Transcript Benefit Overview Meeting Agenda Introduction Benefit Review • • • • • • Blue Cross Blue Shield of Kansas City (medical and dental) VSP Prudential Flexible Spending Accounts EAP Allstate Voluntary Products Enrollment Schedule.

2015
Benefit Overview
Meeting Agenda
Introduction
Benefit Review
•
•
•
•
•
•
Blue Cross Blue Shield of Kansas City (medical and dental)
VSP
Prudential
Flexible Spending Accounts
EAP
Allstate Voluntary Products
Enrollment Schedule
What’s changing in 2015?
Medical:
1. Rate increase due to claims, HCR fees and taxes
2. Changes in plan designs
Dental:
1. New carrier is Blue Cross Blue Shield of Kansas City
Allstate Voluntary Group Products
Medical Plans
(BCBS KC)
Page 8 of Benefit Guide


Original increase- 23.18%
Negotiated with plan changes- 12.5%
HMO (Health Maintenance Organization)
• In-Network Only
PPO (Preferred Provider Organization)
• In and Out-of-Network; National and International Coverage
• Base and Buy-Up Options
High Deductible Health Plan (Preferred Provider Organization)
• Similar features to the Traditional PPO Plans
• Same network of physicians, hospitals and pharmacies
• Eligible for Employee-Owned HSA (Health Savings Account)
Can find website address in Benefit Guide on page 4.
BCBS 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 In-network providers
Also included ~
Generic Contraceptive drugs at 100%
• Contraceptive implants, injectables &
devices at 100%
• Breastfeeding support, supplies
(pumps) and counseling at 100%
Can find more detailed listing in Benefit Guide on
page 18.
In 2015, out-of-pocket maximums will
include all medical and prescription drug
copays, deductibles, and coinsurance.
This is in accordance with the HCR
regulations.
HMO Plan
Office Visit:
Urgent Care:
Emergency Room:
Deductible:
PCP: $30 copay (IM, GP, FP, Ped)
Specialist: $60 copay (ENT, Allergist, OB/Gyn)
$60 copay
$200 copay
N/A
Out-of-Pocket Maximum:
Individual
$6,350
Out-of-Pocket Maximum:
Family
$12,700
Routine Vision
$10 copay
Hospital: Inpatient or Outpatient
$500 copay per day / per occurrence up to $2,500 per calendar year
(applies to inpatient services at a hospital and outpatient surgeries
at a hospital or an outpatient facility)
Inpatient Mental Illness/Substance
Abuse
$500 copay per day / per occurrence up to $2,500 per calendar year
(Prior authorization required from New Directions)
MRI, MRA, CT and PET scans
$200 copay
Only one copay will apply for each provider on a specified date of
service even if multiple scans are performed
$250 copay per day up to $2,500 per calendar year (14 day lifetime
maximum)
Inpatient Hospice
Prescription Drug Coverage
HMO Plan
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
$4 and $10 Generics can be utilized without going through your health
plan.
Base PPO Plan
Office Visit
In-Network
Out-of-Network
Deductible then 20%
Deductible then 50%
Deductible: Individual
$2,000
Deductible: Family
$4,000
Coinsurance (your share):
20%
50%
Out-of-Pocket Maximum:
Individual
$5,400
$15,200
Out-of-Pocket Maximum:
Family
$10,800
$30,400
Routine Vision
Deductible then 20%
Deductible then 50%
Hospital: Inpatient or
Outpatient
Deductible then 20%
Deductible then 50%
Emergency Room
Urgent Care
$150 copay then deductible then 20%
Deductible then 20%
Deductible then 50%
Buy-Up PPO Plan
Office Visit
Specialist
In-Network
Out-of-Network
$30 copay
$60 copay
Deductible then 40%
Deductible: Individual
$1,500
Deductible: Family
$3,000
Coinsurance (your share):
15%
40%
Out-of-Pocket Maximum: Individual
$4,200
$12,600
Out-of-Pocket Maximum: Family
$8,400
$25,200
$30 copay
Deductible then 40%
Deductible then 15%
Deductible then 40%
Outpatient Mental Illness/Substance
Abuse
$30 copay
Deductible then 40%
Emergency Room
$150 copay then deductible then 100%
Urgent Care
$60 copay
Deductible then 40%
Chiropractic
$60 copay
Deductible then 40%
Routine Vision
Hospital: Inpatient or Outpatient
Prescription Drug Coverage
Base and Buy-Up PPO Plans
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
PPO Network
Worldwide Network of PPO Healthcare Providers
National Network
Access through
BlueCard®
•
•
•
1,177,194 Physicians
6,776 Hospitals
Access in ALL 50
States
• Includes MD Anderson
& Mayo Clinic
Welcomed in over 200
countries Worldwide
High Deductible Health Plan (PPO)
Medical Plan
Lower monthly premiums
No copayments at doctor’s
office you pay entire cost until
deductible is met
No copayments at pharmacy;
you pay the entire cost until
deductible is met, then you are
responsible for copays.
HDHP Claim Flow Example

