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EDGEWOOD ISD / Open Enrollment 2011. Humana Inc. OE Presentations November 1, 2010 – November 12, 2010. GCA00CLHH 1008. Plan Offerings for 2011. Medical NPOS 90/60 ($250 deductible) NPOS Coverage First 80/50 ($1,500 deductible) NPOS Coverage First 70/50 ($2,500 deductible)
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EDGEWOOD ISD / Open Enrollment 2011 Humana Inc. OE Presentations November 1, 2010 – November 12, 2010 GCA00CLHH 1008
Plan Offerings for 2011 • Medical NPOS 90/60 ($250 deductible) NPOS Coverage First 80/50 ($1,500 deductible) NPOS Coverage First 70/50 ($2,500 deductible) NPOS Coverage First 70/50 ($5,000 deductible) • FSA • Dental DHMO Traditional Plus • Vision • Basic Term Life • Voluntary Term Life • Critical Advantage (Cancer Only) • Secure Life
Claims Experience • Premium versus claims – 116% • Base PPO – 90.44% • Buy up PPO – 150.85% • HMO – 89.73% • Underwriting formula increase – 48.7% • Actual Increase – 28.62% • Benefit Strategy to absorb increase • Change in Network • Coverage First • Added Deductibles on Facility Services
Humana Preferred Network (HPN) • Lower premiums tied to the high-performing providers • Point-of-Service (POS) style benefits • No referrals needed • Must use Humana Preferred providers for in-network benefit • Subset of Humana PPO / POS network • Approximately 70-75 percent of broader PPO/POS network • Includes all hospitals • Analysis reveals…. • Of the 1450 NPOS providers EISD utilized, 1361 are on the HPN (93.8%) • Of the 1323 HMO providers EISD utilized, 1268 are on the HPN (95.8%)
CoverageFirst - $500 Benefit Allowance • CoverageFirst is an innovative concept in health plans: • Provides an up-front $500 allowance for each covered person to help pay for medical care after any copayments and before the patient has to meet a deductible • The $500 benefit pays the first $500 of the following in-network medical expenses: - Doctor office visits • Allergy shots • Outpatient surgery • Emergency room care • Inpatient hospital charges
How CoverageFirst works • Chris has a CoverageFirst plan: • He goes to the doctor for an illness office visit • Total cost is $75 • After Chris pays the $25 copayment, the benefit allowance covers the remaining $50 • The $500 allowance is reduced by $50 • Chris has minor surgery at the hospital • Cost is $500 for the facility • After Chris pays the $200 copayment, the benefit allowance covers the remaining $300 • Chris’ out-of-pocket costs total $225 (2 copayments $25 + $200) • Chris’ benefit allowance paid $350 ($50 + $300) • Chris still has $150 left in his benefit allowance
National POS Copayment 90/60 250 In-Network BenefitsOut of Network Benefits • Office Visit Copay: PCP - $20 60% After Deductible Specialist - $20 60% After Deductible Urgent Care - $20 60% After Deductible • Deductible: Individual: $250-In Network $750-Out of Network Family: $500-In Network $1,500-Out of Network • Coinsurance: 90%-In Network 60%-Out of Network • Out of Pocket Maximum: Individual: $4,000-In Network $12,000-Out of Network Family: $8,000-In Network $24,000-Out of Network • IP Hospital: 90% After Deductible $60% After Deductible • OP Surgery: 90% After Deductible 60% After Deductible • OP Nonsurgical Care: 90% After Deductible 60% After Deductible • (Advanced Imaging: PET, MRI, MRA, CAT, & SPECT) • ER: (Waived if Admitted) 100% After $100 copay 100% After $100 copay • per visit per visit
National POS Coverage First 80/50 1500 In-Network BenefitsOut of Network Benefits $500 per calendar year per member Not Applicable • Office Visit Copay: PCP - $20 50% After Deductible Specialist - $35 50% After Deductible Urgent Care - $35 50% After Deductible • Deductible: Individual: $1,500-In Network $4,500-Out of Network Family: $4,500-In Network $13,500-Out of Network • Coinsurance: 80%-In Network 50%-Out of Network • Out of Pocket Maximum: Individual: $2,500-In Network $7,500-Out of Network Family: $7,500-In Network $22,500-Out of Network • IP Hospital: 100% After $150 copayment 50% After Deductible per day (3 days) plus deductible • OP Surgery (facility): 100% After $150 copayment per visit 50% After Deductible plus deductible • OP Non-Surgical Care: 80% After Deductible 50% After Deductible • (Advanced Imaging: PET, MRI, MRA, CAT, & SPECT) • ER: (Waived if Admitted) 100% After $150 copay per visit 100% After $150 copay per visit plus participating deductible plus participating deductible
