2013 Health & Welfare Open Enrollment Overview

Transcription

1 2013 Health & Welfare Open Enrollment Overview Open Enrollment October 22 November 7, 2012 Please note: The introduction of this benefits package for represented caregivers will be subject to bargaining obligations.

2 2013 Benefits Program Overview Open Enrollment Key Facts Eligible Dependents Medical HSA and FSA New Wellness Program Dental Vision Life and AD&D Short and Long Term Disability Questions 2

3 Key Facts Open Enrollment Dates: October 22 November 7 Positive Enrollment = All caregivers must enroll or opt out of coverage What happens if I don t enroll or opt-out? You will be enrolled in the following default coverage: ABHP Medical Plan - Caregiver Only (initially without HSA) Core Life Core AD&D Core Short- and Long- Term Disability 3

4 Eligible Dependents Your Legal Spouse Your Qualified Domestic Partner Your Legally Domiciled Adult (LDA); eligible for medical, dental and vision coverage only Your Dependent children up to age 26 Additional dependent benefit eligibility details can be found under the Life Events - Family and Relationships section of MyHR. 4

5 Two Medical Plan Options: Preferred Provider Organization (PPO) and Account Based Health Plan (ABHP) 5

6 Medical Plan Highlights Preferred and In-Network Provider Tier Summary PPO ABHP Preventive Care Annual Deductible Single Family Co-Insurance Office visit (PCP and Specialist) Co-Insurance Hospital Inpatient Laboratory Services Annual Out-of-Pocket Maximum (excludes deductible) Single Family Covered 100% Preferred and In-Network Tiers $500 $1,000 20% (deductible waived) 20% Preferred Tier 30% In-Network Tier (after deductible) $2,500 $5,000 Covered 100% Preferred and In-Network Tiers $2,000 $4,000 10% (after deductible) 10% Preferred Tier 20% In-Network Tier (after deductible) $3,000 $6,000 Annual Health Savings Account Not Applicable 2013 PH contributes up to: $1,200 Single coverage $2,000 Family coverage 6

7 Pharmacy Plan Highlights Preferred and In-Network Provider Tier Summary Preferred PPO In-Network Preferred ABHP In-Network Generic $10 copay $15 copay 20% after deductible* 30% after deductible* Brand Formulary 20% Min = $25; Max = $75 Brand Non-Formulary 30% Min = $40; Max = $120 30% Min = $30; Max = $90 40% Min = $50; Max = $150 Prescription expenses do not count toward the medical deductible or annual out-of-pocket. Minimum and Maximum amounts apply to each script. 20% after deductible* 30% after deductible* 30% after deductible* 40% after deductible* Medical deductible must be met first before coinsurance applies *The ABHP deductible is waived for many preventive and chronic prescription drugs. Out-of-Network not covered Mail Order 90-Day scripts at 2.5X 30-day retail price (after deductible for ABHP) 7

8 How The Two Medical Plans Work 8

9 Health Savings Account (HSA) and Flexible Spending Account (FSA) 9

10 Tax Advantaged Accounts Set aside pre-tax money in an HSA or FSA to cover qualified medical expenses; generally defined as any expense incurred to maintain an individual s health or the health of their family, including: Doctor and hospital visits Medical equipment Dental care, braces, dentures Vision care, glasses & contacts Prescription medications *A definition of Qualified Medical Expense is provided in Section 213(d) of Internal Revenue Code. A list of eligible medical expenses can be found in IRS Publication A pre-tax dependent care FSA is also available for qualified workrelated cost of care for a qualifying dependent. 10

11 HSA vs FSA Medical Plan Pairing Health FSA Not eligible if enrolled in the ABHP with HSA HSA ABHP PeaceHealth 2013 contributions 2013 Annual Contribution Limits $0 Up to $1,200 Single Up to $1,800 Family $2,500 $3,250 Single $6,450 Family $1,000 Catch Up age 55+ Account Ownership PeaceHealth You Use It Or Lose It Yes No, funds rollover year to year Substantiation Option to Change Contributions Yes submit receipts at time of reimbursement Only with qualifying event No keep receipts in the event of individual tax audit Yes can change payroll deductions during the year (not to exceed IRS contribution limit) 11

