OPEN
ENROLLMENT
2014
OPEN
ENROLLMENT
2012
FILICE INSURANCE AGENCY
NINA GARDNER, MELANIE RUIZ
• Click to add text
• Nina Gardner, J.D. – Your Employee Benefits
Consultant – strategic benefit planning
• Melanie Ruiz – Your Account Manager – day-to-day
administration – questions, plan design inquiries,
claims and coverage issues, billing questions, etc.
• CRLA’s Customized Website – Your Own Intranet
• www.filice.com/benefits/crla
EMPLOYEE BENEFITS APP
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ID CARDS APP
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OPEN ENROLLMENT
Open Enrollment is a once-a-year
opportunity to make election changes
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•
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Change plans
Add or drop coverage for yourself
Add or drop coverage for your dependents
Update life insurance beneficiaries
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MID-YEAR QUALIFYING EVENTS
What changes can I make outside of
Open Enrollment?
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•
If you do not make changes during open
enrollment, the only time you can make an election
or enrollment change is if you experience an
eligible qualifying event .
Common examples of qualifying events include,
but are not limited to the following :
Marriage or domestic partner union
Divorce or legal separation
Birth or adoption
Gain or loss of coverage
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IMPORTANT THINGS TO KNOW
MEDICAL COVERAGE
• Changes you make to your elections are
effective 8/1/2014
• Plan year 8/1/14 – 7/31/15
• Deductibles and out of pocket maximums
are calendar year for medical. Deductible
and maximum are plan year for the dental
plan. Vision is calendar year.
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EMPLOYEE BENEFITS OVERVIEW
 Anthem Blue Cross
 Classic PPO 250/20/10
 Value HMO 20/40/250/3 day
 Kaiser
 HMO 10
 Dental – Direct Dental
 Vi s i o n – A n t h e m B l u e C r o s s
 D i s a b i l i t y ( LT D ) – e m p l o ye r p a i d & b u y - u p – M u t u a l o f O m a h a
 E m p l o ye r - p a i d L i f e I n s u r a n ce a n d Vo l u n t a r y L i f e I n s u r a n c e –
Mutual of Omaha
 E m p l o ye e A s s i s t a n c e P r o g r a m
 Tr a ve l A s s i s ta n c e
 FSA
 Commuter Plan
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MEDICAL
• Kaiser – No Changes
• Anthem Blue Cross – No Changes
• Kaiser: Must use Kaiser facility
• Kaiser has a number of free
resources!
• 24 hour nurse line
• Email your doctor
• Make or change appointments
online
• Managing health issues (such
as quitting smoking or losing
weight)
• Anthem Blue Cross: More
flexibility in choosing providers
• Use Anthem network whenever
possible
• Identify local urgent care clinics
for assistance after hours when
not an emergency
• 24/7 Nurse Line
• Future Moms Maternity Program
• Condition Care: Asthma,
diabetes, heart disease,
coronary artery disease
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TIPS – STRETCHING YOUR DOLLARS
 U S E T H E M A I L O R D E R P H A R M AC Y
 ASK FOR GENERIC DRUGS
 CO M PA R E P R I C ES AT D I F F E R E N T P H A R M AC I ES
 G O TO U R G E N T C A R E I N S T EA D O F T H E E M E R G E N C Y RO O M
 M A K E S U R E YO U R D O C TO R , L A B, H O S P I TA L O R P H A R M AC Y I S I N -
N E T WO R K
 G E T YO U R A N N UA L RO U T I N E P H Y S I C A L E X A M A N D R ECO M M E N D E D
SCREENINGS
 I N Q U I R E A B O U T T H E CO S T O F S E RV I C ES I N A DVA N C E
 A N T H E M C A R E CO M PA R I S O N : Q UA L I T Y A N D CO S T S F O R M E D I C A L
P RO C E D U R ES AT H O S P I TA L S A N D OT H E R M E D I C A L FAC I L I T I ES
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PR EVEN TAT IVE C AR E VS. D IAG N OST IC C AR E
What is the Difference?
Preventive = Deductible does not apply
When you have no symptoms with no reason to think you aren't healthy
and you get a service or test listed in the Preventive Health Care
Guidelines, it's a "preventive service.”
