Open Enrollment 2012
October 10, 2011 - November 4, 2011
The Annual Open Enrollment period each year provides you the opportunity to make changes to your benefit plans. During this time, you may add or delete dependents, change your health plan or dental plan, enroll or cancel FlexCash, and if you are currently a Flex Spending Account participant (HCRA/DCRA), re-enroll in your HCRA/DCRA plan for the next year. If you are not a current HCRA/DCRA participant, and wish to participate, you may now enroll for next year.
During this Open Enrollment Period, you may enroll or re-enroll your eligible dependents, which are under the age of 26, in your benefit plans. The enrollment will be effective on January 1, 2012.
If you do not wish to make changes to your benefits during this Open Enrollment period, no action is required.
If you are considering:
- Changes/deletions/additions to Health, Dental, Flex Cash, or the Tax Advantage Premium Plan
- Re-enrollment or enrollment for the 2012 tax year in the Healthcare Reimbursement Account (HCRA) and/or Dependent Care Reimbursement Account (DCRA)
You must log onto MyCSUEB and select the Open Enrollment option to submit any changes to your benefits during Open Enrollment. All Open Enrollment benefit changes must be submitted no later than Friday, November 4, 2011. If you have additional questions, contact the Benefits Office at (510) 885-4598 or email us at HR@csueastbay.edu.
NEW ENROLLMENTS OR CHANGES WILL BECOME EFFECTIVE JANUARY 1, 2012.
For further information, the following links have been provided:
- CSU Dental
- Flex Cash
- Tax Advantage Premium Plan (TAPP)
- Dependent Care Reimbursement Plan(DCRA) and Health Care Reimbursement Account (HCRA)
BENEFIT CHANGES FOR 2012
The following health plan benefit changes are effecive January 1, 2012:
Highlights of the 2012 CalPERS health benefit changes are listed below. Please refer to the health plan's 2012 Evidence of Coverage (EOC) booklet for a complete explanation of the benefits covered, as well as limitations and exclusions that apply. For additional information on CalPERS health plans, please refer to the CalPERS open enrollment materials, or visit the CalPERS website at: http://www.calpers.ca.gov. This information serves as a summary of benefits. If there is a discrepancy between this information and the plan Evidence of Coverage, the official plan Evidence of Coverage will always govern.
IMPORTANT NOTICE: ALL HMO PLANS
All employees who enroll in an HMO plan or change plans during Open Enrollment must now contact their HMO plan directly to select a doctor. The benefits office is no longer able to make doctor selections and online health plan enrollments will not notify the HMO plan of your doctor selection. Once you receive your new health cards in December for your HMO health plan change during open enrollment, please contact your Health plan directly to select your doctor immediately.
BLUE SHIELD NETVALUE (BASIC & MEDICARE)
The Blue Shield Net Value plan is expanding their service area to include Contra Costa County, and withdrawing from Santa Barbara County. The plan is also adding providers in Los Angeles, Riverside, Orange and San Bernardino Counties.
BLUE SHIELD 65 PLUS (MEDICARE)
The Blue Shield 65 Plus plan is expanding their service area to include Imperial, San Joaquin, San Francisco, and Nevada Counties.
PERS SELECT (BASIC & MEDICARE)
The PERS Select plan is expanding their service area to include Marin County.
PERS SELECT/CHOICE/CARE (BASIC)
The PERS Select/Choice/Care (Basic) plan is expanding the Value Based Site of Care program; and establishing a payment threshold for three additional elective procedures. When members receive service at an outpatient hospital rather than an ambulatory surgery center the following thresholds apply:
- Arthroscopy - $ 6,000 limit
- Cataract Surgery - $2,000 limit
- Colonoscopy - $1,500 limit
PEACE OFFICERS RESEARCH ASSOCIATION OF CALIFORNIA (PORAC):
Increasing the deductible from $50 to $100 for the Medicare Prescription Plan.
GENERAL PHARMACY BENEFIT HIGHLIGHTS (HMO PLANS):
- Retail co-payments for brand name drugs will increase by $5.
