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Valley View School District 365U
January 1, 2012 Employee Benefits Open Enrollment Presentation
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2012 Program Overview
• 2012 Program Overview
• Open Enrollment
• Health Care Reform 2011 Recap
• Medical, Prescription Drug, Dental and Vision Plan Summary
• FSA / Dependent Care Plan Summary
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2012 Program Overview
Medical / Prescription Drug BCBS of IL PPO Plan (Mail Order: Prescription Prime Therapeutics)
Dental BCBS of IL PPO Plan
Flexible Spending and Dependent CarePay Flex Flexible Spending Account
Pay Flex Dependent Care Account
Vision VSP Vision PPO Plan
Life SunLife Life AD&D Plan
Long Term Disability SunLife Long Term Disability Plan
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Open Enrollment
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Open Enrollment Process
Open Enrollment Period:
November 1st – November 30th
Current Enrollment Elections:
Medical and Dental elections will automatically continue with no paperwork required.
Federal Government requires annual re-enrollment in Flexible Spending and Dependent Care Accounts. Applications must be completed to enroll in accounts effective January 1, 2012.
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Enrollment Forms can be found at www.vvsd.org.
Elections are to be returned to Human Resources no later than Wednesday, November 30, 2011 11:59pm.
All Elections are effective January 1, 2012 – December 31, 2012.
Open Enrollment Process
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During the open enrollment period you are eligible to make the following enrollment changes to the medical and dental programs for a January 1, 2012 effective date:
Elect Coverage Previously Declined Add Spouse, Civil Union Partner or Eligible
Dependents Terminate Existing Coverage Terminate Spouse, Civil Union Partner or Eligible
Dependents
Open Enrollment Rights
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The only other times during the plan year when you are eligible to make changes to your current election(s) is when the following life events occur:
Birth Death Marriage / Civil Union Divorce / Civil Union Dissolution Adoption Loss of Coverage Spouse, Civil Partner, Dependents loss of coverage
Special Enrollment Rights
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Health Care Reform 2011 Recap
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Health Care Reform 2011 Recap
Effective LAST January 1, 2011:
1. Dependent Children Eligibility to age 26 Regardless Student, Residential or Marital Status.
2. Dependent Children (up to age 19) 3/12 Pre Existing Condition Limitation was Removed.
3. Flexible Spending Account Eligible Expenses Excludes over the Counter Medications unless in the case of Insulin or a Script from a Provider.
4. Health Plan Essential Benefit Lifetime and Annual Maximums were Removed or Converted to Visit Maximums.
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Health Care Reform 2011 Recap Essential Benefit Plan Maximums
Plan Maximums Prior Effective 01/01/11
Medical Plan Lifetime Maximum $5,000,000
Unlimited
TMJ Lifetime Maximum $2,500 Unlimited
Well Baby Care Annual Maximum (Eligibility: Birth Through 26 Months)
$1,500 Unlimited
Well Child & Adult Care Annual Maximum $500 Unlimited
Physical Therapy Annual Maximum $5,000 110 Visits
Occupational Therapy Annual Maximum $2,000 28 Visits
Speech Therapy Annual Maximum $2,000 19 Visits
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2012 Contractual Changes
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Contractual Changes
Civil Union Partner Eligibility
Applicable to the Medical, Prescription Drug, Dental and Vision Plans • Effective June 1, 2011 State Law was passed to allow for civil unions in the state of Illinois. Civil
union dependents from the state of Illinois or any other state are eligible for our medical, prescription drug, dental, and vision plans effective June 1, 2011. Civil union dependents are not eligible for our Section 125, FSA and Dependent Care Federally regulated programs. The Federal government does not recognize civil union dependents as eligible dependents.
Adult Pre-Existing Waiting Period
Applicable to the Medical Plan • The Health Plan has new enrollee pre-existing condition waiting periods for adults (age 19 or
older). Conditions treated in the 3 months prior to the effective date of the Plan are not be eligible for medical coverage for the first 6 months for employees and the first 12 months for adult dependents.
• Effective January 1, 2012 pre-existing condition waiting periods can be reduced or waived by providing the Plan proof of prior credible coverage. The Plan will reduce the medical care pre-existing condition waiting period a month for every month of prior credible coverage.
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Medical / Prescription Drug / Dental Plans
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BCBS of IL Medical & RX Plan Overview
Deductible has a 3 x Family Maximum. Out of Pocket has a 2 x Family Maximum.
