Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Open_Enrollment_Gates_2010 by niusheng11

VIEWS: 11 PAGES: 27

									Gates 2010 Open Enrollment
        October 2009
                Agenda



 2010 Open Enrollment

 2010 Plan Overview Offering

 Questions




                                2
                          2010 Open Enrollment

• Open Enrollment October 26- November 13, 2009
• Open Enrollment booklets
   • Enrollment booklets are available online at www.smartchoicesgates.com and
     will be emailed
   • Premium information available in booklets
• Enrollment Required
   • Several plan changes for 2010
   • Medical require you to elect or waive coverage
   • Flexible Spending Accounts- Health and/or Dependent Care
• Social Security numbers are required for all US Citizen
  dependents (CMS Requirement)
   • You can update SSN online through Oracle Employee Self Service system
• Confirmation notice will be sent to your location for all
  employees
   • Employee must contact Denver HR if the elected enrollment is not correct,
     notification must be submitted prior to end of the year.


                                                                                 3
                        2010 Open Enrollment

• Enrollment should be done online through Oracle
   • Navigation Guide available online at www.smartchoicesgates.com and
     will be emailed
   • TO ENROLL- Log on from home:
       • Go to https://sshr.gates.com or www.smartchoicesgates.com.-.
            • User Name: openenroll
            • Password: gates2010
   • If you are NOT an Oracle user
       • User Name: Employee number (5 digit)
       • Password: Employee number (5 digit), required to change
           this once you sign in.
   • If you are an Oracle User
       • User Name: Network log in ID
       • Password: Oracle Password, (if you have not signed in within 90
           days, your password will be your employee ID (5 digit), you will be
           required to change this once you sign in.
   • Once you log in, choose US EMPLOYEE SSHR.

                                                                                 4
                                        Medical Plan
New for 2010 - Gates will be harmonizing benefits with Tomkins benefit plans
• New Administrator- Anthem Blue Cross and Blue Shield
    • New Medical cards will be sent to your home
        • Card can be used for both medical and pharmacy claims
        • Case management will be coordinated between the old and new plans
• 3 New Medical Plans to choose from
    • High Option- $200 Deductible
    • Mid-Level Option- $500 Deductible
    • $1,500 Deductible Option
• New Coverage Levels to choose from
    •   Associate Only
    •   Associate + Spouse
    •   Associate + Child(ren)
    •   Family (associate + spouse + child(ren)
• Dependent Children Eligibility
    • Dependent children between 19-25 MUST be full-time students to be enrolled in
      medical plan
    • If dependent child s no longer eligible for active plan, they will be eligible for COBRA

                                                                                                 5
                                    Medical Plan
New for 2010 cont…
• Opt Out plan discontinued

• Lifetime Maximum $2,000,000

• Separate lifetime maximum on Organ Transplants $1,000,000

• New amount for working spouse $160

• No routine vision coverage under Medical

• Preventive care benefit at 100% for first $1,500, remainder subject to
  deductible and coinsurance (10% on all plans)

• Limits on therapy and Chiropractic

• $7,500 limit on Durable Medical Equipment

• Increase in copay for ER visits

                                                                           6
            Medical Plan- High Option Plan- $200 Deductible

                                      In-Network                    Out of Network
Annual Deductible                       $200 Individual                  $400 Individual
                                         $600 Family                      $1,200 Family
Out of Pocket Maximum                  $2,000 Individual                $4,000 Individual
                                        $6,000 Family                    $12,000 Family
Coinsurance                                  10%                              30%
Physician Office Visit                 $20 Copayment                  30% after deductible
                                 10% after deductible on other
                                     services performed
Specialist Office Visit                $30 Copayment                  30% after deductible
                                 10% after deductible on other
                                     services performed
Inpatient Hospitalization and         10% after deductible            30% after deductible
Outpatient Services
Preventive Care                 1st $1,500 covered at 100%; then   1st $1,500 covered at 100%;
                                       10% after deductible         then 30% after deductible




                                                                                             7
              Medical Plan- Mid Level Plan- $500 Deductible

                                      In-Network                      Out of Network
Annual Deductible                       $500 Individual                   $1,000 Individual
                                         $1,500 Family                     $3,000 Family

