Duke: Open Enrollment 2014
- 1. Duke University & Health System Oct. 28 – Nov. 8, 2013 Open Enrollment for 2014 Benefits
- 2. 2 Current Status • Covered Lives: 62,300 • Cost: – Total: $246 million – Net: Duke paid $172 million (minus employee premiums) • Experience: Costs lower than national average – Favorable contract with Duke providers – DukeWell: disease management – Rx utilization: generic and mail order
- 3. 3 Pharmacy Usage Trends Generic Dispensing Rate 84.3% 80.1% 78.3%
- 4. 4 Duke’s medical insurance plans •Duke offers 4 plans: –Duke Basic (HMO with Triangle network primarily of Duke physicians) –Duke Select (HMO with Triangle network primarily of Duke physicians) –Blue Care (BCBS HMO with statewide network) –Duke Options (PPO plan with international network) New: Cigna Medical Benefits Abroad provides employer paid coverage for international business travel of less than 6 months for full-time benefits eligible employees
- 5. 5 Duke’s medical insurance plans • Five tiers of coverage –Employee –Employee Spouse/Same-Sex Partner –Employee Child –Employee Children –Family
- 6. 6 Medical insurance premiums • Premium increases will again be less than the projected increases nationally $563$537$123$117Duke Options $569$543$128$122Blue Care $425$414$72$70Duke Select $269$262$29$28Duke Basic 2014201320142013 FamilyIndividual
- 7. 7 What if you had to be hospitalized
- 8. 8 Tobacco Surcharge • In 2014, tobacco use surcharge will increase from $10 to $20 per month for health insurance. • The surcharge does not apply to dependents. • Surcharge will be removed if employee successfully completes a tobacco cessation program.
- 9. 9 Bariatric Surgery • Reduction in co-pay for bariatric surgery • Eligible patients pay $2,500 instead of $4,000 Injury to Mouth • Coverage increased to $5,000 for traumatic injury to teeth within 24 months of injury (previously limited to $750) under Duke Select and Duke Basic Transgender Surgery • Adding coverage for transgender surgery under Duke Options - $50,000 lifetime limit
- 10. 10 Summary of Benefits and Coverage • “Summary of Benefits and Coverage” is a federally mandated document that will be included again with Open Enrollment materials. • This document uses a federally required template to explain health plan benefits so consumers can compare plans from different insurers or employers.
- 11. 11 PHARMACY PLAN Open Enrollment for 2014
- 12. 12 Pharmacy Plan • No increases in co-payments or deductibles for generic, formulary or non- formulary drugs (third consecutive year)
- 13. 13 13 *Participants in the Duke Basic plan have a $100 deductible for all prescription drugs, including generic and mail order. **The 50% co-pay will also be subject to a min. & max co-pay. Minimum $10 for generics, $55 for brand and $65 for non-formulary. $Max: $25 for generic, $125 for brand, and $135 for non- formulary. Retail pharmacy Express Scripts Mailorder or Duke pharmacy Up to a 34-day supply Up to a 90-day supply First 3 purchases of any medication After 3rd purchase of long-term medication Anytime Generic (no deductible)* $10 (or cost of drug if less) 50%** $20 (or cost of drug if less) Brand ($100 per person deductible applies. No deductible for mail order or participating Duke pharmacies.)* $40 50%** $100 Non-formulary ($100 per person deductible applies. No deductible for mail order or participating Duke pharmacies.)* $55 50%** $138
- 14. 14 VISION PLAN Open Enrollment for 2014
- 15. 15 Duke’s vision plan for 2014 Individual Employee & Child Employee & Children Employee & Spouse/ Partner Family $9.47 $18.13 $19.08 $18.14 $29.38 • No increases in premiums or co-payments (second consecutive year)
- 16. 16 DENTAL PLAN Open Enrollment for 2014
