Transcript iRenewal Open Enrollment Meeting Presentation Template

(Group Name)
Benefits Enrollment
( D AT E )
Presented by:
(Broker Name)
(Agency Name)
(Agency Address)
(Agency City, State, Zip)
(Broker Phone)
(Broker Email)
 (Agency Logo)
 To add logo, delete all text in this box
 Click on the Picture icon “Insert Picture
from File”
 Locate the Agency Logo file on your
computer in the finder window and click
the “Open” button
 You may need to resize the logo to make
sure it is not distorted
Open Enrollment Info
What can I do?
When is this effective?
 Change Plans
 Open Enrollment is the month
 Enroll in/remove other lines
of (OE Month)
 Changes will take effect on the
first of (Renewal Month)
 Forms/Changes are due no later
than (Due Date)
of coverage
 Add dependents
 Update your address/contact
info
Benefits Offered






Medical Plan (Carrier - Plan Name)
Dental Benefits (Carrier - Plan Name)
Vision Benefits (Carrier - Plan Name)
Life Insurance (Carrier - Plan Name)
Disability Insurance (Carrier - Plan Name)
Voluntary Benefits (Carrier - Plan Name)
Health Care Reform - Understanding ACA Metal Levels
Health plans are classified into four coverage levels depending on their actuarial value which
represents the share of health care expenses the plan covers and helps to determine the percentage
of cost sharing between your plan and you.
Health Care Reform – Essential Health Benefits
All individual and small group health insurance plans must include the following 10 categories of
care, known as Essential Health Benefits (EHBs).
Health Care Reform – Key Provisions
 No Cost Preventive Care
 No Pre-Existing Conditions
 No Lifetime Maximum
 Dependents Covered To Age 26
 Limitations on Waiting Periods
 New Rating Regions
 1:3 Rating Ratio
 Health Benefits Exchanges – Covered California
Health Care Reform – Subsidy Eligibility
California’s Health
Exchange
To be subsidy eligible, employee
must earn between 138% and
400% of the FPL without an offer
of coverage from the employer
If your employer is offering a
benefit plan at this years open
enrollment, the employee is
not eligible for the
government subsidy
Key Terms in Cost Sharing
DEDUCTIBLE
The amount you pay out of your pocket for certain covered services each year before your
plan starts to pay
COPAY
A fixed amount you typically pay for a covered services like doctor visits
COINSURANCE
Your share of health plan costs (a percentage of total cost) after meeting
your deductible
OUT-OF-POCKET MAXIMUM
The most you have to pay out-of-pocket each year for health care services. Check your
plan details to see if your deductible is part of your Out-of-Pocket maximum
PREMIUM
The amount you pay to belong to a health plan
Key Terms in Cost Sharing - Example
Understanding Health Plan Types
HDHP
PPO
EPO
HMO
High Deductible Health Plan
Preferred Provider
Organization
Exclusive Provider
Organization
Health Maintenance
Organization
$
$$$$
$$
$$$
$$$$
$$
$$
$
Similar to a PPO, except you’ll
pay more out-of-pocket
A PPO offers the most
flexibility and choice. You
can see any doctor without
a referral
A EPO offers flexibility
and choice. You can
see any in-network
doctor
Limited in choice.
Must designate a PCP
and can only see doctors
in a narrow provider
network
Size of Network
Limited/Large
Limited/Large
Limited
Limited
Out-of-Network
Benefits
Yes
Yes
No
No
Premiums
Out-of-Pocket Costs
Flexibility & Choice
Ideal If You…
Tips
• Don’t need much care and
are able to save money to
cover a large deductible
• Pair coverage with an HSA
Plan (Health Savings
Account)
• Like to have flexibility
and provider options
• Want to keep out-ofpocket low
• Looking for lower
premiums
• Don’t want a
gatekeeper
• Looking for cost
savings
• Are OK with a
gatekeeper
• Start saving money each
month
• Stay in-network
• Keep track of
deductibles
• Get necessary preapprovals
• Stay in-network
• Keep track of
deductibles
• Get necessary preapprovals
• Stay in-network
• Get referral from PCP
for specialists
What is a H.S.A.?
A Health Savings Account (HSA) is a special tax-advantaged savings account similar to
a traditional Individual Retirement Account (IRA) but designated for medical expenses.
There are two parts to a HSA
1)
2)
High Deductible
Health Plan (HDHP)
Health Savings
Account (HSA)
Intended to cover serious illness or injury once the
deductible has been met.
High-deductible health plan offered by an insurer or
third-party administrator.
Used to cover small and routine medical
expenses until the deductible is met.
Bank Account: contributions and withdrawals
administered by a bank or other trustee.
How do Health Savings Accounts (HSA)Work ?
Keyword is savings. What you don’t
spend this year rolls over to the next
year.
 All money contributed is pre-tax
 For use on IRS-qualified medical
1. Enroll in a
HDHP Plan
