TMSA Resource Packet

Transcription

1 TMSA Resource Packet This labor agreement is currently unsettled for Benefits and contributions are subject to change consistent with the outcome of contract negotiations. Metropolitan Council Benefits Department 390 Robert Street N St. Paul, MN Phone: Fax: benefits@metc.state.mn.us Please print forms single sided

2 Metropolitan Council Benefit Resource Packet This packet contains information on the benefits and rates available to your specific group. Please keep this information on hand for use throughout the year. There is a separate Open Enrollment newsletter that contains general information and medical, dental, vision, and flex open enrollment forms. Contents What s New? / Dependent Coverage To Age 26 Page 3 Rates Page 4 Health Plan Definitions Pages 5-6 Medical Plan- Empower HRA Pages 7-17 Medical Plan- Distinctions III Pages Dental Plan- Dental Distinctions Pages Vision Plan- VSP Pages Supplemental and Universal Life Pages Flexible Spending Accounts (FSA) Pages Employee Benefit Resources Page 62 If you are considering retirement in the coming year, you might want to consider your open enrollment choices. Please review the Retirement Guide available on MetNet and your benefits website. Important Note: Contents of this document are intended to highlight select benefits information only. Please see your labor agreements and plan documents for additional information. If there is any discrepancy between the labor agreement or plan documents and the information contained here, the labor agreement and plan documents will take precedence. Page 2

3 What s New? New Child Life Options Currently, you may choose child life insurance in the amounts of $1,000, $2,000 or $5,000. We are discontinuing the $1,000 and $2,000 options, keeping the $5,000 option, and adding options of $10,000 and $15,000. Plus, if you enroll or increase your child life amount during this Open Enrollment period, the coverage is guaranteed. Employees who wish to increase coverage would only need to complete the Supplemental Life Insurance Form, not a health questionnaire. There will be no underwriting decisions, you will be granted coverage effective January 1, See form and monthly premium in the Life Insurance section of this packet. The premium is the same regardless of the number of children the employee has. Dependent children up to age 19, or up to age 25 if a full time student and financially dependent on the employee are eligible for coverage under the child life policy. You may make changes to your life insurance at any time during the year. However if you choose to increase your child life (or any other life insurance) after this open enrollment, you will have to complete a health questionnaire and go through underwriting, and coverage may be declined. New Lower VSP Vision Plan Rates When we renewed our contract with VSP this year, they lowered our vision plan rates and added some enhancements to our plan! See new rates and information in the Vision Plan-VSP section of this packet. Dependent Coverage to Age 26 Your natural or legally adopted dependent children up to age 26 are eligible for enrollment on your medical, dental and vision policies, even if they are not a student, not financially dependent on you, or not living with you. You may even cover them if they are married (their spouse, however, is not eligible for coverage under this plan). Coverage ends on the last day of the month in which they turn 26. If enrolling a dependent child on to your medical or dental plan, you must include a copy of their birth certificate or adoption papers with the enrollment form. Life insurance defines dependents differently. Dependent children up to age 19 are covered on the life insurance policies, and may continue up to age 25 if a full time student and financially dependent on the employee. Page 3

4 Medical and Dental Premiums Effective January 1, 2014 INTERIM RATES PENDING CONTRACT SETTLEMENT* TMSA Empower HRA Plan Coverage Level Total Monthly Cost Medical Plans Employer Monthly Contribution Employee Monthly Contribution Employee Annual Cost Single $ $ $6.52 $78.24 Family $1, $1, $ $2, Distinctions III Plan Coverage Level Total Monthly Cost Employer Monthly Contribution Employee Monthly Contribution Employee Annual Cost Single $ $ $8.64 $ Family $1, $1, $ $2, Dental Distinctions Plan Coverage Level Total Monthly Cost Dental Plan Employer Monthly Contribution Employee Monthly Contribution Single $46.92 $45.64 $1.28 Family $ $ $16.52 * These rates are subject to change consistent with the outcome of contract negotiations. Final rates will be distributed when they are determined. Premiums are deducted on a pre-tax basis. Medical and dental premiums will be deducted from the first and second paycheck of each month Page 4

5 Health Plan Definitions In the world of health plans, there are a lot of terms that are very helpful to understand not only in relation to your current health plan, but useful when comparing any health plans. The following are some of the most common terms. Lifetime Maximum- The lifetime maximum is the maximum dollar amount that HealthPartners would pay toward your claims during your lifetime. The lifetime maximum is per individual person. For example, if the lifetime maximum is $2,000,000, HealthPartners would pay up to $2,000,000 in claims for each person covered on your plan. The in-network lifetime maximum is unlimited (there is no maximum) for all of the Metropolitan Council health plans. There is a lifetime maximum for the out-of-network level. Deductible A deductible is a dollar amount that you are responsible for on charges (where the benefit summary shows a deductible applies) before the HealthPartners coverage starts paying in any calendar year. This is very much like the deductible you have on your auto insurance. If you have an auto accident and your auto insurance has a $500 deductible, you have to pay the first $500 to repair damages from the accident. The medical insurance deductible is an amount per person with a maximum amount per family. For example, if your plan has a $100 individual deductible with a $200 maximum per family, you would pay the first $100 in claims on any one person in your family. If you have a family, you would still pay a maximum of the $100 per person, but no more than $200 for your whole family toward that deductible in a calendar year. Once your deductible is met for an individual, no more deductible will apply to your claims for the rest of the calendar year. Once the family deductible is met, no more deductible will apply to any of your family members claims for the rest of the calendar year. Once the deductible is met, HealthPartners pays the claims at the benefit level shown on your benefit summary. Any deductible that you pay applies toward both the in-network and the out-of-network deductible. Copays Copays are specific dollar amounts that you pay for a specific service. For example, if you have a $25 copay for an office visit, you will pay $25 to your doctor s office when you are charged with an office visit. Coinsurance Coinsurance is similar to copays, except it is a percentage. For example, if your plan covers 80% of an ambulance charge, the other 20% that you are responsible for is called coinsurance. Out Of Pocket Maximum An out of pocket maximum is the maximum dollar amount that you could spend on covered medical expenses in a calendar year. This is an individual amount, with a family maximum. It includes the amount that you pay toward deductibles, copays and coinsurance. If your out of pocket maximum is $1,000 per individual and $2,000 per family, you would not pay more than $1,000 in a calendar year out of your pocket for any one person in your family, and no more than $2,000 for your entire family. Once the out of pocket maximum has been met, HealthPartners pays 100% of all covered charges for the rest of the calendar year. Page 5

