Transcript Slide 1

Rochester Public Schools
High Deductible Health Plan (HDHP)
HRA Option
February 2014
Corporate Office: 250 South Executive Drive, Suite 300
Brookfield, WI 53005 800.627.3660
Minnesota Office: 14852 Scenic Heights Road, Suite 210
Eden Prairie, MN 55344 800.443.6011
www.NISBenefits.com
HDHP/HRA Implementation for Rochester Public Schools
High Deductible Health Plan was introduced along side the current Co-pay
Plan effective January 1, 2013
As Employment Contracts are negotiated, acceptance of a Trust allows the
District to contribute funds into a Health Reimbursement Account for
employees to use towards health care expenses
– Effective for Maintenance and Clerical Staff 1/1/2013
– Effective for Paraprofessionals 3/1/2013
– Effective for Principals 4/1/2013
– Effective for Off Schedule and RAA Groups on May 1, 2013
– Effective for REA on March 2014
NIS/MidAmerica is the Third Party Administrator selected to administer the
Trust and Health Reimbursement Account
Overview of Medical Coverage
Plan Design
Annual Deductible
Copay - $400 Deductible
HDHP - $1,500 Deductible
$400 Individual / $1,200 Family
$1,500 Individual / $3,000 Family
$2,500 Individual / $5,000 Family
$3,500 Individual / $7,000 Family
$500 per calendar year of delivery
No separate maximum
80% after deductible; up to the out-ofpocket maximum
80% after deductible; up to the outof-pocket maximum
100% coverage
100% coverage
$30 copay, then 80% coverage
80% coverage after deductible
80% coverage after deductible
80% coverage after deductible
80% coverage after deductible
80% coverage after deductible
$50 copay, then 80% coverage after
deductible
80% coverage after deductible
80% coverage after deductible
80% coverage after deductible
Annual Medical Out-of-Pocket Maximum
(includes deductible & coinsurance, does not
include copays)
Annual Maternity Out-of-Pocket Maximum
(participation in prenatal support program required)
Annual Coinsurance
Preventive Care
(Routine physical and eye exam, cancer
screenings, well-child care)
Physician Office Visit
Visits for Illness or Injury
Chiropractic Care, Physical Therapy
X-Ray and Lab Services
Emergency Room Visit
Inpatient & Outpatient Hospital
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Family deductibles and out-of-pocket maximums must be met by three family member.
This is a brief summary, please refer to the summary plan description for exact terms.
Overview of Prescription Drug Coverage
Plan Design
Annual Deductible
Annual Rx Out-of-Pocket Maximum
Combined with Annual Medical Maximum
Copay - $400 Deductible
HDHP - $1,500 Deductible
Does not apply
Does not apply
$1,500 Individual / $3,000 Family
$1,500 Individual / $3,000 Family
(Does not include Rx copays)
(Does include Rx copays)
No
Yes
$12 copay
$30 copay
$55 copay
$60 copay
$12 copay
$30 copay
$55 copay
$60 copay
$24 copay
$60 copay
$100 copay
$24 copay
$60 copay
$100 copay
Retail Pharmacy (30-day supply)
Generic
Preferred Brand Name
Non-preferred Brand Name
Specialty Drugs
90dayRx Retail and Mail (90-day supply)
Generic
Preferred Brand Name
Non-preferred Brand Name
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Family out-of-pocket maximums must be met by three family member.
This is a brief summary, please refer to the summary plan description for exact terms.
Corporate Office: 250 South Executive Drive, Suite 300
Brookfield, WI 53005 800.627.3660
Minnesota Office: 14852 Scenic Heights Road, Suite 210
Eden Prairie, MN 55344 800.443.6011
www.NISBenefits.com
REA
2014
Our Alliance
National Insurance Services
Local client support is provided by NIS, located in Eden Prairie, MN. NIS is a leading provider of employee
benefits to public sector employers. Founded in 1969, NIS currently works with more than 1,500 public
sector employers in 25 states. NIS offers a variety of services including group Medical, Dental, and Life
and Disability Plans. NIS’s Retirement Income Products include VEBA/HRA/FSA and employer sponsored
401(a)/403(b) plans.
MidAmerica Administrative & Retirement Solutions, Inc.
MidAmerica provides innovative employee benefit programs to over 2,200 school districts nationwide
representing close to one million plan participants. Originally formed in 1995, MidAmerica focused primarily
on providing IRC Section 3121 Social Security opt-out programs for governmental employers. This core
business has grown dramatically and has expanded to include HRA and FSA administration, Special Pay
programs, and more recently, independent 403(b) administrative and common remitting services.
