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KCTCS 2011 Employee Open Enrollment

KCTCS 2011 Employee Open Enrollment. October 11 th – 24 th , 2010. Agenda. Health Highlights Eligibility/Verification Requirements Health Enrollment Health Plan Descriptions Changes in Benefits/Comparisons HRA, FSA, Dependent care overview HRA/FSA enrollment $50 Benefit

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KCTCS 2011 Employee Open Enrollment

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  1. KCTCS2011 Employee Open Enrollment October 11th – 24th, 2010

  2. Agenda Health Highlights Eligibility/Verification Requirements Health Enrollment Health Plan Descriptions Changes in Benefits/Comparisons HRA, FSA, Dependent care overview HRA/FSA enrollment $50 Benefit Dental Life Insurance Insurance Cards KEHP Wellness Programs Double dipping Federal Health Care Reform

  3. Health Insurance Highlights • Mandatory Enrollment – No Exceptions • If you do not enroll for the 2011 Plan Year your current coverage will be terminated, your benefits will be waived and you will not receive a contribution to a HRA • IDS and Passwords were mailed to employees at their home address • Web Enrollment is strongly encouraged • The new Benefits Selection Guide will be provided to employees • Forms and other valuable information are available on the DEI web-site: http://personnel.ky.gov/dei/11oe/

  4. ELIGIBILITY/VERIFICATION REQUIREMENTS

  5. DEPENDENT VERIFICATION New Dependents: • Newdependents/spouse added to a plan for 2011 and those dependents/spouses who were not verified during the 2010 Dependent Eligibility Audit must submit the appropriate documents by December 20, 2010. Each document must have the member’s name and social security number noted on the top of the document. • A list of documentation needed for each event is on page 22 of the Benefits Selection Guide Qualifying Events (QE’s): • The qualifying event application must be signed within the QE time frame • Qualifying event documentation should be submitted with the application • Verification of dependent/spouse must be included with application • Effective date of QE will remain under the same rules as currently in effect and if necessary coverage will be activated retroactively. Coverage will not be activated until dependent verification is received

  6. Dependent Eligibility Dependent Eligibility Increased to Age 26 • The definition now includes dependent children to age 26 • The child can be married (coverage does not extend to their spouse or children) • The child does not have to reside with the plan-holder • The child must NOT be eligible to enroll in their own employer-sponsored plan through their employer • All contribution deductions will now be on a pre-tax basis • See page 22 of the Benefits Selection Guide for further information • For All Dependent children age 19 to 26: Members must submit the affidavit: “2011 Certification of Dependent Eligibility” for each dependent child age 19-26. The affidavit must be completed and signed (Example of affidavit follows)

  7. DEPENDENT AFFIDAVIT-Must be submitted for every dependent child between the ages of 19-26 Kentucky Employees’ Health Plan 2011 Certification of Dependent EligibilityMustbe submitted for covered dependents ages 19 to 26 Section I: Statement of Dependency ____________________________________________ _______________________________________ Name of KEHP Member Member’s Social Security Number ____________________________________________ _______________________________________ Name of Dependent Dependent’s Social Security Number ____________________________________________ Dependent’s Date of Birth Section II: Dependent’s Status Does the dependent meet the dependent eligibility criteria for Kentucky Employees’ Health Plan? 􀆑 Yes 􀆑 No Is this Dependent Employed? 􀆑 Yes 􀆑 No Name and Address of Employer: ___________________________________________________________________ Does this employer offer health insurance for which this dependent is eligible? 􀆑 Yes 􀆑 No Section III: Acknowledgement I, the member, and I, the dependent referenced above, do certify under penalty of perjury that the information I have provided on this affidavit is correct and complete. I understand that omissions or incorrect statements made by me on this affidavit could lead to (1) retroactive loss of benefits for the dependent named above; (2) disciplinary action, up to and including termination of employment; and (3) civil and/or criminal penalties. I understand that this form is not an application for insurance coverage and that the purpose of this form is to establish eligibility of dependent persons named herein for the coverage provided under the Kentucky Employees’ Health Plan. I understand that this signed affidavit will be retained in my employee benefits file. _______________________________ _____________________________ Print Name of Member Print Name of Dependent _______________________________ _____________________________ Signature of Member Signature of Dependent _______________________________ _____________________________ Date Date Mail to

