Anderson UniversityEmployee Benefits Presentation

January, 2016

2016 Medical Plan Overview

• Medical– Carrier: GuideStone

– Slight change $3500/$7000 plan

Health Saver 2500/5000 Plan SummaryEffective Network Benefits Non-Network Benefits

  Your costs are summarized below

Deductible

Individual $ 2,500 $ 2,500

Family $ 5,000 $ 5,000

Coinsurance 10% 40%

Out-of-Pocket Maximum 

Individual $ 3,000 $ 5,000

Family $ 6,000 $ 10,000

Physician Office Visit 10% after deductible 40% after deductible

Specialist Office Visit 10% after deductible 40% after deductible

Preventive Care 0% 40% after deductible

Health Saver 2500/5000 Plan SummaryEffective Network Benefits Non-Network Benefits

  Your costs are summarized below

Retail Prescription Drugs

Generic Formulary 10% after deductible 40% after deductible

Brand Formulary 10% after deductible 40% after deductible

Non-Formulary 10% after deductible 40% after deductible

Mail Order Prescription Drugs

Generic Formulary 10% after deductible Not Covered

Brand Formulary 10% after deductible Not Covered

Non-Formulary 10% after deductible Not Covered

Hospital Services 10% after deductible 40% after deductible

Out-Patient Services 10% after deductible 40% after deductible

Maternity Services 10% after deductible 40% after deductible

Emergency Room Services 10% after deductible

Urgent Care Centers 10% after deductible 20% after deductible

Health Saver 3500/7000 Plan SummaryEffective Network Benefits Non-Network Benefits

  Your costs are summarized below

Deductible

Individual $ 3,500 $ 3,500

Family *($6,850 per Individual) $ *7,000 $ 7,000

Coinsurance 20% 40%

Out-of-Pocket Maximum 

Individual $ 4,000 $ 4,500

Family *($6,850 per Individual) $ *8,000 $ 9,000

Physician Office Visit 20% after deductible 40% after deductible

Specialist Office Visit 20% after deductible 40% after deductible

Preventive Care 0% 40% after deductible

Health Saver 3500/7000 Plan SummaryEffective Network Benefits Non-Network Benefits

  Your costs are summarized below

Retail Prescription Drugs

Generic Formulary 20% after deductible 40% after deductible

Brand Formulary 20% after deductible 40% after deductible

Non-Formulary 20% after deductible 40% after deductible

Mail Order Prescription Drugs

Generic Formulary 20% after deductible Not Covered

Brand Formulary 20% after deductible Not Covered

Non-Formulary 20% after deductible Not Covered

Hospital Services 20% after deductible 40% after deductible

Out-Patient Services 20% after deductible 40% after deductible

Maternity Services 20% after deductible 40% after deductible

Emergency Room Services 20% after deductible

Urgent Care Centers 20% after deductible 20% after deductible

What is an HSA

• Tax-advantaged checking account that works in conjunction with your CDHP

• Allows you to save for future medical expenses or pay current ones

Health Savings Accounts Overview

To Qualify for a Health Savings Account (HSA) you must meet the following:

– HSA’s can only be offered with a Consumer Driven Health Plan (CDHP).

– Cannot be covered under traditional health plan, including Medicare, Tricare, or an FSA Medical Reimbursement plan.

– Cannot be claimed as a dependent on someone’s tax return.

HSA Features

Tax Advantages

– Tax free way to save for current and future medical expenses.

– Contributions are pre-tax or tax-deductible up to annual HSA limits.

– All earnings and interest are tax free.

– Qualified withdrawals are tax free. Once reach age 65, nonmedical

withdrawals are taxed at your current tax rate, like an IRA.

HSA Features

• HSA is fully Portable.

• Ability to Accumulate funds – “Use it or Keep it!”.

• HSA funds can be used for items not covered by health plan such as; dental, vision etc. Same as an FSA plan.

• Lower health plan premiums than traditional PPO plans.

Funding Your HSA

The HSA can be funded:

– In one or more payments

– Via payroll deductions• Elections can be stopped, started, and/or changed anytime

– By the employee, employer, or any other person on the employee’s behalf

– Prior to the individual’s tax filing deadline (generally, April 15th of the following year)

Employee $ 500Employee + 1 $ 750Employee + 2 $1,000

AU’s Annual HSA Contribution for 2016

HSA Contributions

• IRS Maximum 2016 contributions– Self

• $3,350

– Family• $6,750

– Catch up contribution• $1,000 for those 55 and older

Who is Eligible to Use my HSA Funds

You can spend your HSA dollars on qualifying expenses for:– Yourself

– Your spouse

– Anyone you claim as a dependent on your personal income tax

(Your child(ren) may qualify to be covered under your medical plan but NOT qualify to use your HSA funds).

Note: Your spouse and dependent(s) do NOT have to be covered under your CDHP plan to be eligible to use funds from your HSA account.

HSA Distributions

Pre-65 HSA owner:• Qualified Distributions will be tax free. Non-Qualified

Distributions will require individual to pay their personal tax rate on purchase and a 20% penalty.

Post-65 HSA owner:• Qualified Distributions will be tax free. Non-Qualified

Distributions will require individual to pay their personal tax rate on purchase (No IRS Penalty)

What Happens if I Am Enrolled in the CDHP When I Turn 65

At age 65, you have two options:

• You may enroll in Medicare Part A; however, you will NOT be eligible to make or receive HSA account contributions from that point forward. You may be able to receive the AU contribution to an FSA account.

• You may choose NOT to enroll in Medicare Part A, and you will still be able to make and receive contributions to your HSA account.