5. Take a
Tax
Deduction
2. Open a
HSA
Account
expenses
 Contributions rate can be changed
 Can be used for medical expenses
in retirement
 Savings Tool
4. Use
Funds for
Qualified
Medical
Expenses
3. Deposit
Money Into
Account
What is a Flexible Spending Account?
A Flexible Spending Account (FSA) lets you set aside pre-tax dollars to pay for eligible
health and dependent care expenses.
There are two types of FSAs
1)
2)
Health Care
FSA
Dependent Care
FSA
This FSA is for health care expenses not paid
by insurance including co-payments, exams,
deductibles, vision care and dental expenses.
This FSA is for dependent care expenses you
incur to care for your eligible dependents,
including daycare, afterschool care or elder
care.
How do Flexible Spending Accounts Work ?
Keyword is spending. What you
don’t spend this year typically
disappears forever.
1. Estimate
Annual
Healthcare
Costs
7. Tax-Free
Dollars
Reimbursed
2. Enroll in a
FSA Plan
 All money contributed is pre-tax
 For use on IRS-qualified medical
expenses
 Contributions are fixed and can
not be adjusted
3. Tax-Free
Dollars
Deducted
From Pay
6. Submit
Claim
 Spending Tool
5. Incur and
Pay
Expenses
4. Pre-tax
dollars
deposited to
FSA
Account
How do Premium Only Plans (POP) Work ?
A Premium Only Plan is a provision under the Internal Revenue Code Section 125 that
enables employers to allow their employees to have certain premiums that they have to
pay out of their paycheck, to be taken out before the employee pays tax. Employer lower
payroll taxes and employees reduce their taxes and the tax savings pay for the partial
costs of the premiums.
Qualifying Premiums
Employee Savings Example
 Health
AVERAGE EMPLOYEE PAYCHECK ANALYSIS
CURRENT
NEW
 Dental
Gross Monthly Salary
$3,000
$3,000
Monthly Average Employer Section 125 Expenses:
$0
$300
Taxable Monthly Salary
$3,000
$2,700
State and Federal Tax @ 28%
$840
$756
FICA Tax @ 7.65%
$230
$207
Gross Take-Home Pay
$1,930
$1,737
After-Tax Expenses
$300
$0
Net Take-Home Pay
$1,630
$1,737
 Vision
 Disability
 Voluntary Plans (Cancer,
Accident, Hospital
Indemnity, etc.)
 Employee Group Term
Life (up to $50,000)
Monthly employee increase
in net pay received
$107
Open Enrollment Reminders
Refill Current Prescriptions
Refill Prescription Medications under the old plan prior to the end of
the month to ensure you don’t run out
Communicate Pending Procedures
Let your employer or HR Manager know so they can properly advise
your insurance broker
New ID Cards
Typically take 7-10 business days after the coverage effective date.
You may also be able to go online and print a temporary ID card.
Check Your Doctor Is Part Of The Carrier’s Provider Network
Health Insurance
Plan Highlights
 For Example Ded applies to OOP max
 For Example Self Injectables covered under OV
 For Example Ped Dental benefit counts toward OOP
 For Example Preventative Covered in full
Plan Benefits - HMO
(Plan Name/Network)
Benefits
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket Maximum
Family Annual Out-of-Pocket Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs Copay
Brand Name Prescription Drug Deductible
Brand Name Prescription Drug Copay
Pediatric Dental
This is only a summary of some benefits and their copays and coinsurance. This chart does not describe the benefits. Refer to your Evidence of Coverage for information about
coverage, limitations and exclusions of all benefits, including those not listed in this summary.
Plan Benefits – PPO
(Plan Name/Network)
In-Network Benefits
Out-of-Network Benefits
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription
Drug Deductible
Brand Name Prescription
Drug Copay
Pediatric Dental
This is only a summary of some benefits and their copays and coinsurance. This chart does not describe the benefits. Refer to your Evidence of Coverage for information about
coverage, limitations and exclusions of all benefits, including those not listed in this summary.
Plan Benefits –CDHP
(Plan Name/Network)
In-Network Benefits
Out-of-Network Benefits
Single Annual Deductible
Family Annual Deductible
Annual Out-of-Pocket
Maximum
Family Annual Out-of-Pocket
Maximum
Office Visit Copay
Coinsurance
In Patient Hospitalization
Generic Prescription Drugs
Copay
Brand Name Prescription Drug
Deductible
Brand Name Prescription Drug
Copay
Pediatric Dental
This is only a summary of some benefits and their copays and coinsurance. This chart does not describe the benefits. Refer to your Evidence of Coverage for information about
coverage, limitations and exclusions of all benefits, including those not listed in this summary.
Value Add Services
 Member Management
Tools
 Smoking Cessation
Programs
 24/7 Nurse Hotline
 Savings
 Gym Membership
 Dental Products
 Holistic Care
 Stress Management
 Weigh Management
 Wellness Products






