State Health Plan Charter School Presentation - PowerPoint Presentation

1. State Health Plan Charter School PresentationNovember 2019

2. Overview of Topics State Health Plan OverviewLegislation and ProcessNew Group SetupEligibility and EnrollmentGroup PremiumsOverview of Plan OptionsEmploying Retired Teachers in a Full-Time Position2

3. State Health Plan OverviewThe State Health Plan provides health care coverage to more than 727,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, local governments, and their dependents.The State Health Plan is a division of the Department of State Treasurer. The Treasurer is responsible for administering and operating the State Health Plan. An Executive Administrator oversees the day-to-day operations of the Plan.The Plan is governed by a Board of Trustees consisting of 10 members. The State Treasurer serves as the ex officio chair.The State Health Plan is governed by North Carolina General Statute 135 Article B and must adhere to Section 125 of the Internal Revenue Code; therefore, groups must follow the Plan’s rules as established. 3

4. Legislation and ProcessAs required in NCGS 135-48.54, a Charter School Board of Directors must submit the election to join the Plan in writing no later than two (2) years after both parties (the State Board and the applicant) have signed the written charter under G.S. 115C-238.29E. A copy is required to verify the date signed after the election is submitted. Session Law 2018-84 House Bill 977 changed the notification requirement from 30 days to 2 years effective June 25, 2018.Send required documents to the State Board of Education, and to the State Health Plan’s Executive Administrator: Dee Jones, Executive AdministratorState Health Plan for Teachers and State Employees 3200 Atlantic AvenueRaleigh, NC 27604or email HBRInquiries@nctreasurer.com Election is irrevocable.The Board of Directors shall notify each employee of the election in writing whether the board elects to become a participating employer in the Plan. Each employee shall acknowledge receipt.4

5. New Group SetupImportant resources and tools are available on the State Health Plan website at www.shpnc.org. Once the Plan receives the election-to-participate letter, the Plan will send a Group Setup form to start the implementation process. Training and resources are provided to explain the implementation process. This will equip you with the knowledge you will need to educate your employees on their health plan options, and to show you how to use eBenefits, the Plan’s online enrollment system. 5Contact at State Health Plan: Martina Jones Martina.Jones@nctreasurer.com

6. How to Enroll6Paperless Enrollment Enroll online through eBenefits, the Plan’s online enrollment systemInstructions for enrolling via eBenefits can be found on the Plan’s website at www.shpnc.org. Click eBenefits at the top of the home screen landing page to get started.

7. Eligibility for Permanent Employees 7Permanent employeesWorking 30 Hours Per WeekWorking 20 Hours but Less than 30 Hours Per WeekMay enroll themselves and their eligible dependents but must pay full cost of coverage.May enroll themselves and their eligible dependents. Employee is eligible for employer share.

8. Who is an Eligible Dependent?8Legal spouseChildren up to age 26*NaturalLegally adoptedFoster childrenChildren under legal guardianshipStepchildren*A child’s coverage may be extended beyond age 26 if the child is physically or mentally incapacitated and the condition developed before their 26th birthday and the dependent was covered by the State Health Plan.Members are required to provide documentation to verify the eligibility of their dependents when enrolled in health coverage.

9. When Can You Enroll? Employees of new groups are eligible to enroll the first of the month that the group elects to join the Plan. After the group is on the Plan, the effective date for new hires is the first of the month or first of the second month following date of hire.Dependents must be added at time of the employee’s enrollment or can be added within 30 days of a qualifying life event or during Open Enrollment. Documentation is required to validate the status change. Please keep in mind that group set up can still be initiated before we receive the signed charter. However, enrollment may be delayed by statue until the Plan has a copy of the signed charter.9Hired:Can elect coverage until:Effective date of coverage:October 15November 15Either Nov. 1 or Dec. 1, depending on when enrolled

10. Group PremiumsPrepaid PlanBilled monthly for the next monthi.e., June bill is for JulyBills are generated in the middle of the monthPremium is due by the first of the next month and must be paid as billedIf premium is not paid by the due date, claims are heldPremiums not received by the fifteenth day of the month following the due date shall be charged 1 ½% interest of the amount due the Plan, per month beginning with the sixteenth day of the month following the due date. (NCGS 135-48.55)eBilling administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers paperless invoices, electronic one-time and recurring payments, on-demand and scheduled reporting10

