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Benefits Overview The information contained in this presentation is not a contract and is subject to change by the proper authorities. It should be understood that explanations in this summary cannot alter, modify or otherwise change the controlling legal documents or general statutes in any way, nor can any right by reason of any inclusion or omission of any statement in this presentation.
Who’s Eligible • Permanent (non-temporary) part-time employees working 20 – 29 hours per week are eligible for many benefit programs, typically without employer contributions • Permanent (non-temporary) part-time employees working 30 to 39 hours per week or permanent full-time employees working 40 hours per week are considered to be benefits eligible
Health Benefits • State Health Plan of NC – administered by Blue Cross and Blue Shield of North Carolina (BCBSNC) • Use any medical provider you choose • In Network: Your costs are lower when you use a doctor, hospital or other provider from the BCBSNC Blue Options network. • Out of Network: For other providers, your deductibles, coinsurance and copays may be higher • Choose from three plan options for 2014: • Consumer-Directed Health Plan (CDHP) with HRA • (no or low contribution, high-deductible) • Enhanced 80/20 Plan • (higher contributions, higher coverage levels) • Traditional 70/30 Plan • (lower contributions, lower coverage levels)
2013 Both PPO Plans – More Details • Prescription coverage provided by Medco: • Generic: $12 co-pay, up to 30-day supply • Preferred Brand-name: $40 co-pay, up to 30-day supply • Non-preferred Brand-name: $64 co-pay, up to 30-day supply • Specialty: 25% coinsurance up to $100, 30-day supply • NC HealthSmart: voluntary program offering tools and resources to help you live a healthier life such as: • Member Focus newsletter, information on the 24-hour nurse line, the Stork Rewards program, Eat Smart, Move More, Weigh Less program • Sign up for the State Health Plan Member Newsletter at www.shpnc.org
2014 Health Plan Options Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA Traditional 70/30 Plan • The current Standard 80/20 Plan with a new name to match the new features • $0 ACA Preventive Services • $0 ACA Preventive Medications • New Wellness Incentives • Reduced medical copay opportunities • A new health plan option • A high-deductible medical plan • A Health Reimbursement Account (HRA) to help offset the deductible • 85/15 Coinsurance • $0 ACA Preventive Services • $0 ACA Preventive Medications • CDHP Preventive Medication List ($0 deductible) • New wellness incentives • Additional HRA funds for visiting certain providers • The current Basic 70/30 Plan with a new name • No incentives available • No $0 ACA Preventive Services • No $0 ACA Preventive Medications Open Enrollment is October 1 – 31, 2013 for 2014. You must complete enrollment—otherwise, you and your covered family members will be enrolled in the Traditional 70/30 Plan effective January 1, 2014.
A New Focus On Wellness NEW: Consumer-Directed Health Plan (CDHP) with HRA Enhanced 80/20 Plan Traditional 70/30 Plan • Wellness premium credits when: • Subscriber completes a Health Assessment • Subscriber attests for him/herself and spouse (if applicable) to not smoking...or to being in a smoking cessation program • Selecting a Primary Care Provider (PCP) for self and all dependents • Additional wellness incentives • $15 copay reduction for utilizing the PCP (or someone in that practice) listed on the ID card • $10 specialist copay reduction for utilizing a Blue Options Designated Specialist • $0 inpatient hospital copay for utilizing a Blue Options Designated Hospital • Wellness premium credits when: • Subscriber completes a Health Assessment • Subscriber attests for him/herself and spouse (if applicable) to not smoking...or to being in a smoking cessation program • Selecting a Primary Care Provider (PCP) for self and dependents • Additional wellness incentives • $15 added to the HRA when the PCP (or someone in that practice) listed on the ID card is seen • $10 added to the HRA when a Blue Options Designated Specialist is seen • $50 added to the HRA when a Blue Options Designated Hospital is utilized for inpatient services • No incentives available • No $0 ACA Preventive Services • No $0 ACA Preventive Medications
Who can be a Primary Care Provider? • A Primary Care Provider can practice: • General / Family Medicine • Internal Medicine • Pediatrics, or • Obstetrics and Gynecology • A Primary Care Provider can be: • Licensed Nurse Practitioners • Physician’s Assistants • Specialty Providers cannot be selected as a PCP.
