(This section is a Summary of Material Modifications [SMM] to the Summary Plan Description [SPD].)
The following changes to current
January 1, 2013.
Other Changes May Apply to HMO Coverage
Unless noted, the changes in this guide do not apply to Health Maintenance Organization (HMO) options. You will need to check the YBR website during the annual open enrollment period or contact the carriers of those options directly for their 2013 plan changes. Carrier contact information is located on the back of your HMO ID card and in the Benefits At-a-Glance and Resource Contact Information booklet.
What's Changing Due to the Affordable Care Act (Healthcare Reform Law)
There are some provisions of the healthcare reform law that will take effect in 2012 and 2013 that you should be aware of:
New $2,500 Health Care Flexible Spending Account (HFSA) Limit for 2013
Beginning in 2013, the maximum annual amount that eligible employees can contribute to an HFSA is $2,500. This means that when you make your 2013 HFSA contribution elections during the annual open enrollment period this year, the most you will be able to elect to contribute is $2,500. Please note: This change will not impact the Dependent Care Flexible Spending Account (DFSA).
New Summary of Benefits and Coverage (SBC) Available Online on October 8, 2012
This year employers are required to provide employees with SBC(s) in order to compare health plans when making decisions and enrolling in coverage. SBC(s) for the health plan(s) you are enrolled in will be available on the YBR website beginning on October 8, 2012.
New Form W-2 Reporting Requirement
There is a new requirement that employers disclose the value of the employer-provided benefit for health insurance coverage on each participant's Form W-2. This means that plan participants who receive a 2012 Form W-2 from
New This Year:
Special Online-Only Enrollment Period
Already know what you want to elect for 2013? You will have an opportunity to make your elections — only on the YBR website — beginning Monday, October 8, 2012 through Sunday, October 21, 2012. The chart at right shows the timing for enrolling in and/or changing your coverage during the annual open enrollment period:
| From: | Monday, October 8, 2012 at 9:00 a.m., ET, through Sunday, October 21, 2012 |
Monday, October 22, 2012 at 9:00 a.m., ET, through Friday, November 2, 2012 at 5:00 p.m., ET |
|---|---|---|
| You may: | View your coverage and costs and make your elections on the YBR website. You will not be able to call the |
View your coverage and costs and make your elections on the YBR website. You may also call the |
| Be sure to take action before Friday, November 2, 2012 at 5:00 p.m., ET. Late enrollments will not be accepted. | ||
Expanded Coverage for Autism, Speech and Developmental Services
Effective January 1, 2013, the Medical Plan will provide coverage for core autism services: neurological testing, treatment plan evaluation, psychotherapy, and occupational and speech therapy. In addition, the number of out-of-network visits under the Enhanced Point of Service (POS) and Traditional Indemnity options for speech therapy for developmental delays will be increased to an annual maximum of 100. Coverage for Applied Behavioral Analysis is excluded.
Change to Out-of-Network Ambulance Coverage for Standard POS Option
In 2013, out-of-network ambulance coverage will increase from 60 percent to 80 percent. This means that when you use an out-of-network ambulance under the Standard POS medical option, the Plan will pay for 80 percent of reasonable and customary (R&C) charges.
Medco and Express Scripts Are Now One Company
The combined company is in the process of changing the name on all communications to Express Scripts. Beginning on October 1, 2012, the new member website will be www.express-scripts.com. Until the renaming process is complete, you will sometimes see the Medco name in your prescription drug communications and online.
Please continue to refill your prescriptions as you normally would by using your current prescription drug ID card, refill order forms, the member website or the toll-free member services telephone number on your ID card.
Changes to Medco/Express Scripts Prescription Drug Coverage
As part of
"Member Pays the Difference" Program
Effective January 1, 2013, if you purchase a brand-name drug when a generic equivalent is available, you will pay the generic copayment, plus the difference in cost between the brand-name and generic drug.
Expanded Coverage Management Programs
Medco/Express Scripts uses a set of coverage management programs to determine how the Plan will cover certain prescription drugs. These programs now cover additional categories of prescription drugs. You will be notified by Medco/Express Scripts if you are impacted by any of these programs.
New-Look YBR Website
The YBR website was updated in May 2012. If you have not been to YBR since the update, you will notice some enhancements.
You will be prompted to indicate whether you would prefer to receive communications from the
Please note: Your election for receipt of communications on the YBR website will not impact the method of delivery for your annual open enrollment communication materials.
New Dependent Age Limits for Child Life and Child Accidental Loss Coverage
For 2013, Child Life and Child Accidental Loss coverage will be extended to include adult children up to the end of the month in which they become age 26, without regard to student or marital status.
If you are eligible for Child Life and Child Accidental Loss coverage, you may elect coverage if you have eligible adult children who meet the new eligibility requirements during the annual open enrollment period. Coverage will be effective January 1, 2013. Please note: It is your responsibility to drop Child Life and Child Accidental Loss coverage if you no longer have dependents who meet the eligibility requirements.
Premium Costs
Review the YBR website during the annual open enrollment period for your 2013 premium costs.
Communicating Annual Open Enrollment Is a Green Initiative
As part of our corporate environmental commitment, we continue to provide your annual open enrollment information online instead of in print.
1 Includes employees on a leave of absence (LOA), short-term disability (STD), long-term disability (LTD) or workers' compensation, COBRA participants and survivors in the Family Security Program (FSP).