Transcript Out-of- pocket limit - Wittenberg University

Benefits Open Enrollment
Meeting
Effective January 1, 2012
© 2010 Wittenberg University Springfield, Ohio 45501
I.
Review of the Year
Agenda
II.
Medical Insurance

Plan Design Review- No plan changes

Contributions - Medical
III.
Dental Insurance
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Plan Design Review- No plan changes

Dental separate from Medical effective 1/1/ 2012

Contributions- Dental
IV.
Vision Plan
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Plan Design Review-No plan changes

Contributions- No changes
V.
Flexible Spending Account
VI.
Enrollment Process and Deadlines
VII.
Resources
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www.anthem.com
www.tasconline.com
Express Scripts
HR Webpage
© 2010 Wittenberg University Springfield, Ohio 45501
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The Year in Review
Total cost of medical claims for our renewal
experience period: $1,484,925
Total cost of prescription drug claims:
$863,814
Total Medical/Rx claims cost: $2,348,739
Total Cost of top 5 claims… $309,316
None of our high claimants exceeded our
$125,000 stop loss limit
© 2010 Wittenberg University Springfield, Ohio 45501
The Year in Review
Total cost of plan in 2010- $5,009,644
Projected cost of plan Oct 1, 2010- July 31,
2011 – $3,651,894
Actual cost of plan- $2,872,271
Projected 14% increase Oct. 2011 - note
rates will stay same through calendar yr. and
possibly through fiscal year.
© 2010 Wittenberg University Springfield, Ohio 45501
General Information
• Plan is Effective 01/01/2012
• 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 +children plan, & Family plan
• BIG CHANGE – Because of implications resulting from
the Health Care Reform Act, it is necessary to split out
the medical and dental premiums effective Jan. 1 2012.
© 2010 Wittenberg University Springfield, Ohio 45501
General Information
•
Open Enrollment for 2011- Oct. 12th - Nov. 11th
• Qualifying Event – You can only join a plan or make benefit
election changes during an open enrollment period unless you
experience a qualifying life event change as defined by IRS.
• Examples: change in marital status, birth or adoption of a child,
change in spouse’s employment status. You must contact Human
Resources to complete an enrollment form within 31 days of the
event.
© 2010 Wittenberg University Springfield, Ohio 45501
Glossary of Terms
•
Co-pay – a flat dollar amount that is paid at the time of service. Co-pay
does not apply to the deductible
•
Deductible – annual amount of money a member must pay before
benefits are paid at the co-insurance % .
•
Co-insurance – a percentage that a member pays for services received
after they have met their deductible. Member pays in full
until deductible is met.
•
Out-of- pocket limit – the most an employee would pay in deductible
and co-insurance during a plan year (Jan-Dec) for
healthcare services excluding prescription drugs.
Services with a % = Co-insurance
Services with a $ = Co-pay
.
© 2010 Wittenberg University Springfield, Ohio 45501
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Wittenberg’s
Blue Access PPO Health Plan
MEMBER PAYS
Deductible
Emergency Room Services
$400 individual /$800 family
10% after deductible
In-Network Benefit
Out-of-Pocket Limit
Physician Office visits
Preventive Care visits
Urgent Care
Inpatient/Outpatient Services
$1,200 individual /$2,000 family
$20 co-pay
Covered at 100%
$20 co-pay
10% after deductible
© 2010 Wittenberg University Springfield, Ohio 45501
Wittenberg’s PPO Health Plan
Out-of-network benefit
Out-of- Pocket Limit
$1,300 individual /$2,200 family
Physician Office visits
Preventive Care visits
Urgent Care
Inpatient/Outpatient Services
30% after deductible
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.
© 2010 Wittenberg University Springfield, Ohio 45501
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 (“OOP”)
There is a separate out-of-pocket limit for in-network and out-of-network
co-insurance expenses.
Co-insurance costs for services received in-network only apply to
the in-network OOP. Co-insurance costs for services received out-ofnetwork only apply to the out-of-network OOP.
In-network - $1,200/$2,000
Out-of-network - $1,300/$2,200
© 2010 Wittenberg University Springfield, Ohio 45501
Wittenberg Prescription Benefit
Prescription Drug Retail
Express Scripts
Prescription Drug Mail Order
Prescription co-pay OOP limit
$10/$25/$40
$20/$50/$80
3-month supply
$1,200 single/$2,000 family