Carriers pay 100% for preventive services.
Examples of Preventative Services:
Well Woman, Well Man, Well Child Annual Check Up
In association with the Affordable Care Act Schedule of Care
Immunizations, Blood Pressure, Cholesterol, Diet Counseling for Adults
at Risk for Chronic Disease, Type 2 Diabetes Screening for adults with
high blood pressure, Tobacco use & Cessation Intervention.
For a more detailed list please visit:
http://www.healthcare.gov/news/factsheets/2010/07/preventiveservices-list.html
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PREVENTIVE CARE FOR WOMEN
• N EW PR EVEN T IVE C AR E G U ID EL INES F O R W O M EN
C OVER T H E F O L L OWING SERVIC ES ( C OVER ED AT 1 0 0 %
W IT H O UT C O ST SH AR IN G ):
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Well-women visits
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Gestational diabetes screening
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HPV DNA Testing for women 30 and older
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Sexually Transmitted infection counseling; HIV screening and counseling
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FDA approved contraception methods and counseling
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Breastfeeding support, supplies, and counseling
•
Domestic Violence support, supplies, and counseling
• F O R AD D IT IO N AL D ETAIL S
•
www.healthcare.gov/law/provisions/preventive/index.html
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SUMMARY OF BENEFITS AND
COVERAGE (SBC)
• AVAIL ABL E ON FIL IC E W EBSITE
•
Paper copies available from HR upon request
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BALANCED MEAL
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EXERCISE
• Walking is one of the easiest ways to get the exercise you need to stay
healthy.
• Experts recommend at least 2� hours of moderate activity (such as brisk
walking, brisk cycling, or yard work) a week. It's fine to walk in blocks of 10
minutes or more throughout your day and week.
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WELLNESS RESOURCES
• AN T H EM O N L INE R ESO U R C ES:
– Weight Loss: Jenny Craig, Weight Watchers, Lindora
– Fitness Clubs: Curves, Bally’s, Gold’s
– Family & Home: Health- and wellness-related books and products,
elder-care services, baby-proofing products
– Vision, Hearing, Dental: Prescription glasses, sunglasses, laser
vision, contact lenses, audio logical services and testing, dental-related
products
• KAISER R ESO U R C ES :
– Weight Loss
– Smoking Cessation
– Health Risk Assessment
– Classes and Programs
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Kaiser and Wellness
•Kaiser Permanente encourages our members to live healthy and thrive. Get active
and take control of these healthy resources.
•For more information, visit www.kp.org or call Member services at
1-800-464-4000 English
1-800-777-1370 TTY for the hearing/speech impaired
Health classes at Kaiser Permanente facilities. (Many classes are free.)
Healthy lifestyle programs help you
 lose weight
 eat healthy
 manage diabetes
 reduce stress
 quit smoking
 live with ongoing conditions
 reduce pain
 manage depression
 get a good night’s sleep
Discounts on additional health care services give you more options
 acupuncture
 massage therapy
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GOOD HEALTH ON THE GO
Mobile apps
Use your Smartphone or mobile device to fit
wellness into your schedule.
 Manage your care, find nearby facilities,
and more
 Stay fit with the free Every Body Walk! app—
a fun, interactive tool to help you create and
maintain a daily walking routine
 Just download our free apps from the
App StoreSM or Google Play*
*App Store is a service mark of Apple Inc.
MAXIMIZE YOUR HEALTH
Wellness coaches
Experienced coaches are available by phone,
at no cost to members.
 Your coach will work one-on-one with you to
help you set goals to improve your health
 Get a personalized plan to help you lose
weight, quit smoking, manage stress, eat right,
and more
 Coaching is available in English and Spanish
and no referral is needed
COMMON INSURANCE TERM:
DEDUCTIBLE
• Deductible: The amount the insured person has to
pay before the insurance company starts to pay its
portion of costs for a covered health service
• Out of Pocket Maximum: The most you will pay in a
year except for prescription drug copays.
Prescription drug copays continue after the out of
pocket maximum has been met.
• Co-insurance: The portion of the charges that you
pay after you have met the deductible.
