Benefit Meeting Plan Year beginning 06/01/2017

Transcription

1 Benefit Meeting Plan Year beginning 06/01/2017

2 What s Happening? Changing Claim Administrator Moving to UMR Deductibles/Out-of-Pockets met will be credited to new plan Qualified High Deductible Health Plan (QHDHP) $3,000 Deductible Plan $5,000 Deductible Plan Changing to a PPO network Choice Plus PPO Network (UnitedHealthcare) Optum Rx Network

3 Plan Comparison: 2 QHDHP Options QHDHP #1 QHDHP #2 Benefit In-Network Out-of-Network In-Network Out-of-Network Calendar Year Deductible (Up-front cost for services) Single Family $3,000 $6,000 Aggregate Family $6000 $12,000 $5,000 $10,000 Embedded Family Embedded Deductible Clarification: An Embedded Deductible protects an individual from having to meet the full Family Deductible at the time of claim. Qualified High Deductible Health Plan (#2) has an Embedded Deductible of $5,000 $10,000 $20,000 Coinsurance (Applies to costs after the deductible is met) Plan Pays 100% 70% 80% 50% 0% 30% 20% 50% Calendar Year Out-of-Pocket Max* (Includes deductible & coinsurance) Single Family $3,000 $6,000 Aggregate Family $8,000 $12,000 $6,550 $13,100 Embedded Family $13,000 $26,000 Prior Authorization may be required before benefits will be considered for payment. Failure to obtain prior authorization may result in a penalty or increased out-of-pocket costs. Refer to the Care Management section of the Health Benefit Summary Plan Description for a description of these services and prior authorization procedures. ($16,000, $12,000)

4 Plan Comparison: Services QHDHP #1 QHDHP #2 Benefit In-Network Out-of-Network In-Network Out-of-Network Preventive Care 0%, Ded Waived Ded/Coins 0%, Ded Waived Ded/Coins Office Visit 0%, After Ded Ded/Coins Ded/Coins Ded/Coins Specialist Office Visit 0%, After Ded Ded/Coins Ded/Coins Ded/Coins Urgent Care Center 0%, After Ded Ded/Coins Ded/Coins Ded/Coins Outpatient Hospital 0%, After Ded Ded/Coins Ded/Coins Ded/Coins Inpatient Hospital 0%, After Ded Ded/Coins Ded/Coins Ded/Coins Ambulance Ground/Air 0%, After Ded Ded/Coins Ded/Coins Ded/Coins Emergency Room 0%, After Ded Ded/Coins Ded/Coins Ded/Coins NOTE: There are a number of services available for all members under the Preventive Care benefits based on age and gender. Refer to your Health Benefit Summary Plan Description for details.

5 Medical UMR Use ID Card to register online The Plan is Self-Insured

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8 No App No download Just login at View, Scan/Fax ID Card

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13 Plan Comparison: Rx Prescription Drugs QHDHP #1 QHDHP #2 Benefit In-Network In-Network Prescription Drugs Participating Retail Pharmacy (up to 34-day Supply) Tier 1 Tier 2 Tier 3 After Deductible, Plan pays: 100% 100% 100% After Deductible/Coinsurance, Plan pays: 80% 80% 80% Prescription Drugs Participating Retail Pharmacy or Mail Order (90-day Supply = up to 3 Month Supply) Tier 1 Tier 2 Tier 3 After Deductible, Plan pays: 100% 100% 100% Prescription Drugs Specialty Drugs (up to 34-day Supply) -Must be purchased through the Optum Rx Specialty Pharmacy Tier 1 Tier 2 Tier 3 90-Day (Mail Order) After Deductible, Plan pays: 100% 100% 100% Specialty Not Covered After Deductible/Coinsurance, Plan pays: 80% 80% 80% After Deductible/Coinsurance, Plan pays: 80% 80% 80% IMPORTANT: Use of a Non-Participating Pharmacy, requires payment for the prescription upfront. The covered person can then submit a Claim Reimbursement Form with a receipt to OptumRx for reimbursement. Reimbursement for covered prescription drugs will be based on the lowest contracted amount of a Participating Pharmacy minus any applicable deductible and/or retail copay shown in this schedule.

