OPEN ENROLLMENT MAY 1

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OPEN ENROLLMENTMAY 1 MAY 25

• Health Insurance Changes and
• Flexible Reimbursement
• Accounts

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COVA Care, COVA Connect COVA HDHP Plans

• Changes and Review
• of Benefits

3
Slight Premium Increase this Year

• Federal Early Retiree Reimbursement Program
  (ERRP) funds will pay part of the premium subsidy

4
COVA Connect Now Available in this Area

• Optima Health is plan administrator for medical,
  prescription and behavioral health. Delta Dental
  is plan administrator for dental plan.

5
Enhanced Vision Coverage

• The annual vision benefit will be changed to once
  every 12 months from once every 24 months

6
Introduction of Diabetes Management Pilot Program

• For participants in disease management program
  who meet certain requirements, the plan will pay
  100 of the cost of diabetes drugs in Tier 1 and
  Tier 2 and certain diabetic supplies at no cost

7
Applied Behavior Analysis (ABA) for Autism
Spectrum Disorder

• Covered for children ages 2 through 6 (35,000
  annual limit on services)

8
IV and Infused Chemotherapy Subject to Deductible

• You must meet 225/450 deductible, then pay 20
  coinsurance after deductible

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Plan Administrators for COVA Care

• Medical, Vision and Hearing
• Anthem Blue Cross/Blue Shield
• Behavioral Health and Employee Assistance Program
  (EAP)
• ValueOptions, Inc.
• Dental Coverage
• Delta Dental Plan of VA - Premiere
• Prescription Drug
• Medco Health Solutions

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Plan Administrators for COVA Connect

• Medical, Vision and Hearing, Behavioral Health
  and Employee Assistance (EAP) and Prescription
  Drug
• Optima Health
• Dental Coverage
• Delta Dental Plan of VA - Premiere

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Plan Administrator of COVA HDHP

• Anthem Blue Cross/Blue Shield will administer
  medical, behavioral health and EAP, prescription
  drug and dental benefits

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Coverage Review
Benefit COVA Care/COVA Connect COVA HDHP
PCP Visit Co-pay 25 20 after deductible
Specialist Co-pay 40 20 after deductible
Inpatient Hospital Care 300 per stay 20 after deductible
Outpatient Hospital ER Visits 125 per visit (waived if admitted) 20 after deductible
Outpatient Diagnostic Tests/Lab Services/Infusion Services (includes IV or injected chemotherapy) 20 after deductible (225/individual not to exceed 450/family) 20 after deductible
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Coverage Review
Benefit COVA Care/COVA Connect COVA HDHP
Well Child through age 6, office visits at specified intervals, immunizations, lab and x-rays 0 0
Routine Wellness age 7 and older, annual checkup visit, immunizations, lab and x-rays 0 0
Preventative Care includes gyn. exam, Pap test, routine mammograms (35), PSA (40), colorectal cancer screening (40), aortic screening, genetic testing counseling on breast ovarian cancer, screening counseling on breastfeeding, tobacco use diseases caused by tobacco use 0 0
Chiropractic 35 up to 30 visits per plan year 20 after deductible up to 30 visits per plan yr.
Therapy services occupational, speech, physical 35 20 after deductible
Applied behavior analysis (ABA) for autism spectrum disorder ages 2-6 (35,000 annual limit) 25 20 after deductible
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Coverage Review
Benefit COVA Care/ COVA Connect COVA HDHP
Dental Basic Services (plan pays up to 2,000 per member per fiscal year) Administered by Delta Dental Plan of VA In Network Deductible per plan yr 50-single 100-dual 150-family Cleanings (twice a year), x-rays, oral exams - 0 Primary Services (fillings, root canals, oral surgery, extractions) -20 AC after deductible See Expanded Dental
Mental Health and Substance Abuse Program (COVA-ValueOptions COVA Connect-Optima Health HDHP-Anthem) 25 Outpatient - 125/visit Inpatient - 300/stay 20 after deductible
Annual Out-of-Pocket Maximum 1,500/member, not to exceed 3,000/family (excludes dental and prescriptions) 5,000/single 10,000/family
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Coverage Review
Benefit COVA Care/COVA Connect COVA HDHP
Out-of-Network Plan will pay 75 AC for non-participating provider in a non-emergency situation Not Available
Expanded Dental (Plan pays up to 2,000 maximum per person each fiscal year) Administered by COVA-Delta Dental Plan of VA HDHP-Anthem In Network Deductible per plan yr 50-single 100-dual 150-family Diagnostic preventative services-0 Primary services-20 after deductible Complex restorative-crowns, bridges, inlays, partials, dentures 50 after deductible Orthodontic-50 up to 2,000 per lifetime per member Deductible per plan yr 50-single 100-dual 150-family Diagnostic preventative services-0 Primary services-20 after deductible Complex restorative-50 after deductible Orthodontic-50 up to 2,000 per lifetime per member
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Coverage Review
Benefit COVA Care/COVA Connect COVA HDHP
Vision-once every 12 months Routine Eye Exam-40 Frames-100 allow, then 20 of balance Lenses-20 co-pay, then covered in full OR Contact Lenses-100 allowance, then 15 of balance Not Available
Hearing Benefit-once every 48 months 40 Hearing Aids-plan pays up to 1200/member every 48 months Not Available
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Deductible Review