  8. SPECIAL ENROLLMENT FOR PREVIOUSLY DROPPED DEPENDENT OR DEPENDENTS WHO DID NOT MEET KEHP GUIDELINES Enrollment period is 10/1/2010 through 10/31/2010 (30 day special enrollment period due to federal Health Care Reform) • Member should complete the normal Open Enrollment application with 2011 health insurance and FSA enrollment choices, list all dependents who need coverage for 2011 and sign it the same day during the period 10/1-10/10 • Member should complete the affidavit “2011 Certification of Dependent Eligibility” for all dependents age 19 to 26 (Adult child) • During Open Enrollment (10/11-10/24) member can log in and make changes to the OE plan which contains an Adult Child on it, the same as other employees during this period or they may use a paper form for any changes • Between 10/25 and 10/31 the member can also add an Adult Child by completing an application and signing and dating it on the same day • They will also have to complete the affidavit “2011 Certification of Dependent Eligibility”

  9. ONline Enrollment • Your KEHP Online Access will be available for fast accurate and secure enrollment beginning October 11, 2010 at: http://www.personnel.ky.gov/dei/ • You will need your ID and Password to enroll • A Benefits Analyzer is available to assist you in selecting the best plan option for your personal situation • Web enrollment is the fastest most accurate way to enroll!!!

  10. ONLINE Enrollment • Once you complete the enrollment process online, you will see a confirmation number screen. This page will need to be printed out and kept as proof of your enrollment. • A copy of this confirmation MUST be submitted to your college HR Department • If an e-mail address is entered during the enrollment process, you will receive a confirmation message.

  11. ONLINE Enrollment • For assistance with employee ID# and Password contact (877)741-7017 or (502)564-3116 • For computer or technical assistance contact (866)746-1613 or (502)564-4597 • For information about current benefits for 2011 Open Enrollment benefits (877)597-7474 • OR contact (888)581-8835 or (502)564-6534 • Option 1 – user ID and Password/Tech Assistance • Option 2 – Health benefits Questions • Option 3 – Web Enrollment and Eligibility • Option 4 – Member Services • Hours for Open Enrollment Assistance – 10/11/2010 – 10/24/2010 • Monday through Friday 8:00 am – 8:00 pm • Saturday and Sunday 8:00 am – 12:00 pm See Inside cover page of your Benefits Selection Guide for this information

  12. Enrollment – Paper Applications • A paper application will need to be completed for the following scenarios: • Paying by cross-reference with a retiree • A new employee who has not yet enrolled for 2010 or who wants to begin a cross-reference payment option • Switching the “primary” plan holder on a cross-reference payment option • Ending a cross-reference payment option • Retirees who have returned to work and are age 65 All these applications will need to be submitted to your college HR Department for processing

  13. Health Plan Descriptions

  14. 2011 Health Plan Choices Same Choices as 2010 • Commonwealth Optimum PPO • With increases in some out-of-pocket expenses • Commonwealth Maximum Choice • With increases in some out-of-pocket expenses • Commonwealth Capitol Choice • With increases in some out-of-pocket expenses • Commonwealth Standard PPO • No Increases

  15. 2011 PLAN YEAR CHANGE HIGHLIGHTS • Dependent coverage extended to age 26* • Marital status, residing with plan holderand tax statuses have changed • Special 30 day Enrollment period (10/1-10/30) • Autism coverage • Autism Services have increased to $50,000 per year for dependents ages one through six and $1,000 per month for dependents ages seven through 21 • Pre-existing condition elimination for children* • Children under 19 will no longer be subject to pre-existing condition rules starting 2011 * Mandates under federal Health Care Reform

