Transcript Understanding your Medical Plan

Understanding your TRS
ActiveCare Plans
TRS ActiveCare Rates
Medical
Employee
Pays
Employer
Pays
Monthly
Total
TRS Active Care 1-HD
Employee Only
Employee/Spouse
Employee/Child(ren)
Employee/Family
$
$
$
$
1.00
434.00
169.00
660.00
$
$
$
$
297.00
297.00
297.00
297.00
TRS Active Care 1
Employee Only
Employee/Spouse
Employee/Child(ren)
Employee/Family
$
$
$
$
41.00
474.00
243.00
553.00
$
$
$
$
297.00
297.00
297.00
297.00
$
$
$
$
338.00
771.00
540.00
850.00
TRS Active Care 2
Employee Only
Employee/Spouse
Employee/Child(ren)
Employee/Family
$
$
$
$
163.00
749.00
434.00
853.00
$
$
$
$
297.00
297.00
297.00
297.00
$
$
$
$
460.00
1,046.00
731.00
1,150.00
TRS Active Care 3
Employee Only
Employee/Spouse
Employee/Child(ren)
Employee/Family
$
$
$
$
340.00
1,151.00
718.00
1,295.00
$
$
$
$
297.00
297.00
297.00
297.00
$
$
$
$
637.00
1,448.00
1,015.00
1,592.00
$
$
$
$
298.00
731.00
466.00
957.00
What does this mean for you?
• With the rising costs of insurance and medical
expenses, it is beneficial for you to understand
what options are available to you.
• Utilizing the information provided, how do
you choose which plan is best for you and
your family needs?
Out-of-Pocket Expenses
• Deductible: The amount you and your enrolled dependents are required
to pay per plan year, for covered expenses before the plan pays benefits.
• Co-Pay: A contractual amount that the patient will pay with each medical
visit, from a doctor's office visit, an emergency room visit, inpatient
hospital stay, high-tech radiation treatment, and prescription fills.
• Co-Insurance: The specified portion (dollar amount or percentage) that
health insurance may require a person to pay toward his or her medical
bills or services. (80%/20%)
• Out-of-Pocket Maximum: Total maximum amount of co-insurance that a
patient could be required to pay for medical services rendered. This
amount is in addition to any required deductibles or co-pays.
Out-of-Pocket Expenses
ActiveCare 1-HD
ActiveCare 1
ActiveCare 2
ActiveCare 3
Deductible
$2,400/$2,400
Ind./Family
$1,200/$3,000
Ind./Family
$750/$2,250
Ind./Family
$300/$900
Ind./Family
Co-Pay
N/A
N/A
$30 co-pay for
primary
$50 co-pay for
specialist*
$20 co-pay for
primary
$30 co-pay for
specialist*
Co-Insurance
20% (In-net) after
deductible
40% (Out-net)
after deductible
20% (In-net) after
deductible
40% (Out-net)
after deductible
20% (In-net)
after deductible
40% (Out-net)
after deductible
20% (In-net)
after deductible
40% (Out-net)
after deductible
*Specialist In-Network office visits are subject to the co-pay amount. Specialist In-Network treatment visits are subject to the
deductibles and then the co-insurance percentages. Specialist Out-of-Network office visits and treatment visits are all subject to the
deductibles and then the co-insurance percentages. For specific coverage amounts, contact BCBS at 1-866-355-5999.
Understanding your
prescription
benefits
Did you know…
• Most pharmacies will charge you
the co-pay amount for a generic drug
even if it is offered on their discount
plan for less.
• The following are a few local
pharmacies that offer discount
generic drug plans:




CVS
Walgreens
Wal-Mart/Sam’s
HEB
• You could save approximately
$120.00 per year on just 1 generic
maintenance medication by using
the pharmacy discount plans instead
of your insurance co-pay!
ActiveCare
1-HD
ActiveCare
1
ActiveCare
2
ActiveCare
3
$2,400/
$2,400
Ind./Family*
$1,200/
$3,000
Ind./Family*
$200 Individual
$ 0 for Generic
$75 Individual
Retail
Pharmacy
N/A
N/A
Participant pays
20% after
deductible is met.
