Open Enrollment 2015Non State Employee Health PlanWelcome to Open Enrollment for the State Employee Health Plan. We are glad you could attend this presentation to learn about your health plan offerings for Plan Year (PY) 2015.1Changes for PY 2015Plan B will no longer be offeredMembers will need to select Plan A or C for 2015
Coventry was purchased by AetnaWe will be offering Aetna for 2015
UnitedHealthcare will no longer be offeredMembers will need to select Aetna or BCBS
Salary tiers for employee premiums were eliminated
Open Enrollment will be on a new website: https://sehp.member.hrissuite.com/
There are also some changes for Plan Year (PY) 2015. You will have the option of Plans A or C next year. Plan B is being discontinued due to declining enrollment. Coventry was purchased by Aetna so the plans will now be available from Aetna .UnitedHealthcare will not be offered next year so you will have the option of selecting Plan A or C with Aetna or BCBS of Kansas. The plan member contribution will no longer be by salary tier. Everyone will pay the same rates.
2Changes for PY 2015Plan A Combined Medical & Pharmacy Out Of Pocket (OOP) Maximum Single: $4,750/ Family: $9,500 MedicalDeductible$300/$600Coinsurance 20%OOP Max$2,000/$4,000 Pharmacy Coinsurance20%/35%/60%OOP Max$2,750/$5,500Medical Deductible $300/$600Coinsurance 20%Pharmacy Coinsurance20%/35%/60%Combined OOP MaxMedical & Pharmacy$4,750/$9,50020142015This year the Plan A medical and pharmacy programs have separate out of pocket maximums. For an individual it is $2,000 medical and $2,750 pharmacy. For Plan Year 2015, there will be a combined into one out of pocket maximum for network medical and pharmacy claims of $4,750 for an individual and $9,500 for a family. 3Changes for 2015I.R.S requirements for HDHP deductibles increasedPlan Cs new deductible and OOP Max is:$2,600 single/$5,200 family
Deductible $2,500/$5,000Coinsurance 0%Out of Pocket Max$2,500/$5,000Deductible $2,600/$5,200Coinsurance 0%Out of Pocket Max$2,600/$5,2002014 Network2015 NetworkThe I.R.S has increased the minimum High Deductible Health Plan deductible so the Plan C deductible must be increased to $2,600 and $5,200 to remain in compliance.4Changes for 2015Plan C members that are ineligible for a Health Savings Account (HSA) may now elect a Health Reimbursement Account (HRA)
Members who could elect the HRA include:Members eligible for MedicareMembers who have VA or military benefitsAnyone else not eligible for an HSA
Employer contributes the same amounts as for the HSA
Plan C members currently have a Health Savings Account but there are rules on who can have an HSA. For those members that dont qualify for an HSA, next year they can have a Health Reimbursement Account instead. The State will contribute the same amount of funds into an HRA for these members. The account works a little different than an HSA so lets take a closer look at the HRA.5Health Reimbursement Accounts (HRA) - Vs. - Health Savings Accounts (HSA)HRAHSAMember Eligibility Requirements :Self-employed persons are not eligible for an HRAMust meet IRS eligibility guidelinesWho Contributes:Employer OnlyEmployee & EmployerWho Owns the Money :EmployerEmployeeCarryover Funds:NoYesCoverage Period:Plan YearDoesnt applyExpense Documentation:Substantiation is required by a third party subject to IRS substantiation requirementsEmployee responsible for maintaining documentationPortable:NoYesWith an HRA, the eligibility is much more open and only the self employed are excluded from having an HRA.HRA is an account that only the employer deposits funds into for the employee.The account works similar to an Flexible Spending Account in that:The money does not roll over from year to year.Unspent funds are forfeited at the end of the year. You will have to submit a claim for reimburse to US Bank along with documentation to access the funds.The funds are not portable. 6Changes for PY 2015The Autism benefit had to be modified to comply with HB. 2744Annual dollar limits removed
Applied Behavior Analysis (ABA) services for children under age 7 will be limited to 1,300 hours per calendar year
Children between age 7 but less than 19 years of age, Applied Behavior Analysis (ABA) services will be limited to 520 hours per calendar yearHB 2744 was passed by the 2014 legislature and as a result there are some changes to the Autism rider. The annual dollar limits have been removed. Only Applied Behavior Analysis services are limited to a set number of hours based upon the age of the child.7Changes for PY 2015Coverage of wheelchairs has been enhanced to allow for medically necessary motorized wheelchairs
Coverage for prosthetics has been modified to allow for medically necessary prosthetics with electronic components or processors
The limited coverage for eyeglasses for children with certain eye disorders has been modified to remove the dollar cap
Compounded medication costing over $300 will require prior authorization from CaremarkCoverage has been enhanced to include medical necessary motorized wheelchairs. Prior authorization is recommended.
