2016 Annual Enrollment
11/4/15-11/30/15
➢ Make changes to your benefits during the
month of November
➢ Changes are effective January 1, 2016
➢ ONLY qualifying Family Status Changes midyear
2016 Plan Changes
➢ New medical provider United Healthcare
 Full health insurance, co-pays cover office visits
 Two Options, Base Plan and Buy Up Plan
➢ Default coverage: Base Plan/current coverage level
➢ Waive benefits with proof of other coverage
➢ Dental & Voluntary Life rate increases
Affordable Care Act (ACA)
Healthcare reform
• How does it affect your coverage?
• You can shop Exchange/Marketplace for other coverage
• No subsidies/tax credits
- Plan meets “minimum coverage” levels – 60%
- Plan is “affordable” employee-only coverage is free
less than 9.5% of family (employee) income
• Rates based on age/location-may be less expensive
(only have one dependent, a teenager)
• Coverage for 30-hour part-time employees
- Verify if you qualify with supervisor
- Must complete enrollment form whether electing
or waiving coverage
2016 Annual Enrollment
➢Eligible dependents:
❖Spouse
❖Disabled children of any age
❖Children under age 26
❖married or single
❖student or non-student
❖employee must remove when no longer eligible
United HealthCare Plans
Benefits
Base Plan
Buy-Up Plan
Lifetime Maximum
Unlimited
Unlimited
Deductible – In/Out of Network
$1,500/$2,000
$1,000/$1,000**
PCP/Specialist Office Visit-X-ray, lab
$25 PCP/$50 Specialist
$20 PCP/Specialist**
Urgent Care/Walk In Clinics
$75 co-pay
$75 co-pay
(Benefit Summary incorrect)
Wellness Visits - exams/screenings
$0
$0
Coinsurance
80/20%
80/20%
Out of Pocket
$4,000/$8,000
$4,000/$8,000
Preventative Services/Annual Physical
Immunizations
Pap smear/Mammograms
Prostate screenings
Colonoscopies – routine 10 year
No Cost to You
No Cost to You
No Cost to You (1/Year)
No Cost to you
No Cost to you
No Cost to You
No Cost to You
No Cost to You (1/Year)
No Cost to You
No Cost to You
Advanced Imaging MRI/PET/CT Scans
(Limit 2/yr, except staging cancer)
20% coinsurance after
deductible
20% coinsurance
after deductible
Emergency Room Services
Inpatient /Outpatient Services
$250 co-pay
(waived if admitted)
$250 co-pay
(waived if admitted)
**Indicates increased level of coverage with Buy-Up Plan
United HealthCare Plans
Benefits
Base Plan
Buy-Up Plan
Maternity Benefits
Initial visit $25-$50 co-pay
Delivery deductible/coinsurance
Initial visit $20 co-pay**
Delivery deductible/coinsurance
Organ Transplants
20% after deductible
20% after deductible
Elective Surgery
20% after deductible
20% after deductible
Hospice Home Care
20% after deductible
20% after deductible
Home Healthcare Services
20% after deductible
limit 60 visits per year
20% after deductible
limit 60 visits per year
Therapy Services- Physical,
Occupational, Speech, Habilitative
$25-$50 co-pay
limit 20 visits per year
per therapy type
$20 co-pay**
limit 20 visits per year
per therapy type
Mental Health – Inpatient
Mental Health - Outpatient
20% after deductible
$50 copay, no limits
20% after deductible
$20 copay, no limits**
Disease, Stress, Weight
Management
(800) 478-1057
(800) 478-1057
Tobacco Cessation
Telephonic Coaching
Telephonic Coaching
Hearing Aids
100%, every 3 years
use in network provider
100%-every 3 years
use in network provider
**Indicates increased level of coverage with Buy-Up Plan
United HealthCare Rx Coverage
Rx Type
Base Plan
Buy-Up Plan
Tier 1
$15 co-pay
$10 co-pay**
Tier 2
$45 co-pay
$30 co-pay**
Tier 3
$70 co-pay
$50 co-pay**
Mail Order - OptumRx
Mail Service Pharmacy
2.5 times the monthly copay
**Indicates increased level of coverage with Buy-Up Plan
United HealthCare Wellness Program
You and your covered spouse can earn rewards for
completing these health actions:
Rewards
Health Survey
$25
Biometric Screening participation
$75
Fitness Reimbursement program
$20/mo
Online Action Plans (Missions)
$50
Telephone-based Health Coaching program
$75
myHealthcare Cost Estimator
$25
Maximum per Employee/Covered Spouse
$200
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express
permission of UnitedHealth Group.
Biometric Screening
Know the numbers that count…
Many serious health conditions develop over time, but they may be delayed or
prevented if you know your risks and make healthy changes. Understand your
health risks with the following.