Out of Pocket Maximum                  $3,000 Individual                  $6,000 Individual
                                        $9,000 Family                      $18,000 Family

Coinsurance                                  15%                                35%
Physician’s Office Visit              $20 Copayment                     35% after deductible
                                15% after deductible on other
                                    services performed

Specialist Office Visit               $30 Copayment                     35% after deductible
                                15% after deductible on other
                                    services performed

Inpatient Hospitalization and        15% after deductible               35% after deductible
Outpatient Services

Preventive Care                 1st $1,500 covered at 100%; then   1st $1,500 covered at 100%; then
                                       10% after deductible               35% after deductible



                                                                                                      8
                           Medical Plan- $1,500 Deductible Plan

                                         In-Network                       Out of Network
Annual Deductible                         $1,500 Individual                   $3,000 Individual
                                           $4,500 Family                       $9,000 Family

Out of Pocket Maximum                     $3,000 Individual                   $6,000 Individual
                                           $9,000 Family                       $18,000 Family

Coinsurance                                     20%                                 40%

Physician’s Office Visit          Deductible; then 20% of allowable   Deductible; then 40% of allowable
                                  charges                             charges

Specialist Office Visit           Deductible; then 20% of allowable   Deductible; then 40% of allowable
                                  charges                             charges

Inpatient Hospitalization and     Deductible; then 20% of allowable   Deductible; then 40% of allowable
Outpatient Services               charges                             charges

Preventive Care                   1st $1,500 covered at 100%; then    1st $1,500 covered at 100%; then
                                         10% after deductible                40% after deductible




                                                                                                    9
                        Medical Plan- Example


• Primary Care Physician Visit – Avg. cost $82.95

                       High Option            Mid-Level              $1,500 Deductible
                          $200                  $500
                       Deductible             Deductible
Copayment                       $20.00                      $20.00     Co-insurance applies
                                                                            after deductible


Deductible                       $0.00                       $0.00                  $82.95


Total Out of Pocket             $20.00                      $20.00                  $82.95




                         No additional services performed

                            Premiums not factored in


                                                                                           10
                        Medical Plan- Example


• Emergency Room Visit- Avg cost $426.70

                        High Option              Mid-Level              $1,500 Deductible
                      $200 Deductible              $500
                                                 Deductible
Copayment                        $150.00                    $200.00                       $0.00



Deductible                       $200.00                    $226.70                    $426.70



Coinsurance                         $7.67                      $0.00        Coinsurance (20%)
                       Coinsurance (10%)         Coinsurance (15%)      applies after deductible
                             applies after   applies after deductible
                               deductible
Total out of Pocket               $357.67                   $426.70                    $426.70


                              Premiums not factored in

                                                                                              11
                      Medical Plan- Example


• Maternity- Routine- Avg. $7,934.13

                      High Option              Mid-Level                   $1,500
                         $200                    $500                     Deductible
                      Deductible               Deductible
Copayment                       $20.00                     $20.00                     $20.00


Deductible                     $200.00                    $500.00                  $1,500.00


Coinsurance                    $773.41                   $1,115.12                  $1,286.82
                      Coinsurance 10%            Coinsurance 15%            Coinsurance 20%
                           applies after   applies after deductible   applies after deductible
                             deductible
Total Out of Pocket            $993.41                  $1,635.12                  $2,786.82


                         Premiums not factored in


                                                                                           12
                                     Medical Plan

• New for 2010 cont…
• Preventive Care Allowance- 1st $1,500 of preventive care is covered at
  100%.
    • No Co-payments, No Deductible, No Co-insurance
    • Some examples of covered procedures or visits- mammograms, colorectal
      screenings, cervical cancer screenings, HPV and PSA tests, annual exams, bone
      density screening, cholesterol screenings, glucose testing, lipid and liver panels.
      This is just to name few
• The Preventive Care Allowance also covers the cost of membership fees to
  nationally recognized groups for weight loss. (Jenny Craig, Weight Watchers,
  Nutrisystem, etc.)
    • Members pay up front for their membership fees but then can file a
      reimbursement claim with Anthem and be reimbursed 100%
    • The program will not cover any food or education materials
    • The program will also not reimburse for any co-payments for medications




