Pathways VILLANOVA UNIVERSITY Benefits Open Enrollment Guide

Transcription

1 Pathways VILLANOVA UNIVERSITY Benefits Open Enrollment Guide HUMAN RESOURCES April 18 April 29, 2016

2 A Letter from the Senior Director of Benefits, Compensation and Employment Dear Colleague, Benefits Open Enrollment will run from April 18, 2016 through April 29, This is the one time each year that you are able to review and make changes to your health, welfare and voluntary benefit elections. This brochure will highlight the changes for the plan year and provide in depth details regarding the Consumer Driven Health Plan (CDHP) along with the Health Savings Account (HSA). I highly encourage each of you to review this brochure in its entirety. Additional educational resources for open enrollment include: Pathways W ellness video Open Enrollment video CDHP/HSA video Medical Plan Comparison Tool Express Scripts Prescription Drug Cost Estimator IBC Medical Procedure Cost Estimator Please note: The carriers for your Life Insurance and Disability Insurance programs will change as of June 1, In regards to any leaves starting June 1, 2016, you should contact Liberty Mutual who will handle your short term and long term disability benefits. Please refer to the Human Resources website for contact information. In regards to Life Insurance, the new carrier effective June 1, 2016 will be MetLife. Below is a summary of the enhancements with MetLife: During this open enrollment, you will have a one time opportunity to purchase additional Supplemental Life Insurance with guaranteed-issue of one level, not to exceed 3x your annual earnings, or $250,000 without health questions. MetLife will also be offering these benefits at reduced rates. If you purchase Supplemental Life Insurance, you will have access to face-to-face will preparation and estate resolution services at no cost to you. Full-time students can be covered through age 26. In addition, if you currently have an FSA or HSA account, the IRS requires that you enroll in these plans annually. This includes any election to participate in the Child Care Subsidy plan. Your elections for the FSA or HSA plans will not carry forward into Sincerely, Raymond D. Duffy, M.S., SPHR, SHRM-SCP, CBP Senior Director, Benefits, Compensation & Employment 1

3 Table of Contents Page A Letter from Raymond Duffy 1 Elections or Changes to Benefit Programs 2 Important Form 1095-C Information 2 Benefits Enrollment Calendar of Events 3 Benefit Changes in Consumer Driven Health Plan (CDHP) 5 CDHP Summary Chart 6 Features of a Health Savings Account (HSA) 7 Other Resources and Information 8 Examples of the Cost of Care Under the HMO, PPO and CDHP 9 During Benefits Open Enrollment you can make elections or changes to the following benefit programs: Medical/Prescription/Vision Dental Health Care Flexible Spending Account (FSA) or Limited-Purpose FSA (if you enroll in the Consumer-Driven Health Plan, or CDHP) Health Savings Account (HSA), if you enroll in the CDHP Dependent Care FSA Child Care Subsidy Life Insurance Legal ID Theft Pet Insurance To make your elections, log into the Benefits Portal using your Villanova user name and password and select the Launch Icon under Open Enrollment. The Open Enrollment period will run from April 18-29, *Please note: In addition, if you currently have a FSA and HSA account, the IRS requires that you enroll in FSA and HSA plans annually. This includes any election to participate in the Child Care Subsidy plan. Your elections for the FSA and HSA plans will not carry forward into Important Form 1095-C Information As you may already know, the Affordable Care Act (ACA) requires Villanova University to provide a Form 1095-C to all benefit eligible faculty and staff. This form confirms that the University offered you and your eligible dependents affordable medical coverage. One requirement of this document is to include Social Security Numbers (SSNs) so that the IRS can tie the information back to tax records. Please ensure during Open Enrollment that all SSNs for yourself and your dependents are reviewed and updated accordingly. 2

4 Benefits Open Enrollment Calendar of Events Each year, Benefits Open Enrollment affords you the opportunity to enroll in and make changes to your medical, dental, flexible spending accounts (FSAs), health savings accounts (HSAs), life insurance, and certain voluntary benefits plans. This year, Benefits Open Enrollment for 2016 will take place online between April 18-29, If you do not make an election, your elections will carry over to except for the following plans: Medical FSA Dependent Care FSA Child Care Subsidy Health Savings Account HSA We highly encourage you to read this guide and review the information online before making your elections for the plan year. Here are some important dates to keep in mind: April May June April 18: April 29: By May 31: June 1: First day to enroll in or make changes to your benefits. Last day to enroll in or make changes to your benefits. You will receive your new ID cards (if applicable). Benefit plan year begins with new coverages. 3

