Postdoctoral Benefits

Program

Open EnrollmentNovember 17th through December 1st, 2014

Effective January 1, 2015

Reserve University

The Case Western

AGENDA• Introduction of HealthSpan, the

new medical plan carrier.

• Review of benefit plan designs,

rates and changes for 2015.

• Review of the Open Enrollment

Process.

• Q & A

The Postdoctoral Benefits Program (PBP)

• Case Western Reserve University has partnered with Garnett-Powers & Associates to provide administrative, marketing and customer service for the PBP.

• The PBP is a comprehensive package of benefits originally designed to closely match the benefits offered through the Case Western Faculty/Staff plan.

• All Postdocs are eligible for the PBP plan effective the first of the month following the date of their appointment, or the date of their appointment if appointed on the first of the month.

• All Research Scholars are eligible for the benefits

as long as their visit is longer than 45 days.

• Research Scholars pay the total cost for the benefit

package and are billed directly by Garnett-Powers.

Benefits Offered Through ThePostdoctoral Benefits Program (PBP)

Plan Name Insurance Type Company

Select Plus HMONew for 2015!

Medical

Access PPONew for 2015!

Medical

Dental PPO Plan Dental

Vision Plan Vision

Life Insurance Plan Life and AD&D

Medical Evacuation& Repatriation

J1 & J2 Visa HolderRequirement

Plan/Rate Changes for 2015

• Medical will be changing to HealthSpan offering an

HMO and PPO plan.

• The medical rates will be increasing overall by 4%.

• It is important to that you visit the Garnett-Powers

website and enroll in your HealthSpan plan of choice, in order to have coverage for 2015.

• The MetLife dental rates are increasing by 2%.

• No change to the EyeMed vision plan

• The in-network out-of-pocket maximums for both medical plans have been enriched to include deductible, co-pay, co-insurance and pharmacy expenses due to healthcare reform (ACA).

What is Open Enrollment?

• Open Enrollment is an annual period of time designated to allow current enrollees the opportunity to make changes to their coverage that are otherwise not allowed throughout the rest of the year, unless you experience a qualifying life event.

• Open Enrollment also allows those postdocs who initially waived coverage to now enroll, including dependents.

• Examples of qualifying life events are:

Marriage

Divorce

Birth of a child

Death of a dependent

Adoption or placement of adoption of a child

Loss of coverage

Dependent arrival in the U.S.

Dependent loss of eligibility due to attainment of age 26.

Open Enrollment for Plan Year 2015

All postdocs currently enrolled in the Case Western Postdoctoral Benefits Program must visit the online enrollment form November 17th – December 1st , 2014:

• Make your selection of your desired HealthSpan medical plan: Either HMO or PPO

• If you previously waived either yourself and/or your family members, you/they may enroll in the program at this time.

• All changes will be effective January 1st, 2015.

MEDICALINSURANCE

Provided by

What is an HMO Plan?• This plan offers a broad spectrum of benefit coverage with a higher degree of managed care.

• Under the Health Maintenance Organization (HMO) model, the member chooses a Primary Care Physician (PCP). • The PCP becomes the gatekeeper of that member's healthcare needs.

• If the member is in need of treatment from a Specialist or

is in need of an In-Patient or Outpatient procedure, he/she must obtain a referral from their PCP prior to any type of consultation or treatment for most services.

• There is no Out-of-Network benefit.

• In order to choose the HealthSpan HMO, you must be in the HMO service area.

• Any postdocs residing out of the service area, or out-of- state, must choose the HealthSpan PPO medical plan.

Postdoctoral Benefit Program HealthSpan Select Plus HMO

Medical Benefits In-NetworkPostdoc Pays

Physician Office Visit/Specialist $15 CopayWomen’s Preventive Health $0 CopayHospitalization:

Inpatient No Copay *Outpatient No Copay *Pregnancy No Copay *

Prescription Drugs:Tier 1 $10 Copay Tier 2 $30 Copay Specialty Drugs 25% up to $250 max.

Emergency Room Visits $100 Copay (waived if admitted)Urgent Care $35 CopayRoutine Physical Exam No CopayMental Health

Outpatient $15 per visit Inpatient No Copay*

Annual Maximum Out of Pocket $1,000 Individual****includes deductible and pharmacy $2,000 Family**Deductible:

Individual $500Family $1,000

Lifetime Maximum Unlimited*subject to deductible

For more detailed plan design information go to: www.garnett-powers.com/case

What is a PPO Plan?

• There is an In-Network and Out-of-Network component.

• Under the traditional PPO plan, the member does not have to choose a Primary Care Physician (PCP) at the time of enrollment.

• The In-Network benefits (deductible, coinsurance, etc.) will be less costly than the Out-of-Network benefits.

• At the time of service, the member has the ability to seek care from a Specialist, without having to obtain a referral from a PCP.

• PPO premiums tend to be higher than HMO premiums due to the method of reimbursement and contractual agreements with the providers.

