2019 Open Enrollment

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Agenda▪Open Enrollment▪Health Insurance Basics▪EPO Deductible Update▪Health Savings Account - How does it work? ▪Wellness▪Y.E.S. ▪Open Enrollment▪New Hire Enrollment ▪Affordable Care Act▪ZR230 / Report to show employee paid less than 30 hours▪General Reminders

Open Enrollment for 2019Open Enrollment Dates

October 22 @ 8 am - November 9 @ 5 pm(Arizona Time)

Benefits Expo schedule listed in guide

Benefits Effective: January 1-December 31, 2019

Health Insurance Basics Cost Sharing

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.

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PremiumThe amount you pay for insurance per pay period

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Coinsurance / CopaymentA percentage or flat dollar amount you pay for health care services

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Health Plan CostsThis includes the employer premium contribution, its percentage of remaining coinsurance, and remaining expenses for health care services

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DeductibleThe annual amount of money that you must pay before the

health plan will pay

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Out of Pocket MaximumThe most you will pay for health care services - not

including premium

Health Insurance Basics

Remaining deductible$100

The doctor orders an MRI.

You pay $1,100.

Remaining deductible$0

You now have satisfied your annual deductible.

Remaining deductible$1,200

You go to a PCP and pay $150 for the visit.

90%/10% Coinsurance

You now have to pay a percentage of the cost,

called coinsurance.

Remaining deductible$0

You get a brand name prescription

drug $100.

Your deductible is $1,350

Deductible Example - HDHP, Employee Only CoverageThe annual amount of money that you must pay before the health plan will pay

Health Insurance Basics Coinsurance

After your deductible is met, you share responsibility for health care services with the health plan. You pay a percentage and the health plan pays a percentage.

You have hip replacement surgery and the cost is $15,000

You have a $1,350 deductible

You now pay 10% Coinsurance

The health plan pays 90% Coinsurance

You pay a coinsurance up to the Out of Pocket

Maximum

You paid a $1,350 deductible

You now pay $650

The health plan pays $13,000

You have reached your $2,000 Out of Pocket

Maximum

Health Insurance Basics Out of Pocket Maximum

The most you will pay for health care services - not including premium

You paid a $1,350 deductible

You paid a Coinsurance, up to $2,000 Out of Pocket Maximum

The health plan pays Coinsurance

Future health care services

The health plan pays 100%

EPO Deductible Update

■ Deductible is the cost the member pays before the plan pays any benefits

■ 100% of the first $100/$200 of any costs the member incurs - medical ONLY ○ Change from prior announcement○ Operational and system limitations prohibit

combined medical and Rx deductible■ Deductible is embedded - Dependent tiers

○ Once a covered individual of a family unit has reached their own single deductible, copays apply

○ Remaining members combined can reach the remainder of the family deductible

Medical PlanHDHP with HSA - AETNA NetworkDeductible Health Plan with Health Savings Account)

■High Deductible Health Plan (HDHP)

■ Services can be obtained in-Network or out-of-Network, will have much higher costs for out-of-Network services

■ In-Network and out-of-Network deductibles must be met

■ In-Network Deductibles: Individual $1,350 / Family $2,700

■ Out-of-Network Deductibles: Individual $2,700 / Family $5,400

■ No costs for preventive services

■ Coinsurance applies after deductible is met

■ Additional 15% discount at Banner facilities

■ Out of Pocket Maximum

■ In-Network: Individual $2,000 / Family $4,000

■ Out-of-Network: Individual $5,000 / Family $10,000

Medical PlanHDHP with HSAHealth Savings Account (HSA)

■ State makes contribution to the HSA: $720 single, $1,440 dependent tiers; divided over 26 pays per year

■ Administered by PayFlex

■ HSA is a savings account to pay for covered or qualified health expenses on MasterCard® debit card

■ Employer and/or Employee bi-weekly contributions to your HSA

■ IRS Annual Contribution Limits: Individual $3,450 / Family: $6,900 combined

■ Funds are owned by the participant

■ No use it or lose it

Medical PlanHDHP with HSA

■Health Savings Account (HSA) cont’d

■ Account established in the employee’s name once enrolled in the HDHP and verified by PayFlex (Customer Identification Process)

■ Common delays in opening an HSA include: incorrect address, P.O. Box, inconsistent use of legal name

■ Employees are not eligible to contribute to an HSA if:

■ The employee or spouse has a health reimbursement account

■ Enrolled in Medicare or Medicaid

■ Enrolled in Tricare

■ Care is received from the Veteran’s Administration (VA)

Flexible Spending Accounts

Pay eligible medical expenses with pre-tax dollars

• Reduces taxable wages which decreases taxes

Maximum Contribution Allowed $2,650

• Choose total amount you want to contribute• Divide by 26 for

per-paycheck contribution

Visa® Debit Available• Pay at point of service

USE IT OR LOSE IT each year.

