1 Dear Brown County Employee:
October 2013
Brown County is dedicated to providing you and your family with a valuable benefit package. Each year we partner with M3 Insurance to evaluate different health insurance options that are valuable while combating the rising cost of health care.
The market is expecting health care costs to increase at least 10% along with additional requirements associated with the Affordable Healthcare Act that will also impact the cost of health insurance plans. With these expected increases in health care costs, Brown County will be increasing the premiums in 2014 by 5%.
Due to the expected increases in health care costs changes will be made to the current Consumer Driven Health Plan (CDHP) and will go into effect January 1, 2014. These changes will be communicated at the mandatory meetings. Please see the schedule below:
Enrollment forms Due to Human Resources by November 20, 2013
Brown County 2014 Benefit Enrollment
DATE LOCATION TIME(S)
Monday, 11/4/13 Sheriff ’ s Department 2nd Floor Training Room 2684 Development Drive
6:00 AM 7:00 AM 1:00 PM Monday, 11/04/13 Sophie Beaumont Building Boardroom A
111 N. Jefferson St. 10:00 AM
Tuesday, 11/05/13 ADRC Dining Room 300 S. Adams St.
10:00 AM
Tuesday, 11/05/13 Neville Public Museum Theater 210 Museum Place
1:00 PM 5:15 PM Tuesday, 11/05/13 Syble Hopp School 755 Scheuring Road, DePere 3:15 PM
Thursday, 11/07/13 Community Treatment Center Room 365 - Group Activity Room 3150 Gershwin Drive
7:30 AM 2:00 PM 3:30 PM Thursday, 11/07/13
Sophie Beaumont Building Boardroom B
111 N. Jefferson Street
10:00 AM
Friday, 11/08/13 Public Safety/Jail EOC, 2nd Floor 3028 Curry Lane
6:00 AM 7:00 AM 1:00 PM 2:00 PM Friday, 11/08/13 Northern Building Room 200
305 E. Walnut street
10:00 AM
Tuesday, 11/12/13 Public Works Highway Main Shop 2198 Glendale Avenue
Medical:
UMR
1-877-233-1800 (or call the number on your ID card if issued) https://member-fhs.umr.com
Dental:
Delta Dental
1-877-577-7449 www.deltadentalwi.com
Dental Associates / CarePlus
1-800-318-7007 www.careplusdentalplans.com Vision: EyeMed 1-866-939-3633 www.eyemedvisioncare.com
Medical FSA & HRA Administration
Genesis Employee Benefits
1-866-678-8322
www.GenesisBenefits.net
Long Term and Short Term Disability Insurance
The Standard
1-866-756-8116 www.standard.com
Voluntary Critical Illness and Accident Insurance:
United Healthcare
1-800-299-2070
www.unitedhealthcare.com
For detailed instructions on how to access your accounts, please go to
www.employees.co.brown.wi.us,
click on Departments, Human Resources, Employee Benefits, 2014 on-line enrollment.
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2014 Health Benefit Options—Brown County Employees
Please note: This is Annual Enrollment vs. Open Enrollment
1. MedicalNo Health plan election is necessary if no changes are being made for 2014 a. HRA Funding for 2014
Family - $2,100 Annually ($525 Quarterly) Single - $1,050 Annually ($262.50 Quarterly) 2. Flexible Spending
(FSA) elections must be made on-line at www.GenesisBenefits.net Please contact Genesis directly if you need to reset your password at 1 -866-678-8322.
a. FSA will terminate 12-31-13 if not re-enrolled.
b. Grace Period: You will have until 03-15-2014 to incur expenses for the 2013 plan year.
c. Run Out Period: You have 90 days after the end of the plan year, or until 03-30-2014, to submit claims for all expenses incurred in the 2013 plan year. No exceptions can be made.
Get the Most from Your FSA
By participating in the Brown County Flexible Spending Account (FSA) you can lower your taxable income and help you pay for health care expenses on a pre-tax basis. With an FSA, you agree to set aside a portion of your pretax salary in an FSA account. That money is deducted from your paycheck over the course of the year and can be used to pay for eligible out-of-pocket medical expenses like prescription drugs, eye glasses, acupuncture and more! Here are a few things to remember when it comes to your FSA:
FSA accounts are setup on a “use it or lose it” basis, so it’s important to carefully calculate how much money to set aside each year. The pretax dollars you contribute are not subject to social security, federal, state, or local income taxes, which adjusts your annual taxable
salary.
The annual maximum contribution to the health care reimbursement FSA is $2,500 per participant. The annual maximum contribution to the Dependent care reimbursement DCA is $5,000 per participant.
Eligible expenses include deductibles, copayments, immunizations and more. For a complete list of eligible expenses, refer to the attached handout.
3. Dental
In addition to the current Delta Dental plan, this year Brown County will be adding an additional voluntary dental option which you can choose. This plan is offered by Dental Associates and the employer contribution amount is the same percent as the Delta Dental plan.
a. Please refer to the attached Dental Insurance Benefit Comparison for rates and plan designs. b. If continuing on Delta Dental plan, no election is necessary.
c. If electing or changing Dental plans, please complete the enrollment form located at the back of the packet, and return to Human Resources. (if moving from Delta to Dental Associates Plan, you must complete a Delta termination change form)
d. If you enroll late, there will be a 1 year waiting period. 4. Vision
a. If electing Vision-please complete the enrollment form located at the back of the packet. b. If continuing on Vision, no election is necessary.
c. If you are currently on Vision and wish to end coverage you must fill out the form located at the back of the packet.
