Hanover County & Schoolshcps2.hanover.k12.va.us/human_resource/EmpBenefits/Hanover Open... · Claim Example 1 7 Assumptions CORE ... • Download important forms • Send and receive

Hanover County & Schools2015 Open Enrollment

All Rights ReservedDigital Benefit Advisors

Agenda

• Review Benefits

– Anthem Medical

– Health Savings Account with US Bank

– Delta Dental

– Aflac

• Review Paperwork to be completed

• Questions

Open enrollment period is October 15, 2014 to November 14, 2014 for coverage effective January 1, 2015.

2


ANTHEM

MEDICAL

3


Medical Options

• You will have 3 options to choose from:1. CORE POS

• There are no deductibles for in-network benefits. The plan is based on set

co-pays.

2. VALUE POS

• There is a deductible on most in-network benefits ($200 Single

Coverage/$400 Family Coverage).

• Premiums are lower than the Core POS plan; however, this plan has higher

co-pays and a 20% coinsurance for most services.

3. NEW! HIGH DEDUCTIBLE HEALTH PLAN (HDHP + HSA)

• New this year – High Deductible Health Plan (HDHP) that can be paired with

a Health Savings Account (HSA)

• There is a deductible on most in-network benefits ($3,000 for Single

Coverage/$6,000 for Family Coverage)

• Premiums are lower than the Core POS plan and Value plan; however, this

plan has higher co-pays/deductibles

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All Options

• Are Open Access (NO referrals required for specialist visits)

• You may go to an Anthem network primary care physician or

specialist

• Have out-of network benefits as well as prescription and vision

benefits

• Have in-network preventive care services covered

• Require a Primary Care Physician (PCP) be listed on the enrollment

form for each participant. To find out if your doctor is currently

participating with Anthem visit www.anthem.com or call 1-800-421-

1880. We also have a supply of PCP listings available.

• Have vision benefits - Routine eye examinations are covered but

members must utilize the Blue View Vision Providers

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http://www.anthem.com/


PREVENTIVE CARE

SERVICES

Adult ( Age18+) Child (Under Age 18)

Cholesterol and lipid level screeningNewborn screenings including sickle

cell anemia

Tetanus/Diphtheria Booster Routine Immunizations

Annual flu vaccination Cholesterol and lipid level screening

Diabetes screeningAnnual pap smear and pelvic exam, as

appropriate

Annual mammogram Screening for lead exposure

Annual pap smear and pelvic exam Screening for tuberculosis

Prostate cancer screenings including

digital rectal exam and PSA testVision and Hearing Screening

IMPORTANT TO NOTE: To support and surpass health care reform recommendations, Anthem’s plans

cover 100% of covered preventive care services like screenings, immunizations and exams. If you visit

Anthem HealthKeepers in-network providers, you will not have a cost share for the visit. Please note that

how your doctor codes your visit will determine the cost share.

6

Please note: This is a sample of covered services available.


Claim Example 1

7

Assumptions CORE PLAN VALUE PLAN HDHP + HSA

HEALTHY

Plan Deductible None$200 Individual

$400 Family

$3,000 Individual

$6,000 Family

Enrollment Type Employee Only Employee Only Employee Only

Employee Claim

Activity

Employee has routine

physical from an in-

network physician; also

gets a flu-shot.


physical from an in-network

physician; also gets a flu-

shot.


physical from an in-

network physician; also

gets a flu-shot.

Employee Out-of-

Pocket

Cost Incurred

$0 (Routine preventive care is

covered at 100%)


covered at 100%)


covered at 100%)

Semi-Monthly Payroll

Deduction

(Employee Only)

$28.00 $8.50 $0.00

Annual Cost (over 12

months)$672.00 $204.00 $0.00

Hanover HSA

ContributionNot Eligible Not Eligible $1,200.00


Claim Example 2

8


OUTPATIENT SURGERY & MRI SCHEDULED


$400 Family

$3,000 Individual

$6,000 Family

Enrollment Type Employee + Spouse Employee + Spouse Employee + Spouse

Employee/Family Claim

Activity

Spouse has MRI on the Knee,

total cost = $1200

Spouse has Outpatient Knee Surgery,

total cost = $3000

Employee fills one Tier 3 ($50)

