New Charter Schools

December 16 , 2013

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Topics

• Legislation• Group Setup• Electronic Enrollment• Eligibility• Rates• Plans• Effective Dates• Benefits• Group Premiums

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Legislation

• § NCGS 135-48.54• Charter School Board of Directors must make election

in writing • Election must be made no later than 30 days after

charter signed• Send to the SHP Executive Administrator and the State

Board of Education• Election is irrevocable• Shall notify each employee of the election in writing• Each employee shall acknowledge receipt

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New Group Setup

• Contact at State Health Plan (SHP)

Rita Sandoval Rita.Sandoval@nctreasurer.com• Complete group setup form and submit to SHP• Order new employee kits

State Health Plan website www.shpnc.org• Electronic enrollment setup – free (required)

Benefitfocus – electronic enrollment vendor

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Electronic Enrollment

• The State Health Plan is paperless and enrollment is only available electronically.• No paper applications are accepted

• Following receipt of Group Setup form, a Benefitfocus Representative will be assigned to implement the new group onto the eEnroll System.

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Eligibility

• Full-time employees • 30 or more hours per week

• Part-time employees – pay full premium• 20-29 hours• Dependents – employees pay 100% of premium• Legal spouse• Natural, stepchild, adopted, foster and legal guardian up

to age 26

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Plans for 2014

Enhanced 80/20 Plan

• The current Standard 80/20 Plan with a new name to match the new features

$0 Affordable Care Act (ACA) Preventive Services

• $0 ACA Preventive Medications

• New Wellness Incentives

• Reduced copays

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

• A new health plan option

• A high-deductible medical plan

• A Health Reimbursement Account (HRA) to help offset the deductible

• 85/15 Coinsurance

• $0 Affordable Care Act (ACA) Preventive Services

• $0 ACA Preventive Medications

• CDHP Preventive Medication List ($0 deductible)

• New wellness incentives

• Additional HRA funds for visiting certain providers

Traditional 70/30 Plan

• The current Basic 70/30 Plan with a new name

• No incentives available• No $0 Affordable Care Act

(ACA) Preventive Services• No $0 ACA Preventive

Medications

Third Party Claims Administrator - Blue Cross Blue Shield of North Carolina

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Focus on WellnessEnhanced 80/20 Plan

• Wellness premium credits when:• Subscriber completes a Health

Assessment• Subscriber attests for him/herself

and spouse (if applicable) to not smoking...or to being in a smoking cessation program

• Selecting a Primary Care Provider (PCP) for self and all dependents

• Additional wellness incentives• $15 copay reduction for utilizing

the PCP (or someone in that practice) listed on the ID card

• $10 specialist copay reduction for utilizing a Blue Options Designated Specialist

• $0 inpatient hospital copay for utilizing a Blue Options Designated Hospital

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

• Wellness premium credits when:• Subscriber completes a Health

Assessment• Subscriber attests for him/herself

and spouse (if applicable) to not smoking...or to being in a smoking cessation program

• Selecting a Primary Care Provider (PCP) for self and dependents

• Additional wellness incentives• $15 added to the HRA when the

PCP (or someone in that practice) listed on the ID card is seen

• $10 added to the HRA when a Blue Options Designated Specialist is seen

• $50 added to the HRA when a Blue Options Designated Hospital is utilized for inpatient services

Traditional 70/30 Plan

• No incentives available

• No $0 ACA Preventive Services

• No $0 ACA Preventive Medications

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Monthly Premium – Enhanced 80/20 Plan2014 Enhanced Plan Premiums

(Active Employees and Non-Medicare Primary Members)

Coverage Type Employee/ Retiree Monthly Premium

Dependent Monthly Premium

Total Monthly Premium

Wellness Premium Credits*

Net Monthly Premium*

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 Employer Share $448.12

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Monthly Premium – CDHP

*Assumes completion of three wellness activities Employer Share $448.12

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

Coverage Type Employee/ Retiree Monthly

Premium

Dependent Monthly Premium

Total Monthly Premium

Wellness Premium Credits*

Net Monthly Premium*

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

Employee/Retiree + Child(ren)

$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*

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Monthly Premium – 70/30 Plan

Employer Share $448.12

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

Coverage Type Employee/ Retiree Monthly Premium

Dependent Monthly Premium

Total Monthly Premium

Employee/Retiree Only $0 N/A $0

Employee/Retiree + Child(ren)

$0 $205.12 $205.12

Employee/Retiree + Spouse $0 $528.52 $528.52

Employee/Retiree + Family $0 $562.94 $562.94

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

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Effective Dates

• Effective date is the first of the month or first of the second month following date of hire

• Dependents must be added at time of hire or due to a qualifying event

• Dependents must be enrolled within 30 days of the qualifying event or added at annual enrollment

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Group Premiums

• Prepaid Plan• Billed monthly for the next month

• i.e., June bill is for July

• Bills are generated in the middle of the month• Premium is due by the 5th of the next month and must be paid

as billed• If premium is not paid by the due date, claims are held• Premiums not received by the fifteenth day of the month

following the due date shall be charged 1 ½% interest of the amount due the Plan, per month beginning with the sixteenth day of the month following the due date. (NCGS 135-48.55)

• eBilling offers paperless invoices, electronic one-time and recurring payments, on-demand and scheduled reporting

www.shpnc.orgwww.nctreasurer.com

Thank You!