Open Enrollment 2013 Employee Benefits 1. Faith Hites Senior Account Manager, Group Benefits Raffa...

Open Enrollment 2013

Employee Benefits

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Faith HitesSenior Account Manager, Group

BenefitsRaffa Financial Services, Inc.

Brady J. FosterBroker, Group BenefitsHMBS Group Insurance, LLC.

Moderator

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Open Enrollment Means…

You may enroll in coverage

You may add or drop dependents

You may change benefit plans – Medical, Dental, Vision

You must elect new contributions or decline participation with the Flexible Spending Accounts (FSA) - Medical Expense and Dependent Care Plans

You must re-elect your taxation choice on your Short and Long-Term Disability benefits by completing the paper tax election form

Open Enrollment

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Important Information

Open enrollment begins December 3, 2012

All Open Enrollment elections must be made by December 14, 2012 – No Exceptions!

Medical, Dental, and Vision Open Enrollment elections are completed online through Benefit Mall. (Instructions to log into Benefit Mall are available in your open enrollment packet)

If no changes are to be made to your Medical, Dental, and Vision benefits, your benefits from 2012 will automatically renew in 2013; however, please log into Benefit Mall to review your current benefits.

Paper forms will be provided for the FSA (Medical & Dependent care) election, your HRA Medical Reimbursement Acknowledgement, and your STD / LTD taxation election. These forms must be filled out and returned to HR during Open Enrollment.

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Discussion Topics…

CareFirst Medical Plans (POS & PPO)

HRA Debit Card, Prescription & Vision Plans

Guardian Dental Plan

Reliance Standard Plans (Life & Disability)

Flexible Spending Accounts (Medical & Dependent Care)

Benefit Review

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CareFirst Health Plan Options for Local and Out-of-Area Employees…

Option 1: Open Access POS

Option 2: Blue Preferred PPO

Medical Plan Introduction and Pricing

Open Access POS

Blue PreferredPPO

Employee $126.23 $187.21

Employee & Child(ren)

$268.70 $355.69

Employee & Spouse $332.35 $439.94

Family $388.91 $514.82

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• All premiums are shown as monthly employee costs.•To find your bi-monthly premium cost, divide the above amount by 2.

CareFirst Plan Comparison – All Employees

Medical Benefit (All are HRA Plans)

Open Access POSBlue Preferred

PPOIn - Network Out of Network In - Network Out of Network

Deductible (Individual)

$1,400 $2,800 $2,000 $4,000

Deductible (Family) $2,800 $5,600 $4,000 $8,000

Co-Insurance 100% 70% 100% 80%

Out-Of Pocket Maximum

$2,800 / $5,600 $5,600 / $11,200 $7,000 / $14,000 $15,000 / $15,000

Maximum Benefit Unlimited Unlimited Unlimited Unlimited

Inpatient Hospital Ded then $300 Ded then 70% Ded then 100% Ded then 80%

Outpatient ServicesDed then /$30 doc

$300 facilityDed then 70% Ded then 100% Ded then 80%

Lab & X-Ray Ded then $30 Ded then 70% Ded then 100% Ded then 80%

Emergency Room Ded then $300 Ded then $300 Ded then $100 Ded then $100

Physician/Specialist Ded then $30 Ded then 70% Ded then 100% Ded then 80%

Prescription Drugs $15/$35/$60 $15/$35/$60 $15/$35/$60 $15/$35/$60

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CareFirst Open Access POS Health Plan

Local POS plan is part of the Regional CareFirst Blue Choice Network (you

must use this network locally!) Out-of-Area POS plan is part of the National Blue Preferred / Blue Card

Network. All out of area employees may utilize the same network of doctors

for both the POS & PPO plans.

A Primary Care Physician (PCP) must be selected. You DO NOT need referrals

to see a specialist. Instructions on how to find a doctor can be found in your

enrollment package.

POS deductible will be covered by your HRA card up to the in-network

deductible $ amount.

After you meet your deductible, a copayment is charged for all medical

services which is not covered by your HRA card.

Full plan details are in your enrollment packetPOS Networks

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CareFirst PPO Health Plan

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The PPO is part of the National Blue Preferred / Blue Card Network. This means you are eligible to use any Blue Cross Blue Shield doctor from their nationwide network without a referral.

