Transcript hr.owu.edu

Health Care Plan Open
Enrollment 2015-16
Agenda
• ACA Update
• Benefits update
• Health Care plan review
• Tips to save health care dollars
• FSA – Open Enrollment
• Dental – Open Enrollment
• Vision – Open Enrollment
Employee Benefit Plan
Updates 2015-16
• OWU will be renewing with Anthem
• All deductibles, copayments and
coinsurance apply toward the out-of-pocket
maximum including prescription
copayments
• Annual out-of-pocket maximums will be
increasing to offset ACA increase
Employee Benefit Plan
Updates 2015-16
• OWU will continue to offer The OWU Wellness Program
to all employees.
• Opportunity to reduce your health care premiums or earn
cash incentive for non-medical plan participants!
Taxes and Fees
• Employer Taxes Mandated by PPACA
1. Patient Centered Outcomes Research Fee
- Due July 31, 2015
- $2.00 per average covered member in 2014 ($1,662)
2. Transitional Reinsurance Fee
- Due January 15, 2016
- $3.67 per covered member per month in 2015
($18,254.58)
- $2.25 per covered member per month in 2016
($11,191.50)
$31,108.08 July 15-June 16 – OWU’s
approximate spend for PPACA
5
Individual Obligations
If person chooses not to have insurance they will owe
a tax:
* Greater of 1% of income or $95 - 2014
* Greater of 2% of income or $325 - 2015
* Greater of 2.5% of income or $695, indexed - 2016
and later
* Per adult; children 50%; family max of 3x
individual
2015-16 OWU Contribution Options
EE/Count
Current/
Month
Renewal/
Month
< $35,999
EE only
EE + SP
EE + Children
EE + Family
62
14
6
19
$12.21
$159.97
$159.97
$173.71
$39.00
$167.00
$151.00
$265.00
$36,000 - $59,999
EE only
EE + SP
EE + Children
EE + Family
71
15
5
36
$31.75
$267.90
$267.90
$291.32
$66.00
$222.00
$201.00
$344.00
$60,000 - $89,999
EE only
EE + SP
EE + Children
EE + Family
51
17
4
51
$50.07
$332.96
$332.96
$361.89
$92.00
$278.00
$251.00
$422.00
> $90,000
EE only
EE + SP
EE + Children
EE + Family
21
8
5
19
$67.17
$395.46
$395.46
$419.80
$118.00
$333.00
$301.00
$500.00
How Does OWU Compare?
EMLOYEE CONTRIBUTIONS
Ohio Wesleyan University
Survey Benchmarks
Number of Health Plans Reported
Employee Share of Premiums
Monthly Employee Premium Share
($)
Single
EE+1
EE+CH
EE+SP
Family
Family (Composite Non-Single)
Monthly Employee Premium Share
(%)
Single
EE+1
EE+CH
EE+SP
Family
Family (Composite Non-Single)
Client
National Regional
State
Industry EE Size
Group Category
750
1,546
4
<$35,999
7,689
2,338
627
$39
$130
$126
$130
$103
$123
$151
$167
$265
$386
$490
$731
$522
$346
$417
$604
$447
$287
$343
$504
$381
$358
$436
$686
$410
$322
$395
$574
$401
7.3%
27.7%
27.5%
30.8%
19.2%
24.5%
14.8%
14.8%
16.8%
44.8%
47.9%
52.5%
45.4%
41.0%
42.1%
44.0%
38.3%
37.6%
37.7%
38.8%
35.8%
36.6%
39.8%
45.7%
32.3%
35.1%
37.3%
39.5%
33.2%
How Does OWU Compare?
