© 2010 wittenberg university springfield, ohio 45501 annual enrollment presentation effective...

© 2010 Wittenberg University Springfield, Ohio 45501

Annual Enrollment Presentation

Effective January 1, 2015


Agenda

I. Consumerism Tips & Resources

II. General Information

III. Medical and Prescription Plan

IV. Dental Plan

V. Vision Plan

VI. Flexible Spending Accounts

VII. Supplemental Life Insurance


Healthcare Reform Legislation New Mandates High Utilization of Benefits Unhealthy Lifestyle Choices Plan Designs New Brand Name Drugs New Technologies & Treatments Aging Population Defensive Medicine / Malpractice

What Impacts Your Health Plan Cost?


Use your benefits wisely! Use In-Network Providers Use Generic Rx Get your Annual Check-ups Get your Flu Shot Urgent Care Clinic vs. ER …and of course EAT HEALTHY AND EXERCISE!

What Can You Do?


1. How much does that cost?

2. Is this procedure really necessary?

3. Is there a less expensive option?

4. Is there a Generic Rx?

5. Has anybody out there had this before?

(Do your own research online!)

Five Smart Questions to Ask:


Low-Cost / Free Generic Drugs

Low-cost or free antibiotics available at some locations

For low cost Rx - Do NOT use your medical ID card, just present your doctor’s prescription

EXCELLENT time to review your brand name medication and check with your doctor to see if you can switch to the generic

Resources – Low Cost Rx


Resources – Convenient Care ClinicsDesigned for non-emergency care such as:

• Respiratory Illnesses • Skin Conditions • Minor Injuries • Vaccinations

Staffed by Nurse Practitioner or Physician’s Assistant

Care typically available for an office visit copayClinics are available in Dayton & Columbus areas


GENERAL INFORMATION


General Information• Plan is effective 01/01/2015

• Self-Funded Plan subject to ERISA and plan document

• Partnering with Anthem Blue Cross & Blue Shield

Blue Access PPO network – national network

• 4 Plan Types: Employee plan, Employee + spouse plan,

Employee + child(ren) plan, & Family plan


General Information, cont.

• 2015 Annual Enrollment runs from Oct. 27 through Nov. 14

On an annual basis you can enroll in a plan or make benefit changes during the annual enrollment period.

• Qualifying Event – You can join a plan or make benefit changes within 31 days of a qualifying life event as defined by the IRS. • Examples: change in marital status, birth or adoption of a child,

change in spouse’s employment status.

• Contact Human Resources to complete an enrollment form within 31 days of a qualifying event.


Glossary of Terms• Co-pay – The amount you pay each time you see a doctor, get a

prescription filled, or get other services. A copay is a flat fee ($20) for medical services.

• Deductible – The amount you must pay each year before your plan pays anything toward co-insurance.

• Co-insurance – A percentage that you pay after you have met your plan’s deductible. The plan pays a certain percentage (90%) and you pay a certain percentage (10%).

• Out-of- pocket limit – The most you have to pay each year for expenses covered by your plan. It traditionally includes the deductible and coinsurance amounts. Once you reach this amount, you do not pay anything for most services.

.


MEDICAL & PRESCRIPTION PLAN


Blue Access PPO Health Plan

In-Network Benefit member pays:

Deductible $400 individual /$800 familyOut-of-Pocket Limit $1,200 individual /$2,000 familyPhysician Office visits $20 co-payPreventive Care visits Covered at 100%Urgent Care $20 co-payInpatient/Outpatient Services 10% co-insurance after deductibleEmergency Room Services 10% co-insurance after deductible


Blue Access PPO Health Plan, cont.

Out-of-network benefit member pays:

Out-of- Pocket Limit $1,300 individual /$2,200 family

Physician Office visits 30% after deductiblePreventive Care visitsUrgent CareInpatient/Outpatient Services

Balance billing: Providers and hospitals who are out-of-network will bill you for the difference between the amount the plan pays and their billed charges.


Deductibles and Out-of-Pocket Limit

Deductible The $400/$800 deductible simultaneously applies to both in and out-of-network services. In other words, there is not a separate deductible for out-of-network.

Out-of-Pocket Limit (“OOPL”) There is a separate out-of-pocket limit for in-network and out-of-network co-insurance expenses.

