Transcript 2017 Benefits Presentationx

2
But why do we have to
change things? I like things
just the way they are!
3
INTRODUCING THE HEALTH BENEFITS BUFFET
(AKA MODIFIED CAFÉTERIA PLAN)
4
FEATURES OF THE BENEFITS BUFFET:
You will have 705 benefit credits to spend:

A wide variety of insurance choices:
 4 Medical plans (Blue Cross Blue Shield)
 2 Dental plans (Ameritas)
 Vision (Vision Service Plan)
 Disability (Unum)
 Gap Insurance (Custom Benefits)


Choose ONLY insurance you want
NO plan is dependent on the electing another
5
ON THE MENU:
MAIN COURSE
4 Medical Insurance Plans:
Premium (Current Plan)
Preferred (New)
Core (New)
HRA (Current Plan)
Gap Insurance:
Employer-paid Employee-only - If
Electing Preferred or CORE PPO
Plans
SIDE DISHES
DESSERT
2 Dental Plans
Standard And Premium
Flexible Spending Account ($500
Rollover)
Vision Insurance
Dependent Care
Short And Long Term Disability
Supplemental Life Insurance
6
ALSO ON THE MENU
FREE CONDIMENTS
• COMPANY PAID LIFE INSURANCE
• EMPLOYEE ASSISTANCE PLAN
• TUITION WAIVERS
• WELLNESS PROGRAMS &
INCENTIVES
UTENSILS – TOOLS TO HELP
• MEL AND FRAN!
• BENEFIT MANAGEMENT CENTER
• TOM WATSON ~ GAP INSURANCE
• LSSC WEBSITE ~ BENEFITS PAGE
~ LINKS TO PLAN PROVIDERS
7
ENTRÉE: MEDICAL INSURANCE
BCBS not
offering plan in
2018
CURRENT Premium PPO
(Not ACA Compliant)
Cost Sharing - Member's Responsibility
Deductible (DED) (Per Person/Family Aggregate)
$500 / $1,500
In-Network
Out-of-Network Combined with In-Network
Prescription
Coverage
(ALL PLANS):
$15 generic
$45 preferred brand
name
$65 brand name
ACA Compliant Plans:
4th Tier –
25% up to $250 per
month
** See Mel for list of
4th tier meds
Coinsurance (BCBSF pays / Member pays)
80% / 20%
In-Network
70% / 30%
Out-of-Network
Out of Pocket Maximum (Per Person/Family Aggregate)
$5,000/$10,000
In-Network
Out-of-Network Combined with In-Network
Medical / Surgical Care by a Physician
Office Services
In-Network
$25 Copayment
Family Physician
NEW Core PPO
(ACA Compliant)
CURRENT HRA
(ACA Compliant)
$600 / $1,800
Combined with In-Network
$1,000/$3,000
Combined with In-Network
$1,500/$3,000
Combined with In-Network
80% / 20%
60% / 40%
80% / 20%
60% / 40%
80% / 20%
60% / 40%
$6,000/$12,000
Combined with In-Network
$6,000/$12,000
Combined with In-Network
$3,000/$9,000
Combined with In-Network
$30 Copayment
$40 Copayment
DED + 20%
$40 Copayment
$50 Copayment
$75 Copayment
DED + 20%
In-Network Specialist
DED + 30%
DED + 40%
DED + 40%
DED + 40%
Out-of-Network
If admitted as an inpatient from ER, the hospital will submit an inpatient hospital claim instead of an ER facility claim. ER Copay will not
Emergency Room Facility
apply on the claim; only inpatient facility cost share will apply.
(per visit)
$100 Copayment + 20%
DED + 20%
DED + 20%
DED + 20%
In-Network
$100 Copayment + 20%
DED + 20%
DED + 20%
Same as In-Network
Out-of-Network
Limited to $500 (colonscopy
no member cost share
no member cost share
not included in limit)
Ambulance
20%
20%
20%
covered
covered
covered
Gastric ByPass
1 per lifetime
1 per lifetime
1 per lifetime
$15/$45/$65
$15/$45/$65/25%*
$15/$45/$65/25%*
RX
Mail $30/$90/$130
Mail $30/$90/$130/25%
Mail $30/$90/$130/25%
*$250 Monthly Member Out of Pocket Maximum per specialty prescription applies
Women's Wellness
Standard
no member cost share
no member cost share
Wellness
handout
NEW Preferred PPO
(ACACompliant)
no member cost share
DED + 20%
covered
1 per lifetime
$15/$45/$65/25%*
Mail $30/$90/$130/25%
no member cost share
PREFERRED PPO PLAN HIGHLIGHTS
• NO CO-PAYS, DEDUCTIBLES OR LIMITS ON
•
•
•
•
PREVENTIVE CARE (Physical)
SCREENINGS (Colonoscopy, Mammogram)
IMMUNIZATIONS (Flu, Pneumonia)
LAB FEES
Prescriptions: $15 – $45 - $65 – 25% (Injectable)
Deductible: $600
Co-pays: $30 primary care/$50 specialist/$0
mental health/substance abuse
No lifetime max
WHY THIS MAY BE A GOOD PLAN FOR YOU:
 You get an annual physical and are committed to
improving your health;
 Visit the doctor regularly or take medication;
 Spouse/Child/Family need coverage.