Vitamins
Nutritional Supplements
Books
DVDs
Fitness
Skin Care
Complete the sections applicable in its entirety.
Medical Enrollment
Form Completion
Do not fill out any ancillary sections if the ancillary
plans are not being offered with your medical
carrier.
Below are commonly missed fields which are required
and may hold up your group’s approval.







Complete SSN for each member of your family
Complete address
Pick your plan/network
Complete date of hire mm/dd/yy
HMO members – indicate PCP assignment
Complete a waiver for you or any family member
not enrolling
Sign and date application for enrolling in
coverage.
Contact Info
On the Phone:
On the Web:
Carrier Website:
http://www.sharphealthplan.com/
Member Services:
800-359-2002
Find a Provider:
https://www.sharphealthplan.com
/index.php/find-a-doctor/
Dental Insurance
Dental Carrier: (_______________)
(________________)Plan Highlights
 For example DP waiver
 For example benefit roll over
 For example additional cleaning for pregnant women
 For example implants are covered, no missing tooth
clause
 For example endo/perio in basic
 For example composite fillings covered
Plan Benefits - DHMO
(Plan Name/Network)
Calendar Year Deductible
Calendar Year Maximum
Diagnostic & Preventive Services (D0210)
Basic Restorative (D2104)
Periodontics (D4341)
Endodontics (D3310 and D3330)
Oral Surgery (D7140 and D7240)
Restorative (D2790 and D2750)
Prosthodontics (D5110 and D 5211)
Orthodontics (D8070 and D8090)
Benefits
Plan Benefits - PPO
(Plan Name/Network)
Reimbursement Basis
Calendar Year Max
Annual Deductible
Diagnostic & Preventive
Services
Basic
Major
Endo/Perio/Oral Surgery
Orthodontia
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Dental Enrollment
Form Completion
These are some commonly missed fields which are
required and may hold up your group’s approval.
Complete SSN for each member of your family
 Complete address
 Pick your plan
 Complete date of hire mm/dd/yy
 DHMO members – pick your PCP
 Complete a waiver for you or any family member
not enrolling
 Sign and date application for enrolling in
coverage.

