July 2015 Forum Messagesuba-ebc.portals.s3.amazonaws.com/84623_2016 OE... · Avoid Cadillac Tax ......

Health Insurance Strategy ◦ Comply with Affordable Care Act ◦ Avoid Cadillac Tax

◦ Move towards market ◦ Align with other D-HH affiliates ◦ Retain lower wage employees ◦ Retain MAHHC incentive

AVERAGE increases in salary ◦ On Average 3% market based raise in January 2016

(lessen benefit impact)

◦ On Average 3% Merit in July 2016

July 2015 Forum Messages

• Salary Banded Employee Contributions

• Open Enrollment

• Your Employee Benefits

• What’s new for 2016?

• bswift Online Enrollment –

www.mahhc.bswift.com

http://www.mahhc.bswift.com/

November 11-18th Your opportunity to make changes to your benefit elections: Enroll or drop plans Enroll or drop dependents

Update beneficiary information

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Medical Rates are now based off Salary Bands. ◦ Salary = base pay ◦ $0-$40K: premiums going down ◦ $40K-$80K: premiums close to current ◦ $80K plus: premiums increasing

Premium “holiday” in December 2015.

Wellness Portal is now with Alere through HPI ◦ www.hpiwellness.com ◦ Wellness and BMI Assessments will be available Nov 2nd -9th

Long Term Care plan with Unum is now grandfathered – no longer available for new elections.

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http://www.hpiwellness.com/

your options

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overview of plan choices

3 New Plans to choose from Gold – Narrow Network MAH & DH/Affiliates Only

Silver

Bronze – HSA qualified HDHP

New ID Cards will be issued for 2016

Pharmacy Benefits Express Scripts Inc. (ESI) – Retail

New England Mail Order Pharmacy (NEMOP) – Mail

Order

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overview of plan choices

Summary of Benefits

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2015 Plan 2016 Plan

Deductible (Single/Family) None $500/$1,000

Co-insurance (plan pays) 90% 90%

Out of Pocket Max (Single/Family) $500/$1,000 $1,500/$3,000

Copays (PCP/Specialist) $10/$15 $20/$40

Urgent Care/Emergency Care $100 $100

Tier 1Benefits - MAHHC Providers

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Tier 2 Benefits Dartmouth-Hitchcock & Affiliate Providers

2015 Plan 2016 Plan

Deductible (Single/Family) $250/$500 $1,500/$3,000


Out of Pocket Max (Single/Family) $1,000/$2,000 $4,500/$9,000



Tier 2 no longer includes Valley Regional Hospital. Dartmouth-Hitchcock & Affiliate Providers only are covered.

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Tier 3 Benefits In-Network Providers

2015 Plan 2016 Plan

Deductible (Single/Family) $500/$1,000

No Coverage Co-insurance (plan pays) 70%

Out of Pocket Max (Single/Family) $1,500/$3,000

Copays (PCP/Specialist) $20/$30


Tier 3 benefits are only available for Urgent Care and Emergency Room Services

Employees with dependents outside of this area may want to consider alternate plan options

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2015 Plan 2016 Plan

Deductible (Single/Family) $500/$1,000 $2,500/$5,000






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2015 Plan 2016 Plan

Deductible (Single/Family) $1,000/$2,000 $3,500/$7,000






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2015 Plan 2016 Plan






Tier 3 In-Network Providers

Tier 3 coverage provides employees with dependents outside of this area access to additional providers. Outside of the 6 New England States the network is United Health.

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2015 Plan 2016 Plan




Copays (PCP/Specialist) Ded. then 90% Ded. then 90%

Urgent Care/Emergency Care Ded. then 90% Ded. then 90%


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2015 Plan 2016 Plan





Emergency Care Ded. then 90% Ded. then 90%

Urgent Care Ded. Then 80% Ded. Then 60%


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2015 Plan 2016 Plan





Emergency Care Ded. then 90% Ded. then 90%

Urgent Care Ded. Then 70% Ded. Then 50%

Tier 3 In-Network Providers

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Retail Pharmacy Program Co-pay for up to a 30-day supply Generic: $5Preferred Brand: $15Non-Preferred Brand: $30

Bronze Plan: Preventive prescriptions are covered at copays. All other prescriptions will be covered after the deductible ($3,500/$7,000) has been met. You will be responsible to pay the copayment listed per prescription drug.