Note: Prescription OOP limit is completely separate and unrelated to the OOP
for medical.
© 2010 Wittenberg University Springfield, Ohio 45501
How to Find a Provider
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www.anthem.com
Click on “Find a Doctor” in the middle of the page
Choose the state that you want to search
Choose a Plan (PPO)
Choose the type of Provider you want to find
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
© 2010 Wittenberg University Springfield, Ohio 45501
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Healthcare Reform Reminders
• Preventive care is covered at 100% (in network)
• Dependent children are eligible up to the end of
the month in which they turn 26
• Lifetime Maximum on the medical plan is unlimited
• No Pre-Existing condition clause for children under
age 19
© 2010 Wittenberg University Springfield, Ohio 45501
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Monthly Contributions- Medical
No Cost Increase in Calendar Year 2011
Plan Type
Total Cost
Annual/Monthly
Wittenberg 80%
Annual/Monthly
Employee 20%
Annual/Monthly
$5,556.00/$463.00
$4,440.00/$370.00
$1,116.00/$93.00
Employee Plus
Spouse
$13,884.00/$1,157.00
$11,112.00/$926.00
$2,772.00/$231.00
Employee Plus
Children
$13,428.00/$1,119.00
$10,740.00/$895.00
$2,688.00/$224.00
Family
$20,688.00/$1,724.00
$16,548.00/$1,379.00
$4,140.00/$345.00
Single
© 2010 Wittenberg University Springfield, Ohio 45501
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Wittenberg Dental Blue Complete
Plan
Deductible
Annual Maximum (per covered member)
Diagnostic and Preventive
Minor Restorative
Oral Surgery
Endodontic Services
Periodontal Services
Prosthodontic Services
Orthodontic Services
Orthodontic Lifetime Maximum
Orthodontic Age Limit
© 2010 Wittenberg University Springfield, Ohio 45501
MEMBER PAYS
$25 single /$75 family
$1,500
No Charge to member
20% after deductible
20% after deductible
20% after deductible
20% after deductible
50% after deductible
50% no deductible
$1,000
Child to age 19
Monthly Contributions- Dental
No Cost Increase in Calendar Year 2011
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
© 2010 Wittenberg University Springfield, Ohio 45501
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Managing Health Care Costs
• Use in-network providers whenever possible.
• Take advantage of preventive care benefits. Schedule an
annual physical every year.
• Only use the Emergency Room for Life Threatening
Emergencies. Utilize Urgent Care centers or
Convenience Care Clinics after hours for non-emergency
situations.
• If you are scheduling tests such as: X-Ray/MRI/CT scan
use free-standing facilities verses hospitals when
available.
• Take advantage of the retail prescription discount
programs such as the $4 offerings at Wal-Mart, Target,
Kroger etc.
• Use Mail order for Maintenance medications.
© 2010 Wittenberg University Springfield, Ohio 45501
Claims Assistance
If you are having trouble resolving a claim
issue USI Insurance can assist you.
If after you have reached out to Anthem
your questions were not answered or it is
a complex claim issue please contact
Paula Meyers at 1-877-778-7469 or you
can email her at [email protected].
© 2010 Wittenberg University Springfield, Ohio 45501
Anthem Blue View Vision Benefit Plan
for Active Employees
Network Benefits
Routine Eye Exam (once every 12 months)
Eyeglass Frames (once every 24 months)
$10 co-pay
$100 allowance/20% off the remaining balance
Eyeglass Lenses (standard)
Standard Plastic Single vision lenses (1 pair)
Standard Plastic Bifocal lenses (1 pair)
Standard Plastic Trifocal lenses (1 pair)
$15 co-pay, then covered in full
$15 co-pay, then covered in full
$15 co-pay, then covered in full
Eyeglass lens upgrades
Standard Polycarbonate
Standard Progressive
Anti reflective coating
Other add-ons and services
$15 co-pay per upgrade
$40 co-pay
$65 co-pay standard
$45 co-pay
20% off retail price
Contact Lenses Elective
Conventional Lenses
Elective Disposable Lenses
Non-Elective contact Lenses
$105 allowance/15% off the remaining balance
$105 allowance (no add’l discount)
Covered in Full
UV coating, Tint, Standard Scratch-Resistance
© 2010 Wittenberg University Springfield, Ohio 45501
Active Employee Monthly Contributions
Vision Plan
Plan Type
Single
Employee Plus One
Family
Contributions are tax -sheltered
© 2010 Wittenberg University Springfield, Ohio 45501
Employee Monthly
$3.00
$6.00
$10.00
Flexible Spending Account (FSA)
By using PRE-TAX dollars, Flexible Spending Accounts help you take
advantage of tax savings on eligible health care and dependent care expenses.
