Health Care Plan Open Enrollment 2016-17 · •Tips to save health care dollars •FSA –Open Enrollment •Dental –Open Enrollment •Vision –Open Enrollment. Employee Benefit

Health Care Plan Open Enrollment 2016-17

Agenda• ACA Update

• Benefits update

• Health Care plan review

• Tips to save health care dollars

• FSA – Open Enrollment

• Dental – Open Enrollment

• Vision – Open Enrollment

Employee Benefit Plan Updates 2016-17• OWU will be renewing with Anthem• Deductibles, coinsurance, and out-of-pocket

maximums will remain the same• Medical and Rx co-pays will be changing• The dental plans will be changing to Anthem

effective 7/1/16• NEW FSA/DCA vendor, HRPro effective

7/1/16

• OWU will continue to offer The OWU Wellness Program to all employees.

• Opportunity to reduce your health care premiums or earn cash incentive for non-medical plan participants!

Employee Benefit Plan Updates 2016-17

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• Employer Taxes Mandated by PPACA1. Patient Centered Outcomes Research Fee

- Due July 31, 2016- $2.08 per average covered member in 2015 ($1,595.36)

2. Transitional Reinsurance Fee- Due January 15, 2017- $2.25 per covered member per month in 2016

($11,191.50)$12,786.86 July 16-June 17 – OWU’s approximate spend for PPACA

Taxes and Fees

Individual Obligations If person chooses not to have insurance they will owe a tax:* Greater of 1% of income or $95 - 2014* Greater of 2% of income or $325 - 2015* Greater of 2.5% of income or $695, indexed - 2016

and later* Per adult; children 50%; family max of 3x

individual

User Inputs for Plan Parameters

Use Integrated Medical and Drug Deductible?

Apply Inpatient Copay per Day? HSA/HRA Employer Contribution? Blended Network/POS Plan?

Apply Skilled Nursing Facility Copay per Day?

Use Separate OOP Maximum for Medical and Drug Spending?

Indicate if Plan Meets CSR Standard?

Desired Metal Tier

Medical Drug Combined Medical Drug Combined

Deductible ($) $1,000.00 $50.00

Coinsurance (%, Insurer's Cost Share) 90.00% 100.00%

OOP Maximum ($)

OOP Maximum if Separate ($)

Click Here for Important Instructions Tier 1 Tier 2

Type of BenefitSubject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Subject to

Deductible?

Subject to

Coinsurance?

Coinsurance, if

different

Copay, if

separate

Medical

Emergency Room Services $250.00

All Inpatient Hospital Services (inc. MHSA)

Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X-

rays)$30.00

Specialist Visit $60.00

Mental/Behavioral Health and Substance Abuse Disorder Outpatient

Services

Imaging (CT/PET Scans, MRIs)

Rehabilitative Speech Therapy

Rehabilitative Occupational and Rehabilitative Physical Therapy

Preventive Care/Screening/Immunization 100% $0.00 100% $0.00

Laboratory Outpatient and Professional Services

X-rays and Diagnostic Imaging

Skilled Nursing Facility

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

Outpatient Surgery Physician/Surgical Services

Drugs

Generics $10.00

Preferred Brand Drugs $35.00

Non-Preferred Brand Drugs $70.00

Specialty Drugs (i.e. high-cost) 25%

Options for Additional Benefit Design Limits:

Set a Maximum on Specialty Rx Coinsurance Payments?

Specialty Rx Coinsurance Maximum: $250

Set a Maximum Number of Days for Charging an IP Copay?

# Days (1-10):

Begin Primary Care Cost-Sharing After a Set Number of Visits?

# Visits (1-10):

Begin Primary Care Deductible/Coinsurance After a Set Number of

Copays?

# Copays (1-10):

Output

Status/Error Messages: Calculation Successful.

Actuarial Value: 80.40%

Metal Tier: Gold

Copay applies only after deductible?