Mail Order Program Co-pay for up to a 90-day supply Generic: $10 Preferred Brand: $30 Non-Preferred Brand: $60

Remember! Any maintenance medications must go through mail order (no more than 3 fills at retail)

Sample Employee:

$30,000

Current Future Future

Plan Silver Family – Tier 2

Silver Family – Tier 2

Silver Family - MAHHC

Annual Employee Premium

$3,830 $2,961 $2,961

Maximum Out of Pocket*

$5,000 $9,000 $7,000

Total Employee Cost*

$8,830 $11,961 $9,961

Average Raise

N/A $900 $900

Potential Employee Impact*

$8,830 $11,061 $9,061

*Worse case scenario – 2014 data shows Average OOPM is less than $2,000 Per employee

Sample Employee:

$60,000






$3,830 $3,900 $3,900


$5,000 $9,000 $7,000


$8,830 $12,900 $10,900

Average Raise

N/A $1,800 $1,800


$8,830 $11,100 $9,100


Sample Employee:

$90,000






$3,830 $4,839 $4,839


$5,000 $9,000 $7,000


$8,830 $13,839 $11,839

Average Raise

N/A $2,700 $2,700


$8,830 $11,139 $9,139


NE Delta Dental Insurance

Buy-Down

Basic

Enhanced

Health Through Oral Wellness (HOW) – Complete the oral

wellness risk assessment online and share your results with

your dentist; if you are “at risk” you may qualify for additional

preventive benefits.

PPO Providers – Look up providers on www.nedelta.com click

on “Find a Dentist” and choose the Delta Dental PPO Network.

PPO Providers allow deeper discounts, which saves you

money.

http://www.nedelta.com/

NEDD changes effective 1/1/2016

The following services have been enhanced by NEDD:

Sealants once in a 3 year period to age 19 – currently

once in a lifetime to age 15

The following codes have been removed from NEDD

Standardly covered codes:

D0431 – Adjunctive prediagnostic test (clinical efficacy

not proven)

D9910-D9911 – Desensitizing medicament (considered

part of treatment, patient is responsible if separate fee is

charged)

D7953 – Bone replacement graft for ridge preservation

(clinical efficacy not proven)

Vision Coverage (VSP)

◦ 100% Employee Paid

◦ Plan features include:

$20 eye exam copay (1 exam every 12 mos.)

$20 prescription eyewear copay Lenses once every 12 mos.

Frames once every 24 mos.

Coverage available for employee, spouses and children

Note: If you are seeing a Mt. Ascutney vision provider, you may use the Gold/Silver Medical Plan benefits for an eye exam. VSP benefits may be used for hardware at a VSP provider office.

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Health Savings Account (HSA),

Flexible Spending Account (FSA),

& Dependent Care Account (DCA)

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Preventive Services covered at 100%

All other services must apply toward a high

deductible

This plan enables you to put money into a health

savings account – your choice

Health Savings - pre-tax dollars to use for health care

You can deposit pre-tax dollars via payroll or

You can deposit post-tax dollars and deduct expenses at year-end

Or rollover an existing health savings account

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Your Health Savings Account is owned by you

Money put in the Health Savings Account is not taxable

You have investment options with the Health Savings Account through

Health Equity

Only eligible expenses can be used with health savings

◦ Fund dental, vision, medical deductible or just save! Elect HSA contributions to come directly from your paycheck through bswift

+ = Qualified high

deductible

medical plan

Tax-

advantaged

HSA Plan

Health

Savings

Account

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Under age 55 and not enrolled in Medicare

(based on a 12-month period):

Up to $3,350 individual coverage

Up to $6,750 family coverage

Age 55 or older and not enrolled in Medicare:

Maximum contribution increases by $1,000

(considered a “catch-up” contribution)

Up to $4,350 individual coverage

Up to $7,750 family coverage

You can elect up to $2,550

Plan Year: 1/1/16 – 12/31/16

Pre-tax money, contributed through payroll

deductions

2016 Flex Spending will allow for up to $500

of rollover into 2017.

