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OE ABC Training FY2011

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OE ABC Training FY2011 Powered By Docstoc
					         State of Maryland
      Employees and Retirees
Health Benefits for July 2010 – June 2011
       Welcome

           to
        FY 2011

Agency Benefit Coordinator
 Open Enrollment Training
                             2
                 TODAY’S AGENDA
•   Introductions – Anne Timmons
•   What’s New?
•   Compliance Updates - ARRA/COBRA
•   Forms Review
•   Break
•   Website Demo’s – EBD and Carriers
•   Lunch Break
•   Training Presentation – EBD
•   Brief Comments from ConnectYourCare
•   Question & Answer Session
                                          3
Open Enrollment FY 11
April 14 through April 28, 2010

         Open Enrollment Closed
         April 29 through May 11, 2010

                      Correction Period
                      May 12 through May 19, 2010

                           Forms due from ABC’s to EBD
                           May 25, 2010
                                                         4
          What’s New for 2010-2011?
• NEW! Mental Health Parity

• NEW! Flexible Spending Account Administrator




• NEW! Senate Bill 711 – Trooper Tobin Triebel
        Memorial Act
                                                 5
         What’s New for FY 2011?

              Mental Health Parity

• The State of Maryland is implementing parity for its
employees and retirees effective July 1, 2010.

• What is “Parity?”
     The Wellstone-Domenici Mental Health Parity and
     Addiction Equity Act of 2008 requires health benefit
     plans to cover mental health conditions and
     substance use disorders, including alcoholism, the
     same as any other illness.                           6
                     What’s New for FY 2011? (cont.)
                      Mental Health Parity
• Effective July 1

• Copays, deductibles and out-of-pocket limitations must be no
  more restrictive than for physical health benefits

• Current coinsurance benefits for OP mental health visits
  (80%, 65%, 50%) will be $15 for that same visit

• Equal to the current medical PCP office visit copayment of $15

• Even if a member chooses or is referred to a mental health
  “specialist” provider, the copay remains $15
                                                               7
                                               What’s New for FY 2011? (cont.)
Mental Health and Substance Abuse Coverage for PPO and POS Plan Participants

                  Type of Service                  In-Network Care                               Out-of-Network Care
Inpatient Facility and Professional Services       100% of APS’ negotiated fee maximums          80% of APS’ negotiated fee maximums
Partial Hospitalization Services and Residential   100% of APS’ negotiated fee maximums          80% of APS’ negotiated fee maximums
Crisis Services

Outpatient Facility                                100% of APS’ negotiated fee maximums          80% of APS’ negotiated fee maximums


Office and Professional Services (excluding        $15 copay for PCP/Specialist                  80% of APS’ negotiated fee maximums
Intensive Outpatient Services)
Intensive Outpatient Services                      $15 copay for PCP/Specialist                  80% of APS’ negotiated fee maximums
Outpatient Medication Management Services          $15 copay for PCP/Specialist                  80% of APS’ negotiated fee maximums
Emergency Room Services                            100% of medical plan allowed benefit after $50 copay for ER Facility Care and $50 copay
 In-network and Out-of-Network                                                   for ER Physician Services
 (Paid by medical plan, not APS)
Annual Deductible                                  Not Applicable                                Not Applicable
 Individual
 Family
Annual Out of Pocket Maximum                       None                                          $3,000
 Individual                                        None                                          $6,000
 Family
Lifetime Maximum                                                                   $2,000,000 per person
                                                  What’s New for FY 2011? (cont.)
    Mental Health and Substance Abuse Coverage for EPO Plan Participants
                      Type of Service                     In-Network Care                                  Out-of-Network Care
Inpatient Facility and Professional Services              100% of the allowed benefit                      Not Covered
Partial Hospitalization Services and Residential Crisis   100% of the allowed benefit                      Not Covered
Services
Outpatient Facility                                       100% of the allowed benefit                      Not Covered


Office and Professional Services (excluding Intensive     Balance up to the allowed benefit after member   Not Covered
Outpatient Services)                                      co-pay.
                                                          $15 copay for PCP/Specialist
Intensive Outpatient Services                             Balance up to the allowed benefit after member   Not Covered
                                                          co-pay.
                                                          $15 copay for PCP/Specialist
Outpatient Medication Management Services                 Balance up to the allowed benefit after member   Not Covered
                                                          co-pay.
                                                          $15 copay for PCP/Specialist
Emergency Room Services                                   100% of allowed benefit after $50 copay for ER Facility Care and $50 copay for ER
 In-network and Out-of-Network                            Physician Services
Annual Deductible                                         Not Applicable                                   Not Applicable
 Individual
 Family
Annual Out of Pocket Maximum                              Not Applicable                                   Not Applicable
 Individual
 Family
Lifetime Maximum                                                                                   Unlimited
             What’s New for FY 2011? (cont.)