HSA/HRA Options Narrow Network Options

Annual Contribution Amount:2nd Tier Utilization:

1st Tier Utilization:

Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design

Tier 1 Tier 2

$3,500.00

Calculate

All

All

All

All

All

All

All

All

All All

All All

2016-17 OWU Contribution Options

EE/Count

Current/

Month

Renewal/

Month

< $35,999

EE only 62 $39.00 $42.00EE + SP 14 $167.00 $180.00EE + Children 6 $151.00 $162.00EE + Family 19 $265.00 $285.00

$36,000 - $59,999


$60,000 - $89,999


> $90,000


How Does OWU Compare?

Ohio Wesleyan University

Survey Benchmarks Client National Regional State Industry Group

EE Size Category

Number of Health Plans Reported 4 7,689 2,338 627 750 1,546<$35,999

Employee Share of PremiumsMonthly Employee Premium Share

($)Single $42 $130 $126 $130 $103 $123EE+1EE+CH $162 $386 $346 $287 $358 $322EE+SP $180 $490 $417 $343 $436 $395Family $285 $731 $604 $504 $686 $574Family (Composite Non-Single) $522 $447 $381 $410 $401

Monthly Employee Premium Share (%)

Single 7.1% 27.7% 27.5% 30.8% 19.2% 24.5%EE+1EE+CH 14.4% 44.8% 41.0% 37.6% 36.6% 35.1%EE+SP 14.5% 47.9% 42.1% 37.7% 39.8% 37.3%Family 16.4% 52.5% 44.0% 38.8% 45.7% 39.5%Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

EMLOYEE CONTRIBUTIONS


Ohio Wesleyan UniversitySurvey Benchmarks Client National Regional State Industry

GroupEE Size Category

Number of Health Plans Reported 4 7,689 2,338 627 750 1,546

$36,000-$59,999

Employee Share of Premiums

Monthly Employee Premium Share ($)Single $71 $130 $126 $130 $103 $123EE+1EE+CH $216 $386 $346 $287 $358 $322EE+SP $239 $490 $417 $343 $436 $395Family $370 $731 $604 $504 $686 $574Family (Composite Non-Single) $522 $447 $381 $410 $401

Monthly Employee Premium Share (%)Single 12.0% 27.7% 27.5% 30.8% 19.2% 24.5%EE+1EE+CH 19.2% 44.8% 41.0% 37.6% 36.6% 35.1%EE+SP 19.3% 47.9% 42.1% 37.7% 39.8% 37.3%Family 21.2% 52.5% 44.0% 38.8% 45.7% 39.5%Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%



Ohio Wesleyan UniversitySurvey Benchmarks Client

National Regional State Industry


Number of Health Plans Reported 4 7,689 2,338 627 750 1,546$60,000-

$89,999


Monthly Employee Premium Share ($)

Single $99 $130 $126 $130 $103 $123

EE+1

EE+CH $270 $386 $346 $287 $358 $322

EE+SP $299 $490 $417 $343 $436 $395

Family $454 $731 $604 $504 $686 $574

Family (Composite Non-Single) $522 $447 $381 $410 $401

Monthly Employee Premium Share (%)Single 16.8% 27.7% 27.5% 30.8% 19.2% 24.5%

EE+1

EE+CH 24.1% 44.8% 41.0% 37.6% 36.6% 35.1%

EE+SP 24.1% 47.9% 42.1% 37.7% 39.8% 37.3%

Family 26.1% 52.5% 44.0% 38.8% 45.7% 39.5%

Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%



Ohio Wesleyan UniversitySurvey Benchmarks Client National Regional State Industry



>$90000


Monthly Employee Premium Share ($)

