Open Enrollment
Presentation
October, 2012
Filice Insurance Agency
Nina Gardner, Joyce Manansala
• Click to add text
• Nina Gardner, J.D. – Your Employee Benefits Consultant –
strategic benefit planning
• Joyce Manansala – Your Account Manager – day-to-day
administration – questions, plan design inquiries, claims and
coverage issues, billing questions, etc.
• Serena & Lily’s Customized Website – Your Own Intranet
www.filice.com/benefits/serenaandlily
What is Open Enrollment?
 Once-per-year opportunity for employees
to:
 Enroll or drop coverage
 Add or delete dependents
When Can I Change My Election?
 OPEN ENROLLMENT OR A STATUS CHANGE…
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Marriage
Divorce or legal separation
Birth or adoption of a child
Death of a spouse or child
Change in your spouse’s employment
You or your spouse change from full-time to part-time,
You or your spouse experience an unpaid leave of absence
Major changes to your spouse’s benefit program
 You must notify HR and enroll within 30 days
of the event.
Challenges in Health Care
 Drivers of Increased Health Care Cost:
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Aging population
Medical inflation – driving 51% of the growth in healthcare spending
New expensive technology and drugs
Cost of expanding and improving health care facilities
Less competition in the market place
Increased utilization and demand for services
Providers adjust prices charged to insurers to offset losses from nonpayers
 Government regulations:
 Health Care Reform
 Mandated Benefits
Health Care Costs Controlled by You
 Lifestyle Choices:
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Smoking
Obesity
Exercise (lack of)
Stress
Accessing preventive care
Taking medications as prescribed
Seeking care at the appropriate level (urgent care clinics and
physical office visits instead of emergency room care)
 Fraud prevention
 Check your claims. If you need help, contact Joyce.
How can you help control costs?
 Wellness: Eat, sleep and exercise appropriately. Check
out your new wellness website with Filice. Monthly
newsletters.
 Utilize appropriate level of care: Call the 24-hour nurse
line, only go to the emergency room for true emergencies,
use urgent care as necessary, and schedule annual
check-ups.
 Engage: Manage your health and your health-related
expenses. Always stay inside the network whenever
possible.
Ways to Save on RX
 Ask your doctor for generic alternatives
 Use mail order for long-term and maintenance
drugs
 Use over-the-counter medications instead of
prescription drugs when possible
 Ask physician for free samples
 Annually review your medications with your doctor
Benefits Overview
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Blue Shield – New plan names but similar to last year. Blue Shield
changed its small group portfolio.
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Premier PPO 35 – Base Plan
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Access HMO Enhanced 25 – Buy-up Option
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Premier PPO 25 – Buy-up Option - New
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Dental – Direct Dental (Assurant Network) - Enhanced
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Vision – VSP – New Benefit
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Life and disability – Mutual of Omaha
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EAP
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Travel Assistance
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FSA – New Provider on 1/1/2013
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401(k) – New Provider on 1/1/2013
Company Contribution
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Medical: Serena & Lily pays 100% of premium for employees and
50% of the premium for dependents for the Blue Shield Premier
PPO 35 plan. If you choose the Access HMO Enhanced 25 or
Premier PPO 25, you will pay the difference.
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Dental: Serena & Lily pays 100% of premium for employees and
50% for dependents for your Direct Dental plan.
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Vision: Serena & Lily pays 100% of premium for employees and
50% for dependents for your VSP vision plan.
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To calculate your cost per paycheck, please multiply monthly cost
by 12 and divide by 26.
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Long-Term Disability: Paid by Serena & Lily
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Life Insurance: Paid by Serena & Lily
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EAP program: Paid by Serena & Lily
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Travel Assistance: Paid by Serena & Lily
Medical Plan Designs
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Blue Shield Premier PPO 35
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Deductible:
$750/member; $1,500/family ($500/$1,000
last year)
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Office Visit Co-Pay:
$35 (deductible waived) ($40 last year)
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Preventive Care:
No Charge
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Hospitalization:
35% after deductible
($500/admit + 30% last year)
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Surgery:
35% after deductible
($250/surgery + 30% last year)
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Emergency Room:
$100/visit (waived if admitted) + 35% after
deductible ($100/visit + 30% last year)
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Prescriptions:
$10/$30/$50/30% up to $100 per fill ($250
deductible - last year)
Mail: $20/$60/$100/30% (90 day supply)
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Annual OOP Max:
$4,000 /member; $8,000/family (excludes
deductible)
Medical Plan Designs
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Blue Shield Premier PPO 25
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Deductible:
$500/member; $1,000/family
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Office Visit Co-Pay:
$25 (deductible waived)
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Preventive Care:
No Charge
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Hospitalization:
25% after deductible
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Surgery:
25% after deductible
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Emergency Room:
$100/visit (waived if admitted) + 25% after
deductible
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Prescriptions:
$10/$30/$50/30% up to $100 per fill
Mail: $20/$60/$100/30% (90 day supply)
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Annual OOP Max:
$3,000 /member; $6,000/family (excludes
deductible)
Medical Plan Designs
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Blue Shield Access Enhanced HMO 25
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Deductible:
None
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Office Visit Co-Pay:
$25/ $35 specialist
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Preventive Care:
No Charge
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Hospitalization:
25% of allowed charges
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Surgery:
25% of allowed charges
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Emergency Room:
$150 (waived if admitted)
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Prescriptions:
$10/$30/$50/ 20% up to $100 per fill
($300 Tier 2 & 3 Rx deductible)
($15/Generic; $30 Brand after $250 Rx deductible – last year)
Mail: $20/$60/$100 ($300 Tier 2 & 3 Rx deductible) – 90 day supply
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Annual OOP Max:
$3,000/member; $6,000/family ($3,500member; $7,000/family – last
year)
Dental Plan Overview
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Direct Dental (Assurant Network)
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$1,500 annual (plan year) maximum benefit
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$50/individual (plan year) deductible
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Ortho: $1,000 lifetime max for children and adults ($500 per year)
Plan design co-insurance levels
In
Out
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Preventative
100%
100%
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Basic
90%
80%
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Major
60%
50%
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Ortho
50%
50%
Vision Plan Overview
 VSP
 Co-Pay:
$10/$25
 Exams:
Every 12 months
 Lenses:
Every 12 months
 Frames:
Every 12 months (up
to $130 + 20% off)
 OR
 Contact Lens Care: Every 12 months (up to $130)
Life, AD&D and Disability Overview
 Life and AD&D Insurance – Mutual of Omaha
 Benefit:
1 x salary to a maximum of
$250,000
 Long Term Disability – Mutual of Omaha
 Benefit:
60% of salary – maximum benefit of
$10,000/month
 Elimination: 90 days
Voluntary and AD&D Term Life
Insurance
Minimum
Maximum
Guaranteed
For You
$10,000
$250,000
$100,000
For Your Spouse
$5,000
$50,000
$25,000
For Your Children
2,000
$10,000
$10,000
• Employee can elect up to 5 times their salary to a maximum of
$250,000.
• Guarantee issue amount is 5 times salary up to $100,000.
• Spouse can elect up to 50% of employee’s benefit to $50,000.
• Children can elect up to 50% of employee’s benefit to $10,000.
EAP Program – Mutual of Omaha
 24/7 online resources and confidential telephonic consultation with
licensed EAP consultants who provide assistance and guidance on:
• Family, relationship and parenting issues
• Emotional and stress-related issues
• Conflicts at home or work
• Alcohol and drug dependencies
• Financial issues
• Depression
• Parenting
• On-line resources and tools
 Up to 3 in-person counseling sessions each year with a licensed
mental health professional.
Worldwide emergency travel assistance services
The need for emergency travel
assistance is growing.
■ Whether your travel is for business
or personal reasons, our worldwide
emergency travel assistance
program goes with you when you
travel to a foreign country or just
100 miles or more from home.
■ If you, your spouse or your
dependent children need immediate
assistance anywhere in the world.
FSA Vendor Change 1/1/2013
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Provided by Benefit Resource, Inc., starting 1/1/2013
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This move will enhance your current services with the following:
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Online access to your account
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Phone app to submit claims and to check your balance
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Professional customer service via phone, email, and live chat
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Faster reimbursement process including direct deposit
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Just one debit card that holds both your medical FSA and your
commuter and parking elections
More details at the November enrollment meeting
New Benefit 1/1/13
Pre-Tax Commuter and Parking
•Pay $125 of your
monthly eligible
commuter expenses and
$240 of your monthly
eligible parking
expenses pre-tax.
•More details at the
November enrollment
meeting
Flex Plan Benefits
Insurance Premiums
Health Flexible Spending
Account(Health FSA)
Dependent Care Assistance
Account (DCAP)
401(k) Retirement Plan
Serena & Lily is also introducing a new-look 401(k) plan.
Enhancements will include:
 A lower cost, higher quality investment menu
 A higher-touch servicing approach
 One-on-one, customized advice
& Much More.
Our new retirement plan will be provided by Portico Wealth Advisors and Verisight
Will be meeting with you to determine how
to best position your 401(k) account
Will be providing the website and all of the
backend support for your account
More details will follow over the next few months.
Enrollment Instructions
 For Blue Shield, if you are staying on the most similar
plan to last year’s plan, you don’t need to do anything.
If you are moving to a new plan, please fill out a
change form. For dental, you only need to fill out the
form if you are new or making changes. Please
complete the VSP enrollment form. Please fill out the
Mutual of Omaha form as well as the beneficiary form.
No forms to fill out for group life, disability, EAP and
travel assistance. Everyone must turn in rate sheet.
 Forms, applications, plan designs, etc. can be found
at www.filice.com/benefits/serenaandlily under the
Forms section.
 For questions, please call Joyce Manansala at 925299-7203 or email at joyce@filice.com.
Q&A
Open Enrollment for your plans is the month of
September, 2012. Please return all forms to the
office by Monday, September 24, 2012.
•Go to www.filice.com/benefits/serenaandlily to
access all your benefit information
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