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Health Benefit Open Enrollment Webinar.

Added May 11, 2022 •

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sounds like you're doing the cat dairy cow so I started recording so the end jhp which is not a new plan will be going into the second year Baptist I think there might be some questions on that so this webinar is being recorded and will post this on our website if anyone needs to refer back to it at a later time so weird that I'm actually in another meeting so you have any questions at the end of your Robert and that'll be able to answer 99% if there's something that pertains District specific your day and Donna will be able to do the best they can and if not they'll just have to get back to you and the three of us will talk in the Frontier question so that'll be how we move forward I think Robert I have given you the ability to share the screen so that I'll turn it over to you so good afternoon everyone. My name is Robert McGuire but I have a tackle here with me even though it says Robert McGuire but just a tackle thank you for taking the time to listen to our Zoom open enrollment meeting you know a couple things of pulse that is really kind of discuss the New Garden State Plan kind of read a  the Educators Health Plan and then discuss anything else you need in terms of this year's open a Rolex out I received an email a few weeks ago that it is now you're all going to roll it like we have every year for an effective date of July 1st the Open Enrollment started last week which was May 3rd and it closes on May 26th so we still have plenty of time for you to take a look at your health benefits if you wanted that make any changes if you want to switch between plans for any reason this is your opportunity to do it for the folks that were hired on or after July 1st of 2020 songs of the medical and prescription drug plan you really don't have a choice you are either going to be in the Educators health plan or you can go into this new Garden State plan which we going to talk about in a few minutes before the rest of you going to call us with East Windsor prior to July 1st 2020 as you know we have an abundance of different plan designs we're not going to go over each one but you do have that ability to go and make a different selection to your health that's if you want to I can stop again if you are looking to add a spouse to your plan please submit proof of your union marriage license still Union certificate and if you're adding children or if you're about to have newborn congratulations just make sure that you provide copies of the birth certificates for the board office so that they can enroll your spouse and children of your chapter 78 contribution or York recent health benefits of the 0% increase for the medical prescription dental and vision for the 2020 to 2023 years as a great great results of your contributions and taking money out of your paycheck I'm all really good news for this year but a lot of information is on your website is who Beyond The District health benefits website so if you need to find your application to add the pendants remove dependents you can find forms on the website is a Universal Enrollment application if you want to see what your chapter 78 contribution is you can do that as well on the website and also if you are waiving coverage you do half this is the time here to redo your waiver and that is also found in the website so please take a look at that and if you are waiving coverage please download that form fill it out and please get the support office with that being said I'm a try and share my screen and Pat at goal from my office is going to talk about the New Garden State plan and then we'll talk about the plane as well which are far too newest plants of course we will answer any questions you may have if you have anything personal in nature we definitely recommend calling us directly at Integrity Consulting Group at 609-7374 313 big and since this is a public forum yo maybe we want to make sure that your personal questions are brought to our attention so that we can help you out and let me see if I can share my screen can't you see it you can I can so with that being said I'm going to turn my volume up I think I'm too much and that's saying something so what that means take it away this is the new Garden State Plaza Educators Health Plan when we look at why you're going to see they are virtually identical in other words what they did was they took the N J & J E H people and they simply duplicated it called the Garden State lab but there is one huge what is a huge I mean it's huge different and if you look at the top highlight and it says very important New Jersey providers only and what that means is if you see anyone outside of the state of New Jersey seeing you have no coverage for that particular provider you do have in network coverage and out-of-network coverage but only for providers who are located in the state of New Jersey I had a lady called me the other day and she said with my doctor has an office in New Jersey and I see him there sometimes and they have one in Pennsylvania and I see my provider there sometimes what would happen I said when you see the provider in Pennsylvania even though it's the same provider you have no coverage then I know I'm going to say that quite a few times and the reason is I'm going to say it quite a few times as soon as we look at these benefits especially if you're in the