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Balch & Bingham 2013 Open Enrollment Staff. Benefits Enrollment. 30 days from date of hire to elect coverage. Most benefits are effective on the first day of employment except: Vision – beginning of the month following date of hire Voluntary Life – subject to approval of insurance carrier
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Benefits Enrollment 30 days from date of hire to elect coverage. Most benefits are effective on the first day of employment except: Vision – beginning of the month following date of hire Voluntary Life – subject to approval of insurance carrier Information about our benefits is available on the HR page of the intranet or by contacting HR. All benefit enrollments will remain in effect until December 31, 2013, unless you experience a qualifying life event. For specific questions pertaining to qualifying life events please contact our HR department.
Medical Plan Options Balch & Bingham is offering two health plan options: Traditional PPO Plan Consumer Driven Health Plan (CDHP) with a Health Reimbursement Arrangement (HRA) Please choose the plan that best fits the financial and medical needs of you and your family.
Eligibility Information • Employees who are regularly scheduled to work 30 or more hours a week are eligible for benefits. • Your eligible dependents include: • Your spouse (of the opposite sex) • Your domestic partner (of same sex) • Children by birth, adoption or guardianship until age 26 regardless of residency, student status, or financial support • Certain exceptions may apply. • Please contact HR for additional information.
PPO Plan At-a-Glance The Benefits Matrix for the PPO Plan is available on the intranet.
Consumer Driven Health Plan • The Consumer Driven Health Plan (CDHP) offers lower premiums and includes inpatient, outpatient, pharmacy, and preventive care benefits. • The firm will make an annual contribution of $500 for individual coverage and $1,000 for family coverage to a Health Reimbursement Arrangement (HRA). • The money in your HRA will be used to offset the deductible and coinsurance for any eligible medical expense. • Once the HRA is exhausted, you will pay your share of the cost of your medical care until you have met the out of pocket maximum. At that point, the Plan pays 100% of the cost of your covered expenses. • Because fixed copays are excluded from out-of-pocket maximums under both plans, the CDHP may offer cost saving opportunities.
CDHP At-a-Glance The Benefits Matrix for the CDHP is available on the intranet.
Understanding the Aggregate Deductible and Out-of-Pocket Maximums • No one person on a family plan will pay more than $3,000 ($1,500 deductible + $1,500 out of pocket maximum) • The deductible may be split among all or some of the family members to reach the $3,000 deductible. • Example: Dad satisfies $1,200, Mom satisfies $950, Son satisfies $850 and Daughter satisfies $0. The family deductible has been satisfied. • The out-of-pocket maximum works the same way. • Fixed copays do not apply towards the deductible or out-of-pocket maximum for either plan.
Claim example Example based on in-network services
Health Reimbursement Arrangement (HRA) • The firm will make an annual contribution of $500 for individual coverage and $1,000 for family coverage when you enroll in the Consumer Driven Health Plan – prorated for mid year elections. • Your HRA will be used to offset the cost of deductibles and coinsurance. • The HRA is only available when you enroll in the Consumer Driven Health Plan. • Only the employer may contribute funds to the HRA. • You may participate in CheckFlex and the HRA at the same time. Your HRA will be the primary payor and CheckFlex secondary. • You may track your HRA balance online at www.bcbsal.com through myBlueCross. • 50% of unused HRA contributions may be rolled over into the next plan year. • Equity partners are not eligible to participate in the HRA but may participate in the Consumer Driven Health Plan.
2013 Health Premiums and Discount • If you were previously covered under a BCBS health plan, visit www.behealthy.com to view your claims history and help you gauge how your claims would have been paid under each plan. • A premium discount may be available for participating in our routine annual exam program. See HR for additional information.
Plan Comparison Scenarios • When deciding which Plan is best for you, take into account: • The premium cost of each plan • Your out-of-pocket costs when you receive care • What kind of out-of-pocket expenses you generally have and how much you usually spend • Money available to you to help you pay your expenses
Sample Claims Comparison Between Plans Scenario: Maternity, nine months of care plus normal vaginal delivery with 3-day hospital stay. estimated costs after discounts: $8,500 Claims comparison based on In-network benefits
Sample Claims Comparison Between Plans Scenario: Coronary Artery Disease; Cardiac bypass surgery with complications – one 5-day inpatient surgical admission, five outpatient visits; ten physician office visits, and X-Rays. Estimated costs after discounts: $69,925 *Calendar year out-of-pocket maximum has been satisfied. 100% coverage on all in-network applicable charges for the remainder of the year. Claims comparison based on In-network benefits
Sample Claims Comparison Between Plans Scenario: Injury; Ankle fracture – one ER visit, X-rays, one outpatient surgery, three follow-up visits. Estimated costs after discounts: $1,384 Claims comparison based on In-network benefits
Sample Claims Comparison Between Plans Scenario: CT scan of the head to examine the brain for a possible tumor. Estimated cost after discounts: $655 Claims comparison based on In-network benefits
Sample Claims Comparison Between Plans Scenario: Six child visits for one-year-old child; two specialist visits Claims comparison based on In-network benefits
Cost Saving on Prescriptions • Several brand-name drugs are going off patent in 2013 • Always consult your healthcare provider about your prescription drug options • A list popular brand-name drugs with expiring patents is provided below
Enrolling in Your Medical Benefits • You must enroll within 30 days of your date of hire. • Medical benefits are effective the first day of employment. • The following provisions apply to both plans: • You may change your plan election each year during open enrollment. • If you elect family coverage, your family must be enrolled in the same plan as you. • You may add or remove dependents throughout the year if a qualifying life event occurs (i.e. marriage, birth, divorce, loss of coverage).
Dental Plan The Dental Matrix is available on the intranet.
Flexible Spending Account (CheckFlex) • Your FSA allows you to set aside pre-tax earnings to pay for qualifying medical and dependent care expenses. • You must re-enroll each year to continue participation. • Equity Partners are not eligible to participate • Use-it-or-loss-it rule applies • Maximum annual election: • $2,500 for Medical under new HealthCare Reform • $5,000 for Dependent care
Group Life Insurance • Paid by the Firm • $50,000 life insurance coverage benefit • Designate your beneficiary(ies)
Vision • Eye exam every 12 months • Lenses every 12 months • Frames every 24 months • $20 exam copay + $20 lenses or frame copay • $250 contact lenses allowance including fitting fee • Premiums $11.46 single, $26.76 family • Coverage effective at the first of the month after date of hire
Voluntary Life and AD&D • You may elect up to 5x your earnings or $500k whichever is less. • Your spouse may elect up to 50% of your election • Child Life available at $1k, $5k, or $10k • Benefit reduction at age 70+ • Guarantee issue is $150k. For elections over $150k, proof of good health is required. • Premium determined by age and amount of coverage.
HR Contacts For more benefit information, visit the HR page of the intranet Disclaimer: This presentation describes the benefit plans available to you as an employee of Balch & Bingham. This presentation is meant only to cover the major points of each plan. It does not contain all of the details that are included in your Summary Plan Description documents. If there is any discrepancy within this presentation and any other materials provided to you, the summary plan documents will prevail. The summary plan documents are available by contacting Human Resources. Please note that the benefits described in this presentation may be changed at any time and do not represent a contractual obligation on the part of Balch & Bingham.