Daytona State College Open Enrollment for 2019 Agenda Welcome - - PowerPoint PPT Presentation
Daytona State College Open Enrollment for 2019 Agenda Welcome Summary of Benefits Package Review of Medical Benefits Florida Blue Edith Hodges Florida Health Care Plans David Miller Review of Dental Benefits Delta Dental
Welcome – Summary of Benefits Package Review of Medical Benefits Florida Blue – Edith Hodges Florida Health Care Plans – David Miller Review of Dental Benefits – Delta Dental – John Massie Review of Vision Benefits – VSP Open Enrollment Tips & Reminders
Plans (PPO) have minimal changes to overall plan structure.
coupled with a Florida Blue PPO Plan
but there are no co-pays, only co-insurance
Employee Benefits website
commitment for 2019 to help reduce the premium increase to employees
the employee share increased from minimum of $0.76 per month (HMO) to max of $4.76 per month (PPO).
and these rates are locked in until 12/31/2020
$1500 / year / member
No Changes to the rates or benefit levels. The College pays for two times your annual base salary up to a maximum benefit of $500,000
For example: If your annual base salary is $40,000, then the value of your Basic Life insurance policy is $80,000.
You may purchase an additional policy up to three times your base salary, not to exceed a maximum benefit of $500,000
If you purchase an additional policy, you may also purchase a spouse life and/or a dependent life policy.
Please be advised, if you elect to add or increase your Supplemental (self), Spouse
complete a medical questionnaire (EOI). The Employee Benefits Department will contact you if this form is needed and advise you after completion of approval or denial by UNUM. Deductions will not begin until approval is received.
The College provides Long Term Disability coverage and pays 100% of the cost for this benefit. Long Term Disability coverage is pay check insurance. This benefit begins if you become totally and permanently disabled and are no longer able to work, ensuring that your income continues.
Types of Accounts
Healthcare Reimbursement Account – Medical, Dental, Vision & Rx Maximum contribution - $2,500/year Child/Dependent Care Reimbursement Account – Day Care Maximum contribution - $5,000/year
Two Reimbursement Options
Debit Card OR Submit claims to Health Equity for direct deposit
NOTE: Paper checks will be available; however, a fee of $2.00/check will automatically be withheld from the reimbursed amount
Reminder: If you enroll in the HD-HSA, you cannot enroll in the Healthcare Reimbursement Account.
nationally
info, member handbook, order new ID Cards
Brevard, Flagler and Volusia Counties
BREVARD
BlueOptions
Hospitals 7 PCPs 308 Specialists 473 VOLUSIA
BlueOptions
Hospitals 6 PCPs 284 Specialists 264 FLAGLER
BlueOptions
Hospitals 1 PCPs 39 Specialists 49 Wuesthoff Hospital - Rockledge Wuesthoff Medical – Melbourne Cape Canaveral Hospital Holmes Regional Medical Center Palm Bay Hospital Parrish Medical Center Viera Hospital Space Coast Area KEY PROVIDER GROUPS:
Florida Hospital - Flagler Florida Hospital – Oceanside Florida Memorial Hospital - Daytona Halifax Medical Center Halifax Hospital Port Orange Bert Fish Medical Center (Option 2) Florida Hospital – DeLand Florida Hospital – Fish Memorial Mayo Clinic Shands all locations (Option 2) All Florida Hospital System locations Cleveland Clinic
Benefit BlueOptions 03559 BlueOptions 03769 High Deductible Health Savings Account Deductible Person / Family Person / Family Employee Only Emp.+1 / or more $600 / $1,800 $600 / $1,800 $1,500 $3,000 Out-of-Pocket Maximum Person / Family Person / Family Employee Only $4,500 Emp.+1 / or more $6,850 / $9,000 $6,000 / $12,000 $6,000 / $12,000 Primary Care Visit $30 copay $30 copay Deductible + 20% Deductible + 20% Specialist Visit $50 copay $50 copay Deductible + 20% Deductible + 20% Preventative Care No Charge No Charge No Charge No Charge
NOTE: Actual cost share amounts are based on location of service
Benefit BlueOptions 03559 BlueOptions 03769 High Deductible Health Savings Account Diagnostic Tests
Physician Office
$30 / $50 $30 / $50 DED + 20% DED + 20%
Independent Clinical Lab
$0 (Quest only) $0 (Quest only) DED + 20% DED + 20%
Independent Diagnostic Testing Center
DED + 20% $50 (Adv Img-Ded+20%) DED + 20% DED + 20%
Outpatient Hospital
$150 Opt 1 $250 Opt 2 DED+20% Opt 1 DED+20% Opt 2 DED+20% Option1 DED+25% Option 2 DED+20% Option1 DED+25% Option 2
ER (Facility)
$100 + 20% DED + 20% DED + 20% DED + 20% DED + 20% DED + 20%
ER (Physician)
DED + 20% $100
Urgent Care
$50 $65 DED + 20% DED + 20%
Inpatient Hospital Stay
$750 Option 1 $1,000 Option 1 DED+20% Option1 DED+20% Option1 $1,500 Option 2 $2,000 Option 2 DED+25% Option 2 DED+25% Option 2
Prescription Drug Coverage BlueOptions 03559 BlueOptions 03769 High Deductible Health Savings Account Generic
$15 copay $15 copay Integrated Deductible Integrated Deductible
Brand
$60 copay $45 copay Integrated Deductible Integrated Deductible
Non-preferred Brand
$100 copay $65 copay Integrated Deductible Integrated Deductible
Specialty Pharmacy
$100 copay 25%
(member out of pocket max up to $250 per month per Rx)
Integrated Deductible Integrated Deductible
Mail Order
(Up to 90 days supply)
2 x Retail Copay 2 x Retail Copay Integrated Deductible Integrated Deductible
Pharmacy Changes
pharmacy network in the new benefit year.
