BONNER SPRINGS/EDWARDSVILLE SCHOOL DISTRICT. Open Enrollment Presentation

Transcription

1 2019 BONNER SPRINGS/EDWARDSVILLE SCHOOL DISTRICT Open Enrollment Presentation

2 Agenda 1. Welcome! 2. Healthcare Consumerism Tools & Resources 3. Medical Plan Options and Costs 4. Savings Accounts (HSA & FSA) 5. Dental 6. Vision 7. Voluntary Products 8. Next Steps

3 SECTION 1 WELCOME! Important Dates Qualifying Life Event

4 Welcome! The benefits you elect now are effective January 1, 2019 December 31, 2019 Your deductible/out-pocket maximums will re-set to zero on January 1, 2019 If you select the HMO, you will need to designate a primary care physician name and ID#. You can find the ID# doing a provider search at Remember to review all your plan options and networks to determine what best fits your needs Consider these things: 1. How do you and your family use the plan? 2. What you are paying in premium to purchase the plan? 3. Factor in the District s HSA contributions which reduces your overall exposure 4. Does moving to a lower priced plan make sense?

5 Wellness Program USD 204 WELLNESS VISION STATEMENT To empower and reward employees for living sustainable healthy lives both in and out of the workplace 1. Programs and challenges focusing on a variety of topics including physical, mental and financial wellbeing. Have some fun and earn prizes by participating in the initiatives most meaningful to you! 2. Monthly communications to keep you in the loop and offer practical tips for maximizing your personal wellbeing. 3. Get involved and give back with community activity opportunities. 4. A Healthier You online wellness portal from Blue Cross. Utilize resources, complete activities and earn points that can be used to enter Blue Cross sweepstakes. *In 2019, our premium incentive design is evolving and will be linked to the activities available on the Blue Cross A Healthier You portal offering you more options to earn the incentive. Watch for more details to come later this fall. WELLNESS CHAMPIONS: BSHS Crystal Coleman-Richardson CMS Lisa Krone BSE Tammy Dooley DRE Kristi Flack EDW Joshua Merrill McDanield/Head Start/District - Kaela Williams

6 Qualifying Life Event Unless you have a qualified change in status, you cannot make changes to the benefits you elect until the next annual enrollment period. Qualified changes in status include: Birth of a child, adoption, marriage, death, divorce, loss of coverage (if you or your spouse/dependents are covered under another plan and then lose that coverage) Should you wish to make changes to your elections due to a qualifying event, you have 31 days from the event to notify Human Resources and complete/turn in the appropriate paperwork. Otherwise you will have to wait until the next annual enrollment to make any changes to your benefit elections. Adding a Newborn If you have Single Coverage or are currently covering Dependents: Request coverage for the newborn within 31 days following the birth The baby WILL NOT be automatically enrolled for you After you complete the enrollment request, the child will be added retroactive to his/her birth date The member could be responsible for additional Premium

7 SECTION 2 HEALTHCARE TOOLS & RESOURCES BCBSKC Resources Routine Preventative Services

8 BCBSKC Resources RX SAVINGS SOLUTIONS 1. Access via your member portal at Mybluekc.com. 2. Find out if a generic is available. 3. Research savings opportunities. RETAIL TELEHEATLH 1. Visit amwell.com and download the app. 2. Access from anywhere, 24/7/ Pay PCP copay, or $49 if you are enrolled in a QHDHP. 4. Facetime visit for: cold, flu, rash, migraine, pink eye, ear infection, etc.

9 Routine Preventative Services In-Network routine preventive services and the related office visit for routine preventive services covered at 100% Annual Physicals Childhood immunizations Well women exams including mammograms PSA Tests Colorectal cancer exams Generic contraceptive drugs at 100% Breastfeeding support, supplies (pumps) and counseling at 100% Services MUST be Preventive Services MUST be done in a different calendar year All services received from an out-of-network provider are subject to the out-of-network deductible and coinsurance, except for childhood immunizations, which are paid at 100%.

