The Local Choice Health Benefits Program

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The Local Choice Health Benefits Program

• 2005 Regional Meetings
• March 2005

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Whats New?

• CommonHealth Programs
• New Plan Designs
• Broader Plan Choices
• Funding Requirements
• Financial Overview
• Renewal Requirements

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What Else is New?

• COBRA/USERRA/HIPAA Updates
• Dependent Definitions
• GASB 45
• Medicare D
• Alternate ID s
• General Housekeeping

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CommonHealth

• Linda Sweeney
• Rose OToole
• Stacey Dorton

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Continental Health Promotion 804 Moorefield Park
Drive, Suite 304 Richmond, VA 23236 (804)
560-4500 www.chp-online.com/tlc
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Our Vision Statement For CommonHealth is
that State and Local Choice employees in
Virginia will be the healthiest in the nation
The CommonHealth Mission To make a difference
in the health of the employee and the workplace
by Integrating health into the work culture,
Building trustworthy partnerships, Changing
individual behavior.
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What does CommonHealth include?

• On-site Health Check Screening
• Total Cholesterol
• HDL Cholesterol
• Blood Glucose
• Blood Pressure
• Comprehensive Health Questionnaire
• Participant Incentive
• New Incentive for CommonHealth Administrators
  achieving a 35 participation rate

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What does CommonHealth include?

• Annual Health Education Program
• Small Steps, Big Rewards
• Minutes Matter
• Have a Ball with Fitness (Available July 2005)

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What does CommonHealth include?
Baby Benefits This free program is designed to
promote a healthy pregnancy and prevent premature
birth. New Child Safety Seat Program offers a
30 reimbursement for the purchase and safe
installment of a child safety seat. 1-800-828-589
1
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What does CommonHealth include?
Breaking Free from Tobacco This program offers
the support needed to quit and stay quit.
Participants can receive an eight-week supply of
nicotine patch or gum at no cost. 1-800-394-6380
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What does CommonHealth include?
The Compass Quarterly Newsletter Annual Health
Improvement Challenge Fitness Center Discounts
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National Employee Health Fitness Day
May 18, 2005
? Promote the event at your location ? Sign up
interested employees ? Choose a one-mile (about
15 minutes) walking course ? Contact your
CommonHealth Regional Coordinator to order step
counters provided through The Governors Healthy
Virginians Initiative ? Goal 50 or more groups
participate!
Be on the lookout for information in the mail and
on the CommonHealth Web site.
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Questions?
Eastern Region Tammy Glotz 1-804-379-8568
or tglotz_at_chp-online.com Central Region Rose
OToole 1-804-378-9914 or rotoole_at_chp-online.com
Western Region Stacey Dorton 1-276-739-9961
or sdorton_at_chp-online.com CommonHealth Manager
Linda Sweeney 1-804-560-4500 or lsweeney_at_chp-onl
ine.com
Visit us at www.chp-online.com/tlc  Thank you
for supporting CommonHealth!
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Anthem Blue Cross and Blue Shield

• Amy Feinman

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Anthem Cross and Blue ShieldThe Local Choice
2005/2006
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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• Look Back at 2004/2005
• 2005/2006 Changes
• 2005/2006 Plans

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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• Look Back at 2004/2005
• 10 new groups joined TLC
• 1 group left TLC
• Membership increased 4
• Maintained a 13 trend factor
• Benefit analysis and plan changes

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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• 2005/2006 Medical Plan Changes
• New four plan design
• No lifetime benefit maximum on any product
• All plans have the same coverage and exclusion
  base
• All plans have BlueCard
• All plans will have out of network coverage
• Copayments do not count towards the out of pocket
  calculation

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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• 2005/2006 Medical Plan Changes
• Key Advantage Expanded is the only plan with
  vision coverage. (Vision benefits will continue
  to be on a 24 month basis. The 24 months begins
  the month you have your eye exam, or purchase
  frames, lens, or contact lenses.)
• This year only, because of the elimination of 4
  plans, 4th quarter deductible carryover will
  apply for all plan changes.

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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• Really Good News
• New member handbooks will be published this year.
• They will have a standard format with inserts for
  plan specific coverage amounts.

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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• 2005/2006 Plans
• Please refer to your comparison charts.

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Anthem Blue Cross and Blue ShieldThe Local
Choice 2005/2006

• Questions?

