2007 Train-the-Trainer for GMS Flexible Benefits - Benefit Coordinators

1. TEAM GEORGIA. READY TO SERVE. 2007 Train-the-Trainerfor GMS Flexible Benefits - Benefit Coordinators STATE HEALTH BENEFIT PLAN GEORGIA DEPARTMENT OF COMMUNITY HEALTH September 2006

2. Open EnrollmentRetiree Option Change Period • October 10 – November 9, 2006 • Mandatory Website Enrollment • All active employees will use one website, www.oe2007.ga.gov, to make their 2007 Benefit Election.

3. SHBP Plan Changes and Updates for 2007 • No changes in Health Premiums or Benefits for 2007. • Kaiser Permanente will be adding a new medical center in West Cobb at the East/West Connector in early 2007. • BlueChoice has added Catoosa, Chattahoochee, Habersham, Heard, Jasper, Murray, Putnam, Rabun, Stewart, Towns, Washington, and Whitfield counties to their service area and removed Taliaferro. • Pharmacy Benefit Drug Co-Payments terminology will change. The Plan still has a Three (3) Tier System. • Tier One (1) represents the lowest co-payment level, • Tier Two (2) represents the mid-level co-payment, and • Tier Three (3) represents the highest co-payment level.

4. SHBP Plan Changes and Updates for 2007 (Eligibility Changes) • Full-time Students, Disabled and Legal Children – whose verification documentation is not submitted by the coverage expiration date will not be eligible for coverage until the following Open Enrollment or unless a Qualifying Event occurs. • Member contributions not remitted by the due date may result in coverage suspension and/or termination. • SHBP will provide members with additional information on these eligibility changes prior to implementation.

5. SHBP Plan Changes and Updates for 2007(Eligibility Changes) • Add a Dependent – you must submit the documentation requested to cover the dependent or the dependent will not be eligible for coverage until the following Open Enrollment or Qualifying Event occurs. • Lose All Dependents –if all covered dependents lose eligibility for coverage, the SHBP will automatically decrease the coverage tier to Employee Only under the member’s current health benefit option.

6. SHBP Plan Changes and Updates for 2007 (Eligibility Changes) • Qualifying Event – You must make the request to SHBP to add an eligible dependent within 31 days prior to or after the Qualifying Event. • Documentation Request – You have 31 days from the date of the Qualifying Event or the date of the request for coverage to SHBP, whichever is later, to provide documentation to SHBP.

7. Open Enrollment Information This year benefit information is available effective September 25, 2006 on the same website employees use to make their Open Enrollment election. www.oe2007.ga.gov.

8. What Should Employees do prior to Open Enrollment? • Read the Health Plan Decision Guide • Read the Summary Plan Description (SPD) • Use the Plan Cost Estimator • Check rates with their employer or on-line • Call or visit their health plan vendor website for information on provider participation • Check with the vendor administering your health plan to verify the tier for each member’s prescribed drugs

9. Where can employees access this information? The information is available from: • Their Employer • www.dch.ga.gov/shbp_plans • www.oe2007.ga.gov

10. SHBP Login Instructions • Go to www.oe2007.ga.gov between 10/10/06 and 11/9/06 • Click on “Register” • Enter the Policy Number and Date of Birth • Select a “Password” • Enter the selected Password • Re-enter the Password to confirm • Select a “Security Question” and the “Answer” to the Security Question

11. SHBP Login Instructions • 3. Click on “Login” • A. Enter your Policy Number • B. Password • This will take the employee to their Flexible Benefits. Once they complete their Flexible Benefits and confirm, they will receive a confirmation number. • When they make their health election prior to printing • their confirmation, they should review the following: • (A) Did they answer the surcharges? (B) Are the answers to the surcharge questions correct? (C) Is the health coverage Option and Tier election correct? (D) Is the dependent information correct?

12. SHBP Login Instructions • Employees should have two confirmation numbers one for Flexible Benefits and one for health insurance. Prior to printing, employees should confirm that all information is correct. Then they should print the confirmation pages or write down both confirmation numbers. The confirmation notices with the latest date prior to the close of OE confirms benefit elections for the 2007 Plan Year.

13. SHBP Login Notes • The Website will be up from 4:00 a.m. to midnight each day during OE. The website closes at 4:00 p.m. on November 9, 2006. • A new “Confirmation Number” will be assigned with each system login and confirmed benefit election change. Be sure employees understand they must answer the surcharge questions each time they make a change.

