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The State Health Plan for Teachers and State Employees

This presentation contains audio . Please make sure your speakers are on. The State Health Plan for Teachers and State Employees. 2011 Annual Enrollment. Topics. Comprehensive Wellness Initiative: Tobacco Cessation Component Weight Management Component Rate and Coverage Changes

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The State Health Plan for Teachers and State Employees

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  1. This presentation contains audio. Please make sure your speakers are on. The State Health Plan for Teachers and State Employees 2011 Annual Enrollment

  2. Topics • Comprehensive Wellness Initiative: • Tobacco Cessation Component • Weight Management Component • Rate and Coverage Changes • Enrollment Procedures: • Paper • BEACON • HRInTouch / eBenefitsNow • State Retirement System • Health Plan Resources • Benefit Extras

  3. The Comprehensive Wellness Initiative (CWI) • Legislated by Senate Bill 287* (Session Law 2009-16) • Developed to: • Help members quit using tobacco • Help members achieve and maintain a healthy weight • Lower the health costs associated with tobacco use and obesity • Tobacco Cessation component started: • July 1, 2010 • Weight Management component starts: • July 1, 2011 Note: The Comprehensive Wellness Initiative does not include members who have Medicare as primary coverage. * http://www.ncleg.net/Sessions/2009/Bills/Senate/PDF/S287v8.pdf

  4. CWI: Action Required ALL subscribers who do not have Medicare as their primary health coverage -- and their covered dependents – will be moved to the 70/30 Basic plan effective July 1, 2011. If you wish to enroll in the 80/20 Standard plan, your action is required!

  5. Requirements to Enroll in theStandard 80/20 Plan You need to declare on an Attestation Form that you and your covered dependents: • Do not use tobacco and have a Body Mass Index (BMI) less than 40, or • Qualify for exemption due to participation in a tobacco cessation program and/or weight management program, or • Have a medical condition that prevents you from obtaining a healthy weight. For information on how to determine your BMI go to www.shpnc.org

  6. Completing the Attestation Form • The Attestation Form: • A legally binding document • Subscribers must complete each year to enroll in the 80/20 Standard plan • Subscribers complete Attestation Form through the enrollment process used by their employing unit: • Online • Paper For instructions, see the SHP website www.shpnc.org

  7. To Remain in 70/30 Basic Plan Subscribers who want to remain in the 70/30 Basic plan, do not have to complete an Attestation Form during Annual Enrollment. Subscribers who do not submit a completed Attestation Form will remain in the 70/30 Basic plan, along with any covered dependents.

  8. Physician Certification Form • Members applying for an exemption to enroll in the 80/20 Standard plan must: • Participate in a tobacco cessation and / or weight management program • Have a medical condition that prevents them from obtaining a healthy weight • Upon request: • Complete the Physician Certification Form, and • Have that form signed by their provider • Or obtain a letter of enrollment (LOE) from QuitlineNC

  9. Physician Certification Form • The Physician Certification Form is available on the State Health Plan website at www.shpnc.org. • You do not need to submit the Physician Certification Form at the time of Annual Enrollment! • Submit it if the Plan requests it.

  10. Rates

  11. Rates • Rates are determined by the General Assembly • To date no decision has been made on rates for the upcoming benefit year • Rates remain unchanged

  12. Rate Chart

  13. Benefit Changes for 2011/2012 Benefit Year

  14. Grandfathered Plan Status • The Patient Protection and Affordable Care Act (the Affordable Care Act): • Signed into law March 23, 2010 • This State Health Plan believes this plan is a “grandfathered health plan” under the Act • Grandfathered plans may: • Preserve certain basic health covered already in effect on March 23, 2010 • Not be required to include certain consumer protections of the Affordable Care Act (ex: preventive health services without any cost sharing) • Grandfathered plans must comply with other provisions of the Affordable Care Act

  15. Preventive Care • Will continue to be covered as it is today • Based on location: • In-network physician’s office = appropriate copay • Outpatient hospital setting = deductible & coinsurance will apply

  16. Questions on Grandfathered Provisions? • Call Customer Services at 1-888-234-2416 • Contact the U.S. Department of Health and Human Services at www.healthreform.gov

  17. Coverage of Dependent Children up to Age 26 • Effective July 1, 2011 the State Health Plan will cover dependent children up to age 26 regardless of: • Student status • Marital status • Residence • Employees can add dependent children who were previously ineligible. • Note: The covered dependent child cannot be eligible for other employer-sponsored health coverage.