  16. 2011 PLAN YEAR CHANGE HIGHLIGHTS • Increasesin plan co-pays, prescription co-pays, deductibles and out-of-pocket maximums • Standard plan remains unchanged • Premium Increases • The state contribution level strategy is: • Maintain 2010 employer contribution levels-noincrease • Increase employee contributions to offset premium increases • The Standard plan retains the same premium, employer and employee contributions from 2010

  17. 2011 PLAN YEAR HIGHLIGHTS KCTCS Personnel System Contribution Strategy • The state non-smoking employee contribution schedule is reduced by 25% resulting in KCTCS personnel system employees having reduced out-of-pocket contributions • The $50 Benefit Allowance is available to eligible employees to offset out-of-pocket benefit expenses • A health care Flexible Spending Account (FSA) is available to pay for medical out-of-pocket expenses on a pre-tax basis

  18. Commonwealth Standard PPO Value-based, traditional PPO plan • Deductible: $500 single/$1,500 family ($1,500/$3,000 out-of network) • No increase in premiums or employee costs • Higher Out-of-Pocket Maximum: $3,500 single/$7,000 family ($5,000/$9,500 out-of network) • Co-Insurance: • Plan pays 75%, Member pays 25%(50% out-of-network) • Doctors Visits- Deductible then you pay 25% • Routine Preventive Care -Covered at 100%S

  19. Commonwealth Standard PPO Pros • Lowest premium • Catastrophic coverage Cons • Member will pay out-of-pocket first until deductible is satisfied then pay co-insurance • No fixed copays for prescriptions • Out-of-pocket maximum is higher for both single and family plans

  20. Commonwealth Standard PPO Prescription Drugs-30 Day supply Plan pays 75%, you pay 25% Tier 1-Generic Min $10-Max $25 Tier 2 –Formulary Min $20-Max $50 Tier 3- Non-Formulary Min $35- Max $100 Prescription Drugs-90 Day supply (retail or mail order) • Plan pays 75%, you pay 25% • Tier 1-Generic • Min $20-Max $50 • Tier 2 –Formulary • Min $40-Max $100 • Tier 3- Non-Formulary • Min $70- Max $200

  21. Commonwealth Maximum Choice Embedded Health Reimbursement Account (HRA) Single $1,000 Couple $1,500 Parent Plus $1,500 Family $2,000 Cross-Reference $2,000 • When these funds are used to pay for medical and prescription services they reduce the deductible. You are responsible for all costs between the HRA funding, and the total deductible. Example: Single coverage has a $2300 deductible, HRA funds are $1000. The $1300 difference between the two, is member’s responsibility. Once the deductible has been met the plan pays 90%, member coinsurance is 10%. Because this plan has no co-pays, once the out of pocket maximum has been reached services are paid at 100%

  22. Commonwealth Maximum Choice • Annual Deductible: Single $2,300 Family $3,455 (In and out-of network) • Annual Out-of-Pocket Maximum: Single $3,455 Family $5,185 ($4,600/$6,900 out-of-network) • All COVERED expenses apply to maximum out-of-pocket • Co-Insurance: Plan 90% Member 10% (60%/40% out-of network) • Doctors Visits: Deductible then 10%(40% out-of network) • Routine Preventive Care covered at 100%(not covered if out of network)

  23. Commonwealth Maximum Choice Prescription Drugs: 30 Day Supply • In Network: Each tier-Deductible then 10%* • Out of Network: Each tier-Deductible then 40%* Prescription Drugs: 90 Day Supply • In Network: Each tier - Deductible then 10%* • Out of Network: Not applicable *Once member has met the maximum out-of-pocket all services are covered at 100% including prescriptions • Retirees may not participate in the plan