Please note: You cannot cancel for a 12-month period based upon your enrollment date.
5. Short Term and Long Term Disability Plans
Brown County provides its employees short-term and long-term disability benefits. Please review the attached benefit summaries which notes the changes being made to these benefits for 2014. Please refer to page #10 for an outline of benefits.
6. Voluntary Critical Illness and Voluntary Accident
New this year, Brown County will be adding Voluntary Accident and Voluntary Critical Illness options which you can choose to enhance your benefit package. The Voluntary Accident insurance plan can provide benefits for covered accidents that occur off the job. The Group Critical Illness insur-ance provides a lump-sum benefit payment to cover out-of-pocket medical expenses and the costs associated with life-changes following a covered critical illness. If electing this voluntary insurance coverage please complete the enrollment form located at the back of the packet and return to Human Resources.
For detailed instructions on how to access your accounts, please go to www.employees.co.brown.wi.us, click on Departments, Human Resources, Employee Benefits, 2014 on-line enrollment. Or you may go directly to the websites listed below:
Medical - UMR https://member-fhs.umr.com Flexible Spending - Genesis www.GenesisBenefits.net For technical support please call Human Resources at 920-448-4071.
Brown County
Your Consumer-Driven Health Plan……..Health care with a difference
VEBA: Providing high-quality, tax-advantaged health reimbursement plans for public employees
BROWN COUNTY CONSUMER -DRIVEN HEALTH PLAN IMPORTANT INFORMATION
The CDHP plan can help cover medical and prescription ex-penses. Preventative care is covered at 100% when you use an in-network provider.
HRA Plan Advantages
You choose how your health care dollars are spent.
Your preventative care is covered at 100% when you see in-network providers.
For details, refer to your medical summary plan description, which is found on-line at
www.co.brown.wi.us .
Generally, you pay less if you choose a doctor from the network.
There is a limit on how much you will pay each year.
Generally, emergencies are covered anywhere in the world.
Unused HRA dollars roll over to the following year and Brown County will be funding $1,050 for single and $2,100 for family to your HRA, further
reducing your out-of-pocket expense.
Tools on www.myumr.com help you:
Check eligible expenses
Check costs for treatment ahead of time
Find the best doctors and hospitals
Manage your claims
Compare prescription drug costs
Online access to our Health and Wellness content and tools, online health assessment, health coaches, personal health record and automated messaging.
Health Tools and Resources
UMR offers many tools and resources to help you save money and get high quality care. Access these programs via the number on the back of your ID card or at myumr.com. Here is a sample of what’s available:
24 Hour Nurse Line: Contact a nurse anytime of the day when
you are facing important health care decisions or need immedi-ate health information
Consumer Alerts: Get personalized information on managing
your health care in the most effective and cost-efficient way possible. You’ll see these alerts on your member website and health statements.
Prescription Drug tools: Look up the cost of prescription
drugs and get suggestions for saving money. Plus, you can find out if any of the prescription drugs, vitamins and over-the-counter medications you are taking have possible negative interactions.
My Personal Health Record: Build and store your own health
chart to record your health conditions, medical tests,
medications and medical allergies. You can even print a copy to share with your doctor.
Hospital Comparison Tool: Find the facility near you that
provides the highest quality service at the lowest price for a procedure or condition.
Health A to Z Encyclopedia: Provides In-depth information for
major diseases, conditions and other lifestyle issues. It is designed to help you make educated health care decision in partnership with your doctor.
UMR Decision Support Tools: Provides online access to a
complete suite of decision making tools from financial impact, health topics, and medical treatments. Includes:
Health Plan Cost Estimator
Health Education Library
UMR Treatment Cost Calculator
Important updates and reminders
……...Several key pieces of information are available to you in one central location, the Brown County employee’s intranet. Click on 2014 Benefit Information on the home page www.employees.co.brown.wi.us, Brown County Intranet >> Departments >>Human Resources>>Employee Benefits (or go to Departments, Human Resources) Also on the Human Resources home page, click on Forms to find these important forms. Here you will find:
Fitness Reimbursement information (see wellness tab) Beneficiary forms
HRA Reimbursement forms
FSA (Flexible Spending) Reimbursement forms
5 Benefit Plan Highlighted in RED are changes from 2013 plan offering
Health Carrier UMR
Provider Network UHC Choice Plus
Deductible Single Family
In Network $2,000 $4,000
Out of Network $4,000 $8,000
Co-Insurance Percent of shared costs until Maximum out of pocket expense is met
In Network 90% Employer / 10% member
Out of Network 60% Employer / 40% member
Out-of-Pocket Maximum Single (includes deductible) Family (includes deductible)
In Network $3,000 $6,000
Out of Network $6,000 $12,000
Lifetime Maximum Unlimited
Office Visits
In Network $25 copay, then 100%
Out of Network Deductible and Coinsurance Apply
Retail Clinic
In Network $10 copay, then 100%
Routine/Preventive Care
In Network 100%
Out of Network Deductible and Coinsurance Apply
Prescription Drugs Generic / Brand / Non-Preferred (member share)
In Network
20% / 25% / 35%
$0 Copay for generic maintenance meds for the following chronic conditions only: COPD, hyperten-sion, Asthma, Congestive Heart Failure, Depreshyperten-sion, Coronary Artery Disease and Diabetes.
