Updated DSGI Special Edition NL June 2010
Special Legislative Edition
Each year the General Appropriations Act, also called the state budget, sets the benefits for State of Florida employees. This year the budgeting process made some important changes to your health and life insurance benefits.
This special edition newsletter explains those and other plan changes, including recent federal changes from the Affordable Care Act. Please take time to read this issue carefully and take note of our open enrollment dates. This year, more than ever, you need to review your State Group Insurance benefits and take advantage of your once-a-year opportunity to make any and all the changes you want. Doing so will ensure you and your family have the benefits you need for the plan year that starts January 1, 2011. Finally, remember that we are a pretax cafeteria plan (see our February newsletter). This means you can only make changes during open enrollment or other times throughout the year if you have a Qualifying Status Change (QSC) event. Most of the benefit and premium changes listed in the budget do not meet the federal definition of a QSC event. That means you need to take advantage of this year’s open enrollment to make changes to your State Group Insurance benefits for the 2011 plan year.
Director Division of State Group Insurance
2010 Open Enrollment Calendar of Events
State Group Ins ur anc Director’s Corner e
June 2010
Newsletter
September 10
September 13 through September 24 September 27 through October 22 September 27 through October 15 October 25 through November 5
Verify your address—it must be correct in People First by 5 p.m. Eastern time to be sure you receive your open enrollment information in the mail. Look for your packet in the mail. Open Enrollment— complete all changes by 6 p.m. Eastern time. Benefit Fairs—see schedule. Correction Period— make corrections by 6 p.m. Eastern time.
Did You Know?
The State of Florida began covering certain services for the diagnosis and treatment of autism spectrum disorders in January of this year. Learn more about what is covered at MyFlorida.com/MyBenefits.
Health Insurance Premium Changes Effective July 2010 for August Coverage Any state employees with employer-paid health insurance will begin to pay monthly premiums. The payroll deductions for those premiums begin in July for August coverage. This includes employees in Selected Exempt Service (SES), Senior Management Service (SMS) and comparable positions, as well as employees in the Spouse Program (both the husband and wife work for the State of Florida). Premium amounts below are monthly amounts. If you are paid on a biweekly basis, divide the amount by two to find out how much the state will deduct from your paycheck starting in July. Coverage Tier
SES/SMS Employees
Individual coverage
$8.34
Family coverage
$30
Coverage Tier
Spouse Program
Options Make the changes you want during open enrollment, including coverage cancellation, effective January 1, 2011. This is a significant cost increase QSC event; therefore, you may cancel or change to individual coverage by August 1, 2010, for the rest of the plan (calendar) year. Otherwise, you can make changes during open enrollment for an effective date of January 1, 2011.
Options
Individual coverage
NA
Spouse Program coverage is family coverage.
Family coverage
$30
This is a significant cost increase QSC event; therefore, you may cancel or change to individual coverage by August 1, 2010, for the rest of the plan (calendar) year. However, if you and your spouse are Career Service employees, staying in the spouse program is still your least expensive option. The least expensive option for married SES/SMS employees who do not have other dependents is to enroll in two individual plans.
(Each participant pays $15 per month.)
For all other state employees, the current rates of $50 per month for individual coverage ($15 for health investor plans) and $180 per month for family coverage ($64.30 for health investor plans) are not changing at this time.
Tax-favored Accounts Changes Effective January 1, 2011 • Medical Reimbursement Account (MRA) Debit Card—Additional Benefit • If you enroll in an MRA or limited purpose MRA for 2011, you will receive a debit card in the mail sometime in December. After you activate the card, you can use it to pay for eligible medical expenses, such as your doctor’s office copay, glasses and prescription drugs. The card works like any other debit card, provided the expense is eligible, you have money in your account and you are within the plan year reimbursement period. Look for more information about this convenient, new option in upcoming publications. • Health Savings Account (HSA) and MRA Over-the-Counter Medications Change • You must have a doctor’s prescription to pay for over-the-counter (OTC) medications using funds from your HSA or to file an MRA claim; for example, if you take a daily OTC allergy medicine, ask your doctor to write a prescription and then submit the prescription with your MRA claim. If you have an HSA, you should keep the prescription with your OTC receipt.
Health Insurance Plan Changes Effective January 1, 2011 There are two types of plans through the State Group Insurance Program: the standard plan and the health investor plan (lower monthly premium, high annual deductible). Each of these is available in either the PPO Plan or an HMO. The copayment changes listed in this section are for the standard plans. Health investor plans do not have copayments.
