agenda

Embracing a Healthy Lifestyle through the State Health PlanNew Plan Options and Incentives for 2014

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Agenda

• Why are we Making Changes for 2014?

• New Plan Options for 2014

• Introducing New Wellness Incentives

• Open Enrollment for 2014

• Additional Resources

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Why Are We Making Changes for 2014?

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• The State Health Plan is providing more choice for members. The Treasurer conducted a listening tour across the state last year and the Plan has conducted various focus groups and surveys and the message has been clear, members have stated that they want more options.

• Many of the changes and new choices are designed to encourage members to become more engaged in their health and take steps to live a healthier life.

• The Plan also believes an engaged membership will help ensure that the State Health Plan remains financially stable in the years ahead.

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Health Plan Options for 2014

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Enhanced 80/20 Plan

NEW: Consumer-Directed Health Plan (CDHP) with HRA

Traditional 70/30 Plan

Open Enrollment will be conducted October 1 – 31, 2013. You must complete enrollment—otherwise, you and your covered family members will be

enrolled in the Traditional 70/30 Plan effective January 1, 2014.

Three Plans will be offered

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A New Focus On Wellness

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Enhanced 80/20 PlanNEW: Consumer-Directed Health

Plan (CDHP) with HRATraditional 70/30 Plan

• Wellness premium credits when you complete the Wellness Activities

• Additional wellness incentives

• Wellness premium credits when you complete the Wellness Activities

• Additional wellness incentives

• No incentives available

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Wellness Premium Credits

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Wellness Activity How to Complete It When Members Can Take It

Subscriber selects a Primary Care Provider (PCP)A PCP must also be selected for each dependent covered on the State Health Plan.

Log into the BEACON/eEnroll system to select a PCP. If members have trouble locating a provider, they can contact 888-234-2416.

Subscribers don’t have to wait until October to choose a PCP. They can choose one NOW. If they change their mind, they can select a different provider any time. (It takes 5 calendar days to update in the system)

Subscriber completes a confidential Health Assessment (HA)

Through the State Health Plan website (www.shpnc.org), click on NC HealthSmart and member logs into Personal Health Portal. Health Assessments can also be completed by telephone at 800-817-7044.

A new shorter assessment is NOW available on the Personal Health Portal. If the member has completed a Health Assessment since Nov. 1, 2012, through the Personal Health Portal, it will count toward the premium credit. Members may also complete the HA during Open Enrollment via the enrollment portal.

Subscriber attests to being a non-smoker/commits to a cessation programand attests for spouse if applicable

Through the online enrollment system. For instructions, go to the State Health Plan website (www.shpnc.org), click on Important Forms under “Quick Links” and select Enroll in a plan.

During enrollment, Oct. 1-31, 2013.To quit smoking, the Plan offers assistance through QuitlineNC. Members can access online at www.QuitlineNC.org or call 800-QUIT-NOW (800-784-8669)

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Who can be a Primary Care Provider?

• A Primary Care Provider can practice:• General / Family Medicine• Internal Medicine• Pediatrics, or• Obstetrics and Gynecology

• A Primary Care Provider can be:• Licensed Nurse Practitioners• Physician’s Assistants

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Specialty Providers cannot be selected as a PCP.

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What Is a Blue Options Designated Provider?

• Blue Options Designated providers meet BCBSNC criteria for: • Delivering quality health outcomes• Cost effectiveness• Accessibility by members

• The Blue Options Designated provider network includes hospitals and certain types of specialists: • General Surgery• Ob-Gyn• Gastroenterology• Orthopedics• Cardiology• Neurology

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To find a Designated Blue Options provider, members may go online to www.shpnc.org and click on Member Services, then on “Find a Doctor or Facility” or call 888-234-2416

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The Enhanced 80/20 Plan• An enhanced version of the current Standard 80/20 Plan, except

• New name – The Enhanced 80/20 Plan• New incentives to encourage members to manage their health and lower their health care costs

• Preventive Care – There will be no copays on Affordable Care Act (ACA ) preventive services or preventive medications.

