Benefits changes to FSAs, premiums, kids’ coverage

Medical and dental plan coverage changes may be made by employees throughout November, during the annual open enrollment period. Changes will become effective Jan. 1 for the 2011 calendar year.
 
A brief listing of benefits changes for 2011, followed by details about each, is below:
 
  • Increases in medical premiums for all plans except Group Health Classic.
  • Aetna Public Employees Plan and Kaiser Permanente Value will no longer be available.
  • Children may be carried on employees’ medical/dental and life policies until age 26.
  • Many over-the-counter medications will not be covered by the flexible spending account (FSA) without a prescription.
  • Uniform Medical Plan changes.
 
Premium increases: The Health Care Authority (HCA) – administrator of the state employee benefits package – announced that premium rates will be higher in 2011 due to inflation in medical care costs. This will cost both the state and subscribing employees more money for the same level of benefits.
 
To view a chart reflecting the 2010 and 2011 premiums, please visit http://hrs.wsu.edu/OpenEnrollment and click on Medical Premiums Changes.
 
Aetna and Kaiser Permanente Value plans no longer available: Employees enrolled in Aetna or Kaiser Permanente Value will need to select a new plan for 2011 during open enrollment. If employees do not make a selection, they and their enrolled dependents will be defaulted to a new plan as reflected below:
 
  • Aetna participants will be defaulted to Uniform Medical.
  • Kaiser Permanente Value participants will be defaulted to Kaiser Permanente Classic.
 
Coverage of children until age 26: Effective Jan. 1, children may be on an employee plan until age 26 regardless of student status, and they do not have to be an Internal Revenue Service dependent or reside with the employee.
 
Children enrolled as students no longer will need to provide proof of student status. Disabled children will be covered, as long as the disability occurred prior to age 26.
 
Eligible children may be added to employee plans during open enrollment. Children already on employee plans, including children enrolled as adult dependents, automatically will be transferred to the 2011 plan.
Flexible spending account (FSA) changes: Effective Jan. 1, over-the-counter medications will not be covered by the FSA without a prescription from a health care provider.
 
ASIFlex, the administrator of the FSA benefit, has provided information about this change, as well as over-the-counter products that still will be covered, at this  website.
 
Employees will be able to make claims on their 2010 accounts for expenses incurred through March 15, 2011, and claimed no later than March 31, 2011 – with the exception of over-the-counter medications.
 
Employees must enroll/re-enroll each year to participate in the FSA or the Dependent Care Assistance Program (DCAP).
 
Uniform Medical Plan changes:
  • Effective Jan. 1, Regence BlueShield will be the administrative services provider responsible for customer service, claims processing and establishing a comprehensive preferred provider network. Click here to visit the network provider’s website.
  • Regence BlueShield has a broad network of providers nationwide and outside of the country. Therefore, Uniform will reimburse at either a network rate (85 percent of the allowed amount) or non-network rate (60 percent of the allowed amount). The 80 percent out of area rate no longer will be available.
  • When Uniform is the secondary plan, it will process whatever the primary plan did not pay up to the amount that Uniform would have paid if it had been the primary plan. For example, if the primary plan pays 75 percent of the claim, and Uniform pays 85 percent, Uniform will pay up to the additional 10 percent the primary plan did not pay. This change will not apply to those covered by Medicare, and Uniform will continue to cover the amount of the allowed charges that Medicare does not pay.
 

For additional information, please visit the HRS open enrollment Web page.