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Insurance Open Enrollment

2018 Health Insurance Open Enrollment 

Open Enrollment Dates: Oct 30 - Nov 10, 2017
Open Enrollment CLOSES at 5 p.m. Nov. 10, 2017
All changes will take effect January 1, 2018


Open Enrollment is mandatory.  All Benefit Eligible Employees, including recently hired employees, are required to sign into the enrollment tool and confirm their elections during the enrollment window, regardless of whether you choose to enroll or decline coverage for the 2018 benefit plan year.  There are significant changes to the benefit structure in 2018, all benefit eligible employees are strongly encouraged to review the 2018 benefit information and consider which plan options will best fit your and your Families needs for the upcoming benefit year.   No changes will be allowed after the open enrollment window closes, unless you have a qualifying life changing event.     

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Booklet Correction:  The Initial priniting of the benefit booklet listed the an incorrect amount for the traditional Family deductible and the Traditional Buy up family deductible.  The correct amount should have been $2550.00

If you need additional assistance please contact the Insurance Office at 801-826-5428.

Benefits Fair:

To help you to get to know our new carriers we will be having a benefit fair during the enrollment window. We strongly encourage you to attend, talk with the carriers, ask questions and become familiar with the insurance options and carriers.  Enrollment counselors will be on hand to assist you through the enrollment proccess.  

November 2, 2017
Mount Jordan Middle School
9351 S. Moutaineer Ln. (210 East)
Sandy, Utah 84070
4 to 7 p.m.

Summary of Carrier Changes

2018 Summary of Carrier Changes

Carrier Changes:

In accordance with procurement guidelines, the District requested competitive proposals from potential Health, Pharmacy and Dental administrators.  Following a lengthy selection process, PEHP has been selected as the District’s new Health and Pharmacy plan administrator, and EMI Health has been selected as the new Dental administrator.   These carriers were chosen because they will provide improved claims administrations, integrated wellness strategies, and cause the least disruption to employees and their families.  

PEHPHealth Coverage & Pharmacy:

PEHP will manage both the health and the pharmacy coverage, which will ensure that claims administration will be fully integrated.  The network options and plan designs will be similar to the current structure, which in most circumstances will allow everyone to keep their current doctors.   Be aware that the names of the networks will be different under PEHP.   The new networks correspond as follows:
 
SelectMed - Intermountain Health Care (IHC) = PEHP Advantage Network
AETNA network = PEHP Summit Network

Please see the benefit guide for more detailed information on PEHP and your health plan options. 

EMI Health – Dental Coverage:

EMI Health has been administering the District Vision benefits with few complaints.  Participants will see very similar dental coverage at a lower cost.   In most cases participants will be able to go to the same dentist.   If your dentist isn’t in network, you can contact EMI Health to nominate a provider and they will contact the provider about contracting with EMI Health.   The new plan options correspond in coverage and cost as follows:

 Dental Select Silver Plan = EMI Health Value plan
Dental Select Gold Plan = EMI Health Advantage Copay plan
Dental Select Platinum PPO = EMI Health Choice PPO Plan
Dental Select Platinum Indemnity = EMI Health Choice Indemnity Plan

Summary of Health Plan Changes

2018 Summary of Health Plan Changes

Rate Change:

Health care costs continue to rise, requiring that we increase premiums.   The increase in premiums were discussed and agreed to during the annual negotiation process.  The District is covering the larger portion of the total cost increase, but employees will see a premium increases that will range from 4% to 9% depending on the plan selection and coverage tier.  Please see the benefit guide for more details.   

Coverage Changes:

During the annual negotiation process, the following plan parameter changes were agreed upon for the traditional health plan and will be implemented in the 2018 benefit year.       

·        Health Deductible is increasing to $850/$2550
·        Out of pocket maximum is increasing to $3500/$7000
·        Office Visit Copay is increasing to $30/$50
·        No changes to the Qualified High Deductible Health plan

Enrollment Tool Change

The District will be utilizing a new enrollment tool for 2018.   The tool requires you to register before you will be able to log into the website.   The enrollment site will be active on October 30th.  To login you will go to www.navigatemybenefits.com and select “Register as a new user.”  The Company Identifier is “Canyons” and the PIN number is the last four digits of your social security number.  The process is relatively self-explanatory; however, step by step instructions are included in the enrollment packet.  If you need assistance with enrolling, come to the benefit fair, make an appointment with an enrollment counselor, or contact the insurance department. The enrollment process must be completed by the 10th.