• COVA Care/COVA Connect
• 225/single 450/family
• Diagnostic lab, tests, shots, x-rays
• Major/Medical, i.e., ambulance, medical
  equipment, diabetic supplies
• COVA HDHP
• 1,750/single 3,500/family
• Applies to medical, behavioral health and
  prescription drug
• Entire 3,500 family deductible must be met
  before the plan pays for any one family member,
  even if that person has met the individual
  deductible

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What You Need To Know About COVA HDHP

• Eligible to participate in a Health Savings
  Account (HSA)
• You may contribute 2,850/individual or 5,650 if
  you cover others in a full calendar year
• You may not be enrolled in both a Medical
  Reimbursement Account and an HSA

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Before You Enroll in COVA HDHP.

• Review the total expenses you expect to incur
  under the plan
• In case of a catastrophic medical expense during
  the plan year, will you be able to pay your full
  deductible amount and the coinsurance all at one
  time
• Consider the out-of-pocket expense limit is
  higher than under COVA. You will be liable for
  more costs before the plan pays

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Basic COVA Care Monthly Premiums
Single Employee One Family
You Pay 50 116 165
State Pays 451 811 1,190
Total Premium 501 927 1,355
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Additional COVA Care/COVA Connect Coverage
Options Premiums
Single Employee One Family
Out-of-Network 62 132 188
Expanded Dental 65 146 210
Out-of-Network Expanded Dental 77 162 232
Expanded Dental, Vision Hearing 78 168 239
Out-of-Network, Vision, Hearing Expanded Dental 90 184 261
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COVA HDHP Monthly Premiums
Single Employee One Family
You Pay 0 0 0
State Pays 402 745 1,089
Total Premium 402 745 1,089
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Open Enrollment Choices

• Review available health plans
• Additional coverage options
• Carefully review medical expenses
• Change membership
• Remove ineligible dependents
• Waive coverage
• Employees who waive coverage may not enroll
  outside of Open Enrollment without a qualifying
  mid-year event

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Eligible Dependents

• Legally married spouse as recognized in the State
  of Virginia
• Natural and adopted children, stepchildren, and
  children placed for adoption may be covered to
  the end of the year in which he/she turns age 26
• Other children when the unmarried children in the
  court-ordered sole, permanent custody of the
  employee reside full-time with the employee and
  the employee provides more than half of the
  dependents support (custody must have been
  awarded prior to the childs 18th birthday)
• Incapacitated dependents ages 26 if unmarried,
  reside full-time with the employee (or the other
  natural/adoptive parent) and the employee
  provides more than half of the dependents
  support

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Required Documentation Needed to Add Eligible
Dependents

• Spouse photocopy of marriage certificate and
  photocopy of 2011 federal tax return that shows
  the dependent listed as spouse
• Natural or adopted child photocopy of birth
  certificate showing employees name or in the
  case of adoption, photocopy of a legal
  pre-adoptive or adoptive agreement
• Stepchild photocopy of birth certificate (or
  adoption agreement) showing the name of the
  employees spouse and photocopy of marriage
  certificate showing the employee and parents
  name and photocopy of 2011 federal tax return
  that shows the dependents parents name listed
  as spouse
• Other female or male child photocopy of birth
  certificate and photocopy of the final court
  order with presiding judges signature
• Other female or male child (exception)
  photocopy of the other childs birth certificate
  showing the name of the minor child as the parent
  of the child and photocopy of the final court
  order with presiding judges signature

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Outside of Open Enrollment, you may only make
changes to your health insurance with Qualifying
Mid-Year Events
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Qualifying Mid-Year Events

• Changes in marital status
• Marriage
• Divorce
• Death of spouse
• Changes affecting family members
• Birth, adoption, placement for adoption
• Covered child loses eligibility
• Permanent custody of child
• Gains/loses eligibility for Medicare/Medicaid
  (within 60 days)
• Spouse/child begins/ends employment
• Spouse/child begins/ends leave without pay

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Qualifying Mid-Year Events

• Changes affecting family members
• Death of covered child
• Dept. of Social Services order to cover child
• Spouse/child switched from full-time to part-time
  employment or vice versa
• Changes due to special circumstances
• Annual enrollment/change allowed under another
  employers plan
• Special enrollment under HIPPA
• Court has required another party cover your child
• Permanently moves in/out of plans service area
  (plan change only)

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How Do I Enroll?

