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Update on Health Insurance at Rollins College

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Update on Health Insurance at Rollins College Powered By Docstoc
					“Benefits for Educated Consumers”
     Rollins College Open Enrollment
        April 2006-March 2007
    Overview
   Open enrollment dates & tools
   Areas with no changes
   Dental for April 2006
   New for April 2006
   ICUBA recap
   Rollins recap
   April 2006 health rates
   ICUBA wellness benefits
   Plan designs
   BCBS FL Tools & Resources
   HCSA, HRA & DCSA
   Questions

                                    2
 OPEN ENROLLMENT ONLINE
Online through FoxLink(formally Campus Pipeline)
           (know your R # and password)
           February 6 – February 17, 2006
    Effective for April 1, 2006 – March 31, 2007
•All benefits except Flexible Spending Accounts will
   remain the same if you do not make changes
•Health Care Spending Account (HCSA) & Dependent
  Care Spending Account (DCSA) must be elected
              during open enrollment
                                                       3
 Tools to Facilitate Decisions

Rollins open enrollment website open Monday, Feb 6th
predictive modeling on HCSA, DCSA and HRA and health
http://webone.outsourceone.com (will be linked to Rollins
with instructions)
BCBS of FL website resources & member service #
HR representatives available during open enrollment



                                                        4
Areas with no changes
   Vision insurance
   Long term care insurance
   Voluntary life insurance
   Cancer insurance
   Heart Care insurance


                               5
 Dental for April 2006

Dental- same 3 Aetna plans
  DMO, PPO, Indemnity

 6.5% increase DMO
10% increase on PPO & Indemnity

College will continue DMO single coverage
     at no cost for all employees
                                        6
         New for April 1, 2006
       Rate increases on all four PPO medical plans
         3% Risk/Reward; 5% PPO 70; 8% PPO 80; & 12% PPO 90
       No benefit design changes on medical PPO plans
         Obesity nutritional counseling & extra lab tests, male 65-75
          aneurysm screening
         Quantity level Rx limits
         Specialty drugs provider Medmark
         Dependent end dates- either Jan 31 or Sept 30
       Personal Wellness Profile- $25 incentive- now & in fall
       HRA & over the counter
       MBI Debit card NEW Orlando contact information
       HCSA extension

                                                                         7
Independent Colleges & Universities
Benefits Association, Inc. (ICUBA)

   Better Benefits Through Collaboration
   a state approved IRC 501(c) (9)
    corporation
   Multiple Employer Welfare Association
    (MEWA)
   Executive Director - Mr. Mark S.
    Weinstein, CPA, Esq., LL.M., MPH

                                            8
ICUBA- Mission & Focus Points
   ICUBA exists because the member schools believe in
    “Better Benefits Through Collaboration”
       Pool purchasing power to reduce admin fees, commissions,
        premium taxes and high margins of insurance company fees
   ICUBA’s mission is to achieve excellence in the
    delivery of benefit plans of the highest quality
   ICUBA focuses on quality management:
      Access to providers and health care treatments

      Strong preventive/wellness care focus- to promote
       the health & well-being of members
   ICUBA focuses on facilitating the education of
    employees as benefits consumers

