Group Health Insurance Plan 2016 Frenship ISD. CAMPUS REPRESENTATIVES : FHS Michelle Stuart Reese...

Group Health Insurance Plan

2016Frenship ISD

2015-2016 FISD Health Insurance Committee

CAMPUS REPRESENTATIVES:

FHS Michelle Stuart Reese Sara Hays FMS Katrina Smith Terra Vista David SpeerHMS Emily WagnerBennett Christy GantCrestview Ann LentOak Ridge Melinda FuttrellLegacy Stacey OwenNorth Ridge Toni ParrishWestwind Bobbie Jo WilliamsWillow Bend Stacey PriceCustodians Balt PadillaMaintenance Rudy Morales , Derek Cobb, Allen TannerCentral Office Rhonda Dillard, Pat Valdez, Jason Gossett, Dr. McCord, Tim Williams, Courtney Reeves, Farley Reeves

* Remember, Our Plan year…

January 1, 2016 through

December 31, 2016

*Don’t shoot the messenger

Premiums paid to BCBS – Sept. 2014 – Aug. 2015

$4,405,184.37

Claims paid out – Sept. 2014 – Aug. 2015

$5,543,494.00 (includes run out from First Care)

($1,138,307.00)

APPROXIMATE LOSS RATIO: 125.84%

*Premiums versus Claims…

*Insurance required or you pay a

penalty…

*Employee perks with BCBS

*More Doctors and hospitals

*Coverage everywhere you go

*Online resources and programs

*Personalized Customer Service

*Blue Access Mobile

*Health and Wellness programs

*Home Delivery Prescriptions – Must pre-register at bcbstx.com OR call Prime Mail at 1-877-357-7463 by phone

*How to find a PPO Provider

*On line access: bcbstx.com

*Customer Service information on the back of your medical ID card

*BlueCard Access 24/7 - 1-800-810-BLUE (2583)

*Be sure to ask if the provider is contracted with BCBS. Show your medical ID card at every doctor’s visit.

* Plan Options with Blue Cross Blue Shield:

(In network and out of network coverage on every plan)

PPO 1 PPO 2 (Employee only minimal cost plan)

PPO High Deductible plan (Health Savings Acct)

* Premiums Comparison All Plans Side by Side

Coverage PPO1 PPO2 PPO/HSA** Employee Only $262 $20 $158 Emp. & Spouse $1075 $484 $821Emp. & Child $750 $299 $556Emp. & Family $1222 $568 $941 **All employee incurred expenses go towards the

deductible**

District increased contribution per employee from $266 to $300

Note: All premiums INCLUDE $300/month that is paid by FISD and reflect YOUR monthly cost:

* PPO 2…710 employees on this plan

Current 2016Increase

EO $0 to $20 ($20)

ES $412 to $484 ($72)

EC $243 to $299 ($56)

EF $470 to $568 ($98)

* PPO 1…94 employees on this plan


EO $126 to $262 ($136)

ES $713 to $1075 ($362)

EC $470 to $750 ($280)

EF $797 to $1222 ($425)

* HSA…46 employees on this plan


EO $53 to $158 ($105)

ES $494 to $821 ($327)

EC $242 to $556 ($314)

EF $527 to $941 ($414)

PPO 1 Plan Deductible $3000 per member ( $6000/family) - In Network

Co-Insurance – 20% in network/ 40% out of network (Employee pays after meeting the deductible)

Out of network services at a higher cost share

$45 Dr. visit Co-pay ( $60 / specialist)

Urgent Care copay $50 /ER facility charge $150

RX - $10-$35-$75-$150 after $200 deductible/$400 for family

Out-of-Pocket Maximum =$6000 per member – In Network ($12,000/family) – In Network (out of pocket max includes all copays) Hospital/Maternity – 20%/40% (Employee pays after deductible) Emergency room/ 20% after $150 copay (facility charges only)

• Maternity – Pediatrician, delivery, and nursery are covered at 80% after the $3000 deductible