• Co-insurance and copay costs for services received in-network only apply to the in-network OOPL. The in-network OOPL is $1,200/$2,000

•Co-insurance costs for services received out-of- network only apply to the out-of-network OOPL. The out-of –network OOPL is $1,300/$2,200


Prescription Benefit

Prescription Drug Retail copay $10/$25/$40(30-day supply)

Prescription Drug Mail Order $20/$50/$80(90-day supply through Express Scripts) Prescription co-pay OOPL limit $1,200 single/$2,000 family

Note: Prescription OOPL is completely separate and unrelated to the OOPL for medical.


17

How to Find a Provider

• www.anthem.com• Click on “Find a Doctor”• Choose the state that you want to search• Choose a Plan – Under the “(Medical) Employer

Sponsored” section, select “Blue Access PPO”• You can then search by provider name, address, zip

code, etc.• Or call the customer service number listed on the back

of your ID card


2015 Monthly Medical Contributions

Plan Type Total CostAnnual/Monthly

Wittenberg 80%Annual/Monthly

Employee 20%Annual/Monthly

Single $5,834 / $486 $4,667/ $389 $1,167 / $97

Employee Plus Spouse

$14,585 / $1,215 $11,668 / $972 $2,917 / $243

Employee Plus Children

$14,103 / $1,175 $11,282 / $940 $2,821 / $235

Family $21,729 / $1,811 $17,383 / $1,449 $4,346 / $362


DENTAL PLAN


Dental Blue Complete Plan

MEMBER PAYS

Deductible $25 single /$75 family

Annual Maximum (per member) $1,500

Diagnostic and Preventive No Charge to member

Minor Restorative 20% co-insurance after deductible

Oral Surgery 20% co-insurance after deductible

Endodontic Services 20% co-insurance after deductible

Periodontal Services 20% co-insurance after deductible

Prosthodontic Services 50% co-insurance after deductible

Orthodontic Services 50% co-insurance no deductible

Orthodontic Lifetime Maximum $1,000

Orthodontic Age Limit Child to age 19


2015 Monthly Dental Contributions

Plan Type Total Monthly Cost Wittenberg 80% Employee 20%

Single $25.00 $20.00 $5.00

Employee Plus Spouse

$62.00 $50.00 $12.00

Employee Plus Children

$59.00 $47.00 $12.00

Family $91.00 $73.00 $18.00


VISION PLAN


Blue View Vision Plan

Network Benefits

Routine Eye Exam (once every 12 months) $10 co-payEyeglass Frames (once every 24 months) $100 allowance/20% off the remaining balance

Eyeglass Lenses (standard)Standard Plastic Single vision lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Bifocal lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Trifocal lenses (1 pair) $15 co-pay, then covered in fullAdditional co-pays apply for eyeglass lens upgrades

Contact Lenses Elective Conventional Lenses $105 allowance/15% off the remaining balanceElective Disposable Lenses $105 allowance (no additional discount) Non-Elective contact Lenses Covered in Full


2015 Monthly Vision Contributions

Plan Type Employee Monthly

Single $3.00

Employee Plus One $6.00

Family $10.00


ENROLLMENT MEDICAL, DENTAL & VISION


Medical, Dental and Vision Enrollment

You need to complete an enrollment form if:

You want to enroll in the Medical, Dental, or Vision plans for the first time;You want to add or drop your spouse or dependents from your coverage;You want to change one or more of the plans you currently participate in;You want to cancel one or more of the plans you currently participate in;

You DO NOT need to complete any paperwork if:

You are not making any changes to your benefit elections or adding/deleting dependents.

Reminder: Employees can enroll in the Medical, Dental, and Vision plans independently.


Claims Assistance

If you are having trouble resolving a medical, dental or vision claim issue USI Insurance can assist you. If you have reached out to Anthem and your questions were not answered or it is a complex claim issue please contact USI’s Benefit Resource Center at 1-855-USI-6699 or you can email [email protected].


