2016 Open Enrollment Presentation

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Millicent Franklin
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1 2016 Open Enrollment Presentation

2 Agenda Provider Changes Open Enrollment Information Compass Professional Health Services Explanation of each benefit plan Health Savings Accounts (HSA) Premiums Gallagher Benefit Services Reminders and Deadlines Questions

3 Provider Changes The only change for 2016 will be to the Dental Plans and Network. Southwestern s Dental plans will be changing to Guardian as of 1/1/16 with the addition of an enhanced plan for those going to in-network PPO providers. All other benefits will remain the same!

Annual Open Enrollment The Open Enrollment period this year will offer you the opportunity to enroll, renew, or change your Medical, Dental, Vision, or FSA coverage.

4 Annual Open Enrollment The Open Enrollment period this year will offer you the opportunity to enroll, renew, or change your Medical, Dental, Vision, or FSA coverage. Open Enrollment for 2016 benefits will be held October 20, 2015 October 22, Enrollment completed by October 30, Eligibility: New employees of SU are eligible on date of hire for Medical benefits. New employees are eligible for Dental and Vision coverage as of the first of the month following date of hire. You are eligible if you are a full-time employee regularly scheduled to work at least 30 hours per week. Individuals may make changes or add dependents during the open enrollment period. The open enrollment period is the only time employees may enroll in the above listed coverage without the occurrence of a qualifying event.

Making Enrollment Changes During the Year (Qualifying Events) In most cases, your benefit elections will remain in effect for the entire plan year.

You may only make changes to your elections during the year if you have one of the following status changes: Marriage, divorce Gain or loss of an eligible dependent for reasons such as

5 Making Enrollment Changes During the Year (Qualifying Events) In most cases, your benefit elections will remain in effect for the entire plan year. During the annual enrollment period, you have the opportunity to review your benefit elections and make changes for the coming year. You may only make changes to your elections during the year if you have one of the following status changes: Marriage, divorce Gain or loss of an eligible dependent for reasons such as birth, adoption, court order, disability, death, or reaching the dependent child age limit of 26 Significant changes in employment or employer-sponsored benefit coverage that affect you or your spouse s benefit eligibility. Your benefit change must be consistent with your change in family status.

Important Information There are several important notices in the Benefits Summary Booklet available from the HR website, including: Notice of Privacy Practices How your personal information is shared

6 Important Information There are several important notices in the Benefits Summary Booklet available from the HR website, including: Notice of Privacy Practices How your personal information is shared and protected Special Enrollment Rights - Mid-year changes in eligibility and your rights to enter/exit the plan COBRA Your right to continue coverage should you leave the University CHIP Potential premium assistance for dependent child coverage Medicare D Your obligation to be covered under a Creditable prescription plan

7 Benefits and Plan Information Located in your Benefits Summary Booklet available on the HR website!

8 Medical Plan

9 Medical How does our health plan work? Did you know. The University s Medical and Prescription plans are Self-Funded. This means that the University, not Blue Cross Blue Shield, pays the claims. Shopping your health care costs helps everyone!

10 How can I shop my health care costs to save money? Compass Professional Health Services! Provided to you at no cost by the University!

11 Empowering Smarter Healthcare Decisions Decisions COMPASS DOES NOT: Share any employee s personal health information with your employer. Provide medical advice or replace your doctor. Receive money for recommending one doctor or hospital over another. Provide assistance for medical emergencies.

12 Empowering Smarter Healthcare Decisions Decisions FREQUENTLY ASKED QUESTIONS Q: Can Compass assist with issues related to dental and vision benefits? YES Q: Can Compass review old bills? YES (within the last 12 months) Q: Can Compass assist members of my household that are on a different insurance plan? YES Q: How long will it take Compass to respond to my request with an answer? Most requests are answered by the next business day bill reviews and appeals often take longer Q: Does Compass need permission to speak with my doctor or insurance company? YES, you will need to fill out an authorization form giving Compass permission to advocate for you on your behalf

13 Empowering Smarter Healthcare Decisions Decisions MEMBERS ARE USING COMPASS! Individuals Assisted Services Performed Services Performed Doc Reccommendation 186 Cost Estimate 98 Insurance Benefits Question 161 Bill Review 72 Coordination of Care 30 Prescription Review 44 Plan Selection 39

14 Empowering Smarter Healthcare Decisions Decisions CONTACT YOUR HEALTH PRO TODAY Call: ext Hours: M F 8am 6pm Central Get Connected Online! Go online to let your Health Pro know the best way to get connected so you can start receiving insider hints, tips, and savings on healthcare!

