Health Care Plan Open Enrollment 2015-16. Agenda ACA Update Benefits update Health Care plan review...

Health Care Plan Open Enrollment 2015-16

Agenda• ACA Update

• Benefits update

• Health Care plan review

• Tips to save health care dollars

• FSA – Open Enrollment

• Dental – Open Enrollment

• Vision – Open Enrollment

Employee Benefit Plan Updates 2015-16

• OWU will be renewing with Anthem• All deductibles, copayments and coinsurance

apply toward the out-of-pocket maximum including prescription copayments

• Annual out-of-pocket maximums will be increasing to offset ACA increase

• OWU will continue to offer The OWU Wellness Program to all employees.

• Opportunity to reduce your health care premiums or earn cash incentive for non-medical plan participants!

Employee Benefit Plan Updates 2015-16

5

• Employer Taxes Mandated by PPACA

1. Patient Centered Outcomes Research Fee

- Due July 31, 2015

- $2.00 per average covered member in 2014 ($1,662)

2. Transitional Reinsurance Fee- Due January 15, 2016- $3.67 per covered member per month in 2015

($18,254.58)- $2.25 per covered member per month in 2016

($11,191.50)

$31,108.08 July 15-June 16 – OWU’s approximate spend for PPACA

Taxes and Fees

Individual Obligations If person chooses not to have insurance they will owe a tax:

* Greater of 1% of income or $95 - 2014* Greater of 2% of income or $325 - 2015* Greater of 2.5% of income or $695, indexed - 2016

and later* Per adult; children 50%; family max of 3x

individual

2015-16 OWU Contribution Options

EE/CountCurrent/Month

Renewal/Month

< $35,999

EE only 62 $12.21 $39.00EE + SP 14 $159.97 $167.00EE + Children 6 $159.97 $151.00EE + Family 19 $173.71 $265.00

$36,000 - $59,999


$60,000 - $89,999


> $90,000


How Does OWU Compare?

Ohio Wesleyan University

Survey Benchmarks Client National Regional StateIndustry Group

EE Size Category

Number of Health Plans Reported 4 7,689 2,338 627 750 1,546

<$35,999 Employee Share of Premiums Monthly Employee Premium Share ($)

Single $39 $130 $126 $130 $103 $123EE+1EE+CH $151 $386 $346 $287 $358 $322EE+SP $167 $490 $417 $343 $436 $395Family $265 $731 $604 $504 $686 $574Family (Composite Non-Single) $522 $447 $381 $410 $401

Monthly Employee Premium Share (%)

Single 7.3% 27.7% 27.5% 30.8% 19.2% 24.5%EE+1EE+CH 14.8% 44.8% 41.0% 37.6% 36.6% 35.1%EE+SP 14.8% 47.9% 42.1% 37.7% 39.8% 37.3%Family 16.8% 52.5% 44.0% 38.8% 45.7% 39.5%Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

EMLOYEE CONTRIBUTIONS


Ohio Wesleyan UniversitySurvey Benchmarks Client National Regional State

Industry Group

EE Size Category


$36,000-$59,999

Employee Share of Premiums

Monthly Employee Premium Share ($)