eh bee right now you're already experiencing a lesser contributions because it's our tribulations and that New Jersey Educators plan are based on your salary and it's probably I know you have a special contribution plan you no longer follows chapter 78 exactly what even sell you're going to say that all that New Jersey Educators plan the contribution is most likely less than all the other plans based on a percentage of salary and a lower percentage and when you look at the Garden State plant cells percentage numbers are cut in half and I'm people I don't want people to look at that and sleep well I like the Educators plan so I'll go to the Garden State and only have to pay half the contributions that statement is true however that's why I'm to really drilled down on the fact that it's New Jersey only providers we're not going to go through this line by line or Robert will have somebody come over and get me a drag me away when I do want to point out is that these 350 for an individual 704 family and that's pretty much the exact same way the njhpdi Educators plan is and then we do heavy out of pockets and network 500 + 1000 + 2000 + 5000 at work I keep in mind even though we're out of network is the network in New Jersey only limited and it is a plan that pays 70% after the deductible and do payments are still $10 for Primary Care $15 for a specialist in Spain deductable of 70% with the exception of your preventive care there's no deductible if you're adding that work is Fran and 70 set no deductible that work if that's always painted 100% but we want to point on is some of the things that are different in this plan compared to the other plans that you have or if your innate New Jersey Educators glad it's identical to what the New Jersey Educators plan has and one of those just added level of out-of-network coverage that you have on when I said the level I don't mean deductible 70% coinsurance I mean the amount that's allowable reasonable and customary or like we used to say they were the three nasty words and the insurance because if you went out of network and your doctor charged more than reasonable and customary you were liable to pay for that amount will the reason customary amount that are allowed on this Garden State Plan and the New Jersey Educators plan which was introduced as of 1120 1120 21 is only 200% of I say that because 200% of Medicare is much lower than what you currently have on all your other plans where you have out-of-network benefits other than that work it's paid at the 90th percent of fair Health something totally and I will give an example to you just because I always like to do examples I think they're easier to understand and an example could be if you were seeing a mental health provider a man's mental health month we're going to use a mental health provider they might be charging you $200 for a visit because they have a tendency they have a high cost associated with them and they're adding Network in my scenario I will if you do one of the other plans I from the Educators plan cuz what I'm telling you applies to both the Educators and the Garden State plan that allowance could be $200 and it's 3% depending on the other plans you might be Whataburger on this particular plan that $200 they may only allow $120 because the 200% of Medicare is a much lower allowance then percent of fair help 90% of Hair Fair Health means 90% of the doctors in a particular geographical area or charging that amount of money or less and it's a separate company that Aggregates all this information I mean carriers buy it from them that's what you're out of networks with you with the exception of the New Jersey educators of the Garden State are paying up to on these plans are paying 200% of Medicare allowance which is a much less allow. so it's possible that $200 charge now they only allow 120 they would pay it was an 80% or 70% of that 120 and in addition to paying your other part of the coinsurance you're 30 or 20% you would also have to pay the difference between the 120 and the $200 that was actually charged the amount allowed and the amount chart so we want to point these like that to you because you don't want to go into one of these plans to save money I wind up having to pay out more money this is out-of-network early you see that same mental health care provider and they're in that work at the $15 copay so I'll miss Garden state land if your in Network all the time your benefits will be great if your providers are in New Jersey but then you told me a New Jersey Educators plan that has a nationwide network but again you want to also always try to remain in network there's three of them areas of this plan that are affected with twins differences when you go out of network home and leaving again I know I'm repeating myself but they're the same as the New Jersey Educators blank is a simply duplicated the plan but on this particular plan again as we mentioned no out-of-state providers if you're seeing an acupuncturist if it's in that work it's fine it's $15 if it works it's 70% after your 3 $50 deductible and then the max it will pay you $60 no matter what the provider's charges no matter what that reasonable and customary or 200% of Medicare is $60 is the most you will get another area if you look down but we have high Physical Therapy also add a network if you add a network the most you would get for any out-of-network visit is $52 and there's one other area and that area is chiropractic no it's not on