Transcript 2015 Open Enrollment Presentation
Saint Louis University
Employee Benefits 2015 Annual Enrollment
Benefits Overview—Coverages Offered
Medical/Prescription Drug Vitality Wellness Program Voluntary Dental Health Savings Account Flexible Spending Accounts Basic Term Life and AD&D Voluntary Term Life Voluntary AD&D Long Term Disability Long Term Care Business Travel Accident New this year! (Non-Union Employees Only) Voluntary Vision Voluntary Accident
Medical/Prescription Drug Benefits
Annual Enrollment 2015
Highlights Effective January 1, 2015
Medical - UnitedHealthcare
Plus Plan:
Medical and Prescription drug copays will accumulate towards the out-of-pocket maximum in the Plus Plan
QHDHP Plan
No plan changes Health Savings Account
The Vitality™ Wellness Program
Participants save on medical premiums and earn rewards!
Health screenings and HRA completion are needed to receive wellness discount If covering your spouse, both must complete requirements Deadline: November 30
Prescription Drug – Express Scripts
No plan change to prescription drug benefits Network continues to include Walgreens and Dierbergs
2015 Medical Plan Options
SLU Care Plus Plan In-Network Deductible
Individual Family Coinsurance $0 $0 0% $500 $1,000 10%
Out-of-Pocket Maximum
(includes deductibles and all copays) Individual Family
Physician Office Visits
Primary Care Specialist Care Preventive Care
Inpatient Hospital
$1,500 $3,000 $10 copay $20 copay 100% $1,500 $3,000 10% after ded.
100% N/A 10% after ded.
Emergency Room
N/A $100 copay
Urgent Care Center
N/A $50 copay
Out-of Network
$750 $1,500 40% $4,750 $9,500 40% after ded.
100% 40% after ded.
$100 copay $50 copay 0% after ded.
100% N/A N/A N/A
QHDHP Plan SLU Care In-Network Out-of Network
Non-Embedded: (One member can satisfy entire family deductible) $1,500 $3,000 $1,500 $3,000 $3,000 $6,000 0% 10% 40% Non-Embedded: (One member can satisfy entire family OOP Max) $1,500 $3,000 $3,000 $6,000 $6,000 $12,000 10% after ded.
100% 40% after ded.
100% 10% after ded.
40% after ded.
10% after ded.
10% after ded.
10% after ded.
40% after ded.
2015 Pharmacy Plan Options
Tier 1 Tier 2 Tier 3 Tier 4 Preventive Medications
Plus Plan Express Scripts Retail (34-day supply)
$8
Express Scripts Mail Order (90-day supply)
$16 $30 $50 $60 $100 20% to $150 N/A Priced according to the tier in which they fall
QHDHP Plan Express Scripts Retail (34-day supply) Express Scripts Mail Order (90-day supply)
Medical Deductible and Coinsurance Medical Deductible and Coinsurance Medical Deductible and Coinsurance Medical Deductible and Coinsurance Covered at 100%, no copay or deductible Under the QHDHP, certain preventive, or “maintenance,” medications are covered at 100%... No deductible or coinsurance!