Single $66 $130 $126 $130 $103 $123

EE+1

EE+CH $201 $386 $346 $287 $358 $322

EE+SP $222 $490 $417 $343 $436 $395

Family $344 $731 $604 $504 $686 $574

Family (Composite Non-Single) $522 $447 $381 $410 $401


Single 12.3% 27.7% 27.5% 30.8% 19.2% 24.5%

EE+1

EE+CH 19.8% 44.8% 41.0% 37.6% 36.6% 35.1%

EE+SP 19.7% 47.9% 42.1% 37.7% 39.8% 37.3%

Family 21.8% 52.5% 44.0% 38.8% 45.7% 39.5%

Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%



Ohio Wesleyan UniversitySurvey Benchmarks Client

National

Regional StateIndustry Group

EE Size Category


$60,000-$89,999



Single $92 $130 $126 $130 $103 $123

EE+1

EE+CH $251 $386 $346 $287 $358 $322

EE+SP $278 $490 $417 $343 $436 $395

Family $422 $731 $604 $504 $686 $574



Single 20.2% 27.7% 27.5% 30.8% 19.2% 24.5%

EE+1

EE+CH 24.7% 44.8% 41.0% 37.6% 36.6% 35.1%

EE+SP 24.7% 47.9% 42.1% 37.7% 39.8% 37.3%

Family 26.7% 52.5% 44.0% 38.8% 45.7% 39.5%




Ohio Wesleyan UniversitySurvey Benchmarks Client National Regional State

Industry Group

EE Size Category


>$90000



Single $118 $130 $126 $130 $103 $123

EE+1

EE+CH $301 $386 $346 $287 $358 $322

EE+SP $333 $490 $417 $343 $436 $395

Family $500 $731 $604 $504 $686 $574



Single 22.0% 27.7% 27.5% 30.8% 19.2% 24.5%

EE+1

EE+CH 29.6% 44.8% 41.0% 37.6% 36.6% 35.1%

EE+SP 29.6% 47.9% 42.1% 37.7% 39.8% 37.3%

Family 31.6% 52.5% 44.0% 38.8% 45.7% 39.5%




Survey Benchmarks Client National Regional StateIndustry Group

EE Size Category


CoPays

Primary Care Physician CoPay $20 $25 $25 $25 $20 $25

Specialty Care Physician CoPay $30 $35 $40 $35 $30 $30

Urgent Care CoPay $35 $50 $50 $50 $45 $40

Emergency Room CoPay $75 $150 $150 $200 $150 $100

Separate In-Hospital Admission CoPay $250 $250 $300 $225 $250

In-Network Benefits

Deductible - Single $1,000 $1,000 $1,000 $1,000 $500 $750

Deductible - Family $2,000 $3,000 $2,000 $2,000 $1,500 $1,500

Plan Coinsurance 90% 80% 80% 80% 80% 80%

Out-of-Pocket Maximum - Single $3,500 $3,000 $3,000 $2,500 $2,250 $2,500

Out-of-Pocket Maximum - Family $7,000 $7,500 $6,000 $5,000 $5,000 $6,000

Out-of-Network Benefits

Deductible - Single $2,000 $2,000 $2,000 $2,000 $1,000 $1,000

Deductible - Family $4,000 $4,000 $4,000 $4,000 $2,000 $3,000

Plan Coinsurance 70% 60% 60% 60% 60% 60%

Out-of-Pocket Maximum - Single $7,000 $6,000 $6,000 $6,000 $4,000 $5,000

Out-of-Pocket Maximum - Family $14,000 $14,000 $14,000 $13,000 $9,000 $10,500

Ohio Wesleyan University

PLAN DESIGN

Anthem PPO Plan

What are the amounts of the co-payments?Doctor Office Visits (In-Network)

• Primary Care $20.00/visit

• Specialty Care $30.00/visit

• Urgent Care Centers $35.00/visit (In/Out-of-Network)

• Emergency Room $75.00 Co-pay/visit; Then you pay 10%(In/Out-of/Network)

• All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription drugs.

Anthem PPO Plan

Routine/Preventive Benefits Include:• Routine Physical Exams• PSA Tests, Pelvic Exams• Immunizations• Colonoscopy• Mammograms• Cholesterol/Triglyceride• Glucose

Expanded Women’s Care Preventative Coverage

• Gestational Diabetes Screening• HPV Testing• Breast Pumps (rental and purchase) and supplies• Prescribed Contraceptives and counseling • Well Women Exams

Anthem PPO Plan

Anthem Plan Benefits

Prescription Drug Benefit

Retail

$10 Co-Pay for Tier 1 Drugs



$50 deductible applies then copaysMaximum 30 day supply per prescription

Anthem Plan Benefits

Prescription Drug Benefit

Mail Order*

$20.00 Co-Pay for Tier 1 Drugs



Maximum 90 day supply per prescription

Tips To Save $$$

• Verify your doctor and the provider is in Anthem’s network• Remind the receptionist that your co-pay for a preventive care visit is $0• Confirm preventive care procedures are eligible prior to the appointment & that

it will be billed as a preventive when leaving the provider’s office• Verify physician referrals to labs/facilities are in the network• Request in-office tests such as lab/x-ray be sent to an in-network lab or

physician for evaluation• Always reference Anthem’s Explanation of Benefits (EOB) prior to paying the

provider• Take the Preferred Drug List with you to the doctor visit • Request generic drug when available• Request drug samples from your doctor

OWU PPO Plan

Calendar Year Deductible

Co-Insurance after the Deductible (Per Calendar Year)

Insurance Company Pays (Per Calendar Year)

$1,000 Per Person$2,000 Family Maximum

90% of next $25,00010%

of next$25,000

100%

Your Individual Out-of-Pocket

Expenses

$2,500

$1,000

$3,500 Total Out-of-Pocket Expense Per Person

($7,000 Family

Maximum)

+

All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription copayments.

