Transcript PRESENTATION TITLE HERE

Benefits for 2014
Considering your options
Benefits for 2014
Health Protection
• Medical and Prescription Drug Coverage
• Health Reimbursement Arrangement (HRA) with
SmartHealth Plan
• Socially Just Medical Benefits
• Dental Care Coverage
• Vision Care Coverage
Tax-Advantaged Spending Accounts
• Healthcare Flexible Spending Account (FSA)
• Dependent Day Care Flexible Spending Account
(FSA)
Income and Survivor Protection
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Short Term Disability (STD)
Long Term Disability (LTD)
Basic Life and AD&D Insurance
Supplemental Term Life Insurance
Supplemental AD&D
Business Travel Accident Insurance
Legal Services Plan
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Securing Your Retirement
• Voluntary Employee Retirement Savings
Plan Contributions
• Employer-Paid Retirement Benefits
(Eligible Employees)
Enriching Self and Spirit
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Employee Assistance Program (EAP)
SmartHealth Wellness Program
Tuition Reimbursement
Paid Time Off (PTO)
Let’s Discuss
What’s changing and why?
Who is eligible for benefits?
How do my benefits work?
What do I need to do?
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Be sure to
enroll by
October 15,
2013
What’s changing and why
Why benefits are changing
• We are adjusting to a changing healthcare
environment and must work together to slow
down the rising cost of benefits
What’s changing
• New Eligibility Classifications
• New SmartHealth medical plans offering access to
new Ascension Health network as well as the BCBS
network
• Lourdes Health Network is aligning with the
Ascension Health benefit platform, along with • New Medical Plan Administrator
other Health Ministries – gaining access to
competitive programs while saving
• Prescription Drug Program through Lourdes Rx and
administrative costs
MedImpact
• Health Reimbursement Arrangement (HRA) to pay
• We are continuing to offer a competitive
package to meet the needs of a diverse group for medical, pharmacy, dental or vision expenses
of associates – but a package that is more in
• Employer paid Long Term Disability and Short Term
line with benefits offered by other employers
Disability, EIB no longer accruing
• Basic, Supplemental and Spouse Life Coverage
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Who Is Eligible for Benefits?
Benefit Eligibility (non-union)
Full Time Associates
• 32-40 standard hours per week
Part Time Associates
• 20-31.99 standard hours per week
Non Benefit Eligible
• less than 20 standard hours per week
Dependent Eligibility
Spouse
• Legally married spouse
Child
• Less than 26 years old (whether living with you
or not, whether single or married)
• Over 26 years old (if became totally and
permanently disabled while covered under the
plan)
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Medical Benefits
SmartHealth
Medical
Benefits
including
Prescription
Drug Program
through
MedImpact
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SmartHealth Medical Benefits
SmartHealth is…
• Ascension’s system-wide medical plan for associates.
• On the forefront of adopting all healthcare reform initiatives
• Offers both comprehensive and cost-effective health care
through benefit designs and networks
• Creation of our own Ascension network of providers
• Access to a National Network of Blue Cross providers
for services that are not provided by Health Ministry
facilities and contracted physicians.
• While being good stewards of our healthcare spending,
promotes prevention and wellness in mind, body and spirit, to
further our mission of treating the whole person
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SmartHealth Medical Benefits
Our partners
•National Network (Tier 2)
•Ascension Health network (Tier 1)
•Claims administered by ABS
•Coverage includes Rx through MedImpact
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•Contact ABS when you
have questions.
SmartHealth Medical Benefits
Each option offers the same network access
Ascension Health
Network (Tier 1)
National Network
(Tier 2)
• You get the best value and
highest level of benefits when
you receive care from
Ascension Health Ministries
and their contracted providers
• You get preferred pricing and a
competitive level of benefits
when you receive care from
Blue Cross providers
• Since we are providing the
care within our own system,
the cost is less
• You share in the cost savings
when our own facilities and
physicians provide services
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Out-of Network (Tier 3)
• If you use providers who are
not members of either the
Ascension Health Network or
the National Network…
• you will get a lower benefit
level and will be responsible
for higher out-of-pocket costs.