6 Any out of pocket amount that you pay applies toward both the in-network and the out-ofnetwork out of pocket maximum. You are still responsible for the full cost of service for any services not covered under the plan. Providers- refers to physicians, hospitals and ancillary care providers that you seek medical or dental services from. Network Providers - refers to those physicians, hospitals and ancillary care providers that contract with HealthPartners. To check the network affiliation of any provider, visit and click on find a doctor, dentist or specialist in the blue box on the middle left on the homepage. If you are traveling out of the area and need to see a doctor, you have access to the nationwide network, CIGNA. You can go online to or call the number on the back of your card (HealthPartners member services), and get a list of CIGNA providers where you are. If you use the CIGNA network, you receive in-network benefits. If you see any other doctor, you are still covered at the out of network benefit level. The CIGNA network is also a good option for those employees who have college students living out of the area. If you are traveling out of the United States, you still have medical coverage under the out of network level of all of our health plans. Network Discounts Network discounts are the discounts that HealthPartners has negotiated with medical providers within their network. All in-network services are billed from the medical providers to HealthPartners at their standard billing rate, and then they are discounted to the negotiated rate. For example, a doctor may normally charge $150 for a new patient office visit, but HealthPartners may have negotiated a price of $90. When the provider bills the $150 charge to HealthPartners, HP reduces it to $90 and pays the normal benefits under your plan. If your office visit benefit has a $25 copay you would pay $25, HP would pay $65, and the doctor s office would write off the $60 discount. Formulary A formulary is a list of prescription drugs that are covered by HP health plans. So how do I know what to pay at the time of service? Because a medical provider has no way to tell if you have already met a deductible, nor can they tell right away when you arrive what specific services you will be billed for, they generally only ask you to pay any copay listed on your white HealthPartners ID card. It isn t until HealthPartners processes the claim and sends you and the medical provider an Explanation of Benefits (EOB) that you will know how much you actually owe for the services. If you owe more than the copay amount you paid at the time of service (if any), the medical provider will bill you for the balance. It is very important that you make sure the amount the medical provider bills you is the amount you owe as shown on the HealthPartners EOB less the amount you paid at the time of service. If the balance due is not the same, you will want to call the medical provider and/or HealthPartners to ask about the discrepancy. Page 6

7 HealthPartners Empower HRA Plan Uses the HealthPartners Open Access Network. Benefits include a Metropolitan Council contribution to each participants VEBA trust account to reimburse medical expenses. Health Service Network Out of Network Lifetime Maximum Unlimited $2,000,000 Employer Contribution to VEBA Account: $1,375 per single coverage; $2,750 per family coverage Calendar Year Deductible $1,375 per person; $2,750 per family $2,650 per person; $5,250 per family Annual Out-Of-Pocket Maximum $2,875 per person; $5,750 per family $5,750 per person; $11,500 per family Preventive Health Care Routine physical, eye exams & well-child care 70% coverage Prenatal & Postnatal Care 70% coverage Immunizations 70% coverage Office Visits Illness and Injury 80% coverage 70% coverage Behavioral health care 80% coverage 70% coverage Allergy injections 80% coverage 70% coverage Inpatient Hospital Care Illness and Injury 80% coverage 70% coverage Behavioral health care 80% coverage 70% coverage Durable Medical Equipment Illness and Injury 80% coverage 70% coverage Home Health Care Illness and Injury 80% coverage 70% coverage Outpatient Care Scheduled Outpatient Procedures 80% coverage 70% coverage Diagnostics MRI/CT Scans 80% coverage 70% coverage Emergency Room Urgent Care Center 80% coverage 80% coverage Emergency Care at Hospital ER 80% coverage 80% coverage Ambulance 80% coverage 80% coverage Prescription Drugs Prescription Drugs: Retail- 30 days supplyformulary 80% coverage 70% coverage Prescription Drugs: Mail Order- 90 days supply- formulary 80% coverage 70% coverage Page 7