15 Empowering Smarter Healthcare Decisions Medical Plan Options

16 Medical *The above represents in-network benefits only. **SU will contribute monthly $50 for EE and $100 for EE+Dependent in 2016 to your HSA!

17 Medical *The above represents in-network benefits only.

18 Which Medical Plan Should I Choose? This sample represents someone not using the plan at all with Employee-Only coverage. Call Compass for assistance with choosing the right plan for you! Located on the HR website!

19 HDHP vs. PPO How does a HDHP work compared to a standard PPO with co-pays?

20 HDHP vs. PPO Example 1 John is a healthy 35 year old male with minimal medical expenses. During the calendar year John sees his medical provider once for a routine physical exam then again for a sinus infection. John s doctor prescribes two medications for his sinus infection. John has employee-only coverage and all services were rendered by in-network providers.

21 Service / Charge Routine Physical (Including lab and x-ray) Sinus Infection Physician Visit - $95 Sinus Infection Generic RX - $42 Sinus Infection- Brand Name RX - $70 HDHP/HSA Buy-Up PPO Benefit Cost Benefit Cost 100% $0 100% $0 Subject to $3,000 Deductible Subject to $3,000 Deductible Subject to $3,000 Deductible $95 Office Visit Co-Pay $30 $42 $70 Generic Drug Co-Pay Preferred Brand Drug Co-Pay $15 $35 John s Out-of-Pocket Medical Costs $207 $80 Annual Premiums $0 $711 Plan Year Actual Cost $207 ($600 SU HSA Contribution) $393 in savings $791

22 HDHP vs. PPO Example 2 Steve is married with one dependent child and one on the way. During the calendar year he sees his medical provider once for a routine physical exam and has no other medical expenses. Steve s wife delivers their second child without complications; she has one monthly prescription during her pregnancy and no other medical expenses. Steve adds his new son onto the plan and the new baby has routine well baby care for the remainder of 2014 plus one visit for a respiratory infection with one prescription. The older child only has one routine well child exam during the year and two exams for strep throat. Steve has family coverage and all services were rendered by In-network providers.

23 Service / Charge Steve Routine Physical (Incl. lab and x-ray) Wife Maternity: Generic Drug (Prenatal Vitamins) - $40 Maternity/Delivery: $5,000 Hospital Charge Maternity/Delivery: $2,000 Physician Charge Newborn Routine Well Child Exam (Incl. lab) Respiratory Infection: Physician Visit - $125 Respiratory Infection: Generic Drug $10 Older Child Routine Well Child Exam (Incl. lab) Strep Throat (x2) Physician Visit - $125 Strep Throat (x2) Generic Drug - $35 HDHP/HSA Buy-Up PPO Benefit Cost Benefit Cost 100% $0 100% $0 Subject to $3,000 Deductible Subject to: $3,000 Deductible 80% Co-insurance Individual Deductible met 80% Coinsurance $360 ($40 X 9 months) $2,640 $472 $400 Generic Drug Co-Pay Subject to: $500 Deductible 70% Co-insurance 70% Co-insurance $135 ($15 x 9 months) $500 $1, % $0 100% $0 Subject to $6,000 Family Deductible Subject to $6,000 Family Deductible $125 $10 Office Visit Co-Pay Generic Drug Co-Pay $ % $ % $0.00 Subject to $6,000 Family Deductible Subject to $6,000 Family Deductible $250 $70 Office Visit Co-Pay (two) Generic Drug Co-pay (two) $30 $15 $60 $30 Steve s Out of Pocket Medical Costs $4,327 $2,720 Annual Premiums $2,989 $4,846 Plan Year Actual Cost $7, (-$1,200 SU HSA Contribution) = $6,116 $7,566

