Presentation Transcript

1. New Health Care Plan For Active Employees Effective Oct. 1, 2010

2. Agenda General Information Medical/Dental Insurance Plan Design Review Employee Contributions Anthem Resources Anthem.com Look up providers, manage prescriptions etc. Vision Plan- New! Plan Design Review Employee Contributions Flexible Spending Account What is it? Reimbursements Healthcare Reform OTC Change Enrollment Process and Deadlines Medical and Dental Vision Supplemental Life Voluntary Benefits through Integra Benefits Group
3. General Information New Plan is Effective 10/1/2010 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
4. General Information Dental continues to be a part of the Medical Plan Your deductible accrual that started on January 1, 2010 will remain intact. In other words, plan members will not need to restart their deductible accumulations with the Oct. 1 onset of the Anthem plan. The healthcare plan will continue to operate on a calendar year. Deductibles, out-of-pocket maximums etc. will be calculated based on the calendar year.
5. General Information Annual Open Enrollment for 2010- Aug. 25th - Sept. 15th Qualifying Event – You can only join the plan or make benefit election changes during the annual 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 a health care application within 31 days of the event. Addition of Vision Plan for Active Employees (plan is separate from health & dental)
6. 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 .
7. 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
8. 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 the usual and customary amount.
9. 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
10. Deductibles and Out-of-Pocket Limit Three Possible Scenarios Illustration: OOP costs based on an Individual Member Member receives all services from in-network providers = $1,200 per individual OOP limit. ($400 deductible + $800 additional co-insurance expenses) Member receives all services from out-of-network provider = $1,300 per individual OOP limit plus any balance billing. ($400 deductible + $900 additional co-insurance expenses…plus balance billing)
11. Deductibles and Out-of-Pocket Limit 3. Individual Member receives in-network AND out-of -network services. Member must satisfy OOP limit under each benefit. OOP limit = $1,200-$2,100 depending on the cost of the out-of-network service. $1,200 in-network OOP limit plus the cost of the out-of-network service up to a maximum of $900 additional cost. Plus any balance billing.
12. Tiered Prescription Benefit Prescription Drug Retail $10/$25/$40 Express Scripts Prescription Drug Mail Order $20/$50/$80 3-month supply Anthem Tiered Drug List You will need a new script to initiate the new mail order service Prescription co-pay OOP limit: $1,200 single/$2,000 family Note: This OOP limit is completely separate and unrelated to the OOP for medical.
13. Wittenberg Dental 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
14. 80/20 Contribution Medical/Dental Plan
15. 80/20 Contribution Medical/Dental Plan Nationally, Healthcare Costs will continue to trend up. Expect Future Rate Increases
16. Anthem.com website Your Personal Account Summary Manage your Prescription Benefit – Express Scripts Information about the plan benefits and PPO providers Valuable Tools Health and Wellness Discounts and Special Offers You must Register to have access to the website Anthem
17. 1 1 Registration Registering for anthem.com is quick and easy and designed to ensure that your personal information is kept safe and secure. First, go to anthem.com. Click on the Register link. 1
18. How to Find a Provider www.anthem.com Click on “Find a Doctor” on the right side of the page Choose the state that you want to search Choose the Blue Access PPO for the Medical Plan network Choose the type of Provider you want to find You can then search by provider name, address, zip code etc.
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)For Active Employees PAY LESS TAXES - An FSA allows you to set aside PRE-TAX money to pay for qualified out-of-pocket healthcare and dependent care expenses. TASC Third Party Administrator tasconline.com
22. FSA - What is it? Two FSA Accounts- Healthcare & Dependent Care. Every year you set aside funds in an FSA to cover your 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, 2011 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 2011 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, mail, or on-line. 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
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. Over-the-Counter FSA Eligible Expenses Change Effective January, 2011 As of January 1, 2011, over-the-counter (OTC) medicines/drugs will not be eligible FSA expenses, unless you retain a prescription (or Letter of Medical Necessity) from your physician, or if it’s insulin. OTC health-related supplies continue to be FSA eligible.
28. Open Enrollment Process Sept. 15th Deadline Medical/Dental Insurance Enrollment Currently Enrolled? You do not need to fill out a form. Contracts for current participants will be electronically transferred from Principal to Anthem. If you are enrolling for the first time, adding or dropping dependents or canceling your coverage, you need to complete an enrollment form ASAP and no later than Sept. 15th. Anthem ID cards will be mailed to your home addresses. Please watch for them in the mail towards the end of September.
29. Open Enrollment Process Sept. 15th Deadline You need to complete an enrollment form to enroll in: Vision Insurance Supplemental Voluntary Life Insurance – Age-banded program. Can add additional coverage of 1, 2, or 3 times salary. Voluntary Insurance – ex. Cancer, long-term disability, accidental Deadline To Turn In Enrollment Forms is SEPTEMBER 15th. To insure timely receipt of your new benefit card, we recommend that you turn in your enrollment form as soon as possible. Anthem ID cards will be mailed to your home addresses. If you purchase vision insurance, that benefit will be loaded onto your medical card.
30. FSA Open Enrollment Nov. 16th Extension Enrollment Forms will be sent to you electronically. If you are enrolled THIS YEAR, you can enroll on-line. HR will send current enrollee’s a summary sheet via campus mail with your password and current year election.