5 Benefit Changes in Disability The new carrier for your short term and long term disability benefits will be Liberty Mutual. This change takes effect on June 1, 2016 and therefore any leaves starting on or after June 1, 2016, you should contact Liberty Mutual. Please refer to the Human Resources website for contact information. Life Insurance The new carrier for your life insurance plans will be MetLife as of June 1, Below is a summary of the enhancements with MetLife: During this open enrollment, you will have a one time opportunity to purchase additional Supplemental Life Insurance with guaranteed-issue of one level, not to exceed 3x your annual earnings, or $250,000 without health questions. MetLife will also be offering these benefits at reduced rates. If you purchase Supplemental Life Insurance, you will have access to face-to-face will preparation and estate resolution services at no cost to you. Full-time students can be covered through age 26. Co-pay Changes If you enroll in either the PPO or HMO plans, the co-pays related to the (ER) and Urgent Care have changed. In regards to the ER, the co-pay will remain $100 but will be waived if you are admitted. The Urgent Care co-pay will be reduced from $70 to $50. Telemedicine As an enhanced benefit for the plan year, Villanova will be introducing Telemedicne coverage for faculty and staff that are enrolled in the University medical plans. The cost of these services differ based on if you are enrolled in the CDHP versus the HMO or PPO plans. The co-pay for these services under the HMO and PPO plans will be $10. Under the CDHP, the coinsurance for these services will be 20% of the charge and will be subject to the deductible. The average charge for a telemedicine session is approximately $40. Further details regarding Telemedicine and what services are covered can be found in the Pathways document. 4

6 Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) and a Limited-Purpose FSA The Consumer Driven Health Plan with HSA is a different approach to how you pay for today s health care and save for your future. It is a lower-premium, high-deductible health insurance plan, which means you pay less out of your paycheck for premiums and more out of pocket at the point of service before the plan pays for services that are not considered preventive. Villanova s CDHP meets the minimum federal requirements that allow an enrollee to also qualify for a tax-advantaged HSA. There Are Several Features of the CDHP with HSA Health Plan The CDHP provides you the flexibility to receive care from both in-network and out-of-network providers (you ll pay more for out-ofnetwork providers). In-network age appropriate preventative care services as defined by the plan are covered at 100% meaning you do not pay for this type of service. For all other services, you are responsible for paying the full cost of care until you reach the plan s deductible. You are then responsible for a portion of the cost of care (your coinsurance), until you reach the plan s out-of-pocket maximum. See the CDHP with HSA Summary Chart on pages 6 & 7 of this brochure for details. You can also see a side-by-side comparison of all plans in the Pathways booklet. Pre-Tax Savings Plan (Health Savings Account) If eligible, you can contribute via payroll deduction on a pre-tax basis to a Health Savings Account (HSA) to pay for out-of-pocket medical expenses, including deductibles, coinsurance, and copayments. The HSA is a fully employee-owned account. Funds roll over from year to year. There is no use it or lose it rule. Once the balance in your savings account reaches $1,000, you can select from a choice of investment options. For the plan year, Villanova will make a tax-free contribution to your account you must open an HSA, through Villanova s third-party administrator, Wage Works, in order to receive this funding: $600 for individual coverage $1,200 for family coverage This amount will increase by up to $225 if you and/or your spouse completed the Personal Health Assessment and Health Screening under the NOVAfit! program. This means that the funding of your HSA account could be as large as: $750 for individual coverage $1,425 for family coverage Debit Card With your HSA, you receive a debit card that you can use for easy access to your account (once funds are accumulated) to pay for out-ofpocket medical expenses, including your copays, prescriptions, and other health care costs. If you decide to also enroll in the Limited-Purpose FSA which reimburses you for eligible dental and vision expenses only your FSA dollars will be loaded onto the same debit card. See the Pathways booklet to learn more about FSA coverage. 5