• Use funds by 12/31

• Does not roll over

Health Care Flexible Spending Account

▪Use for deductible and copayment expenses for:

▪ Medical, dental and vision, and prescriptions - KEEP YOUR RECEIPTS

▪ Perfect for EPO participants to offset new deductible

Limited Purpose Flexible Spending Account

▪Only available to member who selected the HDHP with HSA option

▪Use for dental and vision expenses only

Pay for dependent care (non-medical) with pre-tax dollars

Reduces taxable wages and decreases taxes

Maximum Contributions - $5,000 annually ($2,500 if married and file separately)

Pay expenses for care of dependent outside your home including day care facilities, babysitting services, preschool, and practical nursing care

Pay for care provided for employee’s children under age of 13 for whom employee has custody, for physically or mentally handicapped spouse or other dependent who spend at least 8 hrs a day in employee’s home

Flexible Spending AccountsDependent Care Flexible Spending Account

Qualified Life Events (QLE)

Marital Status

•marriage•divorce•legal separation•annulment•death of spouse

Dependent Status

•birth•adoption•placement for

adoption•death•loss of

dependent eligibility due to age

Employment Status or Work Schedule

•affecting benefits eligibility for you or your dependents

Changes in Residence

•result in non-availability of plan options

These conditions allow you to make changes mid-year.

• Submit a Declaration for Change Form and Enrollment Form within 31 calendar days of the event

• Or you have to wait until Open Enrollment or the next Qualifying Life Event (QLE)

ONLY 31 Days from

DATE OF EVENT

Qualified Life Events (QLE)

Wellness

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Health Impact Program (HIP)▪What is HIP?▪HIP is a comprehensive well-being program to help you achieve your physical, financial, personal and professional well-being goals all while having fun and reaching milestones along the way.

▪Who is eligible?▪All active, benefits-eligible employees should participate, whether or not they are enrolled in an ADOA medical plan▪ You must be an active, benefits-eligible employee

throughout the program period and the payout period to receive the incentive payment.

Health Impact Program (HIP)▪Getting 500 Points▪Screenings, exams, and activity challenges are self-reported and provide easy ways to earn points

Health Impact Program (HIP)▪Getting a $200 Incentive

▪Earning 500 total points during the program period: January 7 - December 31, 2018▪Exact incentive amount may be lower depending on participation. Incentives are subject to Federal and State taxes.▪You must be an active, benefits-eligible employee throughout the program period and at the time of the payout to receive the incentive payment

Metrics

Weight & Diabetes Management Programs

■ Five new programs

■ Offered at work and Online

■ Employees, spouses and dependents over 18

are eligible

■ No cost and low cost options

■ Earn 150/200 HIP points upon completion

■ See Flyer for details

Wellbeing Updates■ Agency Director “Call to Action” Email ■ Monthly Newsletter

■ New Challenges began September 24■ Diabetes Webinar - October 11■ Worksite flu shots through December 7

■ Mobile App - Launch in 2019■ HIPster Certification■ Wellness Award

Benefit Operations

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Y.E.S. Open Enrollment

Active employees must enroll through Y.E.S.

▪ Paper forms will not be accepted (exception are New Hires)

Personal Email / Phone Requirements

▪ Members will still be required to provide and/or update their information

Supported Browsers

▪ Supported: Internet Explorer and Chrome

▪ Not Supported: Microsoft Edge

Agency Reports

▪ Do not plan to send any reports to agencies during the passive enrollment

Y.E.S. (continued)New Hire / Rehire Enrollment

During Open Enrollment (10/22 – 11/08)

■ First Step: Must complete new hire / re-hire enrollment through Y.E.S.■ Second Step: Wait one business day, then complete open enrollment

After Open Enrollment (11/09 – 12/31)

■ First Step: Must complete new hire / re-hire enrollment through Y.E.S.■ Second Step: Complete a paper enrollment form

■ 2019 Enrollment forms will be available on Benefitoptions.az.gov starting on 11/09

■ Submit forms to ADOA Benefit Services Division

This is only required if an employee wants to make a benefit change or enrolls in Medical or Dependent Flex plans

*Return to Work Retirees that are retired from ASRS and are enrolled into ADOA Dental plan - (e.g. enrolled in Delta Dental as a retiree ) must submit retiree paper election form to ADOA BSD. Retiree forms are provided to employee in the Open Enrollment packet.

