ONU HEALTH BENEFIT PLANS OPEN ENROLLMENT Presentation Available on the HR Website

Transcription

1 ONU HEALTH BENEFIT PLANS 2019 OPEN ENROLLMENT Presentation Available on the HR Website

2 What s changed for 2019? Core plan no new entrance Dental basic & buy-up are voluntary Vision voluntary Employer HSA contribution - $1,000 annually OptumBank only HSA carrier Prescriptions dollar co-pays ONU HealthWise Pharmacy preferred Non-ONU Rx 30-day ONLY HCP rolling calendar to obtain $300 deposit

3 2019 Employee Medical Rates Trend Factor applied 8-9% Average Core plan increase is 20% High Claims costs / Over budget Average HDHP plan increase is 9% Multi-year balancing is allowing a trend-only rate Mid-tier EE is the basis for our rate building

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6 The Cost of Healthcare ONU Vs. Benchmark $13,000 $12,462 $12,000 $11,000 $11,118 $11,037 $10,000 $9,000 $8,000 $7,000 $6,000 $5,000 ONU Higher Ed Regional Area

7 Deductible & OOP Benchmark ONU vs. Benchmark PPO ONU vs. Benchmark HDHP $8,000 $8,000 $7,729 $7,000 $6,471 $7,000 $7,000 $7,000 $6,000 $6,000 $5,488 $5,000 $5,000 $4,500 $4,000 $3,000 $2,000 $2,155 $3,121 $1,500 $3,000 $3,500 $4,000 $3,000 $2,000 $2,788 $4,052 $2,250 $3,500 $1,000 $1,009 $1,000 $0 Average Ded & OOP ONU $0 Average Ded & OOP ONU Ded/Single Fam/Family OOP/Single OOP/Family Ded/Single2 Fam/Family3 OOP/Single2 OOP/Family2

8 Premium Benchmark PPO HDHP $1,050 $525 $850 $425 $650 $325 $450 $225 $250 $125 $50 Average ONU <$35,000 ONU $35,000-$90,000 ONU >$90,000 $25 Average ONU <$35,000 ONU $35,000-$90,000 ONU >$90,000 EE Only EE/SP EE/CH Family EE Only EE/SP EE/CH Family

9 2018 Annual Premium

10 2018 Annual Deductible

11 What Impacts Your Medical Costs? Unhealthy lifestyle choices Plan designs High utilization of benefits New drugs, technologies & treatments State & Federal Regulations Aging population

12 How Can You Control Your Costs? Utilize carrier discounts See innetwork providers Use generic Rx Use urgent care clinic vs. ER Get annual medical & dental check-ups Get a flu shot Use your benefits wisely Pre-tax dollars

13 Dependent Audit Frequently asked questions surrounding the dependent audit: Why did ONU do this? What were the results? What will be done going forward?

14 NEW UMR services in 2019 Real Appeal Plan Advisor Care Search Rewards Joint and Spine Centers Of Excellence

15 Reminder Service/Facility Core Plan Plan B - HDHP (HSA Plan) Teledoc Telephone & Videoconferencing Retail Clinic Located in retail stores such as Rite Aid PCP/UC Primary Care Provider or Urgent Care ER Emergency Room $10.00 $45.00 $15.00 $75.00 (ave) $25.00 $ (ave) $ $ (ave)

16 Medical Preventive Care PREVENTIVE CARE Covered at 100% on all medical plan options. Know what services are covered at 100% by UMR prior to your preventive care visit. Routine preventive for Children* Appropriate screenings based on gender and age Newborn visits Tuberculosis testing Anemia testing Lead exposure Pelvic exam and pap test Development and behavior Lipid profile Depression Obesity and counseling Nutrition counseling Routine preventive for Adults Appropriate screenings based on gender and age Lipid profile Diabetes Pelvic exam and pap testing Breast exam and mammogram PSA testing Bone density testing Colonoscopy Aortic aneurysm *Birth to age 18

17 UMR Medical Plan Highlights In Network Core Plan Plan B Annual Deductible Annual Out-of-Pocket Maximum $1,500 per individual $3,000 per family $3,500 per individual $7,000 per family $3,000 per individual $6,000 per family $4,000 per individual $7,350 per family University HSA Contribution N/A $1,000 Plan Coinsurance 80% in most cases 90% in most cases Office Visit $25 copay 10% after deductible Urgent Care $25 copay 10% after deductible Teladoc $10 copay $45 Basic Lab & X-ray 20% after deductible 10% after deductible Complex Lab & X-ray 20% after deductible 10% after deductible Inpatient Hospital 20% after deductible 10% after deductible Emergency Room $250 copay, waived if admitted 10% after deductible

18 Health Savings Account (HSA) $1,000 ER annual contribution in to OptumBank To receive the ER contribution EE must open an OptumBank HSA account ONU will no longer deposit in to other bank accounts; transfer available No fees, HSA debit card provided, interest-bearing account OptumBank also offers mutual fund investment options for all HSA account dollars once the balance reaches $2,000 UMR portal allows for quick and easy one-stop login to claims, prescriptions, and FSA / HSA balances collectively

19 HSA: How Much Can I Contribute? Individual Enrollment: $3,500 Family Enrollment: $7,000 Please remember: These maximums include the University s $1,000 contribution. To receive the ONU HSA Contribution, you must open an Optum HSA Account. Those 55 years and older and not enrolled in Medicare can contribute an additional $1,000 catch-up each year.

