Transcript Slide 1

2013 Benefit Open Enrollment
Benefit Overview
Medical
• Anthem continues as our carrier for 7/1/13
• Choice of Traditional PPO and HDHP
• No plan design changes or contribution increases
Dental
• Delta Dental continues as our carrier for 7/1/13
• No plan design changes
Vision
• Anthem will replace Cigna as our vision carrier effective
7/1/13
• Similar plan design and slight decrease in premiums
Medical
• Still two medical plan options from
which to choose:
o Traditional PPO – No plan design changes
o High Deductible Health Plan – No plan
design changes
• Find a network provider at
www.anthem.com - choose Blue Access
PPO
Blue Access PPO
Medical Plan
In-Network
Out-of-Network
$ 1,000
$ 3,000
80% / 20%
$ 2,000
$ 4,000
60% / 40%
Out-of-Pocket Maximum – Individual (includes deductible)
$ 3000
$ 6000
Out-of-Pocket Maximum – Family (includes deductible)
$ 6000
$ 12,000
$ 25
$ 50
$100 Copay
100% coverage
40% after deductible
40% after deductible
40% after deductible
40% after deductible
Anthem Network (www.anthem.com)
Deductible – Individual
Deductible – Family
Coinsurance
Primary Care Visit Copay
Specialty Care Visit Copay
Urgent Care Center Copay
Preventive Care
Emergency Room
Hospital Services
Out-Patient Services
Maternity Services
Mental & Nervous Care
Inpatient
Outpatient
Lifetime Maximum
Prescription Drugs
RETAIL
Generic
Preferred Brand (Tier 2)
Non-Preferred Brand (Tier 3)
MAIL ORDER
Generic
$200 Copay
20% after deductible
20% after deductible
20% after deductible
40% after deductible
40% after deductible
40% after deductible
20% after deductible
20% after deductible
40% after deductible
40% after deductible
Unlimited
$10
30%; $40 max
55%; $55 max
40% after deductible
40% after deductible
40% after deductible
$20
Not covered
Preferred Brand (Tier 2)
30%; $80 max
Not covered
Non-Preferred (Tier 3)
$55; $110 max
Not covered
Blue Access HDHP/HSA
Medical Plan
Anthem Network (www.anthem.com)
Deductible – Individual
Deductible – Family (family coverage requires the full family deductible
be met before coinsurance applies)
Coinsurance
Out-of-Pocket Maximum – Individual (includes deductible)
Out-of-Pocket Maximum – Family (includes deductible)
Primary Care Visit Copay
Specialty Care Visit Copay
Urgent Care Center Copay
Preventive Care
Emergency Room
Hospital Services
Out-Patient Services
Maternity Services
Mental & Nervous Care
Inpatient
Outpatient
Lifetime Maximum
Prescription Drugs
RETAIL
Generic
Preferred (Tier 2)
Non-Preferred (Tier 3)
MAIL ORDER
Generic
Preferred (Tier 2)
Non-Preferred (Tier 3)
In-Network
Out-of-Network
$2,000
$4,000
$4,000
$8000
80% / 20%
60% / 40%
$4,000
$8,000
$8,000
$16,000
20% after deductible
40% after deductible
20% after deductible
40% after deductible
20% after deductible
100% Coverage
40% after deductible
20% after deductible
20% after deductible
40% after deductible
20% after deductible
40% after deductible
20% after deductible
40% after deductible
20% after deductible
20% after deductible
40% after deductible
40% after deductible
Unlimited
0% after deductible
40% after deductible
50% after deductible
40% after deductible
40% after deductible
40% after deductible
0% after deductible
40% after deductible
50% after deductible
Not covered
Not covered
Not covered
Anthem Plan Highlights
• ALL mammograms paid at 100%
• Eligible smoking cessation medications
(ex. Chantix or Wellbutrin) covered under
the Anthem Rx plan
• Access to a Worldwide network. Search
for providers at www.bluecares.com
Anthem Website
A demonstration of the Anthem
website.
www.anthem.com
What is an HSA
 Tax-advantaged checking account
 Allows you to save for future medical
expenses or pay current ones
HSA Eligibility
An HSA can be established by an individual
who:
• Is covered under a high deductible health plan (HDHP)
• Is not covered by any other health plan that is not an
HDHP
• Is not enrolled for benefits under any part of Medicare
• Is not claimed as a dependent on another person’s tax
return
HSA Features
•
Tax Advantages
 Tax free way to save for current and future medical
expenses.
 Contributions are pre-tax or tax-deductible up to
annual HSA limits.
 All earnings and interest are tax free.
 Qualified withdrawals are tax free. Once reach age
65, non-medical withdrawals are taxed at your current
tax rate, like an IRA.
•
HSA is fully Portable.
Ability to Accumulate funds – “Use it or Keep it!”.
•
HSA funds can be used for items not covered by health
plan such as; dental, vision etc. Same as an FSA plan.
HSA Contributions Options
The HSA can be funded
• In one or more payments
• Payroll deduction will be available for all DePauw
University employees
 Elections can be stopped, started, changed on a monthly basis
• Contributions can be made by the employee, employer, or
any other person on the employee’s behalf.