Affordable Care Act (ACA)2018 Standard Measurement Period (SMP) is ending on 10/09/2018

ADOA determines which active employees are Benefit Eligible for the 2019 plan year.

Employees are eligible if paid on average of 30 hours per week during the standard measurement period (SMP)

▪ SMP = 10/10/2017 to 10/09/2018

Benefits Operations will summarize hours paid to determine who is benefit eligible for 2019 plan year

Notices will be sent to agency benefit liaisons by Friday November 16th

Affordable Care Act (ACA)Employee was eligible for benefits in 2018 and is still eligible for benefits in 2019

■ No action required as employee is in correct employee status code and will be allowed to enroll during 2019 Open Enrollment

Employee was not eligible for benefits in 2018 and is eligible for benefits in 2019

■ Benefit Liaison will receive notification that your employee was deemed eligible for 2019

■ Employee will receive notification explaining that they are eligible for benefits for 2019 plan year

■ Employee will not be eligible to complete enrollment through Y.E.S. – they MUST submit a paper application

■ Employee must remain in a non-benefit eligible status until 12/31/2018 which at that time they need to be changed to a benefit eligible status code

Affordable Care Act (ACA)Employee was not eligible for benefits in 2018 and is still not eligible for benefits in 2019.

■ No action required as employee is in correct employee status code and will be allowed to enroll during 2019 Open Enrollment

■ No action is required by ADOA or Agency.

■ Employee will not be allowed to enroll through Y.E.S. during 2019 Open Enrollment.

Employee was eligible for benefits in 2018 but not eligible in 2019.

■ Benefit Liaison will receive notification that your employee was deemed ineligible for 2019.

■ Employee must remain in benefit eligible status until 12/31/2018 which at that time the status code must be changed to a benefit ineligible code (e.g. change from D1 to D2).

■ Employee will also receive notification explaining benefits will expire as of 12/31/2018. Employee received will be offered COBRA immediately.

ZR230 ReportReport should be used as a tool to assist with research

■ Will be able to see members who are paid less than 30 hours per pay period

Displays employees who are eligible to enroll into benefit plans

■ Must research to determine if employee is actually enrolled

Does not calculate prior pay period adjustments

■ Must research to determine if employee had an adjustment

Report will include employees on FMLA, Military Leave, Industrial leave, Return to Work (RTW)

■ Based on the research agencies need to determine if the employee is responsible for the employer premium

GAO73B - Request for a One Time Unpaid Benefit Premium Adjustment

Why should an agency submit a GAO 73-B Form?

■ If an employee owes the employer portion of benefit premium

What happens once the form is submitted to ADOA and the form is processed?

■ Agency will be refunded the employer portion of benefit premium ■ Employer portion of Benefit Premium will be allocated to employee■ Unpaid Benefit Premium report will display the employer portion of benefit

premium allocated to employee

Top 3 Reasons ADOA will reject the form■ Not using correct deduction codes■ Not entering correct premium amount■ Not entering dental ER portion

GAO73B - Request for a One Time Unpaid Benefit Premium Adjustment (Continued)

Due to taxes and W2 reporting, ADOA must keep the deduction codes for agencies and employees separated.

AGENCY DEDUCTION CODES: ■ M012, M018, M020, M024, M028, M030, D006 and D008

** Premium amounts for agency deduction codes should always display as a negative in order to refund the agency

EMPLOYEE DEDUCTION CODES: ■ M181, M183, M185, M187, D181, D183

** Premium amounts for employee deduction codes should always display as a positive in order to allocate the premium to employee

Open Enrollment Reminders Dual Coverage

▪ Any benefit eligible State employee may only be enrolled in 1 benefit plan

Dependent Social Security Numbers (SSN)

▪ Correct SSN’s for dependents are required

▪ When submitting a Q.L.E. for a newborn be sure to provide copy of SSN once available

Beneficiary

▪ Update after 1/1/2019

▪ Basic Life - All benefit eligible State employees

▪ Supplemental Life - elected benefit

Key Contact Information

Enrollment - yes.az.gov

benefitoptions.az.gov

(602) 542-5008 (800) 304-3687

benefitsissues@azdoa.gov

OE Communications Calendar▪ 9/28 - Enrollment Mailing Sent▪ 9/28 - OE Materials on benefitoptions.az.gov

▪ 10/10 - OE Coming Preview Email▪ OE Dates, Expos, Guides, ALEX, New Hires

▪ Liaisons to forward to their teams

▪ 10/22 - Open Enrollment Begins ▪ Statewide email - Laura sending

Questions?

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