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January 2014 Employee Insurance Benefits

January 2014 Employee Insurance Benefits. Annual Benefit Review.

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January 2014 Employee Insurance Benefits

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  1. January 2014 Employee Insurance Benefits

  2. Annual Benefit Review Each year we spend time reviewing the medical, dental, life and disability insurance for you, our employee. We obtain proposals from other insurance companies to be certain the benefits we offer you are the most comprehensive, competitively priced and with the most current contractual language to maximize your benefits.

  3. Medical Plan – PreferredOne

  4. Preventive Health Care Covered at 100% in-network and includes: *Medical Exam – including – Vision & Hearing Screening *Immunizations *Osteoporosis screening *Lab services – Cholesterol *Colon Cancer screening *Cervical cancer – Pap test *Mammogram – breast cancer screening *Prostate Cancer screening Women’s Preventive Services * Prenatal/postnatal services * Well Baby care * Well woman visits – contraceptives/counseling, HPV DNA testing *Breastfeeding supplies and support, sexually transmitted infections and HIV screening *Domestic violence screening/counseling

  5. Open Access “200” Network The Open Access Network includes 100% of all the hospitals in Minnesota, and greater than 95% of all primary physicians and specialists. Providers are also available in Western Wisconsin. To access the full list: www.preferredone.com Open Access 200 network

  6. PreferredHealth Network Fairview, HealthEast, and North Memorial care systems have teamed up with PreferredOne to deliver an innovative approach to quality and cost-efficient health care. PreferredHealth combines the largest accountable care network with enhanced collaboration and communication among providers, patients and health plan to improve care and reduce cost. 13 Hospitals Fairview: Lakes, Northland, Ridges, Southdale HealthEast: Bethesda, St. John’s, St. Joseph’s Maple Grove Hospital North Memorial University of Minnesota Amplantz Children’s Woodwinds Over 5,000 primary care and specialty physicians To access the full list: www.preferredone.com/PH: the PreferredHealth network

  7. Out of Network Services Open Access Plan Emergency: The Emergency Room services are paid as in-network. In-patient hospital is paid at the out-of network level. If you use a provider from the PHCS National Network, you will not have the risk of being balance billed. Non-Emergency: The claim is paid at the out-of-network benefit level. If you use a provider from the PHCS National Network, you will not have the risk of being balance billed. PreferredHealth Emergency: The Emergency Room services are paid as in-network. In-patient hospital is paid at the out-of network level. If you use a provider from the PreferredOne Open Access or PHCS National Network, you will not have the risk of being balance billed. Non-Emergency: The claim is paid at the out-of-network benefit level. If you use a provider from the PreferredOne Open Access or PHCS National Network, you will not have the risk of being balance billed.

  8. High Deductible Health Plans (HDHP) Health Savings Accounts (HSA) High Deductible Health Plan: A HDHP compatible with an HSA must have the following characteristics: • A minimum deductible as determined by the Treasury Department ($1,250 in 2014) • All expenses subject to the deductible • The exception is preventive coverage which can be separate and covered at 100% Health Savings Account: This may be opened to pay for qualified medical expenses that are subject to the deductible. The purpose for these plans is to greatly reduce the premium cost and divert those funds into an account that if not used can be saved and owned by the insured.

  9. HSA Advantages • Tax-advantages: contribute pre-tax money, funds accrue tax-free and withdraw funds tax-free (if used for eligible medical expenses) • Can be used for current or future qualified medical expenses • Funds roll over from year to year with “no use it or lose it” • Owned by the account holder and account remains with the account holder, even if leaving employment at the City • HSA can remain active and allow contributions as long as account holder is covered on a qualified high deductible health plan. If account holder is no longer eligible for a high deductible health plan, the HSA freezes from future contributions but withdrawals can continue to be made.

