Benefits Update Open Enrollment 2013 Erika Van Flein Director of Benefits
Today s Agenda: UA Benefits Update for FY14 Open Enrollment April 15 to May 15 Things you need to know Changes, additions, enhancements What s New? Consumer-Directed Health Plan Health Savings Account 2
Open Enrollment April 15 to May 15, 2013 Plan year starts July 1, 2013 Packets mailed to your home address ( HR address) Benefits web site: www.alaska.edu/benefits Enrollment forms due to HR no later than May 15 3
Summary of Benefits and Coverage (SBC) Required by Health Care Reform No more than 8 pages (4 double-sided pages) One for each plan so you can compare your costs What s covered, what s not Examples of out-of-pocket costs for having a baby or managing diabetes Assumes individual coverage Standardized format, consistent comparisons Glossary of Terms available online 4
UA Choice Rates for FY14 Rates have decreased from FY13. Why is that? Last year s rates included collection of the under recovery from FY12 Projected to collect 80% of under recovery in FY13, added that amount to the cost of the plan Plan costs are coming in under projections, so we ll collect the full amount of the under recovery Plan costs are still increasing, but with the under recovery out of the way, what most employees pay for the plans will be less this year 5
Dependent Tiers What Changed: how we charge for dependents Old Tiers: same cost regardless of family size New Tiers: one child, two children, three or more Reallocate cost based on family size Children still cost much less than adults Employees with three or more children will see their costs increase slightly Employees with only one child will see a decrease 6
Dependent Tiers Very important to complete an enrollment form so you verify how many dependents you have Remember to provide proof of eligibility when enrolling a new or returning dependent on the plan Birth Certificate Adoption papers Marriage certificate Divorce decree 7
500 Plan Dropped Low enrollment Cost would trigger the health care reform Cadillac Tax Choose a new plan or default to the 750 Plan Orthodontia is moving to the 750 Plan 8
Flexible Spending Account Health care Flexible Spending Account (FSA) change: Health Care Reform requirement $2,500 is the maximum amount you can elect Still a good tool to help pay for out-of-pocket expenses like your deductible, coinsurance and pharmacy copays Dependent Care FSA for daycare expenses is not changing 9
Consumer-Directed Health Plan (CDHP) New Plan offered this year, compatible with the Health Savings Account (HSA) Employees have requested the HSA, needed to have a plan that qualifies Restrictions on who can have this plan: No other non-cdhp coverage allowed 10
Pharmacy moving to Premera Changed because of Request for Proposal (RFP) for pharmacy benefit management Premera will still administer medical and dental, and also Pharmacy benefits as of July 1, 2013 Partners with Express Scripts (Medco) for retail, mail order and Specialty pharmacy services Having medical and pharmacy together important for the CDHP design 11
New ID Cards Coming Your Way One ID card for medical, dental, pharmacy Plan changes and addition of pharmacy Makes life a little easier with just one card to use Be sure to give your doctor and pharmacy your new card after July 1 12
Premera.com Register at Premera.com, all you need is your ID card Find in-network doctors in your area, all of Alaska or any other state Pharmacy preferred drug lists Benefit information Claims information Spending Activity Report Mobile app for your phone 13
24 Hour Nurse Line Premera offering a 24 hour Nurse Line service Advice, reassurance, answers Help you determine where and when to seek services All calls to the 24-Hour NurseLine are free, confidential and available 24 hours a day, 7 days a week. Call 800-841-8343. 14
Vision Care Benefit Part of the RFP for benefits: Vision care Staying with VSP with the best network and coverage options Increasing the allowance for frames and contacts to $150 (currently it s $130) Register at VSP.com using your employee ID 15
Consumer-Directed Health Plan (CDHP) What s different about this plan? Pharmacy benefit is subject to deductible and coinsurance (no copays) Deductible is aggregated, meaning if you cover more than just yourself, the family deductible applies Out-of-pocket max is also aggregated No 4 th Quarter Carryover for the deductible Preventive benefit pays at 100% like the other plans, and includes a preventive pharmacy benefit Plan design qualifies for Health Savings Account 16