  24. Commonwealth Maximum Choice PROS • Embedded HRA to use toward out-of-pocket expenses and unused funds roll over to next plan year (2010 balances will roll-over to 2011 if you re-enroll in plan) • Good plan for healthy and very unhealthy members • Plan pays 100% after maximum out-of-pocket is obtained CONS • Member will pay out-of-pocket first until deductible is satisfied then pay co-insurance until maximum out-of-pocket is met • Plan does not have fixed co-pays for providers or for prescriptions • Maximum out-of-pocket is higher for both single and family plans compared to Optimum Plan

  25. HRA/FSA Integration: Commonwealth Maximum Choice Plan • A Health Care Flexible Spending Account (FSA) may be used to fund member responsibility expenses on a tax free basis • Premium savings from selection of the Commonwealth Maximum Choice plan versus other selections may fund or assist in funding an FSA • Example KCTCS personnel system: • Annual premium for Couple Maximum Choice= $ 3,283.20 • Annual Premium for Couple Optimum PPO = $ 4,606.08 • Annual Premium savings difference= $ 1,322.88 HANDOUTS AVAILABLE FOR FURTHER EXPLANATION OF PLAN BENEFITS

  26. Commonwealth Capitol Choice • $500 per family member “benefit allowance” that provides 100% coverage (subject to co-pays) for many in-network services before you start paying towards the deductible • Benefit Allowance is “use it or lose it” –Does not roll-over to next plan year • Co-pays on office visits and prescriptions • After payment of $115 per admission co-pay and $575 annual deductible, you pay nothing for additional hospital facility charges. • $500 benefit is not reduced by office visits, only reduced by charges applied to the deductible/co-insurance

  27. Commonwealth Capitol Choice • Deductible: Single $575 Family $1,725 ($1,150/$1,275 Out of Network) • Out-of-Pocket Maximum: Single $2,300 Family $6,900 ($3,800/$9,400 Out of Network)Excludes RX and other Co-Pays • Co-Insurance: Plan pays 80% Member pays 20% (60%/40% Out-of Network) • Doctor Visit Co-Pays: $20 PCP $25 Specialist (Deductible then 40% if Out-of Network) • Preventive Care: $15 Co-Pay (Deductible then 40% if Out-of Network)

  28. Commonwealth CAPITOL CHOICE Prescription Drugs-30 Day supply Tier 1-Generic $10 Co-Pay Tier 2 –Formulary $20 Co-Pay Tier 3- Non-Formulary $45 Co-Pay Out-of-Network Not applicable Prescription Drugs-90 Day supply (retail or mail-order) • Tier 1-Generic • $15 Co-Pay • Tier 2 –Formulary • $45 Co-Pay • Tier 3- Non-Formulary • $90 Co-Pay • Out-of-Network • Not applicable

  29. Commonwealth Capitol Choice PROS • One time Benefit Allowance for each covered person on the plan • Predictable co-pays • Predictable Prescription co-pays • Cheaper maximum out-of-pocket CONS • Higher premium • $15 Co-pay for preventive care • Maximum out-of-pocket is higher for family plan than the Maximum Choice and Optimum plans HANDOUTS AVAILABLE FOR FURTHER EXPLANATION OF PLAN BENEFITS

  30. Commonwealth Optimum PPO • Deductible: Single $345 Family $690 ($690/$1,380 Out-of Network) • Out-of-Pocket Maximum: Single $1,295 Family $2,590 ($2,590/$5185 Out-of-Network) Excludes prescription drug and all other Co-Pays • Co-Insurance: Plan pays 85% Member pays 15% (70%/30% Out-of Network) • Doctors Visits: PCP $15 Co-Pay Specialist $20 Co-Pay (Out-of Network-Deductible then 30%) • Preventive Care : $10 Co-Pay(Out-of Network-Deductible then 30%)