                                                             9
      The ICUBA program has 6,200+ employees
      participating from 10 ICUF schools:




Prospects: Flagler, Stetson, FL Memorial, Embry-Riddle,
Jacksonville, Lynn, Bethune-Cookman, Florida College & Ringling
                                                                  10
        ICUBA 2005-2006 Recap
20.96% in Risk Reward; 31.47% in PPO 70 Plan, 45.28% in PPO 80,
2.29% in PPO 90 as of 11/30/05
$22.2 million paid claims 12 mths ending 9/30/05
Expense PEPY for ending 9/30/05 was $4,445
$6.3 million surplus at 10/31/05
Network discounts BCBS about 54% docs & 60% hospitals (about 10%
higher than CIGNA)
Rx = 22% of total expenses;average of $13.29 per script generic &
$70.39 per script brand; Zocor, Lipitor, Prevacid & Nexium 1-4 top by cost;
potential 51.1% filled Rx had generics available
74% of claimants averaged less than $1,000 in paid claims and 24% less
than $100
                                                                        11
Rollins College Recap
   06-07 is fourth year with ICUBA
   84.14 % of total eligible enrolled
   35.07% in Risk Reward; 9.14% in PPO 70 Plan,
    52.42% in PPO 80, 3.35% in PPO 90
   Rollins contributes 63% of total cost across all levels
    of coverage (single & dependents -about $185,000
    per month) plus HRA contributions of about $53,000
    per month
   Health insurance available to new faculty/staff
    immediately upon hire
   Retiree Health offered
   Both sex Domestic Partner Coverage offered
                                                         12
                       Total Claims
                       03-04 vs. 04-05 vs. April-Nov 05
                                      April-March 03-04 vs 04-05 vs. 05-06 (through Nov 05)


             March

               Feb

                Jan

          December

          November                                                                                                                     2005-2006
 Months




            October                                                                                                                    2004-2005
          September                                                                                                                    2003-2004
            August

               July

               June

               May

               April

                  $0.00   $50,000.00 $100,000.00 $150,000.00 $200,000.00 $250,000.00 $300,000.00 $350,000.00 $400,000.00 $450,000.00
                                                               Claim s Expended

Chart shows paid claims, not incurred- additional claims incurred by not yet paid (especially in
most recent months but up to one year)                                                         13
Plan               (%) Change
PPO 90             12.00    increase
PPO 80             8.00     increase
PPO 70             5.00     increase
Risk Reward        3.00     increase
PPO 90 to PPO 80   25.15 decrease
PPO 90 to PPO 70   37.74 decrease
PPO 90 to R/R      47.35 decrease
PPO 80 to PPO 70   10.17 decrease
PPO 80 to R/R      24.03 decrease
PPO 70 to R/R      11.21 decrease
RR to 80           31.71 increase
RR to 70           17.90 increase
70 to 80           10.17 increase

                                       14
$ chg/yr Sgl             2 Per        Children      Family
     RR    $35.61        $71.23       $64.07        $99.65

     70    $68.92        $137.66      $123.96       $192.75
     80    $128.76       $257.97      $231.84       $360.56
     90    $278.76       $552.48      $501.56       $780.21
           +600-1500     + 900-1800   + 780-1680    + 1200-2100
90 to 80   $583.80       $1167.84     $1051.08      $1634.88
           +$600 hra     +$900 hra    + $780 hra    + 1200 hra
90 to 70   $876.12       $1752.62     $1577.28      $2453.64
           + $900 hra    +$1200 hra   + $1020 hra   + $1500 hra
90 to RR   $1099.32      $2198.88     $1979.04      $3078.48
           + $1500 hra   +$1800 hra   + $1680 hra   + $2100 hra
80 to 70   $163.56       $327.24      $294.36       $458.16
           + $300 hra    +$300 hra    + $240 hra    + $300 hra
80 to RR   $386.76       $773.52      $696.12       $1083
           + $900 hra    + 900 hra    + 900 hra     + $900 hra
70 to RR   $154.28       $308.61      $278.76       $432
           +$600 hra     +$600 hra    + 660 hra     + $600 hra
                                                             15
         April 2006 Monthly Rates &
         HRA Contributions
          PPO 90     PPO 80    PPO 80    PPO 70    PPO 70     Risk/     Risk/
           Plan       Plan     ER HRA     Plan     ER HRA    Reward    Reward
                                                              Plan     ER HRA


