Transcript Willis PowerPoint Screen Template v.1

School District of
Slinger
Health Insurance Coverage Effective September 1, 2013
July 22, July 29 and August 5th
What will be covered in
today’s meeting…
•
Introductions
•
Why is a change taking place?
•
2013 Plan options and premiums
•
Fundamentals of a Health Savings Account
•
Banking arrangement – First National Bank
•
Group Vision
•
Section 125
•
Next Steps
•
Questions
Introductions
Ryan Barbieri – Senior Vice President
Sharon Schulteis-Senior Client Manager
Karen Becker-Account Executive
Clara Scheckel-Field Account Manager
Tammy Tongusi-Personal Banking Manager
First National Bank is the District sponsored bank for H S A contributions starting September 1 st.
Why the health insurance
is changing
•The members of the school board/teacher handbook committee
agreed that it was in everyone’s interest to explore some of the
innovative and consumer driven health options
•Change will offer an opportunity with reduced premium share
for employees
•Puts District in a better position to maximize future savings
•Southeastern Wisconsin healthcare is trending at 12%
What has been done
leading up to this point?
• Employees will have the opportunity to participate in a
Consumer Driven Health Plan that will qualify them for an
additional benefit…H S A contributions made to a First
National account
• Those electing H S A plan will have an option for Limited
Purpose FSA as of 1/1/2014
• Those electing not to participate in the health plan will
continue to have the Full Purpose FSA option as of 1/1/2014
• Employees will be provided with a Group Vision Plan
effective 9/1/2013
Benefit Plan Eff. 9/1/2013
H S A Option
Provider Network
Choice Plus
In-Network
Out-of-Network
Policy or Calendar Year Deductible
Deductible
Single
Family
Coinsurance
$2,500
$5,000
$5,000
$10,000
90%
70%
Out-of-Pocket Max
(Includes Deductible)
Office Visits (PCP / SCP)
Preventive Care
Includes Deductible
Single
$4,000
$10,000
Family
$8,000
$20,000
90% after ded
70% after ded
100%
70% after ded
Hospital Services
90% aft. ded.
70% aft. ded.
Urgent Care
90% aft. ded.
70% aft. ded.
Emergency Room
90% after ded.
Prescription Drugs
Retail
$10/$30/$50
(after deductible is met)
Preventive care services
examples
Covered preventive care services include
many types of exams subject to age and
gender guidelines, which typically include:
Physician office services:
Age- and gender-appropriate preventive
examinations
Well baby and well child preventive examinations
Immunizations
Health screening tests:
Mammography screening
Colorectal cancer screening
Cervical cancer screening
Osteoporosis screening
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Expanded women’s preventive
care services
Preventive Service
Expanded Women’s
Preventive
9/23 Provision
• Gestational Diabetes
Screening
• All pregnant women
• Pregnant women at risk
• HPV DNA testing for women
30 years and older
• All women age 30+ every
• Counseling for sexually
transmitted infections
• All sexually active women
• Screening and counseling for
HIV
• All sexually active women
• Screening and counseling for
domestic violence
• All women
• Women at risk
• FDA-approved contraception
methods and counseling
• All methods, all women
• Not specifically addressed;
• Counseling for breast-feeding
and rental equipment and
supplies
• Part of pre/post-natal
• Well-woman exams
• As many as necessary
(24-28 weeks); high risk
screened twice
3 years
• Women at risk; not mandated
as preventive
• Women at risk (teens,
pregnant women, lifestyle)
• Women at risk (pregnant
women, lifestyle)
not mandated as preventive
• Coverage for counseling only
counseling for pregnant
women, coverage for rental
of breastfeeding equipment
• Yearly
to obtain specified
preventive services
7
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Questions to ask your doctor
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Prevention
Self-care information
Help Finding a doctor
Information on medications
General Health Information
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UnitedHealthcare Health4Me™
makes it simpler for your employees
to manage their health by providing:
• Easy access to their health plan information
• A mobile resource to find doctors and facilities
anytime, anywhere
• Experienced Health Advisors to answer any
questions they may have
• An interface that allows each plan member to
be viewed independently
• Can be personalized with member photos
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Health Insurance Full Premium
UHC H.S.A. Plan
$2,500 / $5,000 Deductible Plan September 1st, 2013
Coverage
Amount per Month
Employee Share per Month
Single
$682.70
24 pays=$ 86 20 pays=$103.20
Family
$1,547.61
24 pays=$195 20 pays=$234
Single Medicare
$429.55 / $132.70*
Family Medicare
$859.09 / $265.39*
Medicare Special
$1,188.17
*Premium for medical only coverage where Medicare D is in place for drug coverage
What Is A H S A
Plan
What Is A HSA?
