Paulding County School District 2015 BENEFITS OPEN ENROLLMENT REVIEW

39  Download (0)

Full text


Paulding County School District



Service Center- can answer questions on all benefits, including state health

Available extended hours 8:30 am – 7:00 pm during open enrollment

 Oct 27 – Nov 14



SHBP Changes for 2015-Carrier Options

3 carriers to choose from: BCBS of GA, United Healthcare, & Kaiser Permanente.  BCBS of Georgia: 3 levels of HRA- Gold, Silver & Bronze and statewide HMO

United Healthcare: High Deductible Health Plan (HDHP) and statewide HMO

Kaiser Permanente: Regional HMO available to members who work or live in the 27 metro


SHBP Changes for 2015- Plan Highlights

Health Reimbursement Arrangement (HRA)

 Copays will no longer apply to medical and pharmacy expenses. All services will be subject to the plan deductible and/or co-insurance.

 Health Maintenance Organization (HMO)

 Members now have the choice of enrolling in statewide or regional HMO plan that offers co-payments for certain services

 High Deductible Health Plan (HDHP)

 Members now have the option of enrolling in an HDHP. With an HDHP you are also eligible to start a Health Savings Account (HSA) to set aside pre-tax dollars for medical expenses.

Out of Pocket Maximums


How the HRA Plans Works

Bronze, Silver and Gold options with different levels of coverage

All services are subject to the plan deductible and/or coinsurance, no copays apply for 2015

SHBP contributes HRA credits to your HRA account based on the plan option and tier of coverage you choose

 These credits provide first dollar coverage for medical and pharmacy expenses

HRA credits left at the end of the year will roll over to the next plan year, if you remain enrolled in an HRA option


HRA Plan Features

Preventive services covered at 100%

After you meet your annual deductible, you pay a percentage of the cost, called co-insurance

You are not required to obtain referrals from a PCP to see a Specialist

The credits in your HRA account are used to help meet your deductible and out of pocket max

The medical and pharmacy out of pocket maximum are combined


How the HDHP Works

Low monthly premium

Must satisfy high deductible ($3,500 individual, $7,000 family) for all medical and pharmacy expenses (except preventive care)

If you have more than single coverage, the entire family deductible ($7,000) must be met before benefits are payable for any family member


HDHP Plan Features

Preventive services covered at 100%

You pay co-insurance (70% in-network, 50% out of network) after you meet the plan deductible for all medical and pharmacy expenses, until you meet the out of pocket maximum ($6,450/$12,900)

Medical and pharmacy out of pocket maximums are combined

No co-pays apply

Eligible to contribute to Health Savings Account


How the Statewide HMO Works

Available through BCBS or UHC

 Rates differ between the 2 carriers

Receive covered services through in-network providers only (except emergency care)

 Be sure to confirm your providers are participating in the BCBS or UHC network

Co-payments apply to certain services- office visits, urgent care, emergency room and prescriptions

Co-payments count toward your out of pocket maximum, but not deductible


How the Regional HMO Works

Services only available through Kaiser HMO network

Must select a PCP

Preventive services covered at 100%

Plan available for members that live or work in one of the 27 metro Atlanta counties:

Barrow Coweta Gwinnett Paulding

Bartow Dawson Haralson Pickens

Butts DeKalb Heard Pike

Carroll Douglas Henry Rockdale



Healthways will continue as the Wellness vendor for the BCBS and UHC plan options with well-being resources and incentive programs

All health actions must be completed between January 15, 2015 and December 15, 2015 to earn well-being incentive credits

If you choose one of the HRA plans, the well-being credits will be deposited into your HRA account

If you choose a statewide HMO, well-being credits will be placed into incentive accounts


Wellness-Kaiser Permanente

Resources Available

 Total Health Assessment

 Biometric screenings

 Online and onsite healthy living classes

 Sign up at and complete at least one health action to be entered in monthly drawing for an iPad and a Fit Bit:

 Completed biometric screening

 Completed online Total Health Assessment

 Get support to meet goals with KP wellness coach

 Complete one online health education class


Tobacco Cessation

Tobacco surcharges are included in all SHBP options

Surcharge applies if you are not tobacco-free or do not complete tobacco cessation coaching program


State Health Open Enrollment

 Open enrollment is from October 27th – November 14th


If you do not login to enroll or make changes, you will be defaulted to your


State Health Open Enrollment

•When making your benefit election make sure you have selected the correct option.

