Presentation Transcript

1. 2014 Benefit Changes

   For Union-Represented Employees Fall, 2013
2. Agenda Safety Procedures New Resources New Medical Plan for 2014 New Resources - where to get more information What’s changing? New Plan Design for 2014 Some examples Question and Answer
3. Safety Procedures Where is the nearest emergency exit? Duck, cover, and hold for an earthquake Who knows CPR/First Aid? Who can call emergency responders? Who can meet/greet first responders?
4. New Resources Provant – Your One-Stop Shop for Health and Wellness Questions Talk to a health advocate for: Billing Questions New Health Account Plan questions Dental or Vision Plan Questions Questions about health screenings, health accounts PROVANT Phone support: 866-271-8144, M-F, 5am-5pm. Pacific Time Email support: PGEsupport@provanthealth.com
5. New Resources Details on the new Anthem and Kaiser HAP for 2014 Accessed from any computer with internet access What to expect at the doctor and pharmacy on your first visit in 2014 How to use your different cards Where to get more information as you use the plans New Website: www.mypgebenefits.com
6. What’s Changing? What Isn’t Changing? What Is?
7. What’s Changing? Rules for Covering Children Children can be covered under your PG&E medical, dental and vision plan until their 26th Birthday They no longer have to be students unmarried your tax dependent They can be employed and be offered benefits (New)
8. New Medical Plan for 2014 The Health Account All active employees enrolled in Anthem or Kaiser will have a Health Account Both the Anthem and Kaiser PG&E plans for active employees will be called the Health Account Plan, or HAP
9. New Medical Plan for 2014 Earning Health Account Credits Automatically receive initial credits into your account each year on January 1st Earn more credits by taking a health screening, testing tobacco-free or completing a telephonic tobacco cessation program Amount you get depends upon whether you have single or family coverage Account is entirely funded by PG&E No individual results are shared with PG&E
10. New Medical Plan for 2014 The Health Account Health Account Deposits Single Coverage Family Coverage Remember: If you don’t use all your credits in one year, they roll over
11. New Medical Plan for 2014 Earning Health Account Credits Health Screening consists of four tests: Weight/Height to get BMI Blood Pressure Glucose Level (non-fasting) Cholesterol Level Tobacco use test is optional anddone with an oral swab Tobacco users can skip the tobacco use test and complete a tobacco cessation course with Provant to earn credits Employees with family coverage will earn credits for their entire family – their dependents do not need to do a screening to earn credits
12. New Medical Plan for 2014 Health Screenings and Tobacco Use Test Available at many PG&E locations beginning October, 2013. Also available through concierge screening at home or office Can do screenings at doctor’s office, but must then walk into an on-site screening to get tobacco use test Results are posted to Provant’s website under your secure login Incentive credits will be posted to your Health Account approximately 4 weeks after you take your screenings, but screenings done before January 1, 2014 will not be posted until January 1, 2014. Have from October 1, 2013 to September 30, 2014 to earn incentive credits for 2014 plan year
13. New Medical Plan for 2014 Health Screenings and Tobacco Use Test Three ways to get a Health Screening/Tobacco Test On-site event: enroll online at www.provantevents.com/pge or call Provant Concierge: call Provant at 1-866-271-8144 to schedule at your home or office Take a form to your doctor: doctor’s offices don’t do tobacco screenings; you’ll need to walk into any on-site screening – no appointment needed. Download the screening form from www.mypgebenefits.com Check for your results at www.provantonline.com
14. New Medical Plan for 2014 How the Health Account Plan (HAP) Works Using Health Account Credits Pay for plan deductibles and other out-of-pocket expenses Credits can be used for: medical, dental and/or vision expenses for you or your family members unused credits roll over year after year and can be used for PG&E Retiree Medical Plan expenses You can still contribute to a Health Care Flexible Spending Account (FSA)
15. New Medical Plan for 2014 How the Health Account Plan (HAP) Works Using Health Care Flexible Spending Account Still a “use-it-or-lose-it” account Will work with the Health Account Administrators: Your Spending Account (for Anthem Blue Cross members) Kaiser (for Kaiser members) Will automatically use the Health Care Flexible Spending Account first
16. How the Plan Works – Health Account Debit Cards YSA (Anthem HAP) Use card to pay expenses for: Medical Mental health Pharmacy Dental Vision Kaiser HAP Use card to pay expenses for: Kaiser pharmacy Kaiser medical expenses and mental health expenses automatically taken out of your account after your visit to Kaiser Submit claims to pay for Dental Vision
17. New Medical Plan for 2014 4 free primary care visits per year for every covered family member First choice for everything from chronic disease management, physicals, everyday ailments Choose a family doctor who knows you and cares about your “whole person” health Primary Care Doctors General or family practitioners (including nurses) Internal Medicine doctors Pediatricians OB/GYNs Urgent care How the Health Account Plan (HAP) Works
18. New Medical Plan for 2014 Other Free Services Some free preventive screening services (e.g., mammograms, pap smears, colonoscopies, immunizations) Some free prescription drugs for preventive care and chronic conditions (e.g., insulin for diabetes) Free maternity and well-baby office visits to age two Go to www.mypgebenefits.com for lists of which preventive services and prescription drugs are free Tip: free doctor visits may include additional tests or services performed during your visit – these are covered, but may not be free
19. New Medical Plan for 2014 A few terms to understand … Annual Deductible For services that aren’t free, amount you’re responsible to pay for first before the plan will start to pay Co-insurance You pay a percent of the cost of a medical service Out-of-Pocket Maximum The limit on the amount you have to pay every year for covered services
