St Stat ate of Indi diana Emp Employee e Hea Health th Ben enefits Jennifer Peschke Benefits Manager Indiana State Personnel Department
State of of In Indiana A Anthem Be Benefit C Comp omparison Sum ummary of of Be Benefits f for or 2017 17 Wellness CDHP CDHP 1 CDHP 2 Traditional PPO Out of In- Out of In- Out of Out of In-Network Network Network Network Network Network In-Network Network Deductible Single $2,500 $2,500 $1,500 $750 $1,500 Family $5,000 $5,000 $3,000 $1,500 $3,000 Out-of-Pocket Maximum Single $4,000 $4,000 $3,000 $3,000 $6,000 Family $8,000 $8,000 $6,000 $6,000 $12,000 - individual embedded $7,150 $7,150 not applicable not applicable Office Visit 20% 40% 20% 40% 20% 40% 30% 50% Inpatient 20% 40% 20% 40% 20% 40% 30% 50% Emergency Room 20% 20% 20% 20% 20% 20% 30% 30% Urgent Care 20% 20% 20% 20% 20% 20% 30% 30% 0% 40% 0% 40% 0% 40% 0% 50% Wellness and Prevention (no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible) (no deductible)
Prescription Dr Drug g Su Summar ary Retail Mail Retail Mail Retail Mail Retail Mail (up to 30 (up to 90 (up to 30 (up to 90 (up to 30 (up to 90 (up to 30 (up to 90 days) days) days) days) days) days) days) days) Preventive $0 $0 $0 $0 $0 $0 $0 $0 (mandated (no deductible) (no deductible) (no deductible) (no deductible) by the ACA) Generic $10 copay $20 copay $10 copay $20 copay $10 copay $20 copay $20 copay $40 copay 20% 20% 20% 20% 20% 20% 30% 30% Brand, Formulary Min $30 Min $60 Min $30 Min $60 Min $30 Min $60 Min $40 Min $80 Max Max $50 Max $100 Max $50 Max $100 Max $50 Max $100 Max $60 $120 Brand, 40% 40% 40% 40% 40% 40% 50% 50% Min $50 Min $100 Min $50 Min $100 Min $50 Min $100 Min $70 Min $140 Non-Formulary Max $70 Max $140 Max $70 Max $140 Max $70 Max $140 Max $90 Max $180 40% 40% 40% 50% Specialty Min $75, Max $150 Min $75, Max $150 Min $75, Max $150 Min $100, Max $175 (30 day supply) (30 day supply) (30 day supply) (30 day supply)
2017 17 Rate tes Minimum Maximum Minimum Maximum Minimum Maximum Annual Bi-weekly Bi-weekly Bi-weekly Monthly Monthly Monthly Annual Annual Plan Coverage Total Employee Employer Rate Employee Employer Rate Employee Employer Rate Rate Rate Rate Rate Rate Rate Single $50.30 $195.48 $245.78 $108.98 $423.54 $532.52 $1,307.80 $5,082.48 $6,390.28 Wellness Family $83.84 $591.36 $675.20 $181.65 $1,281.28 $1,462.93 $2,179.84 $15,375.36 $17,555.20 Single Wellness $15.30 $195.48 $210.78 $33.15 $423.54 $456.69 $397.80 $5,082.48 $5,480.28 W/ Non-Tobacco Family $48.84 $591.36 $640.20 $105.82 $1,281.28 $1,387.10 $1,269.84 $15,375.36 $16,645.20 Use Incentive Single $64.10 $205.08 $269.18 $138.88 $444.34 $583.22 $1,666.60 $5,332.08 $6,998.68 CDHP 1 Family $124.16 $610.56 $734.72 $269.01 $1,322.88 $1,591.89 $3,228.16 $15,874.56 $19,102.72 CDHP 1 Single $29.10 $205.08 $234.18 $63.05 $444.34 $507.39 $756.60 $5,332.08 $6,088.68 W/ Non-Tobacco Family $89.16 $610.56 $699.72 $193.18 $1,322.88 $1,516.06 $2,318.16 $15,874.56 $18,192.72 Use Incentive Single $148.64 $220.56 $369.20 $322.05 $477.88 $799.93 $3,864.64 $5,734.56 $9,599.20 CDHP2 Family $364.46 $641.52 $1,005.98 $789.66 $1,389.96 $2,179.62 $9,475.96 $16,679.52 $26,155.48 CDHP 2 Single $113.64 $220.56 $334.20 $246.22 $477.88 $724.10 $2,954.64 $5,734.56 $8,689.20 W/ Non-Tobacco Family $329.46 $641.52 $970.98 $713.83 $1,389.96 $2,103.79 $8,565.96 $16,679.52 $25,245.48 Use Incentive Single $361.34 $243.60 $604.94 $782.90 $527.80 $1,310.70 $9,394.84 $6,333.60 $15,728.44 Traditional PPO Family $964.28 $687.60 $1,651.88 $2,089.27 $1,489.80 $3,579.07 $25,071.28 $17,877.60 $42,948.88 Traditional PPO Single $326.34 $243.60 $569.94 $707.07 $527.80 $1,234.87 $8,484.84 $6,333.60 $14,818.44 W/ Non-Tobacco Family $929.28 $687.60 $1,616.88 $2,013.44 $1,489.80 $3,503.24 $24,161.28 $17,877.60 $42,038.88 Use Incentive
Rate te His History
Sc School l Member ersh ship
What Can an B Be Customize ized Eligibility ty • School corporations can define eligible employees as full-time, part-time or minimum number of hours/week. The R he Rate e Split • School corporations shall not pay more than the State; the school corporation employees shall pay at least the amount paid by a State employee. Contributi tions t s to an HSA • Your school can decide if you will contribute, how much you will contribute and which financial institution(s) you will use . Example of State of Indiana employer contributions to State employee HSAs for 2017