8 Empower HRA Plan How Does the Empower HRA Plan Work? The HealthPartners Empower HRA plan is actually a health plan and a separate Health Reimbursement Account (HRA). Think of it as an insurance plan and an independent bank account. The Empower HRA health plan covers all eligible in-network expenses at 80% after the deductible (except preventive care, which is covered at 100%, no deductible, in network). Metropolitan Council puts money into the HRA account ( bank account ) for you when you enroll in the Empower HRA health plan. The contribution amount is equal to your deductible- if you have single coverage the contribution is equal to the single deductible; if you have family coverage the contribution is equal to the family deductible. This contribution is used to fully fund your deductible. Financially, it is like not having a deductible at all. HealthPartners administers your HRA funds, sending you checks out of your HRA account when you have out of pocket expenses for health claims. The entire contribution is added to your account and available for use on your first day enrolled in the plan. The contribution is not prorated, so even if you are a new employee who is effective near the end of the year, you still receive a full contribution that is the same as your health plan deductible. So how does this plan work in real life? Many people are concerned about having to pay for the services at the doctor s office and wait for reimbursement, or think there is a lot of complicated paperwork. A vast majority of providers (doctors offices, urgent care, emergency rooms, etc) do not ask for any money at the front desk. At that point, they have no way to tell if you ve met your deductible or out of pocket maximum or what the HealthPartners network discount is for the services you have yet to receive. Once you leave the office, they bill the health plan, HealthPartners, who will process the claim under your insurance plan. If you have not yet met the deductible, HealthPartners will deduct the network discount (which the doctor will not bill you for) from the total billed amount and apply the rest toward your deductible, which you are responsible for and the doctor will bill you for. Then HealthPartners will look at your HRA account and if there are adequate funds, send you the amount you owe on the claim. You may choose to receive paper checks or set up direct deposit for these funds. Generally, you will receive the Explanation of Benefits (EOB) for the services, showing the amount you owe, and a few days later receive HRA funds out of your HRA account for the amount you owe. You pay the doctor. In a vast majority of cases, you will receive the EOB and HRA funds before the doctor office bills you for your balance. Once your deductible is met HealthPartners pays your claims out of the health plan at 80% of the discounted amount (except preventive care, which is covered at 100% with no deducible innetwork). The 80% benefit that is paid out of the Health Plan is sent directly to the provider of services. Page 8

9 Go to medical provider, show HP ID card Provider bills HP, HP processes claim HP sends EOB to you and provider showing the discount, how much they paid, and how much you owe If any benefits are paid from the health plan, they are sent directly to the provider If you owe on the claim, HP checks your HRA account balance If adequate HRA funds, HP sends balance due to you, you pay the provider If no funds in your HRA account, you pay the balance due to the provider The Empower HRA ID card shows that you pay 20%. We ve found that there are some convenience care clinics (like the quick care clinics in CVS Pharmacy or at Target) that may require you to pay that 20% at the front desk. Since their charges are generally low, around $65 for an office visit, the 20% they request that you pay up front would be minimal ($13 for the example above). When HealthPartners receives the claim from the clinic they would apply the network discount and, if you haven t met your deductible, apply the balance toward your deductible then send you funds out of your HRA account for the amount you owe. If the clinic charged $65 for an office visit and the network discount was $10, $55 would be applied to your deductible, and sent to you from your HRA account. Since you already paid 20% ($13) Page 9

10 when you visited the clinic, you would receive $55 in HRA funds and then pay the clinic the remaining $42 when they bill you. If you have single coverage, once your deductible is met, your HRA account generally would be out of funds, since the Metropolitan Council contribution to your HRA account equals your deductible amount. When HealthPartners starts paying your claims at 80% out of the health plan, you will pay 20% out of your pocket, until you meet the maximum Out of Pocket maximum. If you have family coverage, the HRA account can be used to fund claims on any or all family members, there is not a separate amount set for each family member. If you have a high dollar medical claim, you can use the entire family HRA contribution to both fund your deductible and the 20% you would pay on your medical claims after the deductible is met. The deductible and co-insurance apply toward the Out of Pocket maximum. The Out of Pocket maximum listed in your benefit summary, or HealthPartners Schedule of Payments does not take into account the HRA contribution that Metropolitan Councils pays into your HRA account. Therefore, if you have single coverage in a plan that has a $1,375 individual deductible (which has a $1,375 HRA contribution) and the individual Out of Pocket maximum is listed as $2,875, the actual maximum amount you would pay out of your pocket in a calendar year is $1,500 ($2,875 less the $1,375 we contributed to your HRA account). Prescription drugs are also paid at 80% after the calendar year deductible. In order to avoid a potentially large bill at the pharmacy, HealthPartners gives you a red HRA debit card to use only on prescription drugs. When you visit a network pharmacy, you show your white ID card so the pharmacy can run the claim through the health plan to apply the network discount, deductible and co-insurance. Once they determine the amount you owe you may use your red HRA debit Bring RX to network Pharmacy, show HP ID card Pharmacy runs claim through plan, determines amount you owe You use HP debit card to pay balance from HRA account (if adequate funds) card to pull the funds directly out of your HRA account to pay for the prescription. If you have already used all your HRA funds, you pay the amount you owe for the prescription out of your pocket. The network discounted amounts for any drug can be very different from one pharmacy to another. We highly recommend reviewing the discounted amounts on the HealthPartners website After entering the drug name and strength it will show the network discounted amount at several pharmacies in your area. You may be surprised by the amount you can save by choosing a different pharmacy, or you may be able to confirm that your usual pharmacy is already giving you the best price on your medication. Page 10

