The Local Choice Health Benefits Program 2005 Regional Meetings March 2005 1
What’s New? • • • Common. Health Programs New Plan Designs Broader Plan Choices Funding Requirements Financial Overview Renewal Requirements 2
What Else is New? • • • COBRA/USERRA/HIPAA Updates Dependent Definitions GASB 45 Medicare D Alternate ID #s General Housekeeping 3
Common. Health Linda Sweeney Rose O’Toole Stacey Dorton 4
The Local Choice Common. Health Continental Health Promotion 804 Moorefield Park Drive, Suite 304 Richmond, VA 23236 (804) 560 -4500 www. chp-online. com/tlc 5
Our Vision Statement For Common. Health is that: State and Local Choice employees in Virginia will be the healthiest in the nation The Common. Health Mission: To make a difference in the health of the employee and the workplace by: Integrating health into the work culture, Building trustworthy partnerships, Changing individual behavior. 6
What does Common. Health include? On-site Health Check Screening § § § § Total Cholesterol HDL Cholesterol Blood Glucose Blood Pressure Comprehensive Health Questionnaire Participant Incentive New Incentive for Common. Health Administrators achieving a 35% participation rate 7
What does Common. Health include? Annual Health Education Program § Small Steps, Big Rewards § Minutes Matter § Have a Ball with Fitness (Available July 2005) 8
What does Common. Health include? Baby Benefits This free program is designed to promote a healthy pregnancy and prevent premature birth. New Child Safety Seat Program offers a $30 reimbursement for the purchase and safe installment of a child safety seat. 1 -800 -828 -5891 9
What does Common. Health include? Breaking Free from Tobacco This program offers the support needed to quit and stay quit. Participants can receive an eight-week supply of nicotine patch or gum at no cost. 1 -800 -394 -6380 10
What does Common. Health include? The Compass Quarterly Newsletter Annual Health Improvement Challenge Fitness Center Discounts 11
National Employee Health & Fitness Day May 18, 2005 Promote the event at your location Sign up interested employees Choose a one-mile (about 15 minutes) walking course Contact your Common. Health Regional Coordinator to order step counters provided through The Governor’s Healthy Virginian’s Initiative Goal = 50 or more groups participate! Be on the lookout for information in the mail and on the Common. Health Web site. 12
Questions? Eastern Region – Tammy Glotz 1 -804 -379 -8568 or tglotz@chp-online. com Western Region – Stacey Dorton 1 -276 -739 -9961 or sdorton@chp-online. com Central Region – Rose O’Toole 1 -804 -378 -9914 or rotoole@chp -online. com Common. Health Manager – Linda Sweeney 1 -804 -560 -4500 or lsweeney@chp-online. com Visit us at www. chp-online. com/tlc Thank you for supporting Common. Health! 13
Anthem Blue Cross and Blue Shield Amy Feinman 14
Anthem Cross and Blue Shield The Local Choice 2005/2006 15
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • Look Back at 2004/2005 • 2005/2006 Changes • 2005/2006 Plans 16
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • Look Back at 2004/2005 – 10 new groups joined TLC – 1 group left TLC – Membership increased 4% – Maintained a 13% trend factor – Benefit analysis and plan changes 17
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • 2005/2006 Medical Plan Changes – – – New four plan design No lifetime benefit maximum on any product All plans have the same coverage and exclusion base All plans have Blue. Card All plans will have out of network coverage Copayments do not count towards the out of pocket calculation 18
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • 2005/2006 Medical Plan Changes – Key Advantage Expanded is the only plan with vision coverage. (Vision benefits will continue to be on a 24 month basis. The 24 months begins the month you have your eye exam, or purchase frames, lens, or contact lenses. ) – This year only, because of the elimination of 4 plans, 4 th quarter deductible carryover will apply for all plan changes. 19
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • Really Good News – New member handbooks will be published this year. – They will have a standard format with inserts for plan specific coverage amounts. 20
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • 2005/2006 Plans – Please refer to your comparison charts. 21
Anthem Blue Cross and Blue Shield The Local Choice 2005/2006 • Questions? 22
Value. Options Nathan Coley Joseph E. Chodkiewicz 23
March 7, 2005 24
Value. Options • • Founded by a psychiatrist Clinically focused delivery system Over 25 years of EAP experience 84, 000 provider locations- 23 million covered lives for managed care • Virginia based employer 25
Value. Options • Mental Illness/Substance Abuse and EAP Benefits • Dedicated toll free number: 866 -725 -0602 • Website: www. achievesolutions. net/tlc 26
Value. Options 27
Value. Options Employee Assistance Program Benefits • Four sessions per problem per year with no cost to the member • Everyone in the household is eligible • Provides confidential, professional counseling, education and referral services 28