14 UMR - Prescription Drug Benefits Preferred Drug Listing (Formulary) Periodic updates occur. If you or a covered family member are currently taking medications, check the UHC list to confirm the tier it may be different than prior plan. The 2017 Premium Prescription Drug List and the Premium Formulary Exclusions List will be posted at eagbenefits.com Visit with your Physician if you have any questions, or wish to review your medications. Some medications are subject to Prior Authorization, Step Therapy, or Quantity Limits. These guidelines promote safety and efficacy (The ability to produce a desired or intended result) Following recommended guidelines of FDA

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19 Generic Generic

20 Medical Plan Premiums Per Pay Check (Bi-Monthly) Medical Plan QHDHP #1 QHDHP #2 Employee Employee Employee $75.00 $10.00 Employee + Spouse $ $ Employee + Child(ren) $ $ Family $ $390.00

21 Health Savings Account Basics (HSA) Decrease Taxable Income and Increase Spendable Income

22 ELIGIBILITY Flexible Spending Account Health Savings Account (w/qhdhp) Employees Covered by a Qualified High Deductible Health Plan All Eligible Employees Not contributing to an HSA Not enrolled in Medicare (Medicare A is automatic in most cases) Not another person s dependent (i.e. child on parent s plan) Not covered by another health plan that is not a Qualified High Deductible Health Plan (Spouse s Medical FSA disallows HSA contributions) Not contributing to a general FSA ($500 carryover disallows HSA contributions)

23 HEALTH SAVINGS ACCOUNT (HSA) Pre-tax contributions are made through payroll deductions Elections can be changed (Limits may apply) After-tax lump sum contributions allowed (tax return) - (Limits may apply; pro-rated eligibility) Rolls over indefinitely Upon death, rolls to spouse tax free (taxed if left to other beneficiary) Earns interest (Does not go towards calendar year maximum) Investment Options with tax free earnings (Does not go towards calendar year maximum)

24 Account Maintenance HSA Bank is the HSA Administrator and they are not required to determine whether distributions are used for medical purposes; you must do that. You must have receipts in the case of an IRS audit Failure to provide those receipts for verification results in required payment of taxes on those dollars and an additional 20% penalty

25 Recordkeeping

26 DISTRIBUTIONS (AGE 65+) o o

27 Qualified Medical Expenses

28 IRS Section 213 (d)

29 End of the Year Maintenance Plan Year ends December 31 st Expenses must be incurred after the account is established No deadline on claim submission Money remains that of the participant and rolls over indefinitely HSA Bank will report all contributions and distributions annually to the account holder and the IRS. These forms are posted to your online account at Paper forms can be elected

30 Contribution Limits

31 Medical Plan Premiums Per Pay Check (Bi-Monthly) QHDHP #1 QHDHP #2 Difference Medical Plan Employee Employee Annual Employee $75.00 $10.00 $1,560 Employee + Spouse $ $ $2,160 Employee + Child(ren) $ $ $1,860 Family $ $ $2,160

32 Claim Comparison Employee Only Election $3,000 Claim QHDHP #1 QHDHP #2 Difference Deductible $ 3, $ 3, Coinsurance (#1 0%, #2 20%) $ 0.00 $ 0.00 Total Claim Cost $ $ 3, $ 0.00 Employee Only Election $12,750 Claim QHDHP #1 QHDHP #2 Difference Deductible $ 3, $ 5, Coinsurance (#1 0%, #2 20%) $ 0.00 $ 1, Total Claim Cost $ 3, $ 6, $ 3, Family Election $12,750 Claim Aggregate/Embedded QHDHP #1 QHDHP #2 Difference Deductible $ 6, $ 5, Coinsurance (#1 0%, #2 20% $ 0.00 $ 1, Total Claim Cost $ 6, $ 6, $ Risk Tolerance Savings vs. Costs Premiums Single $1,560 Costs Physician Rx Planned services Family vs. Unexpected $2,160 claims Rx claims will cost the same regardless of the plan.

33 Dental Kansas City Life (no benefit changes) Monthly Per Pay Period Employee $22.76 $11.38 Employee + Spouse $45.12 $22.56 Employee + Child(ren) $60.04 $30.02 Family $90.03 $45.02 Initial Limits of Coverage (newly eligible) Orthodontia (up to age 19) 12 Months Late Applicant Limits of Coverage Basic & Major Services 12 Months Orthodontia (up to age 19) 12 Months Dependent children eligible up to the age of 26 years