$1,500 Single / $3,000 Family Annual Out of Pocket Maximum for Prescriptions
Emergency Services / Treatment
Urgent Care: Deductible and Coinsurance Apply
Emergency Room / Emergency Physicians: Deductible and Coinsurance Apply
Hospital Services
In Network Deductible and Coinsurance Apply
Out of Network Deductible and Coinsurance Apply
Other
See Plan Document Deductible, then Coinsurance
90% Employer / 10% member in-network 60% Employer / 40% member out of network
Wellness
Opportunity to earn additional HRA Dollars See details on page 6.
Single $200 Max (Adult Only) Family $400 Max (Adult Only)
Eligibility and Rates
Brown County Employees
(Per contract, Sheriff Non-Supervisory Group @ 12% - PHA not required)
With PHA Without PHA
12% Contribution 15% Contribution
Employee $ 62.32/month $ 77.90/month
Family $165.84/month $207.32/month
This is a summary of benefits and features offered by Brown County and UMR. All benefits are subject to the limitations, and exclusions set forth in the Summary Plan Description.
Brown County will be offering to fund a portion of the Health Reimbursement Arrangement (HRA) if you are enrolled in their health plan. This year Brown County will be funding this account at $1,050 for Single and $2,100 for family. This account will be funded quarterly and can be used to pay for out of pocket expenses incurred by you or your spouse if spouse is covered under your health insurance plan.
Brown County values our employees and to this end you are being offered the opportunity to take control and own your own personal health care. The opportunities below are made available on your own time, to earn additional dollars into your HRA account. These offering will not be offered on Company paid time.
Employees can earn additional wellness dollars totaling $200 single / $400 employee/spouse to your HRA account by participating in the following possible incentives:
Total Total
Single EE/Spouse
a. PHA Coaching sessions with Bellin RN ($25 each / maximum of 3 sessions)… $ 75.00 $150.00 b. Annual wellness exam with Primary Care Provider (PCP) ($100) ……… $100.00 $200.00
i. NOTE: the provider verification form is NOT necessary in 2014
c. Stress management seminar attendance ($75 per series completed)……….. $ 75.00 $150.00 i. Series of 3, one-hour sessions scheduled two-weeks apart (watch for scheduled sessions in 2014)
Session 1 – Stress – What, Where, Why and How Session 2 – Work And Life Balance
Session 3 – Stress Management Lifestyle techniques
d. Dental cleanings ($25 each / maximum of 2 per year)………$ 50.00 $100.00
1. Personal Health Assessments are new this year. There is a 3% increase to premium contributions for non participation.
2. We intend to incorporate in 2015 an Outcome Based Incentive will be tied to your premium contribution. Watch for more information about this incentive to come early 2014.
3. PHA coaching sessions can be scheduled by contacting the Occupational Health Nurse.
Brown County Employees 2014 Health Reimbursement and Wellness
Example: Deductible out-of-pocket for an employee benefit election
Single: Family: Health Plan Deductible ………..……….$2,000.00 ……...$4,000.00 HRA Dollars funded by Brown County………...………...$1,050.00..………..$2,100.00 MEMBER RESPONSIBILITY AFTER HRA……….………...$ 950.00 ……...…$1,900.00 Additional Wellness Incentives Earned………...$ 200.00…..….….$ 400.00 (Any combination of a., b., c., and d. above,
up to $200 Single/$400 Family)
Current Plan member deductible responsibility………..………..…$ 750.00……...….$1,500.00
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Brown County Employees 2014 Dental Insurance Benefit Information
These are summaries of benefits and features offered by Brown County, Delta Dental, and Dental Associates. All benefits are subject to the limitations, and exclusions set forth in the Summary Plan Description.
Dental Carrier: Delta Dental Care Plus
Exclusive Dental Associate providers only
Deductible
Single $0 $0
Family $0 $0
Annual Maximum
$1,250 per person $2,500 per person
Preventive Services Oral Exams 100% 100% X-Rays 100% 100% Cleanings 100% 100% Topical Fluoride 100% 100% Sealants 100% 100% Space Maintainers 100% 100% Basic Services Oral Surgery 80% 100% Amalgam/Composite Fillings 80% 100%
Full & Partial Denture Repair 80% 100%
Stainless Steel Crowns 80% 100%
Simple Extraction 80% 100%
Major Services
Endondontics 80% 100%
Periodontics 80% 100%
Porcelain Crowns 80% 100%
Inlays/Onlays 80% Only re-cements covered
Partial or Complete Dentures 80% 100%
Removable or Fixed Bridgework 80% 100%
Implants 80% 80%
Orthodontics (per course or treatment)
50% to $1500 Lifetime Max. to age 26
50% to $2,500 Lifetime Max. to age 99
Eligibility and Rates
Employee $2.88/month $2.38/month
Family $8.12/month $7.23/month
Brown County Employees 2014 Voluntary Vision Insurance Benefit Information
EyeMed
Plan Name Insight Plan H, Fixed Fee
Frequency Limitations
Eye Examination Once Every 12 Months
Lenses Once Every 12 Months
Frame Once Every 24 Months
Contact Lenses Once Every 12 Months
Deductible None
Copayment Exam Materials
$10 None
Benefits In Network Out of Network
Up To
Vision Examination $10 Copay None
Frames Up To $0 Copay, $120 Allowance, 20% off over $120 $60.00
Lenses (Clear, Standard, Glass, or Plastic)
Retail Value To
Single Vision $25 Copay $25.00
Bifocal $25 Copay $40.00
Trifocal $25 Copay $55.00
Contact Lenses
Retail Value To
Medically Necessary with Pre-Authorization
$0 Copay, Covered in Full
$200.00
Elective Not applicable
Eligibility and Rates
Employee $6.29/month
Family $16.04/month
These are summaries of benefits and features offered by Brown County and EyeMed. All benefits are subject to the limitations, and exclusions set forth in the Summary Plan Description.
