2012
Open
Enrollment
2012 Open Enrollment
• October 11th -November 10th
• New website www.myshbp.ga.gov
• Do NOT wait until the last minute
• You need to register every year.
• You can not use your password from last year
2012 SHBP Benefit and Plan Changes
• PeachCare FOR KIDS®
• TRICARE
• Wellness vs. Standard Plans
• HRA – prescription protocol
• GaBreeze plan changes
2012 Benefit and Plan Changes
PeachCare FOR KIDS®
Federal law has changed.
SHBP members are now
eligible to apply for the –
PeachCare FOR KIDS® program
2012 Benefit and Plan Changes
PeachCare FOR KIDS®
• a link to the PeachCare website that includes an
eligibility calculator to determine if your children
may qualify
• Complete an application on-line or call and request
a paper application
• Information is available at
1-877-GA-PEACH (1-877-427-3224)
and www.peachcare.org
• Earliest an employee can apply
is 10-03-2011
Frequently Asked Question
Q. Should an employee remove their child(ren)
during Open Enrollment (O/E) in anticipation
of PeachCare coverage acceptance?
A. No! You should not remove your child(ren)
during O/E unless the child(ren) has been
approved for enrollment into PeachCare for
Kids. Once approved, you have 60 to remove
your child(ren) from your State Health plan.
2012 Benefit and Plan Changes
New Tricare Supplement
Is anyone
eligible for
TRICARE?
2012 Benefit and Plan Changes
New Tricare Supplement
• SHBP will again offer the TRICARE Supplemental
Insurance to SHBP eligible individuals who are also
eligible for TRICARE (which is the military health
benefit program).
• This coverage is an alternative to SHBP coverage.
• This plan is voluntary and the member will pay all of
the costs for the TRICARE Supplemental Coverage
• Coverage ends at age 65
• Members must provide a Defense Enrollment Eligibility
Report System (DEERS) number when enrolling
2012 Benefit and Plan Changes
New Tricare Supplement (continued)
• Eligibility for Children – NOT THE SAME AS SHBP
Must be single
- Age 19 - 23 must be a full-time student or if under age 26 if
enrolled in the TRICARE Young Adult Program
-
• Loss of eligibility for Tricare Supplement while actively working - Is
a qualifying event to select another option if you make the request
within 31 days
• COBRA - Members who lose eligibility for SHBP coverage while
covered by Tricare supplement will not be offered COBRA
For additional information call 866-637-9911 or on the website at
www.asicorporation.com
2012 Benefit and Plan Changes
New Tricare Supplement (continued)
• At Age 65 and RETIRED
• SHBP will roll your coverage into the MA PPO Standard
Plan with your previous health care vendor prior to
Tricare Supplement if we have your Medicare Part B
information
• If we do not have Medicare Part B information we will
put all family members in the Standard Plan of your
previous option prior to the Tricare Supplement and will
pay 100% of the premiums for coverage
2012 Benefit and Plan Changes
New Wellness/Standard Plans
Wellness
vs.
Standard
2012 Benefit and Plan Changes
New Wellness/Standard Plans
Old Plans
• HDHP
• HRA
• HMO
New Plans
• Wellness HDHP
• Wellness HRA
• Wellness HMO
• Standard HDHP
• Standard HRA
• Standard HMO
With these new Plan Options, all members
will need to make a new election this year.
2012 Benefit and Plan Changes
New Wellness/Standard Plans
Wellness Plans
• Wellness Promise
• Biometric Screening
Required
• Lower Premiums
• More HRA credit
• Lower HMO copays
Standard Plans
• No Wellness Promise
• No Biometric
Screening Required
• Higher Premiums
• Less HRA credit
• Higher HMP copays
2012 Benefit and Plan Changes
New Wellness/Standard Plans
• Wellness Options are designed to help you
(and your spouse, if covered) become a
more active participant in your health and
require you to take additional steps in
engaging in better health.
• If you do not wish to participate in the
Wellness Options, the Standard Options are
available to you.
2012 Benefit and Plan Changes
New Wellness Plans
Rewards received for
Wellness Plan Options
• Lower premiums (only 11% increase)
• Lower out-of-pocket costs through copayments, coinsurance, deductibles and outof-pocket maximums
2012 Benefit and Plan Changes
New Wellness Plans
Includes the HRA, HMO and HDHP Plan Options
• Wellness Plan Promise:
- Members and Covered Spouses (not children)
- Each MUST complete an Online Health Assessment
- Each MUST Obtain biometric screening* between
July 1, 2011 and June 30, 2012
(*Body Mass Index, Blood Pressure, Blood Glucose, Cholesterol –
considered preventive and covered at 100%)
- Biometric screening results MUST be received by
your health care vendor by June 30, 2012
2012 Benefit and Plan Changes
New Wellness Plans
Includes the HRA, HMO and HDHP Plan Options
• Wellness Plan Promise:
If you or your spouse do not take the Health
Assessment, complete and have your physician
submit the results of the required screening
that includes all four measurements by the
June 30, 2012 deadline, you will not be eligible
to enroll in any of the Wellness Plan Options
the following year.
