Commonwealth of Virginia 2019 Open Enrollment Details
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Commonwealth of Virginia
2019 Open Enrollment
Health Care and
Flexible Spending Accounts (FSAs)
May 1-15, 2019
2019 OPEN ENROLLMENT
2
Your Time to Choose
•
It’s the annual window for you to make
decisions on health plans and flexible
spending accounts (FSAs)
•
Nothing is required
if you are:
•
Not changing your health plan or
membership,
•
Not enrolling in an FSA,
and
•
Not participating in Premium Rewards
2019 OPEN ENROLLMENT
3
Health Plans
•
Enroll in or change
your health
plan
•
Elect or remove optional buy-ups
for COVA Care, COVA HDHP and
COVA HealthAware
•
Waive
coverage
•
Add or remove
family members
2019 OPEN ENROLLMENT
4
•
Enroll in a Health or Dependent
Care FSA
or both
•
You must submit an enrollment
request each year
you wish to
have an FSA
Flexible Spending Accounts
(FSAs)
2019 OPEN ENROLLMENT
5
How to Make Elections
•
Visit EmployeeDirect
and select
Health Benefits Direct
or
•
Submit an Enrollment Form
to
your agency Benefits Administrator
•
The deadline is May 15, 2019
2019 OPEN ENROLLMENT
6
Visit EmployeeDirect Online
•
Select
Health Benefits Direct
•
Review your current health benefits record
•
Update your personal information
•
Enroll or make changes to your health plan
and/or membership
•
Enroll in one or both FSAs
•
Submit your elections early and
no later
than 11:59 p.m., May 15, 2019
h
ttps://edirect.virginia.gov
2019 OPEN ENROLLMENT
7
Complete and Submit an
Enrollment Form
•
Complete the fillable form on the DHRM
website:
www.dhrm.virginia.gov
•
Print, sign it and submit to your Benefits
Administrator
•
No computer access? Request a printed form
from your BA
•
Be sure to submit by COB on May 15, 2019
YOUR HEALTH PLAN OPTIONS
8
April 2018
OPEN ENROLLMENT HIGHLIGHTS
9
April 2018
See Spotlight…
•
Premium changes
•
New Optima Health Vantage HMO plan offered in
Hampton Roads
•
COVA Care, COVA HealthAware and COVA HDHP
•
Anthem will administer the outpatient prescription drug
program through IngenioRx
•
Delta Dental will administer dental benefits
•
Medication synchronization program available under
pharmacy benefit
OPEN ENROLLMENT HIGHLIGHTS
10
April 2018
See Spotlight…
•
COVA HealthAware
•
Aetna Health app enhanced
•
Flexible Spending Accounts (FSAs)
•
PayFlex will administer Health and Dependent Care FSAs
•
Health FSA contribution limit increased to $2,700
from
$2,600
GET ADVICE FROM ALEX!
11
April 2018
April 2018
•
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9
EARN PREMIUM REWARDS!
12
April 2018
•
For
employee and/or spouse
enrolled in
COVA Care or COVA
COVA Care or COVA
HealthAware
HealthAware
•
Employee
or
spouse can save
$17/month
$17/month
•
Together
can save
$34/month
$34/month
WHAT DO I NEED TO DO FOR
A PREMIUM REWARD?
13
April 2018
•
Be enrolled in
COVA Care
COVA Care
or
COVA
COVA
HealthAware
HealthAware
•
For a Reward Starting July 1
•
Complete or update your health
assessment between
May 1 and May 15
•
For a Reward After July 1
•
Complete a health assessment
by the
15
th
of any month
to receive a reward in six to eight weeks
•
See Premium Reward requirements chart:
www.dhrm.virginia.gov/healthcoverage/open-
www.dhrm.virginia.gov/healthcoverage/open-
enrollment
enrollment
WHERE DO I SUBMIT MY
HEALTH ASSESSMENT?