2015 Cost Sharing
No change to rates!!! Premium has remained the same for 3 years! Wellness Incentive remains at $50 for employee only coverage and an additional $25 for spouse coverage (all or nothing discount)
Plan
Employee Only Employee and Spouse Employee and Child(ren) Family Employee Only Employee and Spouse Employee and Child(ren) Family Employee Only Employee and Spouse Employee and Child(ren) Family
Monthly Premium Deductions Plus Plan
$143.79 $386.97 $332.25 $520.66
QHDHP Plan
$79.64
$252.24
$210.36
With Monthly Wellness Discount
$93.79 $311.97 $282.25 $445.66 $29.64
$177.24 $160.36
$328.20
Plus Plan – Employees earning up to $33,000
$253.20
$50.00
$0 $293.18
$238.46
$426.87
$218.18
$188.46
$351.87
2015 Cost Sharing
Bi-Weekly Premiums
Plan
Employee Only Employee and Spouse Employee and Child(ren) Family Employee Only Employee and Spouse Employee and Child(ren) Family Employee Only Employee and Spouse Employee and Child(ren) Family
Bi-Weekly Premium Deductions With Bi-Monthly Wellness Discount Plus Plan
$66.36
$178.60 $153.35 $240.30
QHDHP Plan
$36.76
$43.28
$143.98 $130.27 $205.68
$13.68
$116.42
$97.09 $81.80 $74.01 $151.48
Plus Plan – Employees earning up to $33,000
$116.86 $23.08
$135.31
$110.06
$197.02
$0 $100.70
$86.98
$162.40
Health Savings Account
Annual Enrollment 2015
Health Savings Accounts
Health Savings Accounts (HSAs) are designed to help you save and pay for your healthcare now and when you retire Triple tax savings: Put money in pre-tax Grow your savings tax free Pay for qualified medical expenses income tax free Account is always yours
HSA Eligibility for Account Holders only
You are eligible to open and contribute to an HSA if you: Are covered by a Qualified High Deductible Health Plan (QHDHP) Are not covered by any other health plan that is not a QHDHP Are not enrolled in Medicare, Medicaid, or TRICARE Have not received VA benefits within the past 3 months Are not claimed as a dependent on someone else’s tax return Are not covered by a Health FSA (Must have $0 in your Health FSA before contributing to an HSA) If you don’t meet one of these eligibility requirements, you can still enroll in the QHDHP plan, you just cannot open and contribute to a Health Savings Account
HSA Contributions
2015 Maximum Contribution Limit
2015 IRS Maximum SLU Seed Money
Individual $3,350 $250 Family $6,650 $500 * 2014 Limits: $3,300 for Individual, $6,550 for Family IRS maximum reflects a combined employer + employee contribution 55+ can fund an additional $1,000/year; “catch-up” contribution Please note SLU will only put seed money into an OptumHealth administered HSA. If you choose to go to a financial institution of your choice, then you will not receive the seed money.
HSA must be established by November 30 in order to receive seed money on January 1 Funds must physically be in your account before disbursements can be made Any money remaining in the account at the end of the calendar year rolls over into the next year
Taking Money OUT of an HSA
Issues in Distributions Reimbursement of expenses for employee, spouse and Tax Code dependents are tax free Expense must be incurred on or after the date the HSA was established Qualified expenses include: Health, dental and vision expenses COBRA premiums Medicare premiums Qualified long-term care premiums Retiree health insurance after age 65, but not Medigap/Supplement plans Other withdrawals are taxable Income tax, plus… Subject to 20% excise tax if withdrawn prior to age 65 After you turn 65, or enroll in Medicare, you may withdraw money for non medical purposes without a penalty. The withdrawal is treated as retirement income and is subject to normal income tax.
It is important to save your receipts in case you are audited by the IRS Account is between you and the IRS; OptumHealth bank does not substantiate your claims
HSA & FSA Participation
IRS guidelines prohibit participants from contributing to a Health Care FSA and an HSA at the same time Spouses are ineligible to participate in their employer’s Health Care FSA Ok if a Limited FSA – used for dental and vision expenses only In order for you to fund an HSA on January 1, there must be a $0 balance in your Health Care FSA on December 31 You can still enroll in the benefit plan , but cannot contribute to an HSA account
Making Deposits
Payroll Deduction Arrange for an automatic payroll deduction into your account Mail a Check Make a deposit at any time on OptumHealth from your checking or savings account e-Contribute Arrange a regular electronic transfer from an account at another financial institution
Access Your HSA Funds
Use your UnitedHealthcare Health Savings Account Debit MasterCard ® Sign up for automatic bill pay and online banking Use HSA checks Pay with personal funds and reimburse yourself from your HSA
myuhc.com
Benefit summaries Deductible accumulator Treatment cost estimator Check statements Pay bills to health care providers Update personal information Learn about QHDHPs and HSAs HSA calculators
Additional Programs
UnitedHealthcare:
Diabetes Prevention and Control Pre-diabetics work with YMCA lifestyle coaches to prevent the progression Diabetics work with Shop N’ Save pharmacists face-to-face to help control and improve prescription compliance, set goals, and review lab work Diabetes Health Plan Members incentivized to comply with recommended Medical and Rx guidelines Plus Plan: No office visit or pharmacy copays for diabetes-related eligible expenses Available only when using SLU Care physicians
Vitality
Annual Enrollment 2015
www.powerofvitality.com
Earn points by: Review and activate your personal health goals Update or confirm your email contact information Complete an online Course to learn about a health topic Complete a Vitality Check™ biometric screening with a Vitality partner Schedule Healthy Habits and Preventive Screenings Track your workouts using a Vitality-approved fitness device Sign up at a Partner Health Club Get CPR or first aid certified Once you build up your points, go spend them!
