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GOOD, SMART PEOPLE EFFECTIVELY MANAGING
THE ENTIRE HEALTH CARE DOLLAR.
EMPLOYEE MEETINGAPRIL 22, 2016OPEN ENROLLMENT
January 1st, 2020
2
TODAY’S PRESENTATION
OPEN ENROLLMENT
EBC / BENEFIT ENROLLMENT
DEPENDENT AUDIT
BENEFIT REVIEW
1
2
3
4
5 OVERVIEW OF ALL PLANS – QUESTIONS & CLARIFICATIONS
EAP Announcement
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OPEN ENROLLMENT
1
MONDAY, OCTOBER 21ST – FRIDAY, NOVEMBER 1ST
Benefits effective January 1, 2020 All employees must make new elections for the 2020 plan year
Make any changes you want to your benefits Waived previously & want to enroll for 2020 Don’t want to change anything? You must still complete open enrollment.
The only time benefit changes can be made outside of Open Enrollment is in the case of a QUALIFYING EVENT: (within 30 days from date of the event)
Marriage Birth Death Divorce Adoption/Custody Involuntary loss of coverage
Employees must actively engage in enrollment or benefits will be lost!
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OPEN ENROLLMENT – EASY & CONVENIENT
ENROLLMENT PARTNER: EBC – Enrollment Benefit Concepts
THREE ways to enroll (ONLY ONE IS REQUIRED):
CALL CENTER
(937) 401-3739 Monday-Thursday: 8:30 am to 5:30 pm
Friday: 8:30 am to 5:00 pm
SELF-SERVE
www.aflacatwork.comLog in using SS # and PIN
(last 4 digits of SSN and
last 2 digits of birth year)
APPOINTMENT
Benefit Specialists Reserve your slot at:
www.ebcoh.com/enroll
5
OPEN ENROLLMENT – HOW TO BE PREPARED
Date of Birth Social Security Number
IF YOU ARE NEWLY ENROLLING A SPOUSE AND/OR DEPENDENTS:
Date of Birth for each dependent Social Security Number for each dependent
Expect to spend about 30 minutes to enroll, no matter how you decide to enroll.
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DEPENDENT AUDIT – CONSOVA
Any employee adding a new spouse or dependent to the medical, dental, or vision plan, at any time, will be audited.
“Open Enrollment” does not secure coverage for your dependents.
Following enrollment, you will receive a letter in the mail from Consova with instructions on how to complete the required audit.
Failure to respond to the audit will result in termination of coverage for dependents!
7
OPTING OUT OF THE MEDICAL / RX PLAN
THE FOLLOWING OPTIONS ARE AVAILABLE IF YOU CHOOSE TO OPT OUT OF THE MEDICAL / RX PLAN:
1. $600 CASH Taxable (paid $150 per quarter).
2. $600 deposited into a Healthcare Flexible Spending Account – Tax Free!!
IN ORDER TO RECEIVE OPT OUT FUNDS YOU AND ELIGIBLE DEPENDENTS / SPOUSE MUST BE COVERED UNDER OTHER GROUP HEALTH INSURANCE, MEDICARE, MEDICAID OR TRICARE.
8
2020 BENEFIT UPDATE
WHAT IS STAYING THE SAME?
Medical Anthem
PharmacyRx Benefits /
Express Scripts
DentalSuperior Dental
Care
Life/Vol Life/AD&D Voya
Worksite Aflac / Trustmark
Wellness Incentive Wellvibe
WHAT IS NEW?
Employee Assistance Program
Anthem
WHAT IS CHANGING?
