WEA Employee Benefits Presentation...$10/$25 (then ded& coins) Other Copays (Emergency Room/Urgent...
Transcript of WEA Employee Benefits Presentation...$10/$25 (then ded& coins) Other Copays (Emergency Room/Urgent...
Employee Benefits PresentationSCHOOL DISTRICT OF WEST DE PERE
2
AgendaSchool District of West De Pere
Benefit Plan Options
Medical Visit Examples
Plan Selection
Questions?
3
Option 1 - Current PlanSummary of Benefits Essential PPO
Network Trust Preferred In NetworkOffice Copay (Primary Care/Specialist) $10/$25 (then ded & coins)
Other Copays (Emergency Room/Urgent Care) Deductible/Coinsurance $250/$100 (then ded & coins)
Deductible (Single/Family) $400/$800Coinsurance 100%Pharmacy Copay $0/ $10/ $30/ $60 Total Out-of-Pocket (Deductible Medical) $1,400 single / $2,800 familyTotal Out-of-Pocket (Pharmacy) $2,000/$4,000Out of Network
Deductible (Single/Family) $800/$1,600Coinsurance 80%Total Out-of-Pocket (Deductible Medical) $2,800/$5,600
No changes to your benefits– same co-pays and deductibles
No increase in premium cost or contribution (July 1, 2020- June 30, 2021)
Employee Contribution (Contingent upon completion of Health Risk Assessment):
Single Plan: 0% ($0 annually)
Family Plan: 5% ($1350.48 annually)
4
Option 1 - Current Plan: Key Highlights
Option 1 - Example of a Medical Visit: Ken
Ken Network Primary Care Office Visit
$325
Diagnostic Tests
Prescription Drug
Blood work: $225Chest X-ray: $300
Total Cost: $975
Tier 1 Script: $125
Ken would pay:
OV Co-pay: $10
Medical Deductible: $400
Rx Co-pay: $10
Total: $420 of the $975 billWEA Trust pays: $555
Option 1 - Example of a Medical Visit: Tina
Tina Specialist Office Visit
Diagnostic Tests
Child/ Delivery Professional
Services
Ultrasound
Blood work
Total Cost: $12,700
Tina would pay:
OV Co-pay: $50
Medical Deductible: $400
Total: $450 of the $12,700 billWEA Trust pays: $12,275
Child/ Delivery Facility Services
Ken and Tina would pay co-pays until each of their maximum out-of-pocket are met for medical services ($1,400) AND only co-pays until the maximum out-of-pocket for Rx is met ($2,000)
Family Plans: family members need to meet individual deductibles or a combination of dependents could meet the maximum out-of-pocket of ($2800) AND only co-pays until the maximum out-of-pocket for Rx is met ($4,000)
7
Future Medical Visits for Ken and Tina
A High-Deductible Health Plan, or HDHP, is an arrangement that allows you to pay less in monthly premiums, in exchange for higher deductibles when you need care.
A qualified HDHP: Provides coverage for medical and Rx expenses. Does not pay any medical expenses (other than preventive) until the deductible is
satisfied. You are responsible for the first $1,500/$3,000 before plan coverage
8
What is a High Deductible Health Plan?