11 Employer contributed funds in the HRA account are never taxed- not when you receive them, and not when they are sent to you to fund a claim. They do earn interest. Any balance left at the end of the year rolls over into the next year for use on future claims.* Even if you change health plans at Open Enrollment, retire, or terminate, any dollars you have in the HRA plan stay in the plan until you use them to reimburse for an eligible expense.** All IRS 213D list expenses are eligible for reimbursement from the HRA plan. The IRS 213D list is the same list that your medical FSA plan uses to determine eligible expenses. The list includes medical expenses, including deductibles and coinsurance, as well as dental expenses, eyeglasses, hearing aids, medical equipment, etc. We recommend that you use the HRA contribution for your deductible for at least the first year you are on the plan, and consider using it for additional expenses once you build up a balance over the following year(s). The function of HealthPartners automatically sending you a check from your HRA account for the amount you owe on a bill is called Carryover or Automatic Claims Submission. You must turn this off if you have an ex-spouse on your plan (they are not your tax dependent, so they are not eligible for the HRA funds) or if anybody in your family is covered by more than one medical insurance plan. This is because both insurance companies have to process a claim before you can actually determine the amount you owe on a claim. Once you receive the Explanations of Benefits from both insurance companies, you can manually submit the expenses for reimbursement of your out of pocket expenses from your HRA account. You may choose to turn off this feature if you also have money in an FSA (flexible spending account). Remember that FSA dollars do not roll over at the end of the year, so we recommend that you use your FSA dollars first. Once you exhaust your FSA funds, you can turn the Carryover back on. Turning the HRA Carryover off and back on is a simple form that you fax to HealthPartners (form is included in this packet). The Empower HRA plan uses the HealthPartners Open Access network of doctors, so the same doctors and facilities that are in the network under the Distinctions III plans are in the network for the Empower HRA plan. To check any doctor, visit Click on find a doctor, dentist or specialist in the blue box in the middle of the homepage. Click on group medical plans. Under Open Access, either click on find a doctor/dentist or find a clinic/hospital. Enter your zip code and your doctor or clinic name. Like our other health plans, you do not need a referral for any services in the Empower HRA plan. The financial incentive of having this health plan can be the rollover of unused HRA funds, but in many cases is the lower monthly premium you pay for the plan. To accurately compare the worst-case financial picture of each plan you consider at Open Enrollment, add together the annual Out of Pocket maximum (shown on the attached benefit summary- use the single amount if you have single coverage; use the family amount if you have family coverage) and the employee annual cost (shown on the enclosed rate sheet). For this plan, also subtract the HRA contribution paid by Metropolitan Council. When you compare these numbers side by side, you may find that the lower premiums more than make up for the possibility of meeting a higher Out of Pocket maximum. *You have 120 days into the next year to submit the prior years claims for reimbursement from the HRA plan. Any money that is rolling over from the previous year cannot be used for the current years claims until after that 120 day period. ** If you have money in an HRA account, but are no longer in the Empower HRA health plan (i.e. you change plans during open enrollment, retire, or terminate), there is a $4 per month administration fee that you will pay out of your account, taken annually in January. Page 11

12 HRA Questions & Answers Q. How much of my deductible can be paid by HRA contributions? A. Each year you are enrolled in the plan, you will receive an HRA contribution. It is equal to the in-network deductible. Q. What if I have questions about my HRA who do I call? A. Your first point of contact is HealthPartners Member Services, who can be reached Monday through Friday from 7:30 a.m. to 6:00 p.m. at You may also access your HRA account information on-line at HealthPartners.com. Make sure to request your PIN number from HealthPartners to gain access. You can also call the Met Council Benefits-One line at Q. Who pays the fees associated with the administration of the HRA plan? A. Met Council pays the fees for active employees enrolled in the Empower HRA plan (Empower HRA). For all other HRA participants, the HRA fees are the participant s responsibility. The fees are taken once per year for a 12 month period. Therefore, if you have an HRA account with a balance, but are not currently enrolled in the HRA plan, $48.00 in administrative fees are deducted each January for any account that has an account balance. Q. Does the HRA plan cover the same things as covered under the Distinctions III plan? A. Services not specifically excluded under the Distinctions III plan but are excluded under the Empower HRA are: acupuncture, orthognathic dental care, drugs for the treatment of sexual dysfunction, and weight loss services including surgery and prescription drugs. HRA Claims Q. Is there a minimum check amount? A. Yes. Checks will only be issued if the reimbursement is at least $20. If the claim is less than this, it will be put on hold until the reimbursement amount equals at least $20. Q. Can I submit expenses to the HRA for any date of service? Can I submit expenses from the prior year? A. Eligible expenses are those that are incurred during your HRA period of coverage for which the contribution is made. Any medical expenses incurred in 2013 will not be eligible for reimbursement with the 2014 HRA contribution. Funds unused from the previous year roll over into the next year for use on future expenses. You have 120 days into the current year to submit out of pocket expenses from the previous year (i.e. until April 30, 2014 to submit 2013 expenses) this is called the claims submission deadline. Therefore, the leftover HRA funds from one year do not rollover into the next year until the claims submission deadline has passed. If you move to a different medical plan during open enrollment, terminate or retire prior to January 1, 2014, you cannot be reimbursed for 2014 out of pocket expenses until the 2013 HRA balance rolls over around April 30, Waiting for the rollover to occur generally has little to no effect on people who continue to be enrolled in the Empower HRA plan, as they can use the current year employer contribution for expense reimbursement until the past year contributions (if any) roll over. However, if the Page 12

13 current year contribution is exhausted prior to April 30, you will have to wait until the rollover occurs to use the prior year(s) balance. In either case, you may submit the current year out of pocket expenses to HealthPartners, who will initially decline payment, but will then reprocess the expenses once the prior year funds have rolled over. Q. What if my spouse also has an HRA? A. The same eligible expenses cannot be reimbursed from multiple plans. Therefore, you will need to make sure that your spouse s eligible expenses are only reimbursed from one HRA. If that HRA balance is depleted, the remaining expenses can be submitted to the second HRA. You must also opt out of the automatic submission feature of your HRA. Initial Enrollment Q. Will my deductible and HRA contributions change on an annual basis? A. For collectively bargained employees, changes are negotiated and subject to collective bargaining agreements. If any Federal or State laws, regulations, or guidance require changes, the HRA must be amended to comply with those laws, regulations, and guidance. Q. How does the Health Flexible Spending Account work with the HRA? A. You may choose to enroll in both Empwer HRA plan and the health FSA. Both plans will cover the same expenses eligible under section 213(d). Generally speaking, if you may claim the medical expense under your health FSA, the claim is eligible under the HRA. The health FSA requires you to use the funds in the same year or you forfeit the unused balance. The HRA carries forward your unused funds for use in future years. The following points should be kept in mind when you make your enrollment decisions: You are not eligible to be reimbursed for the same expenses under both accounts. The health FSA is considered primary and should pay any eligible expenses first. You may choose to opt out of your HRA automatic submission. Once your health FSA funds are exhausted for the year, you can opt back in to your HRA automatic submission. Mid-Year Changes and Status Changes Q. What if I don t like this medical plan? Can I change plans mid-year? A. An election in the Empower HRA Plan will be for the entire calendar year. The only time you may change medical plans is during open enrollment or when you have certain qualified status changes. Q. What if I have a change in status? Can I change medical plans mid-year? A. Only certain qualified changes in status will provide an opportunity to change medical plans mid-year. An election in the Empower HRA plan generally will be for the entire calendar year. Page 13