Participant pays
20% after
deductible is met.
$15 – Generic
$35- Brand
$60- Nonpreferred
Brand
$15 – Generic
$35- Brand
$60- Nonpreferred
Brand
Retail
Maintenance
(3rd fill)
N/A
N/A
Participant pays
20% after
deductible is met.
Participant pays
20% after
deductible is met.
$20 – Generic
$40- Brand
$75- Nonpreferred
Brand
$20 – Generic
$40- Brand
$75- Nonpreferred
Brand
Mail Order
(up to 90 day
supply)
N/A
N/A
Participant pays
20% after
deductible is met.
Participant pays
20% after
deductible is met.
$45 – Generic
$105- Brand
$180- Nonpreferred
Brand
$45 – Generic
$105- Brand
$180- Nonpreferred
Brand
Specialty
Drugs
N/A
N/A
$200 per fill
$200 per fill
Participant pays
20% after
deductible is met.
Participant pays
20% after
deductible is met.
CoInsurance:
Participant pays
20% after
deductible is met.
Participant pays
20% after
deductible is met.
N/A
N/A
Deductible:
Co-Pay:
*The deductible on ActiveCare 1-HD and ActiveCare 1, include medical and prescription
expenses.
What is a
Health Flexible
Spending Account?
Did you know…
• The IRS only allows you to
• A Health Flexible Spending Account (FSA) is
a special account for healthcare expenses.
• It allows you to pay for Medical, Dental and
Vision expenses not paid by your insurance
plan.
√
√
√
√
√
count medical expenses
exceeding 7.5% of your adjusted
gross income (AGI) in your
itemized tax deductions.
•
Example: an adjusted gross
income of $35,000 would require
$2,625 in medical expenses
before getting any tax credit!
•
You can set aside up to $2,500
per year in a Health FSA and
reduce your taxable income by
the amount contributed.
•
This allows you to receive a tax
credit on your medical expenses
without meeting the 7.5% of your
AGI rule!
Deductibles
Co-pays/Co-insurance
Orthodontics
Glasses/Contacts
Prescriptions
• These expenses may be incurred by you or
your taxable dependents.
•
You elect an annual amount to contribute
which will be deducted monthly from your
pay throughout the plan year.
• Your total annual deduction is available for
use on the first day of the plan year.
• This is a pre-tax deduction!
Understanding the Difference
Between Pre and Post Tax Deductions
Pre-Tax
Post-Tax
• A pre-tax deduction is a
deduction that is made to your
gross income before determining
the amount of taxes to be
deducted. This deduction will
lower your taxable income,
therefore saving you money.
• A post-tax deduction is a
deduction that is made to your
gross income after the amount of
taxes has been determined and
deducted. This deduction does
not lower your taxable income.
Example:
Gross income = $2,000.00
Pre-tax deductions = $500.00
Taxable income = $1,500.00
20% Tax = $300.00
Net Take Home Income = $1,200.00
Example:
Gross income = $2,000.00
Taxable income = $2,000.00
20% Tax = $400.00
Post-tax deductions = $500.00
Net Take Home Income = $1,100.00
What does this
mean for you?
Tips for choosing a plan…
 Estimate the number of sick visits you and
your dependents use in a typical year.
Tip: Use the same number of visits that you
had the previous year. Information can be
found on the Blue Access website.
 Find out the actual cost (not the co-pay
cost) of any maintenance medication that
you currently take.
Tip: You can print off a list of all
prescriptions filled and their actual cost for
the last 18 months on the Medco website.
 Find out the actual cost of any
prescriptions utilized for sickness in the past
year.
Tip: If you do not have access to the Medco
website, you can contact your pharmacy for
a list of prescriptions filled and their actual
costs.
 Calculate the annual premium cost for
each plan offered. Then add the above totals
to that premium to find out the average
annual cost for you and your family on each
plan.
Tip: Use this total, minus the annual
premium cost, to calculate how much you
should put in a Health Flexible Spending
Account!
