Rose Tree Media School District

Transcription

1 Rose Tree Media School District Health Reimbursement Arrangement (HRA), Prescription Drug Plan & Flexible Spending Account (FSA) Benefits Presented by Gallagher Benefit Services Public Entity Team 2017 ARTHUR J. GALLAGHER & CO. AJG.COM

2 Today s Agenda I. Health Reimbursement Arrangement (HRA) II. Prescription Drug Plan III. Flexible Spending Account (FSA) IV. Privacy Notice & Disclaimers 2

3 Health Reimbursement Arrangement (HRA) An HRA is an employer funded account that provides members with funds to cover deductibles, coinsurance and copayments on an as needed basis Effective July 1, 2018, the District will provide employees with an HRA funded up to $2,500 for Single Employees and $5,000 for Employees covering one or more dependent(s) Aglegeus, Independence Blue Cross HRA partner, will be administering the HRA Members will receive a debit card to utilize at the pharmacy The card will only be needed to pay for your prescription drug purchases as Independence Blue Cross medical services will process automatically provided you have funds available through your HRA 3

4 Health Reimbursement Arrangement (HRA) How does the HRA work? Present your IBC ID card to the provider and advise that you are enrolled in a High Deductible Health Plan with an HRA. You will not owe anything at the time of your visit for in network services. Once the provider submits the claim to IBC, the claim will process by automatically deducting funds from your HRA to pay the provider (as long as you still have funds available) You will receive an Explanation of Benefits (EOB) showing the cost of services were applied to your deductible Manage your HRA and check your balance through the IBC portal ibxpress.com Please note that HRA is funded on an as needed basis and funds do not roll over into the next school year. Also, dental and vision out of pocket expenses are not eligible for reimbursement under the HRA. 4

5 Health Reimbursement Arrangement (HRA) How does the HRA work with out of network providers? Present your IBC ID card to the provider Since you are seeing an out of network provider, the provider will most likely require full payment at the time of service When payment is made, request an itemized receipt with procedure and diagnosis codes Submit the itemized receipt with the IBC Out of Network Claim Form Claims will process towards the Out of Network deductible Submit the HRA Reimbursement Form along with the itemized receipt for reimbursement (as long as you still have funds available) 5

6 Prescription Drug Plan Effective July 1, 2018 the deductible will NOT apply to prescription drugs The below chart outlines the copayments that will apply at the retail pharmacy for a one month supply Retail (34 day supply) Generic Drug $10 Preferred Brand Drug $20 Non Preferred Brand Drug $40 Specialty Drug $65 Maintenance Choice If you are taking a maintenance medications on an ongoing basis, after 2 retail fills, you will have the choice to fill a 3 month supply of medication either through CVS Caremark mail service or at any CVS Retail Pharmacy. Regardless of the choice, members will pay 2 copayments for a 3 month supply. 6

7 Prescription Drug Plan Clinical Programs Effective July 1, 2018 the following programs will be in place Quantity Limits The program applies to members taking medications that should not be used every day (i.e. migraine medication, pain medication, sleep medication). CVS/Caremark will cover a specified amount of medication within a specified time period. These quantity limits are established to help ensure members receive the appropriate amount of medication, and are based on FDA approved prescribing information and approved medical guidelines. Prior Authorization In some instances (typically for complex & costly medications) your physician will obtain approval from CVS/Caremark to prescribe a medication for you. Step Therapy This program applies to members taking ongoing medications that have lower costing equivalents. In some instances, you will need to try the lower costing (usually generic) medication before moving onto the more expensive (usually brand) medication. 7

8 Flexible Spending Account (FSA) An FSA is an account that lets you set aside pre tax dollars to pay for eligible health care expenses You can elect up to $2,650 to use from July 1 st through June 30th Your full contribution is available at the start of the plan year At the end of the plan year, you are allowed to rollover up to $500 Examples of FSA Eligible Health Care Expenses: Copays, coinsurance and deductibles Dental expenses (i.e. orthodontia, crowns) Vision expenses (i.e. glasses, contacts, laser eye surgery) Prescription drug copayments 8

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10 Privacy Notice & Disclaimers 2017 ARTHUR J. GALLAGHER & CO. AJG.COM

11 Privacy Notice & Disclaimers Gallagher Benefit Services, Inc. (GBS) treats your personal privacy with care and respect. Because we value our client relationships, we do not disclose a client s nonpublic personal financial and health information with third parties, except for the purposes of placing your insurance coverage(s), and as otherwise permitted by law. Applicable law requires GBS to provide our clients with a copy of our Privacy Policy which is enclosed. This policy does not apply to our efforts to market our products and services to you, so you may receive information from us regarding products that may suit your needs. GBS has always been mindful of our clients privacy. We maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to guard your nonpublic personal financial and health information and that of your employees. Thank you for choosing Gallagher Benefit Services, Inc. We appreciate your business and value our relationship. This Privacy Policy Disclosure outlines our information sharing practices to help you understand how we protect your privacy and that of your employees when we collect and use information about you and your employees, and the measures we take to safeguard that information. Information We Collect. We collect nonpublic personal financial and health information about you and your employees as required by the insurance companies including: Information we receive from you and your employees on applications or questionnaires, such as occupation, current employer and social security number; Information about your transactions with us, our affiliates, or previous insurers; such as your policy coverage, claim information, premiums and payment history; Information we receive from consumer-reporting agencies such as Equifax that is obtained for the purpose of ascertaining credit histories. These reports are obtained as underwriting tools to determine bill paying habits and credit worthiness for certain individual, personal insurance products. These reports are not subject to race, gender or income. Information We Disclose. We do not disclose any nonpublic personal financial and health information about our clients or former clients to anyone, except for the purposes of placing your insurance coverage(s) and as otherwise permitted by law. For example, we may disclose nonpublic personal financial and/or health information about you and your employees to market your insurance coverage directly with insurers and providers. Information Security. We restrict access to nonpublic personal financial and health information about you and your employees to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to guard your nonpublic personal financial and health information and that of your employees. Solvency While GBS does not guarantee the financial viability of any health insurance carrier or market, it is an area we recommend that clients closely scrutinize when selecting a health insurance carrier. There are a number of rating agencies that can be referred to including, A.M. Best, Fitch, Moody s, Standard & Poor s, and Weiss Ratings (TheStreet.com). Generally, agencies that provide ratings of Health Insurers, including traditional insurance companies and other managed care organizations, reflect their opinion based on a comprehensive quantitative and qualitative evaluation of a company's financial strength, operating performance and market profile. However, these ratings are not a warranty of an insurer's current or future ability to meet its contractual obligations. Coverage IMPORTANT: This proposal [analysis, report, etc.] is an outline of the coverages proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverages, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. Renewal/ Financial Legal This analysis is for illustrative purposes only, and is not a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. Please see your policy or contact us for specific information or further details in this regard. The intent of this analysis is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area ARTHUR J. GALLAGHER & CO. AJG.COM

12 2017 ARTHUR J. GALLAGHER & CO. AJG.COM