Single $127 $130 $126 $130 $103 $123

EE+1

EE+CH $324 $386 $346 $287 $358 $322

EE+SP $358 $490 $417 $343 $436 $395

Family $538 $731 $604 $504 $686 $574

Family (Composite Non-Single) $522 $447 $381 $410 $401

Monthly Employee Premium Share (%)Single 21.5% 27.7% 27.5% 30.8% 19.2% 24.5%

EE+1

EE+CH 28.9% 44.8% 41.0% 37.6% 36.6% 35.1%

EE+SP 28.9% 47.9% 42.1% 37.7% 39.8% 37.3%

Family 30.1% 52.5% 44.0% 38.8% 45.7% 39.5%

Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%



Survey Benchmarks Client National Regional State Industry Group

EE Size Category


CoPays

Primary Care Physician CoPay $30 $25 $25 $25 $20 $25Specialty Care Physician CoPay $60 $35 $40 $35 $30 $30Urgent Care CoPay $75 $50 $50 $50 $45 $40Emergency Room CoPay $250 $150 $150 $200 $150 $100Separate In-Hospital Admission CoPay $250 $250 $300 $225 $250

In-Network Benefits

Deductible - Single $1,000 $1,000 $1,000 $1,000 $500 $750Deductible - Family $2,000 $3,000 $2,000 $2,000 $1,500 $1,500Plan Coinsurance 90% 80% 80% 80% 80% 80%Out-of-Pocket Maximum - Single $3,500 $3,000 $3,000 $2,500 $2,250 $2,500Out-of-Pocket Maximum - Family $7,000 $7,500 $6,000 $5,000 $5,000 $6,000

Out-of-Network Benefits

Deductible - Single $2,000 $2,000 $2,000 $2,000 $1,000 $1,000Deductible - Family $4,000 $4,000 $4,000 $4,000 $2,000 $3,000Plan Coinsurance 70% 60% 60% 60% 60% 60%Out-of-Pocket Maximum - Single $7,000 $6,000 $6,000 $6,000 $4,000 $5,000Out-of-Pocket Maximum - Family $14,000 $14,000 $14,000 $13,000 $9,000 $10,500

Ohio Wesleyan UniversityPLAN DESIGN

Anthem PPO Plan

What are the amounts of the co-payments?Doctor Office Visits (In-Network)

• Primary Care $30.00/visit

• Specialty Care $60.00/visit

• Urgent Care Centers $75.00/visit(In/Out-of-Network)

• Emergency Room $250.00 Co-pay/visit; Then you pay 10%(In/Out-of/Network)

• All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription drugs.

Preventive CareCovered at 100% in-network



LiveHealth Online.

See a doctor 24/7 with LiveHealthOnline

• Meet with a doctor via video, chat or phone

• Choice of credentialed providers

• Accessibility anytime, anywhere

• No appointments or waiting rooms

co-branding logo here

Anthem Plan BenefitsPrescription Drug Benefit

Retail$10 Co-Pay for Tier 1 Drugs$35 Co-Pay for Tier 2 Drugs$70 Co-Pay for Tier 3 Drugs

25% to a Max of $250 for Tier 4 Drugs$50 deductible applies then copaysMaximum 30 day supply per prescription

*Anthem formulary list of all 4 copay tiers is available on the OWU HR web page.

Anthem Plan Benefits

Prescription Drug BenefitMail Order*

$10.00 Co-Pay for Tier 1 Drugs$70.00 Co-Pay for Tier 2 Drugs$140.00 Co-Pay for Tier 3 Drugs

25% to a Max of $250 for Tier 4 DrugsMaximum 90 day supply per prescription; Tier 4 30 day supply, includes diabetic test strips

*Anthem formulary list of all 4 copay tiers is available on the OWU HR web page.

Tips To Save $$$• Verify your doctor and the provider is in Anthem’s network• Remind the receptionist that your co-pay for a preventive care visit is $0• Confirm preventive care procedures are eligible prior to the appointment & that

it will be billed as a preventive when leaving the provider’s office• Verify physician referrals to labs/facilities are in the network• Utilize Anthem’s transparency tool to save money• Request in-office tests such as lab/x-ray be sent to an in-network lab or

physician for evaluation• Always reference Anthem’s Explanation of Benefits (EOB) prior to paying the

provider• Take the Preferred Drug List with you to the doctor visit • Request generic drug when available• Request drug samples from your doctor

OWU PPO Plan

Calendar Year Deductible

Co-Insurance after the Deductible (Per Calendar Year)

Insurance Company Pays (Per Calendar Year)

$1,000 Per Person$2,000 Family Maximum

90% of next $25,00010%

of next$25,000

100%

Your Individual Out-of-Pocket

Expenses

$2,500

$1,000

$3,500 Total Out-of-Pocket Expense Per Person

($7,000 Family Maximum)

+

All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription copayments.

