choosing your medical plan columbia public schools plus plan basic plan

Choosing Your Medical Plan

Columbia Public Schools

PLUS

PLAN

BASIC

PLAN

MEDICAL PLAN:BASIC VS. PLUS

Part 1


Medical Plan Options


Basic Plan

Plus Planwith Health

Savings Account

Changes for 2013

Basic Plan

• No plan changes

• New premium rates for 2013

Plus Plan

• No plan changes

• New premium rates for 2013

Health Savings

Account (HSA)• District

contribution:• $400 to be

deposited on 1/30/13

• $200 to be deposited on 9/30/13

• $600 annual total for 2013*


*Prorated amounts for the part-time employee

What You Need to Do


If you are a Basic Plan participant and want to keep the Basic Plan• No action is required; your Basic Plan choice will roll to 2013• If you want to participate in the Traditional Flex Plan for 2013 (unreimbursed medical and dental

expenses), make your election on the green ASI Traditional Flex Plan enrollment form and return by November 30, 2012

• If you want to add a dependent, complete the green Basic Choice Add Dependent form

If you are a Plus Plan participant and want to keep the Plus Plan with HSA• Go to the yellow Plus Plan enrollment form to review the HSA eligibility questions and follow

instructions• Reminder—Make your 2013 HSA payroll deduction election now, as current deductions do not roll.

Decide how much you want to contribute to your HSA through payroll deductions, and enter your election for 2013 on the yellow Plus Plan form; return the election form by November 30, 2012

• If you want to participate in the Limited Flex Plan for 2013 (dental and vision reimbursement only), complete the yellow ASI Limited Flex Plan enrollment form and return by November 30, 2012

• If you want to add a dependent, complete the yellow Plus Plan Choice Add Dependent form

If you want to switch plans• Complete the green Basic Plan enrollment form, or the yellow Plus Plan enrollment form

If you want to flex your day care• Complete the ASI election form for 2013

Open Enrollment election forms are duein Business Services on November 30, 2012

What is the Basic Plan?

• $500 deductible (individual)

• $1,500 maximum out-of-pocket limit (individual)

• $15, $30, and $45 prescription drug copays

• Mail order copays: $25, $55, and $90 for90-day supply


The Basic Plan is our traditional health plan, with:

What is the Plus Plan?

• $1,400 deductible (individual)/$2,800 deductible (family)

• Prescription costs and other eligible expenses count toward the deductible

• 100% coverage after deductible is met, for in-network services

• Maximum out-of-pocket for individual coverage is $1,400; family maximum is $2,800, for in-network services

• If eligible, employee opens a Health Savings Account

• District contributes $600 annually to the employee’s Health Savings Account, lowering the total out-of-pocket maximum to $800 per year

• Employee makes pre-tax contributions to the Health Savings Account

• Use the Health Savings Account to pay for qualified medical expenses


What is the Plus Plan?

• A qualified high deductible health plan (QHDHP) that satisfies Internal Revenue Service requirements regarding deductibles, contributions, and out-of-pocket expenses

• The deductible on thePlus Plan meets theIRS guidelines forQHDHPs


QHDHP

What is a Health Savings Account?

• A Health Savings Account is a tax-free opportunity to save and pay for your qualified out-of-pocket health expenses

• A Health Savings Accountis associated only with aQualified High DeductibleHealth Plan (our Plus Plan)

• A Health Savings Accountis similar to, but differentfrom, a Flexible SpendingAccount


QHDHP

Comparison of Basic and Plus Plans

Effective January 1, 2013


Basic Plan

In-network Out-of-network

Deductible(per calendar year)

$500 single$1,000 family


Coinsurance 80% after deductible

70% after deductible

Out-of-pocket maximum (single/family)

$1,500/$3,000 (excludes

prescription copays)

$2,100/$4,200 (excludes


Prescription drugs Retail Mail Order

Generic $15 copay $25 copay

Preferred $30 copay $55 copay

Non-preferred $45 copay $90 copay

District contributionto Health Savings Account

None

Plus Plan

In-network Out-of-network


$1,400 individual$2,800 family





$1,200/$2,400 (includes

prescription costs)