Full cost of a doctor visit is $140

BCBSKC has negotiated a fee of $65
using Preferred Care Blue Doctors

You pay nothing at the visit

Your doctor sends a bill for $140 to your
home, but you don’t pay it

You receive the Explanation of Benefits
(EOB) from BCBSKC indicating that you
owe $65

You pay your doctor $65
Qualified High Deductible Health Plan PPO
In-Network
Out-of-Network
Calendar Year Deductible: Individual
$2,600
Embedded Calendar Year Deductible:
Family
$5,200
20%
40%
Out of Pocket Maximum: Individual
$3,500
$7,000
Out of Pocket Maximum: Family
$7,000
$14,000
Deductible then 20%
Deductible then 40%
Deductible then 20%
Deductible then 40%
Coinsurance (your share):
Office Visit
Hospital: Inpatient or Outpatient
Emergency Room
Urgent Care
Retail Prescriptions
(34 day supply)
Mail-Order Prescriptions
(102 day supply)
Deductible then 20%
Deductible then 20%
Deductible then 40%
Deductible then
$10 / $50 /$70
Deductible then 40%
Deductible then
$20 / $100 /$140
N/A
Per IRS guidelines for an embedded deductible, must be $2,600 for individual.
High Deductible Health Plan (PPO)
Health Savings Account
(HSA)
Owned by you
Used for eligible expenses
Helps pay for deductible and Rx
(dental and vision as well)
Tax savings
No “use it or lose it” rule
Administered by UMB ($2.50 per
month, waived if daily average
account balance is $3,000 or more).
Eligibility to Open an HSA
(Health Savings Account)
You must be covered by the $2,600 High Deductible Health Plan (HDHP);
You cannot have any “other coverage” such as:
o A plan that is not an HSA-qualified HDHP
o Spouse’s plan that is not a HDHP
o Medicare or Medicaid
o Tricare Coverage (military health care)
o Health Flexible Spending Account (not to include Flexible Spending
Account for Dependent Day Care)
o Health Reimbursement Arrangement (HRA)
o Veterans Administration Health Benefits
You cannot be claimed as a dependent on someone else’s tax return.
Contributions to your HSA
o
Money may be contributed to your HSA by you, or anyone else, as
long as the total doesn’t exceed the IRS annual maximum:
$3,350 individual
$6,650 family
o
Catch up of an additional $1,000 if 55 years of age or older.
o
No expenses may be reimbursed for services incurred before the HSA is set
up, regardless of when the QHDP was effective.
o
Keep Employer Contribution in mind when calculating annual maximum
contribution
Qualified Expenses
Use the HSA funds to pay for IRS “qualified medical expenses”
permitted under Federal Tax law including:









Medical out-of-pocket expenses
Dental treatments
Hearing aids including batteries
Prescription drugs
Eye exams, eyeglasses, and contact lenses
Chiropractic Care and Acupuncture
Premiums for qualified long term care insurance and COBRA
Medicare premiums
Health plan coverage while receiving Federal or State unemployment
benefits
Pay for expenses for yourself and your spouse or tax
dependent children even if only enrolled in employee only on
HDHP.
• Medical Rates- Benefit Guide Page 8
• Other Options• Power Group Client Care Center 1-877-5049650
• www.healthcare.gov
• www.einsurance.com
• Compass
• Available to employees enrolled in PPO plans
(HSA included)
• Compass Pros assist with Billing, Provider
Search, Procedure Cost Comparison
• Compass phone number 1-877-912-0789
Dental Plan
(Blue Cross Blue Shield of Kansas City)
Page 30 of Benefit Guide
Broad Network Protection
BlueKC Dental PPO Network





