City of Canon City Benefit Information With Tools, Resources, and Tips 1
Benefits Overview • Medical Benefits: Two PPO Plans, Plans A & B —A is now a “Buy Up” Option (Medical is bundled with Dental and Vision) Plan Administered by Meritain (Meritain processes and pays claims, and provides customer service) The City utilizes the Aetna Choice POS II Network • Meritain Pharmacy Solutions acts as the Pharmacy Benefit Manager (PBM) • Dental Benefit: Administered by Meritain • Vision/Hearing Benefit: Administered by Meritain • Employer-paid Employee, Spouse, Dependent Life/AD&D: Mutual of Omaha • Employee-Paid (Voluntary) Term Life/AD&D • Employer-Paid Short Term Disability: Administered by Meritain • Employer-Paid Long Term Disability: Lincoln Financial • Flex: Rocky Mountain Reserve (Change from Meritain) 2
Medical In-Network Deductible and Out of Pocket Max (Former Amount in Parentheses) Plan A Plan B Calendar Year Deductible Single $400 ($200) $1000 ($500) Family $1200 ($600) $3000 ($1500) Calendar Year Max Single $1500 $4000 ($1500) Family $4500 $12000 ($4500) (Max includes Deductible, Coinsurance and Copays – combined with Prescription Drug Card) 3
In-Network Medical Benefits (Former Amount in Parentheses) Plan A Plan B Office Visit $20 ($15) $40 ($15) Specialist Visit $40 ($30) $80 ($30) Coinsurance (after deductible) 80% 75% (80%) Chiropractic/Spinal Manipulation 80% 75% (15 Visits) After Deductible After Deductible Emergency Services/ 80% 75% Emergency Room Services After Deductible After Deductible 100% of the first $100 100% of the first $100 per Calendar Year per Calendar Year Diagnostic Testing, X-Ray and Lab (Ded. waived), then (Ded. waived), then (Outpatient) subject to Ded., then subject to Ded., then 80% 75% 80% 75% Hospital/Facility Expenses After Deductible After Deductible Mental/Substance Use Disorders $20 ($15) $40 ($15) (Outpatient) 4
In-Network Medical Benefits, Continued Plan A Plan B Wellness Benefit Single 100% of the first $200 per Calendar 100% of the first $200 per Year (Ded. Waived), then Ded, then Calendar Year (Ded. 80% Waived), then Ded, then 75% 100% of the first $300 per 100% of the first $300 per Calendar Calendar Year (Ded. Employee + 1 Year (Ded. Waived), then Ded, then Waived), then Ded, then 80% 75% 100% of the first $400 per 100% of the first $400 per Calendar Calendar Year (Ded. Family Year (Ded. Waived), then Ded, then Waived), then Ded, then 80% 75% Generic: $20 Generic: $20 Retail Pharmacy: 30-day Formulary: $50 Formulary: $50 supply, or 100 unit dose, Nonformulary: $75 (New) Nonformulary: $100 (New) whichever is a greater supply Specialty: $150 (New) Specialty: 25% Coin. (New) Generic: $40 Generic: $40 Mail Order Pharmacy: 90-day Formulary: $100 Formulary: $100 supply Nonformulary: $150 (New) Nonformulary: $200 (New) 5
Monthly Employee Medical/Dental/Vision Premiums and City Contributions Plan A Plan A Plan B Plan B Employee City Employee City Employee $130.62 $740.20 $80.99 $728.88 Employee + One $277.36 $1571.70 $171.96 $1547.66 Family $326.10 $1847.91 $202.18 $1819.65 Across the nation, the average percent an employee pays for single coverage is 18- 20%. The norm he/she pays for dependents is 30%. As a composite, employees typically pay about 25% of their health care premium. Medical inflation is pegged at about 6-8% per year, not even taking into account claims. Employers must try and control steadily rising health insurance costs each and every year, usually by reducing benefits and/or by increasing employee cost. 6
Meritain Portal Aetna Choice POS II Provider Network • Once you have your ID card, register at meritain.com to open an account and gain access to Meritain Connect —there you can see what’s covered, see what you have paid/owe, and access tools and resources • Access the portal from your cell phone/device • Go to Aetna.com/docfind/custom/mymeritain to do a quick search for participating doctors and facilities near you 7
Dental Plan Design (Subject to Usual and Customary Charges) Dental Plan Administered by Meritain $50 Individual Deductible $150 Family Calendar Year Maximum Benefit $1000 Class A — Preventive and Diagnostic: (Ded waived) (Routine oral exams — cleaning, scaling, polishing, 100% x-rays according to Schedule of Benefits, etc.) Class B — Basic Services: 80% (Extractions, oral surgery, fillings, etc.) Class C — Major Services: (Root canals, crowns, cast and gold restorations, 50% etc.) IMPORTANT: A Pre-Determination of Benefits must be submitted prior to receiving any periodontic or prosthodontic services or appliances. If a Pre-Determination of Benefits is not received, benefits will be reduced by 50%, to a max reduction of $250. 8