Coverage for prosthetics has been enhanced to allow for electronic components or processors when medically necessary. Again prior authorization by the health plan is recommended.
The dollar limit on eyeglasses for children with apakia, pseudophakia or corneal transplants has been removed. This coverage is limited to only children with these specific eye conditions and should not be confused with the Superior Vision Plan coverage.
As a result of recent changes in the market, medications that are being compounded by pharmacies for members that are over $300 must be prior authorized by Caremark. 8Performance Drug List The Performance Drug List has been updated to reflect recent generic drug launches
Applies to both Plans A & C
Three drug classes on the Performance Drug List:ACE/ARBs Blood pressure loweringHMGs Cholesterol lowering PPIs Stomach acid reducers
Must try a Generic before using a Non Preferred Brand Name Drug
Generic and Preferred Brands not affected
9The Performance Drug List that has been in place for several years now has been updated to reflect changes in the pharmacy market.The change is in how Non Preferred brand name drugs in three specific classes of prescription drugs are processed. Those three (3) classes of prescription drugs include:cholesterol lowering medications (HMGs), proton pump inhibitors (PPIs, which reduce the production of acid in the stomach), and high blood pressure medications (ACE/ARBs). These three classes of drugs include a large selection of lower costing generic drug options. Before you can purchase a Non Preferred product in these classes, you have to have tried a generic in the class. The system will automatically check your historyThere are a large number of generic available in these classes You will continue to have access to preferred brand name medications and generics.
Performance Drug ListPreferred HMGsGenericamlodipine-atorvastatinatorvastatin (generic Lipitor)fluvastatinlovastatinpravastatinsimvastatin Preferred BrandsCrestorSimcorVytorin
Non Preferred HMGsAdvicorAltoprevLiptruzetLivalo
Cholesterol Lowering AgentsHMG-CoA Reductase Inhibitors (HMGs or Statins)/CombinationsHMGs are the cholesterol lowering products. The performance drug list will only affect You if You try to purchase a non preferred brand name drug listed on the right. Before you can fill a prescription for one of the Non Preferred products on the right side of the screen, the member would have to have tried one of the generic products in the left side column.
The Caremark claims system will review your claims history to see if you have previously purchased a generic in the drug class first. If this is no record of a generic in your history during the preceding 24 months, the pharmacy will receive a message that the claim cannot be processed since the member has not tried the generic first.