14 Q. What if I change from single to family coverage mid-year? Family to single? A. If you change from single to family coverage during the year due to a qualified change in status, then an additional HRA contribution of the difference between the single and the family amount will be made. If you change from family to single, due to a qualified change in status, your prior HRA contributions remain unchanged. Future contributions will be adjusted. Q. What if I add or drop a dependent during the year? A. If you, due to a qualified change in status, acquire an eligible dependent or an existing dependent becomes ineligible, then you may make the corresponding change to your medical plan. If the change in dependents does not also mean a change in coverage level (either single to family or family to single), then your HRA contribution remains unchanged. Q. What happens if I get divorced? How are my funds divided? A. At the time of your divorce, you should notify the Benefits Department. Your ex-spouse will then be removed from the Empower HRA fund (not the health plan). A court may divide the funds you have in your HRA. In addition, COBRA will be offered to your ex-spouse. Termination, Retirement and Death Q. If I terminate mid-year, do I have to pay back any of my HRA contribution? A. No. Q. What happens to my HRA if I terminate? A. The HRA money is yours to use for eligible medical expenses after termination. You will also be offered COBRA to continue under the Empower HRA Plan. Q. Can I participate after I retire? A. The Empower HRA Plan is currently not available after you retire, unless you elect COBRA. Q. Can I name a beneficiary? A. No. The Internal Revenue Code limits do not allow amounts under an HRA to be transferred to a beneficiary on a tax-favored basis. Therefore, the HRA does not permit you to name a beneficiary. Q. What happens to my HRA balance if I pass away? A. After a participant dies, their accumulated balance may be used to pay for the qualified medical expenses of their surviving spouse or tax dependents and would need to be substantiated. Beneficiaries, dependents and spouses may cash out the account, however it would be considered taxable. Q. Please explain how COBRA works with an HRA. A. COBRA will be offered for the Empower HRA Plan in the same manner as any other plan. For example, if your qualifying event is termination of employment, COBRA will be available for 18 months. If you elect, the first of the year following election, the same amount of funds will be deposited into your HRA account as is deposited for other similar active employees. Page 14

15 Contributions and Funding Q. Can I contribute to an HRA? A. No. Contributions can only be made by Met Council. You may make an annual election to your Flexible Spending Account. Q. Is my contribution available at the beginning of the year? A. Yes. Met Council will fund the HRA in January for those employees enrolled in the plan. HRA Funds Held in a VEBA Trust Q. What is a VEBA? A. Your HRA funds are held in a VEBA trust. A VEBA trust is a Voluntary Employees Beneficiary Association trust. It is a tax-exempt trust that is a funding vehicle for contributions that are set aside in a trust account on behalf of employees. Q. Is the trust irrevocable? A. Yes. That is one of the reasons we chose the VEBA trust because it is irrevocable. Once the HRA contributions are deposited on your behalf, they belong to the trust and may be used by you to pay your eligible medical expenses. Page 15

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18 HealthPartners Distinctions Medical Plan Tiered plan using the HealthPartners Distinctions III Network. Benefits are based on the network level of the provider you obtain services from. Health Service Level 1 Level 2 Level 3 Out of Network Lifetime Maximum Unlimited $1,000,000 Calendar Year Deductible Annual Out-Of-Pocket Maximum Preventive Health Care Routine physical, eye exams & well-child care Prenatal & Postnatal Care Immunizations Office Visits Illness and Injury Lab & X-rays (except MRI/CAT scans) Behavioral health care Allergy injections Inpatient Hospital Care Illness and Injury Behavioral health care Durable Medical Equipment Illness and Injury Home Health Care Illness and Injury Outpatient Care Scheduled Outpatient Procedures Diagnostics MRI/CT Scans Emergency Room Urgent Care Center Emergency Care at Hospital ER Ambulance $23 Copay $23 Copay $100 copayment $100 copayment 80% coverage $25 copayment $30 copayment 80% coverage $25 Copay $113 Copay 80% coverage $275 per person; $550 per family $1,100 per person; $2,200 per family $33 Copay $23 Copay $250 copayment $250 copayment 80% coverage $25 copayment $40 copayment 80% coverage $25 Copay $113 Copay 80% coverage $43 Copay $23 Copay $500 copayment $500 copayment 80% coverage $25 copayment $70 copayment 80% coverage $25 Copay $113 Copay 80% coverage $550 per person; $1,100 per family $3,000 per person; $5,000 per family No Coverage 70% coverage No Coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage 70% coverage Page 18 (continued on next page)

