Retiree Information

2014 Summaries of Benefits and Coverage

2014 PPO75 SBC.pdf2014 Summary of Benefits PPO75 Plan

2014 PPO85 SBC.pdf2014 Summary of Benefits PPO85 Plan

  

Know Your Numbers
kyn.jpgKnow Your Numbers is an annual wellness initiative that is linked to your health insurance plan. Employees, retirees and spouses enrolled in Wake County’s health insurance are being asked to get an annual biometric screening before October 31, 2014. Children are exempt from the program.

 

The program consists of a biometric screening designed to help employees identify and begin to manage health risks factors that could lead to chronic diseases such as diabetes, hypertension, heart disease and obesity.

To ensure the complete biometric screening is performed and that your provider codes the blood draw appropriately, please download the letter below.

A biometric screening includes a blood draw to check your blood sugar and cholesterol. The screening also includes a blood pressure check. You can request a biometric screening during a routine office visit with your doctor. You can also receive one during your annual physical.

Each month, the County will receive a report from BCBSNC that identifies everyone who had their biometric screening during the program period. If you have completed your screening and wish to confirm if your name is on the BCBSNC report, please send an email to wakebenefits@wakegov.com (please wait to inquire at least 45 days after your screening is completed.)

The County will NOT know yourpersonal health information. They will only know whether or not you participated in the program. The County will not be gathering personal health information from participants, nor will the County use this information to penalize individuals or groups of individuals with chronic health conditions. .

Biometric screenings are covered at 100 percent if you use a doctor in the BCBSNC network.

The timeframe to complete your screening is November 1, 2013, through October 31, 2014. If a biometric screening is not completed, your insurance premium will increase beginning January 1, 2015. This will be in addition to any other insurance increases.

The premium increases will be:

  • $20 per month for retiree
  • Additional $20 per month if spouse is covered





Contacts

NC Supplemental Retirement Plans - 401(k)
(administered by Prudential Retirement)
1-866-627-5267
www.nc401k.prudential.com

ICMA
(457 Deferred Compensation Plan)
1-800-669-7400
www.icmarc.org

Local Governmental Employees'
Retirement System Division
919-733-4191
www.nctreasurer.com

Local Government Federal Credit Union
919-839-5331
www.lgfcu.org

Ceridian
(Third Party COBRA Administrator)
1-800-877-7994
www.ceridian-benefits.com

Long-term Care Insurance
Unum
1-800-227-4165
www.unum.com

Wake County Human Resources
919-856-6090


BCBS Medical Plan Highlights

 

BCBSNC - PPO 75

BCBSNC - PPO 85

Benefits In-Network Out-of-Network In-Network Out-of-Network
Deductible (Single/Family) $1,250 / $2500 $2,500 / $5000 $750 / $1,500 $1,000 / $2,000
Out-of-Pocket Maximum (includes deductible) $3,500 / $7000 $7,000 / $14000 $2,500 / $5000 $5,000 / $10,000
Office Visits - PCP $30 Copay 55% after deductible $20 Copay 65% after deductible
Office Visits - Specialist $45 Copay 55% after deductible $35 Copay 65% after deductible
Preventive Care 100% 55% after deductible 100% 65% after deductible
Urgent Care $45 Copay $45 Copay $35 Copay $35 Copay
Chiropractic Care - 24 days max per cal yr $45 Copay 55% after deductible $35 Copay 65% after deductible
Emergency Room $100 copay, then 75% after deductible (copay waived if admitted) $100 copay, then 75% after deductible (copay waived if admitted) $100 copay, then 85% after deductible (copay waived if admitted) $100 copay, then 85% after deductible (copay waived if admitted)
Inpatient Hospital 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Outpatient Hospital 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Skilled Nursing Facility 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Home Health Care - 60
(16 hr day) max days per cal yr
75% after deductible 55% after deductible 85% after deductible 65% after deductible
Hospice 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Durable Medical Supplies 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Short-Term Rehabilitative Therapy* - 30 days max per cal yr 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Maternity
Initial office visit to confirm pregnancy (applicable lab work will be coinsurance after deductible) $30 Copay (if OB/GYN is PCP) 55% after deductible $20 Copay (if OB/GYN is PCP) 65% after deductible
Hospital Services 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Professional Services 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Vision** - one routine eye exam per cal yr, including refraction 100% 55% after deductible 100% 65% after deductible
Inpatient Mental Health/Substance Abuse 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Outpatient Mental Health/Substance Abuse 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Office Visit Mental Health/Substance Abuse $30 Copay 55% after deductible $20 Copay 65% after deductible
*Physical Therapy, Speech Therapy, Occupational Therapy, Pulmonary Rehabilitation, Cognitive Therapy
**Hardware (lenses, frames, contacts) not included

Contact:

Blue Cross Blue Shield
1-877-275-9787
www.bcbsnc.com
 

Prescription Drug Plan

OptumRXEffective 1/1/2014, OptumRx Prescription Drug Plan is the pharmacy benefit manager for Wake County. To receive prescription drug benefits, you and your covered dependent(s) will be required to pay a portion of the covered expenses for prescription drugs and related supplies for each 30-day supply at a retail pharmacy or each 90-day supply which can be filled through the mail-order pharmacy or by visiting a retail pharmacy.
 
For more information about your Pharmacy Benefits, contact OptumRx at 1-800-797-9791 or visit www.optumrx.com.
 

Prescription Drug Plan Documents:
 
 
 
Prescription Drugs - Retail
In-Network Only
Generic (30 Day Supply)
20% up to $100 max
Preferred Brand (30 Day Supply)
35% up to $100 max
Non-Preferred Brand (30 Day Supply)
50% up to $100 max
 
 
 
Prescription Drugs (90 Day Supply)
Retail Pharmacy or OptumRx Home Delivery
 
Generic (90 Day Supply)
20% up to $250 max
Preferred Brand (90 Day Supply)
35% up to $250 max
Non-Preferred Brand (90 Day Supply)
50% up to $250 max
 
OptumRx Free Meter Program.pdf

Questions?

We have answers! Email the Wake County Benefits staff at wakebenefits@wakegov.com or call Human Resources at 919-856-6090.