The Patient Protection and Affordable Health Care Act

Lifetime limits will be banned on medical coverage:

District employees already have the benefit of no lifetime limits.

Physical Therapy and Occupational Therapy under Medical Mutual of Ohio will change from 40 visits per year to:

40 visits annually for Physical Therapy

40 visits annually for Occupational Therapy

Orthodontics for children will be added as of 2011.

Maximum lifetime limit will be $1,500.00 per child.

This is not offered to employees in the AFSCME Union.

There is no special enrollment necessary.

Health insurance will be extended todependents up to age 26 under Federal

law:

The child does not have to live at home

The child does not need to be a dependent on the parent’s tax return

The child does not need to be a full-time student

The child may be married (only the child is eligible for coverage not his/her spouse or child)

The child must be not employed by an employer that offers any health benefit plan under which the child is eligible for coverage

In addition, the Ohio Department of Insurance extends this insurance up to age 28 and all criteria must be met:

The child must be unmarried and

The child must be a natural child, stepchild

or adopted child of the employee and

The child must be a resident of Ohio or a

full-time student at an accredited public or

private institution of higher education and

The child must be not employed by an employer that offers any health benefit plan under which the child is eligible for coverage and

The child must not be eligible for Medicare or Medicaid programs and

The child must be under the age of 28.

Special enrollment forms will be available from Medical Mutual of Ohio and Kaiser Permanente.

Expect to provide certification of eligibility annually.

An Attestation form will be required to state that the child is not eligible for healthcare coverage under his/her employer.

Expiration under Federal Law is midnight on the child’s 26th birthday.

Expiration under State Law is midnight on the child’s 28th birthday.

Employee w/single coverage would go to employee + 1

Employee + 1 would go to Employee + Family

Cost would be incremental to the next tier when the over age dependent is added.

This applies under Federal Law until age 26.

Ages 26 through 28 healthcare coverage is provided under House Bill 1, under the Ohio Department of Insurance

Adding an OAD will increase the employee’s premium (in the appropriate tier of coverage) by approximately 40% of the cost of single coverage for each dependent age 26 – 28.

The cost is the responsibility of the employee parent.

For 2011 ONLY the District will pay this cost.

Keep in mind, although these regulations are in effect, there is still the possibility that the government or medical carrier will change the cost.

Portable term-life insurance for employee & spouse ($10K to $500K)

Portable child life - $5K (6 months to 18 years /age 23 if FT student)

Issue up to $100K (<60 & No on medical questionnaire)

Enhancement to District’s short-term disability benefit

Annual enrollment

Premium deducted from your paycheck post tax

You will pay taxes on money added to your paycheck

If you enroll in DIPPO and go on disability, your disability payments will be tax-free

If you do NOT enroll in DIPPO and go on disability, you will be required to pay taxes on your disability payments

This eliminates reimbursements using tax-free dollars except for prescribed medications or a Note of Medical Necessity (NMN) from a physician.

Flexible Spending Account (FSA) for Health Care:

Allergy & Sinus Cold sore remedies Motion sicknessAntibiotic products Cough, cold & flu Pain relief Anti-diarrhea Digestive aids Respiratory

treatments

Anti-gas Feminine anti-fungal/itch

Sleep aids & sedatives

Anti-itch & insect bite

Hemorrhoid preps Stomach remedies

Antiparasitic treatments

Consider these new rules when estimating the dollar amount to put in your FSA -2011

2011 Cap remains at $4,000.00

FSA funds will be capped at $2,500.00 effective for 2013

NO changes to the Dependent Care Flexible Spending Account, cap remains at $5,000

Employers are required to disclose the value of benefits provided by the employer for each employee’s health insurance coverage.

The amount shown on your W-2 is not being taxed. It is a reporting tool to show the value of your healthcare.

Group health plans or insurance companies providing group plans are prohibited from rescinding coverage once an enrollee is covered under a plan.

Exception will be in the case of an individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material facts.

Email your questions to: openenrollment@neorsd.org

Call the Open Enrollment Line (216) 432-7309 or ext. 6064

Hang in there, we will get through the changes together!

Questions?