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Palmer College of Chiropractic. 2005 Benefit Meeting. Presented by. Tracey Kmetz – Human Resources Tom Tiemeier – Chief Financial Officer Diana Seymour – Gallagher Benefit Services Becky Paul – Wausau Benefits. What’s Happening to Health Care Costs?.
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Palmer College of Chiropractic 2005 Benefit Meeting
Presented by • Tracey Kmetz – Human Resources • Tom Tiemeier – Chief Financial Officer • Diana Seymour – Gallagher Benefit Services • Becky Paul – Wausau Benefits
What’s Happening to Health Care Costs? • Industry Wide Increases Average 10 -18% overall • Employers struggle to balance increasing costs and maintain benefit levels • Some ways that Employers cope include: • Cost Sharing • Lowering Benefit Levels • Limiting Networks • Risk Management Programs • Predictive Modeling
Why are my costs increasing? • Medical Inflation • Prescription Inflation • Research and development of new drugs • Availability and use of expensive drug therapies • Advertising to encourage use of newer drugs • Aging Population • Consumer Demand • Technological Advances in Medical Treatment
Why are my costs increasing? • Litigious Environment • Government-mandated Benefits and Legislative Changes (i.e. COBRA, HIPAA, Section 125) • Lifestyle Issues • Sedentary Lifestyles • Obesity • Stress • Smoking
Cost Projections 2004 - 2007 Palmer College Medical & Dental Projected Costs • 2004 $641.24 PEPM • 2005 $754.28 PEPM • 2006 $861.81 PEPM • 2007 $985.58 PEPM Palmer’s 2004 Annual Projected cost is: $3,224,150.00
Average Employee Contribution Comparison * Mercer 2003 Survey of Employer Sponsored Health Plans
2005 Plan Overview • No change to PPO Benefits for 2005 plan year • Wausau Benefits remains Third Party Administrator • Costs are being managed through Network Discounts and Utilization Management • Technological Capabilities • Electronic claims submission • Internet access to your claims history • Reduce compensation tiers for employee premiums
HIPAA Administration Simplification • HIPAA Privacy Rules became effective April 14, 2004 requiring protection of Private Health Information (PHI) • Requires protection of individually identifiable health information • Restricts the flow of information from the health plan to the employer and the employer’s use of that information
HIPAA Privacy – What does that mean to me? • Restricts the communication of Private Health Information to anyone except the member • Requires written authorization from the member for another person to obtain Private Health Information, even at the member’s request • Wausau online will help you manage your Private Health Information efficiently and securely
Section 125 Lifestyle Events and Deadlines • Lifestyle events allow you to make changes to your health plan enrollment within 30 days of the event for the following reasons: • Legal Marital Change • Number of Dependents • Employment Status • Work Schedule (Reduction in hours) • Change in Eligibility of a Dependent • Loss of Health Plan Coverage of a dependent You must notify your Human Resources Department of any lifestyle event.
Your Flexible Spending Account A Benefit that Saves You Money!
Convenience: No More Shoebox! • Automatic reimbursement of deductibles and co-payments for medical, dental and pharmacy coverage • No claim form necessary! No receipts to save! • You must opt-out if you do not want this feature • You usually receive your payment before your provider or credit card bill is due
How to Enroll • Fill out your election form by 12/10/04 • Contributions to the FSA are pre-tax, reducing your taxable income • Expenses must be incurred during the plan year to be eligible for reimbursement • Plan carefully, as any unused balance at the end of the plan year is lost to you
How does it work? • Health Spending Account • Deposits (Reduction in Taxable Income) $1,000 • Federal Income Tax Savings* $ 200 • FICA Savings** $ 76 • Yearly Tax Savings, More Take-Home Pay $ 276 * Assumes Federal Income tax rate of 20% ** Includes Social Security tax rate of 6.25% and Medicare tax rate of 1.45%
Health Care Expenses Covered Up to $3000 per year for eligible expenses • Health insurance deductibles, co-payments • Vision, including glasses, contacts, contact solution, laser eye surgery • Dental, including braces • Provider visits, lab fees • Prescription drug co-payments • Non-prescription medications Claims processed within 5 days of receipt
Non-prescription medications • Must be a medication used for treatment of a medical condition • Examples include: antacids, pain relievers, cough medicines and allergy medications • Does not include medications merely beneficial to health • Examples include: dietary supplements and vitamins • Claims must be substantiated • You must send in your signed claim form and a cash register receipt containing the merchant name, medication name and date purchased
Dependent Care Expenses Covered • Up to $5000 per year for work-related expenses, including: • Day care for children under age 13 • In-home services by a full-time, live-in housekeeper caring for a qualified individual • Services for other dependents who cannot care for themselves • Claims processed within 48 hours of receipt
Plan Carefully! • Use it or lose it • Use the worksheets in your folder • Refer to plan document and eligible expense lists at www.wausaubenefits.com
Internet Capabilitieswww.wausaubenefits.com Everything you need all in one spot!
www.wausaubenefits.com – Where members go to access a wealth of online services.
With online self-registration, you are able to select a unique username and password. To do this, simply enter your group number and Member ID as shown on your ID card.
Once you have registered, you will simply need to enter your username and password to access all online member services
You will see portlets, or small windows of information, as soon as you login. If more detailed information is needed, you can click ‘View More’ or choose an option from the links on the left side of the screen.
There are two levels of claim detail: • Service dates • Charged amount • Allowed amount • Patient responsibility This view represents the first level of claim information displayed.
Eligibility Inquiry displays information such as: • Your demographic data • Coverage information • Plan selections
Medical Benefits Inquiry • Medical Benefits displays: • Network links • Copays, if applicable • Major medical benefits • Routine benefits • Therapy benefits • Mental, alcohol and drug benefits
Deductible Status Inquiry • Deductible Status displays benefits levels and current amounts applied to date for: • Lifetime Maximum • Individual Deductible • Family Deductible • Individual Out-of- Pocket • Family Out-of-Pocket
You can contact us with this form: • Request is automatically routed to the individual best able to respond to your question • You will receive an auto reply confirmation that the E-mail was received. • Response standard: Reply in 24 to 48 hours.
Flexible Spending Account Resources Gives you the tools needed to make educated decisions about your FSA account: • Health & Dependent Care Calculators • Eligible and ineligible expense listings • Links to IRS publications on recent legislation relating to FSA
myTools On the myTools tab, you can: • Order ID cards • Access commonly requested forms • Update your online profile • Access provider directories
myHealthCenter The tools found on the myHealthCenter tab provide you with a wealth of information and services to help you live a healthier lifestyle.
Disease Management Condition Centers Use online tools to help manage the following conditions: • Diabetes • Heart Disease • Asthma • Chronic Obstructive Pulmonary Disease • High Blood Pressure • Depression • Congestive Heart Failure