Transcript Employee Benefits - Galena Park Independent School District

Galena Park ISD
Employee Benefits
2015 - 2016
Presented By: Colleen Martin
Director of Employee Benefits
Open Enrollment
• Open Enrollment Dates
July 20 –August 28
• Effective Date of Changes
September 1, 2015
• First Paycheck Affected
September 15, 2015
Urgent Information
• Open enrollment is mandatory this year even if you are going
to decline coverage.
• To enroll you must have all of your dependents social security
numbers and dates of birth even if you are not adding your
dependents onto the plan.
• You also must list all dependents, even if you are not covering
them on a plan.
• Only those employees that add or change their Aetna plan
will receive a new Aetna card.
• Flexible Spending Account cards are good for 3 years so do
not throw away your card if it has not been 3 years
Health Insurance
TRS ActiveCare / Aetna
ActiveCare 1 HD
2015-2016
Coverage
Tier
Monthly
Premium
District
Contributi
on per Pay
Period
Employee
Cost
Employee
Cost per
Pay
Period
20142015
Year
Employee
Only
$341.00
$275.00
$66.00
$33.00
$37.50
Employee $615.00
Child(ren)
$292.00
$323.00
$161.50
$153.50
Employee
Spouse
$914.00
$330.00
$584.00
$292.00
$275.00
Employee
Family
$1,231.00 $330.00
$901.00
$450.50
$422.50
the entire amount of the $5,000 family deductible must be met first before insurance
will pay any benefits. This deductible can be met by one family member or a
combination of family members.
5
ActiveCare 2
2015-2016
Coverage
Tier
Monthly
Premium
District
Employee
Contributi Cost
on per Pay
Period
Employee 2014Cost per 2015
Pay
Year
Period
Employee $614.00
Only
$275.00
$339.00
$169.50
$152.50
Employee $992.00
Child(ren)
$292.00
$700.00
$350.00
$305.00
Employee $1,478.00 $330.00
Spouse
$1,148.00
$574.00
$493.50
Employee $1,521.00 $330.00
Family
$1,191.00
$595.50
$511.50
The deductible applies to each covered person individually, up to the maximum per family.
6
ActiveCare Select
2015-2016
Coverage
Tier
Monthly District
Employee
Premium Contribution Cost
per Pay
Period
Employee 2014Cost per
2015
Pay
Year
Period
Employee
Only
$473.00
$275.00
$198.00
$99.00
$100.00
Employee $762.00
Child(ren)
$292.00
$470.00
$235.00
$222.00
Employee
Spouse
$1,122.0 $330.00
0
$792.00
$396.00
$372.00
Employee
Family
$1,331.0 $330.00
0
$1,001.00
$500.50
$469.00
The deductible applies to each covered person individually, up to the maximum per family.
ActiveCare Select
Important Information about this Plan!
• Similar to an HMO.
• You may only see an In-Network provider or your
benefits will not be paid.
Absolutely NO benefits if you go out of network
• The Network Servicing Harris, Fort Bend and
Montgomery counties is:
Hermann Accountable Care Network
Please make sure you look to see if your doctor is in
the network before you choose this plan!
Pool and Split Premiums
•
Married couples both working for Galena Park ISD may “Pool” the
District contributions for their insurance coverage
OR
•
Married couples working for different employers that both
participate in TRS ActiveCare may “Split” the cost of the premiums
between each employer.
•
This requires an “Application to Split Premium” form
•
The form must be completed by both employees and both
employers
**If you are eligible for “Pool” or “Split” premiums, please see our
Benefit Specialists to help you enroll.
