Wood County Employee Health Benefits Plan - 2022 PLAN YEAR UPDATE
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Wood County Employee
Health Benefits Plan
2022 PLAN YEAR UPDATE
1
Committee Members
Employee Health Benefits
Wellness Sub-Committee
Spousal Eligibility Exception Sub-Committee
Insurance Consultant
Jason Beaver
Trustees Kaci N.
of the Plan
Third Party Administrators
County Commissioners Health: Jennifer Bollinger, Jennifer Berens, Trustmark
Doris Herringshaw Prescription: Laura Berberich, PDMI
Dental: Karen Chapman, Delta Dental
Craig LaHote
Dr. Ted Bowlus Administrative Support
Cheryl Albrecht, Josh Schroeder, Shelby Williams
Erica Noel, Janese Diem, Pamela Boyer,
Andrew Kalmar
Engaged Members
You
2
What Makes Our Plan Work
Network
Providers • Educated Employees =
Engaged Consumers
• Working with our Network
Engaged Providers
Consumers
• Innovative Programs to Help
Cost Save Money for Members
Saving and the Plan
Programs Thank you for being here
and being engaged consumers!
The Employee Health Benefits Plan is a non-federal, governmental, self-insured, non-ERISA plan that is grandfathered 3
under the Affordable Care Act and offers minimum essential coverage and meets minimum value and affordability standards.
How Does Our Plan Compare
2020 SERB Report: Cost of Health Insurance for Ohio’s Public Sector
Average Monthly • Statewide: $759 Single $1,946 Family
Premiums - PPO • Counties: $742 Single $2,019 Family
(H/RX) • Wood County: $609 Single $1,584 Family
Average Medical
In-Network • Statewide: $3,088 Single $6,182 Family
Out-of-Pocket • Counties: $3,310 Single $6,619 Family
• Wood County: $400 Single $1,200 Family
Maximums – PPO
(H)
4
Total Plan Expenses 2016 to 2021 (November 5, 2021)
2021 YTD $9,293,307
2020
$11,173,315
2019 $11,501,618
2018 $12,356,611
2017 $11,188,775
Note: Board of DD entered the Plan
2016 $9,072,546 on 1/1/17; 2018 Includes Stop Loss
Reimbursements
$0 $5,000,000 $10,000,000
2022 Monthly Employee Premiums
Coverage Single Family
Same rate
Health/Rx $91.42 $237.70 as 2016
Vision $1.34 $3.06
Dental $4.92 $12.32
Life $0.00 $0.00
All Coverage $97.68 $253.96
Commissioners approved a “premium holiday” for September 2021.
Our Health Benefits Plan
Employer
85% Payment
of Claims
Employee
15%
Be an engaged consumer when pulling money out of the pocket.
7
Participation Features
• Low monthly premiums
• Low deductibles, co-insurance, copayments
Schedule of Benefits
• Comprehensive scope of coverage
• Large network access
• Wellness Programs
Carrot vs. Stick
• Voluntary participation
• Designed for prevention/early detection & appropriate
treatment
8
New Third Party Administrator for Medical Claims
Effective January 1, 2022
New ID Cards for Medical Coverage Date of Service Prior to Jan 1, 2022
• Processed by Meritain
Date of Service Jan 1, 2022 or after
• Processed by Trustmark
• Notify providers of new card Q: What happens if my doctor’s office doesn’t
and group number recognize Trustmark’s name?
A: Tell them Trustmark is your benefits administrator
• Customer Service Number and that they should call Trustmark Health Benefits
and contact information in SPD should they have questions. Also remind them to
submit your claims directly to the address listed on
your ID card under Medical Claims Submission.
