Commonwealth of Virginia Health Benefits Program

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Commonwealth of VirginiaHealth Benefits Program

• Open Enrollment Overview
• April 14 May 14, 2004

Department of Human
Resource Management
April 2004
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Open Enrollment Actions

• Continue your health plan
• COVA Care and additional coverage option(s)
• Kaiser Permanente if live or work in the Northern
  Virginia service area

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Open Enrollment Actions

• Select another health plan
• COVA Care and additional coverage option(s)
• Kaiser Permanente if live or work in the Northern
  Virginia service area

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Open Enrollment Actions

• Continue or change membership
• Remember to remove dependents when they become
  ineligible
• Waive coverage in the health benefits program
• Enroll in the program if you previously waived

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Open Enrollment Actions

• Enroll in a Medical Expense or Dependent Care
  Flexible Reimbursement Account.
• If you already have an FRA, you must re-enroll.
  Current accounts expire on June 30, 2004.

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Available Plans for July 1, 2004

• Kaiser Permanente HMO (Northern Virginia)
• Members must live or work in the Kaiser service
  area
• Search by zip code at http//my.kaiserpermanente.
  org/ mida/commonwealthofvirginia

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Available Plans for July 1, 2004

• Kaiser Permanente HMO (Northern Virginia)
• During Open Enrollment, members enrolled in
  Kaiser who are ineligible for the plan must
• Enroll in COVA Care or
• Waive coverage in the State Health Benefits
  Program

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COVA Care Plan

• Understanding Your Benefits
• For July 1, 2004

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Understanding Your Benefits

• There are three important things you need to know
  about our benefits program for July 1
• First Our COVA Care coverage remains the same
• Second There are administrative changes, for
  both health and flexible benefits
• Third Some COVA Care plan administrators will
  change

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Understanding Your Benefits

• There will be no changes to COVA Care coverage
  beginning in July
• Copayments, coinsurance, deductibles and
  out-of-pocket limits are not changing. Covered
  services also remain the same
• You will use benefits at your doctor, dentist,
  pharmacy or mental health professional in the
  same way

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Understanding Your Benefits

• There are some important administrative changes
  to the program effective July 1
• The benefit year for deductibles, the
  out-of-pocket limit and covered services changes
  from a calendar year (January 1 December 31
  ) to a fiscal year (July 1 June 30)
• The plan year for Flexible Reimbursement Accounts
  also changes to the fiscal year

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Understanding Your Benefits

• What do these administrative changes mean to you?
  
• For Medical and Behavioral Health Benefits
• Any deductible or out-of-pocket expenses that you
  have already met this year will be carried over
  to the new July 1 benefit year.

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Understanding Your Benefits

• For Medical and Behavioral Health Benefits
• If you have already satisfied your deductible or
  out-of-pocket limit this year, you will not have
  to satisfy it again once the new July 1 benefit
  year begins.
• Plan maximums for routine wellness, chiropractic
  care and other benefits with an annual limit will
  start over on July 1.

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Understanding Your Benefits

• What do these administrative changes mean to you?
  
• For Dental Benefits
• The annual maximum the plan pays for dental
  benefits will start over with the new July 1
  benefit year.
• If you have already reached your annual maximum,
  you will receive an additional 1200 for Basic
  Dental or 1500 for Expanded Dental in the new
  July 1 benefit year.

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Understanding Your Benefits

• What do these administrative changes mean to you?
  
• For Flexible Reimbursement Accounts
• The short plan year (January 1 through June 30)
  is now in effect
• The 12-month plan year for your Medical and
  Dependent Care Reimbursement accounts will begin
  on July 1 and run through June 30.
• See the Spotlight newsletter

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Understanding Your Benefits

• Why are we making these administrative changes?
• They make the program consistent and simple.
  The benefit year, changes to your plan or
  premiums, and your Flexible Reimbursement Account
  participation all take place on the same schedule.

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Understanding Your Benefits

• Why are we making these administrative changes?
• You can plan better for medical expenses. If you
  have a Medical Reimbursement Account, youll be
  better able to predict your out-of-pocket
  expenses before the FRA plan year begins.

