ELKHART COMMUNITY SCHOOLS Annual Enrollment

Transcription

1 ELKHART COMMUNITY SCHOOLS 2017 Annual Enrollment

2 Agenda 2017 Medical plan designs Premium contribution structure change New Rx assistance program Review of Dental plan Review of Health Savings Accounts Wellness Plan/ECS Clinic New Voluntary Life benefit

3 Medical UMR continues as our medical plan administrator Adjustments to each of the four medical plan design offerings Premium contribution adjustments New Rx assistance program

4 Deductible High Deductible Health Plan Summary 1 Effective Network: Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Individual $ 2,000 $ 2,000 Family $ 4,000 $ 4,000 Coinsurance 20% 30% Out-of-Pocket Maximum Individual $ 3,000 $ 5,000 Family $ 6,000 $ 10,000 Physician Office Visit 20% after deductible 30% after deductible Specialist Office Visit 20% after deductible 30% after deductible Preventive Care 0% 30% after deductible

5 High Deductible Health Plan Summary 1 Effective Network: Retail Prescription Drugs Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Generic Formulary 20% after deductible 30% after deductible Brand Formulary 20% after deductible 30% after deductible Non-Formulary 20% after deductible 30% after deductible Mail Order Prescription Drugs Generic Formulary 20% after deductible Not Covered Brand Formulary 20% after deductible Not Covered Non-Formulary 20% after deductible Not Covered Hospital Services 20% after deductible 30% after deductible Out-Patient Services 20% after deductible 30% after deductible Maternity Services 20% after deductible 30% after deductible Emergency Room Services 20% after deductible 30% after deductible Urgent Care Centers 20% after deductible 30% after deductible

6 Deductible High Deductible Health Plan Summary 2 Effective Network: Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Individual $ 3,000 $ 3,000 Family $ 6,000 $ 6,000 Coinsurance 20% 30% Out-of-Pocket Maximum Individual $ 4,000 $ 6,000 Family $ 7,150 $ 12,000 Physician Office Visit 20% after deductible 30% after deductible Specialist Office Visit 20% after deductible 30% after deductible Preventive Care 0% 30% after deductible

7 High Deductible Health Plan Summary 2 Effective Network: Retail Prescription Drugs Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Generic Formulary 20% after deductible 30% after deductible Brand Formulary 20% after deductible 30% after deductible Non-Formulary 20% after deductible 30% after deductible Mail Order Prescription Drugs Generic Formulary 20% after deductible Not Covered Brand Formulary 20% after deductible Not Covered Non-Formulary 20% after deductible Not Covered Hospital Services 20% after deductible 30% after deductible Out-Patient Services 20% after deductible 30% after deductible Maternity Services 20% after deductible 30% after deductible Emergency Room Services 20% after deductible 30% after deductible Urgent Care Centers 20% after deductible 30% after deductible

8 Deductible High Deductible Health Plan Summary 3 Effective Network: Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Individual $ 4,000 $ 8,000 Family (EMBEDDED) $ 8,000 $ 16,000 Coinsurance 20% 30% Out-of-Pocket Maximum Individual $ 5,000 $ 16,000 Family (EMBEDDED) $ 10,000 $ 32,000 Physician Office Visit 20% after deductible 30% after deductible Specialist Office Visit 20% after deductible 30% after deductible Preventive Care 0% 30% after deductible

9 High Deductible Health Plan Summary 3 Effective Network: Retail Prescription Drugs Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Generic Formulary 20% after deductible 30% after deductible Brand Formulary 20% after deductible 30% after deductible Non-Formulary 20% after deductible 30% after deductible Mail Order Prescription Drugs Generic Formulary 20% after deductible Not Covered Brand Formulary 20% after deductible Not Covered Non-Formulary 20% after deductible Not Covered Hospital Services 20% after deductible 30% after deductible Out-Patient Services 20% after deductible 30% after deductible Maternity Services 20% after deductible 30% after deductible Emergency Room Services 20% after deductible 30% after deductible Urgent Care Centers 20% after deductible 30% after deductible

10 Deductible High Deductible Health Plan Summary 4 Effective Network: Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Individual $ 5,000 $ 10,000 Family (EMBEDDED) $ 10,000 $ 20,000 Coinsurance 20% 30% Out-of-Pocket Maximum Individual $ 6,500 $ 20,000 Family (EMBEDDED) $ 13,000 $ 40,000 Physician Office Visit 20% after deductible 30% after deductible Specialist Office Visit 20% after deductible 30% after deductible Preventive Care 0% 30% after deductible

11 High Deductible Health Plan Summary 4 Effective Network: Retail Prescription Drugs Network Benefits Choice Plus PPO Non-Network Benefits Your costs are summarized below Generic Formulary 20% after deductible 30% after deductible Brand Formulary 20% after deductible 30% after deductible Non-Formulary 20% after deductible 30% after deductible Mail Order Prescription Drugs Generic Formulary 20% after deductible Not Covered Brand Formulary 20% after deductible Not Covered Non-Formulary 20% after deductible Not Covered Hospital Services 20% after deductible 30% after deductible Out-Patient Services 20% after deductible 30% after deductible Maternity Services 20% after deductible 30% after deductible Emergency Room Services 20% after deductible 30% after deductible Urgent Care Centers 20% after deductible 30% after deductible

12 Contributions Tiers In previous years Medical/Dental premium contributions have been based on two coverage tiers Employee Only Family Beginning in 2017, Medical/Dental contributions will be based on four coverage tiers Employee only Employee & Spouse Employee & Child(ren) Family This type of contribution structure provides the most accurate distribution of plan costs

