Valley View School District 365-U January 1, 2020 Employee Benefits - PowerPoint PPT Presentation

Valley View School District 365-U January 1, 2020 Employee Benefits Open Enrollment Presentation

2020 Open Enrollment Presentation • 2020 Program Overview • Open Enrollment • Special Enrollment Rights • Medical Plan Overview • Prescription Drug Plan Overview • Dental Plan Overview • Vision Plan Overview • FSA / Dependent Care Plan Overview • Recap 2

2020 Program Overview Medical / Prescription Drug BCBS of IL PPO Plan Dental BCBS of IL PPO Plan Flexible Spending and Dependent Care PayFlex Flexible Spending Account PayFlex Dependent Care Account Vision EyeMed PPO Plan Life AD&D Liberty Mutual Life AD&D Plan Long Term Disability Liberty Mutual Long Term Disability Plan 3

2020 Open Enrollment 4

Open Enrollment Process  Open Enrollment Period : December 1 st – December 14 th  Current Enrollment Elections : Medical and Dental elections will automatically continue with no paperwork required. Federal Government requires annual enrollment in Flexible Spending and Dependent Care Accounts. Applications must be completed to enroll in accounts effective January 1, 2020. 5

Open Enrollment Process Enrollment forms can be found at www.vvsd.org . Elections are to be submitted to the Insurance Department no later than Saturday, December 14 th . All elections are effective January 1, 2020 – December 31, 2020 . 6

Open Enrollment Rights During the open enrollment period you are eligible to make the following enrollment changes to the medical and dental programs for a January 1, 2020 effective date:  Elect Coverage Previously Declined  Add Eligible Spouse, Civil Union Partner or Dependents  Terminate Existing Coverage  Terminate Eligible Spouse, Civil Union Partner or Dependents 7

Special Enrollment Rights The only other times during the plan year when you are eligible to make changes to your current election(s) is when the following life events occur:  Birth  Death  Marriage / Civil Union  Divorce / Civil Union Dissolution  Adoption  Loss of Coverage  Eligible Spouse, Civil Partner, Dependents gain or loss of coverage 8

Medical Plan Overview 9

BCBS of IL Medical Program Changes Overview Effective January 1, 2020:  Change to the Emergency Room Copay  Change to the Medical Out of Pocket Maximums  Implementation of a Hearing Aid Benefit 10

BCBS of IL Medical Plan Overview Benefits PPO Plan Network Name PPO Network Level In Network / Out of Network In Network: Contracted Fee ; Out of Network:100% of Medicare; Claim Payment Basis No Balance Billing Balance Billing Applies Deductible Individual $250 / $500 Family Maximum $500 / $1,500 General Coinsurance Health Plan: 90% / 60% Plan Member: 10% / 40% Current : $1,250 / $3,500 Medical Out of Pocket Maximum $2,500 / $7,500 Individual Family Maximum New : $1,500 / $3,750 $3,000 / $8,025 Out of Pocket Eligible Expenses Deductible, Coinsurance, Office Visit & ER Copays The deductible and out of pocket maximums accumulate on a calendar year basis (January 1st – December 31 st ) and therefore reset every January 1 st . Any portion of your in network deductible that is satisfied in the fourth quarter of the year (October, November and December) is automatically credited as satisfied deductible for your next calendar year in network deductible. 11

BCBS of IL Medical Plan Overview Benefits PPO Plan Network Level In Network / Out Network Inpatient Hospital 90% after Deductible / 60% after Deductible Outpatient Surgery 90% no Deductible / 60% after Deductible Office Visit - Primary Care Physician & Specialist Consult $30 Copay / 60% after Deductible Outpatient Diagnostic / Lab Work / Tests 90% after Deductible / 60% after Deductible Hearing Aid Benefit New: 90% after Deductible / 60% after Deductible Exam 1 Per Ear Per 36 Months Aid/Instrument 1 Per Ear Per 36 Months Adult: $2,500 Per Ear / Child(ren): No Maximum Emergency Room Current: $150 Copay then 90% after Deductible (Copay Waived if Admitted to Inpatient) New: $250 Copay then 90% after Deductible Preventive Screenings 100% no Deductible / 100% no Deductible 12

