Valley View School District 365U - January 1, 2021 Employee Benefits Open Enrollment Presentation
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Valley View School District 365U January 1, 2021 Employee Benefits Open Enrollment Presentation
2021 Open Enrollment Presentation
• 2021 Program Overview
• Open Enrollment
• Medical Plan Overview
• Prescription Drug Plan Overview
• COVID-19 Overview
• Dental Plan Overview
• Vision Plan Overview
• FSA / Dependent Care Plan Overview
• Recap
2
2021 Program Overview
Changes Effective January 1, 2021:
Medical Plan: Hearing Aid Benefit Frequency
Current: Per Every 36 Months New: Per Every 24 Months
Dental Plan: Exam Frequency
Current: 1 Per Every 6 Months New: 2 Per Every 12 Months
Insurance Carrier Changes: Vision, Life AD&D and Long Term Disability (LTD)
Vision Current: EyeMed New: BCBS of IL (new id cards!)
Life AD&D Current: Liberty Mutual New: BCBS of IL
LTD Current: Liberty Mutual New: BCBS of IL
3
2021 Program Overview
Medical / Prescription Drug
BCBS of IL PPO Plan
Dental
BCBS of IL PPO Plan
Flexible Spending and Dependent Care
PayFlex Flexible Spending Account
PayFlex Dependent Care Account
Vision
BCBS of IL PPO Plan
Life AD&D
BCBS of IL Life AD&D Plan
Long Term Disability
BCBS of IL Long Term Disability Plan
42021 Open Enrollment 5
Open Enrollment
Process
Open Enrollment Period:
December 1st – December 14th
Current Enrollment Elections:
Medical and Dental elections will automatically continue with no
paperwork required.
Federal Government requires annual enrollment in Flexible Spending
and Dependent Care Accounts. Applications must be completed
to enroll in accounts effective January 1, 2021.
6Open Enrollment
Process
Enrollment forms can be found at www.vvsd.org.
Elections are to be submitted to the Insurance Department no later than
Monday, December 14th.
All elections are effective January 1, 2021 – December 31, 2021.
7Open Enrollment
Rights
During the open enrollment period you are eligible to make the following
enrollment changes to the medical and dental programs for a January 1,
2021 effective date:
Elect Coverage Previously Declined
Add Eligible Spouse, Civil Union Partner or Dependents
Terminate Existing Coverage
Terminate Eligible Spouse, Civil Union Partner or
Dependents
8Special Enrollment
Rights
The only other times during the plan year when you are eligible to make
changes to your current election(s) is when the following life events occur:
Birth
Death
Marriage / Civil Union
Divorce / Civil Union Dissolution
Adoption
Loss of Coverage
Eligible Spouse, Civil Partner, Dependents gain or loss of
coverage
9Medical Plan Overview 10
BCBS of IL Medical
Plan Overview
Benefits PPO Plan
Network Name PPO
Network Level In Network / Out of Network
In Network: Contracted Fee; Out of Network:100% of Medicare;
Claim Payment Basis
No Balance Billing Balance Billing Applies
Deductible
Individual $250 / $500
Family Maximum $500 / $1,500
General Coinsurance Health Plan: 90% / 60%
Plan Member: 10% / 40%
Medical Out of Pocket Maximum
Individual $1,500 / $3,750
Family Maximum $3,000 / $8,025
Out of Pocket Eligible Expenses Deductible, Coinsurance, Office Visit & ER Copays
The deductible and out of pocket maximums accumulate on a calendar year basis (January 1st – December 31 st) and therefore
reset every January 1st. Any portion of your in network deductible that is satisfied in the fourth quarter of the year (October,
November and December) is automatically credited as satisfied deductible for your next calendar year in network deductible.
