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Open Enrollment

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1. Why did my benefits change this year?

Every year, the City re-negotiates medical, dental, and vision insurance rates for the upcoming fiscal year, beginning October 1.  Due to an increase in medical claim activity over the past year, the bid for 2020/2021 from our current carrier, Blue Cross, was 14.5% or $1,557,000 higher than 2019/2020.  The City analyzed cost alternatives to the Blue Cross plan, including joining an association of municipalities in Southeast Idaho in an attempt to leverage potential cost savings with a higher number of covered lives.  Bids were received from multiple insurance companies and while some plans were less expensive, they did not provide the continuity of services Blue Cross has continued to provide to City employees.  In addition to increased costs to the health care plan along with forecasted financial impacts due to the COVID-19 pandemic, the City is faced with a tight overall budget for the rest of this fiscal year, extending into the 2020/2021 fiscal year.  As a result, City Council has determined that the only viable option with the current circumstances is to pass on a higher percentage of insurance costs to employees.  This decision was not taken without a great deal of discussion of the impacts to the employees.
Despite the raised employee premiums and plan modifications, the City still has a generous and highly competitive employee benefits package.

2. If I want all my insurance to remain the same, do I have to do anything?

There are only two things that MUST be renewed every year: 

• The Flex Spending Account (FSA) must be renewed every year.  It stops at the end of the plan year (September 30) unless it is renewed by the employee.
• Additional contributions to the HSA.  Any additional contributions you are making to your HSA as a payroll deduction must be renewed every year. 

Other than those two things, you do not have to do anything if you want your coverage to remain the same.

3. Do I have to renew my Flexible Spending Account?

Yes.  The Flex account must be renewed every year.

4. Do I have to renew my HSA?

Any additional contributions you are making to your HSA as a payroll deduction must be renewed every year.

5. Are there any changes to Dental coverage?

No.  There are no changes to either Delta Dental or Willamette Dental coverage.

6. Are there any changes to the Vision coverage?

No.  There are no changes to the vision coverage.

7. What does “Choice” mean in regard to physician co-pays?

It means that Blue Cross has evaluated their in-network providers and found those providers who have been more successful in keeping patient and prescriptions costs down while providing excellent health care.  These effective providers are classified as Choice.  On this Open Enrollment webpage, there are documents that describe how to search for a Choice provider on the Blue Cross website.

8. Where can I go to see if my Dr. qualifies as a Choice provider?

On this Open Enrollment webpage, there are documents that describe how to search for a Choice provider on the Blue Cross website.

9. What are the new monthly premiums?

Refer to the premiums chart available on the Open Enrollment webpage to see the premiums for the plan year 2020-2021.

10. Will my deductible be affected by the changes to the PPO?

No.  The deductibles remain the same, but the out-of-pocket coinsurance maximum has changed.  See the out-of-pocket coinsurance maximum question below for further explanation.

11. What is the split for the PPO?

The total cost of the insurance premium is split between the City and the employees.  For the PPO, the City pays 86% of the total cost and the employees pay 14%.

12. What are the new out-of-pocket coinsurance maximums for the PPO?

The out-of-pocket coinsurance is the maximum amount the individual pays after the deductible is met.  For example, an individual on the PPO would pay their deductible of $1,000, then 50% of the allowed amounts up to the out-of-pocket coinsurance maximum.  For the individual, this out-of-pocket coinsurance maximum amount is $1,500. 

In other words, on the PPO, an individual will pay the $1,000 deductible, then their portion of allowed amounts up to $1,500 for a total out-of-pocket of $2,500 (see equation below).

Deductible	+	Out-of-Pocket Coinsurance Maximum	=	Total Out-of-Pocket
$1,000		$1,500		$2,500

On the PPO, a family will pay the $1,000 deductible for up to 3 family members, then their portion of allowed amounts up to $4,500 for a total out-of-pocket of $7,500 (see equation below).

Deductible	+	Out-of-Pocket Coinsurance Maximum	=	Total Out-of-Pocket
$3,000 (1,000 x 3 family members)		$4,500		$7,500

13. What is the change to Doctor’s Office visits under the PPO?

The providers have been distinguished by in-network or out-of-network.  Now the added distinction of being “Choice” has been added to help you save money on doctor’s visit co-pays. 

In-Network		Out-of-Network
Blue Cross Choice Provider	$20	Deductible/Coinsurance
Blue Cross Choice Specialist	$40
Non-Choice Provider	$40
Non-Choice Specialist	$60

14. What are the changes to the prescription co-pays?

The prescriptions are now on a 6 Tier schedule.  This helps the consumer save money by opting for not only generic medications, but Blue Cross Choice generic drugs where possible.  If your medications cost less than the co-pay, you pay the lower amount.

Additionally, there is a $250 deductible on the name brand medications which are the Tier 3, 4, 5, and 6 medications.

15. Where can I go to see which Tier my prescriptions are on and how much they will cost?

Here is where the prescriptions are listed:

https://brokers.bcidaho.com/resources/pdfs/pharmacy/2020/2020-Standard-6-Tier-Formulary.pdf

16. What has changed on the HSA?

In general, the changes are the split between the City and the Employee share of the cost; the monthly premiums; an addition of $100 to the deductible per IRS requirements; and the out-of-pocket coinsurance maximums.  See below for more information on each of these.

17. What is the split for the HSA?

The total cost of the insurance premium is split between the City and the employee.  For the HSA, the City pays 94% of the total cost and the employee pays 6%.

18. What are the new monthly premiums for the HSA?

Refer to the Premiums chart available on the Open Enrollment webpage to see the premiums for the plan year 2020-2021.

19. Will my deductible be affected by the changes to the HSA?

IRS guidelines have required an increase of $100 to the HSA deductible.  For an individual on the HSA, the new deductible is $2,800.  For a family on the HSA, the new deductible is $5,600.

20. What are the new out-of-pocket coinsurance maximums for the HSA?

The out-of-pocket coinsurance is the maximum amount the individual pays after the deductible is met.  For example, an individual on the HSA would pay their deductible of $2,800, then 80% of the allowed amounts up to the out-of-pocket coinsurance maximum.  For the individual, this out-of-pocket coinsurance maximum amount is $2,000. 

On the HSA, an individual will pay the $2,800 deductible, then their portion of allowed amounts up to $2,000 for a total out-of-pocket of $4,800 (see equation below).

Deductible	+	Out-of-Pocket Coinsurance Maximum	=	Total Out-of-Pocket
$2,8000		$2,000		$4,800

On the HSA, a family will pay the $2,800 deductible for up to 2 family members, then their portion of allowed amounts up to $4,000 for a total out-of-pocket of $9,600 (see equation below).

Deductible	+	Out-of-Pocket Coinsurance Maximum	=	Total Out-of-Pocket
$5,600 (2,800 x 2 family members)		$4,000		$9,600