Flexible Spending Account Administrator




• The current SHPS FSA contract ends June 30, 2010.

• ConnectYourCare (CYC) is effective July 1, 2010.



                                                      10
             What’s New for FY 2011? (cont.)
Flexible Spending Account Administrator
  ConnectYourCare offers:
    NEW! Healthcare Payment (Debit) Card

    NEW! Secure Online Claims Submission

    NEW! No minimum reimbursement
    NEW! Easy Online Account Access

    NEW! Health Education Tools Available on Dedicated State of
    Maryland Website
    NEW! 24/7 Customer Service Center

    NEW! Local Community Presence
                                                                  11
               What’s New for FY 2011? (cont.)

   Flexible Spending Account Administrator
Click on:   www.ConnectYourCare.com/statemd


            • Get Account Balances
            • View Payment Card Charges
            • Enter a New Claim
            • Access Frequently Asked Questions
            • Access Health Education Tools

                                                  12
                          What’s New for FY 2011? (cont.)
         SB 711 - Trooper Tobin Triebel Memorial Act
Effective July 1, 2010:
This information applies to Public Safety employees who perform the duties
listed below as part of their job:
    • Scuba Dive
    • Fly in or Pilot helicopters
Current employees may purchase up to $200,000 of life insurance in addition
to their current life insurance coverage without medical underwriting during
this Open Enrollment only.
New hires may purchase up to $200,000 of life insurance without medical
underwriting, within 60 days of their start date.
Medical underwriting will be required for anyone eligible who does not enroll
in additional life insurance coverage during this Open Enrollment or within 60
days of their start date.
                                                                                 13
         COMPLIANCE
            ARRA/COBRA

• The latest news.…..



                         14
             Program Eligibility

• Employees
   • Active
   • Satellite
   • Contractual & Part-time
• Retirees
   • Optional Retirement Program (ORP)
   • MSPS/EPS


                                         15
Eligible Dependents
   • Legal spouse
   • Dependent Child(ren) to age 25
   • Same sex domestic partners and the
     partner’s child(ren)
          Eligible Active Employees
• Full-time employees and part-time employees working
at least 50% of the work week who are regularly paid
salary or wages through an official State agency,
including:
    • Central Payroll
    • Maryland Transit Administration
    • University of Maryland
• Elected State Officials
• Register of Wills or an employee of Register of Wills

                                                     17
       Eligible Active Employees


• Clerk of the Court or an employee of the
offices of Clerks of the Court

• State Board or Commission members working
at least 50% of the work week who are
regularly paid salary or wages

                                             18
   Eligible Active Satellite Employees

• Employees of a political subdivision
approved by the appropriate governing
body to participate in the State’s health
benefits
• Employees of an agency, commission or
organization permitted by law to
participate in the State’s health benefits
                                             19
   Eligible Contractual & Part-time Employees
• May enroll in same plans as regular full-time employees
    Exception: Cannot enroll in flexible spending accounts
• Must pay full cost of benefits by monthly coupon
    • Due 1st of each month
    • Coverage cancelled if payment is not received within 30-day
      grace period
• A contract renewal is not a qualifying event and does not
  permit changes to coverage elections
• Effective date of coverage cannot be changed once enrollment
  is processed; all coupons must be paid

                                                               20
        Eligible State of Maryland Retirees
Retirees who are receiving a monthly State retirement
allowance and meet one of the following:

   • Retired before July 1, 1984
   • Ended State employment with at least 16 years
     of creditable service
   • Retired with a State Disability Retirement

* Not eligible for Flexible Spending Accounts
   - Cannot take pre-tax deductions from retirement
   allowance
                                                        21
           Eligible State of Maryland Retirees
• Retirees who are receiving a monthly State retirement
allowance and meet one of the following:
    • Retired directly from State service with at least five but less
    than 16 years of creditable service
   • Left State service within five years of normal retirement age
   with at least 10 but less than 16 years of creditable service
   • State employment ended before July 1, 1984