If your history shows that you have tried a generic previously, the claim will process without delay. You still be responsible for paying the non preferred drug coinsurance of 60%. 10Performance Drug ListPreferredGenericamlodipine-benzazeprilbenazepril & benazepril HCTcandesartan/candesartan HCTZcaptopril & captopril HCTZenalapril & enalapril HCTZeprosartan fosinopril & fosinopril HCTZirbesartan/irbesartan HCTZlisinopril & lisinopril HCTZlosartan/losartan HCTZmoexipril & moexipril HCTZquinapril & quinapril HCTZramipriltelmisartan HCTZtrandolapriltrandolapril-verapamil ext HCTZvalsartan &valsartan HCTZNon Preferred ARBsEdarbiEdarbyclorTeveten HCT
Blood Pressure Lowering ACE/ARBsACE = Angiotensin Converting Enzyme Inhibitors ARB = Angiotensin II Receptor Antagonists and Direct Renin Inhibitors & CombinationsPreferred BrandsBenicar & Benicar HCTMicardis & Micardis HCTThis side is a little busy because there are so many generic options in the ACE/ARB categories to treat high blood pressure.The definitions for ACE and ARB are listed as well for you. You can see that there are many generic options as well as two preferred products to choose from. If you and your provider elect the three on the lower right side of the screen, you will have to have tried one of the generics first.Remember generics have the lowest member coinsurance of 20% and preferred brands are 35%.The non preferred products cost you the most our of your pocket with a 60% coinsurance. 11Performance Drug ListPreferred PPIsGenericesomeprazolelansoprazoleomeprazoleomeprazole sodium bicarbpantoprazolerabeprazolePreferred BrandDexilant
Non Preferred PPIsPrilosec PacketsProtonix PacketsZegerid powder for oral susp
Stomach Acid ReducersProton Pump Inhibitors (PPIs)For PPIs which are long lasting stomach acid reducers, the Non Preferred brand name drugs are highlighted on the right. The preferred and generic are on the left side of the screen.
There are also a number of quality over the counter products available that may be less expensive then the prescription products and provide the same results. Talk to your doctor about will work for you.12Upcoming Generic ReleasesAbilify ODT Abilify Tabs Aggrenox Aloxi Axert Baraclude Doribax Gleevec Namenda Ortho Tri-Cyclen LoOxytrol Patanol Protopic Relenza Teveten HCT Welchol Susp Welchol Tabs Zyvox Injection Zyvox Susp Zyvox Tabs These are just a few of the drugs scheduled to go generic next year. We encourage members to switch to generic as soon as they are released. Generic drugs save you and the plan money. A full list is posted on the SEHP web site for those interested.13Selecting Your Health PlanPick a plan design (A or C)Which plan design provides the coverage you and your family need?What is the total plan cost? Premiums + Deductible & OOP = ?
Review the Provider Networks Each of the medical vendors uses a different provider network
Open Enrollment is your opportunity to decide how you want to finance your healthcare for the upcoming year. We encourage you to review the plan design options. Look at the coverage and the out of pocket cost of each plan design and select an option, A or C.
Each of our health plan vendors offers their own unique provider networks. Being a network provider means that the health care professional has agreed to accept the vendors allowed charge as payment in full. The provider agrees to write off any difference between what they charge and what the health plan allows.
You are free to use any provider that you wish however if you use a provider that is not part of your health plans networks, it will cost you more out of your pocket. Non network providers do not have to accept the health plans allowed charge and can bill you for the difference.
Make sure you review the networks before deciding on a medical vendor.
14Plan AMedical Coverage2015 - NetworkMedicalDeductible$300/$600Coinsurance 20%2015 - Non NetworkMedical Deductible $500/$1500Coinsurance 50%Pharmacy Coinsurance20%/35%/60%OOP MaxMedical & Pharmacy$4,750/$9,500Combined OOP MaxMedical & Pharmacy$4,750/$9,500
Lets take a closer look at the Plans offered. Lets begin with Plan A.
Plan A has a $300 per person and $600 per family network deductible. A higher deductible applies to Non Network services. After the Deductible, Coinsurance applies to most services and network office visits are subject to Copays. The maximum amount of out of pocket expenses for Network medical and pharmacy services in a year are $4,750 for an individual and $9,500 for a family. You will incur additional out of pocket expense if you also use both Network and Non Network providers as the Non Network benefit accumulates separately from the Network benefits. 15Plan A Prescription Drug PlanDrugsCoverage LevelGeneric20% CoinsurancePreferred Brand Name Drugs35% CoinsuranceSpecial Case Medications25% Coinsurance to a Max of $75 per 30 day supplyNon Preferred Brand Name Drugs60% CoinsuranceDiscount TierYou pay 100% of discount cost. Do not count toward your OOPThere are no changes to the coverage tiers under the Plan A pharmacy program. On Plan A, your prescription drugs are subject to Coinsurance. Generic drugs are your best buy and have the lowest OOP cost.Members should review the preferred drug list options with their providers to find the most cost effective options. You many also want to use the new transparency tools from Castlight and Rx Savings to help you reduce your pharmacy spend.
