nicholls state university human resources
DESCRIPTIONNicholls State University Human Resources. Annual Enrollment Overview. IMPORTANT. This year members are required to make a selection during the annual enrollment period . - PowerPoint PPT Presentation
Nicholls State University Human ResourcesAnnual Enrollment Overview
This year members are required to make a selection during the annual enrollment period.
All active employees who are currently enrolled
in a plan and do not make a selection by the end of the enrollment period, will be moved into the Pelican HRA 1000
Retirees will be moved into the plan most comparable to their current plan if no selection is made otherwise
Key Changes for 2015 All employees who are enrolled in a plan for
2014 MUST select a plan for 2015 or they will be moved into the Pelican HRA 1000
All new plan offerings
New ways to enroll (paper, online, or HR)
No opportunity to make changes until next year’s annual enrollment period (except for a qualifying event)
NEW TIMELINE Oct 1st Annual Enrollment Begins
Nov 30th Annual Enrollment Ends
January 1, 2015 Vantage plan & FSA plan years begin
March 1, 2015 Pelican/Magnolia plan year begins
During Annual Enrollment, you may...
Enroll in a health plan
Drop or add dependents
Discontinue OGB coverage
Determine the amount of your HSA contribution (Active Employees only)
Enroll or change contribution to flexible spending account (Active Employees only)
FAQsQ: What’s the difference between a co-
pay and co-insurance?
A: A co-pay is a flat fee billed by providers for a specific service.
Co-insurance is a percentage of the contractually allowed cost of a
FAQsQ: Will my deductible and out-of-pocket max start over in January?
Q: Will they start over again in March?
A: No. You will get credit for out-of-pocket payments made in January & February. But...
FAQsQ: What’s the difference between in-network & out-of-network?
A: In-network providers have contracts with Blue Cross/Vantage and agree to charge only a certain allowable amount for services. Out-of-network providers do not have contracts with the insurers & the member may have to pay the difference between the allowable amount and the actual billed amount.
FAQsQ: What is balance billing?
A: Balance billing is the difference between the provider’s charge and the allowed amount. For example, is the provider’s charge is $100 and the allowed amount
is $70, an out-of-network provider may bill you for the additional $30. An in-
network provider cannot balance bill you for the additional amount.
Pelican Plans OGB’s Pelican plans offer low premiums,
in combination with employer contributions, to create the most affordable options for members in 2015.
Pelican plans offer coverage within the Blue Cross nationwide network, as well as out-of-network coverage.
Pelican HRA 1000 FAQsQ: How does an HRA work?
A: Your employer puts a certain amount into an HRA account in order to help offset your deductible. The HRA funds are available as long as you remain employed by an OGB-participating employer.
Pelican HRA 1000 FAQsQ: Does it rollover every year?
A: Yes. Unused funds will continue to rollover until you reach your in-network, out-of-pocket maximum. So, for example, if you’re on an employee only plan, your unused funds will rollover until you reach $5,000.
Pelican HRA 1000 FAQsQ: How do I use the money?
A: The HRA will automatically pay 100% of covered medical expenses - up to the $1,000 (single) or $2,000 (family)contribution.
Pelican HRA 1000 FAQsQ: What does it mean “prescription drugs are not reimbursable by the Pelican HRA?”
A: Your HRA will not pay for prescriptions. Prescription drugs would be an out-of- pocket expense which would apply to the out-of-pocket maximum.
Pelican HSA 775 FAQsQ: How does an HSA work?
A: A Health Savings Account (HSA) is an employee-owned account used to pay for qualified medical expenses,
including deductibles, medical co-pays, prescriptions, and other eligible medical costs. Both the employee and
employer can contribute to the HSA, but the funds are owned by the employee.
Pelican HSA 775 FAQsQ: Does it rollover every year?
A: Yes. Unused funds will rollover year after year. You won’t lose your
money if you don’t spend it within the year.
Pelican HSA 775 FAQsQ: How do I use the money?
A: You will receive a BCBS MySmartSaver Visa debit card that can be used to pay for eligible expenses.
Magnolia plans offer lower deductibles than the Pelican plans in exchange for higher premiums.
The Magnolia Local and Local Plus are traditional plans that offer $25 primary care co-pays (excluding wellness visits) and $50 specialty care co-pays.
The Magnolia Open Access Plan differs from the other Magnolia plans in that members enrolled in the open access plan will not pay co-payments at physician visits. Instead, once a member’s deductible is met, he or she will pay 10% of the allowable charge for in-network care and 30% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount for out-of-network care.
