July 2015 Forum Messages

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2 July 2015 Forum Messages Health Insurance Strategy Comply with Affordable Care Act Avoid Cadillac Tax Move towards market Align with other D-HH affiliates Retain lower wage employees Retain MAHHC incentive AVERAGE increases in salary On Average 3% market based raise in January 2016 (lessen benefit impact) On Average 3% Merit in July 2016

3 Salary Banded Employee Contributions Open Enrollment Your Employee Benefits What s new for 2016? bswift Online Enrollment

4 November th Your opportunity to make changes to your benefit elections: Enroll or drop plans Enroll or drop dependents Update beneficiary information 4

5 Medical Rates are now based off Salary Bands. Salary = base pay $0-$40K: premiums going down $40K-$80K: premiums close to current $80K plus: premiums increasing Premium holiday in December Wellness Portal is now with Alere through HPI Wellness and BMI Assessments will be available Nov 2 nd -9 th Long Term Care plan with Unum is now grandfathered no longer available for new elections. 5

6 your options overview of plan choices 6

7 3 New Plans to choose from Gold Narrow Network MAH & DH/Affiliates Only Silver Bronze HSA qualified HDHP New ID Cards will be issued for 2016 Pharmacy Benefits Express Scripts Inc. (ESI) Retail New England Mail Order Pharmacy (NEMOP) Mail Order

8 Summary of Benefits overview of plan choices 8

9 Tier 1Benefits - MAHHC Providers 2015 Plan 2016 Plan Deductible (Single/Family) None $500/$1,000 Co-insurance (plan pays) 90% 90% Out of Pocket Max (Single/Family) $500/$1,000 $1,500/$3,000 Copays (PCP/Specialist) $10/$15 $20/$40 Urgent Care/Emergency Care $100 $100 9

10 Tier 2 Benefits Dartmouth-Hitchcock & Affiliate Providers 2015 Plan 2016 Plan Deductible (Single/Family) $250/$500 $1,500/$3,000 Co-insurance (plan pays) 80% 80% Out of Pocket Max (Single/Family) $1,000/$2,000 $4,500/$9,000 Copays (PCP/Specialist) $20/$30 $40/$80 Urgent Care/Emergency Care $100 $100 Tier 2 no longer includes Valley Regional Hospital. Dartmouth- Hitchcock & Affiliate Providers only are covered. 10

11 Tier 3 Benefits In-Network Providers Deductible (Single/Family) $500/$1,000 Co-insurance (plan pays) 70% Out of Pocket Max (Single/Family) $1,500/$3,000 Copays (PCP/Specialist) $20/$ Plan 2016 Plan Urgent Care/Emergency Care $100 $100 No Coverage Tier 3 benefits are only available for Urgent Care and Emergency Room Services Employees with dependents outside of this area may want to consider alternate plan options 11

12 Tier 1Benefits - MAHHC Providers 2015 Plan 2016 Plan Deductible (Single/Family) $500/$1,000 $2,500/$5,000 Co-insurance (plan pays) 90% 90% Out of Pocket Max (Single/Family) $2,000/$4,000 $3,500/$7,000 Copays (PCP/Specialist) $15/$20 $30/$60 Urgent Care/Emergency Care $100 $250 12

13 Tier 2 Benefits Dartmouth-Hitchcock & Affiliate Providers 2015 Plan 2016 Plan Deductible (Single/Family) $1,000/$2,000 $3,500/$7,000 Co-insurance (plan pays) 80% 60% Out of Pocket Max (Single/Family) $2,500/$5,000 $4,500/$9,000 Copays (PCP/Specialist) $30/$40 $60/$120 Urgent Care/Emergency Care $100 $250 13

14 Tier 3 In-Network Providers 2015 Plan 2016 Plan Deductible (Single/Family) $1,500/$3,000 $4,000/$8,000 Co-insurance (plan pays) 70% 50% Out of Pocket Max (Single/Family) $3,000/$6,000 $5,000/$10,000 Copays (PCP/Specialist) $30/$40 $100/$200 Urgent Care/Emergency Care $100 $250 Tier 3 coverage provides employees with dependents outside of this area access to additional providers. Outside of the 6 New England States the network is United Health. 14

15 Tier 1Benefits - MAHHC Providers 2015 Plan 2016 Plan Deductible (Single/Family) $2,500/$5,000 $3,500/$7,000 Co-insurance (plan pays) 90% 90% Out of Pocket Max (Single/Family) $4,000/$8,000 $6,000/$12,000 Copays (PCP/Specialist) Ded. then 90% Ded. then 90% Urgent Care/Emergency Care Ded. then 90% Ded. then 90% 15

16 Tier 2 Benefits Dartmouth-Hitchcock & Affiliate Providers 2015 Plan 2016 Plan Deductible (Single/Family) $2,500/$5,000 $3,500/$7,000 Co-insurance (plan pays) 80% 60% Out of Pocket Max (Single/Family) $4,000/$8,000 $6,000/$12,000 Copays (PCP/Specialist) Ded. then 80% Ded. then 60% Emergency Care Ded. then 90% Ded. then 90% Urgent Care Ded. Then 80% Ded. Then 60% 16

