2022 Health Plan Enhancements Q&A's - VBgov.com
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2022 Health Plan Enhancements Q&A's
Please note, we have provided responses from our webinar, as well as corrections where noted and additional
information that may be helpful to the understanding of the question.
HEALTH PLAN CHANGES/OE INFORMATION
Question: Are these two new plans in addition to the Basic, Standard, and Premier plans we
have had, or are these two plans supplanting the previous plans? So instead of 3
options we have 2?
Answer: The POS and the CDHP are the new plans for 2022 and replace the Basic, Standard, and
Premier plans. The POS plan has the same plan design and premiums as the Premier
plan and the CDHP plan has a blend of the plan designs from the Basic and Standard
plans and retains the premiums of the Basic plan.
*This was the previous response in the live session (it has since been corrected to the above
answer): The POS and the CDHP are the new plans for 2022. The Premier plan will be renamed as
the POS plan. The Standard plan will be eliminated at the end of 2021 and the Basic plan will be
renamed CDHP and will have some components of the Standard plan (with a lower premium).
Question: Are both plans still Optima Health products?
Answer: Yes, both plans offered will be administered through Optima Health.
Question: Why was the decision made to eliminate the Standard plan?
Answer: The Standard Plan is similar in plan design to the Basic plan but does not provide an
employer contribution towards the Health Savings Account and therefore offers no
greater value than the Basic plan. The new CDHP plan will retain the deductibles of the
Basic plan, with an increased employer contribution to the HSA, greater coverage in
coinsurance, while also retaining the premiums of the Basic.
Question: With the Standard Plan going away do I have to elect the CDHP?
Answer: No, you can take the time now and up to Open Enrollment to review your
options and see what plan works for you.
Question: Is the POS like the higher end Optima Insurance that is offered now?
Answer: There is no greater plan than the other. They both offer the same services and network
of providers permitting you to decide how, when and who will manage your healthcare
needs.
Page 1 of 11Question: Do we have to sign up for one of these or will it automatically roll over from this
year? Are they the same as this year?
Answer: While we will automatically map your health plan (Premier to POS, and Basic or
Standard to CDHP), it is important to elect the Health Savings Account if enrolled in the
CDHP plan (if you meet the eligibility requirements) to receive the employer
contribution and elect an employee contribution, if desired. If you will not be enrolled in
the CDHP and wish to elect the Flexible Spending Account, this plan also requires that
you enroll annually.
*This was the previous response in the live session (it has since been corrected to the above
answer): You do not need to re-elect a plan as we will automatically map you to the appropriate
plan for 2022. HOWEVER, you do need to re-elect all of your benefits if you have to add/drop any
dependents, make a change or re-elect an FSA or the HSA.
Question: Will Open Enrollment be held in October again?
Answer: Yes, Open Enrollment will be held in October. Please be on the lookout for our bulletins
with Open Enrollment details and information on our events.
Question: In light of the pandemic, how will Open Enrollment be conducted?
Answer: Open Enrollment once again will be held virtually. The CBO will have extended hours
and if you need assistance please be sure to schedule a virtual appointment through the
virtual scheduler.
Question: If you plan to retire January 1, will we need to still make a selection of one of these
choices?
Answer: During Open Enrollment, if you do not make any changes, your health coverage will be
mapped (Premier to POS, and Basic and Standard to CDHP) but once your retirement is
processed your coverage as an employee will terminate on 12/31/21 and you must elect
your retiree benefits on the platform within 30 calendar days from your retirement
date.
*This was the previous response in the live session (it has since been corrected to the above
answer): During Open Enrollment, if you do not make any changes, your health coverage will be
mapped to the correct plan. Therefore, if you decide not to retire, your coverage would have
been mapped for you. If, however, your retirement date is January 1, you must elect your retiree
benefits on the platform within 30 days from your retirement date.
Question: Can you tell me if the rates will change for 2022?
Answer: The rates will not change UNLESS you do not receive the employer contribution. The
2022 POS plan will have the same rates as the 2021 Premier rates and the 2022 CDHP
plan will have the same rates as the 2021 Basic plan.
Page 2 of 11MAXIMUM OUT-OF-POCKET (MOOP) RELATED QUESTIONS
Question: You mentioned exceptions to the MOOP in the new CDHP. Could we get some examples
on what that might be?
