State Employees’ Insurance Board
2013 Benefits Conference
AGENDA
Registration (Wellness Nurses Available)……………………………………………………………………9:00 AM
Welcome……………………………………………………………………………………………….……….....10:00 AM
I.
LGHIP Overview/Healthcare Reform-Page 2.………………………………………………….……..10:10 AM
SEIB
II.
Voluntary Benefit Options……………………………………………………………………………….10:50 AM
Great West Retirement Solutions
Alabama Retired Employees’ Association
III.
LGHIP Benefit Summary-Page 12……………………………………………………………………..11:10 AM
SEIB
Lunch (On your own)……………………………………………………………………………..………..….12:00 PM
IV.
Retirement Benefits Overview…….………………………………………………………..………......1:30 PM
Retirement Systems of Alabama
V.
Voluntary Benefit Options…..…………………………………………………………………………..2:00 PM
LTC Global
Retirement Systems of Alabama
VI.
Retirees…………………………………………………………………………………………………..…2:20 PM
Social Security
VII.
Wellness-Page 33…………………………………………………………………………..………........2:55 PM
SEIB
Program Concludes……………………………………………………………………………………..………3:25 PM
LOCAL GOVERNMENT
HEALTH INSURANCE
PLAN
BENEFIT AND
HEALTHCARE REFORM
SUMMARY
2
3
LGHIP Advisory Committee
Vicky Hicks Allen
Calhoun-Cleburne MH Board
Appointed By: SEIB Chairman
Term expires February 11, 2014
Carolyn Sutley
Enterprise Housing Authority
Appointed By: SEIB Chairman
Term expires February 11, 2014
Charles Sankey, Commissioner
Roger Rendleman
Crenshaw County Commission
Lee County Administrator
Appointed By: Executive Director of the Association
Appointed By: Executive Director of the Association of
of County Commissions of Alabama
County Commissions of Alabama
Term expires February 11, 2015
Term expires February 11, 2015
Vacant
Appointed By: ARSEA Executive Director
Ken Smith
City of Decatur, Personnel
Appointed By: Executive Director of the Alabama
League of Municipalities
Term expires February 11, 2015
Mayor William E. Blackwell
City of Ozark
Appointed By: Executive Director of the Alabama
League of Municipalities
Term expires February 11, 2015
William Ashmore, SEIB CEO
4
2014 Premium and Benefit
Changes
Benefits
Physician Office Visit Copay
Hospital Deductible
Emergency Room Copay
Out Of Pocket Maximums
Individual
Family
Premiums
5% increase
$30-$35
$100-$200
$100-$200
$6,250
$12,500
5
Premium History
(Rates shown include dental coverage)
Year
Preferred in
Transition
Preferred
Standard
2010
Individual
Family
$367
$892
Individual
Family
$367
$922
Individual
$400
Family $1,008
2011
Individual
Family
$378
$919
Individual
$400
Family $1,008
Individual
$412
Family $1,039
2012
Individual
Family
$378
$919
Individual
$400
Family $1,008
Individual
$412
Family $1,039
2013
Individual
Family
$378
$919
No longer
available
-----------
Individual
$412
Family $1,039
2014
Individual
Family
$396
$963
No longer
available
-----------
Individual
Family
$432
$1089
LOCAL GOVERNMENT
HEALTH INSURANCE
PLAN
HEALTHCARE REFORM
6
7
Summary of Health Care Reform
Patient Protection and Affordable Care Act (PPACA)
 Signed into law on March 23, 2010
 Health
Care and Education Affordability
Reconciliation Act of 2010 signed into law.
 “Grandfathered
Plans”
 Plans
that were in existence on March 23, 2010
 LGHIP will lose grandfathered status on January 1, 2014

Provide preventative services and women’s health with no
copay
8
Summary of Health Care Reform To Date
Lifetime Coverage Limits Prohibited

LGHIP must eliminate the $1 million lifetime limit on coverage of
essential benefits but can allow certain restrictive annual limits until
2014.
Pre-existing Condition Exclusions Prohibited for Dependents

LGHIP must eliminate pre-existing condition exclusions for children
under the age of 19.
Dependent Coverage Expanded up to Age 26


LGHIP must provide coverage for adult dependent children up to
age 26, if the child is not eligible to enroll in other employer
provided coverage.
LGHIP cannot require qualified young adults to pay more than
similarly situated dependents enrolled in the plan.
Health Care Reimbursement Account


