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July 1, 2012 – June 30, 2013July 1, 2012 – June 30, 2013Benefit OverviewBenefit Overview
Dysart\2012\Open Enrollment\12 open enrollment presentation 0430.ppt
Annual Open EnrollmentAnnual Open Enrollment
The Dysart open enrollment period for the 2012 employee benefit plan year will begin May 1, 2012 and conclude on May 18, 2012.
Open enrollment changes will be effective July 1, 2012.
This is your once a year opportunity to add, drop or change existing coverage.
Next opportunity to make a change without a qualifying event will be May 2013 for a July 1, 2013 effective date.
Medical Plan Changes:– No increase to rates!!!
– HMO $500 and HMO $0 plans will continue to be offered
– Current PPO plan will be replaced with $750 PPO Plan that includes a Health Reimbursement Account (HRA)
• District will contribute $250 on 7/1/12 into each employee’s HRA account
• In addition, each employee may have an additional $250 contribution to the HRA upon successful completion of the Blue Cross online Health Risk Assessment
– Continue to offer the $1,500 HSA Saver plan but increase District HSA contribution• District contribution of $1,000 for 7/1/12 plan year ($500 on 7/1/12 and $500 on 1/1/13)
• In addition, each employee may have an additional $250 contribution to the HSA upon successful completion of the Blue Cross online Health Risk Assessment
Key Changes for 7/1/12 Plan YearKey Changes for 7/1/12 Plan Year
Medical Plan Changes – Wellness/Preventive:
Preventive care – claims as a result of an initial visit with an in-network provider are to be paid at in-network level of benefits even if provider/facility are out of network
On all “non-HSA” plans (not allowed on HSA plan due to regulations) an additional $250 wellness allowance per participant will be available:
Employees/dependents are able to use the $250 calendar year allowance for any “wellness” procedure that is not on list of approved services under PPACA and, thus, not on the IRS preventive list of procedures. This benefit is available for both in and “out of network” wellness. After the full $250 is used, any amount over $250 is then subject the medical plan deductible and coinsurance.
Example: Male prostate exam is NOT on the approved list. So for this exam, the participant would have $250 to use toward this exam… If the exam was $300, then the full $250 would be paid in full, then the person would pay $5 (10% of the remaining $50) assuming deductible has been met.
Key Changes for 7/1/12 Plan YearKey Changes for 7/1/12 Plan Year
Medical Plan Changes – Vision Therapy:
Vision therapy, also known as visual training, vision training, or visual therapy, is a broad group of techniques aimed at correcting and improving binocular, oculomotor, visual processing, and perceptual disorders.
Vision therapy will be a covered benefit on all medical plans at the Specialist Office Visit copay applicable to each medical plan. It will become a part of the eligible benefits under the Saver HSA plan and paid according to the current benefit structure.
Key Changes for 7/1/12 Plan YearKey Changes for 7/1/12 Plan Year
Domestic Partners (same and opposite sex) are eligible for Medical, Dental, Vision and Life.
– Affidavit and documentation will be required as proof of Domestic Partnership.
Health Flexible Spending Account (FSA) maximum election reduced from $3,000 to $2,500 due to health reform. Dependent FSA will remain at $5,000.
Key Changes for 7/1/12 Plan YearKey Changes for 7/1/12 Plan Year
Medical $4,960
Dental $118
Increased Health Savings Account District Contribution
$1,000 + opportunity to earn an additional $250 by completing a health risk assessment!!!
Implementation of a Health Reimbursement Account with District Contribution
$250 + opportunity to earn an additional $250 by completing a health risk assessment!!!
100% cost of Basic Life/AD&D for employee coverage
Annual District ContributionsAnnual District Contributions
Medical “26 Pay Period” Employee Medical “26 Pay Period” Employee Contributions 7/1/12Contributions 7/1/12
Coverage 26 Pay Period Cost
BCBS BluePreferred Saver $1,500 with HSA Employee $0.00 Employee + 1 Dependent $152.00 Employee + 2 or More Dependents $273.60
BCBS BluePreferred PPO $750 with HRA Employee $7.63 Employee + 1 Dependent $189.25 Employee + 2 or More Dependents $340.30
BCBS Blue HMO $500 Employee $7.63 Employee + 1 Dependent $206.03 Employee + 2 or More Dependents $364.75
BCBS Select HMO $0 Employee $27.42 Employee + 1 Dependent $245.60 Employee + 2 or More Dependents $420.15
When enrolling in the $1,500 plan you can receive up to $1,250 in your
HSA!!!
When enrolling in the $750 plan you can receive
up to $500 in your HRA!!!
Dental, Vision, Life, Optional Life, Short Term Disability, AFLAC, and 457
No change to plans offered.
