Health Insurance and Flexible Benefits

1
Health Insurance and Flexible Benefits

• Open Enrollment
• Annual Open Enrollment April 16 May 16, 2007
• Presented by Personnel Services
• Department of Human Resources

2
Health InsuranceFlexible Benefits

• What Can I Do During Open Enrollment?
• Health Insurance - Whats New
• COVA Care
• COVA HDHP
• New Rates effective July 1, 2007
• Membership Making Changes
• Flexible Reimbursements Accounts
• Whats New
• Making Changes

3
What Can I Do During Open Enrollment?

• No action same coverage membership
• Add or remove dependents
• Enroll if previously waived
• Add or remove Additional Coverage Options
• Waive coverage
• Enroll in Medical / Dependent Care FRA

4
Whats New on July 1, 2007

• COVA Care
• Routine Wellness Preventive Services
• 500 per plan year limit for routine
  immunizations, lab and x-ray services eliminated

5
Whats New on July 1, 2007

• Diabetic blood glucose test strips and
  glucometers
• You pay 20 coinsurance with no deductible
• Prescription required for purchase
• You continue to pay applicable prescription drug
  tier co-pay for insulin, syringes and lancets.

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Whats New on July 1, 2007

• Diabetic equipment and education
• You pay 20 coinsurance after deductible for
  insulin pumps and associated supplies
• Outpatient self-management training and education
  covered at no cost
• Amounts paid under medical benefit for diabetic
  equipment apply to out-of-pocket expense limit.

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Whats New on July 1, 2007

• 24/7 NurseLine
• 1-800-337-4770
• Speak to a registered nurse
• Answers to medical questions
• Access variety of topics in the AudioHealth
  Library

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Health Benefit Providers

• No Changes for COVA Care
• Medical/Vision/Hearing Anthem BC/BS
• Dental Delta Dental Plan of Virginia
• Prescription Medco Health Solutions
• Mental Health ValueOptions Inc.

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COVA CareWellness Services

• No co-payments or coinsurance for well child
  services
• No deductible for wellness services
• No co-payments for routine wellness exam
• No coinsurance for routine wellness lab, shots,
  x-rays
• 500 cap on services eliminated

10
COVA CarePreventive Services

• No deductible for preventive care
• No co-payments or coinsurance for once-a-plan
  year screenings
• OB/GYN, Pap Test, Mammography Screening, Prostate
  Exam, Prostate Specific Antigen (PSA) Test,
  Colorectal Cancer Screening

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COVA Care Medical

• Large in-network coverage
• Blue Cross PPO Worldwide network
• No coverage out-of-network except for emergencies
• No designated PCP required
• Referrals not required
• Limits out-of-pocket maximum
• 1500 per member/3000 per family
• Optional benefits coverage available

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COVA Care Medical

• Annual Deductible
• Amount you pay first-then you pay coinsurance
• Does not apply to wellness or preventive care
• 200 per member / 400 per family
• Plan Year Deductible July 1 - June 30

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COVA Care Medical

• Copayment
• Fixed amount you pay - plan pays the rest
• PCP visit 25 per visit
• Specialist visit 35 per visit
• Inpatient Hospital 300 per stay
• Outpatient Hospital ER 100 per visit

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COVA Care Medical

• Coinsurance
• Percentage you pay after deductible
• 10 - diagnostic tests, immunizations, lab
  x-ray services
• 20 - medical equipment, appliances, supplies,
  ambulance, private duty nursing

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COVA Care Medical

• Plan Year Out-of-Pocket Limit
• Maximum you pay out-of-pocket, then plan pays
  100
• 1,500 per member, 3,000 per family
• Applies to deductible, in-network medical
  mental health copayments coinsurance
• Does not apply to drug, dental, vision, hearing
  copayments coinsurance

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Additional Coverage Options

• COVA Care with
• Out-of-Network
• Expanded Dental
• Expanded Dental, Routine Vision
  
