DoD NAF HBP
Open Enrollment Overview
November 4 – November 29
Agenda
• Open Enrollment Overview
• Medical Benefit Overview
• Health and Wellness Programs
• Dental Benefits
• Member Tools and Discount Programs
www.nafhealthplans.com
Open Enrollment Overview
• The Open Enrollment Period allows eligible
employees to:
– Join the DoD NAF HBP or another available NAF
health plan if not already enrolled
– Switch plans
– Add or remove eligible dependents
– Add or drop dental
– Drop coverage altogether
– Do nothing and keep current medical/dental
coverage
• If you are making an enrollment change,
complete and return the enrollment forms to
your local Human Resources Office no later
than November 29, 2013
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DoD NAF HBP
Medical Benefits
Review
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2014 HBP Contributions
Plan
Individual Coverage
Family Coverage
2013
2014
2013
2014
Medical Plan
$69.65
$72.09
$162.04
$167.71
Dental Plan
$4.36
$4.36
$10.32
$10.32
Medical and Dental
$74.01
$76.45
$172.36
$178.03
Stand Alone Dental
$17.98
$18.44
$42.52
$43.62
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2014 Benefit Changes
• Annual Medical Deductible Increase:
Aetna Open Choice PPO Plan
If you elect coverage for:
Your 2014 deductible will be:
Individual
$400 in-network; $1,000 out-of-network
Family of 2
$800 in-network; $2,000 out-of-network
Family of 3 or more
$1,200 in-network; $3,000 out-of-network
Aetna Traditional Choice Plan, including Aetna International
If you elect coverage for:
Your 2014 deductible will be:
Individual
$400
Family of 2
$800
Family of 3 or more
$1,200
• You will have the opportunity to earn additional Health
Incentive Credits to offset the increase to the
deductible.
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2014 Benefit Changes
•
•
•
Earn more Health Incentive Credits in 2014!
The maximum an individual can earn will increase from $100
to $150, the family maximum will increase from $300 to $450
You now have seven ways to earn the Health Incentive Credit
in 2014:
Activity
Health Incentive
Credit Earned
Have a preventive care exam (dependents under 18)
$100 – one per year
Have a preventive care exam (employees, retirees and dependents over
18)
$50 – one per year
Complete/Update Health Assessment
$50 – one per year
Complete a Simple Steps online wellness program
$50 – one per year
Complete the Personal Health Record Walk-Me-Through Tool
$50 – one per lifetime
Make entries into the Personal Health Record Health Tracker
$50 – one per year
Make entries into the Personal Health Record Physical Activity Tracker
$50 – one per year
Respond to items on the Member Health Engagement Plan “to-do” list
$50 – one per year
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2014 Benefit Changes
Out-of-Pocket Maximum
•
•
•
•
Effective January 1, 2014, all in-network medical, behavioral health
and pharmacy member cost-sharing will apply towards the out-ofpocket (OOP) maximum. This means that the following costs will now
count toward your OOP limit: PCP and specialist copays, emergency
room copays, inpatient per confinement fees, pharmacy copays and
3rd tier pharmacy coinsurance.
You will still be responsible for the deductible, copays and
confinement fees, but the costs will go toward your annual OOP
maximum.
Once your share of the cost for in-network deductible, copays,
coinsurance and per confinement fees reach the applicable OOP
maximum, the plan pays the covered expenses at 100% for the
remainder of the calendar year.
Please note that the $150 prescription eyewear allowance, bariatric
surgery coinsurance, premiums, out-of-network deductible,
coinsurance, and balance billing, and non-covered services do not
count towards your OOP maximum.
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Health Incentive Credit
These credits will be placed in an account and applied towards
the first family member’s claim where the deductible and/or
coinsurance would be applied. Employees can earn a maximum
of $150 per year per person, up to $450 per family per year.
Health Incentive Credit features:
• Applied to the medical deductible and/or coinsurance as claims
are processed. The Credit cannot be applied to copayments such
as PCP, Specialist, Emergency Room, Urgent Care copays, Hospital
confinement fees, or pharmacy copays.
• The credit will roll over every year until used, up to 3 years.
• Credits are displayed on Explanation of Benefits and in Aetna
Navigator
*Preventive exams eligible for the incentive: annual routine
physical, well woman exam or well child exam.
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2014 Benefit Changes
Pediatric Vision
•
Effective January 1, 2014, prescription eyewear for children up to age
22 will be covered at 100% with no copay (in and out of network).
•
This includes one pair of basic frames and lenses, which have specific
vision codes associated with them called V codes, which indicate what
is covered.