Onsite Event
•
•
•
•
Screening Date: To be announced
Location:
Registration Contact: Phone: Email:
Finger stick-blood draw “non-fasting”; results delivered within
five (5) minutes
Health Provider Form
• Beneficial for individuals who prefer to complete their screening
with their health care provider or at a convenience clinic
• Employee and/or covered spouse simply locates the systemgenerated form from the biometric microsite
Lab Screening
• Beneficial for individuals who work remotely
• Employee and/or covered spouse conveniently locates a
LabCorp Patient Service Center, print the system-generated lab
order, and go to the lab for screening
Your personal information will be kept confidential in accordance with applicable law.
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Health Survey
Complete the Health Survey on myuhc.com®
(available after 1/1/16)
•
•
•
You and your covered spouse can take the Health Survey
on myuhc.com to earn the incentive
Takes 15-20 minutes to complete
Earn a reward
After completing survey:
• Receive a Rally age and results summary
• Can enroll in online action plans (Missions)
• Can qualify for telephone-based health
coaching programs
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express
permission of UnitedHealth Group.
Telephone-based Health Coaching
Support to help you reach your goals
PROGRAM
COACHING GOALS
•
Certified wellness coaches are engaged in these
lifestyle improvement programs that are based on
•
Your motivation and commitment to change
•
Personalized goal-setting, shared decisionmaking and self-directed achievements
•
Enhanced self-awareness of root causes that
trigger habitual
After the health survey, you may be invited to
participate in a health coaching program
You can also enroll by calling (800) 478-1057
Earn a reward
Allow an average of 2 - 5 months to complete the
program
Weight
Management
•
•
•
Achieve 5-10% weight loss
Improve nutrition
Increase physical activity
Tobacco
Cessation
•
•
•
Become tobacco free
Understand/control urges
Increase physical activity
Stress
Management
•
•
•
Reduce stress
Understand stress triggers
Improve time management
•
Exercise
•
•
Increase physical activity
Improve physical fitness
•
Nutrition
•
•
Improve eating habits
(portions and choices)
Increase physical activity
•
•
•
Achieve 5+% weight loss
Improve nutrition
Increase physical activity
•
•
•
Achieve 5+% weight loss
Improve nutrition
Increase physical activity
Heart Health
Diabetes
Health
•
•
Meeting these coaching goals is not required, but you must
complete the coaching program in order to earn the reward.
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express
permission of UnitedHealth Group.
Fitness Reimbursement Program
 Visit a participating gym or YMCA® 12 times per month and
you can earn a reward.
 It's a convenient, fun and profitable way to improved health.
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express
permission of UnitedHealth Group.
•
Register/Login
•
Choose a participating fitness center or
YMCA from a national network
•
Present your fitness ID card each time
you visit the gym
•
Meet the minimum and earn $20 per
month
Myhealthcare Cost Estimator
• Get simple comprehensive estimates of your health care costs to help you make more
informed decisions
• myHealthcare Cost Estimator helps gather the information to help you make more
informed choices about the health care received.
• Results include cost estimates
• Perform one cost estimate, earn a reward!
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express
permission of UnitedHealth Group.
13
2016 Medical Costs
Employee
Coverage level
Employee
Biweekly Cost Monthly Cost
City
Monthly Cost
Base Plan-Employee Only
$0.00
$0.00
$400.64
Buy Up Plan-Employee Only
$17.75
$ 35.50
$400.64
Base Plan-Family
$178.06
$356.12
$530.89
Buy Up Plan-Family
$217.14
$434.28
$530.89
2016 Dental-Basic Plan
In Network
Out of Network
$50 per person
$150 per family
10% reduction in benefits
$1000/individual
$3000/family
10% reduction in benefits
Diagnostic Services
exams, X-rays, cleanings
80%
10% reduction in benefits
Basic Services-fillings, root
canals, extractions
80%
10% reduction in benefits
Major Services-crowns, inlays,
bridges, dentures,
periodontal surgery and
implants
50%
10% reduction in benefits
Deductible
Annual Maximum
Rollover up to $250 if less
than $499 used, with at
least one covered service
Delta Dental-Expanded
$1500 lifetime max
child orthodontia
Deductible
In Network
Out of Network
$50 per person
$150 per family
10% reduction in benefits
Annual Maximum – Rollover up to
$375 if less than $749 used this
year. Must have at least one
covered service.
$1500/individual
$4500/family
10% reduction in benefits
Diagnostic Services:
exams, X-rays, cleanings
100%
10% reduction in benefits
Basic Services: fillings, root canals,
extractions
80%
10% reduction in benefits
50%
10% reduction in benefits
Major Services:
Crowns, bridges, dentures,
periodontal surgery, dental
implants, Child orthodontia
2016 Delta Dental Costs
Employee
Biweekly Cost
Employee
Monthly Cost
City
Monthly Cost
Basic Dental–E/O
$0
$0
$23.58
Basic Dental-Family
$16.75
$33.50
$29.58
Expanded Dental–E/O
$6.57
$13.14
$23.58
Expanded Dental-Family
$37.65
$75.30
$29.58
Coverage Level
Vision Service Plan
For assistance:
Call 1-800-877-7195
Routine Eye Exam
(every 12 mo.)