Anthem PPO PlanDiagnostic Testing Services In-Network

• MRI’s 100%• CT Scans 100%• PET Scans 100%• Nuclear Medicine 100%• X-Ray’s/Radiology 100%

ANTHEM PPO PLANIn-Network

Deductible$1,000 Per Person$2,000 Family maximum

Out of Pocket*$3,500 Per Person(including deductible)

$7,000 Family maximum (including deductible)

Out-of-Network

Deductible$2,000 Per Person$4,000 Family maximum

Out of Pocket*$7,000 Per Person (including deductible)

$14,000 Family maximum (including deductible)

*Out-of-Pocket maximums include co-payments in-network

ConditionCare

• Receive guidance on following your care plan

• Consult with nurse coaches• Better manage your health

HEALTH MANAGEMENT TOOLS

ConditionCare helps participants manage the following conditions:

• Asthma (Pediatric & Adult)• Chronic Obstructive Pulmonary Disease • Coronary Artery Disease• Diabetes (Pediatric & Adult; Types 1 & 2)• Heart Failure

• Receive instant health care information

• Consult with registered nurses• Available by phone

24 hours a day, toll-free

24/7 NurseLine

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Tools to help you choose

Open Enrollment bookRead this guide to help compare your plan options

Find a DoctorSearch for information about doctors in your area

Interactive VideosLearn more about your health plan and how to effectively use it

Estimate Your CostFind cost estimates for common inpatient, outpatient and diagnostic services

32

ANTHEMDependent Age Status

• End of the month in which the dependent turns 26 unless the dependent is eligible for another employer-sponsored health plan other than that of a parent

WHO TO CALL WITH QUESTIONSAnthem Member Services: 1-888-290-9164

• Benefit Information• Claim Inquiries• Provider Searches• Changes to member data• ID Cards, Provider Directories

FLEXIBLE SPENDING ACCOUNT

PLAN DETAILSOhio Wesleyan University Sponsored Plan Allowing Faculty and Staff to Make Pre-Tax Contributions for:

• Health Care Account $2,550 Annual Election Maximum• Dependent Care Account $5,000 Annual Election Maximum

Eligibility Requirements• All full time Faculty and Staff• Do not need to participate in the Medical; Dental or Vision Plan• Annual Voluntary Election• May not have a HSA and a Health Care FSA (IRS Rule)

Plan year will begin July 1, 2016 – June 30, 2017

• Your employer offers a limited use FSA Benefits Card for you to use to pay for your FSA eligible expenses.

• The FSA Benefits Card allows employees participating in a FSA (medical or dependent care) to pay for eligible expenses at point of service

- No more paying cash, and waiting for reimbursement

• The FSA Benefits Card can be used at eligible merchant locations such as:• Doctor and Dentist offices• Pharmacies• Vision service locations• Dependent care facilities

(available funds are limited to actual account balance)

FSA BENEFITS CARD

File claims online athrpro.biz and click on the “Login”button in the top right corner

Complete paper claim form andfax, mail or email with itemizedreceipts or provider Explanation of Benefits (EOBs) to HRPro:

Fax: (248) 543-2296Email: [email protected]

Mail: 1423 East 11 Mile RoadRoyal Oak, MI 48067

HOW TO FILE A CLAIM

HOW TO SET UP DIRECT DEPOSIT

Complete the Direct Deposit Authorization Form

For checking accounts, attach a voided check (or photocopy of a check)

For savings accounts, attach a deposit slip

Once complete, fax all information to HRPro at 1-888-989-8329

There is a mobile app available to view your account balance from your smartphone.