• Primary Care Provider (PCP) – To receive a $15 PCP copay reduction, a PCP must be selected by Oct. 31, 2013.

• If the selected PCP is not available at the time of the appointment, the member may visit any provider in the same practice and still receive the copay reduction

• If a member wants to change PCPs, they can go to their enrollment portal and select a new PCP. A new ID card with the PCP’s information will be mailed to the member. The PCP change must be made before visiting the new PCP.

• Providers* - When a specialist or hospital is needed, members have the option to select a Blue Options Designated Provider:

• Specialists – To receive a $10 Specialist copay reduction, choose a Blue Options Designated provider

• Hospitals – To avoid a $233 Inpatient Hospital copay, select a Blue Options Designated Hospital

*Members may visit any provider in the BCBSNC Blue Options network and be considered “in-network”. The additional rewards are tied to the incentives outlined above and throughout this presentation.

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Monthly Premiums—Enhanced 80/20 Plan

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2014 Enhanced Plan Premiums (Active Employees and Non-Medicare Primary Members)

Coverage Type Employee/ Retiree Monthly

Premium

Dependent Monthly Premium

Total Monthly Premium

(Employees on 12 month

installment pay)

Wellness Premium Credits*

Net Monthly Premium*


installment pay)

Employee/Retiree Only

$63.56 N/A $63.56 $50.00* $13.56*

Employee/Retiree + Child(ren)

$63.56 $272.80 $336.36 $50.00* $286.36*

Employee/Retiree + Spouse

$63.56 $628.54 $692.10 $50.00* $642.10*

Employee/Retiree + Family

$63.56 $666.38 $729.94 $50.00* $679.94*

*Assumes completion of three wellness activities

Increase of 3.57% for Child(ren), Spouse & Family coverage.

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Lower Your Premiums with Wellness Premium Credits—The Enhanced 80/20 Plan

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Complete up to Three Wellness ActivitiesBy October 31, 2013

Enhanced Plan Premium Credits


$20 per month

Subscriber (only) completes a confidential Health Assessment (HA)

$15 per month

Subscriber and any covered dependents selects a Primary Care Provider

$15 per month

Reduce your premium by up to… $50 per month

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Wellness

Activity

Three

CompletedTwo Activities Completed One Activity Completed

Smoking Attestation(Employee & Spouse/applicable)

$20 ReductionX X X X

PCP Selection(Employee & Covered

Dependants)

$15 Reduction

X X X X

HA Completion(Subscriber only)


$$ Cost $$12 month inst. pay

$13.56 $28.56 $28.56 $33.56 $43.56 $48.56 $48.56

$$ Cost $$10 & 11 month pay (8 mths / 6

chks. starting December)$18.08 $38.08 $38.08 $44.75 $58.08 $64.75 $64.75

• If none completed the cost will be $63.56 for employee only on 12 month installment pay & $84.75 for employee only on 10 or 11 month pay.

Wellness Premium Credits—The Enhanced 80/20 Plan – Employee Only Rate

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Wellness

Activity

Three





Dependants)

$15 Reduction

X X X X




$286.36 $301.36 $301.36 $306.36 $316.36 $321.36 $321.36



• If none completed the cost will be $336.36 for employee on 12 month installment pay & $448.48 for employee only on 10 or 11 month pay.

Wellness Premium Credits—The Enhanced 80/20 Plan – Employee + Child(ren) Rate

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Wellness

Activity

Three





Dependants)

$15 Reduction

X X X X




$642.10 $657.10 $657.10 $662.10 $672.10 $677.10 $677.10



• If none completed the cost will be $692.10 for an employee on 12 month installment pay & $922.80 for an employee on 10 or 11 month pay.