14
•
If completed between May 1 and June 30
•
Submit to ActiveHealth as you do now
•
If completed beginning July 1
•
Visit the COVA Care or COVA HealthAware plan
website
www.anthem.com/cova
or
www.covahealthaware.com
Questions? Ask your Benefits Administrator
www.myactivehealth.com/cova
www.myactivehealth.com/cova
1-866-938-0349
1-866-938-0349
15
STATEWIDE PLANS
Administered by Anthem, Delta Dental
a
nd Anthem
Pharmacy delivered through
IngenioRx
Administered by Aetna, Delta Dental
a
nd Anthem
Pharmacy delivered
through
IngenioRx
TRICARE SUPPLEMENT
http://www.selmantricareresource.
com/cova
1-800-638-2610
,
press Option 1
Administered by
Selman & Company
The basic plans include:
The basic plans include:
•
Medical
•
Behavioral Health
•
Employee Assistance Program (EAP)
•
Prescription Drug
•
Diagnostic and Preventive Dental
16
Optional Benefits
Optional Benefits
•
COVA Care:
COVA Care:
•
COVA HDHP:
COVA HDHP:
17
Expanded Dental
Routine Vision/Hearing
Out-of-Network
Expanded Dental
18
Expanded Dental Option
•
Primary Care
– such as fillings,
extractions, root canals
•
Complex Restorative -
crowns, dentures, bridges and
implants
•
Orthodontic services
19
Expanded Vision
•
E
y
egla
ss
es
•
C
onta
c
t
len
s
es
•
Includes allowances for non-Blue
View provider services
20
21
New!
Engage App
•
Manage Anthem benefits from
your smart phone or tablet
•
View your benefits in one place
New!
Anthem Health Guide
•
Enhanced customer service
experience
22
The basic plan includes:
The basic plan includes:
•
Medical
•
Behavioral Health and EAP
•
Prescription Drug Routine Vision and
Hearing Exams
•
Preventive and Diagnostic Dental
Health Reimbursement Arrangement
(HRA)
•
Out-of-Network Coverage
23
What is a Health Reimbursement
What is a Health Reimbursement
Arrangement (HRA)?
Arrangement (HRA)?
•
Account that automatically pays eligible out-of-
pocket expenses
as long as funds are available
•
Medical
•
Behavioral health
•
Pharmacy
•
Funds paid from HRA
toward eligible expenses for any
covered member
•
Unused HRA funds roll over
into future plan years
with no limit if enrollment in the plan continues
•
Initial HRA contribution for 7/1/2019:
•
Employee/Retiree - $600
•
Employee/Retiree + Spouse - $1,200
•
HRA contribution is prorated for new
enrollments or QME changes during the plan
year.
•
The HRA proration chart may be found at
www.COVAHealthAware.com
24
HRA Contribution
HRA Contribution
25
April 2018
Update Since Spotlight Published
Update Since Spotlight Published
•
Beginning July 1:
•
Aetna will continue to administer the
HRA as it does now
•
Automatic reimbursements continue
•
No MasterCard required for HRA
•
More information from Aetna once you
enroll
26
H
R
A
“
D
o
R
i
g
h
t
s
”
•
$
50 HRA contribution for up to three
“Do Rights”
•
Up to $150 per employee/early
retiree
•
Up to $150 per enrolled spouse
27
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E
x
p
a
n
d
e
d
V
i
s
i
o
n
•
Eyeglasses
•
Contact lenses
•
Discounts for eyewear and
accessories
•
Network includes private
practice providers plus
participating national chains
28
ANTHEM PHARMACY DELIVERED
BY INGENIO RX
•
Retail, home delivery and specialty
benefits
•
Existing prior authorizations and retail
prescriptions automatically transfer
•
Current home delivery prescriptions
transfer except for controlled
substances and compounded
medications
8
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•
management
HEALTH & WELLNESS
PROGRAMS
29
Beginning July 1
•
Your medical plan will now administer
your free and confidential health and
wellness programs
•
Disease management
•
Medication and health coaching
incentives
•
Maternity Management
•
Health Assessment
HEALTH & WELLNESS
PROGRAMS
30
Beginning July 1
•
For more information, see individual plan
brochures or the Open Enrollment link on the
DHRM website
www.dhrm.virginia.gov/healthcoverage/open-
enrollment
After
July 1
•
Look for details
from your health plan on
transition of programs
31
EMPLOYEE ASSISTANCE
PROGRAM (EAP)
Up to 4 visits per issue each plan year at
no cost to member
•
For participants and members of their household
•
Confidential resource for personal and workplace
challenges
•
Legal and financial guidance
w
w
w
.
A
n
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m
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32
REGIONAL PLANS
New!