Value. Options EAP Offers help with a variety of issues: • Marital and family problems • Alcohol and /or drug abuse assessment • Balancing work and family • Work-related concerns • Financial or legal issues (including mediation services) • Grief and loss • Personal growth and development 29
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Value. Options 31
Value. Options Mental Illness/Substance Abuse • • Call 866 -725 -0602 for pre-certification Certification is based on medical necessity Benefit coverage is based on provider status Out of Network benefit, when available, provides lower coverage and providers may balance bill the member 32
Value. Options Medical Necessity • • • The service must be appropriate and essential for the evaluation and/or treatment of a mental disorder. The service must expect to improve a patient’s condition or level of functioning, and/or prevent regression. The service must meet national standard of practice. 33
Value. Options As of June 30, 2005, The following plans are no longer offered: • Cost Alliance • Value Alliance • Key. Share 34
Value. Options Beginning July 1, 2005 The TLC Program will offer 4 new plans: Key Advantage Expanded Key Advantage 200 Key Advantage 300 Key Advantage 500 35
Value. Options Questions? ? ? 36
Thank you! www. valueoptions. com 37
Medco Derek Fredenburg Robin Nieman 38
The Local Choice Rx Benefit administered by Medco Presenter: Derek Fredenburg George Bognar 39
New Copay Information Effective upon group renewal date (July or Oct) Retail (per 34 day supply) Mail (34 day supply or less charges retail copay, 35 to 90 charges mail copay) Tier 1 (Typically Generics) $15 $30 Tier 2 (Typically lower cost brand-name drugs) $20 $40 Tier 3 (Typically higher cost brand-name drugs) $35 $70 If a brand name drug has a generic equivalent, the member pays the difference between the two if the brand name drug is requested. 40
Medco Customer Service for TLC 1 -800 -355 -8279 Accessible 24 hours a day, seven days a week (except for Thanksgiving and Christmas) How can this help me? 1. Ask a pharmacist…. 2. Refill a prescription 3. Order new mail order forms 4. Locate a retail pharmacy 5. Get a copay quote These are only some of things we can assist you 41 with.
Retail Pharmacy 1. When you need a drug on a short term basis 2. Over 50, 000 stores in the network nationwide 3. All major chains are in the network 4. A retail copay is applied per 34 day supply of medication, up to a 102 day supply (3 month) with one prescription 42
medco. com secure and convenient prescription management for members Award winning member website • Verified Internet Pharmacy Practice Sites (VIPPS™) A Program of the National Association of Boards of Pharmacy What can I do? 1. Refill medications by mail on line 2. Get the status of a Mail Rx Order 3. Copay quotes 4. Ask a pharmacist 5. Find a retail pharmacy 6. Is my medication covered? 43
Medco by Mail 1. For prescription medications you use on a regular basis 2. Dedicated primary mail pharmacy just for TLC and State employees – located on Richmond VA PO Box 35030 Richmond VA 23235 -0030 3. Wilson Rx Award - Medco has re-earned the distinction of being named the nation's top-rated PBM and mail order pharmacy in the Wilson. Rx Pharmacy Benefit Satisfaction Report 2004. 4. Safe, convenient, cost effective, and it is quick. 44
Delta Dental of Virginia Duncan Sheils Matt Macdonald Terri Green 45
Dental Benefit Solutions 46
Discussion Points • • • History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference 47
Discussion Points • • • History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference 48
History of Dental Service Plans • • • 1954 – International Longshoreman’s Union and dental professionals create dental care program for Union’s children – First not-for-profit dental service plan created, (Washington State Dental Service - now Delta Dental of Washington). 1955 – Similar organizations created by dental societies in CA and OR. 1963 – Aerojet-General Corp first large company to buy a dental program. 1966 – ADA established the National Association of Dental Service Plans - forerunner of Delta Dental Plans Association. – Organization’s main purpose to increase the availability of dental services to the public 1970 s – Commercial insurers enter dental marketplace 49
Discussion Points • • • History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference 50
Current Dental Marketplace IBIS Study, 2000 -2004 51 55% of the US population has group dental insurance
Delta Dental National Enrollment IBIS Study, 2000 -2004 52
Competitive Landscape National Market Share 53
Discussion Points • • • History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference 54
Current Dental Marketplace Transition to PPO products • PPO products are continuing to capture more than 50% of new covered lives • DMO business continues to lag with a continued 55 negative outlook for future sales
Premium Trends Medical trends continue to outpace dental trends. 56
Benefit Trends • • • Composite fillings on posterior teeth Invisalign braces TMJ Cleanings-four/year (periodontal cleanings) Implants Consumer directed healthcare 57
