DoD NAF HBP Open Enrollment Overview November 4 – November 29

DoD NAF HBP

Open Enrollment Overview

November 4 – November 29

Agenda• Open Enrollment Overview

• Medical Benefit Overview

• Health and Wellness Programs

• Dental Benefits

• Member Tools and Discount Programs

www.nafhealthplans.com

Open Enrollment Overview• The Open Enrollment Period allows eligible

employees to:– Join the DoD NAF HBP or another available NAF

health plan if not already enrolled– Switch plans– Add or remove eligible dependents– Add or drop dental– Drop coverage altogether– Do nothing and keep current medical/dental

coverage • If you are making an enrollment change,

complete and return the enrollment forms to your local Human Resources Office no later than November 29, 2013


DoD NAF HBP

Medical Benefits Review


2014 HBP Contributions

Plan Individual Coverage Family Coverage

2013 2014 2013 2014

Medical Plan $69.65 $72.09 $162.04 $167.71

Dental Plan $4.36 $4.36 $10.32 $10.32

Medical and Dental $74.01 $76.45 $172.36 $178.03

Stand Alone Dental $17.98 $18.44 $42.52 $43.62


2014 Benefit Changes• Annual Medical Deductible Increase:

• You will have the opportunity to earn additional Health Incentive Credits to offset the increase to the deductible.

Aetna Open Choice PPO PlanIf you elect coverage for: Your 2014 deductible will be:

Individual $400 in-network; $1,000 out-of-network

Family of 2 $800 in-network; $2,000 out-of-network

Family of 3 or more $1,200 in-network; $3,000 out-of-network

Aetna Traditional Choice Plan, including Aetna InternationalIf you elect coverage for: Your 2014 deductible will be:

Individual $400

Family of 2 $800

Family of 3 or more $1,200


2014 Benefit Changes• Earn more Health Incentive Credits in 2014!• The maximum an individual can earn will increase from $100

to $150, the family maximum will increase from $300 to $450• You now have seven ways to earn the Health Incentive Credit

in 2014:

Activity Health Incentive Credit Earned

Have a preventive care exam (dependents under 18) $100 – one per year

Have a preventive care exam (employees, retirees and dependents over 18)

$50 – one per year

Complete/Update Health Assessment $50 – one per year

Complete a Simple Steps online wellness program $50 – one per year

Complete the Personal Health Record Walk-Me-Through Tool $50 – one per lifetime

Make entries into the Personal Health Record Health Tracker $50 – one per year

Make entries into the Personal Health Record Physical Activity Tracker $50 – one per year

Respond to items on the Member Health Engagement Plan “to-do” list $50 – one per year


2014 Benefit Changes Out-of-Pocket Maximum• Effective January 1, 2014, all in-network medical, behavioral health

and pharmacy member cost-sharing will apply towards the out-of-pocket (OOP) maximum. This means that the following costs will now count toward your OOP limit: PCP and specialist copays, emergency room copays, inpatient per confinement fees, pharmacy copays and 3rd tier pharmacy coinsurance.

• You will still be responsible for the deductible, copays and confinement fees, but the costs will go toward your annual OOP maximum.

• Once your share of the cost for in-network deductible, copays, coinsurance and per confinement fees reach the applicable OOP maximum, the plan pays the covered expenses at 100% for the remainder of the calendar year.

• Please note that the $150 prescription eyewear allowance, bariatric surgery coinsurance, premiums, out-of-network deductible, coinsurance, and balance billing, and non-covered services do not count towards your OOP maximum.


Health Incentive CreditThese credits will be placed in an account and applied towards the first family member’s claim where the deductible and/or coinsurance would be applied. Employees can earn a maximum of $150 per year per person, up to $450 per family per year.

Health Incentive Credit features:• Applied to the medical deductible and/or coinsurance as claims are processed. The Credit cannot be applied to copayments such as PCP, Specialist, Emergency Room, Urgent Care copays, Hospital confinement fees, or pharmacy copays.

• The credit will roll over every year until used, up to 3 years.

• Credits are displayed on Explanation of Benefits and in Aetna Navigator

*Preventive exams eligible for the incentive: annual routine physical, well woman exam or well child exam.


2014 Benefit Changes Pediatric Vision

• Effective January 1, 2014, prescription eyewear for children up to age

22 will be covered at 100% with no copay (in and out of network).

• This includes one pair of basic frames and lenses, which have specific

vision codes associated with them called V codes, which indicate what

is covered.