Insurance Carrier Information

Ins.Plan Vendor Description Phone
 Health PEHP Icon_External_Link Health and Pharmacy Administrator -  The Advantage Network contracts with IHC facilities the Summit Network contracts with Iasis, Mountain star and U of U hospitals. 800-765-7347
Dental & Vision EMI Health EMi health will provides Dental and Vision coverage for the 2018 benefit year.   801-262-7476
 Flex APA BenefitsIcon_External_Link Provides adminitration on Flexible spending and HSA accounts  866-656-0227
 EAP Blomquist Hale Icon_External_Link The Employee Assistance plan Provides counseling to employees and there immediate family members when they encounter struggles. 800-926-9619
 Life Reliance Standard Life Insurance and AD&D 800-351-7500
 Disability Reliance Standard Long Term Disability Insurance 800-351-7500
 Other Carrier Information
 *Supplemental AFLAC Icon_External_Link Supplemental Insurance
Contact: Lee Harmer
801-716-0084
 *Supplemental plans are not part of District group plans.

Open Enrollment FAQs


Q: When is the open enrollment period for the 2018 plan year?

A: Open enrollment will be Oct. 30 - Nov. 10th. The Enrollment window will close at 5:00 PM on Friday, November 10th.  All employees who want to have health, dental, vision, flexible spending or HSA elections in the 2018 plan year will need to go through the enrollment process.  Benefits, Particularly flexible spending and HSA benefits, will not automatically transfer to the new year.  Voluntary plans that are not changing will also require participants to confirm their elections.

Q: I don't know what my user name an password is for the new enrollment system.

The new enrollment system requires to to set your own User Name and Password by first registering on the website.  This is and upgraded security feature and designed ot give you access to your account and no one else.   To register just click on the "new user registration" link that appears under the Password field.  This registriation process is an easy straight forward process,  just fill in the fields as indicated.  the Company Identifier is "Canyons".  More detailed steps are available in the erollment guide included in the supplemental benefit materials.

Q: Will I need to do anything during open enrollment?

A: Yes. As has been the case with previous years, Open Enrollment for the 2018 plan year is mandatory.  It is even more critical because of the substantial changes in carriers and plan options this enrollment cycle.  IF you don't complete the open enrollment you run the risk of not having your preferred benefit elections in the 2018 benefit year.  All employees who are eligible for insurance in the 2018 plan year, which is Jan. 1-Dec. 31, 2018, must log in and confirm their election, even if you want to decline benefits. This online enrollment must be completed by 5 pm on Nov 10, 2017.

Q: Why do I have to participate in the enrollment process? Why can't I just be enrolled automatically?

A: The selection of a health plan is a personal decision and depends largely on the employee's personal circumstances. Needs and circumstances change from time to time, we encourage employees to examine their benefit needs annually to determine if any changes need to be made. This is your only opportunity to make changes without a qualifing event, and we suggest that you consider your options and verify your coverages.  We require that employees confirm their elections annually through the enrollment process.

Q: How do I choose a health plan: Step 1 – Traditional vs Qualified High deductible health plan?

A: The choice between the Traditional plan and the Qualified High Deductible Health Plan is a choice that rests on your personal feeling about security vs control. The traditional plan is more about security, you pay a higher monthly premium but you pay less for the deductibles and the out of pocket maximum, but conversely you also pay a higher monthly premium even if you don’t require any medical care during the year. The High Deductible plan is more about having control over your health care dollars. You pay substantially less in premium and in exchange you will be expected to cover more of your upfront costs based on the deductible and out of Pocket Maximum. To help manage the insecurities associated with this plan, the IRS allows you to set money aside in a Health Savings Account (HSA); the funds in this account can be used to cover the costs you may incur. A very risk averse person would likely lean toward the Traditional plan, and person who wants to have more control over how their health care dollars are spent will likely lean toward the High Deductible plan.

