Transcript HSA - School District 622

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District #622 Health Plan Status
JourneyWell
ISD 622 Well@Work Clinic
High Deductible Health Plan
◦ VEBA Overview
◦ Health Savings Account Overview
Plan Comparison Scenarios
VSP – Vision Service Plan
Flexible Spending Account
Annual Open Enrollment
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District negotiated with HealthPartners 3 year rate deal:
◦ Year 1 (11-12): 4% Overall Increase to Rates
◦ Year 2 (12-13): 7% Overall Rate Cap to Rates—Overall increase was 5.5%
◦ Year 3 (13-14): 8% Overall Rate Cap to Rates
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July 1, 2013 renewal, Year 3, overall decrease is -3%
District will continue to evaluate benefit design changes to
mitigate rate increases.
District focus on managing premiums and cost by encouraging
healthy lifestyle through wellness programs and the ISD 622
Well@Work Clinic
JourneyWell will continue to be a part of the District benefit
plan
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If you participated and completed the Health Assessment and
Wellness Program between July 1, 2012 and March 31, 2013, you
will receive the preferred benefits effective July 1, 2013
The Preferred Benefit
◦ $200-$25: Differential of $20 on the office visit copay
◦ HDHP VEBA and HSA: Differential of $250 on the deductible
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Annual Program begins again July 1, 2013 through March 31,
2014, effective July 1, 2014
◦ Employees and covered Spouses needed to complete the requirements
to qualify for the preferred benefit
◦ Meetings to be held in all buildings in the Fall
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Scheduled to Open Mid-June & Open House at the end of May
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Hours
◦ Monday, Wednesday and Friday: 6:00am-2:00pm
◦ Tuesday and Thursday: 10:00am-6:00pm
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Private and Confidential
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Staffed by Physician’s Assistant
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On Site Pharmacy
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Available for employee and their dependents covered under the
ISD 622 HealthPartners health insurance who is 18 months and
older
Appointment Line 952-967-7481
or
www.healthpartners.com/mychart
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Conditions
Minor injuries
Minor illness
Ear infections
Sinus infections
Minor skin infections
Heartburn
Stomach problems
Pink Eye
Styes
Muscle strains
Joint pain and sprains
Minor burns
Cuts and simple lacerations
Preventions, Screening,
Wellness
Annual physicals
Camp physicals
Blood Pressure
Cholesterol
Nutrition
Stress Management
Smoking Cessations
Employee Cost:
$0 office visit copay and $0 prescriptions copay
HSA Participants Only: $40 office visit including preventative prescriptions
due to IRS regulations
Appointment Line 952-967-7481
or
www.healthpartners.com/mychart
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In-Network Benefits
Available to:
Deductible
Medical Out-of-pocket
Maximum
Prescription Out-ofpocket Maximum
Lifetime maximum
Preventive health care
Office Visits
Urgent Care
Convenience Clinics
(Retail Clinics)
NationalOne
200-25
NationalOne
2000/4000
VEBA*
NationalOne
2400/4800
VEBA*
NationalOne
2500/5000
HDHP-HSA
ALL Units
Teachers
Paraprofessionals
Clerical, Education
Assistants, Local 70,
Non Units, Principals
$200 individual
$600 family
$2,000 individual
$4,000 family
$2,400 individual
$4,800 family
$2,500 individual
$5,000 family
$500 individual
$1,000 family
$2,000 individual
$4,000 family
$2,400 individual
$4,800 family
$2,500 individual
$5,000 family
$500 per person
$750 per family
Combined with
Medical Out-ofPocket Maximum
Combined with
Medical Out-ofPocket Maximum
Combined with
Medical Out-of-Pocket
Maximum
Unlimited
Unlimited
Unlimited
Unlimited
100% coverage
100% coverage
100% coverage
100% coverage
$25 copay
100% coverage
after deductible
100% coverage
after deductible
100% coverage after
deductible
$0 copay
100% coverage
after deductible
100% coverage
after deductible
100% coverage after
deductible
*Food Service VEBA is $1,150 deductible (no change from current)
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District 622 Health Plan Offerings
NationalOne
200-25
NationalOne
2000/4000
VEBA
NationalOne
2400/4800
VEBA
NationalOne
2500/5000
HDHP-HSA
100% after
deductible
100% after
deductible
100% after
deductible
100% after
deductible
$75 copay
100% after
deductible
100% after
deductible
100% after
deductible
Durable medical
equipment
100% after
deductible
100% after
deductible
100% after
deductible
100% after
deductible
Home health care
80% after
deductible
100% after
deductible
100% after
deductible
100% after
deductible
Retail pharmacy:
-- Generic preferred
-- Brand preferred
-- Non-preferred
34 day supply/100
units
31 day supply
31 day supply
$8 copay
$16 copay
$32 copay
100% after
deductible
100% after
deductible
Mail order pharmacy
2 copays for a 90
day supply
100% after
deductible
100% after
deductible
Inpatient, Outpatient
hospital, Ambulance
Emergency Room
Provider network and drug formulary the same for all plans
31 day supply
100% after
deductible
100% after
deductible
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1. You seek
medical care, your
provider submits
the charges to
HealthPartners
2. HealthPartners
processes the claim,
applies their discount
and sends Explanation
of Benefits to provider
and you.
