This memo contains important information about our 2014 Health Benefits and Open Enrollment. Please share this information with your employees.

Our online Open Enrollment for 2015 will start October 31, 2014, through November 21, 2014.

Medical Plans

We are offering the following medical plans to our employees through the Medical Trust.

Dental Plans

We are offering the following Cigna dental plans through the Medical Trust.

What You Need to Know About Open Enrollment

During the Medical Trust's Open Enrollment period:

• Current plan members may change their plan selections for the following year
• Eligible non-participating employees have the option to join a plan
• Eligible non-participating dependents may be added to a member's plan without the need of a qualifying event

Currently Enrolled Employees

Please inform your currently enrolled employees (plan members) that they will receive a letter from the Medical Trust approximately one week before their Open Enrollment period. This letter will provide them with information on when and how to access the Open Enrollment website, a benefits review, and links to important plan resources. In your communications, encourage your employees to begin reviewing their options and research plans early.  

Non-participating Employees

Existing employees who qualify for health coverage but are not participating in one of our plans are eligible to enroll themselves and/or their dependents during Open Enrollment for the 2015 plan year. Please send a communication to these employees informing them of this option as well as the plans and rates available to them. Attached is the enrollment form for new members.  Please complete form and return them to Becky Meyer before November 21, 2014.

Plan comparisons of the three plans, Prescription Drug Benefits from Express Scripts, Vision Benefits and Dental Benefits schedules can be found below to assist you in choosing the 2015 coverages.

2014 Plan Changes

Effective September 15, 2014, the Express Scripts prescription drug benefit will exclude certain compound medication products that have little or no proven clinical value in relation to their higher costs.  The  U.S. Food and Drug Administration (FDA) define a compound medication as one that requires a licensed pharmacist to combine, mix or alter the ingredients of a medication when filling a prescription.  The FDA does not verify the quality, safety and/or effectiveness of compound medications.  Impacted members have been notified directly.

2015 Plan Changes

Medical Management programs will be implemented with all vendors to support stronger medical necessity and outcomes-based criteria.  This enhancement may result in certain services requiring prior authorizations that are presently not required.  Our aim is to continue to allow members to obtain necessary treatment, and to ensure clinically sound, cost-effective treatment and services are received.  This approach will be conveyed to members through a variety of means, including open enrollment and web-based materials, plan documents, and communications from our vendors and providers.

Infertility treatment will be considered a covered benefit with a lifetime limit of $10K for medical services.

Applied Behavioral Analysis (ABA Therapy) for children with Autism Spectrum Disorder will be considered a covered benefit under behavioral health.

Medical transition benefits for transgender clients, including gender reassignment surgeries and hormone replacement therapies, will be considered a covered benefit.

Dialysis will become a network-only benefit for new patients. Allowances will be made directly with the vendor for members with network access limitations due to distance from network facilities and for those currently in treatment.

Prescriptions Drug  Benefits

Rx annual out-of-pocket (OOP) maximums will be added to all plans.  The maximums will be as follows:

      Network:                              $2,500 single and $5,000 family

      Out-of-Network:                $2,500 single and $5,000 family

Now, OOP pharmacy costs will count toward the total OOP maximum in each plan, easing financial exposure for members with multiple copays that do not currently count toward any accumulator.

Additional healthcare reform-related enhancement on oral contraceptives covered at $0 copay.

Infertility treatment will be considered a covered benefit with a separate lifetime limit of $10K for related prescription drugs.

Express Scripts National Preferred Formulary (Preferred Prescriptions) will be updated to include additional exclusions that will impact less than 0.2% of members, while continuing to ensure clinically sound, cost-effective drugs are available to members to drive greater savings, in part by minimizing brand inflation and by reducing the use of coupons and non-preferred brands.

Empire BCBS will shift to the Anthem Blue Cross and Blue Shield name/brand, which will result in the same service quality and National PPO network access, but with a new name, member services phone number, ID cards, web-site and out-of-network claim filing addresses.  More information will be provided as this change is rolled out to members, but where you have seen Empire BXBS historically in our materials, you will now see Anthem BCBS.

Current Plan Selections

Please note that we offer the same plans in 2015 as we offered in 2014.

If you do not want to make changes to your health plan it is important for you to log on to the Open Enrollment website to check that your personal information is correct for yourself and your dependents. You can submit any corrections by notifying an administrator or Becky Meyer.

Employee Assistance Program (EAP) with Cigna Behavioral Health  

In addition to the health plans, we offer a stand-alone EAP plan that parishes may elect to offer to their employees who opt out of medical benefits coverage. (The EAP is already included as part of every medical plan offering.) This will be billed in the same manner as the medical benefits. Your parish may elect to offer the EAP to all eligible employees who have opted out of medical coverage or to no one.

If you have any questions, please don't hesitate to contact me.

Faithfully

2014 Plan Comparisons (Medical, Prescription, Visual, & Dental)