• Co-pays: Fixed amounts you pay for prescription
drugs, office visit or x -rays.
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AN T H EM C L ASSIC PPO 2 5 0 /2 0/20
In-Network
Out-of-Network
$250 (combined)
$750 (combined)
$250 (combined)
$750 (combined)
$2,500 (includes ded.)
$5,000 (includes ded.)
$6,500 (includes ded.)
$13,000 (includes ded.)
$0 (deductible waived)
30% after deductible
$20 (ded. waived)
30% after deductible
Diagnostic Lab & X-ray
10% after deductible
30% after deductible
Hospital Services
10% after deductible
30% after deductible
$150 + 10% after ded.
$150 + 10% after ded.
Plan Features
Deductible
Per Member
Per Family
Out of Pocket Max
Per Member
Per Family
Preventive Care
Office Visits
Emergency Services
Prescription Medication
Generic
Brand Formulary
Brand Non-Formulary
Specialty
No deductible
$10
$30
$50
30% to $150/fill ($3,500 max)
50% + copay
50% + copay
50% + copay
50% + copay
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AN T H EM BL U E C R O SS VAL U E H M O 2 0 /4 0 /25 0/3 D AY
Plan Features
Deductible
Per Member
Per Family
Out of Pocket Max
Per Person
Per Family
Preventive Care
Office Visits
Diagnostic Lab & X-ray
In-Patient Hospital Services
Out-Patient Hospital Services
Emergency Services
Prescription Medication
Deductible
Generic
Brand Formulary
Brand Non-Formulary
Specialty
In-Network Only
$0
$0
$3,000
$6,000
$0
$20/$40
No charge
$250/day, up to 3 day max
$125/admit
$150
None
$15
$30
$50
30% to $150/fill ($3,500
annual max)
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KAISER – HMO 10
Plan Features
Deductible
Per Member
Per Family
Out of Pocket Max
Per Member
Per Family
In-Network Only
None
None
$1,500
$3,000
Preventive Care
Routine exam, screenings
$0
Office Visits
$10
Diagnostic Lab & X-ray
No Charge
Hospital Services
No Charge
Outpatient Surgery
Emergency Services
$10/procedure
$50
Prescription Medication
Generic
Brand and Specialty
$10 (100 day supply)
$25 (100 day supply)
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MEDICATION ASSISTANCE
PROGRAM

If you are taking a medication that is for a chronic illness
or disease and cannot afford to pay your portion, there
may be help.
• The Partnership for Prescription Assistance
Program is designed to help individuals, like YOU
save money w ithout affecting your prescription
drug need.

Not all medications will qualify, but most drugs
manufacturers provide low \free medicine for:

HIV- www.publichealthrx.com \ 888-311-7632

Diabetes- www.caldiabetes.org \ 916-552-9888

Asthma- www.pparx.org \ 888-477-2669

Depression- www.dbsalliance.org \ 800-826-3632

Other conditions and medications may qualify.

Please contact Kryz Novotnaj at (925) 962 -1983 at Filice
Insurance if you need assistance with other conditions
not listed above.
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OPEN ACCESS PLAN
 D i r e c t D e n t a l P P O – Yo u c a n s e e a n y d e n t i s t , b u t yo u p a y l e s s i n t h e n e t wo r k .
 $1,500 annual (plan year) maximum benefit
 Child Ortho: $1,500 lifetime maximum benefit
 $50/individual; $150/family annual (plan year) in-network deductible
 4 cleanings and 2 exams per year
 Maximum Rollover: $700 Threshold, $350 in -network maximum rollover, $1,250
maximum rollover account limit (must be on plan for an entire year)
 Tip: Always get a pre-determination of benefits from your provider for services over
$300.
 P l a n d e s i g n c o - i n s u r a n c e l e ve l s
In
Out
 Preventative
100%
100%
 Basic
90%
80%
 Major
60%
50%
 Ortho
50%
50%
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IN NETWORK ONLY PLAN
 Direct Dental – Only Access to In -Network Providers
 $1,500 annual (plan year) maximum benefit
 Child Ortho: $1,500 lifetime maximum benefit
 $25/individual; $75/family annual (plan year) in-network deductible
 2 cleanings and 2 exams per year
 Tip: Always get a pre-determination of benefits from your provider for
services over $300.