Optima Health Vantage
HMO
Kaiser
Permanente HMO
Available
in Hampton Roads zip codes
www.optimahealth.com/cova
Available primarily
in Northern Virginia zip codes
my.
kp.org/commonwealthofvirginia/
33
Introducing
the Optima Health
Vantage HMO
•
You must live or work in Hampton Roads area
zip codes to enroll
•
You choose a primary care physician (PCP) to
coordinate your care
•
No referrals required to see a specialist
•
Out-of-area coverage for
dependent children
•
No out-of-network coverage except for
emergencies
34
Optima Health Vantage HMO
•
Medical, prescription drug,
d
ental, vision and
hearing benefits
•
Preventive care covered at 100 percent
•
100 percent of hospitals in Hampton Roads are
in-network
•
Employee Assistance Program (EAP)
•
Dedicated member services unit
More at
optimahealth.com/cova
35
Kaiser Permanente HMO
•
You must live or work in primarily Northern Virginia zip
codes to enroll
•
Changes to dental benefits
•
Coinsurance for dental benefits
•
$75 family deductible
•
You pay 50% of the cost for orthodontia for
dependents 19 years old and under
•
Changes to vision benefits:
•
Adults pay 75% of the balance for eyeglass frames
•
Special list of contact lenses and frames for children
More at
my.kp.org/commonwealthofvirginia/
36
Flexible Spending Accounts
(FSAs)
Administered by PayFlex for all employees
eligible for health benefits
He
a
lth
C
a
re
FS
A
•
Set aside
up to $2,700
per
year, pre-tax, for eligible
health care expenses
D
e
p
en
d
ent
C
a
re
FS
A
•
S
e
t as
i
d
e
up
to
$5
,
00
0
pe
r
y
e
a
r
,
p
r
e
-ta
x
, for eligible
expenses for the care of your
dependent
37
Flexible Spending Accounts
(FSAs)
You must enroll
each
each
plan year
plan year
to participate
“
“
Use it or lose it” rule
Use it or lose it” rule
:
•
Use all of your funds by the end
of your coverage period
•
File for reimbursement by
the filing deadline or forfeit
your FSA funds
•
If you enroll in COVA
HealthAware:
•
The
HRA pays first
HRA pays first
•
Use the PayFlex
Use the PayFlex
MasterCard for your FSA
MasterCard for your FSA
38
More Open Enrollment
Information
•
Spotlight on Your
Spotlight on Your
Benefits
Benefits
newsletter
newsletter
•
Retiree Notification
Retiree Notification
booklet
booklet
f
•
or:
•
Comparison of
Benefits
•
Premiums & Premium
Rewards
•
Open Enrollment page on
www.dhrm.Virginia.gov
39
WHO TO CONTACT FOR
ASSISTANCE
•
Your Benefits
Administrator
•
The
health plans
•
Questions on EmployeeDirect registration or
login?
Email: edirectissues@dhrm.virginia.gov
•
Questions on Health Benefits Direct or Open
Enrollment in general?
Email: openenrollment@dhrm.virginia.gov
40
SUBMIT YOUR ELECTIONS
ON TIME BY MAY 15!
The Commonwealth of Virginia's 2019 Open Enrollment period for health care and Flexible Spending Accounts (FSAs) is from May 1-15. During this time, employees can make choices on health plans, FSAs, and Premium Rewards participation. Options include enrolling in or changing health plans, electing optional buy-ups, adding or removing family members, and enrolling in a Health or Dependent Care FSA. The deadline for submitting elections is May 15, 2019. Employees can make selections online through EmployeeDirect or by completing and submitting an Enrollment Form. Various health plan options are available, such as COVA HealthAware, COVA Care, COVA HDHP, Kaiser Permanente HMO, and more.