9
myTrustmarkBenefits Member Portal
See all healthcare bills in one
Contact customer service
place and pay them online
Quickly view, filter and start
Quickly view each family
claims for easy reference
member’s coverage
Check account balances View tailored employer
messages
Create separate logins for View secure electronic
family members explanation of benefits
@2020 – Confidential and Proprietary 10
Self-funded benefit plans are administered by Trustmark Health Benefits, Inc.myTrustmarkBenefits Member Portal
Opt in for fast electronic
communications
Review your claims and Ask a question
deductible and out-of-pocket
amounts
View your coverage and
dependent info
@2020 – Confidential and Proprietary 11
Self-funded benefit plans are administered by Trustmark Health Benefits, Inc.myTrustmarkBenefits Mobile App
See the status of their deductible and View family info and health
out-of-pocket maximum benefits
Show their ID card to Access important benefits
providers information
View and filter claims for quick Filter claims by dependent and
reference type
Find a doctor Contact customer service through the
mobile message center
Easily access member-specific services in Contact customer service by
their health benefit plan phone
@2020 – Confidential and Proprietary 12
Self-funded benefit plans are administered by Trustmark Health Benefits, Inc.myTrustmarkBenefits Mobile App
myTrustmarkBenefits Mobile
Available on:
@2020 – Confidential and Proprietary 13
Self-funded benefit plans are administered by Trustmark Health Benefits, Inc.Use Network to Save Money
FrontPath = In-Network Non-FrontPath = Out-of-Network
Professional Professional
Co-Payment Co-Payment
(Office Visit) $15 (Office Visit) $15
ER ER
Co-Payment $45 Co-Payment $45
Deductible $150 Out-of-Network Deductible $300
Single/ $450 Applies to Single/ $900
In-Network Only
Family Family
Balance billing protection
No balance billing protection
14Choose Quality
Network
Providers
www.frontpathcoalition.com
You wouldn’t trust just anyone
to watch your kids or remodel
your house. Would you?
Doesn’t your health deserve the
same considerations?
15• Have a primary care physician
• Wood County Community Health Center is Primary Care
taking new patients
• Offers Sliding Fee Schedule even for those Acute Issues Monitoring
with insurance coverage
• Provides access to the Rx Savings Program
• Searching for a specialist? Urgent Care
• Wood County Hospital offers a network of
specialty physicians
After Hours
• Search physicians at woodcountyhospital.org
• Falcon Health bills at the doctor office
rate, which is lower than an urgent care
facility Emergency Room
Life Threatening Medical Emergency
• ER visit for non-emergency may not be
covered by the Plan 16• Have a primary care physician
• Wood County Community Health Center is Primary Care
taking new patients
• Offers Sliding Fee Schedule even for those Acute Issues Monitoring
with insurance coverage
• Provides access to the Rx Savings Program
• Searching for a specialist? Urgent Care
• Wood County Hospital offers a network of
specialty physicians
After Hours Non Life Threatening
• Search physicians at woodcountyhospital.org
• Falcon Health bills at the doctor office
rate, which is lower than an urgent care
facility Emergency Room
Life Threatening Medical Emergency
• ER visit for non-emergency may not be
covered by the Plan 17• Have a primary care physician
• Wood County Community Health Center is Primary Care
taking new patients
• Offers Sliding Fee Schedule even for those Acute Issues Monitoring
with insurance coverage
• Provides access to the Rx Savings Program
• Searching for a specialist? Urgent Care
• Wood County Hospital offers a network of
specialty physicians
After Hours Non Life Threatening
• Search physicians at woodcountyhospital.org
• Falcon Health bills at the doctor office
rate, which is lower than an urgent care
facility Emergency Room
Life Threatening Medical Emergency
• ER visit for non-emergency may not be
covered by the Plan 18STOP LOSS = Insurance for the Insurance Plan
Plan Pays Claims up $275,000 Stop Loss Pays on
to Set Amount for a Stop Loss in Claims Above Set
Member 2021 Amount
DETERMINING EMPLOYEE ELIGIBILITY FOR THE PLAN
Full Time (ACA) is defined as 30 Hours of Service
or more per week, Non-Seasonal Stop Loss “Hit” results in Eligibility
Audit to ensure member was eligible
Hours of Service = Hours worked + Paid leave for benefits. If found not eligible,
member is responsible for all claims.
