2019 20 Benefits Open Enrollment - Central Michigan ...

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2019 20 Benefits Open Enrollment - Central Michigan ...
2019 – 20 Benefits Open Enrollment
2019 20 Benefits Open Enrollment - Central Michigan ...
2019-20 Benefits Update
Staff, Fixed Term Faculty, Medical Faculty & Post-
             Doctoral Research Fellows
2019 20 Benefits Open Enrollment - Central Michigan ...
Benefits Open Enrollment – Elections Required
                                                    MANDATORY
                                                   Open Enrollment
                                                     for 2019-20
• IMPORTANT! All benefit-eligible                    Benefit Year

  faculty and staff will be required to actively
  elect benefits online via CMU Choices for:
   – Dental: Default to CORE plan (D100/50/50), if enrolled
   – Vision: Default to no coverage
   – Flexible Spending Account (FSA): Election required
     each plan year
   – Health Savings Account (HSA): Election required each
     plan year
2019 20 Benefits Open Enrollment - Central Michigan ...
What’s News & What’s Changing for 2019-20
• BCBSM PPO2 Medical Plan
   – Increase annual deductible
                                Current                                   2019-20
                        In-Network Out-Network                    In-Network Out-Network
               Single      $400         $800             Single      $500       $1,000
               Family      $800       $1,600             Family     $1,000      $2,000

   – Increase annual out-of-pocket maximum
                                  Current                                   2019-20
                        In-Network   Out-Network                  In-Network   Out-Network
               Single     $1,600       $3,800            Single     $2,000       $4,000
               Family    $3,200         $7,600           Family    $4,000         $8,000

   – Doctor office visit & urgent care copay increasing $10 ($20 to $30 per
     visit)

• No changes to the Advantage HDHP and PPO1 medical plans

                                            - Confidential -
                                                                                             4
2019 20 Benefits Open Enrollment - Central Michigan ...
What’s News & What’s Changing for 2019-20
• CVS / Caremark Prescription Coverage (PPO 1 / PPO2)
   – Adopt Advanced Control Specialty Formulary in an effort to
     control the rising cost of specialty drugs
   – If you are impacted by this change, CVS / Caremark will contact
     you and your doctor directly
• Coverage Enhancements: Designed to align with our
  continued efforts and support of a Culture of Health
   – CVS Caremark Prescription Plan (PPO1 / PPO2): 0% copay for
     preventive medication on the generic drug list
   – Dental Core & Buy Up Plans: Preventive Advantage benefit – all
     preventive care, incl. exams, cleaning, x-rays and fluoride
     treatment cost WILL NOT be deducted from annual benefit
     maximum
2019 20 Benefits Open Enrollment - Central Michigan ...
What’s News & What’s Changing for 2019-20
• Health Care Flexible Spending Account (FSA)
      – Increase annual contribution limit from $2,650 to $2,700
      – Rollover Rule Update: Add a $25 minimum rollover balance
• Health Savings Account (BCBS Advantage HDHP Participants)
   – University HSA contributions will continue for 2019-20 benefit
     year
       » Single Coverage: $107.16 annual contribution
       » Two Person Coverage: $221.88 annual contribution
       » Family Coverage: $271.32 annual contribution
2019 20 Benefits Open Enrollment - Central Michigan ...
What’s the Best Plan for You?

All Your BCBSM Medical Options Provide:
• In-network preventive care that’s free to you
• The same provider network
• Coverage for the same eligible expenses

The Only Difference: How and How Much You Pay
Premium Cost Share                       Out-of-Pocket Costs
(deducted from your pay)                 (deductible, coinsurance, copays)
A fixed cost, no matter how much or how • Varies by the amount of care you need
little you use the plan                 • Capped by your out-of-pocket
                                          maximum