3. Provider
sends you bill
for amount you
owe.
4. You pay the
doctor using
(HSA) provided checks
or Benny card
(VEBA)
5. You pay
the doctor
4. You receive
reimbursement
from VEBA
account
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Both are accounts that you can use to pay
medical expenses
◦ Must be in conjunction with a high-deductible health
plan (HDHP)
◦ Tax-advantages: contribute pre-tax money (HSA only),
funds accrue tax-free and withdraw funds tax-free
(if they are for eligible medical expenses)
◦ You own the account
◦ Contributions
 HSA—Both you and your employer can contribute funds
 VEBA—Only the employer can contribute funds
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Tax advantage means you save money on your
health care expenses
Funds rollover each year, so you can use
you’re the account to save tax-free money for
retirement
You own the account, even if you leave the
District
Lower monthly premiums than a traditional
health plan
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The IRS defines expenses that are
considered “qualified medical expenses” for
HSA/VEBA distributions
Expenses must be primarily to treat or
prevent a physical or mental defect or illness
(HSA Only) If you use HSA funds for
expenses beyond what the IRS defines as
qualified, you will be subject to income tax
on the distribution and an additional 20
percent penalty
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Examples of qualified medical expenses include:
◦ Most medical care that is subject to your deductible (copays,
coinsurance, doctor visits, inpatient or outpatient treatment, etc.)
◦ Prescription drugs
◦ Over-the-counter drugs, only if you obtain a prescription
◦ Insulin (with or without a prescription)
◦ Dental and vision care
◦ Select insurance premiums
 COBRA, qualified long-term care insurance, health insurance premiums paid
while receiving unemployment benefits, health insurance after you turn 65
except for a Medicare supplemental policy
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Examples of not considered “qualified medical
expenses” include:
◦ Insurance premiums (other than the exceptions listed on the previous
slide)
◦ Over-the-counter drugs (unless a prescription is retained from a
physician – insulin is an exception)
A full list of qualified medical expenses is available at corphealthsys.com or from
the Benefits office
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Distributions are tax-free if they are taken for
“qualified medical expenses”
Accounts can only be used for expenses that
are incurred on or after the date the account
was established
Funds can be used for expenses from a prior
year, as long as the expenses incurred on or
after the date the account was established
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Distributions can be taken for qualified
medical expenses for the following people:
◦ The account holder (employee covered by the HDHP)
◦ Spouse of account holder (even if not covered by the
HDHP)
◦ Dependent Children
 VEBA: To age 26
 HSA: Tax Dependents of that individual
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Corporate Health is the third party administrator for
the VEBA and HSA accounts.
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First let’s make some assumptions about the HDHP
for the examples provided:
◦ The average office visit costs $110
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Remember:
◦ Routine Preventative Physicals are covered 100% under all plans
◦ 200-25 Plan has a prescription copay of $8 generic preferred, $16
brand preferred and $32 non preferred; an office visit copay of
$25 and a $200 per person deductible (maximum of $400 per
family).
◦ The Teacher VEBA plan has a deductible of $2,000 per person and
a maximum of $4,000 per family.
◦ The Paraprofessional VEBA plan has a deductible of $2,400 per
person and a maximum of $4,800 per family.
◦ The HSA plan has a deductible of $2,500 per person and a
maximum of $5,000 per family.
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Mary is a single, healthy female who takes advantage of preventive care visits. In a typical year,
she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs
$120 (retail) and is filled twice per year.
200-25 Plan
2000/4000 VEBA
*Annual premiums
$918
$1,078
Office visits
$50
$220
Rx drugs
$32
$240
Total estimated
maximum costs
$1,000
$1,538
Reimbursable
expenses in VEBA
n/a
$460
Cost after VEBA
reimbursement
$1,000
$1,078
VEBA Balance
n/a
$1,140
($1600 VEBA Trust)
*Annual premiums based on groups with highest District contribution.