Postdoctoral Benefit Program HealthSpan Access PPO

Medical Benefits In-Network Out-of-NetworkPostdoc Pays Postdoc Pays

Physician Office Visit/Specialist $10 Copay/$30 Copay 30%*Women’s Preventive Health $0 Copay 30%*

Hospitalization:Inpatient 10%* 30%*Outpatient 10%* 30%*Pregnancy $0 Copay 30%*

Prescription Drugs:Tier 1 $15 Copay 40%*Tier 2 $30 Copay 40%*Tier 3 $60 Copay 40%*

Emergency Room Visits $200 Copay (waived if admitted) $200 Copay (waived if admitted)

Urgent Care $70 Copay 30%*Routine Physical Exam $0 Copay 30%*Mental Health (Non-Serious):

Outpatient $10 Copay 30%* Inpatient 10%* 30%* Annual Maximum Out of Pocket $3,500 Individual** $7,000 Individual**includes deductible and pharmacy $7,000 Family** $14,000 Family Deductible:

Individual $500 $1,000Family $1,000 $2,000

Lifetime Maximum Unlimited * Subject to Deductible

For more detailed plan design information go to: www.garnett-powers.com/case

Postdoctoral Benefit Program Summary of Benefit Differences of the HealthSpan

Medical HMO/PPO Plans

                                                          Select Plus HMO Plan Access PPO Plan Postdoc Pays Postdoc Pays

In-Network In-Network Out-of-Network

Deductible (Sgl/Fam) $500/$1,000 $500/$1,000 $1,000/$2,000

Out of Pocket Limit (Sgl/Fam) $1,000/$2,000 $3,500/$7,000 $7,000/$14,000

Physician Office Service Copay $15/$15 $10/$30 30%*Emergency Room $100 $200 $200Urgent Care $35 $70 30%*Inpatient Hospital No Copay* 10%* 30%*Outpatient Services No Copay* 10%* 30%*

Prescription Drugs: Tier 1 $10 $15 40%* Tier 2 $30 $30 40%* Tier 3 N/A $60 40%**subject to deductible

Important Documents

• Transition of Care: Please use this form if you have a current medical condition, or are in your third trimester of pregnancy, and wish to continue to see your current medical provider.

The decision to grant transition of care should be made no later than January 1st, 2015.

• Application for Disabled Dependent Coverage: Please complete this form if an enrolling dependent is disabled and indicate this in Section 5 of the Open Enrollment Form.

• Both of these forms can be found on the GPA website under ‘Medical’ and sublink ‘HealthSpan Plans 2015’

Mail Order Pharmacy

• You may fill your maintenance prescriptions through mail order and save a copay for up to a 90-day supply.

• Mail order forms and instructions are available at http://www.healthspan.org/formulary

• At this same link, you will find information on approved formulary drugs for both the HMO and PPO plans.

• In order to find the proper information relative to your area, please select ‘North Coast’.

Summaries of Benefits and Coverage

• The ACA requires that you be notified that the Summaries of Benefits and Coverage for your medical plans will be available on our website.

• The Summaries of Benefits and Coverage follow the recommended guidelines of ACA in a standardized format to make them easier to read and comprehend to better serve you in making your plan selections.

• You may request a paper copy at no charge by calling the toll-free number on your new ID card.

• You may also print a copy directly off of the GPA website.

HealthSpan Wellness Benefits

• Dr. Toby Cosgrove, Pres. and CEO of the Cleveland Clinic: “…we need to change from sick care to well care…” and “The health of the country is as good as the health of its citizens…”

• HealthSpan’s Fit First is a comprehensive wellness program that includes helpful tools to help members be well and stay well:

Health risk /well-being assessment Goal and activity tracking Health and activity challenges targeted to

your self-identified risk areas

• HealthSpan offers a mobile application to help you reach your goals conveniently.

• The application works with over 80 fitness and activity applications and devices.

• For more information, check out the GPA website: www.garnett-powers.com/case/healthspan_wellness.htm

• The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010.

• The ACA requires that most people that are either citizens or legal residents to have health insurance coverage, or to pay a tax beginning in 2014 if they do not.

• The intent of the ACA is make health care coverage available to the millions that are uninsured in the U.S.

• All states are required to offer a Health Care Exchange, either through the federal government, on their own or through a partnership between the state and the federal government.

• Ohio is using the federal exchange.

• U.S. citizens and most legal residents are eligible for plans on the exchange.

Healthcare Reform

• There are differing levels of coverage and cost, as well as several insurance carriers offering the plans.

• In order to be eligible for the Premium Tax Credit, also known as a subsidy, a person must meet certain eligibility requirements:

• The employer offers coverage where the plan design does not meet the coverage requirements of the ACA.

• Certain poverty-level income conditions are met.

• The cost of employee-only coverage exceeds 9.5% of an employee’s W-2 wages.

Healthcare Reform(continued)

Important ACA Information Specifically for Enrollees in the

Case Western Reserve University-PBP:

• All of the PBP plans meet or exceed the legal requirements of the ACA.

• To the best of our knowledge, the cost of single coverage for the HMO does not exceed 9.5% of an eligible postdoc’s wages/stipend.

• It is highly unlikely that anyone enrolled in the PBP medical coverage will be eligible for a subsidy through the exchange.