                                 - Confidential -
                                                                                  7
2019 20 Benefits Open Enrollment - Central Michigan ...
Medical / Prescription Monthly & Annual Costs
                        Comparing Medical / Prescription Plan Options
Medical / Prescription Plan Options                Advantage HDHP                           PPO2                                PPO1
                                                      97.5% CMU                          91.7% CMU                           82.6% CMU
Premium Cost Share
                                                    2.5% Employee                      8.3% Employee                       17.4% Employee
Employee                         Single                 $13.78                             $ 49.46                             $115.52
MONTHLY                      2-Person                   $28.53                            $102.38                              $239.11
Cost Share                      Family                  $34.87                            $125.14                              $292.26
                                 Single                $107.16
University ANNUAL
                             2-Person                  $221.88                           Not Available                       Not Available
HSA Contribution
                                Family                 $271.32
Benefit Summary: In-network benefits
Medical Network                                 BCBS                                       BCBS                                 BCBS
Prescription Network                            BCBS                                   CVS Caremark                         CVS Caremark
Preventive care                         $0 (plan pays 100%)                         $0 (plan pays 100%)                  $0 (plan pays 100%)
                                          $1,350 member                                $500 member                          $200 member
Annual deductible (7/1-6/30)
                                          $2,700 family**                              $1,000 family                         $400 family
Coinsurance                                     None                                20% after deductible                        None
Office visit (primary, specialist,
                                        $0 after deductible                                $30 copay                           $20 copay
chiropractic)
Urgent care visit                       $0 after deductible                               $30 copay                            $20 copay
Emergency room visit                    $0 after deductible                               $100 copay                           $100 copay
                                           10%/20%/30%
Prescription                                                                            10%/20%/30%                         10%/20%/30%
                                          after deductible
Annual out-of-pocket maximum              $3,350 member                                $4,000 member                        $2,800 member
(medical & prescription combined)          $6,700 family                                $8,000 family                        $5,600 family
  **The full family deductible must be met under a two-person or family contract before benefits are paid for any person on the contract.

                   This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions,
                                       and limitations are documented in the certificate and amendments.
2019 20 Benefits Open Enrollment - Central Michigan ...
Advantage HDHP vs. PPO2 Claim Example 2
• Maggie is single and injures her hip on a ski vacation.
  The injury requires surgery. The costs associated with
  her procedure total $60,000. Maggie also has 6
  monthly follow-up visits with her orthopedic specialist
  for check-ups on her injury. What does Maggie pay?
               Advantage HDHP Plan
                                                                                      PPO Plan
   Deductible                               $1,350.00
                                                                 Deductible                               $ 500.00
   Coinsurance
                                                                 Coinsurance
   (0% to OOPM)                              $0
                                                                 (20% to OOPM)                            $1,500.00
   Office Visits                             $0
                                                                 Office Visits                            $ 0
   Maggie’s Cost*                            $1,350.00
                                                                 Maggie’s Cost*                           $2,000.00
   CMU HSA Contribution                     ($ 107.16)
                                                                 Maggie’s Premium Cost                    $ 593.52
   Maggie’s Premium Cost                     $ 165.36
                                                                 Maggie’s Total Cost                      $2,593.52
   Maggie’s Total Cost                       $1,408.20
                                                                 *Libby could also use additional pre-tax health care FSA funds to
                                                                 pay the claims costs
 Maggie could also use her own additional pre-tax HSA funds to
 pay the claims cost.
                                                                                                                                     9
2019 20 Benefits Open Enrollment - Central Michigan ...
Advantage HDHP vs. PPO2 Claim Example 2
• Libby is married and has 4 kids. During the year, they
  had 6 visits to the pediatrician ($175 each) and had to
  fill 9 preferred brand name prescriptions ($100 each).
  She and her husband Jack went to the doctor 4 times
  during the year. How much did they spend during the
  year?
                   Advantage HDHP Plan                                                  PPO2 Plan

     6 x $175 Office Visit                     $1,050.00            6 x $30 OV copay                        $180.00
     Tier 2 Rx (9 x $100)                      $ 900.00             Tier 2 Rx (9 x $20)                     $180.00
     4 x Online Visit (4 x $49)                $ 196.00             4 x Online Visit (4 x $5)               $ 20.00
     Libby’s Cost*                             $2,146.00            Libby’s Cost*                           $ 380.00
     VU HSA Contribution                       ($ 271.32)           Libby’s Premium Cost*                   $1,501.68
     Libby’s Premium Cost                      $ 418.44             Libby’s Total Cost                      $1,881.68
     Libby’s Total Cost                        $2,293.12
  *Libby could also use additional pre-tax HSA funds to pay the   *Libby could also use additional pre-tax health care FSA funds to
  claims cost.                                                    pay the claims costs
Know Where to Go
                    Know where
                     to go when
                       you need
                    medical care
                     and receive
                       the best
                      treatment
                       with the
                   lowest out-of-
                    pocket costs.
Blue Cross Online Visits
• Online Visits allows you to have face-to-face
  conversations with a doctor on your computer or
  mobile device
• It’s especially convenient on nights and weekends
  when your doctor’s office or urgent care isn’t open
• Provides access to in-network, board-certified
  doctors and licensed behavioral health professionals
• Allows doctors to ePrescribe utilizing local
  pharmacies (where applicable)
• Costs $5 copay (for PPO1/PPO2) and $49 (for
  Advantage HDHP) for an online doctor visit
• To get started, visit www.bcbsmonlinevisits.com or
  call 844-606-1608
CMU Primary Health Care Services
• Health care services includes:
   –   Routine care and physicals
   –   Acute and chronic illness management
   –   Allergy injections and immunizations
   –   Gynecological exams
   –   Basic cardiac screening
   –   Sports medicine
   –   Cosmetic services
   –   Full service lab testing
• Same-day appointment and walk-in availability
• Clinic services can be billed to your BCBSM or
  MESSA insurance
• Schedule appointments by phone: 989-774-7585