Rewards in the Vitality Mall: Amazon Gift Cards Hotel discounts to Hyatt iTunes gift cards Movie theater ticket vouchers Fitbits, Fitbugs, Garmin, and Polar devices Charity Please note: This list does not cover the program in its entirety. Please refer to the web site for complete program activities, rules and details.
Voluntary Dental Benefits
Annual Enrollment 2015
Voluntary Dental Benefits
Coverage will remain with Delta Dental Choose among two dental plan options Both plans include Delta’s PPO and Premier dentists Option 1: Flex Plan No benefit changes Last year the maximum was increased from $1,000 to $1,500 Option 2: Basic Plus No benefit changes Combination of previous Basic Plus and Basic Plan Both in and out of network benefits
Voluntary Dental Plan—Delta Dental
Flex Option PPO Network Deductible
Individual Family $50 $150
Calendar Year Maximum
Per person $1,500 Preventive Care (Member Responsibility Shown) 0% no deductible Basic Restorative Care ( Member Responsibility Shown) 10% after deductible Major Restorative Services (Member Responsibility Shown) 40% after deductible
Orthodontia
Lifetime maximum (per person) Orthodontia
Out-of-Network
$50 $50 $1,500 0% no deductible 30% after deductible 60% after deductible
PPO Network Only
$25 $75 $1,000
Basic Plus
0% no deductible 30% after deductible 60% after deductible $1,000 $1,000 $1,000 50% For adults and children to age 26 60% For adults and children to age 26 50% For children to age 19 only
Out-of-Network
$25 $75 $1,000 50% no deductible 65% after deductible 80% after deductible $1,000 75% For children to age 19 only
2015 Dental Contributions
Monthly
Single Two-person Family
Bi-Weekly
Single Two-person Family
Flex
$36.01
$70.49
$120.69
$16.62
$32.53
$55.70
Basic Plus
$21.07
$40.52
$72.60
$9.72
$18.70
$33.51
Voluntary Vision Benefits
Annual Enrollment 2015
Voluntary Vision Benefits
New benefit this year! (Non-Union employees only) Offered through Vision Service Plan (VSP) Plan includes benefits for eye exam, frames, contacts, etc. In-Network vs. Out-of-Network In-Network = no claim forms to complete Out-of-Network = must submit claim form for reimbursement VSP.com
Find a provider Network: Choice Register and review benefit information Discounts available Print an ID card (not necessary to use benefits) Plan is 100% employee paid
Voluntary Vision Plan—VSP
Vision Plan In-Network Out-of-Network Exam
Wellvision Exam
Lenses
Single Bifocal Trifocal
Frames Contacts (in lieu of glasses) Frequency
Exam/Lenses/Contacts (in lieu of glasses) Frames $10 copay $10 copay $10 copay $10 copay $150 allowance for a wide selection of frames; $170 allowance for featured frame brands; 20% on the amount over your balance $150 allowance for contacts; including the contact lens exam (fitting and evaluation) Up to $45 allowance Every calendar year Every other calendar year Up to $30 allowance Up to $50 allowance Up to $65 allowance Up to $70 allowance Up to $105 allowance
2015 Vision Contributions
Monthly
Employee Only Employee and Spouse Employee and Child(ren) Family
Bi-Weekly
Employee Only Employee and Spouse Employee and Child(ren) Family
Vision Plan
$7.02
$12.76
$13.38
$20.33
$3.24
$5.89
$6.18
$9.54
Voluntary Accident Benefits
Annual Enrollment 2015
Voluntary Accident Benefits
New benefit this year!