Wellness Premium Credits—The Enhanced 80/20 Plan – Employee + Spouse Rate

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Wellness

Activity

Three





Dependants)

$15 Reduction

X X X X




$679.94 $694.94 $694.94 $699.94 $709.94 $714.94 $714.94



• If none completed the cost will be $729.94 for an employee on 12 month installment pay & $973.26 for employee only on 10 or 11 month pay.

Wellness Premium Credits—The Enhanced 80/20 Plan – Employee + Family Rate

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Lower Your Health Care Costs with Wellness Incentives—The Enhanced 80/20 Plan

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Things you can do to reduce your costs…

Enhanced Plan Incentives

Visit the PCP listed on ID card Your copay is reduced by $15

Visit a Blue Options Designated specialist Your copay is reduced by $10

Get inpatient care in a Blue Options Designated hospital

Your $233 copay is not applied

Remember:

Get preventive services through an in-network provider in a non-hospital setting

100% coverage – this is provided at no cost to you

ACA preventive medication list100% coverage – this is provided at no cost to you

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ACA Preventive Medications

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Drug or Drug Category Criteria

Aspirin (to prevent cardiovascular events)-Generic OTC 81mg and 325mg

Men ages 45 to 79 years and women ages 55 to 79 years

Fluoride – Generic OTC and prescription products Children older than 6 months of age through 5 years old

Folic Acid – Generic OTC and prescription products 0.4 – 0.8 mg Women through age 50 yearsIron Supplements – Generic OTC and prescriptions products

Children ages 6 to 12 months who are at risk for iron deficiency anemia

Smoking Cessation – Generic OTC patches and gum Members must contact QuitlineNC for OTC product coverage

Vitamin D – Generic OTC and prescription products Men and Women ages ≥ 65 who are at increased risk for falls

Women’s Preventive Services & contraception coverage 1) Barrier contraception- i.e. caps, diaphragms 2) Generic hormonal contraception 3) Emergency contraception 4) Implantable medications 5) Intrauterine contraception

Women through age 50

You must have a Prescription for these medication to have them covered at 100%

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Enhanced 80/20 Plan Highlights in 2014

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Coverage In-Network Out-of-Network

Annual Deductible $700 individual/$2,100 family $1,400 individual/$4,200 family

Coinsurance (after deductible is met)

20% of eligible expenses40% of eligible expenses plus 100% of amount above the Plan’s allowed amount

Coinsurance Maximum (excludes deductible)

$3,210 individual/$9,630 family $6,420 individual/$19,260 family

Office Visits

$30 copay for primary doctor; $15 copay if the PCP on the ID card is utilized

$70 copay for specialists; $60 copay if a Blue Options Designated specialist is utilized

40% after deductible

Inpatient Hospital$233 copay, then 20% after deductible; copay not applied if a Blue Options Designated hospital is utilized

$233 copay, then 40% after deductible

Prescription Drugs (for 30-day supply)

Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply$0 for ACA Preventive Medications

Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply$0 for ACA Preventive Medications

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The Consumer-Directed Health Plan (CDHP) with HRA

A different kind of health plan with two components

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Health Reimbursement Account (HRA)

High-Deductible Health Plan

• The Plan funds the members’ Health Reimbursement Accounts (HRA) annually

• HRA funding is based on the number of family members covered

• $500 for employee/retiree only

• $1,000 for employee/retiree + 1 $1,500 for employee/retiree + 2 or more dependents

• HRA funds are used to pay a portion of the members’ deductibles & coinsurance

• Once the HRA is depleted, the member must pay the remaining deductible & coinsurance

• Incentives available to add value to HRA

• Unused HRA funds are available the following year

• Covers the same services as other

Plan options through the same PPO network

• The deductible is higher than other Plan options, but the coinsurance is lower

• In-network: $1,500 Individual/$4,500 Family

• Out-of-Network: $3,000 Individual/ $9,000 Family

• After the deductible is met, the member only pays the 15% coinsurance

• The deductible applies to both Pharmacy and Medical expenses

• If the member reaches his or her deductible and coinsurance out-of-pocket maximum, the Plan pays 100% of the covered expenses for the rest of the benefit year (medical and pharmacy)

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The Consumer-Directed Health Plan (CDHP)

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A High Deductible Health Plan is exactly what it says – A plan with a high front-end deductible.