• Combines a Qualifying High Deductible Health Plan (HDHP)
with a Health Savings Account (HSA)
• Funded by the District and / or you
• Pre-tax basis by salary deferral and direct deposit for
participants
• Pay for qualified expenses or save for the future
• Annual limit that can be contributed to account
• Catch-up contributions (Age 55 and up) up to $1,000
• Funds accumulate and earn non-taxable interest
• The dollars in the HSA are yours!
• It remains your money even if you leave the District or retire
What is the HSA Concept?
Two Basic Parts:
Part 1:
HSA
Concept
Qualifying High
Deductible Health
Insurance Plan
Part 2:
Health Savings
Account
Intended to
cover serious
illness or injury
after the
deductible has
been met.
Pays expenses
until the
deductible is
met.
Comparison of Tax-Advantaged Accounts
HSA
Name of account
HRA
Health Savings Account
Health Reimbursement
Arrangement
Individual/employee
Employer
Who may fund the account?
Employer or employee, can be
both in the same year
Employee can contribute pre-tax
dollars through Section 125 plan
Employer*
What plans may be offered
with the tax-advantaged
account?
An HDHP as follows:
Min. Deductible
$1,250 I $2,500 F**
OPM
$6,250 I $12,500 F**
Any or no health plan
Who owns the account?
Is there a limit on the amount $3,250 I $6,450 F**
Catch-up contributions:
that can be contributed per
year?
$1,000 p/yr – age 55 by end of
tax year
Reduced by MSA contributions in
same year
Does the uniform coverage
rule apply?
No
No, there is no IRS prescribed
limit
No
*Self-employed individuals, including partners, and more than 2% shareholders in a subchapter S-corporation cannot contribute.
**For calendar year 2014.
Comparison of Tax-Advantaged Accounts
HSA
Can unused funds be rolled
over from year to year?
Yes
What expenses are eligible for Section 213(d) medical expenses
reimbursement?
Effective 12/31/10, OTC medicine
or drug expenses cannot be
reimbursed unless they are
prescribed or are insulin.
-COBRA premiums
-QLTC premiums
-Health premiums while receiving
unemployment benefits
-If Medicare eligible due to age,
health insurance premiums except
medical supplement policies
Must claims submitted for
reimbursement be
substantiated?
May account reimburse nonmedical expenses?
Is interest earned on the taxadvantaged account?
No
(keeping in mind that receipts will
be needed for IRS audits)
Yes, but taxed as income and 20%
penalty (no penalty if distributed
after death, disability or eligible for
Medicare)
Yes, accrues tax-free
HRA
Yes, subject to COBRA
Section 213(d) medical expenses
Effective 12/31/10, OTC medicine or
drug expenses cannot be reimbursed
unless they are prescribed or are
insulin.
Health insurance premiums for
current employees, retirees, and
qualified beneficiaries, and QLTC
premiums
Employer can define “eligible medical
expenses”
Yes
No
Yes, paid to the employer
This Chart is provided to you for informational purposes only. Please seek qualified and appropriate counsel for advice
on how to apply the topics discussed herein to your employee benefits plan. (3/04, JS 5/09; 8/10; KP 9/10) © 2004-2010 Zywave, Inc.
Who is eligible for a HSA?
An “eligible individual” is any individual who,
for a given month…
• is covered under a qualified highdeductible health plan (HDHP)
• Is not also covered by any other health
plan unless it is also an HDHP
• may not be claimed as a dependent on
another person’s tax return.