Dental PPO rates increased 6%, no increase to Prepaid Dental rates.
Please log onto the benefitsCONNECT system for payroll deduction information.
Additional BenefitsAdditional Benefits
All benefit eligible employees will be required to re-enroll in medical insurance, AND re-elect FSA/HSA contributions. If you do NOT waive or enroll in medical you will be default enrolled in the $750 HRA plan as “employee only” and will have payroll deduction.
However, the system will assume you will remain in your current selections for dental, vision, life, disability, etc. unless you make a change in the system…
Changes You Can Make Online Changes You Can Make Online Using benefitsCONNECTUsing benefitsCONNECT
Dysart Employee Benefit WebsiteDysart Employee Benefit WebsiteProvides you with Access to:Provides you with Access to:
benefitsCONNECT – The District’s online enrollment system
Benefit summaries
Links to search for providers
2012-2013 benefit guide
Open enrollment presentation
All links and tools discussed during the presentation today can be found here!!!
Dysart Employee Benefit WebsiteDysart Employee Benefit Website
Medical Plan Medical Plan PresentationPresentation
Worksite Wellness ProgramWorksite Wellness Program
During 2011, Dysart began to offer a monthly Wellness newsletter to all employees to educate on current health topics and benefit information.
During 2011, Dysart offered on-site flu vaccination clinics for benefitted staff.
Health education classes like Healthy Pregnancy and Nutrition were offered at the District Office for all employees and family for no cost.
Two Weight Watchers At Work meetings were coordinated at one school and the District Office for all employees and family members.
Nutrition class offered for all Dysart Unified staff in March 2012.
Worksite Wellness ProgramWorksite Wellness Program
A Health Assessment Campaign was promoted to Dysart staff in February/March 2012. Participants were entered to win 1 of 50 $20 Sprouts Gift Cards.
A Wellness Interest survey was promoted in February/March 2012, to learn what employees wanted to see offered in 2012-2013 Wellness Program. Participants were entered to win one of twenty $25 Target gift cards.
In March 2012, Dysart Unified coordinated Mobile Onsite Mammography at multiple sites in the district for onsite screenings.
Future class considerations include sexual assault prevention and successful retirement.
Health Reform UpdateHealth Reform Update
Health FSA maximum contribution reduced from $3,000 to $2,500.
No other major changes for 2012. The changes below were implemented in prior plan years…
Dependent child “up to age 26” on Medical, Dental, Vision and Voluntary Life (this change was made effective 7/1/10 at Dysart)
Removal of pre-existing conditions for children up to age 19
No copay/cost for preventive care services
Lifetime limits will become “unlimited”
FSA/HSA - Prescription required for over the counter medication
Health Savings Account (HSA) penalty increased from 10% to 20% + ordinary income tax
HSA vs. HRA vs. FSAHSA vs. HRA vs. FSAHealth Savings Accounts
(HSA)
Flexible Spending
Accounts (FSA)
Health Reimbursement
Arrangements (HRA)
Tax-Advantaged (Contributions
Reduce Annual Tax Expenses)
Yes Yes No
Earns Interest Yes No No
$ in Account “Owned” by Employee Yes No No
$ in Account “Owned” by District No Yes Yes
Employee Can Contribute Yes Yes No
District Will Contribute Yes No Yes
Annual Contribution Limit Yes
$3,100 for individuals (2012)
$6,250 for families (2012)
No
$2,500 7/1/12 for health
FSA
$5,000 for dependent-care
FSA
Yes
Determined by District
annually – for 7/1/12 plan
year up to $500
Unused Balances Roll Over
Annually
Yes No No
$ Stays with Employee (if Retires or
Changes Jobs)
Yes No No
Medical DefinitionsMedical Definitions
Copayment: The fixed dollar amount you must pay directly to a physician at the time certain covered services, such as prescription drugs or office visits, are received.
Deductible: The fixed dollar amount you must pay for covered services each calendar year before BCBS begins to pay benefits.
Coinsurance: Sharing, between yourself and BCBS, of the cost of covered services.
Out-of-Pocket Maximum: The maximum dollar amount you have to pay under the terms of the BCBS contract in a calendar year for covered services.
Items in red font indicate changes from the 7/1/11 plan year benefits.
