1 / 29

Benefits Open Enrollment Meeting Effective January 1, 2012

Benefits Open Enrollment Meeting Effective January 1, 2012. Agenda. Review of the Year Medical Insurance Plan Design Review- No plan changes Contributions - Medical Dental Insurance Plan Design Review- No plan changes Dental separate from Medical effective 1/1/ 2012

ingrid-palmer
Download Presentation

Benefits Open Enrollment Meeting Effective January 1, 2012

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Benefits Open Enrollment Meeting Effective January 1, 2012

  2. Agenda • Review of the Year • Medical Insurance • Plan Design Review- No plan changes • Contributions - Medical • Dental Insurance • Plan Design Review- No plan changes • Dental separate from Medical effective 1/1/ 2012 • Contributions- Dental • Vision Plan • Plan Design Review-No plan changes • Contributions- No changes • Flexible Spending Account • Enrollment Process and Deadlines • Resources • www.anthem.com • www.tasconline.com • Express Scripts • HR Webpage

  3. The Year in Review • Total cost of medical claims for our renewal experience period: $1,484,925 • Total cost of prescription drug claims: $863,814 • Total Medical/Rx claims cost: $2,348,739 • Total Cost of top 5 claims… $309,316 • None of our high claimants exceeded our $125,000 stop loss limit

  4. The Year in Review • Total cost of plan in 2010- $5,009,644 • Projected cost of plan Oct 1, 2010- July 31, 2011 – $3,651,894 • Actual cost of plan- $2,872,271 • Projected 14% increase Oct. 2011 - note • rates will stay same through calendar yr. and possibly through fiscal year.

  5. General Information • Plan is Effective 01/01/2012 • Self-Funded Plan subject to ERISA and plan document • Partnering with Anthem Blue Cross & Blue Shield • Blue Access PPO network – national network • 4 Plan Types: Employee plan, Employee + spouse plan, • Employee +children plan, & Family plan • BIG CHANGE – Because of implications resulting from the Health Care Reform Act, it is necessary to split out the medical and dental premiums effective Jan. 1 2012. 

  6. General Information • Open Enrollment for 2011- Oct. 12th - Nov. 11th • Qualifying Event – You can only join a plan or make benefit election changes during an open enrollment period unless you experience a qualifying life event change as defined by IRS. • Examples: change in marital status, birth or adoption of a child, change in spouse’s employment status. You must contact Human Resources to complete an enrollment form within 31 days of the event.

  7. Glossary of Terms • Co-pay – a flat dollar amount that is paid at the time of service. Co-pay does not apply to the deductible • Deductible – annual amount of money a member must pay before benefits are paid at the co-insurance % . • Co-insurance – a percentage that a member pays for services received after they have met their deductible. Member pays in full until deductible is met. • Out-of- pocket limit – the most an employee would pay in deductible and co-insurance during a plan year (Jan-Dec) for healthcare services excluding prescription drugs. • Services with a % = Co-insurance . • Services with a $ = Co-pay • .

  8. Wittenberg’s Blue Access PPO Health Plan • MEMBER PAYS • Deductible $400 individual /$800 family • Emergency Room Services 10% after deductible • In-Network Benefit • Out-of-Pocket Limit $1,200 individual /$2,000 family • Physician Office visits $20 co-pay • Preventive Care visits Covered at 100% • Urgent Care $20 co-pay • Inpatient/Outpatient Services 10% after deductible

  9. Wittenberg’s PPO Health Plan • Out-of-network benefit • Out-of- Pocket Limit $1,300 individual /$2,200 family • Physician Office visits 30% after deductible • Preventive Care visits • Urgent Care • Inpatient/Outpatient Services • Balance billing: Providers and hospitals who are out-of-network will bill you for the difference between the amount the plan pays and their billed charges.