Vision Plan Design Vision/Hearing Care Administered by Meritain Benefit Description Benefit Vision/Hearing Care 100% Combined Calendar Year Maximum Benefit $300 9
Employer-Paid Life and AD&D Insurance For you (Eligibility requirement of 30 $150,000 hours worked per week): For your spouse: $20,000 Six months and older, $5,000; 14 days to less than six months, For your Children: $5,000; less than 14 days, $1000 Accidental Death & Dismemberment The Principal Sum amount is equal to the amount of your life (AD&D) Benefit Amount insurance benefit 80% of the amount of the life insurance benefit is available to Living Care/Accelerated death benefit you if terminally ill, not to exceed $100,000 10
Free Value Adds Included with Life/AD&D Coverage Assistance for travels over 100 miles away from Travel Assistance home or outside the country Access for you and your loved ones to trained Employee Assistance Program (EAP) professionals and resources for assistance with personal and workplace issues Access for you and your family to discounted Hearing and Discount Program hearing products, including hearing aids and batteries Discounted online will preparation tools through Will Prep “Willing.” Create a customized plan to protect your family and property 11
Voluntary Life and AD&D Insurance Minimum of $10,000; GI 5 times annual salary, up to For you (Eligibility requirement of 30 $100,000; Maximum of $500,000, in increments of $10,000, hours worked per week): but no more than five times annual salary Minimum of 5,000; GI 100% of employee’s benefit, up to For your spouse: $50,000; Maximum of 100% of employee’s benefit, up to $250,000 Minimum of $2,000; GI 100% of employee’s benefit; Maximum For your Children: of 100% of employee’s benefit, up to $10,000 For you, your spouse, and your dependent children. The Accidental Death & Dismemberment Principal Sum amount is equal to the amount of your life (AD&D) Benefit Amount insurance benefit 80% of the amount of the life insurance benefit is available to Living Care/Accelerated death benefit you if terminally ill, not to exceed $100,000 12
Short Term Disability (Administered by Meritain) • Eligibility: 20 hours/week • Waiting Period: Benefits not paid during this waiting period: Accident and illness, 14 calendar days • Daily Benefit: 1/7 of Weekly Benefit • Weekly Benefit: 100% of Basic Weekly Compensation (Basic weekly rate of pay of the employee prior to the date of the disability. Does not include commissions, overtime pay, bonuses, and any other compensation not received as basic wages or salary.) 13
Long Term Disability (Through Lincoln Financial Group) • Eligibility: All full-time active employees working 20 or more hours per week in an eligible class • Maximum Monthly Benefit: 66.67% of salary, up to $6,000 per month • Maximum Benefit Duration: Later of age 65 or SSNRA • Own occupation period: 60 months • Elimination period: 180 days 14
Flex (through Rocky Mountain Reserve) • Moving 1/1/20 from Meritain to Rocky Mountain Reserve • Healthcare FSA with debit card: 2020 maximum of $2750 • Dependent Care FSA: 2020: $2500 per parent if married and filing separately; $5000 if married and filing a joint return • $500 carryover allowed on healthcare FSA — will carry over from 2019 to 2020 with vendor change 15
Measures to Take Advantage of Health Plan and Cut Costs: • Self Advocacy • Prevention & Free Offerings • Network, Portal Usage • Precertifying • Generics • Teladoc 16
Self Advocacy It’s your health and your pocketbook — no one has more incentive than you to take care of both! • Participate and collaborate with your doctor • Take a proactive role in your health care • Demonstrate assertiveness • Do your homework on referrals 17
Self Advocacy Includes “Lifestyle as Medicine”: • Feet= Physical Activity • Forks= Healthy Diet • Fingers= Not Smoking • Sleep= Quantity and Quality • Stress= Dealing with it Effectively • Love= Strong Social Connections 18
Take Advantage of Free Annual Wellness Visit • The ACA provides us one free preventive/wellness visit a year • Establish a relationship with a Primary Care Provider (PCP) and a baseline for health • Detecting health problems at early stages may make them easier and less expensive to treat, not to mention less painful 19
The CDC Recommends the Following Immunizations for Adults (Talk to Your Healthcare Professional About These Vaccines) Flu, Td/Tdap, Shingles, Pneumococcal, Meningococcal, MMR, HPV, Chickenpox, Hep A/B, Hib Haemophilus Influenza Type B 20
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