What Is a Blue Options Designated Provider? • Blue Options Designated providers meet BCBSNC criteria for: • Delivering quality health outcomes • Cost effectiveness • Accessibility by members • The Blue Options Designated provider network includes hospitals and certain types of specialists: • General Surgery • Ob-Gyn • Gastroenterology • Orthopedics • Cardiology • Neurology To find a Designated Blue Options provider, members may go online to www.shpnc.org and click on Member Services, then on “Find a Doctor or Facility” or call 888-234-2416
Lower Your Premiums with Wellness Premium Credits—The Enhanced 80/20 Plan
Lower Your Health Care Costs with Wellness Incentives—The Enhanced 80/20 Plan
The Consumer-Directed Health Plan (CDHP) with HRA High-Deductible Health Plan Health Reimbursement Account (HRA) A different kind of health plan with two components • Covers the same services as other Plan options through the same PPO network • The deductible is higher than other Plan options, but the coinsurance is lower • In-network: $1,500 Individual/$4,500 Family • Out-of-Network: $3,000 Individual/ $9,000 Family • After the deductible is met, the member only pays the 15% coinsurance • The deductible applies to both Pharmacy and Medical expenses • If the member reaches his or her deductible and coinsurance out-of-pocket maximum, the Plan pays 100% of the covered expenses for the rest of the benefit year (medical and pharmacy) • The Plan funds the members’ Health Reimbursement Accounts (HRA) annually • HRA funding is based on the number of family members covered • $500 for employee/retiree only • $1,000 for employee/retiree + 1 $1,500 for employee/retiree + 2 or more dependents • HRA funds are used to pay a portion of the members’ deductibles & coinsurance • Once the HRA is depleted, the member must pay the remaining deductible & coinsurance • Incentives available to add value to HRA • Unused HRA funds are available the following year
The Consumer-Directed Health Plan (CDHP) • A High Deductible Health Plan is exactly what it says – A plan with a high front-end deductible. • After meeting the deductible the member pays a 15% coinsurance on all in-network medical and pharmacy benefits except ACA preventive services and ACA preventative medications, which are covered at 100%. • The pharmacy and medical deductible and out-of-pockets are shared. • An additional CDHP preventive medication list is covered with no deductible meaning the member is subject to 15% of eligible expense only. • The Deductible Does Not Apply to Every Medication • Under the Affordable Care Act, many ACA preventive medications are paid at 100% • Medications on the CDHP Preventive medication are subject to 15% coinsurance with no deductible. Example of medications include those used to treat heart disease or stroke, asthma, and diabetes. These 2 different medication lists will be posted online at www.shpnc.org.
How The HRA Helps The Member Meet Their Deductible Coverage Type HRA Pays Total Deductible You Pay Employee Only First $500 Remaining Deductible $1,000 $1,500 In-Network $3,000 Out-of-Network Remaining Deductible $2,500 Employee + One Family Member First $1,000 Remaining Deductible $2,000 $3,000* In-Network $6,000 Remaining Deductible $5,000 Out-of-Network Employee + Two or more Family Members First $1,500 Remaining Deductible $3,000 $4,500* In-Network $9,000 Remaining Deductible $7,500 Out-of-Network *The HRA is a pooled account and is available to whichever family member needs it first. It is possible for one family member to use all the funds before another family member has a claim.
How the Consumer-Directed Health Plan with HRA Works #1 #6 #2 #3 #5 To monitor HRA balance and claim’s payments, members may go online to www.shpnc.org and click on My Member Services. #4
Lower Member Health Care Costs with Wellness Incentives—CDHP
The Traditional 70/30 Plan • Traditional 70/30 Plan – The new name for the current 70/30 Basic Plan; there are no changes to the Plan’s benefits for 2014 • Copays and Deductibles – The copays and deductibles on the Traditional 70/30 PPO plan are the same as they are today on the 70/30 Basic Plan. There will be no opportunities for copay reductions on the Traditional 70/30 Plan. • Network Services – Members may visit any provider, but they will pay less when they go to a BCBSNC network provider • Preventive Services – Copays still apply to preventive services.
Monthly Premiums—Enhanced 80/20 Plan *Assumes completion of three wellness activities
Monthly Premiums—CDHP *Assumes completion of three wellness activities 24
Monthly Premiums—Traditional 70/30Plan Reminder: Wellness premium credits are not offered under the Traditional Plan.