• Partial subsidy based on length of creditable service
• See the Benefits Guide for details
                                                                        22
Eligible Optional Retirement Program (ORP) Retirees

 ORP retirees who are receiving a periodic distribution from
 their ORP account and:
    • Retired directly from, with at least five years of service, a
      Maryland State institution of higher education
    • Ended service when at least age 57 with at least
      10 years of service with a Maryland State institution of
      higher education
    • Ended service with at least 16 years of service with
      a Maryland State institution of higher education
                                                                      23
Eligible Optional Retirement Program (ORP) Retirees

 State subsidy for an ORP retiree may be different than the
 State subsidy for the retiree’s dependents or beneficiary.

 • ORP retirees may receive full, partial, or no State subsidy for
 health benefits.

 • ORP retiree dependents and beneficiaries may receive full or
 no State subsidy for health benefits. At least 25 years of State
 service is required for ORP retiree dependent/beneficiary
 subsidy.
                                                                 24
Important Enrollment Information




                                   25
When Coverage Begins…
 • During Open Enrollment:
    - New enrollment and changes
    - July 1
• As a new-hire or newly eligible:
    - 1st or 16th of the month depending on pay
      period in which first benefit deduction
      occurs
    - Must return completed form and
      documentation within 60 days of           26
When Coverage Begins…cont.
As the result of Qualified Family Status Change:
• 1st or the 16th of the month following event
  date
    • Birth or adoption, coverage is always effective
      on the date of the event, employee must pay the
      retroactive deduction
    • All required documentation must be
      received within 60 days of the event
                                                   27
2010- 2011 Open Enrollment Procedures
All employees and retirees enrolled in benefits as of
March 5, 2010 should receive a pre-printed Open
Enrollment Statement in his/her enrollment packet.
    • Yellow forms – Active/Satellite
    • Blue forms - Retirees
The current enrolled benefits will rollover to the
2010-2011 Plan Year with the exception of
Flexible Spending Accounts.

                                                     28
        Important Note for Active Employees:
The Enrollment Unit will not be processing any
July 2010 – June 2011 paper Enrollment Forms for
employees who have received the yellow pre-printed
Open Enrollment Statement.
Important Note regarding Direct Pay/Satellite
Retiree enrollees:
The Direct Pay Unit will ONLY accept Direct Pay
Enrollment forms for processing. All dependent
documents must be included with the returned,
completed form.                                      29
• Active employees who receive a yellow pre-
printed form, must access the IVR to make any
benefit changes
   • Exception - Long Term Care benefit
• EBD will not make changes based on
comments noted on the yellow pre-printed
statements
• If this occurs, a memo will be faxed to the
Agency Benefit Coordinator advising the
employee must access IVR to make changes
                                                30
    A current employee, never having been enrolled
    in benefits under the State Employee and
    Retiree Health and Welfare Benefits Program,
    but during the Open Enrollment Period chooses
    to enroll in benefits for Year 2010-2011


Must complete a 2010-2011 Enrollment Form
 * Documentation for Active Employees will be requested during the
 DVA process in July/August.                                         31
• Current employees who have never enrolled in benefits and
wish to enroll this Open Enrollment must submit their 2010-2011
Enrollment Form to you by the close of business May 19, 2010

• Enrollment forms with an employee signature date after
May 19, 2010 will not be accepted
• Forms must be signed by you no later than May 25, 2010 and
received in the Employee Benefits Division (EBD) by the close of
business (4:30 p.m. Daylight Savings Time) May 25, 2010

• We suggest sending the Enrollment Forms to EBD by courier or
FedEx to insure their delivery by COB…

                      May 25, 2010                            32
                               IMPORTANT INFORMATION FOR
                                        NEW EMPLOYEES
• New employees whose 2010 Enrollment Form was received and processed
 after March 5, 2010, will not receive a yellow pre-printed OE Statement, but
 will be showing enrolled in the BAS system

• These employees will be able to use the IVR

• Year 2010 Summary of Health Benefits Statements indicating the enrollment
 for 2010 should be distributed to your employees immediately

• If they wish to make changes or enroll in a Flexible Spending Account for the
 2010-2011 Plan Year they must call the IVR system

