Transcript Employee Benefits Overview - Galena Park Independent
Employee Benefits Overview
Overview
Benefits at-a-Glance
• • • • • • • Medical/Prescription Drugs Dental Vision Flexible Spending Accounts (FSAs) Life and AD&D Insurance Disability Insurance Critical Illness Insurance
Employee Eligibility
• Employees who are regularly scheduled to work 20 or more hours per week – Exception: If you work more than 10 hours per week but less than 20 hours per week, you may enroll only in medical coverage (at full cost)
Dependent Eligibility
• • Your legal spouse Your children up to age 26 regardless of marital or student status Important Note: Covering ineligible dependents may result in penalties up to and including removal from the TRS ActiveCare medical plan
Employees Waiving Medical
• • • • • If waiving medical for the first time, you must submit a TRS ActiveCare Enrollment Application and Change Form Complete Sections 1,2 & 9 Submit to GPISD Benefits Department Form can be downloaded from www.galenaparkisd.com/benefits Allows you to add coverage mid-year due to loss of other coverage
When to Enroll
•
New Employees
Within 31 days of your eligibility date •
Current Employees
During the Open Enrollment period: August 1 – August 31, 2011
Qualifying Changes in Status
• Examples: – Marriage – Divorce – Birth or adoption of a child – Loss of other health coverage (see also previous slide on Employees Waiving Medical)
• • • • • • •
How to Enroll
Review your benefit options Make your decisions for 2011-2012 Go to www.go2myba.com
User Name: First Initial of First Name followed by last name and last four digits of SSN Example: For Leonardo da Vinci, SSN 123-45-6789, user ID would be ldavinci6789 Password: gpisd Print and save your Confirmation Statement!
“
Pooled
”
Medical Premium
(Formerly Called “ Two Employee ” Rate) • • • • Available if both you and your spouse work for GPISD and you are both eligible for benefits Saves you money on the Family rate May result in lower family deductible and out-of pocket maximums Also applies to Dental
“
Split
”
Medical Premium
• • • • • Available if your spouse works for another entity that has TRS ActiveCare Causes total premium to be “ split ” and the other entity between GPISD SAVES YOU MONEY Deadline for paperwork 9/1/11 Contact GPISD Benefits Department for Details
Your Cost for Coverage (per Paycheck)
ActiveCare 1 ActiveCare 2 Coverage Level
Employee only Employee & child(ren) Employee & spouse Family Pool: Two Employees Pool: Two EEs + Child(ren) Split: 2 EEs Split: 2 EEs + Child(ren)
ActiveCare 1-HD
$31.00
$111.50
$239.00
$347.50
$126.50
$235.00
$63.25
$117.50
$50.00
$147.00
$258.00
$296.00
$145.50
$183.50
$72.75
$91.75
$92.00
$212.50
$343.50
$392.50
$193.50
$242.50
$96.75
$121.25
ActiveCare 3
$167.00
$333.00
$514.00
$580.50
$364.00
$430.50
$182.00
$215.25
Coverage Level
Employee only Employee & children Employee & spouse Family Pool: Two Employees Pool: Two EEs + Child(ren)
Your Cost for Coverage (per Paycheck)
Dental PPO
$12.56
$27.34
$28.41
$40.40
$25.41
$37.40
Dental HMO
$2.09
$5.64
$6.50
$9.40
$7.00
$12.80
Vision
$2.50
$9.08
$8.65
$11.25
N/A N/A
Open Enrollment 2011-2012
Open Enrollment
• • • • • Fall Enrollment Period – August 1 through August 31, 2011 Generally, any changes go into effect on September 1, 2011* New Separate Active Care Medical & RX cards mailed in September 2011 Plan year ends on August 31, 2012 Must reenroll to keep Flexible Spending Accounts * Some changes to life and disability insurance require completion of evidence of insurability form and approval by the insurance company before changes go into effect
What’s New for 2011-2012?
•
Increase in the eligibility age for dependent children
– Because of recent health care reform, TRS Active Care will cover your dependent children up to age 26, regardless of marital status, student status, or financial dependency – District Dental and Vision plans also to allow dependents to age 26 • A TRS member cannot be covered as a dependent child of another TRS member
What’s New for 2011-2012?