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Medical FSA & HRA Qualified Expenses
? IRS Definition of Qualified Expenses and Premiums
Internal Revenue Code Section 213(d) defines qualified expenses, in part, as “medical care” amounts paid for insurance or “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body…” To be eligible, these expenses must be to alleviate or prevent a physical defect or illness. Expenses solely for cosmetic reasons generally are not considered expenses for medical care.
“Dual-purpose Items” may have a medical purpose and a personal/cosmetic or general health purpose. In this case, attach a Letter of Medical Necessity to your claim submission from a licensed medical provider stating the beneficiary had a specific medical condition for which the item was purchased. “Excluded Items” are those used primarily for general health and well being. This is a summary of common eligible expenses; a comprehensive list of IRS Code 213(d) eligible expenses is located at www.GenesisBenefits.net.
MOST COMMON EXPENSES OTHER EXPENSES SERVICES and FEES
Co-pays Coinsurance Deductibles
OTC MEDICINES and DRUGS (* items require a prescription)
Allergy medicines* Antacids*
Anti-diarrhea medicines* Bandages
Blood sugar test kits Bug bite medication* Calamine lotion* Cold medicines* Cough drops*
Diaper rash ointments* Eye products (i.e. Visine®)* First aid kits
Hemorrhoid creams*
Menstrual pain & cramp relief* Motion sickness pills*
Muscle or joint ache pain relievers (i.e. BENGAY®)* Nicotine gum/patches* Pain relievers* Sinus medications* Sleeping aids* Sunburn ointments* Suppositories*
Wart removal treatments*
EXCLUDED ITEMS:
Cosmetics Face creams
Feminine hygiene products Lip moisturizers (i.e. ChapStick®) Medicated shampoos
Soaps Toiletries
Tooth brushes (including electronic) Toothpastes
Vitamins
Adoption (medical expenses incurred before adoption is finalized)
Air conditioning and air filters used for alleviating illness
Alcoholism and drug treatment center costs Ambulance hire
Birth control pills
Contact lenses, solutions, etc. Eye glasses
Fertility treatments
Food & beverage for specific diseases Hearing aids & batteries
Immunizations Laser eye surgery
Learning disability (special school or specially trained educator, recommended by doctor
Lifetime care at medical facility Lodging (for medical care or treatment) Medical supplies and equipment Norplant insertion or removal Obstetrical expense Operations Organ transplants Orthodontia Physical therapy Prescription medicines
Retirement home (costs allocable to medical care)
Seeing-eye dog Stop smoking programs Student health fees Telephone for deaf (TTY) Therapy treatments
Transportation (subject to IRS limits) Vaccines Vasectomy Viagra Wheelchair X-rays Acupuncture Anesthetist Chiropractor Christian Science Dentist Eye exams Gynecologist Hospital Laboratory Naturopath Nursing Obstetrician Oral surgery Ophthalmologist Optometrist Orthodontist Osteopath Physicals Physician Physiotherapist Psychiatrist Psychologist Specialists
DUAL PURPOSE ITEMS (Letter of Medical Necessity required)
Acne medications
Dietary supplements or herbal medicines
Glucosamine/Chondroitin for arthritis Health Club memberships
Massage Therapy
Orthopedic shoes & inserts St. John’s Wort
Sunscreens Weight loss drugs
FAX, EMAIL OR MAIL completed claim forms & supporting documentation to:
Local Claims eFax: 952-460-1480 Toll-Free Claims eFax: 866-450-1480 Email: Claims@GenesisBenefits.net
Genesis Employee Benefits, Inc. PO Box 1578
Minneapolis, MN 55440-1578
Local Phone: 952-653-4422 Toll-Free Phone: 866-678-8322
CustomerCare@GenesisBenefits.net
Check the status of your claim online at www.GenesisBenefits.net. Choose Participant Login in the upper right corner.
© Copyright 2012
Genesis Employee Benefits, Inc
After a thorough review process, Brown County has selected Standard Insurance Company (The Standard)
as our new carrier for Short Term Disability (STD) and Long Term Disability (LTD) Insurance. This change
will take effect on January 1, 2014.
By offering partial income replacement, Disability Insurance can help to lighten the financial load if you
become unable to work due to a disability. Though we are transitioning to a new carrier, no action is required
on your part.
The Standard brings focused expertise, exemplary customer service, a solid financial reputation and a
commitment to excellence to this partnership, and we are pleased to begin working with them.
CHANGES IN THE DISABILITY PLANS FOR 2014
Short-term Disability
Current Plan New Plan
Elimination period - accident 3 days 0 days
Elimination period - sickness 3 working days 7 calendar days
Family Member 7 day benefit Eliminated
Percent of Wages Paid 75% 60%
Duration 180 days 180 days
Amount Paid by Employer 100% 100%
Long-term Disability
Current Plan New Plan
Monthly Benefit 66-2/3% to $5,000 66-2/3% to $5,000
Elimination period 180 days 180 days
Duration ADEA with NRA Normal Retirement Age
Definition of Disability Own Occupation Only *Own Occupation OR
Any Occupation
Amount Paid by Employer 100% 100%
Brown County Employees 2014 Disability Insurance Benefit Information
*Own Occupation disability definition: a claimant will be considered disabled if unable to
perform one, some or all of the material duties of his or her regular occupation.