• For more information, please visit the federal exchange site at www.healthcare.gov.

Healthcare Reform(continued)

DENTALINSURANCE

Provided by

In-Network Out-of-Network Postdoc Pays Postdoc Pays

Annual Maximum: $1,250 per person* $750 per person*Calendar Year Deductible, Basic/Major: $0 $50 per person/$150 family

Diagnostic and Preventative Care:Routine Exams No charge 30%Routine Teeth Cleanings No charge 30% Routine X-Rays No charge 30%

Basic Procedures: Fillings 20% 40%Endodontics 20% 40% Non-Surgical Periodontics 20% 40% Simple Oral Surgery 20% 40%

Major Procedures:Crowns 40% 60%Bridgework 40% 60% Dentures 40% 60% Complex Oral Surgery 40% 60%

Orthodontia:$1,250 Lifetime Maximum (child only) 50% 50%

*This dollar figure refers to the amount the insurance carrier pays toward your care

For more detailed plan design information go to: www.garnett-powers.com/case

Postdoctoral Benefit Program

MetLife PPO Dental

VISIONINSURANCE

Provided by

Postdoctoral Benefit Program EyeMed Vision Plan In-Network Out-of-Network

Postdoc Pays Postdoc Allowance

Exam with Dilation (if necessary) $10 Copay Up to $35

Standard Lenses:

-Single Vision $25 Copay Up to $25-Bifocal $25 Copay Up to $40-Trifocal $25 Copay Up to $60-Progressive $ 90 Up to $40

Frames $0 Copay, $120 allowance , 20% off balance over allowance

Contact Lenses* $135 Allowance, 15% off balance over $135

Frequency: Exam, Frames, Standard Plastic Lenses or Contact Lenses – Once every 12 months

*Contact lenses may be chosen in lieu of eyeglasses

For more detailed plan design information go to: www.garnett-powers.com/case

LIFE AND AD&DINSURANCE

Provided by

Life Insurance/Accidental Deathand Dismemberment Plan

• The plan pays $10,000 in the event of death.

• The plan pays an additional $10,000 in the event of an accidental death.

• The plan provides both postdocs and their dependents the medical evacuation and

repatriation benefits necessary to satisfy the J1 & J2 Visa requirement, which includes the $10,000 of Medical Evacuation Insurance and $7,500 of Repatriation of Mortal Remains Insurance.

• Effective May 15, 2015, the Medical Evacuation and Repatriation coverage requirements by the Department of State will change. MetLife will continue to offer both J1 and J2 visa holders the newly required insurance coverage: Medical evacuation of $50,000 and repatriation of remains of $25,000.

The Enrollment and Open Enrollment Process

• It is important that Postdoctoral Scholars (PDs) follow the open enrollment process carefully.

• The process is basically the same whether you are

enrolling for the first time, (check “New Hire”), or if you are making changes during this open enrollment period check (“Open Enrollment”).

• To make Open Enrollment changes, please go to the Garnett-Powers & Associates website at www.garnett-powers.com/case and click on the “Enrollment” link, then the sub-link “Open Enrollment”.

• Remember you must choose either the HealthSpan HMO or PPO in Section 4 to be enrolled in medical for 2015.

• Under this link you will find information on Open

Enrollment, 2015 Monthly Rates, required forms and the Open Enrollment Instructions for completing the form for Open Enrollment changes.

The Enrollment and Open Enrollment Process

(continued)

• If you are newly appointed, please click on the “New Hire Enrollment Form Instructions” link and print the document for assistance with completing the enrollment form properly.

• Once the appropriate instructions are in hand, go directly to the “New Hire Enrollment Form”.

• The enrollment form must be completed online.

• Once the enrollment form is complete, please click on “Submit and Create Printable Enrollment Form”.

• An electronic version of the enrollment form will be submitted to the GPA secure website for data entry.

The Enrollment and Open Enrollment Process

(continued)

• For newly enrolling postdocs, an email will be sent confirming their participation in the PBP within 24 hours, except on weekends.

• For Open Enrollment changes, an email will be sent

confirming your new open enrollment selections no later than December 19th, 2014.

• New Medical ID cards will be mailed to your home address for your selected medical plan.

• You will not receive an ID card for the MetLife dental

plan.

Family Member Eligibility

Family member eligibility requirements are the same as the family member eligibility requirements for the CASE faculty/staff plans. The major family member categories are the following:

• Spouse

• Natural or adopted children to age 26 and unmarried (unless

eligible to continue coverage because of disability). Adult age children (19-26) may be excluded if they are eligible to enroll in an employer sponsored plan other than the group plans of either of the child's parents.

• Unmarried children of any age if they are mentally or physically incapable of supporting themselves.

• Domestic Partner www.case.edu/finadmin/humres/benefits/attachments/dpaff.pdf

Information Sources

For general inquiries and customer service regardingenrollment, benefit questions and ID cards, you shouldcontact:

Garnett-Powers & Associates

• Website:

www.garnett-powers.com/case

• Toll Free Phone:

Postdocs : 800-319-9557

• Email Address:

casepbp@garnett-powers.com

Thank you for joining us today!

Questions?