16Plan CMedical Coverage2015 NetworkDeductible $2,600/$5,200Coinsurance 0%Combined Medical and Pharmacy OOP$2,600/$5,2002015 Non NetworkDeductible $2,600/$5,200Coinsurance 20%Out of Pocket Max$4,100/$8,200The Plan C Deductible was increased this year due to a change in the IRS requirements for High Deductible Health Plans with Health Savings Accounts. The Plan C Deductible is now $2,600 for one person and a maximum of $5200 for the family.
Once you meet your network deductible additional covered medical or pharmacy services are covered in full for the remainder of the calendar year.
Benefits for Network and Non Network providers are subject to separate deductibles and out of pocket requirements. 17Plan C Prescription Drug PlanCovered drugs are subject to the Network Plan C Deductible
After the Deductible, the plan pays covered prescription drugs at 100% of allowed charge
Uses same Preferred Drug List as Plans A
Plan C is a creditable drug plan
Discount Tier drugs are Not Covered drugsOnly eligible for Caremarks negotiated discountDo not count toward OOP Max
18 On Plan C prescription drugs are subject to the overall plan Deductible and then paid at 100% once the deductible has been satisfied. The Preferred Drug List is the same as the one used for Plans A. It is available on Caremark.com.Discount Tier drugs are not considered covered drugs and are only eligible for the discount. These will always be paid for 100% by the member even after the deductible is satisfied. Plan C is creditable coverage and should not pose an issue for those getting close to Medicare eligibility.
9/22/2014Plan Comparison Example:After work on January 15th, Jill fell injuring her wristJill went to an urgent care center. They x-rayed it, gave her prescription & a splintShe was advised it was broken & to follow up with an orthopedic doctor the next day The orthopedic doctor sent her for a MRI & then placed the wrist in a cast for 6 weeksWhen the cast came off, she went to occupational therapyJills starts receiving bills for services in February with the last of the therapy charges billed in AprilThe following is a real life example of your health plan benefits in action. Jill has an accident early in the year and has claims that will be submitted for several months.
Jill falls on January 15th and immediately knows that her wrist injury is going to require medical attention. She heads to the local urgent care and has her wrist examined, x-rayed and splinted. Its broken. She is told to follow up with and Orthopedic doctor the next day. The orthopedic doctor reviews the x-rays and orders and MRI because of concerns about the break. Cast is put on the arm for 6 weeks and then OT to regain range of motion. 19Jills Claims on Plan AServiceActual ChargeAllowed ChargeDeductibleCopay or CoinsPlan PaidMember OwesUrgent care Facility$279.50$279.50$50.00$229.50$50.00Urgent Care Doctor$108.25$90.04$90.04$90.04Specialist Office visits (4)$276.50$258.13$180.00$78.13$180.00MRI$1,375.93$556.74$209.96$69.36$277.42$279.32Xrays (4)$370.00$200.61$40.12$160.49$40.12Pharmacy (1)$14.38$14.38$2.88$11.50$2.88Therapy visits (6)$2,595.77$1419.80$499.96$919.84$499.96Total$5,020.33$2,819.20$300.00$842.32$1,676.88$1142.32Jill is a Plan A member and only used network providers. She must meet the $300 deductible and then her services are paid a 80% and she owes 20% plus any office visit copays. So when she completes her care in April, she will owe the providers $1,142.82 and the plan will have paid $1,676.88 to the providers. 20Jills Claim on Plan AJill has now met her $300 Deductible & $842.32 in Coinsurance & CopaysA total of $1,142.32 is credited toward her Network Out Of Pocket (OOP) max of $4,750If she needs additional services or prescriptions this year, she will have additional Coinsurance and Copays to payJill will need to pay the providers $1,142.32If she has a health care flexible spending account, she could use those dollars to pay the billsOtherwise she will need to come up with this whole amount out of her pocketSo Jill will have meet $1,142.32 of her annual OOP max. If she needs additional medical care or prescription drugs, she will have additional