Transcript 2005-2006 Frenship ISD

2014
Frenship ISD
Group Health
Insurance Plan
2013-2014 FISD
Health Insurance Committee
CAMPUS REPRESENTATIVES:
FHS
Reese
FMS
Terra Vista
HMS
Bennett
Crestview
Oak Ridge
North Ridge
Westwind
Willow Bend
Custodians
Maintenance
Central Office
Tate Casey
Lynn Mills
Katrina Smith
David Speer
Emily Wagner
Sanae Allison
Cindy York/Kathy Dawson
Shane Langen
Betsy Bucy
Bobbie Jo Williams
Stacey Price
Balt Padilla
Alex Diaz, Derek Cobb, Allen Tanner
Rhonda Dillard, Pat Valdez, Greg Cartwright,
Dr. Vroonland, Michelle McCord, Tim
Williams, Courtney Reeves
January 1, 2014 through
December 31, 2014
* Remember, Our Plan year…
*Plan Options:
(In Network Includes UMC & Covenant )




HMO (free plan for employees)
PPO 1
PPO 2
High Deductable/HSA (Health Savings Acct.)
* Premiums Comparison
All Plans Side by Side
Note: All premiums INCLUDE $266/month that is paid by FISD and reflect YOUR monthly cost:
Coverage
Employee Only
Emp. & Spouse
Emp. & Child
Emp. & Family
HMO
$ 0
$399
$234
$456
PPO1
$313
$1112
$655
$1170
PPO2
$ 42
$504
$313
$570
HSA
$ 21
$417
$191
$446
**Increases in premiums reflects a portion of the 4.3% tax as required by the
Affordable Care Act**
HMO Plan (free plan for employees)
Deductible - $4000 per member
Co-Insurance – 100% (plan pays after deductible)
$40 Dr. Visit Co-pay ($80 specialist)
RX - $10/generic - 50%/preferred after $250 deductible
 Tier 4 drugs 50% ($4000 addl. out of pocket maximum)
Out-of-Pocket Maximum = $4000 individual/ $8000
family
Hospital/Emergency/Maternity – 100% after $4000
Deductible is met
PPO 1 Plan
 Deductible
$1500 per member ( $3000/family) - In Network
 Co-Insurance – 80% in network/
after deductible)
 $30 Dr. visit
60% out of network (plan pays
Co-pay ( $60 / specialist)
 RX - $10-$35-$60 after $100 deductible
 Tier 4 drugs @ 20% ($4000 addl. out of pocket)
 Out-of-Pocket Maximum = $4000 per member
($8000/family) – In Network
 Hospital/Maternity – 80%/60% (Emergency room/ 80% after
deductible)
• Maternity –Pediatrician, delivery, and nursery are covered at 80%
after the $1500 deductible
PPO 2 Plan
 Deductible $2500 per member
( $5000 /family) – In Network
 Co-Insurance – 70% in network / 50% out of network
deductible)
$35
(plan pays after
Dr. visit Copay ( $70 /specialist)
 RX - $10 generic / 30% preferred after $250 deductible
 Tier 4 drugs / 30% ($4000 max. out of pocket)
 Out-of-Pocket Maximum - $4,000 per member
( $8000 / family) - In Network
 Hospital/Maternity – 70%/50%
(Emergency room/ 70% after deductible)
Maternity – Pediatrician, delivery, and nursery charges are covered
at 70% after the $2500 deductible.
In Network / Out of Network
In-network - Any provider that accepts First Care.
Outside Lubbock area –
PHCS / Multiplan
*In Network / Out of
When seeking services with these networks, you will
need preauthorization. This information is on the back
of your insurance card.
Network
HSA Plan
Health Savings Account
 Deductible - $2,500 per member ($5000/family)
 No Copay…Discounted Dr. office visits and 80% after deductible
is met
 RX – 80% after deductible is met
 Out-of-Pocket Maximum - $5,200 per member ($10,400/family)
 Maternity - $5000 max. out of pocket for mom
(Routine Facility charges covered under mom/
Professional service provider applies to baby’s
deductible)
 All coverage starts after member has met deductible or max. out
of pocket. Money placed in HSA account is above and beyond
premium.
 HSA account must be set up prior to incurring claims in order to
have tax advantage.
Individual and/or family deductible must be met
before you are eligible for any insurance benefits.
You have the option to open a Health Savings
account. This money must be used on medical
expenses and is your money as long as the account
is open.
HSA account must be opened prior to accessing any
funds.
