Transcript Salt Lake Community College

Salt Lake Community College
Open Enrollment 2015-2016
WHAT’S NEW FOR 2015-2016
Voluntary Vision Plan – EMI Health
VRX - Pharmacy Administrator for Traditional
Plans
Qualified High Deductible Health Plan (QHDHP)
HealthSparq – Comparison Tool (All Plans)
Health Savings Account – NBS
Employee Options
May 1st – May 22nd
• Enroll or make changes to your health
insurance
• Enroll in a Health Savings Account (HSA) or
Reenroll in the Flexible Spending Account
(FSA)
• Enroll in the Voluntary Vision Plan
• Enroll or increase coverage for Voluntary Life
OPEN ENROLLMENT
May 1st THROUGH May 22nd
IF YOU DO NOT MAKE A MEDICAL AND/OR DENTAL
ELECTION PRIOR TO MAY 22nd, YOU AND ANY
ENROLLED DEPENDENTS WILL REMAIN IN THE
SAME PLAN/NETWORK FOR THE 2015/2016 PLAN
YEAR.
OPEN ENROLLMENT ELECTIONS CANNOT BE MADE
AFTER MAY 22, 2015.
EMI Health VSP Vision
Plan
Vision Plan
Customer Service
Medical & Dental Benefits
Open Enrollment 2015-2016
DENTAL RATES 2015-2016
2014/15
2015/16
Employee
$2.25
$2.25
Two-Party
$3.75
$3.75
Family
$5.95
$5.95
MEDICAL RATES 2015-2016
PAR
TRADITIONAL PLAN
QHDHP
2014/15
2015/16
2014/15
2015/16
Employee
$48.50
$51.21
N/A
$36.92
Two-Party
$109.00
$115.10
N/A
$82.91
Family
$152.00
$160.50
N/A
$115.50
PVC
TRADITIONAL PLAN
QHDHP
2014/15
2015/16
2014/15
2015/16
Employee
$25.00
$26.53
N/A
$13.42
Two-Party
$56.00
$59.44
N/A
$29.91
Family
$77.50
$82.27
N/A
$41.00
PFP
TRADITIONAL PLAN
QHDHP
2014/15
2015/16
2014/15
2015/16
Employee
$7.50
$7.50
N/A
$0
Two-Party
$17.00
$17.00
N/A
$0
Family
$23.50
$23.50
N/A
$0
ONLINE ENROLLMENT
• Click the Regence Online Enrollment link on
the HR website – May 1st – May 22nd
• Click “Create an Account”
• Identify yourself and then create a User ID and
Password
• Begin open enrollment process
Online Enrollment Assistance
5 a.m. to 5 p.m. MDT
855-216-8125
ONLINE ENROLLMENT
ONLINE ENROLLMENT
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Maintain personal information
View important benefit information
Compare plans
Initial changes throughout the year
Manage account information
Link to other benefit websites
NETWORK OPTIONS
HOSPITALS
100%
82%
Includes all
IHC hospitals
+ all others in
Utah
Participating
Traditional
Includes the
UofU, Mtn Star,
IASIS,
independent
and rural IHC
Preferred ValueCare
Includes UofU
& Mtn. Star
23%
Focal Point
All networks include Huntsman Cancer and Primary Children's
PROVIDERS
9400
9220
Includes all
IHC InstaCare
and KidsCare
Clinics
Includes
After Hours
Medical and
First Med
Urgent Care
Centers
3433
Participating Traditional
Preferred ValueCare
Focal Point
DENTAL PROVIDERS
1,275 GENERAL DENTISTS
291 SPECIALISTS
OVER 100,000 ACCESS POINTS NATIONWIDE
BENEFITS
CHANGES FOR 2015-2016
TRADITIONAL PLANS
DEDUCTIBLE
In-network changing from $200/$400 to $400/$800
Out-of-network changing from $500/$1,000 to $1,000/$2,000
OUT-OF-POCKET MAX
In-network changing from $2,700/$5,400 to $2,900/$5,800
Out-of-network changing from $4,500/$9,000 to $5,000/$10,000
OFFICE COPAYMENTS
Primary/Specialists changing from $25 per visit to $30 per visit
OTHER
Out-of-network Inpatient Admits through ER paid as in-network
NEW QHDHP
Covered Service
In-Network
Out-of-Network
Deductible
$1,500 single
$3,000 family
$3,000 single
$6,000 family
Out-of-Pocket Max
$3,000 single
$6,000 family
$6,000 single
$12,000 family
Coinsurance
After deductible, you pay 10%
After deductible, you pay 30%*
Office/Urgent Care
After deductible, you pay 10%
