Unified School District of De Pere Health Plan Changes Tim Deaton The Horton Group N19 W24101 N. Riverwood Drive Waukesha, WI 53188

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1 Unified School District of De Pere Health Plan Changes Tim Deaton The Horton Group N19 W24101 N. Riverwood Drive Waukesha, WI 53188

2 Meeting Agenda Health Plan Changes 2014 Medical Plan Options 2014 Tim Deaton Plan Design Changes Rx Plan Changes New Monthly Premium Health Payment Systems (HPS) Jamie Dietzler

3 Medical Plan Updates Same Administrator Auxiant Same Network HPS/Trilogy Health Plan Change High Deductible Health Plan (HDHP) Prescription Plan Serve-You

4 Current Health Plan Plan In-Network Out-of-Network Deductible per Single $100 $250 Deductible per Family $200 $500 Maximum Out of Pocket per Single $100 $2000 Maximum Out of Pocket per Family $200 $4000 Hospital/Coinsurance 100% after deductible 70% after deductible Emergency Room Services $50 Copay Urgent Care Services $0 70% after deductible Office Visit Copays Primary Care Physician Specialist $0 $0 70% after deductible 70% after deductible Preventive Services 100% 70% after deductible Prescription Drugs $7 generics - $20 Preferred brands $35 Non-Preferred Brands

5 New Plan Plan In-Network Out-of-Network Deductible per Single $1,650 $3,300 Deductible per Family $3,300 $6,600 Maximum Out of Pocket per Single $1,650 $5,000 Maximum Out of Pocket per Family $3,300 $10,000 Hospital/Coinsurance 100% after deductible 70% after deductible Emergency Room Services 100% after deductible Urgent Care Services 100% after deductible 70% after deductible Office Visit Copays Primary Care Physician Specialist 100% after deductible 100% after deductible 70% after deductible 70% after deductible Preventive Services 100% 70% after deductible Prescription Drugs 100% after deductible (no copays)

6 No Copays for: Changes to HDHP Office Visits Prescriptions Emergency Room / Urgent Care All services go to deductible

7 HDHP changes to pay attention to: Still get Rx discounts through Serve-You but will pay entire discounted cost of medication. Rx costs apply to deductible

8 2013 Premium vs Premium Monthly Premium Single $ $ Family $1, $1,431.00

9 What is a Health Savings Account (HSA)? A Health Savings Account (HSA) is an account you own that you put money into for medical expenses now and in the future. A High Deductible Health Plan (HDHP) works in conjunction with the Health Savings Account

10 HSA Overview Use HSA funds to pay for routine expenses Once you meet your deductible, your high deductible health plan begins to pay You can use HSA funds for yourself, your spouse, and your children Use your Health Savings Account to save for future expenses YOU decide how to save and spend on healthcare

11 Advantages for Enrollees in the High Deductible Health Plan (HDHP) who contribute to a Health Savings Account (HSA) Every enrollee Receives triple tax savings on: contributions, earnings, and withdrawals Is in control of personalized healthcare Is rewarded for staying healthy Obtains reduced health care premiums

12 Who is eligible for an HSA? You are enrolled in a qualified High Deductible Health Plan (HDHP) And You re NOT Enrolled in Medicare A dependent on another s tax return Covered by another health plan ( some exceptions apply) You must adhere to contribution and distribution rules: Distributions are used only for IRS qualified medical expenses

13 HSA Contribution Amounts: 2014 Annual Contribution Maximum If age 55+, you can contribution an additional: Self-only $3300 $1000 Family $6550 $1000 The amount that can be contributed from all sources for 2013 is $3300 for self-only coverage and $6550 for family coverage, regardless of what month of the year you open your HSA account. These amounts are indexed annually.

14 Setting up and Funding your Health Savings Account A Health Savings Account can be set up at almost any bank. Check with your personal bank. To open a Health Savings Account, you may be asked to show your enrollment form Your future contributions to your account can be made via payroll deductions. Deductions can be set at any amount. To fully fund family deductions ($3300) = $137.50/bi-week based on 24 pay periods OR = $165.00/ bi-week based on 20 pay periods To fully fund single deductions ($1650) = $68.75/bi-week based on 24 pay periods OR = $82.50/ bi-week based on 20 pay periods

15 How Your HSA Works Enroll in the High Deductible Health Plan Establish a Health Savings Account at your financial institution of your choice Choose how much to contribute to your HSA Start receiving care Pay via debit card or check from your savings account from you Health Savings Account Keep track of you expenses for your tax returns Funds roll over from year to year Your Health Savings Account is portable

16 Qualified HSA Medical Expenses Based on IRC Section 213(d) Physician office visits Lab work X-Rays Prescription drugs Dental services Vision care including glasses and Lasik surgery Medically related transportation and lodging Certain health premiums including COBRA This is a partial listing. IRS Publication 503 gives a complete list.