Provider Services Copay Changes Services
State Employees’ PPO Plan
All HMOs
Current Copay
Copay as of Jan. 1, 2011
Current Copay
Copay as of Jan. 1, 2011
Urgent care physician visit
$15
$25
$15
$25
Emergency room visit
$50
$100
$50
$100
Primary care physician visit
$15, unchanged
$15
$20
Specialist physician visit
$25, unchanged
$25
$40
State Employees’ PPO Plan Additional Benefits Effective January 1, 2011, the State Employees’ PPO Plan will: • Cover routine/preventive mammograms as a preventive service; they will no longer apply to the deductible. • Eliminate the $2 million lifetime maximum. • Eliminate the pre-existing condition exclusions for dependents until their 19th birthday.
Prescription Drug Copay Changes The prescription drug copays for the standard plans are changing. The cost of generic prescriptions is going down. See our May 2010 newsletter for ways to save money on your prescription and over-the-counter drugs. State Employees’ PPO Plan and HMO Plans
Retail (up to a 30-day supply)
Mail Order (up to a 90-day supply)
Current Copay
Copay as of Jan. 1, 2011
Current Copay
Copay as of Jan. 1, 2011
Generic drugs
$10
$7
$20
$14
Preferred brand name drugs
$25
$30
$50
$60
Nonpreferred brand name drugs
$40
$50
$80
$100
Remember, with all State Group Insurance prescription drug plans, you have two ways to fill your prescriptions: 1. Retail—use your insurance card at the pharmacy for short-term medications and those that must be filled immediately. 2. Mail order—send your maintenance prescriptions to the mail order pharmacy and get up to a 90-day supply for the cost of two months. Prescription Drug Mail Order Requirement—State Employees’ PPO Plan Only If you are enrolled in the State Employees’ PPO Plan, you will be allowed to fill certain maintenance prescriptions up to three months at a retail pharmacy. After that, you will be required to send these prescriptions to the mail order pharmacy—a great money saver for you! Prescription Drug Additional Benefit—Smoking Cessation All State Group health plans will offer smoking cessation prescription drug benefits. You pay applicable copays, coinsurance and/or deductibles. This benefit is limited to up to a six-month supply in any plan (calendar) year, with a lifetime maximum benefit of no more than nine months.
HMO Name Change Members of VISTA will receive letters and new ID cards under the company’s new name, Coventry Health Care.
Eligibility Change Effective January 1, 2011 The eligibility requirements for dependents up to age 26 change effective Jan. 1, 2011. Birth up to Age 26
Current Requirements
New Requirements as of Jan. 1, 2011
Dependents must: • Be single
Dependents ages 19 through the end of the calendar year in which they turn 26 must:
• Depend on you for financial support
• Be your legal dependents.
• Live with you or be enrolled in school (ages 19 up to 26)
• Not have access to other insurance coverage, such as through their jobs or through Medicare or Medicaid. Please note: If your dependent is married, only your dependent is eligible to be covered under your plan.
Proof of Eligibility
Health plans request annual verification of dependents ages 19 up to 26 who are enrolled in your family plan.
Health plans no longer request annual eligibility verification for dependents up to age 26.
You Should Know
For the remainder of this plan year, dependents ages 19 up to 26 who do not meet these requirements and dependents ages 26 up to 30 are eligible for the over-age dependent health plan. You pay an additional monthly premium to cover each dependent in this age bracket.
You can add eligible dependents to your family plan during open enrollment with an effective coverage date of Jan. 1, 2011. Eligible dependents remain covered through the end of the calendar year in which they turn 26. Adding eligible dependents to your plan is a three-step process: 1. Enter your dependents’ personal information online in People First. You must provide their Social Security numbers. 2. Add your dependents to each plan as appropriate in the enrollment screens. 3. Fax required documentation to People First at (800) 422-3128. No change for dependents ages 26-30. You pay an additional monthly premium.
Basic Life Insurance Change Effective January 1, 2011 The current basic life benefit (1.5 times or 2 times salary) ends this year. All full-time employees, regardless of classification, will have an automatic, free basic life insurance benefit of $25,000 beginning Jan. 1, 2011. Your employer pays the entire premium for this benefit. Part-time employees pay a prorated amount based on their FTE. For new employees, the coverage begins the first day they physically report to work. If you want to opt out of this coverage, you must make that election during open enrollment. For most state employees this is a reduction in life insurance coverage.