10 SECTION MEDICAL PLAN Medical Insurance Terms Network Availability Network Differences Spira Care Plan Designs & Cost Claim Examples

11 Medical Insurance Terms Copay a fixed dollar amount you pay for covered services. Such services include but are not limited to physician office visits, urgent care, and prescriptions. Deductible is the amount of money you pay for services before coinsurance applies. This does not apply to preventive services required under the Affordable Care Act. Coinsurance is the percentage you pay for certain services based of the allowed amount charged. Generally, the insurance company pays the larger portion of the percentage and you pay the smaller portion. Coinsurance applies after the deductible has been met. Out-of-Pocket Maximum is the most you will pay in a given plan year for your benefits, not including your premium. Your deductible, copays, and coinsurance all accumulate towards this maximum amount. Once this is met, all covered services will be paid at 100% for the remainder of the plan year.

12 Network Availability & Differences The network of providers available to you depends on the plan you choose: BCBS of KC Networks Preferred Care Blue Blue Care BlueSelect Plus 1) Applies to : Option 2: QHDHP Option 3: Base PPO Option 4: Buy-Up PPO 1) Applies to : Option 5: HMO 1) Applies to : Option 1: Spira Care EPO 2) Larger network in Greater KC as well as Nationally and Internationally 3) Provides out-ofnetwork coverage 2) Hospitals and Providers are limited to Greater KC area 3) No coverage out of network unless it is an emergency Visit to find a provider 2) Smallest network, limited to 9 hospitals and approximately 3,300 providers and access to the new Spira Care Centers 3) No coverage out of network, but does provide access to the National Blue Card network

13 BlueSelect Plus Network (Option 1: Spira Care EPO) BlueSelect Plus Hospitals include only: Children s Mercy Hospital Children s Mercy South Hospital Liberty Hospital North Kansas City Hospital Olathe Medical Center Shawnee Mission Medical Center Truman Medical Center Hospital Hill Truman Medical Center Lakewood University of Kansas Hospital All other hospitals in BCBS s service area are considered out of the BlueSelect Plus Network.

14 BlueSelect Plus Network 1) If you are in the BlueSelect Network and have services provided by a hospital or provider that do not participate in the BlueSelect Plus Network, you will have significantly higher out of pocket costs. 2) If you are traveling and are outside of the BlueSelect Network, you still have access to the BCBS national Blue Card PPO Network and can receive in-network benefits. 3) If you are traveling outside the BlueSelect Plus Network and have a life or limb threatening situation, you will receive emergent care at the in-network level.

15 Spira Care Centers WHAT IS SPIRA CARE? Blue KC is collaborating with one of the highest-performing Blue KC Medical Homes, to create Spira Care an innovative new offering centered on a reimagined primary care experience. Spira members will benefit from the network s lower overall costs and convenient access to local providers across the metro area. Spira membership and care locations are exclusive to those employer groups enrolled. WHAT SERVICES ARE INCLUDED IN SPIRA CARE? All preventative health services conducted at your Care Centers are 100% covered with no out-of-pocket cost to members. All diagnostic care is subject to a maximum allowable charge*. WHERE ARE THE CLINICS LOCATED? There are currently two locations - Olathe and Shawnee. OLATHE West 135th St Olathe, KS LEE S SUMMIT 760 NW Blue Pkwy Lee s Summit, MO SHAWNEE Shawnee Mission Pkwy Shawnee, KS Three more care centers will be opened by January 2019 in the locations below. The Wyandotte location is planned to open mid CROSSROADS 1916 Grand Blvd Kansas City, MO LIBERTY 8350 N Church Rd Kansas City, MO WYANDOTTE Location TBD Chronic condition management Lab draws Extended full service hours Specialist referrals & scheduling Digital x-rays Common Prescriptions filled on-site Routine preventative care Behavioral health sciences WHERE ARE THE CLINICS LOCATED? Children s Mercy Hospital Children s Mercy Hospital - South Liberty Hospital North Kansas City Hospital Olathe Medical Center Shawnee Mission Medical Center Truman Medical Center - Hospital Hill Truman Medical Center - Lakewood University of Kansas Hospital

