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Guernsey South - 2018 OE

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Katie Trinh

on 12 October 2018

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Transcript of Guernsey South - 2018 OE

Open Enrollment
Presented by:
Healthcare 101
Insurance Definitions
Preventive Services
Kaiser HDHP HSA $2,000
$1,350 - New Plan
Kaiser HMO Signature
KP Flex Choice Plan
Kaiser Resources Resources
HSA – What is it? How does it work?
Rx Management
Dominion National Dental
The Standard Life & Disability
Flex Spending Account
Meeting Agenda
Insurance Definitions
Amount you pay before insurance starts to pay
May be different for certain benefits (i.e. Rx drugs)

Amount of charges for a service that you are required to pay

Out-of-Pocket Limit
Maximum amount you pay for covered services in a year
Often (but not always) includes deductible, co-insurance and co-payments

Health Savings Account (HSA)
Only available to those enrolled in a high deductible health plan
Tax-free dollars can be used for qualified medical expenses
Funds roll over year to year
Insurance Definitions Continued
Health Reimbursement Account (HRA)
Funded only by the employer
Only available to those enrolled in a high deductible health plan
Use for qualified medical expenses

How health care works outside an Integrated Health Care Model
Kaiser Resources
Signature Network Overview
Everything all under one roof
The right care, at the right time
Dominion National Dental
Reviewing the Health Savings Account
What you should know about an HSA
What is a Health Savings Account?
HSA eligibility requirements
Annual HSA contribution limits
How you can use the HSA
What you should know about the HSA
What is a Health Savings Account?
You can open and fund the HSA to pay the plan deductible and other qualified health care costs - or you can l your account grow.
Annual HSA Contribution Limits
Annual contribution limits are set by the IRS
Contributions above the annual limit are subject to income tax and tax penalty
How you can use the HSA
How you can use the HSA
Other qualified expenses
HSA Eligibility Requirements
You may be eligible to open an HSA if:
You are covered by a qualified high deductible health plan.
You are


covered by any other non-high deductible health plan, such as a spouse’s plan.
You are


enrolled in Medicare.
You do


receive health benefits under TRICARE.
You have


received Veterans Administration (VA) benefits within the past three months.


be claimed as a dependent on another person’s tax return.


be covered by a health care FSA or HRA (dependent care FSA is allowed and available).
2018 Voluntary Long Term Disability - The Standard
*Voluntary Long Term Disability Benefits is available to all full-time employees for an additional cost.

The EMPLOYEE pays 100% of the cost for the following:

Voluntary LTD:
60% of annual salary up to a monthly maximum of $10,000
180 day waiting period before benefits start,
Benefits are payable to age 65 with continued disability,
First two years of disability are based on your occupation.
Rates are age Banded
Includes access to the EAP

In a fee-for-service world, care is fragmented which forces patients to:
Coordinate their own care
Visit or call various locations for services
Pay multiple copays
More time away from office
Health care services are delivered by approximately 900 Mid-Atlantic Permanente Medical Group, P.C. (MAPMG) providers who practice exclusively in 30 Kaiser Permanente Medical Centers.

Free language services are available to members
Interpreters are available 24/7 via phone
Certified bilingual physicians and staff in some medical centers
Because we know across the hall is easier than across town you have hassle-free access to the following at multiple Kaiser Permanente locations:
Primary care, OBGYN, Pediatrician
Specialty care
Laboratory services
Easy to schedule or change routine appointments online, by phone, or mobile app
Save a trip to the doctor and copay when you email your questions
30 convenient locations throughout MD, DC, and VA
24/7 access to medical advice
Emergency care coverage anywhere in the world
Digital Tools
KP Mobile App – access to your health from anywhere in the world

Email your doctors office with questions
Schedule or change routine appointments
Find a medical center

NEW! Video Chat with an emergency trained physician from any mobile device with video capabilities and save a trip to the Urgent Care/Emergency Room and a copay
Video Chat
How it works
Patient calls nurse hotline (available 24/7 – 365 days a year)
Nurse will ask questions about your health care issue to determine best course of action
If your condition & symptoms are a fit for a video chat (i.e. flu symptoms/aches & pains, rash/skin condition, visible eye condition, extremity injuries), you will do the following:
Schedule an appointment with the support staff to speak to an emergency trained physician, either immediately or for a later time
Your video chat link is sent via email, you will log into the video chat at your scheduled time (device with video capability required)
Once logged in, you will have a real time video chat with an emergency physician who will either help you resolve your health care issue or make you an appointment for a follow-up
Kaiser HMO Signature
Below is a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

Below is a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

Kaiser HDHP HSA $2,000
Below is a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

Kaiser Flex Choice Plan
Below is a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

NOTE: If you are not eligible to open an HSA, you may still receive reimbursement for up to $500/single, $1,000/family of deductible expenses through a Health Reimbursement Arrangement (HRA)

You will need to enroll in the Kaiser HDHP $1,350 or $2,000 plan to be eligible
The HRA is not a bank account, but rather a reimbursement arrangement from Guernsey (promise to pay)

You can submit claims for reimbursement of plan deductible expenses only
Funds allocated to the HRA for you will not rollover to the following plan year
Further information about HRA administration and filing claims will be provided to you following enrollment
The Standard will provide Basic Life & Disability benefits for 2018.
Basic Life Insurance & Short Term Disability is provided to all full-time employees at NO COST.

