2015 Annual Benefits Enrollment -...
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2015 Annual Benefits Enrollment
November 2014
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Today’s Objectives
Health Care Reform – What’s New for 2015
2015 Benefit Changes & Rates
Year One in the Private Exchange: What We’ve Learned
Enrollment: Key Dates & Resources
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Health Care Reform –
What’s New for 2015
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Health Care Reform – Employer Obligations
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Affordable Care Act (ACA)
What Employers Must
Do Next Year:
― Consider any associate
working 30 hours or more over
a pre-determined six month period
as Full-Time
― Ensure Associate Only level
coverage in the lowest cost plan
(Bronze) meets the “affordability
threshold”
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Individual Mandate Still In Play
You Must Maintain Minimum Essential Coverage for Yourself and
Your Dependents.
What Happens if You Don’t Have Coverage?
― Tax penalty – increases each year
Health Care Reform – Employee Obligation
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$325 per adult &
$162.50per child
up to $975 per
family
2% of family
income
% of
Household
Income Adult Child
Family
Maximum
2014 1.0% $95 47.50$ $285
2015 2.0% $325 162.50$ $975
2016 2.5% $695 347.50$ $2,085
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Year One In the Exchange-
What Have We Learned?
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It’s A Journey
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Choice Is Valued & Appreciated
Results From Post Annual Enrollment Survey (all exchange client responses)
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Price Matters, But Not Exclusively
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Learnings From Annual Enrollment
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What We’ve Learned What We’ve Done
All carriers were not fully
prepared to answer questions
about the new exchange plans
Misunderstanding of the
differences in covered services
between metallic plans
Aon has provided assistance: • Shared training materials with
carriers
• Encouraged each carrier to
designate an exchange specific
customer service team
• Implemented a “secret shopper”
program
• Consumer ratings solicited &
available during enrollment
• Enhanced carrier microsites
• Payless has a seat on the
Exchange Advisory Board
Education during Annual
Enrollment meetings & in
resource materials
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Key Learnings Throughout the Year
Carriers Are the “Source of Truth” for Networks
― On-line tools reflect contracted names only which can make locating a
provider/facility challenging and may lead to incorrect assumptions about the
network – When in doubt, call the carrier directly
Midyear Network/Pharmacy Changes Possible
― Not all providers are contracted on a calendar year basis and networks may
change throughout the year
― Carriers may re-evaluate their drug tiers periodically and may implement drug
therapy programs
― Not different from our prior plans
― Always check before securing services/filling a script
We Must Expect to Be a Consumer of Health Care
― Ask questions, research, stay engaged
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2015 Benefit Options & Changes
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Private Health Exchange Expands
30 large employers
850,000+ employees & family members
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2015 Carrier Options
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Medical
Dental
Vision
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5 Plan Choices
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BRONZE BRONZE
PLUS SILVER GOLD PLATINUM
Out-of-pocket cost to you at time of service
Impact to Paycheck $ $$$
High Deductible Traditional
No deductible, co-pay or co-insurance changes for 2015
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What’s Changing?
Medical & Prescription Drug Changes
― Out-of-network deductibles & annual out-of-pocket maximums now
separate from in-network deductibles & annual maximums
― Treatment of Rx drugs may have changed
― Separate lifetime maximums for fertility drugs and services
― Many sexual dysfunction drugs will be covered next year
Dental
― Gold level plan will offer adult orthodontic coverage
Vision
― New carrier: EyeMed
Health Savings Account Limits
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Health Savings Accounts
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What Is A Health Savings Account (HSA)? ― Way to save for qualified expenses like deductibles and
coinsurance on a pre-tax basis
― Maximum 2015 pre-tax contributions: $3,350 for individual coverage
$6,650 for you and your dependents
$1,000 additional if you are age 55 or older
― To be eligible, you must: Be enrolled in the Bronze or Bronze Plus medical plan level
Not be covered by Medicare or TRICARE
Not be claimed as a dependent on someone else’s tax return
Not be covered by any other health insurance plan, such as a spouse’s plan
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Flexible Spending Accounts (FSA)
What Is A Flexible Spending Account (FSA)?