Discussion Points • • • History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference 58
The Local Choice Dental Plans Effective 7/1/05 and 10/1/05 Key Advantage Expanded Key Advantage 200, 300, 500 Diagnostic & Preventive Services 100% Premier Allowance Basic Services 80% Premier Allowance Major Services 50% Premier Allowance Orthodontia 50% Premier Allowance Deductibles Maximums $25 ind. / $75 family $1, 500 annual $1, 500 lifetime ortho $25 ind. / $75 family $1, 200 annual $1, 200 lifetime ortho 59
Discussion Points • • • History of Dental Benefits Dental Plan Enrollment Costs and Trends Plan Changes for 2005 The Delta Difference 60
Who Is Delta Dental? • The largest and most experienced provider of group dental benefits nationally • Delta Dental Plans Association – 38 plans with a common mission & focus – Shared national provider networks – National Provider File 61
Superior Networks and Access Delta. Premier • Largest Network Available Anywhere! • 136, 500 dental offices • 2675 Participating Premier Providers in Virginia (79% of all providers statewide) • 29 million members • 82% of TLC/School groups using a Premier provider • 77% of TLC Government groups using a Premier provider • 210 New Premier Providers since 4/1/04 62
National Networks… With Local Control • Seamless network of Delta Dental Plans across the country • Recruitment and management of provider networks performed by local representatives • Professional Relations staffs are well versed on concerns with specific offices or local dental societies - part of the community • Delta Dental offers the best of both worlds – Ability to offer national networks, while providing local support for providers 63
State-of-the-Art Technology DCS 2000® Claims System • Single site for claims processing and customer service • Designed specifically for dental claims • Server-based, Windows technology • Paperless processing 64
Superior Performance 98. 6% 100% 99. 8% Our service and administration are consistently ranked among the best in the industry. 65
Internet Website: www. deltadentalva. com • Find Participating Dentists • Check Benefit Design • Check Claims • Annual Maximum Status • Real Time/On-line Enrollment • Deductible Status 66
Making a Difference in the Community Fulfilling our mission of providing affordable oral healthcare to all Virginians 67
The Delta Difference! • Total Focus on Dental Benefits • Largest, Most Experienced Dental Benefits Carrier in the Nation • Aggressive Cost Management • Superior Network Access • Proprietary DCS 2000® Dental Claims System • Community Involvement • Satisfied Customers! 68
Broader Plan Choices • 25 or fewer - any one plan. • 26 to 100 - any two plans, one of which may be the Regional HMO, if available • 100+ - any two self funded plans plus the Regional HMO, if available 69
Funding Requirements • Full Time Ø 80% of average single rate Ø 20% of average dependent rate if less than 75% participation. • Part Time Ø 40% of average single rate Ø 10% of average dependent rate if less than 75% participation 70
TLC/DHRM Financial Overview T. J. Clayton George Gibbs Walt Norman 71
Renewal Requirements • Data Sheet • Memo of Understanding • Group Profile Sheet 72
COBRA Update • Regulations finally final • New Requirements – Q/Bs to provide certain notices to plan (divorce, etc. ) – Notice of Unavailability – Termination Notice • Changes to Initial Notice, Election Notice – Recommend sending new initial notice to all • TLC will send materials prior to July 1, 2005 – Our forms must be used • TLC will allow 45 -day grace period on COBRA premiums 73
USERRA • Uniformed Services Employment and Reemployment Relief Act requires all groups regardless of size to offer 24 months of Extended Coverage for Active Duty Military call ups. 74
HIPAA • All groups regardless of size must send certificates of creditable coverage to terminating participants • MOU required • With QME, TLC will allow Plan Change effective 7/1/2005 or later. 75
Dependent Definition under WFTRA • Spouse – Legally recognized in VA • Children – To end of year turning age 23 regardless of student status – Lives at home or away at school – Unmarried – Receives over ½ of support from either or both parents (To be effective later in the year) 76
GASB 45 • Federal requirement that cost of retiree coverage be funded or carried as liability on books. • Private sector requirement since early 1990 s as FASB • TLC will provide guidance and data but each group will be responsible for any required actuarial certification and/or filings 77
Medicare D • • Still unclear Requires certification of creditable coverage TLC will initially let you know if creditable Awaiting further CMS guidance 78
Alternate ID #s • Effective 10/1/2005 TLC will issue alternate ID numbers to all covered employees • Still 4 ID cards 79
General Housekeeping • Life Evac Air Ambulance now in network • Reporting Medicare eligibility required • New email and web addresses: www. thelocalchoice. virginia. gov walter. norman@dhrm. virginia. gov 80
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