• Premium increases, plan design changes, and district contribution changes – Medical/PPO dental premiums are changing – Premiums for vision, dental HMO and disability plans remain the same
What’s New for 2011-12
• • • • • 100% Coverage for most Preventive Services Applies only to In-Network Providers Previous Active Care plans imposed maximums of $500/yr or copays and deductibles Effective September 1, 2011, eligible preventive care available at no cost to employee Refer to the 2011-12 TRS ActiveCare Enrollment Guide for details
Deductible Inpatient Copay Outpatient Copay Bariatric Surgeon Copay Retail Rx Retail Rx-Maint.
Mail Order Rx
What’s New for 2011-12?
ActiveCare 1 & 1-HD ActiveCare 2 ActiveCare 3
No change No change No change No change $5,000 (was $0) Individual: $750 (was $500) Family: $2,250 (was $1,500) $150/day (was $100), max 5 days, + 20% $150 (was $100) plus 20% $5,000 (was $0) $150/day (was $100), max 5 days, + 20% $150 (was $100) plus 20% $5,000 (was $0) No change No change No change $15/$35/$60 (was $10/$25/$45) $20/$45/$75 (was $15/$35/$60) $45/$105/$180 (was $20/$62.50/$112.50) $15/$35/$60 (was $10/$25/$45) $20/$45/$75 (was $15/$35/$60) $45/$105/$180 (was $20/$62.50/$112.50)
What’s New for 2011-2012?
• New Option to enroll for critical illness insurance – Pays a lump sum benefit directly to you and your covered dependents upon diagnosis of a covered illness • Examples: cancer, heart attack, stroke, paralysis or other covered illness • You may elect a lump sum benefit up to $50,000 – Amounts over $15,000 require evidence of insurability – See the benefits overview brochure for more details on this plan – Coverage available for spouses and dependent children
What’s New for 2011-2012?
• Enhancements to supplemental life – Monthly rate for employees is decreasing 10% – Employees can enroll in supplemental life insurance coverage up to the lesser of 3 x salary or $100,000 without answering any medical questions (one-time only, up to specified amounts) – Spouses can enroll up to $30,000 without answering medical questions – Employees/Spouses can increase existing coverage by $20,000 without medical questions – See 2011-12 GPISD Benefits Guide for details
What’s New for 2011-2012?
• Enhancements to disability insurance – You may select a monthly amount up to the lesser of 66 2/3% of your salary or $5,000 per month without answering any medical questions • Amounts greater than $5,000/month require evidence of insurability • • As your salary increases you may be eligible for a higher benefit Increases are not automatic—you must elect a higher benefit on the enrollment Web site
Medical
Medical Plan Choices
• • • • ActiveCare 1-HD ActiveCare 1 ActiveCare 2 ActiveCare 3
How the Plans Work
• • • Two tiers – Network benefit – Non-network benefit Save money when you visit network providers – Lowest out-of-pocket costs Non-Network Benefits – 50% of non-network expenses are excluded from coverage by ActiveCare and will be your responsibility to pay – Your non-network deductible and coinsurance is applied to the remaining 50%
ActiveCare 1-HD Plan Overview
Feature
Deductible (per plan year) Out-of-pocket max. (per plan year; excludes deductible and copays) Maximum lifetime benefit Office visit: you pay Preventive care: you pay Retail short-term (30-day supply): you pay Retail maintenance (30-day supply): you pay Mail order (90 day supply): you pay
Network Non-Network
$2,400 employee only; $2,400 family $3,000 employee only; $5,000 family 20% after deductible 0% 20% after deductible 20% after deductible Unlimited 40% after deductible 40% after deductible You will be reimbursed the amount that would have been charged by a network pharmacy less the deductible & coinsurance 20% after deductible N/A
ActiveCare 1 Plan Overview
Feature
Deductible (per plan year) Out-of-pocket max. (per plan year; excludes deductible and copays) Maximum lifetime benefit Office visit: you pay Preventive care: you pay Retail short-term (30-day supply): you pay Retail maintenance (30-day supply): you pay Mail order (90 day supply): you pay
Network Non-Network
$1,200 employee only; $3,000 family $2,000 employee only; $6,000 family 20% after deductible 0% 20% after deductible 20% after deductible Unlimited 40% after deductible 40% after deductible You will be reimbursed the amount that would have been charged by a network pharmacy less the deductible & coinsurance 20% after deductible N/A