EMLOYEE CONTRIBUTIONS
Ohio Wesleyan University
Client
National
Regional
State
Industry
Group
EE Size
Category
4
7,689
2,338
627
750
1,546
$66
$130
$126
$130
$103
$123
EE+CH
$201
$386
$346
$287
$358
$322
EE+SP
$222
$490
$417
$343
$436
$395
Family
$344
$731
$604
$504
$686
$574
$522
$447
$381
$410
$401
12.3%
27.7%
27.5%
30.8%
19.2%
24.5%
EE+CH
19.8%
44.8%
41.0%
37.6%
36.6%
35.1%
EE+SP
19.7%
47.9%
42.1%
37.7%
39.8%
37.3%
Family
21.8%
52.5%
44.0%
38.8%
45.7%
39.5%
45.4%
38.3%
35.8%
32.3%
33.2%
Survey Benchmarks
Number of Health Plans Reported
$36,000-$59,999
Employee Share of Premiums
Monthly Employee Premium Share ($)
Single
EE+1
Family (Composite Non-Single)
Monthly Employee Premium Share (%)
Single
EE+1
Family (Composite Non-Single)
How Does OWU Compare?
EMLOYEE CONTRIBUTIONS
Ohio Wesleyan University
Survey Benchmarks
Number of Health Plans Reported
Client
4
Nationa
Regional State
l
Industry
Group
EE Size
Category
7,689
2,338
627
750
1,546
$92
$130
$126
$130
$103
$123
EE+CH
$251
$386
$346
$287
$358
$322
EE+SP
$278
$490
$417
$343
$436
$395
Family
$422
$731
$604
$504
$686
$574
$522
$447
$381
$410
$401
$60,000$89,999
Employee Share of Premiums
Monthly Employee Premium Share ($)
Single
EE+1
Family (Composite Non-Single)
Monthly Employee Premium Share (%)
Single
20.2%
27.7% 27.5% 30.8%
19.2%
24.5%
EE+CH
24.7%
44.8% 41.0% 37.6%
36.6%
35.1%
EE+SP
24.7%
47.9% 42.1% 37.7%
39.8%
37.3%
Family
26.7%
52.5% 44.0% 38.8%
45.7%
39.5%
45.4% 38.3% 35.8%
32.3%
33.2%
EE+1
Family (Composite Non-Single)
How Does OWU Compare?
EMLOYEE CONTRIBUTIONS
Ohio Wesleyan University
Survey Benchmarks
Number of Health Plans Reported
Client
4
National Regional
State
Industry
Group
EE Size
Category
7,689
2,338
627
750
1,546
$118
$130
$126
$130
$103
$123
EE+CH
$301
$386
$346
$287
$358
$322
EE+SP
$333
$490
$417
$343
$436
$395
Family
$500
$731
$604
$504
$686
$574
$522
$447
$381
$410
$401
22.0%
27.7%
27.5%
30.8%
19.2%
24.5%
EE+CH
29.6%
44.8%
41.0%
37.6%
36.6%
35.1%
EE+SP
29.6%
47.9%
42.1%
37.7%
39.8%
37.3%
Family
31.6%
52.5%
44.0%
38.8%
45.7%
39.5%
45.4%
38.3%
35.8%
32.3%
33.2%
>$90000
Employee Share of Premiums
Monthly Employee Premium Share ($)
Single
EE+1
Family (Composite Non-Single)
Monthly Employee Premium Share (%)
Single
EE+1
Family (Composite Non-Single)
How Does OWU Compare?
