Transcript 2015 PLAN YEAR - William Jewell College

2015 Employee Benefits Review
& Open Enrollment
William Jewell College
November 3rd, 2014
Today’s Agenda
Discussion Topics
Open Enrollment –November 3rd through November 21st
Healthcare Reform
Benefit Review
• Medical: Blue Cross Blue Shield of Kansas City
• Dental: Aetna
• FSA: Phillips Resource Network
• Life and Long-Term Disability: Lincoln Financial Group
• Voluntary Vision: EyeMed
• Voluntary Short-Term Disability: Aflac
Open Enrollment
This is the time to make benefit decisions. Changes outside of Open
Enrollment are only allowed if you have a Qualifying Event:
• Marital Status
• Loss of Coverage
• Birth of a Child
• Adoption
• Death
Pre-tax Premium laws require you make your elections for the Plan year with
no changes unless you have a Qualifying Event.
Please notify the HR Department within 30 days of a qualifying event to make a
change.
Health Care Reform – Updates for 2015
Affordable Care Act (ACA)
• Healthcare reform requires individuals to have a basic level of health coverage
(minimum essential coverage) or pay a penalty (tax).
• Fixed Dollar Amount - $325 in 2015 and $695 in 2016 or (the greater of),
• Percentage of Household Income – 2% in 2015 and 2.5% in 2016
Health Insurance Marketplace (Exchanges)
•
•
If you are not eligible for the William Jewell College’s Healthcare Plans, you can get
information about enrolling in health insurance through the Health Insurance
Marketplace at the following website: https://www.healthcare.gov
Open Enrollment for health insurance coverage through the marketplace begins in
October for coverage starting in January 2015
• Flexible Spending Accounts continue to be capped at $2,500 for healthcare expenses
and $5,000 for dependent day care expenses.
William Jewell College Insurance
Medical Withholdings for 2015
HMO COST SHARING TABLE BY ANNUALIZED SALARY
Under $30,000
At least $30,000 At least $47,000
& under $47,000 & under $61,500
At least $61,500
& over
2014
2015
2014
2015
2014
2015
2014
2015
Employee Only $46.20 $48.51 $59.85 $62.84 $72.45 $76.07 $85.05 $89.30
$144.90 $152.15 $217.35 $228.22 $273.00 $286.65 $363.30 $381.47
Employee + 1
$166.95 $175.30 $235.20 $246.96 $307.65 $323.03 $379.05 $398.00
Family
1/2-3/4 Time
Employees
2014
$205.70
$398.00
$565.69
2015
$215.99
$417.90
$593.97
PCB COST SHARING TABLE BY ANNUALIZED SALARY
Under $30,000
At least $30,000 At least $47,000
& under $47,000 & under $61,500
At least $61,500
& over
2014
2015
2014
2015
2014
2015
2014
2015
Employee Only $43.05 $45.20 $55.65 $58.43 $67.20 $70.56 $78.75 $82.69
$138.60 $145.53 $206.85 $217.19 $262.50 $275.63 $358.05 $375.95
Employee + 1
$159.60 $167.58 $225.75 $237.04 $299.25 $314.21 $370.65 $389.18
Family
1/2-3/4 Time
Employees
2014
$190.73
$377.09
$535.96
2015
$190.73
$377.09
$535.96
William Jewell College
2015 Health Benefits
Your 2015 Medical Plans
Blue-Care HMO – (Health Maintenance Organization)
•
•
•
•
•
Select a Primary Care Physician (PCP); self-refer to specialists
In network coverage only
Metro KC area coverage only
Emergent care while traveling
Away from Home program
Preferred-Care Blue PPO (Preferred Provider Organization)
•
•
•
•
No selection of PCP (Primary Care Physician)
In and out of network coverage
Lower your out of pocket expenses by using network providers
National and International coverage
Hospital Name
PPO
Preferred Care Blue Network
Center Point Medical Center
X
X
Children’s Mercy Hospitals
X
X
KU Medical Center
X
X
Lee’s Summit Hospital
X
X
Liberty Hospital
X
X
Menorah Medical Center
X
X
North Kansas City Hospital
X
X
Olathe Medical Center
X
X
Overland Park Regional
X
X
Providence Medical Center
X
X
Research Medical Center
X
X
Shawnee Mission Medical Center
X
X
St. Joseph Medical Center
X
NO
NO
X
St. Mary’s Medical Center
X
NO
Truman Medical Center (Hospital Hill and
Lee’s Summit)
X
X
E M P L O Y E E
B E N E F I T S
HMO
Blue-Care Network
2 0 1 4
Hospital Locator www.bluekc.com
St. Luke’s (All Locations)
www.bluekc.com
BlueKC Member Portal
View EOB’s
Track claims
Review benefits
Print temporary I.D. cards
Order permanent I.D. cards
Added-value services
Blue365 Discounts
BlueCard PPO Network
Travel with your PPO plans!
National Network Access
through BlueCard®

