Wood County Employee Health Benefits Plan Insurance Group Representative Update 2014 Program Year November 7, 2013 Presented By: Pamela Boyer, HR & Benefits Manager Janese Diem, Personnel Coordinator Cheryl Albrecht, Benefits Coordinator 1
Wood County Employee Health Benefits Plan Big Picture Wood County Employee Health Benefits Plan • Board of County Commissioners: Trustees • Agreement extends to other elected officials and appointing • authorities Same benefits for all − Wood County Plan Document: Subscriber Booklet • Summary Plan Description (SPD) − Standard Eligibility Rules, Schedule of Benefits, etc. − Trustees Establish Annual Funding Rates • Self ‐ insured Plan with Trust Fund Agreement − Rates Uniformly applied − Change of Consultant • Mercer: Jason Beaver − 2
2012 Rate Comparison % of Single Average Employer Monthly Average Average Co-payment Report PEPY Funding Premium Deductible Coinsurance Dr/Spec/ER County $ 9,888 85% $ 59.52 $150 $ 250 $10/$10/$35 Mercer $10,460 78% $111 $500 $2,250 $23/$38/$100 $12,401 87% $ 63 $500-1,199 $2,000 SERB 2014 County $ 10,907 Per Employee Per Year (PEPY) is a method of measuring plan costs, includes health & • prescription only Deductible, Coinsurance and Co ‐ payments are based on averages for single contact in ‐ • network Mercer Survey based on large national employers of 500+ employees. PEPY based on PPO • Midwest region, $10,346 for all PPO plans. Schedule of benefits based on PPO plan. State Employee Relations Board (SERB) based on Counties of similar population as Wood • County. PEPY based on self ‐ insured plans, $12,888 for all PPO plans. Schedule of benefits based on all lines of coverage 3
Positive Performance Excellent Plan Design • Low financial participation features to eliminate barrier for care while − instilling some skin in the game Deep discounts using FrontPath Health Network & lower tier drugs − Invested in Employee Wellness since 1989 • Employee base is long term investment: employee retention − “Pay now or pay later” − Manage at low cost − Engaged Employees • Share information upon hire and ongoing − Teamwork when using the trust – it is our money − Informed Trustees • Fair & consistent application − Value & support recommendations from EHBC & Consultant − Centralized Administration • Work with EHBC meeting to keep all informed − Eligibility audits − Excellent network of insurance group representatives − Understand Health Care Reform and affects on Plan − 4
2014 Health Care Reform Changes Health & Prescription Only Removal of Pre ‐ existing Conditions on adults • Removal of Lifetime Limits on Essential Health Benefits • Change in Dependent Eligibility Rules • Cannot condition eligibility on dependent’s eligibility in other − employer sponsored group health plan Continue Grandfathered Health Plan Status • All reforms do not affect the plan − Plan meets Minimum Value & Essential Health Coverage • Requires Communicating Marketplace Notice to All Employees • Full (upon hire) & Part Time employees (within 14 days) − Postponed Shared Responsibility until 2015 • Track hours for Measurement Period to determine eligibility − Report new part ‐ time hires and terminations − 5
Centralized Administrative Functions Roles & Responsibilities Coordinate Countywide Enrollment and Funding • Check reports/applications & enter into data base − Generate funding based on enrollment − • Code, Payroll Deductions & Trust Fund Report information to TPA − • Enrollment & Administrative Fees Confirm changes to employees − • Individual Enrollment Verification forms Balance Monthly Payroll Deductions & Funding − Public Record: Official File in BCC • Office maintains working file (not part of personnel file) − HIPAA Training • Notification requested if transferring duties to new person − 6
2014 Centralized Employee Communication • Distributed Information to All Employees Nov. 1, 2013 2014 Summary Plan Description (SPD) − 2014 Exchange Notification − Individual Enrollment Verification (IEV) − • On ‐ line Access Updated HIPAA Privacy Practices and forms − 2014 Summary of Benefits and Coverage (SBC) & Glossary of Health − Coverage and Medical Terms • Minimum Essential Coverage and Minimum Value • Wellness Programs Waiver and Release • Signature of Receipt due by November 15 Lauren Schall @ BCC − 7
