Transcript 2014 Employee Benefits Review & Open Enrollment

2014 Employee Benefits Review
& Open Enrollment
William Jewell College
October 28th, 2013
Today’s Agenda
Discussion Topics
Open Enrollment – October 28th through November 15th
Healthcare Reform
Benefit Review
• Medical: Blue Cross Blue Shield of Kansas City
• Dental: Blue Cross Blue Shield of Kansas City
• FSA: Phillips Resource Network
• Life and Long-Term Disability: Lincoln Financial Group
• Voluntary Vision: EyeMed
• Voluntary Short-Term Disability: Aflac
Good News! There are NO benefit
changes for 2014!!!
Open Enrollment
This is the time to make benefit decisions. Changes outside of Open
Enrollment are only allowed if you have a Qualifying Event:
• Marital Status
• Loss of Coverage
• Birth of a Child
• Adoption
• Death
Pre-tax Premium laws require you make your elections for the Plan year with
no changes unless you have a Qualifying Event.
Please notify the HR Department within 30 days of a qualifying event to make a
change.
Health Care Reform – What does it mean for
me?
• Beginning in January 2014, the Affordable Care Act (ACA) requires most
individuals to obtain “minimum essential” health insurance coverage for
themselves and their family members or pay a penalty, unless you qualify for an
exemption.
• This is your opportunity to enroll in William Jewell College’s health plan to
meet that requirement. Both of the health plans offered by Jewell meet the
“minimum essential” coverage requirements for 2014. Therefore, employees
(and their dependents) eligible for coverage through Jewell would not qualify
for subsidies through the Marketplace (Exchange).
• The next opportunity you have to enroll in these benefits will not be until Open
Enrollment next year which will take place in October of 2014. You may have
an opportunity to enroll outside of the Open Enrollment period if you have a
qualifying life event.
• Get more information on the Health Care Reform by going to
www.healthcare.gov
William Jewell College Insurance Withholdings for 2014
HMO COST SHARING TABLE BY ANNUALIZED SALARY
Under $30,000
At least $30,000 At least $47,000
& under $47,000 & under $61,500
At least $61,500
& over
2013
2014
2013
2014
2013
2014
2013
2014
Employee Only $44.00 $46.20 $57.00 $59.85 $69.00 $72.45 $81.00 $85.05
$138.00 $144.90 $207.00 $217.35 $260.00 $273.00 $346.00 $363.30
Employee + 1
$159.00 $166.95 $224.00 $235.20 $293.00 $307.65 $361.00 $379.05
Family
1/2-3/4 Time
Employees
2013
$195.90
$379.05
$538.75
2014
$205.70
$398.00
$565.69
PCB COST SHARING TABLE BY ANNUALIZED SALARY
Under $30,000
At least $30,000 At least $47,000
& under $47,000 & under $61,500
At least $61,500
& over
2013
2014
2013
2014
2013
2014
2013
2014
Employee Only $41.00 $43.05 $53.00 $55.65 $64.00 $67.20 $75.00 $78.75
$132.00 $138.60 $197.00 $206.85 $250.00 $262.50 $341.00 $358.05
Employee + 1
$152.00 $159.60 $215.00 $225.75 $285.00 $299.25 $353.00 $370.65
Family
1/2-3/4 Time
Employees
2013
$181.65
$359.13
$510.44
2014
$190.73
$377.09
$535.96
2014 Benefit Plans
Blue-Care HMO
Preferred-Care Blue PPO
Your 2014 Medical Plan Options
E M P L O Y E E
B E N E F I T S
2 0 1 4
Blue-Care – HMO (Health Maintenance Organization)
• Select a Primary Care Physician (PCP); in-network only; metro Kansas City
area coverage only
Preferred-Care Blue – PPO (Preferred Provider Organization)
• No selection of PCP; In and Out of Network; National and International
Coverage
www.bluekc.com
Office Visits
Blue-Care
PCP: $30 (IM, GP, FP, PED)
Specialists: $60 (ENT, Derm, OB/GYN)
2 0 1 4
Inpatient Hospital Services/Outpatient
Surgery
B E N E F I T S
MRI, MRA, CT and PET Scans Physician’s
Office, Imaging Center, Outpatient Setting
$250 copay per day / per occurrence up to $1,250
per calendar year
(applies to inpatient services at a hospital and outpatient surgeries
at a hospital or an outpatient facility)
$100 copay
Only one copay will apply for each provider on a specified date of
service even if multiple scans are performed
$10 copay
Urgent Care
$60 copay
E M P L O Y E E
Routine Vision Exam
(Minute Clinics, Take-Care Centers)
Emergency Care
(office visit/lab only)
$100 copay if treated and released
(copay waived if admitted to hospital)
Preferred-Care Blue
Office Visit
In-Network
Out-of-Network
$40 copay*
Deductible then 40%