- Members may receive a 90-day supply of maintenance medication through mail order for the price of the 60-day retail supply.
- Members maintain access to brand name drugs when a Food and Drug Administration approved generic equivalent is available by paying the difference between the cost of the generic and brand name drug. A co-payment applies when a prior authorization for the brand name drug is obtained due to medical necessity. Excludes discretionary lifestyle drugs from the $1,000 out-of-pocket maximum for mail order prescriptions.
NEW PHARMACY BENEFIT MANAGER FOR CALPERS PPO MEMBERS
CalPERS has selected CVS Caremark to administer prescription drug benefits for more than 346,000 members of CalPERS self-funded PERS Select, PERS Choice and PERSCare PPOs effective January 1, 2012. CVS Caremark will offer several new benefits: A maintenance Choice Program will allow members to pick up a 90-day supply of medication directly from a CVS pharmacy. Members will pay their typical mail order co-pay for a prescription on the same day and be able to talk face-to-face with a pharmacist. Members will be able to save money by choosing "best choice" medications (generics and preferred brands) and 90-day supplies, where appropriate, in the "iBenefit" personalized mailing program.
NEW BENEFIT SERVICES FOR 2012
CALPERS WILL LAUNCH NEW MYCALPERS SYSTEM
Employees, annuitants and employers will be able to use the new system on September 19, 2011. Information was sent to all CalPERS health plan members in August. You may also find additional information about the new system on www.calpers.ca.gov.
NEW CALPERS "VIRTUAL HEALTH FAIR" FOR OPEN ENROLLMENT
This year CalPERS is introducing a new web-based "virtual health fair". The 2012 Webinar on Health Plan Design, Rate, and Benefit Changes will provide employees, retirees, and their dependents with information presented by expert representatives from each of the CalPERS health plans. The webinar will provide participants with 24/7 access, and you may also download the information covered from the webinar. CalPERS will post the pre-recorded webinar on its website beginning September 1, 2011. Log onto www.calpers.ca.gov to view the new Open Enrollment webinars.
NEW FLEXIBLE SPENDING DEBIT CARD FOR HCRA ENROLLEES
The CSU is pleased to announce the implementation of a new Flexible Spending Plan (FSA) debit card to HCRA enrollees, beginning in the 2012 plan year. The optional "FSA Benny Card" issued by ASIFlex, allows HCRA enrollees to pay for out-of-pocket medical expenses (i.e., health, dental, vision, etc.) when issued as payment at Health Care Providers and at certain retail locations that have implemented an Inventory Control System, per IRS regulations. There is a small, monthly administrative fee applicable to enrollees that choose the FSA bebit card, and additional information will be provided to those who wish to enroll.
VOLUNTARY BENEFIT PLANS
During Open Enrollment, employees may wish to enroll in one of the Voluntary benefit plans available to CSU employees. Please see details of the plans below:
MetLaw® Legal Plan
For a low monthly premium of $19.70, the MetLaw Legal Plan offered by Hyatt Legal Plans, Inc., provides representation for many personal legal services for employees and their eligible dependents. Participants can receive services from a Network or Out-of-Network attorney. Services for covered legal matters performed by a Network attorney are fully paid for by the plan, Out-of-Network attroney fees for covered services are reimbursed based on a set fee schedule. The plan covers telephone and office consultations for an unlimited number of matters, even if the matter is not fully covered, so long as it is not excluded. Please visit the MetLaw Hyatt Legal plan website at: www.metlife.com/mybenefits or call (800) 438-6388.
AFLAC-Critical Illness Plan
The Group Critical Illness plan, offered by AFLAC, provides a lump-sum benefit payment to cover out-of-pocket medical expenses and the costs associated with life-changes following the diagnosis of a covered critical illness. Critical Illnesses covered under the plan include the following: Heart Attack, Stroke, Major Organ Transplant, Renal Failure (End Stage), Cancer, Carcinoma in Situ, Coronary Artery Bypass Surgery, and Skin Cancer. During the CSU annual open enrollment period, October 10, 2011, through November 4, 2011, all CSU eligible employees will be provided a final opportunity to enroll in the AFLAC Critical Illness Plan with Guaranteed Issue - no health questions asked. Guaranteed Issue is available up to $20,000 for employee coverage and up to $10,000 for spouse/domestic partner coverage. Contact Information: (800) 433-3036, or www.aflac.com/csu for enrollment information.
