2010 Insurance Orientation Employee Insurance Program 803-734-0678 (Greater Columbia area)...

2010 Insurance Orientation

Employee Insurance Program803-734-0678 (Greater Columbia area)

888-260-9430 (Toll-free outside the Columbia area)

Disclaimer

BENEFITS ADMINISTRATORS AND OTHERS CHOSEN BY YOUR EMPLOYER WHO MAY ASSIST WITH INSURANCE ENROLLMENT, CHANGES, RETIREMENT OR TERMINATION AND RELATED ACTIVITIES ARE NOT AGENTS OF THE EMPLOYEE INSURANCE PROGRAM AND ARE NOT AUTHORIZED TO BIND THE EMPLOYEE INSURANCE PROGRAM.

THIS PRESENTATION CONTAINS AN ABBREVIATED DESCRIPTION OF INSURANCE BENEFITS. THE PLAN OF BENEFITS DOCUMENTS AND BENEFITS CONTRACTS CONTAIN COMPLETE DESCRIPTIONS OF THE HEALTH AND DENTAL PLANS AND ALL OTHER INSURANCE BENEFITS. THEIR TERMS AND CONDITIONS GOVERN ALL HEALTH BENEFITS OFFERED BY THE STATE. IF YOU WOULD LIKE TO REVIEW THESE DOCUMENTS, CONTACT YOUR BENEFITS ADMINISTRATOR OR THE EMPLOYEE INSURANCE PROGRAM.

THE LANGUAGE USED IN THIS PRESENTATION DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE AGENCY. THIS PRESENTATION DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS. THE AGENCY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS PRESENTATION, IN WHOLE OR IN PART. NO PROMISES OR ASSURANCES, WHETHER WRITTEN OR ORAL, WHICH ARE CONTRARY TO OR INCONSISTENT WITH THE TERMS OF THIS PARAGRAPH CREATE ANY CONTRACT OF EMPLOYMENT.

This overview is not meant to serve as a comprehensive description of the benefits offered by the Employee Insurance Program. For more detailed information, have the 2010 Insurance Benefits Guide handy as you review this presentation.

Important Information

Insurance Orientation

EIP Benefit Programs• Health Plans• Dental Plans• Vision Plan• Life Insurance• Long Term Disability• Long Term Care• MoneyPlu$ (Pre-tax programs)

Insurance Orientation

Eligibility

Eligibility

Active Employee• Must be employed in permanent,

full-time position

• Work at least 30 hours per week unless Employed as a part-time teacher (only

eligible for health, dental, vision and MoneyPlu$)

Employed by employer who allows coverage for 20-hour employees

Retired Employee• Must meet certain

requirements to continue coverage in retirement

• Refer to 2010 Insurance Benefits Guide for retiree eligibility information

Eligibility

Eligible Spouse• Spouse or former spouse* if

coverage is court-ordered

• Cannot cover spouse who is eligible for benefits through EIP as active employee or funded retiree

Eligibility

* Documentation required to cover a former spouse

Children• Natural child

• Step-child

• Adopted child*

• Foster child*

• Child for whom employee has legal custody*

Eligibility

* Documentation required at time of enrollment

Eligibility

Eligible Children• Under age 19, or until 25, if full-

time student*

• Unmarried, not employed with benefits and principally dependent on employee

• Reside with employee or employee is court-ordered* to cover

• Approved for incapacitation*

* Documentation required at time of enrollment

Eligibility

Survivors

• Dependents covered at time of employee’s or retiree’s death may continue health, dental and vision coverage Spouse eligible until remarriage

Children remain eligible as long as eligible dependent

If all coverage is canceled cannot re-enroll as survivor

Insurance Orientation

Enrollment and Coordination of Benefits

Enrollment

Enroll

• Within 31 days of Hire or retirement date

Special eligibility situation

• During open enrollment as late entrant

Enrollment

Pre-existing Condition Exclusion • Applies to health, Basic and

Supplemental Long Term Disability

• Waiting period 12 months

18 months (late entrant)

