2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY:...
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Transcript of 2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY:...
2015 Medical Plan Options, Health Savings Accounts & Flexible Spending
PRESENTED TO:
PRESENTED BY:Greg BieseVice President,Senior Benefits Consultant
Associated Financial GroupEmployee Benefits. Insurance. HR Solutions.
Copyright 2014 by Associated Financial Group, LLC
HEALTHCARE REFORM: YESTERDAY, TODAY & TOMORROW
● Individual Mandate
● Private Exchanges
● Medicaid Expansion
● Play or Pay (Employer Mandate)
● Wellness Incentives
● Government Reporting
● Medical Access
Cadillac Tax
Rules
Plan Design
Fees
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
2015 MEDICAL ELIGIBILITY & RATES
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Eligibility & Rates PPO Plan HDHP Plan (HSA)
Eligibility
Domestic Partner Coverage
Monthly Rates (Employee)
Single $105.00 $79.00
Employee +1 $209.00 $160.00
Family $311.00 $237.00
Annual Rates (Employee)
Single $1,260.00 $948.00
Employee +1 $2,508.00 $1,920.00
Family $3,732.00 $2,844.00
Spousal Surcharge
.75 FTE (Grandfather those currently enrolled in the health plan) *
$75 per month
Same sex partners are now eligible for coverage
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
* St. Norbert College reserves the right to change the eligibility requirements at any time.
Effective January 1, 2015, St. Norbert College’s medical will implement a Spouse Medical Insurance Coverage Statement, requiring that an employee’s spouse enroll in at least single medical coverage through his/her employer to serve as their primary insurance coverage, or pay an additional surcharge to enroll or maintain enrollment in St. Norbert College’s medical plan as primary coverage. This additional surcharge is $37.50 twice a month ($900 annually)
All employees electing coverage for his/her spouse must complete the Spouse Medical Insurance Coverage Statement. If your spouse is covered under the College’s medical plan currently and you do not return this coverage statement, you will be assessed the additional surcharge until St. Norbert College receives the proper notification from you.
Copyright 2014 by Associated Financial Group, LLC
2015 BENEFIT HIGHLIGHTS
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(1) IMPORTANT HSA PLAN NOTICE: No individual family member's deductible or out-of-pocket is considered satisfied until the Full-Family deductible and out-of-pocket has been met.
Benefit Highlights PPO Plan HDHP Plan (HSA)
Deductible Embedded Deductible Non-Embedded DeductibleIn-Network $750 (Single); $1,500 (EE+1); $2,250 (Family) $2,000 (Single); $4,000 (Family)
(1)
Out-of-Network $1,001 (Single); $2,002 (EE+1); $3,303 (Family) $4,000 (Single); $8,000 (Family) (1)
CoinsuranceIn-Network 80% 90%Out-of-Network 60% 70%Out-of-Pocket Max Includes Deductible and Medical & Rx Copays Includes DeductibleIn-Network $1,500 (Single); $3,000 (EE+1); $4,500 (Family) $4,000 (Single); $8,000 (Family)
(1)
Out-of-Network $3,000 (Single); $6,000 (EE+1); $9,000 (Family) $8,000 (Single); $16,000 (Family) (1)
HSA Annual Employer Contribution n/a $500 (Single); $750 (Family)
Office Visits / InstacareIn-Network $20 Copay; then Deductible, 80% Coinsurance Deductible, 90% CoinsuranceOut-of-Network $20 Copay; then Deductible, 60% Coinsurance Deductible, 70% CoinsuranceRoutine/Preventive CareIn-Network 100% 100%Out-of-Network 100% Deductible, 70% CoinsuranceInpatient Hospital ServicesIn-Network Deductible, 80% Coinsurance Deductible, 90% CoinsuranceOut-of-Network Deductible, 60% Coinsurance Deductible, 70% CoinsuranceOutpatient Hospital ServicesIn-Network Deductible, 80% Coinsurance Deductible, 90% CoinsuranceOut-of-Network Deductible, 60% Coinsurance Deductible, 70% Coinsurance