•After meeting the deductible the member pays a 15% coinsurance on all in-network medical and pharmacy benefits except ACA preventive services and ACA preventative medications, which are covered at 100%.

•The pharmacy and medical deductible and out-of-pockets are shared.

•An additional CDHP preventive medication list is covered with no deductible meaning the member is subject to 15% of eligible expense only.

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Consumer Directed Health Plan (CDHP): Pharmacy Benefits

The Deductible Does Not Apply to Every Medication

•Under the Affordable Care Act, many ACA preventive medications are paid at 100% •Medications on the CDHP Preventive medication are subject to 15% coinsurance with no deductible. Example of medications include those used to treat heart disease or stroke, asthma, and diabetes.

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These 2 different medication lists will be posted online at www.shpnc.org.

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How The HRA Helps The Member Meet Their Deductible

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Employee Only

Out-of-Network Remaining Deductible $2,500

$1,500Remaining Deductible $1,000Remaining Deductible $1,000First $500First $500

In-Network

$3,000

Total DeductibleHRA Pays You Pay

Employee + One Family Member


$3,000*Remaining Deductible $2,000Remaining Deductible $2,000In-Network

$6,000First $1,000First $1,000

Employee + Two or more Family Members


$4,500*Remaining Deductible $3,000Remaining Deductible $3,000In-Network

$9,000First $1,500First $1,500

Coverage Type

*The HRA is a pooled account and is available to whichever family member needs it first. It is possible for one family member to use all the funds before another family member has a claim.

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How the Consumer-Directed Health Plan with HRA Works

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Beginning Balance $500Offi ce Visit ($175)Rx ($65)Remaining HRA Balance $260PCP Incentive Reward $15New HRA Balance $275

HRA AccountFirst Medical Cost of the Year

Member's Individual Deductible

Beginning Deductible $1,500Offi ce Visit ($175)Rx ($65)Remaining Deductible $1,260

#1

#2

#3

#4

#5

#6

To monitor HRA balance and claim’s payments, members may go online to www.shpnc.org and

click on My Member Services.

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Monthly Premiums—CDHP

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2014 CDHP Premiums (Active Employees and Non-Medicare Primary Members)

Coverage Type Employee/ Retiree Monthly

Premium


Total Monthly Premium


installment pay)

Wellness Premium Credits*

Net Monthly Premium*


installment pay)

Employee/Retiree Only $40.00 N/A $40.00 $40.00* $0*


$40.00 $184.60 $224.60 $40.00* $184.60*

Employee/Retiree + Spouse

$40.00 $475.68 $515.68 $40.00* $475.68*

Employee/Retiree + Family

$40.00 $506.64 $546.64 $40.00* $506.64*

*Assumes completion of three wellness activities

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Lower Premiums with Wellness Premium Credits—CDHP

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Complete up to Three Wellness ActivitiesBy October 31, 2013

CDHPPremium Credits


$20 per month

Subscriber (only) completes a confidential Health Assessment (HA)

$10 per month

Subscriber selects a Primary Care Provider (and any covered dependents)

$10 per month

Reduce subscriber premium by … $40 per month

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Wellness

Activity

Three


Smoking Attestation(Subscriber & Spouse if

applicable)

$20 Reduction

X X X X

PCP Selection(Subscriber & Covered

Dependants)

$10 Reduction

X X X X



$$ Cost $$

12 month inst. pay$0.00 $10.00 $10.00 $20.00 $20.00 $30.00 $30.00

$$ Cost $$

10 & 11 month pay(8 mths / 6 chks. starting

December)

$0.00 $13.34 $13.34 $26.67 $26.67 $40.00 $40.00

• If none completed the cost will be $40.00 for employee only on 12 month installment pay & $53.34 for employee only on 10 & 11 month pay.