11. Overview of Plan OptionsThe State Health Plan offers two plan options:Members pay a 20% coinsurance for eligible in-network services. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Preventive services performed by an in-network provider are covered at 100% by the Plan, at no cost to the member. Members pay 30% coinsurance for eligible in-network expenses. Members pay a copay for some services (i.e., office visits, urgent care or emergency room visits). NEW for 2020, preventive services will no longer require a copay or be subject to the deductible and coinsurance. For example, procedures like preventive colonoscopies performed in an outpatient setting will now be covered at 100%, which means no charge to the member. Review the Plan Comparison on the Plan’s website for a side-by-side comparison of both plans.11Consumer-Directed Health Plan 85/15 (CDHP)80/20 Plan70/30 Plan

12. 80/20 Plan122020 In-Network2020Out-of-NetworkAnnual Deductible $1,250 Individual$3,750 Family$2,500 Individual$7,500 FamilyCoinsurance20% eligible expenses after deductible40% of eligible expenses after deductible and the difference between the allowed amount and the chargeOut-of-Pocket Maximum(Combined Medical and Pharmacy)$4,890 Individual$14,670 Family $9,780 Individual$29,340 FamilyPreventive Services Covered at 100%N/AOffice VisitsSelected PCPNon-Selected PCP$10$2540% after deductibleOffice VisitsSpecialist$8040% after deductible

13. 80/20 Plan132020In-Network2020 Out-of-NetworkUrgent Care$70 $70Emergency Room (Copay waived w/admission or observation stay)$300, then 20% after deductible$300, then 20% after deductibleOutpatient Hospital20% after deductible40% after deductibleInpatient Hospital$300 copay, then 20% after deductible is met$300 copay, then 40% after deductible is metTherapy Services (Chiro/PT/OT)$5240% after deductible DrugsTier 1 (Generic)Tier 2 (Preferred Brand & High-cost Generic)Tier 3 (Non-preferred Brand)Tier 4 (Low-cost/Generic Specialty) Tier 5 (Preferred Specialty)Tier 6 (Non-preferred Specialty)Preferred Diabetic Supplies*$5$30Deductible/Coinsurance$100$250Deductible/Coinsurance$5$5$30Deductible/Coinsurance$100$250Deductible/Coinsurance$5 *Non-preferred Diabetic Supplies will be priced at Tier 3.

14. 70/30 Plan142020 In-Network2020Out-of-NetworkAnnual Deductible $1,500 Individual$4,500 Family$3,000 Individual $9,000 FamilyCoinsurance30% of eligible expenses after deductible50% of eligible expenses after deductible and the difference between the allowed amount and the chargeOut-of-Pocket Maximum (Combined Medical and Pharmacy)$5,900 Individual$16,300 Family $11,800 Individual$32,600 FamilyPreventive ServicesCovered at 100%N/AOffice VisitsSelected PCPNon-Selected PCP$30$4550% after deductibleOffice VisitsSpecialist Copay$9450% after deductible

15. 70/30 Plan152020In-Network2020Out-of-NetworkUrgent Care$100$100Emergency Room(Copay waived w/ admission or observation stay)$337, then 30% deductible$337, then 30% deductibleOutpatient Hospital30% after deductible50% after deductibleInpatient Hospital $337, then deductible/30% coinsurance$337, then deductible/50% coinsuranceTherapy Services (Chiro/PT/OT)$72 Copay50% after deductible DrugsTier 1 (Generic)Tier 2 (Preferred Brand & High-cost Generic)Tier 3 (Non-preferred Brand)Tier 4 (Low-cost/Generic Specialty) Tier 5 (Preferred Specialty)Tier 6 (Non-preferred Specialty)Preferred Diabetic Supplies*$16$47Deductible/coinsurance$200$350Deductible/coinsurance$10$16$47Deductible/coinsurance$200$350Deductible/coinsurance$10*Non-preferred Diabetic Supplies will be priced at Tier 3.

16. Pharmacy BenefitsPharmacy Benefits administered by CVS CaremarkCustom, closed formulary - certain drugs are not covered.A Formulary Exclusion Exception Process is available. Some medications:Require step therapy or prior authorization Have quantity limitsPharmacy Benefit Preferred Drug List (PDL):Recommends drugs for effectiveness/pricePreferred Options for non-covered medications Updated quarterly CVS Caremark has a broad pharmacy network, and Plan members do not have to go to a CVS pharmacy for prescriptions.For more information, visit www.shpnc.org.16

17. Pharmacy Benefit Reminders17Individual In-Network Benefit Design70/30 Plan80/20 Plan Drugs Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Tier 6$16$47Ded/Coins.$200$350Ded/Coins.$5$30Ded/Coins.$100$250Ded/Coins.Preferred Diabetic Supplies*(e.g. Test Strips, Lancets, Syringes, Needles). Preferred Diabetic Supply brand is OneTouch$10$5Tier 3 and Tier 6 medications do not have a defined copay, but are subject to a deductible/coinsurance. This means that you will have to pay the full cost of the medication until you meet your deductible. Once you meet your deductible, you will be responsible for the 20% or 30% coinsurance amount until you reach the out-of-pocket maximum. Medications that are subject to coinsurance in most cases will result in higher out-of-pocket costs. As a reminder, if an exception is approved for an excluded drug, it is only approved for coverage at the Tier 3 or Tier 6 member copay level.

