2023 Plan Year Update - Wood County Employee Health Benefits Plan - Wood County, Ohio
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Wood County
Employee
Health
Benefits Plan
2023 Plan Year Update
Agenda
1. Wellness Program & Incentives
This Plan is a
non-federal, 2. Plan Performance
governmental,
self-insured,
non-ERISA plan. It is
3. Benefits
also a grandfathered
health plan under
4. Reminders
the ACA.
5. Additional Resources
While some
provisions of the ACA
apply to all plans,
grandfathered plans
do not have to
provide certain
benefits.
Hello!
Who wants $50?
$50
3
Complete a Wellness
Screening in 2023
We want you to know
your health status.
Health Risk Coronary Risk All Benefit-Eligible
Assessment (HDL/LDL) employees hired prior
to 2023 are eligible
to receive $50 for
Blood completing the
Bone Density confidential, free
Pressure wellness screening.
A1C Occult Blood
(Blood Sugar) Screening
Payment is a taxable fringe benefit and will be reported for tax purposes. To qualify, employee must be 4
compliant with the program. Other program provisions apply including charges for missed appointments.
1
Wellness
Programs
’23 Changed Me!
Earn Deductible Credit
for your 2024 Medical Deductible
You Choose How You Earn It!
$50 $100
4 Monthly 8 Monthly
Challenges Challenges
and 1 event and 2 events
OR OR
5 Events 10 Events
6
Monthly Wellness
Challenges
Track Your Activity 23 days out of the Month
Social Media Sit Out Better Yourself Lights Out
Rethink Your Drink Positively You Stay In
Step It Up Curb Your Sweet Tooth Every Dollar Counts
Happier, Healthier You Brain Teaser Make It Colorful
7
Wellness Events
Participate in any of the following events throughout the year
OSU Extension Webinars
KEPRO Online Seminars (EAP)
Wood County Park District Programs
Deferred Compensation Meetings/Presentations
Donate Blood at a County Sponsored Drive
Various “Pop-Up” Events throughout the Year
8
Other Wellness Programs
Up to $150 Reimbursement
Up to $50 Reimbursement
Up to $150 Reimbursement
Fitness Open Tobacco
Program Swim Termination
• Reimbursement • Reimbursement • Requires two
Periods Period visits with the
• Jan – June • Memorial Day EAP
• July – Dec to Labor Day • Choice of
• Up to $50 each Cessation
• Up to $75 with for 3 family Method -
30 visits members with 20 usually
• Up to $150 with visits at local excluded
60 + visits community pool under Rx
coverage
9
Refer to the Reimbursement Forms for additional requirements.
See the EAP Introduction Video posted on the Employee
Website for available services and resources
102
Plan
Performance
Overview of Plan FeaturesWhat
Makes Our
Plan Work!
1 2 3
Being engaged consumers helps you and the Plan save money
to protect the Plan’s long-term viability. Pulling less money out
of our insurance trust pocket is a win for everyone!
12Participation Features
• Low monthly premiums
• Low deductible
• Continued Grandfathered Status under the Affordable Care Act
Schedule of Benefits
• Comprehensive scope of coverage
• Large network access
• Wellness Programs
Carrot vs. Stick
• Voluntary participation
• Designed for prevention/early detection & appropriate
treatment
132022 State Employment Relations Board Survey Plan Design Comparison (represents data as of Jan. 1, 2022) Category 2022 SERB Average Wood County Office Visit Copay $18 $15 Urgent Care Copay $37 $15 Emergency Room Copay $134 $45 Deductibles Single Coverage $590 $150 Family Coverage $1,185 $450 Out-of-Pocket (In-Network) Single Coverage $3,284 $400 Family Coverage $6,593 $1,200 14
2022 State Employment Relations Board Survey Plan Cost Comparison (represents data as of Jan. 1, 2022) Single Coverage* Employer Cost Employee Cost Totals All Plan Types $636.71 $98.55 $735.26 Toledo Area / All Plans $631.90 $93.29 $725.19 PPO Plans $663.36 $111.63 $774.99 Wood County** $553.50 $97.68 $651.18 Family Coverage* Employer Cost Employee Cost Totals All Plan Types $1,779.99 $286.34 $2,066.33 Toledo Area / All Plans $1,649.47 $255.06 $1,904.53 PPO Plans $1,861.79 $334.32 $2,196.11 Wood County** $1,447.78 $253.96 $1,693.02 * Includes all plan types including High Deductible Plans 15 * Includes Health, Prescription, Vision, Dental and Life
2023 Monthly Employee Premiums
Coverage Single Family
Same rate
Health/Rx $91.42 $237.70
as 2016
Vision $1.34 $3.48
Dental $5.32 $13.80
Life $0.00 $0.00
All Coverage $98.08 $254.98
Commissioners approved a ‘premium holiday’ for May 2022.