7 CDHP Summary Chart Plan Feature In-Network Out-of-Network Preventive Care (age appropriate as defined by the plan) Deductible* Covered at 100% $1,300 (individual)/$2,600 (family) For family coverage, the full family deductible must be met before the plan (Villanova) coverage begins. Preventive Care for Adults and Children coverage is 50%, no deductible $5,000 (individual)/$10,000 (family) For family coverage, the full family deductible must be met before the plan (Villanova) coverage begins. Coinsurance (once deductible is met) 20% coinsurance 50% coinsurance imum (includes deductible, coinsurance, and prescription drug costs) $3,000 (individual) $6,000 (family) For family coverage, the full family out-of-pocket maximum must be met before 100% plan (Villanova) coverage begins. $10,000 (individual) $20,000 (family) For family coverage, the full family out-of-pocket maximum must be met before 100% plan (Villanova) coverage begins. Deductible, then 20% coinsurance All other covered non-preventive care such as: PCP/Specialist Office Visits; Hospital Admission; Outpatient Surgery; In-patient Surgery; Advanced Diagnostic Testing; Lab/X-Rays Deductible, then 20% coinsurance Deductible, then 50% coinsurance Prescription Drugs (Retail/Mail-Order) Generic Preferred Brand-Name Non-Preferred Brand-Name Certain preventive drugs covered 100% (see Preventive medication list) All other drugs, deductible then 20% coinsurance *The deductible applies to all non-preventive health care expenses. Amounts paid for covered in-network and out-of-network care are combined to satisfy the deductible. 6

8 Features of a Health Savings Account (HSA) An HSA provides you with flexibility in how you pay for medical services today and in the future. Tax Advantages: Your contributions to your HSA come out of your paycheck before taxes are withheld, so every dollar that goes toward your HSA reduces your taxable income. Participants can also make contributions to the HSA with after-tax dollars. (Because this is a tax-favored account, there are IRS limits on annual contributions; see chart below for details.) Use It Today: Pay for regular health care expenses, including deductibles, coinsurance, copayments, and prescription drugs, with an easy-to-use debit card. Save for Tomorrow: If you save more money than you spend on health care expenses in the plan year, you can use that money in the future. Any money remaining in this account at the end of the plan year rolls over into the next year and, even if you leave Villanova, the money remains yours. Invest for Your Future Tax-Free: Once the balance in your HSA reaches $1,000, your funds will be automatically directed into the investment you select helping you build savings for your future. When used to pay for qualified medical expenses, distributions from your HSA are tax-free. Catch-up Contributions: Employees 55 years of age or older can contribute additional dollars to their HSA. See the chart below for details HSA imum Contributions Coverage Level HSA Contribution HSA Contribution for Age 55+ Individual* $3,350 (Total includes: $2,750 employee contribution plus $600 Villanova contribution) $4,350 (Total includes: $2,750 employee contribution plus $1,000 age 55+ catch-up contribution plus $600 Villanova contribution) Family* $6,750 (Total includes: $5,450 employee contribution plus $1,200 Villanova contribution) $7,750 (Total includes: $5,450 employee contribution plus $1,000 age 55+ catch-up contribution plus $1,200 Villanova contribution) *For illustrative purposes, the chart assumes that an individual did not participate in the annual NOVAfit! Personal Health Assessment and Health Screening Campaign. If you participated, HSA contributions could increase to $750 individual and $1,425 family. Please note that this will reduce the amount of employee contributions accordingly. 7

9 What You May Want to Consider As with any benefit choice, there are things you should carefully consider prior to enrolling. As you think about your health care needs, be sure you understand how the medical plan works. Here are some things to keep in mind as you review the CDHP with HSA plan compared to Villanova s other options: Lower Premium: You pay less out of your paycheck for coverage. Higher Costs: You pay 100% of any covered non-preventive expenses until you meet your deductible before the plan pays for services. Deductible: If you re enrolled in family coverage, you must meet the entire family deductible before the plan pays unlike the PPO plan. imum: If you re enrolled in family coverage, you must meet the entire family out-of-pocket maximum before the plan pays 100% there is no per person maximum like there is in the HMO and PPO plans. Access to the Same Doctors and Networks: The CDHP with HSA is offered through Independence Blue Cross, so you will continue to have access to doctors and networks that are currently part of the IBC network. Limited-Purpose Flexible Spending Account: According to federal regulations, HSA participants are not eligible to participate in a regular Health Care Flexible Spending Account (FSA). However, HSA participants can participate in the Limited- Purpose FSA, which provides a tax-free way to save and pay for dental and vision expenses not covered by your health plan. All other Health Care FSA rules and features apply to the Limited-Purpose FSA same maximum, same use-it- or-lose-it rule, same claim-filing deadline, and if you enroll, you will receive a debit card to pay for eligible dental and vision expenses. If you elect an HSA, you will receive one combined debit card. HSA Requirements You cannot be covered under another non- CDHP medical plan or Health Care FSA (such as your spouse s plan/fsa) and contribute, or receive Villanova s contribution, to the HSA. HSA contributions must be in your account before you can use them to pay for eligible medical expenses or receive reimbursement. Please note that Villanova s funding will be deposited at the beginning of the plan year. You must be under age 65 and not enrolled in Medicare to contribute, or to receive Villanova s contribution, to the HSA. If you enroll in the CDHP for and currently have a Health Care FSA, you must have a $0 balance in your FSA by May 31, 2016 to be eligible for an HSA in June If you have a balance remaining in your Health Care FSA as of June 1, 2016, you will not be eligible to enroll in the HSA or receive Villanova s contribution until September 1, If this occurs, you will not be able to use HSA funds to get reimbursed for medical costs incurred before September 1. 8