• The following 2 slides will
illustrate examples of what
to consider when choosing
a plan.
• The first slide is of an
employee and two
dependent children.
• The second slide is of an
employee only.
What does this mean for you?
Example 1 (Employee/Child(ren))
ActiveCare 1-HD
Annual Emp Only Premium
Annual Emp/Spouse
Annual Emp/Child(ren)
Annual Emp/Family
Occasional Office Visit:
Employee (2 sick visits @
$100/visit)
Child (4 sick visits @
$100/visit)
Child (4 sick visits @
$100/visit)
Prescriptions - maintenance
Employee (cholesterol
meds)
Child (ADHD meds)
Child (ADHD meds)
Prescriptions - sickness
Employee
Child
Child
Total annual expense
(including monthly
premiums):
ActiveCare 1
ActiveCare 2
ActiveCare 3
744.00
5,736.00
2,676.00
8,340.00
1,200.00
6,192.00
3,528.00
7,104.00
2,508.00
9,144.00
5,580.00
10,320.00
4,308.00
13,236.00
8,472.00
14,832.00
200.00
200.00
60.00
40.00
400.00
400.00
120.00
80.00
400.00
400.00
120.00
80.00
48.00
703.84
222.90
48.00
703.84
222.90
180.00
420.00
180.00
180.00
420.00
180.00
35.82
44.49
46.53
35.82
44.49
46.53
30.00
60.00
60.00
30.00
60.00
60.00
4,777.58
5,629.58
6,900.00
9,662.00
What does this mean for you?
Example 2 (Employee Only)
ActiveCare 1-HD
Annual Emp Only Premium
ActiveCare 1
ActiveCare 2
ActiveCare 3
744.00
1,200.00
2,508.00
4,308.00
Annual Emp/Spouse
5,736.00
6,192.00
9,144.00
13,236.00
Annual Emp/Child(ren)
2,676.00
3,528.00
5,580.00
8,472.00
Annual Emp/Family
8,340.00
7,104.00
10,320.00
14,832.00
200.00
200.00
60.00
40.00
2,277.84
1,375.57
630.00
630.00
8.00
8.00
20.00
20.00
3,229.84
2,783.57
3,068.00
4,838.00
Occasional Office Visit:
Employee (2 sick visits @
$100/visit)
Prescriptions - maintenance
Employee (hormone, mood,
joint/muscles meds)
Prescriptions - sickness
Employee
Total annual expense
(including monthly
premiums):
What if….
I choose a high deductible plan, but I’m
worried that if I put too much in flexible
spending trying to prepare for the worst, I
might lose that money.
If I don’t put enough, I could have the stress of
having to pay a large hospital bill.
We have a solution for that!
American Public Life MEDlink® Plan
*MEDlink is designed to supplement your employer’s medical plan. This plan
provides supplemental coverage to help offset out-of-pocket costs that you may
experience due to deductibles and coinsurance of your employer’s medical plan.
In-Hospital Benefit
Pays expenses you incur as an Inpatient (at least 18 continuous hours) up to $2,500 or $1,500 per confinement (based on plan
you select).
Out-patient Benefit
Pays up to $200.00 per treatment in:
Hospital Emergency Room
Outpatient surgery in a Hospital Outpatient Facility
Outpatient surgery in a free-standing Outpatient Surgical Center
Diagnostic testing in a Hospital Outpatient Facility
Diagnostic testing in a MRI Facility
All benefits for the same or related conditions will be subject to the maximum benefit, unless such conditions are separated by
90 consecutive days, then a new maximum out-patient benefit will apply.
Physician Benefit:
Physician visits for sickness or injury due to an accident: $25.00 per visit, maximum five visits per family per calendar year, for
treatment received in a:
Physician’s office
Hospital Outpatient Clinic
Free-standing Emergency Care Clinic
*This policy has limitations and exclusions. Please refer to the policy and brochure for benefits and provisions.