BCBS of IL Medical Preventive vs. Diagnostic Care Both can include physical exams, lab tests, immunizations and prescriptions DIAGNOSTIC PREVENTIVE  Sick office visits  Annual physicals • Checks for disease when  Mammogram due  Well woman exams • ACA you have mandated to a lump & mammograms symptoms or benefit because of a  Travel  Child approved known health • Helps you immunizations immunizations issue stay healthy by checking • Once you find  Blood pressure  Adult approved for disease a health issue medicine before you immunizations feel sick • Subject to  Full body scans  Visit healthcare.gov copays, • 100% no deductibles & for complete list  Other health deductible coinsurance 13 issues 13

BCBS of IL Medical Plan Overview Calendar Year Limits PPO Plan Chiropractic & Osteopathic Manipulation 30 Visits Physical Therapy Services 110 Visits Occupational Therapy Services 28 Visits Speech Therapy Services 19 Visits Additional Speech Therapy Benefits for 20 Visits Treatment of Pervasive Developmental Disorders 14

Prescription Drug Plan Overview 15

BCBS of IL Prescription Drug Program Changes Overview Effective January 1, 2020:  Change to the Drug Copays  Implementation of the Advantage Pharmacy Network  Implementation of Specialty Pharmacy Requirement  Implementation of a Prior Authorization Program  Implementation of a Step Therapy Program  Expansion of the Member Pay the Difference Program  Implementation of Prescription Drug Exclusions 16

BCBS of IL Prescription Drug Plan Overview Benefits PPO Plan In Network Retail Pharmacy (30 Day) Current : Up to a $10 Copay New : $0 Copay Generic Current : Up to a $30 Copay New : Up to a $40 Copay Preferred Brand * Current : Up to a $50 Copay New : Up to a $60 Copay Non-Preferred Brand * Mail Order (90 Day) Mandatory as of 4 th Refill Current : Up to a $20 Copay New: $0 Copay Generic Current: Up to a $60 Copay New : Up to a $80 Copay Preferred Brand * Current: Up to a $100 Copay New : Up to a $120 Copay Non-Preferred Brand * Out of Pocket Maximum $1,500 Individual $3,000 Family Out of Network Retail Pharmacy (30 Day) * Appropriate In Network Copay + 25% Cost of Drug & Balance Billing Mail Order Not Covered Out of Pocket Maximum No Maximum * If a brand name drug is filled and a generic equivalent is available, in addition to the appropriate brand copay, the plan member is responsible for the cost difference between the brand and generic drug. 17

BCBS of IL Prescription Drug Change Effective January 1, 2020 Advantage Pharmacy Network • The retail pharmacy network is changing to the Advantage Network. • CVS is no longer an in network pharmacy and will become an out of network pharmacy . Out of network pharmacy benefits require you to pay the appropriate in network copay + 25% • the cost of the drug and you are subject to balance billing . 18

BCBS of IL Prescription Drug Change Effective January 1, 2020 Advantage Pharmacy Network - Implementation  BCBS will mail impacted members a letter if they currently filling scripts at a CVS pharmacy advising that CVS will be out of network effective 01/01/20. BCBS will provide 2 alternative in network pharmacies in the plan member’s geographic location.  Plan Members can call the CVS pharmacy and request CVS to transfer the current script to an in network pharmacy of the plan member’s choice. Plan members do not need a new script . 19

BCBS of IL Prescription Drug Change Effective January 1, 2020 Specialty Network • BCBS will require plan members to use the mail order Specialty Drug Pharmacy Program administered by AllianceRx Walgreens Prime when filling specialty drugs . • Specialty drugs are high cost drugs which treat complex medical conditions, such as hepatitis C, multiple sclerosis and hemophilia and can include oral, inhaled, injected and infused drugs and are always filled at a maximum 30 day supply per script but the method of delivery will be mail order. 20

BCBS of IL Prescription Drug Change Effective January 1, 2020 Specialty Network - Implementation  BCBS will mail impacted members a letter if they currently filling specialty scripts advising of the requirement to fill the script through AllianceRx Walgreens Prime effective 01/01/20. The letter will provide a dedicated customer service representative’s contact information that can assist with the transition to AllianceRX Walgreens Prime.  Plan Members will utilize the dedicated customer service representative to transfer the specialty script to AllianceRX Walgreens Prime . 21