Employee Benefits

July 1, 2014

Janice L. Wavra

Corporate Benefits Specialist

Agenda

What Does HRA Mean To Me? Group Health Insurance Plan Options Health Reimbursement Arrangement Plans Cost Savings Ideas Group Dental Insurance Plan Flexible Spending Account Plan (FSA) Claims Filing Deadlines Open Enrollment Recap & Questions

The Insurance Center Locally Owned, Established in 1960 Located at 701 Sand Lake Road, Onalaska WI

Your Experienced Service Team:

Janice Wavra (22 years)

Kim Ness (19 years)

Nancy Silbaugh (28 years)

Stacy Sila (16 years)

Brenda Manke (17 years)

What Does “HRA” Mean to Me?

Health Reimbursement Arrangement PlanHRA Plan #1: Co-Insurance PlanHRA Plan #2: Wellness Incentive Plan

Health Risk AssessmentHealics

In-Network Out-of-Network In-Network Out-of-NetworkDeductible

Single $500 $1,000 $500 $1,500 Family $1,000 $2,000 $1,000 $3,000

Maximum Out-of-PocketSingle $1,000 $1,500 $1,500 $3,000

Family $2,000 $3,000 $3,000 $6,000Additional Maximum Out-of-Pocket Copays Only

Single $1,000 $1,000 $1,000 $1,000 Family $2,000 $2,000 $2,000 $2,000

Office Visit CopaysPrimary $25, then Ded/90% coinsurance $25, then Ded/80% coinsurance $25, then Ded/90% coinsurance $50, then Ded/70% coinsurance

Specialist $25, then Ded/90% coinsurance $25, then Ded/80% coinsurance $50, then Ded/90% coinsurance $50, then Ded/70% coinsurance

$100 Copay then PPO $100 Copay then PPO $100 Copay then PPO $100 Copay then PPODed/90% coinsurance Ded/90% coinsurance Ded/90% coinsurance Ded/90% coinsurance

Chiropractic Care $25, then Ded/90% coinsurance $25, then Ded/80% coinsurance$25, then Ded/90% coinsurance w/Chiropractic Treatment Plan

$25, then Ded/70% coinsurance w/Chiropractic Treatment Plan

Emergency Room

$0 Value Choice $25 Preferred Brand $0 Value Choice $25 Preferred Brand $10 Generic $50 Non-Preferred Brand $10 Generic $50 Non-Preferred Brand

Prescription Drug Copays

Coinsurance 90% 80% 90% 70%

Plan #1 Plan #2"Status Quo" "Reduced Premium"

Health Insurance Plan Options

Note: Deductible Year: July 1, 2014 – June 30, 2015

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Sample “Copay” Claim – Plan #1 “Status Quo”

1st Claim of New Plan Year: In-Network Provider Office Visit: $158 Diagnosis Test/X-Ray: $500

Claim Processed: Office Visit: $25 Copay applied to Maximum Out-of-Pocket Office Visit balance of $133 and Diagnosis Test/X-Ray claim of $500

applied to the Deductible, with balance applied to Co-Insurance.

Who Pays: Employee pays $25 Office Visit Copay Employee pays $500 in Deductible expenses Health plan pays $119.70 (90%) in Co-Insurance expenses HRA plan pays $13.30 (10%) in Co-Insurance expenses

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Sample “Copay” Claim – Plan #1 “Status Quo”

1st Claim After Max Out-of-Pocket Met: In-Network Provider Deductible Met: $500 Co-Insurance: 90% Maximum Out-of-Pocket Met: $1,000 ($250 paid by the District’s HRA

Plan)

Claim After Reaching $1,000 Maximum Out-of-Pocket: Office Visit: $158 Diagnosis Test/X-Ray: $800

Claim Processed: Office Visit Copay of $25, applied to the Additional $1,000 out-of-pocket

maximum (copays only) Balance of Office Visit & Diagnosis Test/X-Ray paid at 100%

Health Plan #1: What is My Maximum Out-of-Pocket Exposure?

Health Plan In-Network

HRA Pays Employee Pays

Deductible **$500 Single

$1,000 Family$0 Single$0 Family

$500 Single$1,000 Family

Coinsurance 90%$500 Single

$1,000 Family$250 Single$500 Family

$250 Single$500 Family

Maximum Out-of-Pocket

$1,000 Single$2,000 Family

$250 Single$500 Family

$750 Single$1,500 Family

Maximum Out-of-Pocket Copays ONLY

$1,000 Single$2,000 Family

$0 Single$0 Family

$1,000 Single$2,000 Family

Note: Deductible Year: July 1, 2014 – June 30, 2015

Health Plan #2: What is My Maximum Out-of-Pocket Exposure?