National POS Coverage First 70/50 2500 In-Network BenefitsOut of Network Benefits $500 per calendar year per member Not Applicable • Office Visit Copay: PCP - $25 50% After Deductible Specialist - $40 50% After Deductible Urgent Care - $40 50% After Deductible • Deductible: Individual: $2,500-In Network $7,500-Out of Network Family: $7,500-In Network $22,500-Out of Network • Coinsurance: 70%-In Network 50%-Out of Network • Out of Pocket Maximum: Individual: $4,000-In Network $12,000-Out of Network Family: $12,000-In Network $36,000-Out of Network • IP Hospital: 100% After $200 copayment 50% After Deductible per day (3 days) plus deductible • OP Surgery (facility): 100% After $200 copayment per visit 50% After Deductible plus deductible • OP Non-Surgical Care: 70% After deductible 50% After Deductible • (Advanced Imaging: PET, MRI, MRA, CAT, & SPECT) • ER: (Waived if Admitted) 100% After $200 copay per visit 100% After $200 copay per visit plus participating deductible plus participating deductible
National POS Coverage First 70/50 5000 In-Network BenefitsOut of Network Benefits $500 per calendar year per member Not Applicable • Office Visit Copay: PCP - $25 50% After Deductible Specialist - $40 50% After Deductible Urgent Care - $40 50% After Deductible • Deductible: Individual: $5,000-In Network $15,000-Out of Network Family: $15,000-In Network $45,000-Out of Network • Coinsurance: 70%-In Network 50%-Out of Network • Out of Pocket Maximum: Individual: $6,000-In Network $18,000-Out of Network Family: $18,000-In Network $54,000-Out of Network • IP Hospital: 100% After $200 copayment 50% After Deductible per day (3 days) plus deductible • OP Surgery (facility): 100% After $200 copayment per visit 50% After Deductible plus deductible • OP Non-Surgical Care: 70% After deductible 50% After Deductible • (Advanced Imaging: PET, MRI, MRA, CAT, & SPECT) • ER: (Waived if Admitted) 100% After $200 copay per visit 100% After $200 copay per visit plus participating deductible plus participating deductible
Prescription Drug Plan Level One - $10 Level Two - $30 Level Three - $50 Level One:Lowest copayment for low cost generic drugs Level Two:Higher copayment for higher cost brand-name drugs Level Three:Highest copayment for higher cost drugs, both generic and brand-name. These drugs may have generic or brand-name alternatives in Levels One to Two. RightSource/Mail Order: 3 copayments for a 90-day supply
Healthcare Reform Changes • Required Benefit Changes on Renewal after September 23, 2010 • Grandfathered Dependent age to 26 • Effective January 1, 2011 (EISD Renewal Date) • Unlimited Lifetime Maximum • Pay Non Par ER same as Par • Preventative Services covered at 100% (Par only) • Dependent age to 26th birthday regardless of marital status
Humana Specialty Benefits • *** No Change in Rates or Benefits *** • Dental: • DHMO • Traditional Plus • Vision (EyeMed) • Basic Term Life • Voluntary Term Life • EOI (Evidence of Insurability) forms are required on any increase regardless of GI amount. Contingent on Underwriting approval. • Secure Life • Critical Advantage (Cancer Only)
Humana Enrollment • Enrollment dates: 11/16/2010 – 12/2/2010 • *Important Reminders* • You must utilize the call center for your 2011 benefits • Every employee must speak with a benefit counselor • You must provide Social Security Numbers and date of birth for all eligible dependents enrolling in a product • If electing the DHMO, you must provide the Primary Care Dentist’s number • If you fail to contact the Call Center regarding your Medical and FSA benefits, your coverage will terminate effective December 31, 2010.
