Open Enrollment Overview
City of Clearwater
2015 Plan Year
Insurance Renewal Background
• The City has a Benefits Committee that is
comprised of representatives from each
employee group and the retiree group. The
benefits committee evaluates the best options
available based on the claims experience and
the City’s budget for healthcare and they
determine what is a viable and cost effective
option for their employee group. Fire, Police,
CWA ,SAMP, and Retirees are all under one
insurance policy, so the benefits committee must
work together to find the best plan that will
minimize increases in employee premiums and
out-of pocket expenses.
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Benefits Committee
• CWA: Steve Sarnoff, Steve Finney, Mike Head, Matt McCombs,
Roberta Gluski, Alternates: Phil Hughes & Todd Voigt
• FOP Officers: Jonathan Walser, Christopher Precious
• FOP Supervisors: Sgt. Joel Morley
• IAFF: Lt. John Klinefelter; Matt Schad
• SAMP: Susan Chase; Sandy Clayton; Jim Donnelly (Newly
added SAMP 4-6 Rep); Jay Ravins (Mgt.)
• Retirees: Karen Dombrowski (contact info on
www.myclearwater.com)
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Insurance Renewal Background
• For 2015, the City was faced with an increase of
almost 2 million dollars to keep the current
OAP plan. Since the City currently pays 100%
for employee only coverage; 75% for employee
plus 1 and 68% for employee plus family, a 2
million dollar increase to keep the current plan
would not be financially feasible. It would have
also been an approximate 12% increase to the
employee premiums, which the benefits
committee thought was too much of an increase
for their members.
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Insurance Renewal Background
• Cigna gave us a proposal for a new network
that would increase costs for the City by
approximately $900,000 and for employees by
only $130,000. This new “Local Plus Network”
is a network of Cigna’s highest performing
doctors. This was the most affordable option
and although it may result in employees having
to change physicians, it still offers a network of
qualified physicians, Cigna’s most qualified
physicians, as an alternative without changing
the schedule of benefits.
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Insurance Renewal Background
• Cigna provided the Benefits Committee a “disruption
report” encompassing the physicians that our
employees used between August 2013 and August
2014 and Local Plus Network has a 90% match to
the doctors that were utilized during that time
frame.
• Based on the affordable cost and no changes to the
current schedule of benefits, the benefits committee
voted unanimously for the Local Plus Network.
• Human Resources staff is not a voting member of
the benefits committee and we are simply here to
make sure we educate you on the benefits being
offered in 2015.
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Facts to consider:
• The Health Center is helping! Since 2009, primary care visit
claims through Cigna
50%, which means those claims
have shifted from Cigna to the health center.
• Last year, catastrophic claims (any claim over $50,000)
21%. These conditions cannot be treated or prevented at the
Health Center, but the Health Center can facilitate early
detection. (average claim was approximately $125,000). It’s
a balancing act: Similar to car insurance…you have claims,
you pay more. (on top of normal inflation).
• 2 million dollar increase to keep the same plan with no
changes. Benefits Committee also reviewed a zero
increase plan, but the copays/coinsurance/deductibles
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increased drastically.
Benefits Committee unanimously
voted to:
Continue self-funding and remain with Cigna.
Adopt new “Local Plus Network” with 6%
increase, rather than a 12% increase to
remain with OAP plan.
Keep same schedule of benefits as 2014.
Same premiums for PHA and Base options,
difference is in schedule of benefits.
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Local Plus Network –
What does it mean?
 Network of highest performing doctors
throughout the US, who have proven results
in quality, care and cost-efficiency.
 Local Plus Network has a 90% match to the
doctors being utilized in our current plan.
 Primary care and Specialists are subjected to
the Local Plus directory; hospitals and
ancillaries (such as free standing radiology,
surgery centers, dialysis centers, etc) are
not; employees can use any hospital or
ancillary that accept Cigna OAP.
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Local Plus Network –
What does it mean?
 Employees can access the Local Plus
Network in any area in the country
where one exists.
