What's New or Changing for 2021?

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We are pleased to announce the 2021 plan design for medical, dental and vision plans will not change.  However, there are a few changes to the Pharmacy benefit effective January 1, 2021.

Cost Drivers and Key Considerations

  1. Medical benefits continue to be the primary controllable cost among all benefit offerings.
  2. Market trend for the University‘s medical expenditures is lagging the market average of 7.1% while the university pharmacy spend is at the market average of 2.5%. These percentages are much lower than prior years and have been influenced for the impact of COVID. Especially during the spring, there was a period of low utilization as medical providers were temporarily canceling services and members were delaying care and procedures.
  3. Based on these market trends and the past plan design changes, a $670 thousand inflation cost increase is expected for 2020. The University will absorb the majority of this increase. Therefore, employee premiums will not change except for those earning more than $150,000 per year.
  4. Premiums continue to be targeted at 20% average employee cost share and Wright State at 80%. However, the average employee cost share for 2020 medical plans was 18.6% and since the University is again maintaining premium levels, the average employee cost share for 2021 is further reduced to 18.2%.
  5. As continued to be seen in the marketplace, although currently reversed in next year’s projections as influenced by COVID, pharmacy is expected to continue outpacing medical. Therefore, a couple pharmacy plan design changes are being implemented which will absorb approximately 19% of the increased cost projection.
  6. Medical expenditures for spouses continue to exceed the medical costs for employees, therefore the spouse added fee will continue in 2021.
  7. A premium salary tier 4 has been added for those employees earning greater than $150,000.

 

Healthcare Plan Design Changes

We are pleased to announce the 2021 plan design for medical, dental and vision plans will not change. However, the following are changes to the Pharmacy benefit will be implemented beginning January 1, 2021:

Walgreens will no longer be a participating pharmacy

As you are aware, pharmacies charge different prices for the same prescriptions. Actual prescription costs at Walgreens are higher compared to other pharmacies. By removing Walgreens from the network, the plan can reduce the overall cost of retail prescription drugs.

Mandatory 90-day Maintenance Prescription Drug Program

Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes. Implementing this program will drive additional cost savings and higher medication adherence (improve outcomes).

Members will be able to fill selected maintenance drugs for 30-days at an eligible retail pharmacy for up to three months. In the fourth month, members will be required to utilize 90-day prescriptions. 

Members will have the option of filling these 90-day prescriptions via:

  1. Anthem’s IngenioRx mail order program; or
  2. An approved Rx Maintenance 90 Retail Pharmacy; for most this will be at the same retail pharmacy where they will their 30-day supply.

A listing of the maintenance drugs that fall under this program along with a list of approved Rx Maintenance 90 retail pharmacies are available on the HR Open enrollment website. You will note in this list that our most visited pharmacies, CVS and Kroger, along with Walmart, Sam’s Club and Costco, are on the list; while Meijer, Rite Aid and Walgreens are not.

Specialty Drugs Cost Optimization Program

For our most severe medical cases which impact a handful of members, Anthem offers additional services which are intended to maximize the experience through best practices and if possible, cost savings. 

  1. Exclusive Specialty Pharmacy – all prescriptions will need to be filled through IngenioRx Specialty.
  2. Right Drug Right Channel – optimizes value by directing coverage to either medical or pharmacy channels according to the best practice of clinical experiences and cost management.
  3. Medical Specialty Drug Review – process to improve outcomes and manage costs by applying clinical criteria that is appropriate and safe.
  4. Site of Care – guide members to clinically approved and cost effective site of care whether that is hospital, outpatient, home assistant care or home.

Important note:  If you are in a situation where expensive specialty drugs are being utilized, the physician, member, and Anthem are already in consultation. These additional services offers better management of medical specialty drug utilization and cost while ensuring clinically appropriate and safe use of specialty medications covered under the plan.

Reminder:  Anthem Engage, a digital tool for a personalized member experience connects your selected health plan and benefits data with individual clinical and claims data. Engage will assist you with navigating your 2021 medical and pharmacy benefits beginning January 1, 2021. 

Register for ENGAGE today via WINGSENGAGE websiteAnthem website or download the mobile app by searching for Anthem Engage or Engage Wellbeing. During the registration process, you will be prompted to provide your subscriber ID number listed on your Anthem insurance card.

 

Health Management Initiative - Enhanced

Last year, Wright State Human Resources launched a new Health Management Initiative (HMI). This voluntary initiative was designed to raise health awareness, increase detection of cardiovascular disease and diabetes, and encourage employees to begin and/or continue to make healthier lifestyle choices.