NCFlex Health & Other Insurance Programs • These voluntary programs provide a variety of plans to meet the needs of you and your family • You pay the full cost of coverage through payroll deductions on a pre-tax basis • Programs include: Dental, Vision, Health Care Flexible Spending Account, Dependent Day Care Flexible Spending Account, Cancer, Critical Illness, Group Term Life Insurance, Core AD&D and Voluntary AD&D Insurance
Dental Coverage • Coverage provided through United Concordia • Choose from two plan options: • High Option: Includes orthodontia for children under 19 • Low Option: Does not include orthodontia • Under both options: • Visit any provider • You are responsible for deductibles • You or your dentist may file claims • You may be subject to a waiting period before certain benefits are payable under the plan (see “Benefit Waiting Period” chart under Dental coverage on NCFlex website)
Vision Coverage • Coverage provided through Superior Vision Services (SVS) • Choose from three coverage options: • 2013 • Exam and Materials, Materials Only, or Enhanced Exam and Materials • 2014 • Core, Exam and Materials, or Enhanced Exam and Materials • Under all options, visit any provider but lower expenses with SVS in-network provider
Vision Coverage: Exam and Materials Plan and Enhanced Exam and Materials Plan
Health Care Flexible Spending Account • Coverage provided through P&A Group • Set aside money through pre-tax contributions to pay for eligible out-of-pocket medical, dental and vision expenses: • Deductibles • Co-pays and coinsurance • Out-of-network expenses • Uncovered procedures • Contribute from $120 to $2,500 per year • Convenience card (debit card) for all participants • “Use it or lose it” rule; you forfeit any unused contributions • Expenses can be incurred between January 1, 2013 and March 15, 2014, provided you remain actively employed for all of 2013. Prior year claims must be submitted by April 30, 2014.
Dependent Day Care Flexible Spending Account • Set aside money through pre-tax contributions to pay eligible child care and adult day care expenses so you (and your spouse) can work or attend school full-time: • Care of dependent children under age 13 • Care of dependent adult who lives with you at least 8 hrs/day • You may contribute from $120 to $5,000 per year • “Use it or lose it” rule: you forfeit any unused contributions • Expenses can be incurred between January 1, 2013 and March 15, 2014, provided you remain actively employed for all of 2012. Prior year claims must be submitted by April 30, 2014.
Other NCFlex Health Programs • Cancer Insurance provided through American Heritage Life: pays benefits for cancer-related expenses • Employee Only or Employee + Family Coverage • Low, High and Premium options • Critical Illness Insurance provided through Met Life: pays lump sum benefit in event of certain health conditions • Employee, Spouse, Children or Family Coverage • Three categories of coverage available
Monthly Rates for Critical Illness Coverage Employees may also cover eligible dependent children. Employee will pay one flat rate ($0.92) no matter how many children are covered.
Voluntary Group Term Life Insurance • Group Term Life provided through ING: coverage in $10,000 increments, from $20,000 to $500,000 (limited to five times your base annual earnings) • Coverage over $100,000 subject to Evidence of Insurability (EOI) • Coverage available for yourself only
Accident Insurance • Core Accidental Death and Dismemberment (AD&D) Insurance provided through A.C. Newman • Elect coverage of $10,000 for yourself only • University pays full cost of coverage; however, you must enroll for coverage • Payment to your beneficiaries in case of your accidental death • Payment to you in case of your accidental dismemberment • Voluntary AD&D Insurance provided through A.C. Newman • Elect coverage up to $500,000 for you and your family
Income Protection Programs • Programs designed to provide you and/or your family with financial protection in the event of your death, disability or long-term illness • Some are offered at no cost to you; others require you to pay for coverage
Disability Plans • Disability coverage provided under the Disability Income Plan of North Carolina (DIP-NC) • Short-Term Disability • Provided to eligible employees at no cost • After one year of contributing membership to TSERS or participation in the ORP. • Pays 50% of base compensation up to $3,000/month • Payable up to 365 days, after 60-day waiting period • Long-Term Disability • Provided to eligible employees at no cost • After five years of contributing membership to TSERS or participation in ORP • Pays 65% of base compensation up to $3,900/month • Payable as long as you remain permanently disabled, until eligibility for unreduced service retirement
Supplemental Disability Plans • Can help fill gaps in State coverage • Replacement income while you are ineligible for state Short-Term Disability Plan • Waiting period: 90 days • Pays 66-2/3% of gross monthly salary up to $10,000 • Benefits available during first year • Voluntary benefit; you pay full cost of coverage after-tax • Coverage through The Standard if you elect ORP • Includes contributions into your ORP account on your behalf • Cost of .00209 of monthly salary • Coverage through Liberty Mutual if you elect TSERS • Cost of .00233 of monthly salary
Retirement Programs • Participation in a retirement program is mandatory • You may choose between: • The North Carolina Teachers' and State Employees' Retirement System (TSERS), a defined benefit plan or • the UNC Optional Retirement Program (ORP), a defined contribution plan • You must make your election between TSERS and ORP within 60 days of your date of hire • Once you make the choice it cannot be changed; it is irrevocable
TSERS Plan Highlights • Defined benefit plan • State controls the investment • Benefit you receive is based on a formula (factors include your age, your average final compensation and your years/months of creditable service) • You must contribute 6% of your pay on pre-tax basis