PPO 2 Plan (minimal premium plan for employees)

Deductible - $6000 per member / $12,000 family

Out of network services at a higher cost share

Co-Insurance – 100% (plan pays after $6000 deductible is met)

$45 Dr. Visit Co-pay ($90 specialist)

Urgent Care copay - $75 / ER facility charge $200

RX - 50% after $250 deductible/$500 for family

Out-of-Pocket Maximum = $6500 individual/ $13,000 family (out of pocket max includes all copays)

Hospital/Emergency/Maternity – 100% after $6000 Deductible is met

PPO/HSA – Health Savings Account

Deductible $3000 per member ( $6000 /family) – In-Network

Coinsurance – Employee pays all medical expenses until $3000 deductible is met.

No Dr. copays – Discounted office visits and plan pays 80% after deductible is met

RX – Prescriptions are paid for by employee until deductible is met

Hospital/Maternity/Emergency – Employee pays 20% after deductible is met

Out-of-Pocket Maximum - $6,600 per member ( $13,200 / family) - In Network

Money placed in HSA account is above and beyond the premium

HSA account must be set up prior to incurring claims in order to have tax advantage.

*HSA

Individual and/or family deductible must be met before you are eligible for any insurance benefits.

You have the option to open a Health Savings account. This money must be used on medical expenses and is your money as long as the account is open.

HSA account must be opened prior to accessing any funds.

Maximum - $3350.00/Individual

$6650.00/Family

* In Network / Out of Network

In Network / Out of NetworkIn-network - The BCBS network is called Blue Choice.

Out of network services will be billed at a higher cost share to the employee.

When traveling outside of Texas you will ask if they take “Blue Card”.

Preauthorization may be required for some services. It is always best to check before receiving major services. This information will be on the back of your insurance card.

Options to cover Family or Children…

Health Insurance Market Place / Affordable Care Act

healthcare.gov / 1-800-318-2596Individual policy with independent companyCHIPS – 1-877-KID-SNOWCHIPSMEDICAID.org

*Affordable Care Act (ACA)

*Public Marketplace

*Guaranteed issue / No Pre-existing limitations

*Sold through healthcare.gov, Ashmore & Associates, Aycock and Fowler, independent agents and other entities

*Policies and rates are identical on both public and private marketplaces.

*Only licensed agents can assist consumers with actual purchase decisions.

*Navigators are licensed to assist with the completion of the application.

*Subsidies and Tax credits are available through the public marketplace – ONLY if your

employer does NOT offer you a compliant plan as an option.

*FISD plans comply with all the minimum benefit and affordability

standards.

Ways to manage your insurance…

If at all possible, go to a provider that is contracted with BCBS Choice networks so that claims are paid in network.

Prescriptions – Always ask for generic, check at least three pharmacies for best price, check local pharmacies to see if the meds are FREE, Google prescription for coupons and discounts, and ask Doctor for samples.

Lab work and x-rays done in conjunction with the office visit are included in your office visit copay.

Other class of diagnostic tests are subject to your deductible. (Ex. MRI)

*Healthiest You

Telehealth & Wellness solution plan - $9.00 per month covers the entire family

Compliments the medical plans and saves on medical claims3 easy steps to speak to a physician anytime anywhere online

or by phonePrescriptions are called in to the pharmacy of your choice –

(Must accept Blue Cross Blue Shield)Online tool provided to shop for the best price on prescriptions

in your areaYou must complete medical history on line Covers most common conditions including but not limited to:

allergies, bronchitis, earache, sore throat, sinusitis, pink eye, strep throat, upper respiratory infection, urinary tract infection….

* Preventative Care

All Insurance plans cover Preventative Care at 100%!!This could include: annual routine physicals, routine immunizations, well baby and well child care, routine eye/speech/hearing screenings for children when performed in the office, examination and testing for

the detection of prostate cancer…

Coverage provided in network at 100% with no copay or deductible

**Lab tests related to an illness or condition are not considered preventative**

Blue Cross Blue Shield list of Preventative Care is posted on the

HR website

Additional Contributions

FISD provides $20,000 of Life Insurance on all employees

The group life coverage was offered on a guarantee issue basis to all employees during the first year.