  31. Commonwealth OPTIMUM PPO Prescription Drugs-30 Day supply Tier 1-Generic $10 Co-Pay Tier 2 –Formulary $20 Co-Pay Tier 3- Non-Formulary $45 Co-Pay Out-of-Network Not applicable Prescription Drugs-90 Day supply (retail or mail-order) • Tier 1-Generic • $15 Co-Pay • Tier 2 –Formulary • $45 Co-Pay • Tier 3- Non-Formulary • $90 Co-Pay • Out-of-Network • Not applicable

  32. Commonwealth OPTIMUM PPO PROS • Predictable co-pays • Predictable Prescription co-pays • Cheaper max out-of-pocket CONS • Higher premium • Plan does not pay 100% after max out-of-pocket is met (Still have applicable copays for prescriptions and medical services)

  33. Plan Out-of-Pocket Employee Increases Grid

  34. Health Plan Comparisons (changes in red)

  35. Can’t make up your mind??? • Use the KEHP Benefits Analyzer Tool • Helps you to select the right plan based on your personal healthcare and financial needs • Helps you determine how much you should put in a Flexible Spending Account • Use this handy tool at www.KEHP.ky.gov using your secure Employee ID# and Password to log in • Also consult page 9 of the Benefits Selection Guide

  36. Waiving Health Insurance • If you waive health insurance coverage, the employer contribution towards a HRA will be $175 per month for a total of $2100 for the year • Unused money carries to the next year if you continue to Waive coverage from year to year • If employee is hired with an effective date later that January 1, 2011 the $175 per month for the waiver will be prorated. • Example: Employee is hired on March 1st, with an effective date of May 1st on their waiver with an HRA. The employee would receive $175 per month beginning with the month of May

  37. Health Reimbursement Accounts (HRAs) • Who is NOT eligible for HRAs • If employee or spouse has a Health Savings Account (HSA), you are NOT allowed to have an HRA. If you have an HSA and elect our HRA, you will be in violation of federal tax law. • A retiree who has gone back to work and elects coverage under the retirement system • Retirees • Spouse of a hazardous duty retiree

  38. A word about Medicare & HRAs If you are an active employee over the age of 65… • The KCTCS Health Plan is considered primary over Medicare • You do not need to sign up for Medicare Part “B” until you cease employment. You will then enroll for this coverage under a “Special Enrollment Period” • The prescription drug plan offered through the KEHP is considered “Creditable Coverage”. You do NOT need to sign up for a Medicare part “D” plan • If you are over age 65 and enrolled in Medicare and choose to waive health insurance through the KEHP, your waiver HRA will be your primary health plan over Medicare • Bills must be paid through your HRA before submitted to Medicare

  39. HRA Two Separate Health Reimbursement Accounts • Embedded HRA • Offered in conjunction with Commonwealth Maximum Choice • Funded with employer money only • Administered by Humana and the DEI • Stand alone HRA • Available only to employees who waive health insurance • Funded with employer money only • Administered by Chard-Snyder (Humana materials may refer to an HRA as a Personal Care Account (PCA)

  40. FSA vs. HRA • In addition to the HRA, an employee may fund a Health Care FSA to reimburse unpaid qualified medical expenses (ex: Deductible, Co-pays, Co-insurance, Dental, Vision, etc.) • May fund with employee contributions • If waiving or have single health coverage, may use all or part of the $50 Benefit for funding • For Commonwealth Maximum Choice Plan participants, when using your HRA, only plan covered expenseswill count towards the plan deductible and out-of-pocket maximum (Excludes: Dental, Vision)

  41. FSA vs. HRA • If you have both a Health Care Flexible Spending Account (FSA) and a Health Reimbursement Account (HRA), reimbursement will come from your FSA account balance first. • The FSA balance is forfeited at the end of the plan year (12/31/10) and 2 ½ month grace period (3/15/11). • The HRA balance will roll-over from year to year as long as you remain a waiver or enrolled in the Commonwealth Maximum Choice Plan. • Will not roll-over if you change your plan selection. NOTE: If you use the Benny PrePaid Benefits Card from Chard-Snyder, reimbursements will automatically be from your FSA first until that annual election amount is depleted. Then, reimbursement will be from your HRA.