 Plan design co -insuranc e levels
In
 Preventative
100%
 Basic
90%
 Major
60%
 Ortho
50%
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ANTHEM VISION PPO PLAN
Anthem Blue View Vision BV B1
Co-Pay:
$15
Exams:
Every 12 months
Lenses:
Every 12 months
Frames:
Every 24 months (up
to $130 + 20% off remaining balance)
 OR
Contact Lens Care:
Every 12 months (up to $130)
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DISABILITY
 Long Term Disability – Mutual of Omaha
Benefit: 50% of salary – maximum benefit of $1,500/month
90 day elimination period
Own Occupation Period: 24 Months
 Buy-up Option – Mutual of Omaha
Benefit: 60% of salary – maximum benefit of $7,500/month
Maximum Covered Payroll: $12,500 monthly
Buy-up Rate: $0.13 per $100 monthly covered payroll
Example: John Doe earns $2,500 per month
 $2,500 X 0.0013 = $3.25 (monthly)
 $2,500 X 0.0006 = $1.50 (bi weekly)
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LIFE INSURANCE
 $25,000 Employer-Paid Life Insurance
 $25,000 AD&D
Accelerated Death Benefit:
 You can withdraw a percentage of your life benefit if terminally ill.
 75% of the amount of the life insurance benefit is available if terminally
ill, not to exceed $18,750
Conversion: In case of termination of employment, you can convert
to an individual life policy within 31 days of termination.
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VOLUNTARY LIFE
 Employee : $10,000 increments up to 5 times annual salary to a
maximum of $300,000
 Spouse: $5,000 increments up to 100% of employee elected amount to a
maximum of $150,000
 Dependent: $10,000 child: 14 days to 21 (to age 25 if full-time student)
 Guarantee Issue Amount for new hires only: $150,000 (employee ) /
$30,000 (spouse)/ $10,000 (child)
 AD&D: Optional. Benefit equal to life amount.
 Accelerated Death Benefit: 75% to a max of $225,000
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EMPLOYEE ASSISTANCE PROGRAM
 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 every 6 months with
a licensed mental health professional.
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WORLDWIDE EMERGENCY TRAVEL
ASSISTANCE
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.
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FLEXIBLE SPENDING ACCOUNTS
•
•
Benefit Resource, Inc.
FSAs help you pay eligible health care and dependent care expenses on a pre-tax basis
Tax advantage: When you save pre-tax dollars in your FSA, you’ll also lower your overall
taxable income.
•
There are three components of the FSA that you can take advantage of:
•
•
•
Health care FSA - employees can elect pre-tax deductions of up to $2,000 annually to
use towards eligible medical, Rx, dental and vision expenses
Dependent care FSA – employees can elect pre-tax deductions of up to $5,000
annually to use towards eligible child (12 and under) and adult day care expenses.
$2,500 if married and filing separately.
Pre-tax Premiums
Use-it-or-lose-it forfeiture rule: unused dollars are not returned to you!
Submit your receipts by November 15 for expenses incurred during the benefit year.
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TAX SAVINGS EXAMPLE
MEDICAL FSA
Annual Savings Example
With FSA
Without
Jill's taxable income is:
Contribution to FSA
Taxable Income
Real Spendable Income
Tax Savings
$
$
$
$
$
$
$
$
$
50,000
2,000
48,000
38,871
453
50,000
50,000
38,418
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HOW TO USE BENIVERSAL ® FOR
MEDICAL EXPENSES
Use at qualified merchants (pharmacy,
doctor, dentist, vision, etc.)
If prompted at the point of sale, choose
credit not debit
Always retain your receipts
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SUBSTANTIATION PROCESS
 If we cannot match the charge to your plan
summary, we may require substantiation.
