2016 Open Enrollment
Open Enrollment Dates
November 9 – November 20
THINGS TO KNOW
• TO HAVE COVERAGE IN 2016, YOU ARE REQUIRED TO MEET
WITH A BENEFITS COUNSELOR OR GO ON-LINE TO ENROLL.
• BENEFITS COUNSELORS ARE THROUGH COLONIAL LIFE.
THEY WILL ENROLL YOU FOR ALL BENEFITS
MEDICAL,DENTAL, VISION, FLEXIBLE SPENDING ACCOUNTS
AND VOLUNTARY BENEFITS.
• ELIGIBILITY FOR MEDICAL & DENTAL HAS NOT CHANGED. IF
YOU ARE NOT ELIGIBLE FOR MEDICAL & DENTAL TODAY,
YOU ARE STILL NOT ELIGIBLE.
• EVERYONE IS ELIGIBLE FOR VISION AND IT IS A VOLUNTARY
PLAN.
• EVERYONE IS ELIGIBLE FOR VOLUNTARY BENEFITS.
MEDICAL
4 PLANS
• ***NEW PLAN***NPOS $500- $500/$1000 DEDUCTIBLE THEN 90%,
$2500/$5000 MAX OOP (INCLUDES DED & COINSURANCE), $20 OV/$40 SP, $200 ER
COPAY, $15/$35/$55/25% RX.
• ***NEW PLAN***COVERAGE 1ST $1500- $500 PMPY BENEFIT
ALLOWANCE, $1500/$3000 DEDUCTIBLE THEN 80%, $4500/$9000 MAX
OOP (INCLUDES DED & COINSURANCE), $30 OV/$50 SP, $200 ER COPAY,
$15/$35/$55/25% RX
• HDHP $2650- $2650/$5250 DEDUCTIBLE THEN 100%
• HDHP $5000- $5000/$10000 DEDUCTIBLE THEN 100%
ALL PLANS
• PREVENTIVE CARE COVERED AT 100%*
• BIRTH CONTROL COVERED AT 100%**
• PRESCRIBED SMOKING CESSATION PRODUCTS COVERED AT 100%
• DIABETIC SUPPLIES COVERED AT 100%
*100% COVERAGE DEPENDS ON DIAGNOSIS CODE PROVIDED ON CLAIM
**IUDS/NON ORAL BIRTH CONTROL MAY NOT BE COVERED AT 100%
SHOULD I SWITCH PLANS?
THINGS TO CONSIDER….
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HOW YOU UTILIZE BENEFITS. ARE YOU A CASUAL USER OR DO YOU
GENERALLY MEET YOUR DEDUCTIBLE AND COINSURANCE.
TOTAL COSTS = (PER PAY PREMIUM + DED/COPAYS/COINSURANCE) EVALUATE
BASED ON IF YOU USE PLAN TO THE FULLEST OR IF YOU ONLY USE PLAN
CASUALLY.
PRESCRIPTION COSTS. IF CONSIDERING MOVING TO THE HDHP YOU WILL
WANT TO CHECK WITH YOUR PHARMACIST ON THE COST OF YOUR
PRESCRIPTIONS. GENERALLY PRESCRIPTIONS ARE THE MOST EXPENSIVE
REOCCURRING COST ON AN HDHP. ON THE HDHP YOUR RX GOES TOWARDS
YOUR DEDUCTIBLE AT THE FULL COST LESS ANY DISCOUNTS.
MEDICARE ELIGIBLE. IF YOU ARE MEDICARE ELIGIBLE (65 OR OLDER) YOU
CAN NOT CONTRIBUTE OR HAVE MONEY CONTRIBUTED TO AN H.SA ON YOUR
BEHALF. ADDITIONALLY, AN HDHP IS CONSIDERED NON CREDIBLE COVERAGE
FOR RX. IF YOU ARE ENROLLED ON AN HDHP, YOU WILL BE PENALIZED 2% FOR
EACH MONTH YOU ARE ENROLLED ON AN HDHP AND ARE MEDICARE
ELIGIBLE. THIS PENALTY IS FOR THE LIFE OF YOUR ENROLLMENT ON
MEDICARE.
2016 H.SA INFO
• 2016 LIMITS. Individual with self-only coverage under a high deductible
health plan is $3,350. Individual with family coverage under a high
deductible health plan is $6,750.
– Employees 55 & older can do an additional $1000 per year as “catch up”
• USES. Can be used for all medical expenses outlined by IRS as qualified
medical expenses. Visit www.irs.gov for detailed listing. Dental and Vision
qualify as qualified expenses.
• FSA. You can only have an FSA with an H.SA for dental and vision
purposes. If you currently have an FSA and move to an HDHP with an H.SA
you have to exhaust all your FSA funds before contributing or having a
contribution towards an H.SA.
• ESTABLISHING AN H.SA. To start an H.SA you have to open an account
through Mainsource Bank. You can fill out a paper application with an
enroller or by contacting Deena. Or you can go to the Grant Line Rd.
Mainsource location and open an account.
2016 Prescription Updates
Humana released a letter in October that
overviewed that there are changes to the 2016
Humana Drug List. If you are currently taking
maintenance medications please go online to
www.humana.com/druglist to see if there are
any changes in 2016 to your prescriptions.
• Changes can be from tier, prior authorization,
step therapy, quantity limits or not being
covered.
DENTAL
NO CHANGES TO DENTAL BENEFITS.
PLAN REMAINS THE SAME.
Only change is, you will see lower per
pay premium as NAFCS contribution
to dental has increased.
VISION
LIFE & LTD
• Life & LTD will now be deducted on a per pay basis. Eligibility has not
changed.
LIFE/AD&D/LTD
Effective 1/1/2016
Employee Only
Annual Cost
$
26.00 $
20 pays
22 pays
26 pays
1.30 $
1.18 $
1.00
COLONIAL LIFE
PRODUCTS OFFERED
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FLEXIBLE SPENDING ACCOUNTS
SHORT TERM DISABILITY
CANCER
CRITICAL CARE
VOLUNTARY LIFE
ACCIDENT
ENROLLMENT
PROCESS
• ENROLLMENT BEGINS ON NOV 9 AND WILL END
ON NOV 20
• YOU MUST MEET WITH A BENEFITS COUNSELOR
OR ENROLL ONLINE FOR COVERAGE OR TO
WAIVE
• BENEFITS COUNSELORS WILL:
– ENROLL YOU ON ALL BENEFITS YOU ARE CURRENTLY
ELIGIBLE FOR INCLUDING MEDICAL & DENTAL
– BE ABLE TO PROVIDE GUIDANCE FOR YOUR MEDICAL
CHOICES
– INPUT BENEFICIARY INFORMATION FOR GROUP BASIC
LIFE
• SIGN UP SHEETS ARE AT EACH LOCATION.
• EXPECT TO SPEND 15 MINUTES WITH A
BENEFITS COUNSELOR TO REVIEW BENEFITS
• YOU WILL NEED YOUR SPOUSE & DEPENDENT
SOCIAL SECURITY NUMBERS. IF YOU HAVE
RECENTLY SUBMITTED THEM TO HUMANA OR
DEENA, THEY MAY NOT BE UPDATED IN THE
SELERIX SYSTEM SO YOU WILL MORE THAN
LIKELY NEED TO PROVIDE THEM AGAIN.
QUESTIONS???