximately 76% of the overall costs-

New Humana Vitality Program can help offset the increase in costs if members reach Silver Status or above

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Terms and Definitions

Co-payment - the specified dollar amount that the member must pay for a covered service. You will pay co-payments for services under the HMO Staff plan.

Co-insurance - the % amount of a covered service that the member must pay. Example: An 80%/20% coinsurance means that Humana will pay 80% of the allowable charge and the member will pay 20%.

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Terms and Definitions

Deductible - the amount of covered services that the member must pay per year before Humana pays benefits for covered services.

Medical Out-of-pocket limit - the most a member would have to pay per calendar year before Humana pays 100% of the in network cost. Excludes Rx costs.

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Terms and Definitions

DEDUCTIBLEYou pay 100% of

the cost up to the amount of the

deductible*

CO-INSURANCEYou pay 20% of

the cost up to the out of pocket

limit

OUT OF POCKET LIMIT

Humana pays 100% of the costs

after the costs reach $4000 for an individual,

$8000 for a family

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*All individual deductible amounts will count toward the family deductible, but an individual will not have to pay more than the individual deductible amount.

HMO Staff

Very Narrow Primary Care Physician Network – Tampa Bay area only

No Out-of-Network Benefit except for emergencies

Referrals to Specialists limited by PCP Choice

Co-pays for all services; preventive services covered at 100%

Hospital co-pay: $500 per day, 5 day maximum

Increased Co-pays:

Emergency Room Co-pay from $300 to $500

Lab Co-pay from $0 to $25**or less if actual cost is less than the co-pay

Durable Medical Equipment: from $0 to $50

Out of Pocket Maximumfrom $3,500 to $4000(individual)from $7,000 to $8,000 (family) 

KEY FEATURES CHANGES

Please confirm PCP participation with Humana customer service or online – NOT the doctor’s office!

National Point of Service Plan (NPOS)

Broad National Point of Service (NPOS) network – open access

No specialist referrals

In Network and Out of Network Benefits

Preventive services covered at 100%

Hospital co-pay: $500 per day, 5 day maximum

80%/20% coinsurance for physician visits, outpatient services, lab and x-rays after deductible

Deductiblefrom $300 to $400 (individual)from $600 to $800 (family)

Out of Pocket Maximumfrom $3,500 to $4000(individual)from $7,000 to $8,000 (family) 

KEY FEATURES CHANGES

Good option for out of area retirees and students!

Consumer Directed Health Plan (CDHP)

HMO Premier Network – larger Tampa Bay network than the Staff HMO network

Network includes: Several Florida counties and a limited number of states outside Florida

NO out of network benefits

Preventive services covered at 100%

80%/20% coinsurance for physician visits, outpatient services, lab and x-rays, after deductible

Deductible $1500 (individual) $3000 (family)

Personal Care Allowance (PCA) $500 (individual) $1000 (family)

Rollover feature, however if you move to another plan any remaining PCA funds will be forfeited.

 

KEY FEATURES KEY FEATURES

Out of Pocket Maximumfrom $3,500 to $4000(individual)from $7,000 to $8,000 (family)

CHANGES

Which Health Plan is Right for You?

HMO CDHPNPOSMust stay in Network

Must Select a PCP

No Deductible - set co-pays for all services

Limited coverage area

Must get a referral to see a specialist

Must stay in Network

Not required to select a PCP

No referrals necessary

Must meet a deductible

Healthcare allowance provided

Not required to stay in Network

Not required to select a PCP

No referrals necessary

Must meet a deductible

Pinellas County Schools health insurance coverage meets the standard for minimum essential coverage and is considered affordable under the Affordable Care Act.

Benefit eligible employees who enroll in the Marketplace plans would not be eligible for Advanced Premium Tax Credits (tax subsidy) and would not receive premium assistance.

PCS COVERAGE VS. THE HEALTHCARE MARKETPLACE

Pharmacy BenefitsRx4 Traditional replaces Rx3

RightSource Rx is now Humana Pharmacy

Pay two co-pays for a 90 day supply at a participating pharmacy or mail order through Humana Pharmacy (after deductible on Tier 3 & Tier 4 medications).

Tier/Plan Consumer Directed Health

Plan

Staff HMO National Point of Service (NPOS)

Employee $30 to $53 $48 to $71 $63 to $80

Employee + Spouse

$120 to $159 $158 to $195 $182 to $213

Employee + Child/Children

$115 to $146 $151 to $182 $175 to $200

Family $178 to $215 $230 to $266 $262 to $302

2 Board Family $85 to $120 $137 to $171 $169 to $207

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2016 Health Plan Deductions

Humana Vitality is a wellness and rewards program for employees enrolled in a Humana health plan that gives its members an opportunity to: Set goals – create a personalized plan!Earn Vitality Points™ and shop at the Vitality Mall with Vitality

Bucks!Learn the value of making healthy choices to experience

personal results!