1,177,194 Physicians

6,776 Hospitals

Access in all 50 States
Welcomed
in more than
200 Countries
Worldwide
Routine Preventive Services
In-Network routine preventive services and the related
office visit for routine preventive services covered at 100%
•
•
•
•
•
•
•
Annual Physicals
Childhood immunizations
Well women exams including mammograms
PSA Tests
Colorectal cancer exams
Generic contraceptive drugs at 100%
Breastfeeding support, supplies (pumps) and
counseling at 100%
Services MUST be Preventive
Services MUST be done in a different calendar year
All services received from an out-of-network provider are subject to the out-of-network deductible and coinsurance, except for childhood immunizations,
which are paid at 100%.
Nurse Line Benefits

Access to Care Advisors to help you with
symptoms or answer health-related
questions

How Can They Help?
◦
Gain convenient access to quality care
◦
Become better informed about
healthcare
◦
Gain confidence when speaking to
providers
◦
Become educated on self-care for nonurgent situations
◦
Improve knowledge of drugs and
medications
Registered nurses ready to take your call 24 hours a day…365 days a year!
•
•
Exclusively For Our Members
A value-added program
exclusively for Blue KC members.
•
Helping you live healthy means more than
regular doctor visits
•
Blue365® is a national program that is part of
your Blue KC membership
•
Provides exclusive access to information,
discounts, and savings
Blue365 can:
•
Add exclusive value-added extras to an already
attractive and competitive benefit package
•
Be a strong health and wellness resource
Blue-Care HMO
Center Point Medical Center
PCP: $30 (FP, GP, IM, Ped)
Children’s Mercy Hospitals
Specialist: $60 (ENT, Derm, OB/Gyn)
KU Medical Center
Lee’s Summit Hospital
Liberty Hospital
Inpatient/Outpatient Copay
$250 per day/$250 per outpatient occurrence up to $1,250 per
calendar year
Menorah Medical Center
North Kansas City Hospital
Olathe Medical Center
Overland Park Regional
Providence Medical Center
Research Medical Center
Shawnee Mission Medical Center
Hi-Tech Scans (MRI’s, PET, CT, MRA Scans)
$100 copay
Only one copay will apply for each provider on a specified date of
service even if multiple scans are performed
Urgent Care
$60 copay (Minute Clinics, Take-Care Centers)
St. Joseph Medical Center
St. Mary’s Medical Center
Truman Medical Center (Hospital
Luke’s
Hospitals
Hill andSt.
Lee’s
Summit)
NO
Emergency Room
$100 copay (waived if admitted)
Routine Vision Care
$10 copay (one vision exam per year)
Preferred-Care Blue PPO Plan
www.bluekc.com
In-Network
Out-of-Network
Deductible: Individual
$2,500
Deductible: Family
$5,000
Coinsurance (your share):
20%
40%
Inpatient or Outpatient Services
Deductible then 20%
Deductible then 40%
Radiology, Hi-Tech Scans
Deductible then 20%
Deductible then 40%
$40 copay
Deductible then 40%
$40 copay
Deductible then 40%
Office Visits
(includes lab services performed in
office or network lab)
Urgent Care
Emergency Room
$100 copay then deductible then 20%
(copay waived if admitted)
Out-of-Pocket Maximum*:
Individual
$4,500
$9,000
Out-of-Pocket Maximum*:
Family
$9,000
$18,000
*Out-of-pocket maximum includes deductible, coinsurance and copays
Prescription Drug Coverage
34 day supply
In-Network Pharmacy
Tier 1: $10
Tier 2: $50
Tier 3: $70
102 day supply
Express Scripts Mail-Order
Tier 1: $20
Tier 2: $100
Tier 3: $140
Rx copays help satisfy OOPM
Certain drugs may require prior authorization, have quantity limitations or require step
therapy (Generics First). Refer to www.BlueKC.com for additional details.
Consumer-Driven Tools
Visit the website
bluekc.com to find
an In-Network
Provider
Call Nurseline
Choose the Right
Health Care Setting
Generics vs. Brand
Name Drugs.
Annual Physicals
Communicate with
Explore the website
for added value
discounts,
Prescription drug
costs, price health
procedures
Participate in a
Wellness Program
Active PPO
PPOII Network
Type I
Deductible
Type II
None
Type III
$50 / $150
Type IV
None
Aetna Pays
(Participating Providers)
100%
80%
50%
50%
(Non- Participating)
80%
70%
40%
50%
Covered Services
Dental X-rays
Root Canal
Complete or
Partial Dentures
Orthodontia ( to age
20)
Routine Oral Exam
Tooth Extraction
Aetna Pays
Crowns
Cleaning – two each
calendar year
Calendar Year
Maximum
Lifetime Maximum
