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Enrollment 2010 Plan Year: September 1, 2010 to August 31, 2011 Revised 8/13/2010. 805124 5/06. Today’s Discussion. Why these Plan Designs? PTRx Pharmacy Plan (For HRA and HMO plans) Health Care Plan Options 2010-2011 * CFISD Choice Fund HRA - How CFISD Choice Fund HRA Works
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Enrollment 2010Plan Year: September 1, 2010 to August 31, 2011Revised 8/13/2010 805124 5/06
Today’s Discussion • Why these Plan Designs? • PTRx Pharmacy Plan (For HRA and HMO plans) • Health Care Plan Options 2010-2011 *CFISD Choice Fund HRA - How CFISD Choice Fund HRA Works - CIGNA’s OAP Provider Network - Support and Resources *CFISD KelseyCare HMO - Support and Resources
Why an HRA Plan? • CFISD’s medical plans are self-funded • All claims are paid from a pool of cash • Employees’ premiums + CFISD Contributions • Multiple year claim fund shortages due to: • Increase in large claims • Increase in Out-of-Network utilization • Prior PPO Plan Design: • 2008 – 2009 Plan Year:$ 7,335,639 SHORTAGE • Need for greater cost sharing by participants • A high deductible consumer driven plan option (CFISD Choice Fund HRA Plan) • Larger provider discounts with KelseyCare, the exclusive provider for the CFISD KelseyCare HMO Plan
PTRx Pharmacy Plan 30 Day Retail 90 Day Mail Generic Brand Specialty * For ways to obtain $0 copay generics, see PTRX listing of Prescription Savings Opportunities on the CFISD Insurance Department website.
PTRX Pharmacy Plan (cont.) • RETAIL – The copayment for the 4th fill of a maintenance type drug will be doubled, as an incentive for the member to purchase the drug through the mail service. • BRAND DRUG – If a SaveSmart Generic substitute is available, but declined by the member, the copayment will be doubled. Exception only with medical certification by prescribing physician. • SPECIALTY DRUG – Specialty Drugs are only available for a 30 day supply. • “Life Style Drugs” including, but not limited to, Cialis, Edex Kir, Letairis, Levitra and Viagra are not covered by the plan. • A temporary PTRx ID card is available on the Insurance Department web page.
What is the CFISD Choice Fund (HRA) Plan? • A traditional high-deductible plan with a CFISD -sponsored Fund (Health Reimbursement Account) • Designed to encourage members to insist on quality and value by looking for the best price for services (USE CIGNA’s OAP IN-NETWORK PROVIDERS), and making informed decisions about their health care • Promotes consumerism and awareness of actual costs • Encourages preventive health care services and wellness
CFISD Choice Fund HRA Plan It’s Easy to Receive Care Present CIGNA ID card every time – in- or out-of-network Card includes everything providers need to file a claim on your behalf No paperwork if you stay in-network Track your claims online or with quarterly statements No referrals needed to see a specialist Lower costs from in-network providers (CIGNA’s OAP Network)
Deductible CFISD Choice Fund HRA Plan • Upfront benefit dollars • Funded by CFISD • Automatically pays first $750/$1,500 of medical care * (Unused HRA funds do not carry over to the next Plan Year.) • Covers 100% of expenses for preventive care • Discounted rates when using Open Access Plus (OAP)in-network providers • No payment at time of service for first $750 of medical expenses; no copays* • Tools help you understand the cost of care Health Coverage Preventive Care at 100% Your Contribution Health Reimbursement Account (HRA) *Pharmacy copays still apply
CFISD CHOICE FUND HRA PlanAn Ounce of Prevention . . . and Then Some • 100% coverage for preventive careONLY with In-Network (OAP Network) providers • What is Preventive Care? • Screening tests or interventions as recommended by AMA • Provided when no symptoms are present • Provided to people at general risk in the population • Provided to detect or prevent a common or targeted condition • Preventive care tests are recommended based on age, gender, family history and health status * • Preventive care is provided at no cost to you or your CFISD Choice HRA Fund - No need to use HRA dollars - Not subject to the plan deductible * For preventative procedures recommended by the AMA see CFISD website
100%* EMPLOYEE Co-Insurance Plan 90% Employee 10% Up to $1,750 Preventive Care 100% Your Share of deductible$1,750 Out-of-Pocket Max $3,500 HRA Fund$750 (Unused HRA Funds do not carry over to the next Plan Year.) Deductible$2,500 CFISD Choice Fund HRA Plan Components EMPLOYEE + 1 or More 100%* Your annual out-of-pocket is limited Out-of-pocket equals: Deductible + coinsurance (your contribution) If you reach the maximum Out-of-pocket, expenses are covered 100% for the rest of the plan year Co-Insurance Plan 90% Employee 10% Up to $3,500 Preventive Care 100% Out-of-Pocket Max $7,000 Your Share of deductible$3,500 (Individual Deductible Applies*) Deductible$5,000 HRA Fund$1,500* (Unused HRA Funds do not carry over to the next Plan Year.) * Individual Deductible of $2,500 will be supplemented by available HRA funds. If HRA funds are exhausted another individual within the family may be required to satisfy the entire $2,500 individual deductible. The family will be required to collectively satisfy the family deductible of $5,000. Family members must satisfy their individual deductible and then their claims will be covered under the plan coinsurance. If the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance. Charts represent In-Network Coverage Level * Pharmacy copays still apply HRA Fund levels are re-set at the beginning of each Plan Year, September 1.