Copyright 2014 by Associated Financial Group, LLC
2015 BENEFIT HIGHLIGHTS (CONT.)
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Urgent Care
In-Network $50 Copay; then Deductible, 100% Coinsurance Deductible, 90% Coinsurance
Out-of-Network $50 Copay; then Deductible, 100% Coinsurance Deductible, 70% Coinsurance
Emergency Room
In-Network $100 Copay; then Deductible, 100% Coinsurance Deductible, 90% Coinsurance
Out-of-Network Same as In-Network Benefit Same as In-Network Benefit
Ambulance Services
In-Network / Out-of-Network Deductible, 100% Coinsurance Deductible, 90% Coinsurance
Retail Prescription Drugs
Generic
Brand / Formulary
Non-Formulary
Mail Order Prescription Drugs
Generic $30 Copay
Brand $90 Copay
Contraceptive Coverage
25% ($10 Minimum, $50 Maximum) Deductible, 90% Coinsurance
No coverage, but members legal right to access coverage will be accommodated through UMR
Deductible, 90% CoinsuranceGeneric Preventive HSA Drugs are covered at
100% (Mail Order Only).
What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood pressure, blood thinner, and beta blockers.
Benefit Highlights PPO Plan HDHP Plan (HSA)
Copyright 2014 by Associated Financial Group, LLC
PPO PLAN EFFECTIVE JANUARY 1, 2015
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Preventive Services Unchanged
• All medical and Rx copays (1) apply to maximum out-of-pocket
Increase to Deductible and Out-of-Pocket Maximums
• Costs• New generics drugs
Prescription Drug Plan Design Unchanged
• UMR & Optum Rx
Contraceptive Coverage Outside of Plan
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(1) Due to Health Care Reform changes, beginning in 2015, all copays, including pharmacy copays, will apply to the out-of-pocket maximum.
Copyright 2014 by Associated Financial Group, LLC
HDHP PLAN (HSA) EFFECTIVE JANUARY 1, 2015
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
• 100% Coverage (In-Network)
Preventive Services
• No individual family member’s deductible or out-of-pocket is considered satisfied until the ‘Full Family’ deductible and out-of-pocket has been met.
Deductible and Out-of-Pocket Maximums (Non-Embedded)
• Retail & Mail Order – Subject to Deductible & 90% Coinsurance• Generic Preventive Drugs covered at 100% when filled through Mail
Order.
Prescription Drugs
• UMR & Optum Rx
Contraceptive Coverage Outside of Plan
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Copyright 2014 by Associated Financial Group, LLC
PREVENTIVE SERVICES
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Certain services can be done for preventive or diagnostic reasons.
Covered preventive services performed specifically for preventive screening with no known symptoms, illnesses or history are generally covered as preventive care, subject to age and gender guidelines and
health status.
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Copyright 2014 by Associated Financial Group, LLC
DIAGNOSTIC SERVICES
• Diagnostic services are generally not covered under the preventive care benefit but may be covered under another portion of your medical benefit plan.
• Services are considered diagnostic when a person:
– Has abnormalities found on previous preventive or diagnostic services that require further diagnostic services; or
– Had abnormalities found on previous preventive or diagnostic services that would recommend a repeat of the same service within a shortened time period from the recommended preventive screening time period based on age and gender; or
– Had a symptom(s) that required further diagnosis
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
WHAT EXACTLY IS AN HSA?
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
PART 1:
HIGH DEDUCTIBLEHEALTH PLAN
(HDHP)
PART 2:
HEALTH SAVINGSACCOUNT
(HSA)
HSA
TWO PARTSTO AN HSA
Intended to cover serious illness or injury once the deductible is met.
Used to cover expenses until the deductible is met.
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Copyright 2014 by Associated Financial Group, LLC
IMPORTANT INFORMATION REGARDING YOUR HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
There are NO office visit, emergency room, or prescription drug copays.
All out-of-pocket expenses count towards the deductible & out-of-pocket maximum.