Wellness Premium Credits—CDHP– Employee Only Rate

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Wellness

Activity

Three



applicable)

$20 Reduction

X X X X


Dependants)

$10 Reduction

X X X X



$$ Cost $$

12 month inst. pay$184.60 $194.60 $194.60 $204.60 $204.60 $214.60 $214.60

$$ Cost $$


December)

$246.14 $256.47 $256.47 $272.80 $272.80 $286.14 $286.14

• If none completed the cost will be $224.60 for an employee on 12 month installment pay & $299.47 for an employee on 10 & 11 month pay.

Wellness Premium Credits—CDHP– Employee + Child(ren) Rate

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Wellness

Activity

Three



applicable)

$20 Reduction

X X X X


Dependants)

$10 Reduction

X X X X



$$ Cost $$

12 month inst. pay$475.68 $485.68 $485.68 $495.68 $495.68 $505.68 $505.68

$$ Cost $$


December)

$634.24 $647.58 $647.58 $660.91 $660.91 $674.24 $674.24


Wellness Premium Credits—CDHP– Employee + Spouse Rate

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Wellness

Activity

Three



applicable)

$20 Reduction

X X X X


Dependants)

$10 Reduction

X X X X



$$ Cost $$

12 month inst. pay$506.64 $516.64 $516.64 $526.64 $526.64 $536.64 $536.64

$$ Cost $$


December)

$675.52 $688.86 $688.86 $702.19 $702.19 $715.52 $715.52


Wellness Premium Credits—CDHP– Employee + Family Rate

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Lower Member Health Care Costs with Wellness Incentives—CDHP

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Things you can do to reduce your costs…

CDHP Incentives

Visit the PCP listed on ID card $15 added to the HRA

Visit a Blue Options Designated specialist $10 added to the HRA

Get inpatient care in a Blue Options Designated hospital

$50 added to the HRA

Remember:

Get preventive care through an in-network provider in a non-hospital setting

100% coverage – this is provided at no cost to the member

ACA preventive medication list 100% coverage – this is provided at no cost to the member

CDHP preventive medication list15% of eligible expense with no deductible

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CDHP Highlights in 2014

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Plan-Provided HRA Contribution

$500 employee/retiree$1,000 employee/retiree + 1 dependent

$1,500 employee/retiree + 2 or more dependents

Annual Deductible $1,500 individual/$4,500 family $3,000 individual/$9,000 family


15% of eligible expenses 35% of eligible expenses

Out-of-Pocket Maximum for medical and pharmacy (includes deductible)

$3,000 individual/$9,000 family$6,000 individual/$18,000 family

Office Visits(after deductible is met)

15% of eligible expenses; $15 added to HRA if the PCP on the ID card is utilized; $10 added to HRA if a Blue Options Designated specialist is utilized

35% of eligible expenses

Inpatient Hospital(after deductible is met)

15% of eligible expenses; $50 added to HRA if a Blue Options Designated hospital is utilized

35% of eligible expenses

ACA Preventive Medication List

$0 coinsurance, $0 deductible $0 coinsurance, $0 deductible

CDHP Preventive Medication List

15% coinsurance, $0 deductible 15% coinsurance, $0 deductible

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The Traditional 70/30 Plan

• Traditional 70/30 Plan – The new name for the current 70/30 Basic Plan; there are no changes to the Plan’s benefits for 2014

• Copays and Deductibles – The copays and deductibles on the Traditional 70/30 PPO plan are the same as they are today on the 70/30 Basic Plan. There will be no opportunities for copay reductions on the Traditional 70/30 Plan.