Deductible: Individual
$2,500
Deductible: Family
$5,000
20%
40%
Out-of-Pocket Maximum:
Individual
$4,500
$9,000
Out-of-Pocket Maximum:
Family
$9,000
$18,000
Hospital: Inpatient or
Outpatient
Deductible then 20%
Deductible then 40%
MRI, MRA, CT and PET Scans
Deductible then 20%
Deductible then 40%
B E N E F I T S
2 0 1 4
Coinsurance (your share):
Physician’s Office, Imaging Center,
Outpatient Setting, including hospital
E M P L O Y E E
Emergency Room
Urgent Care
$100 copay then deductible then 20%
$40 copay*
Deductible then 40%
(includes Minute Clinics and Take
Care Centers)
*Copay includes Office Charge & Lab services in Physician’s office or Independent Lab
Hospital Locator www.bluekc.com
HMO
Blue Care Network
PPO - Preferred Care Blue
Network
Center Point Medical Center
X
X
Children’s Mercy Hospitals
X
X
KU Medical Center
X
X
Lee’s Summit Hospital
X
X
Liberty Hospital
X
X
Menorah Medical Center
X
X
North Kansas City Hospital
X
X
NO
X
Olathe Medical Center
X
X
Overland Park Regional
X
X
Providence Medical Center
X
X
Research Medical Center
X
X
Shawnee Mission Medical Center
X
X
St. Joseph Medical Center
X
NO
St. Mary’s Medical Center
X
NO
Truman Medical Center (Hospital Hill and Lee’s
Summit)
X
X
B E N E F I T S
2 0 1 4
Hospital Name
E M P L O Y E E
St. Luke’s (All Locations)
E M P L O Y E E
B E N E F I T S
2 0 1 4
Preventive Care: What to Know!
Your BCBSKC plans will cover Preventive Care Services
at 100%, according to established government
guidelines:
• Annual Physicals
• Childhood Immunizations
• Well Women Exams
• PSA Tests
Services MUST be Preventive and received by Innetwork providers
Effective: January 1, 2014
• Generic Contraceptive drugs at 100%
• Contraceptive implants, injectables & devices at
100%
• Breastfeeding support, supplies (pumps) and
counseling at 100%
Prescription Drug Coverage
Retail and Mail-Order – Both Plans
E M P L O Y E E
B E N E F I T S
2 0 1 4
Certain drugs may require prior authorization, have quantity limitations or require step therapy
(Generics First). Refer to www.BlueKC.com for additional details.
34 day supply
In-Network Pharmacy
Tier 1: $10
Tier 2: $50
Tier 3: $70
102 day supply
Mail-Order
Tier 1: $20
Tier 2: $100
Tier 3: $140
Need To Know… HMO Blue-Care Plan
Urgent Care and Emergency Care
• Receive care for non-life threatening
conditions
• Go to the nearest Emergency Room or call
“911”.
• You are responsible for the $60 Urgent
Care copay when using a Network
Urgent Care Facility
• Use Take-Care Centers or Minute Clinics
NOT the Emergency Room
E M P L O Y E E
2 0 1 4
Emergency Care
B E N E F I T S
Urgent Care
• Outside of the BCBSKC service area?
Contact your PCP prior to treatment
• Receive treatment and pay the $100 ER
copay if treated and released. The ER
copay is waived if admitted to an HMO
hospital for the same condition within 24
hours.
• YOU MUST contact your PCP within 48
hours (or as soon as reasonably possible)
after you receive medical attention.
Please Login to www.bluekc.com for a complete list of Urgent Care Facilities in your area.
BlueCard PPO Network
E M P L O Y E E
B E N E F I T S
2 0 1 4
Worldwide Network of PPO Healthcare Providers
National Network
Access through
BlueCard®
 1,177,194 Physicians
 6,776 Hospitals
 Access in ALL 50 States
Welcomed
in over 200
countries
Worldwide
2014 Wellness Program
Step 1*
Step 2*
Complete the Onsite Health Screening (or alternate means screening form)
for 25 Points
Take the Health Risk Assessment (HRA) for 25 Points
*Steps 1 and 2 must be completed to be eligible to redeem My Rewards.
Step 3
Engage In Additional Activities for 25 Points
You may earn additional points by participating in the following activities:
•
•
•
•
•
•
•
Lifestyle Coaching (goals met): 10 pts; max 30 pts
Health Advising Call: 10 pts
Self-Directed Coaching Assessments: 5 pts; max 15 pts
Tobacco Cessation Program: 20 pts
Onsite Classes or Webinars: 5-20 pts
Healthy Companion Condition Management (goals met): 10 pts; max 30 pts
Little Stars Prenatal Assessment: 5 pts; max 10 pts
My Rewards: Members and spouses on the plan can redeem up to a total of $75
when 75 points are achieved.
E M P L O Y E E
B E N E F I T S
2 0 1 4
www.bluekc.com
View Your Claims, Print a Temporary ID card & Find Added Value Info
24-Hour Nurse Line
877-852-5422