18. Wellness Premium Credit OpportunityActive members can reduce their employee-only premium by $60 on both the 80/20 and 70/30 plans by completing the tobacco attestation. During Open Enrollment or initial enrollment, an employee MUST attest to being a non-tobacco user or agree to visit the CVS MinuteClinic for at least one tobacco cessation counseling session within 60 days of their enrollment, to earn their premium credit.The tobacco attestation premium credit applies only to the employee premium. It does not apply to spouses or dependents.The tobacco attestation is completed during the online enrollment process in the Plan’s enrollment system, eBenefits. 18

19. 2020 Premium Rates19Monthly Premium Rates2020 Rates *80/20 Plan Subscriber Only$50.00Subscriber + Child(ren)$305.00Subscriber + Spouse$700.00Subscriber + Family$720.0070/30 Plan Subscriber Only$25.00Subscriber + Child(ren)$218.00Subscriber + Spouse$590.00Subscriber + Family$598.00*Assumes completion of tobacco attestation. The premium will be $60 higher per month if the tobacco attestation is not completed. Monthly premiums for all members and plans can be found on the State Health Plan website at www.shpnc.org.

20. Employer ContributionThe State Budget provided the following monthly employer contributions for 2020:$413.60/month for the Medicare primary population$532.36/month for the non-Medicare primary population20

21. 21High Deductible Health Plan (HDHP)

22. 22To avoid tax penalties under section 4980H of the Internal Revenue Code (the Code), employers must offer health coverage to all full-time employees. Employees are considered full-time, and thus required to be offered employer-sponsored health care, if they are reasonably expected to work 30 hours per week. Employing units are responsible for determining whether or not an employee is a full-time employee. This includes all non-permanent employees. HDHP for Non-Permanent Full-Time EmployeesThe State Health Plan is not able to provide guidance to employing units regarding eligibility for employees. Additional information is posted on the Plan’s website under the Health Benefits Representatives tab. Click Health Care Reform/Affordable Care Act Information and under Plans for Active Employees.

23. 23High Deductible Health Plan SummaryMedical CoverageIndividual In-NetworkIndividual Out-of-NetworkFamily In-NetworkFamily Out-of-NetworkDeductible$5,000$10,000$10,000$20,000Coinsurance50%50%60%60%Out-of-Pocket Maximum(Medical and Pharmacy) $6,450 $12,900 $12,900 $25,800Preventive Care Services$0 (covered at 100%)$0 (covered at 100%) Dependent on coverage Dependent on coverageOffice Visits50% after deductible50% after deductible60% after deductible60% after deductibleSpecialist Visit50% after deductible50% after deductible60% after deductible60% after deductibleInpatient Hospital50% after deductible50% after deductible60% after deductible60% after deductiblePrescription Coverage2020 CVS/Caremark Formulary Covered Prescription Drugs 50% after deductible 50% after deductible 60% after deductible 60% after deductibleThird Party Claims Administrator – Blue Cross NC

24. 24HDHP Monthly Premium RatesEmployer Pays $145.50.Coverage TypeEmployee Monthly PremiumEmployee$96.00Employee + Child(ren)$284.00Employee + Spouse$513.00Employee + Family$617.00

25. Employing Retired Teachers in a Full-time PositionIn adherence to §135-48.40, a retiree employed full-time (30 hours or more) under an employing unit is no longer eligible for health coverage under the Retirement Systems and the employing unit is responsible for paying the employer premiums. Permanent full-time rehired retirees are eligible for the traditional plans (70/30 Plan and 80/20 Plan) For retirees hired in a non-permanent full-time position, the employing unit has the option to offer them the High Deductible Health Plan (HDHP) or the traditional plans.25

26. Thank You!This presentation is for general information purposes only. If it conflicts with federal or state law, State Health Plan policy or your benefits booklet, those sources will control. Please be advised that while we make every effort to ensure that the information we provide is up to date, it may not be updated in time to reflect a recent change in law or policy. To ensure the accuracy of, and to prevent the undue reliance on, this information, we advise that the content of this material, in its entirety, or any portion thereof, should not be reproduced or broadcast without the express written permission of the State Health Plan.