$4,200/$8,400 (includes

prescription costs)

Prescription drugs

Prescription costs apply toward deductible, similar to other eligible

medical expenses

Generic

Preferred

Non-preferred


$600 for 2013

Basic Plan Plus Plan

In-network Out-of-network In-network Out-of-network











$1,500/$3,000 (excludes


$2,100/$4,200 (excludes


$1,200/$2,400 (includes

prescription costs)

$4,200/$8,400 (includes

prescription costs)

Prescription drugs Retail Mail Order

Prescription costs apply toward deductible, similar to other eligible

medical expenses





None $600 for 2013

Deductible Notes

Basic PlanFamily Deductible

NoteThe Basic Plan family

deductible is $1,000 per

year. The $1,000 can be a

combined deductible of all

of the covered family

members.

Remember that if one

individual in the family

meets the $500

deductible, insurance will

begin to pay on that one

individual.


Plus PlanFamily Deductible

NoteThe Plus Plan family

deductible is $2,800 per

year. This means that if

you have more than one

person on the Plus Plan,

you will need to reach the

$2,800 deductible before

ANY eligible expense will

be covered by insurance.

Once the deductible is

met, insurance pays 100%

of eligible expenses.

Health Savings Account Enrollment Eligibility


To be eligible to contribute to a Health Savings Account, you must:

• Be covered by the Plus Plan

• Not be covered by another health plan that is not a high deductible health plan– Not be covered by Medicare

– Not be covered by a spouse’s plan that hasa deductible of less than $1,200 for a single plan,or $2,400 for a family plan

– Not be covered by another plan that coversfirst dollar expenses, like prescription copaysor office visit copays

• Not be covered as a dependent on another’stax plan

Health Savings Account Enrollment Eligibility


The IRS does not allow you to “double-dip” on saving taxes on medical expenses!

This means:

• If you are married and your spouse has a traditional flexible benefits plan, you would not be eligible to contribute to a Health Savings Account

Enrollment Eligibility


Anyone can enroll Must be eligibleto contribute

Plus PlanHealth Savings Account

Health Savings AccountDistrict Contribution


• Amount of district contribution will be determined each year; cost is the difference between the Basic Plan premium and the Plus Plan premium

• If you are eligible for a Health Savings Account, the district will contribute $600 to the Health Savings Account over the course of the year for the full-time employee

• Example:

Deductible $1,400

District contribution - 600

Your total out-of-pocket expense

$800

Employee Basic Plan premium

$480

Employee Plus Plan premium

- 430

Difference $50

$50 x 12 = $600

Health Savings AccountDistrict Contribution


January $50

February $50

March $50

April $50

May $50

June $50

July $50

August $50

September $50

October $50

November $50

December $50

$50 x 12 = $600

} $400 deposited to Health Savings Account on January 31, 2013

$50 deposited to HSA$50 deposited to HSA$50 deposited to HSA$50 deposited to HSA

$200 on September 30, 2013

Health Savings Account Benefits


You can:• Contribute pre-tax money to your Health Savings

Account through payroll deduction, based on your health care needs; use the money in the Health Savings Account to pay for your health care expenses– Maximum contribution:

• Single coverage: $3,250 per year (max includes district’s amount)

• Family coverage: $6,450 per year (max includes district’s amount)

• Contribute an extra $1,000 into the Health Savings Account if you are over 55

• Contribute by making deposits in person at Landmark Bank

• Elect in November how much you want deducted from your paycheck

• Cannot change payroll deduction amount in 2013

Whose expenses can you pay for with your Health Savings

Account?


• Dependents’ expenses count if you claim them on your income tax return—even if dependents aren’t on CPS insurance plans

• Health Savings Account qualified expenses include:– Over-the-counter drugs must be prescribed by a doctor– Glasses, contact lenses, eye

exams– Dental expenses– Deductible (remember, you pay

100% of expenses up to first$1,400, including prescriptioncosts—less $600 annual districtcontribution)

Reminder

What other expenses arereimbursable from yourHealth Savings Account?


