EUTF and PCP OE Period:  April 1, 2016 through April 29, 2016

Effective Coverage:              July 1, 2016 through June 30, 2017

Deadline for Employees:     COB Friday, April 29, 2016

EC-1 Form (April 2016) and Instructions:  Use revised EC-1 Form (Rev. April 2016) for 2016 OE.

2016 OE Reference Guide:  Refer your employees to the electronic copy of the reference guide.

2016 OE Informational Sessions and webinars: Provide a copy or inform your employees of the open enrollment information session and webinar schedule (instruction on how to access the webinar).

2016 – PLAN CHANGES FOR MEDICAL AND PRESCRIPTION DRUG PLANS:

      I.        For the EUTF HMSA 90/10, 80/20, and 75/25 PPO and HMO medical plans:

1.    Added autism benefits for individuals under 14 years of age up to $25,000 per year (office visit                            coinsurance or copayment apply).

2.    Added orthodontic services for children born with orofacial anomalies under age 26 up to $5,500 per                treatment phase (no coinsurance or copayment apply).

3.    Added advanced care planning office visits (office visit coinsurance or copayment apply).

4.    Added Dr. Dean Ornish program ($20 copayment per session).

    II.        For the EUTF HMSA 80/20 medical plan:

1.    Added an out-of-network deductible of $250 for single coverage and $750 for family coverage.

2.    Changed the copayments for primary care, specialist, and second opinion (surgery), office visits, and                 inpatient physician services to 20% coinsurance.

3.    Changed the outpatient diagnostic lab services to 20% coinsurance.

4.    Changed the in- and out-of-network emergency room charge to 20% coinsurance.

5.    Changed all out-of-network services to 40% coinsurance, excluding out-of-network hospice care which               will be Not Covered and emergency room facility charges which is required to remain at the in-network             charge.  Out-of-network charges for routine physical exams and immunizations will remain at No                       Charge.

   III.        For the EUTF HMSA 75/25 PPO medical plan:

1.    Changed the copayments for primary care, specialist, and second opinion (surgery), office visits, and                  inpatient physician services to 25% coinsurance.

2.    Changed the outpatient diagnostic lab services to 25% coinsurance.

3.    Changed the in- and out-of-network emergency room charge to 25% coinsurance.

4.    Changed all out-of-network services to 40% coinsurance, excluding out-of-network hospice care which              will be Not Covered and emergency room facility charges which is required to remain at the in-network           charge.  Out-of-network charges for routine physical exams and immunizations will remain at No                       Charge.

  IV.        For the EUTF Kaiser Comprehensive and Standard medical plans:

1.    Added autism benefits for individuals under 14 years of age up to $25,000 per year (office visit                           coinsurance or copayment apply).

2.    Added orthodontic services for children born with orofacial anomalies under age 26 up to $5,500 per                treatment phase (no coinsurance or copayment apply).

3.    Changed the prescription drug copayment to $5 for generic tier 1, $10 for generic tier 2, $35 for brand,               and $75 for specialty for the Comprehensive plan.

4.    Changed the prescription drug copayment to $5 for generic tier 1, $15 for generic tier 2, $50 for brand,              and $75 for specialty for the Standard plan.

    V.        For all EUTF Caremark prescription drug plans:

1.    Increased the out-of-pocket limits by $250 for single coverage and $500 for family coverage.

2.    Changed the prescription drug copayments for a 30-day/60-day supply to $5/$10 for generics, $25/$50             for preferred brand, and $50/$100 for non-preferred brand, respectively, for the EUTF plans.

3.    Added the Retail 90 network with copayments of 2 times the 30-day supply copayment for a 90-day                  supply of medications filled at Retail 90 network pharmacies and mail order, and copayments of 3                      times the 30-day supply copayment for medications filled at non-Retail 90 network pharmacies for the              EUTF plans

• Copayment – a fixed amount you pay for a covered service (for example, $15)
• Coinsurance – share of the costs of a covered service, calculated as a percent of the eligible charge (for example, HMSA 90/10 medical plan, coinsurance is 10%)

For detailed information regarding health care benefits, please refer to the EUTF Reference Guide, visit the EUTF website or contact the EUTF at 586-7390 or toll free 1 (800) 295-0089.  Questions may also be emailed to eutf@hawaii.gov.

 NOTE – New hire enrollment/mid-year changes effective today through June 30, 2015:  Use the EC-1 Form (Rev Mar. 2015).

Process

• Deadline for Employees:  If an employee wants to make a change to his/her health plan (i.e., add/change/drop a plan, add/drop a dependent, change coverage tiers from single to family or family to 2-party etc), the employee shall complete the EC-1 Enrollment Form (Rev. Mar 2015) and submit to the human resources office by COB Friday, April 29, 2016.