prescriptions.
the new benefit year. (Target)
01/01/2019 to Walgreens or another in-network pharmacy, like Publix, Winn Dixie, or Walmart. You can view a list of in-network pharmacies at floridablue.com/Performance Pharmacy.
Moving your prescriptions Switching is easy:
and tell the pharmacist your want to move your prescriptions from another pharmacy. They’ll help you make the switch.
picture of your prescription label and send it to your nearest Walgreens. If you continue to use an out-of-network pharmacy after 01/01/2019, you’ll experience higher out-of-pocket costs.
have out-of-network pharmacy benefits.
your medication and then can file a claim for reimbursement. Your claim will be reimbursed based on out-of-network benefits.
Specialty Pharmacy medications are high-cost injectable, infused, oral or inhaled medications that generally require close supervision and monitoring
Self-Administered Specialty Medication & Provider-Administer Specialty Medications listings are links in the Medication Guide. Participating Specialty Pharmacy Providers Many specialty drugs require a Prior Authorization and must be purchased from our Specialty Pharmacies:
Caremark Specialty Pharmacy Services Prime Therapeutics Specialty Pharmacy All Products (Prime Specialty Pharmacy) Phone: 1-866-278-5108 Phone: 1-877-627-6337 Caremark Hemophilia Services TLCRx Specialty Pharmacy Phone: 1-866-792-2731 Phone: 1-855-274-1694
Note: Any other pharmacy is considered a non-participating Specialty Pharmacy even if it participates in Florida Blue’s networks for non-Specialty Pharmacy medications.
HELPING LOWER EMPLOYEE OUT-OF-POCKET COSTS FOR MEDICINES
HSA Plans Copay Plans
Pharmacy or medical deductibles are waived or lowered Copays are waived Health conditions covered:
asthma, COPD, chronic bronchitis and others
Health conditions covered:
asthma, COPD, chronic bronchitis and others
Available medications are included on HSA Preventive Drug List Available medications are included on HSA Condition Care Rx Program Drug List
For the new integrated pharmacy design, Condition Care Rx medications are included and the deductible is waived in the standard plan design.
24/7/365 Access to Teladoc’s nationwide network of board certified physicians is available via phone, video or mobile app
benefit info, member handbook, order new ID Cards
FLAGLER SEMINOLE VOLUSIA
BREVARD
Orange City
Flagler, Volusia, Seminole and Brevard Counties
WFW Locations:
Daytona Beach DeLand Edgewater Ormond Beach Orange City Palm Coast Port Orange-Advanced Urgent Care & FHCP Center
Extended Hours Care:
Cocoa Melbourne Deltona Port St. John Lake Mary Rockledge Longwood Titusville
.
.
(Non-Members - $42)
.
www.doctorondemand.com/FHCP
Benefit HMO TS1 HMO TS2 Deductible Person / Family $500 / $1,500 Person / Family $1,000 / $2,000 Out-of-Pocket Limit Person / Family $3,500 / $10,500 Person / Family $5,000 / $10,000 Primary Care Visit $20 copay $30 copay Specialist Visit $35 copay $50 copay Preventative Care No Charge No Charge
Benefit HMO TS1 HMO TS2 Diagnostic Tests including Radiology
$0 -10% No deductible
$0 - 20% Coinsurance after deductible
Outpatient Surgery
20% Coinsurance after deductible 20% Coinsurance after deductible
Emergency Room Urgent Care Hospital Stay Ambulance Services
NOTE: Actual cost share amounts are based on location of service
Florida Health Care
Primary care visit
$10 copay
Urgent care visit
$10 copay
Sports Physical, Well Woman, Child Health and Vaccinations
$0 copay
Routine Injections that are administered during a PCP visit
Included in the visit copay; no extra participant
Wellness Coaching face-to-face
$10 copay
Central Scheduling 386-676-7198 · Toll Free 855-210-2648 Available 7:00 – 7:00 Monday-Friday
Prescription Drug Coverage Network Pharmacies Preferred Generic
$3 copay FHCP Pharmacy
Non-Preferred Generic
$10 copay $15 copay FHCP Pharmacy Select Walgreen’s Pharmacy
Preferred Brand
$30 copay $35 copay FHCP Pharmacy Select Walgreen’s Pharmacy
Non-preferred Brand
$55 copay $60 copay FHCP Pharmacy Select Walgreen’s Pharmacy
Specialty Drugs Formulary
$250 copay Only available at FHCP pharmacies
Mail Order – up to 90 days supply
$1 discount per 31 day supply FHCP Pharmacy
as you like – FREE!