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ValueOptions

• Nathan Coley
• Joseph E. Chodkiewicz

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• March 7, 2005

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ValueOptions

• Founded by a psychiatrist
• Clinically focused delivery system
• Over 25 years of EAP experience
• 84,000 provider locations- 23 million covered
  lives for managed care
• Virginia based employer

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ValueOptions

• Mental Illness/Substance Abuse and EAP Benefits
• Dedicated toll free number 866-725-0602
• Website www.achievesolutions.net/tlc

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ValueOptions
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ValueOptions

• Employee Assistance Program Benefits
• Four sessions per problem per year with no cost
  to the member
• Everyone in the household is eligible
• Provides confidential, professional counseling,
  education and referral services

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ValueOptions

• EAP Offers help with a variety of issues
• Marital and family problems
• Alcohol and /or drug abuse assessment
• Balancing work and family
• Work-related concerns
• Financial or legal issues (including mediation
  services)
• Grief and loss
• Personal growth and development

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ValueOptions
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ValueOptions

• Mental Illness/Substance Abuse
• Call 866-725-0602 for pre-certification
• Certification is based on medical necessity
• Benefit coverage is based on provider status
• Out of Network benefit, when available, provides
  lower coverage and providers may balance bill the
  member

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ValueOptions

• Medical Necessity
• The service must be appropriate and essential for
  the evaluation and/or treatment of a mental
  disorder.
• The service must expect to improve a patients
  condition or level of functioning, and/or prevent
  regression.
• The service must meet national standard of
  practice.
• Medical Necessity Criteria can be found at our
  website www.valueoptions.com

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ValueOptions

• As of June 30, 2005,
• The following plans are no longer offered
• Cost Alliance
• Value Alliance
• KeyShare

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ValueOptions

• Beginning July 1, 2005
• The TLC Program will offer 4 new plans
• Key Advantage Expanded
• Key Advantage 200
• Key Advantage 300
• Key Advantage 500

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ValueOptions

• Questions???

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Thank you!

• www.valueoptions.com

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Medco

• Derek Fredenburg
• Robin Nieman

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The Local Choice Rx Benefit administered by
Medco

• Presenter Derek Fredenburg
• George Bognar

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New Copay Information
If a brand name drug has a generic equivalent,
the member pays the difference between the two if
the brand name drug is requested.
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Medco Customer Service for TLC

• 1-800-355-8279
• Accessible 24 hours a day, seven days a week
  (except for Thanksgiving and Christmas)
• How can this help me?
• Ask a pharmacist.
• Refill a prescription
• Order new mail order forms
• Locate a retail pharmacy
• Get a copay quote
• These are only some of things we can assist you
  with.

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Retail Pharmacy

• When you need a drug on a short term basis
• Over 50,000 stores in the network nationwide
• All major chains are in the network
• A retail copay is applied per 34 day supply of
  medication, up to a 102 day supply (3 month) with
  one prescription

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medco.com secure and convenient prescription
management for members

• Award winning member website
• Verified Internet Pharmacy Practice Sites
  (VIPPS) A Program of the National Association
  of Boards of Pharmacy
• What can I do?
• Refill medications by mail on line
• Get the status of a Mail Rx Order
• Copay quotes
• Ask a pharmacist
• Find a retail pharmacy
• Is my medication covered?

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Medco by Mail

• For prescription medications you use on a regular
  basis
• Dedicated primary mail pharmacy just for TLC and
  State employees located on Richmond VA
• PO Box 35030
• Richmond VA 23235-0030
• Wilson Rx Award - Medco has re-earned the
  distinction of being named the nation's top-rated
  PBM and mail order pharmacy in the WilsonRx
  Pharmacy Benefit Satisfaction Report 2004.
• Safe, convenient, cost effective, and it is quick.

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Delta Dental of Virginia

• Duncan Sheils
• Matt Macdonald
• Terri Green

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Dental Benefit Solutions
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Discussion Points

• History of Dental Benefits
• Dental Plan Enrollment
• Costs and Trends
• Plan Changes for 2005
• The Delta Difference

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Discussion Points

• History of Dental Benefits
• Dental Plan Enrollment
• Costs and Trends
• Plan Changes for 2005
• The Delta Difference

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History of Dental Service Plans

• 1954
• International Longshoremans Union and dental
  professionals create dental care program for
  Unions children
• First not-for-profit dental service plan created,
  (Washington State Dental Service - now Delta
  Dental of Washington).
• 1955
• Similar organizations created by dental societies
  in CA and OR.
• 1963
• Aerojet-General Corp first large company to buy a
  dental program.
• 1966
• ADA established the National Association of
  Dental Service Plans - forerunner of Delta Dental
  Plans Association.
• Organizations main purpose to increase the
  availability of dental services to the public
• 1970s
• Commercial insurers enter dental marketplace

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Discussion Points

• History of Dental Benefits
• Dental Plan Enrollment
• Costs and Trends
• Plan Changes for 2005
• The Delta Difference

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Current Dental Marketplace
IBIS Study, 2000-2004
55 of the US population has group dental
insurance
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Delta Dental National Enrollment
IBIS Study, 2000-2004
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Competitive LandscapeNational Market Share
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Discussion Points

• History of Dental Benefits
• Dental Plan Enrollment
• Costs and Trends
• Plan Changes for 2005
• The Delta Difference

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Current Dental MarketplaceTransition to PPO
products

• PPO products are continuing to capture more than
  50 of new covered lives
• DMO business continues to lag with a continued
  negative outlook for future sales

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Premium Trends
Medical trends continue to outpace dental trends.
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Benefit Trends

• Composite fillings on posterior teeth
• Invisalign braces
• TMJ
• Cleanings-four/year (periodontal cleanings)
• Implants
• Consumer directed healthcare

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Discussion Points

• History of Dental Benefits
• Dental Plan Enrollment
• Costs and Trends
• Plan Changes for 2005
• The Delta Difference

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The Local Choice Dental PlansEffective 7/1/05
and 10/1/05
Key Advantage Expanded
Key Advantage 200, 300, 500
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Discussion Points

• History of Dental Benefits
• Dental Plan Enrollment
• Costs and Trends
• Plan Changes for 2005
• The Delta Difference

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Who Is Delta Dental?