14. SHBP Login Notes Employees should make their Benefit Elections Early. Delaying entry could cause employees to encounter “traffic” problems on the website and Open Enrollment will not be extended to accommodate these difficulties. For technical difficulty in logging in, contact the Help Desk at 1 – 866 – 676 – 0009.

15. Benefit Coordinator Notes • Employees’ Policy Number is their Social Security Number. • You should review the Decision Guide to understand SHBP options. • There are important changes to eligibility processes • There are no changes in employee premiums or benefits • SHBP will mail retiree personalized change forms to the retiree’s home address.

16. Benefit Coordinator Notes • You should provide SHBP members and interested employees with the following OE information: - Rates - Health Plan Decision Guide (1/1/07 – 12/31/07) (paper or electronic) - Provider directories (encourage employees to call their physician or go to the vendor website) Note: You will receive enough Decision Guides for your SHBP members plus approximately 10% of eligible employees. You may refer eligible employees to www.oe2007.ga.gov for an electronic version of the Decision Guide. SHBP will not distribute provider directories. If you need a small supply, contact each vendor directly.

17. SHBP Vendor Contacts Contact names for each SHBP vendor. • United HealthCare: Kathleen Clifford (770) 300-3509 kathleen_a_clifford@uhc.com • BlueChoice: Traci Lyon, (404) 682-9238 Traci.Lyon@wellpoint.com • Cigna: Valerie Carpenter 404-443-8819 Valerie.Carpenter@cigna.com • Kaiser Permanente: Sheila Leung 404-364-7158 sheila.leung@kp.org. • TriCare Supplement: Pauline Marshall, (800) 638-2610 ext 113; pmarshall@asicorporation.com

18. Benefit Coordinator Notes If you assist an employee in making his benefit election on the website, please print the confirmation page and give to your employee. Employer data entry error is not a Qualifying Event for an employee to change their 2007 Benefit Election Outsourcing of OE activities – any resulting errors from incorrect information by a vendor will NOT be grounds for an “administrative error” and a change of benefit election will not be allowed.

19. New Hire Benefit Elections • New employees hired on or before Nov. 1, 2006, will have to make two benefit elections: one for 2006 benefits and another for their 2007 benefit election. • You must provide new hires with materials about each Plan Year. • Employees not listed on the MEMS Web Availability Cross Reference Report will have to make their 2007 health benefit election on paper. They must complete a Membership/Dependent and Miscellaneous Update Form. • All Membership/Dependent and Miscellaneous Update Forms sent to SHBP must be postmarked by November 9, 2006 to allow time for entry before bills are processed. Forms received after this date will be processed after the January bills run. Holding forms will delay processing. • Forms will not be returned for failure to answer “Surcharge questions” and surcharges will apply to employee’s monthly health insurance premium.

20. Open Enrollment Reports on View Direct SHBP will provide the following reports to assist you in managing OE: 1) MEMS Web Availability Cross Reference Report – • Available no later than October 10 • Lists employees who can make their OE elections on the web Important Note: Employees not listed on this report must make their OE elections on paper using the Membership/Miscellaneous Update Form, SHBP 66-090 (revised 10/05). If you do not have access to View Direct, contact Deborah Sheppard at (404) 463-0212 or dsheppard@dch.ga.gov

21. Open Enrollment Reports on View Direct 2) MEWBNCFM MEMS Not Confirmed on Web Report – • Available October 10 and will be updated nightly. • Will include employees with no current coverage and those who are eligible to use the web and have not confirmed their 2007 benefit election. 3) MEMS SHBP Covered Subscriber & Discontinuation Report – • Available no later than November 17 • May use file to update your personnel and payroll files. It includes the appropriate coverage and deduction information from changes made during the Open Enrollment Period.

22. Retiree Option Change Period (ROCP) • SHBP mails retirees a ROCP packet. • Retirees can change to any available coverage option during the “Retiree Option Change Period.” • Surcharges do not apply. • Changes become effective January 1, 2007. • An employee must retire after January 1 for any Open Enrollment change to be effective. Retirees who discontinue coverage CANNOT re-enroll for coverage during the Retiree Option Change Period (ROCP).

