fuse 2015 open enrollment december 2014. 2 agenda review all 2015 insurance benefits outline action...
TRANSCRIPT
Fuse 2015 Open Enrollment
December 2014
2
Agenda
• Review all 2015 insurance benefits
• Outline action items for enrollment / changes
• Q & A
3
Summary of 2015
• Health Insurance– Staying with Cigna– Staying with HRAs– Changes to HRA funding, EE OOP Exposure
& EE Contributions• Dental / Vision Insurance
– Changes to EE Contributions• Increased limits for FSA Plan• Increased benefits for STD Plan
4
Cigna
• 24/7 Customer Service• Extensive Provider Network• Competitive Rates• Customizable Plan Designs• Claims Processing
5
Health Insurance & HRAs
Annual Deductibles – no change
Single Two-Person / Family
$5,000 $10,000
HRA plan has changed to include an 80/20 co-insurance
6
Health Insurance & HRAs
How does the 80/20 co-insurance work?
1. EE pays first $500 / $1,000 (same as 2014)
2. Fuse / HRA pays 80% of remaining claims up to deductible
3. EE pays 20% of remaining claims up to deductible
Example (EE has a single plan):
EE receives $2,500 hospital bill • EE pays 100% of first $500• Fuse / HRA pays $1,600 (80%) and EE pays $400
(20%) of remaining $2,000
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How claims are paid
EE paysfirst
$500
Fuse HRA pays 80% (up to $3,600)
EE pays 20% (up to $900)
Cigna pays 100%
beyond $5K
Single Plan
$5,000
Excludes prescriptions: Rx $5 / $25 / $50 (up to $1,350) – no change
$0 $500
8
How claims are paid
EE Paysfirst$1K
Fuse HRA pays 80% (up to $7,200)
EE pays 20% (up to $1,800)
Cigna pays
100% beyond $10K
Two-Person / Family Plans
$0 $10,000 $1K
Excludes prescriptions: Rx $5 / $25 / $50 (up to $2,700) – no change
9
Health Insurance & HRAs
With the new 80/20 co-insurance:
Single
$500
+ 20% of all costs between $500 and $5K deductible
Max Med OOP Exposure = $1,400 (+$900 from 2014)
Two Person / Family
$1,000
+ 20% of all costs between $1,000 and $10K deductible
Max Med OOP Exposure = $2,800 (+$1,800 from 2014)
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What Cigna Covers
Preventive Care Paid at 100%, not subject to deductible
Office Visits 100% after $5K/$10K deductible
Inpatient Hospital 100% after $5K/$10K deductible
Outpatient Services 100% after $5K/$10K deductible
ER Visits 100% after $5K/$10K deductible
Chiropractic Care100% after $5K/$10K deductible Must use network provider, up to 20 visits per year
Prescriptions$5 / $25 / $50, not subject to deductibleMax OOP is $1,350 / $2,700 per year
Mental Health 100% after $5K/$10K deductible
Eye Exams Not covered
Lifetime Benefit Unlimited
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HRAs are administered by Cigna
– NO debit cards
– NO manual submissions
– HRA funds cannot be used for dental, vision or prescriptions
Health Reimbursement Accounts
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Health Reimbursement Accounts
HRA Overview
• HRA funds used to offset health insurance deductible
• “Promise to Pay” – this money is available to you only if you need it
• Any unused HRA funds stay with Fuse
• HRAs are funded solely by Fuse (no EE contributions)
• HRAs are not portable and revert back to Fuse upon separation of employment
13
Cigna Online
– Register for online access at www.mycigna.com
• View claim history
• View YTD deductible info
• Find a doctor
• Order new ID cards
• Download claims forms
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Employee Contributions
• Employee Monthly Payroll Contribution:
Single Two-Person Family
$75 $200 $320
+$10/mo +$30/mo +$20/mo
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Opt Out Bonus
– If you opt out of Fuse’s health plan AND can provide proof of your other coverage, you will receive:
Eligible for… Bonus (for 12 mo.)
Single $1,000
Two-Person $1,200
Family $1,500
2P / Family but enroll as single $500
*Bonus listed is earned / paid out via payroll each pay period.
16
Dental & Vision Insurance
• Self-funded plans managed by Northeast Benefits Management (NBM)– Health plan enrollment = auto-enroll in dental &
vision– If you opt out of health, you can still enroll in
dental & vision– Employees submit expenses online at
www.nbmus.com
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Dental / Vision Reimbursements
SERVICE REIMBURSEMENTPreventive
CleaningsX-Rays
Basic RestorativeFillings
ExtractionsEndodonticsPeriodontics
Major RestorativeCrowns
ImplantsDentures
CosmeticVeneers
Teeth whitening
Single $1,000/yearCouple $2,000/yearFamily $2,500/year
50% up to $1,000 per lifetime per member
DENTAL
100%
80%
50%
NONE
Maximums
Orthodontics
Single $200/year $100/yearCouple $400/year $200/year
MATERIALS (glasses/contacts)
EXAMS
VISION
$200/year per member
$100/year per
Family
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Dental & Vision Contributions
• Employee Monthly Payroll Contribution:
Single Two-Person Family
$10/mo $20/mo $20/mo
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FSA - Unreimbursed Medical
• Flexible Spending Accounts (FSA’s)– Managed by Northeast Benefits Management
(NBM)
– FSA funds can be used to pay for:• OOP Medical expenses • OOP Dental and Vision expenses• Rx co-pays
– $500 can be carried over!
– Contribution limit for 2015 is $2,550 (+$50)
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FSA - Dependent Care
• Dependent Care Account: managed by Northeast Benefits Management (NBM)
– Employees can set aside up to $5,000 of pre-tax pay per year per family to be used for Dependent Care (i.e. child care)
– Submit claims online at www.nbmus.com
– Forfeited by end of year if not used
21
Other Insurance Benefits
• Short-Term Disability– For illness, injury or maternity– Pays 66.6% of salary (up to 13 weeks)– Maximum benefit increased to $1,500 per
week
• Long-Term Disability– For illness or injury exceeding 90 days– Pays 60% of salary (max $6K per month)
22
2015 Health Insurance Renewal
• Every eligible employee must complete the checklist and applicable forms and return to Laurie by 12/17/14
• All forms and the checklist can be found on the intranet
• You can use Acrobat’s approval stamp; or print & sign, then email
23
Q&A
Questions?