CFISD Choice Fund HRA Plan Premiums Rates are for plan year September 1, 2010 to August 30, 2011
myCIGNA.com, Your Personal Secure Website • Register after you enroll Review benefit coverage levels Track your HRA account balance, claims and payments Support for your important health decisions Cost and quality information Get personalized messages
Compare Hospital Cost and QualityIdentify CIGNA Centers of Excellence 19 conditions rated Ratings based upon Healthshare plus CIGNA data 3 Stars = Center of Excellence 1 – 3 star rating system
“The CFISD KelseyCare HMO Plan ” Quality Affordability Convenience
For CFISD Employees and Families: • Kelsey-Seybold network plan based on Kelsey-Seybold’s 60-year tradition of excellence. • Predictable costs • No deductible, affordable co-pays • 100% coverage after co-pays • Award winning physicians and programs
Important Items to Know: • All members will need to select a Primary Care Physician (PCP) within the Kelsey-Care Network (current Network members not utilizing a Kelsey provider and new members) • If you do not select a Kelsey-Care provider, your care will be defaulted to the Clinic and Doctors at the Cypress Clinic (1960 @ Wortham) • “Open Access” to all Kelsey-Seybold primary care and specialist physicians – no referral needed. • Referrals needed only for non-Kelsey-Seybold and affiliate specialist physician care • “New Mom Visits” to Kelsey pediatricians offered at no charge • Can use any Kelsey-Seybold doctor, anytime, at any location – no restrictions • 19 Convenient locations – close to work or home • Saturday hours 9 am to 2 pm at Kingwood, Spring, Clear Lake and Galleria area Clinics
Email your primary care physician and nurse, book an appointment online using www.mykelseyonline.com • Kelsey nurse available after-hours by phone to help you with any medical problems or questions • 24/7 appointment scheduling @ 713- 442- 0000 • KelseyCare Concierge personalized service in addition/collaboration with CIGNA member services
CFISD KelseyCare Plan • Affordable, no deductible plan pays 100% after applicable co-payment. • No referrals to Kelsey-Seybold physicians needed. • Office Visits $25 PCP/ $35 Specialist • X-ray and Lab No charge - included in office visit • Preventative Care $25 PCP/ $35 Specialist • Advanced Radiology $ 50 co-payment • Ambulance No Charge • In-Patient Hospital $500 co-payment • Out-Patient Hospital $250 co-payment • Emergency Care $100 co-payment
CFISD KelseyCare Plan • TRANSITION OF CARE • For those enrolling in the CFISD KelseyCare HMO Plan • Allows for the continuation of benefits received for specified medical and behavioral conditions for a defined period of time (usually for a maximum of 6 months) from a provider other than a Kelsey Care provider. • Transition of Care MUST BE APPLIED FOR THROUGH CIGNA AT THE TIME OF ENROLLMENT. (Request Form is available online at the district’s Insurance Department webpage.) • Examples of acute medical conditions that may qualify include, but are not limited to: • Recent major surgeries still in the global follow-up period (generally 6-8 weeks) etc. • Newly diagnosed or relapsed cancer in the midst of treatment • Pregnancy in the 2nd or 3rd trimester at the time of the effective date of coverage
CFISD Choice Fund HRA Premiums CFISD KelseyCare HMO Rates Rates are for plan year September 1, 2010 to August 30, 2011
Kelsey-Seybold Cypress Clinic 13114 FM 1960 West, Suite 200 (@ Wortham Blvd) Houston, TX 77065 Current Specialties: Family Medicine Internal Medicine OB/GYN Orthopedics and Sport Medicine Pediatrics Diagnostic & Ancillary Services: X-ray Laboratory Onsite Pharmacy