Health Plan In-Network

HRA Pays Employee Pays

Deductible **$500 Single

$1,000 Family$0 Single$0 Family

$500 Single$1,000 Family

Coinsurance 90%$1,000 Single$2,000 Family

$250 Single$500 Family

$750 Single$1,500 Family

Maximum Out-of-Pocket

$1,500 Single$3,000 Family

$250 Single$500 Family

$1,250 Single$2,500 Family

Maximum Out-of-Pocket Copays ONLY

$1,000 Single$2,000 Family

$0 Single$0 Family

$1,000 Single$2,000 Family

Note: Deductible Year: July 1, 2014 – June 30, 2015

Monthly Premiums Full-Time Employees

Plan #1 “Status Quo”

Single: $209.48

Family: $474.60

Plan #2: “Reduced Premium”

Single: $119.96

Family: $271.78

Premium Savings Between Plan #1 vs. Plan #2Single: $89.52/month = $1,074.24/annual

Family: $202.82/month = $2,433.84/annual

HRA Plan #1Co-Insurance Plan

The HRA plan is 100% funded and paid by the District so there is no additional cost to you and your family.

Single Coverage: The HRA plan will reimburse up to the maximum of $250 in coinsurance expenses.

Family Coverage: The HRA plan will reimburse up to the maximum of $500 coinsurance expenses.

In order to be eligible for the HRA plan, you must be enrolled in the District’s group health plan with WCA Group Health Trust.

The plan year July 1, 2014 – June 30, 2015

When receiving a service, you must

present your WCA ID card to the health

care provider.

WCA reviews and processes the claim

and provides you with the Explanation

of Benefits (EOB).

Your health care provider submits the

claim to WCA.

You must submit your claim for

reimbursement to EBC by completing, signing, and dating an EBC HRA Claim Form and attaching a copy of the EOB

from WCA.

How to Use the HRA Plan

Explanation of Benefits “EOB”

Patient

Network

“EOB” Continued 90%Coinsurance

B C

A

A minus B minus C = CoinsuranceMaximum HRA Plan #1 Benefit:

$250 Single ~ $500 Family

How to File a HRA Claim Fax

608-831-4790 Email

participantservices@ebcflex.com Online

www.ebcflex.com Mail

Employee Benefit Corporation

PO Box 44347

Madison, WI 53744-4347 Phone Support

800-346-2126 or 608-831-8445

M-F 8:00-5:00 Central

EBC’S HRA Claim Form

Name

Email

Employer

Name

Code “H”

Code “HF

”

HRA Plan #2 Wellness Incentive Plan

The HRA plan is 100% funded and paid by the District so there is no additional cost to you and your family.

Employees on the District’s group health plan that take the Healics Health Risk Assessment and have a minimum score of 71 or improve their score by 5 will

qualify for Plan #2 HRA Wellness Incentive.

Single Coverage: $500

Family Coverage: $1,000 (Note: Both the employee and the spouse must participate in the Healics Health Risk Assessment and both must meet the required scoring to receive the family HRA benefit.)

The plan year July 1, 2014 – June 30, 2015 The HRA dollars will roll forward each year The HRA dollars may be used for eligible expenses under Section 213 In order to be eligible for the HRA plan, you must be enrolled in the

District’s group health plan with WCA Group Health Trust.

Cost Savings Ideas

Utilize your 100% Preventive Care Services Call Nurse Helpline as your first step unless emergency Utilize the Neighborhood Family Clinic and Community Care Clinic Use Urgent instead of Emergency

Average Urgent Care Visit: $250 Emergency Room: $800 Ask about low cost Generic Programs at your pharmacy Purchase 90 day supply on your maintenance scripts

Save 1 copay per 90 day supply Utilize the Flexible Spending Account Plan (FSA) Utilize In-Network Providers

Preventive Care

100% Coverage for: Preventive Care Exams Well-Child Care Well-Woman Gynecological Exams Mammograms Adult and Child Immunizations Hearing Exam (1 per calendar year) Vision Exam (1 per calendar year)

Neighborhood Family ClinicsNo bills, insurance forms

or hassle.WCA Group Health Trust

has a special contract with the Neighborhood Family Clinic. All services are

paid at 100%. You will not be responsible for any

charges at a NFC facility. The deductibles,

copays, and co-insurance are waived!