  10. Deductibles and Out-of-Pocket Limit Deductible The $400/$800 deductible simultaneously applies to both in and out-of-network services. In other words, there is not a separate deductible for out-of-network. Out-of-Pocket Limit (“OOP”) There is a separate out-of-pocket limit for in-network and out-of-network co-insurance expenses. Co-insurance costs for services received in-network only apply to the in-network OOP. Co-insurance costs for services received out-of- network only apply to the out-of-network OOP. In-network - $1,200/$2,000Out-of-network - $1,300/$2,200

  11. Wittenberg Prescription Benefit Prescription Drug Retail $10/$25/$40 Express Scripts Prescription Drug Mail Order $20/$50/$80 3-month supply Prescription co-pay OOP limit $1,200 single/$2,000 family Note: Prescription OOP limit is completely separate and unrelated to the OOP for medical.

  12. How to Find a Provider • www.anthem.com • Click on “Find a Doctor” in the middle of the page • Choose the state that you want to search • Choose a Plan (PPO) • Choose the type of Provider you want to find • You can then search by provider name, address, zip code, etc. • Or call the customer service number listed on the back of your ID card

  13. Healthcare Reform Reminders • Preventive care is covered at 100% (in network) • Dependent children are eligible up to the end of the month in which they turn 26 • Lifetime Maximum on the medical plan is unlimited • No Pre-Existing condition clause for children under age 19

  14. Monthly Contributions- MedicalNo Cost Increase in Calendar Year 2011

  15. Wittenberg Dental Blue Complete Plan • MEMBER PAYS • Deductible $25 single /$75 family • Annual Maximum (per covered member) $1,500 • Diagnostic and Preventive No Charge to member • Minor Restorative 20% after deductible • Oral Surgery 20% after deductible • Endodontic Services 20% after deductible • Periodontal Services 20% after deductible • Prosthodontic Services 50% after deductible • Orthodontic Services 50% no deductible • Orthodontic Lifetime Maximum $1,000 • Orthodontic Age Limit Child to age 19

  16. Monthly Contributions- DentalNo Cost Increase in Calendar Year 2011

  17. Managing Health Care Costs • Use in-network providers whenever possible. • Take advantage of preventive care benefits. Schedule an annual physical every year. • Only use the Emergency Room for Life Threatening Emergencies. Utilize Urgent Care centers or Convenience Care Clinics after hours for non-emergency situations. • If you are scheduling tests such as: X-Ray/MRI/CT scan use free-standing facilities verses hospitals when available. • Take advantage of the retail prescription discount programs such as the $4 offerings at Wal-Mart, Target, Kroger etc. • Use Mail order for Maintenance medications.

  18. Claims Assistance • If you are having trouble resolving a claim issue USI Insurance can assist you. • If after you have reached out to Anthem your questions were not answered or it is a complex claim issue please contact Paula Meyers at 1-877-778-7469 or you can email her at paula.meyers@usi.biz.

  19. Anthem Blue View Vision Benefit Plan for Active Employees Network Benefits Routine Eye Exam (once every 12 months) $10 co-payEyeglass Frames (once every 24 months) $100 allowance/20% off the remaining balance Eyeglass Lenses (standard)Standard Plastic Single vision lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Bifocal lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Trifocal lenses (1 pair) $15 co-pay, then covered in full Eyeglass lens upgradesUV coating, Tint, Standard Scratch-Resistance $15 co-pay per upgradeStandard Polycarbonate $40 co-payStandard Progressive $65 co-pay standard Anti reflective coating $45 co-payOther add-ons and services 20% off retail price Contact Lenses Elective Conventional Lenses $105 allowance/15% off the remaining balanceElective Disposable Lenses $105 allowance (no add’l discount) Non-Elective contact Lenses Covered in Full

  20. Active Employee Monthly Contributions Vision Plan • Plan Type Employee Monthly • Single $3.00 • Employee Plus One $6.00 • Family $10.00 • Contributions are tax -sheltered