Guernsey pays 100% of the cost for the following:
Basic Life Insurance and AD&D:
Depending on your Class, coverage will be a flat:
$50,000, $25,000 or $10,000
All enrolled employees also receive Travel Assist Benefits

Short Term Disability (STD):
30-day waiting period for sickness or accident
Maternity is covered
60% of weekly earnings to a maximum of $1,000 per week
Benefits are payable for up to 180 days
2018 Basic Life and Disability - The Standard
You must re-enroll in the FLEX plans for the 2018 plan year

$2,650 maximum contribution for health and
$5,000 for dependent care accounts;

Flexible Spending Account administration with Flex Facts– a single debit card will be issued for all available accounts (FSA, Dependent Care, HRA) and participants will have access to real-time account information online. Additional debit cards are available upon request.

Get more information once enrolled in the FLEX Facts FSA plan for the 2015 plan year. Call our customer service department toll free at 877-94-FACTS (32287) between the hours of 8:30 AM and 8:30 PM Monday through Friday, excluding holidays. Send an email support@flexfacts.com; Send a fax to 877-747-8564; By mail at 7 Grant Avenue, Lakewood, NJ 08701
Accessing Your Account On-Line
In order to access your account information on-line:
Go to www.flexfacts.com.
Click on the “Participant Login” button on the top right hand side of the screen.
Your first time logging into your account you will have to click on the “Create Account” button.
Enter in the information requested. You will need the following information
Your employee ID is your Social Security Number
Your employer ID will be provided by your employer
Set up your username and password
Note that your password must be at least 7 characters long and include at least one number and one letter
Kaiser HDHP HSA $1,350
Guernsey will contribute $500 Individual / $1,000 Family towards the HSA
2018 Voluntary Life and AD&D
Additional Life Insurance is available through The Standard for Employee, Spouse & Child(ren)

The EMPLOYEE pays 100% of the cost for the following:

Voluntary Employee Life:
Increments of $10,000 to a maximum of the lesser of $500,000 or 5x your annual salary. $50,000 is guaranteed without Evidence of Insurability.
Rates are Age Banded

Voluntary Spouse Life:
Increments of $10,000 to a maximum of $250,000. $10,000 is guaranteed without Evidence of Insurability.
Spouse amount cannot exceed the Employee amount
Rates are Age Banded and based on the Spouse’s age

Voluntary Child Life:
Increments of $2,500 to a maximum of $10,000. All elected amounts are guaranteed without Evidence of Insurability
Preventive care services are provided during a wellness exam. You and your doctor will determine what tests and health screenings are right for you. The screenings are based on your:

Personal health history
Current health

Examples of Preventive Care:

Wellness visits and standard immunizations
Screenings for blood pressure, cancer, cholesterol, depression, obesity and diabetes
Pediatric screenings for hearing, vision, autism and developmental disorders, depression and obesity

Your provider may invoice for the non-preventive part of your annual preventive exam for treatment of a diagnosis (high blood pressure, diabetes, skin rash, headache, etc.)

Example of non-preventive care during a preventive care visit:
During the preventive visit, member complains of pain/swelling in the knee. The provider codes for both examinations and a cost share will apply to the non-preventive examination of the knee.
2018 Health Plan Pre-Tax Per Pay Contributions
Understanding Your Rx Program
Simple ways to save on Prescriptions:
Know Your Prescription Plan Tiers – understanding the tier system can help you choose high value, low cost medications
Generics – Usually the least expensive option
Mail-order – 90-day supply of maintenance medications for only 2 copays
Pill splitting:

Physician writes you a prescription for 2 times the strength and then you split the tablet - you get your usual dosage for half the cost! (not suitable for all medications)

Over-the-Counter (OTC) Substitutions: Some prescriptions have OTC alternatives - check with your doctor or pharmacy
Generic prescriptions fall under Tier 1 of Guernsey's Rx plan, resulting in the lowest cost. Depending upon your plan, members will pay up to a $20 or $25 copay for generic prescriptions after the deductible where applicable.
Location Overview
Guernsey will contribute $500 Individual / $1,000 Family towards the HSA
2018 Dental Pre-Tax Per Pay Contributions
Synthroid (100 mcg - $34.33) $34.33
Zoloft (50mg - $265.72): $50
Xanax (.5mg - $373.79): $35
Crestor (10mg - $260.60): $50
Generic Equivalent
Brand/Non-Preferred Brand Name vs. Generic Prescriptions
Levothyroxine Sodium ($12.84): $12.84


Sertraline HCL ($2.04): $2.04


Alprazolan ($2.57): $2.57


Simvastatin ($32.58): $20


HMO / Flex
HDHP $1350 / $2000
HMO / HDHP $1350, $2000Flex
Flex Par/Non-par providers
Deductible applies to HDHP $1,350, $2,000
Flex Non-par providers
Potomac Contacts
Dedicated Team:
Sara Martinez – Account Manager | Jon Lee – Account Manager
Stephanie Williams - Director, Account Management
Joseph Appelbaum
Milton Foster
Executive Vice President
Full transcript