Anthem PPO Plan

Diagnostic Testing Services In-Network

• MRI’s 100%• CT Scans 100%• PET Scans 100%• Nuclear Medicine

100%• X-Ray’s/Radiology 100%

ANTHEM PPO PLAN

In-Network

Deductible$1,000 Per Person$2,000 Family maximum

Out of Pocket*$3,500 Per Person(including deductible)

$7,000 Family maximum (including deductible)

Out-of-Network

Deductible$2,000 Per Person$4,000 Family maximum

Out of Pocket*$7,000 Per Person (including deductible)

$14,000 Family maximum (including deductible)

*Out-of-Pocket maximums include co-payments in-network

HEALTH MANAGEMENT TOOLS

ConditionCare helps participants manage the following conditions:

• Asthma (Pediatric & Adult)• Chronic Obstructive Pulmonary Disease • Coronary Artery Disease• Diabetes (Pediatric & Adult; Types 1 & 2)• Heart Failure

ANTHEM SUPPORT TOOLS

Nurse Line 24/7• 1-888-249-3820• Helps members assess symptoms• Offers help understanding medical

condition or prescribed course of treatment

• Ensures members have the right care in the right setting

Health Care Advisor• What to expect with an illness• Research treatment options• Find the appropriate hospital

Access to a health care professional can help

answer immediate questions and aid

understanding

Immediate, Live Consultations

A choice of physicians that meets the consumer’s needs

…On Any Device

ANTHEM

Dependent Age Status• End of the month in which the dependent turns 26

unless the dependent is eligible for another employer-sponsored health plan other than that of a parent

WHO TO CALL WITH QUESTIONS

Anthem Member Services: 1-888-290-9164

• Benefit Information• Claim Inquiries• Provider Searches• Changes to member data• ID Cards, Provider Directories

FLEXIBLE SPENDING ACCOUNT

PLAN DETAILSOhio Wesleyan University Sponsored Plan Allowing Faculty and Staff to Make Pre-Tax Contributions for:

• Health Care Account $2,550 Annual Election Maximum• Dependent Care Account$5,000 Annual Election Maximum

Eligibility Requirements• All full time Faculty and Staff• Do not need to participate in the Medical; Dental or Vision Plan• Annual Voluntary Election• May not have a HSA and a Health Care FSA (IRS Rule)

Plan year will begin July 1, 2015 – June 30, 2016

ELIGIBLE EXPENSESHealth Care Account

• Medical, Dental and Vision expenses• Deductible• Coinsurance• Co-payments for office visits, prescription drugs, etc.• Some Expenses not covered by insurance

Dependent Care Account• Daycare expenses during work hours• Daycare/babysitting for children under 13• Preschool programs• After-school care• Home care for disabled dependent age 13 and over

ELIGIBLE EXPENSES

• Day Care expense must be to provide gainful employment

• If married, spouse must also be employed• Dependent must reside with employee• Payment for providing care may not be made to

another dependent• Care provider must disclose TAX ID #

USING THE FSA PLAN

• Automatic Reimbursement through your Health Care Spending Account for Medical, Rx, Dental and Vision claims

• Checks are issued weekly (every Thursday) and mailed Friday to the participant’s home…or

• Direct Deposit into your bank account by Monday• Reimbursements from Accounts are TAX FREE!!• You will have until September 30, 2016 to submit

eligible expenses that were incurred during the plan year (July 1, 2015 – June 30, 2016)

