What Do I Need to Know About Open Enrollment?
- Medical, Dental and Vision benefit enrollment WILL NOT rollover.
- You WILL NOT HAVE INSURANCE coverage in 2010 for any of these benefits if you do not ENROLL DURING THIS OPEN ENROLLMENT for a January 1, 2010 effective date.
- Employee/Dependent Supplemental Life coverage will rollover. You may change your benefit elections or they will remain the same, if no action is taken.
What Has Changed?
- Benefit plan design changes and premium increases for the existing Open Access Select (co-pay) plan.
- Two NEW medical plan options (HRA/HSA) have been added. (Existing Choice POS II has been eliminated.)
- New vision plan with two plan design options will replace the current plan.
- Dental plan options remain the same. Premiums will increase 7%.
- Four tier premium structure replaces the current three tiers for Medical, Dental and Vision plans.
What Coverage Do I Have Now?
You can check your current health benefits selections through Oracle Self Service by:
- STEP 1: Login to Oracle Self Service
- STEP 2: Select "App Logon Links" to bring up the login page
- STEP 3: Select "E-Business Home Page Links" to bring up the login page
- STEP 4: Login with your Oracle username and password
- STEP 5: Select "BoCC Self Service" Link
- STEP 6: Select "Benefits" Link to review your current benefits selection
What If I Forgot My Oracle Self Service Username or Password?
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What Do I Need to Do to Enroll?
Review New Health Plan Options
Review the new options and decide which option best suits your needs.
Attend an Open Enrollment Meeting
Attend one of the Open Enrollment Meetings. To attend an open enrollment meeting this year, you will need to register online. This will ensure space is available for everyone since capacity is limited at each meeting location.
Enroll Online through Oracle Self Service (paper enrollment is not an option)
Open enrollment is between October 20th - November 20th, 2009.
Login to Oracle Self Sevice
Reminder: If you do not enroll in Medical, Dental and Vision online, YOU WILL NOT HAVE INSURANCE coverages as of January 1,2010.
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Tools and Resources
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Four Tier Structure
|
| Employee Only |
No dependents covered |
| Employee + Spouse |
No children covered |
| Employee + Children |
One or more children covered (spouse not covered) |
| Employee + Family |
Spouse and one or more children covered |
Option 1: Open Access Select (*Same as Current Plan)
|
| Bi-weekly Employee Premium Contributions Chart |
|
|
|
|
|
| Employee Only |
$39.00 |
$50.00 |
$11.00 |
| Employee + Children |
|
$98.95 |
|
| Employee + Spouse |
$96.50 |
$125.88 |
$29.38 |
| Employee + Family |
$139.50 |
$193.23 |
$53.73 |
Option 2:HRA - Health Reimbursement Account(*New)
|
| Bi-weekly Employee Premium Contributions Chart |
|
|
|
|
|
| Employee Only |
|
$39.00 |
|
| Employee + Children |
|
$75.81 |
|
| Employee + Spouse |
|
$97.31 |
|
| Employee + Family |
|
$151.04 |
|
Option 3:HSA - Health Savings Account(*New)
|
| Bi-weekly Employee Premium Contributions Chart |
|
|
|
|
|
| Employee Only |
|
$39.00 |
|
| Employee + Children |
|
$75.81 |
|
| Employee + Spouse |
|
$97.31 |
|
| Employee + Family |
|
$151.04 |
|
|
OPTION 1
|
OPTION 2
|
OPTION 3
|
|
Open Access Select
(Same as Current) |
HRA – Health Reimbursement Account
(New Option) |
HSA – Health Savings Account
(New Option) |
| Benefits & Services |
In Network |
Out of Network |
In Network |
Out of Network |
In Network |
Out of Network |
| Employer Paid Health Fund |
N/A
(*No Out of Network Benefits, except hospital emergency) |
$500 Individual
$1,000 Family