ActiveCare 2 Plan Overview
Feature
Deductible (per plan year) Out-of-pocket max. (per plan year; excludes deductible and copays) Maximum lifetime benefit Office visit: you pay Preventive care: you pay Rx drug deductible Retail short-term (30-day supply): you pay Retail maintenance (30-day supply): you pay Mail order (90 day supply): you pay
Network Non-Network
$750 employee only; $2,250 family $2,000 employee only; $6,000 family PCP: $30 copay Specialist: $50 copay 0% 40% after deductible 40% after deductible $100/person per year $15/$35/$60 $20/$45/$75 Unlimited You will be reimbursed the amount that would have been charged by a network pharmacy less the deductible & coinsurance $45/$105/$180 N/A
ActiveCare 3 Plan Overview
Feature
Deductible (per plan year) Out-of-pocket max. (per plan year; excludes deductible and copays) Maximum lifetime benefit Office visit: you pay Preventive care: you pay Rx drug deductible Retail short-term (30-day supply): you pay Retail maintenance (30-day supply): you pay Mail order (90 day supply): you pay
Network
$300 employee only; $900 family $1,000 per person
Non-Network
$500 employee only; $1,500 family $3,000 per person Unlimited PCP: $20 copay Specialist: $30 copay 0% 40% after deductible 40% after deductible $75/person per year $15/$35/$60 $20/$45/$75 You will be reimbursed the amount that would have been charged by a network pharmacy less the deductible & coinsurance $45/$105/$180 N/A
Things to Consider
• • • • • Employee premiums Annual deductible – Must be satisfied before the plan pays benefits Copays – Set sum of money you pay at the time of service Coinsurance – Percentage of health care expenses you pay Out-of-pocket maximum
About Health Savings Account(s)
• If you enroll in ActiveCare 1-HD*, you can participate in an HSA – HSA balance is owned by participant – Accumulate interest tax-free – Your contributions are tax deductible – Use the money to pay for qualified expenses – HSA balance rolls over from year-to-year – You can keep the HSA if you change jobs • HSA not sponsored by GPISD or ActiveCare * ActiveCare 1 meets the IRS definition of a high deductible health plan for employee-only coverage
You Are Eligible to Enroll in an HSA If… • • • • You have coverage under an HSA-qualified high deductible health plan You have no other first-dollar medical coverage (other types of insurance such as specific injury or accident, disability, dental, vision or long-term care are permitted) You are not enrolled in Medicare You cannot be claimed as a dependent on someone else ’ s tax return
Dental
Dental Plan
Features UHC Options PPO
Annual calendar year deductible Annual calendar year maximum Diagnostic & preventive care (2 cleanings per 12 month period) Basic care Major care Orthodontia (children up to age 19) Lifetime orthodontia max.
Network Non-Network $50 per person; $150 per family $1,000/person $50 per person; $150 per family $1,000/person 100%, deductible waived 80% 50% 50% $1,000 100% of UCR, deductible waived 80% of UCR 50% of UCR 50% of UCR $1,000
National Pacific Dental DHMO
Network Only None None See copay schedule See copay schedule See copay schedule See copay schedule None
Vision
How the Vision Plan Works
• • Use a network provider for your care – You pay a copay at time of service – Provider files claims for you – 1 exam, 1 set of frames and lenses (or contacts in lieu of frames lenses) are covered every 12 months Use a non-network provider for your care – You pay expenses in full at time of service – You submit claim for reimbursement up to plan allowances
Vision Benefits
Features
Network You pay:
UHC Vision Plan
Non-Network Plan reimburses you: Exam (every 12 months) $10 copay Up to $40 Materials Lenses* (every 12 months) Single vision Bifocal Trifocal Lenticular $25 copay $0 after copay N/A Up to: $40 $60 $80 $80 Frames (every 12 months) Contact lenses** (every 12 months-in lieu of glasses) Amounts over $130 $0 after copay Up to $45 Up to $150 ($210 if medically necessary) *Includes scratch-resistant coating and polycarbonate lenses ** Contact lenses, fitting fees & evaluation fees are subject to $150 annual maximum after $25 copay.