Blue Cross Medical Plan OptionsBlue Cross Medical Plan Options
Saver HSA $1,500 80/60
PPO $750 with HRA HMO $500 HMO $0
Benefits In Network Out of Network In Network Out of Network
In Network In Network
Deductible
Calendar Year Deductible
$1,500 if enrolled as employee only
$3,000 if enrolled as employee
only
$750 per Member
$1,500 per Member
$500 per Member $0
Calendar Year Deductible
$3,000 if enrolled and covering any dependents
$6,000 if enrolled and covering any
dependents
$1,500 per Family
$3,000 per Family
$1,000 per Family $0
Coinsurance 80% 60% 80% 60% 80% 100%
Out-of-pocket Maximum
(Includes Deductible)
Calendar Year $3,000 if enrolled as employee only
$6,000 if enrolled as employee
only
$2,000 per Member
$6,000 per Member
$2,500 per Member $1,500 per Member
Calendar Year $6,000 if enrolled and covering any dependents
$12,000 if enrolled and covering any dependents
$4,000 per Family
$12,000 per Family
$5,000 per Family $3,000 per Family
Items in red font indicate changes from the 7/1/11 plan year benefits.
* = subject to deductible
Medical Plan OptionsMedical Plan Options
Saver HSA $1,500 80/60
PPO $750 with HRA HMO $500 HMO $0
Benefits In Network Out of Network
In Network Out of Network
In Network In Network
Inpatient Hospital 80%* 60%* 80%* 60%* 80%* $250 copay*
Outpatient Hospital
80%* 60%* 80%* 60%* 80%* $125 copay per visit*
Emergency Room $150 fee per person per day, then 80%*
$200 copay per day then 80%*
$200 copay; then 80%*
$200 copay
Urgent Care 80%* 60%* $50 copay 60%* $50 copay $50 copayPreventive Care 100% Not
Covered100% 60%* 100% 100%
Office Visit 80%* 60%* $25 60%* $20 $25 Specialist Visit 80%* 60%* $45 60%* $45 $45
Pharmacy BenefitsPharmacy Benefits
Saver HSA $1,500 80/60
PPO $750 with HRA
HMO $500 HMO $0
Benefits In Network
Out of Network
In Network
Out of Network
In Network In Network
Deductible Yes - Plan Deductible
None None None
Level 1 80%* 60%* $15 Copay + difference
between IN contracted rate and billed rate
$15 $15 Level 2 80%* 60%* $30 $25 $30 Level 3 80%* 60%* $50 $45 $50 Mail Order (90 day supply)
80%* N/A 2.5x Copay
2.5x Copay
2.5x Copay
Examples of Preventive Examples of Preventive Care ServicesCare Services
Benefits are available for the following services on a preventive basis, as appropriate for your age and gender and as recommended by your
provider:
Preventive physical examination, i.e. routine physical examination, including the following services when done for screening purposes only:
– Annual well child– Mammogram– Bone density testing for osteoporosis– Screening - colonoscopy– Routine gynecologic exam including pap test and other cervical cancer screening tests
Refer to Dysart employee benefit website for complete list of preventive services
Provider Network BlueCross Provider Network BlueCross BlueShield of Arizona (BCBSAZ)BlueShield of Arizona (BCBSAZ)
All 4 Dysart medical plans have access to over 15,000 BCBSAZ contracted Physicians and Specialists
Referrals to specialists are not
required
•
Nurse On Call
866-422-2729
Speak with an experienced registered nurse anytime, day or night.
Online Services Ask a Nurse Health News Online Health Videos
HSAHSAPresentationPresentation
Who is Eligible for an HSA? Who is Eligible for an HSA?
Must be covered under the BCBS BluePreferred Saver $1,500 Deductible plan
Cannot also be covered under a health plan that is not a high deductible health plan (specific illness/accident policies are okay)
Not enrolled for benefits under Medicare or Tricare
Not covered as a dependent under another person’s tax return
Why Enroll in the BCBS BluePreferred Why Enroll in the BCBS BluePreferred Saver $1,500 Deductible with the HSA?Saver $1,500 Deductible with the HSA?
Pre-Tax contributions via payroll deduction and tax free distributions for eligible expenses
Lower premiums offer an affordable cost option to cover dependents vs. the $750 plan and 2 HMO plans
District will contribute $500 to your savings account on 7/1/12 and again on 1/1/13 this year AND you have the opportunity to earn an additional $250 by completing the health risk assessment
Once enrolled, you will receive a debit card to pull money from the savings account to pay for qualified medical expenses
You own the savings account and the money stays with you
The balance rolls over from one year to the next (no use-it-or-lose-it rule)
Long-term savings for healthcare expenses after retirement
HSAHSA“How To” – Doctor Visits“How To” – Doctor Visits
HSAHSA “How To” – Pharmacy “How To” – Pharmacy
PrescriptionsPrescriptions
ExampleExample
BluePreferred Saver $1,500 BluePreferred Saver $1,500 Deductible Deductible
with Health Savings Account (HSA) with Health Savings Account (HSA)
HSA ExampleHSA Example
Why this employee selected the Saver HSA $1,500:
Opportunity to save on taxes and save for future health care expensesPreventive care covered at no cost
Year One Year One
Assumes all network care – different coinsurance levels on non-network care apply.
