Changes in Benefit Plans for FY 12/13
Maricopa County is committed to promoting better health for its employees and their families. For the upcoming plan year, the County has put together a comprehensive benefits package that supports this objective. This year’s benefits package is streamlined to be easier for employees to understand, and is designed to help control rising medical and pharmacy costs without sacrificing quality of care.
Every benefits-eligible employee is encouraged to learn about the changes for FY12/13 because this will be an “Active Open Enrollment” meaning that everyone must take action in order to select their benefits for next year or to waive coverage. Employees should review the benefit plan options and determine which best meet their needs. Although rates and out-of-pocket costs may also be a consideration, from a financial perspective most employees will see either a reduction in premiums or an increase of $10 or less per month.
Preventive care continues to be a primary focus, so employees and their dependents are encouraged to get their well exams and other screenings completed. Preventive services are provided at no cost and serve three main purposes: they help keep employees and their dependents healthy; they help identify potential health issues early; and in general they keep health care costs down.
From March through April 21st, the County is having its annual Biometric Screening Event at various worksite locations. Individual screening results are confidential and will not be shared with the County. Benefits-eligible employees who participate in this event will be eligible for a savings of $5 per pay period on their medical premium, or a savings of up to $120 per year. The same thing holds true for those who complete the Health Assessment. Additionally, employees who previously took and passed the saliva test (for the detection of nicotine presence) will not need to retest. In order to qualify for the Non-Tobacco User Premium Reduction for FY12/13, they will simply need to answer a question about their smoking status and that of their covered dependents during the past six months. New employees or those who have quit smoking will still need to complete the saliva test.
The Passport to Wellness will continue to be offered as a reminder and incentive for employees who are enrolled in a County-sponsored medical plan to get their preventive care taken care of for themselves and their dependents. Upon completion and validation of all program requirements, employees will receive a premium discount for each family member who completes the passport: $100 employee, $100 spouse, and $50 per dependent, up to a $500 per family maximum.
Below is a summary of benefits changes effective July 1, 2012 for active, benefits-eligible employees:
Medical Plan Changes
The medical plans are being consolidated from six plans to three, while still offering distinct plan options – an HMO, a PPO, and a High Deductible Health Plan with a Health Savings Account (HSA).
The new plans will be:
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Cigna Medical Group Plan (CMG) - this is the HMO (Health Maintenance Organization) option which provides in-network managed care only and requires that you use a participating network of Cigna providers, most of whom are at Cigna facilities only. Employees and their dependents enrolled in this plan will have a Primary Care Physician assigned to them who is located at one of the Cigna Health Care Centers.
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Open Access Plus Plan (OAP) – this is the PPO (Preferred Provider Organization) option which gives you the flexibility to use either in or out-of-network healthcare providers. Similar to other PPOs, this plan is structured with copays and co-insurance.
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Choice Fund Medical Plan with Health Savings Account Plan (HSA) – this is the High Deductible Health Plan which offers the broadest network of providers (in and out-of network) but which may pose a greater financial risk up front due to the high deductible. This plan also offers a health savings account.
Cigna will continue to administer the aforementioned medical plans.
The plans that will be eliminated are:
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Cigna Medical Group Low Plan (CMG Low)
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Open Access Plus Low Plan (OAP Low)
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Open Access Plus In-Network Plan (OAPIN)
Employees in the CMG and OAP Low plans will have the opportunity to attend individual counseling intended to help them make a more informed decision when transitioning to a new plan. As details are finalized, information about these meetings will be communicated.
Medical Plan Features (In-Network):
All Plans:
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Bariatric surgery will be an available benefit.
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Cigna is introducing a new disease management program, Your Health First, to provide support for chronic conditions.
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Emergency room copay is increasing to $200.
- Visit limits will be implemented for chiropractic, rehab, and other therapies.
CMG:
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Annual deductible is moving to $350 for individual and $700 for family.
CMG/OAP:
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Routine medical and preventive lab and x-ray services will be free. Advanced imaging, such as an MRI, CT, PET, and MRA, are subject to a copay.
- Copays for primary care physicians, specialists, and other services are increasing.
OAP:
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Moving to a copay and co-insurance plan model.
OAP/HSA:
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In partnership with the University of Arizona, a new integrative medicine clinic will be available.
HSA:
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Annual contribution limits changed to $3,100 for individual and $6,250 for family. If you are age 55 or older you can contribute an additional $1,000 catch-up contribution.