HOW TO SUBMIT REQUEST FOR REIMBURSEMENT

• Automatic Reimbursement through Health Care Spending Account

• Fax Reimbursement to 1-888-347-5212• Mail Requests to: Anthem

P.O. Box 660165 Dallas, TX 75266 • Direct Line to Customer Service 1-866-599-

3061• Account Balance: www.benefitadminsolutions.com

http://www.benefitadminsolutions.com/

DENTAL PLANS

KEY FEATURES OF THE DENTAL PLANS

• Your choice of Basic and Preferred Plans• 100% for Routine Preventive services(1)

• Administrated by the Metropolitan Life Insurance Company

Benefits are subject to MetLife Contract Limitations

KEY FEATURES OF THE DENTAL PLANS

• Receive your care from the Dentist of your choice• No Network Requirement• Optional network of dentists to receive a discount for

services

Benefits are subject to MetLife Contract Limitations

BASIC DENTAL PLAN

Preventive

Plan Pays 100% In-Network

90% Out-of-Network

(No Deductible)

Fluoride Treatments

Oral Exams

Teeth Cleanings

X-Rays

Deductible Amount = $50.00/Person/year; Family Max (3)Basic


60% Out-of-Network

Sealants

Fillings

Periodontal Maintenance

Emergency Treatment

Calendar Year Maximum Amount $1,000 per person

Major

Plan Pays 50% in-network

25% out-of-network

Space Maintainers

Inlays, Onlays and Crowns

Dental Implants

Endodontic Services

Periodontal Services

Bridges and Dentures

Surgical Extractions

PREFERRED DENTAL PLANDeductible Amount = $50.00/Person/year; Family Max (3)

Preventive

Plan Pays 100% In-Network 100% Out-of-Network

(No Deductible)

Emergency Treatment

Fluoride Treatments

Oral Exams

Teeth Cleaning

X-Rays

Basic


80% Out-of-Network

Sealants

Fillings

Periodontal Maintenance

Surgical Extractions

Major


50% Out-of-Network

Space Maintainers

Inlays, Onlays, and Crowns

Dental Implants

Endodontic Services

Periodontal Services

Bridges and Dentures

Calendar year max amount

$1,500 (MetLife Dental

Providers)

Calendar year max amount

$1,000

Orthodontics 50% $1,000 Child only

Lifetime max

OTHER KEY PIECES OF THE PREFERRED DENTAL PLAN• In most cases, the dentist will directly bill

MetLife for services• Annual Maximum Benefit is $1,000 per person • Optional Network of Dentists available to

receive discounts• Annual Maximum Benefit increases to $1,500

per person when services are provided in MetLife’s Network of Dentists

MetLife DentalThe Preferred Dentist Program was designed to help you get the dental care you need and help lower your costs. You get benefits for a wide range of covered services — both in and out of the network. The goal is to deliver affordable protection for a healthier smile and a healthier you. You also get great service and educational support to help you stay on top of your care.

Freedom of choice to go to any dentist. You have the flexibility to visit any dentist — your dentist — and receive coverage under the plan. Just remember that non-participating dentists haven’t agreed to charge negotiated fees. That means you usually save more dental dollars when you go to a participating dentist. Additional savings when you visit participating dentists. Your out-of-pocket costs are usually lower when you visit network dentists. That’s because they have agreed to accept negotiated fees that are typically 15 to 45% less than average dental charges in the same community. This may help lower your final costs and stretch your plan maximum.

Service where and when you want it. MyBenefits, your secure self-service website, is available 24/7. You can use the site to get estimates on care or check coverage and claim status. Plus, if you are on the go and need to find an in-network provider, view a claim or see your ID card, there’s an app for that. Search “MetLife” at the iTunes App Store or Google Play to download the app.

HOW THE OPTIONAL NETWORK SAVES YOU MONEY

• Go to www.metlife.com (click find a dentist)• View PDP Plus network of Dentists in your area• Visit participating Dentists and receive treatment• Dentist will directly bill MetLife at a lower pre-

negotiated rate and receive their payment directly from MetLife

• The Dentist can not charge the difference between the negotiated rate and their normal fee (the plan’s benefits will apply toward the negotiated rate)

http://www.metlife.com/

METLIFE DENTAL PLANS

Monthly Payroll Deductions (1)

Effective July 1, 2015

Employee

Employee + One Dependent

Family

$21.00

$41.18

$67.26

$34.30

$67.96

$110.50

Basic Plan Preferred Plan

(1) Pre-tax deductions. Actual net cost will be reduced based upon IRS Section 125 election and personal income tax bracket.

