Employee Benefits Open Enrollment. Effective October 1, 2016

Transcription

1 Employee Benefits Open Enrollment Effective October 1, 2016

2 FILICE INSURANCE Employee Benefits Brokerage & Consulting Firm Dedicated Account Management Team Coralynn Quimio: Client Services Manager Charlie Weckel & Mario Gosalvez: Benefit Consultants Dawn Alvarez: Client Services Director Patrick Arnold: President Plan Participant Assistance: Claims, Carrier Issues, etc. Open Enrollment & Ongoing Benefit Questions Customized Benefits Website: Dedicated Support Line:

3 OPEN ENROLLMENT Once a year opportunity to: Change plans Add or drop coverage for yourself Add or drop coverage for your dependents Double check beneficiaries 3

4 MID YEAR QUALIFYING EVENTS What changes can I make outside of Open Enrollment? If you do not make changes during open enrollment, the only time you can make an election or enrollment change is if you experience an eligible qualifying event. You have 30 days from the date of the qualifying event to make changes. Common examples of qualifying events include, but are not limited to the following: Marriage or Domestic Partner Union Divorce or Legal Separation Birth or Adoption Loss of Coverage Elsewhere 4

5 Insurance Carriers Effective 10/1/16 Medical: Kaiser 3 HMO Plans: $15 Copay, $30 Copay, H.S.A. Compatible HMO (New) Health Net 2 PPO Plans (Platinum and Gold) Sutter Health Plus 2 Plans: $25 HMO and $1,000 Deductible HMO (New) (Note: Kaiser $1,000 Deductible HMO and Health Net Silver PPO plans will no longer be offered) Dental: (New) replacing Assurant Vision Discount Program: VSP via MetLife replacing Assurant Life/AD&D and Long Term Disability: Unum (New) replacing Assurant Voluntary Term Life /AD&D Voluntary Short Term Disability Health Savings Account (H.S.A.) Administrator: Navia Benefits Solutions (New) Employee Assistance Program (EAP): Unum (New) Flexible Spending Account (FSA): ADP 5

6 KAISER 6

7 KAISER H.S.A. How Insurance Works on an H.S.A. With an H.S.A. plan, patients are responsible for all medical expenses until the Calendar Year Deductible is reached. After the Deductible is met, the Co Insurance phase kicks in. During Co Insurance phase, patients will only be responsible for 30% of medical expenses or a copay if filling a prescription. Over the course of a year, the Deductible, 30% Co Insurance, and Rx Copays all accumulate towards Out of Pocket maximum total. The Out of Pocket Maximum is the maximum dollar liability an individual or family would face in a calendar year H.S.A. s may be established at a financial institution of your choice or through Navia Benefits Solutions. 7

8 HEALTH SAVINGS ACCOUNTS WHAT IS AN H.S.A.? An H.S.A. is a tax advantaged savings account separate from your Insurance plan The IRS allows individuals to set aside tax protected money to be used for qualified medical expenses. To be eligible for an H.S.A. you must participate in the High Deductible (H.S.A. compatible) plan option Stratford employees would need to enroll in the Kaiser H.S.A. $2,700 plan Contributed funds to your H.S.A. can be used for eligible medical expenses Examples: Medical plan deductible expenses, prescription drugs, copays, co insurance, as well as dental, and vision care expenses. How much can I contribute? For 2016 the IRS limits are $3,350 for Singles, and $6,750 two or more enrolled in the Health Plan. All contributions can be written off of your Federal Gross Income tax (Pre Tax or Post Tax) CA does not allow the write off on state income taxes. What happens to the H.S.A. money if I don t use it that year, or I leave the organization? There are no Use it or Lose it provisions with H.S.A. accounts. Unused money rolls over year to year. If you leave your job, the money goes with you it is your personal bank account for medical expenses. At age 65, you are no longer required to use the money for qualified medical expenses 8

9 HSA (CONTINUED): Who can use the money in my H.S.A. Account? An individual or their dependents even if those dependents are not enrolled on the H.S.A. plan. The money must be used for Qualified Medical Expenses. What is a Qualified Medical Expense? A qualified medical expense is one for medical care as defined by Internal Revenue Code Section 213(d). The expenses must be primarily used to alleviate or prevent a physical or mental defect or illness, including dental and vision. See HSA Eligible Expenses link under H.S.A. tab, at Common Expenses that DO NOT fall under Qualified Medical Expenses Over the Counter Drugs (Non Prescribed) Cosmetic Surgery Health club or Gym dues Toothpaste, toiletries, and cosmetics H.S.A Savings Dollars Can Also Be Use For: Dental and Vision expenses COBRA Premiums (i.e.) Health premiums when you're between jobs Qualified long term care premiums Health premiums after age 65 (but NOT Medicare supplements) 9

