state of colorado benefits coverage dates july 1, 2015 – june 30, 2016
TRANSCRIPT
State of Colorado Benefits
Coverage Dates
July 1, 2015 – June 30, 2016
Open Enrollment Dates
April 14, 2015 – May 14, 2015
Topics for Discussion
Mandatory Enrollment Eligibility Premiums Medical Plan Overview and Changes Dental Plan Overview Basic Life Insurance Optional Life Insurance Short- and Long-Term Disability Health Savings Accounts Flexible Spending Accounts Voluntary Retirement Plans
On-line Enrollment
MANDATORY PARTICIPATION! You may add/drop/change plans, add/drop dependent(s),
or enroll in or continue a flexible spending plan(s) or make changes to Optional Life
If you do not wish to participate in one or more plans you still must “Waive Coverage” in Benefitsolver
All enrollments/changes must be done through the State’s online benefits administration system: www.benefitsolver.com
Please take this opportunity to review your plans, qualified dependents, and beneficiaries!
Access is available from work, home, or HR if assistance is needed
Qualifying Events
A qualifying event is an IRS approved change in status which allows a change in benefits outside the open enrollment period
Typical qualifying events are birth of a child, marriage, divorce, and loss of coverage
The change in definition of a dependent will mean that qualifying events will be very limited. (2011) Marriage of a child will no longer be a qualifying event Change in the child’s financial dependence will no longer
be a qualifying event Change in residence will no longer be a qualifying event
Qualifying events must be processed in Benefitsolver within 31 days of the event. Contact HR for assistance
EligibilityDependents
Requirements as of 07/01/2011 Spouse (same or opposite sex), common-law
spouse, SGDP or civil union partner An employee’s, spouse’s, SGDP or civil union
partner’s children through the month in which they turn 26
Marital status, financial status, dependent status, or place of residence do not affect children’s eligibility
EligibilitySame Gender Domestic Partners Effective July 1, 2010, same gender domestic
partners and dependents of same gender domestic partners are eligible for Medical and Dental Insurance, Optional Life Insurance, Health Care Flexible Spending, and Dependent Care Flexible Spending.
Definition-Same Gender Domestic Partner (SGDP) Must be at least 18 years of age Same gender as the employee Shared an exclusive relationship with the employee for
a minimum of one year with the intent for the relationship to last indefinitely.
Not married to another person Check with the Benefits Office for documentation
requirements
EligibilityCivil Union Partners Civil Union Partners and dependents of civil
union partners are eligible for Medical and Dental Insurance, Optional Life Insurance, Health Care Flexible Spending, and Dependent Care Flexible Spending.
Documentation Requirement
Proper documentation will be required for any spouses, common-law spouses, SGDPs, or dependents added during open enrollment.
Documents include signed affidavits with supporting documentation for common law marriage and Same Gender Domestic Partnerships
Spouses and dependents will require birth and marriage certificates
Proof of marital status is also required A full listing of requirements is available on the
State’s benefits web page Documentation must be provided to the CSM HR
Office or DPA Benefits Office
Patient Protection andAffordable Care Act The State of Colorado medical plans meet the
minimum essential coverage and affordability standards set by the ACA
Remember, most individuals will need to have health insurance in 2015 or face a possible financial penalty.