Flexible Spending Accounts (FSAs)
Your FSA Choices
• • • Health Care FSA Dependent Care FSA You cannot contribute to both a Health Savings Account (HSA) and a Health Care FSA
How the FSAs Work
• • • Choose your contribution each year – Automatically deducted in equal installments from your paychecks on a pre-tax basis Incur eligible expenses Receive reimbursement from your FSA
Reimbursement Options
• • • Use an FSA debit card Submit a paper claim form Submit an online reimbursement request
FSA Rules
• • • You cannot stop or change your FSA contribution until the next plan year unless you have a qualified change in status You cannot transfer funds from one FSA account to the other (e.g., not from Health FSA to Dep Care FSA) Any money remaining in an FSA at the end of the plan year will be forfeited
Health Care FSA
• • • Set aside up to $7,500 per year Use pre-tax dollars to pay for eligible health care expenses Eligible expenses may include: – Deductibles and copays for medical, dental, and vision plans – Prescription drugs – LASIK surgery – Chiropractic expenses
Dependent Care FSA
• • • • Set aside up to $5,000 per year ($2,500 if married and filing separately) Use pre-tax dollars to pay for eligible dependent care expenses so that you can work Qualifying children must be under age 13 Dependents over age 13 must be incapable of self care
Life & AD&D Insurance
Basic Life & AD&D Insurance
• • Basic life insurance – Provided at no cost to you – $25,000 Basic AD&D insurance – Your beneficiary will receive an additional AD&D benefit if your death is due to a covered accident or injury – Equal to your basic life insurance amount – Benefit depends on type of loss
Supplemental Life Insurance
• • • Employee – $10,000 to lesser of 5 x salary or $300,000 (in $10,000 increments) Spouse – $10,000 to $50,000 (in $10,000 increments) – Cannot be more than 50% of the employee ’ s supplemental life insurance coverage Children – $5,000 or $10,000
Disability Insurance
Voluntary Long-Term Disability
• • • • • Pays you a monthly benefit up to 66 2/3% of your base salary Pays in addition to sick leave 8 different plan options Benefits reduced by other disability income sources Preexisting condition exclusions apply
• •
Critical Illness Insurance
Directly pays you a lump sum benefit at the diagnosis of a covered illness (benefit varies by illness) – Covered illnesses include, but are not limited to: • • • • • Cancer (not skin cancer) Heart attack Stroke Major organ failure Paralysis Employee coverage: $5,000 to $50,000 in $1,000 increments
Critical Illness Insurance (cont.)
• Dependent coverage – Spouse: 50% of employee amount up to $10,000 – Child: 25% of employee amount up to $5,000 Note: Evidence of insurability is required for employee coverage in excess of $15,000 and for all amounts of dependent coverage. Preexisting condition exclusions apply.
•
Preexisting Condition Limitations
Refer to Critical Illness brochure at www.galenaparkisd.com/benefits for detailed information
Sources of Benefits Information
(Available at www.galenaparkisd.com/benefits ) • • • • • • • 2011-12 TRS ActiveCare Enrollment Guide 2011-12 GPISD Benefits Guide Assurant LTD Disability Brochure UHC Critical Illness Brochure UHC Dental Insurance Certificate of Coverage UHC Vision Insurance Certificate of Coverage UHC Life Insurance Certificate of Coverage
If you have a question about…
Medical (TRS ActiveCare) Dental Vision Flexible Spending Accounts (FSAs) Life and AD&D Disability
Contact
BlueCross BlueShield of Texas UnitedHealthcare (UHC) UnitedHealthcare (UHC) TASC UnitedHealthcare (UHC) Specialty Benefits Assurant Critical Illness GPISD Benefits Department UnitedHealthcare (UHC) Specialty Benefits Diana Villasana Gina Martinez
Questions?
Telephone
1-866-355-5999 1-800-232-0990 1-800-638-3120 1-800-422-4661 or Shelli Dean, Agent 832-878-2605 1-888-299-2070 1-800-877-2701 or Shelli Dean, Agent: 832-878-2605 1-888-299-2070 832-386-1245 832-386-1276
Website or Email
www.bcbstx.com/trs www.myuhcdental.com
www.myuhcvision.com
www.tasconline.com
E-mail: [email protected]
www.myuhcspecialtybenefits.com
N/A www.myuhcspecialtybenefits.com