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Board of Regents of The University System of Georgia Plan Year 2011. Agenda. 2011 Plan Grid BOR Miscellaneous Changes Healthcare Reform Plan Type Overview Questions. Slide 2. 2011 Plans. 2011 Plan Grid. BOR Miscellaneous Changes 2011. Open Enrollment begins 10/25
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Board of Regentsof The University System of Georgia Plan Year 2011 Slide 4
Agenda • 2011 Plan Grid • BOR Miscellaneous Changes • Healthcare Reform • Plan Type Overview • Questions Slide 4 Slide 2
BOR Miscellaneous Changes 2011 • Open Enrollment begins 10/25 • All members will receive new ID cards with new group number effective 1/1/2011 • Medco – co-pay changes • MetLife – no changes to dental benefits • There will be a $100 Medicare Part B premium surcharge for a retiree who is Medicare eligible and does not elected Part B. • There will be a $50 tobacco surcharge added to BOR premiums for smokers • BOR is adding OTC and Prescription-only smoking cessation products to all plans pharmacy benefits. Slide 4
Plan Year 2011 HealthCare Reform Changes • Dependent children will be covered up to age 26 with no requirements • Preventive Services: • PPO: Removal of $20 co-pay • PPO: Removal of $750 yearly wellness maximum • HMO: Removal of $15 co-pay • All Plans- Some new required Preventive Screening Tests will be added to preventive service categories • Behavioral Healthcare: • PPO Plans: Remove $20 co-pay on outpatient mental health professional fees – will be subject to deductible and co-insurance • HMO Plan: Remove $15 co-pay on outpatient mental health professional fees and $200 co-pay from inpatient mental health – will pay at 100% • Miscellaneous HCR changes: • Prescriptions required for over-the-counter drugs. This new standard applies to FSA’s and HSA’s Slide 4
Preferred Provider Organization (PPO) & Open Access POS (Alternative Network) Plans Plan Structure: • No Primary Care Physician assignment needed • No Referrals • Deductibles • $300 individual/$900 family • Co-Insurance • 90/10 • Maximum out of pocket • $1000 individual/$2000 family • Office Visit Co-payments for non-preventive services = $20 • Out of network coverage available (higher deductible $400, co-insurance 60/40 and balance billing) • Pharmacy: • MedCo Slide 4
HSA PPO (High Deductible Health Plan) & HSA Open Access POS (HDHP Alternative Network) Plans • Plan Structure: • No PCP selection required • No Referrals • Deductibles • $1,500 Individual • $3,000 Family • Co-Insurance • 90% In-Network • Maximum out of pocket • $3,000 Individual In-Network • $6,000 Family In-Network • Healthcare Savings Account (HSA) • Offered through US Bank • The monthly maintenance fee has been reduced to $2.75, the one - time set up fee has been reduced to $10.00. • BOR is contributing to your HSA in 2011: • Single $375 (half in January and half in July) • Family $750 (half in January and half in July) • HSA IRS contribution limits for 2011 are as follows: • Single - $3,050.00 • Family - $6,150.00 • Catch-up- $1,000.00 • Out of network coverage available with co-insurance of 70/30 • Unlimited preventive services, based on national guidelines for age and gender appropriate services. • Pharmacy: • BCBSGa (ESI) Slide 4
Health Maintenance OrganizationBlueChoice HMO • Plan Structure: • PCP selection required • Referrals to Specialist Required (Except: OBGYN, Chiro, Dermatologist, Ophthalmologist for medical eye care and Oral Surgeon for impacted teeth) • Co-payment Structure • $15 Office Visit except for preventive care • $200 Inpatient co-pay except for mental health • $75 Emergency Room • No Deductibles • No Co-Insurance • No Maximum out of pocket • Pharmacy: • BCBSGa (ESI) Slide 4
Searching For ProvidersPlease note that some providers may opt-out of being on the web directory. You should always check with the provider or customer service if you don’t show your provider on the web. How to locate an HMO provider 1. Go to bcbsga.com/bor. 2. Click on “Find a Doctor.” 3. Click on “Locate Georgia Providers.” 4. Select “BlueChoice Healthcare Plan (HMO) & BlueChoice Option (POS).” 5. You will then be linked to the ProviderFinder. Follow prompts to locate a provider. Under “Plan Information,” select “BlueChoice Healthcare Plan (HMO)” How to locate Georgia Providers for PPO and HSA PPO (HDHP) 1. Go to bcbsga.com/bor. 2. Click on “Find a Doctor.” 3. Click on “Locate Georgia Providers.” 4. Select “BlueChoice Preferred Provider Organization (PPO).” 5. You will then be linked to the ProviderFinder. Follow prompts to locate a provider. Under “Plan Information,” select “BlueChoice Preferred Provider Organization (PPO)” again. How to locate Georgia Providers for Open Access POS and HSA Open Access POS (HDHP) –BOR 2011 Alternative Network Plans 1. Go to bcbsga.com/bor. 2. Click on “Find a Doctor.” 3. Click on “Locate Georgia Providers.” 4. Select “Blue Open Access HMO & Blue Open Access POS” 5. You will then be linked to the ProviderFinder. Follow prompts to locate a provider. Under “Plan Information” select “Blue Open Access POS.” How to locate national providers 1. Go tobcbsga.com/bor 2. Click on“Find a Doctor.” 3. Click on“Locate National Medical Providers.” 4. Enter the first three letters of the ID number on your ID card. You will then be linked to the National Doctor and Hospital Finder. Follow prompts to locate a provider. Slide 4
Asthma (Adult & Pediatric) Heart Failure Diabetes (Adult & Pediatric) Coronary Artery Disease (CAD) Chronic Obstructive Pulmonary Disease (COPD) 24/7 NurseLine MyHealth Coach Hypertension Hyperlipidemia Oncology (prostate, skin, breast, colon and lung cancer) Musculoskeletal (arthritis and osteoporosis) Low Back Pain Consumer Web Tools @ www.bcbsga\bor 2011 360º Health Programs for all BOR Products Slide 4
Phone Numbers all BOR Products All BCBSGa Products: BOR Dedicated Customer Service Unit.............................................................. 800-424-8950/TDD 404-842-8073 Behavioral Health Services ................................................................................ 800-292-2879/TDD 404-842-8073 Consumer Choice Option Nomination ............................................................... 800-424-8950 Online Tools and Provider Search ......................................................................bcbsga.com/bor 24/7 NurseLine.....................................................................................................800-785-0006/TDD 800-368-4424 Precertification......................................................................................................800-233-5765/TDD 800-368-4424 MyHealth Coach ..................................................................................................800-785-0006/TDD 800-368-4424 ConditionCare.......................................................................................................800-785-0006/TDD 800-368-4424 Pharmacy Benefits ...............................................................................................800-424-8950/TDD 404-842-8073 Pharmacy Benefits Manager for PPO & Open Access POS Medco Health Solutions, Inc. ................................................................................ 877-300-5139/TDD 800-759-1089 Call for information regarding your pharmacy benefit plan and covered benefits 24 hours a day, seven days a week. Slide 4
Questions Slide 4 Slide 16