Embracing a Healthy Lifestyle through the State Health PlanNew Plan Options and Incentives for 2014

Why Are We Making Changes for 2014?

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• More choice for members. The Treasurer conducted a listening tour and the Plan conducted focus groups and surveys. The message was clear, members want more options.

• Encourage members to become more engaged in their health and take steps to live a healthier life.

• An engaged membership will help ensure that the State Health Plan remains financially stable in the years ahead.

Open Enrollment 2014

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Open Enrollment will be conducted October 1 – 31, 2013.

You must complete enrollment—otherwise, you and your covered family members will be

enrolled in the Traditional 70/30 Plan effective January 1, 2014.

Health Plan Options for 2014

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Enhanced 80/20 PlanNEW: Consumer-Directed Health Plan (CDHP) with

HRATraditional 70/30 Plan

• The current Standard 80/20 Plan with a new name to match the new features

• $0 ACA Preventive Services

• $0 ACA Preventive Medications

• New Wellness Incentives

•Reduced medical copay opportunities

• A new health plan option• A high-deductible medical

plan • A Health Reimbursement

Account (HRA) to help offset the deductible

• 85/15 Coinsurance• $0 ACA Preventive

Services/Medications• CDHP Preventive

Medication List ($0 deductible)

• New wellness incentives• Additional HRA funds for

visiting certain providers

• The current Basic 70/30 Plan with a new name

• No incentives available

• No $0 ACA (Affordable Care Act) Preventive Services/ Medications

A New Focus On Wellness

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Enhanced 80/20 Plan NEW: Consumer-Directed Health Plan (CDHP) with HRA

Traditional 70/30 Plan

Wellness premium credits when:

• Subscriber completes a Health Assessment

• Subscriber attests for him/herself and spouse (if applicable) to not smoking

• Selecting a Primary Care Provider (PCP) for self and all dependents

• Additional wellness incentives

Wellness premium credits when:

• Subscriber completes a Health Assessment

• Subscriber attests for him/herself and spouse (if applicable) to not smoking

• Selecting a Primary Care Provider (PCP) for self and dependents

• Additional wellness incentives

• No incentives available

• No $0 ACA Preventive Services

• No $0 ACA Preventive Medications

The Traditional 70/30 Plan

• Traditional 70/30 Plan – There are no changes to the Plan’s benefits for 2014

• Copays and Deductibles – There will be no opportunities for copay reductions on the Traditional 70/30 Plan.

• Network Services – Members may visit any provider, but they will pay less when they go to a BCBSNC network provider

• Preventive Services – Copays still apply to preventive services.

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Traditional 70/30 Plan Benefit Highlights

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 Coverage In-Network Out-of-Network

Annual Deductible $933 individual/$2,799 family $1,866 individual/$5,598 family

Coinsurance (after deductible is met) 30% of eligible expenses

50% of eligible expenses plus 100% of amount above the allowed amount

Coinsurance Maximum (excludes deductible) $3,793 individual/$11,379 family $7,586 individual/$22,758 family

Office Visits $35 copay for primary doctor$81 copay for specialists 50% after deductible

Preventive Care $35 copay for primary doctor$81 copay for specialists Only certain services are covered

Inpatient Hospital $291 copay, then 30% after deductible

$291 copay, then 50% after deductible

Prescription Drugs (for 30-day supply)

Tier 1 $12 copay

Tier 2 $40 copay

Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply

Tier 1 $12 copay

Tier 2 $40 copay

Tier 3 $64 copaySpecialty medications 25% up to $100 maximum per 30-day supply

Monthly Premiums—Traditional 70/30Plan

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2014 Traditional Plan Premiums

Coverage Type Employee/ Retiree Monthly

Premium

Dependent Monthly Premium

Total Monthly Premium

Employee Only $0 N/A $0

Employee + Child(ren)

$0 $205.12 $205.12

Employee + Spouse

$0 $528.52 $528.52

Employeee + Family

$0 $562.94 $562.94

Reminder: Wellness premium credits are not offered under the Traditional Plan.

The Enhanced 80/20 Plan• New incentives to encourage members to manage their health

and lower their health care costs

• Preventive Care – No copays on Affordable Care Act (ACA ) preventive services or preventive medications.

• Primary Care Provider (PCP) – $15 PCP copay reduction.• If PCP is not available at the time of the appointment, the member may visit any

provider in the same practice and still receive the copay reduction• If a member wants to change PCPs, they can go to their enrollment portal and select

a new PCP. The PCP change must be made before visiting the new PCP. • Specialists – $10 Specialist copay reduction, choose a Blue Options Designated

provider

• Hospitals – $233 Inpatient Hospital copay avoidance (Blue Options)

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Enhanced 80/20 Plan Highlights in 2014

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 Coverage In-Network Out-of-Network

Annual Deductible $700 individual/$2,100 family $1,400 individual/$4,200 family

Coinsurance (after deductible is met)

20% of eligible expenses40% of eligible expenses plus 100% of amount above the Plan’s allowed amount