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CORE PPO PLAN HIGHLIGHTS
• NO CO-PAYS, DEDUCTIBLES OR LIMITS ON
PREVENTIVE CARE (Physical)
SCREENINGS (Colonoscopy, Mammogram)
IMMUNIZATIONS (Flu, Pneumonia)
LAB FEES
• Prescriptions: $15 – $45 - $65 – 25% (Injectable)
• Deductible: $1,000
• Co-pays: $40 primary care/$75 specialist/$0 mental
•
health/substance abuse
No lifetime max
WHY THIS MAY BE A GOOD PLAN FOR YOU:
 You get an annual physical and are committed to
improving your health;
You rarely visit a doctor;
 You have no chronic conditions requiring regular
medication;
 You have dependents to insure.
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HRA PPO PLAN HIGHLIGHTS
• NO CO-PAYS, DEDUCTIBLES OR LIMITS ON
•
•
•
•
PREVENTIVE CARE (Physical)
SCREENINGS (Colonoscopy, Mammogram)
IMMUNIZATIONS (Flu, Pneumonia)
LAB FEES
Prescriptions: $15 – $45 - $65 – 25% (Injectable)
Deductible: $1,500 (50% funded by LSSC with HRA
card)
Co-pays: deductible + 20% coinsurance
No lifetime max
WHY THIS MAY BE A GOOD PLAN FOR YOU:
 You have coverage under another health
plan and want to supplement coverage
 Your providers are outside the Blue Cross
network
 You rarely visit a doctor
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PREMIUM PPO PLAN HIGHLIGHTS
2018
WILL BE DISCONTINUED IN
DEDUCTIBLES AND LIMITS ON PREVENTIVE CARE
• $500 limit on annual wellness exam
• Prescriptions: $15 – $45 - $65
• Deductible: $500
• Co-Payments:
$25 primary care (even for preventive care)
$40 specialist
• $1 million lifetime max
WHY THIS MAY BE A GOOD PLAN FOR YOU:
 You are in the midst of a treatment plan;
 You use an injectable medication on the 4th Tier
(insulin is 2nd or 3rd tier);
 You need time to transition to an ACA-compliant
plan.
12
TH
NEW - 4 TIER MEDICATIONS
• WHAT MAY FALL INTO THIS CATEGORY? Medications that are high-cost
injectable, infused, oral or inhaled medications that require close supervision
and monitoring (cancer, hepatitis)
• EXAMPLES: Avastin, Entyvio, Herceptin
• EPIPENS are 2nd tier ($45 per month co-pay)
• INSULIN may be 2nd or 3rd tier, depending on the type
See Mel for complete list
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Having a Baby (normal delivery)
Patient Pays
Plan Pays
PREFERRED PLAN
Hospital charges (mother)
Routine OB care
Hospital charges (baby)
Anesthesia
Lab Tests
Prescriptions
Radiology
Vaccines, other preventive
TOTAL
$
$
$
$
$
$
$
$
$
2,700
2,100
900
900
500
200
200
40
7,540
CORE PLAN
HRA PLAN
PREMIUM PLAN
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
$
$
$
$
$
1,100
200
1,300
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
$
$
$
$
$
1,000
100
500
200
1,800
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
$
$
$
$
$
1,500
20
1,000
200
2,720
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
$
$ 900
$
$ 200
$ 1,100
Amt owed to providers
Plan Pays
Patient Pays
$
$
$
7,540
6,240
1,300
Amt owed to providers
Plan Pays
Patient Pays
$
$
$
7,540
6,440
1,800
Amt owed to providers
Plan Pays
Patient Pays
$
$
$
7,540
4,820
2,720
Amt owed to providers
Plan Pays
Patient Pays
$ 7,540
$ 6,440
$ 1,100
Managing Type 2 Diabetes
Patient Pays
Plan Pays
PREFERRED PLAN
Prescriptions
$
Medical Equipment/Supplies $
Office Visits & Procedures $
Education
$
Lab Tests
$
Vaccines, other preventive $
TOTAL
$
2,900
1,300
700
300
100
100
5,400
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
CORE PLAN
HRA PLAN
PREMIUM PLAN
$
$
$
$
$
70
1,400
80
1,550
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
$
$
$
$
$
70
1,300
80
1,450
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
$
$
$
$
$
600
1,300
80
1,980
Deductibles
Copays
Coinsurance
Limits or exclusions
TOTAL
Amount owed to providers
$
Plan Pays
$
Patient Pays
$
5,400
3,850
1,550
Amount owed to providers $
Plan Pays
$
Patient Pays
$
5,400
3,950
1,450
Amount owed to providers$
Plan Pays
$
Patient Pays
$
5,400
3,420
1,980
Amount owed to providers$ 5,400
Plan Pays
$ 3,950
Patient Pays
$ 1,450
Handout
14
$
70
$ 1,300
$
$
80
$ 1,450
How much will my benefits cost?