For more information: www.healthcare.gov
PlanDefinitions HMO means Health Maintenance Organization (Closed
Network) HDHP means High Deductible Health PlanHDHP means High Deductible Health Plan PPO is a Preferred Provider OrganizationPPO is a Preferred Provider Organization HSA is a Health Savings AccountHSA is a Health Savings Account FSA is a Medical or Dependent Care Flexible Spending FSA is a Medical or Dependent Care Flexible Spending
AccountAccount Deductible is the amount paid out-of-pocket before Deductible is the amount paid out-of-pocket before
benefits become payable. However, you may have benefits become payable. However, you may have access to co-payment based services without satisfying access to co-payment based services without satisfying the deductiblethe deductible
EOI is Evidence of Insurability (Medical Questionnaire)EOI is Evidence of Insurability (Medical Questionnaire) UHC is United HealthcareUHC is United Healthcare
PlanDefinitions Co-insurance is a percentage amount paid for Co-insurance is a percentage amount paid for
services. For instance if your co-insurance is 10% the services. For instance if your co-insurance is 10% the insurance company pays 90% of the bill and you pay insurance company pays 90% of the bill and you pay 10%. Co-insurance payments normally count toward 10%. Co-insurance payments normally count toward your deductibleyour deductible
Co-pay is a flat dollar amount paid for services Co-pay is a flat dollar amount paid for services regardless of the cost of those services. For instance regardless of the cost of those services. For instance $30 co-pay for an office visit. Co-payments do not $30 co-pay for an office visit. Co-payments do not usually apply to the deductibleusually apply to the deductible
Out-of-Pocket Maximum (OPM) The most you will Out-of-Pocket Maximum (OPM) The most you will pay for covered services. Once you reach the OPM pay for covered services. Once you reach the OPM the plan will pick up 100% of the coststhe plan will pick up 100% of the costs
Premiums
Employee contributions for medical have increased or decreased depending on the plan.
The State contributions towards medical insurance has increased
Employee and State contributions for dental insurance have remained the same
Optional Life insurance rates remain the same
Long Term Disability rates have changed
Co-Pay PlansRules of the Road The State of Colorado has two co-pay based plans. The
Co-Pay Choice Plus (UHC) and the Kaiser DHMO Deductibles can be met on an individual basis You do not need to meet the deductible to use the co-pay
based services such as office visits or pharmacy services Co-pays do not count toward meeting your deductible Some services under these plans require co-insurance Co-insurance generally does count toward your deductible Most co-pays and co-insurance count toward your OPM
State of Colorado PPO (UHC)Co-pay Choice Plus
In-Network Out-of-Network
Deductibles•Employee•Family
$1,500$3,000
$3,000$6,000
Out-of Pocket Max•Employee •Family
$5,000$10,000
$10,000$20,000
Preventive Care $0 50%
Primary Care Office $30 50%
Specialist Office $50 50%
Emergency Room $500 $500
Out-Patient Surgery 20% + Deductible 50%
In-Patient Hospital $1,000 co-pay + 20%No Deductible
50%
Pharmacy – 30 Day $10/$30/$50 $10/$30/$50
Mail Order – 90 Day $25/$75/$125 Not Covered
KaiserDHMO
In-Network Out-of-Network
Deductibles•Employee•Family
$750$1,500
n/a
Out-of Pocket Max•Employee •Family
$2,000$4,000
n/a
Preventive Care $0 Not Covered
Primary Care Office $30 + 10% (services) Not Covered
Specialist Office $50 + 10% (services) Not Covered
Emergency Room $500 $500
Out-Patient Surgery 10% + Deductible Not Covered
In-Patient Hospital 10% + Deductible Not Covered
Pharmacy – 30 Day $10/$30 Not Covered
Mail Order – 90 Day $20/$60 Not Covered
High Deductible Health PlansRules of the Road The State offers two HDHP plans one administered
through UHC and one insured through Kaiser You must satisfy the entire deductible before the plan
pays for any services including pharmacy Services with the exception of pharmacy are based
on co-insurance Co-insurance generally counts toward your
deductible Most co-pays and co-insurance count toward your
OPM
State of Colorado (UHC)High Deductible Health Plan
In-Network Out-of-Network
Deductibles•Employee•Family
$1,500$3,000
$4,500$9,000
Out-of Pocket Max•Employee •Family
$3,000$6,000
$9,000$18,000
Preventive Care $0 50%
Primary Care Office 20% + Deductible 50%
Specialist Office 20% + Deductible 50%
Emergency Room 20% + Deductible $500
Out-Patient Surgery 20% + Deductible 50%
In-Patient Hospital 20% + Deductible 50%
Pharmacy – 30 Day $10/$30/$50 + Deductible $10/$30/$50 + Deductible
Mail Order – 90 Day $25/$75/$125 + Deductible Not Covered
