UPDATE: Please review this FAQ for any questions you have. If your question is not answered, please email askbenef@vbschools.com.
The purpose of this communication is to advise school system employees of Health Care Plan changes that will go into effect at the start of the new plan year, Jan. 1, 2014. Since city and school plans mirror each other, city employees are being informed in a similar fashion through their Member Update publication.
Why are plan revisions necessary?
The short answer is that the cost of providing employee health plans is increasing, so we must adjust accordingly. As a reminder, the city and the schools have self-funded health plans, which means the actual cost of receiving services determines the cost of the coverage. The Benefits Executive Committee (BEC), which oversees the health care plan designs, made considerable efforts to hold costs down. In 2014, the school system will continue to pay 90 percent of the total cost of employee coverage (when the VBWellnessforLife incentive is earned by employees) and 60 percent of the dependent’s costs.
However, the biggest driver of increased costs is the required implementation of the Affordable Care Act (ACA). For example, under the ACA, approximately 700 city and school employees will have to be added to the respective health care plans because they work 30 or more hours a week. In addition, the Individual Mandate associated with the ACA requires all individuals to obtain health insurance by Jan. 1, 2014. These two mandates will inevitably increase participation in the city and schools health care plans. This is important because two new required fees are being levied on the city and the schools that relate to our participation rate. One is a temporary reinsurance fee of $63 per health plan member to help stabilize insurance premiums in the individual market. The other is a comparative effectiveness fee of $2.06 per member annually. This fee is designed to help fund research on the outcomes and clinical effectiveness associated with medical treatments. All total, the additional cost of ACA to the city and the schools stands at an estimated $9.3 million. The BEC worked diligently to strike the right balance between keeping the plans as affordable as possible and dealing with the reality that the reserve in the health care fund is incapable of absorbing an increase of this magnitude.
2014 Point-of-Service (POS) Plan Revisions
City and school employees will receive more in-depth details about the 2014 plan from the Consolidated Benefits Office during Open Enrollment. However, the BEC and the Consolidated Benefits Office want to share the major changes with employees now so that you can plan accordingly. There is some good news inherent in the revisions. Employees will no longer pay a deductible for physician office visits, specialists and urgent care services. However, other planned adjustments do involve some cost increases.
Changes include:
- Annual deductibles are increasing for in‑network services, from $100 to $300 per individual and from $200 to $600 for those on the family plan
- While there will no longer be a deductible for physician office visits, specialists and urgent care services, the copay or coinsurance will still be required.
- Hospital inpatient copays are increasing from $250 to $500
- Outpatient surgery copays are increasing from $100 to $250
- Maternity Care global copay is increasing from $50 to $200.The copay for confirmation of pregnancy will remain at $40, and $200 will be the remaining amount paid for outpatient OB services per pregnancy.
- Pharmacy copays (prescriptions) are increasing in some cases*
- Preferred Tier: $10 maximum to $15 maximum
- Standard Tier: $25 maximum to $30 maximum
- Premium Tier: 25 percent coinsurance ($35 minimum) to 25 percent coinsurance ($45 minimum)
- Premium Plus Tier: 50 percent coinsurance ($50 minimum) to 50 percent coinsurance ($60 minimum)
*Important Note: Prescriptions filled at a Preferred Pharmacy (Walgreens or Wal-Mart) will not pay the increased copay
2014 High Deductible Health Plan (HDHP) Plan Revisions
The pharmacy change listed under the POS plan revisions is the only change being made to the HDHP plan for 2014.
Helpful New Features Being Added to the POS and HDHP Plans
The BEC and the Office of Consolidated Benefits have ensured that additional features will become part of the city and school health care plans. These include:
- MDLive provides employees with 24/7 on-demand access to board certified doctors anytime, anywhere. Real time video and phone consultations provide treatment, in a safe and secure environment, for a wide range of medical conditions, regardless of the employee’s location. MDLive can be used when: employees are considering the emergency room or urgent care for non-emergency medical issues; the primary care physician is not available; employees are traveling and in need of medical care; or during or after normal business hours and holidays
- Accordant Rare Disease Management is a program that offers disease management and case management services for people with rare chronic conditions. Members eligible for the program are offered services at no cost to them. This is a specialized program to help people manage their rare chronic illness. These conditions and their associated complications are managed by registered nurses. The program is designed to improve the quality of life for those who are ill, their families and caregivers, while reducing overall health care costs.
2014 Health Plan Rate Structure for School Employees
Below are the 2014 semi-monthly rates for employees on the POS and HDHP plans for school employees (health care plan deductions are made over 20 pay periods for school employees versus 24 pay periods.) The rates below reflect what the semi-monthly deduction would be both with and without the VBWellnessforLife credit which amounts to $25 semi-monthly for school employees for total of $500 annually.
Finally, as implementation of the VBWellnessforLife initiative continues, we believe that healthy behaviors coupled with the required annual health screening and attendant preventive and treatment measures will result in a healthier workforce, which will help improve the cost scenarios. Those who have questions about the planned changes may contact the Consolidated Benefits Office at 263-1060.