- The County’s annual contribution into an HSA will be based on the employee’s coverage level at the start of the plan year. There will not be additional funding associated with a family status change. For new enrollees after July 1, 2012, the County’s contribution will be prorated based on the number of days covered in the plan year.
Additional information about the medical plans will be available on April 16, 2012 in the “What’s New” booklet on the Employee Benefits website at www.maricopa.gov/benefits or via the Intranet at ebc.maricopa.gov/ehi.
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Pharmacy Plan Changes
The pharmacy plans, administered by Catalyst Rx (formerly WHI – Walgreens Health Initiatives), are being consolidated from two plans to one. Effective July 1, 2012, the Consumer Choice Pharmacy Plan is being eliminated, and allowances provided by the County to be applied towards the purchase of prescription drugs will no longer be available.
Because the County bundles its medical, pharmacy, and behavioral health benefit plans, employees who enroll in the Cigna Medical Group (CMG) or Open Access Plus (OAP) plan will automatically be enrolled in the Co-Insurance Pharmacy Plan. This plan will have some modest increases in the minimums and/or maximums and copays.
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Behavioral Health Plan Changes
Magellan Health Services will continue to administer the behavioral health benefit for those enrolled in the Cigna Medical Group or Open Access Plus Plans. Psychological support for bariatric surgery candidates will be available through Magellan for those enrolled in these plans. If enrolled in the Choice Fund Medical Plan, the behavioral health component will be administered by Cigna.
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Vision Plan Changes
For FY12/13, vision coverage will no longer be bundled with medical which means that employees have the flexibility to elect medical coverage without having to elect vision coverage. Rates for vision coverage will be increasing.
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Dental Plan Changes
Dental premiums are decreasing for those enrolled in the Cigna or Delta Dental plans. Additionally, Delta Dental will begin offering a progressive/regressive feature under their plan which means that when you receive your preventive care, your benefit level will increase the following year.
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Flexible Spending Account Changes
Due to a change required under the Patient Protection and Affordable Care Act, the cap for contributions into a Health Care Flexible Spending Account will be lowered from $5,200 to $2,500. This change includes the General Purpose and Limited Use Flexible Spending Accounts.
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Life Insurance Changes
For FY12/13, the County has contracted with a new vendor for life insurance services, ReliaStar Life Insurance Company, a member of the ING family of companies. Employees will be able to take advantage of premium savings of up to 60%.
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Short-Term Disability Plan Changes
Coverage was enhanced for the Short-Term Disability Plan by allowing benefits to start as early as the first day of hospitalization. Therefore, the waiting period is now three weeks OR first day of hospitalization. Premiums for the new plan year will remain unchanged.
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Benefits Effective Date Change
For newly-hired or newly benefits-eligible employees (except elected officials), the effective date for benefits will be the first day of the third pay period following their date of hire or date the employee becomes benefits-eligible.
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Wellness Changes
Two programs administered by Catalyst Rx will no longer be available effective July 1, 2012. These are the Walgreens Optimal Wellness (WOW) Program and the Healthful Living Smoke Free Program. The County, however, will continue to support employees taking steps to manage their diabetes or quit smoking and will do so by enhancing two of its internal programs.
The County’s Diabetes Management Program will be enhanced to include the reimbursement of up to four diabetes-related office visit copays. By taking steps to meet the requirements of the program which include seeing a doctor at least twice a year and getting all diabetes-related exams and screenings completed, participants in the program may now be reimbursed for up to four out-of-pocket, copay costs they incurred.
With regards to the County’s Quit Tobacco Program, employees who are considering giving up smoking will now have an added incentive to do so. If they enroll in the program, they will immediately be eligible to start receiving the Non-Tobacco User Premium Reduction, provided their covered dependents have been tobacco-free for six consecutive months. If they go on to complete the six-week program, the reduction will continue, and then six months later these employees will be required to take and pass the saliva test to continue receiving the reduction. Employees who do not complete the program or who resume using tobacco products will no longer be eligible for the reduction.
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Other Change
A benefits effective date for coverage resulting from a spouse’s annual Open Enrollment event will be considered a Qualifying Event thus permitting an employee to drop coverage through the County to enroll in coverage through his/her spouse, or permitting an employee to enroll in coverage through the County if dropped from coverage by his/her spouse during the spouse’s Open Enrollment event.
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