• Employees may access the IVR to make any benefit changes with the
 exception of the Long Term Care plan for the 2010-2011 Plan Year

           Employee Pin Numbers: 4-digit number of their month and day of
           birth (i.e., May 4th birth date would be 0504).
                                                                             33
                        IMPORTANT INFORMATION FOR
                                NEW EMPLOYEES


• New employees starting employment as of May 1, 2010 will
need to complete the current Plan Year Enrollment Form
(July 2009 - June 2010).
• If the employee wishes to enroll in a Flexible Spending
Account for the July 2010 – June 2011 Plan Year they must
also complete the July 2010 – June 2011 Enrollment Form.
2011 Summary of Health Benefits Statement




                                            35
• Employees making changes via IVR during Open Enrollment should
review their 2011 Summary of Health Benefits Statement for accuracy.

• Corrections to addresses, spelling of names, social security numbers
or dates of birth may only be made on the Summary of Health Benefits
Statement and faxed to the Employee Benefits Division at
410-333-5191 for correction in BAS.

• Enrollment/changes to plans and/or coverage levels and/ or the
“Yes/No’s” on the dependent file may not be corrected on the
Summary of Health Benefits Statement.

• Employees must access the IVR during the Open Enrollment period
to make these corrections.

                                                                   36
           Medical
          8 Plan Choices

2 PPO’s

             3 POS’s

                           3 EPO’s
                                     37
PPO Plans________________________
• Allow you to see any provider you choose, in- or out-of-
  network
• Greater cost savings by using doctors in the network
   – going out-of-network results in higher out of pocket costs for you
• Some services require pre-certification
• Nationwide network of providers
• Locate providers at
   www.carefirst.com/statemd
   www.uhcmaryland.com       NEW! WEBSITE

   Flu shots not covered
   H1N1 covered thru June 30, 2010 - After July 1, 2010 not covered
                                                                    38
 POS Plans______________________
• No PCP’s or referrals required for Aetna, UHC and CF out of
network
• CF in-network only - must choose a Primary Care Physician
    All care must be referred through your PCP
    Greater cost savings by using doctors in the network
    Going out-of-network results in higher out of pocket costs for
    you
• Some services require pre-certification
• Locate providers at
    www.carefirst.com/statemd
    www.uhcmaryland.com
    www.aetnamd.com              NEW! WEBSITE
Flu shots not covered
H1N1 covered thru June 30, 2010 - After July 1, 2010 not covered
                                                              39
EPO Plans________________________
• Must select a Primary Care Physician for Aetna and UHC plans
• No PCP requirement for Carefirst
• Some services require pre-certification
• No referrals required for any plans
    - Members can self-refer to in-network providers
• No coverage out of network except for true emergencies
• Locate providers at
    www.carefirst.com/statemd
    www.uhcmaryland.com
    www.aetnamd.com
Flu shots not covered
H1N1 covered thru June 30, 2010 - After July 1, 2010 not covered
                                                             40
Mental Health and Substance Abuse
Mental Health Benefits_____________
• PPO and POS plans - Carved out, APS administers benefits
• EPO plans use EPO provider network
• Inpatient services still need to be pre-authorized for full plan
  benefits
• NEW ! Office and Professional Services -$15 copay
• No Limit on the number of medically necessary visits
  per plan year
• No limit on out-of-pocket expenses
• Deductible, Out of Pocket and Life Time Maximums are
  aggregated with the medical
                                                                     42
Prescription Drug Plan
Prescription Drug Benefits                        __
• Administered by CatalystRx
• Separate deduction – not included with medical
• If members choose a brand name drug when a
  generic is available, member must pay generic
  copay plus the cost difference of the brand name
  drug vs. the generic drug
• Pharmacy Locator/Preferred Drug Listing available
  through link on DBM website to CatalystRx
                                                      44
               Retail Pharmacy
• Up to 45-day Supply
  –$5 copay generic drugs
  –$15 copay Preferred brand name drugs
  –$25 copay Non-preferred brand name drugs
• Between 46 and 90-day Supply
  –$10 copay generic drugs
  –$30 copay Preferred brand name drugs
  –$50 copay Non-preferred brand name drugs