10 How to enroll: Health Savings Accounts (HSA) After electing the Kaiser H.S.A. eligible health plan you will receive a confirmation from Navia Benefits with instructions on how to get started opening your new HSA bank account. They can also assist with providing you with an HSA transfer form to transfer your current account. HSA Administrative Cost to Employee = $4 per month Hours: Mon Fri, 5am 5pm PST Phone: Toll Free: Questions customerservice@naviabenefits.com Claim Submissions claims@naviabenefits.com How to Open Your HSA (video) > H.S.A. Enrollment

11 HEALTH NET 11

12 Stratford School 2016 Open Enrollment Member Services

13 Bay Area Service Area 13

14 Provider Search Tools sutterhealthplus.org/providersearch When you join Sutter Health Plus, each family member will need to choose a primary care physician (PCP). Your PCP provides most of your primary health care and coordinates care you may need from other providers. Your PCP will refer you as needed to providers for specialty care, X-ray, laboratory and other medical services. If you do not choose a PCP, you will be assigned one. When you choose your PCP, you are also selecting a medical group. 14

15 Health Plan Options 15

16 Member Tools and Resources Comprehensive medical benefits A full range of pharmacy benefits A 24/7 nurse advice triage line Wellness and care management programs Preventive care services and immunizations Member and Employer Portals MedImpact Member Portal My Health Online* Coverage for emergency care anywhere in the world *Not offered by all providers 16

17 DENTAL INSURANCE - DMO/Managed Care Plan - PPO Low Plan - PPO High Plan

18 Dental Plan Options

19 How does the DMO/Managed Care plan work? Benefits are available through a broad network of participating dentists and specialists There are no out-of-network benefits, unless the member has an out of area emergency Each family member enrolling must select a participating dentist Network Type = Dental HMO/Managed Care Network Plan = Met185 No waiting periods, claims forms, deductibles, or annual maximums Please refer to Schedule of Benefits for covered services & copayments

20 How do the PPO plans work? MetLife PPO plan members have the freedom to see any dentist Greater savings can be realized when visiting a participating PPO dentist Participating PPO dentists agree to a negotiated fee schedule that is generally 15-45% below average charges PPO Network = MetLife PDP Plus PPO Low Plan Out of Network benefits will be paid based on In Network negotiated fee schedule PPO High Plan Out of Network benefits will be paid based on the 90 th Percentile of Reasonable and Customary Charges

21 After You Enroll Register with MyBenefits today! AND download our MetLife Application in your App Store Customer Service Information Preferred Dentist Program (PPO) Dental HMO/Managed Care Plan

22 MetLaw An Important Benefit for You to Consider

23 COVERED SERVICES Debt Collection Defense Identity Theft Adoption Immigration Assistance Tenant Negotiations Sale of a Home Real Estate Matter Mortgages Traffic Ticket Defense (No DUI) Living Wills Powers of Attorneys Wills Name Change Administrative Hearings Civil Litigation Defense Incompetency Defense Deeds Demand Letters Telephone and Office Consultations And more. 23

24 COST EFFECTIVE $22.50 / month Convenience of payroll deduction 14,000+ Network Attorneys No waiting periods or claim forms No deductibles or copayments No fees for covered services 1. Fees for legal services are based on the average amount of hours it would take using the average hourly rate of $290.00/hour based on years of legal experience. National Law Journal and ALM Legal Intelligence, Survey of Law Firm Economics (2013). 2. The cost for MetLaw is based on an average rate of $18 per month. Prices may vary. 24

25 EASE OF USE Locating a Network Attorney STEP 1 Call Hyatt Legal Plans at , reference your company name or group number and a Client Service Representative will assist you in locating a network attorney in your area and provide a case number. STEP 2 Call your attorney and provide your case number to make an appointment. STEP 3 You re done! When using a network attorney, no claim forms or co payments are required the attorney handles all the paperwork. 25

26 Disability: What s the risk? Consider the odds A disability can come out of nowhere Every 10 minutes 700 Americans suffer an injury severe enough to seek medical help. 1 That s 37 million per year. 2 Most injuries are not work-related, and therefore not covered by workers compensation. 3 But injuries aren t the only reasons you might not be able to work Approximately 90% of all disabilities are caused by illnesses rather than accidents. 4 1,2,3 National Safety Council, Injury Facts (2014). 4 Council for Disability Awareness, Chances of Disability: Me, Disabled? (2012; accessed Jun. 15, 2014), 26