VOLUNTARY LIFE INSURANCE
The Standard offers CSU eligible employees the opportunity to purchase Voluntary Life Insurance at competitive group rates. Effective January 1, 2012, the Voluntary Life Insurance rates will decrease by an overall average of 15 percent. The new rates for employee, spouse and child are displayed below:
Age Bracket Employee Rate Spouse Rate
<25 $0.06 $0.05
25-29 $0.06 $0.05
30-34 $0.08 $0.07
35-39 $0.09 $0.09
40-44 $0.10 $0.14
45-49 $0.18 $0.24
50-54 $0.30 $0.37
55-59 $0.53 $0.64
60-64 $0.66 $0.67
65-69 $1.27 $1.17
70-74 $2.06 $1.74
75+ $2.06 $2.05
Voluntary Life Insurance – Child(ren)
Coverage Amount Rate
$5,000 $0.69
$10,000 $1.38
$20,000 $2.75
This plan does not have a formal open enrollment period. Eligible employees can enroll in the benefit at any time. The employee will be subject to Evidence of Insurability (EOI) requirements if enrolling after the Open Enrollment period. Contact Information: (800) 378-5745, or www.standard.com/mybenefits/csu to enroll.
VOLUNTARY LONG TERM DISABILITY INSURANCE
The Voluntary Long Term Disability Plan administered by The Standard, provides loss of income protection (up to 60%) due to a qualified disability. The vendor offers two (2) different plan options which include a 30 or 90 day waiting period. Eligible employees can enroll in the benefit at any time during employment. The employee will be subject to Evidence of Insurability (EOI) requirements. Contact Information: (800) 378-5745, or www.standard.com/mybenefits/csu to enroll.
AUTO AND HOME INSURANCE
The Auto and Home Insurance plan offered by California Casualty, allows CSU eligible employees to obtain auto and home insurance policies at a discounted rate. The plan also has an identity theft component known as ID Defense. All policies are written for a 12-month period. Eligible employees can enroll in this benefit at any time during employment. Contact Information: (866)680-5142, or www.csuautoinsurance.com to enroll.
2012 Premium Rates for Medical Plans
| Unit 6 |
All Other Units |
|---|---|
| (SETC) Skilled Crafts |
Unit 1 (CFUAPD) Physicians |
|
Unit 6 |
All Other Units |
||
|---|---|---|---|
| Employee only | $571 | $566 | |
| Employee + 1 | $1,084 | $1,074 | |
| Employee + 2 or more dependents | $1,402 | $1,382 |
|
HMO Premium |
Unit 6 Monthly Premium |
All Other Units Monthly Premium |
|
|---|---|---|---|
| Blue Shield Access +(HMO) |
|||
| Employee only | $622.90 | $51.90 | $56.90 |
| Employee + 1 | $1,245.80 | $161.80 | $171.80 |
| Employee + 2 or more dependents | $1,619.54 | $217.54 | $237.54 |
| Blue Shield NetValue(HMO) | |||
| Employee only | $535.73 | $0.00 | $0.00 |
| Employee + 1 | $1,071.46 | $0.00 | $0.00 |
| Employee + 2 or more dependents | $1,392.90 | $0.00 | $10.90 |
| Kaiser (HMO) | |||
| Employee only | $559.11 | $0.00 | $0.00 |
| Employee + 1 | $1,118.22 | $34.22 | $44.22 |
| Employee + 2 or more dependents | $1,453.69 | $51.69 | $71.69 |
|
PPO Premium |
Unit 6 Monthly Premium |
All Other Units Monthly Premium |
||
|---|---|---|---|---|
| PERSCare (PPO) |
||||
| Employee only | $977.98 | $406.98 | $411.98 | |
| Employee + 1 | $1,955.96 | $871.96 | $881.96 | |
| Employee + 2 or more dependents | $2,542.75 | $1,140.75 | $1,160.75 | |
| PERSChoice (PPO) | ||||
| Employee only | $545.56 | $0.00 | $0.00 | |
| Employee + 1 | $1,091.12 | $7.12 | $17.12 | |
| Employee + 2 or more dependents | $1,418.46 | $16.46 | $36.46 | |
| PERS Select (PPO) * Must reside in California |
||||
| Employee only | $463.12 | $0.00 | $0.00 | |
| Employee + 1 | $926.24 | $0.00 | $0.00 | |
| Employee + 2 or more dependents | $1,204.11 | $0.00 | $0.00 |
Health Plan Definitions
- Health Maintenance Organization (HMO): This type of plan is designed to reduce out-of-pocket expenses, with no deductible and a minimal co-payment. All services must be received from contracting physicians and hospitals.