  18. Removal of Waiting Period for Pre-existing Conditions Beginning July 1, 2011, pre-existing condition waiting periods will be removed for members under the age of 19.

  19. Hearing Aids • Coverage of hearing aids and fitting for members 22 years of age and younger • One hearing aid per impaired ear up to $2,500, once every three years

  20. Questions? Call Customer Service at 1-888-234-2416 • New Customer Service Features for Long Wait times: • Virtual hold: Select this option to have a Customer Service Rep call you back • Rendezvous: Select this option to make an appointment for a Customer Service Rep to call you back

  21. Annual Enrollment

  22. Key Dates • All members should receive an Annual Enrollment kit by May 9th • Annual Enrollment kits are also available on the State Health Plan website at www.shpnc.org. Annual Enrollment: May 9 to June 8

  23. Important Points to Remember During Annual Enrollment, you can: • Enroll in the State Health Plan • Switch plans • Update personal information • Remove dependents, or • Add dependents . . . without a qualifying life event. (This includes dependent children up to age 26.)

  24. Important Points to Remember Once you choose your benefit option, you may not switch plans until the next enrollment period. The coverage tier you select will remain in effect until the next enrollment period, unless you experience a qualifying event: • Marriage • Birth • Death • Retirement

  25. Important Points to Remember To enroll in the 80/20 Standard Plan, you must complete an attestation form. If you wish to remain on the 70/30 Basic Plan, you do not need to do anything.

  26. Benefit Year The benefit year runs from July 1 – June 30 each year July 2011

  27. Enrollment Procedures • Paper Enrollment Forms • BEACON • HRInTouch/eBenefitsNow • State Retirement System • Don’t Know

  28. Enrollment Procedure Agencies that Enroll By Paper

  29. Annual Enrollment Changes Changes must be made between May 9 & June 8. Refer to your Annual Enrollment Kit. NOTE: If you choose to do nothing during Annual Enrollment, you and any covered dependents will be on the 70/30 Basic plan effective July 1, 2011.

  30. Annual Enrollment Changes • Members actively employed by agency with State Health Plan benefits must return the Annual Enrollment and Attestation Forms to their Health Benefits Representative (HBR) by June 8, 2011. • Members who are no longer actively employed but receiving benefits through COBRA, RIF or as a surviving member should follow the instructions in their annual enrollment kit as to where they should send their Annual Enrollment and Attestation forms by June 8.

  31. BEACON Enrollment Procedure

  32. Annual Enrollment Changes Changes must be made between May 9th and June 8th through the BEACON system. NOTE: If you choose to do nothing during Annual Enrollment, you and any covered dependents will be on the 70/30 Basic plan effective July 1, 2011.

  33. Instructions for Enrolling on the BEACON System • Find instructions: • On the State Health Plan website at www.shpnc.org. • On the BEACON website at https://mybeacon.nc.gov • For BEACON assistance, call BEST Shared Services • In the Raleigh area: 707-0707 • Outside the Raleigh area: 1-866-622-3784

  34. HRInTouch/eBenefitsNow Enrollment Procedure

  35. Annual Enrollment Changes Changes must be made between May 9th and June 8th through the InTouch/eBenefitsNow system. NOTE: If you choose to do nothing during Annual Enrollment, you and any covered dependents will be on the 70/30 Basic plan effective July 1, 2011.

  36. Instructions for Making Changes • Find instructions: • On the State Health Plan website (www.shpnc.org). • Verify your address • For login or site navigation questions, call 1-855-859-0966.

  37. State Retirement System

  38. Annual Enrollment Changes • Changes must be made between May 9th and June 8th through the ORBIT system. • If State Health Plan is your primary coverage, and you wish to enroll on the 80/20 Plan you must enroll and complete an attestation. NOTE: If you choose to do nothing during Annual Enrollment, you and any covered dependents will be on the 70/30 Basic plan effective July 1, 2011. • Need help? Call Customer Services: • 1-888-234-2416.