                                                                                            13
                                   Medical Plan
• New for 2010 cont…
• Preventive Care Incentive Program
   • All employees and their eligible dependents who are in enrolled in the Anthem
     medical plans are eligible to receive an annual $50 incentive for receiving an
     approved preventive care procedure.
   • Approved procedures and/or tests:
       •   Annual exams- adult, child and well baby
       •   Mammograms
       •   Well Woman exam
       •   PSA screening
       •   Prostate exam
       •   Colorectal Screening
   • 2010 incentives will be paid semi annually
       • Service billed and paid by Anthem by June 30, 2010 will be
         paid during the 3rd quarter of 2010
       • Service provided by December 31, 2010 and paid by Anthem
         by Feb 26. 2011 will be paid in the 2nd quarter of 2011.
                                                                                      14
                            Prescription Drug Plan

New for 2010
• New Administrator- Anthem Blue Cross Blue Shield
   • Existing mail order prescriptions with Caremark will move to Anthem at the
     end of December- if any refills remain
   • Use your new medical card for pharmacy claims
• New Prescriptions Co-Pay Structure
   • Same co-pays for all 3 plans
• Mandatory mail for all maintenance medications
   • Long term medications (3 months or more) should be filled through the mail
     order service
       • You can continue to utilize retail pharmacies for refills, however you will
          pay full price after your 3rd fill
   • Short-term drugs- i.e.: antibiotics- should continue to be purchased at
     participating retail pharmacies




                                                                                  15
                               Prescription Drug Plan

New for 2010 cont…
• Member pays difference
   •    If you are prescribed a medication that has a generic alternative available and
       “dispense as written” is requested (by you or physician) you will pay the difference in
       co-payments and the difference in the cost of the drug
• Step Therapy-         Specific drugs that require a first step drug before these are
 approved.
   • Most first step alternative drugs work well; in limited instances if a medication isn’t
     effective or appropriate the prescribing physician will need to submit a prior
     authorization request to Anthem.
        • Examples include Boniva, Aciphex, Byetta, Celebrex, Allegra-D, Clarinex-D,
           Prilosec, Protonix, Rhinocort aqua, Ambien CR, Lescol, Veramyst, Lescol XL,
           Vytorin, Benzaclin, Nasacort AQ, Betaseron, Zetia, Blood Glucose Meters/Strips,
           Omeprazole 40Mg, Adderall XR
        • For a complete list contact Anthem BCBS




                                                                                            16
                           Prescription Drug Plan

New for 2010 cont…

• Smoking cessation
   • Up to $5,000 lifetime maximum
   • All Over-The-Counter (OTC) smoking patches are covered with $5 copay
        • Maximum of 12 refills/calendar year
        • Patches do not apply to $5,000 lifetime maximum




                                                                            17
                        Prescription Drug Plan

                                  Retail                        Mail Order
                                                             (required for maintenance
                                                                    medications)

   Generic                         $5.00                            $12.50


    Brand                         $32.00                            $80.00


Non-Formulary                     $60.00                           $150.00


  Specialty                  10% coinsurance with a maximum $200
                                           copay/fill


         Specialty medications- any drug with an ingredient cost of more
   than $1,000 or a self-injectable medication. (exception diabetic medications)


                                                                                         18
                       Medical and Prescription Drug
                           Contact Information
Administered by Anthem BCBS
•If medical care is needed before identification card is received:
     •Anthem group number: 003321255
     •Policy Number: Members SSN
• Mail claims to:
      Local BCBS Plan
• Anthem Member Service Line: 1-866-811-9722
•Website: www.anthem.com
•Resources
    •24/7 Nurse Line: 1-800-337-4770
    •MyAnthem.com: find physicians, view claims, order ID cards, order
    prescriptions, get health information & more!
    •SpecialOffers@Anthem: receive discounts on products and services that
    help promote good health




                                                                             19
                                 Dental Plan

• New for 2010…
• Enhanced Preventive Care Benefit
  • Plan allows an additional 2 annual cleanings, if member has diagnosed
    periodontal disease or is considered an “at risk” member, for a total of
    4 cleanings/year
      • “At-risk” members include:
          • Pregnant women
          • Diabetics
          • Suppressed immune response due to cancer, HIV, organ
             transplant
          • Persons experiencing kidney failure or dialysis
  • Cover Brush Biopsy to detect oral cancer as a preventive treatment
      • Currently covered under oral surgery and requires tissue sample
• Coverage of dental implants

