2012-2013 Plan Year
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Transcript of 2012-2013 Plan Year
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2012-2013 Plan Year Effective September 1, 2012
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PPO Plan OverviewActiveCare 1-HD, 1, 2 and 3 Plans2012-2013 Plan Year
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Enrollment Summary (Employees by Plan, Feb. 2012)
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FirstCare Health Plans 2.5% Scott & White Health Plan 2.5% Valley Baptist Health Plans 0.3%
280,753 Employees • 477,346 Members (Employees and Dependents)
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Cost Of Coverage
Cost of Coverage (Active Care 1-HD, 1,2,3)
• Rate increase effective September 1, 2012ActiveCare 1-HD ActiveCare1 ActiveCare2 ActiveCare 3
4% 4% 6% 9%
• Increases are driven by rising health care costs and higher use of medical and prescription drug services.
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PPO Plan Overview (Network Level of Benefits)
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Services ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3
Deductible (individual/family) $2,400/$2,400 $1,200/$3,000 $750/$2,250 $300/$900
Out-of-Pocket Maximum(individual/family;does not include deductibles)
$3,000/$5,000 $2,000/$6,000 $2,000/$6,000 $1,000 per individual
Coinsurance(Plan pays/participant pays)
80% / 20% 80% / 20% 80% / 20% 80% / 20%
Office Visit Copay 20% after deductible
$30for primary
$50 for specialist
$20 for primary
$30 for specialist
No Medical Plan Changes for 2012-2013
Primary means care provided by family practitioners, internists, OB/GYNs and pediatricians. All other physicians are specialists.
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PPO Plan Overview (Network Level of Benefits)
Services ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3
Preventive Care Plan pays 100% (deductible waived)
Plan pays 100%(no copay required)
Plan pays 100%(no copay required)
Routine eye exam (one per plan year)Hearing exam
20% after deductible $30 for primary$50 for specialist
$20 for primary$30 for specialist
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• Sample services include: annual physical exams, well-woman and well-child care, routine mammograms, immunizations, routine colonoscopies, and more
• Refer to Plan Highlights on the website or see Enrollment Guide for a list of covered services when using network providers
• Covered services under this benefit must be billed by the provider as “preventive care”
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Prescription DrugsActiveCare 1-HD,1, 2 & 32012-2013 Plan Year
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YOUR MEDCO PRESCRIPTION DRUG PLAN 8
• Medco administers your prescription drug plans on behalf of TRS
– ActiveCare 1-HD, 1, 2, and 3 plans• Benefit includes both a retail and mail
component• Medco has its own mail-order pharmacy –
Medco By Mail – where specialist pharmacists focus on compliance and lower cost options for the patient, and the automated filling system ensures the prescription is filled accurately.* Medco only buys medication from the most reputable suppliers
*Medco’s mail-order pharmacies fill about 2 million prescriptions per week through a highly automated process that is 99.9997% accurate and is 23 times more accurate than a retail pharmacy
“Dispensing Error Rate in a Highly Automated Mail-Service Pharmacy Practice”; Nov. 2007, Pharmacology, a peer-reviewedjournal of the American College of Clinical Pharmacy
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PRESCRIPTION DRUG BENEFITS – NETWORK LEVEL
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* If you obtain a brand-name drug when a generic equivalent is available, you are responsible for the generic copayment plus the cost difference between the brand-name drug and the generic drug. Chart illustrates benefits when network pharmacies are used. Non-network benefits are also available; see Enrollment Guide for more information.
Features ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3Drug Deductible(per person, per plan year) Subject to plan year deductible $0 generic;
$200 brand $75
Retail Short-Term(up to 30-day supply)GenericPreferred BrandNon-Preferred Brand
20% coinsurance after deductible
$15
$35* $60*
$15
$35* $60*
Retail Maintenance(after first fill, up to30-day supply)GenericPreferred BrandNon-Preferred Brand
$20 $45* $75*
$20 $45* $75*
Medco by Mail and Retail-Plus(up to 90-day supply)Generic Preferred BrandNon-Preferred Brand
$45$105*$180*
$45$105*$180*
Specialty Medications (retail or mail) 20% coinsurance after deductible $200 per fill $200 per fill
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LONG TERM CARE INSURANCE
Premiums vary by age Purchase Age Cost Per Month
Coverage for a 45-year old Age 50 $23.49Under this program can be Age 55 $32.91 as low as $17.95 per month— Age 60 $47.52Less than a dollar a day Age 65 $75.50
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PROGRAM SOURCES
Program Sources
Benefits Administrator Website Only:http://genworth.com/trsUsername: TRSADMINPassword: groupltc
Apply online or call Customer Service1-866-659-1970
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Enrollment
• Open Enrollment Periods for 2012-2013 Plan Year:– April 23 - May 25 (Spring Enrollment)– August 1 - August 31 (Summer Enrollment)
• No pre-existing condition exclusion applies except for those who previously declined coverage (may be reduced by prior creditable coverage)
• Passive enrollment – If no plan or coverage changes, then no form required
• Premium adjusted to reflect any rate change, effective September 1
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ID Cards (mailed to your home)
• PPO plans (ActiveCare 1-HD, 1, 2 and 3)– Separate cards for medical and prescription drugs
• Blue Cross and Blue Shield of Texas• Medco
– No medical plan changes; BCBSTX will NOT reissue ID cards to existing plan participants (medical plan ID cards do not expire)
– Prescription drug ID cards will be reissued by Medco for ActiveCare 2 and ActiveCare 3 plan participants
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What if I Have Questions?
