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2014 Benefit Changes. For Union-Represented Employees Fall, 2013. Agenda. Safety Procedures New Resources New Medical Plan for 2014 New Resources - where to get more information What’s changing? New Plan Design for 2014 Some examples Question and Answer. Safety Procedures.
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2014 Benefit Changes For Union-Represented Employees Fall, 2013
Agenda • Safety Procedures • New Resources • New Medical Plan for 2014 • New Resources - where to get more information • What’s changing? • New Plan Design for 2014 • Some examples • Question and Answer
Safety Procedures • Where is the nearest emergency exit? • Duck, cover, and hold for an earthquake • Who knows CPR/First Aid? • Who can call emergency responders? • Who can meet/greet first responders?
New Resources Provant – Your One-Stop Shop for Health and Wellness Questions Talk to a health advocate for: • Billing Questions • New Health Account Plan questions • Dental or Vision Plan Questions • Questions about health screenings, health accounts • PROVANT • Phone support: • 866-271-8144, M-F, 5am-5pm. Pacific Time • Email support: • PGEsupport@provanthealth.com
New Resources • Details on the new Anthem and Kaiser HAP for 2014 • Accessed from any computer with internet access • What to expect at the doctor and pharmacy on your first visit in 2014 • How to use your different cards • Where to get more information as you use the plans New Website: www.mypgebenefits.com
What’s Changing? What Isn’t Changing? What Is?
What’s Changing? Rules for Covering Children • Children can be covered under your PG&E medical, dental and vision plan until their 26th Birthday • They no longer have to be • students • unmarried • your tax dependent • They can be employed and be offered benefits (New)
New Medical Plan for 2014 • The Health Account • All active employees enrolled in Anthem or Kaiser will have a Health Account • Both the Anthem and Kaiser PG&E plans for active employees will be called the Health Account Plan, or HAP
New Medical Plan for 2014 • Earning Health Account Credits • Automatically receive initial credits into your account each year on January 1st • Earn more credits by taking a health screening, testing tobacco-free or completing a telephonic tobacco cessation program • Amount you get depends upon whether you have single or family coverage • Account is entirely funded by PG&E • No individual results are shared with PG&E
New Medical Plan for 2014 • The Health Account Health Account Deposits Single Coverage Family Coverage Remember: If you don’t use all your credits in one year, they roll over
New Medical Plan for 2014 • Earning Health Account Credits • Health Screening consists of four tests: • Weight/Height to get BMI • Blood Pressure • Glucose Level (non-fasting) • Cholesterol Level • Tobacco use test is optional anddone with an oral swab • Tobacco users can skip the tobacco use test and complete a tobacco cessation course with Provant to earn credits Employees with family coverage will earn credits for their entire family – their dependents do not need to do a screening to earn credits
New Medical Plan for 2014 • Health Screenings and Tobacco Use Test • Available at many PG&E locations beginning October, 2013. Also available through concierge screening at home or office • Can do screenings at doctor’s office, but must then walk into an on-site screening to get tobacco use test • Results are posted to Provant’s website under your secure login • Incentive credits will be posted to your Health Account approximately 4 weeks after you take your screenings, but screenings done before January 1, 2014 will not be posted until January 1, 2014. • Have from October 1, 2013 to September 30, 2014 to earn incentive credits for 2014 plan year
New Medical Plan for 2014 • Health Screenings and Tobacco Use Test • Three ways to get a Health Screening/Tobacco Test • On-site event: enroll online at www.provantevents.com/pge or call Provant • Concierge: call Provant at 1-866-271-8144 to schedule at your home or office • Take a form to your doctor: doctor’s offices don’t do tobacco screenings; you’ll need to walk into any on-site screening – no appointment needed. Download the screening form from www.mypgebenefits.com • Check for your results at www.provantonline.com
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works • Using Health Account Credits • Pay for plan deductibles and other out-of-pocket expenses • Credits can be used for: • medical, dental and/or vision expenses • for you or your family members • unused credits roll over year after year and can be used for PG&E Retiree Medical Plan expenses • You can still contribute to a Health Care Flexible Spending Account (FSA)
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works • Using Health Care Flexible Spending Account • Still a “use-it-or-lose-it” account • Will work with the Health Account • Administrators: • Your Spending Account (for Anthem Blue Cross members) • Kaiser (for Kaiser members) • Will automatically use the Health Care Flexible Spending Account first
How the Plan Works – Health Account Debit Cards YSA (Anthem HAP) • Use card to pay expenses for: • Medical • Mental health • Pharmacy • Dental • Vision Kaiser HAP • Use card to pay expenses for: • Kaiser pharmacy • Kaiser medical expenses and mental health expenses automatically taken out of your account after your visit to Kaiser • Submit claims to pay for • Dental • Vision
New Medical Plan for 2014 • 4 free primary care visits per year for every covered family member • First choice for everything from chronic disease management, physicals, everyday ailments • Choose a family doctor who knows you and cares about your “whole person” health • Primary Care Doctors • General or family practitioners (including nurses) • Internal Medicine doctors • Pediatricians • OB/GYNs • Urgent care • How the Health Account Plan (HAP) Works
New Medical Plan for 2014 • Other Free Services • Some free preventive screening services (e.g., mammograms, pap smears, colonoscopies, immunizations) • Some free prescription drugs for preventive care and chronic conditions (e.g., insulin for diabetes) • Free maternity and well-baby office visits to age two Go to www.mypgebenefits.com for lists of which preventive services and prescription drugs are free • Tip: free doctor visits may include additional tests or services performed during your visit – these are covered, but may not be free
New Medical Plan for 2014 • A few terms to understand … • Annual Deductible For services that aren’t free, amount you’re responsible to pay for first before the plan will start to pay Co-insurance You pay a percent of the cost of a medical service Out-of-Pocket Maximum The limit on the amount you have to pay every year for covered services
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works • Annual Deductible • If you have single coverage, annual deductible is $1,000 • If you have family coverage, annual deductible is $1,000 per person but no more than $2,000 for your entire family Remember: if you earn all your Health Account credits, you’ll have enough to pay your whole deductible from your Health Account
New Medical Plan for 2014 • How the Health Account Plan (HAP) Works Coinsurance • You’ll be responsible for either 10% or 20% of the covered cost and the HAP will pay the other 90% or 80% respectively. • There are no copayments under the HAP, so instead of paying a flat $10 or $20 copayment at the time of service, you’ll pay 10% or 20% for services that are not free • But, your expense is limited by the Out of Pocket Maximum….