Plan Overview (Network Level of Benefits)
ActiveCare
Select
ActiveCare 2
$1,200 individual
$3,600 family*
$1,000 individual
$3,000 family*
80% / 20%
80% / 20%
$6,450 employee only
$12,900 family*
$6,600 individual
$13,200 family*
$6,600 per individual
$13,200 family*
20% after deductible
$30 for primary
$60 for specialist
$30 for primary
$50 for specialist
ActiveCare 1-HD
Deductible
$2,500 employee only
$5,000 family*
Coinsurance
(Plan pays/
participant pays)
Out-of-Pocket
Maximum
(does include medical
deductible/any medical
copays/coinsurance)
Office Visit Copay
80% / 20%
Quest Diagnostics
(Network Level of Benefits)
Benefits (continued)
Services
Diagnostic Lab
ActiveCare 1-HD
20% after
deductible
ActiveCare Select
ActiveCare 2
Plan pays 100%
(deductible waived)
if performed at a
Quest facility;
Plan pays 100%
(deductible waived)
if performed at a
Quest facility;
20% after
deductible at other
facility
20% after
deductible at other
facility
Preventive Benefits
(Network Level of Benefits)
Preventive Care Clarification
Services
Preventive Care
ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Plan pays 100%
(deductible waived)
Plan pays 100%
(no copay required)
Plan pays 100%
(no copay required)
Prescription Benefits
Caremark
Prescription Drug Benefits
Features
Drug Deductible
(per person, per plan year)
ActiveCare 1-HD
ActiveCare Select
ActiveCare 2
Subject to
plan year deductible
$0 generic;
$200 per individual for brand
name drugs
$0 generic;
$200 per individual for brand
name drugs
$20
$40**
50% coinsurance
$20
$40**
$65**
$25
$50**
50% coinsurance
$25
$50**
$80**
Retail Short-Term
(up to 31-day supply)
Generic
Preferred Brand
Non-Preferred Brand
Retail Maintenance
(after first fill, up to
31-day supply)
Generic
Preferred Brand
Non-Preferred Brand
Mail Order and
Retail-Plus
(up to 90-day supply)
Generic
Preferred Brand
Non-Preferred Brand
Specialty Medications
20% coinsurance
after deductible
$45
$105**
50% coinsurance
20% coinsurance per fill
$45
$105**
$180**
$200 per fill (up to 31-day supply)
$450 per fill (32-day to 90-day
supply)
14
Teladoc
What is Teladoc?
• Founded in ‘2002
• Board certified doctors/pediatricians available for
medical issues via telephone or video consult
• Available 24/7/365 from where ever you are
• For non-emergency medical issues such as
•
•
•
•
•
•
•
•
•
•
Cold & flu symptoms
Bronchitis
Allergies
Poison ivy
Pink eye
Urinary tract infection
Respiratory infection
Sinus problems
Ear infection
& more!
Contact Teladoc…
• Step 1: Contact Teladoc – online or by phone
o Request a phone or online video consult with doctor (avg. call back time is
16 minutes or you can schedule a time for the doctor to call you back)
• Step 2: Talk with a doctor
• Step 3: Resolve your issue
o The doctor will recommend treatment and write a prescription (if necessary)
There is no cost to the employee for using Teladoc.
Set up your account today!
• Go ahead and set up your account with Teladoc so
that it is ready for you to use when you need it!
• Visit www.Teladoc.com or download the Teladoc
app!
Dental Insurance
Humana Dental
www.humanadental.com
Humana Dental
DHMO
PPO High
Preventive (Cleanings, Exams, X-Rays,
etc.)
$15 Office Fee
Plan Pays 100%
Basic (Fillings, Extractions, etc.)
Fixed Co-Pays
Plan Pays 80%
Deductible Applies
Major (Crowns, Bridges, Dentures, etc.)
Fixed Co-Pays
Plan Pays 50%
Deductible Applies
Orthodontics (Children under 19)
Fixed Co-Pays
Plans Pays 50%
up to $1,000
None: You must choose an
in network provider
Yes, but
it could result in higher costs for all
services
Deductible Per Calendar Year
None
$50 Per Person
$150 Family
Annual Maximum Benefit
(Maximum amount the insurance will pay
per person per calendar year)
None
$1,000
Rates per Pay Period
Rates per Pay Period
Employee Only
$0.83
$14.21
Employee + Spouse
$4.65
$31.73
Employee + Child(ren)
$5.60
$30.54
Employee + Family
$9.81
$44.98
Out of Network
Vision Plan
Davis Vision
www.Davisvision.com
Davis Vision
Participating Provider
Examination (Once Every Plan Year)
$10 co-pay
Spectacle Lenses-every Sept. 1, Standard single vision, lined bifocal,
or trifocal lenses. Includes plastic lenses, oversized lenses, tinting of
plastic, scratch coating.
