Overview of 2024 Health Benefits Enrollment and New Offerings
The 2024 health benefits enrollment presentation highlights key updates such as no increase in medical and dental premiums for employees, hearing aid coverage details, new voluntary benefits from MetLife, and the significance of provider networks. Employees can expect improved coverage and access to essential services in the upcoming year.
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2024 2024 HEALTH BENEFITS HEALTH BENEFITS ENROLLMENT ENROLLMENT PRESENTATION PRESENTATION
Welcome to the SEHP https://healthbenefitsprogram.ks.gov Meet Scopes, your SEHP guide, for helpful tips and information!
Whats New for Medical, Rx and Dental 2024 Medical and Rx Coverage No increase in the current medical premiums for Employees. No changes to out-of-pocket amounts except for the IRS regulation changes for Plans C & N. Plans C & N The first deductible for Employee + Spouse, Employee + Family, and Employee + Children coverage tiers will be $3,200 to meet new IRS regulations for members with "non single" coverage. The overall family deductible will remain at $5,500. Hearing Aid Coverage PrudentRx for Specialty Medications Dental Coverage No increase in the current dental premiums for Employees. Dental premiums remain a zero cost item for employees and are reduced for dependent coverage.
Hearing Aid Coverage How Hearing Aid Coverage Works: The hearing aid coverage will be included with the medical plans. Hearing aids are subject to the plan Deductible and Coinsurance During a three (3) year period, one (1) hearing aid device per ear is eligible for coverage. All covered hearing aid services include hearing devices, and covered services from both Network and Non Network apply toward a maximum benefit for all services of $5,000 per a three (3) year period. Over-the-counter (OTC) hearing aids and accessories are not covered. For example, you cannot use your medical card to purchase OTC hearing aids at a pharmacy. The hearing aid benefit may not be combined with discount hearing aid offers. (This would include the discounts hearing aid programs offered through some of the SEHP health plan vendors.) Visit the SEHP website for an FAQ document to Walk Through the New Benefit .
New Voluntary Benefits Vendor MetLife will be your carrier for the three (3) voluntary benefit plans. Voluntary Benefits available: Accident Insurance Hospital Indemnity Insurance Critical Illness Insurance These plans pay you cash to help offset unexpected expenses due to an accident or covered illness. Non State Employer Groups: check with your Employer for availability.
Provider Networks Provider Networks Broad Provider Networks. Provider Directories are available on the SEHP website. Network Providers save you money!
Medical Plan Highlights Medical Plan Highlights All Medical Plans Include: Prescription Drug Coverage Telemedicine Options Preferred Lab Benefits Access to the HealthQuest Health Center
Medical Coverage Available Plans Available Medical Plans Consider Plan A Plan J Plan C* Plan N* Premium Deductible Coinsurance Out-of-Pocket *Qualified High Deductible Health Plan (HDHP)
Plan A Office Visits Benefit Summary Network Non Network Deductible Individual Family $800 $1,600 $800 $1,600 Coinsurance(paid by member) 20% 50% Out of Pocket Maximum (OOP) Individual Family $5,250 $10,500 $5,250 $10,500 Preventive Care $0 Deductible + Coinsurance Office Visits Primary Care Specialist Urgent Care Telemedicine HealthQuest Health Center $20 $40 $50 $10 $0 Deductible + Coinsurance $100 Copay + Deductible + Coinsurance (Copay waived if admitted within 24 hours) $100 Copay + Deductible + 20 % Coinsurance (Copay waived if admitted within 24 hours) Emergency Room Visits Diagnostic Lab Services when using Preferred Lab providers 100% Deductible + Coinsurance
Plan A Prescription Coverage Tier Prescription Type Paid by Member 1 Generic 20% Coinsurance 2 Preferred Brand Name 35% Coinsurance Specialty Medications (See PrudentRX Solutions Program) 3 30% Coinsurance 4 Non Preferred Brand Name 60% Coinsurance 5 Discount Tier 100% Coinsurance 20% Coinsurance 6 Anticancer Oral Maximum of $100 per standard unit of therapy per 30-day supply 40% Coinsurance 7 Special Case Maximum of $100 per standard unit of therapy per 30-day supply 10% Coinsurance Value Based Diabetes Generic Maximum of $20 per 30-day supply 20% Coinsurance Diabetes Preferred Brand Name Maximum of $40 per 30-day supply 10% Coinsurance Value Based Asthma Generic Maximum of $20 per 30-day supply 20% Coinsurance Asthma Preferred Brand Name Maximum of $40 per 30-day supply
Plan J Network Non Network Deductible $500 Single/$1,000 Family $1,000 Single/ $2,000 Family Coinsurance (Paid by Member) 25% 50% Out of Pocket Maximum (OOP) $7,350 Single/$14,700 Family $10,000 Single/$20,000 Family Pharmacy Coinsurance 20% for Generic, 35% for Preferred Brand Name, 30% for Specialty Medications, and 60% for Non Preferred Brand Name. HealthQuest Rewards Dollars (HRA) Up to $500 for Covered Employees Plan J meets the federal requirements for employees with J-1 Visas
High Deductible Health Plans Plan C and Plan N are qualified High Deductible Health Plans (HDHPs). HDHPs have unique rules outlining how the coverage works, such as: Higher annual Deductibles All services are subject to the annual Deductible (except preventive care) Provides you the option for a Health Savings Account (HSA) The plan pays 100% after the Deductible and Out of Pocket Maximum (OOP) are met Due to Department of Treasury guidelines, the Deductible for all non-single policies will be $3,200 for an individual within the family. The overall family deductible will remain at $5,500.