out of pocket expenses to pay. As a Plan A member unless Jill has signed up for a Health Care Flexible Savings Account (HCFSA) to use pre-tax money for health services, she will have to come up with the full amount out of her pocket. Using a HCFSA would at least all her to use pre-tax funds for part of her care. 21Jills Claims on Plan CServiceActual ChargeAllowed ChargeDeductiblePlan PaidMember OwesUrgent care Facility$279.50$279.50$279.50$279.50Urgent Care Doctor$108.25$90.04$90.04$90.04Specialist Office visits (4)$276.50$258.13$258.13$258.13Cat Scan$1,375.93$556.74$556.74$556.74Xrays (4)$370.00$200.61$200.61$200.61Pharmacy (1)$14.38$14.38$14.38$14.38Therapy visits (6)$2,595.77$1419.80$1,200.60$319.20$1,200.60Total$5,020.33$2,819.20$2,600.00$319.20$2,600.00If Jill is enrolled in Plan C, the member deductible applies first. After all the claims are processed she will have the $2,500 deductible for network medical or pharmacy services and the plan will have begun to pay for her medical pharmacy claims in full. But there is more to the story than just the member out of pocket.22Jills Claim on Plan CJill has an HSA that the NSG Emloyer deposited $750 into in January that she can use to pay the providers Using pre-tax dollars she contributes $30 per pay period If she started the year with $0, her HSA would have:by May 1, $1,065 availableby July 1, $1,955 available If she hadnt spent any, by Dec. 31 - $2,340Jill has no more out of pocket for the rest of the yearCovered network medical and pharmacy services will be paid at 100% for the rest of the plan yearJill has a Health Savings Account and her employer has already deposited $750 into her account in January. She will get another $750 in July that she can use to pay her claims. In addition, she is setting aside $30 pre-tax from each of her paychecks. That reduces her taxable income and saves her money and as well as provides her with additional funds to use to pay her claims.
By May, she would have over $1,000 to use to pay the providers. By July $1,955 would have been set aside to help her pay her medical expenses. Now if Jill hadn't had this claim and used none of her money, she would start off next year with over $2,300 already in the account to use for any future health care services she might need.
One other point, Jill has now met the OOP max for Plan C and any other covered network services would be paid in full by the plan for the remainder of the calendar year. 23Plan C Health Saving AccountAn employee-owned bank account for saving money to use to pay for your current or future medical expenses
Account administered by US Bank
Unspent HSA funds roll over and accumulate year to year and can be invested
Portable - The account and the money belong to you
HSA funds can be used to pay expenses of your tax qualified dependents
Plan C includes a Health Savings Account (HSA). As Jill found out this is a great way to set aside funds to pay for health care services. The HSA is an employee-owned bank account. Unlike a Flexible Spending Account, an HSA is a permanent account where funds roll over from year to year if not spent. You can only contribute to an HSA while you are enrolled in a qualified high deductible health plan. Members can invest their HSA funds in a variety of investment options. The account and the funds in it belong to the employee and go with you if you leave State service or if you switch to another health plan at a future open enrollment
This is your account and your funds. As long as the money is spent on healthcare for your or your qualified dependents, the money is not taxable to you. You can set aside funds using pre-tax payroll deduction for additional tax savings.
24HSA Eligibility RequirementsThe following Employees are eligible to have an HSA:You must be covered by Plan C a High Deductible Health Plan (HDHP)
You have no other health coverage that isnt an HDHP except what is permitted under Other Coverage defined by the IRS
You are not enrolled in Medicare or TRICARE
You cannot be claimed as a dependent on someone elses tax return
IRS guidelines identify employees that are eligible to have and make contributions into an HSA account.