NOTE: Some facilities may require a Fitness Evaluation before use.
§ Speak to a
Health Coach or Registered Nurse
§ 24 hours a day,
7 days a week, 365 days a year
§ Confidential
Florida Blue 877-789-2583 · FHCP 866-548-0727
Rates decreased; benefits did not change for the 2019 plan year
Delta Dental - Option 1 Delta Dental - Option 2 DeltaCare – Option 3
Network Payment Basis In-Net PPO Out-Net PPO In-Net PPO Premier Out-Net 80th In-Network Only 48N Plan Year Maximum
$1000 per covered member $1500 per covered member* No plan year maximum
Deductible (per member/per family) per calendar year
$50/$150 $50/$150 $50/$150 $50/$150 Office Visit $5 copay
Diagnostic/Preventive Service (D&P)
100% 100% 100% 100% D&P $0 - $45 copay
Basic Services
80% 60% 80% 80% $0 - $115 copay
Major Services
50% 40% 50% 50% $0 - $485 copay
Major Services Waiting Period
None None None
Increased from $1000 in 2018; all other benefits have not changed for the 2019 plan year
Delta Dental Option 1 Delta Dental Option 2 DeltaCare Option 3
Network Payment Basis
In-Net PPO Out-Net PPO In-Net PPO Premier Out-Net 80th In-Network Only 48N
Exams, cleanings, bite-wing X- rays
100% 100% 100% 100% DeltaCare Schedule 48N
Oral Surgery
80% 60% 80% 80%
Non-Surgical Periodontics
80% 60% 80% 80%
Surgical Periodontics
80% 60% 80% 80%
Space Maintainers
100% 100% 100% 100%
General Anesthesia
80% 60% 80% 80%
Endodontics (root canal)
80% 60% 80% 80%
Perio Maintenance (4910)
80% 60% 80% 80%
Crowns, bridges, inlays, onlays
50% 40% 50% 50%
Implants
50% 40% 50% 50%
Benefits have not changed for the 2019 plan year
Rates and coverage have not changed for the 2019 plan year
VSP Provider Network: VSP Choice
Rates and coverage have not changed for the 2019 plan year
The first step of the enrollment process is to login at bmc.myfbmc.com Your username is an email address; your password can be reset by answering your security question
NOTE: If you are enrolling in the HD-HSA – High Deductible Health Savings Account – we strongly encourage you to attend a lab to complete your enrollment. We will be able to assist you with any enrollment difficulties and will have forms available for additional payroll contributions to your HD-HSA.
Campus Event Date Location Time
ATC Meeting & Lab 10/08/18 Room 211 2:00 pm to 3:30 pm New Smyrna Meeting & Lab 10/09/18
Room 101 1:00 pm to 2:30 pm Flagler-Palm Coast Meeting & Lab 10/09/18
Room 217 3:30 pm to 5:00 pm Deltona Meeting & Lab 10/10/18
Room 222 1:00 pm to 2:30 pm DeLand Meeting & Lab 10/10/18
Room 115 3:30 pm to 5:00 pm Daytona Beach LAB ONLY 10/11/18
Room 322 1:00 pm to 5:00 pm Daytona Beach LAB ONLY 10/19/18
Room 322 9:00 am to 1:00 pm Daytona Beach LAB ONLY 10/22/18
Room 322 1:00 pm to 5:00 pm
Dependent Verification Documentation
If adding NEW DEPENDENTS for plan year 2019, you MUST verify their eligibility for your Medical, Dental, Vision, Spouse Life & Dependent Life Insurance Plans. All required documentation should be uploaded to your account on the FBMC website (https://bmc.myfbmc.com). If unable to scan or upload your documentation, please bring the documents to the Employee Benefits Department for assistance, no later than October 22, 2018. Coverage will not be effective and new premium amount(s) will not begin until ALL required documentation has been uploaded into the FBMC website, reviewed and approved by the Employee Benefits Department. Questions & concerns please contact Kathleen Wrenn 386-506-4404 or Pamela Kelley 386-506-3082. REQUIRED DOCUMENTATION Submit all required documentation to the Employee Benefits Department. Spouse To add spouse coverage: A copy of the legal marriage certificate. REMINDER: A spouse is the legally recognized marital partner (as defined by Florida Law) of a Covered Employee. Child(ren) A copy of the birth certificate, adoption papers, or other legal paperwork for the child(ren). Documents MUST show the child(ren)'s name, date of birth, date of placement for adoption, or date of adoption.
Please review your life insurance beneficiaries listed in the FBMC portal to ensure that they are up-to-date! After your Benefits Enrollment, check the beneficiary listed for your FRS account! You can get a beneficiary form
by calling the MyFRS Financial Guidance Line at 1-866-446-9377.
This is one of the most overlooked items by employees!!
bmc.myfbmc.com
Light Refreshments will be served.