What does "active enrollment" mean and what do I have to do?
Because of the medical plan design changes for 2014, all LANS, LLC non-Medicare retirees will need to select one of the two offered medical plans or waive coverage through Aon Hewitt & Associates during the retiree Open Enrollment period from October 21 to November 15, 2013. Further details are provided in your Open Enrollment Kit from Aon Hewitt, Your Benefit Resources (YBR).
All non-Medicare retirees need to enroll or risk lack of 2014 coverage.
What guidance is available to help me select the right medical plan for 2014?
The 2014 Medical Plan Options for Non-Medicare Retirees website is non-Medicare retirees' central information source for selecting next year’s medical plan. The site provides guidance documents, decision-support tools, frequently asked questions, and useful hyperlinks.
The Medical Expense Estimator decision-support tool will help you compare your projected annual medical expenses under each plan. The DecisionDirect software will ask you a few quick questions and then will offer a plan recommendation based on your response.
Since Blue Cross Blue Shield of New Mexico will continue to be our medical insurance administrator in 2014, but the plans themselves are changing, will we receive new insurance cards?
Yes, new cards will be mailed to your home address in time for the start of the new plan year on January 1, 2014. Because the plans are changing, the cards will show new group numbers.
Will participants in the 2014 plans be able to stay with their current medical providers?
Yes, we still will be using the same Blue Cross Blue Shield provider network as in 2013. With the new plans you have the advantage of being able to see both in-network and out-of-network providers, though going out of network would be more expensive of course.
Do the 2014 plan changes impact out-of-state or international coverage, such as for business or vacation travel?
No. Blue Cross Blue Shield of New Mexico has coverage nationwide and in 23 foreign countries.
Will the changes for 2014 affect preexisting conditions?
No. The current plans do not have any preexisting condition limitations and neither will the new plans next year.
If I enroll in a given plan but later decide that I would prefer the other option, will I have the opportunity to change?
You can switch plans once a year during the Open Enrollment period or during the 31-day window following a qualified life event, such as a change in plan eligibility for a dependent. If your circumstances change, so can your medical plan.
With the Affordable Care Act’s Open Enrollment period underway as of October 1, 2013, would it make sense to compare the Laboratory’s 2014 medical plan offerings to the plans available through the Health Insurance Marketplace at HealthCare.gov?
Comparison shopping is always wise, but keep in mind that since the Laboratory does offer plans of its own it would not pay the employer portion of the monthly premiums for non-LANL medical plans.
HDHP, PPO details
What are some of the major differences between the 2014 Preferred Provider Organization Plan and the High-Deductible Health Plan?
For a quick overview of the major differences between the Preferred Provider Organization (PPO) Plan and the High-Deductible Health Plan (HDHP), consult Blue Cross Blue Shield of New Mexico's 2014 Medical Plan Comparison (pdf).
But the plans also have things in common. For example, both plans will be administered by BCBSNM and cover preventive services at 100 percent (e.g., routine cholesterol monitoring, mammograms, and EKGs) in accordance with the Affordable Care Act.
Can I have other medical insurance in addition to the High-Deductible Health Plan?
Yes, the High-Deductible Health Plan (HDHP) does not have to be your only medical insurance. However, you cannot have other medical coverage if you would like to take advantage of a tax-advantaged, interest-bearing Health Savings Account (HSA), for example through HSA Bank or similar institutions.
Eligibility requirements for HSAs are established by the IRS.
What expenses count toward meeting the deductible under the High-Deductible Health Plan and Preferred Provider Organization Plan?
Under the High-Deductible Health Plan, all costs for medical services and prescription drugs apply toward your deductible. Under the Preferred Provider Organization (PPO) Plan, all coinsurance counts toward your deductible but medical or prescription drug copays do not. Some sample charges that count toward your PPO deductible include hospital charges, surgical charges, labs, x rays, and supplies.
How is the family annual deductible reached under the Preferred Provider Organization Plan and High-Deductible Health Plan?
Under the Preferred Provider Organization Plan, the plan begins to pay benefits for an individual family member within the family coverage as soon as that member’s individual deductible has been met ($300 for the 2014 calendar year).
Under the High-Deductible Health Plan (HDHP), one family member or any combination of family members must meet the full HDHP family deductible before any applicable benefits are paid for anyone ($3,000 for the 2014 calendar year). The HDHP approach is what is referred to as a "True Family Deductible."
How is the family annual out-of-pocket limit reached under the Preferred Provider Organization Plan and High-Deductible Health Plan?
Under the Preferred Provider Organization Plan, the plan begins to pay benefits for an individual family member within the family coverage as soon as that member’s individual annual out-of-pocket limit has been met ($3,000 for the 2014 calendar year). The out-of-pocket limit is comprised of the deductible, copays, and percentage coinsurance, but does not include out-of-network inpatient hospital copays, residential treatment center copays, or drug plan copays.
Under the High-Deductible Health Plan (HDHP), one family member or any combination of family members must meet the full HDHP family out-of-pocket limit before any applicable benefits are paid for anyone ($6,000 for the 2014 calendar year). The out-of-pocket limit is comprised of the deductible, percentage coinsurance, and amounts paid under the drug plan. The HDHP approach is what is referred to as a "True Family Out-of-Pocket Limit."
What are preventive services?
Preventive services include annual physical exams, gynecological exams, immunizations, and routine cholesterol monitoring, mammograms, EKGs, and colonoscopies and are covered in full under both the High-Deductible Health Plan and Preferred Provider Organization Plan. When receiving preventive services, it’s best to not pay anything up front at the doctor’s office and to make sure that your doctor codes the preventive services visit correctly. For additional information, see the Affordable Care Act (ACA) Preventive Services Fact Sheet (pdf)