17 Tier 3 In-Network Providers 2015 Plan 2016 Plan Deductible (Single/Family) $2,500/$5,000 $3,500/$7,000 Co-insurance (plan pays) 70% 50% Out of Pocket Max (Single/Family) $4,000/$8,000 $6,000/$12,000 Copays (PCP/Specialist) Ded. then 70% Ded. then 50% Emergency Care Ded. then 90% Ded. then 90% Urgent Care Ded. Then 70% Ded. Then 50% 17

18 Retail Pharmacy Program Co-pay for up to a 30-day supply Generic: $5Preferred Brand: $15Non-Preferred Brand: $30 Bronze Plan: Preventive prescriptions are covered at copays. All other prescriptions will be covered after the deductible ($3,500/$7,000) has been met. You will be responsible to pay the copayment listed per prescription drug. Mail Order Program Co-pay for up to a 90-day supply Generic: $10 Preferred Brand: $30 Non-Preferred Brand: $60 Remember! Any maintenance medications must go through mail order (no more than 3 fills at retail) 18

19 Sample Employee: $30,000 Plan Annual Employee Premium Maximum Out of Pocket* Total Employee Cost* Average Raise Current Future Future Silver Family Tier 2 Silver Family Tier 2 Silver Family - MAHHC $3,830 $2,961 $2,961 $5,000 $9,000 $7,000 $8,830 $11,961 $9,961 N/A $900 $900 Potential Employee Impact* $8,830 $11,061 $9,061 *Worse case scenario 2014 data shows Average OOPM is less than $2,000 Per employee

20 Sample Employee: $60,000 Plan Annual Employee Premium Maximum Out of Pocket* Total Employee Cost* Average Raise Current Future Future Silver Family Tier 2 Silver Family Tier 2 Silver Family - MAHHC $3,830 $3,900 $3,900 $5,000 $9,000 $7,000 $8,830 $12,900 $10,900 N/A $1,800 $1,800 Potential Employee Impact* $8,830 $11,100 $9,100 *Worse case scenario 2014 data shows Average OOPM is less than $2,000 Per employee

21 Sample Employee: $90,000 Plan Annual Employee Premium Maximum Out of Pocket* Total Employee Cost* Average Raise Current Future Future Silver Family Tier 2 Silver Family Tier 2 Silver Family - MAHHC $3,830 $4,839 $4,839 $5,000 $9,000 $7,000 $8,830 $13,839 $11,839 N/A $2,700 $2,700 Potential Employee Impact* $8,830 $11,139 $9,139 *Worse case scenario 2014 data shows Average OOPM is less than $2,000 Per employee

22 NE Delta Dental Insurance Buy-Down Basic Enhanced Health Through Oral Wellness (HOW) Complete the oral wellness risk assessment online and share your results with your dentist; if you are at risk you may qualify for additional preventive benefits. PPO Providers Look up providers on click on Find a Dentist and choose the Delta Dental PPO Network. PPO Providers allow deeper discounts, which saves you money.

23 NEDD changes effective 1/1/2016 The following services have been enhanced by NEDD: Sealants once in a 3 year period to age 19 currently once in a lifetime to age 15 The following codes have been removed from NEDD Standardly covered codes: D0431 Adjunctive prediagnostic test (clinical efficacy not proven) D9910-D9911 Desensitizing medicament (considered part of treatment, patient is responsible if separate fee is charged) D7953 Bone replacement graft for ridge preservation (clinical efficacy not proven)

24 Vision Coverage (VSP) 100% Employee Paid Plan features include: $20 eye exam copay (1 exam every 12 mos.) $20 prescription eyewear copay Lenses once every 12 mos. Frames once every 24 mos. Coverage available for employee, spouses and children Note: If you are seeing a Mt. Ascutney vision provider, you may use the Gold/Silver Medical Plan benefits for an eye exam. VSP benefits may be used for hardware at a VSP provider office. 24

25 Health Savings Account (HSA), Flexible Spending Account (FSA), & Dependent Care Account (DCA) 25

26 Preventive Services covered at 100% All other services must apply toward a high deductible This plan enables you to put money into a health savings account your choice Health Savings - pre-tax dollars to use for health care You can deposit pre-tax dollars via payroll or You can deposit post-tax dollars and deduct expenses at year-end Or rollover an existing health savings account 26

27 Qualified high deductible medical plan Health + Savings = Account Taxadvantaged HSA Plan Your Health Savings Account is owned by you Money put in the Health Savings Account is not taxable You have investment options with the Health Savings Account through Health Equity Only eligible expenses can be used with health savings Fund dental, vision, medical deductible or just save! Elect HSA contributions to come directly from your paycheck through bswift 27