MEDlink® – Example of Savings
INPATIENT HOSPITAL EXAMPLE:
Illness: Pneumonia (@ hospital in Plano, TX)
Estimated cost after insurance adjustments = $8,258
Plan 1-HD
Deductible
Plan 1
Plan 2
$ 750 $1,200
+ 20% co-insurance
$ 1,502
$ 1,411
$ 1,170
EE out of pocket
$ 2,252
$ 2,611
$ 3,570
MEDlink® pays
$0
$ (1,500)
$(2,500)
EE final out of pocket
$ 2,252
$ 1,111
$ 1,070
$ 2,400
MEDlink® Monthly Premiums
$1500 Benefit (Typically used with AC 1)
MONTHLY RATES
$2500 Benefit (Typically used with AC 1-HD)
MONTHLY RATES
In-Hospital Benefit $1,500
Ages 18-54
Employee Only
$21.50
Employee & Spouse
$39.50
Employee & Children $36.50
Employee & Family
$54.50
Ages 55-59
Employee Only
$32.00
Employee & Spouse
$59.00
Employee & Children
$47.00
Employee & Family
$74.00
Ages 60 & Over
Employee Only
$49.00
Employee & Spouse
$88.00
Employee & Children
$64.00
Employee & Family
$103.00
In-Hospital Benefit $2,500
Ages 18-54
Employee Only
$28.00
Employee & Spouse
$51.50
Employee & Children $45.50
Employee & Family
$69.00
Ages 55-59
Employee Only
$44.50
Employee & Spouse
$81.50
Employee & Children
$62.00
Employee & Family
$99.00
Ages 60 & Over
Employee Only
$68.50
Employee & Spouse
$122.50
Employee & Children
$86.00
Employee & Family
$140.00
MEDlink® Eligibility
*You are not eligible for the MEDlink plan if any
of the following apply to you:
 Covered by TRS-Care, Medicare, Medicaid or Medical
Savings Accounts.
 Employees who have an HSA that is being actively
funded.
 Employees (or their dependents) who are not
covered under the school’s major medical plan.
 Non-residents of the United States.
 Employees not actively at work on the plan effective
date.
*This policy has limitations and exclusions. Please refer to the policy and brochure for benefits
and provisions.
Summary of Supplemental Benefits
 Flex Accounts – Provided by NBS
 Dental – Provided by Dental Select
 Vision – Provided by Superior Vision
 Disability – Provided by UNUM
 Accident – Provided by American Public Life
 Cancer – Provided by American Public Life
 Group Term Life and AD&D – Provided by Dearborn National
 MEDlink – Provided by American Public Life
Flexible Spending Accounts: NBS
Plan Year: 09/01/2012 – 08/31/2013
 Medical Reimbursement
 $2,500/ plan year maximum
 Advance allowed
 Dependent Care Reimbursement
 $5,000/plan year maximum (married filing jointly)
 $2,500/plan year maximum (filing single)
 Advance NOT allowed
 The NBS flex card will be provided to all participants of the Medical
Reimbursement Account. The flex card is provided to you at NO COST!
 Flex cards are valid for 3 years. Remember to keep your itemized receipts in
the event you are asked to substantiate a card swipe.
 Flex Accounts are Use it or Lose it each plan year and amounts must be
re-elected every year – they will not rollover.
La Grange ISD Dental Plans: Dental Select
There are 3 plan options available: Silver Discount Plan, Platinum Co-Pay, and
Platinum Indemnity.
 Indemnity Plan
 Allows you to visit any dentist!
 Has a $50 deductible and $1,000 annual maximum benefit.
 Children under age 19 have a $1,000 lifetime max for Orthodontics.
 Covers 100% Preventative, 80% Basic, and 50% Major & Ortho.
 12 month waiting period on Major & Ortho service.
 Co-Pay Plan
 High quality features & benefits while minimizing employee cost.
 No waiting periods & No maximums
 Must see a contracted Dental Select Provider.
 Discount Plan
 Quality care at discounted rates from the Silver group of contracted providers.
 This is not dental insurance.
La Grange ISD Dental Rates
Platinum Indemnity
Co-Pay Plan
Silver Discount
Employee Only
$22.70
$11.90
$0.00
Employee + Spouse
$56.83
$22.48
$5.00
Employee + Child(ren)
$62.34
$25.29
$5.00
Employee + Family
$86.93
$39.26
$8.00
ESC-20BC Vision Plan: Superior Vision

Members pay a co-pay for in-network benefits.