BCBS of KC Contracted Providers
Discounted Fees In-Network
No Balance Billing
No Claim Forms
BCBS of KC Pays Dentist Directly
Non-Participating





Not Under Contract With BCBS of KC
No Discounted Fees
Balance Billing is Possible
Dentists May Not File Claims
BCBS of KC Pays Patient
BlueKC Dental PPO
←Greatest Patient Savings
Least Patient Savings→
BCBS KC Network
Dentist
Non-Participating
Dentist
100%
100%
90%
90%
60%
60%
Type D: Child Orthodontic Services
(to age 19)
50%
50%
Calendar Year Deductible
$50 single / $150 family
Co-Insurance (Plan Pays)
Type A: Diagnostic and Preventive Services
(exams, cleanings, x-rays, fluoride, sealants)
Fluoride to age 19 and sealants to age 14. See summaries
for additional terms.
Type B: Basic Restorative Services
(fillings, extractions, periodontics, endodontics)
Type C: Major Restorative Services
(crowns, dentures, bridges)
Applies to:
Calendar Year Benefit Maximum
Separate Lifetime Orthodontic Maximum
Dependent Age Limit
Type B & C Services only
$1,000 per person
$1,500 per child to age 19
End of the calendar year in which
dependents turn 26
Customer Service
Dental Member Services- 816-395-2180
This information can also be found on page 4
of the Benefit Guide.
Self-serve features:
Network dentists
Claims status and history
Copy of EOB
Benefit design
Track use of maximums
Print ID cards
Request an ID card
Vision
(VSP)
Page 32 of Benefit Guide
Finding a Doctor