Farrell Hanzaker
Chief Financial Officer &
Member, Benefits Executive Committee
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I am confused as to what this statement means. Can you please clarify? THANKS!
■While there will no longer be a deductible for physician office visits, specialists and urgent care services, the copay or coinsurance will still be required.
Please clarify the sentence of “While there will no longer be a deductible for physician office visits, specialists and urgent care services, the copay or coinsurance will still be required.”
It doesn’t make any sense to me. Do we pay or not?
As time for open enrollment approaches, will more pharmacies be added to the “preferred pharmacy” listing to join Walgreen’s and Wal-Mart?
How did Walgreen’s and Wal-Mart become “preferred pharmacies”?
Thanks!
Since our deductables are increasing, can we increase our flex benefits account?
I believe the Flex benefits maximum is 2,500 per year for singles, 5,000 per year for married couples. This is a federal rule and Flex benefits can’t change that.
I am married but I can only claim $2500 so explain the difference. Married couples can have $5,000 but my paperwork says I can only claim $2500 so I am assuming this comment means that since my husband doesn’t work for the schools/city, that is why I can only claim $2500?
Will the pharmacy copays (prescriptions) apply to the mail order prescriptions at Catamaran Rx? If Walgreens or Wal-Mart will not pay the increased copay, will Catamaran also not pay the increase?
POS — the explanation is very confusing. Am I to understand that I don’t have to pay co-payments for regular office visits, special visits or urgent care, BUT, I have to pay $200 per family member on the Employee/Spouse plan? How will I pay the $200 per family member?
We are sorry for the confusion, but there was a correction made to the deductible section – individual deductibles will be $300; not $200. Again, the Benefits Executive Committee is currently working on answers to your questions, so please send this – and any other question you may have – to askbenef@vbschools.com.
I don’t understand what the deductible is vs. the copay.
The Benefits Executive Committee is currently working on a FAQ to address all the questions employees may have, please send questions to askbenef@vbschools.com to make sure it is included in the response.
POS – I’m confused because it in one area it reads “Employees will no longer pay a deductible for physician office visits, specialists and urgent care services”, then the first bullet item reads “■Annual deductibles are increasing for in‑network services” and lists the increased cost.
Will we still have a deductible or not? What are “In-Network Services”? Is “In-Network Services” not a physician office visit, specialist or urgent care service?
We originally had a overall deductible of $100 per individual and $200 per family. This amount had to be paid before the insurance would cover the cost of any services renders.
Now we will have to pay 3 times the amount of the deductible and still pay the copayment to our PCP, Specialist, etc. This does not even make sense economically.
We have a family of 3 and there is no way that we can afford this so we will have to check in to finding another company and dropping this insurance.
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Please explain the preferred pharmacies. Walgreens no longer takes military insurance, so it is not a viable option for those of us with the 2 insurances. Also, Wal Mart has proven to be less than accurate with their filling of prescriptions and monitoring costumers who take multiple prescriptions. Rite Aid, Target, and CVS are all competitive with their pricing, and are actually recommended by my doctor over the two you all have chosen as “preferred.” Thanks
CVS has proven to be the best pharmacy around. I think it is very unfair to say Walgreen’s who constantly runs out of prescription drugs and Walmart with its never ending lines are preferred pharmacies. Very unhappy about this.
Also, is there a deductable or not?
Is the HMO still an option other than the POS?
Having to raise the deductible to $300 a person when it’s the employee plus each child is unreasonable. Maybe coverage out of pocket wouldn’t cost us so much if there were multiple companies to choose from other than the conglomerate of Optima and Sentara that is required!
Hopefully a FAQ will be posted soon. With the changes made this week to health care reform (being delayed for another year) will we also receive a reprieve from these changes? I agree that Walgreens and Walmart should not be the only preferred pharmacies.
So am I reading this right that there is no longer a deductible that we have to pay for office visits/ urgent care? So what exactly is the deductible for ? Emergency and hospital visits? Please clarify!
Thank you for the explaination. Are there any plans to increase the amount of Wellness for Life credit?
Please see that the FAQ has been posted by the city and is available here: https://benefits.vbcps.com/Documents/CBOHomepage/2014%20Plan%20Changes%20and%20QAs%20%282%29.pdf
I had Optima HMO and now have Optima POS. Why was I not notified prior to receiving my new health insurance cards of the change, since I kept everything as is and never signed anything. It seems to me that you can change things on your end anytime, but we are not allowed to change things on our end other than, 1. During annual Open Enrollment or 2. When a Qualifing Life Event takes place. I certainly hope that I will never have to experience something so devestating to use the Qualifing Life Event. It would be hard enough dealing with the devestation. What would be even harder would be to turn over information to someone that you don’t know depending on the circumstances. One should be able to drop their insurance anytime throughout the year and not have to give an explanation, no matter what.