The preventive healthcare benefit is still covered at 100% (all participants); includes services under the Women’s Care Act. Does not include contraceptive services.
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Copyright 2014 by Associated Financial Group, LLC
IMPORTANT INFORMATION REGARDING YOUR HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
The deductible and coinsurance out-of-pocket maximum for family is a true family deductible and out-of-pocket maximum.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
WHO IS ELIGIBLE FOR HSA’s?
Any employee that:• Is covered by an HDHP• Is not covered by another
non-HDHP health plan• Is not enrolled in Medicare• Cannot be claimed as a
dependent on someone else’s tax return
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
ADVANTAGES OF AN HSA
Ownership - you own the funds in your HSA
Tax-free
Portable
No “use it or lose it”
You may change your employee contribution amount throughout the year.
You can choose to invest your savings in an investment account.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
HSA ANNUAL CONTRIBUTIONS – 2015
• Annual contributions to the HSA are limited to $3,350 single / $6,650 family (Employer & Employee Contributions Combined)
• St. Norbert College - Annual HSA Contribution
o $500 - Single Coverage; $750 - Family Coverage
o Employer contributions will be deposited twice per year
Single: $333 (1st Payroll in January); $167 (1st payroll in September)
Family: $500 (1st payroll in January); $250 (1st payroll in September)
• Benefits are subject to federal regulations. Minimum deductibles, maximum out-of-pocket limits and contribution maximums are determined annually
• Account holders age 55 and up may make additional contributions of $1,000 in 2015.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
CONTRIBUTING TO YOUR HSA
• You can elect how much money you want to put into your HSA.
– It is your responsibility to ensure that you do not exceed the maximum HSA contribution limit.
• Your employer will deduct this amount on the date of each payroll on a pre-tax basis and the money will be direct-deposited to your HSA account.
• You may also deposit funds directly into your bank account with post-tax dollars and claim the amount on your tax return.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
WHO DETERMINES WHETHER HSA DISTRIBUTIONS ARE USED EXCLUSIVELY FOR QUALIFIED MEDICAL EXPENSES?
• YOU!
• Your bank will submit information to the IRS each year to report contributions and withdrawals.
• You will need to report withdrawals on your federal income tax forms.
• Individuals who establish HSAs should maintain records of their medical expenses to show that the distributions have been made exclusively for qualified medical expenses.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
HSA WITHDRAWALS / DISTRIBUTIONS
• Federal tax treatment of funds used:
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Expense Type Age Tax Treatment
Qualified medical expense Any Tax-free
Non-medical expense Over 65 Ordinary tax
Non-medical expense Under 65Ordinary tax + 20% penalty
Copyright 2014 by Associated Financial Group, LLC
ELIGIBLE MEDICAL EXPENSES FOR TAX-FREE DISTRIBUTIONS
• Qualifying medical expenses - IRS Publication 502• Dental and vision care expenses
• Long-term care insurance
• Premiums for coverage while receiving unemployment compensation
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
BANK INFORMATION
Form 1099-SA (distributions)
Form 5498-SA (contributions,
rollover deposits and fair market value for each calendar year)
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
WAYS TO BE A MORE COST CONSCIOUS CONSUMER OF HEALTH CARE
• Get Healthy and Stay Healthy!
• Use Appropriate ‘Levels of Care’ – Fast Care/Urgent Care/Emergency Room
• Use In-Network Providers
• Consider Generic or Mail Order prescriptions
• Consider $4 Generic Programs at Target & Wal-Mart Stores
• Ask doctors and pharmacists questions
o Most effective treatment
o Cost of treatment
o Alternatives to treatment
• Support and participate in company sponsored wellness and disease management initiatives
21St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Copyright 2014 by Associated Financial Group, LLC
LEVELS OF CARE SAMPLE
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Emergency RoomComplex chest pain,
trauma
Urgent Care ClinicSprains, strains, sutures; typically hospital-based
Primary Care ProviderWellness/preventive/screening services, comprehensive management of acute
and chronic conditions
Convenience – Walk-In Care ClinicColds, flu, quick service
Nurse LineHealth and first aid questions, premium provider search,
guidance on appropriate facility and location to meet care needs
Available extended hours & weekends
Available extended hours & weekends
Available extended hours & weekends in some cases
Available extended hours & weekends
No CostAvailable 24/7
COST
$500+
$200+
$125+
$49-$69
$0
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Copyright 2014 by Associated Financial Group, LLC
PRESCRIPTION COST AND SAVINGS OPPORTUNITIES - $4 PRESCRIPTIONS
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
SAVE on Prescription Drug Costs & Copays!