Monthly Measurement used for new hires.
Eligibility may change monthly based on hours of
service. Transition to Look-Back Method
following completion of full Standard
Measurement Period. Refer to Summary Plan
Description for more information on eligibility.Employee ultimately responsible
to obtain precertification
Precertification
Requirements
20See Plan Document for complete list
Employee ultimately responsible Inpatient Admission
to obtain precertification Transplant
Outpatient Infusions
Precertification
Requirements
21See Plan Document for complete list
Employee ultimately responsible Inpatient Admission
to obtain precertification Transplant
Outpatient Infusions
Precertification
Requirements
50% reduction penalty in payment
for failing to obtain precertification
22See Plan Document for complete list
Employee ultimately responsible Inpatient Admission
to obtain precertification Transplant
Outpatient Infusions
Precertification
Requirements
50% reduction penalty in payment Notify family members or close friend
for failing to obtain precertification of the need to precertify services
23Prescription Coverage
Pharmacy Data Management Inc. MyDrug Benefit (RxEOB)
24Formulary Retail Pharmacy
Copay
34-day supply Maximum
Tier 1 or select OTC $5
with prescription
Tier 2 $20 plus 20% AWP
$45 Maximum
Tier 3 $20 plus 20% AWP
$85 Maximum
Medical Necessity $20 plus 50% AWP
Review $200 MaximumFormulary Retail Pharmacy Mail Order
Copay Copay
34-day supply Maximum 90-day supply Maximum
Tier 1 or select OTC $5 $10
with prescription
Tier 2 $20 plus 20% AWP $40 plus 20% AWP
$45 Maximum $90 Maximum
Tier 3 $20 plus 20% AWP $40 plus 20% AWP
$85 Maximum $170 Maximum
Medical Necessity $20 plus 50% AWP $20 plus 50% AWP
Review $200 Maximum $400 MaximumFormulary Prescription Savings Program Retail Pharmacy Mail Order
Copay Copay Copay
90-day supply* 34-day supply Maximum 90-day supply Maximum
Tier 1 or select OTC $5 $10
with prescription $5
Tier 2 $20 plus 20% AWP $40 plus 20% AWP
$5 $45 Maximum $90 Maximum
Tier 3 $20 plus 20% AWP $40 plus 20% AWP
$5 $85 Maximum $170 Maximum
Medical Necessity $20 plus 50% AWP $20 plus 50% AWP
Review $5 $200 Maximum $400 Maximum
• Use the Community Health Center to help lower the cost of your prescription medications
• Use MyDrug Benefit/RxEOB to view medications in the formulary and price shop to save
*Some restrictions applySee the Savings with the Prescription Savings Program
Location Co-Payment Member saves up to
$520 annually.
Retail Pharmacy $45 per month
12 – 30-day fills $540 annually The Plan saves too!
Mail Order Not available: Drug Up to $3,265 per year.
>$1,000
Limited to Retail
• HUMALOG INJ 100 ml
Pharmacy or RX Savings
for diabetes
Program
RX Savings Program $5 – up to a 90 day fill
4 – 90-day fills $20 annually
28Vision Program Covers Benefit Period
Exams $200 per participant during
Payable only as primary
(no coordination of benefits) Prescription 2-year period.
glasses/frames 2-year period resets in 2022
No restriction on access
and contacts
Requires original receipt and 2021 claims must be submitted
Refractive prior to March 31, 2022
claim form with patient and
Surgery
services clearly identified
29$100 Annual Deductible
$1,500 Annual Maximum per person
2 cleanings, 1 bitewing radiograph, and 2
fluoride treatments preventative not
subject to deductible
• Useful Tips:
• Discuss composite resin (white) restorations and
porcelain crowns on posterior teeth
• Recommend a Preferred Network Provider to make
benefits go farther
• Obtain a Predetermination of Benefits Prior to
Service 30Where you go does make a difference
Maximize your savings with a PPO provider.