Benefit Credits: $705.00
Medical Insurance Plan - monthly rate
PREMIUM Plan (current)
Employee
Employee
Employee
Employee
Employee
+
+
+
+
Spouse
Child (1-2)
Child (3-4)
Family
PREFERRED Plan (new)
Blue Options 03562
Blue Options 03769
$
730.00 $
659.00
$
1,425.90 $
1,252.10
$
1,156.05 $
1,015.55
$
1,601.25 $
1,406.00
$
1,863.75 $
1,636.85
CORE Plan (new)
Dental plan rates (No rate increase 2017) - monthly rate
Employee
Employee + Spouse
Employee + Children
Employee + Family
$
$
$
$
Standard Plan
22.64
47.20
47.76
79.20
Premium Plan
$
$
$
$
29.92
62.56
60.76
99.36
Vision Plan rates (No rate increase) - monthly rate
Standard Plan
Employee
Employee + Spouse
Employee + Children
Employee + Family
$
$
$
$
4.68
9.37
9.64
13.36
GAP Insurance - monthly rate (no employee cost if election Preferred or Core PPO Plans)
Employee
Employee + Spouse
Employee + Children
Employee + Family
$
$
$
$
Standard Plan
19.36
33.22
29.28
42.40
$
$
$
$
Premium Plan
31.70
56.80
49.94
73.56
Handout
HRA Plan (current)
Blue Options 05772
Blue Options HRA 03359
$
639.00 $
617.00
$
1,214.10 $
1,105.80
$
984.20
$
1,363.25
$
1,586.50 $
1,400.30
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FOR EXAMPLE:
Benefit Credits: $705.00
PREMIUM Plan
PREFERRED Plan
CORE Plan
HRA Plan
CREDIT:
$705.00
$705.00
$705.00
$705.00
MONTHLY Medical Cost
$730.00
$659.00
$639.00
$617.00
$25.00
-$46.00
-$66.00
-$88.00
$29.92
$29.92
$29.92
$29.92
$54.92
-$16.08
-$36.08
-$58.08
$4.68
$4.68
$4.68
$4.68
$59.60
-$11.40
-$31.40
-$53.40
employee cost
MONTHLY Dental (single Premium)
employee cost
MONTHLY Vision (single)
employee cost
** Savings to be applied ONLY to Dependent coverage Medical, Dental or Vision Plan **
* Divide by 2 for the per pay period deduction
Example spreadsheet will be on website
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GAP INSURANCE
(free with Preferred or Core PPO election)
GAP Insurance
Pays
You pay (in-network)
Current Premium PPO (3562)
Preferred PPO (3769)
Core PPO (5772)
You break your leg
$250/$500 (initial benefit)
Ambulance Ride
Doctor's visit
Deductible + 20%
coinsurance
$25.00
Emergency Room
$100 copay + 20%
Deductible + 20%
coinsurance
$30.00
Deductible + 20%
coinsurance
3 day hospital stay
$750
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
$1,000
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
$40.00
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
Deductible + 20%
coinsurance
$500
20% until you reach $5K
$600
20% until you reach $6K
$1,000
20% until you reach $6K
Surgery to fix
Anethesia
In-home visiting nurse
Deductible
Coinsurance
Standard/Premium
Handout
17
$150/$300 per day
$25/$50
$250 (initial once/year) + $300
$500 (initial) + $600
$20-$500
25%
$50/day - $100/day
$0
$0
SIDE DISHES
Dental Insurance
(Provider: Ameritas Dental)
Employees may select from one of two dental plans:
Vision Insurance
(provider: Vision Service Plan)
Standard Plan
Annual benefit: $1,250 per calendar year
Diagnostic & Preventive (exams, cleanings) – 100% no copay
Basic (fillings, tooth extractions) – 80% with a $50 co-pay
Periodontics (treatment of gum disease) – 80%
Major (crowns, bridges, dentures) – 50% with a $50 co-pay
Out of network: 100% basic, 50% periodontics, 25% major
Benefit Overview:
Eye exam: every 12 months with a $10 co-pay
Prescription
lenses: every 12 months with a $10 copay for single vision, lined bifocal, lined trifocal
Premium Plan
Annual benefit: $1,500 per calendar year
Same coverage for in and out of network providers
Diagnostic & Preventive (exams, cleanings) – 100% no copay
Basic (fillings, tooth extractions) – 80% with a $50 co-pay
Periodontics (treatment of gum disease) – 80%
Major (crowns, bridges, dentures) – 50% with a $50 co-pay
Frames:
every 24 months with a $85 frame
allowance
Contact
lenses in lieu of glasses: $60 co-pay for
combined eye exam; $120 allowance for lenses
Website: www.ameritas.com
Website: www.vsp.com