• Services not covered by the medical plan that do not count toward the deductible, such as:

– Well visits

– Sports physical costs

– Hearing aids

– Lasik eye surgery

Things to Remember AboutHealth Savings Accounts


• The district’s contribution helps offset your deductible and out-of-pocket maximum

• Payroll contributions (and other contributions) are tax-free• The money in your Health Savings Account is always your

money• If you leave employment or retire, the Health Savings Account

is still yours—it is portable• Earnings in your account grow tax-free• If you use this money for non-qualified expenses, you will be

taxed on the amounts spent plus 20% penalty• You can use the Health Savings Account for medical expenses

after employment ends, as the money is always yours• After age 65, you can pay CPS retiree premiums with your

Health Savings Account• The balance in your account rolls from year to year• You will have to plan on how you will pay for expenses during

the first part of the year when your Health Savings Account balance hasn’t had time to accumulate

How to Get Money Out of Your Health Savings Account


• Pay the doctor/provider directly from your Health Savings Account debit card or check

OR

• Pay the doctor/provider directly with yourown cash, check, or credit card, then later write a check to yourself from your HealthSavings Account for expenses

• Keep documentation of theexpenses for your records,in the event of an audit

It’s simple:

Tax ReportingRecordkeeping Requirements


• W-2 will show your payrollcontributions

• Bank issues Form 5498 each year in May, which reports employer and employee contributions

• Form 8889 is completed with yourincome tax return to determine anyexcess contributions or taxabledistributions. Form 8889 is simple:– Report your contributions– Report your expenses (keep your

documentation of expenses)– Report any taxable distributions

It’s simple:

Example: Minimal User


* $75 toward deductible plus$30 Rx copay = $105

** $285 toward deductible

Anticipated expenses after PPO and Rx discounts

Basic Plan($500 deductible)

Doctor visits (assume $75 per visit) $75

Prescription drugs (retail): Generic Preferred Non-preferred

$30

Total medical cost $105

Deductible $500

Coinsurance (plan pays) after deductible 80%

Out-of-pocket cost for health care expenses $100*

District contribution to HSA

Net out-of-pocket $105 cost


Plus Plan($1,400 deductible)



$210


Deductible $1,400


Out-of-pocket cost for health care expenses $285**

District contribution to HSA $600

Net out-of-pocket $315 savings




Doctor visits (assume $75 per visit) $75 $75


$30 $210

Total medical cost $105 $285

Deductible $500 $1,400

Coinsurance (plan pays) after deductible 80% 100%

Out-of-pocket cost for health care expenses $100* $285**


Net out-of-pocket $105 cost $315 savings

Example: Average User



** $1,078 toward deductible





$40

$120


Deductible $500


Out-of-pocket cost for health care expenses $610*

District contribution to HSA






$200

$644

Total medical cost $1,294

Deductible $1,400


Out-of-pocket cost for health care expenses $1,294**






Doctor visits (assume $75 per visit) $450 $450


$40

$120

$200

$644

Total medical cost $610 $1,294



Out-of-pocket cost for health care expenses $610* $1,294**


Net out-of-pocket $610 cost $694 cost


** $1,294 toward deductible

Example: Above Average User

* Out-of-pocket maximum ** $1,400 toward deductible*** $1,500 out-of-pocket max

plus $2,600 Rx copays = $4,100



Doctor visits (assume $75 per visit) $1,800


$360 $150$2,090

Surgery $7,500

Hospital $22,000

Other eligible expenses $5,000


Deductible $500


Out-of-pocket cost for health care expenses $1,500*


Net out-of-pocket cost (savings) $4,100*** cost




Doctor visits (assume $75 per visit) $1,800


$1,015 $904$8,721

Surgery $7,500

Hospital $22,000

Other eligible expenses $5,000


Deductible $1,400


Out-of-pocket cost for health care expenses $1,400**


Net out-of-pocket cost (savings) $800 cost




Doctor visits (assume $75 per visit) $1,800 $1,800


$360 $150$2,090

$1,015 $904$8,721

Surgery $7,500 $7,500

Hospital $22,000 $22,000

Other eligible expenses $5,000 $5,000

Total medical cost $38,900 $46,940



Out-of-pocket cost for health care expenses $1,500* $1,400**

District contribution to HSA $0 $600

Net out-of-pocket cost (savings) $4,100*** cost $800 cost

The Big Picture

How much can you save over the yearsby having a Health Savings Account?