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Commonwealth of Virginia 2019 Open Enrollment Health Care and Flexible Spending Accounts (FSAs) May 1-15, 2019
2019 OPEN ENROLLMENT Your Time to Choose It s the annual window for you to make decisions on health plans and flexible spending accounts (FSAs) Nothing is required if you are: Not changing your health plan or membership, Not enrolling in an FSA, and Not participating in Premium Rewards 2
2019 OPEN ENROLLMENT Health Plans Enroll in or change your health plan Elect or remove optional buy-ups for COVA Care, COVA HDHP and COVA HealthAware Waive coverage Add or remove family members 3
2019 OPEN ENROLLMENT Flexible Spending Accounts (FSAs) Enroll in a Health or Dependent Care FSA or both You must submit an enrollment request each year you wish to have an FSA 4
2019 OPEN ENROLLMENT How to Make Elections Visit EmployeeDirect and select Health Benefits Direct or Submit an Enrollment Form to your agency Benefits Administrator The deadline is May 15, 2019 5
2019 OPEN ENROLLMENT Visit EmployeeDirect Online https://edirect.virginia.gov Select Health Benefits Direct Review your current health benefits record Update your personal information Enroll or make changes to your health plan and/or membership Enroll in one or both FSAs Submit your elections early and no later than 11:59 p.m., May 15, 2019 6
2019 OPEN ENROLLMENT Complete and Submit an Enrollment Form Complete the fillable form on the DHRM website: www.dhrm.virginia.gov Print, sign it and submit to your Benefits Administrator No computer access? Request a printed form from your BA Be sure to submit by COB on May 15, 2019 7
April 2018 YOUR HEALTH PLAN OPTIONS Plans Offered Available COVA HealthAware Statewide COVA Care COVA HDHP Statewide Statewide Regional, Northern Virginia Regional, Hampton Roads Statewide Kaiser Permanente HMO New! Optima Health Vantage HMO TRICARE Supplement 8
April 2018 OPEN ENROLLMENT HIGHLIGHTS See Spotlight Premium changes New Optima Health Vantage HMO plan offered in Hampton Roads COVA Care, COVA HealthAware and COVA HDHP Anthem will administer the outpatient prescription drug program through IngenioRx Delta Dental will administer dental benefits Medication synchronization program available under pharmacy benefit 9
April 2018 OPEN ENROLLMENT HIGHLIGHTS See Spotlight COVA HealthAware Aetna Health app enhanced Flexible Spending Accounts (FSAs) PayFlex will administer Health and Dependent Care FSAs Health FSA contribution limit increased to $2,700 from $2,600 10
April 2018 GET ADVICE FROM ALEX! Review your health plan options with ALEX ALEX will use your input, do the math, and recommend a plan just for you www.myalex.com/cova/2019 April 2018 11
April 2018 EARN PREMIUM REWARDS! For employee and/or spouse enrolled in COVA Care or COVA HealthAware Employee or spouse can save $17/month Together can save $34/month 12
April 2018 WHAT DO I NEED TO DO FOR A PREMIUM REWARD? Be enrolled in COVA Care or COVA HealthAware For a Reward Starting July 1 Complete or update your health assessment between May 1 and May 15 For a Reward After July 1 Complete a health assessment by the 15th of any month to receive a reward in six to eight weeks See Premium Reward requirements chart: www.dhrm.virginia.gov/healthcoverage/open- enrollment 13
WHERE DO I SUBMIT MY HEALTH ASSESSMENT? If completed between May 1 and June 30 Submit to ActiveHealth as you do now www.myactivehealth.com/cova 1-866-938-0349 If completed beginning July 1 Visit the COVA Care or COVA HealthAware plan website www.anthem.com/cova or www.covahealthaware.com Questions? Ask your Benefits Administrator 14
STATEWIDE PLANS Administered by Anthem, Delta Dental and Anthem Pharmacy delivered through IngenioRx Administered by Aetna, Delta Dental and Anthem Pharmacy delivered through IngenioRx TRICARE SUPPLEMENT Administered by Selman & Company http://www.selmantricareresource. com/cova 1-800-638-2610, press Option 1 15
The basic plans include: Medical Behavioral Health Employee Assistance Program (EAP) Prescription Drug Diagnostic and Preventive Dental 16
Optional Benefits COVA Care: Expanded Dental Routine Vision/Hearing Out-of-Network COVA HDHP: Expanded Dental 17
Expanded Dental Option Primary Care such as fillings, extractions, root canals Complex Restorative - crowns, dentures, bridges and implants Orthodontic services 18
Expanded Vision Eyeglasses Contact lenses Includes allowances for non-Blue View provider services Hearing Routine hearing exam once per plan year Hearing aids and related supplies up to $1,200 every 48 months 19
Out-of-Network Plan payment reduced by 25% Provider may balance bill for amounts the plan doesn t pay 20
New! Engage App Manage Anthem benefits from your smart phone or tablet View your benefits in one place New! Anthem Health Guide Enhanced customer service experience 21
The basic plan includes: Medical Behavioral Health and EAP Prescription Drug Routine Vision and Hearing Exams Preventive and Diagnostic Dental Health Reimbursement Arrangement (HRA) Out-of-Network Coverage 22