(Non-Union employees only) Offered through Voya Financial (formerly ING) Plan reimburses expenses that occur due to an accident Coverage is guarantee issue – no health questions asked No “Network” When you have an expense, you must submit a claim form; reimbursement will then be mailed as a check 24-hour coverage – accidents on or off the job are eligible Plan is 100% employee paid
Voluntary Accident Plan—Voya
Below is a sample list of benefits, it does not include all the benefits available under the policy.
Service Benefit Amount Service Benefit Amount Accident Hospital Care
Surgery (open abdominal, thoracic) Hospital Confinement Coma (14 or more days)
Follow-Up Care
Medical Equipment Physical Therapy Prosthetic Device
Emergency Care
Ground Ambulance Transport Air Ambulance Transport Emergency Room Treatment
Common Injuries
Burns, Laceration, Torn Knee Cartilage, Paralysis, Tendon/Ligament/Rotator Cuff $1,200 $250/day up to 365 days $6,000 $120 $30/treatment (6 max) $6,000 $120 $600 $180 Varies
Common Injuries – Dislocations
Hip Joint Knee Shoulder
Common Injuries – Fractures
Hip Leg Ankle Kneecap Nose
Other Benefits
Wellness Benefit (completion of health screening test) Sickness Hospital Confinement Benefit $2,400/$4,800 $1,200/$2,400 $360/$720 $1,800/$3,600 $960/$1,920 $360/$720 $360/$720 $120/$240 $100/employee or spouse $50/child (max of 4) $100/day for employee or spouse $75/day for children
2015 Accident Contributions
Monthly
Employee Only Employee and Spouse Employee and Child(ren) Family
Bi-Weekly
Employee Only Employee and Spouse Employee and Child(ren) Family
Accident Plan
$24.74
$41.90
$39.62
$56.78
$11.42
$19.34
$18.29
$26.21
Flexible Spending Accounts
Annual Enrollment 2015
Flexible Spending and Dependent Care Accounts
Administration will remain with ConnectYourCare You must make a new election for the 2015 plan year; current elections cannot be carried forward Debit card allows direct payment Eases payment, but does not substantiate claims – receipts may still be needed!
Use at authorized vendors (medical facilities, hospitals, pharmacies, etc.) Remember if you are electing the QHDHP plan and open an HSA, the IRS requires your Health FSA balance to be $0.00 on January 1, 2015 before contributing to an HSA
Flexible Spending and Dependent Care Accounts
Due to health reform, annual maximum for the Health FSA will be remain at $2,500 Annual maximum for the Dependent Care Account will remain at $5,000 ($2,500 if married and filing separate returns) For the Health FSA Total election amount less previous reimbursements is available at the time of transaction For the Dependent Care FSA Only the cash balance in your account is available at the time of transaction You cannot roll over unused balances from one year to the next Use it or lose it rule applies
Eligible Medical FSA Expenses
Copays, coinsurance and deductibles for medical, prescription and dental plans Eye exams, contacts and eyeglasses Laser eye surgeries Hearing aids Over-the-counter medical supplies Bandages, splints, contact lens solution, etc.
Over-the-counter medical medications must be accompanied by a prescription Insulin Some expenses not covered by your medical plan
Annual Enrollment 2015
2015 Annual Enrollment
Plan elections are binding for the 2015 plan year, unless you experience a qualifying life event: Marriage Birth/adoption Divorce Death Change in employment status Change in dependent status Life status changes allow you to make benefit election changes The Benefits Department must be notified within 31 days of life change
2015 Annual Enrollment
Enrollment season is November 1 through 30 If making changes, do so through Banner Self-Service Current medical and dental elections will carry forward Must actively enroll in vision and accident plans, if interested New and existing HSA, Dependent Care and Health FSA participants will need to make an election for 2015. Current deductions will not carry forward. New HSA participants will also need to establish an OptumHealth bank account by November 30 in order to receive seed money Update beneficiary information if necessary All enrollment elections must be completed online no later than Sunday, November 30, 2014 Benefits Office will be closed Thursday, November 27 and Friday, November 28 Contact [email protected]
or [email protected] with questions!