  Hearing Benefits
• Out-of Network Expanded Dental Benefits
• Out-of-Network, Expanded Dental, Routine Vision
  Hearing Benefits

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Additional Coverage Options

• Out-of-Network
• Lower level of benefits for services outside of
  the network
• Plan generally pays 75 of allowable charge

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Additional Coverage Options

• Expanded Dental
• Complex restorative (crowns, dentures, bridges)
• Plan pays 50 of allowable charge up to 1,500
  per member per year for Basic Expanded Dental
• Orthodontics
• Plan pays 50 of allowable charge up to 1,200
  per member per lifetime
• No 12-month waiting period for coverage

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Additional Coverage Options

• Expanded Dental, Routine Vision
  
  Hearing Benefits
• Vision includes exam, eyeglass lenses, frames,
  contact lenses once every 24 months
• Vision specialist office visit - 35
• Eyeglass frames - 75
• Single lenses - 50
• Bifocal lenses - 75
• Trifocal lenses or contacts -100

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Additional Coverage Options

• Hearing includes exam one hearing aid per
  impaired ear every 48 months
• Hearing specialist office visit - 35
• One hearing aid per impaired ear
• Plan pays up to 1,200 per member
• Expanded Dental
• Same as stand alone Expanded Dental

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COVA HDHP

• High Deductible Health Plan
• Zero (0) Premium to the Employee
• Deductibles
• 1200 Single
• 2400 Two-or-More People
• 20 Co-insurance for Most Services after
  Deductible
• Out of Pocket Expenses
• 5000 Single
• 10000 Two-or-More People
• Eligible for Health Savings Account (HSA)

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COVA HDHP Deductibles

• Applies to Medical, Behavioral Health,
  Prescription Drug Services
• Per Plan Year
• 1200 for One Person
• 2400 Two or More People

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COVA HDHPMedical Coverage

• Administered by Anthem BC/BS
• You Pay after Deductible
• 20 Coinsurance
• Plan Pays after Deductible
• Remaining 80

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COVA HDHPWellness Services

• 0, No Deductible
• Well Child through age 6
• Professional provider services
• Immunization and screening tests
• Routine Wellness age 7 older
• Annual check-up visits
• Immunizations, lab x-ray services

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COVA HDHPPreventive Services

• One Each Per Plan Year
• w/Specific Age Limits
• OB/GYN
• Pap Test
• Mammography Screening
• Prostate Exam
• Prostate Specific Antigen (PSA) Test
• Colorectal Cancer Screening

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COVA HDHPBehavioral Health

• Administered by Anthem BC/BS
• You Pay after Deductible
• 20 Coinsurance
• Plan Pays after Deductible
• Remaining 80
• Employee Assistance Program (EAP)
• Up to 4 visits per incident
• No cost to Employee

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COVA HDHPDental Services

• Administered by Anthem BC/BS
• Deductible
• 25 Each for One or Two People
• 75 for Three or More People
• Diagnostic and Preventive Services
• 0 - No Deductible
• Primary Services
• 20 Coinsurance after Deductible

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COVA HDHPDental Services

• Complex Restorative
• 50 Coinsurance after Deductible
• Orthodontic Services
• 50 Coinsurance after Deductible
• 1500 maximum per lifetime per enrolled member
• No Waiting Period

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COVA HDHPPrescription Drug Coverage

• Administered by Anthem BC/BS
• Retail Pharmacy and Mail Service
• Mandatory Generic
• You Pay after Deductible
• 20 Coinsurance
• Plan Pays after Deductible
• Remaining 80

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COVA HDHPHealth Savings Account (HSA)

• Tax Deductible Contributions used to Pay for
  Medical Expenses
• Established With Local Bank or Financial
  Institution
• Allowable contributions for 2007 2,850 Single
• 5650 Family

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COVA HDHPHealth Savings Account (HSA)