Health Savings Account (HSA) What is it? A bank account with pre-tax money to pay for eligible health care expenses Contribute by payroll deduction, or make a deposit to HSA by sending a check or transfer funds Can use it for current expenses (deductibles, etc) or save it for future use, the choice is yours You own this account, and take it with you when you leave the University of Alaska Unused balance rolls over year to year, no use it or lose it 17
Health Savings Account (HSA) An account I own, funded with pre-tax dollars, that rolls over year after year and I can take it with me when I leave the University? What s the catch? There are rules designed to limit who can participate and what kind of plan you can have in exchange for all that tax-favored goodness 18
Health Savings Account (HSA) Who can contribute to a HSA? You must be covered by a qualifying high deductible health plan, like the UA Choice Consumer-Directed Health Plan (CDHP) You cannot have any other insurance that is not a qualifying high deductible health plan. This means no Tricare, no Medicare, no AlaskaCare, spouse plan, etc You have not received VA benefits (benefits from the Veteran s Administration) within the last three months You can t have a health care Flexible Spending Account, and that means not even a spouse FSA Can t be claimed as a dependent on anyone s taxes 19
Compare HSA to FSA Health Savings Account Higher contribution maximums 2013: individual $3,250 and family is $6450 If over age 55 can add $1,000 catch up Rolls over year to year No uniform coverage rule: can only pull out what s been deposited Individual owns it and is responsible for compliance with rules Flexible Spending Account Maximum is $2,500 regardless of family size Use it or Lose it means unused amount is forfeited Full amount available from day 1 No special plan requirements Claims must be substantiated 20
Health Savings Accounts (HSA) Some HSA maximum contribution issues Employee has employee only coverage under CDHP, spouse has employee only coverage under non-cdhp Employee may open HSA and fund to single coverage maximum Employee has family coverage under CDHP, spouse has employee-only coverage under non-cdhp Employee may open HSA and fund to family maximum Employee has family coverage under CDHP, spouse has employee-only coverage under CDHP Both may open HSAs, but together can only fund to the family maximum (either equally or some other agreed upon split) 21
Health Savings Accounts (HSA) Bank of America will administer UA s HSA Welcome kit and debit card Can use the debit card to pay for services, or pay some other way and reimburse yourself later Online bill-pay You must keep documentation for all claims and reimbursements File Form 8889 with your tax return 22
Health Savings Accounts (HSA) More Details Account is portable: employee owns it and can use for COBRA premiums or Medicare premiums Restrictions on when you can contribute to the account, not using the funds, can use when not on CDHP Account holder is responsible for compliance: Being eligible to contribute and not exceeding maximum in a calendar year Use for eligible expenses or pay 20% additional tax penalty UA s plan: equal deductions over the plan year (26 or 19) Will help prevent exceeding calendar year maximum, unless you make post-tax contributions 23
Housekeeping Items Please be sure your beneficiaries for life insurance and retirement plans are up to date Verify your current coverage and enrolled dependents on UAOnline Make sure your HR address is correct! (This is the only address UA uses to mail benefits and payroll information) Use Change Form to update, can t do it online yet http://www.alaska.edu/hr/forms/ 24
Wrap up Several changes this year, read the material carefully! Two forms for health care: 750 and HDHP together, and the CDHP and HSA together Supplemental Benefits form for AD&D, Supplemental Life and the Flexible Spending Accounts Please complete an enrollment form listing all dependents Opt Out form is on the web only More HSA information on the benefits web site www.alaska.edu/benefits 25
Appendix Sample of Summary of Benefits and Coverage (SBC) Side-by-Side Plan comparison FY14 UA Choice Plan Design FY14 UA Choice Plan Rates 26
Sample of Summary of Benefits and Coverage (SBC) 27