KaiserHigh Deductible Health Plan
In-Network Out-of-Network
Deductibles•Employee•Family
$1,500$3,000
$3,000$6,000
Out-of Pocket Max•Employee •Family
$2,000$4,000
$4,000$8,000
Preventive Care $0 Not Covered
Primary Care Office 10% + Deductible Not Covered
Specialist Office 10% + Deductible Not Covered
Emergency Room 10% + Deductible 10% + Deductible
Out-Patient Surgery 10% + Deductible Not Covered
In-Patient Hospital 10% + Deductible Not Covered
Pharmacy – 30 Day $10/$30 + Deductible Not Covered
Mail Order – 90 Day $25/$75 + Deductible Not Covered
United Healthcare andPaladina Health Available to employees and family members enrolled in the United
Healthcare Co-Pay Choice Plus or HDHP Plans Primary Care Clinics: 9 locations including 6 in the Denver Metro Area Same and next day urgent appointments No co-pay charge for Co-Pay Choice Plus members No co-insurance for HDHP members once the deductible is satisfied Many services and labs can be preformed on site Certain prescriptions can be filled in office at a lower cost than through
a pharmacy 24/7 access to your personal physician via their personal cell phone State of Colorado pays the membership fees You must register at www.paladeniahealth.com/colorado or by calling
1-866-808-6005
Vision Benefits
Vision Care Exam Vision exams are covered through medical
insurance and may be subject to deductibles, co-pays, or co-insurance. Contact lens exams are normally subject to additional charges
Hardware UHC Plans: $25 materials co-pay plus $130 frames
allowance every two years. Contact Lenses $150 every two year. Must use in-network provider
Kaiser: $150 every two years (Kaiser Optical Department)
United Healthcare
www.myuhc.com – UHC Members Website Online Health Assessment Health Discount Program
Allows members to enjoy a 10%-50% discount on qualifying health and wellness purchases
24 Hour NurseLine Services Health and Wellness programs including healthy
pregnancy, weight management, healthy back programs, and more
Online treatment cost estimator Quicken Health Expense Tracker www.welcometouhc.com/colorado - UHC Non-Member
website Paladina Health www.paladinahealth.com/colorado or 1-
866-808-6005
Kaiser
www.kp.org – Kaiser Members Website My Health Manager
Request/View appointments Refill prescriptions View and learn about test results Communicate via secure email with your health care
providers! Complete a personal health assessment Estimated service costs Online programs for weight-loss, fitness, nutrition, and
more Information about medical conditions and prescription
drugs
Making A ChoiceThings to Consider What types of services do you normally use? Office visits, a couple of
E.R. visits a year or just preventive care? Do you have major surgery planned in the next year? What is your risk tolerance? Remember you have an Out-of-Pocket Maximum. HDHP plans may
have a lower OPM Look at the difference in the cost of premiums. Not just for a single
month but over the course of a year Would you have funds available to cover the deductible if needed on
a HDHP? Could you contribute to an HSA or Flex account to cover deductibles? Consider using United Healthcare and Kaiser’s online tools to
estimate expenses for particular services. Look at your current EOB’s (if available) for the cost of frequent services
BenefitsolverMyChoice When you start the Open Enrollment process in
Benefitsolver you will have an option to click on the MyChoice tool
MyChoice will ask you a series of questions related to your health and your family member’s health if applicable
Using this information it will make plan recommendations for you
You must still select a plan and enroll. You don’t have to choose the MyChoice recommendation
Medical InsuranceSupplement Program A program designed to offer financial assistance in
covering medical premium costs for low-income state employees with at least one eligible child
Must have a 2014 calendar year household income three time (3x) or less of the federal poverty level
Complete details and tables available on the State of Colorado’s Employee Benefits web page
All applications must be filed online (State’s website) and completed by May 14th
Contact Human Resources if you need assistance scanning documentation or with the application process
Dental Plan Highlights
Basic and Basic Plus Plans Composite fillings (white fillings) are now covered for
all teeth (2011) Necessary dental implants are now covered (2012) Members with certain health conditions are eligible for
cleanings up to 4 times per year if deemed necessary. Conditions include pregnancy, cardiovascular disease, diabetes, kidney failure, and suppressed immune system. Verification of a covered condition from a physician will need to be on file with the dental office.
