Open Enrollment 2011
This publication is produced by the Office of Human Resources.
Open Enrollment Like other employers across the nation, Emmanuel College continues to be challenged by rising medical costs. According to the 2011 Segal Health Plan Cost Trend Survey, the national trend projection is 10% for HMO plans and 11% for POS plans. In addition, the Northeast has the highest trends for the POS at 11.2%. We are pleased to announce that through careful negotiation and one plan design change, Emmanuel College’s renewal with Harvard Pilgrim Health Care will be below trend with an increase of 6.95%. In addition we would like to highlight the following: Despite the increase, the College will continue to pay the majority of the cost for the medical plan on behalf of its employees. This result is an increase of only $7.42 per month for the individual HMO coverage and $12.12 per month for the individual POS coverage. To help with our wellness initiatives, Harvard Pilgrim will continue to partner with us on prevention and wellness programs such as stress management workshops, health risk assessments and preventative screenings. Good news! There will be no increase to the Delta Dental rates this year. The 2011 Annual Benefits Open Enrollment period is from Monday, November 22, 2010 through Friday, December 3, 2010. Open Enrollment is your once-a-year opportunity to make changes to your current benefit elections. The benefit elections you choose will be effective January 1, 2011. These elections will remain in effect through the 2011 calendar year and may be changed only if you experience a qualifying change in life/family status as defined by the Internal Revenue Code (IRC). We will also continue to give benefits eligible employees the opportunity to save money by paying your share of the insurance premiums on a pre-tax basis, unless you notify the Office of Human Resources that you do not want to take advantage of this pre-tax savings option.
Health:
Harvard Pilgrim Health Care
This year there will be a 6.95% increase for Harvard Pilgrim Healthcare with one plan design change. The following plan design change will be applied to both the HMO and POS Plans:  Rx Drug Co-pay (30 day supply) will change to $15/$30/$50 from $10/$25/$45  Rx Drug Co-pay (90 day supply) will change to $30/$60/$100 from $20/$50/$90 Harvard Pilgrim Health Care NEW Rates
2011Total Cost (Monthly)
Emmanuel Pays (Monthly)
Employee Pays (Monthly)
Employee Pays (SemiMonthly)
Individual HMO Individual POS
$574.52 $643.35
$459.62 (80%) $459.62 *
$114.90 (20%) $183.73
$57.45 (20%) $91.87
Family HMO Family POS
$1,506.93 $1687.44
$1054.85 (70%) $1054.85*
$452.08 (30%) $632.59
$226.04 (30%) $316.30
*The same dollar amount contribution will also be applied to the POS Plan.
OLD Rates
2010 Total Cost (Monthly)
Emmanuel Pays (Monthly)
Employee Pays (Monthly)
Employee Pays (Semi-Monthly)
Individual HMO Individual POS
$537.42 $601.55
$429.94 (80%) $429.94 *
$107.48 (20%) $171.61
$53.74 (20%) $85.80
Family HMO Family POS
$1,409.62 $1,577.81
$986.73 (70%) $986.73*
$422.89 (30%) $591.08
$211.45 (30%) $295.54
*The same dollar amount contribution will also be applied to the POS Plan.
Dental:
Delta Dental of Massachusetts
Delta Dental will continue offering Rollover Max feature. Members with claims that do not exceed $700 within the plan year may rollover up to $500 for use during the next plan year. Members must go for at least one cleaning or one oral exam in order to be eligible for the rollover. RATES (no increase) Individual Family
Total Cost (Monthly) $39.95 $117.37
Emmanuel Pays (Monthly) $25.97 $76.29
Employee Pays (Monthly) $13.98 $41.08
Employee Pays (Semi-Monthly) $6.99 $20.54
Patient Protection and Affordable Care Act As a result of Federal Health Care Reform, also known as the Patient Protection and Affordable Care Act, the following benefit changes are being made to our coverage. These changes are being made for group health plans in all states, and they will go into effect as Emmanuel renews its coverage with Harvard Pilgrim Preventative Care with No Cost Sharing*- There will be no cost sharing (i.e. copayments, deductibles or coinsurance) on any in-network adult annual visits, well child visits, annual gynecological visits, routine pre-natal and post-partum visits or select preventative services and diagnostic tests described on the next page. Child Dependent Coverage- Coverage will be provided to child dependents until age 26. Lifetime Limits- Aggregate lifetime dollar benefit limits and lifetime dollar limits on essential health benefits will be eliminated for Harvard Pilgrim group plans. Durable Medical Equipment- There will be no annual dollar limits for the Durable Medical Equipment benefit. In addition to the changes above, beginning on July, 1, 2011, a minimum coinsurance of 20% will be introduced for this benefit. If your plan already has coinsurance of 20% or greater for durable medical equipment purchased from a network provider, there will be no charge in your member cost sharing for such equipment. This information governs in any case in which the benefits information in another Harvard Pilgrim enrollment documents may be different. *The list of preventative care services and tests that will be covered in full is subject to change upon the issuance of further guidance from the federal government pursuant to the Affordable Care Act. For POS and PPO plans, services are covered in full at the in-network benefit level. The benefit changes described above are subject to regulatory approval.