It’s quick and easy to find
a VSP doctor near you.
◦ Visit vsp.com from your
computer or Smartphone.
◦ Call VSP Customer Service
at 800.877.7195.
◦ Can find this information on
page 33 of Benefit Guide.
VSP Exam Plus Plan – Low Plan
Your Coverage with a VSP Doctor
WellVision Exam®
$20.00 copay
Once every calendar year
Prescription Glasses Discounts
20% discount when a complete pair of glasses (lenses and
frame)
Contacts
15% discount off the contact lens exam (fitting and evaluation)
VSP Signature Plan – High Plan
Your Coverage with a VSP Doctor
WellVision Exam® focuses on your eye health and overall
wellness
 $20.00 copay
 Once every calendar year
Prescription Glasses
$20.00 copay
Lenses: Once every calendar year
• Single vision, lined bifocal, and lined trifocal
lenses (35%-40% average discount)
• Polycarbonate lenses for dependent children
• Copay varies from $50 to $160 depending on
standard progressive, premium progressive or
custom progressive lenses
Frame: Once every calendar year
• $130.00 allowance for a wide selection of
frames
• $150 allowance for featured frame brands*
• 20% off the amount over your allowance
Contact Lenses
• Once every calendar year
• $130.00 allowance for contacts
and the contact lens exam (fitting
and evaluation)
*featured frame brands complete list
available online at
www.vsp.com/glasses include brands
such as Calvin Klein, Michael Kors,
Sean John and Nike
Example: High Plan
Exam/Eyewear
Without VSP
With VSP
Eye Exam
$152
$20 Copay
Frame
$150
$20 Copay
Single Vision Lenses
$84
Anti-reflective Coating
$108
Transitions®
Lenses
$61
$101
$62
Self-only Annual
Contribution
N/A
$0
Total
$595
$163
Average
Annual
Savings
$432
With A VSP
Doctor
Life/AD&D
(Prudential)
Benefit Guide page 36
Help protect your loved ones from the
unexpected…
Immediate Expenses
Ongoing Expenses
Future Goals
 Funeral costs
Uncovered medical bills
 Mortgage or rent
 College
 Food and utilities
 Wedding
 Estate settlement costs
 Car loans / transportation
 Retirement
 Health care / insurance
 Credit cards
How much does your family need
to maintain their lifestyle?
Log on to: www.prudential.com/EZLifeNeeds
Basic Employer Paid Life/AD&D
Coverage  1 times your annual salary, up to a maximum of
Amount
$200,000
Reductions
 At age 65, your benefit reduced to 65%. At age 70, it
will reduce to 50%
Optional Employee Life
Coverage  Increments of $10,000 from $10,000 to $500,000
Amount  Not to exceed 7 times your annual earnings
Guaranteed
 Up to $150,000 with no medical questions asked
Amount
Reductions
 Coverage will be reduced as you age
 35% at age 65, and 50% at age 70
During annual enrollments, if you have not been previously denied
coverage, you may select to increase you current coverage by up to
$40,000, without providing an EOI. Subject to the plan maximum - lesser of
7 x earnings or 500K.
Waiver of  Premium waived when disability begins before 60,
Premium
continues for 9+ months, proof provided annually.
Conversion  Convert coverage to individual insurance if job ends—no
of Coverage
health questions to answer.
 Your Optional Term Life Coverage includes a portability
Portability
provision, which allows employees to continue their
of Coverage
insurance coverage upon termination. Employees and
spouses can elect portability if under the age of 80
Accelerated
 90% - If terminally ill, you maybe use partial payment as
Benefit
you wish, reduces beneficiary’s amount.
Option
Optional Dependent Term Life
 Coverage is available for your spouse in increments of $5,000 to
$250,000, not to exceed 50% of employee Optional Term Life
Spouse
coverage
Coverage
 The guaranteed issue amount for spousal coverage is
$20,000
 Coverage is available for all employee’s children in increments of
$2,000 to $10,000. The death benefit for children from 14 days to
Children
the end the calendar year in which they turn age 26.
Coverage
Get coverage for all eligible children for one premium amount, no
matter how many children you have—no health questions asked.
Flexible Spending
Accounts (FSA)
(AmeriFlex)
Page 43 of Benefit Guide
Plan Overview For Plan Year
1/1/2015 – 12/31/2015
• Unreimbursed Medical - $2,500
• Dependent Care - $5,000 per calendar year
(if married filing jointly or single/head-of-household; $2,500 if married,
filing separate)
• You receive the benefit of a reduction in your tax liability
Grace Periods:
• To incur expenses – 75 days (March 15, 2016)
• To file claims – 90 days (March 31, 2016)
FSA Debit Card
• Does not expire for THREE years!
• If enrolled last year- On second year!
• Works at doctor, dentist, vision offices, and daycare
• Keep all receipts as you may be asked to
substantiate some claims
•
What if I lose my AmeriFlex Convenience Card?
If your card is lost or stolen, you can request an
additional card online, or contact AmeriFlex
Member Services by visiting member.flex125.com
or calling 888.868.3539.
Customer Service
• Toll-Free
888.868.FLEX (6539)
• Member Service Support Center
www.member.flex125.com
This information can be found on page 4 of the Benefit
Guide.
New Directions
Employee Assistance Program
Bring balance to your life.
What does an Employee Assistance Program Do?
We help find answers to problems you may face
in your personal life and at work.
• 6 visits per incident
• Face to Face Counseling
• Telephonic Counseling
• Financial Information
• Legal Referrals
• Newsletters
• Web-site
• 24 hour telephonic intervention
How do I Access the Program?
Call: (913) 982-8398 or (800) 624-5544.
OR
Allstate Voluntary
Products
o Not offering for 2015
o Current Subscribers eligible for Direct Bill
o Premiums will not change
o Will receive letter from Allstate instructing
how to continue coverage
How to Enroll
Enrollment Options
• Call Center
• Leave one voicemail
• Call will be returned within 24 hours
• Information also on Page 5 of the Benefit Guide
• Online (self service)
• https://www.benefitsconnect.net/mwsu
• See handout or HR website for user name
• Passwords have been reset to your social security
number
PowerEnroll
1 (877) 504-9650
Call-In Schedule
(8:00am to 5:00pm CST)
First letter of
last name
A-C
Monday, October 27th
D-H
Tuesday,October 28th
I-M
Wednesday, October 29th
N-S
Thursday, October 30th
T-Z
Friday, October 31st
Questions?