Plan C Network Non Network Deductible $2,750 Single $3,200/$5,500 Family Coinsurance (Paid by Member) $2,750 Single $3,200/$5,500 Family 10% 50% Out of Pocket Maximum (OOP) $4,500 Single/$9,000 Family $4,500 Single/$9,000 Family Pharmacy Coinsurance 20% for Generic, 35% for Preferred Brand Name, 30% Specialty Medication, and 60% for Non Preferred Brand Name. HealthQuest Rewards Dollars (HRA or HSA) Up to $500 per Covered Employee
Plan N Network Non Network Deductible $2,750 Single $3,200/$5,500 Family Coinsurance (Paid by Member) $2,750 Single $3,200/$5,500 Family 35% 50% Out of Pocket Maximum (OOP) $6,650 Single/$13,300 Family $6,650 Single/$13,300 Family Pharmacy Coinsurance 20% for Generic, 35% for Preferred Brand Name, 30% Specialty Medication, and 60% for Non Preferred Brand Name. HealthQuest Rewards Dollars (HRA or HSA) Up to $500 per Covered Employee
Medical Coverage Telemedicine Costs Plan A Plans C, J, and N Aetna Teladoc General Medicine $49 or less per visit Deductible and Coinsurance apply $10 per visit Blue Cross Blue Shield of Kansas Amwell General Medicine Starts at $59 per visit Deductible and Coinsurance apply $10 per visit Dermatology - $75 per session (or less) Psychiatry - initial diagnostic $190; ongoing session $95 (or less) Mental Health - Non-MD $85 per session (or less) Teladoc & Amwell Specialty Visit $10 per visit Network Provider Subject to primary care Copay Deductible and Coinsurance apply $40 per visit until Deductible is met, then covered at 100% HealthQuest Health Center $0
Prescription Benefits Prescription Drug coverage through CVS Caremark is included when you elect medical coverage. The cost is included in the health plan rates. The Preferred Drug List (PDL) is the same for all plans, the amount you pay varies depending on your selected plan. Home delivery is available through CVS Caremark. Specialty and Biotech Drugs are exclusively available through Caremark Connect
Prudent Rx CVS Caremark & Prudent Rx Specialty Medication Program Here s what s new Caremark Specialty Pharmacy is partnering with PrudentRx to enroll members in available manufacturer copay assistance programs. This change only affects members with Specialty medications through the CVS Specialty Pharmacy. There are approximately 1,300 specialty pharmacy prescriptions today so only a small group of members is impact by this change. The PrudentRx Solution Program is effective January 1, 2024 Starting January 1, 2024, Caremark Specialty Pharmacy is partnering with PrudentRx to enroll members in available manufacturer copay assistance programs. Plan A members will benefit by receiving their specialty medications at no cost, since the copay assistance will apply. Plans C, J and N members will benefit once their deductible has been met. PrudentRx is a voluntary program Members can opt-out at any time, however, if the member chooses not to participate in the PrudentRx program, a 30% Coinsurance will apply to their specialty medications. How to get started Your enrollment in the program will begin automatically, but additional steps may be needed. A PrudentRx trained member advocate will assist you in completing the enrollment and getting started in the program. You will receive a welcome letter from PrudentRx which provides information about the PrudentRx Solutions as it pertains to your medication. Questions:For any questions or additional information about the new program contact PrudentRx at 1-800-578-4403.
