Mandatory

Online

Open Enrollment

November 9-23, 2015

MVPOE16

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Enrollments not completed during Open

Enrollment will result in a loss of coverage.

If you waive your insurance benefits,

you must complete a waiver online.

If you want to keep your current

coverage, you must enroll online.

All enrollees eligible for

coverage must enroll.

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What is Open Enrollment?

Who is Eligible?

Medical Plan Options

Dental Plan Options

Steps to Enroll

Discussion Items

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The only time you can enroll or

drop in the medical and/or dental

plans without a qualifying event.

Open Enrollment is …

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Loss of medical and/or dental coverage due to: Divorce

Death

Spouse’s coverage ends with employer due to

termination or reduction of hours

COBRA benefits exhausted

Marriage

Adoption

Qualified Medical Child Support Order

Newborn – Special provisions allows enrollment within

60 days of the event

Please Note: You must enroll within 31 days of a qualifying event; otherwise, you will need to wait until the next Open Enrollment.

A Qualifying Event is…

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Dependent Eligibility

Who is Eligible?

Spouses and children up to age 26.

New: Dental Plan Eligibility Changes for 2016

• A dependent child may stay in the Dental Plan until the end of the month of their 26th birthday.

• The full-time student status requirement is removed.

You may add eligible dependents into the Dental Plan during Open Enrollment.

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Dependent Eligibility

Spouses for Medical Plan Only

Spouses who have access to group health coverage must take

that coverage on an individual basis as primary insurance in

order to be covered with Butler Health Plan as a secondary

insurance, unless they pay more that 55% of the single

premium.

This includes employed and retired spouses who have access

to group health plans or a group retiree health plan such as

STRS or SERS.

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Dependent Eligibility

Adding a Dependent for First Time? Legal Documentation must be provided to your

Treasurer or Personnel Department for

dependents at the time of enrollment.

You may upload documents during the online

enrollment.

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No Rate Increase

For Medical and Dental Plans!

Good News for 2016!

Get your premium rate share from your Treasurer

or Personnel Department or at online enrollment.

See your 2016 medical plan rates online or ask your Treasurer or Personnel Department.

Medical Plan Options - 2016

EPO PPO

Preventive Care Preventive services covered 100% for all plans

Annual Deductible*

This is the dollar amount you must pay first in a

year before the plans begin paying specified

benefits.

$650 /person

$1,300 /family

You do not have to meet the

deductible before copays apply.

$650 /person

$1,300 /family

You do not have to meet the deductible

before copays apply.

Annual Maximum Out-of-Pocket

Includes deductibles and copays. This is the

most you will pay toward your in-network

medical and prescription expenses.

$2,650 /person

$5,300 /family

$2,650 /person

$5,300 /family

Doctor Office Visit

Primary care includes family practice, internist,

pediatrician, OB/GYN, mental health and

chiropractor.

$15 for primary care

$30 for specialist

$30 for primary care

$50 for specialist

Urgent Care $40 copay $40 copay

Emergency Room $200 copay

(waived if admitted)

$200 copay

(waived if admitted)

Inpatient Hospital and Outpatient Surgery Ded, then Plan pays 80%

Tier 1 Network Tier 2 Network

Ded, then Plan

pays 80%

Ded, $300 copay,

then Plan pays 70%

Radiology

MRI, X-ray, CT, ultrasound Ded, then Plan pays 80%

Ded, then Plan

pays 80%

Ded, then Plan

pays 70%

Prescription Drugs ** Deductible does not apply

Retail

(Up to 30 day)

$15 generic

$35 preferred brand

$15 generic

$35 preferred brand

Mail Order

(Up to 90 day)

$35 generic

$85 preferred brand

$35 generic

$85 preferred brand

Specialty

(Up to 30 day) $75 $75

Pharmacy Network Express Scripts Prime Network

(More than 32,000 pharmacies nationwide including

CVS, Kmart, Kroger, Meijer, Sam’s Club, Target and Wal-Mart.)

HDHP Minimum Value Plan

Preventive services covered 100% for all plans

$2,600 /person

$5,000 /family

You must meet the deductible before

prescription copays apply

$6,550 /person

$13,100 /family

$5,000 /person

$10,000 /family

$6,550 /person

$13,100 /family

Ded, then Plan pays 80% Ded, then Plan pays 100%

Ded, then Plan pays 80% Ded, then Plan pays 100%

Ded, then Plan pays 80% Ded, then Plan pays 100%

Tier 1 Network Tier 2 Network Ded, then Plan pays 100%

Ded, then Plan

pays 80%

Ded, $300 copay,

then Plan pays 80% Ded, then Plan pays 100%

Ded, then Plan pays 80% Ded, then Plan pays 100%

After the deductible is reached Deductible does not apply

$15 generic

$35 preferred brand After medical deductible,

Plan pays at 100%

$35 generic

$85 preferred brand After medical deductible,

Plan pays at 100%

$75

Express Scripts Prime Network

(More than 32,000 pharmacies nationwide including

CVS, Kmart, Kroger, Meijer, Sam’s Club, Target and Wal-Mart.)