medication each month at the

pharmacy


total cost = $1200

Spouse has Outpatient Knee Surgery,

total cost = $3000



pharmacy


total cost = $1200

Spouse has Outpatient Knee

Surgery,

total cost = $3000



pharmacy

Employee Out-of-Pocket

Cost Incurred

SPOUSE

MRI Copay = $125

Outpatient Surgery Copay = $125

Total Medical Cost = $250

EMPLOYEE

Rx Copays = $50 / Month

Rx Cost = $600/ Year

SPOUSE

MRI Deductible + Copay = $200 +

$175

Outpatient Surgery Copay = (20% of

$3,000) = $600


EMPLOYEE

Rx Copays = $50 / Month

Rx Cost = $600/ Year

SPOUSE

MRI Deductible = $1,200

Outpatient Surgery Deductible =

(remaining portion of $3,000

deductible) = $1800

Total Medical Cost = $3,000

EMPLOYEE

Employee Rx Cost = $120 / Month

Rx Cost = $1,440/ Year


Deduction

(Employee + Spouse)

$190.00 $110.00 $83.00

Annual Cost (over 12 months) $4,560.00 $2,640.00 $1,992.00

Hanover HSA Contribution Not Eligible Not Eligible $2,400.00

Total Annual Cost (Out-Of-

Pocket & Premiums)$5410.00 $4,215.00

$6,432.00 or

$4,032.00 when considering HSA

Contribution of $2,400


Claim Example 3

9


PREGNANCY


$400 Family

$3,000 Individual

$6,000 Family

Enrollment Type Employee + Family Employee + Family Employee + Family

Employee/Family Claim

Activity

Employee Maternity Care over 9

Months,

Total cost = $5,500

Employee has a baby via C-Section,

stays in hospital for 3 nights, total

cost = $12,200


Months,

Total cost = $5,500

Employee has a baby via C-Section,

stays in hospital for 3 nights, total

cost = $12,200


Months,

Total cost = $5,500

Employee has a baby via C-

Section, stays in hospital for 3

nights, total cost = $12,200

Employee Out-of-Pocket

Cost Incurred

Initial Maternity Copay = $25

Pre & Post Natal Care = $0

Ultrasounds = $0

Delivery, 3 nights in-patient =

$150/day = $450


Initial Maternity Copay = $25

Pre & Post Natal Care = $50

Ultrasounds = $0

Delivery, 3 nights in-patient = $200

+ 20% = (20% of $12,000) = $2,400

+ $200


Initial Maternity Copay, Pre &

Post Natal Care, Ultrasounds =

$3,000

Delivery, 3 nights in-patient = $0

because the deductible has been

met



Deduction

(Employee + Family)

$275.00 $165.00 $124.50

Annual Cost (over 12

months)$6,600.00 $3,960.00 $2,988.00

Hanover HSA Contribution Not Eligible Not Eligible $2,400.00

Total Annual Cost (Out-Of-

Pocket & Premiums)$7,075.00 $6,635.00

$5,988.00 or

$3,588.00 when considering HSA

Contribution of $2,400


Payroll Deductions

10

EMPLOYEE SEMI-

MONTHLY SHARE

CORE

PLAN

VALUE

PLAN

HDHP +

HSA

PLAN

Contributions

to H.S.A. by

Employer

Employee $28.00 $8.50 $0.00 $1,200.00

Employee + Child $108.50 $51.00 $38.50 $2,400.00

Employee + 2 Children $186.50 $106.50 $80.50 $2,400.00

Employee + Spouse $190.00 $110.00 $83.00 $2,400.00

Employee + Family $275.00 $165.00 $124.50 $2,400.00

Married (FT or FT/PT)

Employee Family$175.00 $65.00 $24.50 $2,400.00


ANTHEM RESOURCES

11

Please note: all pricing listed is a sample and can vary. This is not meant to be a certification of cost.


Member Self Service

Features @ Anthem.com

Managing Your Health

• Check who’s covered under your policy

• Look up the status of your claims + EOB’s

• Access Provider Directory

• Change your Primary Care Physician

• View authorizations

• Request a new member ID card

• Download important forms

• Send and receive secure email

• Look up Rx cost

• Look up some procedure cost

12

13

Find A Doctor

• Look up a doctor,

pharmacy or urgent

care center

• View doctor profile and

read patient reviews

• Get directions to

health care facilities

• Separate the needles from the

haystack


Easier and less expensive than

urgent care.

What is LiveHealth Online?

LiveHealthOnline is a convenient way for members to interact with a

doctor via live, two-way video on their computer or

mobile device.