27 Long Term Disability Insurance INCOME PROTECTION Long Term Disability - Benefits begin after 90 days of being sick or injured and unable to work - Benefit pays 60% income replacement up to $6,000/month Does offset with state disability - Pays until age 65 (2 years own occupation coverage) 27

28 Voluntary Short Term Disability Insurance INCOME PROTECTION Employee Funded - Guarantee Issue - Benefits begin after 7 days of being sick or injured - Benefit pays 66.67% income replacement up to $1,500/week Does offset with state disability - Pays for 12 weeks If you still cannot return to work after 12 weeks, then Long Term Disability kicks in 28

29 Life/AD&D Insurance & Voluntary Life/AD&D ESTATE PLANNING Employer Funded $25,000 (Life and AD&D) Accelerated benefit - 75% Age reduction: starts at age 65 Portable Employee Funded additional life/ad&d insurance Employee and dependent coverage options Guarantee issue options no medical questions Conveniently payroll deducted Portable Anyone who currently has voluntary term life coverage will be rolled into the Unum plan 29

30 Voluntary Life/AD&D Plan features Eligibility: Employees working a minimum of 30 hours per week Volunary Life/AD&D Coverage Options: Employee coverage choices: 5 X your annual salary in increments of $10,000 to a maximum benefit of $500,000 * Employee Guarantee Issue Amount: You can elect up to $150,000 of coverage without having to answer any medical questions! Spouse coverage choices: Up to 100% of your elected coverage in increments of $5,000 to a maximum benefit of $500,000 * Spouse Guarantee Issue Amount: You can elect up to $50,000 of coverage for your spouse without having to answer any medical questions! Child(ren) coverage choices: Up to 100% of your elected benefit in increments of $2,000 to a maximum benefit of $10,000 (all coverage is guarantee issue) Accidental Death and Dismemberment paid in addition to the life benefit if you or a covered dependent: Die in a covered accident or suffer a covered dismemberment or disability Accelerated Death Benefit: 75% to $500,000 Age Reduction: 65% at age 70 and 50% at age 75 30

31 Reasons to buy now Flexible coverage Guaranteed issue during this enrollment Competitive group rates Convenient payroll deduction Portable - you have the opportunity to continue coverage should you leave or retire from the company 46% of Americans die with less than $10,000 in financial assets, or none at all. 1 31

32 Guarantee Issue Protection GET YOUR FOOT IN THE DOOR If you and your dependents enroll in at least the minimum amount of coverage at this initial offering ($10,000 for employee, $5,000 for spouse, and $2,000 for children) you protect your ability to buy up to the guarantee issue maximums at any future annual enrollment. 63% of life insurance owners obtained all or some of their coverage through the workplace. 2 32

33 Employee Assistance Program Find help to everyday challenges of work, home, and emotional wellbeing Examples: Child/elder care referrals Personal relationship information Legal consultations with licensed attorneys Financial planning assistance Unlimited 24/7 access to telephonic consultations Master s Level Counselors Meet face-to-face with a local consultant 3 x per issue per 6 months 33

34 World Wide Emergency Travel Assistance When traveling for business or pleasure at least 100 mi. from home One call away for emergency assistance Examples: Emergency medical evacuation Prescription replacement assistance Hospital admission coordination Lost luggage 34

35 YOUR HEALTHCARE COSTS: 35

36 YOUR HEALTHCARE COSTS: 36

37 FLEXIBLE SPENDING ACCOUNTS (FSA) Flexible Spending Accounts - FSA FSAs help you pay eligible health care and dependent care expenses on a pre-tax basis. You must make new elections every year! Tax Advantage: When you contribute pre-tax dollars to your FSA, you ll also lower your overall taxable income. There are two components of the FSA that you can take advantage of: Health Care FSA - $2,550 Annual Max to use towards eligible medical, Rx, dental and vision expenses. Dependent Care FSA - $5,000 Annual Max towards child and adult day care expenses. -Additionally- Limited Purpose FSA - For H.S.A. participants (to be used for dental and vision expenses only) Use-It-or-Lose-It! Unused dollars are NOT returned to you! 37

38 NEXT STEPS: You must log into and elect your plan selections for the coming plan year. You will need your social security number as well as your dependent s social security numbers and birthdates. You should also double check that your information is correct. Enrollment Period Begins: Friday, September 2 Concludes: Friday, September 9 38

39 Questions? If you have questions or would like additional information, please contact your Benefits Manager, Sharon Coate at or our Client Service Support Team and Filice Insurance or e mail via the following link: benefits@stratfordschools.com Stratford Benefits Website 39