2014 Benefit Changes
Conference Call for ESC Represented Employees
November 19, 2013
Benefits 2014
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Agenda
• New Medical Plan for 2014
– New Resources - where to get more information
– What’s changing?
– New Plan Design for 2014
• Question and Answer Period
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New Resources
Provant – Your One-Stop Shop for Health and
Wellness Questions
Talk to a health advocate for:
• Billing Questions
• New Health Account Plan questions
• Dental or Vision Plan Questions
• Questions about health screenings, health accounts
PROVANT
Phone support:
866-271-8144, M-F, 5am-5pm. Pacific Time
Email support:
PGEsupport@provanthealth.com
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New Resources
New Website: www.mypgebenefits.com
Benefits 2014
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Details on the new Anthem and
Kaiser HAP for 2014
•
Accessed from any computer with
internet access
•
What to expect at the doctor and
pharmacy on your first visit in 2014
•
How to use your different cards
•
Where to get more information as
you use the plans
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What’s Changing?
What Isn’t Changing?
What Is?
Dental
Delta Dental
New coverage for dental
implants
Vision
VSP
Discounts on non-covered
services are different
Medical
Monthly Premium
New Health Account Plan in
effect for both Kaiser and
Anthem: two provider
networks-same plan design
Hearing Aids covered for all
employees and retirees
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What’s Changing?
Rules for Covering Children
• Children can be covered under your PG&E medical, dental
and vision plan until their 26th Birthday
• They no longer have to be
• students
• unmarried
• your tax dependent
• They can be employed and be offered benefits (New)
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New Medical Plan for 2014
The Health Account
• All active employees enrolled in Anthem or Kaiser will
have a Health Account
• Both the Anthem and Kaiser PG&E plans for active
employees will be called the Health Account Plan, or
HAP
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New Medical Plan for 2014
The Health Account
Health Account Deposits
2014
Single Coverage
Family Coverage
• You automatically get:
• $ 750
• $1,500
• If you take a health screening:
• $ 250
• $ 500
• If you test tobacco-free or complete PG&E’s
tobacco cessation program:
• $ 250
• $ 500
• Total
• $ 1,250
• $ 2,500
• $ 500
• $ 1,000
• $ 250
• $ 500
• If you test tobacco-free or complete PG&E’s
tobacco cessation program:
• $ 250
• $ 500
• Yearly Total
• $ 1,000
• $ 2,000
2015
• You automatically get:
through • If you take a health screening:
2020
Remember: If you don’t use all your credits in one year, they roll over
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New Medical Plan for 2014
Earning Health Account Credits
• Health Screening consists of four tests:
• Weight/Height to get BMI
• Blood Pressure
• Glucose Level (non-fasting)
• Cholesterol Level
• Tobacco use test is optional and done with an oral
swab
• Tobacco users can skip the tobacco use test and
complete a tobacco cessation course with Provant to
earn credits
Employees with family coverage will earn
credits for their entire family – their dependents
do not need to do a screening to earn credits
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New Medical Plan for 2014
Health Screenings and Tobacco Use Test
• Three ways to get a Health Screening/Tobacco
Test
• On-site event: enroll online at
www.provantevents.com/pge or call Provant
• Concierge: call Provant at 1-866-271-8144 to
schedule at your home or office
• Take a form to your doctor: doctor’s offices
don’t do tobacco screenings; you’ll need to
walk into any on-site screening – no
appointment needed. Download the screening
form from www.mypgebenefits.com
• Check for your results at www.provantonline.com
• Have until Sept. 30, 2014 to earn credits for 2014
Benefits 2014 plan year
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
Using Health Account Credits
• Pay for plan deductibles and other out-of-pocket expenses
• Credits can be used for:
– medical, dental and/or vision expenses
– for you or your family members
– unused credits roll over year after year and can be used for PG&E
Retiree Medical Plan expenses
• You can still contribute to a Health Care Flexible Spending Account
(FSA)
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
Using Health Care Flexible Spending Account
• NEW! Can roll over $500 from one year to next, amounts above $500
left in account at end of year are still a “use-it-or-lose-it”
• Will work with the Health Account
• Administrators:
– Your Spending Account (for Anthem Blue Cross members)
– Kaiser (for Kaiser members)
• Will automatically use the Health Care Flexible Spending Account
first
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How the Plan Works – Health Account
Debit Cards
YSA (Anthem HAP)
Kaiser HAP
Use card to pay expenses for:
• Medical
• Mental health
• Pharmacy
• Dental
• Vision
Use card to pay expenses for:
• Kaiser pharmacy
Kaiser medical expenses and mental health expenses
automatically taken out of your account after your visit
to Kaiser
Submit claims to pay for
• Dental
• Vision
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
• 4 free primary care visits per year for every covered
family member
• First choice for everything from chronic disease
management, physicals, everyday ailments
• Choose a family doctor who knows you and cares
about your “whole person” health
• Primary Care Doctors
• General or family practitioners (including nurses)
• Internal Medicine doctors
• Pediatricians
• OB/GYNs
• Urgent care
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New Medical Plan for 2014
Other Free Services
• Some free preventive screening services (e.g., mammograms,
pap smears, colonoscopies, immunizations)
• Some free prescription drugs for preventive care and chronic
conditions (e.g., insulin for diabetes)
• Free maternity and well-baby office visits to age two
Go to www.mypgebenefits.com for lists of which preventive
services and prescription drugs are free
Tip: free doctor visits may include additional tests
or services performed during your visit – these are
covered, but may not be free
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New Medical Plan for 2014
A few terms to understand …
Annual Deductible
For services that aren’t free, amount you’re responsible to pay for first
before the plan will start to pay
Co-insurance
You pay a percent of the cost of a medical service
Out-of-Pocket Maximum
The limit on the amount you have to pay every year for covered
services
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
Annual Deductible
• If you have single coverage, annual deductible is $1,000
• If you have family coverage, annual deductible is $1,000 per
person but no more than $2,000 for your entire family
Remember: if you earn all your Health Account credits,
you’ll have enough to pay your whole deductible from
your Health Account
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
Coinsurance
• You’ll be responsible for either 10% or 20% of the covered
cost and the HAP will pay the other 90% or 80% respectively.