LiveHealth Online:

• Is available anywhere you have an internet connection

(at home, in the office or on the go)

• Is available 24 hours a day/7 days a week/365 days a year

• Provides access to in-network, U.S. board-certified doctors

• Offers help at the same price as (or less than) a regular doctor visit

• Doctors can ePrescribe to local pharmacies

(where applicable)

• Takes member payments via Visa, MasterCard and Discover

• Is secure, convenient and easy-to-use

http://www.livehealthonline.com/

LiveHealth Online is the trade name of Health Management Corporation, a separate

company providing telehealth services on behalf of Anthem Blue Cross. 14

All Rights ReservedDigital Benefit Advisors 15

Anthem LiveHealth Online


You can take it with you.

LiveHealth Online mobile solutions.

The mobile

LiveHealth

Online app is

available on

both iOS and

Android devices.

LiveHealth Online is the trade name of Health Management Corporation, a separate

company providing telehealth services on behalf of Anthem Blue Cross. 16


• Maternity - Normal Delivery $7,695-$11,743

17

Please

note: all

pricing

listed is a

sample and

can vary.

This is not

meant to be

a

certification

of cost.

Sample Anthem Care

Comparison Tool


• Maternity - C-Section $8,677-$18,883

18

Please

note: all

pricing

listed is a

sample and

can vary.

This is not

meant to be

a

certification

of cost.

Sample Anthem Care

Comparison Tool


• MRI - $715-$1,857

19

Sample Anthem Care

Comparison Tool

Please

note: all

pricing

listed is a

sample and

can vary.

This is not

meant to be

a

certification

of cost.


• Coronary Artery Bypass Surgery$51,144-$78,061

20

Anthem Care Comparison Tool

Please

note: all

pricing

listed is a

sample and

can vary.

This is not

meant to be

a

certification

of cost.


• Cymbalta

21

Sample Anthem Drug Cost

Please note: all pricing listed is a sample and can vary. This is not meant to be a

certification of cost.


• Simvastatin & Metformin

22

Sample Anthem Drug Cost

Please note: all pricing listed is a sample and can vary.

This is not meant to be a certification of cost.


Health Savings

Account

23

All Rights ReservedDigital Benefit Advisors 24

HDHP + HSA


Individual Pays First

$3,000

For Medical & Rx Costs

Individual Pays

Next $1,000 in

Rx copays10/30/50/20% to $200*

Hanover / Anthem

Pays After

$4,000

Individual Deductible ($3,000)

Family Deductible ($6,000))

Medical Plan Design

(In-Network)

The family deductible is embedded, meaning one person will never incur

more than the individual deductible or out-of-pocket maximum.

Family Pays First

$6,000

For Medical & Rx Costs

Family Pays

Next $2,000 in

Rx copays10/30/50/20% to $200*

Hanover / Anthem

Pays After

$8,000

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* Copays shown are for retail pharmacy


Health Savings Account

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Insurance Plan with

Deductible

Health Savings Account

HDHP/HSA (Insurance Protection w/ Savings

Vehicle)

• HSA is owned by the individual

• You can contribute $ to an HSA

account, on a pre-tax basis, to

pay for qualifying expenses

• Hanover is contributing $1,200

to employees and $2,400 to

employees + dependents to the

to fund the HSA;

• Some employers contribute and

some do not, Hanover may alter

this contribution each year at

Open Enrollment


Who can select an HSA?

• You must be enrolled in the qualified high deductible health

plan

• Cannot be enrolled in Medicare (usually 65+) and contribute

funds to the account

– However, HSA funds can be used when enrolled in Medicare for

qualifying expenses not covered by Medicare

• Cannot be covered by another health insurance plan

• Cannot be enrolled in TriCare, or have had VA benefits in the

last 90 days

• Cannot be eligible to be claimed as a dependent on another’s

tax return (does not apply to joint filing)

• Can not be enrolled in a medical Flexible Spending Account

(you or spouse) and put funds in an HSA27


What if I am in the FSA

today?

• Hanover offers an FSA with a 2.5 month extension (1/1 –

12/31 + Extension to 3/15)

• If you enroll in the HDHP, you cannot contribute to the HSA if

money is still in your FSA after 1/1/14

• If there is a $0 balance on 1/1/14, then you can open the HSA

and contribute

• If a spouse is enrolled in an FSA and they have a different

plan year than Hanover, employees can only contribute to the

HSA once the spouse’s plan year is over

– There is no exception and no way to get around this.

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Advantages of the HSA

• Vested immediately – it is your $$$, including

County contributions

• Portable – it is your account and you can build it

over time

• NO “use it or lose it”

• Can usually invest $ and/or elect a debit card

• Money must be in the account to spend, it is not

pre-funded

• Money in account will pass on to your

spouse/beneficiary

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Tax Advantages of the HSA

• Will not pay State, Federal or FICA taxes on

money contributed through payroll deductions

• If contributing post-tax money (not part of

payroll), will be able to claim when filing taxes,

but you will miss the FICA tax savings

• Payroll deductions are deposited pre-tax,

investments/interest can grow tax-free, money

can be withdrawn with no tax consequences for

allowed expenses (similar to FSA)

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Contributions

• Contribution limits

• There is no minimum contribution.