How my plan works
Preventive
Care is
covered at
100%
in network
The network
you choose
determines
how much you
pay
Take time to
understand
Doctor Visits go
to Deductible in
Tier 2 – except
Preventive Care
is covered 100%
your
medical
coverage
before you
Comprehensive
covered benefits
– Prior
Authorization
may be required
Contraceptives
are excluded
for 2014
Check exclusions
and annual
maximums
need to use it
My Plan Details
Lifetime Maximum
$200 Deductible/0% Coinsurance
Ascension
National Network Out-of-Network
Health Network
(Tier 2)
(Tier 3)
(Tier 1)
Unlimited
Unlimited
Unlimited
Annual Deductible
All Deductibles and OOP Maximums are satisfied by Coinsurance expenses
from all Tiers.
Medical
Plan
Single
Family
OOP Max including
Deductible
Single
Family
Hospital Services
Inpatient
Outpatient
Urgent Care
ER Services
Office Visit
Primary Care
Specialist
Specialist-Pediatrics
Mental Health
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$200
$400
$400
$800
$3,000
$6,000
All Tier expenses apply to all OOP Maximums. Co-pays do not accrue toward
OOP Maximum.
0%
0%
$1,650
$3,300
Co-pay/Coinsurance
25%
25%
$5
25%
$75 + Tier 1 ded
$75 + Tier 1 ded
Co-pay/Coinsurance
25%
25%
25%
$5
$1,450
$2,900
$5
$5
$5
$5
$9,000
$18,000
50%
50%
30% after Tier 2
ded
$75 + Tier 1 ded
50%
50%
50%
50%
2014
SmartHealth
Medical
Benefit
Plans
Prescription Drug Benefits
In-House
Pharmacy
30-day Supply
Co-Pay
In-House Pharmacy
60-90 day Supply
Co-Pay
Retail Pharmacy
30-day Supply
Co-Pay
Generic
$5
$12.50
$10
Preferred Brand
Name (on
formulary)
$15
$37.50
$25
Non-Preferred
Brand Name
$35
$87.50
$50
Prescription
Drugs
MedVantx program discontinued, mail order through Lourdes Rx only.
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Biweekly Payroll Contributions
Biweekly Medical Plan Premiums
Classification
Full Time
Part Time
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$200 Deductible/10% Coinsurance
Single:
Associate + One:
Associate & Child(ren):
Family Plan:
$28.44
$112.07
$86.87
$144.23
Single:
Associate + One:
Associate & Child(ren):
Family Plan:
$71.09
$168.11
$130.30
$216.35
The true cost
of your medical
plan includes
not just your
out
of pocket
expenses, but
also
your payroll
contributions
Prior Authorization – New Process
All services received from the following providers must receive Prior Authorization:
• Kadlec Health System, Richland, WA
• Kennewick General Hospital, Kennewick, WA
• Tri-City Orthopedic, Richland, WA
• Benton Franklin Orthopaedic Associates, Kennewick, WA
• Tri-City Radiology, Kennewick, WA
• Northwest Cancer Clinic, Kennewick, WA
Services will be approved for Tier 2 coverage include:
• Brain
• Heart
• Obstetrics/Labor and Delivery
• Newborn Care
No benefits will be payable by the Plan if Prior Authorization is not obtained for
services received at the providers shown above.
Authorization to receive care at the facilities listed above will ONLY be granted if
the service is not available at Lourdes Health Network.
No benefits will be payable by the Plan if Prior Authorization is not obtained.
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SmartHealth Medical Benefits
Terms to know
Deductible: You pay this amount each year before Coinsurance starts
• Satisfied by all services, excluding Co-Pays and non-covered services
• With Family Coverage, each individual satisfies their own Deductible but once the
family deductible is satisfied, benefits can start for all covered family members
Coinsurance: After satisfying the deductible, you and the Plan pay a % up to
the Out-of-Pocket Maximum (OOP Max)
OOP Max: After your Coinsurance reaches the OOP Max, the Plan pays 100%
for the rest of the calendar year
Co-Pay:
A fixed dollar amount that you pay for non-hospital services –
Co-Pays do not apply to OOP Max
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New Wellness Program – Simple & Effective
Earn Health Reimbursement Arrangement (HRA)
dollars for wellness participation.
Activities
&
Rewards
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Biometric Screening
$125
Health Risk Questionnaire
$125
Primary Care Provider (PCP) Visit
$100
Total FSA Contributions/Year
$350
HRA and FSA—what’s the difference?