(Preventive Service = 100% Coverage in-network) |
$500 Individual
$1,000 Family
(Preventive Service = 100% Coverage in-network) |
| Co-Insurance |
80/20 (from 90/10) |
N/A |
80/20 |
60/40 |
80/20 |
60/40 |
| Annual Deductible |
NOW |
NEW |
|
|
|
|
|
| Individual |
$100 |
$450 |
N/A |
$1,650 |
$3,250 |
$1,875 |
$3,600 |
| All Family Tiers |
$300 |
$1,350 |
N/A |
$3,300 |
$6,500 |
$3,750 |
$7,200 |
| Annual Out-of-Pocket Maximum |
NOW |
NEW |
|
|
|
|
|
| Individual |
$2,000 |
$3,750 |
N/A |
$3,300 |
$6,500 |
$3,875 |
$4,100 |
| All Family Tiers |
$6,000 |
$11,250 |
N/A |
$6,600 |
$13,000 |
$7,750 |
$8,200 |
| Copays |
|
|
|
|
|
|
| Primary Care Physician |
$20 |
N/A |
N/A |
N/A |
N/A |
N/A |
| Specialist |
$30 |
N/A |
N/A |
N/A |
N/A |
N/A |
| Preventive Care Coverage |
Subject to Copays/Deductible/ Coinsurance |
N/A |
100%
Coverage |
100%
Coverage |
100%
Coverage |
100%
Coverage |
Prescription Drugs
|
Retail
(30-day supply) |
| $5 |
Generic |
| $25 |
Preferred Brand Name |
| $50 |
Non-Preferred Brand |
|
| $5 |
Generic |
| $25 |
Preferred Brand Name |
| $50 |
Non-Preferred Brand |
|
Deductible/Co-Insurance
*Some preventive prescriptions covered 100% in-network
Non-preventive prescriptions subject to deductible/coinsurance |
Mail Order
(90-day supply) |
| $12.50 |
Generic |
| $62.50 |
Preferred Brand Name |
| $125 |
Non-Preferred Brand |
|
| $12.50 |
Generic |
| $62.50 |
Preferred Brand Name |
| $125 |
Non-Preferred Brand |
|
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More About the Health Plan Options
|
OPTION 1
|
OPTION 2
|
OPTION 3
|
|
Open Access Select (EPO)
|
Health Reimbursement Account (HRA)
|
Health Savings Account (HSA)
|
|
|
No Out-of-Network Coverage |
In-network and Out-of-Network Coverage |
|
|
Subject to copays, deductibles, & Co-insurance |
100% Coverage (In Network Only) |
|
|
Each employee has an individual deductible limit of $450. Employees with a family (3 or more), a deductible limit of $1,350 must be met before benefits apply |
Employees who include family members on their plans:
- The entire family deductible amount must be met before any benefits apply. This is true regardless of whether it is the employee or the family member who seeks services
|
|
|
YES – Employee may use Flex Spending Account |
YES – Limited use available for Dental, Vision & other qualified expenses only |
|
|
No prescription drugs covered at 100% |
Some prescriptions covered 100% under the preventive benefit |
|
|
Prescription drug plan with set copays (no deductible/co-insurance) |
Allnon-preventive drugs subject to deductibles/co-insurance |
|
|
N/A |
Employer pays $500 Employee/$1,000 Family into a fund to use toward higher deductible. When funds are depleted, employee pays out-of-pocket until the net deductible is met. |
|
|
N/A – All copay/deductible expenses are paid out-of-pocket by employee |
All funds available at the beginning of the year to cover non-preventive claims and reduce employee deductible |
Funds available in increments per pay period. Employee can use the amount in the account at the time of service |
|
|
N/A |
Unused funds do not go with employee upon separation from employer |
Employee owns unused funds, and can transfer them or cash out. |
|
|
N/A |
Only employer may contribute to this account |
Employer, individuals and family members may contribute to this account up to 100% of deductible |
|
|
N/A |
Unused funds do not go with employee upon separation from employer |
Unlimited balance carries over year to year. Designed to set aside pretax earnings to pay for medical expenses. Deposits can be made up to retirement. Employees can withdraw without penalty after retirement age 65 or older) |
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What Do These Insurance Terms Mean?