• The V codes that are payable at 100% are limited to (V2020, V2100-

2199, V2200-2299, V2300—2399, V2121, V2221, V2321)

• In order to have this benefit paid at 100%, you may have to pay for

the frames and lenses out-of-pocket and submit a claim to Aetna for

reimbursement of the covered charges.


DoD NAF HBP

Health and Wellness Programs


Aetna Health Connections Disease Management

What is it: • Personal support to help you manage your ongoing

health conditions• Support for 34 health conditions including Diabetes,

High Cholesterol, High Blood Pressure, etc.

How it can help you:• Telephone outreach on how to manage

your health conditions• Support for working with your doctors• Notification about potential medical errors

and opportunities to improve care• Information about your health conditions


Simple Steps To A Healthier LifeWhat is it: • Online guide to health and wellness

How it can help you:• Identify potential health issues with a

health assessment• Get personalized reports to help you set goals• Participate in online wellness programs• You can visit the website as often as you like. Simple

Steps is more than just the health assessment. You can use site features such as articles, quizzes, recipes and other tools to learn more about the health topics that mean the most to you.

Eligible for Health Incentive Credit • Earn $50 for completing/updating Health Assessment • Earn $50 for completing online wellness program


Personal Health Record• The Personal Health Record (PHR) is an online service,

accessed through Aetna Navigator, that provides a secure place for all your health information gathered from:– Medical claims– The Health Assessment at Simple Steps To A

Healthier Life– Personal medical data you provide, such as over-

the-counter drugs, family history and health problems you may not necessarily see a doctor for (like back pain).

– Your PHR also provides health alerts and reminders from MedQuery, a health monitoring system.

Eligible for Health Incentive Credit • Earn $50 per lifetime for completing PHR Walk-Me-

Through Tool• Earn $50 for updating PHR Physical Activity Trackers• Earn $50 for updating PHR Health Trackers


Member Health Engagement Plan

What is it: • Provides you with a personalized list of recommended

actions to help improve your health and wellness

How it can help you:• Site offers personalized action plans based upon your

specific health status• Includes reminders on core health activities, such as

completing health assessment, to health screenings

Eligible for Health Incentive Credit • Earn $50 for completing item on “to-do” list.


Pharmacy Advisor ® - 1-877-418-4128What is it: • Proactive outreach to members to help manage

medication and health conditions• One-on-One support by phone or mail

How it can help you:• It’s staffed with registered pharmacists and

technicians that are available to help you manage your medicine and condition. Rely on:– Quick, secure advice that’s planned around your schedule.– Information about medicines and how they work in your body.– Guidance to help you stay on track with your prescription

medicine.


Informed Health Line (1-800-556-1555)What is it: • 24-hour nurse helpline for your health questions • Online health resource

How it can help you:• Get answers to your health questions from registered

nurses day or night• Make decisions about when to call your doctor• Learn about medical tests and procedures• Go online for health information, tools and resources


DoD NAF HBP

Dental Benefits Review


Dental Options for 2014

Passive PPO Dental Plan• For members enrolled in a DoD NAF HBP

Stand Alone Dental Plan• For members who are not enrolled in a NAF

medical plan under the DoD HBP through your employer


Your dentist...your choice

• Choice #1 - Visit an Aetna PPO dentist and receive services at negotiated rates

• Choice #2 - Visit any licensed dentist of your choice for maximum flexibility under your plan


How both options work• Option #1 - When you visit a dentist in our dental PPO

network…– Meet your deductible – Coinsurance – No claim forms

• Option #2 - When you see any other licensed dentist …– Meet your deductible – Coinsurance– Out-of-pocket expenses may be higher– You may have to file claim forms– You may be subject to balance billing


Member Tools and Discount

Programs


Member Tools – Aetna Navigator• Transactions, Decision Support and

Health Information• Health History Report• Check claims, balances, enrollment• DocFind®

• Hospital Comparison Tool• Member Payment Estimator• Price-A-DrugSM

• Rate Your Medical Professional• Aetna InteliHealth®

• Healthwise® Knowledgebase


Stay well, get fit and save moneyDiscount Programs & Services:

Vision related discounts Hearing Fitness Alternative health care Dietetic counseling Weight management Natural products And more….

Discount information can be found on Aetna Navigator, by calling Aetna Member Services or at www.nafhealthplans.com.

These valuable discounts are not insurance.


Questions?

More information can be found at www.nafhealthplans.com


Documents

DoD NAF HBP Open Enrollment Overview November 4 – November 29