In-network co-pay is $10 for exams and $25 for materials. The insured
is responsible for paying charges in excess of plan allowances.

Out-of-network vision services are reimbursed up to a certain dollar
amount for covered expenses.

Benefits are covered for Exam and Lenses once every 12 months and
Frames once every 24 months.

The plan covers contacts in lieu of glasses.
Employee Only
Employee &
Spouse
Employee &
Child(ren)
Employee &
Family
$6.98
$13.86
$13.58
$20.66
La Grange ISD Disability Plan: UNUM
 Designed to provide a monthly income to an individual that is disabled
due to an accident or illness.
 La Grange ISD offers a disability plan to all eligible employees
working 18.75+ hours per week.
 You can choose a monthly benefit ranging from $200.00 per month up
to 66 2/3% of your monthly earnings.
 You can choose your elimination period ranging from 1 day up to 180
days, depending on how soon you want your benefit payments to
begin.
La Grange ISD UNUM Disability Plan
 Pre-Existing Condition Limitation: A Pre-Existing Condition is an injury,
sickness, or pregnancy for which the employee in the past 3 months before the
effective date: received medical treatment, consultation, care, services, took
prescription medications or had medications prescribed.
 No benefits would be payable under the plan in connection with a disability
that is due to a pre-existing condition unless the employee’s elimination
period started after they were employed under the plan for 12 consecutive
months.
La Grange ISD Cancer Plan: APL
Cancer insurance is designed to be a supplement and helps pay for many of the costs
not covered by your major medical. This coverage is offered on a guarantee issue
basis, however, no benefits are payable for any loss during the first year of a Covered
Person’s coverage as the result of a Pre-Existing Specified Disease.
A continuation rider is included in this plan and allows employees to keep their plan at
the same premium amount and coverage level at separation of service.
Plan Benefits Include:
 Option 1: $500/month Radiation/Chemo benefit, and a $100 daily room benefit
 Option 2: $1,500/month Radiation/Chemo benefit, and a $300 daily room benefit
Both Plans Include:
 An optional $600 per day ICU rider.
 A $2,500 Lump Sum Critical Illness benefit for Cancer or Heart/Stroke.
 Reimburses up to $50 per calendar year for each insured person for cancer
screening tests.
La Grange ISD Cancer Plan: APL
Option 1: Low Plan
Option 2: Low/ICU
Individual
$14.80
$17.80
Single Parent Family
$20.60
$24.80
Family
$26.40
$32.70
Option 3: High Plan
Option 4: High/ICU
Individual
$29.40
$32.40
Single Parent Family
$40.40
$44.60
Family
$51.50
$57.80
Voluntary Life Plan: Dearborn National
 This plan offers you and your dependents an excellent opportunity to purchase
affordable term life insurance on a payroll deduction basis. Employees must
elect coverage on themselves in order to cover dependents.
 The important plan features are:




High limits
Conversion and Portability rights
Accelerated Benefit Riders
New Enrollee Guaranteed Issue: $200,000 Employee, $50,000 Spouse (up to
7x annual salary)
 Employees may apply for up to 7 times annual salary (up to $500,000) on
themselves. They may also insure spouses for up to 50% of the employee
benefit up to $100,000 maximum, and dependent children up to $10,000.
IDWatchdog Identity Theft Protection
This plan monitors your personal information for threats of identity theft:
 Monthly reporting alerts
 Full resolution services should your identity be compromised while
utilizing IDWatchdog services
2012-2013 Summary of Benefits
This is an overview of available benefits. You can access
all benefit plan summaries and brochures for complete
information and rates on the ESC-20BC benefits website
under the “Benefits and Forms” tab:
www.ESC20BC.net
Thank you for attending your
Benefits meeting today!
We will be back in August to help you through
the online enrollment process and to answer
any questions you may have!
Joining Together to Benefit Employees