Dental Plan Highlights
Basic and Basic Plus Plans Delta Premier Dentists are now considered In-
network (2012) No balance billing when using a Premier Dentist If you are currently using a Premier Dentist you
should see your costs decrease Premier dentists have a higher contract rate than
PPO dentists. If co-insurance applies it is still usually less expensive to use a Delta PPO Dentist
Dental Plans
Both the Basic and Basic Plus plans cover in-network preventive care twice a year at no charge
Reminder! Preventive care costs will no longer count toward the annual maximum benefit!
Basic Maximum $1000 annual benefit per person Deductible $50 Employee / $150 Family
Basic Plus Maximum $2000 annual benefit per person Additional Orthodontia benefit Deductible $50 Employee / $150 Family
For the greatest cost savings use a Delta PPO dentist
Delta DentalEyeMed Vision Care Discount Program
Available for employees and dependents enrolled in a Delta Dental Plan
Offers discount exams and hardware through designated providers
www.eyemedvisioncare.com/deltadental 1-866-246-9041
Basic Life
New! Coverage is 1x base salary or $50,000 whichever is greater
Mines will continue to pay this premium You are encouraged to check your
beneficiaries
Optional Life
Optional Life is available for employees, spouses, and same gender domestic partners through Minnesota Life Employees are eligible for up to $500,000 in increments of
$10,000 Spouses and same gender domestic partners are eligible for up
to 50% of the amount elected by the employee Different rates for employees and spouses Children are eligible for either $5,000 or $10,000 in coverage Employees, spouses, and SGDPs must complete the Evidence
of Insurability form and submit to Minnesota Life. Enrollment is now available year round Evidence of insurability is required if you are increasing your
elected amount or enrolling for the first time during O.E! Make sure to click on the Minnesota Life link during your Benefitsolver registration session to complete the EOI questionnaire
Optional LifeChild (Dependent) Life Child Life is available for dependent children and
dependent children of SGDPs Employee must be enrolled in Optional Life Dependents are only eligible for coverage through
the month in which they turn 26 All dependents are covered for one flat rate No evidence of insurability is required for children All children covered under Child Life must be listed
as dependents in Benefitsolver and enrolled under the dependent life plan
Life InsuranceAdditional Benefits Available to employees with Basic Life and/or
Optional Life insurance through Minnesota Life
Travel Assistance Helps coordinate care during medical
emergencies if you are more than 100 miles from home. Includes locating doctors offices, hospitals, replacement of lost/stolen prescriptions, eyeglasses, repatriation services, plus much more.
Not a substitution for medical/dental insurance
Life Insurance Additional Benefits Continued Will Preparation and Legal Services
Free 30 minute consultation with an attorney plus legal referrals
Create legally valid wills, financial power of attorney, and living wills online
Download legal forms Legal Information Library
Financial Counseling for Beneficiaries Receive free independent and objective financial
counseling Information on these services is available on the
Department of Personnel and Administration’s website
Short Term Disability
The State has a new disability insurance carrier, Unum
There are no changes to the Short-Term Disability plan (6 month coverage) and Mines continues to pay the full premium.
Long Term Disability
You insure your car and your house are you insuring your income?