Account balance rolls over year to year

• Employer ($600 for 2013)

• Employee

• Payroll deduction

• In-person deposits at bank Health Savings Account

Plan CostsEffective January 1, 2013

* District-paid


Covering Basic Plan Plus Plan

Full-time employee only $480* $430*



Retiree (non-Medicare) $480 $430

Retiree (Medicare) $364 $328





Spouse $472 $426

Spouse of retiree (non-Medicare)

$472 $426

Spouse of retiree (Medicare) $354 $318





Spouse $472 $426


$472 $426


One child $220 $194

Children $374 $334





Spouse $472 $426


$472 $426


One child $220 $194

Children $374 $334

Spouse and one child $692 $620

Spouse and children $846 $760

How to Choose

• Think about your health care expenses; are you a minimum user, average user, or above average user?

• Don’t forget to count in the district’s Health Savings Account contribution

• If you have family coverage, remember to count premium savings as you weigh your choice

• Consider these factors:– Deductibles– Out-of-pocket maximums– Prescription costs

• Plan how you would pay for unexpected expenses early in the year with the high deductible (Plus Plan) Columbia Public Schools

FLEX PLAN:TRADITIONAL VS. LIMITED

Part 2


Flex Plan Options

Basic Medical Plan

TraditionalFlex Plan

Plus Medical Plan with

Health Savings Account

LimitedFlex Plan


Flex Plan Qualified Expenses

Traditional Flex Plan• Deductibles• Prescription copays• Glasses, eye exams, contacts• Lasik eye surgery• Dental expenses• Hearing aids• Orthodontic expenses• Over-the-counter drugs (must

be prescribed by a doctor)• Other services not covered by

the medical plan

Limited Flex Plan• Dental expenses• Glasses, eye exams, contacts• Orthodontic expenses


NO MEDICAL

$2,500 maximum allowed

$2,500 maximum allowed

Basic Plan Plus Plan with HSA

Enroll in the Plus Plan and Pay Your Out-of-pocket Expenses Like

This

You can have:Pre-tax payroll deductionsto Health Savings Account

plus district’s contribution toHealth Savings Account

Health Savings Account Limited Flex

You can have:Pre-tax payroll deductions to

limited flex

Contribution maximum:Single: $3,250 (includes district contribution)Family: $6,450 (includes district contribution)

Contribution maximum:$2,500

HSA Qualified ExpensesPrescriptionsDeductibles

Over-the-counter drugs (if prescribed by a doctor)

Hearing aidsLasik eye surgery

GlassesVision exams

ContactsDental

Limited Flex Qualified Expenses

NO MEDICAL

GlassesVision exams

ContactsDental

AND

Reimbursable under Health Savings

Account or Limited Flex

HSA and Flex Plan Qualified Expenses

• The HSA and Flex Plan share the same list of eligible and ineligible expenses

– In your open enrollment packet, see the Frequently Asked Questions about HSAs

– On the back of the Frequently Asked Questions page is a listof eligible and ineligible expenses for the HSA

– The same list applies to both plans


Open Enrollment

• Employees can add a dependent to the medical plan of their choice

• Coverage begins January 1

• Form to add a dependent to the plan must be received by Business Services by November 30

Deadline for open enrollment is November 30, 2012


Open Enrollment

• You will be allowed to choose between the plans each year during open enrollment

– If you enroll in the Plus Plan for 2013, accumulate a balance in your Health Savings Account, and decide at a subsequent open enrollment that you wish to switch to the Basic Plan, you may do so; once the money is in your Health Savings Account, it belongs to you

– However, as long as you are enrolled in the Basic Plan, you will not receive any new Health Savings Account contributions from the district, and you may not put additional money into the Health Savings Account yourself