24 BCBS Value-Added Programs

25 Health Savings Accounts (HSA)

26 What is a Health Savings Account? A savings account in your name that: Allows money to be deposited on a pre-tax basis to an annual limit Has certain IRS rules around it because of the tax advantage Is intended to be used for certain health care (Medical, Dental, Vision) expenses Helps you prepare for health care costs in the future Is always in your name and no one else s Different than a Health Flexible Spending Account (FSA) There is no Use it or Lose it! rule You only have access to the funds that have been contributed Allows you to change your contribution any time you want Has investment opportunities once certain balances have been attained Southwestern will continue to contribute on a monthly basis: $50 for those electing Employee-only coverage and $100 for those electing Employee + Dependent coverage for 2016

* Refer to the detailed information pages in your Benefits Summary Booklet available soon on the HR

27 Health Savings Account You may not contribute to a Health Savings Account if you OR your spouse are participating in a Health Flexible Spending Account (FSA)! * Refer to the detailed information pages in your Benefits Summary Booklet available soon on the HR website for more information. *HSA contributions made by the University are considered taxable income for employees living in CA, NJ, and AL.

28 Health Savings Account You may not contribute to a Health Savings Account if you are covered by Medicare, Tricare, or any other insurance that is not a Qualified HDHP!

29 Dental Plan

30 Change to Guardian s Dental Plans for 2016 DHMO still available Most affordable plan offering, but a limited number of dentists Requires referral for all specialist services If you re currently seeing a dentist who shows as not accepting new patients in the Guardian directory, you will still be able to select that dentist as your primary Standard PPO Network Access Plan (NAP) The same PPO plan design SU has had in the past Best for those seeing a non-network dentist (discounts still available in-network) Value Plan NEW! Same large PPO network as the NAP Best for those who are already seeing or don t mind seeing a DentalGuard Preferred provider Non-network claims are eligible for coverage, but at a significantly reduced rate Offers a higher level of coverage for basic and major services at the same cost

31 Dental Best for those seeing nonnetwork providers Best for those seeing innetwork providers

32 Dental Maximum Rollover - NEW! For those electing a PPO plan option (NAP or Value), your benefits include the Maximum Rollover Account (MRA) benefit. So long as you see a dentist at least once during the calendar year but do not exceed $500 in paid-out benefits from Guardian, you will receive a $250 reward to your MRA for the following year. Applies to each covered member of your family Accrues year over year (to a maximum of $1,000)

33 Vision Plan

34 Vision

35 Flexible Spending Account (FSA)

36 Flexible Spending Account (FSA) Remember Do not elect to participate in the Medical FSA if you plan on electing the HDHP with the SU contribution to an HSA! Do not throw away your Benny Card if you are electing FSA it will be reloaded!

37 How much do the benefits cost in 2016? Refer to the Benefit Summary Booklet available soon on the HR website for the 2016 rate information that pertains to you. No change in Medical cost, a decrease to Dental and a slight increase to Vision

A reminder about GBS...we are here to help! Gallagher Benefit Services, Inc.

If you are having problems getting claims paid or have questions regarding your coverage, let

Please contact anyone at Gallagher Benefit Services, Inc.

38 A reminder about GBS...we are here to help! Gallagher Benefit Services, Inc. is here to act as a liaison in your dealings with insurance carriers. If you are having problems getting claims paid or have questions regarding your coverage, let us deal with the insurance company for you. Please contact anyone at Gallagher Benefit Services, Inc. with questions regarding your employee benefits package. Benefit Advocate Center Phone: (800) Austin.GBS.CustomerService@ajg.com Fax: (512) Hours of Operation: Monday - Friday 8:00 a.m. - 5:00 p.m. CST

39 Things to Remember Open Enrollment is only during October. Please complete enrollment no later than Friday, October 30 so we will have ID cards in hand on January 1. Choosing the right Medical plan is just a phone call or away. Compass is available to assist you in making that decision. QUESTIONS?

HSA Frequently Asked Questions

HSA Frequently Asked Questions Overview Q1. WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)? An HSA is a tax-exempt trust or custodial account established exclusively for the purpose of paying qualified medical