PLAN DESIGN
Ohio Wesleyan University
Client
National
Regional
State
Industry
Group
EE Size
Category
4
7,689
2,338
627
750
1,546
$20
$25
$25
$25
$20
$25
Specialty Care Physician CoPay
$30
$35
$40
$35
$30
$30
Urgent Care CoPay
$35
$50
$50
$50
$45
$40
Emergency Room CoPay
$75
$150
$150
$200
$150
$100
$250
$250
$300
$225
$250
Survey Benchmarks
Number of Health Plans Reported
CoPays
Primary Care Physician CoPay
Separate In-Hospital Admission CoPay
In-Network Benefits
Deductible - Single
$1,000
$1,000
$1,000
$1,000
$500
$750
Deductible - Family
$2,000
$3,000
$2,000
$2,000
$1,500
$1,500
90%
80%
80%
80%
80%
80%
Out-of-Pocket Maximum - Single
$3,500
$3,000
$3,000
$2,500
$2,250
$2,500
Out-of-Pocket Maximum - Family
$7,000
$7,500
$6,000
$5,000
$5,000
$6,000
$2,000
$2,000
$2,000
$2,000
$1,000
$1,000
$4,000
$4,000
$4,000
$4,000
$2,000
$3,000
70%
60%
60%
60%
60%
60%
Out-of-Pocket Maximum - Single
$7,000
$6,000
$6,000
$6,000
$4,000
$5,000
Out-of-Pocket Maximum - Family
$14,000
$14,000
$14,000
$13,000
$9,000
$10,500
Plan Coinsurance
Out-of-Network Benefits
Deductible - Single
Deductible - Family
Plan Coinsurance
Anthem PPO Plan
What are the amounts of the co-payments?
Doctor Office Visits (In-Network)
• Primary Care
$20.00/visit
• Specialty Care
$30.00/visit
• Urgent Care Centers
$35.00/visit
(In/Out-of-Network)
• Emergency Room
$75.00 Co-pay/visit; Then you pay 10%
(In/Out-of/Network)
•
All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including
prescription drugs.
Anthem PPO Plan
Routine/Preventive Benefits Include:
•
•
•
•
•
•
•
Routine Physical Exams
PSA Tests, Pelvic Exams
Immunizations
Colonoscopy
Mammograms
Cholesterol/Triglyceride
Glucose
Anthem PPO Plan
Expanded Women’s Care
Preventative Coverage
•
•
•
•
•
Gestational Diabetes Screening
HPV Testing
Breast Pumps (rental and purchase) and supplies
Prescribed Contraceptives and counseling
Well Women Exams
Anthem Plan Benefits
Prescription Drug Benefit
Retail
$10 Co-Pay for Tier 1 Drugs
$45 Co-Pay for Tier 2 Drugs
$75 Co-Pay for Tier 3 Drugs
$50 deductible applies then copays
Maximum 30 day supply per prescription
Anthem Plan Benefits
Prescription Drug Benefit
Mail Order*
$20.00 Co-Pay for Tier 1 Drugs
$90.00 Co-Pay for Tier 2 Drugs
$150.00 Co-Pay for Tier 3 Drugs
Maximum 90 day supply per prescription
Tips To Save $$$
• Verify your doctor and the provider is in Anthem’s network
• Remind the receptionist that your co-pay for a preventive care visit is $0
• Confirm preventive care procedures are eligible prior to the appointment & that
it will be billed as a preventive when leaving the provider’s office
• Verify physician referrals to labs/facilities are in the network
• Request in-office tests such as lab/x-ray be sent to an in-network lab or
physician for evaluation
• Always reference Anthem’s Explanation of Benefits (EOB) prior to paying the
provider
• Take the Preferred Drug List with you to the doctor visit
• Request generic drug when available
• Request drug samples from your doctor
OWU PPO Plan
Calendar Year
Deductible
Your Individual
Out-of-Pocket
Expenses
$1,000 Per Person
$2,000 Family Maximum
$1,000
+
Co-Insurance after
the Deductible
(Per Calendar Year)
90% of next $25,000
10%
of next
$25,000
$2,500
$3,500
Insurance
Company Pays
(Per Calendar Year)
100%
Total Out-of-Pocket
Expense Per Person
($7,000 Family
Maximum)
All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum
including prescription copayments.
