2015 annual enrollment · 2016. 3. 29. · 2015 annual enrollment!! this year, members are required...

2015 Annual Enrollment Retirees with Medicare

2015 Annual Enrollment WHAT HAS NOT CHANGED: •  Plan Offerings – PPO and HMO plans still offered •  Provider Network – Blue Cross and Vantage National Networks WHAT HAS CHANGED: •  Plan Names •  Some Cost Share •  Enrollment and Change Timelines •  Default Plan for Retirees •  Enrollment Guides and Books •  Retirees on or after 3/1/2015 •  Retirees before 3/1/2015

Retiree Plans

•  Retirees on or after 3/1/2015 •  same benefits as Actives

•  Retirees before 3/1/2015 •  deductible and out of pocket maximum

same as 2014

2015 Annual Enrollment

This year, members are required to make a selection during the annual enrollment period. If your have Medicare as primary coverage, have OGB as secondary coverage, and do not make a selection by the end of the enrollment period, you will still retain your Medicare coverage and will be automatically enrolled in the benefit option most comparable to the plan you have now. The following Chart shows the benefit options for 2015 that are comparable to current OGB plans. **LSU First plan members who do not make a selection will remain in their current LSU First plan.

IMPORTANT

Comparable 2015 OGB Benefit Options 2015 Benefit Options: Comparable To: Pelican HRA 1000 None

Magnolia Local HMO, but only in limited areas

Magnolia Local Plus HMO

Magnolia Open Access PPO

Vantage Medical Home HMO Vantage Medical Home HMO

People’s Health HMO-POS People’s Health HMO-POS

Vantage HMO-POS Vantage HMO-POS

Vantage Zero-Premium HMO Vantage Zero-Premium HMO

One Exchange Extend Health

Key Changes for 2015 o All retirees with Medicare who are enrolled in an

OGB plan for 2014 as a secondary plan MUST select a secondary benefit option for 2015 or they will remain in the plan within the benefit option most comparable to their current selection

o All new plan offerings o New ways to enroll o No opportunity to make changes until next year’s

annual enrollment period (except for a qualifying event)

Timeline

TIMELINE Oct 1 Annual Enrollment Begins Oct 15 Medicare Advantage Enrollment Begins Dec 7 Annual Enrollment Ends

Medicare Advantage Enrollment Ends Jan 1 2015 plan year begins (Effective Date for all Vantage and Medicare

Advantage Benefit Options) Mar 1 New Health Plans Implemented (Effective Date for all other Benefit

Options)

Note: While the new plan year will begin on Jan. 1, the new benefit op8ons for the Blue Cross op8ons will not take effect un8l March 1. From Jan. 1 through Feb. 28 your current plan benefits will be applied.

Your Responsibilities

DURING ANNUAL ENROLLMENT, YOU MAY: o Enroll in a health plan o Drop or add dependents o Discontinue OGB coverage

Please note that in many cases, if you choose to cancel your OGB coverage, you cannot get it back.

YOUR RESPONSIBILITIES

Medicare Advantage Enrollment What’s the difference?

o  Every year, retirees have the opportunity to change benefit options during annual enrollment. Also during this time, retirees with both Medicare Part A and Part B can choose to transfer to a Medicare Advantage benefit option or choose an OGB secondary benefit option. Both enrollments take place once a year with coverage beginning in January for Vantage and Medicare Advantage, and this year in March for OGB secondary benefit options.

o  Medicare holds an open enrollment each year as well. This year, the

Medicare open enrollment period begins October 15 and ends December 7.

o  If you are selecting an OGB benefit option as secondary coverage, you

must make your selection by December 7. If you are selecting a Medicare Advantage benefit option through OGB we encourage you to make your selection by December 7 to ensure accurate and timely deductions from your retirement check.

Frequently Asked Questions

•  Why is OGB extending annual enrollment? •  We take the concerns of our enrollees seriously. By shifting the enrollment

timeline, we allow more time for enrollees to get accurate information and make the right plan choice.

•  What is the new deadline to select a plan? •  Annual enrollment will run from October 1 through December 7, 2014, giving you

two full months to review all the materials available, attend informational meetings and make an informed decision about your health coverage.

•  Will the new plan year still start on January 1, 2015? •  Yes, but the health plan changes won’t be implemented until March 1, with the

exception of Medicare Advantage plans and health plans through Vantage. •  You don’t have to do anything to keep that coverage until Feb. 28. Most

members will remain in their current plan until March 1, unless they choose to make a change. However, members who wish to remain in or select a Vantage plan must make their selection effective January 1.

•  If you are enrolled in a flexible spending account that allows you to set money aside before taxes to pay for qualified expenses, you are required to re-enroll each year. Those elections will go into effect January 1, as required by law.

•  If I don’t select one of the new plans by the end of the enrollment period will I still be enrolled into the Pelican HRA 1000 plan?

•  No, if you are a retiree. Retirees who are enrolled in an OGB plan option, either as primary or secondary coverage, will remain in the plan within the benefit option most comparable to their current selection if no action is taken by the end of the annual enrollment period.

Frequently Asked Questions • Why do the benefit options have new names?

•  As OGB added more benefit offerings of the same plan type (multiple HMO options, multiple CDHPs), it became confusing to name them the way we did in the past (HMO, PPO, CDHP). This year we categorized them and offered more details about benefit option specifics in the name. For example, the Pelican HRA 1000 offers a $1000 employer contribution into a health reimbursement account.

•  Which benefit option is most like my current OGB plan?

•  It’s important that you take the time to review each of the 2015 offerings to ensure you are selecting the coverage for your circumstances.

2015 Benefit Option: Comparable To: Pelican HRA 1000 None Pelican HSA 775 CDHP Magnolia Local None Magnolia Local Plus HMO Magnolia Open Access PPO Vantage Medical Home HMO Vantage Medical Home HMO

•  Will BCBS be the administrator for all Pelican and Magnolia plans?