American United Life Insurance Company®, a ONEAMERICA Company®
Investments for our programs are provided by AUL, headquartered in Indianapolis, Indiana. AUL has been
in business for over 125 years, has close to $6 billion of pension assets under management and has
excellent financial ratings. Plan Sponsors can choose from over 100 quality variable annuity investment
options to offer to plan participants covering the entire risk-return spectrum, including asset allocation funds
and a high quality guaranteed fixed annuity option currently crediting interest at 2.50%.
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Why NIS / MidAmerica?
• Committed 100% to the Education and Governmental Market, representing over
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2,200 employers and close to one million participants
HRA Programs have been core businesses since 2002, with over 500 plans on the
books
We will be there in the event of an IRS audit
Several of our clients have been audited without incident
Proven long-term relationship with our insurance partner, American United Life
Insurance Company®, a ONEAMERICA Company®
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New for 2013:
The Health Reimbursement Arrangement (HRA)!
• High Deductible Health Plan with
District HRA contribution
• The HRA is 100% tax-free to you,
your spouse and eligible tax
dependents
• Section 125 flex plan HRA
integration
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What is an HRA (Health Reimbursement
Arrangement)?
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HRA is a tax-exempt account used to pay
for eligible medical expenses
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HRA dollars grow tax-free
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Unused funds roll over from year to year
and are not forfeited at the end of the year
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Funds grow tax-free and are used tax-free
while actively employed or after
separation of service
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Procedures if there is no surviving spouse
or tax dependents
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Key Points of the High Deductible Health Plan with HRA
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Preventative care is 100% covered and NOT subject
to the deductible
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Covered medical expenses are paid at 80% after the
deductible of $1,500 for single and $3,000 for family is
met up to your out of pocket maximum
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Pharmacy costs apply the annual out of pocket
maximum
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Network provider discounts are always applied
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District Annual HRA Contributions*:
• Single
• Family
$ 750
$1,500
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HRA helps you build a rainy-day fund for unexpected
medical expenses…
…and a retirement nest-egg to pay for future medical expenses
• Unused funds roll over from year to year
• Accounts earn interest tax-free currently crediting 2.5% with variable
investment options also available
• Goes with you wherever you go
• Funds can be accessed by you, your spouse and any eligible tax
dependent
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What can you use the HRA funds for?
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Medical
Prescription drugs
Dental
Eye glasses
Laser eye surgery
Long-term care
Nursing home care
Surgeries
Etc…*
*All eligible IRS 213(d) medical expenses
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Investment Line-up
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AUL Fixed Interest (I2)
OneAmerica Money Market (AB)
OneAmerica Investment Grade Bond (AA)
American Century Strategic Allocation:
Aggressive (MK)
Russell Lifepoints Conservative Strategy
(Y1)
American Century Strategic Allocation:
Moderate (MM)
OneAmerica Asset Director (A9)
OneAmerica Value (AC)
American Century Equity Income (MD)
American Funds Fundamental Value (8C)
State Street Index 500 (X7)
T. Rowe Price Growth Stock (T6)
*Other Funds are available
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Calvert Social Investment Equity
Fidelity Advisor LevCo Stock
First America Mid Cap Index
Oppenheimer Main St Small & Mid Cap
First America Small Cap Index
T. Rowe Price International Growth &
Income (T9)
Oppenheimer International Growth
Oppenheimer Developing Markets
Russell 2020 Strategy (Y7)
American Century Livestrong 2035
American Century Livestrong 2045
Securities offered through GWN Securities, Inc.
11440 Jog Road, Palm Beach Gardens, FL 33418 / 561.472.2700
Member FINRA, SIPC
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2014 High Deductible Health Plan with HRA Choices:
REA Illustration
Single Plan ($1,500 deductible/$3,500 out of pocket max)
Annual total cost of the plan: $7,548
District annual share: $7,548 / Your share: $0
District annual HRA contribution: $750
Family Plan ($3,000 deductible/$7,000 out of pocket max)
Annual total cost of the plan: $15,192
District annual share: $15,192/ Your share: $0
District annual HRA contribution: $1,500
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RISK Breakdown for Single Plan
Single $1,500 Deductible, $3,500 Out-of-Pocket Maximum Plan:
Worst Case Scenario:
Your plan premium cost:
Deductible:
Maximum Out-of-pocket:
Total Expense:
$
0
$ 1,500
$ 3,500
$ 3,500
District HRA Contribution*:
$ 750
Worst Case Scenario:
$ 2,750
Best case: Use preventative care only and save the district HRA
contribution in your account. Your HRA savings = $750 for future medical
nest egg or use toward uncovered eligible expenses such as vision or
dental.