Any Occupation disability definition: a claimant will be considered disabled if he/she is unable to work in any gainful occupation for which he/she is qualified by education, training or experience.
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United Healthcare Voluntary Accident Insurance
Voluntary Accident insurance will help you with out of pocket medical expenses associated with an accident either on or off the job. It is designed to assist with the expenses that are not covered through your major medical insur-ance plan. Should you suffer an accident, you would be paid out based on a schedule of benefits. Below is the list of benefits through the Accident Plan.
Accident – Basic Benefit Dental Emergency
Accident Death/Dismemberment Broken Teeth ( crown ) $200
Life $20,000 Broken Teeth ( extraction ) $80
Both Hands or feet $20,000 Eye surgery $200
One hand or foot $10,000 Dislocations $80 - $3,200
Two or more finger or toes $4,000 Fractures $40 - $4,000
One finger or toe $2,000 Lacerations $30-$400
Accident al death – common carrier $80,000 Paralysis
Initial Care Quadriplegia $10,000
Ground Ambulance $200 Paraplegia $5,000
Air Ambulance $1,200 Hemiplegia $5,000
Emergency Room treatment $100 Tendons/Ligaments/Rotator/Knee Physicians Office/Urgent Care $40 Surgery to repair one $400 Hospital Care Surgery to repair more than one $800 Hospital admission $800 Exploratory without repair $140
Hospital confinement $160 Family Day Care $28 ( per day )
Hospital ICU admission $2,500 Family Lodging $140 ( per day )
Hospital ICU confinement $500 Transportation $400
Ruptured Disc $400
Accident Enhanced Benefit
Follow-up Care
Major diagnostic exam $160
Follow up physician visit $40
Medical appliances $140 Monthly Rates
Physical therapy $30 Base plan Enhanced plan
Prosthetic Employee: $6.24 Employee: $11.32
One device $500 Employee/Spouse: $10.16 Employee/Spouse: $18.04 Two or more devices $1,000 Employee/Children: $6.80 Employee/Children: $14.44
Rehabilitation Unit $80 Family: $10.72 Family: $21.16
Common Injuries
Blood/plasma/platelets $280
This is a summary of benefits and features
offered by Brown County and UHC.
All benefits are subject to the limitations
and exclusions set forth in the
Summary Plan Description.
Abdominal/Thoracic Surgery Surgery to repair $1,000 Exploratory without repair $100
Burns
2nd degree $500
3rd degree $1,000
3rd degree requiring skin grafts $8,000
Coma $10,000
Concussion $140
United Healthcare Voluntary Critical Illness Insurance
Effective January 1st, 2014, Brown Co. will be offering voluntary critical illness insurance through United Healthcare.
This benefit is intended to help you with out of pocket medical expenses associated with a critical illness. Critical Illness coverage will assist you with the additional costs associated with the following high cost illness:
Cancer Cancer and carcinoma in situ
Cardiovascular Heart Attack, Stroke, Heart Transplant, Ruptured Aneurysm, and Coronary Bypass
Critical Illness – All Other Chronic Renal Failure, Paralysis, Severe Burns, Severe Brain Damage, Coma, and Major Organ Transplant ( except heart ) Employees have the option to purchase different amounts of Critical Illness coverage. Coverage can be elected on spouses and chil-dren. Please review the following for how to purchase coverage:
Increments in which you can purchase coverage: $1,000 Employee Minimum benefit $5,000 Employee Maximum benefit $20,000
Spouse Minimum benefit $5,000 Spouse Maximum benefit ( not to exceed 50% of employee election) $10,000
Child Flat Benefit ( not to exceed 50% of employee election ) $2,500
Benefit Waiting Period 30 Days
Pre-existing Condition Exclusion Period 12 Months / 12 Months Benefit Reduction 50% Reduction at age 70 Coverage Termination At Retirement
Monthly Rates
Rate Basis—Employee / Spouse voluntary benefit Age Banded Tobacco/NonTobacco rate per $1,000 Rate Basis—Child ( ren ) Composite Rates per $1,000 of Coverage
Monthly Rates
Monthly Rate — Child ( ren ) $0.20
Age Range Tobacco Non-Tobacco
Under 25 $0.29 $0.28 25-29 $0.47 $0.45 30-34 $0.58 $0.53 35-39 $0.78 $0.66 40-44 $1.17 $0.90 45-49 $1.84 $1.27 50-54 $2.80 $1.74 55-59 $4.20 $2.37 60-64 $6.18 $3.20 65-70 $9.31 $4.47 70-74 $11.31 $5.71 75+ $13.65 $7.89
New offering
13
Department of Employee Trust Funds
June 21, 2013
WRS Contribution Rates for 2014 Set
Contribution rates for most Wisconsin Retirement System ( WRS ) employees and employers will increase in 2014, the Employee Trust Funds Board announced. The following rate increases were recommended by the WRS consulting actuary and approved by the Board on June 20, 2013:
0.7% of payroll for general category employees ( including teachers ) 1.5% of payroll for executive/elected official/judge category employees 0.7% of payroll for protective category employees covered by Social Security 1.7% of payroll for protective category employees not covered by Social Security
In general, the total contribution rate is split equally between the employee and the employer. This means general
category employees will contribute .35% more in 2014. Executive/elected official/judge category employees will see an increase of .75%.
