2015 Benefit Enrollment Presentation November 2014.
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Transcript of 2015 Benefit Enrollment Presentation November 2014.
2015 Benefit Enrollment PresentationNovember 2014
2Copyright © 2013 DecisionPathHR. All Rights Reserved.
The Affordable Care Act
• Requires employers to provide affordable insurance to all eligible employees
• Requires Insurance premiums that do not exceed 9.5% of eligible employees annual income
• Plans must offer dependent coverage (spouse is not defined as a dependent)
• Imposes a tax penalty on individuals who are not enrolled in an insurance plan. The penalty progresses over a three year period.
3Copyright © 2013 DecisionPathHR. All Rights Reserved.
The Affordable Care Act (cont’d)
Tax Penalty:‾ 2014: the greater of 1% of adjusted household income
or $95 per adult plus $47.50 per child;
‾ 2015: the greater of 2% of adjusted household income or $325 per adult plus $162.50 per child; and thereafter
‾ The greater of 2.5% of adjusted household income or $695 per adult plus $347.50 per child
• Established the Health Insurance Marketplace (Exchange) to shop for insurance plans. www.healthcare.gov
• Provides premium tax credits to eligible individuals who purchase insurance through the Exchange. Tax credits are determined by the federal government using your prior year’s income, as noted on the prior year’s tax return (meaning 2013 tax return will determine 2014 tax credit).
4Copyright © 2013 DecisionPathHR. All Rights Reserved.
DecisionPathHR MV Plan
• Meets all the requirements of the Affordable Care Act
• Offered through EssentialStaffCARE
• Provides coverage for employees and dependents
• Offers a “Buy Up” option for flat rate benefits for inpatient and outpatient care
• Includes Employer contributions for employee only premium costs
THE MV PLAN DOES NOT PROVIDE SUBSTANTIAL IN-HOSPITALIZATION AND PHYSICIAN SERVICES
BENEFITS
5Copyright © 2013 DecisionPathHR. All Rights Reserved.
Eligibility
• Full time employees working an average of 30 hours per week or an average of 130 hours per month. This is determined in the first 60 days of employment (waiting period). Coverage begins for full time eligible employees after 90 days of employment.
• Dependent children of enrolled employees, up to age 26
• Spouse of enrolled employees who are not eligible for medical coverage through their own employer
6Copyright © 2013 DecisionPathHR. All Rights Reserved.
Premium Payments
• Premiums are paid one month in advance
• Premiums are not payroll deducted
• Premiums are direct billed to employee’s debit, credit, or Global cash card by EssentialStaffCARE
• Premiums for January 1, 2015 effective date will be charged to your cash, credit or debit card the first week in December 2014
• Failure to make payments will result in benefit termination
7Copyright © 2013 DecisionPathHR. All Rights Reserved.
Basic MV Plan BenefitsMVP
MVP Covered Benefits Network Non-Network
Deductible $0 / $0 $500 / $1,000
Coinsurance 100% 40%Out of Pocket Maximum $1,850 /
$12,700N/A
MVP Covered Benefits Network Non-Network
PPO Network MultiplanEmergency Room Services $400
Copay$400 Copay
Primary Care Visit to Treat an Injury or Illness (exc. Well Baby, Preventive, and X-rays)
$15 Copay Ded/Coins
Specialist Visit $25 Copay Ded/CoinsImaging (CT, PET Scans, MRIs) $400
CopayDed/Coins
Laboratory Outpatient and Professional Services
$50 Copay Ded/Coins
X-rays and Diagnostic Imaging $50 Copay Ded/CoinsPreventive Care/Screening/Immunization (MEC)
100% Covered
Ded/Coins
Chronic Disease Management Benefit 100% Covered
Ded/Coins
Prescription Drugs
Generics $15 Copay Ded/CoinsPreferred Brand Drugs $25 Copay Ded/CoinsNon-Preferred Brand Drugs $75 Copay Ded/Coins
8Copyright © 2013 DecisionPathHR. All Rights Reserved.
MV Plan Buy Up Benefit Option Benefit Paid
Days Per Per Day
Year
Inpatient Benefits
Hospital Indemnity $ 300 150
Intensive Care $ 600 30
Inpatient Surgical (Flat Rate Benefit) $ 300 1
Anesthesia Benefit $ 75 1
Outpatient Benefits
(Outpatient Maximum $1,000)
Outpatient Surgical (Flat Rate Benefit) $ 200 -
Anesthesia Benefit $ 50 -
Outpatient Surgical Facility $ 200 -
THE MV PLAN DOES NOT PROVIDE SUBSTANTIALIN-HOSPITALIZATION AND PHYSICIAN SERVICES
BENEFITS
9Copyright © 2013 DecisionPathHR. All Rights Reserved.
Employee Cost Employee Hourly Rate $7.25 - $9.99
Basic Plan Monthly
Buy Up Option Monthly
Employee Only (After Employer Contribution)
$ 89.54 $114.14
Employee + Child(ren) $170.52 $207.75
Employee + Spouse $174.20 $226.51
Employee + Family $259.79 $324.65
10Copyright © 2013 DecisionPathHR. All Rights Reserved.
Basic Plan Monthly
Buy Up Option Monthly
Employee Only (After Employer Contribution)
$116.78 $141.38
Employee + Child(ren) $197.76 $234.99
Employee + Spouse $201.44 $253.75
Employee + Family $287.03 $351.89
Employee CostEmployee Hourly Rate $10.00 and Up
11Copyright © 2013 DecisionPathHR. All Rights Reserved.
Cost of Coverage While Not On Assignment
Basic Plan Monthly
Buy Up Option Monthly
Employee Only(No Employer Contribution)
$169.78
$194.38
Employee + Child(ren)
$250.76
$287.99
Employee + Spouse
$254.44
$306.75
Employee + Family
$340.03
$404.89
• You can continue your coverage while you are not working
• You will be responsible for the entire cost of the coverage
12Copyright © 2013 DecisionPathHR. All Rights Reserved.
Supplemental Benefit Options
• You may enroll in supplemental insurance for the following benefits through EssentialStaffCARE Fixed Indemnity Plan:
- Dental Insurance‾ Disability Insurance‾ Life Insurance
• Supplemental benefit premiums are payroll deducted on a weekly basis
13Copyright © 2013 DecisionPathHR. All Rights Reserved.
Wrap Up
• You are eligible for coverage under the MV Plan after working an average of 30 hours per week or an average of 130 hours per month during your first 60 days of employment (60 day waiting period)
• Your premiums are deducted one month in advance from benefit start date
• Premiums for January 1, 2015 benefit effective date will be charged to your credit or debit card during the first week of December 2014.
• You have 30 days from your eligibility period to make any changes to your enrollment election
• Your coverage begins 30 days after the 60 day eligibility period
• You can continue your coverage while not on an assignment. It is your responsibility to contact EssentialStaffCARE if you do not want to continue your coverage while you are not working.
14Copyright © 2013 DecisionPathHR. All Rights Reserved.
Final Note
• This presentation highlights DecisionPathHR’s Employee benefits. While every effort has been made to ensure accuracy, if any discrepancies exist between this presentation and the governing plan documents, the governing documents will prevail.
• If you need legal, financial or other professional advice, you should seek the service of a competent professional.
• While DecisionPathHR intends to continue offering coverage, it retains the right to change, suspend or discontinue any of its benefits programs.