10 Examples of the Cost of Care under the CDHP, PPO and HMO It s important to understand how these changes could affect you. Take a look at some examples of how costs yours and Villanova s may exist under the CDHP, PPO and HMO. These examples are provided for illustrative purposes. Individual situations may differ. Villanova University Cost Estimates EMPLOYEE ONLY COVERAGE CDHP Categories Copays Deductible* Coinsurance Maternity Office Visits $0 $1,300 80% $3,000 $180-$240 $180-$240 Maternity Inpatient $0 $1,300 80% $3,000 $0 $1,300 80% $3,000 $8,057- $24,765 $17,237- $62,531 $2,651-$3,000 $3,000 Urgent Care $0 $1,300 80% $3,000 $270-$298 $270-$298 PPO Categories Copays Deductible* Coinsurance Maternity Office Visits $30 copay first visit $300 90% $3,000 $180-$240 $30 Maternity Inpatient $0 $300 90% $3,000 $0 $300 90% $3,000 $8,057- $24,765 $17,237- $62,531 Urgent Care $50 $0 $0 $3,000 $270-$298 $50 HMO Categories Copays Deductible Coinsurance Maternity Office Visits $20 copay first visit N/A 100% $1,500 N/A $20 Maternity Inpatient $250 N/A 100% $1,500 N/A $250 $0 N/A 100% $1,500 N/A $0 Urgent Care $50 N/A 100% $1,500 N/A $50 $1,075-$3,000 $0 copay. Deductible and/ or coinsurance may apply *For illustrative purposes, the deductibles are individual amounts based on employee only coverage. If you have family coverage, the deductible will be higher. 9

11 Examples of the Cost of Care under the CDHP, PPO and HMO It s important to understand how these changes could affect you. Take a look at some examples of how costs yours and Villanova s may exist under the CDHP, PPO and HMO. These examples are provided for illustrative purposes. Individual situations may differ. Villanova University Cost Estimates EMPLOYEE & FAMILY COVERAGE CDHP Categories Copays Deductible* Coinsurance Maternity Office Visits $0 $2,600 80% $6,000 $180-$240 $180-$240 Maternity Inpatient $0 $2,600 80% $6,000 $0 $2,600 80% $6,000 $8,057- $24,765 $17,237- $62,531 $3,961-$6,000 $5,527-$6,000 Urgent Care $0 $2,600 80% $6,000 $270-$298 $270-$298 PPO Categories Copays Deductible* Coinsurance Maternity Office Visits $30 copay first visit $900 90% $9,000 $180-$240 $30 Maternity Inpatient $0 $900 90% $9,000 $0 $900 90% $9,000 $8,057- $24,765 $17,237- $62,531 Urgent Care $50 $0 $0 $9,000 $270-$298 $50 HMO Categories Copays Deductible Coinsurance Maternity Office Visits $20 copay first visit N/A 100% $3,000 N/A $20 Maternity Inpatient $250 N/A 100% $3,000 N/A $250 $0 N/A 100% $3,000 N/A $0 Urgent Care $50 N/A 100% $3,000 N/A $50 *For illustrative purposes, the deductibles are based on a family unit. 10 $1,705-$3,376 $0 copay. Deductible and/ or coinsurance may apply