Vision Anthem
Educator Voluntary Disability
Voya
9
WHAT IS STAYING THE SAME
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MEDICAL PLAN HIGHLIGHTS – ANTHEM
High Deductible Health Plan IN NETWORK OUT OF NETWORK
Annual Deductible : Non-Embedded$1,500 Single$3,000 Family
$4,000 Single$8,000 Family
Co-Insurance (after deductible) 100% 70% / 30%
Preventive Care COVERED IN FULL Deductible
Hospital / Inpatient & Outpatient Deductible Deductible
Professional Services Deductible Deductible
Primary Care Physician (after deductible)$20 PCP /
$40 Specialist Deductible
Emergency Room (after deductible) $150 $150
Urgent Care (after deductible) $50 Deductible
Prescription Drugs (after deductible) $10 / $30 / $50 Deductible
Mail Order (after deductible) $30 / $90 / $150 N/A
Maximum Out-of-Pocket(includes deductible, co-insurance & copays)
$3,500 Single$6,850 Family
$5,000 Single$10,000 Family
ALL OTHER MEDICAL BENEFITS ARE SUBJECT TO DEDUCTIBLE & CO-INSURANCE
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PHARMACY – RX BENEFITS
PHARMACY BENEFIT MANAGER (PBM)
Express Scripts (ESI) You have access to the Members
Services Team 1-800-334-8134
Monday – Friday 7:00 am to 8:00 pm Is my drug covered? Is my Pharmacy in network? Are there lower cost alternatives? Can you assist me with my claim
questions?
MAIL ORDER
ESI HOME DELIVERY: 1-877-503-4073
Mail Order forms can be found at Express-Scripts.com
New Prescriptions: Can be mailed to ESI by using a mail order
form Physicians can phone in ESI Scripts
Physicians can e-scribe ESI Scripts
** NOTE: Mail Order can take up to two weeks for initial order, so members should make sure they have enough medication on hand to last until delivery.
12
MEDICAL & PHARMACY PLAN CONTRIBUTIONS
NO CHANGE FROM 2019!!
Weekly Hours
Total Premium
Cost/Month
EmployerCost/Month
EmployeeCost/Month
EmployeeCost Per 20 pay period
EmployeeCost Per 26 pay period
SINGLE
30+25-2920-2415-1910-14
$740.44
$629.37$614.57$496.09$370.22$244.35
$111.07$125.87$244.35$370.22$496.09
$66.64$75.52
$146.61$222.13$297.66
$51.26$58.09
$112.78$170.87$228.96
FAMILY
30+25-2920-2415-1910-14
$1,874.15
$1,593.03$1,555.54$1,255.68$937.08$618.47
$281.12$318.61$618.47$937.08
$1,255.68
$168.67$191.16$371.08$562.25$753.41
$129.75$147.05$285.45$432.50$579.54
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HEALTH SAVINGS ACCOUNT
A health savings account or HSA is an individually-owned account used to save and
pay for eligible medical expenses. Any individual who:
Is NOT covered by any first dollar health coverage
Is NOT enrolled in Medicare
Is NOT claimed as a dependent on someone else’s tax return
Two banking options available :
Who is eligible for an HSA?
AVIDIA WRIGHT-PATT CREDIT
Online only On location services
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HEALTH SAVINGS ACCOUNT
An HSA works with your HDHP The HDHP covers illness or injury after your annual deductible is met,
and certain preventive care services at no cost.
Funds in your HSA can pay for eligible medical expenses (defined by the IRS), before AND after your annual insurance deductible is met.
Funds roll over year to year and earn interest tax free.
Visit flexbank.net for a complete list of eligible expenses
15
HEALTH SAVINGS ACCOUNT – FLEXBANK Employees must open an account through FlexBank in order to receive funding into the HSA from Dayton
Board. If you opt for the Wright-Patt account, you will need to submit your paperwork to FlexBank by 12/6/19 or you will be defaulted into an Avidia.
Contributions from Dayton Board into the HSA will be based upon enrollment status for actively working employees as of January 1, 2020.
Dayton Board Contributions will be allocated in January: $750 Single/$1,500 Family
Employee contributions can change on a monthly basis.
Employees who are not eligible to contribute to an HSA will receive the Dayton Board Contribution via a HRA (Health Reimbursement Account).
2020 HSA Contribution Limits: Single: $3,550 $50Family: $7,100 $100
Catch up Contribution: $1,000 No change(age 55 or older)
Maximum contribution limits include Dayton Board Contributions
16
FLEXIBLE SPENDING ACCOUNT – FLEXBANK
Healthcare Flexible Spending Account (FSA): Not contributing to an HSA Tax Free General Purpose FSA: Medical, Vision, Dental, and Hearing Expenses Maximum election = $2,700 Can withdraw entire annual election at anytime regardless of year to date deposits Use it or lose it!