WHAT IS IT?Many retail pharmacies have recently created new and innovative programs to help control prescription drug costs for consumers. One of the most popular is the $4 prescription drug program, which has allowed consumers to take advantage of tremendous savings for their everyday prescriptions needs. This program is offered at many national and regional pharmacies, including those shown above, and typically includes hundreds of medications in a variety of therapeutic classifications.
Other programs that may be available in your area may include free antibiotics and various 90-day supply discounts for maintenance medications. Many pharmacies also have low-cost membership programs that allow you to access significant savings. It is likely that there will be new programs and enhancements to existing programs in the future as pharmacies continue to compete for the right to fill your prescriptions.
Interaction with insurance - continue to provide your insurance information to ensure you receive the deepest discount and that your coinsurance is applied to your deductible and/or out-of-pocket maximum. If your insurance company has negotiated a deeper discount than $4 (or the pharmacy’s discount rate) for the prescribed medication, you will be charged the lesser of the two prices.
KEEP MONEYIN YOUR BANK!
2323
Copyright 2014 by Associated Financial Group, LLC
HEALTH SAVINGS ACCOUNTS (HSA) AND FLEX SPENDING ACCOUNTS (FSA)
One of the qualifications to have an HSA is that you are not covered by any other low deductible insurance – this includes an FSA.
Therefore, if you enroll in the HDHP Plan and open an HSA Account, you may not participate in a Standard FSA Plan. However, you may enroll in a Limited FSA which can be used to reimburse Dental & Vision expenses ONLY.
You may still participate in the dependent care account.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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Copyright 2014 by Associated Financial Group, LLC
Flexible Spending Account (FSA)
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Healthcare FSA Annual limit of $2,500 (capped per IRS regulations)
Pre-tax dollars used to pay for qualified medical, dental & vision expenses
New: Limited Flex (reimbursement for dental & vision expenses only) for those enrolled in the HDHP Plan (HSA)
New: $500 Roll-Over Feature. Allows Health Care FSA participants to roll-over up to $500 of their previous year’s funds and add them to the new year plan. Rollover funds can only be used after the dollars from the new year’s plan have been used up. (Unused FSA funds in 2015 will roll-over into 2016)
Dependent Care FSA Annual limit of $5,000 (pre-tax dollars used to pay for daycare
expenses)
Copyright 2014 by Associated Financial Group, LLC
EBC FEATURES: Submitting claims is EASY
My Mobile Account Assistant– For Android and iPhone
– Camera scans documentation
– Upload with claim information
– Receive notification when a claim is processed
– Use the app to review FSA account information
Submit claims online or using paper• My Account Assistant
– Your secure web portal lets you review all aspects of your account online at www.ebcflex.com
– Submit claims and documentation
– Receive notification when a claim is processed
• Claim Form
– Mail or fax a paper form with attached documentation
26St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
• New ID cards issued – new member and group number• Other Insurance Questionnaire• Re-Register on UMR.com • Same Network – Choice Plus
1/1/2015 CHECKLIST
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx27
Better information, better decisions, better health on UMR.com
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx28
UMR.com gives members access to:
• Health cost estimator tools MyHCE (My Healthcare Cost Estimator)
• Provider search capability to identify quality and cost efficient providers classified as Tier 1.