5th employee ‘holiday’ since November 2019.Total Plan Expenses 2017 to 2022 (Nov. 1, 2022)
2022 YTD $10,313,655
2021 $11,255,034
2020 $11,173,315
2019 $11,501,618
2018 $12,356,611
2017 $11,188,775
$0 $5,000,000 $10,000,0003
BENEFITS
Ways to Stretch Your Dollars FurtherKnow where to go…
Need a primary care physician?
Acute Issues/Monitoring
PRIMARY CARE PHYSICIAN
• Taking new patients
• Offers Sliding Fee Schedule even
for those with insurance coverage
• Provides access to the Rx Savings
After Hours/Non-Life Threatening
Program
Need urgent care?
URGENT CARE
• Bills at the doctor office rate, Life Threatening/Medical Emergency
which is lower than an
urgent care facility EMERGENCY ROOM
Non-emergency visit may not be covered by the Plan.
19Precertification Required
for Certain Services
Employee ultimately responsible
Advise family members (close friend) of the need to precertify in an emergency situation
See Plan Document for complete list
e.g., Inpatient Admission, Transplant, Outpatient Infusions
Failure to comply results in claim denial
Upon appeal, if found medically necessary a penalty applies.
(50% reduction in payment) 20Health Coverage
NEW TPA NEW ID CARDS NEW CUSTOMER
SERVICE NO.
New Group Number 1.800.925.2272
19238
SAME NETWORK SAME CLAIMS
BILLING ADDRESS
FrontPath
See back of ID card
Meritain will also be processing any claims received for services billed after 1/1/23.
21
Trustmark will stop processing Wood County claims on 12/31/22.HEALTH
COVERAGE
In-Network Out-of-Network
(Balance billing protection) (No balance billing protection)
Co-Payments Co-Payments
Questions about an EOB? Office Visit - $15 Office Visit - $15
Contact Meritain ER - $45 ER - $45
• 1.800.925.2272 Deductible Deductible
• meritain.com $150 Single $300 Single
• Mobile App available
$450 Family $900 Family
Co-Insurance
Insurance Co-Insurance
Questions about a provider? 20% Employee 40% Employee
Contact FrontPath Maximum Maximum
$250 S /$750 F $500 S/$1,500 F
• 1.888.232.5800
Out-of-Network Applies
• Frontpathcoalition.com to In-Network Only
22Choose Network Providers
23
www.frontpathcoalition.comCoordination of Benefits
Review 2022 EOBs upon receipt and report any issues to
Trustmark before 12/31/22.
Claims processing issue was identified under Trustmark for
members reported as secondary on the Plan.
Working to identify claims and reprocess claims to correct
issue.
• Contacting Providers to request Primary info/Overpayment
• Watch your mail for a letter requesting additional
information needed by Trustmark to reprocess claim.
• Respond to request.
• Failure to provide information may result in reversal of paid
claims.
Audit of Secondary Coverage will be completed in 2023
to ensure COB correctly reported to new TPA. 24Prescription Coverage
NEW TPA NEW ID CARDS NEW CUSTOMER
SERVICE NO.