May be reduced by creditable coverage

Enrollment

October Enrollment Periods• Annual Enrollment (Every year)

Change health plans Enroll in or drop State Vision Plan Enroll or re-enroll in MoneyPlu$ programs

• Open Enrollment (Odd-numbered years, i.e., 2011, 2013)

Enroll in or drop health, dental or Dental Plus

Add or drop eligible dependents

Coordination of Benefits

Health and Dental • Plan that covers person as

employee is primary to plan that covers person as dependent

• Children – Plan of parent whose birthday occurs earliest in year is primary

• Deductible and coinsurance linked for married EIP subscribers enrolled in same health plan

Insurance Orientation

Health Plans

Insurance Orientation

Health Plan Options• State Health Plan

Standard Plan

Savings Plan

• HMO BlueChoice HealthPlan

CIGNA HMO

Insurance Orientation

Before you choose a health plan:• Read the plan overviews listed in

the 2010 Insurance Benefits Guide• Review the exclusions and

limitations listed for each plan• Determine if your doctor is in the

network• Ask questions – contact EIP, your BA

or the plan administrator for assistance

State Health Plan(SHP)

Administered by BlueCross BlueShield of South Carolina

State Health Plan

Common to Both• Worldwide coverage

• In- and out-of-network benefits

• Pharmacy network

• Online access available www.SouthCarolinaBlues.com

State Health Plan Standard Plan and Savings Plan

Preauthorization• Refer to 2010 Insurance

Benefits Guide for information regarding Medi-Call National Imaging Associates APS (mental health and

substance abuse services) Medco

State Health Plan Standard Plan and Savings Plan

Provider Network• Provider files claims and accepts

allowable charges as payment in full

• Subscriber pays deductibles and coinsurance

State Health Plan Standard Plan and Savings Plan

Out-of-network• Subscriber

May have to file claims

Can be balance billed

Pays higher coinsurance

• No benefits paid for out-of-network prescription drugs

State Health Plan Standard Plan and Savings Plan

Limited Preventive Benefits*

• Routine mammogram

• Pap test

• Well child care

• Routine colonoscopy

State Health Plan Standard Plan and Savings Plan

* Refer to the 2010 Insurance Benefits Guide for plan guidelines

State Health Plan Standard Plan

SHP Standard Plan

Standard Plan

Annual Deductible $350 individual $700 family

Out-of-network Coinsurance Plan pays

60%

Subscriber pays 40%

Coinsurance Maximum $4,000 individual

$8,000 family

In-network Coinsurance Plan pays 80%

Subscriber pays 20%

Coinsurance Maximum $2,000 individual

$4,000 family

Deductibles and Coinsurance

Standard Plan

Per-occurrence Deductibles $10 Office visit

$75 Outpatient facility service

$125 Emergency room visit

Network Retail

Pharmacy*

(up to 31-day supply)

$ 9 Tier 1 $ 30 Tier 2 $ 50 Tier 3

MedcoMail Order*

(up to 90-day supply)

$ 22 Tier 1 $ 75 Tier 2 $125 Tier 3

Retail Maintenance Network

Prescription Drug Benefits

$2,500 maximum copayment per person

Standard Plan

State Health Plan Savings Plan

SHP Savings Plan

Annual Deductible

$3,000 individual

$6,000 family

Out-of-network Coinsurance Plan pays

60%

Subscriber pays 40%

Coinsurance Maximum $4,000 individual

$8,000 family

In-network Coinsurance Plan pays 80%

Subscriber pays 20%

Coinsurance Maximum $2,000 individual

$4,000 family

Deductibles and Coinsurance

Savings Plan

Savings Plan

Rules• Subscriber pays 100% of

Allowable charges in-network

Actual charges out-of-network

Allowable charges at network pharmacies

• After deductible is met, Plan will reimburse subscriber 80% of allowable charges

