Commonwealth of Virginia Health Benefits Program

1. Commonwealth of VirginiaHealth Benefits Program Open Enrollment Overview April 14 – May 14, 2004 Department of Human Resource Management April 2004

2. Open Enrollment Actions • Continue your health plan • COVA Care and additional coverage option(s) • Kaiser Permanente if live or work in the Northern Virginia service area 2

3. Open Enrollment Actions • Selectanother health plan • COVA Care and additional coverage option(s) • Kaiser Permanente if live or work in the Northern Virginia service area 3

4. Open Enrollment Actions • Continue or change membership • Remember to remove dependents when they become ineligible • Waive coverage in the health benefits program • Enroll in the program if you previously waived 4

5. Open Enrollment Actions • Enroll in a Medical Expense or Dependent Care Flexible Reimbursement Account. • If you already have an FRA, you must re-enroll. Current accounts expire on June 30, 2004. 5

6. Available Plans for July 1, 2004 • Kaiser Permanente HMO (Northern Virginia) • Members must live or work in the Kaiser service area • Search by zip code at: http://my.kaiserpermanente.org/mida/commonwealthofvirginia 6

7. Available Plans for July 1, 2004 • Kaiser Permanente HMO (Northern Virginia) • During Open Enrollment, members enrolled in Kaiser who are ineligible for the plan must: • Enroll in COVA Care or • Waive coverage in the State Health Benefits Program 7

8. COVA Care Plan Understanding Your Benefits For July 1, 2004 8

9. Understanding Your Benefits • There are three important things you need to know about our benefits program for July 1: • First: Our COVA Care coverage remains the same • Second: There are administrative changes, for both health and flexible benefits • Third: Some COVA Care plan administrators will change 9

10. Understanding Your Benefits • There will be no changes to COVA Care coverage beginning in July • Copayments, coinsurance, deductibles and out-of-pocket limits are not changing. Covered services also remain the same • You will use benefits at your doctor, dentist, pharmacy or mental health professional in the same way 10

11. Understanding Your Benefits • There are some important administrative changes to the program effective July 1 • The benefit year for deductibles, the out-of-pocket limit and covered services changes from a calendar year (January 1 – December 31 ) to a fiscal year (July 1 – June 30) • The plan year for Flexible Reimbursement Accounts also changes to the fiscal year 11

12. Understanding Your Benefits • What do these administrative changes mean to you? • For Medical and Behavioral Health Benefits • Any deductible or out-of-pocket expenses that you have already met this year will be carried over to the new July 1 benefit year. 12

13. Understanding Your Benefits • For Medical and Behavioral Health Benefits • If you have already satisfied your deductible or out-of-pocket limit this year, you will not have to satisfy it again once the new July 1 benefit year begins. • Plan maximums for routine wellness, chiropractic care and other benefits with an annual limit will start over on July 1. 13

14. Understanding Your Benefits • What do these administrative changes mean to you? • For Dental Benefits • The annual maximum the plan pays for dental benefits will start over with the new July 1 benefit year. • If you have already reached your annual maximum, you will receive an additional $1200 for Basic Dental or $1500 for Expanded Dental in the new July 1 benefit year. 14

15. Understanding Your Benefits • What do these administrative changes mean to you? • For Flexible Reimbursement Accounts • The short plan year (January 1 through June 30) is now in effect • The 12-month plan year for your Medical and Dependent Care Reimbursement accounts will begin on July 1 and run through June 30. • See the Spotlight newsletter 15

16. Understanding Your Benefits • Why are we making these administrative changes? • They make the program consistent and simple. The benefit year, changes to your plan or premiums, and your Flexible Reimbursement Account participation all take place on the same schedule. 16

17. Understanding Your Benefits • Why are we making these administrative changes? • You can plan better for medical expenses. If you have a Medical Reimbursement Account, you’ll be better able to predict your out-of-pocket expenses before the FRA plan year begins. 17

18. Understanding Your Benefits • There are also changes in COVA Care plan administrators 18

19. Understanding Your Benefits • Let’s focus on each administrator • Medical, Vision and Hearing Benefits - Anthem • Your benefits remain the same • You will continue to have the Anthem Virginia and BlueCard provider networks • You will use the same Member Services telephone number for benefits questions (355-8506 in Richmond and 1-800-552-2682 outside Richmond) • You will visit the same Web site (www.anthem.com) 19