Composite
Fillings
Inlays/Onlays
$1,000 per person for all services
N/A
None
$1,000
• No ID Cards needed
• Finding Providers
 Go to ww.Aetna.com
 Select PPOII Network
Flexible Spending Accounts
Information + Enrollment = Savings
What is an FSA anyway?
An FSA adds spendable income and covers many expenses.
You may redirect part of your paycheck into a pretax account.
FSA Benefit Buckets Available:
IRS Determines Limits
1- HEALTHCARE FSA: Medical, Dental, Vision, Pharmacy & approved OTC.
$2,500
and/or
2- DEPENDENT CARE FSA: Daycare expenses.
$5,000
You can participate in one or both types of FSA
21
How will it benefit me?
• Paycheck Advantages:
- Increased take-home pay
- Lower income taxes
$$ Double benefit $$
Average family of four in the U.S. can save hundreds of dollars in taxes. ….
• Immediate availability of Healthcare
account funds
22
Expenses covered?
Medical & Dental
Dependent Care
•
•
•
•
•
•
•
•
•
•
•
•
Deductibles & co-pays
Prescription drugs
Vision (exams, glasses, laser eye surgery,
contact lens solution)
Diabetic supplies
Hearing Aids
Medical travel expenses
Chiropractic services
Dental (cleanings, fillings, orthodontia,
dentures)
And many more!
*Over the counter….what qualifies….
Daycare (child under age 13)
Private Nanny or Babysitter
Adult Daycare
23
How to submit claims
Option 1: The Benny Card. The card is used at the point of service at hospitals, doctor’s offices and pharmacies. The card
cannot be used to purchase over-the counter medication without a prescription. Save all receipts as you may be asked to
substantiate your expense. Keep your Benny Cards!
NOTE: Grace Period is now available on Benny Card Swipes and Manual Claims for 75 days
•
For the 2014 plan year, the last day to use your 2014 funds is March 16, 2015
•
For the 2015 plan year, the last day to use your 2015 funds is March 16, 2016
Option 2: Paper Claims. Fax or mail a claim form to Phillips Resource Network with an Explanation of
Benefits (EOB) and/or receipt. Receipts must include a patient name, date of service, type of service and dollar
amount.
2015 PLAN YEAR: On January 1, 2015, your Benny Card will be loaded with your new plan year
dollars. Please DO NOT use your card to go back and pay for any services in 2014 past the 75 days.
2014 PLAN YEAR: 75 day extension on allowable expenses with an additional 30 days to submit
claims from any monies remaining from the 2014 bucket.
Services must be incurred while actively employed and will be applied to the applicable plan year.
24
Things to remember…
• Choose plan election amounts carefully
Use it or Lose it Rule after the 75 day grace period
• Contribution amounts can only be changed during the plan year due to a
qualifying event (marriage or birth of a child, etc.)
• Expenses are reimbursed through an FSA after they are incurred; prepayments are reimbursed as services are received
Participation at any level will increase your take home pay!
25
We’re here to help!
PLEASE DIRECT QUESTIONS TO PHILLIPS RESOURCE NETWORK, INC.
OUR PHONE NUMBER AND EMAIL ADDRESS IS ON EVERY CLAIM FORM.
REMEMBER BY ENROLLING IN THIS PLAN, THE MONEY YOU REDIRECT IS
NOT SUBJECT TO FEDERAL, STATE, OR SOCIAL SECURITY TAXES!
Every employee must complete a 2015 FLEX form
even if waiving coverage or not making any changes
26
William Jewell College
Employer Paid Benefits
(All Full-Time Employees and All Regular Part-Time Employees and Adjunct Faculty who are
enrolled in the Employer’s Group Health Plan)
Basic Life Insurance
•
•
1 times annual salary for employees
$50,000 minimum amount to $150,000 maximum
Dependent Life Insurance
•
•
$2,000 benefit for spouse
$1,000 benefit for children from 14 days to 20 (26 if full time student) years of age
Basic Accidental Death and Dismemberment
•
$25,000 for employees
Long Term Disability
•
•
•
60% of monthly salary to $5,000 maximum monthly benefit
Payable after 120 days of disability
Payable to later of age 65 or SSNRA
William Jewell College
Voluntary (Employee Paid) Options
(All Full-Time Employees and All Regular Part-Time Employees and Adjunct Faculty who are
enrolled in the Employer’s Group Health Plan)
Voluntary Life
Voluntary AD&D

Choice of $10,000 increments of coverage for yourself not
to exceed the lesser of 5 times salary or $500,000
maximum benefit for employees.