• Network Services – Members may visit any provider, but they will pay less when they go to a BCBSNC network provider

• Preventive Services – Copays still apply to preventive services.

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Monthly Premiums—Traditional 70/30Plan

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2014 Traditional Plan Premiums (Active Employees and Non-Medicare Primary Members)

Coverage Type Employee/ Retiree Monthly Premium


Total Monthly Premium(Employees on 12 month

installment pay)

Employee/Retiree Only $0 N/A $0


$0 $205.12 $205.12 (12 month inst. pay)

$273.50 (10 or 11 month pay)

Employee/Retiree + Spouse $0 $528.52 $528.52 (12 month inst. pay)

$704.70 (10 or 11 month pay)

Employee/Retiree + Family $0 $562.94 $562.94 (12 month inst. pay)

$750.59 (10 or 11 month pay)

Reminder: Wellness premium credits are not offered under the Traditional Plan.

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Traditional 70/30 Plan Benefit Highlights

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Annual Deductible $933 individual/$2,799 family $1,866 individual/$5,598 family


30% of eligible expenses50% of eligible expenses plus 100% of amount above the allowed amount

Coinsurance Maximum (excludes deductible)

$3,793 individual/$11,379 family $7,586 individual/$22,758 family

Office Visits$35 copay for primary doctor$81 copay for specialists

50% after deductible

Preventive Care$35 copay for primary doctor$81 copay for specialists

Only certain services are covered

Inpatient Hospital$291 copay, then 30% after deductible

$291 copay, then 50% after deductible

Prescription Drugs (for 30-day supply)

Tier 1 $12 copay

Tier 2 $40 copay

Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply

Tier 1 $12 copay

Tier 2 $40 copay

Tier 3 $64 copaySpecialty medications 25% up to $100 maximum per 30-day supply

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Completing Open Enrollment

• Action must be taken during Open Enrollment—October 1–31, 2013:

• Choose a health plan

• Decide whom to cover

• Complete wellness activities

• Remember, NC Flex Benefits enrollment in Oct. as well.

• Online enrollment only – through the eEnroll.

• Choices are effective from January 1, 2014 through December 31, 2014

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If you do not complete your enrollment by October 31, 2013, you, and any currently covered family members will be enrolled

in the Traditional 70/30 Plan effective Jan. 1, 2014.

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How will I name my PCP (Primary Care Physician)

If members have trouble locating a provider, they can contact 888-234-2416.

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How to complete Smoking Attestation Form

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How to complete Health Assessment

Health Assessments can also be completed by telephone at 800-817-7044

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How will I know if I have completed all the Wellness Activities

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Enrollment Instructions

eEnroll•All changes need to be done through the eEnroll system by logging in to the system at https:// shp-login.hrintouch.com to enroll. For assistance in navigating eEnroll members can call Benefitfocus Customer Service at 855-859-0966.

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• Please READ your mail!• There will be 4 mailers sent to you to assist you in your

decision.• SHP Website

• There will be 4 instructional videos posted to the Plan’s website.

• Premium Rate Calculator tool available online in September

• Enrollment tour will be conducted across the state in October, more information will be included in one of your mailers

• Sign up for our monthly electronic newsletter, Member Focus, which can be done by visiting the Plan’s website

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Resources for Members

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Important Numbers / Web-Sites

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• ELIGIBILITY AND ENROLLMENT for eEnroll Agencies 855-859-0966

• BLUE CROSS AND BLUE SHIELD OF NC (BENEFITS, CLAIMS and HRA) 888-234-2416

• EXPRESS SCRIPTS (PHARMACY QUESTIONS for Active/Non-Medicare Retirees)800-336-5933

• http://www.rock.k12.nc.us/SHP

www.shpnc.org

www.nctreasurer.com43

Thank you!

agenda

Documents

health plan options

health plan cdhp

state health plan website

plan effectivejanuary

health assessments

personal health portal

enrollment portal

complete itwhen members