  Annual Out of Pocket copay maximum of $700   45
             Mail Order Pharmacy
• Up to 45-day Supply
  – $5 copay generic drugs
  – $15 copay Preferred brand name drugs
  – $20 copay Non-preferred brand name drugs
• Between 46 and 90-day Supply
  – $10 copay generic drugs
  – $20 copay Preferred brand name drugs
  – $20 copay Non-preferred brand name drugs

                                               46
Zero Copay for Generics Program
    The copayment for five specific drug classes is $0

          Drug Class         Used to Treat           Generic Drugs

Statins                   High Cholesterol   simvastatin (generic Zocor)
                                             pravastatin (generic Pravachol)
ACEI’s                    High Blood         lisinopril (generic Zestril)
                          Pressure           enalapril (generic Vasotec)

Proton Pump Inhibitors    Ulcer/GERD         omeprazole (generic Prilosec)
(PPI’s)
Inhaled Corticosteroids   Asthma             budesonide (generic Pulmicort
                                             Respules)
SSRI’s                    Depression         fluoxetine (generic Prozac)
                                             sertraline (generic Zoloft)
                                                                            47
Specialty Drug Management Program
  Designed to ensure appropriate use of specialty drugs
  – many are biotech meds that:
    • Are toxic
    • Require special handling
    • May involve complicated treatment regimens
    • Are subject to significant waste
    • Very expensive




                                                    48
Specialty Drug Management Program (cont.)
  The specialty drugs included may be used for
  treatment of:
      • Rheumatoid Arthritis
      • Multiple Sclerosis
      • Blood Disorders
      • Cancer
      • Hepatitis C
      • Osteoporosis
Specialty drugs are automatically reviewed for step
therapy, prior authorization and quantity or dosage limits
and will be limited to a maximum 30 day fill.
                                                        49
Leukotriene Modifier Step Therapy Program
  Leukotriene Modifiers such as:
            • Singulair
            • Accolate
            • Zyflo
• Medications used to treat asthma and generally
should not be taken as first-line therapy for asthma or
allergic rhinitis (allergies).
• Members and dependents over age 12 who are not
currently taking other asthma medications must request
prior authorization for coverage.                       51
        Dental
       2 Plan Choices



DPPO                    DHMO

                               52
Dental Benefits (DPPO)            _________
 • Patient may seek care from either
   participating or non-participating
   dentists.
 • Benefits paid at the same percentages
   for both in and out of network care
 • Out of network providers may balance
   bill for charges over the allowed amount
 • Locate providers at www.ucci.com
                                              53
Dental Benefits (DPPO)___________
                                                      In Network or Out of Network
Annual Deductible
Individual                                  $50
Family                                      $150
Annual Maximum                              $1,500 per participant; applies to Class II and III only
Class I – Preventive Services               Plan pays 100% of in-network allowed amount
Exam, cleaning, x-rays

Class II – Basic Restorative                Plan pays 70% of in-network allowed amount after
Composite/resin fillings, inlays,           deductible
periodontics, oral surgery, general
anesthesia
Class III – Major Services                  Plan pays 50% of in-network allowed amount after
Implants, crowns, bridges, dentures         deductible

Class IV – Orthodontia                      Plan pays 50% of in-network allowed amount up to
Eligible children only, age 25 or younger   $2,000 lifetime maximum
                                                                                                  54
Dental Benefits (DHMO)__________
•   Must select a Primary Dental Office (PDO)
•   May only use participating dentists
•   No out of network coverage
•   Locate providers at www.ucci.com
•   Remind employees to confirm their dentist’s
    continued participation in the network before
    Open Enrollment ends. Members will not be able
    to change plans because their dentist no longer
    participates.
                                                      55
Dental Benefits (DHMO)
                                                           In Network Only
Annual Deductible
 Individual                              None
 Family
Annual Maximum                           None
Class I – Preventive Services            Plan pays 100% of allowed amount
Exam, cleaning, x-rays
Class II – Basic Restorative             Reduced fee schedule
Fillings, inlays, periodontics,          - refer to plan websites for details
oral surgery, general anesthesia
Class III – Major Services               Reduced fee schedule
Crowns, bridges, dentures
Class IV – Orthodontia                   Reduced fee schedule
Eligible adults and children (Children
must be age 25 or younger)                                                      56
Flexible Spending Accounts
Flexible Spending Accounts (FSAs)
• Tax free way to be reimbursed for eligible dependent care or
  health care expenses
• Reduces taxable income – increasing net “take-home” pay
• Eligible expenses for services incurred within plan year
• Reimbursements processed daily
   – can be directly deposited
• Must re-enroll each year
• Administered by CYC
• Claim forms available on CYC and DBM websites