Updated customer 1.866.900.3711
service number
Using same group
number
SAME MEDICAL
SAME FORMULARY SAME RxEOB NECESSITY
REVIEW PROCESS
25PRESCRIPTION COVERAGE
Formulary Retail Pharmacy Mail Order RX Savings Program
Copay Copay Copay 90-day supply
34-day supply Maximum 90-day supply Maximum * Some restrictions apply
Tier 1 or select $5 $10
OTC with $5
prescription
Tier 2 $20 + 20% AWP; $45 max $40 + 20% AWP; $90 max
$5
Tier 3 $20 + 20% AWP; $85 max $40 + 20% AWP; $170 max
$5
Medical $20 + 50% AWP; $200 max $20 + 50% AWP; $400 max
Necessity $5
Review
Use the Community Health Center to help lower the cost of your prescription medications
26
Use MyDrug Benefit/RxEOB to view medications in the formulary and price shop to saveDENTAL COVERAGE
2 Cleanings
1 Bitewing
$1,500 Annual Radiograph
$100 Annual
Maximum Per
Deductible 2 Fluoride
Person
Treatments
Not subject
to deductible.
27Where you go does make a difference
Maximize Plan savings with a PPO provider.
Adult Cleaning and Exam Sample Cost
PPO Dentist Premier Dentist Use of Premier Dentists
Plan Cost = $54 Plan Cost = $77 resulted in about $83,000 more
in claim costs compared to a
1,576 claims 3,612 claims PPO Dentists
View a list of PPO providers at www.deltadentaloh.com.
28Where you go does make a difference
Maximize your savings with a PPO provider.
Sample Cost for a Crown PPO Dentist PREMIER Dentist
(not actual costs)
Submitted Fee $1,100 $1,100
Maximum Allowed $754 $988
Coverage Level 50% 50%
Amount Plan Pays $377 $494
PPO Dentist
Saves Member $117
AMOUNT YOU PAY $377 $494 and also the Plan
Saves $117
View a list of PPO providers at www.deltadentaloh.com.
Applies to $1,500 annual maximum benefit
29Vision Program Covers Benefit Period
Payable only as primary Exams $200 per participant
(no coordination of Prescription glasses/frames during 2-year period
benefits) and contacts (2022 – 2023)
No restriction on access Refractive Surgery
Requires original receipt Submit 2022 claims by
and claim form with March 31, 2023
patient and services
clearly identified
304
REMINDERS
To Do List with TimelinesEligibility Reminders
Report Any Changes
• Monthly Measurement for New Hires: within 30 Days
Ensure averaging 30 hours per week Address Changes,
Marriage, Births,
• Spousal Eligibility: Loss/Gain of Coverage,
Other Insurance, etc.
Income Thresholds Increase in 2023
• Dependent Students over 19
on Vision and/or Dental:
Report if no longer full time or
attending school
32Individual Enrollment
Verification &
SPD Sign Off
• Review Enrollment:
Dependents
Primary/Secondary
• Update Other Coverage:
Must provide Primary information if Return Signoff
with signatures
requesting Secondary Coverage to Group Rep by
• Confirm Life Insurance Beneficiaries Nov. 30
• Use Legal Names:
As printed on Social Security Card
(Required for Federal Data Matching) 33Open Election
Opportunity to change
coverage without a Qualifying
Event/Special Enrollment Right
Application is required and
must be received by 4:30 p.m.
on December 15
Changes eff. January 1, 2023
34Notify Medical Providers of Changes Share new ID cards with providers starting Jan. 1st 35
Claims not
processed
properly
County paid as
primary when
member had
other primary
coverage
365
Additional
Resourceswww.woodcountyohio.gov/employee
Follow the Insurance Link
￮ Plan Document
￮ Summary Plan
Description
￮ Summary of Benefits
and Coverage
￮ Glossary of Terms
￮ Forms
￮ Links to Providers
Employee Website 38Vendor Resources
Mobile App also available!
39Vendor Resources
40Plan Administrators
for 2023 Plan Year
Third Party Pharmacy Benefit Third Party Administrator for
Administrator for Manager Administrator for Vision Benefit
Health Benefit Dental Benefit And Enrollment/Eligibility
Hannah Bouman
Robin Serwatka Benefits Clerks
Josh Schroeder
Shelby Williams
41Thanks for Third Party
Being Plan
Administrators
Engaged Trustees
Consumers Members
Wellness
Subcommittee
Employee
Health
Benefits
Committee
42You can also read