 In service areas where the Local Plus
Network is not available, employees
can access doctor’s and hospitals in the
Open Access Plus Network and receive
coverage at the in-network benefit.
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Open Enrollment 2015
• Open Enrollment: Oct 29th to Nov. 26, 2014.
• Benefit Plan Year: Jan. 1 to Dec. 31, 2015.
• During Open Enrollment, you may change plans,
add/drop dependents, elect FSA, and enroll/drop other
benefits.
• Changes are not allowed after the Open Enrollment
period unless you experience an eligible qualifying event.
(Examples on page 4)
• Effective date of changes made during open enrollment
is Jan. 1, 2015.
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Employee Benefit Highlights
Handbook
• Available in hardcopy as well as electronically on the
city’s Intranet site.
• Handbook contents:
o
Carrier and Benefits Administrator contact information
o
Qualifying event and dependent eligibility guidelines
o
Available benefits
o
Rates for premium payroll deductions
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City Premium Payment Plan – page 4
• As an employee, you are automatically enrolled in the
City IRS Section 125 qualified Premium Payment Plan
when you elect eligible benefits such as medical, dental,
vision and supplemental insurance.
• Premiums are deducted pre-tax from your paycheck.
• Changes to elections may not be made outside of open
enrollment except for qualifying events.
• Qualifying events are listed on page 4 in the
Employee Benefit Highlights Booklet.
• Exception: Domestic Partners are a post tax deduction
as they do not qualify under the Section 125 plan.
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Medical Insurance for 2015
pages 5-7
• Same two Cigna plan options, a “Base” plan and a “PHA”
plan.
• The plan you are enrolled in will depend on whether or
not you have completed 2 Health Assessments. One
biometric PHA with the Health Center Staff and the Cigna
online Health Assessment. Both must be complete
between January 1, 2014 and November 26, 2014.
• The rates will be the same for both plan options, the
difference will be in the schedule of benefits.
• The PHA plan will have lower deductibles, out-of-pocket
limits, co-insurance, and office visit co-payments.
• See pages 5-7 in the Employee Benefit Highlights Booklet.
How to complete the
Personal Health Assessments?
Requirement #1 Cigna online Health Assessment:
• Go to www.mycigna.com and take the online health
assessment. HR Staff assisting at all PHA onsite locations.
Requirement # 2 Person Health Assessment Biometric
Screening
• Make an appointment online at www.careatc.com .
Dedicated PHA appointments from 7:00 a.m. to
10:00 a.m. daily at the EHC.
• CareATC staff will be onsite from 7:00 a.m. to 10:00 a.m.
at various departments during the month of November.
See the schedule of locations on the City intranet.
Medical Insurance
Cigna OAP Base plan
You will be enrolled in this plan if you have not completed
both Personal Health Assessments, one through the City’s
Employee Health Center staff and the other through
www.mycigna.com (Cigna online health assessment)
between January 1, 2014 and November 26, 2014.
Cigna OAP PHA plan
To be enrolled in this plan, you must have completed both
Personal Health Assessments, one through the City’s
Employee Health Center staff and the other through
www.mycigna.com (Cigna online health assessment)
between January 1, 2014 and November 26, 2014.
Medical Insurance
Summary of Differences
With PHA
Without PHA
Deductible
$2,000/$4,000
$3,000/$6,000
Out-of-pocket Limit
$3,500/$7,000
$4,000/$8,000
Co-insurance
10%
20%
PCP Copayment
$40
$50
Specialist Copayment
$60
$75
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Possible Incentive!
• Potential Shared Savings Incentive: Cigna projects 6%
savings from moving to the Local Plus Network Plan.
Any savings will be shared with the employees who
complete both the PHA and Cigna’s online Health
Assessment. 50% of savings will be placed in an HRA
at the end of 2015 and the other 50% will be used to
possibly fund another HRA in 2016.
Surplus Range
1.25% - 2.24%
2.25% - 3.49%
3.5% - 4.49%
4.5% - 5.99%
>6%
HRA Account Funding
________$100
________$200
________$300
________$400
___$500
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Medical Insurance
SAME outline of benefits as 2014:
• $500 inpatient ($300 outpatient) hospital admission charge,
then subject to deductible and applicable co-insurance.