Sample Cost for a Crown PREFERRED (PPO) PREMIER Dentist
(not actual costs) Dentist
Submitted Fee $950 $950
Maximum Allowed $675 $898
Coverage Level 50% 50%
Amount Delta Dental Pays $337.50 $449
AMOUNT YOU PAY $337.50 $449
View a list of providers at www.deltadentaloh.com.
31www.memberportal.com
32
• www.memberportal.com• If you are ready to invest in • When is up to you!
Wellness yourself, now or a few
months down the road,
Programs the Wellness Programs are
ready for you
You Matter!
Sooner rather than later as age & time are working against us
33See the EAP Introduction Video posted on the
Employee Website for available services and resources
34Wellness Program
Eligibility
Available to benefit-eligible employees and
their family members eligible for coverage
regardless of enrollment
Non-benefit eligible employees encouraged
to participate for prizes, drawings and credit
if moved to benefit-eligible status
• Not eligible for wellness screenings or reimbursements
as the Plan pays costs associated with these programs
35Program features monthly challenges • Make/Break the Habit!
• Eat Clean!
to help you focus on healthy habits • Reduce Your Stress!
• Muscle Through It!
• Get 5!
Form a team within your office or participate on your own. Each
month, prizes will be awarded to departments with the highest • Stay Hydrated!
percentage of participation in the featured challenge. • This for That!
• Catch Some ZZZs!
Monthly tracking logs will be posted on the employee website. • Focus on Fitness!
Monthly Challenges must be started and completed within the • Money Matters!
same calendar month. • Stretch Yourself!
• Walk It Off!
Each month will feature a different challenge, but you can
complete them in any order you like.
Complete monthly challenges to be entered to win prizes!
36Earn a $25 Deductible Credit each Quarter:
Complete the confidential, free, Wellness Awareness Screening
Eligible to complete every 3 years (credit provided if completed in 2020 or 2021)
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
(Jan. – March) (April – June) (July – Sept.) (October – December)
Attend One Wellness Event Each Quarter
• KEPRO On-line Seminar • OSU Extension On-Line • Other events as posted on wellness website
with printed certificate of Programs
completion
Complete Two Monthly Challenges Each Quarter
• Challenges and • Can track utilization • Must be started and • Can do multiple
information posted on using smartphone or completed within the challenges during the
wellness website computer – Just attach month same month (different
printout to tracking log goals); but challenges
cannot be repeatedOpen
Election: Changes permitted without a Qualifying
Event/Special Enrollment Right
Nov. 15 to
Dec. 15
Application Required
Must be received by group rep
by 4:30 p.m. on Dec. 15
Additional Assistance Available
Changes effective
January 1, 2022
38Coordination of Benefits:
Know the Rules for Dual Enrollment
Other Group
Coverage
• Person holding contract is primary: secondary on other coverage if enrolled in another plan
• If both parents cover children, the birthday rule applies to determine who carries primary coverage
• Whoever’s birthday falls first in the year would be primary for the children
• Primary coverage must be documented to enroll as secondary
High Deductible
Plans
• If partnered with a Health Savings Account (HSA), not eligible to enroll in other coverage
• IRS Rule
39Take Action
1 2 3
Review Individual Report Changes within 30 Notify Providers of new
Enrollment Verifications days of Event Third Party Administrator
• Only use legal names as listed • Qualifying Events, e.g. birth, by sharing new id card
on Social Security Cards wedding, divorce
• Report primary coverage if • Changes in primary/secondary
electing secondary at County coverage
Notify Provider/Pharmacy
• Confirm life insurance • Application Required within Following Loss of Benefits
beneficiaries the 30-day period
• Return sign-off by Nov. 30
40www.woodcountyohio.gov/employee
Check employee
website for Plan
updates as most recent
information is posted
on the website
41You can also read