• Employee Direct
• www.dhrm.virginia.gov and click on the
  EmployeeDirect link
• Complete enrollment form in Human Resources

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Log-in Process for EmployeeDirect

• Users may go to EmployeeDirect and click on
  Frequently Asked Questions and Getting
  Started for helpful login information
• Users who forget their Username, Password, or
  Answers to Challenge Questions need to know the
  following information to complete their login
• ID number on your health insurance card
• Date of birth
• Last four digits of SSN
• Email address

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Flexible Reimbursement Accounts

• Changes and Review of Benefits

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Change in Maximum Medical FRA Contribution

• Due to federal health reform, the maximum
  contribution will be 2,500 beginning plan year
  July 1, 2012 June 30, 2013 (change from current
  5,000)

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Plan Administrator Name Change

• Starting July 1st, administration of FRAs will
  move to a new system supported by WageWorks, Inc.

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New Medical FRA VISA Payment Cards

• All participants will receive new WageWorks
  Health Care Cards

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WageWorks Health Care Card

• You will automatically receive two VISA cards
  when you enroll in a medical FRA. It is your
  decision whether or not to activate and use your
  card. Filing paper claims for reimbursement is
  still an option
• There are certain IRS rules to follow regarding
  the validation of claims expenses. In certain
  cases, you must complete an FRA Claim Form,
  attach supporting documents, and send it to
  WageWorks. Your card will be deactivated if you
  fail to take this step
• No more paying up front and requesting
  reimbursement
• Immediate access to medical FRA funds
• Instant approval of many medical, dental, vision
  and prescription expenses

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FRA Plan Review

• Pre-taxed accounts available to offset costs for
  medical or dependent care expenses
• For dependent care accounts, you pay up front for
  expense complete and submit reimbursement form
  receive reimbursement from pre-taxed account
• For medical reimbursement accounts, you may use
  the WageWorks Health Care Card to debit your
  account balance or you pay up front for expense
  complete and submit reimbursement form receive
  reimbursement from pre-taxed account
• Use it or lose it
• Fiscal year expenses (July 1 June 30)
• Changes can only be made with mid-year qualifying
  events
• 3.67/month administrative fee

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Medical Reimbursement Accounts

• Minimum - 10/pay period
• Maximum - 2,500/year
• Covers employee, employees spouse and eligible
  dependents
• Eligible expenses include co-payments,
  co-insurances, deductibles, dental and vision
  care expenses

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Orthodontia

• Documentation
• Bill, receipt-name, date of service, cost
• Letter of medical need
• Patients contract of treatment
• Extended plan
• Initial down payment, with balance spread out
  under a payment plan
• Full contract amount paid monthly by coupon
• Full payment amount paid entirely up front
  (reimbursement must occur during the plan year in
  which braces are first installed)

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Dependent Care Accounts

• Minimum - 10/pay period
• Maximum up to 5,000 (based on tax filing
  status)
• Covers eligible dependents under age 13 and
  elderly parents who reside in your household more
  than 8 hrs./day
• Eligible expenses include babysitter and daycare
  costs, elderly daycare costs, summer camps, etc.

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IRS Limitations

• Based on calendar year for tax purposes
• Based on tax filing status
• Carefully evaluate the amount you set aside to
  ensure you remain within the IRS limits
• Any amount over the allowed IRS limit is subject
  to taxes

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Reimbursement

• Medical may be reimbursed as expenses occur
• Dependent care payroll contribution must be
  received and posted before you can be reimbursed
• Checks are issued within five working days once
  complete reimbursement request is received

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How Do I Enroll?

• Employee Direct
• www.dhrm.virginia.gov and click on the
  EmployeeDirect link
• Complete enrollment form in Human Resources

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Log-in Process for EmployeeDirect

• Users may go to EmployeeDirect and click on
  Frequently Asked Questions and Getting
  Started for helpful login information
• Users who forget their Username, Password, or
  Answers to Challenge Questions need to know the
  following information to complete their login
• ID number on your health insurance card
• Date of birth
• Last four digits of SSN
• Email address

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Reminder

• Enrollment in your Flexible Reimbursement
  Accounts must be done each year, even if your
  total contribution for the new plan year remains
  the same

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Questions