  10. Who is Eligible for an HSA? • An Employee who is: • Covered by a qualified High Deductible Health Plan • Not enrolled in Medicare • Not covered under other health insurance* • Not another person’s dependent • * Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance

  11. HSA Contribution Limits • Each year, the IRS sets maximum contribution limits • These limits are for the total funds contributed, including company contributions, your contributions and any other contributions. • 2014 limits • $3,300 for individual coverage • $6,550 for family coverage • $1,000 additional “catch-up” contribution allowed for employees 55 and over • NOTE: in 2014, the City of North St. Paul will no longer contribute to the HSA

  12. HSA Contributions • Employee contributions are typically made with pre-tax dollars • Individual contributions can also be made with after-tax dollars which would then require the account holder to take an “above-the-line” deduction on their tax return • Contributions can be made up until April 15 of the following year

  13. Qualified Medical Expenses • Qualified medical expenses must be primarily to treat or prevent an illness, injury, vision or dental • The IRS defines expenses that are considered “qualified medical expenses” for HSA distributions the same as those for Flexible Spending Account distributions • Premiums such as COBRA, health coverage while receiving unemployment benefits, Medicare premiums (Parts B and D, but not supplement) and qualified Long-Term care insurance are all considered qualified medical expenses • Only qualified medical expenses incurred after the HSA has been established are eligible for reimbursement

  14. HSA Distributions • Distributions can be made at anytime from the account and there is no time limit on when the distribution must occur • Distributions for “qualified medical expenses” are never taxed • Distributions for the qualified medical expenses of the spouse or dependent of the accountholder are never taxed (even if the spouse or dependent are not covered under the HDHP.) • Distributions for non-qualified expenses are subject to ordinary income taxes and if under age 65, a 20% penalty unless due to death or a disability

  15. Flexible Spending Account You may still participate in the FSA, however, you will be limited to vision and dental expenses ONLY.

  16. FSA vs. HSA Claim Funding • FSA (Flex Spending Account): • Annual Amount: Employee determines the total amount that they want deducted at the beginning of the year (deducted equally from all paychecks for the entire year) • This amount cannot be changed unless there is a qualifying event • Expenses can be incurred at anytime and reimbursed to the member right away • If the member does not spend the amount elected in the plan year, they will lose the remaining balance (“use it or lose it”) • HSA (Health Savings Account): • Annual Amount: Employee can deposit up to the total IRS allowable amount throughout the year and up to April 15 of the following year • The amount deducted from each paycheck can be changed on a monthly basis • Incurred expenses can only be reimbursed from the HSA when there are available funds in the account • Unused funds will rollover from year to year

  17. HSA Accountholder Responsibilities • Keep appropriate records to support distributions from the account including; • documentation of incurred expense; such as receipts, explanation of benefits, provider billing statements, pharmacy statements • ensure that expenses were not also reimbursed by another source • Ensure that the contributions do not exceed the annual maximum • Add any non-qualified distributions back into gross income

  18. HSA Tax Treatment upon Death • A spouse named as beneficiary may retain the account as an HSA and is not treated as a taxable event • A non-spouse beneficiary is taxed on the fair market value of the HSA and the account ceases to exist

  19. PreferredOne Value Added Services • Website Access…… www.preferredone.com • Medical Cost Tools • Claims summary • Health Resources: risk assessment, links • Comparing prescription prices: www.goodrx.com • NEW! MDLive – 24/7/365 access to doctors on-line, by phone or video • Mdlive.com/PreferredOne or 1-888-632-2738 • ClearScript • Mail order RX available • Formulary listing - access on PreferredOne website • Network Provider: “Open Access 200” or PreferredHealth • Fitness Program • You will receive $20 per month when you exercise 12 times per month at a Fitness Center. Participating providers are administered through PreferredOne. Non-participating providers are administered through the Diocese.

  20. Health Care Reform - MNsure Health Coverage Mandate: Effective January 1, 2014, most adults over age 18 must have health insurance or pay a fine.  • If you are covered by your employer, you meet the requirement. • If you are covered by Medicaid, MinnesotaCare or Medicare, you meet the requirement. The website to review available options and/or apply for coverage is: http://www.mnsure.org/individual-family/

  21. Health Care Reform - MNsure All health plans offered by the City of North St. Paul meet the Affordable Care Act requirements. What does this mean for you: Since you are eligible for your employer’s health plan, you would not be eligible for a subsidy for MNsure or any other State Exchange. What does this mean for your dependents: Family members would also not be eligible for a subsidy based on your eligibility for a qualified group plan, however, they may be eligible for Medicaid or MinnesotaCare based on Household income levels.