COMPARISON OF TAX- ADVANTAGED ACCOUNTS
Account
FSA
HRA
Who owns the account
Associate
Ascension Health
Who funds the account
Associate
Ascension Health
What plans are offered with the
account
Traditional PPO
Traditional PPO with HRA
Limits
$2,500
$350 in annual wellness rewards
Fund availability
Immediate
As earned
Use it or lose it
Yes
No
Portable
No
No
Interest bearing
No
No
The difference a network makes: An example
FT Associate with Associate + 1 coverage
Medical Care
Ascension Health Network (Tier 1)
Blue Cross Blue Shield (Tier 2)
Hospitalization for
$10,000
I meet individual deductible…..$200
And I pay 0% of the rest
While the plan pays …………….$9,800
You satisfy the deductible…………. $400
25% Cost-Share ……………………….$2,400
Capped at OOP Max ……………… $1,650
So I only owe…………………………..$1,650
2nd hospitalization
$20,000
Already met deductible
0% Cost-Share
I already paid……………………..…..$200
While the plan pays ……………$20,000
I owe .………..…………………………..$0
Already met deductible
25% Cost-Share = $5,000 but
I met my OOP Max
I already paid…………………..….…$1,650
So I owe only.………..…………...…..$0
Hospitalization for
spouse of $18,000
He meets deductible…..……......$200
0% Cost-Share
I already paid ………………......….$200
While the plan pays …………….$18,000
Spouse pays only……………………$200
He satisfies the deductible..…………... $400
25% Cost-Share = $4,400 but
Capped at family OOP Max............ $3,300
And I already paid …………………...….$1,650
So he pays …….……………………………..1,650
Bottom line
Annual premium……………….. …$2,913
Deductible………………………… $ 400
Out of Pocket Max……………… …..$0
Annual premium……………………$2,913
Deductibles………………………… ..$800
Out of Pocket Max…………….. $3,300
I pay…………………….. $3,313
I pay…………………………. $7,013
Plus Doctor/ER/Urgent Care co-pays
and Rx co-pays.
Plus Doctor/ER/Urgent Care Co-Pays
and Rx Co-Pays.
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Tips to Avoid Unnecessary Costs
Be a wise healthcare consumer
• Choose Ascension Health Network (Tier 1) for all care if you can
and verify network affiliation by using the Provider Directory
available on our intranet or at MySmartHealth.org (during open
enrollment)
• Have all ancillary testing done at our hospitals/facilities. Remind
your physician’s office to refer your lab/pathology specimens to
our facilities – don’t assume they will
• Understand your benefits
Verify prior authorizations
• The ordering physician is responsible for obtaining the prior
authorization according to the guidelines set by the Third Party
Administrator who handles your claims
• Always ask whether or not a prior authorization is needed for
services
• Note: Bariatric Surgery is only covered in Tier 1 if it’s available
from a Health Ministry within 100 miles
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Women’s Preventive Services
• The U.S. Department of Health and Human Services, the Department of Labor and the Internal
Revenue Service have jointly released final regulations regarding women’s preventive services
under the Affordable Care Act (“ACA”). The ACA requires group health plans to provide coverage
for "contraceptive services" as part of an array of women’s preventive services that must be
included in health plans without cost sharing to covered participants.
• The regulations contain an accommodation for eligible non-profit religious organizations that oppose
providing contraceptive coverage. As a healing ministry of the Catholic Church, Ascension Health
does not promote or condone contraceptive practices and objects to providing such coverage.
Therefore, as the plan sponsor of both our self-insured Ascension Health SmartHealth Medical Plan
(“SmartHealth Plan”) and our self-insured Ascension Health Prescription Drug Program (“Rx Plan”),
Ascension Health qualifies as an eligible organization that is entitled to the accommodation. As a
result, neither the SmartHealth Plan nor the Rx Plan will provide coverage for contraceptive benefits
that are in conflict with our Catholic Identity and the Ethical and Religious Directives for Catholic
Health Care Services.
• As part of the accommodation, third party administrators of our SmartHealth and Rx plans are
required to provide this coverage to covered members at no cost, independently of Ascension
Health and consistent with the authority given them by the final regulation. You will receive
information directly from those Administrators about the coverage that may be available to you for
those “preventative services.”