Limited Purpose Flexible Spending Account: Can use if contributing to HSA Dental and vision expenses only Maximum election = $2,700
Work-Related Dependent Care Reimbursement Maximum contribution $5,000 if married/filing jointly or single $2,500 if married/filing separately Can withdraw up to what has been deposited to date….
more like a regular bank account, but tax-free
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ANTHEM BENEFITS OF REGISTERING ONLINE
Blue Access (PPO) Network – anthem.com
Sydney Health
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ANTHEM – MEET SYDNEY
Your personal health ally, offering the same great services as Anthem Anywhere, plus new features like custom content, personalized wellness activities and more. Access Sydney using your online login info, or simply download the app and log in with your Anthem Anywhere username and password.
WHERE TO GET CARE Care Provider Wait & Average Cost When to Go
Board-Certified Doctors10 minutes
$59
• Minor allergic reactions• Minor headaches • Nausea or diarrhea • Cough, cold, or sore throat • Sinus pain or fever • Eye or ear pain/irritation
Physician 30 minutes
$72
• Allergic reactions • Cough, cold, & sore throat • Eye/ear pain• Certain Shots • Minor burns
Family practice Doctors30 minutes
$124
Same as retail clinic & telemedicine plus –• Asthma• Back pain• Preventive visit
Doctors who treat conditions that need immediate attention, but
are not life threatening
30 minutes$143
Same as PCP plus –• Animal bites• Sprains• Stitches• X-rays
Doctors trained in emergency medicine
4 hours$1,500
• Symptoms that feel life threatening or disabling
• Chest pain/severe shortness of breath • Major injury or broken bones• Coughing or vomiting blood • Sudden loss of consciousness
PRIMARY
CARE
PHYSICIAN
TELEMEDICINE
(LiveHealth Online)
RETAIL-BASED
CLINICS
URGENT
CARE
EMERGENCY
ROOM
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ANTHEM – TALK TO A DOCTOR NOWLiveHealth Online
24/7 healthcare when you need it $59 or less per consultant $10 co-pay after deductible ePrescribing to your local pharmacy Integrated with Anthem’s claims
system
LiveHealth Online Psychology
Online non-prescribing licensed psychologist or therapist when you need it
$80 – Social Worker / Therapist$95 – Psychologist$10 co-pay after deductible Available 7am to 11pm 7 days a week Visits last up to 45 minutes Integrated with Anthem’s claims system
Types of Conditions Treated:• Cough• Cold• Flu• Allergies• Suspected Sinus Infection• Pinkeye• etc.
Covers ALL Dependents & Spouses
www.livehealthonline.comCan also download the LiveHealth Online from the app store for your smartphones and iPads.
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Health Management & Engagement
Wellvibe is a health engagement portal designed to
help administer your 2020 Wellness Program
Program is available to all employees enrolled in the medical / Rx plan.
It is VERY easy for you to receive your incentive for 2020! Here is how : Visit your physician for an annual physical
between January 1, 2020 and December 31, 2020.
Create or login into your Wellvibe account You will receive a $75 gift card via the Wellvibe
portal.