Savings Plan

Added benefits• Annual flu shot

• Annual physical that includes specific services

• Eligibility to contribute to Health Savings Account (HSA)

HMOs

Health Maintenance Organizations

(HMOs)

HMOs

Requirements• Must live or work in HMO

service area

• Must choose Primary Care Physician (PCP) in network and receive referrals before seeing specialist

• Only out-of-network benefit is emergency care

BlueChoice HealthPlan (Available in all South Carolina counties)

BlueChoice HealthPlanAvailable in all South Carolina Counties

Coinsurance Maximum

$2,000 individual

$4,000 family

Annual Deductible

$250 individual

$500 family

Network Coinsurance Plan pays 85%

Subscriber pays 15%

Deductibles and Coinsurance

BlueChoice HealthPlan(Available in all South Carolina counties)

BlueChoice HealthPlan(Available in all South Carolina counties)

Provider:

$15 PCP $15 OB-GYN $40 specialist $35 urgent care

Plan pays 100% after copay

Facility:

$100 outpatient $125 ER $200 inpatient

Plan pays 85% after copay

Copays

Network Retail Pharmacy

(up to 31-day supply)

$ 8 Lower-cost generic

$ 15 Higher-cost generic

$ 35 Preferred brand

$ 55 Non-preferred brand

$ 80 Preferred brand specialty

pharmaceuticals

$125 Specialty pharmaceuticals

Mail Order (up to 90-day supply)

$ 20.00 Lower-cost generic

$ 37.50 Higher-cost generic

$ 87.50 Preferred brand

$137.50 Non-preferred brand

BlueChoice HealthPlan (Available in all South Carolina counties)

CIGNA HMO

CIGNA HMOAvailable in all South Carolina counties except Abbeville,

Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Coinsurance Maximum $2,000 individual $4,000 family

Annual Deductible

None

In-network Coinsurance Plan pays

80% Subscriber pays 20%

Deductibles and Coinsurance

CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Copays

Provider

$15 PCP $15 OB-GYN $30 specialist $100 ER

Plan pays 100%after copay

Hospital

$250 outpatient $500 inpatient

Plan pays 80%after copay

CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Mail-Order (up to 90-day supply)

$ 14 generic $ 50 preferred brand $100 non-preferred brand

Network Retail Pharmacy (up to 30-day supply)

$ 7 generic $25 preferred brand $50 non-preferred brand

CIGNA HMOAvailable in all South Carolina counties except Abbeville, Aiken, Barnwell, Edgefield, Greenwood, Laurens, McCormick and Saluda

Insurance Orientation

Active EmployeeHealth Premiums

Premiums forlocal

subdivisions may vary

Premiums forlocal

subdivisions may vary

SHPSavings

Plan

SHPStandard

Plan

Employee only

Employee/spouseEmployee/children Full family

$ 9.28 $ 72.56 $ 20.28 $108.56

$ 93.46$237.50$142.46$294.58

Blue Choice

HMO

Employee only

Employee/spouseEmployee/childrenFull family

$185.56$508.78$382.66$741.22

$251.94$608.42$518.08$930.84

CIGNA HMO

2010 Active Employee Monthly Health Premiums

Tobacco Surcharge• $25 per month for tobacco users

• Automatically charged unless certify no one uses tobacco

• May certify by completing paper Certification Regarding Tobacco Use form

Tobacco Surcharge

Avoid the Surcharge• Must be tobacco free for 6

months to certify as non-tobacco user

• All health plans offer free tobacco cessation program

• Refer to 2010 Insurance Benefits Guide for detailed information

Tobacco Surcharge

Insurance Orientation

State Dental PlanAdministered by BlueCross BlueShield of South Carolina

State Dental Plan

Features• Free to choose dentist

• No pre-existing condition exclusions

• Two year plan – may not drop or change until next open enrollment

• $1,000 maximum benefit

* $25 Combined Deductible for Classes II and III

Classes of Services Class I Preventive

services 100% of fee

schedule

Class III*

Prosthodontics 50% of fee schedule

Class IV Orthodontics (only

children younger than 19; $1,000 lifetime maximum)