Employees reaching Silver Status or above by June 30, 2016, will be eligible for a premium credit during 2016 AND 2017!

Employee Only              $10 credit per pay period   Employee + Spouse      $15 credit per pay period  Employee + Child/ren   $15 credit per pay period  Employee + Family        $20 credit per pay period

Better health, great rewards-it's all part of Humana Vitality!

Dental Plans/Rate Changes

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Humana Comp Benefits

Employee Only $7.45 per pay

Employee + 1 $13.74 per pay

Employee + Family $20.07 per pay

2 Board Family $18.07 per pay

No plan design changes

Preventive services covered 100%

In-network benefits only

Co-pays for services

Met Life Dental

Employee Only $13.36 per pay

Employee + 1 $24.64 per pay

Employee + Family $35.56 per pay

2 Board Family $33.56 per pay

No plan design changes

Preventative services covered

100%

In-network and out-of-network

benefits

Reimbursement based upon

services (negotiated rates)

Eye Med Vision Plan

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KEY FEATURES CHANGES

Free coverage for employee only May purchase coverage for dependents Routine eye exam once every calendar year - $10 co-pay Single vision lenses OR contact lenses once every calendar year

Frames once every two years National retail and private practice optometrists & ophthalmologists

Standard plastic lens co-pay from $10 to $15

Contact lens allowancefrom $90 to $11020% of balance over $110

Frame allowancefrom $90 to $110

RATES Employee Only Free Employee + 1 $2.83 Employee + Family $5.92

Short Term/Long Term Disability

Rate Decreases

No plan design changes

One time open enrollmentNo medical underwriting

Salary limitations and preexisting conditions apply

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Flexible Spending Accounts (FSA)

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A Health Care FSA could save you money if you or your dependents:

Have out of pocket health expenses like co-pays or deductibles

Take Tier 3 or Tier 4 prescription medications and have an Rx deductible

Wear glasses or contact lenses

Need orthodontia care, such as braces or other eligible dental expense

A Dependent Care FSA provides pre-tax reimbursement of out of pocket expenses related to dependent care, if you and your spouse are working or in school and:

Your dependent children under age 13 attend daycare, after-school care or summer day camp

Flexible Spending Accounts (FSA)

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You decide how much to contribute:

Health Care FSA: $200 - $2500

Dependent Day Care FSA: $200 - $5000

Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31.

Receive a debit card – for Health Care Expenses. Not for Dependent Day Care.

Funds available for Health Care expenses on January 1, 2016

Look for Humana Access Visa cards last week in December (plain envelope)

What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana:

1. Visit www.MyHumana.com2. Have your Humana ID card

handy3. Go to Humana.com4. Click “Register for

MyHumana”5. Follow the easy steps to

register

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24 Hour Humana Online Resources

Humana PCS Resources

Heather Keegan, RN – Patient AdvocateAssists employees with medical and provider issues. Coordinated Diabetes Care Program. Advocates for employees.

Jessica O’Connell, RN – Health & Wellness SpecialistFacilities wellness and health education programs, enrolls members in disease management, clinical programs and Humana Vitality.

Janet Lang - On Site Claims RepresentativeAssists employees with eligibility, claims and coverage issues.

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RemindersChanges through Web only October 14 - 26th

Confirmation notices available on line for employees to print

Review health plan options and new Rx4 Traditional plan

Review new rates for dental plans

Review new rates and plan changes for vision

Review special disability open enrollment, reduced rates

Make sure your life insurance beneficiaries are current

Make sure you have enrolled only eligible dependents

Humana will mail everyone new ID Cards. Make sure your address on Employee Self Service is correct

Enroll in MyHumana so that you can participate in the Humana Vitality Program

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QuestionsVisit our web site for current information, including full Beneflex Guide, Understanding your Rx4 Traditional plan, CDHP & FSA flyers at:www.pcsb.org/annual-enrollment

Call the Humana Hot Line:888-393-6765, 8:00 am – 8:00 pm, Monday thru Friday.

Call the PCS Benefits Help Line for enrollment assistance 588-6197, 8:00 am – 4:30 pm, Monday thru Friday.

Email us at houckc@pcsb.org

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