The rules for spouses and dependents are different. Additional information is available on the SEHP website, US Bank Website and on the Treasury Department website.25Non State HSA FundingNon State Groups may elect to pay your HSA contributions monthly or in lump sums as the State does for its employees:Active State Example: Half paid on second pay period in January & First pay period in July
2014 Plans A & B members If moving to Plan C in 2015: Your Health Care FSA must have a $0 balance by 12/31/14 If HCFSA funds remain on 1/1/15, the Employer HSA contribution is reduced & will not be made in April 2015SingleFamilyEmployer (ER) Contribution $1,500/$2,250$750 & $750$1,125 & $1,125The State will make two (2) equal contributions into the employees HSA:The first half of the employer payment will be deposited into your account the second pay period in January.
The second half of the employer payment will be deposited into your account the first pay period in July.
If you are currently in enrolled in Plans A or B and have a Health Care Flexible Spending account, you must have spent all your money by 12/31/14 in order to received the full employer contribution into your HSA in January 2015. If HCFSA funds remain during the FSA grace period, the HSA will be funded after the grace period ends on March 15, 2015, and the employer contribution will be reduced.
26Plan C HSA ContributionsHSA AccountSingleFamilyTotal Annual HSA Maximum Contribution $3,350$6,650ER Maximum HSA Contribution $750 & $750$1,125 & $1,125EE Minimum Contribution Annually: $25 Bi-weekly $50 Monthly$600$600Available Employee (EE) Contributions*$25 to $77.08$25 to $183.32Additional over age 55 Catch up amount$1,000$1,000* Based on 24 pay period deductions. The total annual maximum amount is the total amount that you and your employer can set aside each year into a HSA. The State is going to put a total of $1,500 into your Health Savings Account for single coverage over the course of the year ($2,250 if you choose family coverage)..
You will be asked to set aside a minimum of $25 per pay period by payroll deduction. Over the course of the year your contribution will result in $600 being added to your account.
You can elect to contribute more to your HSA, but the total contribution to the HSA by the State and by you cannot exceed the maximum allowed by the IRS of $3,300 for a single plan and $6,550 for a family plan.
Members over age 55 may use the Catch Up provision to set aside an additional $1,000 per year into their HSA. Which you can now elect in MAP
27Health Reimbursement Account (HRA)Available for Plan C members not eligible for an HSAThe HRA is 100% employer fundedNo employee contributions are allowedHRA members may have a Health Care FSA HRAs are not portableUnused amounts do not roll from year to yearUnused amounts cannot be converted to cashUnused amounts cannot be assigned to a beneficiaryNew for 2015 for our28Non State HRA FundingMembers that qualify for an HRA, the Non State Group will send the entire composite rate to the SEHP.
The SEHP will then fund the HRA account for the member.
The funding schedule will match the States.
Prorated for new members.
Members will have 60 days after their termination date or the end of the plan year to get their claims submitted for reimbursement from their HRA account at US Bank.
HRA will have debit cards for members to use.
May be asked to send in documentation of expenses, just like on a HCFSAFor members that qualify for an HRA, the non state that qualify for an HRA, the non state group will send the entire composite rate to the SEHP.
The SEHP will then fund the HRA account for the member.
The funding schedule will match the States: $750 in January and $750 in July
Prorated for new members.
SingleFamilyEmployer (ER) Contribution $1,500/$2,250$750 & $750$1,125 & $1,125State will pay HRA funding in two (2) equal contributions:The first half of the employer payment will be deposited into your account the second pay period in January.
The second half of the employer payment will be deposited into your account the first pay period in July.
If you are currently enrolled in Plans A or B and have a Health Care Flexible Spending account, you must have spent all your money by 12/31/13 in order to received the full employer contribution into your HSA. If HCFSA funds remain during the FSA grace period, the HSA will be funded after the grace period ends on March 15, 2014, and the employer contribution will be reduced.