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DENTAL PLAN HIGHLIGHTS –SUPERIOR DENTAL CARE
NO CHANGES TO PLAN DESIGN IN NETWORK OUT OF NETWORK
Preventive Services 100% 100%
Basic Services 80% 80%
Major Services 50% 50%
Contract Maximum (per member per contract period) $1,500
DEDUCTIBLE(applies to Basic and Major services and follows the contract period)
$25 Single$75 Family
Copayment(applies to preventive exams) N/A
Orthodontics 50% 50%
Ortho Lifetime Maximum $5,000
Network Access Open Access – same level of coverage in & out of network
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DentalWeekly Hours
Employee Cost Per 20 Pays
Employee Cost Per 26 Pays
Single
30+25-2920-2415-1910-14
$1.39$2.37$4.59$6.96$9.32
$1.07$1.82$3.53$5.35$7.17
Family
30+25-2920-2415-1910-14
$4.40$7.48
$14.53$22.01$22.49
$3.39$5.76
$11.17$16.93$22.69
DENTAL PLAN CONTRIBUTIONS –SUPERIOR DENTAL CARE
NO CHANGES
TO RATES
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VOLUNTARY ACCIDENT / CRITICAL ILLNESS & HOSPITAL INDEMNITY
AFLAC
SUPPLEMENTAL LIFE / AD&D VOYA
UNIVERSAL LIFE WITH LTC TRUSTMARK
OTHER PLANS OFFERED DURING OE
25
WHAT IS CHANGING
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VISION PLAN CONTRIBUTIONS – ANTHEM
WHAT IS CHANGING Changing carriers :
EyeMed Anthem Rates are DECREASING
VisionWeekly Hours
Employee Cost Per 20 Pays
Employee Cost Per 26 Pays
Single
30+25-2920-2415-1910-14
$0.31$0.53$1.02$1.55$2.07
$0.24$0.41$0.78$1.19$1.60
Family
30+25-2920-2415-1910-14
$0.79$1.34$2.60$3.94$5.28
$0.60$1.03$2.00$3.03$4.06
NETWORK Same Insight Network
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VISION PLAN HIGHLIGHTS – ANTHEM
IN NETWORK OUT OF NETWORK REIMBURSEMENT UP TO:
EXAM (with dilation as necessary)
$10 Copay $40
FRAMES (any available frame at provider location)
$0 Copay $150 allowance
20% off over $150 $105
CONTACT LENSES(allowance includes materials only)
Conventional DisposableMedically Necessary
$0 Copay | $150 allowance | 15%$0 Copay | $150 allowance | 15%
$0 Copay | paid in full
$120$120$210
STANDARD PLASTIC LENSES Single VisionBifocalTrifocalLenticularStandard ProgressivePremium Progressive Tier 1 Premium Progressive Tier 2Premium Progressive Tier 3
$25$25$25$25$65$85$95
$110
$30$50$70$70$0$0$0$0
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EDUCATOR VOLUNTARY DISABILITY - VOYA
WHAT IS CHANGING Changing carriers | SunLife Voya Rates are DECREASING
SHORT TERM DISABILITY $0.835 per $10 of weekly benefit
LONG TERM DISABILITY $1.68 per $100 of covered benefit
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GOOD, SMART PEOPLE EFFECTIVELY MANAGING
THE ENTIRE HEALTH CARE DOLLAR.
EMPLOYEE MEETINGAPRIL 22, 2016WHAT IS NEW
30
EMPLOYEE ASSISTANCE PROGRAM (EAP)
Helps with life’s challenges, including personal, legal, financial and dependent care at NO COST to you!
Available 24/7 by phone or website
Confidential access to customer care specialists and licensed clinicians
Up to 5 face to face visits or video consultations per household member per issue
EAP Member Center available to locate EAP providers and access valuable information
All employees will receive an introductory brochure with a wallet card
More information coming soon!
NEW
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WRAPPING UP
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Sign up by providing RetireMEDiQ with your email address:
www.retiremediq.com/daytonschools
Once you finish this step, you will receive a welcome email. You can complete your online profile by selecting topics of interest, as well as customize how often you’d like communications delivered to your inbox.
You can also call RetireMEDiQ and speak with a licensed benefit advisor 1-866-600-4266
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MCGOHAN BRABENDER ADVOCATE TEAM
At MB, advocacy is more than a department – it’s the foundation of our organization. Our
Knowledgeable problem-solvers are passionately
committed to finding the right solution for every client, every time.
HOW IT WORKS :
If you have contacted your physician or carrier and do were not satisfied with the response, our MB
Advocates team are there to step in on your behalf! We have direct access to senior-level
representatives at our carrier partners. We know how to get to the bottom of issues like :
• Explanation of Benefits (EOB)• Provider Billing Questions• Coordination of Benefits• Pre-Authorization help• Enrollment Status
CONTACT USMonday-Friday 8 a.m. to 5 p.m.P: 937-260-4300 or 877-635-5372F: 937-499-1160E: [email protected]
Have all your paperwork ready
for speedier solutions!
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LET’S REVIEW …
OPEN ENROLLMENT : OCTOBER 21ST – NOVEMBER 1ST
EBC : MAKE APPOINTMENT IN PERSON / CALL / SELF SERVE ONLINE
REVIEW YOUR BENEFIT OPTIONS
DEPENDENT AUDIT
1
2
3
4
5 QUESTIONS??
TAKE ACTION
Respond quickly!