•  Yes •  What benefit options are available to Retirees with Medicare?

•  As a retiree with Medicare as your primary insurance, you have several options: •  First, you can enroll in an OGB benefit option as a secondary plan. •  Second, you can enroll in a Medicare Advantage plan.

Frequently Asked Questions •  What’s the difference between a co-‐pay and co-‐insurance?

•  A co-‐pay is a flat fee billed by providers for a specific service. Coinsurance, however, is a percentage of the contractually allowed cost of a specific service.

•  Will my deduc:ble and out-‐of-‐pocket max start over in January? •  Yes. January begins a new plan year and your deduc8ble and out-‐of-‐pocket max will be reset.

•  Will they start over again in March? •  No. You will get credit for out-‐of-‐pocket payments made in January and February. If you meet your

deduc8ble or out-‐of-‐pocket max before March 1 and begin paying co-‐insurance, you may have to meet a new threshold beginning March 1 when new deduc8bles and new out-‐of-‐pocket maximums take effect. However, your deduc8ble and out-‐of-‐pocket maximum will be credited with the money you paid between January 1 and February 28.

•  What is the difference between in-‐network and out-‐of-‐network? •  In-‐network providers have a contract with the vendor and agree to certain payable amount for

eligible expenses. Out-‐of-‐network providers do not have a contract with the vendor and the member may have to pay the difference between the allowable and actual billed amount.

• What is balance billing? •  Balance billing is the difference between the provider’s charge and the allowed amount. For

example, if the provider’s charge is $100 and the allowed amount is $70, an out-‐of-‐network provider may bill you for the remaining $30. A contracted provider may not balance bill you above the allowable amount.

•  What plans cover those who no longer live in Louisiana? •  The Pelican plans, the Magnolia Open Access or the Magnolia Local Plus plans all use the Blue Cross

na8onwide network and would be appropriate for out-‐of-‐state members. •  Vantage also offers na8onwide coverage through its Tier II Network. Tier II Providers are covered as

Tier I for members living out-‐of-‐state.

Frequently Asked Questions •  What if my doctor doesn’t take Medicare?

•  If you have Medicare as your primary insurance, and your doctor does not take Medicare, you have two options:

•  Choose a new doctor who takes Medicare •  Pay a non-Medicare doctor, take the claim/bill and file with Medicare and BCBS concurrently.

•  Will I still be able to see my doctor under the new benefit options? •  If you choose one of the Pelican benefit options, the Magnolia Local Plus, or Open Access benefit options

you will have access to the Preferred Care network in Louisiana and the BCBS nationwide provider network. •  The Magnolia Local benefit option is a narrow network option that offers a limited group of providers in

exchange for a lower premium. This network is available only in certain areas. •  If you choose the Vantage Medical Home option you will have access to Vantage’s Tier II nationwide

provider network. •  Please visit annualenrollment.groupbenefits.org for links to the vendor provider directories. When searching

the BCBS Louisiana network for these benefit options, please select the “OGB Preferred Care” in the drop down menu. When looking for a national provider, such as MD Anderson, select the “BlueCard PPO/EPO Basic” in the drop down menu or enter “OGS” in the member ID field.

•  To view the Vantage Medical Home network, simply go to www.VHP-StateGroup.com and select “OGB Medical Home”, click on “Find a Physician” and search by name, location, or specialty. Links to the Affinity Health Network, Verity Health Network (if applicable) and the Tier II Network can also be located through the “Find a Physician” webpage.

•  Am I covered if I travel out of the country? •  Emergency room visit and ER physician services for life and limb threatening emergencies, as defined by

state law, received outside of the United States are covered at the network benefit level. For non-emergency services received outside of the United States please contact Blue Cross Blue Shield for coverage details.

2015 Plan Options

Retiree Benefit Options OGB retirees with Medicare have several options available to them. Retirees who have Medicare Part A and Part B coverage can select from three OGB sponsored Medicare Advantage plans:

•  the Peoples Health HMO-POS; •  the Vantage HMO-POS; •  and the Vantage Zero-Premium HMO-POS.

They can also choose a Medicare Advantage plan through OneExchange (formerly Extend Health) and be enrolled in a health reimbursement arrangement (HRA) receiving HRA credits of $200 or $300 per month.

Retiree Plans

Sample Medicare

Advantage Plans via OneExchange

Sample Medicare

Advantage Plan via

Vantage HMO-POS

Sample Medicare

Advantage Plan via Vantage Zero-Premium HMO-

POS

Sample Medicare

Advantage Plan via Peoples

Health HMO-POS

Zero Dollar Premium Plan Available ü ü

Employer contribution to HRA ü Disease management program ü ü ü ü

Wellness program ü ü ü ü

Emergency coverage ü ü ü ü

Important! If you choose a Medicare Advantage plan, you will retain the option to return to an OGB sponsored benefit option during the next annual enrollment period.

Individual Medicare Advantage Plans via OneExchange

OneExchange offers the broadest range of individual Medicare coverage options for post-65 retirees with well known insurance carriers. Additionally, retirees will also be enrolled in a health reimbursement arrangement (HRA) receiving HRA credits of $200 or $300 per month.