19 Prescription Drugs Prescription Drugs: Retail- 30 days supply- generic formulary $15 Copay $15 Copay $15 Copay 70% coverage Prescription Drugs: Retail- 30 days supply- brand name formulary Prescription Drugs: Mail Order- 90 days supply- generic formulary Prescription Drugs: Mail Order- 90 days supply- brand name formulary $33 Copay $30 Copay $66 Copay $33 Copay $30 Copay $66 Copay $33 Copay $30 Copay $66 Copay 70% coverage 70% coverage 70% coverage Page 19

20 Distinctions III Plan How Does the Distinctions III Plan Work? The Distinctions plan uses the Distinctions III network. HealthPartners assigns in-network providers to a network level (or tier) of 1, 2, or 3. Tiering is based on many factors, such as quality of care, cost, technology used, patient satisfaction, and other criteria. Your benefits are based on your provider s network level, just like our Distinctions Dental plan. Not all benefits are different between network levels. For example, preventive health care is covered at 100% with no deductible for any in-network provider. Also, this plan applies the annual deductible to some benefits, but not others. Each benefit on the benefits summary either states or no deductible. The deductible does not apply to those benefits where the summary says no deductible. HealthPartners tiers providers by specialty. General Practitioners, Cardiology, Ear, Nose and Throat, Ob/Gyn, Orthopedics and Hospitals are tiered. Any other specialty is not tiered (such as Oncology, Opthamology, Endocrinology, etc.) and defaults to a level 2 benefit. The best value (i.e. lowest copays for the highest rated providers) is for those doctors in level 1. Providers in the same clinic may be tiered at different levels. Your general practitioner at your clinic may be a level 1, and the Ob/Gyn doctor at the same clinic may be a level 2. It is important to note that you have coverage for all providers on this plan, even those that are out of network. Let s say you are visiting your level 1 general practitioner and they recommend that you see an orthopedic specialist, and they can get you in with one at the same clinic the same afternoon. You would not know at that point if the orthopedic specialist is a level 1, 2, or 3. It is your choice to determine if you wish to see that orthopedic specialist not knowing what level they are at and pay the corresponding copay, or if you wish to review your provider options online (or by phone with HealthPartners Customer Service) and either confirm what level the orthopedist is, or make an appointment with a level 1 specialist to get the lowest copay. To check the tier of any doctor, visit Click on find a doctor, dentist or specialist in the blue box in the middle of the homepage. Click on group medical plans. Under tiered network plans Distinctions III, either click on find a doctor/dentist or find a clinic/hospital. Enter your zip code and your doctor or clinic name. The network level will either be on the list of clinics you chose, or you may have to open the link for your clinic and look under the doctors tab to find the network level. HealthPartners determines the tier of all in-network providers each calendar year. Whichever tier your provider is assigned in January is the tier they will be in December, but they could change for the following year, so check your providers levels each year. Like all our health plans, you do not need a referral to see any doctor, the benefit on each claim is based on the network level of the provider you receive the services from. Your best benefit will be for services provided by a HealthPartners Distinctions III Level 1 network provider. There is a different copay for brand name prescriptions than for generic prescriptions. If there is no generic equivalent of the drug you need to take, you would pay the brand name copay. If Page 20

21 there is a generic available, but you want to take the brand name version, the brand copay will apply, PLUS you would pay the difference between the cost of the brand drug and the generic drug. If you cannot tolerate the generic drug, your doctor must complete a HealthPartners Pre- Authorization Exception form and submit it to HealthPartners. If they approve, you may then fill the brand name prescription and pay only the brand name copay. Once the exception is approved the doctor should write the script for dispensed as written. To accurately compare the worst-case financial picture of each plan you consider at Open Enrollment, add together the annual Out of Pocket maximum (shown on the attached benefit summary- use the single amount if you have single coverage; use the family amount if you have family coverage) and the employee annual cost (shown on the enclosed rate sheet). For the HRA plan, also subtract the HRA contribution paid by Metropolitan Council. When you compare these numbers side by side, you may find that the lower premiums more than make up for the possibility of meeting a higher Out of Pocket maximum. Page 21

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24 HealthPartners Dental Distinctions Plan Uses the HealthPartners Dental Distinctions network. Benefits are based on the network level of the provider from which you obtain services. Dental Service Level 1 Level 2 Out of Network Individual Calendar Year Deductible None $10 $25 Family Calendar Year Deductible None $30 $75 Calendar Year Maximum Benefits $2,000 $1,500 $1,000 Preventive and Diagnostic Services Exams, cleaning, fluoride, sealants Subject to plan limits Subject to plan limits Bitewing and full mouth x-rays Space maintainers (dependents under age 19) Basic Services Consults Fillings Oral Surgery Periodontics Endodontics Special Services Special restorative care Repair/recement of crowns, inlays or onlays Prosthetic Services Bridges, Dentures, Partial Dentures 80% coverage 80% coverage 80% coverage Subject to plan limits Subject to plan limits - Subject to plan limits 80% coverage 80% coverage 80% coverage Subject to plan limits Subject to plan limits 80% coverage 80% coverage 80% coverage - Subject to plan limits 80% coverage 50% coverage 50% coverage 50% coverage Orthodontic Services Orthodontics for all members 50% coverage 50% coverage 50% coverage Orthodontic Lifetime Maximum $2,000 $1,500 $1,500 Page 24