What Can annot B Be Chan anged Pla lan Des Design • Plan designs are set by the State. • You must offer all plans to all benefit eligible employees. Inclus lusion ion • All benefit eligible employees in your school corporation must be included. You cannot split out employees by classifications/groups. Dependent t Defin finit ition ion • Definition of dependent is set by the State.
Eligib ligible le De Dependents “Dependent” means: (a) Spouse of an employee; (b) Any children, step-children, foster children, legally adopted children of the employee or spouse, or children who reside in the employee’s home for whom the employee or spouse has been appointed legal guardian or awarded legal custody by a court, under the age of twenty- six (26). Such child shall remain a “dependent” for the entire calendar month during which he or she attains age twenty-six (26). In the event a child: i) was defined as a “dependent”, prior to age 19, and ii) meets the following disability criteria, prior to age 19: (I) is incapable of self-sustaining employment by reason of mental or physical disability, (II) resides with the employee at least six (6) months of the year, and (III) receives 50% of his or her financial support from the parent such child’s eligibility for coverage shall continue, if satisfactory evidence of such disability and dependency is received by the State or its third party administrator in accordance with disabled dependent certification and recertification procedures. Eligibility for coverage of the “Dependent” will continue until the employee discontinues his coverage or the disability criteria is no longer met. A Dependent child of the employee who attained age 19 while covered under another Health Care policy and met the disability criteria specified above, is an eligible Dependent for enrollment so long as no break in Coverage longer than sixty-three (63) days has occurred immediately prior to enrollment. Proof of disability and prior coverage will be required. The plan requires periodic documentation from a physician after the child’s attainment of the limiting age.
Fees Informati ation Fe Fee • Similar to a monthly premium COBRA Administr trati ation • $0.35 per enrolled member per month
Plan lan Administra trati tion on Sta tate • Notify school of any changes to plans (including Open Enrollment) • Sample communications Insuran ance C e Carriers • Send billing inquiries and adjustments. • Administer COBRA School C ool Corpora oration ion • Administration of HIPAA • Administration of FMLA • Comply with ACA Reporting Requirements
Benefit it Eligib ligibilit ility Open Enrollm rollmen ent • Occurs at the same time as Open Enrollment for State employees Benefit changes will be effective on January 1 st • New E Employee ees • Benefits effective on the first day of the month following their date of hire. Terminat ated Employees • Benefits terminate on the last day of the month in which they separate employment.
Sc School l Benefit it C Coordin inator R Role le Communicati ations • Communicate benefit options and open enrollment information for current and new employees. Enrollm rollmen ent • Complete enrollment of current and new employees on medical plans. • Paper applications or Anthem Employer Access Carrier rrier N Not otif ific ication ion • Update carriers with eligibility and plan enrollment information Payroll oll • Inform school payroll of benefit adjustments and verify correct deductions for employees
Addi diti tion onal Benefit its Anthem 360˚ Health program: • 24/7 NurseLine: 888-279-5449 • Condition Care - assisting members in managing symptoms related to the most frequently diagnosed conditions. • Complex Care - reaching out to members with multiple health care issues to offer support and assistance. • Case Management – working with members to achieve health goals designed for specific circumstances, such as a recent hospital stay.
Addit itional B al Benefit its Go365 • An online tool for employees to manage their well-being. • Employees can qualify for the 2018 Wellness CDHP by reaching an Earned Status of Silver in Go365 by August 31, 2017. This means all points must be processed and posted to your Go365 account by the August 31 deadline. • The quickest path to Silver status within the program includes completing the: 1) Health Assessment 2) Vitality Check 3) Action Items recommended within Go365 to take charge of your health.
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