20. New Medical Plan for 2014 How the Health Account Plan (HAP) Works Annual Deductible If you have single coverage, annual deductible is $1,000 If you have family coverage, annual deductible is $1,000 per person but no more than $2,000 for your entire family Remember: if you earn all your Health Account credits, you’ll have enough to pay your whole deductible from your Health Account
21. New Medical Plan for 2014 How the Health Account Plan (HAP) Works Coinsurance You’ll be responsible for either 10% or 20% of the covered cost and the HAP will pay the other 90% or 80% respectively. There are no copayments under the HAP, so instead of paying a flat $10 or $20 copayment at the time of service, you’ll pay 10% or 20% for services that are not free But, your expense is limited by the Out of Pocket Maximum….
22. New Medical Plan for 2014 How the Health Account Plan (HAP) Works Out-of-Pocket Maximum Limits how much you are responsible for paying every year Once out-of-pocket maximum is reached, all covered services are free for the rest of the year Includes all money you spend on covered medical services, prescription drugs and mental health services Includes credits you used from your Health Account for medical expenses Includes deductible and co-insurance
23. New Medical Plan for 2014 How the Health Account Plan (HAP) Works Out-of-Pocket Maximum If you have single coverage, the annual out-of-pocket maximum is $2,400 If you have family coverage, the annual out-of-pocket maximum is $2,400 per person but no more than $4,800 for your entire family All covered expenses paid at 100% for the rest of the calendar year
24. How the Plan Works – Coinsurance
25. New Medical Plan for 2014 Things to note about pharmacy Express Scripts will continue to be the pharmacy provider for Anthem Blue Cross; Kaiser provides pharmacy benefits for its members Free medications for Anthem HAP must be obtained from Express Scripts mail order Free medication from Kaiser can be from any Kaiser pharmacy or mail order Anthem HAP members will have mandatory mail order for many maintenance drugs – drugs you take on a long-term basis In 2014, can get three fills at a retail pharmacy, then must get the drugs through Express Scripts mail order, or pay 100% of the cost Can sign up now with Express Scripts mail order if currently enrolled in Anthem Most narcotics, ADHD drugs and compound drugs are not included – you will continue to have coverage for these at a retail pharmacy
26. Some Quick Examples of how the HAP Works Jenny is a PG&E employee, who is married and has 3 children. She has taken her health screening and tested tobacco-free, so she has a total of $2,500 in her Health Account for 2014. Jenny is pregnant, and will deliver her baby by cesarean section in 2014, which will cost $27,000 dollars. All other family members are healthy, will get check-ups and immunizations, but have no other health needs in 2014. Question: How much will Jenny spend on her family’s health care with the Health Account Plan in 2014?
27. Some Quick Examples of how the HAP Works Answer: Jenny must pay a maximum of $2,400 for her cesarean delivery (this is her individual out-of-pocket maximum which includes her deductible). Since she has $2,500 in her Health Account, she can use those credits first and to pay the entire amount The check-ups and immunizations for her family were covered at 100%. Jenny will have $100 to roll-over to her Health Account in 2015.
28. Some Quick Examples of how the HAP Works Jenny is a PG&E employee, who is married and has 3 children. She has taken her health screening and tested tobacco-free, so she has a total of $2500 in her Health Account for 2014. Jenny is pregnant, and will deliver her baby by cesarean section in 2014, which will cost $27,000 dollars. Jenny’s husband is on an expensive medication that costs $50,000 per year. Question: How much will Jenny spend on her family’s health care with the Health Account Plan in 2014?
29. Some Quick Examples of how the HAP Works Answer: Jenny must pay a maximum of $4,800 for her cesarean delivery and her husband’s medication. (Each of them will hit their individual out-of-pocket maximum of $2,400) Since she has $2,500 in her Health Account, she can use those credits first and then pay $2,300 out of her own pocket. In addition, if she had a Health Care Flexible Spending Account of $2,300, the amount would be deducted from her pay on a tax-free basis and she would have saved approximately $750 in taxes.
30. Some Quick Examples of how the HAP Works Jenny is a PG&E employee, who is married and has 3 children. She has taken her health screening and tested tobacco-free, so she has a total of $2,500 in her Health Account for 2014. Jenny is pregnant, and will deliver her baby by cesarean section in 2014, which will cost $27,000 dollars. Jenny’s husband is on an expensive medication that costs $50,000 per year, and her son will have a bike accident that will cost $20,000 due to his broken leg. Question: How much will Jenny spend on her family’s health care with the Health Account Plan in 2014?
31. Some Quick Examples of how the HAP Works Answer: Jenny must pay a maximum of $4,800 for her cesarean delivery, her husband’s medication, and her son’s broken leg. Since Jenny and her husband both hit the out-of-pocket maximum and therefore met the family out-of-pocket maximum of $4,800, all covered expenses for all family members are free for the rest of 2014. Since she has $2,500 in her Health Account, she can use those credits first and then pay $2,300 out of her own pocket. In addition, if she had a Health Care Flexible Spending Account of $2,300, the amount would be deducted from her pay on a tax-free basis and she would have saved approximately $750 in taxes.
32. What do you need to do now? Schedule a Health Screening to maximize your Health Account credits for 2014 Look for Open enrollment materials in late October Review Health Account Plan User Guide that will be sent to you in late December Visit www.mypgebenefits.com for more information on the new Health Account Plan Contact Provant with detailed questions 866-271-8144, M-F, 5am-5pm, Pacific Time PGEsupport@provanthealth.com

33. Question & Answer

34. Thank You

    Questions? Log onto www.mypgebenefits.com for more information Email PGEsupport@provanthealth.com Or call Provant at 1-866-271-8144 for medical plan questions