25 Dental Plan Q&A Q. What do the different benefit levels represent? A. Benefit Level 1 is your benefits for services obtained from HealthPartners Dental clinics, Park Dental Clinics, Orthodontic Care Specialists and WOW Orthodontics. Benefit Level 2 is your benefits for services obtained from all other HealthPartners in-network providers. Benefit level 3 is your benefits for services from out of network providers. Q. Where are HealthPartners Dental Clinics located? A. Apple Valley, Arden Hills, Blaine, Bloomington, Brooklyn Center, Como (St. Paul), Coon Rapids, Inver Grove Heights, Maplewood, Midway (St. Paul), Riverside (Mpls), St. Cloud, St. Paul, St. Louis Park, White Bear Lake, and Woodbury. Q. Where are Park Dental Clinics located? A. Blaine, Bloomington, Brooklyn Park, Burnsville, Champlin, Chaska, Coon Rapids, Eagan, Eden Prairie, Edina, Farmington, Inver Grove Heights, Lake Elmo, Maple Grove, Maplewood, Minneapolis, Minnetonka, Plymouth, Roseville, Shakopee, St. Anthony, St. Louis Park, and St. Paul. Q. Where are Orthodontic Care Specialists Clinics located? A. Apple Valley, Blaine, Brooklyn Center, Coon Rapids, Eden Prairie, Farmington, Lake Elmo, Maple Grove, Plymouth, Rosemount, Shakopee, St. Louis Park, St. Paul and White Bear Lake. Q. Where are WOW Orthodontic Clinics located? A. Anoka, Elk River, Champlin and Princeton. Q. How do I find out if my dentist is in the HealthPartners network? A. You can visit HealthPartners.com website to find a dental provider in your area. Click on find provider on the bar of quick links at the bottom of the homepage, then group dental plans. Under the heading of HealthPartners Distinctions Dental Network click on find a dentist. You will then be able to enter your zip code and come up with a number of dentists to choose from. Directories on paper and on computer disk will also be available during Open Enrollment meetings. Q. Do I have to pick a dentist and get a referral to go elsewhere? A. No, you may see whichever dentist you wish. The benefit on each claim is based on the dentist you receive the services from. Your best benefit will be for dental services provided by a HealthPartners Dental Clinic or Park Dental Clinic and from orthodontic services provided Page 25

26 by Orthodontic Care Specialists or WOW Orthodontic. Q. Are there separate medical and dental insurance cards? A. Yes, even though our medical and dental coverage is through HealthPartners, they will send you separate medical and dental ID cards, even though your Identification number will be the same for Dental as Medical. Q. I have the Empower HRA health plan, does the fact that we have dental with HealthPartners have any advantages for me? A. Yes! If you have the Empower HRA, your dental out-of-pocket expenses can be automatically reimbursed from your HRA account after the claim has been processed by HealthPartners (unless you have this feature turned off). Q. What other advantages does the Distinctions Open Access Dental Plan have? A. The Distinctions Open Access Dental Plan allows for exams and cleanings twice per calendar year. You can go twice per year regardless of the time period between each exam. Also, this limit only applies to Benefit Level 2 and Out-of- Network providers. If you use the HealthPartners Dental Clinics or Park Dental Clinics (Benefit Level 1), these limits do not apply, you may have as many visits as dentally necessary. Page 26

27 Vision Plan (VSP) Vision Plan through VSP This plan is completely voluntary and fully employee paid (post tax). Employees can choose from two plans, the Basic plan and the Buy Up plan. Both plans have the same benefits, but with the Basic plan, VSP allows frames/lenses or contact lenses once every other calendar year, while the Buy-Up plan allows for fames/lenses or contact lenses every calendar year. Note that the premiums are four tier (employee only, employee + spouse, employee + children, or family) so you can chose the coverage level that is right for you and your family. Vision Plan Q&As Q. Once enrolled, do I get an ID card? A. No, VSP does not use ID cards. If you want an information card for your wallet, there is one at the end of the Q&A that you can cut out, fold, and carry with you. Q. How do I obtain network benefits? A. VSP doctors will validate eligibility by the last four numbers of your social security number, date of birth and full name of the employee when you call to make the appointment. They will then provide the exam, or guide you through your glasses or contacts choices and benefits. Q. How do I find a VSP Doctor? A. You can see the participating providers online at Click on members or prospective members then find a VSP doctor, and then enter your address to find providers in your area. You can also call their customer service line at Q. What if I like a pair of frames that cost more than $130 ($70 at Costco)? A. VSP s retail frame allowance is backed by a guaranteed wholesale allowance. Different doctors may mark up frames at different rates, so a frame that is retail priced at $115 at one doctors office, may retail at another doctors office for $145. However, the wholesale price is the same. Once you pick a frame, have the doctor s office check to see if it is within your allowance. If not, you will receive a 20% discount on the amount that exceeds your allowance. In 2014, VSP has added an additional benefit that certain brands of frames will get a $150 frame allowance. This list of brands is extensive and can change over the course of a plan year. The extra $20 allowance will automatically be added to your current frame allowance by the VSP doctor if you select a featured frame brand. (turn over) Page 27

28 Q. Why is there a different frame maximum at Costco than other VSP Network providers? A. Costco is a new VSP network provider for The allowance at Costco Optical is an equivalent allowance to what is available at VSP Providers and other affiliates. Costco already has in place their every day, low cost pricing, they do not markup the cost of frames the same way most retailers do. The average frame price at Costco is $68, with 89% of frames under $99, and 70% under $90. Q. Why is a routine vision exam benefit offered under VSP when I have one under my HealthPartners medical plan? A. If you have a HealthPartners health plan through Metropolitan Council as an active employee, you have 100% preventive coverage in the HealthPartners network, and that includes routine eye exams. You have the option of getting your eye exam at a HealthPartners network doctor, and then using your VSP benefits for glasses or contacts at a VSP Doctor. Several VSP Doctors are also HealthPartners network doctors, but if not, we wanted you to be able to have the choice of where to have your vision exam. Q. Can I change my election at any time? A. You may only change your plan election during Open Enrollment, which happens every year during November, for a January 1 effective date. No mid year changes are allowed unless you have a qualified family status change. Q. How does the Vision plan work with the Flexible Spending Account? A. You are not eligible to be reimbursed for vision services that are paid by VSP. However, your in-network copays or non network out-of-pocket expenses are eligible for reimbursement from your FSA. Q. I will be retiring soon, can I keep this coverage after I retire? A. Yes, you may continue this plan at full cost. Q. If I terminate my employment, may I keep this coverage? A. You may continue under COBRA rights, for 18 months, at 102% of full cost of the plan. Important Note: Contents of this document are intended to highlight select benefits information only. Please see your labor agreements and plan documents for additional information. If there is any discrepancy between the labor agreement or plan documents and the information contained here, the labor agreement and plan documents will take precedence. Page 28