2012 Benefit and Plan Changes
New Standard Plans
Includes the HRA, HMO and HDHP Plan
Covers the same services as the Wellness Plans
EXCEPT:
•
•
•
•
•
No Promise (no biometric requirements)
Higher premiums (17% increase)
Less credit on the HRA plan
No preventive incentive for the HRA ($125 credit)
Higher Copays under the HMO plan
2012 Benefit and Plan Changes
HRA Wellness and Standard Plans
SHBP HRA Credit Comparison
Wellness HRA Credit
You
$ 500
You + Spouse
$ 1,000
You + Child(ren)
$ 1,000
You + Family
$ 1,500
Standard HRA Credit
You
$ 375
You + Spouse
$ 650
You + Child(ren)
$ 650
You + Family
$1,000
HRA Deductibles and Out of Pocket Maximums have not changed. They are the same for the
Wellness and Standard options.
2012 Benefit and Plan Changes
HRA Wellness and Standard Plans
Prescription Drug Coverage
• The Pharmacy benefit - the same under the Wellness and
Standard HRA Plans
• Pharmacy costs will NO longer apply to the HRA deductible or
out-of-pocket limit no matter how you pay for them.
• Starting day one member will pay a % (co-pay) amount
• HRA dollar credits may be used for prescription drug
• The benefit will change to a 3 Tier structure with a minimum
and maximum out-of-pocket
2012 Benefit and Plan Changes
HRA Wellness and Standard Plans
Prescription Drug Coverage is the
same for the Wellness and
Standard Plans:
A 3 tier structure with a minimum and maximum
amount, you will pay as follows:
•
Tier 1 – 15% (min $20 – max $50)
•
Tier 2 – 25% (Min $50 – max $80)
•
Tier 3 – 25% (min $80 – max $125)
Changes
HRA Wellness and Standard
Prescription Drug
Coverage - continued
Plans
Retail Pharmacy - 31 day
90-Day Retail Pharmacy
90-Day Voluntary Mail
Order
Tier 1
Tier 2
Tier 3
Tier 1
Tier 2
Tier 3
Tier 1
Tier 2
Tier 3
–
–
–
–
–
–
–
–
–
15%
25%
25%
15%
25%
25%
15%
25%
25%
($20 min/$50 max)
($50 min/$80 max)
($80 min/$125 max)
($60 min/$150 max)
($150 min/$240 max)
($240 min/$375 max)
($50 min/$125 max)
($125 min/$200 max)
($200 min/$312.50 max)
2012 Benefit and Plan Changes
HRA Wellness and Standard Plans
Prescription Coverage Examples–Drug A is Tier 1
Cost of the drug is less than the minimum amount for Tier 1 drugs
– For a 31-day supply the usual and customary price (contracted rate) is
$15
– The minimum for Tier 1 is $20
– The SHBP Member pays only the $15 since the actual cost is less than
$20.
Cost of the drug when coinsurance applies for Tier 1 drugs
–
–
–
–
For a 31-day supply the contracted price is $100
The Coinsurance is 15% and the minimum amount for Tier 1 is $20
15% of $100 is $15
Since the actual cost is $100, The SHBP Member would pay the
minimum amount of $20
Note: The $4 generics from $4 Generic Programs offered by some
pharmacies will still be only $4
2012 Benefit and Plan Changes
HRA Wellness and Standard
Prescription Coverage Examples – Drug B is Tier 2
Cost of the drug is less than the minimum amount for Tier
2 drugs
– For a 31-day supply the usual and customary price is $35.79
– The minimum for Tier 2 is $50
– The SHBP Member would only pay $35.79 since the actual drug cost is
less than the minimum.
Cost of the drug when coinsurance applies for Tier 2 drugs
– For a 31-day supply the contracted price is $350
– The Coinsurance is 25% and the maximum amount for Tier 2 is $80
– 25% of $350 is $87.50
– The SHBP Member pays $80
Frequently Ask Questions FAQs
Q. What happens when I have used all of
my HRA credit and I need to purchase
prescriptions?
A. The cost would be the same as in the
previous examples you would just pay
out of pocket instead of using HRA
credits.
2012 Benefit and Plan Changes
HRA Wellness and Standard Plans
Prescription Drug Coverage
• Please note: In addition to your insurance card,
United Healthcare (UHC) members will need to
provide a separate Pharmacy Health Care Spending
Card (PHCSC) to access HRA dollar credits for their
pharmacy expenses. (This additional card is not
connected to the HCSA you may elect through
GaBreeze.)