Manage Prescription Costs Enable your account at MyRxSS.com
Preferred Lab Benefit Included with all medical plans Plan A: Your lab costs have been significantly discounted and are covered at 100%. Plans C, J, and N: Your lab costs have again been significantly discounted and applied to your deductible until your deductible is met. Then covered lab services are paid at 100%.
HRA and HSA Information If you select Plans C, J, or N, you will have either a Health Reimbursement Account (HRA ) or a Health Savings Account (HSA) through MetLife.
Health Reimbursement Accounts (HRA) HRA Plans C, J, & N Employer contributions only Use it or Lose it
HRA Contributions EMPLOYER CONTRIBUTIONS| Health Reimbursement Account Full-Time Employee Part-Time Employee Employee/Spouse & Family Employee/Spouse & Family Employee Only Employee Only Employee/Child(ren) Employee/Child(ren) Employer Contribution $250.00 per quarter $1,000 year $500 per quarter $2,000 year $500 per quarter $2,000 year $156.30 per quarter $625.20 year $296.88 per quarter $1,187.52 year $296.88 per quarter $1,187.52 year Plan C Employer Contribution $125.00 per quarter $500.00 year $281.25 per quarter $1,125 year $250 per quarter $1,000 year $78.15 per quarter $312.60 year $210.94 per quarter $843.76 year $148.44 per quarter $593.76 year Plan N Employer Contribution HealthQuest Rewards Earned HealthQuest Rewards Earned HealthQuest Rewards Earned HealthQuest Rewards Earned HealthQuest Rewards Earned HealthQuest Rewards Earned Plan J
Health Savings Account (HSA) Eligibility Requirements Per IRS policy, to qualify for an HSA, you must meet all the following stipulations: Enrolled in Plan C or Plan N Not enrolled in Medicare (including Part A only), Medicaid or Tricare Not claimed as a dependent on someone else s tax return Not enrolled in another non-HDHP Qualified Plan Not have a Medical FSA (Limited Purpose is available)
HSA Contributions Plan C, to receive the scheduled employer contribution, you must contribute a minimum amount of $25 per pay period, or $50 per month. Plan N does not require you to contribute to receive the employer contribution to your HSA. In addition to the employer contributions and your contributions, your HealthQuest Rewards Dollars will be deposited in your HSA. IRS 2024 HSA Maximums Single $4,150 Family $8,300 In addition, if you are age 55 or older, you may make an additional catch-up contribution of $1,000 each year. HSA the funds belong to you! As funds accumulate in your HSA, you will have additional investment options available. Your money goes with you, even after you leave employment since it belongs to you.
HSA Contributions EMPLOYER CONTRIBUTIONS | Health Savings Account Full-Time Employee Part-Time Employee Employee/Spouse & Family Employee/Spouse & Family Employee Only Employee/Child(ren) Employee Only Employee/Child(ren) IRS Maximum $4,150 $8,300 $8,300 $4,150 $8,300 $8,300 $250 per quarter $1,000 year $500 per quarter $2,000 year $500 per quarter $2,000 year $156.30 per quarter $625.20 year $296.88 per quarter $1,187.52 year $296.88 per quarter $1,187.52 year Plan C $125 per quarter $500 year $281.25 per quarter $1,125 year $250 per quarter $1,000 year $78.15 per quarter $312.60 year $210.94 per quarter $843.76 year $148.44 per quarter $593.76 year Plan N
Delta Dental Coverage Two Networks, One Plan Delta Dental PPO Delta Dental Premier YOUR ANNUAL BENEFIT MAXIMUM $1,700 per member YOUR DEDUCTIBLE $50 per person, per Plan Year (Not to exceed a yearly family maximum of $150) Deductible does not apply to Diagnostic & Preventive Services YOUR ORTHODONTIA LIFETIME BENEFIT MAXIMUM 50% Coinsurance up to $1,000 per Member
Dental Benefits Summary Your Dentist Network Options: Delta Dental PPO Delta Dental Premier Non Network BENEFIT PAID (% PLAN PAYS) ENHANCED BENEFIT Applies when you have had at least one routine cleaning and/or preventive oral exam in the past 12 months. Diagnostic & Preventive Services 100% 100% 100%* 80% 60% 60%* Basic Restorative Services 50% 50% 50%* Major Restorative Services 50% 50% 50% Implant Coverage Basic Benefit Applies when you have not had at least one routine cleaning and/or preventive oral examine in the past 12 months. Diagnostic & Preventive Services 100% 100% 100%* 50% 50% 50%* Basic Restorative Services 40% 30% 30%* Major Restorative Services 40% 30% 30% Implant Coverage
Avsis Vision Insurance Don t Forget: Your first eye visit regardless of reason or diagnosis each year is covered at 100% if you are enrolled in any of the SEHP medical plans and you use a Network provider.