Individual Medicare Advantage Plans via OneExchange

BENEFITS – PARTICIPANT COST

MEDICARE ADVANTAGE OPTION IN

BATON ROUGE

MEDICARE ADVANTAGE

OPTION IN NEW ORLEANS

MEDICARE ADVANTAGE OPTION IN

BOSSIER CITY

COMBINED PLAN N & PDP (MALE

AGED 75)

COMBINED PLAN F & PDP (MALE

AGED 75)

PREMIUM $0 $0 $0 $202 $264

NETWORK

HMO

HMO

HMO

Any Doctor who accepts Medicare

Any Doctor who accepts Medicare

DEDUCTIBLE $0 $0 $250 $147 $0 (plan pays 100%)

OFFICE VISIT - PRIMARY CARE /

SPECIALIST $0/$0 - $25 $0/$20 $7/$50 $0 $0 (plan pays

100%)

EMERGENCY ROOM $65 Waived if admitted

$65 Waived if admitted

$65 Waived if admitted $50 $0

HOSPITAL $25 co-pay per day for first five days, then $0

$50 co-pay per day for first five days, then $0

$335 co-pay per day for first five days, then $0

$0 (plan pays 100%) $0 (plan pays 100%)

RX $0/$10/$35/$80/ 33%

$0/$3/$35/$55/ 33%

$3/$10/$45/$95/ 25% $200 ded (on

Tier 4 & 5) $2/$6/$40/$85/

33% $2/$6/$40/$85/

33%

The table below is a sampling of available plans.

Medicare Advantage Plan through Peoples Health The Peoples Health Medicare Advantage plan offers much more than Medicare, with extra benefits like vision and dental coverage, free health club membership and prescription drug coverage. As a Peoples Health Medicare Advantage member, retirees pay a premium in addition to paying their Medicare Part B premium; retirees receive 100 percent coverage for many services with NO Medicare deductibles.

Medicare Advantage Plan through Peoples Health

COVERED BENEFIT PEOPLES HEALTH HMO-POS MONTHLY PREMIUM (EMPLOYEE SHARE)Retiree with 1 Medicare $60.50

MONTHLY PREMIUM (EMPLOYEE SHARE)Retiree with 2 Medicare $121.00

PLAN YEAR DEDUCTIBLE $0 MAXIMUM OUT-OF-POCKET EXPENSE (IN-NETWORK) $2,500

MAXIMUM OUT-OF-POCKET EXPENSE (OUT-OF-NETWORK) 20%

OFFICE VISIT - PRIMARY CARE / SPECIALIST $5 / $10 co-pay per visit EMERGENCY ROOM $50 ER co-pay per visit

INPATIENT HOSPITAL $50 per day (days 1-10) PRESCRIPTION DRUGS (PART D)

Preferred Generics · $0 co-pay Non-Preferred Generics · $0 co-pay

Preferred Brand · $20 co-pay (30-day supply) Non-Preferred Brand · $40 co-pay (30-day supply)

Specialty · 20%

Medicare Advantage Plans through Vantage Health Plan For retirees who are 65 and over, Vantage offers several great Medicare Advantage plans as an alternative to Medicare. One benefit to Vantage’s Medicare Advantage plans is that a network of providers is already contracted with the plan throughout Louisiana. These physicians, hospitals and specialty medical facilities have already agreed to provide health care services to treat Medicare Advantage members.

Medicare Advantage Plans through Vantage Health Plan

COVERED BENEFIT VANTAGE POS PLAN (HMO-POS) NO MEDICAL

DEDUCTIBLE

VANTAGE ZERO-PREMIUM HMO-POS

MONTHLY PREMIUM (EMPLOYEE SHARE) Retiree with 1 Medicare

$48.75 $0

MONTHLY PREMIUM (EMPLOYEE SHARE) Retiree with 2 Medicare

$97.50 $0

PLAN YEAR DEDUCTIBLE N/A N/A MAXIMUM OUT-OF-POCKET

EXPENSE $3,000 $6,700

OFFICE VISIT PRIMARY CARE / SPECIALIST

$10 / $40 co-pay per visit $15 / $50 co-pay per visit

EMERGENCY ROOM $65 ER co-pay per visit - worldwide coverage

$65 ER co-pay per visit - worldwide coverage

INPATIENT HOSPITAL $300/day for days 1-5 $345/day for days 1-5

PRESCRIPTION DRUGS (PART D) •  Tier 1 – Preferred Generics •  Tier 2 – Non-Preferred

Generics •  Tier 3 – Preferred Brand •  Tier 4 – Non-Preferred Brand •  Tier 5 – Specialty

· $3 co-pay · $8 co-pay · $45 co-pay · $95 co-pay · 33% coinsurance

· $3 co-pay · $8 co-pay · $45 co-pay · $95 co-pay · 33% coinsurance

Medicare and Medicare Advantage Frequently Asked Questions •  I am still actively employed but my spouse is retired and on Medicare. Who is primary on my spouse?

•  OGB is primary as long as you are actively employed. •  Are all doctors in Medicare plans?

•  No. You can visit www.cms.gov to see which doctors accept Medicare. •  What is a $0 premium plan?

•  A zero dollar premium plan does not require you to pay monthly to stay enrolled in the plan.

•  Do I still have to pay a Medicare Part B premium? •  Yes. To qualify for a Medigap or Medicare Advantage plan, beneficiaries must be

enrolled in and continue to pay for Medicare Part B. •  How does OGB pay secondary to Medicare?

•  Depending on the benefit option you enroll in with OGB, your secondary benefits will apply after Medicare has paid. Refer to our comparison chart for specific secondary benefits.

Medicare and Medicare Advantage Frequently Asked Questions •  Who is OneExchange?

•  OneExchange is a broker that offers members access to individual Medicare Advantage and supplemental plans from multiple carriers and are available to council retirees to select the best plan for them. Members will also be enrolled in a health reimbursement arrangement (HRA) receiving HRA credits of $200 to $300 per month from the state.

•  Do they provide prescription drug coverage? •  The plans they offer may or may not have a drug component – it will depend on

the individual plan. You are encouraged to speak with a OneExchange Benefit Advisor for more detailed benefit information, 1-855-663-4228.

•  Can I come back to OGB if I go to OneExchange? •  Yes, during the annual enrollment each year.