28 Under age 55 and not enrolled in Medicare (based on a 12-month period): Up to $3,350 individual coverage Up to $6,750 family coverage Age 55 or older and not enrolled in Medicare: Maximum contribution increases by $1,000 (considered a catch-up contribution) Up to $4,350 individual coverage Up to $7,750 family coverage 28

29 You can elect up to $2,550 Plan Year: 1/1/16 12/31/16 Pre-tax money, contributed through payroll deductions 2016 Flex Spending will allow for up to $500 of rollover into Eligible expenses: Medical & Rx expenses Dental Expenses Vision Expenses Limited OTC No medical if you contribute to your H.S.A. in 2016

30 You can elect up to: $2500 if married filing separately $5000 if single or married filing jointly Pre-tax money, contributed through payroll deductions Pay as you go, can only spend what you have contributed Use it or Lose it Eligible Expenses: Custodial care of dependents while employee is at work

31 New Life and Disability Carrier Employer Paid Life, Voluntary Life, Disability, Accident and Critical Illness/Cancer Plans Eligibility 60 + biweekly 31

32 Life and Disability Insurance 100% MAHHC Paid Term Life & AD&D Insurance 1.5x annual salary up to $250,000 AD&D doubles the benefit value if death results from an accident The benefit offerings Long Term Disability Insurance 60% of basic monthly pay up to $8,000/month Payments begin after 90 days from the start of a qualified disability

33 Life and Disability Insurance 100% Employee Paid The benefit offerings Voluntary Short Term Disability Insurance 60% of current base rate of pay up to $2,000/week Benefits begin on the 15th day of disability due to injury or illness Benefit period is up to 11 weeks per eligible disability For 2016 OE ONLY you may enroll in Vol. STD with no EOI requirements!

34 Life and Disability Insurance 100% Employee Paid The benefit offerings Voluntary Term Life Insurance (Employee) Choice of coverage in $10,000 increments up to 5x annual salary or $500,000 whichever is less EOI required for amounts over $200,000 For 2016 OE ONLY you may enroll in Vol Term Life up to the GI with no EOI requirements!

35 Life and Disability Insurance 100% Employee Paid Voluntary Term Life Insurance (Dependents) Spouse increments of $5,000 up to $500,000 (not to exceed employee election) EOI required for amounts over $25,000 Child(ren)- increments of $2,000 up to $10,000 You must choose Employee coverage in order to cover spouse/child(ren) The benefit offerings

36 Life and Disability Insurance Imputed Income The benefit offerings Similar to basic life insurance with a benefit over $50,000, voluntary life insurance is subject to imputed income when the cost of the premium is less than the IRS Section 79 Table 1 rates. If this applies to you, the imputed income will show on bswift during enrollment as well as reported on your paycheck beginning in January 2016

37 100% Employee Paid Benefits Payable 1X Per Category Up to 200% Policy Maximum Circulatory Conditions Category: Heart Attack, End-stage Heart Failure, Stroke, and Coronary Artery Disease (25%). Other Conditions Category: Benign Brain Tumor, Coma, Major Organ Failure, Paralysis, and Severe Burns. Childhood Conditions Category: Cerebral Palsy, Complex Congenital Heart Disease, Cystic Fibrosis, Type 1 Diabetes Mellitus, and Muscular Dystrophy. Cancer Category: Cancer and Non Life Threatening Cancer (25%) Provides a lump sum, tax-free benefit based on diagnosis paid to insured Includes an Annual Wellness Benefit & Access to Health Care Support Services Guaranteed Issue Coverage up to $20,000 in $5,000 increments Coverage for Spouse and Dependent Children available 10-year age banded, smoker / non-smoker rates 37

38 100% Employee Paid Comprehensive Schedule of Benefits for: Dislocations, Fractures, Lacerations, and Burns Medical Services (X-Rays, Physical Therapy, etc.), Hospital Services (Emergency Room Admission, Ambulance, Blood Transfusion, etc.), Surgery Benefits, and Emergency Dental Benefits Includes Accidental Death and Dismemberment coverage Guaranteed Issue Coverage available for Employee, Spouse and Dependent Children No Annual or Lifetime Maximums* No Benefit Reduction for Other Coverage (i.e. Medical Insurance Benefits) Tax-Free Benefits paid directly to the Insured * Concussion Lifetime Maximum Benefit = $

39 Critical Illness/Cancer & Accident Insurance The benefit offerings MAHHC has elected Sun Life Financial to provide voluntary Critical Illness/Cancer and Accident in All eligible employees will have the option to elect or decline this coverage during this Annual Enrollment Period - Fall The Unum Critical Illness and Accident plans will be discontinued and payroll deduction for these plans will cease as of Unum s Critical Illness and Accident plans are portable Employees currently participating may continue coverage by notifying Unum on or before to be billed directly by Unum for the plan premium

40 All employees must re-enroll in their insurance benefits online through bswift Between November th At work At Home Or with Assistance Go to: Passwords will be reset on 10/15 to the last 4 digits of your SSN

41 Questions?