29Quest Diagnostics Preferred Lab BenefitPlan A - 100% coverage of eligible outpatient lab tests Plan C Discount on eligible outpatient lab servicesStatewide & nationwide preferred lab vendor Your doctor can draw the sample and send to Quest, You can visit Quests website for collection sitesServices must be performed and billed by QuestOnline appointment scheduling availableAll Plan A & C members can use QuestUse Your Quest ID card or medical ID card www.labcard.com Quest Diagnostics is the statewide preferred lab vendor for Plans A and C. When you have covered outpatient lab work performed and billed by Quest, the plan pays 100 percent of the cost of the services. The health plan pays the additional amounts due to the negotiated discounts with Quest. Please note: if the lab work is denied by the medical plan as a non-covered service or as not medically necessary, it is not covered by the Preferred Lab Benefit either those tests are member responsibility. Outside of the covered preventive care services, lab work not performed and billed by a preferred lab vendor such as Quest is covered but subject to the plan deductible and coinsurance. Any provider may use the Quest lab service by calling Quest to pick up the sample. You and your provider will decide whether or not to do so. Visit Quests website for a complete list of Quest collection sites. Your ID number on your Quest ID card is the same as the number on your medical plan ID card. Either ID card will work.
Reminder for Plan C members: The preferred lab program is not part of Plan C. You may use Quest for services; however: The claim will be subject to your deductible and not just paid in full. Quest may or may not be a network provider for your Plan. 30Stormont Vail Preferred Lab BenefitRegional Preferred Lab vendor in NE KansasPlan A - 100% coverage for eligible outpatient lab servicesPlan C Discounts on eligible outpatient lab servicesAll Plan A &C members may use the Stormont-Vail draw site locationsLabs drawn at other Cotton-ONeil locations may be included if by network providersShow your medical ID Card to access benefit
Stormont-Vail HealthCare is a regional preferred lab vendor for Plans A and B. When you have covered outpatient lab work performed and billed by Stormont-Vail, the plan pays 100 percent of the cost of the services. The plan can pay the additional amounts due to the negotiated discounts. Please note: if the lab work is denied by the medical plan as a non-covered service or as not medically necessary, it is not covered by the Preferred Lab Benefit either those tests are member responsibility. Outside of the covered preventive care services, lab work not performed and billed by a preferred lab vendor such as Stormont-Vail is covered but subject to the plan deductible and coinsurance.You will show your medical plan ID card and a photo ID to access benefits.
Reminder for Plan C members: The preferred lab program is not part of Plan C. You may use Quest for services; however: The claim will be subject to your deductible and not just paid in full. Stormont-Vail may or may not be a network provider for your health plan. Make sure you check the Network for your plan.
Delta DentalDental CoveragePlan pays in full for 2 exams & cleanings Annual benefit maximum: $1,700 per person per year
Benefit LevelPPOPremierNon NetworkPreventive Services
Covered in fullCovered in fullAllowed amount covered in fullValue Based Benefit: Basic BenefitBasic Restorative50%50%50%Enhanced BenefitBasic Restorative20%40%40%32 The annual dental benefit of $1,700 is unchanged. The plan continues to cover two preventive cleanings per person per year. The $50 dental deductible applies to both basic and major restorative services and a maximum of $150 will apply to a family membership. Orthodontic coverage is available and is limited to $1,000 per person per lifetime. The annual maximum benefit paid per person per year is unchanged at $1,700.