Plan Benefits In Network Out of Network
Lifetime Maximum Unlimited Unlimited
Calendar Year Deductible (In and out of Network Amounts Cross Apply)
$250 $500
Calendar Year Out of Pocket Maximum (In and out of Network Amounts Cross Apply)
$1,000 $3,000
Coinsurance 90% 70%
Office Visit Services (Consultation Only)
$25 70% after Deductible
Emergency Room $75; 90% after Deductible $75; 90% after Deductible
Urgent Care Facility 90% after Deductible 90% after Deductible
Pharmacy Prescription Drug Coverage (Generic / Brand Formulary / Brand Non Formulary)
$5 / $15 / $30 Copay; 75% after Deductible
Mail Order Prescription Drug Coverage (Generic / Brand Formulary / Brand Non Formulary)
$10 / $30 / $60 N/A
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BCBS of IL Dental Plans Overview
Annual Deductible has a 3 x Family Maximum. Orthodontia deductible has no Family Maximum.
Plan Benefits Dental Plan 1 Dental Plan 2
Eligibility TAs, Maintenance, Transportation & Food Service
Administrators & Secretaries
Annual Deductible $25 Per Member $25 Per Member
Annual Maximum $2,000 Per Member $2,000 Per Member
In Network Versus Out of Network In Network: Maximum Allowance
Out Network: Usual and Customary
In Network: Maximum Allowance Out Network: Usual and Customary
Preventive Services 100% 100%
Basic Services 80% 85%
Major Services 50% 50%
Orthodontia Services (Children up to age 23)
Not Covered 50%
Orthodontia Deductible Per Member Not Covered $50 Per Member
Orthodontia Lifetime Maximum Not Covered $1,000 Per Member
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BCBS of IL “Blue Access” For Members
Online Internet Site Provider Finder
News & Updates
Formulary RX List / Forms
View Current Enrollment
View Explanation of Benefits
Order ID Cards
Access to Blue Care Connection
Blue Points Redeemable for Prizes
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BCBS of IL “Blue Extras” Services For Members
24 Hour / 7 Day a Week Nurseline
Blue Care Advisors
Access to Health & Wellness
Special Beginnings
Tobacco Cessation
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BCBS of IL “Blue Extras” Discounts For Members
Alternative Medicine 35,000 providers
Vitamins / Herbal Supplements / Health Magazines
Weight Management Seattle Sutton, Jenny Craig, Lifetime Fitness
Vision Davis Vision
Hearing TruHearing
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Vision Plan
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VSP Vision Plan Overview
Plan Benefits In Network Out of Network
Eye Exam $10 Copay Up to $45 Allowance
Prescription Glasses $25 Copay Up to $70 Allowance
Frames Up to $130 Allowance Up to $70 Allowance
Lenses: Single Vision
Lenses: Bifocal Vision
Lenses: Trifocal Vision
Lenses: Lenticular Vision
$25 Copay
$25 Copay
$25 Copay
$25 Copay
Up to $30 Allowance
Up to $50 Allowance
Up to $65 Allowance
Up to $100 Allowance
Contact Lenses Up to $130 Allowance Up to $105 Allowance
Frequency: Exam
Frequency: Lenses
Frequency: Frames
Once Every 12 Months
Once Every 12 Months
Once Every 24 Months
Once Every 12 Months
Once Every 12 Months
Once Every 24 Months
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Flexible Spending Plan
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PayFlex
Plan Details Valley View School District 365U provides you the opportunity
to pay for out-of-pocket medical dental, vision, and dependent care expenses with pre-tax dollars.
Flexible Spending Account Annual Maximum Election: $2,500
Dependent Care Account Household Annual Maximum Election: $5,000
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PayFlex Transition FSA – HealthCare Expenses
Examples of Eligible Expenses Prescriptions Deductibles Copayments Coinsurance Vision Care Expenses Medical Care Expenses Dental Care Expenses
Examples of Ineligible Expenses Health care premiums
Expenses reimbursed by any other plan
Expenses you incur before you enroll in the plan
Expenses you claim as a deduction or credit on your federal income taxes
Over the counter equivalents (Unless Insulin or script from a provider)
Where can you find a list of eligible expenses?
Visit http://www.irs.gov/publications/p502/index.html
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Open Enrollment Recap
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Open Enrollment Recap
Open Enrollment Period: November 1st – November 30th
Medical and Dental elections will automatically continue with no paperwork required. Federal Government requires annual re-enrollment in FSA and Dependent Care accounts.
Forms are available at www.vvsd.org.
Elections are to be returned to Human Resources no later than Wednesday, November 30th 11:59pm. Effective Date of Elections are January 1, 2012.
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Questions?
Please Contact:
Lorrie Alsobrooks Administrative Assistant for Employee BenefitsValley View School District 365UPhone: 815-886-2700 x 233Email: alsobrooksl@vvsd.org
Renee Formell Insurance Consultant Mesirow Financial Insurance ServicesPhone: 312-595-7341Email: rformell@mesirowfinancial.com
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