Transcript Measurement Specialties 2013 OE

Open Enrollment
2014
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Prepared for:
HEALTH CARE REFORM UPDATE
Notice of Marketplace Exchange
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You should have received this notice on or around
October 1, 2013.
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No action is required by you.
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This is a required notice to be sent by your
employer to inform you of your options in the
federal marketplace exchange.
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The notice contained information specific to the
plans offered by the Diocese of Cheyenne.
Individual Mandate
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Beginning January 1, 2014, all taxpaying, U.S.
Citizens must be covered by a health care plan that
meets minimum standards.
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If you fail to meet this requirement, you may be
subject to a penalty through the IRS.
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For more information, visit www.healthcare.gov
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YOUR BENEFITS IN 2014
Medical
 NEW for 2014:
 Diocese of Cheyenne Health Plan is joining the Reta Trust
 Reta Trust is a Catholic Healthcare Trust that has been in existence since the 70’s
 Advantages:
 Adhere to Catholic directives
 Online enrollment portal
 Wellness program through WebMD
 Buying power in larger numbers
 New Plan offerings – through Aetna
 PPO Plan - $1,000 deductible – pharmacy plan through Optum
 HSA Plan - $2,500 deductible – pharmacy plan through Aetna
 New ID Cards for Aetna (new group number) and Optum
 Health Savings Account with Aetna/Payflex
 Flexible Spending Account for Health and Dependent Care
Dental
 Remain with Aetna PPO Dental Plan – no plan changes – use same ID card
Vision
 VSP - no plan changes
Life/AD&D and Long-Term Disability
 Basic & Voluntary Life coverage and Long-Term Disability with Christian Brothers/MetLife
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MEDICAL - AETNA
Type of IN-NETWORK
Service
PPO Plan
HSA Plan
$1,000 / $2,000
$2,500 / $5,000
80% / 60%
80% / 60%
$5,000 / $10,000
(Includes deductible &
coinsurance)
$5,000 / $10,000
(Includes deductible &
coinsurance)
Preventive Services
100%
100%
Office Visits
$25 copay PCP /
$40 copay Specialist
80% after deductible
Lab and X-Ray
80% after deductible
80% after deductible
Inpatient/ Outpatient
Services
80% after deductible
80% after deductible
Emergency Services
$200 copay,
80% after deductible
$200 copay,
80% after deductible
Deductible
(Individual/Family)
Coinsurance
(In-/Out-of-Network)
Maximum Out-of-Pocket
(Individual/Family)
Out-ofNetwork
benefits
available
. Please
see plan
summary
for
details.
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PREVENTIVE SERVICES
Preventive services are covered at 100%!
Preventive services may include:*
• Routine physicals
• Well-baby exams
• Immunizations
• Mammograms
• PSA Tests
• Pap Smears
• Colonoscopies
 If your doctor codes your exam as “Diagnostic”, it will NOT be covered at 100%.
*Services are age-specific and not covered as preventive for everyone. They may also be limited in frequency.
See plan documents for details.
If you are not sure whether your procedure will be covered as preventive or not, ask your doctor to file a
Predetermination of Benefits before you go in for your appointment.
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2014 Wellness
New
Take Control and Be Accountable for your Health
Health and wellness begins with an individuals choice and lifestyle . Reta and The Diocese want to support
you, their employee, with tools and resources in helping you achieve a healthier outcome. 2014 will bring
new opportunities to earn wellness financial credits. Watch your mailbox for more information.
Financial Incentive opportunities include:
•Completion of the Health Quotient through WebMD ($50)
•Completion of 3 Health Coach Calls or 5 Weekly Digital Health Plans ($100)
•Biometric Screening Participation
•January & February 2014
•Biometric Healthy Results
•BMI
•Blood Pressure
•Cholesterol
•Hemoglobin
•Tobacco Free
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MAXIMIZE YOUR BENEFITS
Be proactive!
• Ask your doctor how medical procedures will be billed
• Ask for a Pre-Determination of Benefits
• Added value benefits & discount programs
Stay in the network!
• Confirm the provider is IN the network
o Out-of-Network providers will cost more
Get educated about your prescriptions!
• Consider Generic
• Take advantage of discount pharmacy programs
o Wal-Mart: $4 (30-day) and $10 (90-day)
• Shop around
o Sam’s Club: No membership needed
• Ask your doctor for samples
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HSA 101 – What is an HSA?
There are two components to an HSA:
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1. The Insurance Plan – Qualified High Deductible Health Plan (HDHP)
2. The Bank Account – a Health Savings Account (HSA) is IRS regulated and
allows you to save money on a pre-tax basis for qualified medical expenses
PART 1:
High Deductible
Health Plan (HDHP)
Protects you from big
medical bills
Helps pay your deductible
Health Savings
Account Plan
Tax-deductible deposits
PART 2:
Savings Account
(HSA)
Tax-deferred growth
Tax-free for medical care
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HSA 101 – What are the benefits?