University of Alaska Medical Side by Side with HSA Plan 500 Plan Eliminated 750 Plan HDHP CDHP (HDHP with HSA) Deductible Individual $500 $750 $1,250 $1,250 Family $1,500 $2,250 $3,000 $2,500 OOP Maximum (Includes Ded) Individual $3,500 $4,250 $5,000 $5,000 Family $7,500 $9,250 $11,000 $11,000 Coinsurance 80% / 60% 80% / 60% 80% / 60% 80% / 60% Office Visits Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Preventive Care 100% 100% 100% 100% Pharmacy ($1,000 Maximum) Generic $5 $5 $5 Deductible & Coinsurance Brand $25 $25 $25 Deductible & Coinsurance Non-Preferred Brand $50 $50 $50 Deductible & Coinsurance Comment Qualified HSA plan deductible & Out-of-Pocket Maximum have a family aggregate Qualified HSA plan cannot have FSA or Spouse FSA at another employer HSA 2013 Limits Plan Minimum Deductible Single Coverage $1,250 Family Coverage $2,500 Plan Maximum Out-of-Pocket (Includes Deductible) Single Coverage (In-Network) $6,250 Family Coverage (In-Network) $12,500 Annual Contribution Maxmium Single Coverage $3,250 Family Coverage $6,450 Catch-up Contributions (+age 55) $1,000
Deductible Medical Benefits Coinsurance (all benefits are subject to allowable charges) $750 Individual $2,250 Family 750 Plan UA Choice Plan July 1, 2013 High Deductible Health Plan HDHP $1,250 Individual $3,000 Family Consumer-Directed Health Plan CDHP $1,250 Individual OR $2,500 Family (note: if more than one person covered, family deductible applies) In network: 80% of allowable charges after deductible, and charges accrue toward maximum out-of-pocket Out of network: 60% of allowable charges after deductible, and charges do not accrue toward the maximum out-of-pocket; member is responsible for all amounts over the allowable charge Network applies to Anchorage, Fairbanks, Juneau and all locations outside of Alaska Annual Out-of-Pocket (OOP) Maximum (Includes Deductible) $4,250/Individual $9,250/Family $5,000/Individual $11,000/Family $5,000/Individual OR $11,000/Family (note: if more than one person covered, family OOP max applies) Lifetime Maximum Benefit The lifetime maximum benefit is unlimited. Hospital Admissions (Inpatient) Emergency Room Co-Payment Physician Visits, Outpatient Surgery, Second Surgical Opinions, Diagnostic Lab and X-Ray Mental Health and Chemical Dependency Chiropractic Treatment Massage Therapy Physical Therapy, Rehabilitation Morbid Obesity and Bariatric Surgery In-network: 80% of allowable charges, after deductible Out-of-network: 60% of allowable charge after deductible; your 40% coinsurance does not accrue toward maximum out-of-pocket and member is responsible for any amount over the allowable charge 80% of allowable charges, after deductible, whether in-network or out-of-network; member is responsible for any amount over the allowable charge for out-of-network services In-network: 80% of allowable charges, after deductible Out-of-network: 60% of allowable charge after deductible; your 40% coinsurance does not accrue toward maximum out-of-pocket and member is responsible for any amount over the allowable charge In-network: 80% of allowable charges, after deductible Out-of-network: 60% of allowable charge after deductible; your 40% coinsurance does not accrue toward maximum out-of-pocket and member is responsible for any amount over the allowable charge In-network: 80% of allowable charges, after deductible Out-of-network: 60% of allowable charge after deductible; your 40% coinsurance does not accrue toward maximum out-of-pocket and member is responsible for any amount over the allowable charge Maximum of 26 visits per year unless additional visits are pre-certified 80% of allowable charges, after deductible. Massage therapists are not subject to the lower out-of-network coinsurance, but the member is responsible for any amount over the allowable charge. Limited to 26 visits per year unless additional visits are pre-certified. Massage therapy must be billed and supervised by a medical doctor, chiropractor or physical therapist to be covered. In-network: 80% of allowable charges, after deductible Out-of-network: 60% of allowable charge after deductible; your 40% coinsurance does not accrue toward maximum out-of-pocket and member is responsible for any amount over the allowable charge Maximum of 45 visits per year unless additional visits are pre-certified Non-surgical benefit: covered as any other medical condition; covered services include behavioral health, nutritionist/dietician visits, physician visits, related lab and diagnostic services. Surgical Benefit: member must meet morbid obesity criteria; coverage for bariatric procedures must be medically necessary and considered only after non-surgical measures have proven ineffective. Subject to a $25,000 maximum lifetime benefit. A Benefit Advisory is recommended for members considering this approach to weight loss.