11BCBS of IL Medical
Plan Overview
Benefits PPO Plan
Network Level In Network / Out Network
Inpatient Hospital 90% after Deductible / 60% after Deductible
Outpatient Surgery 90% no Deductible / 60% after Deductible
Office Visit - Primary Care Physician & Specialist Consult $30 Copay / 60% after Deductible
Outpatient Diagnostic / Lab Work / Tests 90% after Deductible / 60% after Deductible
Hearing Aid Benefit 90% after Deductible / 60% after Deductible
Exam 1 Per Ear Per 24 Months
Aid/Instrument 1 Per Ear Per 24 Months
Adult: $2,500 Per Ear / Child(ren): No Maximum
Emergency Room
(Copay Waived if Admitted to Inpatient) $250 Copay then 90% after Deductible
Preventive Screenings 100% no Deductible / 100% no Deductible
12BCBS of IL Medical
Preventive vs. Diagnostic Care
Both can include physical exams, lab tests, immunizations and prescriptions
DIAGNOSTIC
Annual physicals PREVENTIVE Sick office visits
• Checks for
Well woman exams • ACA disease when Mammogram due
mandated you have
& mammograms to a lump
benefit symptoms or
because of a Travel
Child approved known health
• Helps you
immunizations stay healthy issue immunizations
by checking • Once you find
Adult approved for disease Blood pressure
a health issue
immunizations before you medicine
feel sick • Subject to
Visit healthcare.gov copays, Full body scans
for complete list • 100% no deductibles &
deductible coinsurance Other health
13
issues
13BCBS of IL Medical
Plan Overview
Calendar Year Limits PPO Plan
Chiropractic & Osteopathic Manipulation 30 Visits
Physical Therapy Services 110 Visits
Occupational Therapy Services 28 Visits
Speech Therapy Services 19 Visits
Additional Speech Therapy Benefits for
20 Visits
Treatment of Pervasive Developmental Disorders
14Prescription Drug Plan Overview 15
BCBS of IL Prescription Drug
Plan Overview
Benefits PPO Plan
In Network
Retail Pharmacy (30 Day)
$0 Copay
Generic
Up to a $40 Copay *
Preferred Brand
Up to a $60 Copay *
Non-Preferred Brand
Mail Order (90 Day)
Mandatory as of 4th Refill
Up to a $0 Copay
Generic
Up to a $80 Copay *
Preferred Brand
Up to a $120 Copay *
Non-Preferred Brand
Out of Pocket Maximum
$1,500
Individual
$3,000
Family
Out of Network
Retail Pharmacy (30 Day) In Network Copay + 25% Cost of Drug & Balance Billing *
Mail Order Not Covered
Out of Pocket Maximum No Maximum
* If a brand name drug is filled and a generic equivalent is available, in addition to the appropriate brand copay, the
plan member is responsible for the cost difference between the drugs, not to exceed the cost of the brand name drug.
The cost difference responsibility does not apply to plan member’s prescription drug out of pocket maximum.
16Prescription Drug Plan
Benefits PPO Plan
Network Access Advantage Pharmacy Network. CVS is an Out of Network pharmacy.
Members are required to fill specialty drugs at the BCBS preferred specialty pharmacy
Specialty Pharmacy Alliance Rx Walgreens Prime. Drugs are filled at a maximum 30 day supply per script
and the method of delivery is mail order.
The prescribing physician to submit prior authorization paperwork to substantiate medical necessity
and to cross check for potential drug interactions. Paperwork has to be approved by BCBS before the
Prior Authorization script is approved and can be filled by the pharmacy. If the script is denied, the physician can file an
appeal which typically requires the submission of supporting medical records. Denied scripts will not
be eligible for coverage and the plan member will be responsible for paying the full cost of the drug.
The prescribed drug be substituted with a “first line” (typically a generic equivalent or alternative
drug) when the script is filled regardless of if the prescribing physician indicates “Dispense as
Step Therapy
Written”. If drug proves to be ineffective, the prescribing physician can provide medical
documentation and request the member be allowed fill the original prescription drug.
