RISK MANAGEMENT & INSURANCERISK MANAGEMENT & INSURANCEOCTOBER, 2014OCTOBER, 2014

Annual Enrollment

What’s Not Changing

What’s Changing & New

MetLife Hospital Indemnity Plan

MetLife Defender

Terms and Definitions

2015 Health Renewal

Humana Health Benefits

2015 Health Plan Payroll Deductions

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AGENDAAGENDAHumana Vitality

Humana On-Line Resources

Humana Resources

Flexible Spending Accounts (FSA)

Reminders

Questions & Answers

Annual EnrollmentAnnual Enrollment October 15 thru October 27, 2014

** 2 WEEK WINDOW!! ** Coverage Begins: January 1, 2015

Deductions begin: 12/5/14 – Support 12/12/14 – Instructional/Administrative/PTS

2015 Flexible Spending Account and & MetLife Legal deductions begin:

1/2/15 - Support 1/9/15 -Instructional/Admin/PTS

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What’s Not ChangingWhat’s Not Changing?? Humana Dental – No change in benefits or deductions.

Met Life Dental – No change in benefits or deductions.

Eye Med Vision - No change in benefits or deductions.

Prudential Life – No change in benefits or deductions. All new or increased levels of coverage subject to medical underwriting approval. Spouse coverage amount may not exceed employee’s coverage amounts (Board life and/or optional term life).

Corporate Care Works EAP Plan – No changes. (Employee Assistance Plan)

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What’s Changing & NewWhat’s Changing & New Humana Health Plans – Changes to Out of Pocket Max and

National Point of Service (NPOS) Deductible. Payroll deduction changes. New employee + child/ren Tier.

RX Benefits – Co-pay changes.

Assurant Disability Insurance – No change in benefits or deductions. All increases subject to medical underwriting. HIP Plan has been discontinued.

New MetLife Programs –

Hospital Indemnity Plan

Defender Identity Theft Plan5

MetLife HOSPITAL INDEMNITYMetLife HOSPITAL INDEMNITY

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Covered Benefits: Hospital Admission - $500 Hospital Confinement - $250 per day, 30 day maximum Inpatient Rehabilitation Unit - $100 per day, 15 day

maximum – Accident only Payroll Costs:

Employee Only - $8.00 Employee + Spouse - $13.00 Employee + Child(ren) - $17.00 Employee + Family - $21.00

Employees may use board credits if not enrolled in health plan.Preexisting conditions apply 12/12 . (See certificate for full list of exclusions and limitations.)

MetLife DefenderMetLife DefenderBenefitsID Theft Monitoring

Personal Identity Monitoring and Security

Patented Peer-to-Peer Network Monitoring

Junk Mail Removal

Health Data Protection

Financial Data Protection

On-Line Child Safety

Payroll DeductionEmployee Only - $9.00Employee + Spouse - $15.00Employee + Children - $12.00Employee + Family - $18.00

Enrollment any time during the year through: 1-800-Get Met 8 (438-6388)

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Terms and DefinitionsTerms and Definitions Deductible - the amount of covered services that the

member must pay per year before Humana pays benefits for covered services.

Co-payment - the specified dollar amount that the member must pay for a covered service.

Co-insurance - the % amount of a covered service that the member must pay. Example: An 80%/20% coinsurance means that Humana will pay 80% of the allowable charge and the member will pay 20%.

Medical Out-of-pocket limit - the most a member would have to pay per calendar year before the Humana pays 100% of the in network cost. Excludes RX costs.

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2015 Health Renewal2015 Health Renewal Proposed 2015 health renewal was 11.6%. Final renewal

after negotiations and plan design changes was approximately 5%.

Projected 2015 premium -$117.8M; $5.5 premium increase.

Overall the District will pay approximately 80% and employees will pay 20% of total premium.

New Five Tier Enrollment structure – Employee, Employee + Child(Children); Employee + Spouse, Family and Two Board Family.

New Humana Vitality Program

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Staff HMOStaff HMOKey Features & ChangesKey Features & Changes

Staff Network with a limited number of physicians.

Referrals to Specialists limited by PCP Choice.

No Out-of-Network Benefit, except for emergencies.

Service areas Pinellas, Pasco, Hillsborough, Manatee, Polk, Sarasota, Hernando & Citrus.

Co-pays for all services; preventive services covered at 100 %

Hospital co-pay $500 per day, 5 day maximum.

Out of Pocket Maximum - $3,500 (employee) and $7,000 (family).

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Please confirm participation with Humana’s toll free customer service

or website –NOT Doctor’s Office!

NPOS Plan NPOS Plan Key Features & ChangesKey Features & Changes

Deductible: $300/individual$600/family

Hospital co-pay -$500 per day, 5 day maximum.

80/20% co-insurance for physician visits, outpatient services, lab and x-rays.

Out of Pocket Maximum - $3,500 (employee) and $7,000 (family).

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Broad National Point of Service (NPOS) Network – open access.

No Specialist referrals.