Answer: The services and costs that do not count towards the Maximum Out of Pocket are the
same for the POS and the CDHP. Examples include amounts you pay for ridered benefits
(e.g., vision, chiropractic and hearing aids), services after a benefit limit has been
reached (e.g., after 30 physical therapy visits), ancillary pharmacy charges which result
when you request a brand name drug when a generic is available. Also note that costs
for Medical and Pharmacy when received by an in-network provider goes toward the in-
network MOOP, and services received from an out-of-network provider will apply
toward your out-of-network MOOP.
Question: On the POS plan, if you pay $ during the last quarter, it gets rolled over during the next
calendar year IF you've met your deductible AND MOOP, correct?
Answer: If you enroll in the POS plan for 2022 and are moving from the Premier [Premium] plan,
the amount paid toward your deductible in the 4th quarter of 2021 will roll over. You
are not required to have met your deductible or MOOP in the prior year.
Question: Can you please repeat what you said regarding heart attack or cancer treatment as
related to the MOOP - maximum out of pocket?
Answer: Both plans have maximum out of pocket amounts, and these are the most you would
have to pay for health care services in a calendar year. So, you are protected from
catastrophic healthcare costs (for example, costs resulting from treatment for a heart
attack or cancer). There are exceptions. You would have to continue to pay for certain
services not covered by the plan after the MOOP has been met. Examples of this are
provided in a prior question.
HEALTH PLAN COVERAGE QUESTIONS
Question: If you have Medicare Part A only, we cannot get CDHP…correct?
Answer: You can enroll in the CDHP plan, but you would not be eligible for the Health Savings
Account. If you have an existing HSA you can continue to use the funds for medical
expenses, but you would no longer be able to contribute to the account.
*This was the previous response in the live session (it has since been corrected to the above
answer): No, you can enroll in the CDHP with Medicare Part A. However, you cannot elect or
actively contribute to the HSA. If you have an existing HSA you can continue to pay for medical
expenses with the remaining HSA balance.
Page 3 of 11Question: Did I hear correctly that if you have Optima & Tricare as a secondary that you're not able
to sign up for the HSA or Flexible Spending Account?
Answer: You can elect and participate in the FSA with having Tricare but cannot elect the HSA as
the HSA does not allow you to have any other health coverage other than a high
deductible health plan.
*This was the previous response in the live session (it has since been corrected to the above
answer): You can elect and participate in the FSA with having Tricare but cannot elect the HSA.
This gets a little tricky. I recommend contacting HealthEquity directly and they can assist in your
specific situation.
Question: For 2 people, whatever one person pays above the individual deductible it does not
count for the other person?
Answer: It depends on the plan you are enrolled in. If enrolled in CDHP, this has a non-embedded
deductible meaning the family deductible must be met before the plan pays for those
enrolled in any tier coverage other than Subscriber Only. For POS, the plan will pay after
a member meets the individual deductible.
Question: Can we use Optima insurance in North Carolina?
Answer: Yes, you can. If you have further questions regarding the in-network, PHCS or out-of-
network benefits/coverage, please contact Optima Health at 757.687.6141.
Question: Is our provider paid differently for preventative and treatment appointments? So, does
my provider have an incentive to bill appointments as treatment?
Answer: Network providers have agreed upon negotiated rates that they will be reimbursed for
services. Preventive visits are covered at 100% by the plan and diagnostic visits will
require a member cost share. If members ever believe that a charge was billed as
diagnostic when it should have been preventive, they should question the charge.
*This was the previous response in the live session (it has since been corrected to the above
answer): The provider is paid based on how the claim is billed. Preventive visits are covered at
100% by Optima but the allowed amount is still applied. Treatment visits are done the same way
however the member will have a cost share.
Question: Are virtual MDLIVE visits billed at the same rate as in-person visits?
Answer: No, an MDLIVE visit is not billed at the same rate as an in-person visit. For MDLIVE there
is an allowable amount at this time of $39.00. The POS plan covers 100% of this cost
while members on the CDHP will pay $39.00 until the deductible has been met and then
the plans covers 100% (currently due to COVID-19 the member’s responsibility has been
waived). Let me explain what a virtual consult through MDLIVE is. With MDLIVE, you can
access a board-certified doctor by secure online video, phone, or the MDLIVE app –
anytime, anywhere, 24/7/365. MDLIVE is a low-cost, convenient alternative to Urgent
Care Clinic visits or waiting days to get an appointment with your primary care doctor
for non-emergency medical conditions. Doctors can diagnose your symptoms, prescribe
Page 4 of 11non-narcotic medication (if needed), and send e-prescriptions to your nearest
pharmacy.