After deductible, you pay 30%*
Covered at 100%
After deductible, you pay 30%*
Retail
Mail-order
Preventive Care
After deductible, you pay:
Generic
$7
$7
Preferred
25% to a max of $150
25% to a max of $300
Non-Preferred
30% to a max of $175
30% to a max of $437.50
Specialty
*balance billing applies
10% to a max of $250 for generic & preferred
15% to a max of $300 non-preferred
Optimum Value
Value-based medications
Deductible waived on QHDHP for medications used to prevent
or manage chronic conditions:
Depression
Cardiovascular Disease
Diabetes
High Cholesterol
Osteoporosis
Asthma
PLAN COMPARISON
Traditional Plan
HDHP
$3,852 PAR
$1,975 PVC
$564 PFP
$2,772 PAR
$984 PVC
$0 PFP
Deductible
$400 per individual
$800 family
$100 / $300 pharmacy
$1,500 single
$3,000 family
N/A
Coinsurance
80/20%
90/10%
$2,900 per individual
$5,800 family
$2000 / $6000 pharmacy
$3,000 single
$6,000 family
N/A
N/A
$1,200*
Annual Premium
Family Coverage
Out-of-Pocket max
2015-2016 SLCC Annual HSA
Contribution*
*SLCC will contribute $100 per month into an employees HSA account for employees
enrolled as single or family coverage in the QHDHP.
EXAMPLE 1 - SINGLE
Example:
Individual
Deductible/Coinsurance
Traditional
HDHP
$2,000 in medical expenses
Deductible: $400
20% Coinsurance: $320
Member Total = $720
Deductible: $1,500
10% Coinsurance = $50
Member Total = $1,550
N/A
$1,200*
($1,280)
($450)
HSA Pays
N/A
($1,200)*
Member Balance
$720
$350
Member Savings
N/A
$370
Annual Premium-Single
Coverage - ValueCare
$637
$315
Annual Premium Savings
N/A
$322
2015-2016 SLCC HSA
Contribution
Insurance Pays
*SLCC will contribute $100 per month into the employee ‘s HSA account
EXAMPLE 2 - FAMILY
Example:
Individual
Deductible/Coinsurance
Traditional
HDHP
$35,000 in medical expenses
Deductible: $800
20% Coinsurance: $5,000
Member Total = $5,800
Deductible: $3,000
10% Coinsurance $3,000
Member Total = $6,000
N/A
$1,200*
($29,200)
($29,000)
N/A
($1,200)*
Member Balance
$5,800
$4,800
Member Savings
N/A
$1,000
Annual Premium-Family
Coverage – ValueCare
$1,975
$984
Annual Premium Savings
N/A
$991
2015-2016 SLCC HSA
Contribution
Insurance Pays
HSA Pays
*SLCC will contribute $100 per month into the employee ‘s HSA account
EXAMPLE 3 – PHARMACY
Traditional
HDHP
$100 per individual
$300 per family
Subject to medical
deductible
$1,500 single
$3,000 family
$272 per script
$272 per script
Deductible: $100
25% Coins = $43
Member total = $143
Deductible = waived =
Optimum Value
25% Coins = $68
Member total cost = $68
2015-2016 SLCC Annual
HSA Contribution
N/A
$1,200
HSA Balance
N/A
$1,132
Example:
ExampleSymbicort
3 - Pharmacy
– Preferred/Formulary Medication
Pharmacy Deductible
Average Cost of Medication
Patient Balance
*SLCC will contribute $100 per month into the employee ‘s HSA account
EMPLOYEE TOOLS
HEALTHSPARQ
Shopping Tools do Work
Affordable care options exist today
Ogden Regional Medical Ctr
Total: $4,200 - $6,100
OOP: $1,450
St Marks Outpatient Surg Ctr
Total: $2,100 - $2,500
OOP: $850
Central Utah Surgical Center
Total: $1,300 - $2,200
OOP: $750
Tonsillectomy and
adenoidectomy (Under
age 12) in Utah
Components of health care shopping
balance cost, quality, convenience, and social content
quality
convenience
cost
social
Enable Transactions and Services
Conveniences
Toll-free concierge services
50 N Medical Drive, Salt Lake City, UT 84108
Online appointment
scheduling
High-Deductible Health Plan
• HSAs can only be offered with a high-deductible health
plan (HDHP).