•  Will I lose or “replace” my Medicare? •  You will not lose Medicare, but it may work differently depending on the type of

plan you choose. Medicare Advantage plans are administered by private insurance companies that are part of the Medicare program. If you enroll in a Medicare Advantage plan it will cover all of your Medicare benefits. You must have Medicare Part A & Part B in order to enroll in a Medicare Advantage plan.

Medicare and Medicare Advantage Frequently Asked Questions •  Are the Medicare Advantage plans offered by Vantage Health Plan and Peoples Health available statewide?

•  Yes. Both vendors offer plans in regions across the state. Please contact the vendor for more information on what plan is available in your area.

•  What Medicare Advantage plans are available to enrollees who no longer live in Louisiana?

•  OneExchange has a broad network of plans available all over the country. Please contact them at 1-855-663-4228.

•  Is there a “donut hole” in Medicare Advantage? •  The Peoples Heath Medicare Advantage and the Vantage POS Plan (HMO-POS) do

not have “donut holes”. But Vantage’s Zero-Premium HMO-POS plan and other Medicare Advantage plans may have a “donut hole”.

•  How does Medicare’s Extra Help Program help me? •  Medicare’s Extra Help Program, also known as the low-income subsidy (LIS), provides

financial assistance to people who have limited assets, income and resources to help pay for prescription drug costs. Members who receive extra help pay limited costs for drugs covered by their Peoples Health plan.

•  How can I apply for Medicare’s Extra Help program? •  You can fill out an electronic application for extra help online at https://secure.ssa.gov/

i1020/start. If you would like assistance completing your application, you may call the Social Security Administration at 1-800-772-1213.

OGB Secondary Plans Retirees can also select from five OGB benefit options during annual enrollment:

•  Pelican HRA 1000 •  Magnolia Local Plus •  Magnolia Local •  Magnolia Open Access •  Vantage Medical Home HMO plan

These benefit options will be secondary to Medicare.

OGB Secondary Benefit Options

Pelican HRA 1000

Magnolia Local

Magnolia Local Plus

Magnolia Open

Access

Vantage Medical Home

HMO

Employer contribution to HRA or HSA ü

Out-of-network coverage ü ü ü

Wellness program ü ü ü ü ü Wellness visits covered 100% ü ü ü ü ü

Emergency coverage ü ü ü ü ü

Routine vision coverage ü

Routine dental coverage ü

Pelican HRA 1000 The Pelican HRA 1000 includes employer contributions in a health-reimbursement arrangement that can be used to offset deductible and other out-of-pocket medical expenses throughout the year. Any unused funds roll up to the in-network, out-of-pocket maximum, allowing members to build up balances that cover eligible medical expenses. (Prescription drugs are not reimbursable by the HRA.) The Pelican HRA 1000 offers coverage within the Blue Cross nationwide network, as well as out-of-network coverage.

Pelican HRA 1000

Medical Coverage Employee

-Only Employee + Spouse

Employee + Children Family

Monthly Premiums (employee

share) Retiree with 1 Medicare $59.61 $220.23 $103.21 $293.42

Monthly Premiums (employee share)Retiree with 2 Medicare

$107.15 $132.66

Employer Contribution to HRA $1,000 $2,000 $2,000 $2,000

Deductible (in-network) $2,000 $4,000 $4,000 $4,000

Deductible (out-of-network) $4,000 $8,000 $8,000 $8,000

Out-of-pocket max (in-network) $5,000 $10,000 $10,000 $10,000 Out-of-pocket max (out-of-network) $10,000 $20,000 $20,000 $20,000

Coinsurance (in-network) 20% 20% 20% 20%

Coinsurance (out-of-network) 40% 40% 40% 40%

Prescription Coverage Tier Member

Responsibility Generic 50% up to $30

Preferred 50% up to $55

Non-Preferred 65% up to $80

Specialty 50% up to $80

Once you pay $1,500:

Generic $0 co-pay

Preferred $20 co-pay

Non-Preferred $40 co-pay

Specialty $40 co-pay

Benefits effective March 1, 2015

Pelican HRA 1000 Frequently Asked Ques:ons • How does an HRA work?

•  A Health Reimbursement Arrangement, or HRA, is an account that employers use to reimburse employees' healthcare expenses, such as deductibles, medical co-pays and eligible medical costs.

• Does it rollover every year? •  Yes. Unused funds will rollover until you reach your in-network out-of-pocket

maximum. So for example, if you are on an employee-only plan, your unused funds will rollover until you reach $5,000.

• How do I use the money? •  Under the Pelican HRA 1000, the HRA pays up to 100% of the covered medical

expenses up to the $1,000(employee) or $2,000 (family) contribution. • What does it mean "prescription drugs are not reimbursable by the Pelican HRA"?

•  HRA only covers eligible medical expenses. Prescription drugs would be an out-of-pocket expense which would apply to the out-of-pocket maximum.

•  For the Pelican HRA 1000 plan, will you have to pay a bill or receive a bill for every time you utilize the insurance except for wellness?

•  Your provider will submit the claim to BCBS for you. •  Once you satisfy the deductible and reach the out-of-pocket maximum then what amount will the plan pay?

•  100% until the end of the calendar year for in-network care. Members can be balance billed for out-of-network charges.

Magnolia Benefit Options Magnolia benefit options offer lower deductibles than the Pelican options in exchange for higher premiums. The Magnolia Local and Local Plus are traditional plans that offers $25 primary care co-pays (excluding wellness visits) and $50 specialty care co-pays. The Magnolia Open Access Plan differs from the other Magnolia options in that members enrolled in the open access plan will not pay co-payments at physician visits. Instead, once an enrollee’s deductible is met, he or she will pay 20% of Medicare co-insurance for in-network and out-of-network care.

