Transcript TITLE PAGE

Open Enrollment
State Health 2015
0
Welcome to open enrollment 2015!
• Website Open & Close Dates
– Website opens at 12 a.m. October 27, 2014
– Website closes at 5:00 p.m. November 14, 2014
• Online Election
- Members make their health election at
www.myshbpga.adp.com
Open Enrollment
2015
1
State Health Open Enrollment
Monday, October 27th – Friday, November 14th
Where do I go to enroll?
- Go to www.mycalhounbenefits.com by clicking on the RED button
or
- Go to www.myshbpga.adp.com
•Your password expires every 45 days.
• If you do not know your current User
Name or Password: Click the Forgot
User ID? Or Forgot Password? from
the login page
• If the system does not recognize you:
Please click on REGISTER HERE from
the login page.
Open Enrollment
2015
2
2015 Plan Options
Blue Cross Blue Shield – HRA & HMO
United Healthcare – HMO & HDHP
Kaiser Permanente– HMO
(Only if you live or work in one of the 27 counties. Barrow, Bartow, Butts, Carroll,
Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Forsythe,
Fulton, Gwinnett, Haralson, Heard, Henry, Lamar, Meriwether, Newton, Paulding,
Pickens, Pike, Rockdale, Spaulding, Walton.)
Open Enrollment
2015
3
2015 Plan Options… What’s new?
Applied Behavior Analysis (ABA) for Autism
•
Effective January 1, 2015, SHBP will provide limited coverage for medically necessary ABA treatment of Autism
Spectrum Disorder
•
Maximum benefit of $35,000 per year per approved member (through age 10)
•
Co-payments, deductibles and/or co-insurance may apply
Bariatric Pilot
•
The Georgia Legislature has established a pilot program to provide benefit coverage for certain bariatric surgical
procedures for the treatment and management of obesity and related conditions
•
Effective January 1, 2015, the pilot program is limited to 75 non-Medicare Advantage members for the 2015 Plan
Year
•
Qualified applicants will be randomly selected by the vendors for which you are enrolled. Please contact your vendors
for more information
Hearing Aids
•
Benefit allowance for hearing aids has increased for children up to age 19 from $1,500 to $3,000 every five years
Incentive Accounts
•
Includes well-being incentive credits that accompany the HMO and HDHP Plan Options. Credits can be earned by
completing certain health actions
Open Enrollment
2015
4
2015 Plan Design – HRA
BCBSGA / Gold Plan
Medical Benefits
Network
Provider
Out-ofNetwork
You
$1,500
You + Child(ren)
BCBSGA / Silver Plan
Rate
Network
Provider
Out-ofNetwork
$3,000
$166.08
$2,000
$2,250
$4,500
$300.38
You + Spouse
$2,250
$4,500
You + Family
Plan Pays after
deductible
$3,000
$6,000
BCBSGA / Bronze Plan
Rate
Network
Provider
Out-ofNetwork
Rate
$4,000
$108.64
$2,500
$5,000
$66.28
$3,000
$6,000
$202.74
$3,750
$7,500
$130.74
$405.52
$3,000
$6,000
$284.90
$3,750
$7,500
$195.96
$539.84
$4,000
$8,000
$379.00
$5,000
$10,000
$260.40
Deductible
85%
60%
80%
60%
75%
60%
100%
Not covered
100%
Not covered
100%
Not covered
You
$4,000
$8,000
$5,000
$10,000
$6,000
$12,000
You + Child(ren) or Spouse
$6,000
$12,000
$7,500
$15,000
$9,000
$18,000
You + Family
$8,000
$16,000
$10,000
$20,000
$12,000
$24,000
ACA Preventive Care
Out-of-Pocket Maximum
Base HRA Contribution
You
$400
$200
$100
You + Child(ren) or Spouse
$600
$300
$150
You + Family
$800
$400
$200
15%, Min $20, Max $50
15%, Min $20, Max $50
15%, Min $20, Max $50
Pharmacy Benefits
Tier 1
Tier 2
25%, Min $50, Max $80
25%, Min $50, Max $80
25%, Min $50, Max $80
Tier 3
Add $80 surcharge
for tobacco use
25%, Min $80, Max $125
25%, Min $80, Max $125
25%, Min $80, Max $125
Open Enrollment