  39. Instructions for Making Changes • All changes must be made electronically • Find instructions: • On the State Health Plan website at www.shpnc.org HR InTouch/ eBenefits Now ORBIT • If unable to enroll electronically, contact Customer Services at 1-888-234-2416.

  40. Instructions for Making Changes • For login questions to ORBIT • In the Raleigh area: 733-4191 • Toll-free outside the Raleigh area: 1-877-733-4191 • For questions about HR InTouch/eBenefitsNow, call 1-855-859-0966.

  41. Health and Wellness Programs and Benefits

  42. What is NC HealthSmart? • Disease and Case Management (DM/CM) Coaching • Maternity Coaching • Tobacco Cessation Support • Weight Management/Nutrition Support • Lifestyle Health Coaching • Personal Health Portal • Worksite Wellness and Health Promotion The State Health Plan’s healthy living initiative, offering*: Call: 1-800-817-7044 Visit: www.shpnc.org * Members eligible for NC HealthSmart services are members whose primary health coverage is through the State Health Plan. 1-800-817-7044 | www.shpnc.org

  43. Disease and Case Management Disease Management Coaching /Case Management is available to eligible members with: Chronic diseases (heart disease, diabetes, etc.) and/or Serious health conditions (cancer, car wreck, etc.) • Nurse Coach works one-on-one with you to: • Help you understand your condition, • Answer questions about medications, • Understand treatment options, • Explain test results, and • Help you make healthy changes. 1-800-817-7044 | www.shpnc.org

  44. Disease and Case Management • Disease/case management nurse coaching available at 1-800-817-7044 or www.shpnc.org: • 8:30 am until 11:30 pm, Monday-Friday; • 10 am until 2 pm, Saturdays • 24-Hour nurse line available at 1-800-817-7044 • Specialty case managers are available to members with chronic kidney disease and end-stage renal disease. Call 1-800-577-3625. 1-800-817-7044 | www.shpnc.org

  45. Maternity Case ManagementGive your baby a healthy start! Maternity coaching available to eligible members Your Nurse Coach will guide you through your pregnancy Nurse coaching available at 1-800-817-7044: 8:30 am to 11:30pm, Monday-Friday; 10 am to 2 pm, Saturdays 1-800-817-7044 | www.shpnc.org

  46. Tobacco Cessation Support QuitlineNC: 1-800-QUIT-NOW (1-800-784-8669) Partners: NC Division of Public Health and NC Health and Wellness Trust Fund (HWTF) • Access FREE coaching to all North Carolinians • Create a plan & help you stick to it • Obtain free nicotine replacement patches available to members enrolled in the multi-call program • Call 8 am – 3 am, 7 days a week, English/Spanish 1-800-817-7044 | www.shpnc.org

  47. Tobacco Cessation Support Medical & Pharmacy Benefits • Tobacco cessation counseling by primary care & behavioral health providers • Tobacco cessation medications 1-800-817-7044 | www.shpnc.org

  48. Weight Management Medical & Pharmacy Benefits • All members receive 4 nutrition visits with a network dietitian each year for a primary care co-pay. • Members with diabetes receive 6 nutrition visits each year for a $0 co-pay. • Access to weight loss strategies, tools and healthy recipes through the Personal Health Portal at www.shpnc.org. • Telephonic and online coaching to help you to manage your weight (1-800-817-7044) • FDA approved prescription medications covered. • Bariatric Surgery at a Blue Distinction Centers 1-800-817-7044 | www.shpnc.org

  49. Wellness Supports • Lifestyle Coaching • Health Coach helps you choose your own healthy goals & achieve them! • Personal Health Portal • One-stop for health information, tools, resources • Personal Health Record for you & your family • Personal Health Assessment and Action Plan • Expansive health information library • Email your coach • Healthy recipes • And much more! 1-800-817-7044 | www.shpnc.org

  50. Don’t Delay! • Call 1-800-817-7044 today to learn more about your resources or reach a Coach. • Log on to www.shpnc.org for access to your Personal Health Portal. 1-800-817-7044 | www.shpnc.org

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