Health Plan Options Open Enrollment 2020 Open Enrollment Overview Choosing a Plan Health Plan Overviews Participating in Open Enrollment Making Changes Later 2 Open Enrollment Overview Make health plan changes ID: 810645
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Slide1
Health Plan Options
Open Enrollment 2020
Slide2Health Plan Options: Open Enrollment 2020
Open Enrollment Overview
Choosing a Plan – Health Plan OverviewsParticipating in Open EnrollmentMaking Changes Later
2
Slide3Open Enrollment Overview
Make health plan changes
Enroll in Flexible Spending2020 Open Enrollment Dates:
Plan
Coverage:
July 1, 2020 – June 30, 2021
3
May 1-15, 2020
https://edirect.Virginia.gov
Slide4Open Enrollment Overview
No Action is Required if You:
Have no health plan-related changesAre not enrolling in a Flex Spending AccountDo not plan to participate in Premium Rewards
4
Slide5Open Enrollment Overview
Make any plan
changesFlexible Spending Account (FSA) – ANNUALContinue Premium Rewards - ANNUALDental – Basic/Expanded
Vision – Basic/Expanded
5
Slide6Open Enrollment Overview
Flexible Spending Accounts (FSAs)
Health FSADependent Care FSAMust enroll every year
6
Slide7Open Enrollment Overview
Flexible Spending Accounts (FSAs) -
NEW this YearLimit for FSA = $2,750
Reminder
Monthly Flex Fee =$
2.10PAYFLEX MasterCardLocked in Rate for the year
7
Slide8COVA Care &
HealthAware
Only – Premium RewardsEarn $17 off monthly premiums ($34 couple)Complete online assessment
Must be completed during Open
Enrollment
www.anthem.com or www.aetna.com
8
Slide9Choosing a plan
OPEN ENROLLMENT 2020
9
Slide10Factors in Choosing a Plan
If you have small children
If you or someone on your plan has a chronic illnessIf you or someone on your plan take(s) prescription medicationsIf you tend to be very healthy
If your physicians are in the network
10
Slide11Factors in Choosing a Plan
Frequently travel outside of coverage area
Travel internationallyTight budgetHave experienced increase in out-of-pocket expenses
11
Slide12Factors in Choosing a Plan
All Plans Include –
WellnessFree Office Visits – Children up to age 6Free Annual Check-ups – Children age 7
&
older
Free Routine Screenings & Exams – AdultsFree EAP Plans
12
Slide13Telemedicine
Anthem
LiveHealth Online
Aetna COVA
HealthAware
Teladoc
Optima Health HMO MDLive
13
Slide14COVA Health Plans: Dental
Open Enrollment Options
Basic – Diagnostic & Preventative2 free cleanings per yearExpanded Dental – Dental work, Orthodontic
Deductible per person
Different levels of co-insurance based on procedure
14
Slide15Choosing a Plan
15
Health Plan Choices
Available
COVA Care
Statewide and elsewhere
COVA
HealthAware
Statewide and elsewhere
COVA
HDHP
Statewide and elsewhere
Optima Health HMO
Regional,
mostly in Hampton Roads
Kaiser Permanente
HMO*
Regional,
mostly N. Virginia
TRICARE
Supplement*
Eligible Military Retirees
*Not covered in this presentation
Slide16COVA Care
Primary Care
Specialty
Care
In
Patient Hospital
Emergency
Room
$25
$40
$300 per stay
$150 facility
PCP- $25
Specialist-$40
16
Slide17COVA Care
Deductible
–
Per plan year
Out of Pocket Max–
One Person - $300
One Person
- $1500
Two or
More - $600
Two or More - $3000
17
Slide18COVA Care
International Travel – Blue Cross Blue Shield Global Core
Domestic Travel – BlueCard PPO ProgramOut-of-Network Option
18
Slide19COVA Care
Vision Basic – Blue View Vision
Routine exam once per year$15 co-payVision & Hearing OptionsExpanded visionRoutine hearing exams - $40 co-pay
Hearing aids and other services
19
Slide20COVA High Deductible Health Plan
Primary Care
Specialty
Care
In
Patient Hospital
Emergency
Room
20% after deductible
20% after deductible
20% after deductible
20% after deductible
20
Slide21COVA HDHP
Deductible
–
Per plan year
Out of Pocket Max–