  21. Flexible Spending Account (FSA) By using PRE-TAX dollars, Flexible Spending Accounts help you take advantage of tax savings on eligible health care and dependent care expenses. Wittenberg offers you two reimbursement accounts: 1. Health Care Reimbursement Account (for your eligible health care expenses not covered by insurance) 2. Dependent Care Reimbursement Account (for reimbursement of day care expenses for eligible dependents). TASC Third Party Administrator tasconline.com

  22. FSA - What is it? • You set aside funds in an FSA to cover your out-of -pocket medical or dependent care costs. You need to decide upfront how much money you want to elect for the calendar year. • Voluntary election of payroll deductions on a pre-tax basis. Savings of nearly 30% is the Rule of Thumb – Use the TASC On-line Tax Savings Calculator to estimate your tax savings. http://www.tasconline.com/buytasc/flexsystem/ • You cannot change your election unless you have a qualifying event. Also, you cannot transfer money from one account to another. • “Use it or Lose it” - You have a grace period of three months after the end of the calendar year to submit claims for eligible expenses incurred duringthe previous calendar year. Any money left in your account after the three months will be forfeited.

  23. FSA – Enroll Now for Jan. 1, 2012 effective date • Healthcare FSA • $3,000 annual maximum limit • You have immediate access to your full election at the onset of the calendar year even though the full election has not been deducted from your pay.

  24. FSA - Enroll Now for Jan. 1, 2012 effective date • Dependent Care FSA • If married, spouse must work or attend school full-time • Maximum - $5,000 for single or married filing joint tax return, $2,500 married filing separate return • Under IRS guidelines, you can only be reimbursed for dependent care that has already taken place. Also, you can only be reimbursed for the amount you have already contributed to your dependent care FSA. • Eligible expenses include dependent care expenses for children under age 13, a disabled spouse, and/or a disabled relative or household member who depends on the account holder for at least half of his orher support.

  25. FSA Reimbursement • You can request reimbursement by • Fax – 608-663-2762 • Mail – TASC, P.O. Box 7308 , Madison, WI 53707-7308 • On-line – www.tasconline.com • 24-hour turnaround on reimbursements via Direct Deposit. • Use the FlexSystem Claim Card for seamless real-time payments. You can also order a card for your spouse. • Instant account status availability on-line or via FlexSystem’s voice response system. • Toll-free customer service assistance 800-422-4661

  26. FSA Card • How to use your Claim Card:You may use the card like a credit card when you pay for eligibleexpenses at the point of service. The funds are automatically deducted from your Flex Account balance. It is important to remember that you may still need to submit substantiation upon request. • Where to use the card: • Medical and dental physicians • Vision care providers • Medical facilities • Drug stores and in-store pharmacies • Hospitals including emergency rooms • Dependent care providers who accept Visa

  27. You need to complete an enrollment form if: • You want to enroll in the Medical, Dental or Vision Insurance programs for the first time • You want to add or drop your spouse or dependents from your coverage • You want to cancel your one or more of the plans your currently participate in • You DO NOT need to complete any paperwork if: • You are currently enrolled in the medical and dental plan; want to remain on both plans and do not want to add or drop your spouse or dependents • Reminder: Employees can enroll in Medical and/or Dental independently. • DEADLINE TO TURN IN FORMS IS NOVEMBER 11th . • New Anthem ID cards will be mailed to your home addresses. Medical, Dental and VisionOpen Enrollment

  28. FSA Open Enrollment • Anyone who wants to participate in an FSA must enroll or re-enroll for 2012. • If you were enrolled in 2011, an email will be sent to you with re-enrollment information and you can re-enroll online. If you are enrolling for the first time, you’ll need to complete a paper enrollment form. • Enrollment DEADLINE IS NOVEMBER 11th . • If you are re-enrolling please keep your existing TASC cards (no new cards will be sent). New enrollees will get an email about the card and information will be mailed to your home address about 10 days after enrolling.

  29. Questions? • THANK YOU FOR YOUR TIME!

More Related