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Janet, Janet & Suggs- 2018 - Open Enrollment

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Katie Trinh

on 23 October 2018

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Transcript of Janet, Janet & Suggs- 2018 - Open Enrollment

2018 Open Enrollment
presented by:
Meeting Agenda

Healthcare 101
Insurance Definitions
Preventive Services
CareFirst
HealthyBlue HMO HSA Silver $2,000
HealthyBlue Advantage HSA Silver $2,000
HealthyBlue PPO HSA Silver $2,000
BlueRewards
CareFirst Resources
HSA - What is it? How does it work?
Rx Management
Know Where to Go
Dental & Vision
Life & Disability
Insurance Definitions
Deductible
Amount you pay before insurance starts to pay
May be different for certain benefits (i.e. Rx drugs)

Co-insurance
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 which can be used for qualified medical expenses
Funds roll over year to year
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
Know Where to Go
Know where to go
when you need medical
care and receive the best
treatment with the lowest
out-of-pocket costs.
HealthyBlue HMO Network
CareFirst Dental
Guardian Dental
Open access / no referrals
PCP selection is required
CareFirst Service Area: MD, DC, Northern VA

In-network:
BlueChoice network in the service area

Out-of-network:
BlueChoice plans include the BlueCard program for out-of-area (OOA) emergency and urgent care situations (visit an OOA Participating BCBS physician or hospital for ER or Urgent care and receive in network level care)
Potomac Contacts
Dedicated Team:
Jon Lee- Account Manager
Stephanie Williams- Director, Account Management
greenteam@potomacco.com

Milton Foster – Executive Vice President
mfoster@potomacco.com

Joseph Appelbaum - President
ja@potomacco.com

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 Janet, Janet & Suggs' Rx plan, resulting in the lowest cost. After the deductible has been met, members will pay a $0 copay for generic prescriptions
*PCMH provider selection required to participate in the BlueRewards program (except employees outside CareFirst Service area.
HealthyBlue HMO HSA Silver $2,000
Below is only a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

Guardian
Vision
Next Steps
Open Enrollment will run from 8/2/18 - 8/20/18
ALL staff members MUST access Payroll Network to make plan selection
To prevent disruption, all enrollments must be completed by 8/20/18 (
no exceptions
)
If you need one on one assistance, please see Kim O'Brien

HealthyBlue PPO Network
Open access / no referrals
PCP selection is NOT required*
CareFirst Service Area: MD, DC, Northern VA

In-network:
CareFirst PPO network in the service area
BlueCard PPO network out of the service area

Out-of-network:
Non-participating providers
*PCMH provider selection required to participate in the BlueRewards program (except employees outside CareFirst Service area.
HealthyBlue PPO HSA Silver $2,000
Below is only a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics
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 let your account grow.
Annual HSA Contribution Limits
Annual contribution limits are set by the IRS. The amounts shown below reflect both employee and employer contributions.
Contributions above the annual limit are subject to income tax and tax penalty
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

not

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

not

enrolled in Medicare
You do
not

receive health benefits under TRICARE unless for disability
You have
not
received Veterans Administration (VA) benefits within the past three months
You

cannot

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

cannot

be covered by a health care FSA or HRA (dependent care FSA is allowed and available)
HealthyBlue Advantage Network
Open access / no referrals
PCP selection is NOT required*
CareFirst Service Area: MD, DC, Northern VA

In-network:
BlueChoice network in the service area
BlueCard PPO network out of the service area

Out-of-network:
CareFirst PPO network and non-participating providers in the service area
BlueCard participating network and non-participating providers outside the service area
*PCMH / PCMH+ provider selection required to participate in the BlueRewards program (except employees outside CareFirst Service area.
HealthyBlue Advantage HSA Silver $2,000
Below is only a brief overview
See detailed Summary of Benefits or Evidence of Coverage for more specifics

Online Access –
www.guardiananytime.com
Once registered with your own ID and password you will have direct access to your dental benefits
Provides quick access to:
Find a dentist
Your Plan Coverage
Check a claim
Common Questions & Answers
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:

Age
Gender
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.
CareFirst
Blue Rewards Incentive Amounts
With Blue Rewards you have the opportunity to earn financial incentives for taking an active role in your health. By completing (4) four important steps and achieving certain health measures, you and your covered spouse/domestic partner can each earn up to $300.
For more information, visit
carefirst.com/bluerewards
CareFirst Resources
Let's take
a closer look...
CareFirst Online
On-Line Access for CareFirst Members through “MyAccount”
Once Registered with your own ID and password, you will be able to:
View the status of your claims
View your benefits
Determine you out-of-pocket costs
Provides quick access to:
Prescription Drug Information
Health & Wellness Information
The link to your Further Account
Resource for Medical news, CareFirst news and a whole lot more
Find a DOC at www.carefirst.com
Logging into CareFirst
Treatment Estimator Tool
Prescription Pricing Tool
View Claims
Explanation of Benefits (EOB)
Mobile App for Members
Members can:
Verify eligibility
View benefits
View claims status
View your Balance in Further
Go Green - Review and Print EOBs
Track out-of-pocket expenses (deductible balance)
Compare drug prices, check generic availability
Update Coordination of Benefits information (COB)
Find A Provider
Urgent Care
FirstHelp® Nurse Hotline
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
Administered by Further
Guardian
Voluntary Life / AD&D
Voluntary Employee Life:

Maximum Benefit:
$500,000
Guarantee Issue:
$100,000
Age Reduction Formula:
35% at age 65
60% at age 70
75% at age 75
85% at age 80
Accelerated Benefit:
50% of benefit amount
Voluntary AD&D:
Maximum Benefit: $500,000

Spouse Life:
Benefit:
50% of EE amount
Maximum Benefit:
$250,000
Guarantee Issue:
$25,000

Spouse AD&D
Benefit:
50% of EE amount
Maximum Benefit:
$250,000

Child(ren) Benefit
Maximum Benefit:
$10,000

Child(ren) AD&D:
Maximum Benefit:
$10,000

Basic Life / AD&D
Life/AD&D Employee Benefit:
Class 1:

$200,000
|
Class 2:

$100,000
|
Class 3:

$50,000

Age Reduction Formula:
Age 65: 35%
Age 70: 50%

Accelerated Benefit:
Benefit %: 50% of coverage level
Voluntary Disability
Voluntary Short-Term Disability

Benefit:
60% of weekly salary

Maximum benefit:
up to

$1,500

Benefits begin:
15th day accident/sickness

Duration:
11 weeks
Voluntary Long-Term Disability

Benefit:
60% of monthly salary

Maximum benefit:
up to $5,000

Elimination Period:
90 days

Duration:
To age 65 / SSNR
Full transcript