16 Medical Rates EMPLOYEE ONLY DISTRICT FUNDED HSA (EMPLOYEE ONLY) FAMILY Option 1: Spira Care EPO $0 $102 $590 Option 2: QHDHP $0 $10 $824 Option 3: BASE PPO $0 N/A $868 Option 4: BUY-UP PPO $116 N/A $1,140 Option 5: HMO $52 N/A $978

17 2018 Medical Plan Design Deductible Individual Family Option 1: Spira Care EPO BlueSelect Plus $2,700 $5,400 Option 2: QHDHP Preferred Care Blue $2,700 $5,400 Member Coinsurance 0% 0% Out-of-Pocket Maximum In-Network In-Network Out-of-Network Individual $2,700 $2,700 $5,400 Family $5,400 $5,400 $10,800 Office Visit Primary Care Physician Specialist Spira Care Center Subject to Deductible Subject to Deductible $60 Subject to Deductible Subject to Deductible N/A Preventive Care Covered 100% Covered 100% Urgent Care Subject to Deductible Subject to Deductible Emergency Room Subject to Deductible Subject to Deductible Outpatient Surgery Subject to Deductible Subject to Deductible Inpatient Hospital Services Subject to Deductible Subject to Deductible Prescription Drug Retail (30-day supply) Tier 1 Generic Tier 2 Preferred Tier 3 Non-Preferred Mail Order (120-day supply) Subject to Medical Deductible Subject to Medical Deductible Subject to Medical Deductible Subject to Medical Deductible Subject to Medical Deductible Subject to Medical Deductible Subject to Medical Deductible Subject to Medical Deductible

18 2018 Medical Plan Design Option 3: BASE PPO Preferred Care Blue Option 4: BUY UP PPO Preferred Care Blue Option 5: HMO Blue Care Deductible Individual $1,000 $500 None Family $2,000 $1,000 None Member Coinsurance 20% 20% 0% Out-of-Pocket Maximum Individual Family $4,000 $8,000 $2,750 $5,500 $3,000 $7,500 Office Visit Primary Care Physician Specialist $40 $80 $20 $40 $40 $80 Preventive Care Covered 100% Covered 100% Covered 100% Urgent Care $80 $40 $80 Emergency Room $200 then deductible then 20% $150 then deductible then 20% $200 Outpatient Surgery Deductible then 20% Deductible then 20% Inpatient Hospital Services Deductible then 20% Deductible then 20% Prescription Drug Retail (30-day supply) N/A N/A Tier 1 Generic $12 $12 Tier 2 Preferred $35 $35 Tier 3 Non-Preferred $60 $60 Mail Order (120-day supply) $24 / $70 / $120 $24 / $70 / $120 $500 per day up to $2,500/ calendar year/person $500 per day up to $2,500/ calendar year/person N/A $12 $35 $60 $24 / $70 / $120

19 Medical Premium Savings Opportunities There are many opportunities for savings, especially for those enrolled in family coverage. If you are looking for a premium savings, consider what your savings would be if you were to enroll in one of the lower priced plans. Example #1: Sally is enrolled as a Family in the Buy-up PPO plan today. She would save $3,264 in premium over the year by moving to the Base PPO. Yes, the Base PPO family out-of-pocket maximum is $2,500 more but, Apply the premium savings of $3,264 toward the out-of-pocket expenses Sally saves $764 over the year! Example #2: Sally is enrolled as a Family in the Buy-up PPO plan today. She would save $3,792 in premium over the year by moving to the QHDHP. Yes, the QHDHP family out-of-pocket maximum is only $100 more but, Apply the premium savings of $3,792 toward the out-of-pocket expenses Sally saves $3,692 over the year!