Your HRA debit card is funded to cover your in-network PPO deductible

After you meet your deductible, the PPO plan covers in-network medical expenses at 100% (no copayment for office visits and most services) and out-of-network is covered at 80%

All Local and Out-of-Area employees are eligible to elect the PPO plan option

Full plan details are in your enrollment packet

All CareFirst BCBS Health Plans are HRA’s…

CareFirst Health Plans – HRA Debit Card

BCF management elected to cover all in-network employee medical

deductible expenses through the HRA debit card. Employees' HRA debit

card is funded 100% on the first day of the plan year.

The $ amount on the HRA debit card is equal to your Medical In-Network

deductible. Please note this card is to be used ONLY for medical deductible

expenses.

If an employee or eligible dependent enrolls at a time other than open

enrollment the dollar amount on the HRA card is pro-rated and begins

accruing the month they enroll.

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The HRA debit card can ONLY be used to pay for eligible

services that are subject to the Medical Deductible, this

includes:

Inpatient and Outpatient hospitalization services or surgeries

Emergency Services (Ambulance, Emergency Room, or Urgent

Care)

Visits to your Primary Care Doctor or a Specialist

Lab and X-Ray Fees

Mental/Nervous or Substance Abuse hospitalizations or

physician visits

* Please note this is not a complete and comprehensive list.

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Below are some examples of what the HRA debit card

CANNOT BE USED FOR:

Prescription Drug Copayments

Cosmetic Surgery

Vision Care

All Dental Expenses

All POS Copayments (after the deductible is met)

Any expense related to co-insurance after the deductible has

been met

* Please note this is not a complete and comprehensive list.

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Prescription Drug Plan

Benefit: $15 Generic Drug copayment

$35 Preferred Brand prescription or refill copayment

Preferred Brand is designated by CareFirst

$60 Non Preferred Brand prescription or refill copayment

Injectables – you pay 50% up to a $100 copayment

FAQs: If you use a Non Preferred Brand name drug and a Generic is available, you will

pay the difference in the cost of the drugs.

All $ amounts are copayments per prescription. The copay is Not covered by the

HRA debit card.

Maintenance medications are eligible for the Mail Order Program, where you can

get 3 months of medication for only 2 copayments. Forms and information can

be found online at www.carefirst.com

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Plan is Administered by CareFirst and Davis Vision

Network = Davis Vision

Providers can be located online at https://idoc.davisvision.com/davis/member/adv_doc_locate_v2.asp

CareFirst Blue Vision Plus Plan

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Vision Plus2013 cost

Employee $3.64


$6.72

Employee & Spouse $8.36

Family $10.36

• All premiums are shown as monthly employee costs.• To find your bi-monthly premium cost, divide the above amount by 2.


Vision Benefits Davis Vision Network

Exam Frequency 1 per 12 Months

Lenses Frequency 1 per 12 Months

Frame Frequency 1 per 12 Months

Copayments Davis Vision Provider Other Provider

Vision Exams $0 Co-Pay Plan Reimburses $45

Lenses (Single Vision) $0 Co-Pay Plan Reimburses $52 - $181

depending on lens type

Lenses (Bifocals) $0 Co-Pay

Lenses (Trifocals) $0 Co-Pay

Frames

$0 copay for Tower Collection; Plan

Allowance of $45 for Non-Tower Collection

Plan Reimburses $45

Contacts (Medically Necessary)

$0 copay Plan Reimburses $285

Overview of Vision Benefits…

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Your CareFirst Medical plan does have vision coverage that will cover most vision related needs. You will have to pay a $10 copayment at the time of your visit for an eye exam on both the POS and PPO plans. There are discounts for eyeglasses and contacts.

All eye injuries and eye related diseases are covered through your CareFirst medical plan.

The Vision Plus benefit is for those individuals who need extra vision coverage.

All in-network Vision Plus plan participants receive an annual eye exam, frames, lens, and contacts with no copayments. All out of network participants are required to pay a portion of their vision services as illustrated on the previous page.


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Guardian Dental Plan

Network = PPO / Traditional Preferred

TX and GA employees have state mandated benefits - NAP

Providers can be located online at www.guardiananytime.com/fpapp/FPWeb/home.process

Orthodontia is not covered under either dental plan but you may get a discount if you use an in-network orthodontist

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Guardian Dental

2013 cost

Employee $14.98


$29.15

Employee & Spouse $34.52

Family $48.70• All premiums are shown as monthly employee costs.•To find your bi-monthly premium cost, divide the above amount by 2.