If you want to increase your group live coverage, you now have to apply for the additional coverage.

You will have the opportunity to talk to an FBS representative during enrollment about supplemental benefits.

FISD Cafeteria Plan (Section 125)“Why should I participate?”

The only entity to benefit from your participation is YOU.

The district does not profit from #125No insurance agent or company benefitsIndividual enrollments @ your campus

Section 125 is the tax code which allows participating employees to place certain financial expenses into an account PRIOR to taxes being withheld.

FISD Cafeteria Plan OPTIONS

Child Care Reimbursement PlanMedical Reimbursement PlanCancer/Intensive Care InsuranceVisionAccident InsuranceDental Reimbursement Plan – Must file paper copy

Medical Insurance

Medical Reimbursement Account NBS Flex card

Money can be taken from your check before taxes each month and placed in a medical reimbursement account.

You will use an NBS Flex Visa credit card preloaded with the amount of money that you will put in for the year. (Ex. $50 x 12 = $600) This money can only be used for medical expenses. Additional cards are $5.00 each.

The NBS Flex card cannot be used for dental expenses. You must submit a claim form with receipt for reimbursement.

Maximum - $2550 per year (you must use it or lose it at the end of each year)

FISD – 2 ½ month grace period to spend funds in flexible account.

90 day run out period – can file claims up to 90 days after plan year ends.

“UNDERSTANDING” Your Insurance plan

You can learn more about the advantages of the PPO1, PPO2, PPO/HSA:

*Contacting The Ashmore Agency or Aycock & Fowler Insurance Agency for a consultation.

*Visiting with an Insurance representative on the day of enrollment from 8:30 – 10:00 to discuss your insurance options.

Consultations Available

NOTE: If you are going to meet your deductible for any reason please call:

Ashmore and Associates - 806-745-8358 Aycock & Fowler - 806-798-2700

You will get one-on-one assistance to help you know what is ahead of you (i.e. – know what your plan is paying and what you should pay.

Frenship ISD Brokers

Beth Ashmore

745-8358

Ashmore & Associates

Brent Aycock

798-2700

Aycock& Fowler Insurance Agency

Changing the Game

Where Benefits Meet Technology

The content of this Power Point is designed only for communication purposes and is not to be

considered a contract, nor does it guarantee or imply coverage. Consult your plan booklet or

Administrator for detailed coverage or pre-existing limitations.

2016 Benefit Open Enrollment Plan Overview

Frenship Independent School District

Section 125 Cafeteria Plan

There are special rules and requirements to receive the pre-tax benefit election plan privileges:

― Frenship ISD must set a plan year. The district’s plan year is January 1 to December 31 of each year.― Although coverage is voluntary, every employee is required to review their current elections, make changes if desired and *sign a Section 125 Benefit Election Form.― Any pre-tax elections will remain in effect unless you have a qualified change in family status. Changes must be made within 31 days of the event.― Any pre-tax elections will remain in effect and cannot be revoked or changed during the plan year unless you have one of the following: Marriage, Divorce, Birth/Adoption, Death, Change in Dependent Eligibility, etc.

Time to Enroll

If you need login assistance, click this link to watch a video about how to login.

Medical Gap Insurance · American Public Life

Designed to cover your out-of-pocket expenses such as co-payments,

deductibles and co-insurance.

In-Hospital Benefit: pays up to the maximum amount chosen for Covered

Charges incurred when a Covered Person is confined in a Hospital for 18

hours. $1,500 or $2,500 in-patient benefit available.

Outpatient Benefits: pays a $200 benefit for Covered Charges incurred for

treatment in a Hospital Emergency Room, outpatient facility or a free-

standing outpatient surgery center. *Same condition must be separated by

90 days.