there stop this isn't arriving account so we don't have an exact time I correct on that benefits would be would be definitely count for you and if you look at the bottom we even wrote the out-of-network reasonable and customary allowance is only $200 and Medicare this is the same allowance and jhp but considerably less than Horizon Pointe if you see an out-of-state provider they will not be covered again we don't want it we can't stress that enough and we even will ask that if somebody comes to Don our diet and says we want to enroll in this plan we would ask that maybe but we actually put together an affidavit and we don't have that up here on the screen what we put it together so that people could actually up we do have it here it is very good can I see this is an affidavit to actually show that you understand and I'm not saying that people are stupid and don't understand what I'm saying is we want to educate you because this is so unkind and so unlike any other plans that you have we want people to we want to be sure that when you're enrolling in this program you realize that the only time a doctor outside of New Jersey is covered his word accidental emergency or a medical emergency and we go on on this affidavit to even show what that what the two definitions are these bottom line is if you're seeing a doctor at excuses why I think the best place you performed is that the the hospital of surgery in New York City that's not a medical emergency you don't have coverage there if someone says well your child has this and I really believe probably the best place to go is where to CHOP Children's Hospital of Philadelphia that's not a medical emergency a medical emergency is something that happens unexpectedly unexpected its onset is a median you need to seek immediate attention give you an example you are now on vacation in Florida and you fall and break your leg accident emergency you're going to the hospital. Forbid you're someplace else outside of the state you have a heart attack you're going to the hospital those are medical and emergencies that we want to make sure that everyone understands that and we're actually having people sign something saying that you do understand this because we don't want somebody to and Roland something and not totally understand the repercussions that can happen if you don't see a doctor outside of the state the prescription plan on the Garden State plan is also exactly the same as the prescription only agitators plant it's $5 for retail I mean it's $5 for retail for generic and it's $10 for brand name however what we do have is mandatory generic and what does mandatory generic mean it means that is there a generic available to the brand that you're currently taking you must take that generic or you have to pay the cost differential again Give an example I like doing examples let's say and I know Robert always likes to use Lipitor let's just say if Lipitor is the is the drug you're taking and that's a brand name and it probably because I haven't looked lately but it's probably about 3 $400 a month to purchase that particular prescription and there's we know there's generics and that generic might only cost $27 but you say I definitely want Lipitor I don't care I'm taking Libby and there's a brand available not only do you pay the $10 retail copay for the brand name but you pay the cost differential between the $27 generic of a possible $400 brand name that are there used to that rule there are some exceptions but that would only be if your doctor what you write in ask for an exception and clinical proof that you cannot take the generic equivalent so if somebody's doctor said there's no way they can take the generic Lipitor and here they trade it it says a word that are allergic whatever then you can possibly have an override put in the system that you can purchase that a brand-name drug what would be the exceptions to the rule so I know if you're going to this planned or the njeh people and it's a mandatory generic the other thing one does plan to step therapy and what step therapy and say is you have to try and smoke make me a lower-cost drug before you get the higher-cost right and migraine medication a lot of pain medication out there we we can't even turn on the television without seeing some kind of commercials for 4 vacations out there but I was actually singing along to the jingles the other night for these advertisements but what happens is they seem to be the really high, so you may go to your doctor and say I want to really take one of these something's going to happen if and there probably isn't a generic available yet because it's new drink was drugged maybe in the step Therapy Program was going to say you have to take a if he doesn't work then you have to try if he doesn't work after trying it for a certain amount of time then you can go to see so what do some steps the lower cost of the next to lower-cost and eventually you can work your way up the other drugs don't help you do that. so that's called Step therapy that's on this program as well as on the n j e h p program I think you know I don't know if we have any other questions we do have a chat area where you can what you didn't we can look at the contribution schedule as I mentioned I think if Robert goes down there it is you can see is extremely low contributions at but we don't want you to just look at those contributions we want you to look at the big picture that's why we want to be so sure that when you