Overview of Dental Benefits…

Guardian Dental Plan – Non TX or GA

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GuardianDental Benefits

Guardian Choice Plan

PPO Value Plan (Fee Schedule) PPO NAP Plan (90% UCR)

In - Network Out-of-Network In - Network Out-of-Network

Deductible (Individual) $50 Combined $50 $50

Deductible (Family) $150 Combined $150 $150

Preventive Care100% (No Deductible)

100% (No Deductible)



Basic Services100% After Deductible

100% After Deductible



Major Services60% After Deductible




Annual Maximum $2,500 with Rollover $2,500 with Rollover

Overview of Dental Benefits…

Guardian Dental Plan – TX and GA

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Guardian Guardian PPO NAP Plan (90% UCR)

In-Network Out-of-Network

Deductible (Individual) $50 Combined

Deductible (Family) $150 Combined

Preventive Care 100% (No Deductible) 100% (No Deductible)

Basic Services 80% After Deductible 80% After Deductible

Major Services 50% After Deductible 50% After Deductible

Annual Maximum $2,500 with Rollover

*Due to state mandates all TX and GA employees must be on this plan*

Ancillary Benefits (Employer Paid)…• Group Short-Term Disability (STD) Insurance

• Group Long-Term Disability (LTD) Insurance

• Group Term Life Insurance

• Employee Assistance Program

• Identity Theft Recovery Services (refer to the BCF website for additional information)

• On Call Travel Assistance (refer to the BCF website for additional information)

Reliance Standard Benefits

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Waiting Period (0 Days Accident/7 Days Sickness)

Benefit Percentage (up to 60% of eligible income)

Duration of Benefits (up to 13 weeks)

Benefit Weekly Maximum ($1,500)

You must re-elect your taxation choice on your Short-Term Disability benefits by completing the paper form

Tax Choice Option – Payment on Premium or Benefit

Short-Term Disability (STD) Insurance

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Waiting Period (90 days) - LTD is continuation of STD benefits. The STD benefit period satisfies this waiting period.

Benefit Percentage (up to 60% of eligible income)

Duration of Benefits to Age 65 / Social Security Normal Retirement Age (SSNRA)

Benefit Monthly Maximum is ($7,500)

You must re-elect your taxation choice on your Long-Term Disability Benefits by completing the paper form

Tax Choice Option– Payment on Premium or Benefit

Long-Term Disability Insurance

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Procedure

Employees seeking to use BCF’s disability insurance are required to provide notice to their Supervisor of the need to utilize their STD or LTD benefits. Employee requests are submitted via the BCF Leave Request Form (found on the BCF Website).

To receive disability benefits, a claim form must be submitted. The Reliance STD Claim Form can be found on the BCF website. Please return this form to HR. Supervisors will forward the Leave Request Form to HR. If an employee is uncomfortable discussing or providing information on a medical condition, the employee may contact HR directly. In this case, HR will notify the Supervisor and inform them of the request and decision. Every effort will be made to maintain employee privacy regarding the medical condition.

Disability Insurance

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Two (2) Times Annual Salary

Maximum Benefit Without Medical Questionnaire

In the event that something should happen to you, your beneficiary will need to contact your direct manager who will start the claims process with the HR Manager.

Group Life Insurance

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Class I - Regular Benefit Class II - Tax Relief Benefit

2 x salary up to $200,000 2 x up to $50,000. Employees who elect Class II do so to avoid paying tax on the amount over $50,000

EAP Services are available to all employees!

Employee Assistance Program (EAP)

The EAP is a voluntary and confidential service that provides professional counseling and referral services designed to help you and your family members with personal, job or family related problems.

Your EAP can help you and your dependents identify, resolve and gain control over personal problems that may be interfering with work and daily life.

Dedicated Toll Free Crisis Line:24 hours a day – 7 days a week – 365 days a

year1-800-767-5320

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HRA Debit Card vs. FSA

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Health Reimbursement Account (HRA Debit Card)

Flexible Spending Account (FSA)

Moneys are contributed by BCF management

Moneys are contributed by employees on a pre-tax basis

Funds are to be used ONLY to cover in-network eligible medical

deductible expenses

Funds can be used to cover any eligible medical, dental, or

vision expense

In the past, there has been confusion regarding the HRA vs. FSA. Please note, these are two different

accounts. The main differences are listed below.

Pre-Tax Contributions for Eligible Out-of-Pocket Medical expenses…

FSA – Medical Expenses

Up to $2,500 can be set aside to pay for eligible medical expenses for plan year 2013

Full amount elected can be accessed immediately

An FSA can be used to pay for eligible medical, dental, vision, or prescription expenses.