Access to Care Advisors to help you with symptoms or answer
health-related questions
How Can They Help?
◦ Gain convenient access to quality care
◦ Become better informed about healthcare
◦ Gain confidence when speaking to providers
◦ Become educated on self-care for non-urgent situations
◦ Improve knowledge of drugs and medications
24 hours a day…365 days a year!
Exclusively For Our Members
E M P L O Y E E
B E N E F I T S
2 0 1 4
•
•
A value-added program exclusively for Blue KC
members.

Helping you live healthy means more than
regular doctor visits

Blue365® is a national program that is part of
your Blue KC membership

Provides exclusive access to information,
discounts, and savings
Blue365 can:

Add exclusive value-added extras to an already
attractive and competitive benefit package

Be a strong health and wellness resource
Preferred-Care Dental
BluePremier Network
Type I
Deductible
Type II
None
Type III
$50 / $150
Type IV
None
E M P L O Y E E
B E N E F I T S
2 0 1 4
Blue Cross Pays
(Preferred-Care Dental
and Out-Of-Area
Providers)
100%
80%
50%
50%
80%
70%
40%
50%
Dental X-rays
Root Canal
Complete or
Partial
Dentures
Routine Oral Exam
Tooth Extraction
Blue Cross Pays
(Non-Preferred-Care
Dental Providers within
our Operating Area)
Covered Services
Orthodontia ( to age
19):
Cephalometric X-rays.
Cleaning – two each
calendar year
Bridge
Recementing
Surgery of
Gums
Diagnostic casts.
Periodontal
Scaling
Calendar Year
Maximum
Lifetime Maximum
$1,000 per person for all services
None
N/A
$1,000 Preferred
Visit the website
bluekc.com to find
an In-Network
Provider
Choose the Right
Health Care Setting
Generics vs. Brand
Name Drugs.
E M P L O Y E E
Explore the website
for added value
discounts,
Prescription drug
costs, price health
procedures
B E N E F I T S
2 0 1 4
Consumer-Driven Tools
Open a
Call Nurseline
Annual Physicals
Communicate with
your Doctor
Flexible Spending
Account
Participate in a
Wellness Program
Flexible Spending Accounts
Information + Enrollment = Savings
What is an FSA anyway?
An FSA adds spendable income and covers many expenses.
You may redirect part of your paycheck into a pretax account.
FSA Benefit Buckets Available:
IRS Determines Limits
1- HEALTHCARE FSA: Medical, Dental, Vision, Pharmacy & approved OTC.
$2,500
and/or
2- DEPENDENT CARE FSA: Daycare expenses.
$5,000
You can participate in one or both types of FSA
22
How will it benefit me?
• Paycheck Advantages:
- Increased take-home pay
- Lower income taxes
$$ Double benefit $$
Average family of four in the U.S. can save hundreds of dollars in taxes. ….
• Immediate availability of Healthcare
account funds
23
Expenses covered?
Medical & Dental
Dependent Care
•
•
•
•
•
•
•
•
•
•
•
•
Deductibles & co-pays
Prescription drugs
Vision (exams, glasses, laser eye surgery,
contact lens solution)
Diabetic supplies
Hearing Aids
Medical travel expenses
Chiropractic services
Dental (cleanings, fillings, orthodontia,
dentures)
And many more!
*Over the counter….what qualifies….
Daycare (child under age 13)
Private Nanny or Babysitter
Adult Daycare
24
How to submit claims
Option 1: The Benny Card. The card is used at the point of service at hospitals, doctor’s offices and pharmacies. The card
cannot be used to purchase over-the counter medication without a prescription. Save all receipts as you may be asked to
substantiate your expense. Keep your Benny Cards!
NEW !!
Grace Period is now available on Benny Card Swipes and Manual Claims for 75 days
•
For the 2013 plan year, the last day to use your 2013 funds is March 16, 2014
•