Participating in an HSA offers a healthy return on your investment.
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Control – You decide how much money to put into the
account and when to use it to pay for medical expenses. You
can stop contributing at any time.
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Affordability – Lower your health insurance premiums by
participating in a health insurance plan with a higher
deductible.
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Tax Savings – Tax deductions when you contribute to your
account, tax-free earnings through investment, tax-free
withdrawals for qualified medical expenses.
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Portability – You keep the account even if you change
insurance plans, jobs or retire.
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Flexibility – Use the funds to pay for current medical
expenses or save the money for future needs.
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Savings – Grow your account through investment earnings.
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HSA 101 – What expenses qualify?
Qualified Medical Expenses
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Use for Medical, Dental, and Vision expenses for you, your spouse, or your
dependent children – even if they are not covered by your High Deductible
Health Plan (HDHP)
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•
Note: You may not use your HSA funds to pay for medical premiums for you or your
spouse
COBRA, Long-Term Care and Medicare premiums
Non-Qualified Medical Expenses
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Subject to ordinary income tax and a 20% premature withdrawal penalty if:
• Made before age 65 AND
• Used to pay non-qualifying medical expenses
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Withdrawals are NOT subject to a premature withdrawal penalty if:
• Made after turning age 65
• Due to death or disability (at any age)
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HSA 101 – Contribution Limits
The IRS sets maximum limits on HSA
Contributions for a calendar year.
2014 Calendar Year
Coverage
IRS Maximum
Employee Only
$3,300
Employee + 1 or More
$6,550
Catch Up Contribution
$1,000
(age 55+)
HSA Bank Account Registration:
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Go to retaenroll.org and pull information
how to set up your account online
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PRESCRIPTION DRUG BENEFIT – PPO PLAN
Separate ID Card – Benefit administered through Optum
Reta Value Option Program Applies
PRESCRIPTION
CO-PAYS
Retail
Mail Order
Up to 30 Day Supply
Up to 90 Day Supply
Tier 1: Generic
$10
$20
Tier 2: Preferred Brand
$20
$40
Tier 3: Non-Preferred
$30
$60
Using Mail Order for maintenance medications can save you money!
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PRESCRIPTION DRUG BENEFIT
The RVO program will help you and your doctor identify lower cost
prescription drugs for treating some very common health
conditions. These lower cost drugs are called preferred drugs
under the RVO program. If you use a drug that is not on the
preferred drug list (called a non-preferred drug), your out-ofpocket cost will likely be much higher. If you will be affected based
on current drug utilization, you will receive a letter from Optum
prior to January 1, 2014, explaining your medication options. The
RVO program is only applicable to those who elect the PPO Plan.
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PRESCRIPTION DRUG BENEFIT – HSA PLAN - AETNA
After your $2,500 or $5,000 deductible has been met, you pay copays for prescriptions, up to your Out-of-Pocket Maximum
PRESCRIPTION
CO-PAYS
Retail
Mail Order
Up to 30 Day Supply
Up to 90 Day Supply
Tier 1: Generic
$10
$20
Tier 2: Preferred Brand
30%
30%
Tier 3: Non-Preferred
50%
50%
Using Mail Order for maintenance medications can save you money!
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DENTAL – Aetna
Use same ID Card you have today – Same Group Number
No change to covered benefits
TYPE OF IN-NETWORK SERVICE*
Calendar Year Maximum
BENEFITS
$1,000 per person
Preventative
100%
Deductible (Applies to Basic & Major)
$50 per person
– Max 3 per family ($150)
Basic: Fillings, Extractions, Oral Surgery,
Endodontics, Periodontics
Deductible + 80%
Major: Anesthesia, Implantology, Dentures,
Bridges, Crowns, Inlays, Onlays
Deductible + 50%
Orthodontia (Children up to age 19)
Not covered
*Out-of-Network benefits are paid based on Usual & Customary Rates.
Use Contracted Providers when possible to make
your maximum go farther
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VISION - VSP
IN-NETWORK SERVICES*
Network
Out-of-Network
Exams
$10 co-pay
Paid up to $50
Lenses
$25 copay, allowed every 12
months
Allowed every 12 months, amount
dependent on single ($50), lined bifocal
($75), lines trifocal ($100)
Frames
Covered up to $130 retail,
allowed every 24 months
Paid up to $70 frame, allowed every 24
months
Contact lenses
(in lieu of frames)
Covered up to $130
Paid up to $105 in lieu of frames
 No ID Cards needed
 Use VSP providers – stretch your vision dollars farther
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LIFE / AD&D – Basic
MetLife through Christian Brothers
Basic Life and AD&D
• 1.5x Annual Salary up to $150,000 maximum
• Doubled in the event of Accidental Death
• 100% Employer Paid
Important Information…
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“Age Reduction” applies at age 65
Update your beneficiary at any time
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DISABILITY – Long Term Disability
MetLife through Christian Brothers
Long-Term Disability (LTD)
• Elimination Period: Accident, Illness – Day 90
• Total Duration: to age 65 or SSNRA
• Coverage Amount: 60% salary up to $5,000 per month
• 100% Employer Paid
Long-Term Disability helps replace a portion of your income for an extended period of time if
you are unable to work.