 If so, you will receive an email from BRI asking for
a receipt or an Explanation of Benefits (EOB)
 You can send it to us by Fax, uploading it online,
or from your smart phone with the BRI app
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CASH REIMBURSEMENT CLAIMS
 Submit reimbursement claims for all Dependent Care
expenses and those Medical expenses for which you could
not use your Beniversal ® card
 Reimbursement is available in two ways:
 A check mailed to your home address
 Direct deposit into your checking/savings account (you can
set up direct deposit via your online account or by mailing
or faxing the direct deposit authorization form)
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BRI MOBILE APP
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WEBSITE LOGIN
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Enter your Company Code = CRLA
Member ID = Social Security Number
Password = Home Zip Code
(unless previously changed)
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YOUR HOME PAGE
Your home page allows you
to resolve receipt requests,
view a table of eligible
expenses, review your
account balance and
transaction detail, submit
claims, set up direct deposit
and obtain any forms you
may need.
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IMPORTANT DATES
 Make your election by July 12 for the 2014/2015 plan year.
 Payroll deductions will occur in equal amounts from each biweekly
paycheck beginning in August 2014
 You should receive your Beniversal ® cards by the middle of August
unless you already have a card. Any charges eligible 8/1 should be
submitted via claim form until you get your card.
 Eligible services must have been provided during the plan year or
during the 2 ½ month grace period following the end of the plan year.
The grace period ends October 15, 2015. You have until November 15,
2015 to submit claims.
 Expenses have to be incurred inside the plan year and before the end
of the grace period. Continue to use your card for expenses incurred
during the 2014/2015 plan year until the new plan year starts and your
grace period ends.
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RECEIVING BENIVERSAL ® CARDS
Cards are mailed
to employees’
homes after
enrollment
Beniversal® Cards are activated
via a toll-free phone call
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CUSTOMER SERVICE
• Go online: www.benefitresource.com
• Email: participantservices@benefitresource.com
• Call BRI Participant Services:
800-473-9595 (5 am – 5pm PST)
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COMMUTER BENEFIT
• Commuter Benefits is a federal transportation benefit program
that allows employees to save on their transit costs by
deducting their commute expenses pre-tax from their paycheck
each months.
• You can deduct $130 per month from your paycheck on a pretax basis for transit, and an additional $245 per month for
parking at your transit or carpool pick-up location.
• This plan is managed by CRLA.
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ENROLLMENT INSTRUCTIONS
OE period to make enrollments, changes, or terminations to your benefits, will be from 6/27/14
to 7/13/14. Changes can only be made during this time period.
To e n r o l l , y o u w i l l n o l o n g e r b e u s i n g p a p e r e n r o l l m e n t f o r m s , y o u w i l l b e u s i n g t h e n e w
Paycom Benefits Administration system. Although we are no longer using enrollment forms, all
employees are required to complete the Rate Sheet, located on the benefits website. Please
fill out the correct Rate Sheet. There is one for those who make 40k or more annually and one
f o r t h o s e w h o m a k e u n d e r 4 0 k a n n u a l l y. A l s o , i f y o u a r e e l e c t i n g v o l u n t a r y o r b u y - u p c o v e r a g e
greater than the guarantee issue amount, you will need to fill out an Evidence of Insurability
form, also located on the benefits website. These two forms must be submitted to HR no later
than 7/13/14.
Yo u w i l l b e m a k i n g y o u r O E e l e c t i o n s t h r o u g h P a y c o m B e n e f i t s A d m i n i s t r a t i o n i n P a y c o m
Employee Self Service. Please be sure to attend your Paycom Benefits Administration
Tr a i n i n g t o d a y a t 1 : 0 0 P M , o r v i e w t h e r e c o r d i n g , b e f o r e u s i n g B e n e f i t s A d m i n i s t r a t i o n . T h e
recording will be on the benefits website, along with the OE webinar recording, by Monday
morning. Even though you may not want to make changes to your benefits for the 2014 to
2 0 1 5 p l a n y e a r, y o u w i l l s t i l l n e e d t o c o n f i r m y o u r b e n e f i t e l e c t i o n s , e n t e r y o u r d e p e n d e n t
information, and confirm your contact information on Benefits Administration.
If you have any benefits questions, please contact Melanie Beranek. For any Paycom Benefits
Administration questions after the training, please contact your HR Department.”
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QUESTIONS?
?
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