2018 Update WOOD COUNTY EMPLOYEE HEALTH BENEFITS PLAN YOU MATTER! - Keeping a pulse on your health
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2018 Update WOOD COUNTY EMPLOYEE HEALTH BENEFITS PLAN Keeping a pulse on your health YOU MATTER!
NO RATE INCREASE FOR 2018
START HERE!
• Available every three years
• Lower cost option to get data
for physical
• Free, confidential
• Review recommended
screenings based on age and
health status
Wood County is committed to wellness!
Screenings have been offered to
employees since 1993.
What is your current health status?
Excellent I expect ____ years in good or better health.
Average I expect ____ years free of limitation of activity.
Poor I expect ___ years free of chronic disease.
Where do you see your health status in five to 10 years?
Maintaining our current health
status is actually considered
as improvement.
Age
Both age and time
Time
are working against us.
Tips to maintaining your current health status
from the American Heart Association: Life’s simple 7
Stop Smoking
Cigarette smokers have a higher risk of developing cardiovascular disease. If you smoke, quitting is the best thing you can do for your health.
Eat Better
A healthy diet is one of your best weapons for fighting cardiovascular disease. When you eat a heart-healthy diet, you improve your chances for feeling
good and staying healthy – for life!
Get Active
Living an active life is one of the most rewarding gifts you can give yourself and those you love. Simply put, daily physical activity increases your length
and quality of life.
Lose Weight
When you shed extra fat and unnecessary pounds, you reduce the burden on your heart, lungs, blood vessels and skeleton. You give yourself the gift of
active living, you lower your blood pressure and you help yourself feel better, too.
Manage Blood Pressure
High blood pressure is a major risk factor for heart disease and stroke. When your blood pressure stays within healthy ranges, you reduce the strain on
your heart, arteries, and kidneys which keeps you healthier longer.
Control Cholesterol
High cholesterol contributes to plaque, which can clog arteries and lead to heart disease and stroke. When you control your cholesterol, you are giving
your arteries their best chance to remain clear of blockages.
Reduce Blood Sugar
Most of the food we eat is turned into glucose (or blood sugar) that our bodies use for energy. Over time, high levels of blood sugar can damage your
heart, kidneys, eyes and nerves.Reward Yourself for Being Engaged in Your Health
▪ Earn Wellness Warrior status and Challenge
earn a special reward Wellness
Credits
Reward Level
▪ Complete all 12 monthly wellness Needed
challenges*
$50 Credit 5
▪ Benefit Eligible Employees can:
▪ Earn a Deductible Credit for $100 Credit 10
Participating in Wellness Programs
▪ Receive 1 challenge credit for each of the Wellness
12*
following completed programs: Warrior
▪ Monthly Challenge
▪ Wellness Screening conducted in 2018
▪ Fitness Program
▪ Nutrition for Life Program
▪ Tobacco Termination
▪ Summer Swim Refer to the Summary Plan
Description for program details.Items to Note for Reimbursement Programs
▪ Plan will reimburse for gym memberships, fitness classes and
other programs listed in the Summary Plan Description
▪ Plan will not reimburse for:
▪ Food/Beverages
▪ Child Care Services
▪ Sports programs unless part of a regular facility membership
▪ Supplies
▪ Tanning and other ancillary services
▪ Detailed receipts are required
▪ Contracts may be requested if receipts do not provide adequate information
for auditing purposes
▪ Deadlines for FormsSome things can’t be prevented NEXT STEPS IF YOU NEED CARE
Know Your Plan
▪ ER visit for non-emergency may Emergency Room
not be covered by the Plan
Life Threatening Medical Emergency
▪ Falcon Health bills at the doctor
office rate, which is lower than
an urgent care facility
Urgent Care
▪ Have a primary care physician
▪ Wood County Community Health After Hours Non Life Threatening
and Wellness Center is taking new
patients
▪ Offers Sliding Fee Schedule even for
those with insurance coverage Primary Care
▪ Provides access to the Prescription
Savings Program Acute Issues MonitoringKnow Your Plan
In-Network Out-of-Network
Professional Professional
Co-Payment Co-Payment
(Office Visit) (Office Visit)
$15 $15
ER ER
Co-Payment Co-Payment
$45 $45
Deductible Out-of-Network Deductible
$150 Single/ Applies to $300 Single/
In-Network Only
$450 Family $900 Family
No carryoverChoose Quality Network Providers www.frontpathcoalition.com You wouldn’t trust just anyone to watch your kids or remodel your house. Would you? Doesn’t your health deserve the same considerations? See your Group Representative for username and password.