• is not covered by Medicare and receiving
benefits
Example of HSA Usage – Tom
Employee Coverage
Expense
Deductible
$2,500
Preventive Care - 1
Physical Exam
Coinsurance
90% / 10%
For HSA
Reimbursement
Covered at 100%
4 Office Visits
(Non-Preventive)
$400
Emergency Room
$800
$400
—
$400
(Deductible)
$800
—
$800
(Deductible)
Diagnostics
$2,000
$1300
Plan pays $630
Tom pays $70
$70
Totals
$3,200
$2,500
Tom Pays $70
$1,270
Health Savings Account
Total
Contribution
Less
Balance
$2,000
- $1,270
$730
$2,000 District Contribution
Example of HSA Usage – Sarah
Employee + Family Coverage
Expense
Deductible
$5,000
Preventive Care 3 Physical Exams
Coinsurance
90% / 10%
For HSA
Reimbursement
Covered at 100%
$600
$600
—
$600
Outpatient
Surgery
$10,500
$4,400
Plan Pays-$5,490
Sarah pays $4,400 +
$610=$5,010
$3,400
3 Specialist Visits
$3,600
$0
Plan pays $3,240
Sarah pays $360
$14,700
$5,000
Sarah pays $5,370
6 Office Visits
(Non-Preventive)
Totals
$4,000
Health Savings Account
Total Contribution
$4,000
Less
- $4,000
Balance
$0
Sarah’s Responsibility
$1,370
$4,000 District Contribution
What form can contributions
be made?
• Contributions to a HSA must be made in
“cash”. For example, contributions may not
be made in the form of stock or other
property.
• Contributions to the HSA can be made
through payroll deduction on a pre-tax
basis.
• The District will contribute $2,000 for
Employee coverage and $4,000 for Family
coverage
District HSA Contributions
2013-2014
FAMILY
SINGLE
24 pays: $4,000/12 = $333.33/mo.
24 pays: $2,000/12 = $166.67/mo.
Sept. 10th : $333 x 4 = $1,332
Sept. 10th : $167 x 4 = $668
(Sept–Dec lump sum to get started)
(Sept–Dec lump sum to get started)
Jan – Aug: $333/mo = $2,331
Jan – Aug: $167/mo = $1,169
June: $337
June: $163
(to accommodate for rounding difference)
(to accommodate for rounding difference)
20 pays: $4,000/10 = $400.00/mo.
20 pays: $2,000/10 = $200.00/mo.
Sept 10th: $400 x 4 = $1,600
Sept 10th: $200 x 4 = $800
Jan - June: $400/mo = $3,400
Jan - June: $200/mo = $1,200
How are distributions treated
for tax purposes?
• Tax Free
(Qualifying medical expense)
• Ordinary Tax
(Non-medical distribution after age 65)
• Ordinary Tax + 20% penalty
(Non-medical distribution prior to age 65)
When may I take distributions
from my HSA?
• Your HSA dollars can be taken at any time
to pay for qualifying medical expenses.
Note: If reimbursing expenses from previous
years, you must maintain sufficient records to
prove the expense was not previously
reimbursed.
Qualified HSA Expenses
•
Medical, dental, vision deductibles and
coinsurance amounts
•
Certain Long Term Care insurance premiums
•
COBRA premiums
•
Hearing aids
•
Smoking cessation
•
Wheelchairs
•
Organ transplants
•
Medicare premiums
What are qualifying Medical
Expenses?
• A Qualifying Medical Expense (QME) is
generally any expense incurred to
maintain your health or your family’s
health
• A partial list of expenses that can be
reimbursed is included with the HSA
information
• A complete listing provided in Section 213
of IRS Ruling.
Vision
Provider Network Access and Choice
 A national network of over 54,000 access points
National reach, local providers
 50% Private Practice Providers / 50% Retail Chain Providers
More than 100 national and local retail brands including 16 of the top 20*
* Vision Monday, May 18, 2009
Your Vision Program:
In-Network Benefits
Eye Examination
• Fully covered, after applicable copay
• Performed by a licensed optometrist or ophthalmologist
• Includes case history, examination for eye pathology and
abnormalities, visual analysis (refraction), diagnosis, visual field
testing, and prescription (if necessary)
Your Vision Program:
In-Network Benefits
Lens Benefit
•
•
•
•
•
Standard single vision
Standard lined bifocal
Standard lined trifocal
Standard lenticular
Standard Scratch Resistant coating
Discounts on non-covered lens options including popular selections such as:
•
•
•
•
•
Polycarbonate lenses
Photo-chromatic lenses
Anti-reflective coating
Tints
Progressive lenses
Your Vision Program:
In-Network Benefits
Frame Benefit
• $130 allowance applied to the retail price of any frame of the
member’s choice. If members choose frames over $130 retail cost,
they are only responsible for the difference between the allowance
and the retail cost.