Anthem PPO Plan
Diagnostic Testing Services
• MRI’s
• CT Scans
• PET Scans
• Nuclear Medicine
• X-Ray’s/Radiology
In-Network
100%
100%
100%
100%
100%
ANTHEM PPO PLAN
In-Network
Out-of-Network
Deductible
$1,000 Per Person
$2,000 Family maximum
Deductible
$2,000 Per Person
$4,000 Family maximum
Out of Pocket*
Out of Pocket*
$3,500 Per Person
$7,000 Per Person
(including deductible)
(including deductible)
$7,000 Family maximum
$14,000 Family maximum
(including deductible)
(including deductible)
*Out-of-Pocket maximums include co-payments in-network
HEALTH MANAGEMENT TOOLS
ConditionCare helps participants manage the following
conditions:
•
•
•
•
•
Asthma (Pediatric & Adult)
Chronic Obstructive Pulmonary Disease
Coronary Artery Disease
Diabetes (Pediatric & Adult; Types 1 & 2)
Heart Failure
ANTHEM SUPPORT TOOLS
Nurse Line 24/7
• 1-888-249-3820
• Helps members assess symptoms
• Offers help understanding medical
condition or prescribed course of treatment
• Ensures members have the right care in the
right setting
Health Care Advisor
• What to expect with an illness
• Research treatment options
• Find the appropriate hospital
Access to a health care
professional can help
answer immediate
questions and aid
understanding
Immediate, Live Consultations
A choice of physicians that meets the consumer’s
needs
…On Any Device
ANTHEM
Dependent Age Status
• End of the month in which the dependent
turns 26 unless the dependent is eligible for
another employer-sponsored health plan
other than that of a parent
WHO TO CALL WITH
QUESTIONS
Anthem Member Services: 1-888-290-9164
• Benefit Information
• Claim Inquiries
• Provider Searches
• Changes to member data
• ID Cards, Provider Directories
FLEXIBLE SPENDING ACCOUNT
PLAN DETAILS
Ohio Wesleyan University Sponsored Plan Allowing Faculty and
Staff to Make Pre-Tax Contributions for:
• Health Care Account
• Dependent Care Account
$2,550 Annual Election Maximum
$5,000 Annual Election Maximum
Eligibility Requirements
•
•
•
•
All full time Faculty and Staff
Do not need to participate in the Medical; Dental or Vision Plan
Annual Voluntary Election
May not have a HSA and a Health Care FSA (IRS Rule)
Plan year will begin July 1, 2015 – June 30, 2016
ELIGIBLE EXPENSES
Health Care Account
• Medical, Dental and Vision expenses
•
•
•
•
Deductible
Coinsurance
Co-payments for office visits, prescription drugs, etc.
Some Expenses not covered by insurance
Dependent Care Account
•
•
•
•
•
Daycare expenses during work hours
Daycare/babysitting for children under 13
Preschool programs
After-school care
Home care for disabled dependent age 13 and over
ELIGIBLE EXPENSES
• Day Care expense must be to provide gainful
employment
• If married, spouse must also be employed
• Dependent must reside with employee
• Payment for providing care may not be made to
another dependent
• Care provider must disclose TAX ID #
USING THE FSA PLAN
• Automatic Reimbursement through your Health Care
Spending Account for Medical, Rx, Dental and Vision
claims
• Checks are issued weekly (every Thursday) and
mailed Friday to the participant’s home…or
• Direct Deposit into your bank account by Monday
• Reimbursements from Accounts are TAX FREE!!