FLEXIBLE SPENDING ACCOUNTS


Flexible Spending Account (FSA)

TASC Third Party Administrator

www.tasconline.com

A flexible spending account (FSA), is a tax-advantaged financial account that allows an employee to set aside a portion of earnings to pay for qualified medical and dependent care expenses. Money deducted from an employee's pay into an FSA is not subject to payroll taxes resulting in substantial payroll tax savings. The IRS now allows up to $500 to be rolled into the next calendar year for the HealthCare FSA. Funds in excess of $500 are forfeited. There is no rollover option for Dependent Care FSA. Please estimate your expenses carefully.


Flexible Spending Account, cont. • Estimate your expenses carefully:

• On an annual basis, determine how much you want to contribute toward your FSA account(s) for the calendar year.

• You cannot change your election(s) during the calendar year unless you have a qualifying event.

• You cannot transfer money from one account to another.

• Funds in excess of $500 in your Health Care FSA account after the three month grace period will be forfeited.


Health Care FSA

• $2,500 annual contribution limit

• You have immediate access to your full election at the beginning of the calendar year even though the full election has not been deducted from your pay.

Click here to view a list of eligible expenses: FSA Eligible Expenses


Dependent Care FSA

• If married, spouse must work or attend school full-time

• Annual contribution limit - $5,000 for single or married filing joint tax return, $2,500 married filing separate return

• Under IRS guidelines, you can only be reimbursed for dependent care that has already taken place. Also, you can only be reimbursed for the amount you have already contributed to your dependent care FSA.

• Eligible expenses include dependent care expenses, including summer day camp expenses, for qualifying children under age 13, a disabled spouse, and/or a disabled relative or household member who depends on the account holder for at least half of his or her support.


FSA Reimbursement• TASC is going green! No need to fax or mail paper forms – simply submit

reimbursement requests electronically:• Online Request for Reimbursement Wizard at www.tasconline.com• Download the MyTASC Mobile App (for Apple and Android devices) at

www.tasconline.com/mobile• Text message TASC RFR, service code, service provider, and reimbursement

amount to 41411• Use the TASC Card (even order one for your spouse!) and avoid the

reimbursement process entirely! Use the TASC card when incurring an eligible expense and the card automatically pays and substantiates most expenses at the point-of-purchase.

• 24-hour turnaround on almost all “green” and TASC Card reimbursement methods via direct deposit

• If a paper form is required, download a Request for Reimbursement form from your MyTASC account at www.tasconline.com and submit it via fax (608) 663-2762 or mail to TASC, PO Box 7308, Madison WI 53707-7308

• Contact Customer Care for assistance at 800-422-4661


FSA Enrollment

If you want to participate in an FSA you must enroll or re-enroll for 2015.

• If you were enrolled in 2014: You’ll get an email with re-enrollment information and you can re-enroll online. Please keep your existing TASC cards (no new cards will be sent unless your card is set to expire in 2014).

• If you are enrolling for the first time: You’ll need to complete a paper enrollment form. Information and a TASC card will be mailed to the new enrollees home address about 10 days after enrolling.


VOLUNTARY LIFE INSURANCE


Voluntary Life Insurance Employee

• $10,000 increments not to exceed 3x annual earnings.• Benefits will reduce 33% at age 65 and an additional 17% of original amount

at age 70.• Additional Features: Portability and Accelerated Death Benefit

Spouse (includes domestic partners)• $5,000 increments up to $100,000 not to exceed 50% of the employees

elected coverage amount.

Children • 6 months and older can receive $10,000 benefit for each child (up to age 19,

or 25 if full-time student).• Coverage from 14 days to 6 months is $250.

The Employee must elect coverage to enroll Spouse and/or Dependent Children.


Voluntary Life Insurance Enrollment

You need to complete an enrollment form if:

You want to enroll in the Voluntary Life insurance for the first time;You want to cancel the Voluntary Life insurance you currently have;You want to change the volume of the Voluntary life Insurance you currently have.

You DO NOT need to complete any paperwork if:

You are not making any changes to your Voluntary Life insurance


Reminder: The Enrollment Deadline is NOVEMBER 14th.

• For general plan questions, please contact the USI Benefit Resource Center at 1-855-USI-6699 or [email protected].

• For enrollment specific questions, please email DeAnna Sullivan at [email protected]

THANK YOU FOR YOUR TIME!

© 2010 wittenberg university springfield, ohio 45501 annual enrollment presentation effective...

Documents

employee plan

family plan slide

plan types

vision plan

plan document

general information

health plan cost

employee spouse plan