Another covered benefit is virtual visits offered by your PCP, which is a separate benefit
from MDLIVE. This is when your physician will use any interactive method of
communication for the purpose of diagnosis, consultation or treatment. The amount
billed is the same whether it is in-person or virtual and therefore, the member
responsibility would be the same based upon the plan design (co-pay or co-insurance).
Member cost-sharing for the treatment of COVID-19 from health care providers, as well
as telehealth visits with any in-network care provider, are being waived through July 31,
2021.
Be sure to check our website for any COVID-19 updates at: vbgov.com/benefits.
Question: Is behavioral health covered in the new plans? Can you use the HSA to pay for therapy?
Answer: Yes. Behavioral Health will be covered on both the CDHP and POS plan in 2022. You may
use the HSA card to pay for the visit.
Question: How is lab work covered for both of the plans?
Answer: Diagnostic (x-ray, lab work and imaging) is covered for both plans. For the CDHP it is
covered at 80% after deductible. For the POS plan, it is 85% after deductible.
Question: Why is thyroid disorder not part of preventive health and Rx? [or did I misunderstand
the presentation?]
Answer: Preventive services and pharmacy are federally regulated and not determined by the
health plan. And while Thyroid disorder is not part of the preventive listing of
medications, our plan does offer a discount if you use a preferred network of
pharmacies (Sam's Club, Walmart or Walgreen's).
Question: Why isn't a skin care screening on the preventative list?
Answer: Skin cancer screening is performed by a dermatologist and is not considered preventive.
You will have a specialist copay.
*This was the previous response in the live session (it has since been corrected to the above
answer): Screening for skin cancer is considered preventative. The list provided in this
presentation is not all inclusive.
Question: If the skin cancer screening is with a dermatologist, do I still pay the $40 specialist
copay?
Answer: Skin cancer screening is performed by a dermatologist and is not considered preventive.
You will have a specialist copay.
Page 5 of 11*This was the previous response in the live session (it has since been corrected to the above
answer): If the provider bills as a preventive visit it would be covered at 100%. If the provider bills
as diagnostic, you will pay your specialists copay/coinsurance.
Question: Regarding the skin care exam: She (Terry) said it was covered 100%. Do we have to pay a
copay for the dermatologist? We pay $0 for physical which is covered 100%. Can you
explain this please?
Answer: Please note that the previous response was incorrect. Skin cancer screening is
performed by a dermatologist and is not considered preventive. You will have a
specialist copay/co-insurance. If you have additional questions, please call Optima
Health at 757.687.6141.
*This was the previous response in the live session (it has since been corrected to the above
answer): If the dermatologist bills as preventive you would not have a copay. If you have
additional questions, please call an Optima Health Customer Service Representative at
757.687.6141.
Question: What is the number again for diabetes management?
Answer: You may contact Optima Health at 866.503.2730.
PRESCRIPTION RELATED QUESTIONS
Question: Is preventative pharmacy = prescriptions?
Answer: Yes, it is. Pharmacy is referring to your prescriptions and preventive pharmacy are
prescriptions used to prevent certain conditions as explained in the next question.
Question: What is a preventative Medication?
Answer: Prescription medications are not subject to the deductible for hypertension, high
cholesterol, diabetes, asthma, osteoporosis, stroke, prenatal nutrient deficiency...please
visit Optima Health's website for more information at optimahealth.com.
Question: So, for prescriptions, do you have to reach the deductible first or is it always the copay?
Answer: You will need to meet the deductible on the CDHP first before you pay a copay. On the
POS plan you will pay a copay.
Question: Can the Consolidated Benefits office assist with trying to find the most cost-effective
way or place to purchase an expensive prescription?
Answer: You should call the Optima Health Customer Service Team for assistance with this. Their
phone # is on the back of your ID card. You may also visit optimahealth.com to utilize
their pharmacy tool to price drugs.
Page 6 of 11Question: I tried Optum and it was more expensive. Why is it more expensive?
Answer: OptumRx provides mail order pharmacy for a three-month supply of Rx. Drug costs are
different among pharmacy suppliers and drug prices change daily so it may have been
due to the cost of the drug at the time of your purchase. However, you may also receive
a three-month supply at the preferred pharmacies (Walgreens/Walmart/Sam’s Club).