enroll in that plan you're not just looking at dollars because if you need to go outside of the state or a sinking a lot of service is out-of-network the dollars can be washed away within a month or two other thing we have the affidavit which we already went over and I believe we have the ehp planned up here and we can breathe I will briefly see its exact same thing 350 deductible 700 family the difference with this program as though it has all of those all of those I'm oversight it has the prescription oversight that we spoke about it has the physical therapy in the acupuncture limitations it has the 200% of Medicare allowance that we talked about before but difference with this plan is it is a nationwide plan so be it Network providers are the same as your in network providers in your other direct access programs not only in New Jersey but in Pennsylvania and they are the Nationwide PPO providers that they work with outside of the state of New Jersey so these two plants are identical as far as what is covered as far as the maximum that are covered the deductibles the Big Dipper the big differences the fact that one's very restrictive to New Jersey just don't tell her the plan benefit pages that were showing are they available on the website and I believe yes they are on your website so you can view both that's about 3 page benefits on the website do we have any other questions I know we we kind of went through it fast but we wanted to get just I didn't think you wanted me to stay here and say if you go see a specialist it's a $15 copay and network 70% after deductible or go line-by-line so we gave you the overview they're out there on the website for you to review if you do have any questions or you have any personal questions you could call her office would be happy to help you okay question is if you want to continue with the same plan do you have to submit nap which I absolutely not if you are not doing anything during this open enrollment you don't need to do anything the only people who need to actually do something I believe waivers have to be re-signed where is must be re-signed if you're currently on the waiver and if you're making a change from one plan to the other but if the plans you're on now is the plan you wish to remain in the all you need to do is absolutely nothing everything will just go on as it's always it's only if you wish to you know move from one plant to another that you would need to actually fill out a form to you make that switch in that form can also be found on your web see if we have any other questions just a friendly reminder I mean open enrollment good news is we still have a couple more weeks of open enrollment so a lot of time to think about any of this is that you're even thinking of making again if you're not making any changes at all no forms to fill out you just going to continue on with your current benefits again you would need to fill out a form if you are going to enroll in the educator a plan or if you are adding or removing dependents those are the only circumstances where you would need to fill out a passport never question the question Rihanna question is where happen if you see my daughter pulling up here so I can see if you qualify for Medicare or what changes would be made and the answer to that is absolutely nothing so when you get to that point if someone's turning sick by their eligible for Medicare the first of the month in which they turn age 65 does it matter if you do it on the 15th if your birthday is on the 30th whatever it's the first of that month because you are actively employed and you're in an active group plan Verizon plan is going to be your primary and it'll go on exactly as a does right now that would be the same for you or your spouse what you would need to do is you would need to notify cuz medicare's going to send you all the paperwork to enroll Medicare part A is free to you but Medicare Part B and I don't know the exact amount for the rent $150 a month right now might be a little more or a little less I'm not exactly certain on that when it's not necessary enroll in Medicare Part B because this plan is your primary plan but you will need to advise Medicare that the reason you're not enrolling in Medicare Part B at this time when you're eligible is because you are covered an employer in an active group plan now what you get to that point if you have some more questions on that please feel free to give us a call that's a very common question question when people are turning 65 but it will Go On Your Horizon will be your primary planning you'll actually get a new ID card and if it's for you the employee will be a little weird drug test for it and what that does is it says I'm over 65 but I'm still employed plant lab when the time comes closer if you need to hear that again or you want to talk again please feel free to contact our office and will help you go through that right there's nothing else thank you so much for the time today again open enrollment is until May 26th so it's still plenty of time to get it want to reach out to us and integrity for some personal questions or if you just want to confirm some things that we discussed today do not hesitate to call us or number is 609-737-4313 and anybody in the office will be assist you with that being said thank you so much for the time today and have a great rest of the afternoon in the rest of the week thank you I'm taking his back. 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