• Prior to the individual’s federal tax filing date (generally
April 15)
HSA Contribution Maximums
IRS Maximum 2013 contributions
• Self - $3,250
• Family - $6,450
• Catch up contribution - $1,000 for those
55 and older
Note: Maximums include contributions made by DePauw
HSA University Contributions
DePauw University’s Annual HSA
Contribution
Employee
Employee + Dependent(s)
$1,000
$2,000
Note: Employee’s will receive one-fourth of the
University’s contribution each quarter.
HSA Distributions
Pre-65 HSA owner:
• Qualified Distributions will be tax free. NonQualified Distributions will require individual to
pay their personal tax rate on purchase and a
20% penalty.
Post-65 HSA owner:
• Qualified Distributions will be tax free. NonQualified Distributions will require individual to
pay their personal tax rate on purchase (No IRS
Penalty)
Dental
• Carrier: Delta Dental
• Passive PPO plan:
o Three levels of providers
• Find a network provider at
www.deltadentalin.com
Dental Plan Design
Dental
Benefits
Class I
Class II
Services
Deductible
Coinsurance
Exams, cleanings, x-rays,
sealants, emergency
treatment
100%
Minor Restorative – fillings,
root canals, extractions,
gum disease
80%
Class II
TMJ ($750 lifetime
maximum per person)
Class III
Major Restorative – crowns,
bridges, dentures, implants
Class IV
Orthodontics – braces (To
Age 19)
$50 individual/
$100 family,
per calendar
year
Benefit
Maximum
$1,250
maximum
per plan year
80%
50%
50%
$1,000
lifetime
maximum
Delta Dental Network
Delta Dental Network
Delta Dental PPO
• significant discounts
• no balance billing
• acceptance of processing policies
• 108,000 dentist locations
Delta Dental Premier
• negotiated fees
• no balance billing
• acceptance of processing policies
• 186,000 dentist locations
Nonparticipating
• no discounts
• balance billing
Delta Dental Payment Example
PPO Dentist
Class II payment example for:
Filling - Amalgam Restoration/One Surface
(assuming any applicable deductible has been
met)
Submitted Fee:
$120.00
Premier Dentist
Nonparticipating Dentist
Submitted Fee:
$120.00
Submitted Fee:
$120.00
PPO Fee Schedule amount:
$68.00
Maximum Approved Fee:
$111.00
Nonparticipating Dentist Fee:
$92.00
Delta Dental pays 80% of the
PPO Fee Schedule amount:
Member pays:
$54.40
$13.60
Delta Dental pays 80% of the
Maximum Approved Fee:
$88.80
Member pays:
$22.20
Delta Dental pays 80% of the
Nonparticipating Dentist Fee:
Member pays:
$73.60
$46.40
The Premier dentist cannot charge the $9
difference between the Maximum Approved
Fee and his/her fee.
Because the dentist does not participate, you
are responsible for the difference between Delta
Dental’s payment and his/her fee.
The PPO dentist cannot charge the $52
difference between the PPO Fee Schedule
amount and his/ her fee.
Dental Rates
Delta Dental Monthly Premium
Contributions
Enrollment Tier
Employee Contribution
Employee Only
$10.92
Employee + Spouse/SSPD
$21.63
Employee + Child(ren)
$29.93
Family
$42.86
Vision
• NEW Carrier: Anthem
• Find a network provider at
www.anthem.com
Vision Plan Design
In-Network
Benefit
Out-of-Network
Benefit
12 Months
$10 Copay
Up to $42 Allowance
Lenses
24 Months
Covered in full after
$10 Copay
$42-$80 Allowance
Frames
24 Months
$130 Allowance
Contact Lenses
24 Months
If elective
$130 Allowance
If elective
$105 Allowance
If necessary
Covered in Full
If Necessary
$210 Allowance
Service
Eye Exam
(in lieu of lenses and frames)
Frequency
$45 Allowance
To receive greater benefits, utilize a network provider: www.anthem.com.
Vision Rates
Anthem Vision Monthly Premium
Contributions
Enrollment Tier
Employee Contribution
Employee Only
$4.49
Employee + Spouse/SSPD
$7.87
Employee + Child(ren)
$8.54
Family
$13.04
What is a Flexible
Spending Account (FSA)
•
With an FSA plan, you elect to have a certain dollar amount
withheld from your paycheck so you can pay for health care and
dependent care expenses with pre-tax money.
•
Eligible expenses include your unreimbursed medical expenses,
including deductibles, co-pays, co-insurance, and childcare expenses!
•
“Use it or Lose it Rule” – If you do not use all of your FSA funds they
will be forfeited at the end of the plan year.
•
If you elect the HDHP then you can enroll in FSA for Dependent
Care Only.
Reminder: Over-the-counter medications no longer eligible for reimbursement
without a prescription.
2013-2014 FSA Annual Plan Limits:
Health Care: $2,500
Dependent Care: $5,000
FSA Debit Card
•
Your FSA debit card can be used at providers offices,
hospitals, pharmacies, etc.
•
If you receive a bill at home, you can write your debit card
number on the bill to make payment like any other
credit/debit card.
•
If your childcare provider accepts Visa, you can use your debit
card for childcare expenses as well
•
You can also file claims online, using a smartphone app, or via
mail
Important Note: You still need to keep receipts and AdminPro will
request them under certain circumstances
Employee Action
Remember:
• All benefit-eligible employees must elect
or waive coverage and assign
beneficiaries to life insurance plans no
later than May 15, 2013.
• Enrollment will be completed in the ADP
portal at https://portal.adp.com.