                                                             58
            Healthcare FSA
• Eligible expenses include out of pocket healthcare
  costs
   – Medical, dental, vision, prescription, over-the-
      counter medicines
   – Copays, deductibles, coinsurance
• Covers all eligible dependents in your home (Same
  sex domestic partners and partner’s children not
  eligible)
• Limited to $3,000 per year
• No requirement to be enrolled in State health plans
• Full elected amount available on July 1st
• Swipe Healthcare Payment (Debit) Card or file secure
  claim online
• No EOB’s required!                                   59
60
             Dependent Care FSA
• Eligible expenses are daycare services that enable you and/or your
   spouse to work outside your home, look for work, or attend school
   full time
• Dependent children under age 13
    – Summer Camp (not overnight camp)
    – Before and after school care
    – Nursery School or daycare
• Elderly/disabled adults that reside in your home
    – Adult day care
 • Limited to $5,000 per year
     – $2,500 if married, filing separate tax returns
     – Limited to deductions and reimbursements for July-December plus
         January-June
 • Reimbursed only up to the amount taken from your pay at that point 61
      Healthcare FSA - Grace Period
• Participants have until September 15th of the next plan
  year to incur claims and until October 15th to submit claims
  for the previous plan year - only if you are an active
  employee
• Helps ease the fear of having money left over at the end of
  the plan year
• Gives participants extra time to use money in account




                                                             62
Healthcare FSA - Grace Period
• NOTE: Healthcare FSA claims with dates of service
thru June 30, 2010 should be sent to SHPS for
processing.
• If you have remaining funds in your 2009-2010 SHPS
healthcare FSA account, you have until September 15,
2010 to incur eligible expenses and until October 15,
2010 to file the claim with SHPS for reimbursement.
• Once SHPS account is exhausted, claims with dates
of service July 1, 2010 and beyond should be
submitted to ConnectYourCare for processing.
                                                        63
  Heroes Earning Assistance and
 Relief Tax Act of 2008 (HEART Act)
   Allows plans to offer “qualified
  reservist distributions” of unused
     amounts in health FSA’s to
reservists ordered or called to active
 duty for at least 180 days or on an
           indefinite basis.
                                         64
 Term Life
Insurance




             65
                Term Life Insurance
        Employee
        • May purchase coverage in $10,000
          increments up to $300,000*
        • No medical history needed on amounts
          up to $50,000
        • Amounts over $50,000 require medical
          history
* SB 711 allows for higher coverage amounts for scuba divers and those who
fly in /pilot helicopter.                                                  66
       SB 711 - Trooper Tobin Triebel Memorial Act

• Effective July 1
• Public Safety employees who perform the following as part of
  their job:
   • Scuba Dive
   • Fly in/pilot helicopters

• May only purchase up to $200,000 additional life insurance
• Does not pertain to AD&D
• Medical underwriting WILL BE NOT REQUIRED during this OE
  or for new hires
• Medical underwriting WILL BE REQUIRED for anyone eligible
  who does not enroll for extra coverage at this time
                                                                 67
         Term Life Insurance
Dependents
• Spouse/Same Sex Domestic Partner’s
  Eligible children
• Employees may purchase coverage in $5,000
increments up to 50% of your elected amount
(up to $150,000)
• Amounts over $25,000 require medical history
       Statement of Health Form and Beneficiary Designation
            Forms are available on the MetLife website        68
           Term Life Insurance
• Accelerated death benefit
  – pays up to 100% of life insurance if terminally ill
    with less than twelve months to live
• Coverage can be continued after employment ends
  – Portability – coverage converts to an individual
    term life policy
  – Conversion – coverage converts to a whole life
    policy
     • Builds cash value
                                                          69
             AD&D Insurance
• Employees may purchase coverage in amounts
  of
  –$100,000
  –$200,000 or
  –$300,000
• May choose either individual or family coverage
  – Family coverage pays benefits on a percentage of
    the whole amount based on the number of
    dependents                                       70
          Long Term Care
• What is Long Term Care?
  – Help or supervision provided for someone with
    severe cognitive impairment or the inability to
    perform Activities of Daily Living (ADL)
  – ADLs are bathing, dressing, eating, toileting,
    transferring and continence