  42. Using Benny Pre-Paid Benefits Card for HRA at Pharmacies – “Waivers” Only • Ifemployee is covered under spouse’s health plan, they would use that health insurance card first. • Employee would then use Chard-Snyder Benny card for any co-pay or coinsurance amounts due.

  43. Save Your Receipts: HRA and FSA Reimbursed Expenses • It is important to save all itemized receipts • The IRS requires proof (substantiation) that expenses are qualified under your plan’s benefits • For the Commonwealth Maximum Choice Plan -Humana automatically verifies transactions, in most cases, as they occur. However, Humana may ask members to submit receipts for verification of an expense • For Waivers, Chard-Snyder automatically verifies transactions, in most cases, as they occur. However, Chard-Snyder may ask members to submit receipts for verification of an expense • Always save all receipts and explanation of benefits (EOB) in case you are contacted to verify an expense that could not be matched automatically • If a refund is needed: • Card should be credited by the provider • If providers refund the member directly the member will be required to refund the card (per IRS guidelines)

  44. Flexible Spending Accounts (FSA) • There are two kinds of FSA’s • Health Care Spending Account for medical expenses: • Minimum $ 5 per paycheck( including $50 benefit); total annual maximum : $ 5,004 ($208.50 per paycheck) • Dependent Day Care Account for Dependent care expenses • Minimum $ 5 per paycheck; total annual maximum $4,992 Please refer to the FSA booklet for further information

  45. Flexible Spending Accounts • Money does not roll from year to year; use it or lose it rule • Can either use the Benny card or file a paper claim for reimbursement • Can be used to get reimbursed for any dependents up to age 26 • Substantiation for Benny card may be required. • Federal regulations require that employees that wish to enroll in a FSA do so every year • The carrier for 2011 will continue to be Chard Snyder and Associates

  46. Flexible Spending Account“Grace Period” • Use left over money from 2010 plan year until March 15, 2011 • You may use your FSA Benny Prepaid Benefits card for grace period expenses. The Reimbursements will automatically be applied to the correct year • Or, you may also pay for these expenses and then file for reimbursement from Chard-Snyder by mail or fax • Note: If all of your FSA has been used for 2010 and you have money left in your HRA, you will need to file a paper claim for the service you had in 2010. HRA money does not roll-over until April 1st

  47. FSA and HRA NEW FOR 2011 • Due to federal Health Care Reform Over-the-Counter (OTC) medications (except for insulin and those prescribed by a physician) will no longer be reimbursed by a Health Care Flexible Spending Account (FSA)or Health Reimbursement Account (HRA) • Your last reimbursable date of purchase for these items will be December 31, 2010

  48. FSA and HRA • The termination date for an FSA and an HRA is the day employment ends or the day the employee retires • You will have 90 days in which to file claims for reimbursement for expenses incurred through your last date of service • HRA contributions are paid by the employer up to the date employment ends

  49. Dependent Care Flexible Spending Account • Retirees are not eligible to participate • Amount that can be contributed is based on your tax filing status • Reimbursement by claim form • Benny Card is not available for use with the Dependent Care FSA • Plan Maximum is $4,992 per year

  50. Web Enrollment Chard-Snyder FSA/HRA (Waiver) Coverage: • Enrollment into the FSA and/or the stand alone HRA is a separate process. KCTCS employees MUST web-enroll for FSA Coverage through the Chard-Snyder Website at www.chard-snyder.com • If you are currently enrolled in Chard Snyder, you will use your Social Security number or your current password to web-enroll • Detailed instructions will be available in the Chard-Snyder material • You will be able to sign up for your employee health care and/or dependent care elections and any $50 Benefit allocations NOTE: If you are signing up for both a FSA and a HRA, you will be able to do both through the same screen ONLINE ENROLLMENT WILL BE MANDATORY THROUGH CHARD-SNYDER

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