Coinsurance Maximum (excludes deductible) $3,210 individual/$9,630 family $6,420 individual/$19,260 family

Office Visits

$30 copay for primary doctor; $15 copay if the PCP on the ID card is utilized$70 copay for specialists; $60 copay if a Blue Options Designated specialist is utilized

40% after deductible

Inpatient Hospital$233 copay, then 20% after deductible; copay avoided if a Blue Options Designated hospital is utilized

$233 copay, then 40% after deductible

Prescription Drugs (for 30-day supply)

Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply$0 for ACA Preventive Medications

Tier 1 $12 copay Tier 2 $40 copay Tier 3 $64 copay Specialty medications 25% up to $100 maximum per 30-day supply$0 for ACA Preventive Medications

Lower Your Health Care Costs with Wellness Incentives—The Enhanced 80/20 Plan

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Things you can do to reduce your costs…

Enhanced Plan Incentives

Visit the PCP listed on ID card Copay is reduced by $15

Visit a Blue Options Designated specialist Copay is reduced by $10

Get inpatient care in a Blue Options Designated hospital $233 copay is avoided

Remember:

Get preventive services through an in-network provider in a non-hospital setting

100% coverage – this is provided at no cost to you

ACA preventive medication list 100% coverage – this is provided at no cost to you

Who can be a Primary Care Provider?

• A Primary Care Provider can practice:• General / Family Medicine• Internal Medicine• Pediatrics, or• Obstetrics and Gynecology

• A Primary Care Provider can be:• Licensed Nurse Practitioners• Physician’s Assistants

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Specialty Providers cannot be selected as a PCP.

Wellness Premium Credits

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Wellness Activity How to Complete It When Members Can Take It

Subscriber selects a Primary Care Provider (PCP)A PCP must also be selected for each dependent covered on the State Health Plan.

Log into the eEnroll system to select a PCP.

If members have trouble contact 888-234-2416.

If you change your mind, you can select a different provider any time. (It takes 5 calendar days to update in the system)

Subscriber completes a confidential Health Assessment (HA)

Through the SHP website (www.shpnc.org), click on NC HealthSmart and log into Personal Health Portal.

If you completed a Health Assessment since Nov. 1, 2012, through the Personal Health Portal, it will count toward the premium credit.

Subscriber attests to being a non-smoker/commits to a cessation programand attests for spouse if applicable

During enrollment, Oct. 1-31, 2013.

Lower Your Premiums with Wellness Premium Credits—The Enhanced 80/20 Plan

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Complete up to Three Wellness ActivitiesBy October 31, 2013

Enhanced Plan Premium Credits

Subscriber attests to being a non-smoker/commits to a cessation program and attests for spouse if applicable

$20 per month

Subscriber (only) completes a confidential Health Assessment (HA)

$15 per month

Subscriber and covered dependents select a Primary Care Provider

$15 per month

Reduce your premium by up to… $50 per month

Monthly Premiums—Enhanced 80/20 Plan

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2014 Enhanced Plan Premiums

Coverage Type

Employee/ Monthly Premium

Dependent Monthly Premium

Total Monthly Premium

Wellness Premium Credits*

Net Monthly

Premium*

Employee Only

$63.56 N/A $63.56 $50.00* $13.56*

Employee + Child(ren)

$63.56 $272.80 $336.36 $50.00* $286.36*

Employee + Spouse

$63.56 $628.54 $692.10 $50.00* $642.10*

Employee + Family

$63.56 $666.38 $729.94 $50.00* $679.94*

*Assumes completion of three wellness activities

The Consumer-Directed Health Plan (CDHP) with HRAA different kind of health plan with two components

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Health Reimbursement Account (HRA)High-Deductible Health Plan

• The Plan funds the members’ Health Reimbursement Accounts (HRA) annually• $500 for employee only• $1,000 for employee + 1• $1,500 for employee + 2 or more

dependents• When HRA is depleted, the member

must pay the remaining deductible & coinsurance

• Unused HRA funds roll to the following year

2• Covers the same services as

other Plan options through the same PPO network

• In-network: Deductible $1,500 Individual/ $4,500 Family• Out-of-Network: Deductible

$3,000 Individual/ $9,000 Family • After the deductible is met, 15%

coinsurance • The deductible applies to both

Pharmacy and Medical expenses

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CDHP Highlights in 2014

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 Coverage In-Network Out-of-Network

Plan-Provided HRA Contribution

$500 employee/retiree$1,000 employee/retiree + 1 dependent

$1,500 employee/retiree + 2 or more dependents

Annual Deductible $1,500 individual/$4,500 family $3,000 individual/$9,000 family

Coinsurance (after deductible is met) 15% of eligible expenses 35% of eligible expenses

Out-of-Pocket Maximum for medical and pharmacy (includes deductible)

$3,000 individual/$9,000 family $6,000 individual/$18,000 family

Office Visits(after deductible is met)

15% of eligible expenses; $15 added to HRA if the PCP on the ID card is utilized; $10 added to HRA if a Blue Options Designated specialist is utilized