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Understanding Your Benefits

• There are also changes in COVA Care plan
  administrators

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Understanding Your Benefits

• Lets focus on each administrator
• Medical, Vision and Hearing Benefits - Anthem
• Your benefits remain the same
• You will continue to have the Anthem Virginia and
  BlueCard provider networks
• You will use the same Member Services telephone
  number for benefits questions (355-8506 in
  Richmond and 1-800-552-2682 outside Richmond)
• You will visit the same Web site (www.anthem.com)

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Understanding Your Benefits

• Dental Benefits Delta Dental of Virginia
• Your dental benefits remain the same
• Delta Dental has a national network, including
  2,500 dentists in Virginia
• You will use a new Web site (www.deltadentalva.com
  ) to find out if your current dentist is in the
  network, or to search for a new dentist
• You will call a new toll-free telephone number
  (1-888-335-8296) for benefits information

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Understanding Your Benefits

• Prescription Drugs Medco Health
• You will use the same Medco Health network for
  retail pharmacies
• You will use the same home delivery service
• Theres no change to the three-tier structure or
  copayments
• You call a new telephone number for benefits
  questions (1-800-355-8279)
• Theres a new Web site for tier and drug
  information (www.medcohealth.com)

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Understanding Your Benefits

• Behavioral Health and the Employee Assistance
  Program Value Options
• Your benefits remain the same
• You will use the ValueOptions national provider
  network that includes more than 2,000 mental
  health professionals in Virginia
• You can search the provider directory on the
  ValueOptions Web site (www.achievesolutions.net/co
  vacare)
• To access behavioral health and EAP benefits, you
  will call a new telephone number (1-866-725-0602)

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Understanding Your Benefits

• For more benefits information
• See the Spotlight newsletter or
• Contact your Benefits Administrator
• Telephone numbers and Web sites for all COVA Care
  plan administrators are in Spotlight and on the
  DHRM Web site at www.dhrm.virginia.gov

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Understanding Your Benefits

• For questions about Open Enrollment
• Contact your Benefits Administrator or DHRM at
  hbp_at_dhrm.virginia.gov
• To Enroll
• Visit EmployeeDirect online at http//edirect.virg
  inia.gov or
• See your Benefits Administrator

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Available Plans for July 1, 2004

• COVA Care Statewide Plan Premiums
• Premiums will increase - see page 7 of
  Spotlight
• Premiums were accurate at press time, but may be
  subject to change by the General Assembly

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Types of Membership

• Single
• Employee One
• Family

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Flexible Reimbursement Accounts (FRAs)

• What are FRAs?
• Medical Expense FRA
• Set aside money before taxes to pay for eligible
  expenses not covered by your health plan
• Dependent Care FRA
• Set aside money before taxes to pay for day
  care, day camp or at-home care of a dependent
  child or qualified adult while you or your spouse
  are working

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Flexible Reimbursement Accounts (FRAs)

• Who can enroll?
• Medical Expense FRA
• Must be eligible for health benefits program for
  six months
• Dependent Care FRA
• Must be eligible for health benefits program

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Flexible Reimbursement Accounts (FRAs)

• Return to 12-month plan year on 7/1/04
• Plan year contributions
• Minimum 10/pay period
• Maximum Up to 5,000/plan year (Dependent Care
  maximum depends on tax filing status)

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Flexible Reimbursement Accounts (FRAs)

• FRA elections must be in whole dollar amounts
• Use it or Lose It
• You must incur expenses to use all the money in
  your account by June 30, 2005
• Cannot be carried over into the next plan year
• If your FRA ends on June 30, 2005, you must file
  for reimbursement by September 30, 2005

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Reminders

• Employees who waive coverage may not enroll
  outside of Open Enrollment without a qualifying
  mid-year event
• Your Open Enrollment elections for both health
  benefits and FRAs are binding
• Once in effect, your elections cannot be changed
  without a qualifying mid-year event

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More Information

• DHRM Web site
• www.dhrm.virginia.gov
• Spotlight newsletter

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Enroll Without Paper Use EmployeeDirect!

• Logon at http//edirect.virginia.gov
• System available 24-7

Get Your Passcode Now!
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Enroll Without Paper Use EmployeeDirect!

• Forget Your Passcode?

• Use EmployeeDirect to request a new passcode
• 1 Hour Turnaround

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Enroll Without Paper Use EmployeeDirect!

• Update personal information today in
  EmployeeDirect

• Review Benefits Profile
• Update address
• Update dependent information (names, birth dates)

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Make Open Enrollment Changes in EmployeeDirect

• April 14 May 14, 2004

• Change Your Plan
• Change Your Membership
• Enroll in an FRA

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Keep Your Confirmation Number!

• Confirms processing of your selection
• Is displayed on your Benefits Profile when
  approved
• Is the documentation for your records

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Received No Confirmation Number?

• Your selection has not been approved
• Contact your Benefits Administrator, OR
• Send an e-mail to edirect_at_dhrm.virginia.gov

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Commonwealth of VirginiaHealth Benefits Program

• Questions and Answers

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