20. Understanding Your Benefits • Dental Benefits – Delta Dental of Virginia • Your dental benefits remain the same • Delta Dental has a national network, including 2,500 dentists in Virginia • You will use a new Web site (www.deltadentalva.com) to find out if your current dentist is in the network, or to search for a new dentist • You will call a new toll-free telephone number (1-888-335-8296) for benefits information 20

21. Understanding Your Benefits • Prescription Drugs – Medco Health • You will use the same Medco Health network for retail pharmacies • You will use the same home delivery service • There’s no change to the three-tier structure or copayments • You call a new telephone number for benefits questions (1-800-355-8279) • There’s a new Web site for tier and drug information (www.medcohealth.com) 21

22. Understanding Your Benefits • Behavioral Health and the Employee Assistance Program – Value Options • Your benefits remain the same • You will use the ValueOptions national provider network that includes more than 2,000 mental health professionals in Virginia • You can search the provider directory on the ValueOptions Web site (www.achievesolutions.net/covacare) • To access behavioral health and EAP benefits, you will call a new telephone number (1-866-725-0602) 22

23. Understanding Your Benefits • For more benefits information • See the Spotlight newsletter or • Contact your Benefits Administrator • Telephone numbers and Web sites for all COVA Care plan administrators are in Spotlight and on the DHRM Web site at www.dhrm.virginia.gov 23

24. Understanding Your Benefits • For questions about Open Enrollment • Contact your Benefits Administrator or DHRM at hbp@dhrm.virginia.gov • To Enroll • Visit EmployeeDirect online at http://edirect.virginia.gov or • See your Benefits Administrator 24

25. Available Plans for July 1, 2004 • COVA Care Statewide Plan – Premiums • Premiums will increase - see page 7 of Spotlight • Premiums were accurate at press time, but may be subject to change by the General Assembly 25

26. Types of Membership • Single • Employee + One • Family 26

27. Flexible Reimbursement Accounts (FRAs) • What are FRAs? • Medical Expense FRA • Set aside money before taxes to pay for eligible expenses not covered by your health plan • Dependent Care FRA • Set aside money before taxes to pay for day care, day camp or at-home care of a dependent child or qualified adult while you or your spouse are working 27

28. Flexible Reimbursement Accounts (FRAs) • Who can enroll? • Medical Expense FRA • Must be eligible for health benefits program for six months • Dependent Care FRA • Must be eligible for health benefits program 28

29. Flexible Reimbursement Accounts (FRAs) • Return to 12-month plan year on 7/1/04 • Plan year contributions: • Minimum: $10/pay period • Maximum: Up to $5,000/plan year (Dependent Care maximum depends on tax filing status) 29

30. Flexible Reimbursement Accounts (FRAs) • FRA elections must be in whole dollar amounts • Use it or Lose It: • You must incur expenses to use all the money in your account by June 30, 2005 • Cannot be carried over into the next plan year • If your FRA ends on June 30, 2005, you must file for reimbursement by September 30, 2005 30

31. Reminders… • Employees who waive coverage may not enroll outside of Open Enrollment without a qualifying mid-year event • Your Open Enrollment elections for both health benefits and FRAs are binding • Once in effect, your elections cannot be changed without a qualifying mid-year event 31

32. More Information • DHRM Web site: www.dhrm.virginia.gov • Spotlight newsletter 32

33. Enroll Without Paper – Use EmployeeDirect! • Logon at http://edirect.virginia.gov • System available 24-7 Get Your Passcode Now! 33

34. Enroll Without Paper – Use EmployeeDirect! • Forget Your Passcode? • Use EmployeeDirect to request a new passcode • 1 Hour Turnaround 34

35. Enroll Without Paper – Use EmployeeDirect! • Update personal information today in EmployeeDirect • Review Benefits Profile • Update address • Update dependent information (names, birth dates) 35

36. Make Open Enrollment Changes in EmployeeDirect April 14 – May 14, 2004 • Change Your Plan • Change Your Membership • Enroll in an FRA 36

37. Keep Your Confirmation Number! • Confirms processing of your selection • Is displayed on your Benefits Profile when approved • Is the documentation for your records 37

38. Received No Confirmation Number? • Your selection has not been approved • Contact your Benefits Administrator, OR • Send an e-mail to edirect@dhrm.virginia.gov 38

39. Commonwealth of VirginiaHealth Benefits Program Questions and Answers 39