Our New System

March 13, 2014

Presentation to HBT Healthcare and Community Employers

Agenda

• Communications

• Suspension Periods

• ADMINnet

• Group to Policy Mapping

• Prefixed BID’s

• Enrollment Forms

• ID cards

• Invoices & Billing

• Address Updates

• Questions

2

Introduction

• ACES is the new PBC health and dental system

• Go-live is April 4, 2014

3

Plan Administrator Communication

• Open house website: www.pbcopenhouse.com\adminnet

• Invoice stuffers

• Plan Updates

• Groups to Policies Transition, May 2012

• Invoices, June 2013

• Online Tools, November 2013

• Communication, February 2014

• Implementation, March 2014

• Notification of when suspension periods for enrollment and claims begin and end

• PBC corporate website announcements

• Communications to support your employees

• Member communications toolkit

4

Member Communications

• Member Open House Website• Provides information on timing, eClaims, ID cards and

CARESnet enhancements

• www.pbcopenhouse.com\caresnet

• Additional communication channels• EOB & direct deposit notifications

• CARESnet pop-ups & email to subscribers

• Blue & You

• IVR hold messaging

• PBC corporate website announcements

• Direct communications to pharmacists and dentists

• Direct mail communications to employees on LTD regarding the suspension periods

5

Enrollment Suspension Periods

• March 18 – April 3 Enrolment transactions will be

suspended (12 business days)

• Paper enrollment transactions will be held for processing post go-live

• Bluelink and ADMINnet for life and disability will be suspended. On April 4th, the new ADMINnet will be available for earnings processing

6

ADMINnet Roll-Out

• BlueLink & ADMINnet

• Read only starts March 18

• Replaced with new ADMINnet April 4

• New features such as combined invoice, reports and

communications

• Support

• User videos on-line

• PBC/HBT Member Administrators via phone

• Your access in ADMINnet will be converted from the old version to the new version.

• When you log into the new ADMINnet, you will be prompted to

enter your email address, policy number and current password

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Online Service for Plan Administrators

• Plan benefits lookup

• Easy-to-use enrollment wizard (Replaces BlueLinkfor non contract employees).

• Earnings updates will continue to be available

• Access expansive array of reports

• Forms

• Newsletters and Bulletins

• Single Sign On

Earnings

• March—Submit your February earnings by March 12

• April—Submit your March earnings by April 10

• COMVIDA clients

• You will receive information regarding minor process changes post

go-live.

• March files, for February earnings, will be status quo.

• Excel clients

• The naming convention for the Excel spreadsheet will change. We

will send each of you an email with the new naming convention and

update the instructions tab.

• Process and cutoffs will remain the same

• ADMINnet

• After April 4, continue using ADMINnet for earnings update

• Process and cutoffs will remain the same

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Invoices & Billing

• February bill available on ADMINnet on March 19th, not March 16th

• March bill available on ADMINnet on April 16th

• At go-live, you will move from billing in advance to billing in arrears for health and dental.

• Life and disability will continue as billing in arrears.

• Your invoice will now include all lines of benefit (health, dental, life and disability).

10

Claim Suspension Period

• March 27- April 3 claims processing will be suspended

• The pay direct drug system will be suspended. Prescription drugs

can still be purchased but will need to be submitted for

reimbursement

• Employees are encouraged to purchase regular medications prior

to the suspension. Early refills are being allowed.

• Dentists can continue to submit claims for processing and payment

post go-live: it will be business as usual for all dental visits

• CARESnet will be available in read-only format for members to

view their coverage and claims paid to March 26

• Suspensions will end at go-live on April 4th

• At go-live, members will enjoy enhanced services

• Coordination of Benefits occurs at point of sale for drugs.

Secondary plan processed via pay direct.

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• Redesigned for optimal usability

• Increased eClaims functionality

• Update address and spousal (COB) coverage

• Smart search (“glasses” = “prescription lens”)

• Print ID card or send to smartphone

• Drug Lookup

• Mobile CARESnet

• Expanded to full CARESnet 2.0 functionality

• Upload picture of receipt to submit a claim

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Member e-Claims

Today

Massage therapy

Physiotherapy

Chiropractic

Vision care

HSA

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New in ACES

NaturopathyAcupuncturePodiatry Psychology Monthly orthodontic treatmentsCoordination of Benefits

Group to Policy Mapping Information

• Late March, you will receive information regarding your group to policy mapping for Health and Dental.

• New numbers will appear on your invoice and will be needed for

enrollment

• Remember that legacy E and D numbers will discontinue with ACES

• The divisions, sub-divisions and classes will remain the same as today

• Mapping information will include:• Legacy E and D numbers

• Policy number of 50000 (50001 for STD)

• Division, Sub-division and class

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Prefixed BID’s

• In ACES, when a person has two active coverages, we will need to add

a digit to the front of the BID for one of the coverages.

• In early April, PBC will provide you with a list of employees who have a

prefixed BID due to dual coverage. This will only occur for people who

are not already enrolled in Life and Disability coverage.

• Process for submitting applications will not change.

• Use the BID Portal on ADMINnet to obtain a BID for the employee based on

their SIN

• Submit the application with the BID

• If the employee has an existing active coverage, PBC will contact the

Employer to advise. The Employer will contact the Employee to determine if

the other coverage should cancel.

• If the other active coverage is valid, the Employer will advise PBC.

• PBC will assign a prefixed BID and advise the Employer.

• The Employer will need to keep a record of the prefixed BID, to use for

future enrollment changes and for reference on the invoice.

15

New Enrollment & Change Forms

• The Application for Group Benefits form and the Change form have been updated to include information for Health and Dental on ACES

• See sample of the new forms and information sheet.

16

ID Cards

New ID cards will be sent out within three months of go-live

• Card will show Policy, ID (ie., BID) and Employee’s first and last name

• Old Group and ID numbers will work for a period of time post go-live

• Dependent number information is no longer required for claiming.

• Simply provide the full name

and date of birth

• To verify dependents use

CARESnet or call the

PBC Call Centre

17

Address Updates

• Employees can update their address on CARESnet

• There will be a message on CARESnet to advise employees to notify Employers of their address change and why this is important.

• Call Centre will also remind employees when they receive an address update over the phone.

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Key Dates & Information

March 18 – April 3rd Enrollment suspension

March 27th – April 3rd Claims suspension

April 4th

Claims and enrollment suspension lifted;

CARESnet and ADMINnet live; ID cards

sent within 3 months of go live

Administrator Open House

Member Open House

www.pbcopenhouse.com\adminnet

www.pbcopenhouse.com\caresnet

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Questions?

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