Vision Insurance
Vision Carrier: (_______________)
(________________)Plan Highlights




Plan Benefits
(Plan Name/Network)
Annual Copayment
Eye Exam
Single-Vision Lenses
Bifocal Lenses
Trifocal Lenses
Frames
Contact Lenses
Eye Exam Frequency
Lenses Frequency
Frames Frequency
Contact Lenses (In lieu of
Lenses and Frames
In-Network Benefits
Out-of-Network Benefits
Complete the sections applicable in its entirety.
Vision Enrollment
Form Completion
These are some commonly missed fields which are required
and may hold up your group’s approval.
Complete SSN for each member of your family
 Complete address
 Pick your plan
 Complete date of hire mm/dd/yy
 Complete a waiver for you or any family member
not enrolling
 Sign and date application for enrolling in
coverage.

Life Insurance
Life Carrier: (_______________)
(________________)Plan Highlights




Life Plan Benefits
(Plan Name)
Base Volume
Guarantee Issue Amount
Age Reduction Schedule
Buy Up Option
Dependent Coverage
Benefits
Life Enrollment
Form Completion
Complete the sections applicable in its
entirety.
These are some commonly missed fields which are required
and may hold up your group’s approval.
Complete SSN
 Complete address
 Complete date of hire mm/dd/yy
 Name your beneficiary
 If your benefit is salary amount, indicate annual
salary
 Sign and date application for enrolling in
coverage.

Disability Insurance
Disability Carrier: (_______________)
(________________)Plan Highlights




Disability Plan Benefits
(Plan Name)
Elimination Period
Maximum Monthly Benefit
Maximum Coverage Period
Benefit Amount
Elimination Period
Benefits
Life Enrollment
Form Completion
Complete the sections applicable in its
entirety.
These are some commonly missed fields which are required
and may hold up your group’s approval.
Complete SSN
 Complete address
 Complete date of hire mm/dd/yy
 Name your beneficiary
 If your benefit is salary amount, indicate annual
salary
 Sign and date application for enrolling in
coverage.

Costs
 Your employer contributions:

Medical

Dental

Vision

Life

Disability
Employee Subsidy Eligibility Reminder
Because you are being offered a group
benefits plan at this years open enrollment,
you are not eligible for the government
subsidy
Important Information
Paperwork must be received by: (Due Date)
Return forms to: (Contact Name; Email; etc)
Have Questions? Call: (Contact Name & Phone)
Tips and Resources
Go to urgent care centers instead of emergency rooms
Save with a <$X> Urgent Care copay versus the <$X> copay at the ER
Use in-network doctors
Save with a lower deductible and coinsurance
Pre-certify hospital services (PPO plans)
Call to pre-certify services to avoid the <$X> admission deductible
Save money with Special Offers
Get discounts on health-related products and services
Thank You For Your Attention
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Carrier Website:
http://www.ameritasgroup.com/
Member Services:
800-487-5553
Find a Provider:
http://www.ameritasgroup.com/
resources/419.asp
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services/Claims
877-433-6825
Ext 3
Carrier Website:
http://www.caldental.net
Find a Provider:
http://www.caldental.net/CDN
Website/FindDentist.do
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services:
800-275-4638
Carrier Website:
http://www.metlife.com/
Claims:
Find a Provider:
Life: Option 2, then 4, then 1
Dental: Option 2 then 2
Disability: Option 2, then 3,
then 1
Vision: Option 2 then 5
https://metlocator.metlife.com/
metlocator/execute/Search
(Line of Coverage) Insurance
Contact Info
On the Phone:
Member Services:
888-715-0760
On the Web:
Carrier Website:
http://www.premierlife.com/
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services Dental
and Vision:
800-247-4695
Carrier Website:
http://www.principal.com/
Member Services Life
and Disability
800-245-1522
Find a Provider:
http://www.principal.com/
partners/providers/prov
iderdirectory.htm
(Line of Coverage) Insurance
Contact Info
On the Phone:
On the Web:
Member Services:
800-351-7500
Carrier Website:
Claims:
800-351-7500 ext 4149
Find a Provider:
http://ameritasdental.prismisp.com/
http://www.reliancestandard.com/