Vision Insurance Summary Enhanced Plan - Covers everything in the Basic Plan PLUS Basic Plan $50 Office Visit Copay $150 Frame Allowance $25 Materials Copay Up to $116 High Index Allowance $100 Frame Allowance Covered in Full Polycarbonate lenses Lenses: single vision, standard bifocal, trifocal or lenticular 100% Progressive lenses Allowance Up to $165 $150 Contact lenses Allowance Covered in full Scratch & UV coating $35 Contact Fitting Fee Copay
Flexible Spending Accounts The SEHP offers five options for Flexible Spending Accounts (FSAs): Health Care FSA Limited Purpose FSA (Dental and Vision Only) Dependent Care FSA Mass Transit FSA Parking FSA Non State Employer Groups: check with your Employer for availability
Flexible Spending Accounts 2023 FSA Maximums Medical, Dental and Vision FSA $3,050 (Rollover Amount $610) Limited Purpose FSA $3,050 (Rollover Amount $610) Dependent Care $5,000 (per family) $300.00 (per month) Mass Transit FSA $300.00 (per month) Parking FSA
HealthQuest Premium Discount Program Available on Plans A, C, J, & N To receive the Premium Incentive Discount, ONLY the Employee needs to earn credits. Employees need to earn 40 credits to receive the full Premium Incentive Discount. Employees on Plan A who have been employed for minimum of 365 days who earn 20-39 credits can receive a partial Premium Incentive Discount.
HealthQuest Rewards Dollars Available on Plans C, J & N Available on Plans C, J & N One HealthQuest credit = $12.50 Earn up to $500 per employee Reward Dollars are contributed into your HRA or HSA Enable your account at HealthQuest.ks.gov Visit the HealthQuest web page for activities! https://healthbenefitsprogram.ks.gov
HealthQuest Health Center The HealthQuest Health Center is open to all employees, spouses and dependent children over age 2 covered by SEHP medical insurance. SEHP members will need to make an appointment and bring their insurance card to prove eligibility for service. All preventive visits are provided free of cost regardless of health plan enrollment. Healthcare services are provided at no cost for Plan A members. Medical visits will require a $40 fee for members with Plans C, J, and N Schedule an appointment, request prescription refills, access your medical records and forms by visiting the Marathon Health ePortal at my.marathon-health.com. You can also schedule an appointment by calling the HealthQuest Health Center. The HealthQuest Health Center 901 S. Kansas Ave. Topeka, Kansas. 785-783-4080 Clinic Hours Monday, Wednesday, and Friday from 7am - 4pm Tuesday and Thursday from 9am - 6pm.
HealthQuest Health Center Included with all medical plans Preventive Care Covered at 100% Health Screenings Annual Exams Blood Pressure Body Mass Index Cholesterol Glucose School, Camp and Sports physicals Chronic Condition Coaching Arthritis Asthma COPD Depression Diabetes Heart Health Low Back Pain Sleep Apnea Educational Offerings Health Coaching Nutrition Physical Activity Tobacco Cessation Stress Management Weight loss Flu Shots
HealthQuest Health Center Marathon Health Anywhere Program Clinic Hours Monday, Wednesday, & Friday 7am - 4pm Tuesday & Thursday 9am - 6pm. Anywhere is the virtual care platform that provides access statewide to a dedicated care team of primary care providers, behavior health specialists and health coaches for members covered under the SEHP medical Insurance. HealthQuest Health Center Appointments: 1. Schedule an appointment for in person or virtual care by calling 785-783-4080 or by visiting the Marathon Health ePortal at my.marathon-health.com. 2. You need to bring or show your health insurance id card and a photo id. Anywhere Hours: Monday - Friday 7am - 5pm CST with Nurse Triage available from 5pm 7am CST. 3. Plans C, J and N will need to bring $40 to pay for services other than preventive care until their Deductible is satisfied. Payment is due at the time of service.