23. Retiree Option Change Period (ROCP) • Retirees can only add dependents within 31 days of a Qualifying Event: marriage, adoption, new child, loss of other insurance. • Retirees may change to single or drop coverage at any time. • Any ROCP questions: 1-877-246-4190.

24. If You Have Employees Retiring who will be covered as an ERS, PSER, Superior Court or Legislative Retiree… • Employees who retire and will immediately draw a monthly retirement benefit are eligible to continue coverage at the time of retirement if they have coverage at the time they retire. • The retirement system will send SHBP a file giving the date of the first retirement check. • SHBP will automatically transfer the active health coverage to retiree coverage; terminating active coverage.

25. If You Have Employees Retiring who will be covered as an ERS, PSER, Superior Court or Legislative Retiree … • The payroll location must send the last deduction date on a Forms Transmittal Sheet to verify that the enrollment system generated the correct termination date. • SHBP sends a letter to the new retiree offering the opportunity to change options or discontinue coverage within 31 days of retirement. • SHBP will bill the employee for any premium lapse from active to retirement coverage based on the Forms Transmittal reported date.

26. If You Have Employees Retiring who will be covered as an ERS, PSER, Superior Court or Legislative Retiree … • SHBP will bill the retiree directly when the retirement benefit does not cover the premium. • SHBP will bill or refund the retiree for any premiums resulting from the change from active to retirement coverage based on the date reported on the Forms Transmittal Sheet if this creates overlapping coverage. • It is the retiree’s responsibility to make sure health insurance deductions are taken from his check.

27. If You Have Employees Retiring who will be covered as a Teachers Retirement System Retiree … • Employees who retire and will immediately draw a monthly retirement benefit are eligible to continue coverage at the time of retirement if they have coverage at the time they retire. • Employees who will be retiring must complete and submit the Retiree Surviving Spouse Form to SHBP prior to retirement, but no earlier than 90 days prior to retirement. • You may access this form (MS 66-092) at www.dch.ga.gov/shbp_plans.

28. If You Have Employees Retiring who will be covered as a Teachers Retirement System Retiree … • The payroll location must send the last date of deductions on a Forms Transmittal Sheet. • SHBP will bill the retiree directly when the retirement benefit does not cover the premium. • SHBP will bill or refund the retiree for any premiums resulting from the change from active to retirement coverage based on the date reported on the Forms Transmittal Sheet if this creates overlapping coverage. • It is the retiree’s responsibility to make sure health insurance deductions are taken from his check.

29. Normal Health Benefit Form Processing(Changes not related to Open Enrollment) • Routine transactions should be batched separately and attached to a completed Forms Transmittal Sheet and checked “OUTSIDE OPEN ENROLLMENT.” • After Open Enrollment, you will return to normal forms-processing procedures for all health plan coverage updates using the Membership/Miscellaneous Update Form, SHBP 66-090 (revised October 2005).

30. After Open Enrollment is Complete Advise members who have made changes or new members … • To verify information on their identification cards for possible errors • If they selected an HMO, they should contact the HMO after December 1 to select a Primary Care Physician (PCP). NOTE: United HealthCare, does not require a PCP.

31. Payroll Processing Send batched forms directly to the SHBP weeklyduring the Open Enrollment Period. All forms must be postmarked by November 9, 2006 to allow time for entry before bills are processed. Forms received after this date will be processed after the January bills run. Do Not Hold or Fax Forms.

32. Payroll Processing MEMS SHBP Covered Subscriber & Discontinuations Interface will be available by November 17 in View Direct. You may use this file to update your personnel and payroll files as it includes the appropriate coverage and deduction information based upon the elections made by your employees • Review January’s SHBP billing statement to verify that payroll deductions are entered correctly.

33. SHBP Plan Information Pre-Existing Condition Limits • PPO and Indemnity Options have a 12-month pre-existing condition limit. Enrollees may submit a Certificate of Creditable Coverage from their previous insurance carrier to reduce or eliminate the pre-existing waiting period under the plan. • DONOT hold enrollment forms for documentation.

34. High Deductible Health Plan Indemnity Preferred Provider Organization (PPO) (Administered by United HealthCare) SHBP Plan Information(SHBP Plan Options) • BlueChoice HMO • Cigna HMO • Kaiser Permanente HMO • United Healthcare Choice • HMO • TRICARE Supplement

35. SHBP Plan Information • PPO – offers a network of more than 12,900 participating GA physicians and all acute care hospitals in GA. • PPO – offers a national network of more than 424,582 participating physicians and 4,084 hospitals. • To receive the highest level of benefits – 90%, see an in-network participating provider. • Out-of-network benefits are paid at a reduced rate, 60%.