One Person - $1,750
One Person
- $5,000
Two or More - $3,500
Two or More - $10,000
21
Slide22COVA HDHP
Pharmacy
Mandatory genericRetail & Mail OrderVisionNot AvailableHearing
Out of Network
22
Slide23COVA
HealthAware
Consume-driven health planIncludes a Health Reimbursement Arrangement(HRA) fundUp to $600 for employeeUp to $1,200 for employee and spouse
23
Slide24COVA
HealthAware
Primary Care
Specialty
Care
In
Patient Hospital
Emergency
Room
20% after deductible
20% after deductible
20% after deductible
20% after deductible
24
Slide25COVA
HealthAware
Deductible -
Per
plan year
Out of Pocket Max–
One Person
- $1,500
One Person - $3,000
Two or More
- $3,000
Two or More - $6,000
25
Slide26COVA
HealthAware
Earn HRA funds – Healthy Activities “Do Rights”$150 maximum“Do Rights” include:Routine exams
Use
MyActiveHealth
TrackerFlu ShotCompleting Coaching Module26
Slide27COVA
HealthAware
PharmacyHRA covers pharmacy expensesRetail and Mail OrderSome free generic and preferred brandsVision & Hearing – basic
Out-of-Network Coverage
27
Slide28OPTIMA HEALTH HMO
Regional – Hampton Roads coverage area
26,000 providersSentara Quality Care Network & Riverside Health SystemsReferral-less HMO/No Out-of-Network except Children
28
Slide29OPTIMA HEALTH HMO – Coverage Area
17 County Service Areas
Chesapeake, Franklin,
Gloucester
, Hampton, Isle of Wight,
James
City, Mathews, Newport News, Norfolk,
Poquoson
, Portsmouth, Southampton, Suffolk, Surry, Virginia
Beach, Williamsburg
,
York
29
Slide30OPTIMA HEALTH HMO
Primary Care
Specialty
Care
In
Patient Hospital
Emergency
Room
$5 – Tier 1
$25 – Tier 2
$10 – Tier 1
$40 – Tier 2
$300 per stay
$150 facility
30
Slide31OPTIMA HEALTH HMO
Deductible –
Per plan
year
Out-of-Pocket
Max–
One
Person - $150
One Person - $1,500
Two or More - $300
Two or More - $3,000
31
Slide32OPTIMA HEALTH HMO
Includes Expanded Dental
Dominion National Includes VisionEyeMed
32
Slide33OPTIMA Health HMO
Network
No out-of-network provided
Except in emergencies over 100 miles away from residence
Coverage only provided in 17 cities and counties
Out of Area Dependent Program provides coverage to dependent children who live outside of service area
Slide34COVA PLANS – SUMMARY OF CHANGES, OPTIONS
OPEN ENROLLMENT 2020
34
Slide35COVA Care & HDHP –
New
this YearSydney Health Mobile AppBehavioral Health In-Home Services Age limits removed
HDHP Live Health online cost $59
35
Slide36COVA Health Plans –
New
this YearInformed RewardsTeladoc now $0New ID cards mailed
36
Slide37Additional Help
Get Advice from ALEX
State online benefit counselorwww.myalex.com/cova/2020
37
Slide38Eligibility Definitions
Documents to add dependents need to be sent to HR for online enrollment
Slide39Making Changes
After open enrollment, when may I make changes to my health benefits plan or FSAs?
During Next Year’s Open Enrollment
Usually occurs May 1 to May 15; effective July 1, 2021
OR
With a Qualifying Mid-Year Event
Within
60 days
of the event with appropriate documentation
Slide40Making Changes
QUALIFYING STATUS CHANGES INCLUDE:
Marriage or Divorce
Death of spouse or dependent
Birth or adoption of child
Loss of dependent eligibility
Employment begin/end for spouse
Employee or spouse change to/from part-time/full-time employment
Loss of other employer plan
Eligibility for or loss of government health care
Dept. of Social Services Health Care Coverage Order
Slide41Other Voluntary Benefits
Genworth
Long Term Care
Any time with Enrollment Website
Legal Resources
November 1
st
to November 22
nd
Optional Life Insurance
Any time with Enrollment & EOI Forms
Slide42Questions?
Need
more information?
William & Mary
Office of Human Resources
Bell Hall, 109 Cary Street
Main HR Phone Number: (757) 221-3169
Main HR Fax Number:
(757) 221-3156
HR Email: ASKHR@WM.EDU