Magnolia Local Plus

The Magnolia Local Plus benefit option offers the same coverage as the Magnolia Local option, with the additional benefit of a nationwide network. The Local Plus option is ideal for enrollees who prefer the predictability of co-payments rather than using employer funding to offset out-of-pocket costs. This benefit option provides care in the Blue Cross nationwide network. Out-of-network coverage is provided in emergencies.

Magnolia Local Plus – Retirees on or after 3/1/15

Medical Coverage Employee-

Only Employee +

Spouse Employee + Child(ren) Family

Monthly Premiums (employee share) Retiree with 1 Medicare $86.63 $316.60 $149.02 $421.41

Monthly Premiums (employee share) Retiree with 2 Medicare $155.27 $192.26

Employee Only Employee +1 Employee

+2/Family Employer Contribution to HRA/HSA $0 $0 $0

Deductible (in-network) $400 $800 $1,200

Deductible (out-of-network) No coverage No coverage No coverage

Out-of-pocket max (in-network) $2,500 $5,000 $7,500

Out-of-pocket max (out-of-network) No coverage No coverage No coverage

Co-Payment (in-network) $25 / $50 $25 / $50 $25/$50

Co-Payment (out-of-network) No coverage No coverage No coverage

Prescription Coverage

Tier Member Responsibility

Generic 50% up to $30





Generic $0 co-pay





Magnolia Local Plus - Retirees before 3/1/15 Medical Coverage

Employee-Only

Employee + Spouse

Employee + Child(ren) Family

Monthly Premiums (employee share) Retiree with 1 Medicare $86.63 $316.60 $149.02 $421.41

Monthly Premiums (employee share) Retiree with 2 Medicare $155.27 $192.26


+2/Family

Employer Contribution to HRA/HSA $0 $0 $0

Deductible (in-network) $0 $0 $0













Generic $0 co-pay





Magnolia Local Plus Frequently Asked Questions •  Can I enroll in the Magnolia Local Plus benefit option if I do not live in Louisiana?

•  Yes. OGB’s benefit options offer Blue Cross’s nationwide network, making it easy to stay in-network for your care.

•  What’s the difference between this option and the old HMO? •  Some of the main cost differences are noted in the table below. Of

course, please review the benefit comparison sheet at www.groupbenefits.org

HMO Plan = Magnolia Local Plus July 1, 2014 March 1, 2015

Primary care co-‐pay = $15 Specialty care co-‐pay = $25

Primary care co-‐pay = $25 Specialty care co-‐pay = $50

ER co-‐pay = $100 ER co-‐pay = $150

Out-‐of-‐network coverage available No out-‐of-‐network coverage available (Last year, 98.7% of providers were covered in-‐network)

Magnolia Local Plus Frequently Asked Questions •  Will the Magnolia Local Plus benefit option cover out-of-state specialists?

•  If the out-of-state specialist is contracted with BCBS, eligible charges will be covered.

•  Can I keep my current physician on one of the Magnolia plans because it is "similar" to the current HMO plan?

•  Providers should remain the same. Please check the provider list on the BCBSLA website or contact BCBS customer service to verify.

•  What is subject to the deductible? •  Any service that is not subject to a co-pay. Types of services that are subject to

the deductible include, but are not limited to, chemotherapy, dialysis and durable medical equipment.

•  Will we have to pay the deductible before we pay only co-pays? •  No. If your benefit option has a co-pay amount for a service such as $25 for a

PCP office visit, then the deductible does not apply and you will pay the specified $25 co-pay for that covered service.

•  If your benefit option does not cover out-of-network, does that mean my expense to me will be unlimited?

•  If you choose to use a doctor, hospital, or service that is out-of-network, you will pay an unlimited amount out-of-pocket. If you don’t know if your medical team is a part of the Blue Cross network, look in the provider directory on the BCBS website, or call Blue Cross directly, or ask your medical professional. Note: Ask your Medical Professionals if they are in the Preferred Care network in Louisiana or the nationwide BlueCard PPO network.

Magnolia Local This benefit option is ideal for enrollees who live in the parishes within the available networks and don’t plan to utilize out-of-network care. However, out-of-network coverage is provided in emergencies.

•  Community Blue Community Blue is a select, local network designed for enrollees who live in the Baton Rouge (East & West Baton Rouge and Ascension Parishes) and Shreveport communities (Caddo and Bossier Parishes).

•  BlueConnect BlueConnect is a select, local network designed for enrollees who live in the New Orleans community (Orleans and Jefferson Parishes).

Magnolia Local - Retirees on or after 3/1/15 Medical Coverage

Employee-Only

Employee + Spouse


Monthly Premiums (employee share)Retiree with 1 Medicare $80.85 $298.75 $139.96 $398.07

Monthly Premiums (employee share)Retiree with 2 Medicare $145.34 $179.97


+2/Family


Deductible (in-network) $400 $800 $1,200













Generic $0 co-pay





Magnolia Local - Retirees before 3/1/15 Medical Coverage

Employee-Only

Employee +Spouse





+2/Family Employer Contribution to HRA/HSA $0 $0 $0














Generic $0 co-pay





Magnolia Local Frequently Asked Questions •  What is a narrow network?

•  A narrow network means your coverage extends to a limited group of providers. The Magnolia Local benefit plan offers three networks, depending on where you live.

•  What if I want to join the plan but don’t live in an approved parish? •  Only enrollees who reside in the parishes designated can enroll in the Magnolia Local plan. That’s to protect

you from having to use out-of-network services. •  Which parishes are covered?

•  Community Blue East & West Baton Rouge, Ascension, Caddo and Bossier Parishes

•  BlueConnect Orleans and Jefferson Parishes

•  What hospitals are covered under this narrow network? •  Baton Rouge General Medical Center •  Christus Schumpert Highland Hospital & Christus Schumpert Health System in Shreveport •  Ochsner Medical Center in New Orleans

•  What happens if I sign up for the Magnolia Local benefit option with Community Blue and move out of the coverage area, can I select another benefit option?