                                                                               20
                                 Vision Plan

• Administered by Vision Service Plan (VSP) & EyeMed
• Three plans offered
   • VSP features a network of independent preferred providers
   • EyeMed’s network features providers associated with Target Optical,
     Pearle Vision, Sears Optical, JC Penney Optical and LensCrafters, as well
     as a network of independent preferred providers
• New for 2010
   • Enhanced contact lens coverage with VSP ($150 allowance)
   • EyeMed is offering a new buy-up plan similar to the VSP plan




                                                                                 21
                                Vision Plan

  Benefits             VSP             EyeMed Basic         EyeMed Buy-Up
                                        Vision Plan           Vision Plan
                   In-Network           In-Network            In-Network



   Exam             $10 copay            $10 copay              No copay

Single Vision       $25 copay            $10 copay              No copay
   Lenses
  Frames        Covered up to $120   $100 allowance plus   $150 allowance plus
                  after $25 copay    20% of balance over   20% of balance over
                                       $100 (every 12        $150 (every 12
                                          months)               months)
  Contacts      Covered up to $150    Conventional &        Conventional &
 (instead of                         Disposable: $105       Disposable: $150
  glasses)                           allowance after $10   allowance plus 15%
                                     copay plus 15% off      off balance over
                                     balance over $105             $150




                                                                                22
                        Biweekly Premiums - Pre tax

                      Employee   Employee and   Employee and   Family
                      Only       Spouse         Child(ren)

High Option - $200      $52.90      $111.10         $100.52      $157.49
Deductible
Mid-level - $500        $23.64       $49.65         $44.92       $70.92
Deductible
High Deductible -       $11.84       $24.88         $22.46       $30.79
$1500 Deductible
Dental                  $3.17        $6.33           $7.28       $10.44

Vision – VSP            $5.72        $8.58           $9.06       $14.30

Vision- Eyemed Base     $2.55        $5.10           $4.58        $6.12

Vision- Eyemed Buy-     $4.48        $8.97           $8.05       $10.76
up


                                                                          23
                          Flexible Spending Accounts
                                   HELPS YOU SAVE MONEY!!

• Flexible Spending Account
• Pre-tax dollars set aside to pay for Healthcare and Dependent Care expenses
    • Healthcare FSA
        • Allows for reimbursement of eligible medical expenses such as:
             • Deductibles
             • Co-payments
             • Out of pocket expenses for medical, dental, and vision care
             • Over the counter purchases of medically related items
             • Maximum contribution $3,000
    • Dependent care FSA – This account is available for reimbursement of dependent care
      expenses incurred when working
        • Allows for reimbursement of continued care for adult children or other adult family
            members
        • Maximum contribution $5,000
• Must use funds by the end of the calendar year (12/31/2010) or you will lose
  unused dollars- plan carefully!
• Debit Card available – If enrolled for 2009, debit card will be good for 2010
• Annual enrollment is required- must enroll if wish to continue


                                                                                                24
                      Other Benefit Plans


• EAP – Company Paid Benefit
• Hyatt Legal - $15/month
• Basic Life Insurance with AD&D
• Supplemental Life Insurance
• Supplemental Accidental Death and Dismemberment
  Insurance (AD&D)
• LTD – Long Term Disability – Decrease in rates for 2010
    • ($3,000 ÷ $100) or 30 x $0.225 = $6.75
• Business Travel Accident Insurance
• CIGNA Secure Travel Assistance – Emergency Assistance



                                                            25
                                  Summary

• Enrollment is REQUIRED
     • Medical and FSA accounts
• New Medical and Pharmacy Plan Carriers
     • New ID cards will be mailed to your home in late December
•   New Medical plan options- must make election into new plan!
•   Social Security Numbers for dependents required
•   Enroll online through Oracle
•   Open Enrollment dates October 26 – November 13, 2009




                                                                   26
Questions??




              27

								
To top