Optional Life Insurance Change Effective January 1, 2011 Minnesota Life offers additional benefits in the Optional Life insurance plan that you may elect during the upcoming open enrollment period. Premiums are based on your age bracket and how much coverage you want.
Optional Life Changes Current Benefits
New Benefits
Coverage Tiers
• • • • •
1 times salary 2 times salary 3 times salary 4 times salary 5 times salary 6 times salary 7 times salary
Maximum Benefit
• Lesser of up to 5 times salary or $500,000… ………… Lesser of up to 7 times salary or $1,000,000
Maximum Guaranteed Issue
• Lesser of up to 5 times salary or $500,000… ………… No change
Proof of Good Health
1 times salary… 2 times salary… 3 times salary… 4 times salary… 5 times salary…
…………………………………………………… …………………………………………………… …………………………………………………… …………………………………………………… ……………………………………………………
• You may increase existing Optional Life … …………… No change coverage by one increment (for example, from 3 times salary to 4 times salary), as long as the amount does not exceed $500,000 or 5 times salary. • To increase by more than one increment … ………… During this open enrollment period only, you can or to enroll for the first time, you must enroll for the first time for coverage 1 times your provide proof of good health. annual salary without providing proof of good health. • New employees can enroll in the lesser … …………… No change of up to 5 times salary or $500,000 within their 60-day QSC event window without providing proof of good health. Proof of good health required for any coverage greater than $500,000 or for times 6 or 7 times salary.
You Should Know
• Current benefits are valid through … …………………… If you apply for Optional Life coverage that requires December 31, 2010. proof of good health and it is not approved, you will be enrolled in the highest coverage available without proof of good health. For example, you have 2 times salary Optional Life coverage and apply for 4 times salary. You must provide proof of good health. If you fail proof of good health, you are enrolled in 3 times salary because moving up one tier is guaranteed (for tiers 2 times to 5 times salary or less than $500,000).
Next Steps 1. Stay informed—visit http://www.myflorida.com/mybenefits/Health/Health.htm or http://dms.myflorida.com/dsgi for updates. 2. Prepare—read your open enrollment materials when they come in September. 3. Act—check your elections in People First to be sure you have the plans you need and that all eligible dependents are added to each plan. Also be sure to remove any ineligible dependents from your plans.
Remember, it’s your health, your benefits and your decision!
Each year the General Appropriations Act, also called the state budget, sets the benefits for State of Florida employees. This year the budgeting process made some important changes to your health and life insurance benefits.
This special edition newsletter explains those and other plan changes, including recent federal changes from the Affordable Care Act. Please take time to read this issue carefully and take note of our open enrollment dates. This year, more than ever, you need to review your State Group Insurance benefits and take advantage of your once-a-year opportunity to make any and all the changes you want. Doing so will ensure you and your family have the benefits you need for the plan year that starts January 1, 2011. Finally, remember that we are a pretax cafeteria plan (see our February newsletter). This means you can only make changes during open enrollment or other times throughout the year if you have a Qualifying Status Change (QSC) event. Most of the benefit and premium changes listed in the budget do not meet the federal definition of a QSC event. That means you need to take advantage of this year’s open enrollment to make changes to your State Group Insurance benefits for the 2011 plan year.
Director Division of State Group Insurance
2010 Open Enrollment Calendar of Events
State Group Ins ur anc Director’s Corner e
June 2010
Newsletter
September 10
September 13 through September 24 September 27 through October 22 September 27 through October 15 October 25 through November 5
Verify your address—it must be correct in People First by 5 p.m. Eastern time to be sure you receive your open enrollment information in the mail. Look for your packet in the mail. Open Enrollment— complete all changes by 6 p.m. Eastern time. Benefit Fairs—see schedule. Correction Period— make corrections by 6 p.m. Eastern time.
Did You Know?
The State of Florida began covering certain services for the diagnosis and treatment of autism spectrum disorders in January of this year. Learn more about what is covered at MyFlorida.com/MyBenefits.
Health Insurance Premium Changes Effective July 2010 for August Coverage Any state employees with employer-paid health insurance will begin to pay monthly premiums. The payroll deductions for those premiums begin in July for August coverage. This includes employees in Selected Exempt Service (SES), Senior Management Service (SMS) and comparable positions, as well as employees in the Spouse Program (both the husband and wife work for the State of Florida). Premium amounts below are monthly amounts. If you are paid on a biweekly basis, divide the amount by two to find out how much the state will deduct from your paycheck starting in July. Coverage Tier
SES/SMS Employees
Individual coverage
$8.34
Family coverage
$30
Coverage Tier
Spouse Program
Options Make the changes you want during open enrollment, including coverage cancellation, effective January 1, 2011. This is a significant cost increase QSC event; therefore, you may cancel or change to individual coverage by August 1, 2010, for the rest of the plan (calendar) year. Otherwise, you can make changes during open enrollment for an effective date of January 1, 2011.