•Verify your coverage tier (you only, you + spouse, you + child(ren) or you + family)

•Confirm you have added all eligible dependents you wish to be included under your coverage.

•Confirm you have answered the tobacco question correctly.

Review/Confirm your elections and click “Finish”. NOTE: If Finish is NOT clicked, your enrollment

process has not been completed.


Bswift Enrollment Portal

Will make all non-medical plan elections through the Bswift portal

Open Enrollment October 27 – November 14


 User Name: First Initial, Last Name, Last 4 digits of SSN



MetLife will be the dental carrier for 2015

 Expansive national network, superior service

 All members will receive a new ID card


Plan Option 1- Low Plan Plan Option 2 – High Plan Coverage

Type In-Network

Out-of-Network In-Network Out-of-Network

Type A – Diagnostics & Preventative 100% of Negotiated Fee* 100% of R&C Fee** 100% of Negotiated Fee* 100% of R&C Fee** Type B – Basic 40% of Negotiated Fee* 40% of R&C Fee** 80% of Negotiated Fee* 80% of R&C Fee** Type C – Major 25% of Negotiated Fee* 25% of R&C Fee** 50% of Negotiated Fee* 50% of R&C Fee** Type D –

Orthodontia N/A N/A

50% of Negotiated Fee*

50% of R&C Fee**

Deductible† In-Network

Out-of-Network In-Network Out-of-Network

Individual $50.00 $50.00 $50.00 $50.00 Family $150.00 $150.00 $150.00 $150.00 Annual Maximum Benefit: In-Network

Out-of-Network In-Network Out-of-Network

Per Person $500.00 $500.00 $1,000 $1,000

Orthodontia Lifetime Maximum

In-Network Out-of-Network

Per PersonMetLife Employee Employee + 1$1,000 Family1,000



Davis Vision will continue as the vision carrier for 2015


Basic Life with AD&D

PCSD provides basic life coverage at no cost to you

This includes a life and accidental death and dismemberment benefit

$30,000 for all Full Time Administrators & Technical Professional Employees

$15,000 for all Other Full Time Employees

Coverage available for dependents

$5,000 for Spouse


Short Term Disability

No changes to STD benefit

All sick leave must be exhausted prior to STD benefits beginning


Long Term Disability


Flexible Spending Accounts

Two separate accounts- Medical Spending Account and Dependent Care Spending Account

Allows you to set aside pre-tax dollars to spend on qualified expenses, saving on your taxable income

Must make new elections for 2015

If enrolling in the HDHP medical plan, you are not eligible to contribute to FSA

TASC will administer FSA account for 2015


Flexible Spending Accounts

Medical Spending Account

 Maximum contribution of $2,500

 Some eligible expenses- Deductibles, copayments, dental expense, vision services and materials

Dependent Care Spending Account

 $5,000 for married couple filing joint income tax returns, $2,500 if unmarried or married and filing separate income taxes

 Some eligible expenses- any care of a dependent that allows you and your spouse to work: day care, after school program, in-home care, camps


Whole Life

 Benefit never decreases, premiums never increase


Critical Illness Coverage

Pays a lump sum benefit to you at the time of diagnosis of a covered illness.

Benefit Choice: From $5,000 to $25,000

Able to cover you and your family

 Some covered illnesses: Heart Attack, Stoke, Coronary Artery Bypass, Major Organ Transplant, End Stage Renal Failure





Related subjects :