9
Option 2 - High Deductible Health Plan with HSASummary of Benefits Essential Qualified
Network Trust Preferred In NetworkOffice Copay (Primary Care/Specialist) $0/$0 (then ded & coins)
Other Copays (Emergency Room/Urgent Care) Deductible/Coinsurance $0/$0 (then ded & coins)
Deductible (single/family) $1,500/$3,000Coinsurance 100%Pharmacy Copays $0/ $0/ $0/ $0 CopaysTotal Out-of-Pocket (Includes Deductible and Medical/ Rx Copays) $1,500 single / $3,000 familyOut of NetworkDeductible (single/family) $3,000/$6,000Coinsurance 80%
Out-of-Pocket (Includes Deductible ER, UC & Rx Copays) $5,000/$10,000
Effective July 1, 2020 – June 30, 2021
Stay with current network and providers
Seamless transition
No co-pays
No separate RX deductible
Smaller monthly premium
You are responsible for the first $1,500/$3,000 before plan coverage
10
Option 2 - High Deductible Health Plan: Key Highlights
Employee Contribution (Contingent upon completion of Health Risk Assessment):
Single Plan: 0% ($0)
Family Plan: 5% ($1098.48 annually - $252 less than Option 1)
District will provide Health Savings Account (HSA) contribution:
$1,000 Single or $2,000 Family
11
Option 2 - High Deductible Health Plan: Key Highlights (Continued)
Option 2 - Example of a Medical Visit: Ken w/ HDHP
Ken Network Primary Care Office Visit
$325
Diagnostic Tests
Prescription Drug
Blood work: $225Chest X-ray: $300
Total Cost: $975
Tier 1 Script: $125
Ken would pay:
Total cost of $975*
*He would then need to satisfy an addition $525 before WEA Trust starts paying*If Ken was on a family plan = $3,000 ($2,025)
Maximum Out-of-Pocket Satisfied at $1,500/$3,000
Option 2 - Example of a Medical Visit: Tina w/ HDHP
Tina Specialist Office Visit
Diagnostic Tests
Child/ Delivery Professional
Services
Ultrasound
Blood work Total Cost: $12,700
Tina would pay:
Deductible Cost: $3,000
Total: $3,000 of the $12,700 billWEA Trust pays: $9,700
Family plan: one member can meet the full family deductible
Child/ Delivery Facility Services
In these examples:
Single Plan: Ken would need to satisfy an additional $525 in deductible before benefits can be paid. Meeting a total of $1,500 single deductible.
Family Plans: When two or more are insured under a qualified HDHP, the full family ($3,000) deductible must be satisfied before benefits can be paid. This means one person may be required to satisfy the full family deductible.
Once the plan deductible is met, medical and prescription benefits will pay according to plan policy.
14
Future Medical Visits for Ken and Tina
Health savings account, or HSA, allows an individual to set aside pre-tax dollars for qualified medical expenses.
The funds are in a separate bank account in your name. It is your money.
The funds can roll over from year to year and you can also take them with you if you change jobs.
15
What is a health savings account (HSA)?
Account holders get a triple tax savings! Deposits into HSA accounts are exempt from Income Tax Savings continue to grow in accounts Tax-Free Money spent on Qualified Medical Expenses are not taxed
16
What is the benefit of an HSA?
Option 1 - Current Plan
Employee Contribution (Contingent upon completion of Health Risk Assessment):
Single Plan: 0% ($0 annually)
Family Plan: 5% ($1,350.48 annually)
Member Out of Pocket Costs:
Deductible Medical: Single $400 Family $800
Copays: Medical and Pharmacy
Max Out of Pocket (Medical): Single $1,400 Family $2,800
Pharmacy Out of Pocket (Rx): Single $2,000 Family $4,000
17
Cost ComparisonOption 2 – High Deductible Health Plan w/HSA
Employee Contribution (Contingent upon completion of Health Risk Assessment):
Single Plan: 0% ($0 annually)
Family Plan: 5% ($1,098.48 annually)
Member Out of Pocket Costs:
Deductible (Medical & Pharmacy) Single $1,500 Family $3,000
Pharmacy Out of Pocket: None
Copays: None
Max Out of Pocket (Medical and RX) Single $1,500 Family $3,000
District Health Savings Account Contribution:
$1,000 Single or $2,000 Family
Plan selection form due: June 5th, 2020
If you do not turn in an enrollment or change form, all current elections (or waivers) will remain in place for the next plan year.
New dependent, marriage, divorce, child reaching age 26, etc.
It is your responsibility to let us know during this annual enrollment time OR within 30 days of a qualifying event
18
Plan Selection
19
Plan Selection Form
20
Questions?Submit your questions via the Zoom chat function or via email to Kim Vande Hey [email protected]