•
The V codes that are payable at 100% are limited to (V2020, V21002199, V2200-2299, V2300—2399, V2121, V2221, V2321)
•
In order to have this benefit paid at 100%, you may have to pay for
the frames and lenses out-of-pocket and submit a claim to Aetna for
reimbursement of the covered charges.
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DoD NAF HBP
Health and Wellness
Programs
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Aetna Health Connections Disease Management
What is it:
• Personal support to help you manage your ongoing
health conditions
• Support for 34 health conditions including Diabetes,
High Cholesterol, High Blood Pressure, etc.
How it can help you:
• Telephone outreach on how to manage
your health conditions
• Support for working with your doctors
• Notification about potential medical errors
and opportunities to improve care
• Information about your health conditions
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Simple Steps To A Healthier Life
What is it:
• Online guide to health and wellness
How it can help you:
• Identify potential health issues with a
health assessment
• Get personalized reports to help you set goals
• Participate in online wellness programs
• You can visit the website as often as you like. Simple
Steps is more than just the health assessment. You can
use site features such as articles, quizzes, recipes and
other tools to learn more about the health topics that
mean the most to you.
Eligible for Health Incentive Credit
• Earn $50 for completing/updating Health Assessment
• Earn $50 for completing online wellness program
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Personal Health Record
•
The Personal Health Record (PHR) is an online service,
accessed through Aetna Navigator, that provides a
secure place for all your health information gathered
from:
– Medical claims
– The Health Assessment at Simple Steps To A
Healthier Life
– Personal medical data you provide, such as overthe-counter drugs, family history and health
problems you may not necessarily see a doctor for
(like back pain).
– Your PHR also provides health alerts and reminders
from MedQuery, a health monitoring system.
Eligible for Health Incentive Credit
• Earn $50 per lifetime for completing PHR Walk-MeThrough Tool
• Earn $50 for updating PHR Physical Activity Trackers
• Earn $50 for updating PHR Health Trackers
www.nafhealthplans.com
Member Health Engagement Plan
What is it:
• Provides you with a personalized list of recommended
actions to help improve your health and wellness
How it can help you:
• Site offers personalized action plans based upon your
specific health status
• Includes reminders on core health activities, such as
completing health assessment, to health screenings
Eligible for Health Incentive Credit
• Earn $50 for completing item on “to-do” list.
www.nafhealthplans.com
Pharmacy Advisor ® - 1-877-418-4128
What is it:
• Proactive outreach to members to help manage
medication and health conditions
• One-on-One support by phone or mail
How it can help you:
• It’s staffed with registered pharmacists and
technicians that are available to help you manage
your medicine and condition. Rely on:
–
–
–
Quick, secure advice that’s planned around your schedule.
Information about medicines and how they work in your body.
Guidance to help you stay on track with your prescription
medicine.
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Informed Health Line (1-800-556-1555)
What is it:
• 24-hour nurse helpline for your health questions
• Online health resource
How it can help you:
• Get answers to your health questions from registered
nurses day or night
• Make decisions about when to call your doctor
• Learn about medical tests and procedures
• Go online for health information, tools and resources
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DoD NAF HBP
Dental Benefits Review
www.nafhealthplans.com
Dental Options for 2014
Passive PPO Dental Plan
•
For members enrolled in a DoD NAF HBP
Stand Alone Dental Plan
•
For members who are not enrolled in a NAF
medical plan under the DoD HBP through
your employer
www.nafhealthplans.com
Your dentist...your choice
• Choice #1 - Visit an Aetna PPO
dentist and receive services at
negotiated rates
• Choice #2 - Visit any licensed
dentist of your choice for
maximum flexibility under your
plan
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How both options work
• Option #1 - When you visit a dentist in our dental PPO
network…
– Meet your deductible
– Coinsurance
– No claim forms
•
Option #2 - When you see any other licensed dentist …
– Meet your deductible
– Coinsurance
– Out-of-pocket expenses may be higher
– You may have to file claim forms
– You may be subject to balance billing
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Member Tools
and Discount
Programs
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Member Tools – Aetna Navigator
• Transactions, Decision Support and
Health Information
• Health History Report
• Check claims, balances, enrollment
• DocFind®
• Hospital Comparison Tool
• Member Payment Estimator
• Price-A-DrugSM
• Rate Your Medical Professional
• Aetna InteliHealth®
• Healthwise® Knowledgebase
www.nafhealthplans.com
Stay well, get fit and save money
Discount Programs & Services:
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Vision related discounts
Hearing
Fitness
Alternative health care
Dietetic counseling
Weight management
Natural products
And more….
Discount information can be found on Aetna Navigator, by calling
Aetna Member Services or at www.nafhealthplans.com.
These valuable discounts are not insurance.
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Questions?
More information can be found at
www.nafhealthplans.com
www.nafhealthplans.com