20 HSA: Who Can Spend the Dollars? HSAs may reimburse any qualified health expense of the: Account holder (i.e. employee) Account holder s legal spouse Any tax dependents of the account holder Non-Tax Dependents and Domestic Partners: Expenses of non-tax dependents are not eligible for reimbursement through the account holders HSA, however if they are HSA-eligible, i.e. have no other disqualifying coverage, they can open their own HSA!

21 HSA: Record Checklist You must keep records sufficient to show that: The distributions were exclusively to pay or reimburse qualified medical expenses The qualified medical expenses had not been previously paid or reimbursed from another source The medical expenses had not been taken as an itemized deduction in any year Do not send these records with your tax return. Keep them with your tax records

22 Flexible Spending vs. Health Savings Type of Expenses General Purpose FSA Medical, dental and vision Limited Purpose FSA Dental and vision only Can be used with an HSA? No Yes n/a Medical Plan Requirement None None Health Savings Account Medical, dental and vision Only available with a QHDHP medical Contribution Limit $2,700 General and Limited Purpose offered $2,700 General and Limited Purpose offered $3,500 for EE $7,000 for Family $1,000/yr catch up if age 55 or older Can funds be rolled over? No No Yes Can it be used for nonmedical expenses? No Is interest earned? No No Yes No Yes, but taxed as income w/20% penalty

23 Dental Superior Dental Calendar Year Deductible Low Plan $0 per individual $0 per family High Plan $0 per individual $0 per family Calendar Benefit Maximum $750 $1,000 Preventive Care Waived Yes Yes Basic Services 50% 90% Major Services Not covered 50% Orthodontia Not covered Not Covered Orthodontia Maximum N/A N/A Employee Monthly Premium Low Plan High Plan Employee Only $19.45 $44.23 Employee + 1 Dependent $40.71 $92.89 Family $58.56 $ Remember: Make sure you are using an in-network provider or your benefits will be reduced in most cases.

24 Vision - VSP Vision Service Plan Vision Exam Lenses Frames Contacts (Elective) $10 copay (Once every 12 months) $25 copay (Once every 12 months) $130 allowance, then 20% off balance (Once every 12 months) $130 allowance (Once every 12 months) Employee Monthly Premium Employee Only $7.15 Employee + Spouse $13.27 Employee + Child(ren) $13.61 Family $19.10

25 Prescription Drugs Core Plan Plan B Rx Out of Pocket Maximum $1,200 Single / $2,400 Family Same as Medical ONU Health Wise Pharmacy Prescription Drugs (30, 90 day supply & mail-order) Generic (Tier 1) $5 copay $5 after deductible Preferred Brand Name (Tier 2) $30 copay $30 after deductible Non Preferred Brand Name (Tier 3) $60 copay $60 after deductible Specialty (Tier 4) Non-ONU Retail Prescriptions 10% copay (generic) 30% copay (preferred brand) 40% copay (non-preferred brand) 20% after deductible Generic (Tier 1) 20% copay 20% after deductible Preferred Brand Name (Tier 2) 20% copay 20% after deductible Non Preferred Brand Name (Tier 3) 20% copay 20% after deductible

26 Healthy Campus Program It s Not Too Late! Program Guide Activity and Points Documented in Wellworks Portal Points needed for points Rolling calendar into 2019 Plus 2 REQUIRED Activities New Hire (August forward) Pro-rated Requirements Spouses Eligible to Participate

27 USI Benefit Resource Center Do you have a claim that is not paying? Did a call to your carriers leave you more confused about your health benefits? Are you just not sure what is covered? Contact the BRC for help! BRCMidwest@usi.com Monday through Friday 8:00am to 5:00pm EST

28 Wellworks Get Registered Today Not a single sign-on program please create username and password Spouses Create Own Account Account is linked to ONU Employee Device Syncing and Mobile Access Capabilities Tons of Wellness and Healthy Lifestyle Resources

29 ONU FALL BENEFIT FAIR OCTOBER 31 11:30 AM 1:30 PM MCINTOSH ACTIVITES ROOM QUESTIONS & ANSWERS

30 HEALTH SERVICES ADVISORY COMMITTEE (HSAC) MEMBERS William Ballard, Chair ex-officio Tonya Paul, Dir. of Human Resources exofficio Mike Rush, Dir. of HealthWise ex-officio Mark Russell, Controller ex-officio Katie Fitzgerald, Benefit Plan Rep ex-officio Jeff Allison, Faculty Rep Jane Williams, Class 5 Rep Sharon Hawkins, Retiree Rep Jennifer Lambdin, Class 2/4 Rep Jill Christopher, Personnel Committee Rep