Health Care Plan Open Enrollment

Transcription

1 Health Care Plan Open Enrollment

2 Agenda ACA Update Benefits update Health Care plan review Tips to save health care dollars FSA Open Enrollment Dental Open Enrollment Vision Open Enrollment

3 Employee Benefit Plan Updates OWU will be renewing with Anthem Deductibles, coinsurance, and out-of-pocket maximums will remain the same Medical and Rx co-pays will be changing The dental plans will be changing to Anthem effective 7/1/16 NEW FSA/DCA vendor, HRPro effective 7/1/16

4 Employee Benefit Plan Updates OWU will continue to offer The OWU Wellness Program to all employees. Opportunity to reduce your health care premiums or earn cash incentive for non-medical plan participants!

5 Taxes and Fees Employer Taxes Mandated by PPACA 1. Patient Centered Outcomes Research Fee - Due July 31, $2.08 per average covered member in 2015 ($1,595.36) 2. Transitional Reinsurance Fee - Due January 15, $2.25 per covered member per month in 2016 ($11,191.50) $12, July 16-June 17 OWU s approximate spend for PPACA 5

6 Individual Obligations If person chooses not to have insurance they will owe a tax: * Greater of 1% of income or $ * Greater of 2% of income or $ * Greater of 2.5% of income or $695, indexed and later * Per adult; children 50%; family max of 3x individual

7 User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Options HSA/HRA Employer Contribution? Narrow Network Options Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $1, $50.00 Coinsurance (%, Insurer's Cost Share) 90.00% % OOP Maximum ($) OOP Maximum if Separate ($) $3, Click Here for Important Instructions Tier 1 Tier 2 Tier 1 Tier 2 Type of Benefit Subject to Deductible? Subject to Coinsurance? Coinsurance, if different Copay, if separate Medical All All Emergency Room Services $ All Inpatient Hospital Services (inc. MHSA) Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X- rays) $30.00 Specialist Visit $60.00 Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT/PET Scans, MRIs) Rehabilitative Speech Therapy Subject to Deductible? Subject to Coinsurance? Coinsurance, if different Rehabilitative Occupational and Rehabilitative Physical Therapy Preventive Care/Screening/Immunization 100% $ % $0.00 Laboratory Outpatient and Professional Services X-rays and Diagnostic Imaging Skilled Nursing Facility Outpatient Facility Fee (e.g., Ambulatory Surgery Center) All All Copay, if separate Copay applies only after deductible? All All Outpatient Surgery Physician/Surgical Services Drugs All All Generics $10.00 Preferred Brand Drugs $35.00 Non-Preferred Brand Drugs $70.00 Specialty Drugs (i.e. high-cost) 25% Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: $250 Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 80.40% Metal Tier: Gold All All All All

8 OWU Contribution Options < $35,999 EE/Count Current/ Month Renewal/ Month EE only 62 $39.00 $42.00 EE + SP 14 $ $ EE + Children 6 $ $ EE + Family 19 $ $ $36,000 - $59,999 $60,000 - $89,999 > $90,000 EE only 71 $66.00 $71.00 EE + SP 15 $ $ EE + Children 5 $ $ EE + Family 36 $ $ EE only 51 $92.00 $99.00 EE + SP 17 $ $ EE + Children 4 $ $ EE + Family 51 $ $ EE only 21 $ $ EE + SP 8 $ $ EE + Children 5 $ $ EE + Family 19 $ $538.00

9 How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2, ,546 <$35,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $42 $130 $126 $130 $103 $123 EE+1 EE+CH $162 $386 $346 $287 $358 $322 EE+SP $180 $490 $417 $343 $436 $395 Family $285 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 7.1% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 14.4% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 14.5% 47.9% 42.1% 37.7% 39.8% 37.3% Family 16.4% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