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SIDE DISHES
Long Term Disability
Short Term Disability
Benefit: 60% of basic monthly earnings
Maximum monthly benefit: $5,000
Minimum monthly benefit: greater of $100 or 10%
Waiting or Elimination Period: 90 days
Maximum duration: To age 65
Some waiting periods for pre-existing conditions may
Worldwide emergency travel assistance included
Cost: dependent upon age and salary
Benefit: 60% of basic weekly earnings
Maximum weekly benefit: $1,000
Minimum weekly benefit: $25
Waiting or Elimination Period: 7 days accident/7
Maximum duration: 12 weeks
Cost: dependent upon age and salary
apply
days illness
Website: www.unum.com
Website: www.unum.com
Reminder: If electing either benefit for the first time, you must complete an Evidence of Insurability form.
You will not be charged for the benefit until it is approved by the carrier.
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DESSERTS
Healthcare Reimbursement Account





Up to $2,550
Reimbursement for qualified medical expenses not covered
by insurance;
Use in calendar year but up to $500 can be rolled over into
next year account
Benefit is auto adjudicated without additional documentation
Easily downloaded app
Dependent Care Reimbursement Account




Up to $5,000
Reimbursement for daycare and after school care
Use in calendar year.
Auto pay available
Reminder: Both are calendar year elections
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FREE CONDIMENTS
Employee Assistance Program
Free Confidential 24/7 Assistance:
Childcare and/or eldercare referrals
 Personal relationships
 Legal consultations with licensed attorneys
 Financial planning
 Stress management
www.lifebalance.net – login/password: lifebalance

Life Insurance/Supplemental Life Insurance
 Employees get 1 x annual salary in additional life
insurance at no charge (Max of $200K)
 Additional Term Life/AD&D insurance coverage
 No Physical Exam required to increase coverage
but Evidence of Insurability form must be completed
and approved.
 Dependent Coverage:
$40 per pay; Spouse: $5,000
Child - 14 days – 6 mos. $500
Child - 6 mos. to 25 yrs. $2,500
DON’T FORGET!
 Tuition Waivers
 Wellness Programs
 Professional Development trainings
 403(b) Tax-Deferred Plans
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Pet Insurance
 Accidents and injuries
 Illnesses and diseases
 Cancer
 Poisonings
 Spaying or neutering
 Dental cleanings
 Flea and tick preventives
 Vaccinations
 And more . . .
Handout
22
CHOOSE A PET PLAN TO FIT YOUR NEEDS
# of Pets
With Wellness
1
2
3
4
$ 35.16
$ 70.32
$ 105.48
$ 140.64
All policies include 24/7 access to the exclusive
Without Wellness
$
$
$
$
21.96
43.92
65.88
87.84
Per pay period
BENEFITS STILL ON THE MENU – WHAT
PLANS AREN’T CHANGING?
 Dental Insurance ~ Ameritas
 Vision Insurance ~ VSP
 Flex Spending
Health Equity: $500 carryover to 2017
 Short and Long Term Disability
 Life Insurance
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TOOLS TO HELP YOU PICK THE PLANS THAT
WILL WORK BEST FOR YOU
 Mel and Fran and Dr Sidor
 LSSC Benefits Page ~ links to summary plan descriptions, plan overviews,
benefit provider websites
 Benefit Management Center ~ Open Enrollment site will walk you through the
different scenarios for costs
 Tom Watson ! Custom Benefits
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TO RECAP:
Modified Cafeteria Plan ~
NEW ~
705 benefit credits to spend in 2017
2 Medical Plans, Gap Insurance, Pet Insurance
Current PPO plan will not be offered in 2018.
Employees electing Preferred and Core PPO plans ~ Automatically
enrolled in Employee-Only Gap Insurance
Open Enrollment ~ October 17-28
LOIS ~ Online Benefit Management Center
All employees must re-enroll their Benefits
during Open Enrollment
Electing Short or Long Term Disability, or Life Insurance products ~ Complete Evidence of Insurability form
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