20 Claim Example #1 Employee in good health with single coverage. Sally has a Preventive exam & lab services, one diagnostic office visit, a Tier 1 Rx filled monthly and one additional Tier 2 Rx filled just once. Option 1: Spira Care EPO Option 2: QHDHP Option 3: Base PPO Option 4: Buy-up PPO Option 5: HMO Premium $0 $0 $0 $1,392 $624 Preventive Exam ($75) $0 $0 $0 $0 $0 One PCP Diagnostic Exam ($95) $95 $95 $40 $20 $40 Tier 1 Rx ($15/month) $180 $180 $144 $144 $144 Tier 2 Rx ($60) $60 $60 $35 $35 $35 District HSA Contribution $1,224 $120 N/A N/A N/A Total Employee Cost ($889) $215 $219 $1,591 $843

21 Claim Example #2 Employee with single coverage. Has a car accident in September and is in the hospital for six days, four follow up specialist visits, two Tier 2 Rx s for 3 months. Option 1: Spira Care EPO Option 2: QHDHP Option 3: Base PPO Option 4: Buy-up PPO Option 5: HMO Premium $0 $0 $0 $1,392 $624 Hospital Stay ($50,000) $2,700 $2,700 $4,000 $2,760 $2,500 Four Specialist Visits ($150 each) $0 $0 $0 $0 $320 Tier 2 Rx ($80/month) $0 $0 $0 $0 $105 Tier 2 Rx ($135/month) $0 $0 $0 $0 $75 District HSA Contribution $1,224 $120 N/A N/A N/A Total Employee Cost $1,476 $2,580 $4,000 $4,152 $3,624

22 Claim Example #3 Employee with Spouse enrolled. Employee has chronic condition while the spouse is a healthy, low utilizer. The employee has two brand name prescriptions filled monthly, four diagnostic specialist office visits, and a 5 day inpatient hospital stay. Option 1: Spira Care EPO Option 2: QHDHP Option 3: Base PPO Option 4: Buy-up PPO Option 5: HMO Annual Premium $7,080 $9,888 $10,416 $13,680 $11,736 5 Day Inpatient Hospital ($40,000) $2,700 $2,700 $4,000 $2,760 $2,500 Tier 3 Rx #1 ($160/month) $0 $0 $0 $0 $320 Tier 2 Rx #2 ($85/month) $0 $0 $0 $0 $105 Specialist Office Visits ($125 each) $0 $0 $0 $0 $75 District HSA Contribution N/A N/A N/A N/A N/A Total Employee Cost $9,780 $12,588 $14,416 $16,440 $14,736

23 Claim Example #4 Employee + Family Plan. Employee in fair health with a monthly cholesterol medication. Spouse is on a $3,000 prescription drug, Child receives well child care and one urgent care for the flu and a tier 1 prescription. Option 1: Spira Care EPO Option 2: QHDHP Option 3: Base PPO Option 4: Buy-up PPO Option 5: HMO Annual Premium $7,080 $9,888 $10,416 $13,680 $11,736 Employee Tier 2 Cholesterol Rx ($100/month) Spouse Tier 3 Rx ($3,000/ month) $1,200 $1,200 $420 $420 $420 $2,700 $2,700 $720 $720 $720 Well-child visit ($180) $0 $0 $0 $0 $0 Child Urgent Care ($90) $90 $90 $80 $40 $80 Child Tier 1 Rx ($35) $35 $35 $12 $12 $12 District HSA Contribution N/A N/A N/A N/A N/A Total Employee Cost $11,105 $13,913 $11,648 $14,872 $12,968

24 SECTION 4 SAVINGS ACCOUNTS Health Savings Account Flexible Spending Account

25 Health Savings Account (HSA) A tax-exempt account Contributions are tax-deductible (or pre-tax ) Earnings on your balance and investments are not taxed Funds withdrawn for qualified medical expenses are not taxed An individually owned, tax-advantaged account that may be used to pay for qualified medical expenses or saved for retirement and certain long-term care expenses. Established for the purpose of paying qualified healthcare expenses of the account owner or dependents. The account owner must be covered under a Qualified High Deductible Health Care Plan to contribute to an HSA. Portable, it stays with you for life. Even if you change jobs, become unemployed, or retire. Unused funds can rollover to use on future expenses. 25

26 You CANNOT receive/make contributions to an HSA if You are claimed as a dependent on someone else s tax return (You are NOT a dependent if you are married filing jointly or married filing single ). You are covered by another health insurance plan that is NOT a QHDHP, such as coverage under a spouse s traditional PPO or HMO plan. You or your spouse have a Flexible Spending Account (FSA), even if the FSA dollars are not used for you. You or your spouse are covered by a Health Reimbursement Arrangement (HRA). You are in receipt of Veteran Administration (VA) benefits, for a non-service related disability, including prescription drugs, within the previous 3 months you are not eligible to contribute for 3 months following. You CAN still have other disability, dental, vision, and long- term care insurance policies & Dependent Care Account through an FSA. You have medical coverage under TRICARE, or eligible for Medicare, or Medicaid.