Pipeline ▪ CarePoints ® : A severity-adjusted episode of illness evaluation system which measures physician resource utilization. ▪ Top tier physician report by specialty. ▪ Continue to add reports to the portal.
Know Your Plan
General Reminder ▪ Vision coverage calendar resets
on 1/1/18
Understand Your Plan’s Rules! ▪ Submit claims within 90 days
▪ Detailed receipts and invoices are
required
• Coordination of Benefits
▪ Wal-Mart register receipt alone does not
• High Deductible with HSA provide required information
• Special Enrollment Rights ▪ No coordination of benefits
and Reporting TimelinesKnow Your Plan
Prescription Formulary Prescription Savings Program
Retail Co-Payment Amount ▪ Up to a 90 day supply* = $5 co-payment
Co-payments double for mail order
▪ Must transfer primary care services to
Select OTC $0 Center which grants access to the
Tier 1 $5 pharmacy
Tier 2 $20 plus 20% of AWP ▪ Payable as primary (does not coordinate
$45 maximum benefits)
*Some restrictions apply
Tier 3 $20 plus 20% of AWP
$85 maximumHow to Access the Wood County
Community Health and Wellness Center
It’s Easy! Center offers:
▪ Health care services for your entire
▪ Sign-off on a Release of family
Information to transfer ▪ Pharmacy services for Center patients
information from current primary ▪ Reproductive health services
care provider to the Community ▪ Social work services
Health & Wellness Center
▪ Financial assistance/sliding fee scale
▪ Schedule an appointment for those who qualify (even those with
insurance)
▪ Call 419.354.9049
▪ Evening appointments
▪ Can keep your specialist!
▪ Reverse referral process for
prescriptionsBenefits of Switching: Rx Savings Program
Tier 3 Save money from both your pockets
Tier 2
Our Health Benefits Trust
Tier 1 Employer
85%
Select
OTC Payment of
Employee
15%
Claims
Medical
Review*
* Some restrictions apply – Not all medications are available through this programBenefits of Switching: Rx Savings Program
90 Day Supply Comparison
(3 – 30 day fills at Pharmacy v. 1 – 90 day fill with Rx Savings Program)
Employee Plan
saves saves
$130 $593Benefits of Switching: Rx Savings Program
Annual Costs
Employee pays Plan pays $200 less
$20 for a year’s per month.
worth of medication.
That’s a savings of
A savings of approximately
$520 annually. $2,400 a year.Savings under RX Savings Program
If five people made the switch, the Plan could
experience a savings
of $12,000.
Remember, the Plan’s money
is your money too!Employee Health Benefits Status Report
Plan Expenses 2013 to 2017 (as of 9/30/17)
Note: Board of DD entered Plan 1/1/17
2017 $7,992,908
2016 $9,072,546
2015 $9,946,784
2014 $10,187,703
2013 $8,060,242
$0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000
Health Prescription Vision Dental Life Wellness AdministrationHow Does our Plan Compare?
2016 SERB Report: Cost of Health Insurance for Ohio’s Public Sector
Average •Statewide: $582 Single $1,526 Family
Medical & Rx •Counties: $627 Single $1,680 Family
Premiums •Wood County: $609 Single $1,584 Family
Average •Statewide: $13,928
Annual Cost •Counties: $13,164
(H, Rx, V, D) •Wood County: $10,741
Medical In-Network •Statewide: $2,000 Single $4,000 Family
Out-of-Pocket •Counties: $2,500 Single $5,000 Family
Maximums (H) •Wood County: $400 Single $1,200 FamilyChallenges Ahead
▪ Compare your plan to others using the Summary of Benefits and
Coverage
▪ 2018 Revised Version available on employee website
▪ Formulary Change
▪ Enroll in Rx EOB for Therapeutic Alternatives
▪ Review Drug Tier Changes
▪ Plan’s intent is to comply with current and future Federal
regulations regarding Health Care coverage
▪ The Plan reserves the right to develop and/or modify eligibility
rulesDon’t Forget FRIENDLY REMINDERS
▪ Review Your Individual Enrollment
Summary
▪ Notify group rep of needed changes
▪ May require an updated Universal Application
▪ Report Changes within 30 days of event
▪ Pre-certify as required
▪ Notify family members
▪ Complete a release to share HIPAA
protected information with family
members
▪ Required on an annual basis
▪ With no insurance rate increase,
OPEN ELECTION
remember it’s never too early to save for Nov. 15 to Dec. 15
retirement Jan. 1 effective date
▪ Deferred Compensation ProgramsTime to Stretch THANK YOU FOR ATTENDING TODAY’S MEETING!
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