•  Depending on the location, this would be considered an I.R.S.-recognized qualifying event. You would need to contact OGB and provide documentation of proof of residency.

•  What does it mean when there is no out-of-network coverage available? •  There is no coverage for out-of-network providers who are not contracted with your plan vendor to provide

services at a specific contracted rate.

Magnolia Local Frequently Asked Questions •  For Magnolia plans is the deductible for both medical coverage and prescription coverage?

•  No. The deductible applies to the medical charges only. There is no separate prescription drug deductible. The prescription drug plan does have an out-of-pocket limit that you have to reach before you receive reduced co-pays.

•  What is the out-of network coverage for emergencies with the Magnolia Local and Local Plus plans? •  A medical emergency is defined as “a life or limb threatening condition.” Life and Limb emergencies

are covered at the network benefit level.

•  Are x-rays and lab work covered under my co-pay? •  For the Magnolia Local and Magnolia Local Plus plans, the plan will pay 100% of the allowed

amount for low tech imaging and lab claims when performed at an in-network physician's office, free standing independent diagnostic testing facility or a contracted reference lab.

•  The plan will apply the deductible and/or co-insurance, based on the allowed amount, for low tech imaging and lab claims performed in a hospital based lab.

•  Once you satisfy the deductible and reach the out-of-pocket max, what amount will the plan pay?

•  100% until the end of the calendar year for in-network care. Members can be balance billed for out-of-network charges. Remember the deductible is counted toward your out-of-pocket maximum.

Magnolia Open Access The Magnolia Open Access Benefit Option offers coverage both inside and outside of Blue Cross’s nationwide network. It differs from the other Magnolia options in that members enrolled in the open access benefit option will not pay co-payments at physician visits. Instead, once a member’s deductible is met, he or she will pay 20% of the overall bill for in-network care and out-of-network care, subject to copayments/coinsurance, if Medicare deductibles have not been met. Though the premiums for the open access benefit option are higher than OGB’s other options, its moderate deductibles combined with a nationwide network make it an attractive plan for enrollees who live out of state or travel regularly.

Magnolia Open Access – Retirees on or after 3/1/15 Medical Coverage

Employee-Only

Employee + Spouse




Employee Only Employee + 1 Employee

+2/Family


Deductible (in-network) $900 $1,800 $2,700 Deductible (out-of-network) $900 $1,800 $2,700 Out-of-pocket max (in-network) $2,500 $5,000 $7,500

Out-of-pocket max (out-of-network) $3,700 $7,500 $11,250

Coinsurance (in / out network) 20% 20% 20%








Generic $0 co-pay





Magnolia Open Access – Retirees before 3/1/15 Medical Coverage

Employee-Only

Employee + 1 (Spouse or Child)




Employee Only Employee + 1 Employee

+2/Family



Out-of-pocket max (in-network) $2,300 per person up to 3 people + $2,000 per additional, up to $12,700

Coinsurance (in/out network) 20% 20% 20%








Generic $0 co-pay





Magnolia Open Access Frequently Asked Questions •  Is this option the same as the current PPO plan?

PPO Plan = Magnolia Open Access July 1, 2014 March 1, 2015 Deduc8ble = $300 (EE only re8rees) Deduc8ble = $300 (before 3/1/15)

Deduc8ble = $900 ( on or ader 3/1/15) Out-‐of-‐pocket max = $2,300 per person up to 3 people + $2,000 per addi8onal, up to $12,700

$2,300 per person up to 3 people + $2,000 per addi8onal, up to $12,700 (before 3/1/15) $2500 (on or ader 3/1/15)

•  Is the Magnolia Open Access option the best for someone living outside the state of Louisiana? •  It depends on your needs. The Magnolia Open Access and Pelican benefit options have in-network and out-

of-network coverage and are on the Blue Cross nationwide network. We encourage you to compare the options to see which is the best fit for your situation.

•  If I choose the Magnolia Open Access Benefit Option, would deductible have to be met before any benefits would be paid?

•  Yes. The family deductible would have to be met before the co-insurance would take affect.

Retiree 100 Retired enrollees in the Magnolia Open Access benefit option who have Medicare Part A and Part B as their primary insurer are eligible to participate in the Retiree 100 program. This program serves as additional coverage for enrollees who have extensive hospital bills and/or large amounts of physician charges due to a serious illness, accident or long-term chronic condition. You are eligible to enroll in Retiree 100 if:

o  You are a retired state employee o  You are a member of the Magnolia Open Access benefit option o  Medicare is your primary insurer (You have both Medicare Part A

and Part B) You can also enroll your spouse if:

o  You currently cover your spouse as a dependent o  Medicare is your spouse’s primary health insurer (Your

spouse has both Medicare Part A and Part B)

Retiree 100 Not All Expenses Are Eligible Retiree 100 coordinates only those expenses considered eligible for reimbursement by both Medicare and the Magnolia Open Access benefit option. Expenses not eligible for consideration include:

•  Benefits assigned - when a provider agrees to accept what Medicare allows as full payment. (OGB does not pay for any portion of a bill in excess of the Medicare allowable amount.)

•  Prescription drugs Premiums The monthly premium for Retiree 100 is $39.00 per person in addition to your monthly OGB premium. There is no state contribution toward the premium amount; you must pay the entire cost for Retiree 100 coverage. Enrollment If you are already retired, you can enroll during the annual enrollment period held each year. Also, you can enroll within 30 days after the date you first became eligible for Medicare (Parts A and B). Coverage becomes effective on the first day of the month you became eligible for Medicare. Enrollment documents are available on the OGB website, www.groupbenefits.org.