Preventive services and tests covered in full, in-network: Abdominal aortic aneurysm screening (for males 65-75 one time only, if ever smoked) Alcohol Misuse screening and counseling (primary care visits only) Behavioral Assessments (children of all ages; developmental surveillance, in primary care settings) Breast Cancer Chemoprevention (Counseling only for women at high risk for Breast Cancer and low risk for adverse effects of chemoprevention) Breastfeeding Primary Care Interventions (Applicable to pregnant women and new mothers; includes lactation classes and support at prenatal and post partum visits, and newborn visits.
Autism Screening (for children at 18 and 24 months of age: primary care settings) Aspirin for the prevention of heart disease (primary care counseling only) Blood pressure screening (adults, without known hypertension Breast cancer screening, including mammograms and counseling for genetic susceptibility.
Cervical cancer screening, including pap smears.
Cholesterol screening (for adults only)
Colorectal cancer screening, including colonoscopy sigmoidoscopy and fecal occult blood test
Congenital Hypothyroidism Screening (for newborns only)
Dental caries prevention- oral fluoride (for children to age 5 only) [Note: Coverage for fluoride is only provided if your Plan includes outpatient pharmacy coverage.
Depression screening (adults, Children ages 12-18, primary care visits only) Diet Behavioral Counseling (included as part of annual visit and intensive counseling by primary care clinicians or by nutritionists and dieticians) Folic acid supplements (women planning or capable of pregnancy only) [Note: coverage for folic acid is only provided if your Plan includes outpatient pharmacy coverage.] Hemoglobin A1c HIV screening Iron Deficient Anemia (pregnant women at prenatal visits) Lead screening (Children at risk) Obesity screening (Adults and children screening only, in primary care setting.) Ovarian cancer susceptibility screening Rh(D) Incompatibility, Screening Sexually transmitted diseases (STDs)-screening and counseling Total cholesterol tests Vision screening (children to age 5 only)
Diabetes screenings Dyslipidemia Screening (For children at high risk for higher lipid levels) Hearing Screening (Screening for newborns only, primary care settings) Hepatitis B testing Immunizations, including flu shots (for children and adults as appropriate. Iron deficiency prevention (primary care counseling for children age 6 to 12 months only) Microalbuminuria test Osteoporosis screening (screening to begin at age 60 for women at increased risk) Phenylketonuria Screening (Newborns before 7 days old) Sickle Cell Disease, Screening (Screening at birth and first newborn visit) Tobacco use counseling (primary care visit only) Tuberculosis skin testing
Flexible Spending Accounts: Benefit Resource, Inc. The limit on medical accounts will continue to be $2,500. Examples of medical expenses include doctor co-pays, dental (cleanings, fillings, crowns, etc.), prescription drug co-pays, allergy injections, prescription eyewear and contact lenses, and orthodontia. The limit for Dependent Care FSAs will continue to be $5,000. New enrollment forms need to be completed each year for this benefit. Please note: The deadline to submit receipts for reimbursement is March 1st of each year. Any funds remaining in the Account after this will be forfeited. Health Care Reform Impacts Purchasing Over-the-Counter Drugs and Medicines with FSA Funds Effective January 1, 2011, medical FSA funds may no longer be used to purchase OTC drugs and medicines (other than insulin) without a prescription from a medical provider. This also means that these items cannot be purchased with a benefit card but must be submitted as a claim for reimbursement with a prescription. Some examples of OTC drugs and medicines that will require a prescription are: Allergy and sinus medicines Pain relief medicines Cough, cold and flu medicines This rule does not apply to eligible OTC medical supplies such as band-aids, contact lens solution and hearing aid batteries. Please be advised that this is not a comprehensive list of OTC items. Please visit www.BenefitResource.com for more information.
Supplemental Life Insurance The College will once again be offering benefits eligible employees working at least 25 hours per week the opportunity to enroll in supplemental life insurance coverage. You may purchase this for yourself, your spouse or your dependents. Please contact the Office of Human Resources for more information.
Next Steps If you are staying with your current health, dental and life insurance choices, you do not need to do anything. If you are making changes to your current benefit elections please stop by the Office of Human Resources for the appropriate paperwork. If you are enrolling or re-enrolling in the FSA you need to complete a new enrollment form. Please download the form on the HR Forms Team Site on the portal or come by the Office of Human Resources to complete a new form. Please be advised that Open Enrollment will end promptly on Friday, December 3rd and all employees must be enrolled in all benefit plans at that time. For questions regarding the following benefit plans please contact: Medicare and Creditable Coverage Erin Farmer Noonan 617-735-9892 farmer@emmanuel.edu Supplemental Life Insurance Scott Lerner 617-735-9967 lernesc@emmanuel.edu Flexible Spending Accounts Leah Kendall 617-975-9332 kendalll@emmanuel.edu Health and Dental Coverage Contact any of the above individuals for assistance.