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31 Life Insurance through Minnesota Life Supplemental Life Insurance Basic Life TMSA members have employer paid basic life insurance in the amount of two times your annual salary, up to a maximum of $200,000. Supplemental Life Employee Supplemental Life insurance is an optional, employee paid benefit you may purchase in $5,000 increments up to a maximum of $500,000. To enroll or increase the amount of this benefit, you must complete a Supplemental Life Insurance Form, as well as a Group Life Insurance Health Questionnaire. Determination of coverage is made by Minnesota Life underwriters. Rates are as follows: Age Group Monthly Rate Per $5,000 Coverage (Includes AD&D) Age Group Monthly Rate Per $5,000 Coverage (Includes AD&D) Under 30 $0.76* $ $0.87* $2.63* $ $ $0.98* $ $ $10.82 *rates rounded to the nearest cent Dependent Life Insurance Eligible employees can purchase supplemental life for their spouse in $5,000 increments to a maximum benefit of $100,000. Coverage for dependent children is also available in amounts of $5,000, $10,000 or $15,000. The child life premium is the same regardless of the number of children covered. Dependent children up to age 19, or up to age 25 if a full time student and financially dependent on the employee are eligible for coverage under the child life policy. Age Group Monthly Rate Per $5,000 Coverage Spouse Age Group Monthly Rate Per $5,000 Coverage Coverage Amount Child(ren) Monthly Rate Under 30 $0.61* $1.54 $5,000 $ $0.72* $2.48* $10,000 (new) $ $ $3.63 $15,000 (new) $ $0.83* $ $ $10.67 *rates rounded to the nearest cent Page 31

32 Beneficiary Changes Minnesota Life manages your group life insurance beneficiary. Minnesota Life provides a secure web site for electing, storing, and updating your life insurance beneficiary designations. This secure online service protects the privacy of your information while making sure beneficiary information is available when it's needed. How to designate your beneficiary: 1. Go to Minnesota Life s web site at 2. At the Welcome page, enter your user ID and password as shown below. You'll be asked to change your password when you enter the web site for the first time. Minnesota Life also offers an online password help feature. If you forget your password when logging on in the future, this feature will help you get into the site if you answer your personalized questions correctly. We highly recommend signing up for this feature. 3. Designate your beneficiary by following the instructions on the web site. 4. Click on the "Submit" button to save your beneficiary designations. 5. Minnesota Life will mail you a confirmation after you complete your designation. If you do not designate a beneficiary the default beneficiary will be: spouse, children, parents then estate. This "default" beneficiary may not reflect your wishes and should be used as a last resort, similar to the distribution of assets in an estate when there is no written will. User ID and Password User ID: MET plus your Employee ID Password: Enter your eight-digit date of birth (mmddyyyy) followed by the last four digits of your Social Security number* For technical assistance, call: *Example: If your date of birth was 11/27/1950 and the last four digits of your Social Security number were 1234, you would enter as your password. If you have questions about your group life insurance coverage please call the Metropolitan Council Benefits-One line at (651) Page 32

33 MINNESOTA LIFE Supplemental Life Insurance Form TMSA Name: Employee #: Last First MI Complete this Section to Enroll or Increase Coverage: Employee Supplemental Life & ADD Spousal Dependent Life Child(ren) Life Employee Paid- Available in $5,000 Increments up to $500,000 Check One: Enroll Increase coverage amount Complete Health Questionnaire Employee Paid- Available in $5,000 Increments up to $100,000 Check One: Enroll Increase coverage amount Complete Health Questionnaire Employee Paid- Available in amounts of $5,000, $10,000 or $15,000: Check One: Enroll Increase coverage amount Amount of Coverage $ No Health Questionnaire Needed Dependent Information (Complete only if dependent coverage is elected) Spouse: Child: Child: Child: Last First MI Sex: Birth date: (M/D/Y) SSN M F M F M F M F Employee Supplemental Life Cancel coverage Spousal Supplemental Life Cancel coverage Child(ren) Life Cancel coverage Complete this Section to Decrease or Cancel Coverage: Decrease coverage amount Indicate new coverage amount: Decrease coverage amount Indicate new coverage amount: $ ($5,000 increments) $ ($5,000 increments) No Health Questionnaire Required I hereby apply for the coverage I have indicated above on behalf of myself and all dependents listed, and I authorize my Employer to make the appropriate deductions, if any, from my wages to pay for my share of the cost. I understand that the coverages available to me are in accordance with the provisions of the contract between MINNESOTA LIFE and my Group Plan. Signature Date Page 33 Received Health Questionnaire (FOR OFFICE USE ONLY)

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46 FLEX (FSA) PLANS Total Administrative Services Corporation (TASC) Our Flex (FSA) plans are administered by Total Administrative Services Corporation (TASC). We offer three types of FSA plans: Healthcare, Dependent Care, and Parking. The parking account reimburses work related parking expenses, so only employees who work out of the Robert Street office are eligible for this plan. All other Metropolitan Council locations offer free parking. Page 46

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