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RISK Breakdown for Family Plan
Family $3,000 Deductible, $7,000 Out-of-Pocket Maximum Plan:
Worst Case Scenario:
Your plan premium cost:
Deductible:
Maximum Out-of-pocket:
Total Expense:
$
0
$ 3,000
$ 7,000
$ 7,000
District HRA Contribution*:
$ 1,500
Worst Case Scenario:
$ 5,500
Best case: Use preventative care only and save the district HRA
contribution in your account. Your HRA savings = $1,500 for future medical
nest egg or use toward uncovered eligible expenses such as vision or
dental.
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Mail-in Reimbursements
1.
Incur eligible medical
expenses totaling $100 or
more.
2.
Fill out a form. Attach your
receipt or Explanation of
Benefits (EOB).
3.
Mail or fax the form and
receipt to MidAmerica.
4.
MidAmerica will send a
check.
5.
$5 fee for each
reimbursement, not to
exceed $30 per year.
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Online Reimbursements
1.
Incur eligible medical expenses
totaling $100 or more.
2.
Fill out a digital PDF form (found
on MidAmerica’s website).
3.
Use a digital copy of your
Explanation of Benefits (EOB),
prescription record or scan your
receipt.
4.
Email to
[email protected]
5.
MidAmerica will send a check.
6.
$5 fee for each reimbursement,
not to exceed $30 per year.
Things to remember:
• You are required to use your Section 125 funds
first prior to accessing your HRA balance
• HRA reimbursements may be made by direct
deposit (authorization form must be completed)
• $5 Fee reimbursement not to exceed $30
annually; you control frequency
• HRA funds are never taxed when deposited or
when reimbursed
• If employee separates from service prior to one
year of participation in the HRA, unused amounts
will be forfeited back to the District
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For additional questions, contact:
National Insurance Services
Aaron A. Casper, AIF®
[email protected]
www.NISBenefits.com
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Premiums
Actual Cost of Plan
Single:
Dependent:
Plan 1 (Copay plan)
$756.00
$766.00
Plan 2 (HDHP)
$629.00
$637.00
Effective with the February paychecks for March Insurance Coverage:
Plan 1 (Copay plan)
Single Coverage
Plan 2 (HDHP)
District Pays
Employee Pays
District Pays
Employee Pays
$756.00
$0
$629.00
$0
$235.54
$235.54
$637.00
$1266.00
$0
$0
Dependent Coverage $530.46
$1286.46
Cost Shifting language may apply to Employees’ dependent coverage when your spouse is offered Employer-sponsored
coverage, and that Employer offers to pay any portion of the premium, but your spouse chooses to NOT participate
in his employers plan.
Premiums
 If you and your spouse are both benefit- eligible District
employees under the REA, your monthly premium will be:
$0/mo. for Plan 1 (Copay Plan) Family Coverage
(District pays up to $1,522/mo. according to contract)
$0/mo. for Plan 2 (HDHP) Family Coverage
(District pays up to $1,522/mo. according to contract)
Eligibility
Eligibility to the Insurance Benefits is based on your Employment
contract language and Plan Language. If you are under a .5 FTE, you
may participate in the health plan, but are not eligible for the District
contribution nor the HRA, even if you elect the HDHP.
Special Enrollment allows only a change to your Health Insurance Plan
Election. No change can be made to your dental, nor flexible spending
elections.
Special Enrollment elections will impact coverage beginning March 1st,
2014 thru Dec 31st, 2014.
How to Access the Form
 A Special Enrollment form will be available February 10-14,
2014.
 All REA members are being e-mailed the link to access the
form or
 You can access the form on the Insurance Services web page
at www.rochester.k12.mn.us/insurance, or
 You can complete a paper form in the Insurance Services
office at MSB
Additional Comments
 You only need to complete the Special Enrollment form if you
want to make a change to your current health plan election.
 If you are currently enrolled in the High Deductible Health Plan,
you will automatically be enrolled in the HRA-you do not need
to do anything.
Effective Dates
 Special Enrollment elections made will be implemented on your
February paychecks impacting your coverage beginning March
1st, 2014.
 If you change plans during special enrollment, claim activity from
January and February 2014 will NOT be applied to your new plan.
These charges will not apply to your new plans deductible nor out
of pocket maximum.
 The Health Reimbursement Account will be established for REA
members as of March 1st, 2014, therefore claim expenses prior to
March 1st will not be eligible to be turned in for reimbursement.
Questions
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