10 How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2, ,546 Employee Share of Premiums Monthly Employee Premium Share ($) $36,000-$59,999 Single $71 $130 $126 $130 $103 $123 EE+1 EE+CH $216 $386 $346 $287 $358 $322 EE+SP $239 $490 $417 $343 $436 $395 Family $370 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 12.0% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 19.2% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 19.3% 47.9% 42.1% 37.7% 39.8% 37.3% Family 21.2% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

11 How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Survey Benchmarks Client Nationa Regional State l Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2, ,546 Employee Share of Premiums Monthly Employee Premium Share ($) $60,000- $89,999 Single $99 $130 $126 $130 $103 $123 EE+1 EE+CH $270 $386 $346 $287 $358 $322 EE+SP $299 $490 $417 $343 $436 $395 Family $454 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 16.8% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 24.1% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 24.1% 47.9% 42.1% 37.7% 39.8% 37.3% Family 26.1% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

12 How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2, ,546 Employee Share of Premiums Monthly Employee Premium Share ($) >$90000 Single $127 $130 $126 $130 $103 $123 EE+1 EE+CH $324 $386 $346 $287 $358 $322 EE+SP $358 $490 $417 $343 $436 $395 Family $538 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 21.5% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 28.9% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 28.9% 47.9% 42.1% 37.7% 39.8% 37.3% Family 30.1% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

13 How Does OWU Compare? PLAN DESIGN Ohio Wesleyan University Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2, ,546 CoPays Primary Care Physician CoPay $30 $25 $25 $25 $20 $25 Specialty Care Physician CoPay $60 $35 $40 $35 $30 $30 Urgent Care CoPay $75 $50 $50 $50 $45 $40 Emergency Room CoPay $250 $150 $150 $200 $150 $100 Separate In-Hospital Admission CoPay $250 $250 $300 $225 $250 In-Network Benefits Deductible - Single $1,000 $1,000 $1,000 $1,000 $500 $750 Deductible - Family $2,000 $3,000 $2,000 $2,000 $1,500 $1,500 Plan Coinsurance 90% 80% 80% 80% 80% 80% Out-of-Pocket Maximum - Single $3,500 $3,000 $3,000 $2,500 $2,250 $2,500 Out-of-Pocket Maximum - Family $7,000 $7,500 $6,000 $5,000 $5,000 $6,000 Out-of-Network Benefits Deductible - Single $2,000 $2,000 $2,000 $2,000 $1,000 $1,000 Deductible - Family $4,000 $4,000 $4,000 $4,000 $2,000 $3,000 Plan Coinsurance 70% 60% 60% 60% 60% 60% Out-of-Pocket Maximum - Single $7,000 $6,000 $6,000 $6,000 $4,000 $5,000 Out-of-Pocket Maximum - Family $14,000 $14,000 $14,000 $13,000 $9,000 $10,500

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15 Anthem PPO Plan What are the amounts of the co-payments? Doctor Office Visits (In-Network) Primary Care Specialty Care $30.00/visit $60.00/visit Urgent Care Centers $75.00/visit (In/Out-of-Network) Emergency Room $ Co-pay/visit; Then you pay 10% (In/Out-of/Network) All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription drugs.

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17 Preventive Care Covered at 100% in-network

18 Preventive Care Covered at 100% in-network

19 Preventive Care Covered at 100% in-network

20 co-branding logo here LiveHealth Online. See a doctor 24/7 with LiveHealth Online Meet with a doctor via video, chat or phone Choice of credentialed providers Accessibility anytime, anywhere No appointments or waiting rooms

21 Anthem Plan Benefits Prescription Drug Benefit Retail $10 Co-Pay for Tier 1 Drugs $35 Co-Pay for Tier 2 Drugs $70 Co-Pay for Tier 3 Drugs 25% to a Max of $250 for Tier 4 Drugs $50 deductible applies then copays Maximum 30 day supply per prescription *Anthem formulary list of all 4 copay tiers is available on the OWU HR web page.