• You will have until September 30, 2016 to submit
eligible expenses that were incurred during the plan
year (July 1, 2015 – June 30, 2016)
HOW TO SUBMIT REQUEST
FOR REIMBURSEMENT
• Automatic Reimbursement through Health Care
Spending Account
• Fax Reimbursement to 1-888-347-5212
• Mail Requests to: Anthem
P.O. Box 660165
Dallas, TX 75266
• Direct Line to Customer Service 1-866-599-3061
• Account Balance: www.benefitadminsolutions.com
DENTAL PLANS
KEY FEATURES OF THE
DENTAL PLANS
• Your choice of Basic and Preferred Plans
• 100% for Routine Preventive services(1)
• Administrated by the Metropolitan Life Insurance
Company
Benefits are subject to MetLife Contract Limitations
KEY FEATURES OF THE
DENTAL PLANS
• Receive your care from the Dentist of your choice
• No Network Requirement
• Optional network of dentists to receive a discount for
services
Benefits are subject to MetLife Contract Limitations
BASIC DENTAL PLAN
Deductible Amount = $50.00/Person/year; Family Max (3)
Preventive
Basic
Major
Plan Pays
100% In-Network
90% Out-of-Network
Plan Pays
80% In-Network
60% Out-of-Network
Plan Pays
50% in-network
25% out-of-network
(No Deductible)
Sealants
Space Maintainers
Fluoride Treatments
Fillings
Oral Exams
Periodontal Maintenance
Inlays, Onlays and
Crowns
Teeth Cleanings
Emergency Treatment
Dental Implants
Endodontic Services
X-Rays
Periodontal Services
Bridges and Dentures
Calendar Year
Maximum Amount
$1,000 per person
Surgical Extractions
PREFERRED DENTAL PLAN
Deductible Amount = $50.00/Person/year; Family Max (3)
Preventive
Basic
Major
Plan Pays
100% In-Network
100% Out-of-Network
Plan Pays
90% In-Network
80% Out-of-Network
Plan Pays
60% In-Network
50% Out-of-Network
(No Deductible)
Sealants
Space Maintainers
Emergency Treatment
Fillings
Inlays, Onlays, and Crowns
Fluoride Treatments
Periodontal Maintenance
Dental Implants
Oral Exams
Surgical Extractions
Endodontic Services
Teeth Cleaning
Periodontal Services
X-Rays
Bridges and Dentures
Calendar year
max amount
$1,000
Calendar year
max amount
$1,500
(MetLife
Dental
Providers)
Orthodontics
50% $1,000
Child only
Lifetime max
OTHER KEY PIECES OF THE
PREFERRED DENTAL PLAN
• In most cases, the dentist will directly bill
MetLife for services
• Annual Maximum Benefit is $1,000 per person
• Optional Network of Dentists available to receive
discounts
• Annual Maximum Benefit increases to $1,500
per person when services are provided in
MetLife’s Network of Dentists
MetLife Dental
The Preferred Dentist Program was designed to help you get the dental care you need and
help lower your costs. You get benefits for a wide range of covered services — both in and
out of the network. The goal is to deliver affordable protection for a healthier smile and a
healthier you. You also get great service and educational support to help you stay on top of
your care.
Freedom of choice to go to any dentist.
You have the flexibility to visit any dentist — your dentist — and receive coverage under the
plan. Just remember that non-participating dentists haven’t agreed to charge negotiated
fees. That means you usually save more dental dollars when you go to a participating
dentist.
Additional savings when you visit participating dentists.
Your out-of-pocket costs are usually lower when you visit network dentists. That’s because
they have agreed to accept negotiated fees that are typically 15 to 45% less than average
dental charges in the same community. This may help lower your final costs and stretch your
plan maximum.
Service where and when you want it.
MyBenefits, your secure self-service website, is available 24/7. You can use the site to get
estimates on care or check coverage and claim status. Plus, if you are on the go and need to
find an in-network provider, view a claim or see your ID card, there’s an app for that. Search
“MetLife” at the iTunes App Store or Google Play to download the app.
HOW THE OPTIONAL NETWORK
SAVES YOU MONEY
•
•
•
•
Go to www.metlife.com (click find a dentist)
View PDP Plus network of Dentists in your area
Visit participating Dentists and receive treatment
Dentist will directly bill MetLife at a lower prenegotiated rate and receive their payment directly
from MetLife
• The Dentist can not charge the difference between the
negotiated rate and their normal fee (the plan’s
benefits will apply toward the negotiated rate)
METLIFE DENTAL PLANS
Monthly Payroll Deductions (1)
Effective July 1, 2015
Basic Plan
Preferred Plan
Employee
$21.00
$34.30
Employee + One Dependent
$41.18
$67.96
Family
$67.26
$110.50
(1) Pre-tax
deductions. Actual net cost will be reduced based upon IRS
Section 125 election and personal income tax bracket.
