RISK MANAGEMENT & INSURANCE
OCTOBER, 2015
AGENDA

Annual Enrollment


2016 Health Renewal
 Short and Long Term Disability

Terms and Definitions


Humana Health Plan Changes
 Humana Resources

Rx4 Traditional Prescription Plan

Reminders

2016 Health Payroll Deductions

Questions & Answers

Humana Vitality

Dental Plan Rate Changes
Eye Med Vision Changes
Flexible Spending Accounts (FSA)
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Annual Enrollment
October 14 thru October 26, 2015
Coverage Begins: January 1, 2016
Deductions begin:
12/4/15 – Support
12/11/15 – Instructional/Administrative/PTS
2016 Flexible Spending Account and
MetLife Legal deductions begin:
1/15/16 - Support
1/8/16 -Instructional/Administrative/PTS
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2016 Health Renewal
Proposed 2016 health renewal was 9.3% over 2015
plan costs. After plan design changes , the
increase was reduced to 6.5%
Projected 2016 premium is $121M; which equates
to a $7.4M premium increase
Overall the District will pay approximately 76% of
the overall costsNew Humana Vitality Program can help offset the
increase in costs if members reach Silver Status
or above
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Terms and Definitions
 Co-payment - the specified dollar amount that the member
must pay for a covered service. You will pay co-payments
for services under the HMO Staff plan.
 Co-insurance - the % amount of a covered service that the
member must pay. Example: An 80%/20% coinsurance
means that Humana will pay 80% of the allowable charge
and the member will pay 20%.
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Terms and Definitions
 Deductible - the amount of covered services that the
member must pay per year before Humana pays benefits for
covered services.
 Medical Out-of-pocket limit - the most a member would
have to pay per calendar year before Humana pays 100% of
the in network cost. Excludes Rx costs.
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Terms and Definitions
OUT OF POCKET
LIMIT
DEDUCTIBLE
CO-INSURANCE
You pay 100% of
the cost up to the
amount of the
deductible*
You pay 20% of
the cost up to the
out of pocket
limit
Humana pays
100% of the costs
after the costs
reach $4000 for
an individual,
$8000 for a
family
*All individual deductible amounts will count toward the family deductible, but
an individual will not have to pay more than the individual deductible amount.
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HMO Staff
KEY FEATURES
CHANGES
Very Narrow Primary Care
Physician Network – Tampa
Bay area only
Increased Co-pays:
No Out-of-Network Benefit
except for emergencies
Lab Co-pay
Referrals to Specialists
limited by PCP Choice
Durable Medical Equipment:
Co-pays for all services;
preventive services covered
at 100%
Hospital co-pay: $500 per
day, 5 day maximum
Emergency Room Co-pay
from $300 to $500
from $0 to $25*
*or less if actual cost is less than the co-pay
from $0 to $50
Out of Pocket Maximum
from $3,500 to $4000(individual)
from $7,000 to $8,000 (family)
Please confirm PCP
participation with
Humana customer
service or online – NOT
the doctor’s office!
National Point of Service Plan (NPOS)
KEY FEATURES
Broad National Point of
Service (NPOS) network –
open access
CHANGES
Deductible
from $300 to $400 (individual)
from $600 to $800 (family)
No specialist referrals
In Network and Out of
Network Benefits
Out of Pocket Maximum
from $3,500 to $4000(individual)
from $7,000 to $8,000 (family)
Preventive services covered
at 100%
Hospital co-pay: $500 per
day, 5 day maximum
80%/20% coinsurance for
physician visits, outpatient
services, lab and x-rays after
deductible
Good option for out of area
retirees and students!
Consumer Directed Health Plan (CDHP)
KEY FEATURES
KEY FEATURES
HMO Premier Network –
larger Tampa Bay network
than the Staff HMO network
Deductible
Network includes: Several
Florida counties and a limited
number of states outside
Florida
Personal Care Allowance (PCA)
NO out of network benefits
Preventive services covered
at 100%
80%/20% coinsurance for
physician visits, outpatient
services, lab and x-rays,
after deductible
$1500 (individual)
$3000 (family)
$500 (individual)
$1000 (family)
Rollover feature, however if you
move to another plan any
remaining PCA funds will be
forfeited.
CHANGES
Out of Pocket Maximum
from $3,500 to $4000(individual)
from $7,000 to $8,000 (family)
Which Health Plan is Right for You?
HMO
NPOS
CDHP
Must stay in
Network
Not required to stay
in Network
Must stay in
Network
Must Select a PCP
Not required to
select a PCP
Not required to
select a PCP
No referrals
necessary
No referrals
necessary
Must meet a
deductible
Must meet a
deductible
No Deductible set co-pays for all
services
Limited coverage
area
Must get a referral
to see a specialist
Healthcare
allowance provided
PCS COVERAGE VS. THE HEALTHCARE
MARKETPLACE
Pinellas County Schools health insurance coverage meets the
standard for minimum essential coverage and is considered
affordable under the Affordable Care Act.
Benefit eligible employees who enroll in the Marketplace plans
would not be eligible for Advanced Premium Tax Credits (tax
subsidy) and would not receive premium assistance.
Pharmacy Benefits
Rx4 Traditional replaces Rx3
Pay two co-pays for a 90
day supply at a
participating pharmacy
or mail order through
Humana Pharmacy (after
deductible on Tier 3 &
Tier 4 medications).
RightSource Rx is now Humana Pharmacy
2016 Health Plan Deductions
Tier/Plan
Consumer
Directed Health
Plan
Staff HMO
National Point of
Service (NPOS)
Employee