• The largest and most experienced provider of
  group dental benefits nationally
• Delta Dental Plans Association
• 38 plans with a common mission focus
• Shared national provider networks
• National Provider File

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Superior Networks and Access

• DeltaPremier
• Largest Network
• Available Anywhere!
• 136,500 dental offices
• 2675 Participating Premier Providers in Virginia
  (79 of all providers statewide)
• 29 million members

• 82 of TLC/School groups using a Premier provider
• 77 of TLC Government groups using a Premier
  provider
• 210 New Premier Providers since 4/1/04

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National NetworksWith Local Control

• Seamless network of Delta Dental Plans across the
  country
• Recruitment and management of provider networks
  performed by local representatives
• Professional Relations staffs are well versed on
  concerns with specific offices or local dental
  societies - part of the community
• Delta Dental offers the best of both worlds
• Ability to offer national networks, while
• providing local support for providers

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State-of-the-Art Technology

• DCS2000 Claims System
• Single site for claims processing and customer
  service
• Designed specifically for dental claims
• Server-based, Windows technology
• Paperless processing

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Superior Performance
Superior Performance
98.6
100
99.8
99.8
Our service and administration are consistently
ranked among the best in the industry.
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Internet Website www.deltadentalva.com

• Find Participating Dentists
• Check Benefit Design
• Check Claims

• Annual Maximum Status
• Real Time/On-line Enrollment
• Deductible Status

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Making a Difference in the Community
Fulfilling our mission of providing affordable
oral healthcare to all Virginians
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The Delta Difference!

• Total Focus on Dental Benefits
• Largest, Most Experienced Dental Benefits Carrier
  in the Nation
• Aggressive Cost Management
• Superior Network Access
• Proprietary DCS2000 Dental Claims System
• Community Involvement
• Satisfied Customers!

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Broader Plan Choices

• 25 or fewer - any one plan.
• 26 to 100 - any two plans, one of which may be
  the Regional HMO, if available
• 100 - any two self funded plans plus the
  Regional HMO, if available

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Funding Requirements

• Full Time
• 80 of average single rate
• 20 of average dependent rate if less than 75
  participation.
• Part Time
• 40 of average single rate
• 10 of average dependent rate if less than 75
  participation

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TLC/DHRMFinancial Overview

• T.J. Clayton
• George Gibbs
• Walt Norman

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Renewal Requirements

• Data Sheet
• Memo of Understanding
• Group Profile Sheet

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COBRA Update

• Regulations finally final
• New Requirements
• Q/Bs to provide certain notices to plan (divorce,
  etc.)
• Notice of Unavailability
• Termination Notice
• Changes to Initial Notice, Election Notice
• Recommend sending new initial notice to all
• TLC will send materials prior to July 1, 2005
• Our forms must be used
• TLC will allow 45-day grace period on COBRA
  premiums

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USERRA

• Uniformed Services Employment and Re-employment
  Relief Act requires all groups regardless of size
  to offer 24 months of Extended Coverage for
  Active Duty Military call ups.

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HIPAA

• All groups regardless of size must send
  certificates of creditable coverage to
  terminating participants
• MOU required
• With QME, TLC will allow Plan Change effective
  7/1/2005 or later.

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Dependent Definition under WFTRA

• Spouse Legally recognized in VA
• Children
• To end of year turning age 23 regardless of
  student status
• Lives at home or away at school
• Unmarried
• Receives over ½ of support from either or both
  parents (To be effective later in the year)

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GASB 45

• Federal requirement that cost of retiree coverage
  be funded or carried as liability on books.
• Private sector requirement since early 1990s as
  FASB
• TLC will provide guidance and data but each group
  will be responsible for any required actuarial
  certification and/or filings

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Medicare D

• Still unclear
• Requires certification of creditable coverage
• TLC will initially let you know if creditable
• Awaiting further CMS guidance

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Alternate ID s

• Effective 10/1/2005 TLC will issue alternate ID
  numbers to all covered employees
• Still 4 ID cards

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General Housekeeping

• Life Evac Air Ambulance now in network
• Reporting Medicare eligibility required
• New email and web addresses
• www.thelocalchoice.virginia.gov
• walter.norman_at_dhrm.virginia.gov