In-Network and Out-of- Network benefits.

++ Good option For

Out of Area Retirees

& Students.

CDHP CDHP – – Key Features & ChangesKey Features & Changes

HMO Premier Network which is a larger Tampa Bay area network than the Staff HMO Network.

Network includes: Pinellas, Pasco, Hillsborough and several other Florida counties as well as a limited number of states outside of Florida.

NO Out-of-Network benefits If you move to another plan for 2015, any remaining PCA funds will be forfeited as of December 31, 2014.

$1,500 (employee) and $3,000 (family) deductible with a $500 (employee) and $1,000 (family) allowance.

80%/20% In–Network Co-insurance once deductible has been met.

Out of Pocket Maximum - $3,500 (employee) and $7,000 (family)

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++ For Out of Area Retirees

& Students, you may wish to

consider the NPOS plan.

Pharmacy BenefitsPharmacy Benefits No deductible on Tier 1 Drugs - $20 copay

Deductible ($250 Single/$500 Family) on Tier 2 & Tier 3 Drugs. After deductible: Tier 2 -$55 co-pay

Tier 3 -$95 co-pay Preferred Retail Pharmacy Network – Sam’s Club, Walmart, and

CVS.

Non-Preferred Network – available with additional 30% coinsurance after applicable deductible and copay.

Three month supply for two co-pays still available (after applicable deductible) at retail locations.

Right Source Mail Order still available.

RightSourceRx

Tier/Plan Consumer Directed

Health Plan

Staff HMO National Point of Service (NPOS)

Employee $30 $48 $63

Employee + Spouse

$120 $158 $182

Employee + Child/Children

$115 $151 $175

Family $178 $230 $262

2 Board Family $85 $137 $169

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2015 Health Plan Deductions2015 Health Plan Deductions

Humana Vitality For Employees & Dependents enrolled in Humana Health

Plan.

On Line Wellness Plan.

Complete Vitality Check & HRA.

Provides Personalized Plan.

Access to tools and resources to meet your goals.

Earn Points to Receive Prizes.

Reach “Silver Status”, receive payroll credit in 2016.

Improve your health and well-being.

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What is MyHumana? It’s Humana’s secure website that gives you access to your information anytime you want it. If you haven’t registered for MyHumana:

1. Visit www.MyHumana.com2. Have your Humana ID card

handy3. Go to Humana.com4. Click “Register for

MyHumana”5. Follow the easy steps to

register

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24 Hour Humana Online Resources24 Hour Humana Online Resources

Humana PCS ResourcesHumana PCS Resources Heather Keegan, RN – Patient Advocate

Assists employees with medical and provider issues. Coordinated Diabetes Care Program. Advocates for employees.

Jody Lowry, RN – Health & Wellness SpecialistFacilities wellness and health education programs, enrolls members in disease management, clinical programs and Vitality.

Janet Lang - On Site Claims RepresentativeAssists employees with eligibility, claims and coverage issues.

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Flexible Spending Account Flexible Spending Account (FSA) (FSA)

FSA Plan Deductions are taken pre-tax over 20 pays. You save Social Security and Income Tax – you increase your

take home pay. Reimbursed for Dependent Day Care (Dependent Care FSA)

Up to $5000 for two working parents Pretax savings for day care expenses Children up to age 13

Reimbursed for eligible Medical Expenses (Medical FSA) : Medical, dental, vision co-pays, co-insurance &

deductibles Prescription drug costs Contact Lenses & Prescription Eyeglasses Lasik & other vision improvement surgery

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Flexible Spending Account Flexible Spending Account You decide how much to contribute:

Health Care FSA: $200 - $2500

Dependent Day Care FSA: $200 - $5000

Use it or lose it – the amount deposited into FSA may be used for services incurred for the plan year ending 12/31.

Receive a debit card – for Health Care Expenses. Not for Dependent Day Care.

Amount available for Health Care Expenses on Jan. 1, 2015. Use for deductibles, co-pays, co-insurance and other eligible expenses.

Look for Humana Access Visa cards last week in December – plain envelope.

RemindersReminders Changes through Web only October 15 thru 27th. Confirmation notices available on line for employees to print. Review health plan options and new enrollment tiers. Review new MetLife offerings – Hospital Indemnity Plan and

Defender Identity Theft Protection. Make sure your life insurance beneficiaries are current. Make sure you have enrolled only eligible dependents. Humana will mail everyone new ID Cards. Please make sure

your address on Employee Self Service is correct. Enroll in MyHumana so that you can participate in the Humana

Vitality Program.20

QuestionsQuestions

Visit our web site for current information, including full Beneflex Guide, enrollment and benefit module videos, CDHP & FSA flyers at www.pcsb.org/annual-enrollment.

Call the Humana Hot Line - 888-393-6765, 8:00 am – 8:00 pm, Monday thru Friday.

Call the PCS Benefits Help Line for enrollment assistance - 588-6197, 8:00 am – 4:30 pm, Monday thru Friday.

Email us at houckc@pcsb.org

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