2015
5
2015 Plan Design – HMO / HDHP
BCBSGA / UHC
HMO
Covered Services
In –Network
only
Monthly Rate
You
$1,300
You + Child(ren)
UHC
HDHP
KP
HMO
In-Network
Provider
Out-ofNetwork
Monthly Rate
In-Network
Only
Monthly Rate
$130.74 / $181.32
$3,500
$7,000
$53.02
None
$145.78
$1,950
$240.88 / $326.86
$7,000
$14,000
$108.74
None
$266.44
You + Spouse
$1,950
$333.06 / $439.26
$7,000
$14,000
$169.84
None
$364.64
You + Family
$2,600
$443.18 / $584.80
$7,000
$14,000
$225.56
None
$480.53
Deductible
BCBSGA / UHC
Plan Pays after
deductible
80%
70%
50%
100%
ACA Preventive Care
100%
100%
Not covered
100%
You
$4,000
$6,450
$12,900
$6,350
You + Child(ren) or Spouse
$6,500
$12,900
$25,800
$12,700
You + Family
$9,000
$12,900
$25,800
$12,700
Out-of-Pocket Maximum
Pharmacy Benefits
Tier 1
$20
Tier 2
$50
Tier 3
$90
70% coverage;
subject to deductible
$20
$50
$80
Add $80 surcharge for tobacco use
Open Enrollment
2015
6
2015 Wellness Incentives
(Well-Being requirements must be met between January 15 to December 15, 2015)
What to DO
1.
Assess Your Health
Complete your 2015 Healthways Well-Being Assessment® (WBA), a
confidential, online questionnaire that will take about 20 minutes.
Know Your Numbers
Complete a 2015 biometric screening and submit results (body mass
index, blood pressure, cholesterol, glucose).
The biometric screening must be completed at an SHBP sponsored
screening event or by your physician and your results submitted
appropriately on the 2015 Physician Screening Form.
2.
Open Enrollment
TAKE Action
It’s your choice! Complete the coaching pathway, online
pathway or a combination of both.
Coaching Pathway
• Complete your WBA and,
• Actively engage in telephonic coaching.
Online Pathway
Complete your WBA and,
Record FIVE online activities using the same tracker within four
consecutive weeks and earn 40 well-being incentive credits. HRA
funds. You can earn these rewards up to six times. Sample
activities: track exercise five times, record daily steps five times
within four consecutive weeks.
What you EARN
Complete BOTH
and earn
240
Well-being incentive
credits.
(WBA must be
completed before any
incentive can be
earned.)
Earn up to
240
Well-being incentive
credits.
(WBA must be
completed before any
incentive can be
earned.)
7
Questions or Additional Information?
Resource
Contact #
Website
Blue Cross Blue Shield of Georgia (BCBSGa)
Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET
855-641-4862
www.bcbsga.com/shbp
United Healthcare
Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET
888-364-6352
www.welcometouhc.com/shbp
Kaiser Permanente (KP)
Member Services: 24 hours a day/7 days per week
(Appointment Scheduling, Prescriptions and Nurse Advice)
855-512-5997
www.my.kp.org/shbp
Healthways
Member Services: Monday thru Friday, 8:00 a.m. to 8:00 p.m. ET
888-616-6411
www.BeWellSHBP.com
Express Scripts
Member Services: 24 hours a day/7 days per week
877-841-5227
www.express-scripts.com/georgiaSHBP
SHBP
Member Services: Monday thru Friday, 8:30 a.m. to 5:00 p.m. ET
800-610-1863
www.mySHBPga.adp.com
Open Enrollment
2015
8
State Health Benefit Plan
State Health Benefit Plan / Active Employee Rates
January 1, 2015 – December 31, 2015
You
You +
Children
You +
Spouse
You +
Family
BCBS Gold
$166.08
$300.38
$405.52
$539.84
BCBS Silver
$108.64
$202.74
$284.90
$379.00
BCBS Bronze
$ 66.28
$130.74
$195.96
$260.40
BCBS HMO
$130.74
$240.88
$333.06
$443.18
UHC HMO
$181.32
$326.86
$439.26
$584.80
UHC HDHP
$ 53.02
$108.74
$169.84
$225.56
Kaiser HMO
$145.78
$266.44
$364.64
$485.30
Thank You
Open Enrollment
2015
9