• No separate card is required for CIGNA
members at the pharmacy.
2012 Benefit and Plan Changes
HRA Wellness and Standard Plans
United Healthcare Pharmacy Health Care Spending Card
– How does it work and what happens at the pharmacy?
• Activate your card as soon as you receive it by calling the number
on the back of your card.
• Your card must be activated 1 business day prior to use.
• When you use your card, payment is transferred directly from your
card to the pharmacy.
• Once HRA funds are no longer available transactions will be
denied.
• This card can only be used for covered prescription expenses (not
for medical or dental).
• Unauthorized transactions will be denied.
2012 Benefit and Plan Changes
HMO Wellness and Standard
HMO Plan Changes
The $200 annual vision benefit
for glasses and contacts will
no longer be offered.
2012 Benefit and Plan Changes
HMO Wellness and Standard
HMO Plan Changes
Type of Service
Wellness HMO
Co-payment
Standard HMO
Co-payment
Primary Care Physician
$35 – no change
$45
Specialist
$45 – no change
$55
Prescription Co-pays, Deductibles and Out of Pocket Maximums
have not changed.
Pharmacy 90- day
Voluntary Mail Order
Tier 1- $ 50
Tier 2- $125
Tier 3- $225
2012 Benefit and Plan Changes
High Deductible Health Plan
Wellness and Standard
HDHP Deductible and Out-of-Pocket Comparison
Deductible
You
You + Spouse
You + Child(ren)
You + Family
Out-of-Pocket
You
You + Spouse
You + Child(ren)
You + Family
Wellness HDHP
(In/Out of Network)
Standard HDHP
(In/Out of Network)
$1500/$3000
$3000/$6000
$3000/$6000
$3000/$6000
$1750/$3500
$3500/$7000
$3500/$7000
$3500/$7000
Wellness HDHP
(In/Out-of-Network)
Standard HDHP
(In/Out-of-Network)
$2400/$5300
$4100/$9800
$4100/$9800
$4100/$9800
$2650/$5800
$4600/$10800
$4600/$10800
$4600/$10800
2012 Benefit and Plan Changes
High Deductible Health Plan (HDHP)
Wellness and Standard
HDHP Co-Insurance and Pharmacy
Comparison
Type of Service
Wellness HDHP
Standard HDHP
Co-Insurance
90% IN or 60% OON
80% IN or 60% OON
Pharmacy 90-Day
Voluntary Mail Order
(this is not a change)
80% ($25 min/ $250 max)
IN = In Network
OON = Out of Network
2012 Benefit and Plan Changes
All Plan Options
– Certain Tobacco Cessation Medications
• Covered when prescribed as part of a
Tobacco Cessation Program
• Contact each vendor for specifics
– Bariatric Surgery
• Bariatric (weight loss) surgery will no longer
be covered under any plan options
Making Your 2012 Benefit Election
- Considerations
• Determine if healthcare provider is in-network
• Carefully review the 2012 Decision Guide
available at www.myshbp.ga.gov
• Compare the benefits in relation to the
premiums
• Check the Preferred Drug Lists for each plan
and healthcare vendor as the formulary varies
between plans and vendors
Making Your 2012 Benefit Election –
Did You?
Remember to:
• Make sure you have selected the correct option
• Confirm you have added all eligible dependents
you wish to be covered
• Confirm you have answered the surcharge
questions correctly
• Click “Confirm” and always Print your
Confirmation (this WILL include a confirmation
number)
Making Your 2012 Benefit Election
– If You Don’t
If you don’t go online and make a 2012 election
Your coverage will default to:
• To the Standard HRA, HMO or HDHP Option
with your current vendor
• The tobacco and spousal surcharges (if you
cover your spouse) will apply for the 2012 Plan
Year
2012 Benefit and Plan Changes
Eligibility Changes
• Surviving Spouse/Adding New Born
– 90 days to request to continue coverage/add
newborn
• Election Error Reporting
– Active employees will have until December 31 to
report an election error made during the Open
Enrollment Period to their Payroll Location
– Office closure for the holidays will not extend the
deadline
– Once coverage goes into effect, SHBP will not allow a
change
2012 Benefit and Plan Changes
Eligibility Changes
– Spousal Surcharge Verification
• it is important that you answer the Spousal Surcharge
questions accurately to avoid disruption of coverage.
• SHBP will be requesting from you documentation or an
affidavit from your spouse’s employer verifying the
spouse is not eligible for health insurance.
• You do not need to take any additional action
until documentation is requested.
Important Notice
• The information provided in this presentation is
a summary of changes for the 2012 Plan Year.