Employee Assistance Program (EAP) Confidential Emotional Support 24/7 Support, Resources & Information at no additional cost Highly trained clinicians Available 24/7 Work-Life Solutions Call 888.275.1205, Option 1 TTY: 800.697.0353 Find child and elder care Hire movers or home repair contractor Legal Guidance Online: guidanceresources.com App: GuidanceNowSM Web ID: SOKEAP Talk to Attorneys for assistance Discuss Divorce, family law, wills, etc. Financial Resources Get assistance from financial experts Discuss debt, mortgages, retirement planning. Etc.
Coverage Comparison Tool Ask ALEX Ask ALEX www.myalex.com/kansassehp/2024 ALEX is an educational and guidance resource and assists in the explanation of available benefits, how benefits work and the selection and comparison of coverage. Talk to ALEX anytime and anywhere from your smartphone, tablet, or computer. It is NOT an Enrollment Tool. All benefit enrollment MUST be completed through the Membership Administration Portal (MAP).
Enrollment - Dates Open Enrollment October 1-31, 2023 All Employees covered under the medical insurance will need to re-enroll for 2024. New employees whose coverage is effective October, November or December 2023, will need to complete two separate enrollments through MAP. Member Administration Portal (MAP) https://sehp.member.hrissuite.com Employees with ESU, KSU, KU, KUMC and PSU https://sso.cobraguard.net/seer_login.php
Enrollment What do I need to do? What Do I Need to Do? During October, log in to the Membership Administration Portal (MAP) and complete the election process for 2024. Make sure to click Click Here to Submit your Elections Print the Pending Elections Statement IMPORTANT: If you access MAP and enroll in any new plans, you must complete the entire enrollment process. For example, if you access MAP to enroll in Dental only, you mustactively waive your medical coverage, or you will be defaulted into Plan N for medical coverage.
EnrollmentWhat if I dont enroll? What Happens If I Don't Enroll? All active State of Kansas (SOK) employees and Non-State (NSE) employees who are currently enrolled, MUST make elections for Plan Year 2024. If you are currently enrolled and do not re-enroll, then your medical coverage will be defaulted to Plan N with your current medical carrier and an HRA for the employer contributions. Medical Coverage: Vision Insurance: Members currently enrolled in the Vision plan only, will remain enrolled for 2024. Dental Only: Members currently enrolled in the Dental plan only, will remain enrolled for 2024. Due to changing vendors from The Hartford to MetLife, members enrolled in Voluntary Benefits Insurance, MUST RE-ENROLL in those plans for 2024. Voluntary Benefits: Waived Benefits: Members who have waived coverage will remain waived. FSAs Members currently enrolled in an FSA will need to enroll annually to keep the accounts active.
Dependent Eligibility Eligible dependents are covered to age 26 if you have enrolled for dependent coverage.
Dependent Eligibility - Newborns Administratively, the SEHP provides benefits for a newborn child of a covered member for first 31 days (beginning on the date of birth); however, NO benefits will be available beyond that time unless action to enroll the dependent is taken by the member. Within 31 days of birth, the member MUST submit a change request form in MAP to add the newborn.
Premium Assistance Programs Healthy KIDS State employees only Annual application is required KanCare Children s Health Insurance Program (CHIP) Check eligibility and apply during Open Enrollment
SEHP Contact Information SEHP Website https://healthbenefitsprogram.ks.gov/ Membership & Eligibility Questions SEHBPMembership@ks.gov Benefit Questions SEHBPBenefits@ks.gov HealthQuest/SEHP: SEHPHealthQuest@ks.gov When using email addresses above, please remember to provide detailed information, including employee # and current contact information.
Vendor Contact Information Benefit & Coverage Questions: 1.866.851.0754 1.855.249.6317 1.800.332.0307 1.800.294.6324 1.888.270.8897 1.800.234.3375 1.785.783.4080 Aetna: Av sis: BCBSKS: CVS/Caremark: ComPsych (EAP): Delta Dental: HealthQuest Wellness Program: Marathon Health HealthQuest Health Center 1.785.783.4080 MetLife (HRA/HSA): NueSynergy: MetLife (Voluntary Benefits): Quest Select: Rx Savings Solutions: Stormont Vail Health: 1.800.637.4716 The University of Kansas Health System (TUKHS): 1.877.759.3399 1.855.750.9440 1.800.438.6388 1.800.646.7788 1.800.268.4476 1.866.358.5227