Compound Drugs, Brand-Name Proton Pump Inhibitors (Acid Reflux Medication), Non-Sedating
Exclusions
Antihistamines and Weight Loss Drugs are excluded from coverage under the plan.
16COVID-19 Overview 18
BCBS of IL
COVID-19
Benefits PPO Plan
COVID-19 Plan members will not be responsible for plan member cost share (copays, deductibles
Testing / Testing Related Visits or coinsurance) for testing to diagnose COVID-19 or for testing-related visits with in-
network providers. Pre-authorization for testing is not required.
Plan member cost share waiver ends with the end of the Health and Human Services
(HHS) public health emergency as required by the Families First Coronavirus Response
Act.
Telehealth Visits Telehealth visits are covered as a regular office visit in accordance with plan terms for
in-network providers who offer the service through two-way, live interactive telephone
and/or digital video consultations.
Plan Members will continue to have access to the expanded in network telemedicine
services through 2020. In 2021 BCBS will make changes to the services that can be
provided on a telehealth basis.
19BCBS of IL Medical
Finding a PPO Provider
BCBS of IL PPO Medical Providers
BCBS of IL offers you access to their PPO network of providers, facilities and hospitals. Members
that enroll in the PPO plan will have the freedom to seek care from providers regardless of their
network relation. Choosing care from a provider in the BCBS of IL PPO network affords you and
your dependents an in network level of benefit which can mean lower deductibles and out of pocket
expenses, as well as discounted services and no balance billing. To search the BCBS of IL PPO
network please use the following internet search instructions:
1.Go to www.bcbsil.com.
2.On the top right side of the screen, click on the box labeled “Find a Doctor or Hospital”. You can login as a
member to search or you may continue to search as a guest.
3.Enter your location and then select your network. For the PPO network, select “Participating Provider
Organization [PPO]”. You will then select from the “Browse by Category” dropdown or enter a Name or Specialty
in the search box.
4.After your initial search, you can further narrow your search results by selecting from the various dropdown
menus, including Specialties, Gender, Patient Ratings and more.
20
20Dental Plan Overview 21
BCBS of IL Dental
Plan Overview
Benefits * Dental Plan
Deductible (Waived for Preventive)
$25
Individual
$75
Family
Annual Maximum Per Individual $2,000
In Network: Maximum Allowance
In Network Versus Out of Network
Out Network: Usual and Customary
Preventive Services 100%
Basic Services 80%
Major Services 50%
Orthodontia Services (Children to Age 23) Not Covered
Exam Frequency 2 Every 12 Months
*If you are an Administrative or Secretarial classed employee, your plan will differ slightly.
Please see the Insurance Department with any questions.
22BCBS of IL Dental
Finding a PPO Provider
BCBS of IL PPO Dental Providers
BCBS of IL offers you access to their PPO network of providers. Members that enroll in the PPO
plan will have the freedom to seek care from providers regardless of their network relation.
Choosing care from a provider in the BCBS of IL PPO Dental network affords you and your
dependents an in network level of benefit which can mean lower out of pocket expenses, as well as
discounted services and no balance billing. To search the BCBS of IL PPO Dental network please
use the following internet search instructions:
1.Go to www.bcbsil.com/providers/dental.htm.
2.Under “Find a Dentist” select your Network. For the PPO dental plan, select “BlueCare Dental PPO”.
3.You can search by “Dentist Name”, “Location”, “County” or “Center Name”. Each search allows you to further
refine your search results by selecting a Specialty and/or Language.