1526 Rose StreetLa Crosse, WI 54603

Mon-Fri: 8am – 6pmSat: 8am - Noon

Community Care Clinic1202 County Road PH

Onalaska WI 54650608-781-2225

No bills, insurance forms or hassle.

WCA Group Health Trust has a special contract

with the Community Care Clinic. All services are paid at 100%. You will not be responsible for

any charges at a Community Care Clinic.

The deductibles, copays, and

co-insurance are waived!

Urgent Care vs Emergency Room

Average Urgent Care Visit $250

Average Emergency Room Visit $800Gundersen Lutheran

1900 South Avenue, La Crosse, M-F: 7am – 9pm, Sat-Sun: 9am – 7pm

3111 Gundersen Drive, Onalaska, M-F: 7am – 9pm, Sat-Sun: 9am – 5pm

Franciscan Skemp

** West Ave & Market, La Crosse, Daily: 6am – Midnight

191 Theater Road, Onalaska, M-F: 5pm – 9pm, Sat-Sun: 9am – 5pm

1303 Main, Holmen, M-Thur: 7am – 7pm, Fri: 7am – 5pm

Winona Health

M-Thur: 8am – 8pm, Fri-Sun: 8am – 5pm

** Services at this location may be billed as emergency room.

Health Care Access

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Express Care Urgent Care Emergency Room

Bladder, urinary tract infections

Non-life threatening illness or injury

Life threatening illness or serious injury

Bronchitis After regular clinic hours Chest pain, heart attack

Common Warts Colds, sore throat Broken bones

Ear pain, infections or excess wax

Cuts, scrapes, bruises,skin rash, minor burns

Numbness or weakness on one side, stroke symptoms

Flu, influenza Back pain Severe headache

Insect, tick bites Strains, sprains Loss of consciousness

Mononucleosis Your primary care provider is not available

Shortness of breath, confusion, dizziness

Pink eye Severe abdominal pain

Sinus infections

WCA Group Health TrustIn-Network Providers

Website: www.umr.com Click on: “Find A Provider” Then, “Medical”, “Medical Provider Search”, Select “U” Select a Plan “United Healthcare Option” Click on, “Medical, click here to access the UHC

Provider Search Application” Select State, City, Physician, or Facility

OR Call UMR: 1-800-651-8231, Press Option #1. Have your Member

ID number and Group Number available.

WCA Group Health TrustDental Plan

Benefits

Deductible**$25 Per Person$75 Per Family

Annual Maximum Per person $1,000

Preventive Services 100%

Basic Services 80%

Major Services 50%

Orthodontia 50%$1,500 Lifetime maximum

**Deductible Year: July 1, 2014 – June 30, 2015

What is a FSA Plan?A great way to help you increase your spendable income

while reducing your payroll taxes!

A Flexible Benefit Plan is a pre-tax payroll deduction plan that allows you to set aside dollars for eligible insurance, medical, dental, optical

and daycare expenses before Federal, State, and Social Security taxes are applied.

Flexible Spending Account Plan (FSA)

New FSA Benefits

Rollover

Benefit up to

$500

“Benny” Card

FSA Plan Limits

Plan Year:

July 1, 2014 – June 30, 2015 General Purpose Medical:

$2,500 Dependent Care Calendar Year:

$5,000.00

Note: The 2-1/2 month “Grace Period” will end on September 15, 2014.

Reminders: Claim Filing Deadlines

for Plans ending June 30th

Flexible Spending Account Plan (FSA) September 30, 2014

Heath Reimbursement Arrangement Plan (HRA)

September 30, 2014

Open EnrollmentPlans: Group Health Insurance Plan Group Dental Insurance Plan Flexible Spending Account (FSA) Plan

Forms: WCA Employee Enrollment Form

This form is only required if you are changing your current health

and/or dental elections. Employee Election Form

Required: States your election for the health insurance plan effective July 1, 2014 EBC Best Flex Enrollment Form

Required: States your election to Enrolling or Waiving

Questions

All forms must be returned to

Ben Miller, in the District Business Office

no later than

June 9, 2014