Physician Benefit: pays for a physician visit up to $25 per visit, for up to

five visits per family, per calendar year for treatment received outside of a

Hospital as an outpatient. Also includes treatment at your Physician’s

Office, Emergency Room or Clinic.

Must participate in Districts Medical Plan to be eligible for this Benefit.

Medical Gap Rates · $1,500

Employee Only$21.50

Ages Under 55:

Family$18.36

Employee & Spouse$39.50

Employee & Children$36.50

Family$54.50

Employee Only$32.00

Ages 55-59:



Family$74.00

Employee Only$49.00

Ages 60+:



Family$103.00

Medical Gap Rates · $2,500

Employee Only$28.00

Ages Under 55:

Family$18.36



Family$69.00

Employee Only$44.50

Ages 55-59:



Family$99.00

Employee Only$68.50

Ages 60+:



Family$140.00

Telehealth · HealthiestyouTelehealth is 24/7 access to a doctor via phone, video and email for the diagnosis and treatment of illness, second opinions and common conditions. An estimated 80% of primary care, urgent care and emergency room visits can be avoided using Healthiestyou's telehealth services. Improved patient outcomes, better access to care and tremendous time and cost savings can be achieved through healthiestyou. Telehealth can deliver medical services where they are needed most, and remove barriers of time, distance, and provider scarcities.

Plan is $9.00 for the Family.

Telehealth · Healthiestyou

Direct Reimbursement Dental Plan

You are covered at 100% of the 1st $100

You are covered at 80% of the next $250

You are covered at 50% of the next $1,400

Annual maximum benefit per covered person is $1,000

Orthodontia is covered for participants and has a lifetime

benefit of $1,000. Benefits are paid just like they are on

dental.

Exclusions: cosmetic dentistry, implants, TMJ

Use of the NBS Flex Card is prohibited with dental claims;

you must file a paper flex claim.

Employee Only$26.00



Employee & Family$81.00

EXPERTISE

Vision Insurance · Superior Vision

Eye Exam Co-Pay $10

Eyewear Co-Pay $20

Contact Lens Fitting Co-pay $25

Frame allowance $125 Retail (in-network).

Lenses allowance Paid In Full (in-network).

Contact Lenses allowance up to $150 (in-network).

Vision examination allowed once every 12 months.

Frames allowed once every 12 months.

Lenses allowed once every 12 months.

Contact Lenses allowed once every 12 months.

Contact Lenses fitting fee once every 12 months.

Employee Only$7.28



Employee & Family$21.46

Long-Term Disability Insurance · Aetna

Coverage is Guarantee Issue, no health questions asked!

Coverage is guaranteed up to $7,500 of monthly benefit based on your

annual income.

New coverage and increased benefits amounts are subject to a 12 month

pre-existing condition exclusion.

Benefits can last while you are under a doctor’s care to age 65 due to

illness or injury.

You may choose waiting periods in days of: 0/7, 14/14, 30/30, 60/60, 90/90

and 180/180, based on your individual needs.

Disability benefits are received tax free.

Claims are processed Telephonically.

Group Cancer Insurance · Loyal American

Very Competitive Rates.

Two options are available on the cancer plan:

High Option and Low Option.

Annual Cancer Screening Benefit: $50 per calendar year.

First Occurrence Benefit: High Option $2,000, Low Option $500.

Daily Radiation/Chemotherapy Benefit: High Option $400, Low Option $200.

Daily Hospital Confinement Benefit: High Option $200/Day, Low Option

$100/Day.

Optional ICU Benefit: $1,000/Day for the 1st 30 days of ICU Confinement.

Optional Specified Disease Benefit: Available with ICU Benefit.

Transportation and Lodging: $0.50 per mile and up to $75/Day for Lodging.

