Open Enrollment
for the 2015 Plan Year
2:00 p.m. Eastern Time
August 27, 2014: Betty Easley 152
August 28, 2014: Conference Call
Dial-in: 888-670-3525
Passcode: 766-565-3066#
Craig J. Nichols, Secretary
Agenda
• Benefit Changes for 2015
• System Enhancements
Pharmacy Benefits Manager
– Key Dates Screen
90-Day Maintenance at Retail
– Reports
Vision
• Communications
Supplemental Plan Premiums
– Open Enrollment
HSA Contribution Limits
– Helpful Documents
• Eligibility Changes
– Wellness Wire
– Definitions
– Changing Employee Status
– Jury Duty, Military Leave and
FMLA Leave
– Rehired Retirees
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Benefit Changes for 2015
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Pharmacy Benefits Manager
• CVS/caremark
– Contact Info:
• caremark.com – user account Jan. 1
• Caremark.com/sofrxplan – plan info
• 888-766-5490 – 24/7
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Welcome letter
Preferred Drug List and Maintenance Drug List
Transferring Mail Order Prescriptions
PPO Members Maintenance Medications
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90-Day Maintenance at Retail
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HMO and PPO Plan Members
All CVS Retail Pharmacies
90-Day Maintenance at Retail Pharmacies
Mail Order Copays
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Vision
• New Contract Awarded to Humana
• One Vision Plan for 2015: Exam Plus Materials
– Similar or Better Benefits
• Materials Only Plan Ends 12/31/14
– Notices to Current Members
– Must Enroll during OE for Vision Coverage
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Supplemental Plan Premium Changes
• Dentals
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Assurant Freedom Advance
CIGNA Prepaid
Humana Network Plus
Humana Preferred
• Humana Exam Plus Materials Vision
• CIGNA Hospitalization
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HSA Contribution Limits
• Includes the state’s contribution:
– Single: $3,350
– Family: $6,650
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Eligibility Changes
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Periods
• New Hire Measurement Period – the
period of 12 consecutive months starting the first
of the month following the initial hire date and
ending the last day of the twelfth month
• Open Enrollment Measurement Period – the
period of 12 consecutive months from October 3
through the following October 2 of each year
• Stability Period – the period of 12 consecutive
months starting from the first day of enrollment
(or possible enrollment if coverage waived) in
health insurance
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Break in Service
• Termination of employment or unpaid
leave that exceeds 13 consecutive weeks (26
weeks for employees of academic institutions);
or a break between four weeks and 13 weeks
(26 weeks for employees of academic
institutions) if the period of service prior to the
break is less than the period of the break.
• Applies to ALL Employees
– Termination after Full Calendar Month QSC Event No
Longer Applies
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Salary to OPS and OPS to Salary
• All salaried or OPS appointments are
considered when determining the employee’s
measurement and stability periods.
• If no 13/26 week break in service, measurement
period determined based on initial start date in a
position, regardless of type.
• Stability period based on whether employee is in the
new hire measurement period or the open
enrollment measurement period.
– If the employee was employed for more than 12 months
and was measured as a new hire, the employee is
thereafter in the open enrollment stability period (January
through December).
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FT Salaried to FT Salaried
• FTE 0.75 to 1.00
• Must have a 13/26-week break in service to be
treated as a new hire for insurance election
purposes.
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FT Salaried/OPS Eligible to PT Salaried
• Affordable health coverage guaranteed for 12
months starting from date of enrollment, so coverage
continues as if PT salaried is full-time for remainder of
the stability period (i.e., FT employer contribution
continues).
• Appointment date in the initial salaried position
generates the measurement period start date.
Employee is then measured to determine eligibility to
continue full-time rate for the next stability period.
• Life insurance rolls and PT employee pays prorated
premium.
• All other elections roll.
• If OPS eligible, allowed to enroll in only optional life
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and/or MRA/LPMRA.
Caution: PT Salaried FTE
Please do not use FTEs less than
0.75 but allow employees to work
0.75 or more.