- 17. 17 Dental Premiums for 2014 • PPO Plan: No premium increases • Dental Plan A: No premium increases • Dental Plan B: No premium increases $45.24$12.18$12.18Dental Plan B $119.89$39.58$39.58Dental Plan A 2014201320142013 FamilyIndividual $119.89 $45.24 $111.66$36.86$36.86PPO $111.66
- 18. 18 Dental Plan A vs. PPO Plan Sample Cost Savings Procedure % covered under plan Plan A Your Cost PPO Plan Your Cost Savings Exam 100% $0 $0 N/A Cleaning 100% $0 $0 N/A Filling 80% 90% 100% $26.40 $13.20 $0 $22.40 $11.20 $0 $4 $2 N/A Simple extraction 80% 90% 100% $38.45 $25.55 12.65 $21.80 $10.90 $0 $16.65 $14.65 12.65 Root canal 65% $452.76 $309.40 $143.36 Crown 50% $736.90 $416 $320.90
- 19. 19 Late Entrant • Late entrant: if you or a dependent are planning to enroll for 2014 but are not currently enrolled for dental coverage at Duke – Only covers two preventive care exams (not including X-rays), two cleanings, and one fluoride application (for children under age 19) for the first 12 months 19
- 20. 20 REIMBURSEMENT ACCOUNTS Open Enrollment for 2014
- 21. 21 Save with reimbursement accounts • Pre-tax savings is about $30-$40 for every $100 of eligible expenses • Health Care Reimbursement Account • Dependent Care Reimbursement Account • The maximum contribution for a health care reimbursement account is $2,500. • The maximum for dependent care is $5,000
- 22. 22 Many ways to save • WageWorks Health Care Card • App for iPhones, Androids and Blackberries • Website • Paper forms (fax/mail)
- 23. 23 LOOKING AHEAD Open Enrollment for 2014
- 24. 24
- 25. 25 Decision: Pay or Play?
- 26. 26 Summary for 2014 • Modest premium increase less than national average • No increases in deductibles or co-payments • $10 increase in surcharge for tobacco users • Increase to $5,000 from $750 on treatment within 24 months of traumatic injury to teeth (Duke Select/Basic) • Reduced co-pay for bariatric surgery • Coverage of up to $50,000/lifetime under Duke Options for transgender surgery • Individual mandate for health insurance: Jan. 2014 • Required notice to all employees re: Marketplace • Continue assessing potential changes for 2015
- 27. 27 Supplemental Life Enrollment • Special Open Enrollment for Supplemental Life Insurance from Oct. 28 to Nov. 8 – 20% premium reductions – Simplified underwriting – Enroll or change current coverage online or via paper – New rates and changes effective Jan. 1, 2014
- 28. 28 Open enrollment: Oct. 28 - Nov. 8 1. Enroll online through the Duke@Work Self-Service website Or 2. By phone at 919-684-5600 hr.duke.edu/selfservice
- 29. 29 What’s next? When What Sept. 10 HR Forum Sept. 26 Primetime Employee Forum Sept. 30 Manager Memo/Presentation: Open enrollment changes for 2014 benefits Oct. 1 Article: Open enrollment for 2014 benefits Oct. 7 Guide: Print guide mailed home. Oct. 28 Open Enrollment Period Begins Oct. 28 Email: Open enrollment period begins Nov. 5 Article: Reminder about deadline Nov. 7 Email: Reminder about deadline Nov. 8 Open Enrollment Period Ends
- 30. Duke University & Health System Open Enrollment for 2014 Questions?
Editor's Notes
- #8: But when looking at costs, you have to also consider the coverage and what you would pay if you had to use the benefit. For example, if you had to be hospitalized, your out-of-pocket costs would be significantly lower through Duke than at most of our peers.
- #30: More information about specific changes for benefits will be communicated next month as part of the annual open enrollment process.Articles and events are planned throughout the next few months to help provide context and set expectations about changes for 2011. Here are a few of the highlights of what you can expect to see.