Vantage Medical Home HMO

Vantage’s Medical Home HMO is a patient-centered approach to providing cost-effective and comprehensive primary health care for children, youth and adults. This benefit option creates partnerships between the individual patient and his or her personal physician and, when appropriate, the patient’s family.

Vantage Medical Home HMO Medical Coverage

Employee-Only Employee + 1 (Spouse or Child)



Monthly Premiums (employee share)Retiree with 2 Medicare

$155.27 $192.26

Employer Contribution to HRA/HSA $0 $0 $0 $0 Deductible (in-network) $500 $1,500 $1,500 $1,500 Deductible (out-of-network) $1,500 $3,000 $3,000 $3,000

Out-of-pocket max (in-network) Tier I: $3,000 Tier II: see below

Tier I: $9,000 Tier II: see below



Out-of-pocket max (out-of-network) None None None None Co-Payment (Affinity Network) PCP/SPC $0/$35 $0/$35 $0/$35 $0/$35

Co-Payment PCP/SPC $10/$45 $10/$45 $10/$45 $10/$45

Tier I Providers Enrollees seeing Tier I providers pay the Tier I co-pays, co-insurance and deductibles as listed in the Certificate of Coverage. (Affinity Health Network Providers) Tier II Providers Enrollees who choose to see Tier II providers will have to pay an additional 20% coinsurance in addition to their Tier I cost share. There is no out-of-pocket maximum for Tier II services.

Prescription Coverage Tier Member

Responsibility Tier 1 Low Cost Generic $3 Tier 2 Non-Preferred Generics

$10

Tier 3 Preferred $45 Tier 4 Non-Preferred $95

Tier 5 Specialty 33% coinsurance up to

$150

Benefits effec:ve January 1, 2015

Vantage Medical Home HMO Frequently Asked Questions •  What do the tiers mean?

•  Tier I Providers Most participating providers are Tier I providers. Enrollees seeing Tier I providers pay the Tier I co-pays, co-insurance and deductibles as listed in the Certificate of Coverage and Cost Share Schedule. Tier I includes Affinity Health Network, the Vantage Tier I Network and Verity Health Network. Tier I Providers may not balance bill members.

•  Tier II Providers (Nationwide) Tier II providers are participating providers whose cost may be higher than other similar participating providers. Enrollees who choose to see these providers pay an additional 20% coinsurance in addition to their Tier I cost share. There is no out-of-pocket maximum for Tier II services and Tier II Providers may not balance bill members.

•  Out-of-Network Providers Vantage does cover non-emergency covered services performed out-of-network. There is

a separate out-of-network deductible and out-of-network providers may balance bill members.

•  What is Affinity Health Network? •  The Affinity Health Network is a preferred provider network that enrollees may access for

lower co-pays. Please contact Vantage or visit www.VHP-stategroup.com for more details. •  What is Verity Health Network?

•  The Verity Health Network is a Tier I provider network that is available to enrollees living in southern Louisiana. Please contact Vantage or visit www.VHP-stategroup.com for a list of eligible parishes and more details about the Verity Health Network.

Vantage Medical Home HMO Frequently Asked Questions • Is Vantage Medical Home in all regions?

•  Yes. Vantage Medical Home HMO is now offered statewide. Please visit Vantage’s website or call their customer service line to find providers in your area.

•  I see that routine vision, glasses/contacts and dental exams and cleanings are covered services under Vantage Medical Home HMO. Do deductibles or co-pays apply to these services?

•  Routine vision, glasses/contacts and dental exams and cleanings are indeed covered services through Vantage. The in-network deductible does not apply for vision and most dental covered services. Please see benefit comparison in your decision guide and online for more information or contact Vantage directly.

•  Does Vantage have a nationwide provider network? •  Yes, they do have a nationwide provider network. Please visit Vantage’s website or contact

their customer service for more details.

Live Better Louisiana

What’s the Game Plan?

Personal Health Assessment Preventive Onsite

Health Check Take Charge of your

Own Health

One of the keys to living a better life is managing your health. Preventing chronic disease can help you live a longer, more active life as well as save you thousands of dollars on health care. That’s why OGB launched the Live Better Louisiana program to its Blue Cross plan members in 2014. Live Better Louisiana provides resources

to help you better monitor your health, understand your risk factors and make educated choices that keep you healthier – in addition to providing you with a

discount on your insurance premiums beginning in 2016!

Wellness Frequently Asked Questions •  Why does OGB offer wellness programs?

•  The Office of Group Benefits provides health insurance to more than 230,000 state employees, retirees and dependents, a group who is on average seven years older, spends 129 percent more on pharmacy drugs, and visits the hospital 53 percent more often than the general population.

•  OGB launched Live Better Louisiana: Our Game Plan for Better Health in May with the goal of preventing serious illness and diseases before they happen.

•  Members enrolled a Vantage plan can take advantage of Vantage Wellness. • What is the cost to participate?

•  The programs are sponsored by the vendors at no extra charge to members. •  Are there any discounts on gym memberships or other services?

•  Yes. Blue Cross members can sign up for the Blue365, which offers exclusive health and wellness deals that can help keep you healthy and happy—every day of the year! The newest incentive offered by Vantage Wellness includes discounted gym memberships with local popular gyms.

•  Vantage Health Plan also has a wellness program called SilverSneakers available to it’s members.

•  I heard there is a premium discount if you participate in the Live Better Louisiana program. How much is the discount and when will we see it?

•  The discount will take effect beginning January 2016. We will evaluate our rates and claims costs during FY15 to determine what type of discount is appropriate.

2015 Enrollment

How to Enroll OGB encourages benefit option participants to use the online annual enrollment portal.* However, if members are discontinuing OGB coverage or adding or removing dependents, they must contact OGB.

