open enrollment presentation january 2010. agenda changes to bigband’s benefit programs overview...
TRANSCRIPT
Open Enrollment Presentation
January 2010
Agenda
Changes to BigBand’s Benefit Programs Overview of Plans What You Need to Do Important Paperwork Life Changes
Overview of Benefits Programs
The following slides are condensed overview of BigBand’s benefits
For details, please consult providers’ plan documents
Filice Insurance Services/Resources
Dedicated Account Management team
Eric Pogue – 925-299-7212; [email protected]
Chris Kelly – 925-299-7216; [email protected]
Alaina Kelly – 925-299-7213; [email protected]
Assistance with claims, eligibility, forms, carrier issues, etc.
Customized benefits website: www.filice.com/benefits/bigband
Blue Shield HMO Plan Design Blue Shield HMO
Deductible (facility deductible) $1,500 per member
Co-payment maximum $2,000 per member
Primary Care Physician Visits $15 (deductible does not apply)
Routine physicals / well-child $15 (deductible does not apply)
No cost for vision / hearing screenings or medically necessary immunizations
Emergency $100 (Waived, if admitted)
Outpatient Surgery Facility deductible, then $100 / surgery
Hospitalization Facility deductible, then 10%
Prescription (Mail Order = 2 times these co-pays for up to a 90-day supply)
Generic $10 (deductible does not apply)
Brand Formulary *** $25 (deductible does not apply)
Non-Formulary *** $40 (deductible does not apply)
*** $250 Calenday-year Brand-name Drug Deductible
What is a deductible reimbursement plan? (Commonly referred to as a Health Reimbursement Account)
A company-sponsored deductible reimbursement plan. Reimburses employees and their dependents for any
allowable medical expenses under the company sponsored plan
Set up in accordance with IRS Code Section 105: medical reimbursements to employees are not considered taxable income to the employees or their dependents.
Kaiser HMO (HRA) Plan Design Kaiser HMO (HRA)
Deductible $2,000 self only & one member in a family of 2, or more
Deducbile $4,000 for an entire family of 2, or more members
Co-payment maximum $4,000 self only & one member in a family of 2, or more
Co-payment maximum $8,000 for an entire family of 2, or more members
Primary Care Physician Visits $20 (after deductible)
Routine physicals $20 (deductible does not apply)
Well-child $10 (deductible does not apply)
Emergency 20% (after deductible)
Outpatient Surgery 20% (after deductible)
Hospitalization 20% (after deductible)
Prescription (Mail Order varies)
Generic $10 (deductible does not apply)
Brand Formulary $30 (deductible does not apply)
Blue Shield PPO Plan Design (HRA) Blue Shield (Shield Spectrum PPO Savings Plus 2250 Deductible Plan
Deductible: $2,250 / individual - $4,500 / family (in or out-of-network combined)
Out-of-Pocket Max. $3,000 / individual - $5,500 / family (in or out-of-network combined)
Co-Insurance 80% in-network – 50% out-of-network
Office Visit 20% in-network (after deductible) – 50% out (after deductible)
Preventive / well-child No charge (deductible does not apply) – Not covered out-of-network
Other covered non-preventive services subject to the deductible
Emergency 20% (after deductible) – in or out-of-network
Outpatient Surgery 20% in-network (after deductible) – 20% out (after deductible)
Hospitalization 20% in-network (after deductible) – 50% of $600 + excess
Prescription (Mail Order = 2 times these co-pays for up to a 90-day supply)
Generic $10 (you must meet your deductible before co-pays begin)
Brand Formulary $25 (you must meet your deductible before co-pays begin)
Non-Formulary $40 (you must meet your deductible before co-pays begin)
The BigBand Health Reimbursement Arrangement and the Comparative Costs
SINGLE EMPLOYEE Monthly premium costs:
$42.10 for the Blue Shield HMO $60.11 for Kaiser (HRA) $79.89 for the Blue Shield PPO (HRA)
Annual deductible exposure: $1,500 facility deductible for Blue Shield HMO $1,000 for Kaiser HRA (BigBand will fund up to the first $1,000 via the HRA) $1,000 for Blue Shield PPO (BigBand will fund up to the first $1,250 via the HRA)
Office Visits $15 (no deductible) for the Blue Shield HMO 20% for Blue Shield PPO (after deductible) BigBand funds $1,250 via HRA $20 for Kaiser (after deductible) BigBand funds $1,000 via HRA
Inpatient care exposure: $1,500 for the HMO $1,000 for Kaiser ($2,000 - $1,000 HRA funding) $1,750 for Blue Shield ($3,000 - $1,250 HRA funding)
The BigBand Health Reimbursement Arrangement and the Comparative Costs (for a family)
FAMILY Monthly premium costs:
$201.17 for Blue Shield HMO $180.32 for Kaiser (HRA) $228.84 for Blue Shield PPO (HRA)
Annual deductible exposure: $1,500 facility deductible (per member) for Blue Shield HMO $2,000 for Kaiser HRA (BigBand will fund up to the first $2,000 via the HRA) $2,000 for Blue Shield PPO (BigBand will fund up to the first $2,500 via the HRA)
Office Visits $15 (no deductible) for the Blue Shield HMO 20% for Blue Shield PPO (after deductible) BigBand funds $2,500 via HRA $20 for Kaiser (after deductible) BigBand funds $2,000 via HRA
Inpatient care exposure: $1,500 for the HMO $2,000 for Kaiser ($4,000 - $2,000 HRA funding) $3,000 for Blue Shield ($5,500 - $2,500 HRA funding)
Dental Plan Design Delta Dental PPO
Questions ? Call 1-800-765-6003
Provider Directory = www.deltadentalins.com
Services Deductible * $50 / individual - $150 / family