• Employees may choose to cover themselves
  and/or:
   – Eligible legal spouse
   – Parents or in-laws
   – Grandparents
   – Children age 18 or over and their spouses        71
             Long Term Care
• Eight options available with different benefit
  payment levels
   – Nursing home or assisted living
   – Home and community based care
   – Lifetime maximums
• Employees may choose a different plan for each
  individual covered
• 90 day elimination period before benefits are
  payable
                                                   72
                Long Term Care
• How it works
   – Patient certified by a licensed health care practitioner as
      • having a chronic illness or disability or
      • severe cognitive impairment
          – Means loss of ability to perform two or more ADL’s
            without substantial assistance
   – Loss must be expected to last at least 90 days
   – Benefits payable beginning on the 91st day
      • based on the plan selected

                                                               73
             Long Term Care
• How to Enroll
    • Contact Prudential directly
      – Phone
      – Website
   • Unable to enroll through IVR
       Open Enrollment Reminders
Current benefits will rollover to July 2010 except for FSA’s

             Open Enrollment FY11
            April 14 through April 28
              Correction Period
            May 12 through May 19
   Forms due by 4:30 p.m. May 25, 2010
                                                         75
Open Enrollment Materials
• Coordinators will receive a small supply of
  – Forms
     • Active/Satellite Form for 2010-2011
     • Retiree Enrollment Form for 2010-2011
     • Direct Pay Enrollment Form
  - Benefit Guides
• All materials available on DBM Health
  Benefits website www.dbm.maryland.gov

                                                76
Open Enrollment Materials
• Active/Satellite Packets
  – Individual sealed packets containing:
      • Active/Satellite Open Enrollment Benefits
        Statement
      • 2010-2011 Benefit Guide (Rates included in
        guide)
      • Rate Charts with imputed income calculations for
        same sex domestic partners posted on the DBM
        website
                                                      77
Open Enrollment Materials
• Retiree Packets (mailed to their home address):
   – Open Enrollment Benefit Statement
   – Benefit Guide
• Direct Pay Packets (mailed to their home address):
   – Direct Pay Form
   – Rate Sheet and Instructions
   – Open Enrollment Benefit Statement
   – Benefit Guide
 Open Enrollment Materials
• Postcard announcing OE – mailing date March 15th
• Other Communications – SECU newsletter, Morgan State
  University radio spot (WEAA FM 88.9) and check stub notices
• Deliveries to Coordinators scheduled for April 1- April 9,
  2010
• Please inform your Building Main Entrance Staff or Building
  Loading Dock to expect a large delivery of boxes
• Retiree and Direct Pay Packets mailed first week of April
• Personalized forms will show only last 4 digits of the SSN
   – Use to cross-match to the full SSN on the BAS
                                                                79
Important Reference Information
• Benefit Guide:
  – Phone numbers and websites for all the plans
  – Eligibility details
  – Plan summaries
  – Important notices regarding HIPAA, COBRA,
    Newborns’ and Mothers’, and Medicare Part D
  – Employee Benefits Division (EBD) contact
    information
• Our EBD website: www.dbm.maryland.gov
  – Click on Health Benefits                       80
EBD Contact Information
Anne Timmons – Director of Employee Benefits          Denise Behler – Admin. assistant
               atimmons@dbm.state.md.us               dbehler@dbm.state.md.us
               410-767- 4787                          410-767-4710

Mary E. Balducci – Director of Operations
                   mbalducci@dbm.state.md.us
                   410-767-1810


Renee Hammock – Manager, Customer Service
                rhammock@dbm.state.md.us
                  410-767-4806

  Note: Our Customer Service Unit is fully-staffed with representatives available to
         assist your employees and you from 8:30 a.m. – 4:30 p.m. M-F.
                       410-767-4775 or 1-800-30-STATE.                               81
Debbie Halterman - Manager, Retiree/Medicare
                   dhalterman@dbm.state.md.us
                   410-767-6045

Fran Melchior –     Manager, Enrollment
                    franz@dbm.state.md.us
                    410-767-1389

Kelly Valentine –   Manager, Direct Pay & Satellites
                    kvalentine@dbm.state.md.us
                    410-767-4690
                                                       82
Questions?

				
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