22 Anthem Plan Benefits Prescription Drug Benefit Mail Order* $10.00 Co-Pay for Tier 1 Drugs $70.00 Co-Pay for Tier 2 Drugs $ Co-Pay for Tier 3 Drugs 25% to a Max of $250 for Tier 4 Drugs Maximum 90 day supply per prescription; Tier 4 30 day supply, includes diabetic test strips *Anthem formulary list of all 4 copay tiers is available on the OWU HR web page.

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25 Tips To Save $$$ Verify your doctor and the provider is in Anthem s network Remind the receptionist that your co-pay for a preventive care visit is $0 Confirm preventive care procedures are eligible prior to the appointment & that it will be billed as a preventive when leaving the provider s office Verify physician referrals to labs/facilities are in the network Utilize Anthem s transparency tool to save money Request in-office tests such as lab/x-ray be sent to an in-network lab or physician for evaluation Always reference Anthem s Explanation of Benefits (EOB) prior to paying the provider Take the Preferred Drug List with you to the doctor visit Request generic drug when available Request drug samples from your doctor

26 OWU PPO Plan Calendar Year Deductible $1,000 Per Person $2,000 Family Maximum Your Individual Out-of-Pocket Expenses $1,000 Co-Insurance after the Deductible (Per Calendar Year) 90% of next $25,000 10% of next $25,000 + $2,500 $3,500 Insurance Company Pays (Per Calendar Year) 100% Total Out-of-Pocket Expense Per Person ($7,000 Family Maximum) All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription copayments.

27 Anthem PPO Plan Diagnostic Testing Services In-Network MRI s 100% CT Scans 100% PET Scans 100% Nuclear Medicine 100% X-Ray s/radiology 100%

28 ANTHEM PPO PLAN In-Network Deductible $1,000 Per Person $2,000 Family maximum Out of Pocket* $3,500 Per Person (including deductible) $7,000 Family maximum (including deductible) Out-of-Network Deductible $2,000 Per Person $4,000 Family maximum Out of Pocket* $7,000 Per Person (including deductible) $14,000 Family maximum (including deductible) *Out-of-Pocket maximums include co-payments in-network

29 ConditionCare Receive guidance on following your care plan Consult with nurse coaches Better manage your health

30 HEALTH MANAGEMENT TOOLS ConditionCare helps participants manage the following conditions: Asthma (Pediatric & Adult) Chronic Obstructive Pulmonary Disease Coronary Artery Disease Diabetes (Pediatric & Adult; Types 1 & 2) Heart Failure

31 24/7 NurseLine Receive instant health care information Consult with registered nurses Available by phone 24 hours a day, toll-free 31

32 Tools to help you choose Open Enrollment book Read this guide to help compare your plan options Find a Doctor Search for information about doctors in your area Interactive Videos Learn more about your health plan and how to effectively use it Estimate Your Cost Find cost estimates for common inpatient, outpatient and diagnostic services 32

33 ANTHEM Dependent Age Status End of the month in which the dependent turns 26 unless the dependent is eligible for another employer-sponsored health plan other than that of a parent

34 WHO TO CALL WITH QUESTIONS Anthem Member Services: Benefit Information Claim Inquiries Provider Searches Changes to member data ID Cards, Provider Directories

35 FLEXIBLE SPENDING ACCOUNT

36 PLAN DETAILS Ohio Wesleyan University Sponsored Plan Allowing Faculty and Staff to Make Pre-Tax Contributions for: Health Care Account Dependent Care Account Eligibility Requirements All full time Faculty and Staff $2,550 Annual Election Maximum $5,000 Annual Election Maximum Do not need to participate in the Medical; Dental or Vision Plan Annual Voluntary Election May not have a HSA and a Health Care FSA (IRS Rule) Plan year will begin July 1, 2016 June 30, 2017

37 FSA BENEFITS CARD Your employer offers a limited use FSA Benefits Card for you to use to pay for your FSA eligible expenses. The FSA Benefits Card allows employees participating in a FSA (medical or dependent care) to pay for eligible expenses at point of service - No more paying cash, and waiting for reimbursement The FSA Benefits Card can be used at eligible merchant locations such as: Doctor and Dentist offices Pharmacies Vision service locations Dependent care facilities (available funds are limited to actual account balance)