Single
  EE     $216.72     $144.84     -       $120.48     -       $101.88      -
  ER     $369.01     $246.62   $50.00    $205.13   $75.00    $173.47   $125.00
EE &SP
  EE     $433.44     $289.68     -       $240.95      -      $203.76      -
  ER     $738.02     $493.25   $75.00    $410.27   $100.00   $346.94   $150.00
EE &CH
  EE     $390.10     $260.71     -       $216.86     -       $183.38      -
  ER     $664.22     $443.92   $65.00    $369.24   $85.00    $312.25   $140.00
Family
  EE      $606.82    $405.56      -      $337.33      -      $285.26      -
  ER     $1,033.23   $690.54   $100.00   $574.37   $125.00   $485.72   $175.00
                                                                          16
         April 2006 Annual Rates &
         HRA Contributions
          PPO 90       PPO 80      PPO 80      PPO 70     PPO 70        Risk/       Risk/
           Plan         Plan       ER HRA       Plan      ER HRA       Reward      Reward
                                                                        Plan       ER HRA


Single
  EE     $2,600.64    $1,738.08      -        $1,445.71       -       $1,222.55       -
  ER     $4,428.12    $2,959.44   $600.00     $2,461.61    $900.00    $2,081.65   $1,500.00

EE &SP
  EE     $5,201.28    $3,476.21      -        $2,891.42       -       $2,445.11       -
  ER     $8.856.24    $5,918.95   $900.00     $4,923.22   $1,200.00   $4,163.29   $1,800.00

EE &CH
  EE     $4,681.18    $3,128.56      -        $2,602.28       -       $2,200.60       -
  ER     $7,970.66    $5,327.00   $780.00     $4,430.92   $1,020.00   $3,746.96   $1,680.00

Family
  EE      $7,281.82   $4,866.68       -       $4,047.95       -       $3,423.15       -
  ER     $12,398.78   $8,286.52   $1,200.00   $6,892.45   $1,500.00   $5,828.61   $2,100.00
                                                                                     17
       ICUBA Wellness Benefits
   No deductible for office visits
   USPSTF, CDC & ACOG based Preventive Health 100% Schedule
   100% Enhancements: mammograms, pap, PSA, ECG/EKG, Urinalyses,
    general blood panels, venipuncture, well child visits, adult immunizations
    & 1st reported bone mineral density & colonoscopy
   $25 incentive Maternity (yr round) & Personal Wellness Profile (2x/yr)
   Magellan EAP services for ALL employees
   Discounts on wellness, complementary services & alternative medicines
    (Blues Complements)
   24/7 Nurse Line & Blues on Call counselors/coaches
   On-line services for predictive modeling, tools, claims, provider network,
    quality comparisons, medical reference materials , Rx info and more
   Access to one of the largest network of quality providers

                                                                        18
       Plan Similarities & Differences
   All four plans have same:
                                      Differences are:
      Prescription drug benefit-
        $10/$25/$50                      Deductibles
      Annual wellness benefit 100%

      Enhanced wellness benefits
                                         Coinsurance
        100%
                                         Copays
      Personal Wellness Profiles

      Plan rules & coverages            Annual Out of
      Network of providers              Pocket Maximums
      BCBS FL website access
                                         HRA Amounts
      24/7 health info line

      Blues on Call resources

      ER & Urgent Care                                    19
 Summary of
April 2006 Plans
             In Network- 4 Plan Comparison
                                 PPO 90                PPO 80             PPO 70           Risk/Reward

Deductible                   $150/$450          $300/$900             $500/$1,500        $1,500/$4,500
Coinsurance (after Ded)      90/10%             80/20%                70/30%             80/20%
Out of pocket Limits         $2,000/$4,000      $2,500/$5,000         $3,000/$6,000      $3,500/$7,000
Primary Physician Services   $15 copay          $15 copay             $20 copay          80/20% No Ded
Routine Wellness Exams       $15 or $25         $15 or $25            $20 or $30         80/20% No Ded
Non-Physician Charges        100%               100%                  100%               100%
Specialist Physician         $25 copay          $25 copay             $30 copay          80/20% No Ded
Outpatient Surgery in Drs    $15 or $25         $15 Or $25            $20 Or $30         Ded, 80/20%
Outpatient Surgery in        $100 copay ded,    $100 copay            $100 copay ded,    Ded, 80/20%
Outpatient Facility          90/10%             ded, 80/20%           70/30%