• It is highly encouraged that you contribute to the HSA if

you enroll in a QHDHP plan.

2015

Employee $3,350

Employee + 1 or more $6,650

Age 55+ Catch-up(must be 55 by 12/31 of that year)

$1,000

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What is Reimbursable?

• Eligible expenses – medical expenses that are covered by the

plan but subject to the deductible, as well as expenses that

are eligible for reimbursement in an FSA – such as vision,

dental, some supplies, etc.

• Can reimburse for self, spouse, and tax dependents’ medical

expenses (even if not covered under the medical plan)

• All medical expenses defined by IRS publications 969 and

50232


Sample List of

Reimbursable ExpensesAcupuncture Ambulance Services Antacid (with prescription)

BandagesBlood sugar test kit and

stripsChiropractors

Blood pressure monitoring

device

Birth Control /

ContraceptivesCrutches

Contact lenses Deductibles Dental treatments

Diabetic suppliesDrugs and medicines

(legal, with prescription)Egg donor fees

Diagnostic Services Glucose monitoring

equipmentHearing aids

Eye Exams/eyeglassesInsulin Lab fees

Hospital Services Nicotine gum or patches Obstetrical expenses

Laser/Lasik eye surgeryOver-the-counter medicines

(with prescription)Prenatal vitamins

Orthodontia / Braces Psychiatric careSmoking cessation

programs

Pregnancy test kitsThermometers Toothache/teething pain

relievers

Sunglasses

(prescription only)

WheelchairX-rays for medical reasons

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Using the HDHP Plan at the

Doctor or Hospital

Present

ID card to

doctor, and

do not pay

provider at

time of visit

1Doctor

sends claim

to

insurance

carrier.

2

If you have satisfied

your deductible,

Health Coverage will

pay the provider. If you

owe anything, the

provider will bill you

for your portion.

3b

If you owe payment as

part of your deductible,

your provider should bill

you the discounted

amounts for the services

provided.

3a

You may

use HSA

funds

to pay

qualified

medical bills

!

When you

have claim

activity, you

will receive an

Anthem

Claims Recap

4

34


Present

ID card to

pharmacy.

1Pharmacy verifies

eligibility online with

carrier. At the same

time, the pharmacy is

notified by carrier (if

they are the pharmacy

vendor) of any amount

you owe at the point of

sale.

2 You pay

pharmacy any the

discounted

amount, from the

HSA or personal

funds, up to the

deductible or OOP

max.

3When you

have claim

activity, you

will receive an

Anthem

Claims Recap

that tracks the

deductible

credit through

the year.

4

Using Your HDHP Plan at the

Pharmacy

35


Reimbursement from HSA

• No documentation required to withdraw HSA funds

• Save receipts and documentation in case of IRS audit

• You can withdraw funds from the HSA for prior year

expenses, as long as you were eligible in the year

expense was incurred

• Later in life, you can use HSA funds for Medicare B and

D premium, eligible long-term care expenses and other

eligible expenses

36


Penalties

• If audited by the IRS, you must provide receipts and/or

EOB’s to show substantiation of reimbursement

• Before age 65, if you withdraw the funds for non

qualifying purposes, the withdrawal will be taxed and

subject to a 20% penalty

• After age 65, funds used for anything other than eligible

medical expenses will be subject to taxes but not

penalized

37


What If I Terminate or Retire?

• The HSA Account belongs to you and you can take it

with you

• You can continue to pay medical expenses tax-free out

of the account - even after Medicare eligibility

• Always available for self, spouse, and tax dependents’

medical expenses

• You cannot make further contributions unless covered by

another HDHP insurance policy

38


HSA Summary

• An HDHP+HSA is an attractive opportunity for you to

build up a non-taxed savings account to offset future

expenses and to manage your deductible exposure

• An HDHP+HSA adds to personal responsibility but puts

you in the driver’s seat to manage your health care and

related expenses

39


Delta Dental

40


Plan Options

41


As a result of the growing evidence connecting oral health to overall health,

Delta Dental has developed a program designed specifically with our members

in mind: Healthy Smile, Healthy You ®.

This innovative program provides one additional cleaning or periodontal

maintenance procedure for three important health conditions connected to oral

health:

Pregnancy

Diabetes

Cardiac Conditions

Undergoing cancer treatment via chemotherapy and/or

radiation

Download and print an enrollment form for Healthy Smile, Healthy You®

at: www.deltadentalva.com

This program is only available under the PPO and Premier Plans.

