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Employee Benefits Insurance Plans. Insert your Company’s Logo Here. Presented by: O’Neill Benefits Group Brokerage. Plan Administrator. Medical Insurance UNITED HEALTHCARE Open Enrollment May 1, 2006. Dependent Enrollment.
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Employee Benefits Insurance Plans Insert your Company’s Logo Here Presented by: O’Neill Benefits Group Brokerage
Plan Administrator • Medical Insurance • UNITED HEALTHCARE • Open Enrollment May 1, 2006
Dependent Enrollment • Effective May 1, 2006, employees may enroll dependent children through the age of 25 with no student status verification • Dependent children are eligible until the end of the month of their 25th birthday • Dependent children must be unmarried and financially dependent or living at home
OPEN ENROLLMENT • If you had waived coverage for yourself or your dependents, you may enroll now with no medical screening. • You may switch your current plan selection with United Health Care – you may enroll in the HSA plan or stay in the current plan USJ.
CRISIS? Principal Premium 1998 39 employees: $180,839 UHC USJ Premium 2006 31 employees: $366,001
What is a dual option? You select one plan between two different medical it plan option. • The employer pays for 100% of the HD-D (base plan) for single coverage and dependent coverage (spouse and/or children). The employer will also contribute $750 of the plan deductible to the employee’s Health Savings Account for the base plan. • If the employee selects the US-J (buy-up) plan, the employee must contribute towards the cost for single and dependent coverage.
What are the costs to the employee for the Buy Up plan? Plan US-J ($1,500/$4,500 deductible) BUY-UP Plan Employee only: $56.06 / month Employee + spouse: $111.81 / month Employee + child/children: $94.93 / month Employee + family: $158.68/month
Deductible Carry-forward • Deductibles incurred in calendar year 2006 will be credited to either plan you enroll in.
United Healthcare Websites • http://www.uhc.com/ • www.myuhc.com • www.unitedhealthwellness.com
Distinguishing Features: • Balanced approach to total well-being (more than physical health) • “Wellness-only” focus for distinct appeal when compared to most health-related Web sites
Distinguishing Features: • Balanced approach to total well-being (more than physical health) • “Wellness-only” focus for distinct appeal when compared to most health-related Web sites
The Uncovered “Spend” You have purchasing power for services not covered by a insurance plan – which reduce your overall out of pocket expenses. • Savings on out of pocket expenses for services traditionally not covered by health insurance • Web-enabled consumer information and decision-making tools • Concierge services • No referrals or claim forms • Dental • Vision • Long-Term Care • Alternative Care • Wellness • Infertility • Hearing The average family spends roughly $675 a year on non-covered health care services.
1. Search for provider by name, location, or specialty 2. Compare provider rates 3. View provider details and make selection 4. Confirm rate & print confirmation HealthAllies Easy to Use
Distinguishing Features: • Balanced approach to total well-being (more than physical health) • “Wellness-only” focus for distinct appeal when compared to most health-related Web sites
HSA Overview • HSA is money put in an account owned by an individual to pay for future medical expenses • Must be used in conjunction with “High Deductible Health Plan” (HDHP) • Insurance that does not cover first dollar medical expenses (except for prevention)
Advantages of HSAs • HSA accounts encourage savings for future medical expenses • When employer-sponsored coverage is lost during periods of unemployment • COBRA continuation coverage • other coverage • Insurance coverage or medical expenses after retirement (before Medicare eligibility) • Long-term care expenses • Out-of-pocket expenses for Medicare • Non-covered services under future coverage
Advantages of HSAs • Accounts are owned by the individual (not an employer) • Individual decides: • How much to contribute • How much to use for medical expenses • Which medical expenses to pay from the account • Whether to pay for medical expenses from the account or save the account for future use • Which company will hold the account • What type of investments to grow account
Advantages of HSAs • Accounts are completely portable, regardless of: • Whether the individual is employed or not • Which employer the individual works for • Which state an individuals moves to • Age or marital status changes • Future medical coverage
Advantages of HSAs • No “use it or lose it rules” like Flexible Spending Arrangements (FSAs) • Unspent balances in accounts remain in the account and can grow through investment earnings • Encourages account holders to spend their funds more wisely on their medical care • Encourages account holders to shop around for the best value for the health care dollars
Advantages of HSAs • Accounts can grow through investment earnings • Many different investment options could be pursued • Individual chooses investment option that best meets their needs • HDHP premiums are cheaper than health insurance with traditional deductibles
Who Is Eligible for HSAs? • Any individual that: • Is covered by a HDHP • Is not covered by other health insurance • does not apply to specific injury insurance and accident, disability, dental care, vision care, long-term care • Is not eligible for Medicare • Can’t be claimed as a dependent on someone else’s tax return
What Is a “High Deductible Health Plan” (HDHP)? • Health insurance plan with minimum deductible of: • $1,000 (self-only coverage) • $2,000 (family coverage) • Annual out-of-pocket (including deductibles and co-pays) does not exceed: • $5,100 (self-only coverage) • $10,200 (family coverage) • HDHPs can have: • no deductible for preventive care • higher out-of-pocket (copays & coinsurance) for non-network services
HSA Contribution Rules • Contribution to HSA can be made by either the employer or the individual, or both • If made by the individual, it is an “above-the-line” deduction • If made by the employer, it is not taxable to the employee (excluded from income) • Can be made by others on behalf of individual and deducted by the individual • All contributions are aggregated
Employer Contribution The W.W. Reynolds Companies is making a one time contribution of $750 in a lump sum either to: Employee’s HSA Trust Account OR as ordinary income if Plan US J is selected
Employee Contribution Employees of The W.W. Reynolds Companies can contribute up to the individual or family maximum by depositing funds directly into their Trust account. Tax forms now have a line item for HSA contributions and are deducted before tax is calculated.