• Advanced imaging services (MRI, CAT/PET scans) at
hospital-affiliated facilities subject to deductible and
applicable co-insurance; no charge for advanced imaging
at freestanding facilities (West Coast, Rose, etc.).
• $150 co-payment per visit for emergency room services
and $75 co-payment per visit for urgent care services.
• Out of network benefit available if you don’t want to use the
Local Plus Network.
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Medical Insurance
SAME outline of benefits as 2014
• Prescription co-payments of $30 for generic, $40 for
preferred brand, and $60 for non-preferred brand
(30 day retail); mail order (90-day supply) at 2X the
30-day copayment.
• No charge for Preventive Care after PCP or Specialist
office visit co-payment (well-person exams, inoculations,
colonoscopy, mammogram, etc.)
• Hospitals and Ancillaries (such as free standing radiology,
surgery centers, dialysis centers, etc) are all included and
not subjected to Local Plus directory. As long as they take
Cigna OAP, they are in network. Pharmacy is not affected
by Local Plus either.
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Medical Insurance
How the Deductible and Co-Insurance Works
• For services requiring a co-payment, you pay only the
amount of the co-payment each time you receive the service.
• For services requiring co-insurance, you pay the full cost of
services up to the deductible amount, and you then pay a
percentage of the remaining cost of services up to your
out-of-pocket limit.
• Once you reach your out-of-pocket limit, the plan pays the full
cost of any services.
• Only services requiring co-insurance go toward satisfying
the deductible. All services, including co-payments and
co-insurance, will go toward satisfying the out-of-pocket
limit. Prescription Drugs now go towards the OOP max.
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Medical Insurance
• The city continues to subsidize coverage for the Base and
PHA plans at 100 percent of the cost for employee-only,
75 percent of the cost for employee plus one dependent,
and 68 percent of the cost for employee plus family.
• There will be an increase of 6% in premiums. Rates are on
page 7 of the employee benefits highlights book.
• Employee +1 increased $6.91 per pay
• Employee + family increased $14.96 per pay
• Retiree only increased $30.65 per month
• Retiree + 1 increased $55.47 per month
• Retiree + family increased $93.66 per month
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Cigna On-site Representative
Stacy Lambert
Stacy.lambert@myclearwater.com
Municipal Services Building
Third Floor
• Hours:
Monday and Wednesday 8:30 a.m. – 5:00 p.m.
Tuesday, Thursday & Friday 8:00 a.m. – 4:30 p.m.
• Direct phone # (727) 562-4503
City Employee Health Center – Page 8
• Must be enrolled in city’s medical insurance to be
eligible - no other requirement.
• Completely confidential.
• Three physicians and four medical assistants on staff.
• No cost for ANY services:
o Primary and urgent care office visit
o Labs
o Radiology
o Prescription drugs
• All services must be authorized by an EHC physician.
• See page 8 of Employee Benefit Highlights handbook.
Employee Assistance Program- Page 9
EAP and Mental Health/Chemical Dependency Coverage
• MHNet is now known as Resources for Living.
• Resources for Living will continue to administer our EAP
Services.
• EAP can help to resolve issues with family, personal, financial,
marital, job, and substance abuse.
• Mental health/chemical dependency benefit will be offered
through the Cigna medical plan, but will maintain the $10
co-pay.
Employee Assistance Program
• Entitled to five free EAP visits annually.
• $10 per visit co-pay after five visits or if diagnosed.
• No limit to the number of visits.
• Co-pays for services go toward satisfying
Cigna Out-of-Pocket Maximum.
• National network of providers.
• See page 9 of Employee Benefit Highlights handbook.
Dental & Vision Insurance – Page 10-12
• Assurant and Humana remain as 2015 dental providers
o No plan changes
o No premium increases
• Humana Vision benefit remains the same for 2015
o No plan changes
o No premium increase
See pages 10-12 of Employee Benefit Highlights handbook
Supplemental Insurance
• Administered by Aflac
• Hospital Confinement Indemnity
• Group Accident
• Dental
• Disability
• Critical Care
• Cancer
• You must meet with an Aflac representative to add, drop,
or make changes to Aflac insurance elections.