Choice of $25,000 increments of coverage not to exceed
10 times salary or $500,000 maximum benefit for the
employees on the Employee Only Plan or Family Plans

Choice of $5,000 increments of coverage for your spouse
not to exceed ½ of employee amount or $250,000.

If elected, Spouse is provided 60% of employee amount
when Children are not covered on the Family Plan.

Choice of $5,000 increments of coverage for children after
6 months of age to a maximum benefit of $20,000.


You or your spouse may elect or increase coverage by one
or two increment levels on a guaranteed acceptance basis
during your company’s defined annual open enrollment
period, provided that you or your spouse have not been
previously declined for coverage or withdrawn a previous
application for coverage.
If elected, Spouse is provided 50% of employee amount
and Children are covered for 10% of the employee
amount (not to exceed $15,000) when all are covered on
the Family Plan.

If elected, Child is provided 15% of employee amount
(not to exceed $15,000) if only Children are covered on
the family plan.

There is an annual open enrollment
for coverage on Voluntary AD&D.
Eye Vision Plan Highlights
Exam and Materials Plan
In Network
Eye Exam
Material Co-pay
LENSES
Single Vision Lenses
Bifocal Lenses
Trifocal Lenses
FRAMES
Frames (Covered in Full)
Retail Allowance
CONTACT LENSES
Contacts
Retail Allowance
FREQUENCY OF SERVICES
Exam
Lenses
Frames
$10 Copay
$25 Copay
Included in Material Copay
Included in Material Copay
Included in Material Copay
Included in Material Copay
$130
up to $40
$130
Once every 12 months
Once every 12 months
Once every 24 months
www.eyemedvisioncare.com (Select Network)
Eye Vision Plan Highlights
Materials Plan Only
In Network
Material Co-pay
LENSES
Single Vision Lenses
Bifocal Lenses
Trifocal Lenses
FRAMES
Frames (Covered in Full)
Retail Allowance
CONTACT LENSES
Retail Allowance
FREQUENCY OF SERVICES
Lenses
Frames
$0 Copay
Materials Only
Materials Only
Materials Only
Materials Only
$130
$130
Once every 12 months
Once every 24 months
www.eyemedvisioncare.com (Select Network)
Voluntary Short-Term Disability
• Guaranteed-issue Short-Term Disability
• Guaranteed, renewable to age 70
• Benefits paid regardless of any other insurance
• 3-Month Benefit for illness or off-the-job accident
• $500 to $3000 in monthly benefit guaranteed issue
• Waiting period defined by each individual’s needs
• Partial disability benefit
• Payroll deduction
Income Replacement Example
• Jewell employees are provided long-term
disability that begins after 120 days for an
illness or off-the-job accident.
• Aflac short-term disability can be
purchased to provide income
replacement for the first 90 days, reducing
the income gap to only 30 days
Example: $34,000 Annual Salary
Age: 18 - 49
• 14/14
– 14 calendar days waiting for an off-the-job
accident
– 14 calendar days waiting for an illness
• 3 Month Benefit period
• Qualify for $1,700 Monthly Benefit
• $28.73 monthly premium
Example: $50,000 Annual Salary
Age: 18 - 49
• 14/14
– 14 calendar days waiting for an off-the-job
accident
– 14 calendar days waiting for an illness
• 3 Month Benefit period
• Qualify for $2,500 Monthly Benefit
• $42.25 monthly premium
Commerce Bank
Special employee banking benefits
No ATM fee when using the on-campus ATM
located in Yates-Gill College Union
IMPORTANT
•
Forms to turn in:
• 2015 FLEX form
• Any changes to other benefits*
Open Enrollment: November 3rd through November 21st
ALL applications and changes must be turned in no later than November 21st to
the Office of Human Resources
*Examples of changes include:
• Changing plan options
• Adding or Removing dependents
• Address or phone number changes
• Changing beneficiary designation
If you have any additional questions please contact the Office of Human Resources.