12 HSA Eligibility Caregivers who are enrolled in a PeaceHealth Account Based Health Plan (ABHP) are qualified to enroll in the Health Savings Account (HSA) unless they are: Covered by another insurance coverage plan that is not a High Deductible Health Plan, including spouse s insurance and/or TriCare Claimed as a dependent on another person s tax return (such as being claimed on parent s taxes) Enrolled in Medicare (Part A or B) 12

13 HSA Advantages Tax-deferred, interest-accumulating account Automatic enrollment at HSA Bank with ABHP medical plan election Initial contribution made by PeaceHealth in January 2013 You can contribute money to the account on a pre-tax basis Funds roll over from year to year No use it or lose it Portability - Funds go with you if you leave PeaceHealth or change health plans You control your healthcare dollars and decide when to use your funds. Pay medical bills direct from this account through online banking or the HSA bank debit card or checks. HSA Bank does not require you to submit receipts - keep receipts with tax filing paperwork for any IRS audit needs. 13

14 HSA Contributions The IRS limits total contributions to an HSA each year; this includes dollars you contribute as well as those deposited by PeaceHealth. Remember, any unused dollars roll over from year to year HSA Contribution Limits Medical Plan Enrollment Coverage Level 2013 IRS Limit = PeaceHealth Contribution + Wellness Credit + What you can contribute Individual $3,250 $1,000 $200 $2,050-$2,250 Family $6,450 $1,800 $200 $4,450-$4,650 Catch Up if age 55+ Additional $1,000 14

15 Using Your HSA Doctor Visit Submit Claim Medical TPA Applies network discounts Sends EOB Pay Doctor Pharmacy Visit Fill Prescription Pharmacy Applies network discounts Pay Pharmacy 15

16 FSA Eligibility Caregivers are eligible if: They are not covered by another insurance coverage plan that is a High Deductible Health Plan paired with an HSA, including spouse s insurance Spouse has not elected the annual maximum contribution under their own Health FSA (maximum of $2,500 is per household) Dependent Care FSA is not linked to medical plan enrollments. 16

17 FSA Features - Health and Dependent Care Use-It-Or-Lose-It; claim filing deadline April 30 of following year Tax benefits on contributions Health FSA can be used for qualifying medical expenses - see IRS Publication 502: Extended Grace Period: Unless enrolling in ABHP, Health FSA reimbursement claims may be incurred between your benefit effective date and March 15 of the following year. ABHP enrollee deadline: end of plan year (12/31/12) Dependent Care FSA for daycare for children up to 12 years old, disabled dependents of any age, and elder care Annual Minimum Contribution Health Care FSA Annual Maximum Contribution Dependent Care FSA Annual Maximum Contribution $100 $2,500 $5,000 or $2,500 (married filing separately) 17

18 Using Your FSA Doctor Visit Submit Claim Medical TPA Applies network discounts Sends EOB Pay Doctor with FSA debit or submit receipts for reimbursement Pharmacy Visit Fill Prescription Pharmacy Applies network discounts Day Care Expense Pay Day Care Provider submit receipts for reimbursement 18

19 Wellness at PeaceHealth 19

20 Why does Wellness matter? Good health helps us live better lives at work and at home, and manage increasing health care costs for both you and our organization. And we believe healthy caregivers deliver better and safer care to the communities we serve. Whether it s getting your annual checkup, committing to regular exercise, or spending more time with family and friends we can all take steps to improve our own health. 20

21 Wellness in Medical Plans Our 2013 medical plans have been carefully designed to support continued good health for you and your family. Preventive services covered at 100%. ABHP deductible waived for a broader range of preventive and chronic condition prescription medications. Special support for caregivers or family members who have chronic conditions. In addition to coaching and support, PPO participants will be able to get their prescription drugs at a lower cost. Coordinated HealthCare. Our new health and wellness partner serves as your central point of contact and advocate when you need to navigate the health care system. They provide care coordination, disease management, care management, customer service and more. Biometric and health risk screenings 21

22 Wellness Participation and Incentives 1. Complete an online Wellness Assessment 2. Take part in the Biometrics Screening: Total Cholesterol; Height, Weight, BMI; Blood Pressure ; HDL, TC/HDL Ratio; Waist Circumference and A1C (blood sugar) 3. Enroll in one of the two medical plans 4. Complete all of the above? Receive additional $200 HSA contribution (for ABHP participants) or a $200 premium reduction (PPO participants) 5. You are then eligible to take part in the PeaceHealth / Virgin HealthMiles program. You will receive a pedometer/ accelerometer and be able to take part in fitness challenges, set individual goals, monitor your progress and compete for prizes 22