$30 to $53
$48 to $71
$63 to $80
Employee +
Spouse
$120 to $159 $158 to $195
$182 to $213
Employee +
Child/Children
$115 to $146 $151 to $182
$175 to $200
Family
$178 to $215 $230 to $266
$262 to $302
2 Board Family
$85 to $120
$169 to $207
$137 to $171
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Humana Vitality is a wellness and rewards program for employees enrolled in
a Humana health plan that gives its members an opportunity to:
Set goals – create a personalized plan!
Earn Vitality Points™ and shop at the Vitality Mall with Vitality Bucks!
Learn the value of making healthy choices to experience personal results!
Employees reaching Silver Status or above by June 30, 2016, will be eligible
for a premium credit during 2016 AND 2017!
Employee Only
Employee + Spouse
Employee + Child/ren
Employee + Family
$10 credit per pay period
$15 credit per pay period
$15 credit per pay period
$20 credit per pay period
Better health, great rewardsit's all part of Humana Vitality!
Dental Plans/Rate Changes
Humana Comp Benefits
Employee Only
$7.45 per pay
Met Life Dental
Employee Only
$13.36 per pay
Employee + 1
$13.74 per pay
Employee + 1
$24.64 per pay
Employee + Family
$20.07 per pay
Employee + Family
$35.56 per pay
2 Board Family
$18.07 per pay
2 Board Family
$33.56 per pay
No plan design changes
No plan design changes
Preventive services covered 100%
Preventative services covered
In-network benefits only
100%
Co-pays for services
In-network and out-of-network
benefits
Reimbursement based upon
services (negotiated rates)
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Eye Med Vision Plan
KEY FEATURES
Free coverage for employee
only
May purchase coverage for
dependents
Routine eye exam once every
calendar year - $10 co-pay
Single vision lenses OR
contact lenses once every
calendar year
Frames once every two years
National retail and private
practice optometrists &
ophthalmologists
CHANGES
Standard plastic lens co-pay
from $10 to $15
Contact lens allowance
from $90 to $110
20% of balance over $110
Frame allowance
from $90 to $110
RATES
Employee Only
Free
Employee + 1
$2.83
Employee + Family $5.92
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Short Term/Long Term Disability
Rate Decreases
No plan design changes
One time open enrollment
No medical underwriting
Salary limitations and preexisting
conditions apply
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Flexible Spending Accounts (FSA)
A Health Care FSA could save
you money if you or your
dependents:
 Have out of pocket health
expenses like co-pays or
deductibles
 Take Tier 3 or Tier 4
prescription medications
and have an Rx deductible
 Wear glasses or contact
lenses
 Need orthodontia care,
such as braces or other
eligible dental expense
A Dependent Care FSA
provides pre-tax
reimbursement of out of
pocket expenses related to
dependent care, if you and
your spouse are working or
in school and:
 Your dependent children
under age 13 attend
daycare, after-school
care or summer day
camp
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Flexible Spending Accounts (FSA)
You decide how much to contribute:
Health Care FSA: $200 - $2500
Dependent Day Care FSA: $200 - $5000
Use it or lose it – the amount deposited into
FSA may be used for services incurred for
the plan year ending 12/31.
Receive a debit card – for Health Care
Expenses. Not for Dependent Day Care.
Funds available for Health Care expenses on
January 1, 2016
Look for Humana Access Visa cards last
week in December (plain envelope)
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24 Hour Humana Online Resources
What is MyHumana? It’s Humana’s
secure website that gives you access
to your information anytime you want
it.
If you haven’t registered for
MyHumana:
1. Visit www.MyHumana.com
2. Have your Humana ID card
handy
3. Go to Humana.com
4. Click “Register for
MyHumana”
5. Follow the easy steps to
register
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Humana PCS Resources
 Heather Keegan, RN – Patient Advocate
Assists employees with medical and provider issues.
Coordinated Diabetes Care Program. Advocates for
employees.
 Jessica O’Connell, RN – Health & Wellness Specialist
Facilities wellness and health education programs, enrolls
members in disease management, clinical programs and
Humana Vitality.
 Janet Lang - On Site Claims Representative
Assists employees with eligibility, claims and coverage
issues.
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Reminders
Changes through Web only October 14 - 26th
Confirmation notices available on line for employees to print
Review health plan options and new Rx4 Traditional plan
Review new rates for dental plans
Review new rates and plan changes for vision
Review special disability open enrollment, reduced rates
Make sure your life insurance beneficiaries are current
Make sure you have enrolled only eligible dependents
Humana will mail everyone new ID Cards. Make sure your address on Employee
Self Service is correct
Enroll in MyHumana so that you can participate in the Humana Vitality Program
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Questions
Visit our web site for current information, including full Beneflex Guide,
Understanding your Rx4 Traditional plan, CDHP & FSA flyers at:
www.pcsb.org/annual-enrollment
Call the Humana Hot Line:
888-393-6765, 8:00 am – 8:00 pm, Monday thru Friday.
Call the PCS Benefits Help Line for enrollment assistance
588-6197, 8:00 am – 4:30 pm, Monday thru Friday.
Email us at houckc@pcsb.org
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