*HSA
Maximum - $3300.00/Individual
$6550.00/Family
Options to cover Family or
Children…
Health Insurance Market Place /
Affordable Care Act
healthcare.gov / 1-800-318-2596
Individual policy with independent
company
CHIPS – 1-877-KID-SNOW
CHIPSMEDICAID.org
*Affordable Care Act (ACA)
*Public Marketplace
*Guaranteed issue / No Pre-existing limitations
*Sold through healthcare.gov, Ashmore & Associates,
Aycock and Fowler, independent agents and other
entities
*Policies and rates are identical on both public and
private marketplaces.
*Only licensed agents can assist consumers with actual
purchase decisions.
*Navigators are licensed to assist with the completion
of the application.
*Subsidies and Tax credits are
available through the public
marketplace – ONLY if your employer
does NOT offer you a compliant plan
as an option.
*FISD plans comply with all the
minimum benefit and affordability
standards.
If at all possible, go to a provider that takes First Care so
that claims are paid in network.
Prescriptions – Always ask for generic, check at least three
pharmacies for best price, check United to see if the meds
are FREE, Google prescription for coupons and discounts, and
ask Doctor for samples.
Lab work and x-rays done in conjunction with the office
visit are included in your office visit copay.
Other class of diagnostic tests are subject to your
deductible. (Ex. MRI)
Ways to manage your
insurance…
Telehealth & Wellness solution plan - $9.00 per month covers
the entire family
Compliments the medical plans and saves on medical claims
3 easy steps to speak to a physician anytime anywhere online
or by phone
Prescriptions are called in to the pharmacy of your choice –
(Must accept First Care)
Online tool provided to shop for the best price on
prescriptions in your area
You must complete medical history on line
Covers most common conditions including but not limited to:
allergies, bronchitis, earache, sore throat, sinusitis, pink eye,
strep throat, upper respiratory infection, urinary tract
infection….
*Healthiest You
All Insurance plans cover
Preventative Care at 100%!!
This could include: annual routine physicals, routine immunizations, well
baby and well child care, routine eye/speech/hearing screenings for
children when performed in the office, examination and testing for the
detection of prostate cancer…
*
First Care list of Preventative Care is posted on the HR website
Preventative
Care
Additional Contributions
FISD provides $20,000 of Life
Insurance on all employees
The group life coverage was offered on a guarantee
issue basis to all employees during the first year.
If you want to increase your group live coverage, you
now have to apply for the additional coverage.
You will have the opportunity to talk to an FBS
representative during enrollment about supplemental
benefits.
FISD Cafeteria Plan (Section 125)
“Why should I participate?”
Section 125 is the tax code which allows participating
employees to place certain financial expenses into an
account PRIOR to taxes being withheld.
The only entity to benefit from your participation
is YOU.
The district does not profit from #125
No insurance agent or company benefits
Individual enrollments @ your campus
FISD Cafeteria Plan
OPTIONS
Child Care Reimbursement Plan
Medical Reimbursement Plan
Cancer/Intensive Care Insurance
Vision
Accident Insurance
Dental Reimbursement Plan – Must file paper
copy
Medical Insurance
Medical Reimbursement Account
NBS Flex card
Money can be taken from your check before taxes each month and
placed in a medical reimbursement account.
You will use an NBS Flex Visa credit card preloaded with the amount of
money that you will put in for the year. (Ex. $50 x 12 = $600) This money
can only be used for medical expenses. Additional cards are $5.00 each.
The NBS Flex card cannot be used for dental expenses.
submit a claim form with receipt for reimbursement.
You must
Maximum - $2500 per year (you must use it or lose it at the end of each
year)
FISD – 2 ½ month grace period to spend funds in flexible account.
90 day run out period – can file claims up to 90 days after plan year
ends.
“UNDERSTANDING”
Your Insurance plan
You can learn more about the advantages of the PPO1,
PPO2, HMO and High Deductible/HSA by:
* Contacting The Ashmore Agency or Aycock & Fowler Insurance
Agency for a consultation.
* Visiting with an Insurance representative on the day of
enrollment from 8:30 – 10:00 to discuss your insurance
options.
Consultations Available
NOTE: If you are going to meet your deductible for any
reason please call:
Ashmore and Associates Aycock & Fowler -
806-745-8358
806-798-2700
You will get one-on-one assistance to help you know what is
ahead of you (i.e. – know what your plan is paying and what
you should pay.
Frenship ISD Brokers
Beth Ashmore
745-8358
Ashmore & Associates
Brent Aycock
798-2700
Aycock& Fowler Insurance Agency