2015 Annual Enrollment: Questions and Answers
Inside this Q&A, you’ll find answers to general questions
you might have about the changes to our benefits for
2015. For answers to specific questions, attend one of the
two informational meetings during Open Enrollment.
Open Enrollment
Q.
When will Open Enrollment take place?
A.
Open enrollment for 2015 will take place from Monday, October 20 to Friday, October 31.
Remember to mark these dates on your calendar and keep the October 31 deadline in mind!
Q.
If I like my plans I have right now, do I need to do anything during Open Enrollment?
A.
Yes! This year, we are making several changes to your health benefits for 2015. Due to the
changes, we are requiring that you must make an election for the health plan to continue to be
enrolled in coverage.
*Take time to review your benefits and make sure you enroll. If you DO NOT make an
election and DO NOT enroll in either the PPO75 or PPO85 plans, you and your family
WILL NOT have health coverage as of January 1, 2015.
Changes to Your 2015 Benefits
Q.
Are my health benefits changing next year?
A.
Yes. Wake County is making changes including several enhancements to your benefits
coverage for next year. These changes will become effective January 1, 2015.
Q.
Why are my benefits changing?
A.
Before recommending changes for next year’s benefits, we carefully reviewed our current
plan design. The changes made are based on analysis of claims data and the County’s
philosophy of wellness with respect to charges for health care. The changes are based on: 1)
Cost shift (strategically and targeted) to drive desired behaviors and that those who use the
benefit more pay more through the plan design instead of raising premiums across the board
for everyone and 2) encourage health and wellness behaviors that positively impact overall
health and thereby control claims utilization.
Health Plan
Q.
What changes are being made to the Health Plan?
A.
Blue Cross Blue Shield will continue to administer the PPO75 and PPO85 plans. The following
changes are being made:

Employee and retiree health insurance premiums will remain constant for the third year in a
row, for both the PPO75 and PPO85 plans. Copays for office visits and coinsurance will
remain the same as well.

Affordable Care Act (“ACA”) new requirement: Currently, only your medical deductibles,
copays and coinsurance amounts apply toward the out-of-pocket maximum. Once you
reach your out-of-pocket maximum, the County pays 100% of your services for the rest of
the year.
The ACA now requires that payments for pharmacy must now apply to the out-of-pocket
maximum as well. To address this change, out-of-pocket maximums under the Medical
Plan will be increased to a level that maintains the same relative benefit while taking into
accounts the amounts paid for pharmacy that had not previously applied to the out-ofpocket maximum.

There will be an increase in the emergency room copay (from $100 to $300) to encourage
urgent care for situations that could be handled outside of the emergency room. Copay is
waived if admitted.

We have established a hospital inpatient admission copay of $200.

Bariatric surgery is being added to both the PPO75 and 85 Plans and will be covered at
Blue Cross Blue Shield Blue Distinction Centers only.
ER Copay
Individual
Deductible
Out-of-pocket
Maximum
Inpatient
Bariatric
HEALTH COVERAGE PLAN DESIGN CHANGES
PPO 75
PPO 75
PPO 85
PPO 85 Change
Current
Change
Current
$100
$300
$100
$300
$1250 /$2500
+$250 /+$500
$750/$1500
No Change
$3500 / $7000
+ $900 / $1800
$2500 / $5000
+ $1200 / $2400
None
N/A
$200 Copay
None
$200 Copay
Covered at
N/A
Covered at Blue
Blue Distinction
Distinction Center
Center Only
Only
No changes to: Office (primary or specialty) or urgent co-pays and coinsurance.
Q.
Will I get a new member ID card?
A.
If you enroll in the PPO75 or PPO85 plans, you and other eligible participants will get a new
member ID card from BCBSNC. Cards will be mailed to your homes before January 1, 2015.
Prescription Drug Plan
Q.
What changes are being made to the Prescription Drug Plan?
A.
OptumRx will continue to administer the Prescription Drug Plan. The new changes are:

The maximum cost for generic drugs is being reduced from $100 to $50.
Important Reminder: Between now and the end of the year, you may want to ask your
doctor to switch your prescriptions to generics to save money for you and your family.

The maximum cost for non-preferred drugs will increase for both 30-day retail and
90-day supply (as shown in the following chart).

Pre-authorization will now be required for compounded drugs.
Note: Compounding is the combination of different ingredients of a drug to create a
medication tailored to the needs of an individual patient.
Generic
Preferred
Brand
Non-Preferred
Brand
Compounding
PRESCRIPTION DRUG PLAN DESIGN CHANGES
Retail (30 day) Retail (30 day) 90-Day Supply 90-Day Supply
(2014) Current (2015) Change (2014) Current (2015) Change
20% up to
20% up to $50
20% up to
20% up to $125
$100 maximum
maximum
$250 maximum
maximum
35% up to
No change
35% up to
No change
$100 maximum
$250 maximum
50% up to
50% up to $150
50% up to
50% up to $300
$100 maximum
maximum
$250 maximum
maximum
None
Preauthorization
None
required for
$150 maximum
or more*
*Bulk chemical products are excluded for compounded drugs
Preauthorization
required for
$150 maximum
or more*