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Socially Just Health Benefits Subsidy
Ensuring access to care for all
• Offered to FT associates
• Income must be less than 200% of the Federal
Poverty Level based on family size
• If eligible, associates must enroll in the PPO
$200 deductible/ 0% cost-share plan
• Associates may be eligible for 100% waiver or
a discount of 25%, 50% or 75% on associate
premiums, inpatient and outpatient service copay/cost-share at our facilities only
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Non-Medical Benefits
Flexible
Spending
Accounts
(FSAs)
Delta Dental
Coverage
Vision Service
Plan (VSP)
Life, Disability,
and More
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Flexible Spending Accounts
Administered
by ADP
Healthcare FSA
Minimum
$ 260
Maximum
$2,500
Your Health Ministry deposits your annual contribution amount in your FSA debit
card at first of year
You will receive new debit card the for 2014
Be sure to
elect your
contribution
amount before
deadline
Dependent Day Care FSA
Minimum
$260
Maximum
$5,000 for married associates
$2,500 for single associates
You pay bills, then submit them for reimbursement
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Remember: if
you don’t use
it, you lose it
Dental Plan
Your Delta Dental plan provides comprehensive coverage
Delta Dental of Missouri
Service
Comprehensive Plus Traditional
Deductible
$50 per person
$150 family maximum
Does not apply to Preventative services.
Preventative
100%
Basic
80%
Major
50%
Orthodontia
50% child coverage to age 19; $1,500 lifetime maximum
No adult coverage unless you are currently enrolled in a
dental plan that covers adult orthodontia, the banding is
applied by December 31, 2013, and you are enrolled in this
Delta Dental plan after January 1, 2014
Annual Maximum
$1,500 - Excludes Preventative (w/MAXAdvantage) and
Orthodontia
Watch for a new Delta Dental card coming in the mail before 1/1
Vision Services Plan
You may elect Full Coverage with VSP
Vision Service Plan – Full Coverage
Service
Exam
Prescription Glasses
VSP Network
Out-of-Network
100% 1 in 12 months after $10 Co-Pay
Up to $45
100% 1 in 12 months, after $25 Co-Pay
Up to $45
Single vision
100% 1 in 12 months, after $25 Co-Pay
Up to $65
Lined bifocal
100% 1 in 12 months, after $25 Co-Pay
Up to $85
Lined trifocal
100% 1 in 12 months, after $25 Co-Pay
Up to $125
$130 after $25 Co-Pay, plus 20% off any outof-pocket costs, every 12 months
Up to $47
*If you choose contact lenses instead of
glasses, you will be eligible for a frame 12
months from the date the contact lenses
were obtained.
$130 allowance after $25 Co-Pay, every 12
months
Up to $105
Diabetic Eyecare Program
100% supplemental services for Type 1
diabetics after a $5 Co-Pay
Lasik Surgery
For details about benefits for laser vision
correction surgery contact VSP directly
Lenses
Lenticular Lenses
Frame OR
Contacts Elective*
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Disability Coverage
Short Term Disability
Eligibility
Lourdes Health Network pays the full cost for
FT and PT non-union associates
Elimination Period
7 days
Coverage
Covers a percentage of weekly base pay
for 180 days
• Workers’ Compensation injuries are excluded from STD benefits.
• After qualifying for EIB and STD due to illness or injury, you must exhaust EIB
before STD benefits begin.
Long Term Disability
Eligibility
Lourdes pays the full cost for FT and PT
associates.
Coverage
Covers a percentage of monthly base pay
from the 181st day until recovery or age 65
LTD benefits for Mental Health conditions are limited to 24 months.
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STD and LTD
benefits are
offset by any
other income
you may receive
EIB plans will
stop accruing at
the first of the
year – balances
may be used
through June
2015
Other protection
Legal Services Plan
• Low-cost legal assistance is available to you through Hyatt Legal,
including assistance with adoption services, wills, trusts, living wills, and
identity theft, etc.
• You may enroll during any open enrollment period if you think you’ll need
a lawyer in the year ahead.
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Enriching Self and Spirit
• Lourdes Health Network provides additional benefits to support associates in
meeting goals for personal development and well-being, including:
• Employee Assistance Program – support is available to you and covered
dependents through LifeWorks for assistance with managing stress,
relationships, and financial issues. You can talk to someone 24/7 by phone or in
person by appointment.
• Educational Assistance – please see newly revised policy on Ellucid.
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Open Enrollment Resources
Available on our Intranet – click on
• 2014 Benefits Handbook
• Benefit FAQs
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Next Steps
Take time to consider your options
• Open enrollment begins October 1, 2013
• Remember: This is an “active enrollment” – all benefits eligible associates must
re-enroll in all benefits for 2014
• Enroll before October 15, 2013
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Thanks for listening!