Benefit Changes Effective
January 1, 2016
Open Enrollment Highlights
Changes made during open enrollment will be effective January 1, 2016.
Premiums for medical, dental and vision insurance, as well as pre-paid legal, will be collected beginning in December 2015.
Flexible spending contributions will begin in January 2016.
Health insurance premiums for active and pre-Medicare retirees increased by 9.9%, on average, with plan design changes and converting to self insurance.
Dental insurance premiums increased 3.5% across all tiers with no plan design changes. Vision insurance, flexible spending and legal benefit plans are not changing for 2016.
Plan Change Highlights
Current Options Options Effective January 1, 2016
HMO POS PPO HMO POS PPO
Annual Deductible
Individual/Family
$400/800 $300/600 $750/$1,500 $600/$1,200 $500/$1,000 $750/1,500
Coinsurance
85% 90% 80% 80% 85% 75%
Specialist/Urgent
Care Copay $70 copay $50 copay $50 copay $70 copay $50 copay $70 copay
Medical Out of Pocket Maximum
Individual/Family
$3,500/$7,000 $4,000/$8,000 $4,000/$8,000
Pharmacy Out of Pocket Maximum
Individual/Family
$3,000/$6,000 $3,100/$6,200 $2,600/$5,200 Combined with Medical Out of Pocket
Medical Rates – Employee Contributions
2015 HMO POS PPO
Employee Only $38.96 $52.60 $106.56 Employee &
Spouse
$143.44 $266.00 $475.80 Employee &
Child
$89.28 $159.00 $288.12 Employee &
Children
$137.44 $244.68 $443.40
Family $352.08 $578.60 $847.28
2016 HMO POS PPO
Employee Only $41.08 $62.20 $120.80 Employee &
Spouse
$153.96 $297.52 $523.64 Employee &
Child
$95.16 $178.28 $317.96 Employee &
Children
$146.68 $274.28 $488.68
Dental
Plan Design Amount/Percentage
Annual Deductible $50/$150
Annual Benefit Maximum $1,500
Orthodontic Lifetime Maximum (eligible dependent children)
$1,500 Diagnostic and Preventative Care
(including sealants for dependents under age 16)
Covered at 100%
Basic Dental Care - Fillings, simple extractions
Covered at 80% after deductible Major Dental Care – Bridges, crowns Covered at 50% after deductible
Dental Rates
2015 Total Employer Employee
Employee Only $26.84 $14.04 $12.80 Employee &
Spouse
$53.68 $32.16 $21.52 Employee &
Child
$59.04 $35.44 $23.60 Employee &
Children
$67.12 $40.32 $26.80
Family $93.12 $56.32 $37.60
2016 Total Employer Employee
Employee Only $27.80 $14.56 $13.24 Employee &
Spouse
$55.56 $33.28 $22.28 Employee &
Child
$61.12 $36.92 $24.20 Employee &
Children
$69.48 $41.60 $27.88
Vision
RATES
Monthly Premium
Employee Only $3.96
Employee & Spouse $6.96 Employee & Child $6.96 Employee & Children $7.92
Family $11.52
PLAN DESIGN
Service In-Network Cost
Routine eye exam (once every calendar year
$15 copay
Eyeglass frames $140 allowance then 20% off remaining balance
Eyeglass lenses $15 copay +
Standard contact fitting Fitting and follow up visits up to $55
Flexible Spending
•
Medical
–
Can contribute up to $2,550 per year.
• $500 carryover from calendar year to calendar year.
• Funds are available on the first day of the plan year
• WageWorks’ EZ Receipts® mobile app has new functionality
• user friendly claims submissions and
• services to pay providers on the go. For more information, visit
http://wageworks4me.com/aboutmobile/.
Legal Resources provides an affordable way for you and your
family to have legal representation whenever you need it.
Legal Resource
Protect yourself and your family
•
Pay no attorney fees
for the most common legal services
– everyday & unexpected
•
Work directly with local law firm
•
Annual cost less than one hour of attorney’s time
How the plan works
Enroll online with your other benefits as a new hire or at
open enrollment
Receive a welcome kit with member cards and provider
contact information
Call you law firm when you need services and say “I am a
Legal Resources member”
Use the Plan as often as needed throughout the year
Online Enrollment
The City will be using a new site for online enrollment this year.
Employees will enroll through Employee Self Service (ESS), https://ess.cityofchesapeake.net. Employees in the Active Directory will use their computer user name and password to access ESS
Employees not in the Active Directory (e.g. libraries, CIBH) will use their employee number and last four of their SSN to access ESS.
Visit the City of Chesapeake’s dedicated benefits website, www.optimahealth.com/ches for detailed information about benefits offered.
Monday Tuesday Wednesday Thursday Friday
1 2
5 6 7 8 9
12 Columbus Day
13 Social Services 1stfloor, multi-purpose
room 100 Outlaw St. 10:00 – 11:00 am ______________ Central Library 1stfloor meeting room
298 Cedar Road 2:00 – 3:00 p.m.
14 Sheriff’s Office Administrative Building
Multi-Purpose room 401 Albemarle Dr. 10:00-11:00 a.m.
15 Streets Maintenance &
Cleaning 925 Executive Blvd 7:30 – 8:30 a.m. ______________ CIBH 2nd floor conference room
224 Great Bridge Blvd 2:00 – 3:00 p.m.
16 HR Training Room City Hall 4thfloor HR training
room 306 Cedar Rd 11:00 am - noon
19 S Norfolk Library 801 Poindexter St 11:00 a.m.- noon
20 HR Training Room City Hall 4th floor HR training room
306 Cedar Rd 9:00 -10:00 am
21 22 23
26 27 28 29 30
Open Enrollment - Elections
Medical, Dental, Legal, Vision
o
If no changes are made, employees and pre-Medicare eligible retirees will
maintain enrollment in their current plan/tier.
Flexible Spending
o
Re-enrollment is required annually. Employees may rollover up to $500 of
unused medical flexible spending balances. Re-enrollment for calendar year
2016 is required in order for unused calendar year 2015 funds to rollover.
Pre-Medicare Eligible Retirees
oAs required by Virginia Code, pre-Medicare retirees are eligible for medical insurance through the City until they become eligible for Medicare.
oThe retiree’s covered spouse who is not eligible for Medicare can remain on the pre-Medicare plan until he/she becomes eligible, but is responsible for the entire premium of the selected coverage.
oDependents can stay on the pre-Medicare plan until they are no longer eligible to be a
dependent on the plan (generally age 26), but are responsible for the entire premium of the selected coverage.
Elimination of Medicare Carve-Out Plan
On September 15, 2015, City Council voted on a recommendation by the City Manager to
discontinue offering medical insurance to Medicare eligible retirees. The City of Chesapeake is is currently the only municipality in South Hampton Roads that offers medical insurance to
Medicare eligible retirees.
The reasons for the recommendation are highlighted below:
Cost – There are more cost effective options available in the Medicare supplemental market. In addition, if the City continued to offer a plan which only a small number of retirees elected, the premiums would undoubtedly increase.
Pre-existing conditions – If the City continued to offer a plan, retirees with pre-existing conditions could be denied coverage or their coverage could be significantly delayed.
Transition for Medicare Eligible Retirees
•The City of Chesapeake has partnered with OneExchange, one of the largest independent health care plan exchanges in the United States, to assist retirees with this transition. OneExchange is not an insurance company, but a resource that provides access to a variety of individual health care plans at no cost to the retiree.
•OneExchange has successfully helped more than 500,000 Medicare-eligible individuals enroll in Medicare plans, including assisting retirees from other municipalities in the region.