Kelsey-Seybold The Vintage Clinic 10701 Vintage Preserve Parkway (South of Louetta, east of FM 249) Houston, TX 77070 Current Specialties: Cardiology Dermatology Endocrinology Family Medicine Internal Medicine Internal Medicine/Pediatrics OB/GYN Orthopedics and Chiropractic Medicine Orthopedics and Sport Medicine Pediatrics Pulmonary Medicine Rheumatology Diagnostic & Ancillary Services: Bone Density Screening Cardiac Treadmill Digital Mammography Laboratory X-ray, MRI, and CT Scan Ultrasound
Locations Close to Home and Work. Saturday Hours: 9 am to 2 pm Spring Medical and Diagnostic Center 15655 Cypress Woods Medical Drive (South of FM 1960 West, across from Northgate Forest Dr) Houston, TX 77014 Specialties: Allergy Optometry Audiology Orthopedics and Hand Surgery Cancer Center Orthopedics and Sports Medicine Cardiology Pain Management Dermatology Pediatric Ophthalmology Dietitian and Nutritional ServicePediatrics Ear, Nose and Throat (ENT) Podiatry Endocrinology Pulmonary Medicine Family Medicine Radiology Gastroenterology Rheumatology Hematology/Oncology Spine Center - Chiropractic Internal Medicine Surgery Neurology Urology OB/GYN Diagnostic & Ancillary Services: Cancer Center – Infusion Therapy Services Diagnostic Imaging and Nuclear Medicine Infusion Center Laboratory and X-ray Surgery Center with Endoscopy Suite
Kelsey-Seybold Katy Clinic 21660 Kingsland Blvd (@ Mason Park Blvd.) Katy, TX 77450 Current Specialties: Family Medicine OB/GYN Orthopedics and Sport Medicine Pediatrics Diagnostic & Ancillary Services: Corporate Care Diagnostic Imaging (including X-ray and other studies) Drug Screen Laboratory Travel Medicine
Open House and Special Welcome for Cy-Fair ISD Employees and Their Family Members Meet our doctors, get a behind-the-scenes tour of our Kelsey-Seybold Clinic – Cypress and Kelsey-Seybold Clinic at The Vintage locations, and learn more about your KelseyCare health benefits plan from Your Doctors for Life. 2010 Open House Dates: Kelsey-Seybold Cypress Clinic Kelsey-Seybold at The Vintage 13114 FM 1960 West, Suite 200 10701Vintage Preserve Parkway Houston, Texas 77065 Houston, TX 77070 Thursday, July 22 Saturday, July 31 4 p.m. – 6 p.m. 9:30 a.m.- 11:30 a.m. RSVP: 713-442-4696
Our Hospital Partners Methodist Hospital at Willowbrook St. Luke’s Community Medical Center -The Woodlands St. Luke’s Sugar Land Hospital Memorial Hermann The Woodlands Methodist Hospital at Sugar Land St. Luke’s Episcopal Hospital – Medical Center Texas Children’s Hospital The Women’s Hospital of Texas Texas Heart Institute Clear Lake Regional Medical Center
Support and Resources For Questions about the CFISD Choice Fund HRA or the CFISD KelseyCare HMO Plan?
OTHER BENEFIT PLANS OFFERED: Basic Life & AD&D ($15,000) - FREE – paid by CFISD Supplemental Life Insurance to $235,000. 4 Dental Plans each with Vision Discounts 2 Dental Insurance Plans (Assurant & Heritage) 2 Discount Dental Plans (Dent-Al & QCD) Disability Insurance to protect your income Cancer & Specified Disease Insurance Long Term Care Insurance available through TRS Tax Deferred Investment Programs (403 & 457)
Going Online: www.cfisd.net Departments/Insurance “Your Benefit Station” for benefit outlines, current monthly rates, claim and change forms (if applicable), and the plan representatives’ contact information. “benefitsCONNECT” Online Enrollment System to actually enroll. Don’t forget to name your life insurance beneficiary.