Upload
cyrus-truss
View
213
Download
0
Tags:
Embed Size (px)
Citation preview
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
Your opinion is important to us. Please click on the link below to complete a short, online survey.
http://www.zipsurvey.com/LaunchSurvey.aspx?suid=24841&key=EBD7A5D8
When you have finished, click on “Submit.”
Thank you for your evaluation of this presentation.