Salt Lake Community College Open Enrollment 2015-2016.

Salt Lake Community College

Open Enrollment 2015-2016

WHAT’S NEW FOR 2015-2016

Voluntary Vision Plan – EMI HealthVRX - Pharmacy Administrator for Traditional Plans Qualified High Deductible Health Plan (QHDHP)HealthSparq – Comparison Tool (All Plans)Health Savings Account – NBS

Employee OptionsMay 1st – May 22nd

• Enroll or make changes to your health insurance

• Enroll in a Health Savings Account (HSA) or Reenroll in the Flexible Spending Account (FSA)

• Enroll in the Voluntary Vision Plan• Enroll or increase coverage for Voluntary Life

OPEN ENROLLMENT

May 1st THROUGH May 22nd

IF YOU DO NOT MAKE A MEDICAL AND/OR DENTAL ELECTION PRIOR TO MAY 22nd, YOU AND ANY ENROLLED DEPENDENTS WILL REMAIN IN THE SAME PLAN/NETWORK FOR THE 2015/2016 PLAN YEAR.

OPEN ENROLLMENT ELECTIONS CANNOT BE MADE AFTER MAY 22, 2015.

EMI Health VSP Vision Plan

Vision Plan

Customer Service

Medical & Dental Benefits

Open Enrollment 2015-2016

DENTAL RATES 2015-2016

2014/15 2015/16

Employee $2.25 $2.25

Two-Party $3.75 $3.75

Family $5.95 $5.95

MEDICAL RATES 2015-2016PAR TRADITIONAL PLAN QHDHP

2014/15 2015/16 2014/15 2015/16

Employee $48.50 $51.21 N/A $36.92

Two-Party $109.00 $115.10 N/A $82.91

Family $152.00 $160.50 N/A $115.50

PVC TRADITIONAL PLAN QHDHP

2014/15 2015/16 2014/15 2015/16

Employee $25.00 $26.53 N/A $13.42

Two-Party $56.00 $59.44 N/A $29.91

Family $77.50 $82.27 N/A $41.00

PFP TRADITIONAL PLAN QHDHP

2014/15 2015/16 2014/15 2015/16

Employee $7.50 $7.50 N/A $0

Two-Party $17.00 $17.00 N/A $0

Family $23.50 $23.50 N/A $0

ONLINE ENROLLMENT• Click the Regence Online Enrollment link on

the HR website – May 1st – May 22nd • Click “Create an Account”• Identify yourself and then create a User ID and

Password• Begin open enrollment process

Online Enrollment Assistance 5 a.m. to 5 p.m. MDT

855-216-8125

ONLINE ENROLLMENT

ONLINE ENROLLMENT

• Maintain personal information• View important benefit information• Compare plans• Initial changes throughout the year• Manage account information• Link to other benefit websites

NETWORK OPTIONS

HOSPITALS

Participating Traditional Preferred ValueCare Focal Point

100%

82%

23%

Includes all IHC hospitals + all others in

UtahIncludes the

UofU, Mtn Star, IASIS,

independent and rural IHC

Includes UofU & Mtn. Star

All networks include Huntsman Cancer and Primary Children's

PROVIDERS

Participating Traditional Preferred ValueCare Focal Point

9220

3433

9400

Includes all IHC InstaCare and KidsCare

Clinics

Includes After Hours Medical and

First Med Urgent Care

Centers

DENTAL PROVIDERS

1,275 GENERAL DENTISTS

291 SPECIALISTS

OVER 100,000 ACCESS POINTS NATIONWIDE

BENEFITS

CHANGES FOR 2015-2016TRADITIONAL PLANS

DEDUCTIBLEIn-network changing from $200/$400 to $400/$800Out-of-network changing from $500/$1,000 to $1,000/$2,000

OUT-OF-POCKET MAXIn-network changing from $2,700/$5,400 to $2,900/$5,800Out-of-network changing from $4,500/$9,000 to $5,000/$10,000

OFFICE COPAYMENTSPrimary/Specialists changing from $25 per visit to $30 per visit

OTHEROut-of-network Inpatient Admits through ER paid as in-network

Covered Service In-Network Out-of-Network

Deductible $1,500 single$3,000 family

$3,000 single$6,000 family

Out-of-Pocket Max $3,000 single$6,000 family


Coinsurance After deductible, you pay 10% After deductible, you pay 30%*

Office/Urgent Care After deductible, you pay 10% After deductible, you pay 30%*

Preventive Care Covered at 100% After deductible, you pay 30%*

Retail Mail-order

After deductible, you pay:

Generic $7 $7

Preferred 25% to a max of $150 25% to a max of $300

Non-Preferred 30% to a max of $175 30% to a max of $437.50

Specialty 10% to a max of $250 for generic & preferred15% to a max of $300 non-preferred

*balance billing applies

NEW QHDHP

Optimum Value

Value-based medications

Deductible waived on QHDHP for medications used to prevent or manage chronic conditions:

DepressionCardiovascular Disease

DiabetesHigh Cholesterol

OsteoporosisAsthma

Traditional Plan HDHP

Annual PremiumFamily Coverage

$3,852 PAR$1,975 PVC$564 PFP

$2,772 PAR$984 PVC

$0 PFPDeductible $400 per individual

$800 family$100 / $300 pharmacy


N/ACoinsurance 80/20% 90/10%

Out-of-Pocket max $2,900 per individual$5,800 family

$2000 / $6000 pharmacy


N/A2015-2016 SLCC Annual HSA Contribution*

N/A $1,200*

*SLCC will contribute $100 per month into an employees HSA account for employees enrolled as single or family coverage in the QHDHP.