Why are contribution rates increasing?
While many complex factors affect WRS contribution rates, the increase is primarily due to the lingering effects of
2008 ’ s global economic meltdown. 2014 is the last year that the investment declines will affect WRS contribution rates. Contribution rate changes, whether increases or decreases, are considered normal for retirement systems that have defined, or pre-funded benefits.
Core Trust Fund investment results are distributed ( “ s moothed ” ) over five years to soften the impact of year-to-year volatility of investments. This also helps to keep WRS contribution rates stable. For example, over the past 25 years the rate for general category employees has deviated by just 2%.
The new rates ( shown below ) go into effect January 1, 2014. Rates may be different for employees who have collective bargaining arrangements. Other mandatory employer contributions for duty disability, the states
Accumulated Sick Leave Conversion Credit Program, or unfunded liabilities are not included and vary by employer.
Employee Category Total Rate 2013
Total Rate 2014 Employee Contribution for 2014 Employer Contribution for 2014 General/Teacher 13.3% 14.0% 7.0% 7.0% Elected Official/ Executive/Judge 14.0% 15.5% 7.75% 7.75% Protective with Social Security 16.4% 17.1% 7.0% 10.10%
In this issue: Medical study indicates that 30 percent of all emergency room visits could have either been ad-dressed in an urgent care facility,
retail clinic facility or solved in a doctor’s office. But how can you determine which is more
appropri-ate for your condition?
Did You Know….? For emergency room treatment, your out-of-pocket cost, plan cost, and Contract Health costs are usu-ally much higher than an urgent
care or retail clinic visit.
Remember…. You have a $10 co-pay for treat-ment at a retail (or fast care) clinic
For Your Reference…. Keep the list on the following page handy
on the front of your refrigerator, in your cubicle, and for the
babysitter.
How to Choose
It is important to be a wise health care consumer. We consistently provide you with information that will help you save health care costs, help the employee health plan save health care cost, and save Contract Health costs as well. Many medical situations need emergency treatment. However, studies indicate that about 30% of all emergency room visits are not true emergencies, and treatment could have been provided at an “urgent” care or “retail” clinic or doctors office. As we all know, emergency room treat-ment costs are significantly higher than urgent care or retail clinics. To help you save, please read the following information carefully. This is meant to be a practical guide to help you choose the right care at the right place at the right cost. Each visit may be different based on where you are treated, the type of medical issue you’re being treated for, and the services provided.
Using an Emergency Room (highest cost)
Emergency rooms are equipped to handle life-threatening injuries and illnesses and other serious medical conditions. An emergency is a condition that may cause loss of life or permanent or severe disability if not treated immediately. You should go directly to the nearest emergency room if you experience any of the following:
Chest pain or Shortness of breath Severe abdominal pain following an injury Uncontrollable bleeding
Confusion or loss of consciousness, especially after a head injury Poisoning or suspected poisoning
Serious burns, cuts or infections Inability to swallow
Seizures Paralysis Broken bones
Those who go to the ER with relatively minor injuries or illnesses often have to wait more than an hour to be seen, depending the severity of other patients conditions. Often, many patients could be seen at an urgent care or retail clinic.
Using Urgent Care (lower cost than ER - higher than retail clinic)
Urgent care centers are stand alone clinics or located in clinics or hospitals, and, like emergency rooms, offer after-hours care. Unlike emergency rooms, they are not equipped to handle life-threatening situations. In-stead, they handle conditions that require immediate attention - those where delaying treatment could cause serious problems or discomfort. Examples of conditions that require urgent care are:
Ear infections (though can usually also be treated at retail clinics) Sprains
Urinary tract infections (though can usually also be treated at retail clinics) Vomiting
High fever
The Right Care, the Right Place,
the Right Cost
15
Aurora QuickCare Retail Clinics
DePere Green Bay Oshkosh Kenosha
1415 Lawrence Drive 2440 W. Mason Street 351 S. Washington Street 2801 14th Place (920) 339-4328 (920) 499-5917 (920) 232-0718 (262) 553-9325 Mon-Fri 9 am – 6:30 pm Mon-Fri 9 am – 6:30 pm Mon-Fri 9 am – 6:30 pm Mon-Fri 9 am - 6:30 pm Sat 9 am – 4:30 pm Sat 9 am – 4:30 pm Sat 9 am – 4:30 pm Sat-Sun 9 am - 2:30 pm Sun 10 am - 3:30 pm Sun 10 am - 3:30 pm Sun 10 am - 3:30 pm
Mukwonago Pewaukee Greendale Mequon
250 E. Wolf Run 411 Pewaukee Road 5300 S. 76th Street 10932 N. Port Washington (262) 363-4751 (262) 695-4439 (414) 423-5538 (262) 241-0169
Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 7 pm Sat 9 am - 4:30 pm Sat 9 am - 4:30 pm Sat-Sun 10 am - 3:30 pm Sat 9 am - 5 pm Sun 10 am - 3:30 pm Sun 10 am - 3:30 pm Sun 9 am - 3 pm
Brookfield Sheboygan
95 N. Moorland Road 3711 S. Taylor Drive (262) 786-9037 (920) 457-2915 Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 6:30 pm Sat-Sun 10 am - 3:30 pm Sat 9 am - 4:30 pm