VISION PLANS
BASIC VISION PLAN
•
•
•
•
Exam every 12 months, $20 co-pay
Prescription glasses every 24 months, $20 co-pay
Contacts, no co-pay applies ( 24 months)
Coverage from a VSP Doctor
PREFERRED VISION PLAN
•
•
•
•
•
•
Exam every 12 months, $10 co-pay
Prescription lenses every 12 months, covered in full
Contacts, no co-pay applies ( 12 months)
Frames every 24 months, $25.00
$140.00 Allowance
Coverage from a VSP Doctor
FIND A VSP PROVIDER
•
•
•
•
Go to www.vsp.com
View Network of Doctors in your area
Visit participating Doctors and receive treatment
Call 1-800-877-7195
VSP PLANS
Payroll Deductions (1)
Effective July 1, 2015
Basic Plan
Preferred Plan
Employee
$6.94
$9.84
Family
$19.62
$27.82
(1) Pre-tax
deductions. Actual net cost will be reduced based upon IRS
Section 125 election and personal income tax bracket.
OPEN ENROLLMENT
•
•
•
•
•
Open Enrollment will be April 27th through May 15th
You may add or remove dependents
Enroll or terminate from the plan(s)
Your election(s) will be effective 7/1/15
Election will be in effect until 6/30/16; unless a
qualified change in your status occurs
• All benefit eligible employees must enroll though ADP
during the open enrollment period (4/27-5/15)
QUALIFIED CHANGE IN
YOUR STATUS?
• Change in marital status
• Change of dependents
• Involuntary loss of coverage through spouse’s
employer
• Change of spouse’s employment resulting in loss
of coverage
• Must notify Human Resources within 30 days of
change!
OWU WELLNESS PROGRAM OVERVIEW
What’s the big idea?
• Our lifestyle decisions impact our
long-term health, wellbeing and
productivity
• Our healthcare costs are
impacted by the lifestyle
decisions we make
• OWU continues its
commitment to encouraging
well-thought-out decisions
regarding healthcare solutions,
and to promoting a healthy
family life
OWU WELLNESS PROGRAM OVERVIEW
Where’s the “gain”?
• OWU benefits when its employees are healthy,
and able to carry-out their work responsibilities
efficiently and effectively
• Employees benefit by leading healthy lifestyles,
and are therefore happier, more stable, more
dependable, more satisfied
• Everyone benefits when human resource costs
are under control (both insurance premiums and
productivity)
OWU Wellness Program
OWU WELLNESS PROGRAM OVERVIEW
Where’s the “hook”?
• $25 one time premium credit for the year or
$25 through payroll for completing the
wellness assessment
• One time $75 premium credit for the year or
$75 through payroll for achieving 34 credits
OWU Wellness Program
HOW DO I “SIGN-UP”?
www.UBAwellnessworks.com
WELLNESSWORKS PROGRAMS…
Quarterly
Challenges
Healthy
Living
Programs
Health Risk
Assessment
Monthly
Seminars
OWU Wellness
www.ubawellnessworks.com
P/W = OWU
BASIC PROGRAM –
TRACKING (APRIL-MARCH TRACKING CYCLE)
Credit
Value
Annual
Max
Wellness Assessment
6
6
Physical Exam / Biometric Screening
6
6
Virtual Coaching
5
10
Online Monthly Seminars
1
12
Activity
Thanks
in advance
for your
help. 5
Healthy Heart Challenge
(February
1-29)
5
Rate Your Plate Challenge (May 1-31)
5
5
Choose Your Health Challenge (August 1-31)
5
5
Winter Warm Up Challenge (November 1-30)
5
5
Community Event
3
6
Local Discretionary Activity
3
6
End of Year Survey
2
2
Total Credit Opportunity
68
Earn 34+
Credits in
12month
period to
earn
incentive
QUESTIONS?