― Way to save for qualified expenses like deductibles and coinsurance on a pre-tax basis
No Change to Current Limits:
― $5,000 for Dependent Care FSA
― $2,500 for Health Care FSA
Substantiation Obligation Exists with the IRS
― You must maintain adequate records to prove you’ve used your FSA contributions for
eligible expenses
― Your Spending Account (YSA) is required to request this documentation
― All expenses that don’t match a co-pay or a multiple of a co-pay for the exchange plans
must be substantiated
Make It Easy
― Download the ‘Reimburse Me’ app for your smart phone
― Scan and upload directly to the YSA site
― Fax or mail
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Tobacco Surcharge Changing
Tobacco Surcharge Will Be Increasing Next Year
― Benchmark is $100 - $150/month
― Current surcharge is $50/month per household
― 2015 surcharge will increase to $75/month per household
― 2016 surcharge will increase to $100/month per household
Surcharge applies to the following:
― Cigarettes, pipes, cigars, chewing tobacco, vapor/e-cigarettes
Want to Quit?
― Check out the resources provided by the carriers
― Surcharge can be removed anytime during the year as long you have been
tobacco-free for 12 months
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Voluntary Benefits Available in 2015
Voluntary Benefits
― Discounted Auto & Home Insurance
Coverage options include: Auto, home, renter’s, condominium,
recreational vehicles, boat, mobile home & rental properties
Offered through MetLife
― Pet Insurance
Policies cover many medical problems & conditions related to accidents,
emergencies and illnesses
Offered through Healthy Paws
― Benefits offered by the carrier directly
― Payment arrangements made directly with the carrier
― Enroll at https://payless.benefitsnow.com
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2015 Benefit Premiums
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Medical Premiums
Medical premiums vary depending on where you live
Dental and vision premiums do not differ based on geography
Rates for each metallic plan and carrier will be visible on the
enrollment site at https://payless.benefitsnow.com beginning
November 10
The company subsidy will also be visible for each option offered
in your area
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Enrollment Experience
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Same Shopping Experience
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-Network and Rx (formulary)
-Premium/Price
-Brand/Reputation/Experience
Aetna
United
Kaiser
HealthNet
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Key Dates & Resources
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Resources
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Start with the Make It Yours website
Go to the Make It Yours website at www.makeityoursource.com/payless to:
―Watch videos
―Review plan details
―Read the Reference Guide
―Learn more about how you can save
money through an HSA
―Get answers—browse FAQs
―Prepare for enrollment
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Communications
Change for 2015:
― Fewer printed communications
― Fewer mailings to the home
Enrollment checklist
Reference & Users Guides available at mypayless.com &
https://payless.benefitsnow.com
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On-Line Enrollment
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Enroll between November 10 and November 26, 2014
― Log on to https://payless.benefitsnow.com
― Click Enroll! and follow the prompts
Before You Enroll
― Know how it works
― Do your homework
― Get a personalized suggestion
‘Need Help Deciding’ to narrow choices
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From the medical, dental, and vision pages:
Choose who you want to cover
Choose your plan level
Choose your insurance carrier
Make your pre-tax savings
account election(s)
Be sure to use the online tools!
Review your elections!
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Resources to help you make your choices
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Need help enrolling? Call customer service
― Payless Benefits Center at 1-855-564-6152
― Representatives are available Monday through Friday, from 9 a.m. to 6 p.m. ET
Questions about coverage? Call the insurance carrier
― They know their plans best
― They have final authority on claims, billing disputes, etc.
Have an issue? Call a health care advocate
― Available through the Payless Benefits Center
at 1-855-564-6152 to assist with tough issues like claims and billing disputes
― Representatives are available Monday through Friday, from 9 a.m. to 6 p.m. ET
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If You Need Help…
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Health Care Advocates Help Before, During, and After Enrollment
Education Can someone help
me understand?
Problem Resolution
I need help and don’t know where
to turn.
Coordination How do I know
what to do next?
Navigation How do I access my
benefits?
Decision Support I’m confused about
all of the options available to me.
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Life & Disability
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Increase your current optional or dependent life insurance
coverage level by 1x without answering any medical questions
Optional life up to 4x your eligible base salary
Spouse life either $5,000, $10,000 or $25,000
Dependent life either $2,500 or $5,000
Enroll through MyInfo at mypayless.com
Great time to verify/update your beneficiaries & emergency
contact information
No changes to your life or disability
elections?
If you do not wish to make any changes to your life and
disability elections, you do not need to take any action
through MyInfo.
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Annual Enrollment: November 10 - November 26, 2014
You must take action if you want:
― Medical, dental, and vision coverage
― Prescription drug coverage
― To save money with an HSA or FSA
No action necessary for life
& disability elections
ID cards will be mailed in
December (if applicable)
2015 benefit deductions begin
on the paycheck we receive on
January 9th
Don’t Forget
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Remember to Enroll!
November 2014
S M T W T F S
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