Annual Enrollment

Portal Annual Enrollment

Form OGB

Enroll in a health plan with the same covered dependents as

2014 ü ü ü

Enroll in a health plan with different or new covered

dependents than 2014 ü

Discontinue OGB coverage ü

*Members currently enrolled in an LSU First or OneExchange plan cannot use the online annual enrollment portal. OneExchange enrollees must call 1-855-663-4228. LSU First enrollees must contact their human resources department.

Member Annual Enrollment Portal Enrollees choosing a health plan with the same covered dependents as their 2014 plan are eligible to use the annual enrollment portal to make their 2015 selection. To enroll on the annual enrollment portal: o  Follow the links from the OGB homepage to the annual enrollment portal

o  Enter your Member ID from your current medical ID card and the last four

digits of your social security number

o  Make your selection for the next plan year

o  Select a primary care physician for Pelican and Magnolia benefit options

o  Submit

Annual Enrollment Paper Form

If an enrollee cannot access the annual enrollment portal, they can make their benefit selection using the annual enrollment form in the decision guide.

Enrollment Frequently Asked Questions •  How do I get to the annual enrollment web portal?

•  Visit annualenrollment.groupbenefits.org and click the Enroll Now link. •  How do I log in?

•  Please select a plan administrator by clicking on one of the radio buttons (circles). Next, enter your current member ID number, found on your current insurance card, in the Current Member ID input box. Finally, enter the last 4 digits of your social security number in the corresponding box and click Submit.

•  What if I enroll in a benefit option and then change my mind? •  If you wish to change your benefit selection during the annual enrollment period, simply visit the annual

enrollment portal and select a new benefit option. Your most recent choice will be considered valid. If you change your mind after annual enrollment is over, you won’t be able to change your plan until next year’s annual enrollment period unless you experience a qualifying event.

•  If I enroll through the enrollment portal, how will I know my information was received? •  You will see a confirmation page once you submit your selection. You can print that page for your records

and after a few days check with your human resources department to verify the coverage you selected has been entered into the system.

•  Where do I mail the paper enrollment form? •  Office of Group Benefits

Eligibility Division P.O. Box 66678 Baton Rouge, LA 70896

•  Can I fax it? •  Yes. (225) 925-6333 or (225) 925-4074

Enrollment Frequently Asked Questions •  I filled out the paper enrollment form and mailed/faxed it to OGB. Have they received it yet?

•  It depends on when you mailed it and where you mailed it from. Please allow a minimum of four business days from the date you mailed or faxed the form for processing.

•  Why does OGB no longer allow late applications? •  OGB can only accept applications during an annual enrollment period, unless the enrollee

experiences a qualifying event, recognized by the IRS. •  If our check is direct deposit, will we be sent a check stub to verify our deduction for the new premiums?

•  Check with the bank or your retirement system. •  How do I change my dependents? I don’t see a spot on the form?

•  Please contact OGB for assistance. •  How do I change my address?

•  Please contact OGB for assistance.

Eligibility

Dependent Verification Enrollees must provide human resources or OGB with proof of the legal relationship of each covered dependent.* Without that documentation, enrollment cannot be completed. Acceptable documents include: o  Marriage license o  Birth letter or birth certificate o  legal adoption or custody papers, if applicable, for each covered

dependent. OGB must verify the eligibility of dependents. *Dependent verification is not needed if the documentation has already been provided to OGB.

No late applications will be accepted.

Eligibility Frequently Asked Questions •  What are qualifying events?

•  Qualifying events are defined by the IRS. You can view a full list at their website, but they include things like:

•  Birth or adoption of a child, or placement for adoption •  Death of spouse or child, only if the dependent is currently enrolled •  Your spouse’s or dependent’s loss of eligibility for other group health insurance •  Marriage or divorce (once divorced, your ex-spouse is not eligible for dependent

coverage under OGB) •  Medicare eligibility

•  Who can I add to my plan? •  The following people can be enrolled as dependents:

•  Your legal spouse •  Children until they reach age 26 (coverage ends on the last day of their birthday

month) •  If I have already submitted birth certificates and marriage license in a previous year, do they need to be submitted again to prove dependent status for new plans?

•  No. Dependent verification is not needed if the documentation has already been provided to OGB.

•  Can I keep my child on my plan after he/she turns 26? •  A covered child under age 26 who is or becomes incapable of self-sustaining employment

may be eligible to continue coverage as an over-age dependent, if OGB receives a request for continued coverage and the required medical documents verifying the child’s incapacity before the child reaches age 26. Upon receipt, a determination of eligibility will be made based upon the medical information provided.

Other Benefit Offerings

Life Insurance

Coverage Reductions •  Plan members enrolled in life insurance coverage

will automatically have 25 percent reduced coverage on January 1 following their 65th birthday.

•  Another automatic 25 percent reduction in coverage will take effect on January 1 following their 70th birthday. Premium rates will be reduced accordingly.

Vendor Contact Information

Blue Cross Blue Shield of Louisiana Vantage Health Plan ü  1-800-392-4089 ü  www.bcbsla.com/ogb

ü  1-888-823-1910 ü  www.vhp-stategroup.com

Peoples Health OneExchange ü  1-866-912-8304 ü  www.peopleshealth.com

1-855-663-4228 medicare.oneexchange.com/ogb

MedImpact/Medicare Generations Rx Discovery Benefits ü  1-800-910-1831 ü  https://mp.medimpact.com/ogb

ü  1-877-633-7943 ü  www.medicaregenerationrx.com/ogb

ü  1-866-451-3399 ü  www.discoverybenefits.com

OGB Contact Information www.groupbenefits.org

www.annualenrollment.groupbenefits.org Customer Service: 1-800-272-8451 *Hours extended: 7 a.m. – 7 p.m. Monday - Saturday

Agency Services: 225-925-6951 Mailing Address: OGB P.O. Box 44036 Baton Rouge, LA 70804

2015 annual enrollment · 2016. 3. 29. · 2015 annual enrollment!! this year, members are required...

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