Outpatient Pre-Admission     ded 90/10%         ded 80/20%            ded 70/30%         Ded,80/20%
ALL Mammo, PSA, Pap          100%               100%                  100%               100%

MRI, MRA, CAT, PET           $100 copay ded,    $100 copay ded,       $100 copay ded,    Ded, 80/20%
                             90/10%             80/20%                70/30%
ST Rehab & Spinal            $25 60 visits      $25 60 visit          $30 60 visit       Ded, 80/20% 60
Manipulation                 Spinal & 30 each   Spinal & 30 each PT   Spinal & 30 each   visit
                             PT & Occ &         & Occ & Speech        PT & Occ &         Spinal & 30 each
                             Speech                                   Speech             PT & Occ & Speech
                                                                                                       21
       In Network- 4 Plan Comparison contd.
                                   PPO 90            PPO 80             PPO 70          Risk/Reward

Inpatient Hospital Services   $250 copay,ded,    $250 copay,ded,    $250 copay,ded,    Ded, 80/20%
                              90/10%             80/20%             70/30%
Emergency Room                $100 copay         $100 copay         $100 copay         $100 copay
Urgent Care                   $25 copay          $25 copay          $30 copay          80/20% no ded
Maternity Care-Outpatient     $25 initial        $25 initial        $30 initial        80/20% No Ded
               -Inpatient     $250 copay, ded,   $250 copay, ded,   $250 copay, ded,   Ded, 80/20%
                              90/10%             80/20%             70/30%

Mental Health & Substance     $250 copay, ded,   $250 copay, ded,   $250 copay, ded,   Ded, 80/20%
Abuse                         90/10%             80/20%             70/30%
Inpatient (30 days max)

Mental Health & Substance     $25 copay          $25 copay          $30 copay          80/20% No Ded
Abuse
Outpatient (20 visit max)

Prescription Drugs            $10/$25/$50        $10/$25/$50        $10/$25/$50        $10/$25/$50
Mail Order 90 days            $20/$50/$100       $20/$50/$100       $20/$50/$100       $20/$50/$100



                                                                                                      22
Deductibles/Max with HRA
                          PPO 80             PPO 80
                                             ER HRA
Deductible             $300/$900       Single $600
Coinsurance (after     80/20%          SP      $900
Ded)
Out of pocket Limits   $2,500/$5,000   CH   $780
                                       Fam $1,200


                       PPO 70                PPO 70     Risk/Reward     R/R
                                             ER HRA                     ER HRA

Deductible             $500/$1,500     Single   $900    $1,500/$4,500   Single   $1,500
                                       SP     $1,200                    SP       $1,800
Coinsurance (after     70/30%                           80/20%
Ded)                                   CH      $1,020                   CH       $1,680
Out of pocket Limits   $3,000/$6,000   Fam     $1,500   $3,500/$7,000   Fam      $2,100



                                                                                          23
BCBS ID Card
   Unique Identifier prefix IWF(no ssn)




            First Name Last Name
     ID# IWF123456789001                 GR#

      COPAY OV $$ SP $$ ER $$

               BC PLAN 363 BS PLAN 865
                                          ICUBA



                                                  24
BCBS Member Access
Customer Service
 Customer Service Telephone Assistance
   Toll-free 1-866-470-2963
   8:00 a.m. – 5:00 p.m. Eastern Standard Time
   Monday – Friday
 Voice Mail
   After hour calls returned within 24–48 hours
 Web Site
   Self Service/Secure Messaging

                                                   25
BCBS On Line Capabilities
www.mybenefitshome.com
   Access to Nationwide Provider Directory
   Request ID Cards
   Track Claim Status
   Find Medical Information- calculators & national quality measures
   Answers to Frequently Asked Questions
   Healthwise® KnowledgeBase
   Access to Blues on Call – Health Coach 24/7
   Wellness Programs including Personal Wellness Profile (aka Health Risk
    Appraisal)
   E-mail Questions to Member Services
   RX Information- review formulary, renew mail order Rx, locate pharmacy