Question: Will either of these new plans cover preventative weight loss medications as the other
ones did not?
Answer: Preventative weight loss medication will not be covered on either plan for 2022.
Question: Has the city or pharmacy of health coverages considered covering meds for weight loss?
Preventative?
Answer: This is not under consideration at this time.
PREGNANCY RELATED QUESTIONS
Question: What's the difference between a global co-pay (maternity) vs. the other co-pay?
Answer: A global copay is a one-time fee that covers the pre and postnatal visits and avoids you
having to pay a co-pay for each visit.
Question: Is there a way to estimate your global fee on your own when you are pregnant? Is there
an equation?
Answer: The global fee for the POS plan is $350 for a SQCN provider or $500 for non-SQCN
provider for in-network services and the CDHP plan is 10% after meeting deductible for
a SQCN provider or 20% after meeting deductible for a non-SQCN provider in-network.
*This was the previous response in the live session (it has since been corrected to the above
answer): Yes. You can log into your Optimahealth.com account and go to the treatment
calculator.
Question: Are routine ultrasounds covered during pregnancy?
Answer: Yes. Ultrasounds are covered during your pregnancy.
Question: Has the city ever considered offering an add-on rider for infertility coverage?
Answer: The Benefits Executive Committee (BEC) evaluates and manages the health plan
offerings, monitors financial performance and utilization of the plans and at this time
infertility coverage is not a consideration.
Page 7 of 11HSA/FSA RELATED
Question: Who is Health Equity? I have not heard of that company associated with benefits.
Answer: We partner with HealthEquity to administer our Health Savings Account (HSA).
Question: Health Equity used to be Wage Works, right?
Answer: HealthEquity and WageWorks merged. They are now administering the HSA and the
Flexible Spending Accounts (Health Care and Dependent Care).
Question: Please confirm Health Equity is working with FSA and HSA?
Answer: Yes, HealthEquity is the vendor for both FSAs and HSAs.
Question: What is the phone number to call about the HSA and FSA? [that is a different number for
HSA than what was given earlier, was this a mistype?]
Answer: Please note that HealthEquity is the vendor for FSAs and the HSA. The contact
information for FSA is 855.428.0446 and for the HSA is 866.346.5800. (HealthEquity is
also the plan administrator for FSA.)
Question: Is the HSA the same as the FSA?
Answer: No, the Health Savings Account (HSA) and Flexible Spending Account (FSA) can both help
you save money and prepare for medical expenses, but they are different from one
another. Each account has different requirements and components. You must be
enrolled in the CDHP plan to elect the HSA. The HSA allows the employee to contribute
pre-tax payroll funds to pay for medical expenses and there will be an annual pro-rated
employer contribution ($750 single subscriber; $1,250 all other tiers) as well, if eligible.
Funds in the account belong to the member even after termination or retirement and
never forfeit. The HSA contribution limits for 2022 are $3,650 for single subscriber and
$7,300 for all other tiers. Additionally, there is an age catch-up provision that allows
members to contribute an additional $1,000 annually if age 55 or greater. Both the
subscriber and employer contributions cannot exceed the limit (e.g., if enrolled in family
coverage and receive $1250 employer contribution you can contribute a max of $6,050
or $7,050 if age 55 or greater).
The FSA plan can be elected without regard to health plan enrollment. The contribution
limit for the employee is $2,750 annually, and there is not an employer contribution.
Unspent funds in the FSA will forfeit. Note that there is an amount annually that is
allowed to rollover if the plan is re-elected for the next plan year. Prior to COVID the
amount was $500 but for the 2021 plan year an unlimited amount may rollover into
2022.
Page 8 of 11Please review pages 10 and 11 of the 2021 Active Benefits Guide (found on
vbgov.com/benefits under "Active Employees" and "Resources & Information") for more
detailed information and a side-by-side comparison of both accounts.
Question: If I don't spend all of my HSA funds, how much rolls over? Can these funds be used
when I retire? [If not used--how much rolls? And, can be used at time of retirement?]
Answer: The HSA allows for all funds in the account to rollover each year and the account
belongs to the member even after termination or retirement. The purpose of the HSA is
to allow you to save these funds over time for future retirement use.
Question: Will there still be a monthly fee for the HSA?