Sun 10 am - 3:30 pm
Bellin Health
(located in Shopko)- ThedaCare Retail Clinics
[Note: Patients must be 18 months or older]Green Bay/Ashwaubenon Green Bay East Green Bay/Suamico Shawano (in Shawano Med Ctr)
301 Bay Park Square 2430 E. Mason Street 2318 Lineville Road 309 N. Bartlett Street (920) 445-7377 (920) 445-7377 (920) 445-7377 (715) 526-8110
Mon-Fri 8:30 am - 8:30 pm Mon-Fri 8:30 am - 8:30 pm Mon-Fri 8:30 am - 8:30 pm Mon-Fri 8:30 am - 8:30 pm Sat 8:30 am - 5 pm Sat 8:30 am - 5 Pm Sat 8:30 am - 5 pm Sat 8:30 am—5 pm Sun 10 am - 5 pm Sun 10 am - 5 pm Sun 10 am - 5 pm Sun 8:30 am - 5 pm Holiday 10 am - 2 pm Holiday 10 am - 2 pm Holiday 10 am - 2 pm Holiday 10 am - 2 pm
Aurora Urgent Care:
Aurora BayCare Health Center Aurora Health Center Aurora BayCare Medical Center
2253 W. Mason Street 1881 Chicago Street 2845 Greenbrier Road
Green Bay DePere Green Bay
Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm 24 hours - 7 days a week
Closed Holidays Weekends: 9 am to 5 pm 920-288-4040
920-327-7240 920-403-8291
Prevea Urgent Care:
Prevea - Ashwaubenon Prevea - Howard Prevea - East DePere
2502 S. Ashland Avenue 2793 Lineville Road 3860 Monroe Road
Green Bay Green Bay DePere
Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm
Weekends: 8 am to 4 pm Weekends: 8 am to 4 pm Weekends: 8 am to 4 pm
920-496-4700 920-496-4700 920-496-4700
Prevea - Plymouth Prevea - East Mason Community Memorial Hospital -
825 Walton Drive 3021 Voyager Drive Oconto Falls
Plymouth Green Bay 835 South Main Street
Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm Oconto Falls
Weekends: 8 am to 4 pm Weekends: 8 am to 4 pm Mon - Fri: 5 pm to 10 pm
920-892-4322 920-496-4700 Weekends: 8 am to 4 pm
888-277-3832
(Bellin does not have any Urgent Care locations)
Using In-Network Retail (Fast Care) Clinics (LOWEST COST)
Retail clinics are the lowest cost option for you and the health plan.
Many services can be rendered and common medical conditions can be treated at retail clinics like:
Monospots Pregnancy Tests Rapid Strep Urinalysis
Allergies (6 yrs. & up) Bladder Infections Sports/Camp Physical Cold/Flu Symptoms
Cold Sores (females 12 yrs. & up) Ear Infections Impetigo
Insect Bites Laryngitis Minor Burns & Rashes Mononucleosis
Pharyngitis Poison Ivy (3 yrs. & up) including sunburn) Sinus Infection
Styes Upper Respiratory
Infection
Uncertain? You can Ask A Nurse by calling the 24/7 Nurse Line at 888-758-7373
A listing of in-network retail clinics is included.
Urgent Care Locations in Greater Green Bay Area
***Urgent care visits are not covered under the retail clinic copayment. You are still required to meet your deductible should you use an Urgent Care facility***
17 Medicaid and the Children’s Health Insurance Program (CHIP)
Offer Free or Low-Cost Health Coverage to Children and Families
If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, you can con-tact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your depend-ents might be eligible for either of these programs, you can contact your State Medicaid or CHIP office or dial
1-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the State if it has a
pro-gram that might help you pay the premiums for an employer-sponsored plan.
Once it is determined that you or your dependents are eligible for premium assistance under Medicaid or CHIP, your employer’s health plan is required to permit you and your dependents to enroll in the plan – as long as you and your dependents are eligible, but not already enrolled in the employer’s plan. This is called a “special enrollment” oppor-tunity, and you must request coverage within 60 days of being determined eligible for premium assistance.
If you live in one of the following States, you may be eligible for assistance paying your employer health plan premiums. The following list of States is current as of March 3, 2010. You should contact your State for fur-ther information on eligibility –
MICHIGAN – Medicaid WISCONSIN – Medicaid
Website: http://www.michigan.gov Phone: 1-517-373-3740
Website: http://dhs.wisconsin.gov/medicaid/publications/p-10095.htm
Phone: 1-800-362-3002
To see if any more States have added a premium assistance program since March 3, 2010, or for more information on special enrollment rights, you can contact either:
U.S. Department of Labor U.S. Department of Health and Human Services
Employee Benefits Security Administration Centers for Medicare & Medicaid Services www.dol.gov/ebsa www.cms.hhs.gov
1-866-444-EBSA (3272) 1-877-267-2323, Ext. 61565
Women’s Health and Cancer Rights Act Notice
On October 21, 1998, the federal government passed the Women’s Health and Cancer Rights
Act of 1998. As part of our plan’s compliance with this Act, we are required to provide you with
this enrollment notice outlining the coverage that this law requires our plan to provide.
Our group health plan has always provided coverage for medically necessary mastectomies.
This coverage includes procedures to reconstruct the breast on which the mastectomy was
performed, as well as the cost of necessary prostheses (implants, special bras, etc.) and
treat-ment of any physical complications resulting from any stage of the mastectomy. However, as a
result of this federal law, the plan now provides coverage for surgery and reconstruction of the
other breast to achieve a symmetrical appearance with the breast on which the mastectomy is
performed.