UA Choice Plan July 1, 2013 Medical Benefits / Preventive / Wellness 750 Plan High Deductible Health Plan HDHP Consumer-Directed Health Plan CDHP Well Baby and Well Child Checkups Covered under the General Preventive Benefit (see below) General Preventive Benefit (Physical Benefit) Including Adult Immunizations The health plan will cover at 100% of the allowable charge with no deductible, all preventive services given an "A" or "B" recommendation by the U.S. Preventive Services Task Force, as well as preventive services recommended by the Advisory Committee on Immunization Practices. See the list of recommended services at http://www.alaska.edu/files/benefits/preventivelist.pdf Pharmacy Benefits Network Pharmacy - 30-day supply The 750 Plan and HDHP have the same pharmacy benefit. Go to www.premera.com to register and get more information on mail order and other plan features. The Pharmacy benefit plan has a $1,000 annual out-of-pocket maximum for each member enrolled on these plans. Please note this is separate from the medical out-of-pocket maximums in the medical plan. $5 copay for generic $25 copay for brand name $50 copay for non-preferred brand CDHP pharmacy benefits are subject to the medical plan deductible and coinsurance subject to the medical plan deductible, then 20% coinsurance Maintenance Medications - Retail (30 day) Supply Up to 2 refills at retail with regular copays (see above) For the third and future refills at retail (On 3rd refill): $10 copay for generic $50 copay for brand name $100 copay for non-preferred brand This plan provides a preventive medication benefit for certain generic medications at zero copay. Please see the current list at the benefits web site (www.alaska.edu/benefits) or at Premera.com Mail Order - 90-day supply $10 copay for generic $50 copay for brand name $100 copay for non-preferred brand subject to the medical plan deductible, then 20% coinsurance Maintenance Medications - Mail Order (90 day supply) Non-Network Pharmacy (charges do not apply to out-ofpocket maximums) Same as the regular Mail Order benefit shown above. Pay retail price at time of purchase, and submit claim form to be reimbursed at negotiated price less appropriate co-payment. Please note that you will be reimbursed the negotiated (contracted) rate, less the copay. This will most likely always be less than the full price paid at an out-of-network pharmacy. See above information on preventive generic medications Pay retail price at time of purchase, submit claim to have negotiated price applied to deductible or coinsurance benefits, as appropriate. Note that non-network pharmacy can charge more than negotiated price.
UA Choice Plan July 1, 2013 Dental Benefits 750 Plan High Deductible Health Plan HDHP Consumer-Directed Health Plan CDHP Annual Deductibles* Preventive $0 $0 $0 Restorative $25 $50 $50 Prosthetic $25 (combined with restorative) $50 (combined with restorative) $50 (combined with restorative) *Per person, paid once per plan year Coinsurance Preventive 100% 80% 80% Restorative 80% 80% 80% Prosthetic 50% 50% 50% Annual Maximum Benefit $2,000 $2,000 $2,000 Orthodontia Covered at 50%, with a $1,500 lifetime maximum Not Covered Not Covered Vision Benefits All UA Choice Plans have the same vision benefit as described below. For more information, visit www.vsp.com Copay Exam once every plan year $10 copay for exam $25 copay for glasses (lenses and frame) No copay for contacts VSP Network Doctor: Covered in full after $10 copay Non-VSP Provider: Up to a $50 reimbursement after the $10 copay Lenses covered in full after $25 copay, frame of your choice up to $150, plus 20% off any out-of-pocket cost. Lenses and frames every other plan year OR Contacts every other plan year Discounts & Savings Non-VSP Provider: Reimbursement after the $25 copay as follows: Single vision lenses Up to $50 Lined bifocal lenses Up to $75 Lined trifocal lenses Up to $100 Frames Up to $70 Contact Lens Care program gives yo ua $150 alloawance with no copay every other plan year for the cost of your contacts and the contact lens exam/fitting Non-VSP Provider: Reimbursement Up to $105 VSP offers other discounts and savings to plan members. Go to vsp.com to learn about discounts on non-covered lens options, additional prescription glasses and sunglasses and laser vision corrections through a VSP network doctor.