                                                   13
C.H.I.P. Injury Rehabilitation Services
• C.H.I.P. rehabilitation services include:
   – Rehabilitation of musculoskeletal injuries (e.g. sprains,
     strains, contusions, spasms)
   – Pre- and post-operative injuries
   – Conditioning & long-term maintenance programs for
     chronic injuries
   – Some of the treatments available include: ice packs, heat
     packs, ultrasound, electronic muscle stimulation,
     Acuscope/Myopulse, stretches, resistive exercises, range
     of motion exercises, and warm and cold whirlpool
• No cost for regular full-time and part-time employees,
  spouses / OEIs and dependents 16 years of age and older
• Hours are Monday – Friday from 8am – noon and 1pm – 5pm
• A prescription is required for treatment
• Schedule appointments by phone: 989-774-3198

                                                             14
What’s News & What’s Changing for 2019-20
• New claims administrator:
• Dental plan options remain the same plans: Core
  (100-50-50) Plan and Buy-Up (100-75-50-50) Plan
• No longer a passive PPO network
   – Dental providers are either in-network or out-of-network
   – Out-of-network claims will be processed at 100% UCR
   – To find an in-network dentist, go to
     www.guardiananytime.com and click “Find a Provider” in
     the upper navigation
• New ID cards will be mailed to employee’s
  home in the middle of June
                          - Confidential -
                                                                15
Dental Monthly & Annual Costs
                                   Comparing Dental Plan Options
                            (Staff, Fixed Term Faculty, Medical Faculty, Post Docs)

Dental Plan Options                                       Core Plan                                  Buy-up Plan
                                                            100/50/50                                  100/75/50/50
                                                         85% CMU                                    49.5% CMU
Premium Cost Share
                                                       15% Employee                               50.5% Employee

Employee                Single                               $ 4.88                                       $28.30
Monthly                 2-Person                             $10.06                                       $57.48
Cost Share              Family                               $12.55                                       $74.64
Benefit Summary: In-network Benefits (No changes)
Annual             Single                 $50
deductible         2-Person              $100                                                              None
(7/1-6/30)         Family                $150
Maximum annual benefit
                                  $1,000 per person                                              $1,500 per person
(7/1-6/30)
Class 1: Preventive Services    100% (no deductible)                                                   100%
Class 2: Basic Services         50% after deductible                                                   75%
Class 3: Major Services         50% after deductible                                                   50%
                                                                                                       50%
Class 4: Orthodontic Service                                  None                          $2,000 lifetime maximum
(children 19 years or younger)
                                                                                                   per person
       This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions,
                           and limitations are documented in the certificate and amendments.
Dental Treatment in Progress
• Any treatment incurred on or after July 1, 2019 will be a
  claim processed under the Guardian plan
• A dental service is incurred on the date the:
   –   Root canal: tooth is opened
   –   Crown, inlay/onlay, bridgework: tooth is initially prepared
   –   Dentures: first impression is made
   –   All other covered charges: services are received
• Orthodontia: Guardian will prorate the total treatment
  fee and the length of treatment and consider benefits
  from the effective date – July 1, 2019 – forward
   – Total benefit paid between the two claims administrators will
     not exceed the $2,000 lifetime orthodontia maximum
   – Example: A child used $1,000 under the Meritain Health plan.
     The benefit available after July 1, 2019 will be the lesser of
     $1,000 or 50% of the total prorated amount
What’s News & What’s Changing for 2019-20
• Same vision carrier:
   – Largest nationwide network of participating providers
   – Voluntary participation – you decide whether or not to
     enroll for this benefit & pay the fully monthly premium
• Two vision plan options:
   – Standard plan
   –      Premium plan
• In- or Out-of-network eye doctor? Visit
  www.vsp.com
• No ID Cards
   – Use SSN to verify eligibility

                           - Confidential -
                                                               18
Vision Monthly & Annual Costs

                               Comparing Vision Plan Options
             (Staff, Fixed Term Faculty Lecture II/III, Medical Faculty, Regular Faculty)

Vision Plan Options                                Standard Plan                               Premium Plan