- Preferred Provider Organization (PPO)/Indemnity – This plan requires that a deductible be met before the plan benefits are payable (90% - 80% depending upon which PPO is selected). Similar to HMO’s, the PPO Indemnity plan contracts with specific doctors and hospitals in certain areas. The plan pays higher benefits when utilizing a participating provider (Anthem) than a non-participating provider. Under a PPO/Indemnity plan, there is no geographic restriction. Anthem Administers both PPOs. MEDCO is the pharmacy benefit manager for both PPOs.
2012 CalPERS Medical Plans
Blue Shield Access+ (HMO) and Blue Shield NetValue (HMO) 1-800-334-5847
Kaiser (HMO) 1-800-464-4000
PERSCare (PPO), PERSChoice (PPO) and PERS Select (PPO) 1-877-737-7776
(Anthem administers the PPO plans)
CalPERS Health Plans Evidence of Coverages
The 2012 Health Benefits Summary and 2012 Health Benefits Program Guide will assist you making health plan choices during the Open Enrollment Period.
Medical ID cards: The health plans will make every effort to ensure members who change health plans receive their new identification cards before January 1, 2012. If you change plans and do not receive new cards by the above date, do not continue to use your prior plan after December 31, 2011. To resolve this problem, contact your new health plan and inquire about the issuance of cards. Delta Dental does not issue dental cards; please refer to your Dental evidence of coverage for benefit information at http://www.aba.csueastbay.edu/HR/Benefits/dental.htm.
HMO CO-PAYMENTS/ OFFICE VISITS AND URGENT CARE CHANGES:
- Office co-payments will be waived for preventive care office visits including periodic health exams, Maternity care, well baby visits, allergy testing and treatment, immunizations, hearing evaluations and pre/post natal care. Please Note: Kaiser will continue to charge a co-payment for allergy testing and treatment.
- Other office visits co-payments $15.
- Co-payments for urgent care visits will be $15.
- Emergency care co-payment is $50 (unless admitted to the hospital).
- Out-of-pocket maximum will be $1,500 for individual and $3,000 for family. Pharmacy is excluded.
HMO PRESCRIPTION DRUG COSTS - BLUE SHIELD ACCESS PLUS AND NET VALUE
Retail Pharmacy * (Short-term use/ up to 30 day supply)- $5 generic
- $20 brand name
- $50 non-formulary
- $30 for specialty drugs
Maintenance Drugs (after 3rd filled prescription)
- $10 generic
- $40 brand name
- $100 non-formulary/prescription
Mail Service (up to 90-day supply)
- $10 generic
- $40 brand name
- $100 non-formulary
KAISER Retail Pharmacy GENERIC
- $5 co-pay for 30 day supply
- $10 co-pay for 31 to 60 day supply
- $15 co-pay for 61 to 100 day supply
Generic refills from Kaiser mail-order
- $5 for up to a 30 day supply
- $10 for a 31 - 100 day supply
Brand-name items from a Plan Pharmacy
- $20 for up to a 30 day supply,
- $40 for a 31 to 60 day supply,
- $60 for a 61 to 100 day supply
Brand-name refills from our mail-order service
- $20 for up to a 30 day supply
- $40 for a 31 to 100 day supply