27 Is there a limit to how much I can contribute? ANNUAL MAXIMUMS The annual contribution is established by law and subject to change each calendar year. If you are between the ages of 55 & 65, you may also be able to make a $1,000 catch-up contribution to the HSA each year. Contribute up to $3,500 Single, or $7,000 Family

28 HSA Contributions Your own HSA contributions are either pre-tax (via payroll deduction), OR tax deductible if contributed directly to the account. You have until April 15th of the following calendar year to make HSA contributions for the prior year, including eligible catch-up contributions. In order to contribute the full limit, you must maintain enrollment in a QHDHP for at least 12 months. Contribution limits are prorated if you do not maintain enrollment in a QHDHP for at least 12 months. - For example, if you are eligible for 4 months: $1,150 per individual $2,300 for family

29 HSA Disbursements You must retain all receipts in the event of an IRS Audit Disbursements for qualified healthcare expenses are not subject to taxation Disbursements for non-qualified expenses are subject to regular taxation plus a 20% penalty. The 20% penalty is waived upon attainment of age 65 Expenses incurred prior to establishing an HSA are NOT eligible for reimbursement

30 HSA Eligible Expenses Eligible health care expenses include expenses for the individual who open the account, his or her spouse and dependent children. The spouse and dependent children do not need to be covered under the QHDHP in order to have an eligible HSA expense. Hospitalization Prescription Drugs Doctor Office Visits Premiums for Medicare, Long Term Care, COBRA Dental expenses (Including Orthodontia) Vision (Including Lasik) Full list of eligible expenses available on the Treasury website at:

31 Flexible Spending Account (FSA) Part 1) Pre-tax Premiums Your premiums for medical, dental, vision and some other insurance coverages are eligible to be deducted from your paycheck pre-tax - Additional tax savings for you - Increase in your take-home pay

32 Flexible Spending Account (FSA) Part 2) Medical FSA Pre-tax Medical, Dental & Vision expenses for you and your dependents. Saves approximately 25% on every healthcare dollar spent May contribute up to $2,650/year Use it or Lose it If you do not use all your funds by December 31, 2019, all but $500 will be forfeited All funds available day one of the plan year Cannot participate in the Medical FSA if you contribute to a Health Savings Account (HSA). IMPORTANT: If you contribute to the FSA and during future enrollments move the QHDHP with the intent of making/receiving contributions to a HSA, you must have a zero balance in your FSA.

33 FSA Eligible Expenses Eligible health care expenses include expenses for the individual who open the account, his or her spouse and dependent children. The spouse and dependent children do not need to be covered under the employee s plan in order to have an eligible FSA expense. Hospitalization Prescription Drugs Doctor Office Visits Dental expenses (Including Orthodontia) Vision (Including Lasik) Full list of eligible expenses available on the Treasury website at:

34 Flexible Spending Account (FSA) Part 3) Limited FSA Pre-tax Dental & Vision expenses only Use for expenses for yourself and your dependents Saves approximately 25% on every healthcare dollar spent May contribute up to $2,650/year. Use it or Lose it If you do not use all your funds by December 31, 2019, all but $500 will be forfeited All funds available day one of the plan year You CAN participate in the Limited FSA if you contribute to a Health Savings Account (HSA).

35 Flexible Spending Account (FSA) Part 4) Dependent Care FSA Pre-tax dependent & elder care expenses. May contribute up to $5,000/year. If married and filing separately, the maximum is $2,500. Use it by December 31, 2019 or lose it. No carry-over No restriction applies with regard to HSA account-holder.

