1 ShawHankins Service Center can answer questions on all benefits Available 800 am 500 pm during open enrollment Available until 7pm until November 14th 8009947429 Benefit Resource Center shawhankinsbenefitsnet ID: 780331
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Slide1
City of Marietta
2015 Benefits open enrollment review
1
Slide2ShawHankins
Service Center- can answer questions on all benefits
Available 8:00 am – 5:00 pm during open enrollment
Available until 7pm until November 14th
800-994-7429
Benefit Resource Center- shawhankinsbenefits.net/cityofmarietta
2
Slide3Changes for 2015
BCBS POS Plan
Change in copays, deductible and out of pocket maximum
BCBS PPO Plan
Change in deductible and out of pocket maximum
New Medical Plan offering with Piedmont/
Wellstar
Out of pocket maximum on all plans will now include prescription costs
New Pharmacy Benefit Manager-PharmAvailEveryone will receive new ID cards from BCBS with PharmAvail informationOptional Vision Plan-Avesis
3
Slide4Open Enrollment
Open Enrollment is November 3
rd- November 21st
Benefits Fair will be November 3
rd
– November 7thHR and ShawHankins will be available to answer questions and assist with online enrollment
Open Enrollment is your opportunity to make elections for 2015
Only time you can make a change to those elections is if you experience a qualifying event:
Marriage, divorceBirth or adoptionChange in your or your spouse’s work status that affects benefits
Spouse’s annual open enrollment period
Change in dependent eligibility status
Change in eligibility for Medicaid or MedicareDeath of dependentCourt order
4
Slide5Bswift Online Enrollment
Will make elections through
Bswift enrollment portal
www.cityofmarietta.bswift.com
Username: first letter of first name, last name, and last 4 digits of SSN
Example: JSmith0563
Password: last 4 digits of your SSN
Example: 0563
If you do not make elections through the enrollment portal, your coverage will roll over for the 2015 plan year. You will not be permitted to make changes after the open enrollment period ends, unless you experience a qualifying event.FSA elections must be made with Colonial representative. Must make new election for 2015.
5
Slide6Benefits Fair
Fire Department Conference Rooms B & C- 112 Haynes StMonday November 3
rdTuesday November 4th
Wednesday November 5
th
Thursday November 6thFriday November 7th9:00 am-12:00 pm
1:30 pm-4:00 pm
6
Slide7Medical and Prescription Coverage
7
Slide88
Slide99
PPO Plan-Grandfathered Employees
K
e
y
Benefit
In-Network
Out of Network
Li
f
etime
Maximum
Unlimi
t
ed
Deductible
Coinsurance
$800 per person
$2,400 per family
$1,200 per person
$3,600 per family
80% plan / 20% member
70% plan / 30% member
Maximum
Annual
Out-of-
P
oc
k
et
Limit
$6,600 per person
$13,200 per family
No maximum
Out of Pocket Maximum includes deductible, coinsurance and all copays – Office Visit, Urgent Care, Emergency Room and Prescriptions
Office Visits
Primary Care Physician
Specialty Care Physician
Urgent Care Facilities
Plan pays 80% after deductible
Plan pays 70% after deductible
Routine Preventive Care
No charge
Plan pays 70% after deductible
Inpatient Hospital Facility Services, Physician’s Visits/Consultations, Professional Services
Plan pays 80% after deductible
$300 per admit , then plan pays 70% after deductible
Outpatient Facility Services, Professional Services
Plan pays 80% after deductible
Plan pays 70% after deductible
Hospital Emergency Room
Plan pays 80% after deductible
Slide1010
Slide11Prescription Benefit Changes
Step Therapy-
Require prior authorization and will be subject to step therapy
Brand name only cholesterol-lowering agents (statins)
Advicor, Altoprev, Crestor,
Lescol
XL,
Livalo, Simcor, VytorinBrand name only COX-2 NSAID (Celebrex)Brand name only Anti-Migraine Medication (Triptans)Axert,
Relpax
,
Frova, Sumavel, TreximetSelect brand name only Fibromyalgia Agents (Lyrica)
Brand name only ACE Inhibitors & ACE Inhibitor
Anit
-Hypertensive Agents
Diovan
,
Edarbi
, Benicar,
Tekturna
11
Slide12Prescription Benefit Changes
Coverage Change
OTC Proton Pump Inhibitor-Nexium
24HR will be covered, Brand-name Rx
Nexium
will not be covered Brand name only drugs with therapeutic generic equivalentsWill exclude coverage for brand name drugs with therapeutic generic equivalents
Adoxa
,
Doryx, Monodox, Oracea, Arestin, Dynacin, Solodyn, Moxatag, Duexis,
Vimovo
Andogel
, Testim, Fortesta, Axiron, Androderm, Striant
12
Slide13Prescription Benefit Changes
Additions to Non-Preferred Formulary Tiers- 3
rd tier copays apply
Azor
, Coreg CR, Crestor,
Janumet, Januvia, Lovanza, Modafinil, Pexeva
,
Pristiq
, Provigil, Patanase, Pataday, VilibrydSpecialty Medication Coverage- Prior authorization required and copayment changeMember share will be 10% of total prescription cost up to maximum of $200 per prescriptionExamples: Simponi
,
Avonex
, Stelara, Orencia, Humira, Enbrel, Cimzia13
Slide1414
K
e
y
Benefit
Piedmont/Wellstar HMO
In-Network
Li
f
etime
Maximum
Unlimi
t
ed
Deductible
Coinsurance
$750 per person
$2,250 per
family
80% plan / 20% member
Maximum
Annual
Out-of-
P
oc
k
et
Limit
$6,600 per person
$13,200 per family
Out of Pocket Maximum includes deductible, coinsurance and all copays – Office Visit, Urgent Care, Emergency Room and Prescriptions
Office Visits
Primary Care Physician
Specialty Care Physician
Urgent Care
Facilities
$
25
$40
$100
Routine Preventive Care
No Charge
Inpatient Hospital Facility Services, Physician’s Visits/Consultations, Professional Services
Plan pays 80% after deductible
Outpatient Facility Services, Professional Services
Plan pays 80% after deductible
Hospital Emergency Room
$200
Prescription Drugs
Rx Deductible
Tier 1
Tier 2
Tier 3
Tier 4
Mail Order- 90 day supply
None
$10
$40
$65
10% to $200 max
2.5 x copay
Slide1515
Slide1616
City of Marietta Employee Medical Center:
Location
268 Lawrence Street, Marietta, GA
30060
Hours of Operation
Mondays: 8 am – 5 pm
Tuesdays: 7 am- 1pm
Wednesdays: 8 am – 2pm
Thursdays: 8 am – 2 pm
Fridays: 8 am – 1pm
Saturday: 8 am – 12 pm
Available Services
Primary
, urgent and preventive care
Laboratory testing
Flu shots
Treatment for chronic health conditions
Medications
What are the benefits to you?