Employee            Single                               $ 6.40                                       $ 9.97
Monthly             2-Person                             $12.82                                       $19.96
Cost Share          Family                               $20.62                                       $32.12
Benefit Summary (In-network Payment Level)
Well Vision Exam                                       $20 copay                                    $0 Copay
Frame Allowance (Allowance                $120 or $170 for featured                    $175 or $225 for featured
or contacts OR frames)                              brands                                       brands
                                          $20 copay for single vision,                 $20 copay for single vision,
Lenses                                       lined bifocal/trifocal,                      lined bifocal/trifocal,
                                            standard progressives                        standard progressives
Contacts (Allowance on
                                                          $120                                         $175
contacts OR frames)

         This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions,
                             and limitations are documented in the certificate and amendments.
Not sure which plan is right for you?
           Or do you want to learn more?
• Try using the ALEX tool!
  – ALEX is an easy to use, on-line, decision
    support tool!
     •   Fun and interactive
     •   Shows you most likely and worst case cost scenarios
     •   Accessible from any internet connected device
     •   Includes medical/prescription, dental, vision,
         life/AD&D, disability and FSA/HSA
• Check out ALEX online at
          https://www.myalex.com/cmu/2019
Reminder: Working Spouse / OEI Rule*
      Working spouse / OEI is required to enroll in the medical coverage
      offered through their employer to be added to a CMU medical plan

• Here’s How It Works
  – If your spouse / OEI is eligible for, but does not to enroll in, their own
    employer’s group medical and dental plans, they WILL NOT be eligible
    for CMU medical and dental coverage
  – If your spouse / OEI is enrolled in their employer’s plan, you may add
    them as a dependent to CMU medical and dental plan, but the CMU
    plan will pay secondary coverage ONLY
  – If you enroll in both plans, benefits under each plan are coordinated.
    The total reimbursement from both plans cannot be more than the
    allowable benefit under the CMU plan

         *Applies to staff, fixed term faculty, medical faculty and post-doctoral research fellows.
REMEMBER
 Questions?                          You MUST enroll
                                     between April 22
    –Call 989-774-3661               and May 3, 2019
    –Email benefits@cmich.edu
    –Website: www.cmich.edu/openenrollment

    ENROLL BY FRIDAY, MAY 3rd, 5 P.M. (ET)
No changes can be made after 5 p.m. on May 3rd
Thank you for attending.
Consider a Flexible Spending Account (FSA)

Use tax-free dollars to pay eligible health care and dependent
care expenses
General Purpose Health FSA                    Limited Purpose Health FSA             Dependent Care FSA
Medical, Rx, dental and vision expenses       Dental and vision expenses only        Dependent day care expenses
Maximum annual contribution: $2,700           Maximum annual contribution:           Maximum annual contribution: $5,000
Use to pay: Out-of-pocket medical, Rx,        $2,700                                 (or $2,500 if married filing separately)
dental and vision expenses                    Use to pay: Out-of-pocket dental and   Eligible Dependents: Children under age
(deductibles, copays, eyeglasses, dental      vision expenses only                   13 or another dependent who relies on
work, etc.)                                                                          you for more than half of his or her
                                              Up to $500 annual rollover
Up to $500 annual rollover                                                           support, such as a disabled elderly
Not available if you enroll in the BCBS       Not available if you enroll in the     parent. The dependent must live in the
Advantage HDHP or MESSA ABC HSA-              BCBS PPO1 or PPO2 and MESSA            same principle residence as you at least
Saver plan and elect to receive or make       Choices 10-20 or Choices Saver or do   half the year.
contributions to an Health Savings            not elect to receive or make
                                                                                     Eligible Expenses: Qualified day care
Account (HSA)                                 contributions to an HSA
                                                                                     expenses such as a day care or eldercare
Available only if you enroll in the BCBS      Available only if you enroll in the    center, babysitters, after school
PPO1 or PPO2 and MESSA Choices 10-            BCBS Advantage HDHP or MESSA ABC       programs and day camps.
20 or Choices Saver or do not elect to        HSA-Saver plan and elect to receive
                                                                                     Not available for health care expenses
receive or make contributions to an HSA       or make contributions to an Health
                                              Savings Account (HSA)                  or residential homes.

                                           Estimate carefully: use or lose it
Guardian Find a Provider
 Smile – Finding a dentist in
  Guardian network is easy
1.   Go to guardiananytime.com
2.   Click on “Find a Provider” in
     the upper navigation
3.   Click the “Search Providers”
     button
4.   Choose the “Find a Dentist”
     tab
       • Select the PPO as the
           Plan Type
       • Enter your search
           parameters
5.   Customize your search by
     distance, specialty and
     language spoken
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