UA Choice FY14 Rates for 12 month employees (26 pay periods per year) 750 Plan $750 Individual Deductible, $2,250 Family Deductible Employee Bi- Weekly Charge 26 Payrolls Dependent Bi-Weekly Charge Total Bi-Weekly Charge Annual Charge Employee (EE) $79.74 N/A $ 79.74 $ 2,073 EE + Spouse $79.74 $79.74 $159.48 $ 4,146 EE + 1 Child $79.74 $39.89 $119.63 $ 3,110 EE + 2 Children $79.74 $71.77 $151.51 $ 3,939 EE + 3 or more Children $79.74 $95.70 $175.44 $ 4,561 EE, Spouse, 1 Child $79.74 $119.62 $199.36 $ 5,183 EE, Spouse, 2 Children $79.74 $151.50 $231.24 $ 6,012 EE, Spouse, 3 or more Children $79.74 $175.43 $255.17 $ 6,634 High Deductible Health Plan (HDHP) $1,250 Individual Deductible $3,000 Family Deductible Employee Bi- Weekly Charge Dependent Bi-Weekly Charge Total Bi-Weekly Charge Annual Charge Employee (EE) $51.27 N/A $ 51.27 $ 1,333 EE + Spouse $51.27 $ 51.27 $102.54 $ 2,666 EE + 1 Child $51.27 $ 25.66 $ 76.93 $ 2,000 EE + 2 Children $51.27 $ 46.16 $ 97.43 $ 2,533 EE + 3 or more Children $51.27 $ 61.54 $112.81 $ 2,933 EE, Spouse, 1 Child $51.27 $ 76.93 $128.20 $ 3,333 EE, Spouse, 2 Children $51.27 $ 97.43 $148.70 $ 3,866 EE, Spouse, 3 or more Children $51.27 $112.81 $164.08 $ 4,266 Consumer-Directed Health Plan (CDHP) with Health Savings Account (HSA) $1,250 Individual Deductible OR $2,500 Family Deductible Employee Bi- Weekly Charge Dependent Bi-Weekly Charge Note: This plan has different benefits from a regular HDHP and restrictions on eligibility apply. Total Bi-Weekly Charge Annual Charge Employee (EE) $45.50 N/A $ 45.50 $ 1,183 EE + Spouse $45.50 $ 45.50 $ 91.00 $ 2,366 EE + 1 Child $45.50 $ 22.77 $ 68.27 $ 1,775 EE + 2 Children $45.50 $ 40.97 $ 86.47 $ 2,248 EE + 3 or more Children $45.50 $ 54.62 $100.12 $ 2,603 EE, Spouse, 1 Child $45.50 $ 68.27 $113.77 $ 2,958 EE, Spouse, 2 Children $45.50 $ 86.47 $131.97 $ 3,431 EE, Spouse, 3 or more Children $45.50 $100.12 $145.62 $ 3,786 2013 Health Savings Account limits are $3,250 for an individual, and $6,450 for family coverage. Restrictions apply. See the enrollment guide for more information on health savings accounts.
UA Choice FY14 Rates for less-than-12 month employees (19 pay periods per year) Includes all faculty (UNAC and UAFT), and staff with contracts less than 12 months 750 Plan $750 Individual Deductible, $2,250 Family Deductible Employee Bi- Weekly Charge 19 Payrolls Dependent Bi-Weekly Charge Total Bi-Weekly Charge Annual Charge Employee (EE) $109.11 N/A $109.11 $ 2,073 EE + Spouse $109.11 $109.11 $218.22 $ 4,146 EE + 1 Child $109.11 $ 54.58 $163.69 $ 3,110 EE + 2 Children $109.11 $ 98.22 $207.33 $ 3,939 EE + 3 or more Children $109.11 $130.95 $240.06 $ 4,561 EE, Spouse, 1 Child $109.11 $163.69 $272.80 $ 5,183 EE, Spouse, 2 Children $109.11 $207.32 $316.43 $ 6,012 EE, Spouse, 3 or more Children $109.11 $240.06 $349.17 $ 6,634 High Deductible Health Plan (HDHP) $1,250 Individual Deductible $3,000 Family Deductible Employee Bi- Weekly Charge Dependent Bi-Weekly Charge Total Bi-Weekly Charge Annual Charge Employee (EE) $70.16 N/A $ 70.16 $ 1,333 EE + Spouse $70.16 $ 70.16 $140.32 $ 2,666 EE + 1 Child $70.16 $ 35.11 $105.27 $ 2,000 EE + 2 Children $70.16 $ 63.16 $133.32 $ 2,533 EE + 3 or more Children $70.16 $ 84.22 $154.38 $ 2,933 EE, Spouse, 1 Child $70.16 $105.27 $175.43 $ 3,333 EE, Spouse, 2 Children $70.16 $133.32 $203.48 $ 3,866 EE, Spouse, 3 or more Children $70.16 $154.37 $224.53 $ 4,266 Consumer-Directed Health Plan (CDHP) with Health Savings Account (HSA) $1,250 Individual Deductible OR $2,500 Family Deductible Employee Bi- Weekly Charge Dependent Bi-Weekly Charge Note: This plan has different benefits from a regular HDHP and restrictions on eligibility apply. Total Bi-Weekly Charge Annual Charge Employee (EE) $62.27 N/A $ 62.27 $ 1,183 EE + Spouse $62.27 $ 62.27 $124.54 $ 2,366 EE + 1 Child $62.27 $ 31.16 $ 93.43 $ 1,775 EE + 2 Children $62.27 $ 56.06 $118.33 $ 2,248 EE + 3 or more Children $62.27 $ 74.74 $137.01 $ 2,603 EE, Spouse, 1 Child $62.27 $ 93.43 $155.70 $ 2,958 EE, Spouse, 2 Children $62.27 $118.32 $180.59 $ 3,431 EE, Spouse, 3 or more Children $62.27 $137.00 $199.27 $ 3,786 2013 Health Savings Account limits are $3,250 for an individual, and $6,450 for family coverage. Restrictions apply. See the enrollment guide for more information on health savings accounts.