Teacher premiums will be adjusted after Open Enrollment based on
employee enrollment. The premiums above are preliminary amounts.
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Scenario 2: High Healthcare User-Family
HDHP VEBA (Teachers)
Cindy’s family includes two children under the age of 6 and her husband. During the year there
are a total of 15 visits to the doctor and 2 prescriptions per month between all the family
members. The prescriptions filled included 12 preferred generic and 12 preferred brand ($1,500
total retail cost).
200-25 Plan
2000/4000
VEBA Plan
*Annual premiums
$4,708
$4,066
Office visits
$375
$1,650
Rx drugs
$288
$1,500
Total estimated
maximum costs
$5,371
$7,216
Reimbursable
expenses in VEBA
n/a
$3,150
Cost after Employer
VEBA reimbursement
$5,371
$4,066
VEBA Balance
n/a
$50
*Annual premiums based on groups with highest District contribution.
Teacher premiums will be adjusted after Open Enrollment based on
employee enrollment. The premiums above are preliminary amounts.
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Mary is a single, healthy female who takes advantage of preventive care visits. In a typical year,
she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs
$120 (retail) and is filled twice per year.
200-25 Plan
2400/4800 VEBA
*Annual premiums
$1,172
$1,755
Office visits
$50
$220
Rx drugs
$32
$240
Total estimated
maximum costs
$1,254
$2,215
Reimbursable
expenses in VEBA
n/a
$460
Cost after VEBA
reimbursement
$1,254
$1,755
VEBA Balance
n/a
$1,460
($1920 VEBA Trust)
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Maggie is a single, healthy female who takes advantage of preventive care visits.
In a typical year, she usually sees the doctor twice. She has a preferred brand
prescription for Singulair that costs $120 (retail) and is filled twice per year.
2500/5000 HSA Plan
200-25 Plan
($1,127 District
Contribution to HSA)
*Annual premiums
$619
$0^
Office visits
$50
$220
Rx drugs
$32
$240
Total estimated
maximum costs
$701
$460
Reimbursable
expenses in HSA
n/a
$460
Cost after HSA
reimbursement
$701
$0
HSA Balance
n/a
$667
*Annual premiums
based on groups with
highest District
contribution.
^The HSA premiums will
vary based on individual
contribution to the HSA
account (the higher
contribution the higher
health premium)
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Carol’s family includes two children under the age of 6 and her husband. During the year there
are a total of 15 visits to the doctor and 2 prescriptions per month between all the family
members. The prescriptions filled included 12 preferred generic and 12 preferred brand ($1,500
total retail cost).
2500/5000 HSA Plan
200-25 Plan
($750 District
Contribution to HSA)
*Annual premiums
$3,908
$0^
Office visits
$375
$1,650
Rx drugs
$288
$1,500
Total estimated
maximum costs
$4,571
$3,150
Reimbursable
expenses in HSA
n/a
$750
Cost after HSA
reimbursement
$4,571
$2,400
HSA Balance
n/a
$0
*Annual premiums
based on groups with
highest District
contribution.
^The HSA premiums will
vary based on individual
contribution to the HSA
account (the higher
contribution the higher
health premium)
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Anyone who is covered by the:
• High Deductible Health Plan, NationalONE $2000100% (Teachers only)
• High Deductible Health Plan, NationalONE $2400100% (Para Professionals only)
• High Deductible Health Plan, NationalONE $1150100% (Food Service only)
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Contributions to the VEBA account are set amounts determined by the bargaining
units and the District. The contribution amounts can’t be individualized or
modified during the year.
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Teachers
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Paraprofessionals
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Contribution to $2000/$4000 VEBA Plan is 80% of Deductible
Single contribution is $1,600 -- $500 deposited in VEBA account in July 2013 with deposits
of $100 each month thereafter
Family contribution is $3,200 -- $1000 deposited in VEBA account in July 2013 with
deposits of $200 each month thereafter
Contribution to $2400/$4800 VEBA Plan is 80% of Deductible
Single contribution is $1,920 -- $576 deposited in VEBA account in July 2013 with deposits
of $122.18 each month thereafter
Family contribution is $3,840 -- $1,152 deposited in VEBA account in July 2013 with
deposits of $244.36 each month thereafter
Food Service Group continues to have the $1150 VEBA plan and the VEBA
contribution will be:
◦ Single contribution is $617.16 ($51.43/month)
◦ Family contribution is $1,646.40 ($137.20/month)
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The monthly administration fee is $3.09/month and will be
deducted quarterly from the VEBA account.