Class II*

Basic services 80% of fee

schedule

State Dental Plan

Employee only

Employee/spouse

Employee/children

Full family

$ .00

$ 7.64

$13.72

$21.34

Monthly Premiums

State Dental Plan

Insurance Orientation

Dental PlusAdministered by BlueCross BlueShield of South Carolina

Dental Plus

Features• Supplement to Basic Dental

• Higher allowance for Class I, II and III services

• Combined maximum benefit of $2,000

• May enroll in or cancel coverage during open enrollment

Dental Plus premiums are in addition to State Dental Plan premiums.

Monthly Premiums

Category Basic Dental

Dental Plus

Total Premium

Employee None $22.04 $22.04

Employee/ Spouse

$ 7.64 $41.72 $49.36

Employee/ Child

$13.72 $45.54 $59.26

Full Family $21.34 $65.22 $86.56

Dental Plus

Insurance Orientation

State Vision PlanAdministered by EyeMed Vision Care

State Vision Plan

Features• May enroll within 31 days of

date of hire or retirement

• May enroll in or drop coverage every year during October enrollment

State Vision Plan

Vision Care Services• Eye exams

• Frames

• Lenses

• Contact lens services and materials

• Discounts on LASIK and PRK vision correction

State Vision Plan

Providers• In-network

No claims to file Pay copayment and charges above the

plan’s allowance

• Out-of-network Pay provider for service EyeMed will reimburse you for a

portion of expenses for certain services* Locate a provider on EIP’s web site or by calling EyeMed at 877-735-9314

State Vision Plan

Eye Exams• $10 copayment

• Standard contact lens fitting No copayment

• Premium contact lens fitting 10% discount and

$55 allowance toward discounted price

State Vision Plan

Eyeglasses• Frames every 2 years

$140 allowance*

20% discount off balance

• Lenses every year $10 copayment for single vision,

bifocal, trifocal and lenticular plastic lenses

$45 copayment for standard progressive lenses

*Cannot be combined with any other promotion or discount

State Vision Plan

Contact Lenses*

• Every year

• Conventional lenses $130 allowance 15% discount off balance

• Disposable lenses $130 allowance

* Subscriber may choose either eyeglass lenses or contact lenses, but not both in the same plan year.

State Vision Plan

Employee only

Employee/spouse

Employee/children

Full family

$ 7.76

$15.52

$16.48

$24.24

Monthly Premiums

Insurance Orientation

Vision CareDiscount Program

Vision CareDiscount Program

Features

• No enrollment or premium

• Discount program

• Participating providers only $60 for routine eye exam – excludes

contact lens exam

20% discount on eyewear except disposable contact lenses

Insurance Orientation

Life InsuranceAdministered by MetLife

Basic Life

Basic Life

• $3,000 term life insurance to all eligible employees under age 70

• Premium paid by employer

• Employees enrolled in any health plan are covered

• Accidental death and dismemberment benefits

Optional Life

Optional Life• Premium based on amount of

coverage and employee’s age• Coverage up to three times salary if

enrolled within 31 days of employment

• Medical evidence required for additional coverage

• Maximum coverage level of $500,000

Dependent Life

Child coverage• $15,000 per child

• Premiums ─ $1.24 per month, regardless of number of children covered

• Can enroll eligible children throughout the year without medical evidence of good health