No more long stays in the waiting room
No out of pocket expense
Increased convenience and access
More one-on-one time with the doctor
Slide17Dental Coverage
Will remain with BCBSGA
No change to plan design
PPO plan option allows you to see any dentist. However, you can see less out of pocket expense if you stay in the BCBSGA dental network.
Locate participating providers at bcbsga.com
17
BCBS Dental
In-n
et
w
ork
Ou
t
-o
f
-n
et
w
ork
Annual
maximum
$
1
,
000
per
pe
r
so
n
Dedu
c
tible
(
Single/
F
amil
y
)
$
25/
$
75
$
25/
$
75
Diagno
s
tic
/
p
r
e
v
e
n
ti
v
e servi
c
es*
100%
100%
Basic
benefit
servi
c
es
80%
80%
Major
benefit
servi
c
es
50%
50%
Slide18Flexible Spending Accounts
Two separate accounts- Medical Spending Account and Dependent Care Spending Account
Allows you to set aside pre-tax dollars to spend on qualified expenses, saving on your taxable income
Must make new elections for 2015-See Colonial rep
18
Slide19Flexible Spending Accounts
Medical Spending Account
Maximum contribution of $2,500
Some eligible expenses- Deductibles, copayments, dental expense, vision services and materials
Dependent Care Spending Account
$5,000 for married couple filing joint income tax returns, $2,500 if unmarried or married and filing separate income taxes
Some eligible expenses- any care of a dependent that allows you and your spouse to work: day care, after school program, in-home care,
camps
Use funds by end of plan year or lose remaining amounts19
Slide20Basic Life and AD&D
City of Marietta provides basic life and AD&D benefit at no cost to you
Provided through MetLife
City Council Employees: $150,000
Closed Group of Public Safety Employees: $40,000
All Other Employees: 3 x your annual earnings, maximum $180,000
20
Slide21Optional Life Insurance
Purchase coverage for yourself in increments of 1 x your annual earnings up to a max of 4 x earnings or $420,000
Elect coverage for your spouse in increments of $10,000 up to $100,000
Coverage for your children of $5,000 or $10,000
Includes Will Preparation Service and Legal services through Hyatt Legal
If you have declined this coverage in the past and wish to add coverage during this open enrollment, you must complete an evidence of insurability form and be approved for all amounts of coverage
21
Slide22Long Term Disability Coverage
Pays a benefit after you are disabled for 180 days
Covers 50% of your earnings up to a maximum of $5,300 per month.
Continues to pay until you can return to work or reach SSNRA
Elect coverage with Colonial representative Nov 3-7
If you have declined this coverage in the past and wish to add at this time, you must complete an evidence of insurability form and be approved for coverage
22
Slide23Optional Vision Coverage
Coverage for 2015 provided through
Avesis
You may receive an exam and new lenses every 12 months, new frames every 24 months
23
Avesis
V
ision
In-n
et
w
ork
Ou
t
-o
f
-n
et
w
ork
r
eimburseme
n
t
E
x
am
$
10
c
op
a
y
$35
Standard
lens
$25
c
op
a
y
$25 single, $40 bifocal, $50 trifocal
F
r
ames
$
50 wholesale
all
o
w
an
c
e
$
45
C
o
n
ta
c
t
lenses
$
130
all
o
w
an
c
e
$
130
Medically ne
c
e
s
sary
c
o
n
ta
c
t lenses
P
aid
in
full
$250
Laser vision correction
$150 one time
$
150 one time
Slide24Colonial Benefit Options
Disability Insurance
Accident Insurance
Cancer Insurance
Critical Illness Insurance
Life Insurance
24
Slide25MetLaw
Telephone and Office Consultations
Legal Representation
Estate Planning-Wills, Powers of Attorney
Financial Matters-Bankruptcy, Foreclosure, Tax Collection
Real Estate Matters-Sale, Purchase, or Refinance, Eviction, ZoningElder Law Matters- Medicare, Deeds, Wills, Nursing Home Agreements
Family Law- Adoption, Guardianship, Prenuptial Agreement
Traffic Offenses- excludes DUI
Document Preparation- Deeds, Mortgages, Affidavits25
Slide26Employee Assistance Program
Provided through
LifeWorksAssistance with questions regarding handling stress, relationships, challenges at work, parenting, caring for an older relative, or health issues.
Available 365 days a year
Provided at no cost to you
26
Slide27Questions?
27