                                                                             26
   Highlight Of BCBS Amenities
 Blues on CallSM
    RN Nurse Line 24/7
    Individual Health Information and support
    Access to Health Coach
    1-888-BlUE-428
    Treatment Decision Support
    Chronic Condition Support
    BlueCard Worldwide- international
    Blues Complements- discounts
                                                 27
BCBS PPO Program Kit
   Quantity Level & Specialty Rx programs
   Summary of benefits for each plan
   Pre-existing notice (only for new enrollees)
   Locate Providers Instructions
   2006 Preventive Schedule
   Rx Pocket Guide
   www.mybenefitshome.com
   Blues on Call
   Blues Complements
   Mail Order Rx
                                                   28
       Health Care Spending Account
       (HCSA) & Health Reimbursement
       Account(HRA)-MasterCard Debit Card
   NEW – Orlando contact for Outsource One:
    Derek Larsen, Administrator for Flex & HRA
    P.O. Box 616927
    Orlando, FL 32861-6927
    flex@icuba.org
    407-354-4997 or Toll Free: 866-377-5102 fax: 866-377-5180
 Will be required to provide less & less substantiation
  (itemized receipts and/or EOB) for expenses- recommended
  that you still keep receipts
 If no funds, transaction denied-

check balances www.mbicard.com
(using Internet Explorer)
                                                                29
         Health Care Spending Account (HCSA)
         Health Reimbursement Account (HRA)
                                          HRA (Health Reimbursement Accounts)
HCSA (Health Care Spending Accounts)
                                          •Approved by Federal govt
•Part of IRS Section 125 FSA
                                          •Employer contributions only
•Employee contributes tax-free
                                          •Funds earn interest & are never taxed
•Unused funds at end of year (April-
March) cannot be rolled over into next    •Offered with PPO 80, PPO 70 & Risk/Reward
year (except 2.5 month extension)         •Unused funds at the end of year can be rolled
•Cannot be used to pay insurance          over into subsequent years
premiums                                  •May be used to fund retiree & COBRA medical
•May be used for all IRS dependents       premiums & long term care premiums
•Total limit available April 1st          •May be used for dependents on medical plan
•Used before the HRA                      •Balance available last day of each month
•May be used for over the counter drugs   •NEW- may be used for over the counter drugs


                                                                                      30
Health Care Spending Account (HCSA)
   Tax sheltered money to pay for out of pocket medical
    expenses (including over the counter drugs)
   Annual maximum = $3,000
   Entire annual HCSA funds are accessible April 1st
   Use debit card at point of service or submit hard copy
    reimbursement request to Outsource One-Orlando
   Reimbursement requests may be submitted until
    June 30th (3 months after end of plan year-expense
    must occur within plan year)
   NEW-2.5 month extension on use it or lose it (to
    incur expense by June 15th)
   Must elect new limit for April 2006-March 2007
                                                      31
         Health Reimbursement Accounts
         (HRA)
   College funded accounts with PPO 80,PPO 70 and Risk/Reward medical plans
   Eligible Expenses include out of pocket medical (all HCSA eligible expenses
    plus COBRA, long term care & retiree premiums).
        NO other premiums, non-medical expenses or expenses for non-dependents
   Unused money rolls over while employed & is held in a secure trust fund
   Money earns interest at FL Dept Financial Services rate quarterly
   Can never be converted to cash
   Portable with 36 months participation
        April 04-March 05, April 05-March 06 & April 06-March 07 vested
   Available the last day of each month of participation in one of the medical
    plans
   April 2004-December 2005- Rollins has contributed $ 1,053,910
   Current HRA participants = 518 out of the 536 enrolled in medical

                                                                                  32
Dependent Care
Spending Account (DCSA)
     Eligible expenses
     Maximum Annual Limit $5,000
     Funds available each month after payroll
     Must elect new limit for April 2006-March 2007

     Claim Reimbursement process
          Send claims and receipts by mail or fax to Outsource
           One-Orlando
          Use Debit card if merchant can be set up with a
           merchant code with Outsource One


                                                                  33
FEEDBACK/QUESTIONS




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