23 Additional Benefits: Dental, Vision, Life and AD&D, Disability 23

24 Dental Plan Highlights Washington Dental Service (WDS) Maximum Benefit per person per calendar year Benefit $2,000 Annual Deductible per Individual/Family $50/$150 Preventive Services: Routine Exams, Cleaning, X-rays Covered in full Basic Restorative: Fillings, Root Canals, Oral Surgery, Endodontics, Periodontics Major Restorative: Crowns, Dentures, Bridges, Implants Orthodontia 20% after deductible 50% after deductible 50% after deductible $2,000 Lifetime Maximum Benefit per covered member 24

25 Vision Plan Highlights Northwest Benefit Network (NBN) In-Network Out-Of-Network Frequency Routine Eye Exam 100% $50 allowance 12 months Material Copay $25 $25 Basic Lenses 12 months Single Vision Bifocal Trifocal 100% (after copay) 100% (after copay) 100% (after copay) $50 allowance $75 allowance $100 allowance Frames $150 allowance $70 allowance 24 months Elective Contact Lens Allowance $150 allowance $105 allowance 12 months 25

26 Life and AD&D Highlights Core Life and AD&D 2x Base Annual Salary up to $200,000 maximum Caregiver Supplemental Life and AD&D Additional 1x to 3x Base Annual Salary to $1,000,000 maximum Spouse Supplemental Life and AD&D $10,000 - $100,000 in $10,000 increments ($50,000 Guarantee Issue) Child Supplemental Life and AD&D $10,000 or $15,000 Open Enrollment Evidence of Insurability Approval Requirements Supplemental Life New Supplemental Caregiver/Spouse coverage and Spouse amounts above Guarantee Issue Increase in Caregiver Supplemental Life from 1X to 3X 26

27 Core Short Term Disability (STD) 66 2/3% base salary continuation up to $1,500 weekly benefit 7 calendar day waiting period; available PTO/EIB to be used during this time After waiting period: must exhaust all EIB hours before STD benefits will apply; option to use 33 1/3% PTO in addition to STD benefit Continues for up to 6 months (integrates with long term disability) For those who have less than 12 months of continuous STD coverage prior to 1/1/2013, pre-existing condition limitations apply 27

28 Long Term Disability (LTD) Core LTD - Provides 50% of base salary continuation up to $15,000 monthly - Fully paid by PeaceHealth Supplemental LTD - Caregivers may purchase additional 16 2/3% of LTD for total coverage of 66 2/3% of base salary continuation up to $20,000 per month Benefit begins after continuous, approved disability of 180 days Open Enrollment Evidence of Insurability Approval Requirements Supplemental LTD No requirements during Open Enrollment this year. Evidence of Insurability required for supplemental coverage newly elected in future years. 28

29 Special Benefits Program Caregivers may be eligible for the following benefits if they have worked for PeaceHealth for at least 6 months and meet the financial requirements for total household income: Medical Premium Assistance Program Eligible caregivers may receive financial assistance to help cover 100% of the cost of their health care premiums for them and their families (ABHP enrollment). Applications accepted during Open Enrollment. Emergency Loan Program Eligible caregivers may receive an interest-free loan (maximum $500) to be repaid within 1 year. Enhanced Tuition Assistance Eligible caregivers may have part or all of their school tuition paid for by PeaceHealth. Additional details can be found under the My Other Benefits section of myhr. 29

30 Enrollment 30

31 How to Enroll 1. Log onto myhr (from work or home) and select the Open Enrollment button to bring up the OE home page 2. Use check list on the OE home page to get ready 3. Click on Enroll Now to start your 2013 enrollment 4. If you are using a shared computer, be sure to log out for security. 31

32 Resources/Questions myhr Open Enrollment Home Page Links ecascade Newsletters E-Learning Modules Plan Summaries Calculator tools Premium and Eligibility documents myhr/askhr Caregiver Resource Center (CRC) AskHR via MyHR or Phone