What is a Health Reimbursement Arrangement (HRA)? Account that automatically pays eligible out-of- pocket expenses as long as funds are available Medical Behavioral health Pharmacy Funds paid from HRA toward eligible expenses for any covered member Unused HRA funds roll over into future plan years with no limit if enrollment in the plan continues 23
HRA Contribution Initial HRA contribution for 7/1/2019: Employee/Retiree - $600 Employee/Retiree + Spouse - $1,200 HRA contribution is prorated for new enrollments or QME changes during the plan year. The HRA proration chart may be found at www.COVAHealthAware.com 24
Update Since Spotlight Published Beginning July 1: Aetna will continue to administer the HRA as it does now Automatic reimbursements continue No MasterCard required for HRA More information from Aetna once you enroll April 2018 25
HRA Do Rights Annual routine physical exam Routine dental exam Annual routine vision exam Annual flu shot Physical activity tracker Digital coaching Employees/Early Retirees and enrolled spouses $50 HRA contribution for up to three Do Rights Up to $150 per employee/early retiree Up to $150 per enrolled spouse 26
Expanded Vision Eyeglasses Contact lenses Discounts for eyewear and accessories Network includes private practice providers plus participating national chains Expanded Dental Primary Care such as fillings, extractions, root canals Complex Restorative - crowns, dentures, bridges and implants Orthodontic services 27
ANTHEM PHARMACY DELIVERED BY INGENIO RX Retail, home delivery and specialty benefits Existing prior authorizations and retail prescriptions automatically transfer Current home delivery prescriptions transfer except for controlled substances and compounded medications 833-267-3108 or www.anthem.com 28
HEALTH & WELLNESS PROGRAMS management Beginning July 1 Your medical plan will now administer your free and confidential health and wellness programs Disease management Medication and health coaching incentives Maternity Management Health Assessment 29
HEALTH & WELLNESS PROGRAMS Beginning July 1 For more information, see individual plan brochures or the Open Enrollment link on the DHRM website www.dhrm.virginia.gov/healthcoverage/open- enrollment After July 1 Look for details from your health plan on transition of programs 30
EMPLOYEE ASSISTANCE PROGRAM (EAP) Up to 4 visits per issue each plan year at no cost to member For participants and members of their household Confidential resource for personal and workplace challenges Legal and financial guidance www.AnthemEAP.com www.mylifevalues.com 31
REGIONAL PLANS New! Optima Health Vantage HMO Available in Hampton Roads zip codes www.optimahealth.com/cova Kaiser Permanente HMO Available primarily in Northern Virginia zip codes my.kp.org/commonwealthofvirginia/ 32
Introducing the Optima Health Vantage HMO You must live or work in Hampton Roads area zip codes to enroll You choose a primary care physician (PCP) to coordinate your care No referrals required to see a specialist Out-of-area coverage for dependent children No out-of-network coverage except for emergencies 33
Optima Health Vantage HMO Medical, prescription drug, dental, vision and hearing benefits Preventive care covered at 100 percent 100 percent of hospitals in Hampton Roads are in-network Employee Assistance Program (EAP) Dedicated member services unit More at optimahealth.com/cova 34
Kaiser Permanente HMO You must live or work in primarily Northern Virginia zip codes to enroll Changes to dental benefits Coinsurance for dental benefits $75 family deductible You pay 50% of the cost for orthodontia for dependents 19 years old and under Changes to vision benefits: Adults pay 75% of the balance for eyeglass frames Special list of contact lenses and frames for children More at my.kp.org/commonwealthofvirginia/ 35
Flexible Spending Accounts (FSAs) Administered by PayFlex for all employees eligible for health benefits Health Care FSA Set aside up to $2,700 per year, pre-tax, for eligible health care expenses Dependent Care FSA Set aside up to $5,000 per year , pre-tax, for eligible expenses for the care of your dependent 36
Flexible Spending Accounts (FSAs) You must enroll each plan year to participate Use it or lose it rule: Use all of your funds by the end of your coverage period File for reimbursement by the filing deadline or forfeit your FSA funds If you enroll in COVA HealthAware: The HRA pays first Use the PayFlex MasterCard for your FSA 37
More Open Enrollment Information Spotlight on Your Benefits newsletter Retiree Notification booklet f or: Comparison of Benefits Premiums & Premium Rewards Open Enrollment page on www.dhrm.Virginia.gov 38
WHO TO CONTACT FOR ASSISTANCE Your Benefits Administrator The health plans Questions on EmployeeDirect registration or login? Email: edirectissues@dhrm.virginia.gov Questions on Health Benefits Direct or Open Enrollment in general? Email: openenrollment@dhrm.virginia.gov 39
SUBMIT YOUR ELECTIONS ON TIME BY MAY 15! Visit EmployeeDirect at https://edirect.virginia.gov OR Submit an enrollment form to your agency benefits office Employee forms must be received by the close of business on May 15 Retiree forms must be postmarked no later than May 15 40