Options
Individual coverage
NA
Spouse Program coverage is family coverage.
Family coverage
$30
This is a significant cost increase QSC event; therefore, you may cancel or change to individual coverage by August 1, 2010, for the rest of the plan (calendar) year. However, if you and your spouse are Career Service employees, staying in the spouse program is still your least expensive option. The least expensive option for married SES/SMS employees who do not have other dependents is to enroll in two individual plans.
(Each participant pays $15 per month.)
For all other state employees, the current rates of $50 per month for individual coverage ($15 for health investor plans) and $180 per month for family coverage ($64.30 for health investor plans) are not changing at this time.
Tax-favored Accounts Changes Effective January 1, 2011 • Medical Reimbursement Account (MRA) Debit Card—Additional Benefit • If you enroll in an MRA or limited purpose MRA for 2011, you will receive a debit card in the mail sometime in December. After you activate the card, you can use it to pay for eligible medical expenses, such as your doctor’s office copay, glasses and prescription drugs. The card works like any other debit card, provided the expense is eligible, you have money in your account and you are within the plan year reimbursement period. Look for more information about this convenient, new option in upcoming publications. • Health Savings Account (HSA) and MRA Over-the-Counter Medications Change • You must have a doctor’s prescription to pay for over-the-counter (OTC) medications using funds from your HSA or to file an MRA claim; for example, if you take a daily OTC allergy medicine, ask your doctor to write a prescription and then submit the prescription with your MRA claim. If you have an HSA, you should keep the prescription with your OTC receipt.
Health Insurance Plan Changes Effective January 1, 2011 There are two types of plans through the State Group Insurance Program: the standard plan and the health investor plan (lower monthly premium, high annual deductible). Each of these is available in either the PPO Plan or an HMO. The copayment changes listed in this section are for the standard plans. Health investor plans do not have copayments.
Provider Services Copay Changes Services
State Employees’ PPO Plan
All HMOs
Current Copay
Copay as of Jan. 1, 2011
Current Copay
Copay as of Jan. 1, 2011
Urgent care physician visit
$15
$25
$15
$25
Emergency room visit
$50
$100
$50
$100
Primary care physician visit
$15, unchanged
$15
$20
Specialist physician visit
$25, unchanged
$25
$40
State Employees’ PPO Plan Additional Benefits Effective January 1, 2011, the State Employees’ PPO Plan will: • Cover routine/preventive mammograms as a preventive service; they will no longer apply to the deductible. • Eliminate the $2 million lifetime maximum. • Eliminate the pre-existing condition exclusions for dependents until their 19th birthday.
Prescription Drug Copay Changes The prescription drug copays for the standard plans are changing. The cost of generic prescriptions is going down. See our May 2010 newsletter for ways to save money on your prescription and over-the-counter drugs. State Employees’ PPO Plan and HMO Plans
Retail (up to a 30-day supply)
Mail Order (up to a 90-day supply)
Current Copay
Copay as of Jan. 1, 2011
Current Copay
Copay as of Jan. 1, 2011
Generic drugs
$10
$7
$20
$14
Preferred brand name drugs
$25
$30
$50
$60
Nonpreferred brand name drugs
$40
$50
$80
$100
Remember, with all State Group Insurance prescription drug plans, you have two ways to fill your prescriptions: 1. Retail—use your insurance card at the pharmacy for short-term medications and those that must be filled immediately. 2. Mail order—send your maintenance prescriptions to the mail order pharmacy and get up to a 90-day supply for the cost of two months. Prescription Drug Mail Order Requirement—State Employees’ PPO Plan Only If you are enrolled in the State Employees’ PPO Plan, you will be allowed to fill certain maintenance prescriptions up to three months at a retail pharmacy. After that, you will be required to send these prescriptions to the mail order pharmacy—a great money saver for you! Prescription Drug Additional Benefit—Smoking Cessation All State Group health plans will offer smoking cessation prescription drug benefits. You pay applicable copays, coinsurance and/or deductibles. This benefit is limited to up to a six-month supply in any plan (calendar) year, with a lifetime maximum benefit of no more than nine months.