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FLEXIBLE SPENDING ACCOUNT (FSA)
Full Health Care FSA
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Contribute up to $2,500 per year
• (6-month election up to $1,250)
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Use for Medical, Dental, and Vision expenses for you, your
spouse, or your dependent children – even if they are not
covered under your employer’s benefit plan(s)
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NOT AVAILABLE if you are contributing to a Health Savings
Account (HSA)
Limited Health Care FSA
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Contribute up to $2,500 per year
• (6-month election up to $1,250)
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Use is limited to Dental and Vision expenses for you, your
spouse, or your dependent children
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ALL Medical expenses, including over-the-counter, should be
filed under your Health Savings Account (HSA)
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FSA 101 – What are the benefits?
Participating in an FSA allows you to lower your taxable income.
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Choose your contribution during Open Enrollment
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Maximum annual contribution
o Health Care: $2,500
o Dependent Care: $5,000
o (6-month election beginning in January – only
half the annual amounts allowed)
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Tax Savings - Contributions are made pre-tax via
payroll deduction
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Accessibility - Money available up-front at beginning
of plan year (Health Care FSA only)
Money does NOT roll over....use it or lose it!
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FLEXIBLE SPENDING ACCOUNT (FSA)
Dependent Care FSA
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Contribute up to $5,000 per year ($2,500 if married filing separately)
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Use for daycare, after-school care, and summer day camp program expenses for
child(ren) under age 13
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Care of disabled dependents over the age of 13
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Adult daycare for disabled spouse or dependent
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FSA vs. HAS - The difference is in the “S.”
FAQ
FSA
HSA
Who can enroll?
Full Health Care FSA – Employees waiving Medical
Limited Health Care FSA – HSA Plan Enrollees
Dependent Care FSA - Anyone
HSA Plan Enrollees
Are Contributions Pre-Tax?
Yes
Yes
Will My End-of-Year Balance Roll
Over?
No. If it isn’t spent, it’s lost
Yes. If it isn’t spent it, the money
rolls over
What is the maximum I can
contribute annually?
Medical = $2,500
Dependent Care = $5,000
Per Calendar year: $3,300 if only
covering myself, $6,550 if covering
dependents
Will I have to submit receipts?
Yes, for charges other than co-pay
amounts
No, but keep the receipts in case of
an IRS audit
Does the company contribute to
the account?
No
No
What happens to unused funds if
I leave the company?
Kiss them good-bye
You take them with you
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Contributions
See the enrollment guide or online enrollment
platform for monthly contributions for both
medical plans, the dental plan, and the voluntary
vision plan.
Basic Life insurance and Long-Term Disability are
paid for in full by your location.
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NEXT STEPS
Open Enrollment is the only time during the year that you can make
changes to your benefit plan(s) without a qualifying event.
To enroll or make changes to your 2014
benefits:
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•
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Go to www.retatrust.org to enroll online
(see enrollment guide for login instructions)
Paper option is also available
Last day to make changes: November 22, 2013
New
Changes effective
January 1st, 2014
This will be a short plan year (6 months).
Therefore, elections will be good up to 7/1/14.
You will have another open enrollment in the
Spring 2014 for a July 1 effective date.
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www.retatrust.org
NEXT STEPS
ENROLLMENT:
We highly encourage you to go online and confirm your elections and/or
change your coverage. If you do not have access to enroll online, you can
obtain a paper enrollment form from your location administrator or from the
Diocese of Cheyenne website (www.dioceseofcheyenne.org)
If you do not actively make your elections online, your coverage will be
continued for 2014 with the exception of your flexible spending account
contributions. FSA elections must be made annually. Your current medical plan
election (PPO or Health Fund) will be transferred as follows:
PPO Plan = new PPO Plan for 2014
Health Fund = new HSA Plan for 2014
Qualifying Events
30 days from date of qualifying event to make changes
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Marriage or Divorce
Birth or adoption
Death of a spouse or dependent
Gain or loss of other coverage
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QUESTIONS
If you have ANY questions regarding your benefits, please
contact your location coordinator or Human Resources.
Thank you for attending the
Gallagher Benefit Services
benefit presentation for the
Diocese of Cheyenne
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