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Benny Card option
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Reimbursements are made by completing a claim form, attaching
the proper documentation. Typically this is an Explanation of
Benefit (EOB) and submitting to Corporate Health Systems (CHS).
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You can elect to receive your reimbursement funds either by check
or direct deposit.
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You can check your account information via the CHS website
(www.corphealthsys.com)
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Money that remains in your account at the end of the plan year
will be rolled into the next plan year after the run-out period has
expired
In the event of the death of the participant, tax dependents will be
able to continue to submit claims for medical expenses until the
balance is exhausted
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Benny™ Prepaid Benefits Card for all your eligible VEBA
expenses
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Easy – a simple swipe of the Card makes it hassle free!
Automatic – funds are immediately transferred from your VEBA at
the time you incur the expense.
Convenient – there are no manual claim forms to submit.
Simple to track – your current balance is available 24/7 at the web
site listed on the back of your Card.
Cost to you: $18.00 Annually
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Anyone who is:
• Covered by the High Deductible Health Plan, NationalONE
$2500-100%
• Not enrolled in Medicare
• Not covered under other health insurance*
Cannot be covered by any other health insurance that reimburses
you for health expenses you incur, unless it is another HSAqualified HDHP.
• Not another person’s tax dependent
*Other health insurance does not include: specific disease or
illness insurance, accident, disability, dental care, vision care
and long-term care insurance
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 Flexible Spending Accounts (FSAs) and VEBA accounts may make
you ineligible for an HSA unless they are designated as “Limited
purpose,” meaning they are limited to dental, vision, and child
care.
 Acceptable VEBA accounts
 set aside money only for retiree health expenses
 are suspended
 To preserve the eligibility for the HSA plan, the District FSA
Medical plan will be a “Limited” plan for employees participating
on the HDHP HSA.
 Limited purpose medical FSA is limited to only allow for dental and vision expenses
to be reimbursed.
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 To preserve the eligibility for the HSA plan contributions,
your VEBA account will need to be changed:
• VEBA plan participant can implement a Suspension that
will limit eligible expenses to dental and vision only each
plan year
 Election must be made each plan year
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Eligibility Scenarios -- Acceptable Situations:
Single employee enrolled in HDHP
 no medical flex
 no HRA/VEBA
 limited medical flex
 limited HRA/VEBA
 suspended HRA/VEBA
 not on Medicare
Married employee enrolled in HDHP
 not enrolled in spouse’s medical
plan
 spouse doesn’t have a traditional
medical flex
 spouse doesn’t have an HRA/VEBA
 spouse has an HRA/VEBA that is
limited to spouse’s expenses
 limited HRA/VEBA
 suspended HRA/VEBA
 not enrolled in Medicare
Spend Down Approach:
Employee elects HDHP and wishes to spend down their HRA/VEBA balance.
The first of the month following when the VEBA balance is $0, the
participant could establish an HSA account, assuming they are not enrolled
in the traditional flex plan or have any other coverage that would make
them ineligible for an HSA account.
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Eligibility Scenarios -- Problem Situations:
Some scenarios
 Single employee enrolled in non HDHP, doesn’t suspend or limit existing VEBA
 Gets married, want to enroll in HDHP and HSA.
 Can’t start HSA as long as HRA/VEBA has funds remaining or until next plan year when
the HRA/VEBA can be limited or suspended
 Single employee enrolled in non HDHP, doesn’t have HRA/VEBA, but elects traditional
medical flex
 Gets married, want to enroll in HDHP and HSA.
 Can’t start HSA until next flex plan as flex creates HSA ineligibility
 Married employee enrolled in non HDHP, doesn’t suspend or limit existing HRA/VEBA
 Wishes to enroll in HDHP and HSA due to spouse plan change/cost.
 Can’t start HSA as long as HRA/VEBA has funds remaining or until next plan year when
the HRA/VEBA can be limited or suspended
Married employee enrolled in non HDHP, doesn’t have VEBA, but elects traditional
medical flex
 Wishes to enroll in HDHP and HSA due to spouse plan change/cost.