Due to the importance of the HMI program and the impact participation can have on our employee’s future health; we are continuing and expanding the program for the upcoming year. In exchange for three actions, you will receive a $400 incentive (increased from $300) in the form of an employer contribution into either a Healthcare Flexible Spending Account (FSA) or a Health Savings Account (HSA). You will need to be enrolled in a Wright State medical plan (as the policyholder) and be in active employment at the time the incentive is deposited during May 2021.

The three actions for you to deliver:

  1. Participate in an onsite biometric screening – scheduling is in process now for October or November.
  2. Complete online Health Risk Assessment by March 31, 2021 located on the Healthworks website.
  3. Share your Biometric Screening results and discuss your overall health with your Primary Care Physician anytime upon receipt through March 31, 2021. A Physician Verification form will need to be provided to Healthworks.

Also new this year:  The online Health Risk Assessment and Biometric Screening is open to spouses that are enrolled in a Wright State Medial plan. Spouses may also take advantage of our free onsite flu shots being offered by The College of Nursing and Health and HR. Appointments are required for onsite Biometric Screening and flu shots. No additional incentive dollars are available for spouses and employees enrolled on a Wright State medical plan as a spouse.

Continuing this year:   Solera, a Pre-Diabetes Prevention Program, will continue to be offered to our eligible medical enrollees. This innovative program is designed to help participants lose weight, adopt healthy habits and reduce the risk of developing type 2 diabetes. To see if you qualify for Solera, please visit https://solera4me.com/en/wsu.

For more information on the HMI program, please visit Health Management Initiative website.

 

Virtual Experience for Benefits Open Enrollment

In order to adhere to the COVID-19 safety protocols, the 2021 Benefits Open Enrollment will be a virtual experience. The following virtual resources will be available to help you make informed benefit decisions.

  1. Virtual open enrollment meetings, recorded for on-demand viewing.
  2. Virtual one-on-one sessions with Anthem, Delta Dental, VSP and HORAN (the university’s benefit consultant). Appointments are required.
  3. Computer labs will be replaced with virtual one-on-one assistance with online enrollment. Appointments are required.

Please watch for emails from HR-Benefits@wright.edu for instructions on how to schedule appointments and Open Enrollment details.

 

Flexible Spending Accounts (FSA)

Wright State offers two Flexible Spending Accounts (FSA):  Healthcare and Dependent Care. A FSA allows you to set aside money out of your paycheck to pay for eligible expenses on a pre-tax basis (exempt from federal and state taxes.) 

The IRS has not released the 2021 limits for Healthcare FSA or the Dependent Care FSA. Therefore at this time the limits remain $2,750 for Healthcare FSA and $5,000 for Dependent Care FSA ($2,500 for married filing separate.) 

Also new for 2021, participants in the enhanced Health Management Initiative will receive a Wright State University contribution of $400 to their FSA Healthcare account in May 2021. This payment will be made regardless of whether you personally contribute to an account. This $400 contribution is in addition to the allowed IRS employee limit of $2,750. 

The FSA Flex Debit card, introduced in 2020, will continue to be available tor 2021.

 

Health Savings Account (HSA) Contribution Limits increased by IRS

The IRS issued the 2021 annual contribution limits listed below, increasing the single coverage by $50 and family coverage by $100.

  • $3,600 for single coverage
  • $7,200 for family coverage
  • $1,000 additional for HSA catch-up contributions (age 55 or older)

The Wright State University contribution to the Health Savings Account for 2021 will be paid in two semi-annual deposits:

 Wright State University’s HSA Contribution—Staff & Non-Bargaining Unit Faculty

Coverage

January 3

July 3

Total

Employee

$250

$250

$500

Employee + child(ren)

$500

$500

$1,000

Employee + spouse

$500

$500

$1,000

Employee + family

$500

$500

$1,000

According to the IRS, it is your personal responsibility to ensure that you do not exceed these HSA contribution limits. You can determine your total HSA contributions by adding the following:

  • Wright State University contributions noted above, and
  • $400 Health Management Initiative in May 2021 (if participated), and
  • Your personal paycheck contributions

 

Employee Premium Cost-Share

For another year, the university has decided to absorb the majority of expected additional costs in 2021 which means premiums for 2021 will remain unchanged unless you earn greater than $150,000. 

This action will further reduce the employee cost share to 18.2%; although our goal for the future continues to be as close as possible to 20% employee cost-share established in 2018.