Answer: Yes, there is currently a $0.99 monthly administration fee on HSA accounts. (Fee
decreased effective 3/1/2021 from $1.45). In the event this changes, the CBO would
announce updated information.
Question: Do we get issued a card from the city to access our HSA account?
Answer: HealthEquity who is the HSA administrator will send you an HSA debit card when you
are a first-time enrollee or if your current card expires.
Question: If I switch from an FSA to an HSA and have a balance in the FSA, can I apply the balance
to the new HSA?
Answer: No. If you have a balance in an FSA and elect an HSA, any monies in the FSA will forfeit.
*This was the previous response in the live session (it has since been corrected to the above
answer): No. The FSA balance can be switched to a LPFSA which allows payment of dental/vision
expenses. The HSA then can be used for all medical expenses. CORRECTION: We do not offer a
Limited Purpose FSA (LPFSA).
Question: Who do I talk to about the LPFSA? Health Equity or CBO?
Answer: Unfortunately, we do not offer a Limited Purpose FSA.
Question: I have been with the city for a little over 8 months and still have not received my HSA
card, whom do I contact about receiving that?
Answer: If you enrolled in the HSA, please contact HealthEquity at 855.428.0446. If you're not
sure, please contact the CBO and we can also assist you.
Page 9 of 11Question: Is the $750 HSA money also available to retirees?
Answer: Yes, if you meet the eligibility requirements for the HSA the employer contribution is
available for retirees. There is a $750 employer contribution for Subscriber Only and
$1250 for all other tiers.
Question: Is the HSA Employer funding new for 2022?
Answer: It is not new for 2022 as we offer the HSA employer funding this year, but the amounts
will change for 2022. $750 Subscriber only and $1,250 all other tiers.
Question: Is the employer contribution to the HSA a one-time contribution or is it a
annual contribution?
Answer: The HSA employer contribution is an annual contribution paid to you pro-rated
throughout the year (City: bi-weekly; School: semi-monthly; Retirees: monthly).
Question: Is the Employer funding paid over 24 or 26 pay checks?
Answer: The Employer funding is paid per pay. City employees (26 pay period); School (20 pay
period); Retirees (monthly).
Question: Does the Health Equity card only pay for what is a health expense or do you have to pay
for non-medical stuff separately?
Answer: HSA Card is to be used only on Medical expenses. For a full list of eligible expenses,
please visit: learn.healthequity.com/qme/.
Question: Can you use your HSA card for medical expenses over the summer months when you're
not working?
Answer: Yes. You can.
Question: Seems like the city is pushing more for HSA as opposed to FSA which is what I have used
for years.
Answer: The HSA and the FSA have different components so you will need to see which best fits
your needs. For instance, the FSA is pre-funded whereas, the HSA is not. The HSA funds
never forfeit and belong to the member even after termination/retirement. The HSA has
investment opportunity if you have a balance of $2,000. (HealthEquity is also the plan
administrator for FSA). The HSA has greater benefits to the member and should be
considered rather than the FSA if eligible.
Page 10 of 11Question: Can you get the CDHP and HSA? [For clarification. You can get the CDHP, but you can't
get the HSA]
Answer: You must enroll in the CDHP to enroll in the HSA. However, if you are not eligible for the
HSA (e.g., have other health coverage like Tricare) you may still enroll in the CDHP
without the HSA.
See page 10 of the Active Benefits Guide or page 12 of the Retiree Benefits Guide for
requirements.
Question: Are retirees eligible for FSA? I thought they are not eligible.
Answer: Retirees are not eligible for the FSA.
Question: So, if the FSA contribution by the City is used to offset the $2,000 individual deductible,
the resulting effective amount of deductible that is the responsibility of the insured is
$1,250?
Answer: There is no FSA contribution by the City/School. There is an employer contribution for
the HSA. In the example provided on the CDHP for single subscriber where there is a
$2,000 deductible and a $750 employer contribution towards the HSA it does help
reduce your responsibility for the deductible to $1,250. However, monies must be in the
HSA account in order to use them and funds are contributed on a pro-rated basis with
each paycheck. Therefore, monies may need to be paid out-of-pocket until you have
enough funds in your HSA account.
Question: Why does the city of [v] Va Beach not accept our FSA card for covered mental health
[MH] expenses?
Answer: Mental health [MH] expenses are covered on your FSA card.
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