Prescription glasses
Contact lenses
non-uniformed/uniformed management
In Network
Out of Network
$10 co-pay
up to $43 reimbursement
$50 co-pay
lenses-every 12 months
frames-every 24
months
Lenses
single vision-up to $40
lined bifocal - up to $60
lined trifocal - up to $73
frames - up to $47
covered up to $105
every 12 months
up to $105
2016 VSP Vision Costs
Employee
Biweekly Cost
Employee
Monthly Cost
City
Monthly Cost
Vision - EE Only
$0.00
0.00
$5.00
Vision - Family
$1.00
$2.00
$5.00
Coverage Level
Passport to Wellness
➢ Turn in Passport to Wellness envelopes by 11/30/15
➢ Gift cards will be distributed in December
➢ Points earned for wellness exams, screenings, attending
seminars, fitness activities
➢ Documentation required
Flexible Spending Plan
➢ Pre-tax deduction = lower taxable income
❖ Medical - $2550/year max
❖ Dependent Care - $5000/year maximum
➢ Over the Counter meds (written prescription required)
➢ Debit Card for Rx, glasses, contacts, co-pays, etc.
❖ 2016 amount will be added to your card
❖ Hold onto card - $5 replacement charge for lost cards!
➢ Keep documentation - may need to submit copies
Re-enroll--2015 election does not rollover to 2016
Basic Term Life - MetLife
➢ Regular, full-time employees
➢ Paid for by City of Little Rock
❖ Life Insurance: 1-3 times annual salary
❖ AD&D Insurance: 1 times annual salary
Voluntary Term Life – Metlife
➢ Employee coverage levels
❖ 1X – 3X Salary
❖ Cost varies, based on age (10% increase)
➢ Spouse coverage levels (up to 50% of employee coverage level)
❖ $5,000 to $50,000 - $25,000 guaranteed issue
❖ Cost varies, based on age
➢ Dependent children coverage levels (fixed cost)
❖ $5,000 - $.90 per month
❖ $10,000 - $1.80 per month
Voluntary AD&D - MetLife
➢ Employee Supplemental AD&D
❖ 1X – 10X salary
❖ .031¢ per $1,000 in coverage
➢ Family Supplemental AD&D
❖ Spouse Only - 60% of employee coverage
❖ Spouse + Children - 50% spouse + 10% each child
❖ Children Only* – 20% of employee amount
❖ Maximum benefit per child - $50,000
❖ .045¢ per $1,000 in coverage
Voluntary Life/AD&D
Additional Benefits
Voluntary Life
➢ Free Will Preparation, Group # 143688
❖ Basic will preparation/revisions
❖ Probate/Estate Resolution assistance
❖ Hyatt Legal Plans, 1-800-821-6400
Voluntary AD&D
➢ Free Travel & ID Theft Assistance
❖ Medical and legal assistance
❖ AXA Travel, 1-800-454-3679
Voluntary Benefits
USAble Cancer/Critical Illness
➢ Covered illnesses--Cancer, Heart Attack, Stroke
❖ Rates based on age at initial enrollment
❖ Cash benefits paid upon initial diagnosis
❖ Spouse coverage - up to 50% of your coverage amount
Dependent children coverage - up to $10,000
❖ Guaranteed issue-new employees
❖ Portable, permanent, direct bill at termination
➢ To enroll, return Benefit Application form to HR Benefits
or acall USAble Enrollment Services at 1-888-945-0999
AR Diamond/VOYA 457 Plan
Maximum contribution:
$18,000
Age 50 & above:
$24,000
Age 61, 3-year catch up:
$36,000
❖ Contribute pre-tax (defer taxes until withdrawal)
❖ Contribute after-tax/Roth (pay taxes now,
no tax liability on earnings at retirement)
❖ Minimum contribution per pay period - $10
❖ Change or stop contributions at any time
❖ Emergency withdrawals-per IRS criteria, documentation required
❖ Manage your account online with PIN
Call 1.800.905.1833 or 501.301.9900 for assistance.
Catastrophic Leave
Short-term medical leaves
➢ Request CAT Leave 1 month before banked time runs out
➢ Enroll now thru December 31, 2015—after 1 year full-time status
❖ Need 108 hours (124 hours 56-hr FF) banked to join
❖ Donate 1 shift (8 or 24 hours) each year
➢ Medical documentation required
➢ Medical review/approval granted by CAT Leave Committee
➢ Enrollment rolls to next year, unless you stop participation
Family Status Changes
➢ Benefit changes – deadline 11/30/15
or within 30 days of Family Status Change
❖ Birth or adoption
❖ Death
❖ Marriage
❖ Divorce
❖ Dependent becomes ineligible
❖ Loss or gain of other group coverage
❖ Employment status change
Documentation required!
Actions Required
➢ Default coverage - Base plan
❖ Add or remove dependents
❖ Coverage changes-medical, dental, life, cancer
❖ Enrollment form required: Buy-Up Plan, Flex Spending, 30-hr Part-time
❖ Proof of other insurance required to waive coverage
❖ Check mailbox for new card in late December
❖ 2016 payroll deductions start in December--check paystubs!
➢ No changes no change form please!
Contact Benefits at 501.371.4518 or 501.371.4578
or email HRBenefits@littlerock.org