38 HOW TO FILE A CLAIM File claims online at hrpro.biz and click on the Login button in the top right corner Complete paper claim form and fax, mail or with itemized receipts or provider Explanation of Benefits (EOBs) to HRPro: Fax: (248) accounts@hrpro.biz Mail: 1423 East 11 Mile Road Royal Oak, MI 48067

39 HOW TO SET UP DIRECT DEPOSIT Complete the Direct Deposit Authorization Form For checking accounts, attach a voided check (or photocopy of a check) For savings accounts, attach a deposit slip Once complete, fax all information to HRPro at

40 SMARTPHONE MOBILE APP There is a mobile app available to view your account balance from your smartphone. You are able to upload your itemized receipts and attach them to claims on the Employee Portal or from your smartphone. This works for claims you submit for reimbursement and debit card transactions requiring documentation for substantiation.

41 ELIGIBLE EXPENSES Health Care Account Medical, Dental and Vision expenses Deductible Coinsurance Co-payments for office visits, prescription drugs, etc. Some Expenses not covered by insurance Dependent Care Account Daycare expenses during work hours Daycare/babysitting for children under 13 Preschool programs After-school care Home care for disabled dependent age 13 and over

42 ELIGIBLE EXPENSES Day Care expense must be to provide gainful employment If married, spouse must also be employed Dependent must reside with employee Payment for providing care may not be made to another dependent Care provider must disclose TAX ID #

43 DENTAL PLANS

44 KEY FEATURES OF THE DENTAL PLANS Your choice of a Low and High Plan 100% for Routine Preventive services (1) Administrated by the Anthem Benefits are subject to Anthem Contract Limitations

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46 KEY FEATURES OF THE DENTAL PLANS Receive your care from the Dentist of your choice No Network Requirement Optional network of dentists to receive a discount for services Benefits are subject to Anthem Contract Limitations

47 LOW DENTAL PLAN Deductible Amount = $50.00/Person/year; Family Max (3) Preventive Plan Pays 100% In-Network 90% Out-of-Network (No Deductible) Oral Exams Teeth Cleanings X-Rays Basic Plan Pays 80% In-Network 60% Out-of-Network Amalgam fillings Front composite fillings Simple Extractions Calendar Year Maximum Amount $1,000 per person Major Plan Pays 50% in-network 25% out-of-network Periodontics Endodontics Oral Surgery Crowns Dentures Bridges Dental implants Those who are actively managed in the Anthem Diabetic or Maternal Health Care Management programs will be eligible for an additional dental cleaning or periodontal maintenance procedure per benefit period.

48 HIGH DENTAL PLAN Deductible Amount = $50.00/Person/year; Family Max (3) Preventive Plan Pays 100% In-Network 100% Out-of-Network (No Deductible) Oral exams Teeth cleaning X-Rays Basic Plan Pays 90% In-Network 80% Out-of-Network Sealants Amalgam Filling From Composite Filling Back Composite Filling Simple Extractions Major Plan Pays 60% In-Network 50% Out-of-Network Periodontics Endodontics Oral Surgery Crowns Dentures Bridges Dental Implants Calendar year max amount $1,000 Calendar year max amount $1,500 (Anthem Dental Providers) Orthodontics 50% $1,000 Child only Lifetime max Those who are actively managed in the Anthem Diabetic or Maternal Health Care Management programs will be eligible for an additional dental cleaning or periodontal maintenance procedure per benefit period.