Q: How do I choose a health plan: Step 2 – Advantage vs Summit

A:  This choice rests on which network you are more comfortable with. The Advantage network is mainly the Intermountain Health Care (IHC) network, whereas the Summit network is essentially the Non–IHC affiliated hospitals and clinics.   This would include Mountain Star, Iasis, and the University of Utah Health Care clinics and hospitals. Some individuals might have strong opinions toward one network or the other, while others don’t really care at all. The plan designs are equivalent and you should receive excellent care through both networks.  If you don’t have strong feelings toward one or the other you may want to look at the list of covered hospitals, on page 10 & 11 of the benefit guide, and select the network with the hospital closest to your home.

Q: How do I choose a Health plan: Step 3 – Base vs Buy Up?

A: This is question largely about out-of-network coverage. While the base option has regional network agreements that allow participants to receive emergency services out of the Utah region, they don’t provide any kind of out-of-network benefit. The Buy Up option allows you to have out-of-network coverage. There are two advantages to the buy up:  first, some participants who travel might have concerns about finding a doctor to treat a medical need while traveling, this option allows them to get services almost anywhere.  Second, some people might be treated for a condition by a specialist that may not be in their preferred network; the buy up allows them to have coverage for this out-of-network specialist. The additional cost is substantial, so you will want to consider your projected out-of-network costs carefully before selecting this option.

Q: I don’t understand the HSA tax dependent rules. Who can I use my HSA dollars for?

A: Because the HSA is governed by the IRS, the HSA regulations follow tax law for dependency. This means that the funds can only be used for medical expenses for either you and your tax dependents. In short if you claim them on your taxes, as a dependent, you can use your HSA dollars for their approved medical expenses.  If you don’t claim them as a tax dependent, you can’t use your HSA to pay for their expenses. The confusion comes because the Affordable Care Act allows children to stay on a parents health plan until they reach age 26, but dependents who are in there 20’s may, or may not be a tax dependent. Let me give you an example, I have two children one age 22 and one age 24. The 22 year old is a student and living at home, I claim him as a dependent for taxes. The 24 year old has graduated from college, is married and has started a career; I don’t claim her on my taxes. I am however, covering both children on my health insurance. I can use my HSA to cover the medical expenses of the 22 year old because they are still my tax dependent; however, I can’t use my HSA to cover the expenses of the 24 year old because I no longer claim her as a dependent on my taxes.

Q: Will my premiums change?

A: UNfortunately health care cost continue to increase which has required us to increase premiums.   As agreeed upon in the annual negotiations premiums will increase in the 2018 benefit year.  The premium increases will be between 4% and 9% depending on the benefit and coverage tier.  The District absorbed the larger portion of the increase.

Q: Will my benefits change?

A: Aside from the rate increase on the total Premium that was divided equally between employees and the District, we needed to make changes to the Traditioanl Plan.  Those Changes are as follows:

 -Change In deductible from $750/$2,250 to $850/$2550
 -Change in out‐of‐pocket max from $3,000/$6,000 to $3500/$7000
 -Office Visit Copay will move $20/$35 to $30/$50
There were not any plan design changes to the High deductible plan, other than the rate increase.

Q: Why are Socials Security numbers required for my dependents?

A: The Social Security Number is the unique identifier used by insurance companies to reconcile claims data when more than one carrier is involved. Starting January 2015, the Affordable Care Act requires that pharmacy claims and health insurance claims both count toward the annual out-of-pocket maximum. While this is a small change to the plan design it requires a major change to the administrative process. In order to accumulate claims data toward the annual out-of-pocket maximum, the carriers must communicate and reconcile claims between the pharmacy and health administrators. If dependent Social Security Numbers are not recorded in the enrollment system then the claims incurred may not accumulate toward your out-of-pocket maximum correctly. If you do not have Social Security Numbers for your Dependents, please contact the Insurance Department as soon as possible at 801-826-5428 or send an email to This email address is being protected from spambots. You need JavaScript enabled to view it. and we will assess your situation to determine your options.

What carrier changes will occur in the 2018 benefit year.

Due to prcurment rule the District was required to sollicity proposals for Health Pharmacy and dental coverage.   Through the selection process PEHP was selected as the new health & Pharmacy carrier and EMI health was selected as the new Dental Carrier.   See the supplemental benefit materials for more details.