Rx ‘n Go

– You will continue to have the option to receive up to a 90 days’ supply of preventive generic maintenance drugs by mail at no cost to you through Rx ‘n Go.

– Over 500 generic drugs are available on the Anderson University Preventive Drug List. Generic prescription drugs covered by our Preventative Drug List and available through Rx ‘n Go will be provided to you at no cost.

– To learn what drugs are on our Preventative Drug List please see http://hr.anderson.edu/ or call 888.697.9646 to speak to a Rx ‘n Go customer service associate.

2016 Dental Benefit Overview

• Dental– New Carrier: Delta Dental

– Larger network of providers (two provider levels)

– No change in premium contributions

– Generic ID cards will be distributed by Human Resources

– Dependent children are eligible to age 19 or to age 24 if a full-time student

– Search for providers at: http://www.deltadental.com/DentistSearch/DentistSearchController.ccl

Dental Plan SummaryEffective Network Benefits Non-Network Benefits

  Your costs are summarized below

Deductible (Applies only to Major Services)

Individual $ 50 $ 50

Family $ 150 $ 150

 

Annual Plan Maximum $ 900 $ 900

 

Preventive Services

Diagnostic Services 80% 80%

Preventive Services 80% 80%

Emergency Palliative Treatment 80% 80%

 

Basic Services

X-rays 80% 80%

Oral Surgery 80% 80%

Endodontics 80% 80%

Dental Plan SummaryEffective Network Benefits Non-Network Benefits

  Your costs are summarized below

Major Services  

Prosthodontics 50%50%

Major Restorative 50% 50%

 

Orthodontia

Separate Ortho Deductible 60% 60%

Ortho Lifetime Max $ 900 $ 900

Ortho EligibilityChild, 19 years or younger

Non-network charges are subject to reasonable and customary fees.Charges above R&C are the patient's responsibility.

Provider Directory www.deltadental.com

Delta Dental Premier• negotiated fees• no balance billing• acceptance of processing policies• 186,000 dentist locations

Nonparticipating• no discounts• balance billing

Delta Dental NetworkDelta Dental PPO• significant discounts• no balance billing• acceptance of processing policies• 108,000 dentist locations

Delta Dental Network

PPO Dentist Premier Dentist Nonparticipating Dentist

Class II payment example for: Filling - Amalgam Restoration/One Surface (assuming any applicable deductible has been met)

Submitted Fee: $120.00

PPO Fee Schedule amount: $68.00

Delta Dental pays 80% of thePPO Fee Schedule amount: $54.40Member pays: $13.60

The PPO dentist cannot charge the $52 difference between the PPO Fee Schedule amount and his/ her fee.

Submitted Fee: $120.00

Maximum Approved Fee: $111.00

Delta Dental pays 80% of the Maximum Approved Fee: $88.80Member pays: $22.20

The Premier dentist cannot charge the $9 difference between the Maximum Approved Fee and his/her fee.

Submitted Fee: $120.00

Nonparticipating Dentist Fee: $92.00

Delta Dental pays 80% of the Nonparticipating Dentist Fee: $73.60Member pays: $46.40

Because the dentist does not participate, you are responsible for the difference between Delta Dental’s payment and his/her fee.

2016 Vision Plan Overview

• Vision– Carrier: Superior Vision

– No change in plan design

– Children eligible to age 26

Vision Plan Summary

Member In-Network Cost

Your costs are summarized below

Exam – Every 12 months

Ophthalmologist $ 10 Co-PayOptometrist $10 Co-Pay

Frames – Every 24 months $130 allowance

Standard Plastic Lenses – Every 12 monthSingle Vision $25 Co-PayBifocal $25 Co-PayTrifocal $25 Co-Pay

Contacts (in lieu of glasses) $120 allowance

Flexible Savings Account (FSA)

• With an FSA plan, you elect to have a certain dollar amount withheld from your paycheck so you can pay for health care and dependent care expenses with pre-tax money.

• Eligible expenses include your unreimbursed medical expenses, including deductibles, co-pays, co-insurance, and childcare expenses!

• “Use it or Lose it Rule” – If you do not use all of your FSA funds they will be forfeited at the end of the plan year.

2016 FSA Accounts Cond’t

• Flexible Spending Accounts– Unreimbursed Medical FSA Account

• Employee who waive medical coverage• Employees who enroll in a medical plans option but do not qualify to

make or receive HSA contributions

– Limited Purpose FSA Account• Employee who have an HSA account (Dental and Vision expenses

only)

– Dependent Daycare FSA Account• All employees with qualified daycare expenses

Employee $ 500Employee + 1 $ 750Employee + 2 $1,000

AU’s Annual FSAContribution for 2016

Employees who enroll in one of AU’s medical plan options but do not qualify to make and receive contributions to an HSA, AU will make a contribution, based on the above schedule, to an FSA account.

IRS Form 1095-B

• As mandated by the Affordable Care Act, all employees eligible for medical benefits in 2015 will receive IRS Form 1095-B at the beginning of 2016

• This form will provide information to be utilized in the filing of your 2015 income tax return

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Dependent Social Security Numbers

• In order for GuideStone to provide form 1095-B, they must have Social Security Numbers for your covered dependents

• If you have not provided the correct Social Security Numbers for your covered dependents in the benefitsCONNECT system, please add this information during open enrollment

Enrollment Instructions

• On-line enrollment system: benefitsConnect hosted by Transcend Technology Systems

• Passive enrollment – All 2015 election rolled over for 2016 with the exception of HSA and FSA elections. These must be elected for 2016.

• Open Enrollment: 11/2/15 – 12/2/15

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