For the 2014 plan year, the last day to use your 2014 funds is March 16, 2015
Option 2: Paper Claims. Fax or mail a claim form to Phillips Resource Network with an Explanation of
Benefits (EOB) and/or receipt. Receipts must include a patient name, date of service, type of service and dollar
amount.
2014 PLAN YEAR: On January 1, 2014, your Benny Card will be loaded with your new plan year
dollars. Please DO NOT use your card to go back and pay for any services in 2013 past the 75 days.
2013 PLAN YEAR: 75 day extension on allowable expenses with an additional 30 days to submit
claims from any monies remaining from the 2013 bucket.
Services must be incurred while actively employed and will be applied to the applicable plan year.
25
Things to remember…
• Choose plan election amounts carefully
Use it or Lose it Rule
• Contribution amounts can only be changed during the plan year due to a
qualifying event (i.e., marriage or birth of a child)
• Expenses are reimbursed through an FSA after they are incurred; prepayments are reimbursed as services are received
Participation at any level will increase your take home pay!
26
We’re here to help!
PLEASE DIRECT QUESTIONS TO PHILLIPS RESOURCE NETWORK, INC.
OUR PHONE NUMBER AND EMAIL ADDRESS IS ON EVERY CLAIM FORM.
REMEMBER BY ENROLLING IN THIS PLAN, THE MONEY YOU REDIRECT IS
NOT SUBJECT TO FEDERAL, STATE, OR SOCIAL SECURITY TAXES!
Every employee must complete a 2014 FLEX form
even if waiving coverage or not making any changes
27
William Jewell College
Employer Paid Benefits
(All Full-Time Employees and All Regular Part-Time Employees and Adjunct Faculty who are
enrolled in the Employer’s Group Health Plan)
Basic Life Insurance
•
•
1 times annual salary for employees
$50,000 minimum amount to $150,000 maximum
Dependent Life Insurance
•
•
$2,000 benefit for spouse
$1,000 benefit for children from 14 days to 20 (26 if full time student) years of age
Basic Accidental Death and Dismemberment
•
$25,000 for employees
Long Term Disability
•
•
•
60% of monthly salary to $5,000 maximum monthly benefit
Payable after 120 days of disability
Payable to later of age 65 or SSNRA
William Jewell College
Voluntary (Employee Paid) Options
(All Full-Time Employees and All Regular Part-Time Employees and Adjunct Faculty who are
enrolled in the Employer’s Group Health Plan)
Voluntary Life
Voluntary AD&D

Choice of $10,000 increments of coverage for yourself not
to exceed the lesser of 5 times salary or $500,000
maximum benefit for employees.

Choice of $25,000 increments of coverage not to exceed
10 times salary or $500,000 maximum benefit for the
employees on the Employee Only Plan or Family Plans

Choice of $5,000 increments of coverage for your spouse
not to exceed ½ of employee amount or $250,000.

If elected, Spouse is provided 60% of employee amount
when Children are not covered on the Family Plan.

Choice of $2,500 increments of coverage for children after
6 months of age to a maximum benefit of $10,000.


You or your spouse may elect or increase coverage by one
or two increment levels on a guaranteed acceptance basis
during your company’s defined annual open enrollment
period, provided that you or your spouse have not been
previously declined for coverage or withdrawn a previous
application for coverage.
If elected, Spouse is provided 50% of employee amount
and Children are covered for 10% of the employee
amount (not to exceed $15,000) when all are covered on
the Family Plan.

If elected, Child is provided 15% of employee amount
(not to exceed $15,000) if only Children are covered on
the family plan.