HSA Contribution Rules • Maximum amount that can be contributed to an HSA (and deducted): • Amount of High Deductible for 12 month plans HOWEVER • For 2006 the amount is pro-rated for the year • Individual: Maximum contribution is: $1,333.33 • Family: Maximum contribution is: $2666.66
HSA Contribution Rules • For individuals age 55 and older, additional “catch-up” contributions to HSA allowed • 2005 - $600 • 2006 - $700 • 2007 - $800 • 2008 - $900 • 2009 and after - $1,000 • Contributions must stop once an individual is eligible for Medicare
HSA Distributions • HSA funds can be used to pay for eligible expenses incurred • ON OR AFTER the date the Trust account is established.
HSA Distributions • Distributions are tax-free if taken for “qualified medical expenses” • Now includes over-the-counter drugs • Can ALSO pay for other health insurance: • COBRA coverage • Qualified long-term care insurance • Health plan coverage while receiving unemployment compensation • For individuals eligible for Medicare: • Medicare (Part A, Part B, Medicare+Choice) • employee share of premiums for employer-based coverage • Cannot pay Medigap premiums
HSA Distributions • Distributions are tax-free if taken for: • person covered by the high deductible • spouse of the individual • any dependent of the individual • Spouse and dependents don’t need to be covered by the HDHP • If not used for qualified medical expenses, then amount is included in income • 10% additional tax if taken for non-medical expenses, except when taken after: • Individual dies or becomes disabled • Individual is eligible for Medicare
HSA Distributions • HSA custodian (Trust account) must report all distributions – but is not required to check them for eligibility • Should the HSA participant keep receipts? • YES! Need to prove that deductible was met • Not all medical expenses paid out of the HSA have to be charged against the deductible (e.g. prescription sunglasses)
Preventive Covered at 100% on HAS plan No co-pay or deductible • Preventive Definition • Periodic Health Evaluations • Well baby and/or well-child • Immunization
Funding (Deposit) Process • Fund HSA bank account via payroll deductions, or direct deposit. • Obtain health services that are subject to the deductible after using myuhc.com to determine lowest cost, best treatment options, etc. • Receive EOB from claim system, or view claim on-line at myuhc.com stating consumer liability. • Use debit card or check to pay the physician directly from the HSA bank account or use you disposable income to save today for tomorrow’s expenses • Receive monthly bank statement detailing deposits and withdrawals or view on-line on bank web-site. • End of the year consumer will receive tax forms (direct deposits outside of payroll) and will see interest, but they do not have to pay taxes on that interest • Enjoy savings and establish a more secure retirement.
Identification and Debit Cards • Healthcare Account Card (ID or Eligibility card) • Can be used at any Mastercard terminal • Used to obtain eligibility and copay information within 10 seconds • Ability to send optional fax back with enhanced information • HIPAA compliant 270/271 transactions • Health Savings Account Debit Card • Effective 1/1/05 • Works like any checking account debit card - use at ATM or any merchant (part of the Cirrus network)
Banking Services • Banking services are through Exante Bank, a UnitedHealth Group owned affiliate • Account is interest bearing • Access to account is via a Mastercard debit card or checkbook • On-line bill pay • Bank arrangement: • $5 per account for set up • $3 PEPM Banking Fees charged to employee bank account • Other miscellaneous consumer banking fees apply
O’Neill Benefits Group Brokerage • Broker • Pat O’Neill • Customer Service • (303) 443-9929
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NEW WEBSITE FOR ALL PLAN DOCUMENTS- FORMS- LINKS www.obgb.com