Dependent Life

Spouse coverage• New hire can enroll spouse for

$10,000 or $20,000 without medical evidence of good health

• Premiums based on employee’s age and amount of coverage

• Employee is beneficiary • May enroll in up to 50% of

employee’s Optional Life coverage with medical evidence

Insurance Orientation

Long TermDisability InsuranceAdministered by Standard Insurance Company

Basic Long TermDisability Insurance

Basic Long Term Disability (BLTD)

• Premiums paid by employer

• Employee automatically enrolled with selection of a health plan

• 62.5 percent benefit, up to $800 per month

• 90-day waiting period

Supplemental Long TermDisability Insurance

Supplemental Long TermDisability (SLTD)

• Provides protection for employee if annual salary exceeds $15,360

• Benefit – 65% of monthly salary up to $8,000 per month

• Choice of two plans 90-day waiting period

180-day waiting period

Supplemental Long TermDisability Insurance

Enrollment in SLTD• New hire may enroll without

providing medical evidence of good health

• Late entrant must provide medical evidence of good health to enroll

• Employee pays premium – based on monthly salary, plan chosen and age

Insurance Orientation

Long Term CareAdministered by Prudential

Long Term Care

Features

• Benefits paid when subscriber Is unable to perform at least two

activities of daily living (ADL) for at least 90 days or

Has severe cognitive impairment requiring ongoing help or supervision

Long Term Care

Eligible Participants• Active full-time permanent

employees and their Spouse, parents, parents-in-law,

grandparents, grandparents-in-law, siblings, adult children (and their spouses)

• Retirees and their spouse

• Surviving spouses

Long Term Care

Enrollment• Guaranteed coverage for

employees who enroll within 31 days of hire or during a designated open enrollment period

• Medical evidence of good health required for late entrants and all other eligible participants

Long Term Care

Premiums• Based on

Age at time of purchase Selected plan

• Paid directly to Prudential -- subscriber may continue coverage upon retirement or leaving employment

Insurance Orientation

MoneyPlu$Administered by

Fringe Benefits Management Company (FBMC)

MoneyPlu$

Features• Pretax premiums

• Medical Spending Account (MSA)

• Dependent Care Spending Account (DCSA)

• Health Savings Account (HSA)

MoneyPlu$Pre-tax Premium

Pretax Premiums• Health• Dental and Dental Plus• State Vision Plan• First $50,000 of Optional Life • Tobacco Surcharge• $0.28 monthly administrative fee

MoneyPlu$Medical Spending Account

Medical Spending Account (MSA)

• Employed for one year before participating

• $5,000 maximum annual contribution

• $3.50 monthly administrative fee

• “Use it or lose it” account

MoneyPlu$Medical Spending Account

Eligible expenses include• Deductibles, coinsurance

and copayments

• Medically necessary expenses

• Prescription medications and approved over-the-counter medications

MoneyPlu$Dependent Care Spending Account

Dependent Care Spending

Account (DCSA)

• $5,000 maximum contribution

• $3.50 monthly administrative fee

MoneyPlu$Dependent Care Spending Account

Eligible expenses• Day care fees

• Care for qualified individuals in your home or someone else’s home

• Summer day camps

MoneyPlu$Health Savings Account

Health Savings Account (HSA)• Employee must be enrolled in the

SHP Savings Plan

• Money deposited into account carries forward from year to year

• Account is portable

• Fees $1 per month to FBMC $1 per month ($10/year) to NBSC

MoneyPlu$Health Savings Account

2010 HSA Contributions• $3,050 for individuals

• $6,150 for family

• Additional $1,000 catch-up provision for individuals age 55 and older

Health Savings AccountLimited-Use Medical Spending Account (MSA)

Limited-Use MSA• Must be employed for one year

• Only used for dental and vision care expenses

• $5,000 maximum contribution

• $3.50 monthly administrative fee

• “Use it or Lose it” account

Important Reminders

You are responsible for your benefits.*

Nothing is automatic.*

For detailed information of the benefits offered by the Employee

Insurance Program, refer to the 2010 Insurance Benefits Guide

Survey

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