$25 copayment
Frames-every Sept 1, covered in full any fashion or designer frame
from Davis Vision’s Collection(up to $160) OR $130 retail allowance to
ward any frame from provider OR $180 allowance, +20% off balance
to go toward any frame from Visionworks
See Allowance
Contact Lens Eval, Fitting & Follow-up - every Sept 1, collection
contacts covered in full after co pay. Non collection contacts $60
allowance
$60 Allowance
Contact Lenses (in lieu of eyeglasses) - every Sept 1, covered in full
contact lenses from Davis Vision’s Contact Lens Collection OR $130
allowance toward provider supplied contact lenses
$130 Allowance
Tier Level
Rates Per Pay Period
Employee Only
$2.40
Employee + Spouse
$4.31
Employee + Child(ren)
$4.55
Family
$7.19
Disability Insurance
Disability Insurance
•
Disability Income - Replaces a portion of your income when you are sick or
injured and cannot work.
•
Benefit Waiting Periods available: 7, 14, 30, 60, 90, and 150 days – the
period of time that you must be continuously disabled before benefits
become payable. Benefits are not payable during the benefit waiting
period!
•
Eligible to select a benefit amount up to 70% of annual wage.
•
During the 1st 60 days, you will receive 100% of the benefit amount you
purchased. After 60 days, AFA will take into account all income sources
and adjust your benefit amount so that your income is no greater thank
70% or your wage with Disability.
•
The plan pays a minimum benefit of $100 or 10% of your benefit whichever
is greater.
•
Pre-existing condition exclusion – any condition you had 12 months prior to
the effective date of your insurance will be considered pre-existing.
Benefit amount up to
70% annual wage.
Life Insurance
Basic Life Insurance
• Galena Park ISD provides each employee:
o $25,000 Life Insurance
o 100% Employer Paid
o Through Dearborn National Life
o Make certain to complete a beneficiary form
Dearborn National Supplemental Life

Who is eligible - All active, full-time employees working at least 20
hours per week.
•
Allowable Employee Benefit - $10,000 - $300,000 in increments of
$10,000, not to exceed 3 times basic annual salary. Guarantee issue
of $200,000. (Cost $2.16 per $10,000 coverage)
•
Spouse Benefit - $10,000 - $50,000, not to exceed 50% of the
employee’s benefit. Guarantee issue of $30,000. (Cost $2.96 per
$1,000 coverage).
•
Child Benefit - Birth to 6 months-$100. Cost $0.28 for $5,000 or $0.56 for
$10,000.
Supplemental Life is available for purchase while employed at GPISD,
and is not portable.
Portable Life Insurance
Texas Life
Texas Life
• Offers permanent life insurance through age 121.
• Coverage is available for you, as well as other
family members, (spouse, children and
grandchildren).
• Guaranteed base life insurance premiums NEVER
INCREASE
• Accelerated Death Benefit Rider for Terminal Illness
AllState Cancer Plan
The Allstate Cancer Plan
covers cancer and 29 other dreaded diseases.
o
o
o
o
o
o
o
o
o
o
Poliomyelitis
MS
Encephalitis
Rabies
Tetanus
TB
Osteomylitis
Diphtheria
Scarlet Fever
Cerebrospinal
Meningitis
o
o
o
o
o
o
o
o
o
o
Brucellosis
Lou Gehrig’s
Sickle Cell Anemia
Thalassemia
Rocky Mountain
Spotted Tick Fever
Legionnaires’
Addison’s Disease
Hansen’s Disease
Tularemia
Hepatitis-Chronic B
or C, or Hepatoma
o
o
o
o
o
o
o
o
Typhoid Fever
Myasthenia Gravis
Reye’s Syndrome
Walter Payton’s
Liver Disease
Lyme Disease
Systemic Lupus
Erythematosus
Cystic Fibrosis
Primary Biliary
Cirrhosis
Allstate Cancer Plan
Allstate coverage can help provide added financial
support when it is needed most.
Allstate Cancer coverage can help offer you and your family financial
support.
• Benefits paid directly to you unless otherwise assigned
• Coverage for you or your entire family
• No evidence of insurability required at initial enrollment
• Waiver of premium after 90 days of disability due to cancer
for as long as your disability lasts for the primary insured.