17 Flexible Spending Account (FSA) Medical Flexible Spending Account through WageWorks is not going to be offered in *You are still eligible to participate in the Dependent Care reimbursement plan in 2014 ($5,000 annual limit)*

18 De Pere School District Overview Present ID card when seeing provider - Look for the HPS Logo - ALWAYS PRESENT YOUR CARD TO YOUR HEALTHCARE PROVIDER! No pre-payment required for an HPS provider Receive HPS SuperEOB Pay bill as directed Bringing clarity to healthcare confusion

19 The SuperEOB Please refer to the sample SuperEOB included in your hand-outs Family Based Monthly Statements Credit Card-like Statement Bringing clarity to healthcare confusion

20 Health Payment Systems Contracted Providers* Affinity Health System - Mercy Medical Center (Oshkosh) - St. Elizabeth Hospital Agnesian Health Care Appleton Medical Center Aurora Advanced Health Care Aurora Health System - All locations BayCare Clinic Beaver Dam Community Hospital Bellin Health Systems Columbia St. Mary s All locations Community Health Network (CHN)/Berlin Hospital Community Memorial Hospital Door County Memorial Hospital Froedtert Health All locations Gundersen Lutheran Health System Holy Family Memorial Independent Physicians Network (IPN) Medical College of Wisconsin Meriter Hospital and Affiliated Physicians Ministry Health Care - All locations New London Family Medical Center Oconomowoc Memorial Hospital Physician s Health Network of Sheboygan (PHN) Prevea Clinic ProHealth Care Medical Associates Ripon Medical Center Riverside Medical Center Rogers Memorial Hospital Shawano Medical Center St. Joseph s West Bend St. Mary s Hospital Green Bay St. Nicholas Hospital St. Vincent Hospital The Sleep Wellness Institute ThedaCare Physicians and Affiliates Theda Clark Medical Center UW Hospital & Clinics Waukesha Memorial Hospital Wheaton Franciscan Healthcare * See our Website for a complete list of Providers Bringing clarity to healthcare confusion

21 Health Payment Systems Provider Search Bringing clarity to healthcare confusion

22 Payment Plans Balance of $0.00 to $50.00 The balance is to be paid in full. Balance of $50.00 and greater minimum monthly payment of $50.00 or 8% of the initial balance, whichever is greater. If you are unable to pay the amount due as calculated using the above Payment Plan Guidelines, call the HPS Billing Department at as soon as possible. A HPS member advocate will assist you in establishing a personalized payment plan. If you incur additional charges after your original payment plan is established, you have the option to add the new charges to your existing payment plan balance. In order to do so, you MUST call the HPS billing department at to make the request. Bringing clarity to healthcare confusion

23 QUESTIONS? Tim Deaton, The Horton Group Jaime Dietzler, Health Payment Systems, Inc Stay Healthy!!

24 High Deductible Health Insurance Plan [Effective January 1, 2014 ] Unified School District of De Pere 1700 Chicago Street De Pere, WI 54115

25 In Network Deductible Levels Effective January 1, 2014 $1,650 Single Plan $3,300 Family Plan

26 Premium Waiver for Full Time Employees Full time employees will be eligible for a premium waiver by meeting the required participation standard. Part time employees will continue premium share on a prorated basis. Who is a Full Time Employee? Support Staff Professional Staff hrs./week 1.0 FTE

27 Required Participation Standard Flu Vaccination Submit one of the following to on-site Aurora nurse, Connie Scheld Proof of Flu Vaccination, or Medical Exemption Form, or Religious Exemption Form

28 Single Policy Employee submits proof of receiving the flu vaccination. Family Policy Employee submits proof of receiving the flu vaccination. Employee submits proof that significant other (spouse or domestic partner) who is participating in the district s health insurance received the flu vaccination.

29 Timeline November 30, 2013: December 15, 2013: January 1, 2014: Deadline to submit proof of vaccination or exemption to Connie Scheld, Aurora Nurse. Full time employees who meet the participation standard will have their premium share waived for the 2014 calendar year. (Note: January health insurance premiums are deducted in December) New High Deductible Health Plan Takes Effect.

30 Timeline HSA Payroll Deduction January 3, 2014: Employees who wish to contribute to a Health Savings Account through payroll deduction (beginning with the January 15, 2014 paycheck) must submit the following to Bruce Moeller by January 3rd: 1. A salary deduction form 2. HSA account information.