•
See pages 13-14 of Employee Benefit Highlights handbook
Flexible Spending Accounts
• Administered by Aflac through WageWorks.
• Flexible Spending Account limits will be $2,550 (increased)
for unreimbursed medical and $5,000 for dependent care.
• A debit card will be issued for FSAs – no need to submit
forms for reimbursement. If you did not keep your FSA
debit card, you can request a new one online through the
EBC.
• FSA requires a new online enrollment each year!
•
See pages 15-16 of Employee Benefit Highlights handbook.
Dependent Eligibility – Page 3
• An eligible dependent is defined as your legal spouse,
domestic partner or dependent child of you or your
spouse/domestic partner:
o Natural child, stepchild, legally adopted child, foster
child, or a child for whom legal guardianship has been
awarded to you or your spouse/domestic partner.
• Documentation verifying dependent eligibility will be
required from all employees covering a dependent that
was not covered in 2014.
• Documentation examples include marriage certificate,
affidavit for domestic partnership, birth certificate,
guardianship court order.
Dependent Eligibility – Page 3
• Medical coverage for eligible dependents is provided to
the end of the calendar year in which the child turns age
26. Dental and vision coverage is provided through the
end of the month in which the child turns age 26.
• Dependent children may continue to be covered for
Medical only from age 27 to the end of the calendar year
in which the child reaches age 30 if they meet the
following criteria:
o Unmarried with no dependents
AND
o A Florida resident OR full-time or part-time student
AND
o Otherwise uninsured and not entitled to Medicare
Domestic Partner Benefits
• A domestic partner and any eligible dependent(s) will
be provided the same benefits afforded to all
employees or retirees and their eligible dependents
excluding Aflac & FMLA.
• Must meet all eligibility requirements listed in policy
and provide proof of eligibility.
• Must submit affidavit of domestic partnership.
• The City will subsidize the premium cost consistent
with the same subsidies afforded to all eligible
employees. Retiree’s medical premium costs are
not subsidized.
• Premium deductions will be post-tax.
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BENTEK-Employee Benefits Center
• Open enrollment is available 24 hours/7 days a week
through the online Employee Benefits Center – no forms.
• Go to www.mybentek.com/clearwater
• Enter your username and password. (forgot
username/forgot password links available).
• Bentek Contact information located on the inside cover
of Employee Benefits Highlights Book.
• Here you can:
• Make changes to current benefits
• Add or remove dependents
• Enroll or re-enroll in FSA
• Update beneficiaries
Tips for a Successful
Online Open Enrollment
•
Your medical insurance election will be defaulted to the
BASE plan with the tier of coverage (employee only,
employee plus one, or employee plus family) that you
have elected for the current plan year. You are not
required to go into Bentek unless you are:
–
changing your tier of coverage
–
opting out of the city’s insurance and were insured in 2014
–
Enrolling or re-enrolling in FSA
•
Once open enrollment is over, all those who have
completed both PHAs will be automatically placed in the
PHA plan.
•
If waiving medical insurance coverage, you must provide
proof of other coverage for yourself only and complete a
waiver form.
Tips for a Successful
Online Open Enrollment
• You must meet with an Aflac representative if you
are adding, dropping, or making changes to your
supplemental insurance elections.
• If you made changes, you must hit “submit” on the final
page. If you exit before clicking “SUBMIT,” your changes
will not be saved.
• After you submit your elections, you can print a
confirmation but one will be provided to you by Human
Resources at the end of open enrollment.
Thank You!
Don’t Forget ….
All election changes must be completed online
no later than 11:59pm on November 26,2014.
www.mybentek.com/clearwater
BOTH PHAs must have been completed between
January 1, 2014 and November 26, 2014
to qualify for the PHA Plan.
www.careatc.com or 800-993-8244
www.mycigna.com