Important Notice from Emmanuel College Regarding Prescription Drug Coverage and Medicare
The following section is for Medicare Eligible Employees only
Important Notice from Emmanuel College About Your Prescription Drug Coverage and Medicare Emmanuel College has determined that the prescription drug coverage offered by the Harvard Pilgrim Healthcare is Creditable Coverage and, on average for all plan participants, is expected to pay out as much as the standard Medicare prescription drug coverage will pay. Read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with Emmanuel College and prescription drug coverage available for people with Medicare. This notice can help you decide whether or not you want to enroll. It explains the options you have under Medicare prescription drug coverage, and tells you where to find more information to help you make decisions about your prescription drug coverage. If you enroll in one of the plans approved by Medicare which offers prescription drug coverage, you may need to give a copy of this notice when you join to show that you are not required to pay a higher premium amount. Prescription drug coverage is now available to everyone with Medicare through Medicare prescription drug plans. All Medicare prescription drug plans will provide at least a standard level of coverage set by Medicare. Some plans might also offer more coverage for a higher monthly premium. Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare. There is also an annual open enrollment from November 15th to December 31st. Beneficiaries leaving employer or union coverage that has been determined to be creditable may be eligible for a Special Enrollment Period.
Creditable Coverage means that the amount Emmanuel College expects to pay, on average, for prescription drugs for individuals covered by the plan in the current year is the same or more than what standard Medicare prescription drug coverage would be expected to pay, on average. Because your existing coverage is considered Creditable Coverage, you have the following several options. Your options include, but are not limited to the following: Maintain your current benefits with Harvard Pilgrim Healthcare and delay enrollment in Medicare prescription drug coverage. Keep your current benefits with Harvard Pilgrim Healthcare and enroll in prescription drug coverage. Enroll in Medicare prescription drug plan and drop your current benefits with Harvard Pilgrim Healthcare. If you choose to maintain your current coverage with Emmanuel College, a late enrollment penalty will not apply if Creditable Coverage is maintained until you enroll in Medicare prescription drug coverage. However, if you drop or lose your coverage with Emmanuel College and don’t enroll in Medicare prescription drug coverage after your current coverage ends, you may pay more to enroll in Medicare prescription drug coverage later. If you are eligible for Medicare and go 63 days or longer without prescription drug coverage that is considered Creditable Coverage for prescription drugs, your monthly premium will go up at least 1% per month for every month that you did not have that coverage. For example, if you go 19 months without coverage, your premium will always be at least 19% higher than what most other people pay. You will have to pay this higher premium as long as you have Medicare coverage. In addition, you may have to wait until the following November to enroll.
Things to Consider About Medicare If you decide to elect Medicare and a Medicare drug plan as your primary coverage, your current Emmanuel College Plan coverage will be affected. The Emmanuel College Plan that is available to you and your dependents will cease. If you do decide to join a Medicare drug plan and drop your current Emmanuel College Plan coverage, be aware that you and your dependents will be able to get this coverage back only under certain circumstances. You should compare your current coverage, including which drugs are covered, with the coverage and cost of the plans offering Medicare prescription drug coverage in your area. If you need assistance, you should contact your local State Health Insurance Program (SHIP) counselor. You can find your local SHIP counselor at www.shiptalk.org. You can find information regarding your current prescription drug benefits in your standard plan document you received upon enrollment in the plan. If you have misplaced your standard plan document, please contact your human resources office. Furthermore, your current coverage pays for other health expenses in addition to prescription drugs, and you will still be eligible to receive all of your current health benefits if you choose to enroll in a Medicare prescription drug plan.
For more information about this notice or your current prescription drug coverage, please contact the Office of Human Resources at 617-735-9991. NOTE: You will receive this notice annually and may receive it at other times in the future, such as before the period you can enroll in Medicare prescription drug coverage. Additionally, you will receive this notice if this coverage changes. You also may contact our office and request a copy. More detailed information about Medicare plans that offer prescription drug coverage is available in the “Medicare & You” handbook. You’ll receive a copy of the handbook in the mail from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug plans: Visit www.medicare.gov; Call you State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help; or, Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-4862048. For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information about this extra help is available from the Social Security Administration (SSA). For more information about this extra help, visit SSA online at www.socialsecurity.gov, or call them at 1-800-7721213 (TTY 1-800-325-0778). Date: Name of Entity/Sender: Position/Office: Address: Phone Number:
November 22, 2010 Erin Farmer Noonan Director of Human Resources 400 The Fenway Boston, MA 02115 617-735-9991