Healthy Smile, Healthy You®

42


Payroll Deductions

43

EMPLOYEE SEMI-MONTHLY

SHAREDELTACARE DELTA PPO

DELTA

PREMIEREmployee $11.84 $11.81 $15.73

Employee + Child $20.55 $20.32 $27.05

Employee + 2 Children $21.78 $23.89 $31.80

Employee + Spouse $21.78 $23.89 $31.80

Employee + Family $29.66 $42.79 $52.44


Aflac

44


Aflac Options

• Group Critical Illness Plan – Employee benefit amounts available from $5,000 to $50,000

– Spouse coverage is also available in benefit amounts to $25,000

– Annual wellness benefit of $50 for employee and spouse

• Group Accidental Plan– Initial doctor’s visit is $125

– $125 X-ray benefit

– Ambulance $100 vehicle/$500 air ambulance

– $60 per year wellness benefit per covered person

• Individual Cancer Protection Plan – $2,000 first occurrence plus $500.00 per year building benefit

– $300 per day for hospitalization, radiation or chemotherapy

– Surgery benefit $100 to $5,000

– $75 per year wellness benefit per covered person

45


Flexible Spending Account

• Through payroll deduction employees may defer up to $2,550 annually for an unreimbursed medical spending account and up to $5,000 annually in a dependent day care account. Our Flexible Spending Account (FSA) program is currently administered by WageWorks.

• There are two types of FSAs in which employees may participate:

1. Unreimbursed Medical (URM) for medical expenses you pay out of pocket for yourself and your eligible dependents such as copayments, deductibles, eye glasses, dental work, orthodontics, prescriptions, etc.

2. Dependent Day Care (DDC) for expenses outside of your household for the care of a dependent.

46


Flexible Spending Account

• Participants receive a Visa Debit Card through WageWorks

• Your Debit Card will be accepted at your doctor’s office, pharmacy, hospital, dental office or your vision care provider as well as most dependent care providers

• Your card does not eliminate the need for receipt substantiation. IRS regulations require that you retain documentation to substantiate expenses.

• Over-the-Counter (OTC) drugs are NOT reimbursable as a medical expense unless you have a prescription for the OTC drug

• All employees wishing to participate for calendar year 2015 MUST complete a new Election Form (even if you are currently participating in this program).

47


Paperwork

48


Important Reminders

Open enrollment period is October 15, 2014 to November 14,

2014 for coverage effective January 1, 2015.

Our Health Savings Account (HSA) is available to all benefit eligible

employees starting January 1, 2015. You MUST be enrolled under

the NEW High Deductible plan to participate in our HSA program.

Employees may enroll in either our Medical Reimbursement Flexible

Spending Account OR our Health Savings Account BUT cannot be

enrolled under both.

Employees may enroll in BOTH the Dependent Care Flexible

Spending Account and our Health Savings Account.

TIER CHANGES – Employee+Spouse/2 Children will now be 2

separate tiers. You will either choose Employee+Spouse or

Employee+2 Children for this coverage.

49


Forms Needed:

• Medical – You only need to complete an Anthem form if you are making a

change to your family members covered, or if you would like to change

plans. This includes a move to the HDHP plan. – NO action is needed if you are not making any changes to these plans.

• Dental – You only need to complete a Delta form if you are making a

change to your family members covered, or if you would like to change

plans.– NO action is needed if you are not making any changes to these plans.

• HSA Enrollment – You will need to complete an election form if you will be

taking the HDHP medical plan and want to set up a HSA.

• Flex – You will need to complete an election form if you will be setting up a

flexible spending account for 2015.– NO action is needed if you do not wish to participate.

• Aflac – You should set up a time to meet with the Aflac representative one

on one to discuss your options and to elect coverage.– NO action is needed if you are not making any changes to these plans.

50


Summary

• Review your options for 2015.

• Complete and submit any enrollment changes by

Friday, November 14, 2014

• Show new ID cards after January 1st, 2015 upon your

next visit if you change plans.

• If you select the HDHP plan and set up a HSA, you will

receive a debit card in the mail. You will need to follow

the instructions at that time to activate the account/card.

• Take advantage of carrier on-line features to stay

informed!

THANK YOU!

51

Documents

Hanover County & Schoolshcps2.hanover.k12.va.us/human_resource/EmpBenefits/Hanover Open... · Claim Example 1 7 Assumptions CORE ... • Download important forms • Send and receive