Key Terms
|
| Employer Health Fund |
Provides an employer-paid fund that rolls over and accumulates year-to-year while enrolled in the plan. Health fund money is used for routine medical expenses. Health fund money helps to cover non-preventive claims and reduce employee deductibles. |
| Co-payment (Copay) |
The charge a plan participant is required to pay for certain eligible expenses. This would be a defined dollar amount and would be payable when services are received. |
| Co-insurance |
A percentage of eligible expenses a plan participant is required to pay after the claim is processed and the plan has paid a certain percentage of eligible expenses. The amount the member pays will be applied toward the Out-of-Pocket Maximum. |
| Deductible |
The dollar amount payable toward covered medical expenses each year before the plan issues any payments. |
| Out-of-Pocket Maximum |
Covered expenses payable at a defined percentage (co-insurance) accumulate until a specified dollar amount is reached during a calendar year (January through December). The plan participant's co-insurance becomes 0% when the maximum is met and covered expenses are payable at 100%. |
| Reasonable & Customary (R&C) |
The amount usually charged by providers in a specific geographical location for a particular medical service. The Reasonable & Customary (R&C) limit is standard on which claim payments are generally based unless there is a clearly defined schedule of benefit payments. |
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MetLife Dental Plan Options
Dental Benefits & Services
|
HIGH OPTION
|
LOW OPTION
|
| In Network |
Out of Network |
In Network |
Out of Network |
| Annual Deductible |
$50 (both options) |
| Annual Out-of-Pocket Maximum |
$1,750 |
$1,250 |
| Preventive Procedures |
100%
PDP Negotiated Fees |
100%
Usual & Customary Fees |
100%
PDP Negotiated Fees |
Scheduled Allowable Benefit |
| Basic Procedures |
80%
PDP Negotiated Fees |
80%
Usual & Customary Fees* |
73%
PDP Negotiated Fees |
Scheduled Allowable Benefit |
| Major Procedures |
50%
PDP Negotiated Fees |
50%
Usual & Customary Fees |
48%
PDP Negotiated Fees |
Scheduled Allowable Benefit |
| Orthodontia* |
NO BENEFIT |
Premiums (Bi-Weekly)
|
OLD $ |
NEW $ |
OLD $ |
NEW $ |
| Employee Only |
$13.47 |
$14.42 |
$6.49 |
$6.95 |
| Employee + Children |
N/A |
$27.10 |
N/A |
$12.46 |
| Employee + Spouse |
$23.45 |
$23.09 |
$10.78 |
$10.61 |
| Employee + Family |
$39.22 |
$41.97 |
$18.78 |
$20.10 |
* Includes periodonic / endodontic
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Davis Vision - Vision Plan Options
Benefits & Services
|
HIGH OPTION
(In-Network Benefit)
|
LOW OPTION
(In-Network Benefit)
|
| Benefit |
Two-Pair Benefit* |
One-Pair Benefit |
| Examinations |
Every 12 months |
| Lenses |
Every 12 months |
| Frame |
Every 24 months |
| Contact Lenses |
Every 12 months (in lieu of eyeglasses – 8 boxes) |
Every 12 months (in lieu of eyeglasses – 4 boxes) |
| Copays |
|
|
| Exams |
$10 |
| Eyewear |
$25 |
Premiums (Bi-Weekly)
|
OLD $ |
NEW $ |
OLD $ |
NEW $ |
| Employee Only |
N/A |
$5.99 |
$3.32 |
$3.11 |
| Employee + Children |
N/A |
$11.39 |
N/A |
$5.85 |
| Employee + Spouse |
N/A |
$10.79 |
$6.10 |
$5.64 |
| Employee + Family |
N/A |
$17.98 |
$9.60 |
$9.01 |
*High plan participants have three options:
- Option 1: Two pair of eyeglasses
- Option 2: One pair of eyeglasses; one dispense of contact lenses
- Option 3: Two dispenses of contact lenses
**Other variances in benefit allowances exist between the two plan options
Have Questions?
Please contact the Polk County Human Resources Health Plan Coordinator via e-mail or phone 863-534-5943
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