• Though the deductible is higher for a HDHP plan than a
traditional plan, your monthly premium is lower, and HSA
funds can pay for medical expenses subject to the
deductible.
Employer Contribution
• For 2015-2016, SLCC will
contribute $50 per paycheck into
each employee’s HSA effective
July 1, 2015.
• Future SLCC contributions will be
evaluated on a year to year basis.
Benefits of an HSA
• Triple tax advantage means you save money on
your health care expenses
• Funds rollover each year, so you can use your
HSA to save tax-free money for retirement
• You own the account, even if you leave the
company
• Lower monthly premiums for a HDHP than a
traditional health plan
How Does The HSA/HDHP Work?
• You and your employer contribute money to
the HSA (either a lump sum payment or
monthly through payroll deductions).
• You can use HSA dollars to pay your health
insurance deductible, along with other
qualified medical expenses such as dental or
vision services.
• Once you meet your deductible, your insurance
pays additional covered expenses in
accordance with our plan.
Who is Eligible for an HSA?
• Anyone who is:
– Covered by an HDHP
– 18 years or older
– Not enrolled in Medicare
– Not covered under other health insurance*
– Not another person’s tax dependent
* Other health insurance does not include: specific
disease or illness insurance, accident, disability, dental
care, vision care and long-term care insurance
Examples of Medical Benefits That
Make Someone Ineligible for an HSA?
• Medicare
• Tricare Coverage
• Flexible Spending Arrangements
• Health Reimbursement Arrangements
Ineligible Medical Expenses
• Expenses that are not considered “qualified medical
expenses” include:
– Insurance premiums (other than the exceptions
listed previously)
– Over-the-counter drugs (unless a prescription is
retained from a physician – insulin is an exception)
– Surgery purely for cosmetic reasons
– Expenses covered by another insurance plan
– General health items such as tissues, toiletries,
hand sanitizer
Definition of Dependent
• For health insurance a dependent can be
covered to age 26 regardless of status.
• HSA funds cannot be used for medical
expenses incurred by a child who is not
claimed as a dependent on your tax return.
• Those dependents can still be covered on your
HDHP.
Recordkeeping
• Whenever you use HSA funds to pay for a
medical expense, you should keep your receipt.
• You may need to demonstrate to the IRS that
HSA distributions were for qualified medical
expenses.
• If the IRS requests receipts for verification
purposes, failure to provide those receipts
could result in having to pay a penalty.
Administration Fee
• There is a $1.50 per paycheck administration
fee, if you enroll in the FSA, Dependent Day
Care FSA or the HSA.
• If you already have a debit card from last year,
your funds will be loaded onto that card on
July 1st.
Contacts / Questions
• Please email questions to:
• Kristi Egbert – [email protected]
• Shelley Currey – [email protected]
• Patti Williams – [email protected]