VISION PLANS

BASIC VISION PLAN

• Exam every 12 months, $20 co-pay• Prescription glasses every 24 months, $20 co-pay• Contacts, no co-pay applies ( 24 months)• Coverage from a VSP Doctor

PREFERRED VISION PLAN

• Exam every 12 months, $10 co-pay• Prescription lenses every 12 months, covered in full• Contacts, no co-pay applies ( 12 months)• Frames every 24 months, $25.00• $140.00 Allowance• Coverage from a VSP Doctor

FIND A VSP PROVIDER

• Go to www.vsp.com• View Network of Doctors in your area• Visit participating Doctors and receive treatment• Call 1-800-877-7195

http://www.vsp.com/

VSP PLANSPayroll Deductions (1) Effective July 1, 2015

Employee

Family $19.62

$6.94

$27.82

$9.84

Basic Plan Preferred Plan

(1) Pre-tax deductions. Actual net cost will be reduced based upon IRS Section 125 election and personal income tax bracket.

OPEN ENROLLMENT

• Open Enrollment will be April 27th through May 15th • You may add or remove dependents• Enroll or terminate from the plan(s)• Your election(s) will be effective 7/1/15• Election will be in effect until 6/30/16; unless a

qualified change in your status occurs • All benefit eligible employees must enroll though

ADP during the open enrollment period (4/27-5/15)

QUALIFIED CHANGE IN YOUR STATUS?• Change in marital status• Change of dependents• Involuntary loss of coverage through spouse’s

employer• Change of spouse’s employment resulting in loss

of coverage• Must notify Human Resources within 30 days of

change!

THE OWU WELLNESS PROGRAM

OWU WELLNESS PROGRAM OVERVIEWWhat’s the big idea?• Our lifestyle decisions impact our

long-term health, wellbeing and productivity

• Our healthcare costs are impacted by the lifestyle decisions we make

• OWU continues its commitment to encouraging well-thought-out decisions regarding healthcare solutions, and to promoting a healthy family life

Where’s the “gain”?• OWU benefits when its employees are healthy,

and able to carry-out their work responsibilities efficiently and effectively

• Employees benefit by leading healthy lifestyles, and are therefore happier, more stable, more dependable, more satisfied

• Everyone benefits when human resource costs are under control (both insurance premiums and productivity)

OWU WELLNESS PROGRAM OVERVIEW

OWU Wellness Program

Where’s the “hook”?

• $25 one time premium credit for the year or $25 through payroll for completing the wellness assessment

• One time $75 premium credit for the year or $75 through payroll for achieving 34 credits

OWU WELLNESS PROGRAM OVERVIEW

OWU Wellness Program

HOW DO I “SIGN-UP”?

www.UBAwellnessworks.com

http://www.ubawellnessworks.com/

OWU Wellness

www.ubawellnessworks.com

P/W = OWU

Monthly Seminars

WELLNESSWORKS PROGRAMS…

Healthy Living

Programs

Health Risk Assessment

Quarterly Challenges

http://www.ubawellnessworks.com/

BASIC PROGRAM – TRACKING (APRIL-MARCH TRACKING CYCLE)

ActivityCredit Value

AnnualMax

Wellness Assessment 6 6

Physical Exam / Biometric Screening 6 6

Virtual Coaching 5 10

Online Monthly Seminars 1 12

Healthy Heart Challenge (February 1-29) 5 5

Rate Your Plate Challenge (May 1-31) 5 5

Choose Your Health Challenge (August 1-31) 5 5

Winter Warm Up Challenge (November 1-30) 5 5

Community Event 3 6

Local Discretionary Activity 3 6

End of Year Survey 2 2

Total Credit Opportunity 68

Earn 34+ Credits in

12- month

period to earn

incentive

Thanks in advance for your help.

QUESTIONS?

Health Care Plan Open Enrollment 2015-16. Agenda ACA Update Benefits update Health Care plan review...

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Transcript of Health Care Plan Open Enrollment 2015-16. Agenda ACA Update Benefits update Health Care plan review...