You are able to upload your itemized receipts and attach them to claims on the Employee Portal or from your smartphone. This works for claims you submit for reimbursement and debit card transactions requiring documentation for substantiation.

SMARTPHONE MOBILE APP

ELIGIBLE EXPENSESHealth Care Account

• Medical, Dental and Vision expenses• Deductible• Coinsurance• Co-payments for office visits, prescription drugs, etc.• Some Expenses not covered by insurance

Dependent Care Account• Daycare expenses during work hours• Daycare/babysitting for children under 13• Preschool programs• After-school care• Home care for disabled dependent age 13 and over

ELIGIBLE EXPENSES

• Day Care expense must be to provide gainful employment

• If married, spouse must also be employed• Dependent must reside with employee• Payment for providing care may not be made to

another dependent• Care provider must disclose TAX ID #

DENTAL PLANS

KEY FEATURES OF THE DENTAL PLANS

• Your choice of a Low and High Plan• 100% for Routine Preventive services(1)

• Administrated by the Anthem

Benefits are subject to Anthem Contract Limitations

KEY FEATURES OF THE DENTAL PLANS

• Receive your care from the Dentist of your choice• No Network Requirement• Optional network of dentists to receive a discount for

services

Benefits are subject to Anthem Contract Limitations

LOW DENTAL PLAN

PreventivePlan Pays

100% In-Network 90% Out-of-Network

(No Deductible)

Oral Exams

Teeth Cleanings

X-Rays

Deductible Amount = $50.00/Person/year; Family Max (3)Basic

Plan Pays 80% In-Network

60% Out-of-Network

Amalgam fillings

Front composite fillings

Simple Extractions

Calendar Year Maximum Amount $1,000 per person

MajorPlan Pays

50% in-network 25% out-of-network

Periodontics

Endodontics

Oral Surgery

Crowns

Dentures

Bridges

Dental implants

Those who are actively managed in the Anthem Diabetic or Maternal Health Care Management programs will be eligible for an additional dental cleaning or periodontal maintenance procedure per

benefit period.

HIGH DENTAL PLANDeductible Amount = $50.00/Person/year; Family Max (3)

PreventivePlan Pays


(No Deductible)

Oral exams

Teeth cleaning

X-Rays

BasicPlan Pays


Sealants

Amalgam Filling

From Composite Filling

Back Composite Filling

Simple Extractions

MajorPlan Pays


Periodontics

Endodontics

Oral Surgery

Crowns

Dentures

Bridges

Dental Implants

Calendar year max amount

$1,500 (Anthem Dental

Providers)

Calendar year max amount

$1,000

Orthodontics 50% $1,000 Child only

Lifetime max

Those who are actively managed in the Anthem Diabetic or Maternal Health Care Management programs will be eligible for an additional dental cleaning or periodontal maintenance procedure per

benefit period.

OTHER KEY PIECES OF THE PREFERRED DENTAL PLAN• In most cases, the dentist will directly bill

Anthem for services• Annual Maximum Benefit is $1,000 per person • Optional Network of Dentists available to receive

discounts• Annual Maximum Benefit increases to $1,500

per person when services are provided in Anthem’s Network of Dentists

HOW THE OPTIONAL NETWORK SAVES YOU MONEY• Go to www.Anthem.com (click find a doctor)• Select the Dental Complete network• View network of Dentists in your area• Visit participating Dentists and receive treatment• Dentist will directly bill Anthem at a lower pre-

negotiated rate and receive their payment directly from Anthem

• The Dentist can not charge the difference between the negotiated rate and their normal fee (the plan’s benefits will apply toward the negotiated rate)

http://www.anthem.com/

ANTHEM DENTAL PLANSMonthly Payroll Deductions (1)

Effective July 1, 2016

Employee

Employee + One Dependent

Family

$23.26

$45.60

$74.49

$32.50

$64.39

$104.70

Basic Plan Preferred Plan

(1) Pre-tax deductions. Actual net cost will be reduced based upon IRS Section 125 election and personal income tax bracket.