• Health Education Library
• Resources on healthy living
• Access to OptumRx
In two
clicks
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SECURE Mobile Web Access(No Download Necessary)
Log in
Enter your username
and password for instant
access to all our mobile
inquiry tools.
Find a provider
Need to find a doctor fast?
Access an alphabetical listing
of network providers.
What’s new
Find out about new tools and
information to help you live a
healthier life.
Check your benefits
View medical and/or
dental benefits, as well as
persons covered.View, scan or fax your ID card
View your ID card, allow your provider to
scan the on-screen bar code for instant
access to your benefit information, and/or
fax it to a provider.
Look up claims
Look up a claim for
yourself or an authorized
dependent.
.
Need help?
Click the question mark any time you
are confused about a term or benefit
and get an explanation.
Home: Return to the main menu.Menu: Display the menu.Gear: Log out or learn more.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Simplified navigation
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 30
PPO Plan vs. HDHP/HSA Plan (OptumRx)
PPO Plan HDHP Plan (HSA)
Deductible No Deductible on Rx $2,000 Single $4,000 Family
Maximum Out-of- Pocket (Includes Medical & Rx)
$1,500 Single$3,000 EE+1$4,500 Family
$4,000 Single $8,000 Family
Copayment / Coinsurance
Retail: 25% ($10 Min / $50 Max)
Mail Order: $30 Copay (Generic) $90 Copay (Brand)
Deductible, 90% coinsurance
Generic Preventive HSA Medication n/a 100% coverage if filled at mail
order
What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood pressure, blood thinner and beta blockers.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 31
Contraceptive Services Only (CSO)coverage for Eligible Organizations
Coverage for contraceptives services only (both medical and/or Rx, as provided by insurer/TPA) as required by PPACA.
Provides 100% coverage for standard, eligible preventive contraceptive services
Separate from the customer’s medical policy
No cost to employer – not passed on through ASO administrative fees
Must be prescribed (even OTC contraceptives) and filled at a network pharmacy
Cover certain female birth control drugs and services only
All female members, no matter their age, will have birth control available to them
Age limits not applied because:
1. The age that a woman is no longer able to have children is different for everyone.
2. It is up to the family, not the health insurance company, to decide if or at what age a young woman might get birth control.
3. Health insurance companies are required by the health reform law to provide this benefit to ALL females.
Eligible Organization
Medical/Rx (non CSO) coverage
Contraceptive Services Only
(CSO) coverage
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
www.optumrx.com
32
• Review benefit highlights and coverage
• Access to Mail Service Pharmacy prescriptions
• My Prescription Dashboard to refill, renew and manage prescriptions
• My Medicine Cabinet to manage and price prescription and OTC medications
• Locate a retail pharmacy
• Explore lower-cost alternatives and options
• Download order forms
• Access general health information
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3333
www.optumrx.com
Personalized Rx Dashboard
Visual Image of All Drugs
– Quickly identify Refills
– View drugs for renewal
– Check Order Status
At-a-Glance Calendar for expiration and refill dates
Quick drop down box to change account for Household/Caregiver view
Simple tab design and quick links to improve navigation and user experience.
Mobile Website
Copyright 2014 by Associated Financial Group, LLC
REQUIRED FORMS TO BE COMPLETED
35St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Deadline for enrollment forms is November 26, 2014. Return completed forms to your Human Resources Department.
UMR Enrollment Form (New Enrollees, Adding/Removing Dependents, Enrolling in the HDHP/HSA Plan, Dropping Coverage) Not required if you are keeping your current coverage
Spouse Medical Insurance Coverage Statement. Required if you have a spouse covered under the SNC plan.
Associated Bank Health Savings Account (for those enrolling in the HDHP/HSA Plan) Complete application and applicable forms to open your HSA bank account
and start contributing!
Delta Dental Enrollment Form (New Enrollees, Adding/Removing Dependents Only, Dropping Coverage)
EBC - FSA Enrollment Form Enrollment does not carry over - employees who wish to participate must
enroll again for 2015
Copyright 2014 by Associated Financial Group, LLC
QUESTIONS?
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
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