Wittenberg offers you two reimbursement accounts:
1. Health Care Reimbursement Account
(for your eligible health care expenses not covered by insurance)
2. Dependent Care Reimbursement Account
(for reimbursement of day care expenses for eligible dependents).
TASC
Third Party Administrator
tasconline.com
© 2010 Wittenberg University Springfield, Ohio 45501
FSA - What is it?
• You set aside funds in an FSA to cover your out-of -pocket medical or dependent care
costs. You need to decide upfront how much money you want to elect for the calendar
year.
• Voluntary election of payroll deductions on a pre-tax basis. Savings of nearly
30% is the Rule of Thumb – Use the TASC On-line Tax Savings Calculator
to estimate your tax savings. http://www.tasconline.com/buytasc/flexsystem/
• You cannot change your election unless you have a qualifying event. Also,
you cannot transfer money from one account to another.
• “Use it or Lose it” - You have a grace period of three months after the end
of the calendar year to submit claims for eligible expenses incurred during
the previous calendar year. Any money left in your account after the three
months will be forfeited.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA – Enroll Now
for Jan. 1, 2012 effective date
Healthcare FSA
• $3,000 annual maximum limit
• You have immediate access to your full election at the onset of
the calendar year even though the full election has not been
deducted from your pay.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA - Enroll Now
for Jan. 1, 2012 effective date
Dependent Care FSA
• If married, spouse must work or attend school full-time
• Maximum - $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 for 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.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA
Reimbursement
• You can request reimbursement by
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Fax – 608-663-2762
Mail – TASC, P.O. Box 7308 , Madison, WI 53707-7308
On-line – www.tasconline.com
• 24-hour turnaround on reimbursements via Direct Deposit.
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Use the FlexSystem Claim Card for seamless real-time payments.
You can also order a card for your spouse.
• Instant account status availability on-line or via FlexSystem’s voice
response system.
• Toll-free customer service assistance 800-422-4661
© 2010 Wittenberg University Springfield, Ohio 45501
FSA Card
How to use your Claim Card:
You may use the card like a credit card when you pay for eligible
expenses at the point of service. The funds are automatically deducted from
your Flex Account balance. It is important to remember that you may still
need to submit substantiation upon request.
Where to use the card:
•Medical and dental physicians
•Vision care providers
•Medical facilities
•Drug stores and in-store pharmacies
•Hospitals including emergency rooms
•Dependent care providers who accept Visa
© 2010 Wittenberg University Springfield, Ohio 45501
Medical, Dental and Vision
Open Enrollment
You need to complete an enrollment form if:
You want to enroll in the Medical, Dental or Vision Insurance programs for the first time
You want to add or drop your spouse or dependents from your coverage
You want to cancel your one or more of the plans your currently participate in
You DO NOT need to complete any paperwork if:
You are currently enrolled in the medical and dental plan; want to remain on both plans
and do not want to add or drop your spouse or dependents
Reminder: Employees can enroll in Medical and/or Dental independently.
DEADLINE TO TURN IN FORMS IS NOVEMBER 11th .
New Anthem ID cards will be mailed to your home addresses.
© 2010 Wittenberg University Springfield, Ohio 45501
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FSA Open Enrollment
 Anyone who wants to participate in an FSA must
enroll or re-enroll for 2012.
 If you were enrolled in 2011, an email will be sent to
you with re-enrollment information and you can
re-enroll online. If you are enrolling for the first time,
you’ll need to complete a paper enrollment form.
Enrollment DEADLINE IS NOVEMBER 11th .
If you are re-enrolling please keep your existing TASC cards (no
new cards will be sent). New enrollees will get an email about
the card and information will be mailed to your home address
about 10 days after enrolling.
© 2010 Wittenberg University Springfield, Ohio 45501
Questions?
THANK YOU FOR YOUR TIME!
© 2010 Wittenberg University Springfield, Ohio 45501
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