VISION PLANS

BASIC VISION PLAN

• Exam every 12 months, $20 co-pay• Prescription glasses every 24 months, $20 co-pay• Contacts, no co-pay applies ( 24 months)• Coverage from a VSP Doctor

PREFERRED VISION PLAN

• Exam every 12 months, $10 co-pay• Prescription lenses every 12 months, covered in full• Contacts, no co-pay applies ( 12 months)• Frames every 24 months, $25.00• $140.00 Allowance• Coverage from a VSP Doctor

FIND A VSP PROVIDER

• Go to www.vsp.com• View Network of Doctors in your area• Visit participating Doctors and receive treatment• Call 1-800-877-7195

http://www.vsp.com/

VSP PLANSPayroll Deductions (1)

Effective July 1, 2016

Employee

Family $22.87

$8.09

$26.82

$9.49

Basic Plan Preferred Plan

(1) Pre-tax deductions. Actual net cost will be reduced based upon IRS Section 125 election and personal income tax bracket.

4 year rate guarantee!

OPEN ENROLLMENT• You may add or remove dependents• Enroll or terminate from plan• Election is effective 7/1/16• Election is in effect until 6/30/17; unless a qualified

change in your status occurs • Open Enrollment will be April 29th through May

20th 2016

QUALIFIED CHANGE IN YOUR STATUS?• Change in marital status• Change of dependents• Involuntary loss of coverage through spouse’s

employer• Change of spouse’s employment resulting in loss

of coverage• Must notify Human Resources within 30 days of

change!

OWU WELLNESS PROGRAM OVERVIEWWhat’s the big idea?• Our lifestyle decisions impact our

long-term health, wellbeing and productivity

• Our healthcare costs are impacted by the lifestyle decisions we make

• OWU continues its commitment to encouraging well-thought-out decisions regarding healthcare solutions, and to promoting a healthy family life

Where’s the “gain”?• OWU benefits when its employees are healthy,

and able to carry-out their work responsibilities efficiently and effectively

• Employees benefit by leading healthy lifestyles, and are therefore happier, more stable, more dependable, more satisfied

• Everyone benefits when human resource costs are under control (both insurance premiums and productivity)

OWU WELLNESS PROGRAM OVERVIEW

OWU Wellness Program

Where’s the “hook”?

• $25 one time premium credit for the year or $25 through payroll for completing the wellness assessment

• One time $75 premium credit for the year or $75 through payroll for achieving 34 credits

OWU WELLNESS PROGRAM OVERVIEW

OWU Wellness Program

HOW DO I “SIGN-UP”?

www.UBAwellnessworks.com

http://www.ubawellnessworks.com/

OWU Wellness

www.ubawellnessworks.com

P/W = OWUMonthly

Seminars

WELLNESSWORKS PROGRAMS…

Health Risk

Assessment

Quarterly

Challenges

http://www.ubawellnessworks.com/

BASIC PROGRAM –TRACKING (APRIL-MARCH TRACKING CYCLE)

ActivityCredit

Value

Annual

Max

Wellness Assessment 6 6Physical Exam / Biometric Screening 6 6

Virtual Coaching 5 10Online Monthly Seminars 1 12

Get Heart Smart Challenge (February 1-29) 5 5Stretch and Go Challenge (May 1-31) 5 5Keeping Your Cool Challenge (August 1-31) 5 5Dump the Junk Challenge (November 1-30) 5 5

Community Event 3 6Local Discretionary Activity 3 6End of Year Survey 2 2

Total Credit Opportunity 68

Earn 34+ Credits in

12-month

period to earn

incentive

QUESTIONS?

Documents

Health Care Plan Open Enrollment 2016-17 · •Tips to save health care dollars •FSA –Open Enrollment •Dental –Open Enrollment •Vision –Open Enrollment. Employee Benefit