36 SECTION 5 DENTAL Plan Design

37 Voluntary Dental DELTA DENTAL OF KANSAS Individual Individual & Spouse Individual & Child(ren) Individual & Family Cost Per Month $32.31 $63.94 $63.76 $ PPO PREMIER Deductible Individual / Family $50 / $150 Annual Maximum $1,500 Preventive Services 100% 100% Basic Services 90% 80% Major Services 60% 50% Ortho Services N/A

38 SECTION 6 VISION Plan Design

39 Voluntary Vision SURENCY Individual Individual + Spouse Individual + Children Individual + Family Materials Only $7.76 $16.27 $13.95 $26.10 Copays Exams Lenses (Single, Bifocal, Trifocal) Frequency of Service Exam Lenses Frames Reimbursement Schedule Exam Glass Lenses (Single, Bifocal, Trifocal) $10 $25 Every 12 months Every 12 months Every 24 months 100% 100% Frames $100 allowance Contacts $115 allowance, 15% off amount of $115

40 SECTION 7 VOLUNTARY PRODUCTS Disability Insurance Voluntary Life Insurance Cancer Critical Illness Accident Secure ID2

41 Voluntary Products DISABILITY INSURANCE Disability insurance provides income protection if or when you can t work because of an illness or injury. It is an additional way to help provide you a source of income should you become disabled from a non-work related injury or sickness. POLICY FEATURES: Several different benefit plan options Benefit payments deposited directly into your bank account Benefits are payable year round VOLUNTARY LIFE INSURANCE Help make sure your family is protected financially in the event of a loved one s death is an important way of caring for their needs. American Fidelity has several types of individual life insurance plans to choose from, including permanent, term and children s policies. POLICY FEATURES: Death benefit amount that is generally tax free and paid directly to beneficiaries A policy that you own take with you if you leave employment

42 Voluntary Products CANCER INSURANCE A cancer diagnosis can change your life, and the expenses associated with a cancer diagnosis can be overwhelming. Limited Benefit Cancer Insurance may offer a solution to help you so you can focus on your treatment and healing. POLICY FEATURES: Benefit payments are made directly to you Individual, individual and spouse, individual and child (eligible child as defined in the policy) and family coverage available CRITICAL ILLNESS INSURANCE American Fidelity s Limited Benefit Critical Illness Insurance is an insurance policy that will pay a lump sum if you experience an eligible critical illness, such as a heart attack, permanent damage due to a stroke, major organ failure and/or major burns. POLICY FEATURES: Three lump sum benefit amounts available Annual health screening test benefit Benefits paid directly to you

43 Voluntary Products ACCIDENT COVERAGE Accidents can bring unexpected costs. A limited Benefit Accident Only Insurance policy may help lessen the impact of your finances by paying benefits to help cover your expenses, regardless of any other coverages you have. C POLICY FEATURES: Benefit payments are made directly to you Individual, individual and spouse, individual and child (eligible child as defined in the policy) and family coverage available SECURE ID2 Unexpected problems can have serious influence on your peace of mind. Secure ID2 helps you face those problems with a sense of confidence. POLICY FEATURES: ID Sanctuary Enhanced Legal Services Roadside Assistance Global Travel Assistance

44 SECTION 8 NEXT STEPS How to enroll Review Ask Questions Enroll!

45 How To Enroll Online Self Enrollment: Complete your self-enrollment online between November 5 th and November 16 th. Just use the link on page 3 of your employee guide - OR - Assisted Enrollment: Schedule your one-on-one enrollment session for the week of November 12 th to November 16 th. Just click on the scheduling link on page 3 of your guide to sign up for a time.

46 Next Steps REVIEW INFORMATION In the meantime, review this presentation and your employee benefits guide carefully. ASK QUESTIONS Utilize your HR Department to ask questions to better understand your benefit options. ENROLL Remember to use the worksheet at the end of your guide to gather all necessary info in preparation for enrolling.

47 Contact Information If you have any questions regarding your benefits, please contact one of your CBIZ representatives or your Bonner Springs representative. CBIZ Representatives Maggie Releford, Account Executive Molly Harrison, Account Manager Sarah Kane, Client Service Representative Bonner Springs Benefits Coordinator Stormi Vitt ext

48 QUESTIONS?