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Pre-Tax Contributions for Eligible Dependent Care Expenses…

FSA - Dependent Care Account

Up to $5,000 can be set aside to pay for eligible Dependent Care expenses for plan year 2013

Expenses are reimbursable as contributions become available through your payroll deductions. The reimbursement form is located on the BCF website.

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Reminder - Important Information

All Open Enrollment Elections must be made by December 14, 2012 – No Exceptions!

Medical, Dental, and Vision Open Enrollment Elections are completed online through Benefit Mall. Instructions to log into Benefit Mall are available in your open enrollment packet.

Forms to be filled out and submitted to HR:• FSA – Medical and Dependent Care • STD / LTD Taxation Election• HRA Medical Reimbursement Acknowledgement

• These forms MUST be returned even if you are not making changes!

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Thank You For Your Participation…

Questions

Who can I call with Additional Questions?

BCF Human Resources Department Triad/S4/RedBlack – Sunita Gupta; 703-817-9475;

[email protected] Defense & Space – Dina Johns; 703-717-9937;

[email protected]

Angela Fitzpatrick, Raffa Financial ServicesBCF’s Dedicated Customer Service Representative240-403-2546

Brady J. Foster, HMBS Group InsuranceBCF’s Dedicated Insurance Broker949-630-2523, [email protected]

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Appendix

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CareFirst – How to Find a Doctor

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POS – Local and Out of Area

PPO

Who is an Eligible Dependent

Medical: • Legal Spouse • Domestic Partner (in accordance with

state law)• Dependent child(ren) up to age 26

(marital & student status not a factor)

Dental & Vision: • Legal Spouse • Domestic Partner (in accordance with

state law)• Dependent child(ren) up to age 26

(unmarried and must live with Employee; student status not a factor)

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Medical Benefits Terminology

Networks

Local includes employees located in VA (excluding Dalgren), DC, & MD

Out-of-Area includes all other BCF employees

In-Network includes doctors participating in the Blue Cross Blue Shield Network

Out-of-Network includes all doctors not participating in the Blue Cross Blue Shield Network

Terms

Deductible the amount an individual must pay for health care expenses before co-pays & co-insurance begins to cover your medical costs. BCF covers this expense by issuing you an HRA card.

Co-insurance refers to the percentage of money that an individual is required to pay for services, after a deductible has been paid, up to the annual out of pocket max.

Copayment a predetermined (flat) fee that an individual pays for health care services. For example, the POS plan requires a $30 copayment for each office visit.

Out-of-Pocket Maximum a predetermined amount that an individual must pay, annually, before health care expenses will be covered at 100% by Blue Cross Blue Shield. 34

Additional HRA Card Information

HRA Website: www.125Company.com

How to use the HRA:• Do not use your card at the time of the service

• After your medical service wait until you receive an Explanation of Benefits (EOB) CareFirst indicating that the medical service was applied to your deductible

• Then you can use your HRA Debit Card to pay the provider the amount that the EOB indicates is your deductible.

Deductible expense verification may be requested by 125 Company.

Proof may be upload at www.125Company.com. EOB and/or deductible

receipts are mailed to you from Blue Cross Blue Shield and can also be

found on the CareFirst website

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Issues Using HRA Card

If you cannot use your HRA debit card for any reason

1. You may file a manual claim when you get the EOB from Blue Shield

Blue Cross. Complete our HRA online claim form on BCF website

and you can fax/mail or e-mail/scan the EOB to 125Company for

reimbursement.

2. If your doctor wants payment at the time of service and will not

accept the HRA card. You can pay for it out of pocket and then

submit a reimbursement claim (form on the BCF website)

STD/LTD Benefits Terminology

Tax Choice Option

Payment on Premium you can opt to pay the initial taxes on the premium payments to avoid paying taxes on your disability income benefits once you are receiving them.

Payment on Benefit you will pay taxes on any disability income benefits you receive.

Terms

Waiting Period or Elimination Period the period of time that must lapse from the onset of a disability, before you are eligible to receive weekly or monthly benefits.

Benefit Percentage the amount payable to you, based on a percentage of the your income prior to disability. The proceeds are limited to an overall maximum amount.

Duration of Benefits the amount of time you are able to collect disability income

Benefit Maximums the maximum amount of disability income you are allowed to receive based on your salary at the time of injury. Amounts are paid weekly for STD and monthly for LTD

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