 Can’t start HSA until next flex plan as flex creates HSA ineligibility
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Each year, the IRS sets contribution limits
◦ These limits are for the total funds contributed, including company
contributions, your contributions and any other contributions
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You are allowed to contribute the entire year’s limit
whenever you first become eligible for the HSA (even if
that is in December)
However, you must remain eligible for at least 12 months
after that date, or you will be subject to taxes and
penalties on the amount you contributed
2013
2014
Individual
$3,250
$3,300
Family
$6,450
$6,550
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For individuals ages 55 and older, the IRS
allows additional “catch-up contributions”
Eligible individuals may contribute an extra
$1,000 for the year (for 2013)
This is to help save additional money for
retirement
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For individuals age 65 and older, HSA
distributions can be used for non-qualified
medical expenses without facing the 20
percent penalty
◦ However, income taxes will apply for non-medical
distributions
◦ This rule is regardless of whether the individual is
enrolled in Medicare
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Whenever you use HSA funds to pay for a
medical expense, you should keep your receipt
Different from the VEBA, you are responsible for
demonstrating to the IRS that HSA distributions
were for qualified medical expenses
If the IRS requests receipts for verification
purposes, failure to provide those receipts could
result in having to pay a penalty
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Corporate Health is the third party administrator
collecting the contributions. Corporate Health uses
Bancorp.
HSA is Interest Bearing Account
Investments Available when Balance is $2,500
◦ Investment Transactions Costs Apply
Monthly Administration Fee: $3.50
◦ Deducted from your account monthly
Online Access: at www.thebancorphsa-eb.com
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You will receive checks and a Benny™ Card so that
you can easily access the funds in your account.
Corporate Health is the administrator collecting the
contributions.
Corporate Health uses Bancorp.
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Vision coverage is bundled with the health election.
www.vsp.com
1-800-877-7195
Signature Plan
Network
Frequency Exam/Lenses/Frame
Copayments – Exam/Materials
Exam
Covered Lenses
Retail Frame Allowance
Elective Contact Lens Allowance
(Material copay does not apply)
Lens Options
VSP Network
New: Includes retail chain affiliates such as:
Costco, Visionworks
12/12/24
$0/$10
Covered in full
Single Vision, Lined Bifocal and Trifocal, Polycarbonate
lenses for Dependents
$150
$150
AR, Scratch, UV and Color Coatings, Photochromic,
mirror, tints and dyes and rimless lenses.
Cost-controlled pricing on all others in which members
save an average 35-40%
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A Flexible Spending Account (FSA) allows you to use pre-tax
dollars to pay for eligible health care and dependent day care
expenses
Flexible Spending enrollment for Medical and Dependent Care is
the 12 month period from:
July 1, 2013 through June 30, 2014
Maximum Per Calendar Year
 Health FSA: $2,500
 Dependent Care FSA: $5,000
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Third Party Administer: Corporate Health Systems
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Health/Vision Plans
All groups:
If you do not want to make a change to your current coverage, you do not
need to do anything; you will automatically be reenrolled for July 1, 2013.
Current elections will rollover to the new plan year.
Add Coverage, Change Plans or Drop Coverage: If you want to
make a change to your plan (i.e. move from 200-25 to the VEBA or HSA) or
enroll or drop yourself or your eligible family members, please make your
election on SmartBen.
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Flexible Spending Account
‣If you want to participate in the FSA medical or dependent care
accounts for the July 1, 2013 through June 30, 2014 plan year, you
must designate a benefit amount through the online enrollment
portal, SmartBen.
‣Previous year’s elections will not rollover.
‣Remember that the Medical Reimbursement will be a “Limited”
plan for individuals signing up for the qualified HSA-HDHP
CIGNA Dental Plans (EA, Food Service, Paraprofessionals, Part-Time Local
70, Part-Time Clerical)
‣If you want to make a change to your plan (enroll, add or drop
yourself or your eligible family members) please make your
election on SmartBen.
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Open Enrollment = Your opportunity to make benefit elections for
the 2013-14 plan year
Enrollment Dates = May 7th through June 3rd
Benefit elections take effect July 1, 2013
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Employees are allowed to add or drop coverage during open enrollment.
The only changes allowed after the open enrollment period are for qualified
events or status changes.
Qualified
1.
2.
3.
Events/Status Changes include:
Marriage
Birth or Adoption of Child
Divorce, Legal Separation, Termination of Employment,
Reduction of Number of Hours Worked or Death of
Spouse (making them ineligible for their employers’
group benefit plan)
4. Loss of coverage under Medicaid or a state child health plan
5. Gaining eligibility for coverage under Medicaid or a state child
health plan
Employees must notify HR Department within 30 days of qualifying events
in items 1, 2 and 3; and within 60 days in items 4 and 5.
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District Benefits Office (651) 748-7425
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www.isd622.org/benefits
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HealthPartners Member Services @
(952) 883-5000 or 1-800-883-2177
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Thank you for your
attention!