Insurance Group Representatives Role & Responsibilities • Primary Responsibilities 1. Communicate Plan Design & Eligibility to Employees • Notification of All New Hires – Full & Part Time • Initial Eligibility & Wellness Screening • Ongoing 2. Report Enrollment & Funding • Interaction with payroll officer • Determine those on FMLA or other leave status • Document on monthly insurance reports to BCC 3. Distribute & Collect Information/Signatures • One of Many Job Responsibilities − 30 Individual Group Representatives 8
1. Communicate Plan Design • Uniform Eligibility Rules & Plan Design − Plan Document & SPD • Utilize Insurance Checklists − Part Time Employees – New Process • Must provide information within 14 days of employment • Use new part ‐ time form – employee must sign − Full Time Employees • Must provide information within 30 ‐ day Enrollment Period • Conduct Insurance Orientation within FIRST DAY of employment • Use Universal Application Checklist • Signed Checklist provides enrollment in Life Insurance but forfeits enrollment eligibility in other benefits if Application and other requirements are not met within 30 ‐ day Enrollment Period – New Process 9
• Review Checklist with New Part Time Employees hired after 10/18/13 • Report on monthly insurance report 10
1. Communicate Plan Design • Communicate Due Dates in Writing (See Checklist) − Full Time Hire date October 14 • 30 ‐ day enrollment period starts October 14 • Materials due from employee by November 12 • Schedule Wellness Screening & Follow Up within 30 ‐ day Enrollment Period − Required for all Employees & Spouses seeking coverage − Insubordination for employee if employer schedules/advises − Charge for missed appointments w/o 24 hr advanced notice − Spouse does not attend = No coverage Oc t 14 No v 12 De c 2 30 Day E nr ollme nt Pe r iod Hire Date E nd of 30 Day Monthly Insur anc e Comple te App, F or ms E nr ollme nt Pe riod R e por t Due with & We llne ss Sc r e e nings F or ms 11
Review Checklist • with New Full Time Employees hired on 11/1/13 forward Be sure all areas • are reviewed and due dates are communicated Mark dates on • your calendar to follow up 12
1. Communication of Plan • Conduct Exit Interview − Completion of COBRA Personnel Action Report − Check COBRA eligibility − 60 ‐ day election period • Serves as a safety net between coverages − 45 ‐ day grace period for initial premium payment after election • Following payments 30 ‐ day grace period (claims pended) − Same Schedule of Benefits & Funding • 102% of total premium self ‐ paid by enrollee • Share deductible/co ‐ insurance in same calendar year 45-day 60 day e le c tion pe r iod initial payme nt pe r iod Aug 1 Aug 15 Oc t 15 No v 1 Cove r age COBR A E le c tion pe r iod e nds COBR A e ff. Aug 1 te r minate s mailing se nt If no e le c tion made E le c tion r e c e ive d & payme nt made 13
1. Communication of Plan • Certificate of Creditable Coverage − Still required in 2014 by ACA − Documents continuous coverage − Pre ‐ exiting Condition Period waived in new coverage • 63 ‐ day break or less between coverages − Provided in COBRA Notification mailing • Life Insurance Options for Terminal Illness − Medical Waiver of Premium • Disabled before age 60 − Accelerated Death Benefit 14
2. Enrollment & Funding • Monthly Insurance Reports − Due Monday @ 4:29 p.m. following last pay date of month − Electronic Monthly Insurance Report Template available − Plan for delivery time if using currier – plan ahead − Follow up from previous month changes including: • Individual Enrollment Verifications • Terminations of Part ‐ Time Employees • Changes in funding status, self ‐ pay to payroll deduction − Add current changes • Any new or terminated part time employees − Make notation on future reports for ongoing issues − Review applications and forms to ensure information is complete, legible & signed 15
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2. Enrollment & Funding • Greater Review of Eligibility due to ACA − No pre ‐ existing conditions − Unlimited coverage − Stop loss coverage will inquire on hits • Health & Prescription combined in 2014 • Ensure Completion of Appropriate Forms Based on Eligibility − Mandatory Life Insurance – uses checklist − Utilize Eligibility Guide − Sept. – Dec. Enrollees must complete current (2013) and future year (2014) certifications • Spousal Certification • Dependent Certifications 17
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