2016 Cancer Rates · Low Plan

“Stand UPto Cancer”

Employee Only$11.56

Single Parent Family$13.03

Family$18.36

Low Option

Employee Only$16.70


Family$29.65

Low Option W/ICU & Specified

Disease Riders

2016 Cancer Rates · High Plan

“Stand UPto Cancer”

Employee Only$19.92


Family$31.97

High Option

Employee Only$25.06


Family$43.26

High Option W/ICU & Specified

Disease Riders

Accident Insurance · American Public Life

Benefits are paid directly to you!

Pays regardless of any other medical coverage.

Protects you 24 hours a day on or off the job.

Issue ages for employee and spouse are 18-64.

Policy is guaranteed renewable up to age 70.

Benefits are available from 1 to 4 units.

There is no limit on the number of accidents covered.

++

2016 Accident Rates · 1-2 Units

Family

$29.80 Family$18.36

Employee Only$17.10



2 Units

Family$47.60

Employee Only$10.80



1 Units

Family$29.80

2016 Accident Rates · 3-4 Units

Family$62.60 Family

$72.40

Employee Only

$24.50



4 Units

Family$62.60

Employee Only

$21.50



3 Units

Employer Paid Base Life Insurance

Frenship ISD provides a $20,000 Basic Life and AD&D policy at

++For Employees working 30 hours or more per week.

No Cost to

the

Employee!

Voluntary Group Life Insurance · Aetna Employees may elect additional coverage in $10,000 increments up

to $500,000 not to exceed 5 times annual salary.

Employees may elect up to 50% of the employee’s amount on their

spouse.

Children may be insured for $10,000 for $1.00 with one rate for all

children.

Any increases in coverage does require an evidence of insurability to

be completed.

Employees can elect AD&D coverage on a stand

alone basis. AD&D is available for both employee

or for the employee and family.

Individual Life Insurance · TexasLife Permanent life is an individual life policy that provides a specified death

benefit to your beneficiary at the time of death. The advantage of having a

permanent life insurance plan as opposed to a group supplemental term life

plan is that the permanent life insurance is guaranteed renewable, portable

and premiums remain the level to age 121.

Refund of Premium - Unique in the marketplace, purelife-plus offers you a

refund of 10 years’ premium, should you surrender the policy if the premium

you pay when you buy the policy ever increases. (Conditions apply.)

You can cover yourself, and or your spouse, minor children (15days-18 / 19-26

if a full-time student), even your grandchildren without covering yourself.

Plan includes an accelerated death benefit due to terminal illness.

If you pass prior to age 65 due to an accident the face amount of your policy

doubles.

Health Savings Account Information

H.S.A. Eligible Participants: Employees that contribute to an H.S.A. account are restricted to a limited-purpose Health F.S.A., for reimbursement

for dental and vision care expenses only.

Flex Plan Admin · National Benefit Services

Plan Year: January 1, 2016 to December 31, 2016.

Plan Maximum: $2,550 Annually.

Flex funds are fronted to you at beginning of plan year on a

MasterCard.

Services must be incurred in plan year.

2 ½ month grace period to incur claims following plan year.

90 day grace period to file claims following plan year.

Can be used for all IRS Classified Dependents.

“Use it or lose it” ++

Medical Reimbursement Account · NBS

Tax Free Account for Out-of-Pocket Medical Expenses on a Pre-

Loaded Visa Card Plan Maximum: $2,550 Annually.

Examples are:

Doctor Office Co-Payments

Prescription Co-Payments

Dental Expenses

Vision – Glasses, Contacts, etc.

Dependent Care Reimbursement Account · NBS

Tax Free Account for eligible Dependent/Child Care Expenses.

Tax Free Deduction via payroll vs. deduction on income tax.

Annual Maximum: $5,000 for married couple filing jointly or head of

household or $2,500 if filing single.

Thank You

Group Health Insurance Plan 2016 Frenship ISD. CAMPUS REPRESENTATIVES : FHS Michelle Stuart Reese...

Documents

Transcript of Group Health Insurance Plan 2016 Frenship ISD. CAMPUS REPRESENTATIVES : FHS Michelle Stuart Reese...