9/22/2014Superior VisionVision BenefitsBasic VisionCovers everything in the Basic Plan PLUSFrame Allowance$150High Index or Polycarbonate lensesUp to $116Progressive lensesUp to $165Scratch & UV coatingCovered in fullEnhanced VisionMaterials Copay Office Visit Copay$25$50Frame Allowance$100Lenses: single vision, standard bifocal, trifocal or lenticular100%Contact lenses & fitting fee$150$35We offer two vision plans through Superior Vision: Basic and Enhanced. Vision is a separate offering, so you may elect a different coverage level than you have for medical coverage. The Basic plan covers a basic pair of glasses or contact lenses. The Enhanced plan covers everything that Basic covers, plus a $150 frame allowance and additional lens options. 33Employee Assistance ProgramFocus is on EAP, work-life, & wellness services
All calls are answered 24/7 by a masters level clinician
Fully integrated counseling, work-life, legal, and financial services available Unlimited telephonic financial, legal, and family support Up to 8 in-person counseling sessions at no cost Referrals to local attorneys with free 30-minute consultation & 25% discount on fees
ComPsych is our Employee Assistance Program vendor. ComPsych offers members a comprehensive program for work-life, legal and financial services. 34HealthQuest (HQ) RewardsThe earning period is being extended to 11/15/2014The new year will be 11/16/2014 11/15/2015This change means that during Open Enrollment an employee can see if they have earned the HQ Reward incentive discount or not If they have not, they still will have to time to earn it by 11/15/2014Preventive Appointment Grace Period 8/1/2014 11/16/2014 You must wait until after Nov. 15, 2014 to report well person, dental and eye appointments for credit next yearComplete the self report form @ Kansashealthquest.com
The new HealthQuest Rewards earning period is 11/16/2014 11/15/201535 Open EnrollmentEnroll at: https://sehp.member.hrissuite.com/
Enroll between October 1 31, 2014
Coverage effective January 1, 201536Now that weve discussed your options, lets talk about what you need to do. Open enrollment takes place from October 1 through October 31, 2013. You must go online to: Review and enroll in your health plan elections Make changes in who is covered by your plan
Remember, after October 31, unless you experience a qualifying event, you cannot change your coverage level until the next Open Enrollment period. The choices you make now will be effective starting January 1, 2015.9/22/2014New Open Enrollment WebsiteNew SEHP Membership Administrative Portal (MAP): https://sehp.member.hrissuite.com/
You will need to upload electronic copies of birth certificates and marriage licenses if you are adding dependents during OE in MAP
You will be able to update your information & mailing address
Address changes are for health plan information only
MAP Questions: SEHPMembership@kdheks.gov
37Registering for MAPBecause MAP contains your Protected Health Information (PHI) it is a HIPAA compliant site
All of your information is encrypted for security
Once registered, you will set up a unique password for future authentication
MAP Questions: SEHPMembership@kdheks.govBecause MAP contains your Protected Health information (PHI) the site is fully HIPAA compliantInformation you submit is encrypted for added securityOnce you authenticate in the system, you will set up a unique user name and password to use for future site visits.
38Welcome To MAP
MAP Questions: SEHPMembership@kdheks.govThis is a look at the new Member Portal in MAP. You will all need to register the first time to authenticate yourself in MAP. After the initial registration, you will set up a user name and password. If you wish to re-enter the portal, you would sign in using the user name and password you have created.39Identification CardsAetna, BCBSKS and Delta Dental will send new cards to everyone
Caremark & Superior Vision will only send card to new members or members making changes
Reminder:If you lose your ID card, contact the vendors customer service directly at the phone numbers on the inside cover of the Open Enrollment booklet to request a new card.
40 Coventry will send new ID cards to Plans A and B members (but not to Plan C members).
Otherwise, new ID cards will only be sent to those individuals who are making plan or coverage changes. Reminder:If you lose your ID card, contact the vendors directly at the numbers on the inside cover of the Open Enrollment booklet to request a new card.9/22/2014Transparency ToolsRx Savings Solutions is a pharmacy transparency tool, to help save you money on your prescription drugsAvailable now at: www.rxsavingssolutions.com
Castlight, a transparency tool for medical and prescription drugs, will launch for 2015. Castlights website allows you to search your health plans providers and compare prices. More information to come soon. We are offering employees two new tools to help them manage their health care spending. Rx Savings provides you with information on your prescription drugs and ways to save money. You can contact their customer service and speak to a pharmacist or pharm tech for assistance.
Launching later this year will be the Castlight Health website. Castlight provides you with access to health care prices, quality information and health care information to assist you in making your health care decisions. More information on this will be sent out once the site is launched. 41Questions?Email ?s to SEHP: email@example.com