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PT Salaried to FT Salaried
• All elections roll
• Significant cost decrease QSC event to enroll in
or increase health coverage
• Auto enrolled in basic life
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PT Salaried to PT Salaried
• All elections roll
• Potentially a significant cost increase or
decrease QSC event to change health coverage
• Appointment date in the initial salaried position
generates the measurement period start date
– Employee is measured at the end of the new hire
measurement period to determine eligibility for fulltime benefits for the next 12 months
– Subsequently measured again during open
enrollment to determine eligibility for full-time benefits
for the next plan year.
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FT Salaried to OPS
• Appointment date in FT salaried position
generates the measurement period start date.
• Employee is guaranteed health benefits as OPS,
regardless of the expected hours as OPS, for
remainder of stability period.
• All benefits roll except optional life and
MRA/LPMRA.
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PT Salaried to OPS
• OPS appointment drives eligibility
– If OPS appointment is at least 30 hours, benefits
continue for remainder of stability period.
– If OPS appointment is less than 30 hours, benefits are
terminated.
• Optional life and MRA/LPMRA end.
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OPS Eligible to FT Salaried
• All elections roll.
• Auto enrolled in basic life
• Employee allowed to enroll only in optional life
and/or MRA/LPMRA.
• Employee is treated as salaried for all future QSC
events and open enrollment.
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OPS Eligible to OPS
• Affordable health coverage guaranteed for
12 months starting from date of enrollment, so
coverage continues for remainder of the stability
period (i.e., FT employer contribution continues),
regardless of the expected hours for the new
OPS appointment.
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OPS Not Eligible to OPS Eligible
• Must be in the new hire measurement
period and experience one of the following:
– Increase hours to at least 30 per week
– Move from short-term to regular status
– Move from seasonal to regular status
• Allowed to enroll in coverage.
– The effective date of coverage can be the first day of
the third month following and including the status
change or the first day of the second month following
the new hire measurement period, whichever is
earlier.
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Jury Duty – OPS Employees
• For hours the OPS employee would have
worked if not called to jury duty:
– Agencies: use 0031 (Administrative Leave – Jury
Duty) on the timesheet.
– JAC, SCS, universities and BENOS: record hours
type 2024 on the alternate time entry screen.
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Military Leave – OPS Employees
• Starting in November, submit military leave
for OPS employees using action code 11,
reason code 83.
• When the employee returns from military leave,
use return from leave action code 36, with
reason code 00.
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FMLA Leave – OPS Employees
• Starting in November, submit FMLA leave
for OPS employees using action code 11,
reason code 49.
• When the OPS employee returns from FMLA,
use return from leave action code 36, with
reason code 00.
• OPS employees on FMLA and enrolled in health
insurance are only eligible for the state
contribution up to 12 weeks.
– Return the employee from FMLA or terminate the
employee at the end of 12 weeks; otherwise, the state
contribution will continue and it should not.
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Rehired Retirees
• Benefits automatically moved from the
retiree ID to the salaried or OPS eligible
employee record upon hire.
– To continue retiree health and life (and lose eligibility
for state health contribution and all other state group
insurance benefits), employee must call service
center to elect retiree coverage.
• Benefits will automatically be moved each open
enrollment if eligible for employee coverage –
required to offer affordable coverage.
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System Enhancements
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Key Dates Screen
• New screen that will include measurement
dates, hours measured and other information
specific to OPS employees.
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Reports
• New OPS Employee Report will include all
OPS employees for the agency and their
eligibility status for benefits.
• OPS Leave of Absence Report will show the
time period the OPS employees are on Military
Leave, FMLA leave or Academic Break.
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Communications
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Open Enrollment
• OE summary inserts in benefits packages
– Mailing starts 10/06/14
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Benefits guide
OE communication kits
myBenefits website
CVS/caremark welcome letter
Humana vision letter (materials only ending)
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Helpful Documents
• QSC Event Matrix
• Employee Eligibility for State Group Insurance
• MA 14-003
– Be a member of and retire under one of the following
retirement options:
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Early retirement
Disability Retirement
FRS Pension Plan
FRS Investment Plan
State University System Optional Retirement Program
(SUSORP)
• Senior Management Service Optional Annuity Program
(SMSOAP)
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The Wellness Wire
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Thanks for all you do!
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