23
23Vision Plan Overview 24
BCBS of IL Vision
Plan Overview
Benefits In Network Out of Network
Eye Exam $10 Copay Up to $45 Allowance
Up to $130 Allowance;
Frames Up to $70 Allowance
20% off Balance
Single Vision Lenses
$25 Copay Up to $30 Allowance
Bifocal Vision Lenses
$25 Copay Up to $50 Allowance
Trifocal Vision Lenses
$25 Copay Up to $65 Allowance
Lenticular Vision Lenses
$25 Copay Up to $100 Allowance
Standard Contact Lenses Fitting Up to $55 Copay Not Covered
Specialty Contact Lenses Fitting 10% off Retail Price Not Covered
Conventional Contact Lenses $130 Allowance; 15% off Balance Up to $105 Allowance
Disposable Contact Lenses $130 Allowance Up to $105 Allowance
Lasik Vision Care Discounts Available Not Covered
Exam Frequency Once Every 12 Months
Lenses Frequency Once Every 12 Months
Frames Frequency Once Every 24 Months
25BCBS of IL Vision
Finding a PPO Provider
BCBS of IL Vision Providers
BCBS of IL Vision offers you access to the EyeMed Insight network of providers. Members that
enroll in the Vision plan will have the freedom to seek care from providers regardless of their
network relation. Choosing care from a provider in the EyeMed Insight network affords you and
your dependents an in network level of benefit which can mean lower out of pocket expenses, as
well as discounted services. If you choose to go to an out of network provider, you will pay the bill
at the time of services and can submit the claim for reimbursements. To search the BCBS of IL
Vision network please use the following internet search instructions:
1.Go to eyemedvisioncare.com/bcbsilvis.
2.You can login as a member or you may continue to search as a guest by selecting “Provider Locator”.
3.Enter your zip code in the search box or select the “Use My Location”. You can then choose from the dropdown
menu “What else is important?” or the “Advance Search” button to narrow your results.
4.Your search results will populate. You can further narrow your results with filters on the left side of the screen.
26
26Flexible Spending / Dependent Care Plan Overview 27
PayFlex
Plan Overview
Valley View School District 365U provides you the opportunity to pay for out-
of-pocket medical dental, vision, and dependent care expenses with pre-tax
dollars.
Flexible Spending Account
Annual Maximum Election: $2,750
Annual Maximum Rollover: $500
Dependent Care Account
Household Annual Maximum Election: $5,000
28PayFlex
Flexible Spending Account - Expenses
Examples of Eligible Expenses Examples of Ineligible Expenses
Deductibles Health care premiums
Coinsurance Expenses reimbursed by any other plan
Medical Copays Expenses incurred before 01/01/21
Expenses incurred after 12/31/21
Prescriptions Copays / Costs
Expenses you claim on your tax return
Vision Care Expenses
Over the counter equivalents
Medical Care Expenses
(Unless with script from a provider)
Dental Care Expenses Cosmetic Services
Expenses incurred 01/01/21 – 12/31/21
29Open Enrollment Recap 30
Open Enrollment
Recap
Open Enrollment Period: December 1st – December 14th
Medical and Dental elections will automatically continue with no paperwork
required. Federal Government requires annual enrollment in FSA and
Dependent Care accounts.
Be on the lookout for your new BCBS of IL vision id card(s) that will be
mailed to your residence at the end of December which you begin using
effective January 1, 2021.
Forms are available at www.vvsd.org.
Elections are to be submitted to the Insurance Department no later than Monday,
December 14th. Effective Date of Elections are January 1, 2021.
31Questions?
Please Contact:
Mary Kelner Peggy Sheahan
Administrative Assistant for Employee Benefits Alliant Insurance Representative
Valley View School District 365-U Phone: 312-595-7342
Phone: 815-886-2700 x 6015 Fax: 312-595-4432
Fax: 815-886-6386 Email: peggy.sheahan@alliant.com
Email: kelnerme@vvsd.org
Jamie Douglass
Renee Formell Alliant Insurance Representative
Alliant Insurance Representative Phone: 312-595-8480
Phone: 312-595-7341 Fax: 312-595-4432
Fax: 312-595-4432 Email: jamie.douglass@alliant.com
Email: renee.formell@alliant.com
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