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• With the PPO, you pay more out of your paycheck to

“buy” the coverage, and then less out of your pocket

because you pay flat copays for routine office visits and

prescriptions.

• The PPO has a lower deductible compared to the HDHP.

Preferred Provider Organization

PPO

Medical Plan Options

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• With the HDHP, you pay less out of your paycheck to “buy”

the coverage, and then more out of your pocket for

services.

• You can set up a health savings account (HSA) that lets you

build up tax-deductible money to pay medical expenses.

You pay a lower premium, but are subject to a higher

deductible and maximum out-of-pocket. Check with your

local bank or employer to see if they offer an HSA.

High Deductible Health Plan

HDHP

Medical Plan Options

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• If you use the Mercy Health System or don’t mind changing your

doctor, you may want to choose this plan. It can save you money!

• The Mercy Preferred Plan is an exclusive provider organization (EPO)

plan. It is a smaller network of doctors and hospitals.

• There is no out-of-network coverage except for emergencies.

Care coordination with a team of people who work with you and your

doctor.

Easier to make appointments and, in some cases, extended office hours.

Lower office visit copays.

Online access to your medical record and for emailing your doctor and care

team.

Mercy Preferred

EPO

Medical Plan Options

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• With the MVP, there is a higher deductible. Once the deductible

is met, the Plan pays at 100%.

• There are no copays.

• This plan offers basic coverage and has the following exclusions:

· No out-of-network coverage except for emergencies.

· No coverage for treatment of temporomandibular joint dysfunction (TMJ).

· No coverage for chiropractic care.

· No coverage for certain medications such as lifestyle medications.

Minimum Value Plan

MVP

Medical Plan Options

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Prescription Drug Coverage

Basic Standard Premium

Dental Networks

Delta Dental Provider Search

Delta Dental PPO Network

Delta Dental Premier Network

Annual Deductible $75 /person

$150 /family

$50 /person

$100 /family

$25 /person

$50 /family

Annual Maximum Benefit $1,000 /person $1,500 /person $2.500 /person

Lifetime Maximum Benefit

Orthodontia Not Covered $1,500 /person $1,800 /person

Preventative 80% Covered

Deductible Waived

100% Covered

Deductible Waived

100% Covered

Deductible Waived

Basic Care Covered at 80% Covered at 80% Covered at 80%

Major Care Covered at 50% Covered at 50% Covered at 60%

Orthodontia Care Not Covered 60% 60%

Adult Orthodontics Not Covered Yes Yes

Sealants Covered to age 16 Covered to age 16 Covered to age 16

Dental Plan Options - 2016

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See your 2016 dental plan rates online or ask your Treasurer or Personnel Department.

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The intent of the Butler Health Plan Wellness program is to

support employees to live healthier and more productive

lives by getting in front of potential health issues.

The free benefit allows you to have a convenient way of getting

your health screening at your work place in the spring of each

year. We all know that lifestyle choices have consequences and

making healthy choices helps employees and the Plan spend

less on health care.

*Watch for free health evaluation at your district.

BHP Wellness

Program

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Employees and spouses, enrolled in the Medical Plan

will have the opportunity to earn a $150 credit toward

next year’s medical plan deductible.

• Year 1 baseline: The first time you have a health screening

completed is considered the “baseline” year. You qualify for

the incentive simply by participating.

• Year 2 and beyond: In years two and later, your goals will

be set from the previous year (based on your baseline). You

must meet the goals in order to keep the incentive.

BHP Wellness

Program

*Watch for free health evaluation at your district.

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Open Enrollment Enrollment is Mandatory

For Everyone

(even if you are waiving coverage) !

The Butler Health Plan Open Enrollment will take place starting

November 9, 2015 through November 23, 2015.

ALL employees eligible for medical and dental benefits must enroll,

even if they are waiving coverage.

Before you enroll, you will need the following information about you and

your dependents:

- Social Security Number

- Date of Birth

- Information on other medical or dental coverage

that you and your dependents may have

Log on to https://butlerhealthplan.benelogic.com

Enter your UserID:

First Initial and Last Name with Last four of SSN

(For Example, John Doe would be: jdoe1234)

Your Password is your Date of Birth (MMDDYYYY).

Change your password (if you log into the website again, you

will need this new password).

Follow the instructions on the website and enroll in your 2016

benefits or waive coverage.

Click on the Finish button to save your elections.

Print your confirmation statement.

How to Enroll Online

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How to Enroll Online

You may make changes on the

enrollment website until 11:59 p.m. EST

on November 23, 2015.

The last elections that you save will be

your benefits beginning January 1, 2016.

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https://butlerhealthplan.benelogic.com

MARK YOUR CALENDAR

November 9-23

Open Enrollment is Mandatory For Everyone.

All employees eligible for medical and dental benefits

must enroll, even if they are waiving coverage.

Share your enrollment materials with your family.

Enroll before November 23 at 11:59 p.m.

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ID cards will be

mailed before

December 31 for

new BHP enrollees

and for employees

making Plan changes.

Everyone will receive

new Express Scripts

Prescription cards

with a new ID

number.

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Your

Open Enrollment

Changes for

Medical and Dental

Plan Begin

January 1, 2016

www.butlerhealthplan.org

Questions?