HMO Name Change Members of VISTA will receive letters and new ID cards under the company’s new name, Coventry Health Care.
Eligibility Change Effective January 1, 2011 The eligibility requirements for dependents up to age 26 change effective Jan. 1, 2011. Birth up to Age 26
Current Requirements
New Requirements as of Jan. 1, 2011
Dependents must: • Be single
Dependents ages 19 through the end of the calendar year in which they turn 26 must:
• Depend on you for financial support
• Be your legal dependents.
• Live with you or be enrolled in school (ages 19 up to 26)
• Not have access to other insurance coverage, such as through their jobs or through Medicare or Medicaid. Please note: If your dependent is married, only your dependent is eligible to be covered under your plan.
Proof of Eligibility
Health plans request annual verification of dependents ages 19 up to 26 who are enrolled in your family plan.
Health plans no longer request annual eligibility verification for dependents up to age 26.
You Should Know
For the remainder of this plan year, dependents ages 19 up to 26 who do not meet these requirements and dependents ages 26 up to 30 are eligible for the over-age dependent health plan. You pay an additional monthly premium to cover each dependent in this age bracket.
You can add eligible dependents to your family plan during open enrollment with an effective coverage date of Jan. 1, 2011. Eligible dependents remain covered through the end of the calendar year in which they turn 26. Adding eligible dependents to your plan is a three-step process: 1. Enter your dependents’ personal information online in People First. You must provide their Social Security numbers. 2. Add your dependents to each plan as appropriate in the enrollment screens. 3. Fax required documentation to People First at (800) 422-3128. No change for dependents ages 26-30. You pay an additional monthly premium.
Basic Life Insurance Change Effective January 1, 2011 The current basic life benefit (1.5 times or 2 times salary) ends this year. All full-time employees, regardless of classification, will have an automatic, free basic life insurance benefit of $25,000 beginning Jan. 1, 2011. Your employer pays the entire premium for this benefit. Part-time employees pay a prorated amount based on their FTE. For new employees, the coverage begins the first day they physically report to work. If you want to opt out of this coverage, you must make that election during open enrollment. For most state employees this is a reduction in life insurance coverage.
Optional Life Insurance Change Effective January 1, 2011 Minnesota Life offers additional benefits in the Optional Life insurance plan that you may elect during the upcoming open enrollment period. Premiums are based on your age bracket and how much coverage you want.
Optional Life Changes Current Benefits
New Benefits
Coverage Tiers
• • • • •
1 times salary 2 times salary 3 times salary 4 times salary 5 times salary 6 times salary 7 times salary
Maximum Benefit
• Lesser of up to 5 times salary or $500,000… ………… Lesser of up to 7 times salary or $1,000,000
Maximum Guaranteed Issue
• Lesser of up to 5 times salary or $500,000… ………… No change
Proof of Good Health
1 times salary… 2 times salary… 3 times salary… 4 times salary… 5 times salary…
…………………………………………………… …………………………………………………… …………………………………………………… …………………………………………………… ……………………………………………………
• You may increase existing Optional Life … …………… No change coverage by one increment (for example, from 3 times salary to 4 times salary), as long as the amount does not exceed $500,000 or 5 times salary. • To increase by more than one increment … ………… During this open enrollment period only, you can or to enroll for the first time, you must enroll for the first time for coverage 1 times your provide proof of good health. annual salary without providing proof of good health. • New employees can enroll in the lesser … …………… No change of up to 5 times salary or $500,000 within their 60-day QSC event window without providing proof of good health. Proof of good health required for any coverage greater than $500,000 or for times 6 or 7 times salary.
You Should Know
• Current benefits are valid through … …………………… If you apply for Optional Life coverage that requires December 31, 2010. proof of good health and it is not approved, you will be enrolled in the highest coverage available without proof of good health. For example, you have 2 times salary Optional Life coverage and apply for 4 times salary. You must provide proof of good health. If you fail proof of good health, you are enrolled in 3 times salary because moving up one tier is guaranteed (for tiers 2 times to 5 times salary or less than $500,000).
Next Steps 1. Stay informed—visit http://www.myflorida.com/mybenefits/Health/Health.htm or http://dms.myflorida.com/dsgi for updates. 2. Prepare—read your open enrollment materials when they come in September. 3. Act—check your elections in People First to be sure you have the plans you need and that all eligible dependents are added to each plan. Also be sure to remove any ineligible dependents from your plans.
Remember, it’s your health, your benefits and your decision!