Eligible expenses: ◦ Medical & Rx expenses

◦ Dental Expenses

◦ Vision Expenses

◦ Limited OTC

◦ No medical if you contribute to your H.S.A. in 2016

You can elect up to:

◦ $2500 if married filing separately

◦ $5000 if single or married filing jointly

Pre-tax money, contributed

through payroll deductions

Pay as you go, can only spend

what you have contributed

“Use it or Lose it”

Eligible Expenses: Custodial care of dependents while

employee is at work

New – Life and Disability Carrier

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Employer Paid Life, Voluntary Life, Disability, Accident and Critical Illness/Cancer Plans

Eligibility 60+ biweekly

Life and Disability Insurance 100% MAHHC Paid

Term Life & AD&D Insurance

1.5x annual salary up to $250,000

AD&D doubles the benefit value if death

results from an accident

Long Term Disability Insurance

60% of basic monthly pay up to

$8,000/month

Payments begin after 90 days from the start

of a qualified disability

The benefit offerings

Life and Disability Insurance 100% Employee Paid

Voluntary Short Term Disability Insurance

60% of current base rate of pay up to

$2,000/week

Benefits begin on the 15th day of disability

due to injury or illness

Benefit period is up to 11 weeks per eligible

disability

For 2016 OE ONLY – you may enroll in

Vol. STD with no EOI requirements!



Voluntary Term Life Insurance (Employee)

Choice of coverage in $10,000 increments –

up to 5x annual salary or $500,000 –

whichever is less

EOI required for amounts over $200,000

For 2016 OE ONLY – you may enroll in

Vol Term Life up to the GI with no EOI

requirements!



Voluntary Term Life Insurance

(Dependents)

Spouse – increments of $5,000 up to

$500,000 (not to exceed employee election)

EOI required for amounts over $25,000

Child(ren)- increments of $2,000 up to

$10,000

You must choose Employee coverage in

order to cover spouse/child(ren)


Life and Disability Insurance Imputed Income

Similar to basic life insurance with a benefit

over $50,000, voluntary life insurance is

subject to imputed income when the cost of

the premium is less than the IRS Section

79 Table 1 rates. If this applies to you, the

imputed income will show on bswift during

enrollment as well as reported on your

paycheck beginning in January 2016


100% Employee Paid

Benefits Payable 1X Per Category Up to 200% Policy Maximum

Circulatory Conditions Category: Heart Attack, End-stage Heart Failure, Stroke,

and Coronary Artery Disease (25%).

Other Conditions Category: Benign Brain Tumor, Coma, Major Organ Failure,

Paralysis, and Severe Burns.

Childhood Conditions Category: Cerebral Palsy, Complex Congenital Heart

Disease, Cystic Fibrosis, Type 1 Diabetes Mellitus, and Muscular Dystrophy.

Cancer Category: Cancer and Non Life Threatening Cancer (25%)

Provides a lump sum, tax-free benefit based on diagnosis paid to insured

Includes an Annual Wellness Benefit & Access to Health Care Support Services

Guaranteed Issue Coverage up to $20,000 in $5,000 increments

Coverage for Spouse and Dependent Children available

10-year age banded, smoker / non-smoker rates

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100% Employee Paid

Comprehensive Schedule of Benefits for:

Dislocations, Fractures, Lacerations, and Burns

Medical Services (X-Rays, Physical Therapy, etc.), Hospital Services (Emergency Room Admission, Ambulance, Blood Transfusion, etc.), Surgery Benefits, and Emergency Dental Benefits

Includes Accidental Death and Dismemberment coverage

Guaranteed Issue Coverage available for Employee, Spouse and Dependent Children

No Annual or Lifetime Maximums*

No Benefit Reduction for Other Coverage (i.e. Medical Insurance Benefits)

Tax-Free Benefits paid directly to the Insured

* Concussion Lifetime Maximum Benefit = $1500

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Critical Illness/Cancer & Accident

Insurance

MAHHC has elected Sun Life Financial to provide voluntary Critical

Illness/Cancer and Accident in 2016. All eligible employees will have

the option to elect or decline this coverage during this Annual

Enrollment Period - Fall 2015.

The Unum Critical Illness and Accident plans will be discontinued

and payroll deduction for these plans will cease as of 12.31.15

Unum’s Critical Illness and Accident plans are portable

Employees currently participating may continue coverage by

notifying Unum on or before 1.31.16 to be billed directly by Unum for

the plan premium


All employees must re-enroll in their

insurance benefits online through bswift

Between November 11-18th

At work

At Home

Or with Assistance

Go to: www.mahhc.bswift.com

Passwords will be reset on 10/15 to the last 4 digits of your SSN

http://www.mahhc.bswift.com/

Questions?

July 2015 Forum Messagesuba-ebc.portals.s3.amazonaws.com/84623_2016 OE... · Avoid Cadillac Tax ......

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