Paulding County School District 2015 BENEFITS OPEN ENROLLMENT REVIEW

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Paulding County School District

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ShawHankins

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

678-535-6369

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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

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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

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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

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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

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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

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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

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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

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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

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Wellness

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

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Wellness-Kaiser Permanente

Resources Available

 Total Health Assessment

 Biometric screenings

 Online and onsite healthy living classes

 Sign up at my.kp.org/shbp 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

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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

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State Health Open Enrollment

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

myshbpga.adp.com

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

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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.

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Bswift Enrollment Portal

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

Open Enrollment October 27 – November 14

Pauldingschools.bswift.com

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

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Dental

MetLife will be the dental carrier for 2015

 Expansive national network, superior service

 All members will receive a new ID card

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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

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Vision

Davis Vision will continue as the vision carrier for 2015

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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

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Short Term Disability

No changes to STD benefit

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

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Long Term Disability

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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

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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

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Whole Life

 Benefit never decreases, premiums never increase

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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

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