35% of eligible expenses

Inpatient Hospital(after deductible is met)

15% of eligible expenses; $50 added to HRA if a Blue Options Designated hospital is utilized

35% of eligible expenses

ACA Preventive Medication List $0 coinsurance, $0 deductible $0 coinsurance, $0 deductible

CDHP Preventive Medication List

15% coinsurance, $0 deductible 15% coinsurance, $0 deductible

Lower Member Health Care Costs with Wellness Incentives—CDHP

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Things you can do to reduce your costs…

CDHP Incentives

Visit the PCP listed on ID card $15 added to the HRAVisit a Blue Options Designated specialist $10 added to the HRA

Get inpatient care in a Blue Options Designated hospital $50 added to the HRA

Remember:

Get preventive care through an in-network provider in a non-hospital setting

100% coverage – this is provided at no cost to the member

ACA preventive medication list 100% coverage –no cost to the member

CDHP preventive medication list 15% of eligible expense with no deductible

Example: CDHP Office Visit and Prescription

Present HRA ID Card at Office Visit. Total office visit $175 submitted to BCBSNC by provider.

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Claim processes in primary claims system and applies towards $1,500 deductible – EOB/EOP issued.

Claim automatically rolls over to HRA for adjudication - $175 remitted to provider-

Member picks up prescription at pharmacy and pays $65 because deductible has not been met.

Pharmacy claim automatically submitted to HRA. Member reimbursed $65.

At end of the month, $15 credited to member’s HRA for visiting PCP on ID Card.

Lower Premiums with Wellness Premium Credits—CDHP

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Complete up to Three Wellness Activities

By October 31, 2013

CDHPPremium Credits

Subscriber attests to being a non-smoker/commits to a cessation programand attests for spouse if applicable

$20 per month

Subscriber (only) completes a confidential Health Assessment (HA)

$10 per month

Subscriber selects a Primary Care Provider (and any covered dependents)

$10 per month

Reduce subscriber premium by … $40 per month

Monthly Premiums—CDHP

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2014 CDHP Premiums Coverage

TypeEmployee Monthly Premium

Dependent Monthly Premium

Total Monthly Premium

Wellness Premium Credits*

Net Monthly

Premium*

Employee Only

$40.00 N/A $40.00 $40.00* $0*

Employee + Child(ren)

$40.00 $184.60 $224.60 $40.00* $184.60*

Employee + Spouse

$40.00 $475.68 $515.68 $40.00* $475.68*

Employee + Family

$40.00 $506.64 $546.64 $40.00* $506.64*

*Assumes completion of three wellness activities

Completing Open Enrollment

• Action must be taken during Open Enrollment:• Choose a health plan• Decide whom to cover• Complete wellness activities

• Remember, NC Flex Benefits enrollment in Oct. also.• Online enrollment only – https://shp-login.hrtintouch.com• Effective January 1, 2014 through December 31, 2014

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If you do not complete your enrollment by October 31, 2013, you, and any currently covered family members will be enrolled

in the Traditional 70/30 Plan effective Jan. 1, 2014.

Enrollment Instructions

eEnroll• All changes need to be done through the eEnroll system by logging in to the system at https://shp-login.hrintouch.com

• For assistance in navigating eEnroll members can call Benefitfocus Customer Service at 855-859-0966.

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NC FLEX – Vision Changes

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Plan 1 Basic Plan Exam and MaterialsNEW FOR 2014  Reduced premiums$20.00 co-pay on contact lens exam.Increased frame allowance to $125 retailNew calendar year frequency.

Plan 2 Materials only No longer available

Plan 3 Enhanced Plan Enhanced Exam and materialsNEW FOR 2014  Reduced premiums$20.00 co-pay on contact lens exam.Increased frame allowance to $175 retailNew calendar year frequency.

NC FLEX – NEW Vision Benefit

• Core Wellness Exam• Annual Comprehensive Eye Exam• $20 copay• In-network providers only• Discounts on materials• No premium – but MUST enroll

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NC FLEX – NEW Group Term Life Option

• Employee and Spouse Coverage• Rates based on age of employee

• Employee and Child(ren) Coverage• Flat rate for child(ren) coverage

• If elected, premiums for Employee and Dependent(s) will be after-tax.

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NC Flex - Flexible Spending Accounts

• MUST re-enroll each year.• Employee-only contribution to reimburse yourself for eligible expenses

• Does not roll over• Not to be confused with HRA

• (Health Reimbursement Account)

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• Please READ your mail!

There will be 4 mailers sent to you to assist you in your decision.

• SHP Website• There will be 4 instructional videos posted to the Plan’s website.

• Premium Rate Calculator tool available online

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Resources for Members

Important Numbers

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• www.shp-login.hrintouch.com

• ELIGIBILITY AND ENROLLMENT for eEnroll855-859-0966

•• BLUE CROSS AND BLUE SHIELD OF NC

(BENEFITS, CLAIMS and HRA) 888-234-2416

www.shpnc.orgwww.nctreasurer.com

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Thank you!