Annual Maximum $1,500
Co-Insurance In Out (Subject to Usual, Customary & Reasonable)
Preventive - 100% 100%
Basic - 90% 80%
Major - 60% 50%
Orthodontics (child only) 50% 50% ($1,000 Lifetime Maximum)
Pre-determination Review (Recommended for services > $300)
Dental Plan Design (Buy-up Option) Delta Dental PPO
Questions ? Call 1-800-765-6003
Provider Directory = www.deltadentalins.com
Services Deductible * $50 / individual - $150 / family
Annual Maximum $2,000 in-network / $1,500 out-of-network
Co-Insurance In Out (Subject to Usual, Customary & Reasonable)
Preventive - 100% 100%
Basic - 90% 80%
Major - 60% 50%
Orthodontics (adult & child) 50% 50% ($1,500 Lifetime In & $1,000 Lifetime Out))
Pre-determination Review (Recommended for services > $300)
Vision Plan Design Vision Service Plan
Questions ? Call 1-800-877-7195
Provider Directory = www.vsp.com
Services Co-pay $25 (does not apply to contacts)
Exams: Once every 12 months
Lenses: Once every 12 months
Frames ($120 allowance) Once every 24 months
Contact Lenses ($120 allowance) Once every 12 months
*** Laser Vision Correction Discounts ***
* See fee schedule for out-of-network benefits
Life/AD&D and Disability Sun Life
Questions ? Call 1-800-247-6875
Website = www.sunlife-usa.com
Life Insurance
1.5 times basic annual salary to a maximum of $375,000
Voluntary Life up to 5 times salary (maximum benefit = $500,000)
Disability
STD = 66 2/3% of weekly earnings to a maximum of $2,309 per week
7-day elimination period
LTD = 66 2/3% of monthly pay to maximum monthly benefit of $10,000
90-day elimination period
Employee Assistance Program
Employee Assistance Program
Need Assistance ? Call 1-877-327-4753
Website = www.guidanceresources.com
Company ID # ZB3042Q
Assistance with the following:
Confidential Counseling on Personal Issues
Legal Information, Resources and Consultation
Financial Information, Resources and Tools
Information, Referrals and Resources for Work-Life Needs
Online Information, Tools and Services
The Importance of Having a Will
Assist America Travel Assistance) Provides medical assistance when traveling more than 100 miles from home
Need Assistance ? Call 1-800-872-1414 in the United States
Need Assistance ? Call 301-656-4152 outside of the United States
Assistance with the following:
Medical Consultation and Evaluation
Hospital Admission Guarantee
Emergency Evacuation
Critical Care Monitoring
Medically Supervised Repatriation
Prescription Assistance
Care for minor children
Legal and Interpreter Referrals
Return Mortal Remains
Pension Dynamics (Flexible Spending) Questions ? Call 800-888-1998
Website = www.pensiondynamics.com
Medical Expenses
Medical Reimbursement Limit = $3,000
Eligible Expenses
Non-Eligible Expenses
Over-the-Counter Reimbursements
Dependent Care
$5,000 limit
Educational versus Custodial
Day Camp versus Overnight Camp
Voluntary Pet Insurance VPI Pet Insurance
Nation’s largest & oldest provider Plan is completely portable Discounts (5% core policies / 10% for 2-3 pets) Low deductible of $50 Vaccination & Routine Care coverage available Easy Enrollment
www.petinsurance.com/nbg 866-332-7620
Customer Care my.petinsurance.com 800-USA-PETS
Pre-Paid Legal Pre-Paid Legal plan
Telephone Conversations (unlimited) Letters/Phone Calls on your behalf (one per subject) Unlimited Document Review (10-pages per document)
Identity Theft Shield (Kroll Background America) Detailed Credit Report (Experian / FICO Score / Analysis Continuous Credit Monitoring (Daily)
Safeguard for Minors Children under age 18 Continuous Credit Monitoring
Liberty Mutual Auto & Home Voluntary Benefits Car Insurance
Liability Medical Payments / Personal Injury Uninsured / Underinsured Motorists Collision Comprehensive Mechanical Parts Replacement Car Windshield Repairs New Car Replacement
Homeowners Insurance Your Home Your Possessions Your Liability
Maximizing Health Benefits
Utilize benefits that provide for preventive coverage Semi-annual dental cleanings and exams Annual eye exam
Be a savvy consumer – can save you $$$ Choose plans that fit your situation best Familiarize yourself with spouse’s/partner’s plan Question doctor regarding procedures and necessity,
generic prescriptions, billing rates, joining carrier’s in-network listing, referrals to in-network specialists
Open Enrollment - BeneTrac
BeneTrac: We will notify you when you can access the system for enrollment.
BCBS MA / Delta Dental & VSP – If you are enrolled and you do not want to make any changes, you do not need to do anything but you should review your BeneTrac account and click “finalize”.
Group Life/AD&D and Disability - You are automatically enrolled for the group benefits.
Voluntary Life – If electing to increase your Voluntary Life, or enroll for the first time, please complete an application. If you are adding to existing coverage, or a new enrollment exceeding the Guarantee Issue amounts, you will also need to complete an Evidence of Insurability Form.
Flexible Spending Accounts for 2010 – If you are enrolling, you must re-elect your contributions in BeneTrac, even if you were enrolled last year.
Life Changes
Must be done within 31 days from Qualifying Event
Birth or adoption of a child or dependent change Marriage, divorce, or domestic partner Child(ren) – Full-time students between the ages of 19
and 25 Spouse’s change of employment Temporary assignment outside of coverage area