Maximum contribution capped at $2,500 annually
Over-the-Counter drugs must be pre-approved
9
Health Care Reform Changes
Effective October 1, 2013
Open enrollment for Marketplace*
Coverage may become effective as
early as January 1, 2014.
*For more information on the Marketplace, click here.
10
Healthcare Reform Changes
Effective January 1, 2014
Pre-existing condition exclusion for all enrollees prohibited.
 LGHIP currently has a 270 waiting period less credit for
time served under other group coverage.
Coverage Eligibility
 Employees must be offered coverage within 90 days of
employment.
Marketplace Subsidy
 LGHIP members who fall between 100%-400% of the FPL
may qualify to receive credit for participation in the
Marketplace.
Individual Mandate
 Everyone, unless exempted by law, is required to
maintain health insurance.
11
Healthcare Reform Changes
Effective January 1, 2018
Excise tax on “Cadillac” Plans
which cost of coverage exceeds
$10,200 on individual and $27,500
on family coverage
LGHIP cost of coverage is
currently well below these levels.
Local
Government
Health
Insurance
Plan
Benefit Summary
12
Blue Cross
Blue Shield
of
Alabama
Blue Card PPO
13
14
What you need to know about
a PPO

Using a PPO provider/facility saves money



Contracted allowed amount accepted
Higher benefit level in most cases
Using a non-PPO provider/facility costs more



Some services are covered at 80% (versus 100%)
Member incurs charges over the allowed amount
Some services are non-covered
Please visit www.bcbsal.org for a full list of PPO
providers.
15
Inpatient Hospital
 $200

per admission
$50 copay per day for days 2-5
 All
hospital admissions require preadmission
certification except maternity. Emergency
admissions require certification within 48 hours of
admission. For preadmission certification, call
1-800-551-2294
 If
preadmission certification is not obtained, no
benefits are available
16
Outpatient Hospital
 Surgery

$100 facility copay per visit
 Diagnostic

$100 facility copay
 Medical

Emergency
$200 facility copay
 Accidental

X-Rays & Tests
Injury
Covered at 100% of the allowance with no
deductible or copay required if services are
provided within 72 hours of the accident
17
Routine Physician Care
 Physician

$35 per office visit
 Nurse

Practitioner Copay
$20 per office visit
 Lab

Office Copay
Copay
$3 per test
18
Major Medical
 Calendar

$200 per person each calendar year; Maximum of
three deductibles per family
 Annual


Year Deductible
Out-of-Pocket Maximum
Individual
Family
$6,250*
$12,500*
*All out-of-pocket expenses include copays, deductibles, and
coinsurance.
19
Prescription Drugs

Generic drugs*


$5 copay per prescription; 60-day supply on maintenance drugs**
Brand name drugs*

Covered at 80% of the allowance, subject to the $200 calendar
year deductible
* No benefits are available for prescriptions purchased
at a non-Participating Pharmacy.
** The generic copay expense does not apply to the annual
deductible.
Please visit www.bcbsal.org for a list of participating pharmacies,
and maintenance drug list.
20
Baby Yourself
“Baby Yourself,” SEIB’s Maternity Management
Program offers assistance in identifying high-risk
pregnancies and managing them to prevent
complications at the time of delivery.



As soon as a pregnancy is confirmed, the patient or
the doctor should call BCBS at 1.800.551.2294.
By participating in “Baby Yourself” and notifying
BCBS before the end of the second trimester, your
$200 deductible and applicable daily copay(s) will
be waived.
A BCBS nurse will contact the member’s physician
to obtain additional clinical information.
Blue Cross
Blue Shield
of
Alabama
Dental
21
22
Deductible
$25 per person each calendar year;
maximum of three deductibles per family.
This deductible applies to basic and major
services only.
23
Diagnostic & Preventive
Covered at 100% of the preferred dental
fee schedule, with no deductible.
 Two
routine cleanings per year
 One set of x-rays per year
24
Basic & Major Services
Covered at 50% of the preferred dental fee
schedule, subject to a $25 annual deductible.
$1,500 annual maximum for all covered services.
These services include:





Fillings
Oral Surgery
Periodontics
Endodontics
Prosthodontics
25
Orthodontics
 $25
annual deductible
 Covered
at 50% of the Preferred Dental
Fee Schedule
 Lifetime
maximum of $1,000 per person for
Dependent Children 19 and under only
Southland
Benefit
Solutions
Dental
Voluntary Insurance
Coverage
26
27
Premium
 Premium
is $40 per month, regardless of
number of dependents
 Separate
enrollment is required in
Southland dental
 Will
operate as primary or secondary
dental coverage
28
Deductible
 $25
per person each calendar year;
maximum of three deductibles per family
NOTE: Only applies to Basic & Major Services
for family coverage only
29
Diagnostic & Preventive
Covered at 100% of reasonable and
customary charges with no deductible.
Services include, but are not limited to
2
routine cleanings per year
 1 set of x-rays per year
30
Basic & Major Services

Individual Coverage



Family Coverage



Covered at 80% of reasonable and customary charges with no
deductible
$1,250 annual maximum for all covered services
Covered at 60% of reasonable and customary charges subject to a $25
annual deductible
$1,000 annual maximum per member for all covered services
Services include, but are not limited to





Fillings
Oral Surgery
Periodontics
Endodontics
Crowns
Southland
Benefit
Solutions
Vision
Voluntary Insurance
Coverage
31
32
Southland Vision Benefits

Premium is $20 per month, regardless of number of dependents.

This will coordinate with the SEIB Discount Routine Vision Care
Network.
Examination
40.00
Frames
Single Vision
Bifocals
Trifocals
Lenticular
60.00
50.00
75.00
100.00
125.00
Contacts
100.00
Plan provides either contacts or lenses and frames, but not both in any plan year.
It is the responsibility of the member to submit a claim for either lenses or contacts
and the payment will be made based on the date the claim is received.
LGHIP WELLNESS
PROGRAM
WELLNESS
33
34
Wellness Screenings
Members are screened for the following risk factors
Blood pressure
At risk if systolic reading is 160 or higher
or your diastolic reading is 100 or higher
Cholesterol
At risk if 250 or higher
Glucose
At risk if 200 or higher
Body mass index
At risk if 35 or higher
35
At-Risk Members
If determined at-risk, the member will receive a
copay waiver and physician referral form for
follow-up visit with their physician.
36
A Few Things You Should Know

Local Government units that have 80% or greater wellness
participation will receive a $10 premium discount per active
employee each month. Employees may participate through
a worksite wellness screening or by having a provider
screening form completed by their health care provider.

Units with 30% or more employee participation in a wellness
screening may qualify for the “Preferred” rate category.
37
Tobacco Cessation Program
Members and their covered spouse may
receive a reimbursement of 80% of the cost
of a non-covered tobacco cessation
product, up to $150 lifetime maximum.
38
Physician Weight
Management Program
Covered LGHIP members can receive 80%,
up to $150 annually, for non-covered
weight management programs that are
overseen by a physician.
39
Reimbursement Process
To receive reimbursements for both tobacco
cessation and weight management,
receipts should be:
Mailed: PO Box 304900,
Montgomery, AL 36130-4900
Faxed: (334) 517-9980
Be sure to include name, contract number, and date of
birth on all correspondence.
LGHIP Payroll
and
Personnel
Officer
Assistance
Plan Information and Forms
40
41
Enrollment and Plan Forms
For enrollment forms and plan summaries,
visit the SEIB website at www.alseib.org.
42
LGHIP Benefits
 Blue
Cross Blue Shield Health Benefits
Summary
 Blue Cross Blue Shield Dental Benefits
Summary
 Southland National Dental and Vision
Summary of Benefits
43
Enrollment Forms







Enrollment Form (LG01)
Change Form (LG02)
Cancellation Form (LG03)
Declination of Coverage (LG04)
Southland National Enrollment Form (LG07)
Southland National Plan Change Form (LG08)
Southland National Cancellation Form (LG09)
44
Benefit and Claims Forms
 Blue
Cross Blue Shield Prescription Claim
Form
 Blue Cross Blue Shield Medical Expense
Claim Form
 Provider Screening Verification Form
 Blue Cross Blue Shield Direct Deposit
Enrollment Form
 Southland National Cancer and Hospital
Indemnity Claim Form
 Southland Dental Claim Form
 Southland Vision Claim Form
45
SEIB Wellness Benefits, Forms
and Programs
 Wellness
Screening Schedule
 Tobacco Cessation Program
 Physician Administered Weight
Management Program
 Provider Screening Form (LG12)
46
LGHIP Benefit Advisors
Tonya Campbell
866-841-0978
tcampbell@alseib.org
Connie Grier
877-500-0581
cgrier@alseib.org