Magnolia LocalOnly for members who live in the Baton Rouge (East & West Baton Rouge and Ascension Parishes), Shreveport (Caddo and Bossier Parishes), and New Orleans communities (Orleans and Jefferson Parishes).
Magnolia Local Plus FAQsQ: Will the Magnolia Local Plus plan cover out-of-state specialists?
A: If the out-of-state specialist is contracted with BCBS, eligible charges will be covered.
Magnolia Local Plus FAQsQ: Can I keep my current physician on
this plan since it “similar” to the current HMO plan?
A: Providers should remain the same. Please check the provider list on the BCBS website or contact BCBS
customer service to verify.
Magnolia Local Plus FAQsQ: What is subject to the deductible?
A: Any service that is not subject to a co- pay.
Q: Will we have to meet the deductible before we pay only co-pays?
A: No. If your plan has a co-pay amount (such as $25 for a physician visit), then the deductible does not apply.
Magnolia Local Plus FAQsQ: Since the plan does not cover out-of- network, does that mean the expense to me will be unlimited?
A: If you choose to use a doctor, hospital, or service that is out-of-network, you will pay an unlimited amount out-of-pocket.
Vantage HMO FAQsQ: What do the tiers mean?
A: Tier 1 Providers: Most providers fall into this category. Members would pay the Tier 1 co-pays, co-insurance, and deductibles listed. Tier 1 includes Affinity Health Network, the Vantage Tier 1 Network, and Verity Health Network. Tier 1 providers may not balance bill members.
Tier 2 providers: Members who choose to see Tier 2 providers must pay an additional 20% co-insurance in addition to their Tier 1 cost share. No out-of-pocket max and Tier 2 providers may not balance bill members.
Vantage HMO FAQsQ: How do I find out which providers are in the different networks:
A: Visit www.VHP-stategroup.com or call Vantage Member Services at 888-823-1910.
Which plan is most like your current plan?
2015 Plan: Comparable To:
Pelican HRA 1000 None (new offering)
Pelican HSA 775 CDHP
Magnolia Local None (new offering)
Magnolia Local Plus HMO
Magnolia Open Access PPO
Vantage Medical Home HMO Vantage Medical Home HMO
What’s Different? Current PPO plan Magnolia Open Access Plan
Increased In-Network Deductible: $500 to $1,000 for Active Employee (Retirees from $300 to $1000)
Coinsurance In-Network: No Change (90/10)
Network: No Change – Blue Cross Nationwide Network
Coverage: No Change in out-of-network coverage (70/30)
Out-of-Pocket Max increase for In-Network: $1,500 to $3,000 Employee Only
CDHP - HRA 1000 & HSA 775 Yearly plan contributions that rollover to cover out of pocket expenses
What’s Different? Current HMO plan Magnolia Local Plus Plan
Increased primary care and specialty co-pays: PCP $15 to $25, SCP $25 to $50
ER and hospital co-pays: ER $100 to $150; Hospital – no change
Network: No Change
Coverage: No out-of-Network coverage on the Local Plus Plan and Local Plan
Deductible and co-insurance on services where co-pay does not apply
Out-of-Pocket Max In-Network Increase - $1,000 to $3,000 Employee Only
FAQ’sQ: Is my network changing?
A: If you are enrolled in a Blue Cross plan, you will have access to the same nationwide network as last year. The only exception is the Magnolia Local plan (for BR, NO, & S’port only) or if you enroll in the Vantage plan.
FAQ’sQ: If I enroll through the online portal, how will I know my information was received?
A: You will see a confirmation page once you submit your selection. You can print that page for your records.
FAQ’sQ: What if I choose a plan and then change my mind?
A: If you wish to change your plan selection during the annual enrollment period, simply visit the annual enrollment portal and select a new plan. Your most recent choice will be considered valid. If you change your mind after annual enrollment is
over, you won’t be able to change your plan until next year’s annual enrollment period unless you experience a qualifying event.
FAQ’sQ: What does it mean when there is no out-of-network coverage available?
A: Out-of-network coverage is coverage outside of your available network. OGB’s plans offer Blue Cross’s nationwide network, making it easy to stay in-network for your care. Several OGB plans also offer options for out-of-network care, including OGB’s Pelican plans and the Magnolia Open Access plan. No matter which plan you choose, emergencies are covered both in and out of network.
Resources Annual Enrollment Site: https
Main OGB site: www.groupbenefits.org
Customer Service: 1-800-272-8451