34 Voluntary Life Insurance and AD&D Kansas City Life (Voluntary benefit paid by the employee) Coverage Amount Personal Life Insurance Maximum: Increments: Guarantee Issue Amount: AD&D Amount: Spouse Maximum: Increments: Guarantee Issue Amount: AD&D Amount: (Insurance terminates when You retire) $10,000 to 5x Your Annual Earnings, not exceeding $300,000 $10,000 (rounded to next higher) Under age 70: 5x Your Annual Earnings, not exceeding $150,000 Age 70+: $25,000 Equals Your life insurance election (Spouse s insurance terminates at EE attainment of age 70) $5,000 to $25,000, not exceeding 50% of Your election to $150,000 $5,000 The lesser of 100% of Your elected amount or $30,000 Equals Spouse s life insurance election Dependent Child(ren) Maximum: Increments: Guarantee Issue Amount: AD&D Amount: (age 14 days to 19, or 25 if full-time student) $10,000 $2,500 $10,000 Vol. Life Election Living Care/Accelerated Death Benefit Waiver of Premium Contact Human Resources at the time of claim or to update beneficiaries. EE Only - 50% of the amount in force to $100,000 is available if terminally ill If it is determined that you are totally disabled, your life insurance benefit will continue without payment of premium, subject to certain conditions.

35 Short-Term Disability Kansas City Life (Voluntary benefit paid by the employee) Benefits Elimination Period Injury Illness Weekly Benefit The period of time before benefits are payable Payable on the 1 st day Payable on the 8 th day 60% of gross (before taxes) weekly earnings not exceeding the weekly benefit max Maximum Weekly Benefit $1,000 Minimum Weekly Benefit $25 Maximum Benefit Period Benefits are available for up to 26-weeks Because of an injury or illness, a significant change in your abilities has occurred Disability preventing you from performing at least one of the material duties of your regular job and are unable to generate current earnings of your regular job. Weekly Earnings Partial Disability Benefits Pre-Existing Condition Earnings will defined as prior year s W2 s for salaried and commissioned employees. Earnings will be updated each year effective June 1. These earnings are used to determine your benefit in the event of claim. Earnings may include commissions overtime or differentials. If you become disabled and can work part-time (but not full-time), you may be eligible for partial disability benefits, which will help supplement your income until you are able to return to work full-time. Disabilities that occur during the first 12 months of coverage due to a pre-existing condition treated within the 3 months prior to coverage are excluded. Premiums are based on age

36 -Paycheck Insurance-

37 -Paycheck Insurance-

38 Long-Term Disability Kansas City Life (Voluntary benefit paid by the employee) Benefits Elimination Period: Maximum Monthly Benefit: Maximum Benefit Duration: Own Occupation Period: Disability Waiver of Premium: Pre-Existing Condition: Benefit Limitations: Premiums are based on age Your benefits begin 180 days after the onset of Your disabling injury or illness. 60% of monthly salary up to $5,000 per month (less other income sources) If You become disabled prior to age 62, benefits are payable to age 65 or Social Security Normal Retirement Age. At age 62 (and older), the benefit period will be based on a reduced duration schedule. 24 months (see definition of disability) Disability and disabled mean that because of an injury or illness, a significant change in your mental or functional abilities has occurred, for which you are: Prevented from performing at least one of the Material Duties of your regular Occupation on a full-time or part-time basis; and unable to generate current earnings which exceed 80% of your basic monthly earnings due to that same injury or illness. After a monthly Benefit has been paid for 24 months (the Own Occupation Period), Disability and Disabled mean You are unable to perform all of the Material Duties of any Gainful Occupation. Disability is determined relative to Your ability or inability to work. It is not determined by the availability of a suitable position with Your employer. You will not be required to pay premium for as long as you are entitled to receive monthly benefits, provided the premium is paid during the Elimination Period. Disabilities that occur during the first 12 months of coverage due to a pre-existing condition for which you were treated during the 3 months prior to coverage are excluded. Mental Illness & Substance Abuse: Benefits will be paid for up to 24 months

39 Supplemental Voluntary Benefits Allstate (Voluntary benefits paid by the employee) These coverages are: Available to employees/spouses 18+ years of age and Child(ren) to age 26 These coverages are portable Benefits are paid with pre-tax premiums Plans Available Critical Illness Cancer Accident Refer to Allstate brochure for more complete description of benefits.

40 Supplemental Voluntary Benefits Allstate

41 Things To Do Dead Line Friday, May 26 th All Employees must access online enrollment system or call the # All Employees must log in and confirm benefit elections effective June 1 st 2017 All Employees must verify their name, address and dependent information Any new elections or changes to current elections must be completed by the Dead Line If you do not change or waive medical coverage and you are currently enrolled in a medical plan, you will be automatically defaulted to the $3000 Deductible Plan Any new Voluntary Life elections or benefit increases, must include a completed Evidence Of Insurability form Not electing coverage? You must Waive coverage

42 Thank you for your attention!