  22. Health Care Reform - MNsure • Medical Assistance (MA) – Minnesota’s Medicaid program • MinnesotaCare– a program for residents who do not have access to affordable health care coverage  If you apply for health coverage through MNsure, you will be informed if you qualify for MA or MinnesotaCare.

  23. Health Care Premiums For 2014, the City will contribute $960 per month towards the monthly premium Monthly Premium: Open Access Plan Single: $484.10 Family: $1,154.15 PreferredHealth Single: $387.28 Family: $921.72 NOTE: if Employee waives health insurance, they will receive $355.72 per month as an “opt-out” payment which is taxable income

  24. Guardian Dental Plan

  25. Guardian Dental • The plan includes the benefit of 2 periodontal maintenance services in addition to the 2 regular teeth cleanings for a total of 4 periodontal maintenance or prophylaxis treatments in a 12 month period. • Access network providers: www.guardianlife.com “Resources….Find a provider….Find a dentist…..PPO……DentalGuardPreferred/Premier”

  26. Guardian Dental Maximum Rollover Feature With the Maximum Rollover feature, Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). The MRA can be used in future years, if you reach the plan’s annual maximum of $2,000 in any given year and need additional dollars for dental claims. • To qualify for rollover dollars, you must use dental services at least once for the account to be activated (a preventive visit would activate the account) • As long as your claims do not exceed $800, rollover dollars will be added to the MRA • For in-network services (PPO provider): $600 can be rolled over • For out-of-network services: $400 can be rolled over • Dollars can be rolled over each year until the MRA has a balance of $1,500 • Each covered member has their own MRA

  27. Dental Premiums For 2014, the City will contribute $960 per month towards the benefit premiums which include Dental: • 2014 Monthly Dental Premium • Single $ 47.19 • Single plus one $102.38 • Family $149.32

  28. Life Insurance / Optional Life Insurance Standard Insurance Company The City provides each employee with life insurance of $35,000. The premium for this coverage is deducted from the $960 contribution by the City each month. Optional Life Insurance: Premiums are the responsibility of the Employee You may purchase: Employee: increments of $10,000 up to $300,000 Guarantee Issue: $50,000 for new employees Spouse: increments of $10,000 up to $250,000 Guarantee Issue: $10,000 for new employees Children: $10,000 Guarantee Issue: $10,000 for new employees **See the Premium summary in your employee packet

  29. Long Term Disability - Lincoln National Effective January 1, 2014, the monthlybenefit paid to the employee will be tax-free. The City pays for the monthly premium, but the employee will just pay for the taxes on the monthly premium and will receive the benefit of a tax-free benefit payment when out on disability.

  30. Forms to Complete • PreferredOne – Medical: • Enrollment Form: Complete this form if newly electing coverage • Change Form: Complete this form if changing Network option (Open Access or PreferredHealth), changing dependent coverage or if terminating coverage • Guardian - Dental: • Enrollment/Change Form: Complete this form if newly enrolling, changing Plan option (Value Plan or NAP), changing dependent coverage or if terminating coverage • Flexible Spending: • Enrollment Form: complete this form to participate in the 2014 Flexible Benefits Plan. A new form is required each plan year. • Please return all forms to Mary Mills by Monday, December 9, 2013 • .

  31. Resources Johnson McCann Benefits is our advocate to PreferredOne, so please give them a call if you have any questions regarding coverage, claims, or any service issue. Britt Osterhues, Senior Account Manager Direct: 651-486-2186 Email: bosterhues@johnsonmccann.com Gayle McCann, President Direct: 651-486-2181 Email: gmccann@johnsonmccann.com 206 E. Little Canada Road Little Canada, Minnesota 55117 Fax: 651-484-1602 Toll Free: 800-497-3424, ext. 186

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