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51 OTHER KEY PIECES OF THE PREFERRED DENTAL PLAN In most cases, the dentist will directly bill Anthem for services Annual Maximum Benefit is $1,000 per person Optional Network of Dentists available to receive discounts Annual Maximum Benefit increases to $1,500 per person when services are provided in Anthem s Network of Dentists

52 HOW THE OPTIONAL NETWORK SAVES YOU MONEY Go to (click find a doctor) Select the Dental Complete network View network of Dentists in your area Visit participating Dentists and receive treatment Dentist will directly bill Anthem at a lower prenegotiated rate and receive their payment directly from Anthem The Dentist can not charge the difference between the negotiated rate and their normal fee (the plan s benefits will apply toward the negotiated rate)

53 ANTHEM DENTAL PLANS Monthly Payroll Deductions (1) Effective July 1, 2016 Employee Employee + One Dependent Family Basic Plan $23.26 $45.60 $74.49 Preferred Plan $32.50 $64.39 $ (1) Pre-tax deductions. Actual net cost will be reduced based upon IRS Section 125 election and personal income tax bracket.

54 VISION PLANS

55 BASIC VISION PLAN Exam every 12 months, $20 co-pay Prescription glasses every 24 months, $20 co-pay Contacts, no co-pay applies ( 24 months) Coverage from a VSP Doctor

56 PREFERRED VISION PLAN Exam every 12 months, $10 co-pay Prescription lenses every 12 months, covered in full Contacts, no co-pay applies ( 12 months) Frames every 24 months, $25.00 $ Allowance Coverage from a VSP Doctor

57 FIND A VSP PROVIDER Go to View Network of Doctors in your area Visit participating Doctors and receive treatment Call

58 VSP PLANS Payroll Deductions (1) Effective July 1, 2016 Employee Basic Plan $8.09 Preferred Plan $9.49 Family $22.87 $ year rate guarantee! (1) Pre-tax deductions. Actual net cost will be reduced based upon IRS Section 125 election and personal income tax bracket.

59 OPEN ENROLLMENT You may add or remove dependents Enroll or terminate from plan Election is effective 7/1/16 Election is in effect until 6/30/17; unless a qualified change in your status occurs Open Enrollment will be April 29 th through May 20 th 2016

60 QUALIFIED CHANGE IN YOUR STATUS? Change in marital status Change of dependents Involuntary loss of coverage through spouse s employer Change of spouse s employment resulting in loss of coverage Must notify Human Resources within 30 days of change!

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62 OWU WELLNESS PROGRAM OVERVIEW What s the big idea? Our lifestyle decisions impact our long-term health, wellbeing and productivity Our healthcare costs are impacted by the lifestyle decisions we make OWU continues its commitment to encouraging well-thought-out decisions regarding healthcare solutions, and to promoting a healthy family life

63 OWU WELLNESS PROGRAM OVERVIEW Where s the gain? OWU benefits when its employees are healthy, and able to carry-out their work responsibilities efficiently and effectively Employees benefit by leading healthy lifestyles, and are therefore happier, more stable, more dependable, more satisfied Everyone benefits when human resource costs are under control (both insurance premiums and productivity) OWU Wellness Program

64 OWU WELLNESS PROGRAM OVERVIEW Where s the hook? $25 one time premium credit for the year or $25 through payroll for completing the wellness assessment One time $75 premium credit for the year or $75 through payroll for achieving 34 credits OWU Wellness Program

65 HOW DO I SIGN-UP?

66 WELLNESSWORKS PROGRAMS Health Risk Assessment Quarterly Challenges Monthly Seminars OWU Wellness P/W = OWU

67 BASIC PROGRAM TRACKING (APRIL-MARCH TRACKING CYCLE) Activity Credit Value Annual Max Wellness Assessment 6 6 Physical Exam / Biometric Screening 6 6 Virtual Coaching 5 10 Online Monthly Seminars 1 12 Get Heart Smart Challenge (February 1-29) 5 5 Stretch and Go Challenge (May 1-31) 5 5 Keeping Your Cool Challenge (August 1-31) 5 5 Dump the Junk Challenge (November 1-30) 5 5 Earn 34+ Credits in 12- month period to earn incentive Community Event 3 6 Local Discretionary Activity 3 6 End of Year Survey 2 2 Total Credit Opportunity 68

68 QUESTIONS?