The following benefits are required to be provided if benefits are provided for a mastectomy:
Coverage for reconstruction of the breast on which the mastectomy is performed.
Coverage for surgery and reconstruction of the other breast to produce a symmetrical
appear-ance with the breast on which the mastectomy is performed.
Coverage for prostheses and physical complications resulting from any state of the mastectomy,
including lymphedemas.
These benefits are subject to the same deductible, copays and coinsurance that apply to
mastectomy benefits under the plan.
19
2014 Enrollment Instructions
Deadline for enrollment is November 20, 2013
If you are not making any changes to the following coverage no plan election forms are necessary
Medical
Dental (Delta Dental)
Vision
If you are Adding, changing, or terminating coverage:
Medical
- elections can be made online at www.umr.com
Flex Spend
- elections can be made online at www.GenesisBenefits.net
Dental
(please select only one of the two dental options below)- Delta Dental - complete enrollment form on page 21
- Dental Associates (CarePlus Form)- complete enrollment form on page 23
Reminder: if you are enrolled in current Delta program, you need to terminate that coverage
Voluntary Vision - complete enrollment form on page 25
New offering :
Voluntary Accident - complete enrollment form on page 27
Voluntary Critical Illness - complete enrollment form on page 27
For any changes made due to marriage, divorce, birth, adoption, etc., throughout the year,
docu-mentation of dependent status is required and must be submitted to Human Resources
Depart-ment within 30 days of the qualifying event date or coverage could be affected. Required
docu-ments can be found on the Human Resources intranet site.
Important Reminders
Certificates of Credible Coverage (referred to as CCC) are issued by UMR and sent to “former”
em-ployees and/or retirees at the time they leave Brown County employment. The CCC is a critical piece
of information and future insurance carriers will ask you for this document. It is vital that you keep
this document. There is a $10 reprinting fee for lost or misplaced CCC documents.
Genesis One Cards are issued by Genesis. Genesis One Cards are valid for more than one year; do
not destroy them at the end of the plan year even if you do not plan on participating in the Flexible
Spending (FSA) the next year. Your FSA funds for 2014 will be loaded on the Genesis One Card you
had in 2013. If you destroyed that card, a $10 fee will be charged to you to replace that Genesis One
Card.
21 21
23
Terms and Conditions
1. All statements and answers in this application are representations made by the member on behalf of himself/herself and other persons named in the appli-cation, if any, to induce the issuance of the dental contract applied for.
2. The Applicant, on behalf of himself/herself and other persons named in the application, if any, consents, authorizes and directs any physician, dentist, consultant, hospital or other person or corporation by whom or in which any diagnosis, medical, surgical or dental treatment or advice is being, shall be or shall have been rendered to furnish and make available to Care-Plus Dental Plans, Inc., all such medical, surgical and dental reports, records and other information as they may request, at no cost to them.
3. The contract applied for will become effective only upon the acceptance of this application by Care-Plus Dental Plans, Inc. to be evidenced by the issuance of Identification Card(s) which will be delivered to the Group or to the Member designated herein as the Applicant.
4. The member authorizes the Group as his remitting agent to deduct from his wages or salary a sufficient amount to provide for the regular and timely repay-ment of the prevailing subscription fees that are not otherwise contributed for the contract applied for, and to remit the same for him on his behalf to Care-Plus Dental Plans, Inc. as specified in the agreement between Care-Care-Plus Dental Plans, Inc. and the Group.
25 EMPLOYER INFORMATION: To be Completed by Employer
Group Number
9802166 Employer Name BROWN COUNTY VISION PLAN Effective Date 01/01/2014 EMPLOYEE INFORMATION A: Add (enroll) T: Terminate C: Change (change of name, address or phone)
□ ADD □ TERM □ CHG Sex □ M □ F Member ID
Last Name (Employee or sub-scriber) First Name M.I. Date of Birth Social Security Number
Home Street Address
City/State/Zip Home Phone
( ) FAMILY INFORMATION (Only those eligible may be enrolled.) A: Add (enroll) T: Terminate
C: Change (change of name)
□ A
□ T
Sex
□ M
□ F
Last Name (spouse) First Name M.I. Date of Birth
Social Security Number □ A □ T Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number □ A □ T Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number □ A □ T Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number □ A □ T Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number
Employee Signature: _____________________________________________________ Date: _________________________ 6
1
Enrollment/Change Form
Please print and complete all sections.
See instructions below.
Underwritten by Fidelity Security Life Insurance Company of Kansas City, Missouri
Instructions:
Employer Name: Legal name of the employer. Group Number: Provided by EyeMed or EyeMed
representative.
Location code: Optional field for employers to track multiple
locations.
Effective date: Date set by employer in accordance with EyeMed
proposal. Employer also sets effective date for new adds during contract period.
Family Information: List only eligible family members who
are enrolling.
Dependent eligibility is the same as employer’s health plan.
(A) Add: Open (group enrollment or new (individual)
enrollment during the contract period.
(T) Terminate: To terminate enrollment.
(C) Change: A change of name, employee address or employee phone.
Once you elect EyeMed vision coverage, you cannot cancel for a 12-month period based
upon your enrollment date.
29
31 BRO WN CO UNTY HUM AN RES OURC ES et Stre lnut . Wa E 305 Gree n B ay, Wi 5430 1 PRESO RTED FIRST -CLASS MAIL U.S. PO STAGE PAID UMS If A tte nding En roll men t Mee ting Plea se B ring Thi s P ack et