• Call TRS-ActiveCare customer service for:– Claim questions/status– Network provider information– Membership and eligibility – Medical and prescription drug coverage questions– Inquiries (telephone and e-mail)– ID card requests– Transition of care information– Help with online tools!
Customer Service
1-866-355-5999
Personalized Service
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Proposed 2012-2013 RISD Health Plan Rates
Heath Plans District Employee Total Contribution Contribution TRS Premium
TRS-ActiveCare 1HD $287.00 $11.00 $298.00TRS-ActiveCare 1 $287.00 $51.00 $338.00TRS-ActiveCare 2 $287.00 $173.00 $460.00TRS-ActiveCare 3 $287.00 $350.00 $637.00
EXAMPLE ONLY NOT APPROVED BY RISD
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Voluntary Benefit Review- 2012-2013
• Annual Open Enrollment- April 23- May 25 ONLY.
• Dental and Vision Carriers will be Changing.
• New Critical Illness Offering for 2012 with Guaranteed issue Opportunities.
• Every Employee should login to InRoll to Double Check and Confirm Benefit Selections for 2012- 2013.
• Please Update Beneficiary Designations and Dependent Information if Needed.
• Take Advantage of Open Enrollment Opportunities- Remember, you are responsible for the benefit elections you make. Make Sure they are correct to avoid eligibility problems in the future.
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Dental
• New Carrier for 2012-13– Lincoln Financial Group– Full Take Over of Currently Insured Employees– 3 Options Still Available- High, Medium, Low– PPO Plan Design- You can use any dentist– Benefit Structure will Remain the Same– Rates Guaranteed for 2 years
High Option Middle Option Low OptionE/O $37.18 $31.55 $17.74E+1 $72.36 $61.39 $34.52E/F $126.07 $106.97 $60.15
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Long Term Disability
• Standard Insurance – Same Carrier as last Year– 8 plan Options to Choose From- 4 short term, 4 long term– Insures Against a Loss of Income Due to Sickness or Accident– Insures up to 66 2/3% of Income– Guaranteed issue, Open Enrollment
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Supplemental Term Life
• Standard Insurance – Rockwall ISD Provides $15,000 Coverage on all Employees– Employees can Purchase Additional Coverage– Very Affordable Group rates– Coverage amounts up to $200,000 or 5 Times Annual Salary on Employee– Coverage Amounts up to 50% of Employee Amount on Spouse– Coverage Available on Children– Easy Underwriting Process- simple to complete/evidence of insurability
form is required for all enrollments.
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Permanent Life Insurance
• Fidelity Life– $25,000 - $150,000 Benefit Amounts.– Premiums will Never Change.– Take the Coverage with You When You Leave Portable.– Simple Underwriting Process.– Coverage for Employee, Spouse, Children.
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Accidental Death and Dismemberment- AD&D
• Standard Insurance – Same Carrier as last Year– Coverage amounts up to $500,000 – Very Affordable Group Rates- $500,000 coverage for only $10.00– Coverage Amounts up to 50% of Employee Amount on Spouse– Coverage Available on Children– Guaranteed Issue. No Health Questions
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Critical Illness- New for 2012-13
• Lincoln Financial Group– Provides Lump Sum Benefit for Critical Illnesses
• Cancer, Heart Attack, Stroke, Quality of Life, etc.– Coverage amounts up to $20,000– Very Affordable Group Rates– Available for Employee, Spouse, Children– Guaranteed Issue. No Health Questions
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Vision
• New Carrier for 2012-13– Block Vision– Full Take Over of Currently Insured Employees– Much Improved Benefits– Premiums Remain the same– Very Large Provider Network, Including Walmart– Benefits for Exams, lenses, Frames, Contacts
E/O $7.88E+1 $14.18E/F $21.86
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Legal Plan/ Identity Theft
• Legal Plan of America– Provides Free and Discounted Legal Care– Tax Preparation and Advice– Financial Education & Credit Counseling Services– Identity Theft Solutions– Life Events Counseling
One Low Rate- $14.00
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Flexible Spending Accounts
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Rockwall ISD-2012 Enrollment Calendar
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Rockwall ISD- 2012 Enrollment
30-Apr 1-May 2-May 3-May 4-May
RHS RHHS Dobbs Williams MS Utley MS
Mike Mike Mike Mike Mike
Joel Joel Cain MS
Joel
7-May 8-May 9-May 10-May 11-MayCLP APHE Hartman Jones NebbieMike Mike Mike Mike Joel
Shannon Springer Hays
Joel Joel Joel
14-May 15-May 16-May 17-May 18-MayPullen Reinhardt Rochell Quest/Administration
Mark Mark Mark Maintenance Mike Keith
Mark
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QuestionsThank you for attending
Presentation will be on the District Benefits Website next week.www.rockwallisd.comClick on Staff LinkClick on Employee BenefitsClick on Benefits Information/Education Session
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