• It is intended only to highlight principal benefits
• Please refer to the Active Employee Decision
Guide for more details
• TTT, rates, decision guides and other
information will be available soon at
www.dch.georgia.gov/shbp and
www.myshbp.ga.gov
37
Questions or Additional
Information
36
Frequently Ask Questions FAQs
Q. If I complete my Health Assessment and obtain my
biometric screening but my spouse doesn’t, will I be
able to enroll in a Wellness Option in 2013? - A. No.
Q. Can I still earn $125 for taking my online health
assessment and obtaining my annual physical? A. Yes
but only if you are enrolled in the Wellness HRA Plan.
Q. If I smoke, will I be able to enroll in a Wellness
Option? A. Yes
Frequently Ask Questions FAQs
Q. Can I submit my biometric screening results to my
healthcare vendor? A. No. Your physician must fax
to your vendor by June 30, 2012. (This physician fax
form will be available January 1, 2012)
Q. In year two, what happens if my biometric numbers
don’t improve? A. You may continue in the Wellness
Plan. You will need to show that you are taking steps
to improve your health unless you have a medical
condition that does not allow you to take steps to
improve your biometric numbers.
Questions or Additional
Information
• CIGNA - HMO, HRA, HDHP
800-633-8519
www.mycigna.com/shbp
• UnitedHealthcare HMO, HDHP - 877-246-4189
HRA - 800-396-6515
www.welcometouhc.com/shbp
• Refer to www.myshbp.ga.gov to access additional
information
36
Changes to
Flexible Benefits
for 2012
February
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Plan Design/Premium Changes for 2012
Dental Plans
Regular and PPO Dental
– Increase in premiums*
– No changes to the plan design
DHMO – CIGNA
– Increase in premiums*
– No changes to the plan design
*Premium amounts will be listed on the 2012 Rate Sheet
February
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Plan Design/Premium Changes for 2012
Employee, Spouse, Child Life and AD&D Plans –
Minnesota Life
 All life insurance options will deducted as after-tax options.
Plan Enhancements
– Child Life
> Removed the limitation for 0 - 6 months ($6,000 cap)
> Child coverage can begin at live birth
• Automatic coverage of $3,000 for a newborn child if the
child dies within 30 days of birth but prior to the employee
enrolling for child life coverage
– Employee/Spouse Life
> Legacy Planning Services: End-of-life planning and resources
February
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Plan Design/Premium Changes for 2012
Short-Term Disability Plans –
The Standard
5% Rate decrease in STD premiums
February
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2010 2010
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Plan Design/Premium Changes for 2012
Critical Illness Plan – CAIC
Plan enhancement
–Additional covered illness:
Coverage for Alzheimer’s disease
(25% of the benefit amount)
Also, if you have the critical/specified illness plan for this year, and went for
your wellness check, don’t forget to send them a claim from to receive your
$100. You can find the link to the claim form on our website.
February
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Plan Design/Premium Changes for 2012
Legal Plans – Hyatt
Plan enhancements
– Additional covered services for Both plans (Select &
Select Plus)
> Elder law matters
> Home equity loans assistance
– Additional covered services for Select Plus plan
> Civil litigation defense
> Incompetency defense
February
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Plan Design/Premium Changes for 2012
No Plan Changes
Vision
Long Term Care (contact Unum directly
to enroll)
Long Term Disability
Health Care/Dependent Care Spending
Accounts
February
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GaBreeze Enhancements for 2012
GaBreeze Confirmation Number
Employees will receive a Confirmation Number upon
successful completion of their online Annual
Enrollment on the completed successfully page on the
GaBreeze Website
Additional changes will be permitted online during the
remainder of the Annual Enrollment period.
– Employees will retain the same Confirmation Number
– Date/Time Stamp will update to reflect the most
recent completion
Employees should print a copy of the Confirmation
Number page for their records
February
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Reminders for 2012
Website
www.GaBreeze.ga.gov
Link on Team Georgia Flexible Benefits tab
http://www.gms.state.ga.us/employees/flexible_benefits.asp
Benefits Call Center
1-877-3GBreez
or 1-877-342-7339
Monday – Friday, 8:00 am – 5:00 pm ET
excluding holidays
February
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Direct Deposit
• Direct deposit of all payroll checks will be required
with the January 15, 2012 payroll.
• For those employees that do not already have direct
deposit, we ask that you have an account with a
financial institution and transmit your account
information to the payroll office by January 1, 2012.
• You must notify payroll at least 10 days before a pay
date in order to have your funds transferred to the
right account.
February
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Confirmations
• Compare your paycheck statements
with your Confirmation Statement.
• It is your responsibility to notify
your personnel/ payroll office
immediately if there is an error.
• Deductions should match the
confirmed choices.
February
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February
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?????
Questions
?????
February
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