Medical Premiums

The premium structure continues to be a 5-step process:

1. Horan Associates, our benefit consultant, provided the following total cost projections: 

Total cost projections

Coverage

Ratio

PPO 80/20

 HDHP

Employee

1.0x

   $652

   $570

Employee + child(ren)

1.8x

$1,174

$1,026

Employee + spouse

2.2x

$1,436

$1,254

Employee + family

3.0x

$1,958

$1,712

2. To obtain the employee cost share, these total costs were multiplied by an average of 18.2%.  The premiums remain the same as Year 2020 premiums: 

Employee cost share

Coverage

Ratio

PPO 80/20

 HDHP

Employee

1.0x

 $118

  $104

Employee + child(ren)

1.8x

 $214

 $188

Employee + spouse

2.2x

 $262

 $228

Employee + family

3.0x

 $356

 $312

3. The premium structure is being increased adding a fourth tier for those employees earning greater than $150,000. The tier structure reflects salary levels that provide an equal distribution of employees among the tiers. 

Cost share tiers

Tier 1

Tier 2

Tier 3

Tier 4

< $47,000

$47,000 - $75,000

> $75,000 - $150,000

>$150,000

1/3 employees

1/3 employees

1/3 employees

4. The premiums for Tier 2 represent the 18.2% average cost share noted in Step 2 above. The discount value for Tier 1 equals the additional percentage assigned to Tier 3/4. Consistent with the 1/3 guidance in Step 3, we established Tier 1 to represents 67% of Tier 2 premiums (a 33% decrease) and Tier 3 to represent 133% of Tier 2 (33% increase). Tier 4 is being established at 140% of Tier 2 (40% increase)

Cost share by tier

Tier 1

Tier 2

Tier 3

Tier 4

< $47,000

$47,000 - $75,000

> $75,000 - $150,000

>$150,000

67%

100%

133%

140%

The resulting monthly medical premiums for 2021 are as follows:

Monthly medical premiums

Plan

Coverage

< $47,000

$47,000 - $75,000

> $75,000 - $150,000

> $150,000

PPO 80/20

Employee

$80

$118

$158

$166

Employee + child(ren)

$144

$214

$286

$300

Employee + spouse

$176

$262

$348

$366

Employee + family

$240

$356

$472

$498

 

HDHP

 Employee

$70

$104

$138

$146

 Employee + child(ren)

$126

$188

$250

$264

 Employee + spouse

$154

$228

$302

$320

 Employee + family

$210

$312

$416

$436

5. The spousal added fee listed separately will be in addition to the premiums listed in chart above. If the trend reverses and our costs for spouses become more aligned with employees, the added fee will be re-evaluated.

Salary Tier

< $47,000

$47,000 - $75,000

> $75,000 - $150,000

> $150,000

Medical Spousal Added Fee*

$32

$50

$68

$70

 

Dental and Vision Premiums

Premiums for 2021 remain unchanged from 2020.

The dental and vision premiums were developed similar to the medical premiums with the total cost spread over the four coverage levels utilizing the same relationship ratio. The 20% employee cost is applied to the total costs. These premiums will remain one tier.

Dental and Vision Premiums

Coverage

Ratio

Delta Dental of Ohio

 Vision Service Plan (VSP)

Employee

1.0x

$7.40

$1.60

Employee + child(ren)

1.8x

$13.32

$2.88

Employee + spouse

2.2x

$16.28

$3.52

Employee + family

3.0x

$22.20

$4.80

 

New Anthem Medical Cards

Your current Anthem Medical Cards will continue to be used in 2021.

For this enrollment, new Anthem Medical Cards will only be mailed to your home address if the following occurs:

  • Employees who are new to one of the plans; either switching or adding coverage.
  • Addition of a spouse or dependent(s)

If at any time you need a replacement for your Anthem insurance cards, you can personally access your card via the following: 

  • You can access a copy of your card at www.anthem.com. You can either print or request replacement cards be mailed to your home.
  • You can access a copy of your card via Anthem Engage.

 

Reminder: $50 Late Enrollment Fee

Wright State University believes it’s important for each employee to take the time to understand their healthcare options so they can select the coverage that best suits their needs and their budget.

Regardless of current coverage or if waived coverage, you must take action online via WINGS Express to continue, change, enroll or waive your 2021 healthcare coverage during the October 29th through November 16th open enrollment. 

A $50 late enrollment fee, will be charged for anyone failing to take action. This late fee will be deducted from your January 2020 paycheck.