New carrier, Unum During this Open Enrollment period only anyone can enroll in
LTD coverage. No evidence of insurability required! 3/12 exclusion period Individuals enrolled currently in The Standard’s policy will not
have an exclusion period and enrollment will transfer to Unum Rates have changed many people will pay less Reduced rates for vested employees More flexible than PERA’s definition of Disability Retirement
including long-term partial disability Exclusions and limitations apply
Health Savings Accounts (HSA)
Allows you to use pre-tax dollars to pay for qualified medical expenses as they occur or to save for qualified expenses in the future
Unused funds roll over from year to year To be eligible you must be enrolled in an HSA qualified
plan HDHP with HSA (United Healthcare) HMO High Deductible Health Plan (Kaiser)
Health Savings Accounts can be arranged through financial institutions including the Credit Union of Colorado
The School of Mines does not offer salary deduction for HSAs however, you may be able to direct part of your paycheck to your HSA account through direct deposit
Flexible Spending Accounts
Healthcare Flexible Spending allows you to deduct money on a pre-tax basis from your paycheck to pay for unreimbursed medical expenses such as deductibles, co-pays, eye glasses, and dental care
Dependent Care Flexible Spending allows you to deduct money on a pre-tax basis to pay for qualified child care expenses. This account does not cover medical expenses for children/dependents
Both plans lower your taxable income by the amount contributed to the plans!
Flexible Spending Accounts
The maximum contribution for the Healthcare Flexible Spending Account is $2,550
Remember, if your spouse is eligible for a flexible spending account through their employer, they may also be able to deduct up to $2,550
Flexible Spending Accounts
Important! You must re-enroll in flexible spending accounts each year during open enrollment
Healthcare FSA maximum annual contribution is $2,550
Dependent Care FSA (does not cover medical expenses) annual contribution is $5,000 per family
Money not used during the plan year is forfeited for the Dependent Care FSA and all but $500 for the Healthcare FSA (starting June 30, 2015)
Starting January 1, 2011, over the counter medications will not be reimbursable under flexible spending without a prescription
Flexible Spending Account
Starting June 30, 2015, you can rollover up to $500 in unused Healthcare Flex dollars into the next plan year
A Debit Card is available for Healthcare Flexible Spending Accounts! .50 cent charge per month deducted from your
flex account balance Eliminates the filing of most claim forms Does not relieve you of record keeping
responsibilities – Keep your Documentation!
Flexible Spending Account Changes A “Limited Purpose” Healthcare Flexible
Spending Account has been added (2014). Allows individuals contributing to a Health
Savings Account (HSA) to contribute to a Healthcare Flexible Spending account to cover dental and vision expenses
Voluntary Retirement Plans
It is never too early or late to start saving for retirement!
The School of Mines offers a variety of voluntary pre-tax retirement plans including:
The PERA 457 Deferred Compensation Plan The PERA 401(k) Plan The 403(b) plan which is available through four
vendors Pre-tax contributions do not lower your highest
average salary as calculated by PERA The Roth 403(b) (post-tax) plan which is available
through three vendors
Voluntary Retirement Plans
You may enroll in a voluntary retirement plan at any time
Contact Human Resources for plan information
Enrollment forms should be sent to the vendor
Contact Human Resources or Payroll for a salary deduction form
Enrollment Tips
All dependents in Benefitsolver will need to have a social security number listed as well as the tax dependent and full-time student fields filled in
If Benefitsolver is missing any of this information for existing dependents you will be required to complete it before moving forward
If you can’t remember your Benefitsolver user name and/or password click on “Forgot Password” and follow the recovery instructions. You must format the information exactly as shown. The company key is: soc
You will receive a confirmation number when your transaction is complete
If you are having difficulties with Benefitsolver please call the Benefits Office at (303) 273-3052 for assistance
Resources United Health Care
www.welcometouhc.com/colorado 1-877-283-5424
Kaiser Permanente www.kaiserpermanente.org 303-338-3800
Delta Dental www.deltadentalco.com 1-800-489-7168
Department of Personnel and Administration www.colorado.gov/dpa/dhr/benefits
CSM Human Resources (303) 273-3052