New Medical Plan for 2014 How the Health Account Plan (HAP) Works Out-of-Pocket Maximum • Limits how much you are responsible for paying every year • Once out-of-pocket maximum is reached, all covered services are free for the rest of the year • Includes all money you spend on covered medical services, prescription drugs and mental health services • Includes credits you used from your Health Account for medical expenses • Includes deductible and co-insurance
New Medical Plan for 2014 How the Health Account Plan (HAP) Works Out-of-Pocket Maximum • If you have single coverage, the annual out-of-pocket maximum is $2,400 • If you have family coverage, the annual out-of-pocket maximum is $2,400 per person but no more than $4,800 for your entire family All covered expenses paid at 100% for the rest of the calendar year
New Medical Plan for 2014 • Things to note about pharmacy • Express Scripts will continue to be the pharmacy provider for Anthem Blue Cross; Kaiser provides pharmacy benefits for its members • Free medications for Anthem HAP must be obtained from Express Scripts mail order • Free medication from Kaiser can be from any Kaiser pharmacy or mail order • Anthem HAP members will have mandatory mail order for many maintenance drugs – drugs you take on a long-term basis • In 2014, can get three fills at a retail pharmacy, then must get the drugs through Express Scripts mail order, or pay 100% of the cost • Can sign up now with Express Scripts mail order if currently enrolled in Anthem • Most narcotics, ADHD drugs and compound drugs are not included – you will continue to have coverage for these at a retail pharmacy
Some Quick Examples of how the HAP Works • Jenny is a PG&E employee, who is married and has 3 children. She has taken her health screening and tested tobacco-free, so she has a total of $2,500 in her Health Account for 2014. • Jenny is pregnant, and will deliver her baby by cesarean section in 2014, which will cost $27,000 dollars. All other family members are healthy, will get check-ups and immunizations, but have no other health needs in 2014. Question: How much will Jenny spend on her family’s health care with the Health Account Plan in 2014?
Some Quick Examples of how the HAP Works Answer: Jenny must pay a maximum of $2,400 for her cesarean delivery (this is her individual out-of-pocket maximum which includes her deductible). • Since she has $2,500 in her Health Account, she can use those credits first and to pay the entire amount • The check-ups and immunizations for her family were covered at 100%. Jenny will have $100 to roll-over to her Health Account in 2015.
Some Quick Examples of how the HAP Works • Jenny is a PG&E employee, who is married and has 3 children. She has taken her health screening and tested tobacco-free, so she has a total of $2500 in her Health Account for 2014. • Jenny is pregnant, and will deliver her baby by cesarean section in 2014, which will cost $27,000 dollars. • Jenny’s husband is on an expensive medication that costs $50,000 per year. Question: How much will Jenny spend on her family’s health care with the Health Account Plan in 2014?
Some Quick Examples of how the HAP Works Answer: Jenny must pay a maximum of $4,800 for her cesarean delivery and her husband’s medication. (Each of them will hit their individual out-of-pocket maximum of $2,400) • Since she has $2,500 in her Health Account, she can use those credits first and then pay $2,300 out of her own pocket. • In addition, if she had a Health Care Flexible Spending Account of $2,300, the amount would be deducted from her pay on a tax-free basis and she would have saved approximately $750 in taxes.
Some Quick Examples of how the HAP Works • Jenny is a PG&E employee, who is married and has 3 children. She has taken her health screening and tested tobacco-free, so she has a total of $2,500 in her Health Account for 2014. • Jenny is pregnant, and will deliver her baby by cesarean section in 2014, which will cost $27,000 dollars. Jenny’s husband is on an expensive medication that costs $50,000 per year, and her son will have a bike accident that will cost $20,000 due to his broken leg. Question: How much will Jenny spend on her family’s health care with the Health Account Plan in 2014?
Some Quick Examples of how the HAP Works Answer: Jenny must pay a maximum of $4,800 for her cesarean delivery, her husband’s medication, and her son’s broken leg. Since Jenny and her husband both hit the out-of-pocket maximum and therefore met the family out-of-pocket maximum of $4,800, all covered expenses for all family members are free for the rest of 2014. • Since she has $2,500 in her Health Account, she can use those credits first and then pay $2,300 out of her own pocket. • In addition, if she had a Health Care Flexible Spending Account of $2,300, the amount would be deducted from her pay on a tax-free basis and she would have saved approximately $750 in taxes.
What do you need to do now? • Schedule a Health Screening to maximize your Health Account credits for 2014 • Look for Open enrollment materials in late October • Review Health Account Plan User Guide that will be sent to you in late December • Visit www.mypgebenefits.com for more information on the new Health Account Plan • Contact Provant with detailed questions 866-271-8144, M-F, 5am-5pm, Pacific Time PGEsupport@provanthealth.com
Thank You Questions? Log onto www.mypgebenefits.com for more information Email PGEsupport@provanthealth.com Or call Provant at 1-866-271-8144 for medical plan questions