• Portable
Cancer Plan Options
Tier
Low Plan Rate per
Pay Period
High Plan Rate per
Pay Period
Employee Only
$10.17
$16.34
Employee & Spouse
$16.33
$25.44
Employee &
Child(ren)
$14.25
$23.11
Employee & Family
$20.40
$32.21
Health Savings Accounts (HSA)
American Fidelity
Benefits of an HSA
The HSA at GPISD is funded by the employee
It is a tax-free contribution
Earns interest once deposited
Rolls-Over year to year ( you do not use it or lose it)
Follows you wherever you go
You can change how you contribute at any time
The money is accessible as soon as it is deposited
Contributions are tax deductible
Your account can be passed onto your spouse
upon your death
•
Who is Eligible for HSA
•
You must be covered by a qualified high deductible health plan (HDHP) –
ActiveCare 1HD;
•
You cannot be enrolled in Medicare;
•
You cannot be covered by other health insurance;
•
You cannot be claimed as a dependent on someone else's tax return; and
•
You cannot be enrolled in a Flexible Spending Account (FSA).
Yearly Maximum Contributions
2015
Age under 55
Age 55+
Individual
$3,350
$4,350
Family Coverage
$6,550
$7,550
You May Fund Your HSA through
•
•
•
Payroll deductions
Online transfers
Personal check
Example: Financial Comparison ActiveCare 1HD verses ActiveCare 2
Year 1
ActiveCare 1HD
Employee Only Premium
Difference Between
Plans
ActiveCare 2
792.00
4,068.00
Health Savings Account (Rolls Over if Unused)
3,276.00
-
Total Premiums/Savings
4,068.00
4,068.00
450.00
90.00
-
Assume you visit the doctor 4 times
Copays/Office Visits (assume 3 office Visits @ $150 per visit)
Annual Check Up (Wellness visit)
-
-
Prescriptions (estimate 3 prescriptions @ $75 each)
225.00
75.00
Total Expense for Doctors and Prescriptions
675.00
165.00
Less Amount Paid for from Health Savings
Total Out of Pocket for Doctors/Prescription
(675.00)
-
Total Out of Pocket for the Year
4,068.00
Amount of Savings that rolls over to next year
2,601.00
165.00
4,233.00
-
165.00
Example: Financial Comparison of ActiveCare 1HD verses ActiveCare 2
Year 2
ActiveCare 1HD
Employee Only Premium
ActiveCare 2
792.00
4,068.00
Health Savings Account (Rolls Over if Unused)
3,276.00
-
Total Premiums/Savings
4,068.00
4,068.00
Plus amount rolled over from Year 1
2,601.00
Total amount available in Health Savings for year 2
5,877.00
Difference Between Plans
-
Assume you visit the doctor 4 times
Copays/Office Visits (assume 3 office Visits @ $150 per visit)
450.00
Annual Check up (wellness visit)
90.00
-
-
Prescriptions (estimate 3 prescriptions @ $75 each)
225.00
75.00
Total Expense for Doctors and Prescriptions
675.00
165.00
Less Amount Paid for from Health Savings
(675.00)
Total Out of Pocket for Doctors/Prescription
-
-
165.00
Total Out of Pocket for the Year
4,068.00
4,233.00
Amount Remaining in Health Savings (after doctors visits)
5,202.00
-
Catastrophic Event
Assume you get really sick or injured and max out the total out of pocket expense for the year (after this point,
TRS pays 100% of additional expenses for that plan year)
Less Amount Paid from Health Savings Account
Total Out of Pocket Expense for Worst Case Scenario
Total Out of Pocket Expense for Year 2
Total Amount to Rollover in Health Savings Account for Year 3
$6,450 Annual Out of Pocket Max
165.00
$6,600 Annual Out of Pocket Max
5,775.00
6,435.00
(5,202.00)
-
573.00
6,435.00
5,862.00
4,641.00
10,668.00
6,027.00
-
-
Flexible Spending Plan
First Financial
Medical Reimbursement
•
Employee can pay for out-of-pocket medical expenses with before tax
dollars
o Use the debit card that is provided or
o File claims for reimbursement
•
Deductibles, co-insurance, co-pays, vision care, dental care etc.
•
This is a “Use it or Lose it” plan!!
•
Plan year is September 1st through August 31st.