Open Enrollment



November 2012Sunday Monday Tuesday Wednesday Thursday Friday Saturday

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4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30

Thanksgiving

Medical Plan Enrollment Choices

Basic Plan

1. No action is necessary for employees wanting the Basic Plan, which is similar to the current plan only with a higher deductible and increased prescription copays

2. Can add a dependent to medical plan in November


BASIC

PLAN

Medical Plan Enrollment Choices

Plus Plan

1. Employee completes enrollment form and submits by November 30

2. Can add a dependent to medical plan at this time

3. Employee completes payroll deduction form for Health Savings Account contribution

4. If employee is a new participant, employee opens account with Landmark Bank– Name the beneficiary for your

account– Choose checkbook or debit card or

both– No monthly fee– Earnings grow tax-free


PLUS

PLAN

Other Enrollment Options

• Traditional Flex Plan– For those enrolled in the Basic Plan– Election form required for 2013

election

• Limited Flex Plan– For those enrolled in the Plus Plan– Election form required for 2013

election

• Dependent Care Reimbursement– Flexing your day care– Election form required for 2013

election Columbia Public Schools


Additional Information on the Employee Benefits Web Site

• Plan comparison—How to choose

• Decision calculator• Prescription drug information

—Medtrak Pharmacy Web site

• FAQ on HSAs• Landmark Bank brochure for

HSA


Kelly RichBenefits AssistantColumbia Public Schools1818 W. WorleyColumbia, MO 65203(573) [email protected]

http://www.columbia.k12.mo.us/bcs/bcsbus/EmplBen.htm

Jane HarmonBenefits ManagerColumbia Public Schools1818 W. WorleyColumbia, MO 65203(573) [email protected]

Your Homework

• Go to the Employee Benefits Web site and click on Plan Comparison Calculator for assistance in making your choice.

• You will need information about your prescription usage for the calculator. An easy way to get your prescription history is to go to the MedTrak Pharmacy Web site.– If you haven’t already done so, please register at MedTrak’s online services,

to view your prescription history costs. This valuable tool can help you make your enrollment choice. For prescription drug information, go to www.medtrakservices.com and click on the Members tab at the top. Go to Need to Register?. For the Cardholder ID entry, enter the number from your medical ID card. Next, log in by creating a user ID and password. You will have access to a history of your prescription drug purchases, your costs, and total cost of your prescriptions. The MedTrak information will help you carefully analyze your prescription drug use and cost. To get the total cost of the drug, add your copays and the plan costs together.

– NOTE: If you don’t have computer access, contact your pharmacy and ask for a statement of your account for the past year. Be sure to ask for the history of the copay amounts you paid aid the true cost of the drug. This will help you carefully analyze your prescription use and cost.


http://www.medtrakservices.com/

Choosing Your Medical Plan


PLUS

PLAN

BASIC

PLAN

Comparison of Basic and Plus Plan 2013


Basic Plan Plus Plan

In-network Out-of-network In-network Out-of-network

Deductible (per calendar year)

$500 individual$1,000 family

$600 individual$1,200 family



Coinsurance 80% after deductible 70% after deductible 100% after deductible 70% after deductible

Out-of-pocket maximum (individual/family)

$1,500/$3,000 (excludes prescription copays)

$2,100/$4,200 (excludes prescription copays)

$1,400/$2,800 (includes prescription costs)

$4,200/$8,400(includes prescription costs)

Childhood immunizations

100% 100% 100% 100%

Hospitalization (pre-certification required)

80% after deductible 70% after deductible 100% after deductible 70% after deductible

Other covered medical services

80% after deductible 70% after deductible 100% after deductible 70% after deductible

Mental illness/nervous disorders

80% after deductible; 90 days max/yr




Chemical dependency (inpatient)





Prescription drugs Retail Mail Order Prescription costs apply toward deductible, similar to other eligible medical expenses




District contribution to Health Savings Account

None $600 annually

choosing your medical plan columbia public schools plus plan basic plan

Documents

plan basic plan slide

traditional health plan

plus plan participant

basic plan choice

basic plan participant

yellow plus plan form

health savings account

yellow plus plan choice