PLAN COMPARISON

EXAMPLE 1 - SINGLE Traditional HDHP

Example: $2,000 in medical expenses

Individual Deductible/Coinsurance

Deductible: $40020% Coinsurance: $320Member Total = $720

Deductible: $1,50010% Coinsurance = $50Member Total = $1,550

2015-2016 SLCC HSA Contribution

N/A $1,200*

Insurance Pays ($1,280) ($450)

HSA Pays N/A ($1,200)*

Member Balance $720 $350

Member Savings N/A $370

Annual Premium-Single Coverage - ValueCare

$637 $315

Annual Premium Savings N/A $322

*SLCC will contribute $100 per month into the employee ‘s HSA account

EXAMPLE 2 - FAMILY Traditional HDHP

Example: $35,000 in medical expenses

Individual Deductible/Coinsurance

Deductible: $80020% Coinsurance: $5,000Member Total = $5,800

Deductible: $3,00010% Coinsurance $3,000Member Total = $6,000

2015-2016 SLCC HSA Contribution

N/A $1,200*

Insurance Pays ($29,200) ($29,000)

HSA Pays N/A ($1,200)*

Member Balance $5,800 $4,800

Member Savings N/A $1,000

Annual Premium-Family Coverage – ValueCare

$1,975 $984

Annual Premium Savings N/A $991


Example 3 - PharmacyEXAMPLE 3 – PHARMACY Traditional HDHP

Example: Symbicort – Preferred/Formulary Medication

Pharmacy Deductible $100 per individual$300 per family

Subject to medical deductible


Average Cost of Medication $272 per script $272 per script

Patient Balance Deductible: $10025% Coins = $43

Member total = $143

Deductible = waived = Optimum Value 25% Coins = $68

Member total cost = $68

2015-2016 SLCC Annual HSA Contribution

N/A $1,200

HSA Balance N/A $1,132


EMPLOYEE TOOLS

HEALTHSPARQ

Shopping Tools do Work

Affordable care options exist today

Central Utah Surgical Center

Total: $1,300 - $2,200

OOP: $750

Ogden Regional Medical Ctr

Total: $4,200 - $6,100

OOP: $1,450

St Marks Outpatient Surg Ctr

Total: $2,100 - $2,500

OOP: $850

Tonsillectomy and adenoidectomy (Under age 12) in Utah

Components of health care shoppingbalance cost, quality, convenience, and social content

costquality

convenience social

Enable Transactions and Services

Online appointment scheduling

Conveniences

Toll-free concierge services50 N Medical Drive, Salt Lake City, UT 84108

High-Deductible Health Plan

• HSAs can only be offered with a high-deductible health plan (HDHP).

• Though the deductible is higher for a HDHP plan than a traditional plan, your monthly premium is lower, and HSA funds can pay for medical expenses subject to the deductible.

Employer Contribution

• For 2015-2016, SLCC will contribute $50 per paycheck into each employee’s HSA effective July 1, 2015.

• Future SLCC contributions will be evaluated on a year to year basis.

Benefits of an HSA

• Triple tax advantage means you save money on your health care expenses

• Funds rollover each year, so you can use your HSA to save tax-free money for retirement

• You own the account, even if you leave the company

• Lower monthly premiums for a HDHP than a traditional health plan

How Does The HSA/HDHP Work?

• You and your employer contribute money to the HSA (either a lump sum payment or monthly through payroll deductions).

• You can use HSA dollars to pay your health insurance deductible, along with other qualified medical expenses such as dental or vision services.

• Once you meet your deductible, your insurance pays additional covered expenses in accordance with our plan.

Who is Eligible for an HSA?• Anyone who is:

– Covered by an HDHP– 18 years or older– Not enrolled in Medicare– Not covered under other health insurance*– Not another person’s tax dependent

* Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance

Examples of Medical Benefits That Make Someone Ineligible for an HSA?

• Medicare• Tricare Coverage• Flexible Spending Arrangements• Health Reimbursement Arrangements

Ineligible Medical Expenses

• Expenses that are not considered “qualified medical expenses” include:– Insurance premiums (other than the exceptions

listed previously)– Over-the-counter drugs (unless a prescription is

retained from a physician – insulin is an exception)– Surgery purely for cosmetic reasons– Expenses covered by another insurance plan– General health items such as tissues, toiletries,

hand sanitizer

Definition of Dependent

• For health insurance a dependent can be covered to age 26 regardless of status.

• HSA funds cannot be used for medical expenses incurred by a child who is not claimed as a dependent on your tax return.

• Those dependents can still be covered on your HDHP.

Recordkeeping

• Whenever you use HSA funds to pay for a medical expense, you should keep your receipt.

• You may need to demonstrate to the IRS that HSA distributions were for qualified medical expenses.

• If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty.

Administration Fee

• There is a $1.50 per paycheck administration fee, if you enroll in the FSA, Dependent Day Care FSA or the HSA.

• If you already have a debit card from last year, your funds will be loaded onto that card on July 1st.

Contacts / Questions

• Please email questions to:

• Kristi Egbert – [email protected] • Shelley Currey – [email protected] • Patti Williams – [email protected]

Salt Lake Community College Open Enrollment 2015-2016.

Documents

Transcript of Salt Lake Community College Open Enrollment 2015-2016.