36. SHBP Plan Information • Indemnity – is a traditional fee-for-service plan that generally provides the same benefit coverage regardless of which qualified medical provider you use. • Not all doctors participate and you can be balance billed. • HMOs – SHBP offers four HMOs. To receive benefits you must see a participating provider. You must select a PCP. (exception United Healthcare HMO.) Your PCP must refer you to specialists.

37. SHBP Plan Information • High Deductible Health Plan – in return for lower premiums has a higher deductible that must be satisfied before benefits are payable. If eligible can contribute to a Health Savings Account. • TRICARE Supplement – offered to employees and dependents who are eligible for Tricare and have a DEERS number. The Supplement coordinates with Tricare and has low premiums. • If an employee enrolls in the Tricare Supplement and is not eligible, they will be moved to the PPO Option retroactively to January 1, 2007 and surcharges will apply.

38. Retirees Who Return to Work • Retirees who return to work in a benefits eligible position must enroll as an active employee and discontinue retirement health coverage. • Retirees who return to work have 31 days to re-enroll in retiree coverage when they leave employment, only if they continued coverage while active.

39. Dependent Verification • SHBP requires dependent verification for all new enrollees. Dependents must have the member’s SSN on all documentation. • Acceptable Documents • Marriage License or Tax Return with both signatures (must submit Marriage License to cover step-children) • Birth Certificate with parents’ names listed • Adoption Papers • Notarized Residency Letter and Birth Certificate for step-child • Birth Cards are not acceptable.

40. Dependent Verification: Student Status • Documentation attached to the enrollment forms may not be entered the same day as the form, therefore; the employee may receive a letter requesting documentation of dependent verification. The employee should verify if there is a need for additional documentation from SHBP. Employees may call (404) 656-6322 or 1(800) 610-1863 for information. • DO NOT hold enrollment forms for these documents. • DO NOT send original documents as they will not be returned.

41. Dependent Verification: Student Status • Members must verify dependents’ eligibility at age 19 as a full-time student prior to their benefit expiration date or they will not be eligible after this date until the next OE. • Members will receive a request to recertify student status 90 days prior to the dependent’s birth date. Coverage will end the last day of the month of the dependent’s birth month, if SHBP does not receive the information. You may add eligible dependents at the next OE for the next Plan Year.

42. Dependent Verification: Student Status Full Time Student Verification Example: John is 21 and his birthday is November 2, and he is a full-time student approved through November 30, 2006. To continue coverage past November 30, SHBP must receive a competed student status form and the annual certification from the school’s registrar’s office. If this information is not received by November 30, John will not be eligible for future coverage, if you are retired, or until the next open enrollment if active.

43. Tobacco and Spousal Surcharges • Employees who fill out a paper form MUST answer the surcharge questions. Forms will NOT be returned for failure to answer these questions. • Employees who fail to answer these questions will have the surcharges apply until the next Plan Year: • Unless the spouse enrolls in his/her employer’s health plan, or • Unless tobacco product users complete a cessation program through Kaiser, the American Cancer Society, American Lung Association, or other approved programs listed on the DCH website and provide the required documentation.

44. SHBP Medicare Policy & Coordination of Benefits Active Employees • Georgia State law requires that as long as you are actively employed, SHBP will pay primary benefits. Retirees • Georgia State law requires that SHBP pay benefits after Medicare has paid (Georgia Code 45-18-2). • SHBP will calculate premiums and claim payments based upon Medicare enrollment for retirees over age 65 or those eligible for Medicare due to disability. • SHBP will coordinate benefits for members who are enrolled in Medicare (A, B, or D). • SHBP will pay primary benefits on members not eligible or not enrolled in Medicare. • Higher Premiums will be charged for each part of Medicare for which you are not enrolled.

45. For More Information about Medicare • www.cms.hhs.gov/medicarereform • www.medicare.gov • www.ssa.gov • 1-800-669-8387 (Georgia Cares) • 1-800-633-4227 (Medicare) Do NOT call SHBP for answers to Medicare Questions.

46. Thank you! STATE HEALTH BENEFIT PLAN GEORGIA DEPARTMENT OF COMMUNITY HEALTH