• There are no copayments under the HAP, so instead of paying
a flat $10 or $20 copayment at the time of service, you’ll pay
10% or 20% for services that are not free
• But, your expense is limited by the Out of Pocket Maximum….
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
Out-of-Pocket Maximum
• Limits how much you are responsible for paying every year
• Once out-of-pocket maximum is reached, all covered services are
free for the rest of the year
• Includes all money you spend on covered medical services,
prescription drugs and mental health services
• Includes credits you used from your Health Account for medical
expenses
• Includes deductible and co-insurance
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New Medical Plan for 2014
How the Health Account Plan (HAP) Works
Out-of-Pocket Maximum
• If you have single coverage, the annual out-of-pocket maximum is
$2,400
• If you have family coverage, the annual out-of-pocket maximum is
$2,400 per person but no more than $4,800 for your entire family
Single Coverage
Your Maximum 2014 Health Account Credits:
Your Annual Out-of-Pocket Maximum:
$1,250
Family Coverage
$2,500
– $2,400
– $4,800 at the most
<$1,150>
<$2,300 at the most>
(includes annual deductible)
Your 2014 Effective Out-of-Pocket Maximum:
All covered expenses paid at 100% for the rest of the calendar year
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How the Plan Works – Coinsurance
MEDICAL SERVICES
•
•
•
•
•
•
•
•
Primary care office visits after first four free
visits
Outpatient mental health visits
10% with no deductible
Therapies – 1st five visits (i.e., acupuncture,
chiropractic, outpatient physical therapy,
occupational therapy)
10% after deductible
Specialists
Laboratory/X-ray
Therapies – additional visits after five (i.e.,
acupuncture, chiropractic, outpatient
physical therapy, occupational therapy)
Hospital care
Emergency room
20% after deductible
PRESCRIPTION DRUGS
Benefits 2014
Retail Pharmacy – must first meet deductible
•
•
15% generic
25% brand
Mail-Order – must first meet deductible
•
•
10% generic
20% brand
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New Medical Plan for 2014
Things to note about pharmacy
• Express Scripts will continue to be the pharmacy provider for Anthem
Blue Cross; Kaiser provides pharmacy benefits for its members
• Free medications for Anthem HAP must be obtained from Express
Scripts mail order
• Free medication from Kaiser can be from any Kaiser pharmacy or
mail order
• Anthem HAP members will have mandatory mail order for many
maintenance drugs – drugs you take on a long-term basis
– In 2014, can get three fills at a retail pharmacy, then must get the drugs
through Express Scripts mail order, or pay 100% of the cost
– Can sign up now with Express Scripts mail order if currently enrolled in
Anthem
– Most narcotics, ADHD drugs and compound drugs are not included – you
will continue to have coverage for these at a retail pharmacy
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What do you need to do now?
• Schedule a Health Screening to maximize your
Health Account credits for 2014
• If you want a flexible spending account, enroll by
November 21, 2013
• Review Health Account Plan User Guide that will
be sent to you in late December
• Visit www.mypgebenefits.com for more
information on the new Health Account Plan
• Contact Provant with detailed questions
866-271-8144, M-F, 5am-5pm, Pacific Time
PGEsupport@provanthealth.com
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Question & Answer
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Thank You
Questions?
Log onto www.mypgebenefits.com for more
information
Email PGEsupport@provanthealth.com
Or call Provant at 1-866-271-8144 for medical
plan questions
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