• No Use-it or Lose-It Rule
• Must be enrolled in COVA HDHP Not Covered Under
  Any Other Plan
• May Not Be Enrolled in HSA Medical FRA

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July 1, 2007Monthly Premiums

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Monthly Premiums
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Monthly Premiums

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Types of Membership

• Employee Single employee only
• Employee Plus One employee plus one eligible
  family member (spouse or child)
• Family Coverage - employee and two or more
  eligible family members

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Eligible Dependents

• Legally married spouse
• Unmarried, biological, or legally adopted
  children under age 23
• Unmarried children must live at home or away at
  school and receive over ½ of his/her support from
  the employee
• Unmarried stepchildren living full time with the
  employee in a parent-child relationship and
  claimed as a dependent on the employees federal
  tax return
• Other children, on an exception basis, if you
  have permanent, court-ordered custody
• Disabled children

37
Eligible Dependents

• Employees who enroll ineligible persons may be
  removed from the health insurance program for up
  to 3 years and may be liable for any payments
  made on behalf of the ineligible person.

38
Changes Outside Open Enrollment

• Employees who waive coverage may not enroll
  outside of Open Enrollment without a qualifying
  mid-year event.
• Qualifying mid-year events allow you to change
  your plan, membership and additional coverage
  options.
• Qualifying mid- year event make changes within
  31 days of the event.

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Flexible Reimbursement Accounts (FRA)

• Dependent Care Reimbursement Account
• Pay expenses to care for your child, disabled
  spouse, elderly parent or dependents medically or
  mentally incapable of self-care
• Medical Reimbursement Account
• Out-of-pocket medical, dental, vision care
  expenses not covered by health benefits plan.
  (Includes some over- the- counter medications)

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FRAsWhats New on July 1, 2007

• Medical Flexible Reimbursement Accounts
• New EZ REIMBURSE MasterCard
• Pay for certain medical and prescription drug
  expenses not covered by health insurance
• Accepted by Walgreens, Walmart, Sams
• Check with your pharmacy before signing up for
  the card

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FRA Important Points

• Use it or Lose it
• Cannot transfer money between medical dependent
  care accounts or between plan years
• Do not overestimate expenses
• May not be enrolled in FRA and HSA
• Enroll in a New FRA Each Year During Open
  Enrollment

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FRA Important Points

• FRA Open Enrollment concurrent with Health
  Insurance open enrollment
• Medical Accounts
• Reimbursed as expenses occur
• Dependent Care Accounts
• Reimbursement after payroll contribution is
  received and posted

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FRA Important Dates

• Open Enrollment Begins
• April 16 thru May 16 _at_ 400 p.m.
• New Plan Year Begins July 1, 2007
• 12 month plan year July 1 June 30
• Current Plan Ends June 30, 2007
• File for reimbursement by 09/30/07

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Flexible Benefits Plan

• Medical Reimbursement Account
• Minimum 10 per pay period
• Maximum 5,000 per plan year
• Dependent Care Reimbursement Account
• Minimum 10 per pay period
• Maximum 5,000 per plan year
• Depends on tax filing status
• Cannot exceed IRS guidelines

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Dependent Care AccountAnnual Maximum Deposit
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Open EnrollmentApril 16 thru May 16

• Health Insurance
• changes effective July 1, 2007
• add or remove dependents
• enroll if previously waived
• change additional coverage options
• waive coverage
• Enroll in Flexible Benefits Plan
• dependent care reimbursement
• medical reimbursement

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Open EnrollmentHow to Enroll/Make Changes

• Enroll on-line using Employee Direct
• Logon at http//edirect.virginia.gov
• Or use www.dhrm.state.va.us
• System available 24/7
• Enroll using paper forms
• Drop by Human Resources
• No Appointment Necessary
• Deadline Wednesday, May 16, 2007
• at 400 p.m.

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QUESTIONS

• Health Benefits
• and
• Flexible Reimbursement Accounts
• 2007 Open Enrollment