13 Rx Help Centers Rx Help Centers is a new benefit that may help reduce the cost of prescription drugs for you and your covered family members If you and/or members of your family spend more than $75 for any one prescription or $100 or more per month for all your prescriptions, this program may be able to able to reduce or eliminate these expenses This new benefit is provided at no cost to you

14 Abilify Advair Advair Discus Albuterol Atorvastatin Celebrex Cialis Concerta Crestor Cymbalta Rx Help Centers ECS s new partner, Rx Help Centers, may be able to significantly lower or eliminate the cost of certain medications. Examples include but are not limited to: Dilantin Effient Eliquis Enbrel Flovent HFA Humira Hydroclorothia zide Invokana Janumet Latuda Levothyroxine Lipitor Lisinopril Lyrica Nexium Plaavix Prozac Restasis Seroquel Singulair Spiriva Suboxene Viagra Victoza Vivanse Welchol Xaralto

15 Health Savings Account Teachers Credit Union Your Health Savings Account Provider

16 Health Savings Account Overview To Qualify for a Health Savings Account (HSA) you must meet the following: HSA s can only be offered with a High Deductible Health Plan (HDHP) Cannot be covered under traditional health plan, including Medicare, Tricare, or an FSA Medical Reimbursement plan Cannot be claimed as a dependent on someone s tax return

17 HSA Contributions The HSA can be funded in the following ways: Lump Sums Payroll deductions Contributions can be made by the employee, employer, or any other person on the employee s behalf. Employees may change their contributions to the HSA one time per month. Changes turned into Human Resources by the 15th of the month will be effective for the first payroll of the next month.

18 Using HSA Funds You can spend your HSA dollars on qualifying expenses for: Yourself Your spouse Anyone you claim as a dependent on your personal income tax (Your child(ren) may qualify to be covered under your medical plan but NOT qualify to use your HSA funds). Note: Your spouse and dependent(s) do NOT have to be covered under your CDHP plan to be eligible to use funds from your HSA account.

19 HSA CONTRIBUTIONS IRS Maximum 2017 contributions Self $3,400 Family $6,750 Catch Up Contribution - $1,000 for those 55 and Older

20 HSA Contributions ECS HSA Plan Contributions Single Benefit $250 Family Benefit $500 Note: Full contribution will be made on the first pay in January, 2017.

21 Health Savings Account If you already have a Health Savings Account with TCU You do NOT have to fill out the forms again If you are new to the HDHP, you will need to open a Health Savings Account with Teachers Credit Union by filling out the forms

22 Health and Wellness Center Provides primary care, comprehensive physicals, labs, approximately 50 generic drugs at low or no cost, and other low cost services. Incentive-based wellness activities supervised by the Health and Wellness Center. Completely confidential.

23 Health and Wellness Center Lower Costs for You and Your Family Low or no-copay for visits with the physician or nurse practitioner. Approximately 50 high-quality generic drugs will be available at either no cost for preventive drugs or a cost of $4.00 High-quality labs available at low or no cost All fees paid to the Health and Wellness Center will be applied to your insurance deductible and can be paid out of your HSA.

24 Dental MetLife continues as our dental plan provider No plan design changes

25 Dental Deductible Single $25 Family $50 Calendar Year Maximum $1,250 Coinsurance (Amount Plan Pays) Preventive 80% Basic Services 80% Major Services 80% Orthodontia (Children Only) Coinsurance 60% Lifetime Maximum $1,200

26 Flexible Spending Accounts Dependent Care Flexible Spending Account: $5,000 Maximum Contribution Use it or Lose it Must reenroll for Election will not roll over from 2016

27 Flexible Spending Accounts Unreimbursed Medical FSA Only for employees who are not currently enrolled in ECS medical plans Maximum Contribution Limit - $2,600 Use it or lose it May use money to pay for qualified medical expenses for children to age 26 Must reenroll if you wish to contribute

28 2017 Annual Enrollment Begins November 9 th and ends November 15 th You must enroll in Medical/Dental, HSA Unreimbursed Medical, and Dependent Care Account Your elections will NOT automatically roll over for 2017

29 Voluntary group benefits can be purchased in addition to your medical and dental plans to provide additional support and protection Life insurance Term life Group rates You may pay less as an employee than you would as an individual for the same coverage. Convenient payroll deductions You ll have no separate bills to pay or checks to write. Choice You select the coverage that suits the needs of you and your family. 2/3 of Americans live paycheck-to-paycheck* *American Payroll Association, Getting Paid in America Survey Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 29

30 Voluntary Life Valuable Help your family cover expected and unexpected costs and living expenses Easy If you apply during your enrollment period, you may not have to answer medical questions Portable You can take your coverage with you if you retire or leave your company prior to age 70 Waiver of premium If you become disabled prior to age 60, premium payments are waived Accelerated life insurance benefits You can receive up to 75% of your benefit if you re diagnosed with a terminal illness

31 Voluntary Life Employee Units units of $10,000 Up to maximum coverage of 5x salary or $500,000 Guaranteed issue coverage of $100,000 You may receive up to this amount without answering any medical questions during the open enrollment period.

32 Voluntary Life Spouse Units units of $10,000 Up to maximum coverage of $250,000 Guaranteed issue coverage of $50,000 You may receive up to this amount without answering any medical questions during the open enrollment period.

33 Voluntary Life Children Units units of $1,000 Up to maximum coverage of $10,000 Guaranteed issue coverage - None

34 Enrollment Instructions Make your 2017 elections by logging into benefitsconnect Refer to the Enrollment Instructions sheet for specific instructions on this year s enrollment process All passwords have been reset to your Social Security Number