•
You must enroll every year
•
Funds are available in full on the first day of the plan year
•
The maximum allowed for 2015-2016 is $2,550.00
Dependent Care
Reimbursement Plan
Dependent Care Reimbursement Plan
•
The plan allows you to set aside money on a pre-tax basis that can be used to
cover certain costs associated with providing care for children age 13 and
under, handicapped dependents, and elderly parents needing day care while
you and your spouse work away from the home.
•
Dependent care centers must be qualified according to the Internal Revenue
Code
•
Funds are available only as deposits are made and not before
•
The maximum allowable contribution is $5,000 per year.
•
This is a “Use it or lose it” plan
•
File claims for reimbursement
•
If you choose Dependent Care Reimbursement, you may not claim the Federal
Dependent Care Tax Credit
LegalEASE (prepaid legal)
LegalEASE offers prepaid legal services through Legal Guard and
provides in network attorney’s to assist you with such matters as
 Consumer issues - small claims, bank fee disputes etc.
 Criminal matters - traffic tickets, civil litigation etc.
 Financial matters - debt collection defense, bankruptcy, tax
audits, credit coaching
 Identity Theft
 Elder and Family Law
 Estate Planning and Wills
 Legal Consultations
LegalEase Rate: $7.89 PER PAY PERIOD.
Life Works…Resources for Work and Life
GPISD is providing to all employees, Life Works which
offers:

Telephonic Life Coaching-3 phone sessions with
a masters’ level certified life coach

24/7 Resources-online and mobile apps, access
to legal, financial, and work life libraries as
resources.

Work-Life Program-telephonic support
For more information call 1-800-456-0018
Retirement Planning
403(b) or 457
What is a 403b or 457b?
403(b) Plan
 Contributions are tax deferred, that means
you are taxed when you being
withdrawing money
 Amounts are taxable when distributed
 Employees can contribute to both a 403b
and 457b
 Maximum annual contribution for 2015 is
$18,000
 Additional $6,000 is permitted for those
50 and over as a savings “catch-up”
 May access funds if you separate from
employment, you are age 59 ½, retire, are
disabled, have a QDRO, the plan
terminates, or upon your death.
 There is a 10% early withdrawal penalty
before age 59 ½ unless financial hardship
457(b) Plan
 Contributions are tax deferred, that
means you are taxed when you being
withdrawing money
 Employees can contribute to both a
403b and 457b
 Maximum annual contribution for 2015
is $18,000
 Additional $6,000 is permitted, for
those age 50 and over as a savings
“catch-up”
 May access funds if you separate from
employment, at the age of 59 ½, retire, are
disabled, have a QDRO, the plan
terminates or upon death
 No early penalty withdrawal on
distributions regardless of age only if
there has been separation of service
Roth 403(b) and Roth 457(b) are also offered.
Maximum Contributions
403(b) Plan
•
•
•
$18,000
Participants who reach age 50 by calendar yearend can make an additional $6,000 (2015)
contribution if allowed by the plan
2016 Maximums–No decision has been made by
the IRS
457(b) Plan
•
•
•
$18,000
Participants who reach age 50 by calendar yearend can make an additional $6,000 (2015)
contribution if allowed by the plan
2016 Maximums–No decision has been made
by the IRS
Online Enrollment Instructions
• To use the “Self-Service Enrollment” system, please
visit https://ffga.benselect.com/enroll
• The Default Login – Your User Name is your social security
number (123456789) or employer ID number
• The Default Password – Your Password is the last four digits of
your social security number.
Once you have logged in please
Verify your personal information is correct
Verify your beneficiary information is correct
including social security numbers
Follow instructions to complete enrollment.
Disclaimer
It is your responsibility to:
•
Ensure you have enrolled timely
•
Review your paycheck stub in September to
make sure the benefits and amount for each
benefit is being deducted.
Please contact the Benefits Office promptly in the event of an
error or discrepancy with these deductions.
Where to go for more
Information
To find more information about benefits and benefit
rates offered by Galena Park ISD please visit:
www.galenaparkisd.com/benefits/
For detailed information about TRS ActiveCare go to:
www.trsactivecareaetna.com
Contacts in the Benefit
Office
• Gina Martinez
o Benefits Specialist
o [email protected]
o Ext. 1276
• Stephanie Soto
 Benefits Specialist
 [email protected]
o Ext. 1245
• Colleen Martin
o Director of Employee Benefits
o [email protected]
o Ext. 1507