• Many providers offer a discount of 30% off of the difference
between the retail cost and the $130 allowance. Providers offering
this discount are indicated in the online provider directory.
Your Vision Program:
In-Network Benefits
Industry-Leading Contact Lens Benefit
• Covered-in-full Contacts*
Fitting/evaluation fee, contacts (including up to 6 boxes of
disposables, depending on prescription and frequency of
disposable contact)
• Outside covered-in-full selection
$150 allowance for fitting/evaluation, purchase, and up to two
follow-up visits
• Online ordering and discount on contact lenses
Online ordering with10% discount off already low prices from
Vision Direct via www.myuhcvision.com
*Coverage for Covered Contact Lens Selection does not apply at Walmart, Sams Club and
Costco. The allowance for non-selection contact lenses will be applied towards the
fitting/eval fee and purchase of all contacts.
Your Vision Program:
Out-of-Network Benefits
Standard Out-of-Network Benefits*
• Examination
reimbursement up to $40
• Lenses
Single Vision
Bifocal
Trifocal/Lenticular
• Frames
reimbursement up to $40
reimbursement up to $60
reimbursement up to $80
reimbursement up to $45
• Contacts
Elective
Necessary
reimbursement up to $150
reimbursement up to $210
*Out-of-network reimbursement not subject to plan copays.
Bridge2Health
UnitedHealthcare Medical and Vision – Better Together
Taking care of your eyes benefits your overall health
Because UnitedHealthcare provides both your medical and vision benefits, we
understand how the health of one part of your body affects the health of the rest
of your body. We’re not just focusing on your eye health. We’re connecting the
dots to help you understand and improve your overall health.
Get the most from your benefits
•
•
•
Members have access to a wide variety of online health and wellness
information, easy-to-use tools and reminder programs.
myuhc.com – find important information about your medical and vision plans,
locate a provider, and access health and wellness education materials.
myuhcvision.com – access your vision plan information, print and ID card, search
for a provider, fine eye health and wellness information.
Reminder call program: It’s important to have an annual eye exam, especially if
you have a chronic condition such as diabetes, hypertension, high cholesterol
and vascular disease. If you missed your annual exam, our program is here to
remind you.
33
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Health Savings
Account
1st National Bank of Hartford
Your Independent Local Community Bank since 1907
Three Convenient Locations
Hartford Location
Richfield Location
Slinger Location
116 W. Sumner Street
1297 State Hwy 175
439 E. Washington Street
Hartford, WI 53027
Hubertus, WI 53033
Slinger, WI 53086
262-673-5800
262-628-5500
262-644-7606
MEMBER FDIC
How does your bank account work?
 $500.00 Minimum Daily Balance is required to earn interest
(If the balance falls below $500.00 a $2.50 monthly maintenance will be assessed)





Free debit card (10 business days to receive)
Free 24-hour internet banking (Setup online or at the branch)
Free bill pay (Setup online or at the branch)
Free telephone banking (Setup at the branch by calling or stopping in)
Interest paid monthly
$500.00 or greater and less than $2,499.99
$2,500.00 or greater and less than $9,999.99
$10,000.00 or more

.50%
1.00%
1.49%
Rate of interest is subject to change at any time
MEMBER FDIC
.50%APY
1.00%APY
1.50%APY
Who do we contact?
 Beverly Schatz at our Slinger Location
262-644-7606
 Tammy Tongusi at our Hartford Location
262-673-5800
 Kathy Schliepp at our Richfield Location
262-628-5500
or any New Account Representative!
We are here for you!
MEMBER FDIC
What’s Next?
•On track to have Health ID cards to members by September 1st
•Deductibles accumulate on a calendar year basis – they will
reset and start over January 1st - for this year, September
through December incurred deductibles will carryover into 2014
•You must complete a separate health and vision enrollment
form to designate your level of coverage
•Information regarding the FSA benefit options will be provided
by the district this fall - IF you intend to participate in the FSA
benefit, you MUST re-enroll
What’s Next?
•Your benefit election is an Annual Irrevocable Election unless
there is a Qualifying Event
Qualifying Event, such as:
 New Child – Adoption or Newborn
 Change of Child Custody or Support Order
 Marriage/Divorce
 Spouse Loses/Quits their Job
 Death of Spouse
NOTE:
Changes must be received within 31 days after the qualifying event
If changes are received after 31 days, changes will not take place until the next open
enrollment scheduled for 2016
Questions…