There is an annual open enrollment
for coverage on Voluntary AD&D.
EyeMed Exam & Materials Plan
In Network
Member’s Cost
Exam with dilation as necessary
$10 copay
Frequency:
Examination
Lenses or Contact Lenses
Frame
Exam Options:
Standard Contact Lens Fit and Follow-Up:*
Premium Contact Lens Fit and Follow-Up:**
Out of Network
Allowance
$30
Once every 12 months
Once every 12 months
Once every 24 months
Up to $40
10% off retail price
N/A
N/A
$130 allowance, 20% off balance
$65
Standard Plastic Lenses:
Single Vision
Bifocal
Trifocal
Standard Progressives
$25 copay
$25 copay
$25 copay
$90
$25
$40
$60
$40
Lens Options
UV Coating
Tint (Solid and Gradient)
Standard Scratch-Resistance
Standard Polycarbonate
Standard Polycarbonate-Kids under 19
Standard Anti-Reflective Coating
Other Add-Ons and Services
$15
$15
$15
$40
$40
$45
20% off retail
N/A
N/A
N/A
N/A
N/A
N/A
$130 allowance, 15% off balance
over $130
$130 allowance, plus balance over
$130
$104
$104
$200
Frames:
Any available frame at provider location
Contact Lenses (Materials Only)
Conventional
Disposable
Medically Necessary
EyeMed Materials Only Plan
Materials Only Plan
In Network
Member’s Cost
Frequency:
Lenses or Contact Lenses
Frame
Frames:
Any available frame at provider location
Out of Network
Allowance
Once every 12 months
Once every 24 months
&0 Copay ; $130 allowance, 20% off balance over $130
$65
Standard Plastic Lenses:
Single Vision
Bifocal
Trifocal
Standard Progressives
Premium Progressives
Lenticulars
$0 copay
$0 copay
$0 copay
$65
$65,80%of charge less $120 allowance
$0 copay
$25
$40
$63
$40
$40
$63
Lens Options
UV Coating
Tint (Solid and Gradient)
Standard Scratch-Resistance
Standard Polycarbonate
Standard Polycarbonate-Kids under 19
Standard Anti-Reflective Coating
Other Add-Ons and Services
$15
$15
$15
$40
$40
$45
20% off retail
N/A
N/A
N/A
N/A
N/A
N/A
Contact Lenses (Materials Only)
Conventional
Disposable
Medically Necessary
$0 Copay $130 allowance, 15% off balance over $130
$130 allowance, plus balance over $130
$0 copay, paid-in-full
$104
$104
$200
EyeMed – Providers
• One of the largest, and most diverse vision panels
• Includes thousands of private practice optometrists, ophthalmologists
and opticians
• Composition of panel – 75% independent, 25% retail
• Includes the nation’s top optical retailers, including:
Online Management for Members
• Once registered online at www.eyemedvisioncare.com the member will
be able to:
– Locate a provider – choose the “Select” network
– View benefit details
– Order replacement ID card
– View claims
Voluntary Short-Term Disability
• Guaranteed-issue Short-Term Disability
• Guaranteed, renewable to age 70
• Benefits paid regardless of any other insurance
• 3-Month Benefit for illness or off-the-job accident
• $500 to $3000 in monthly benefit guaranteed issue
• Waiting period defined by each individual’s needs
• Partial disability benefit
• Payroll deduction
Income Replacement Example
• Jewell employees are provided long-term
disability that begins after 120 days for an
illness or off-the-job accident.
• Aflac short-term disability can be
purchased to provide income
replacement for the first 90 days, reducing
the income gap to only 30 days
Example: $34,000 Annual Salary
Age: 18 - 49
• 14/14
– 14 calendar days waiting for an off-the-job
accident
– 14 calendar days waiting for an illness
• 3 Month Benefit period
• Qualify for $1,700 Monthly Benefit
• $28.73 monthly premium
Example: $50,000 Annual Salary
Age: 18 - 49
• 14/14
– 14 calendar days waiting for an off-the-job
accident
– 14 calendar days waiting for an illness
• 3 Month Benefit period
• Qualify for $2,500 Monthly Benefit
• $42.25 monthly premium
Commerce Bank
Special employee banking benefits
No ATM fee when using the on-campus ATM
located in Yates-Gill College Union
IMPORTANT
•
Forms to turn in:
• 2014 FLEX form
• Any changes to other benefits*
Open Enrollment: October 28th through November 15th
ALL applications and changes must be turned in no later than November 15th to
the Office of Human Resources
*Examples of changes include:
• Changing plan options
• Adding or Removing dependents
• Address or phone number changes
• Changing beneficiary designation
If you have any additional questions please contact the Office of Human Resources.