HRAHRAPresentationPresentation
Who is Eligible for a HRA?Who is Eligible for a HRA?Benefits of the HRA? Benefits of the HRA?
Must be covered under the BCBS BluePreferred $750 Deductible plan
Contributions to the HRA by Dysart are excluded from your gross income
Use money from the account to pay for eligible medical expenses that go toward your deductible, coinsurance and out of pocket maximum
Lower premiums offer an affordable cost option to cover dependents vs. the 2 HMO plans (but more expensive than the HSA Saver plan)
District will contribute $250 to your HRA AND you have the opportunity to earn an additional $250 by completing a health risk assessment
Once enrolled, as you incur qualified medical expenses that go toward your deductible, coinsurance, and out of pocket maximum (no reimbursement for copays…) Health Equity will mail checks to your home address to reimburse you up to the amount you have in your HRA account
Please note ‘unlike’ the HSA, the HRA balance will “not” roll over from one year to the next
HRA ExampleHRA Example
Why this employee selected the $750 HRA plan:
District contribution of $500 to the HRAPreventive care covered at no cost
Year One Year One
Member services call center open
24 hrs a day / 7 days a week / 365 days a year:
1.866.960.80261.866.960.8026
Health Equity Help LineHealth Equity Help Line
Medical ID CardMedical ID Card
All employees will receive new ID cards. The cards will be shipped to your home mailing address.
Continue to use your current ID cards until 6/30/12. Use the new ID cards effective 7/1/12.
Online Tools & ResourcesOnline Tools & Resources
The tools listed below can be found under the “Medical” tab on the Dysart employee
benefit website
Medical plan evaluator tool
BCBSAZ cost & quality comparison tool
Health Equity tool which allows you to schedule payments to providers, schedule electronic funds transfer & more
Medical Plan Evaluator Medical Plan Evaluator Tool DemonstrationTool Demonstration
Age, Gender, Health Status EntryAge, Gender, Health Status Entry
Side by Side Comparison of Side by Side Comparison of Premium Cost & BenefitsPremium Cost & Benefits
Side by Side Comparison of Side by Side Comparison of Premium Cost & BenefitsPremium Cost & Benefits
Side by Side Comparison of Side by Side Comparison of Premium Cost & BenefitsPremium Cost & Benefits
(Takes District HSA/HRA Contribution Into Account) (Takes District HSA/HRA Contribution Into Account)
Healthcare Claims ProjectionHealthcare Claims Projection
Final Output – Best Option Saver Final Output – Best Option Saver HSA for this Individual’s FamilyHSA for this Individual’s Family
Total Dental Total Dental Administrators Administrators
You can select from 2 dental plansYou can select from 2 dental plans
Dental A500S – Lower Cost Dental Dental A500S – Lower Cost Dental OptionOption
District pays $118.06 annually toward either Dental plan option
No annual maximum
Must use dentist within the network
Routine Office Visit No Charge
Oral Exam - Periodic No Charge
Complete Series X-rays No Charge
Routine Cleaning No Charge
Amalgam Restoration $12 - $26
Porcelain Crown $455
Root canal-4 $395
Larger network of dentists
May pay less “out of pocket” for certain procedures vs. lower cost option
Predetermination of benefits is recommended for treatment over $300
Dental PPO – Dental PPO – Higher Cost Dental OptionHigher Cost Dental Option
Annual Deductible Individual $50 Family $150Annual Plan Maximum $1,000Orthodontia Maximum $1,000Benefits In-Network / Out-of-Network
Type I - Diagnostic & Preventive 100% / 100%Type II - Basic Service 90% / 80%Type III - Major Services 60% / 50%Type IV - Orthodontia (child only)
50% / 50%
Periodontic Coverage 90%Endodontic Coverage 90%Waiting Periods (timely entrants)
Major 12 months
Orthodontia 12 months
AvesisAvesisVisionVision
Avesis VisionAvesis Vision
In-Network (note out of network reimburses you “up to” a
certain amount….)
$10 copay for exam $10 copay for single, bifocal, trifocal
or lenticular lenses $130 contact lens allowance Exam, lens, contacts - 12 month
benefit frequency Frames - 24 month benefit frequency
AssurantAssurant
Short Term Short Term DisabilityDisability
Short Term Disability (STD)Short Term Disability (STD)
Benefit up to 66 2/3% of your regular monthly salary Waiting period: 5th day injury, 5th day sickness 6 Month Duration Up to $5,000 guarantee issue if you enroll when you are first eligible.
Should you enroll at a later date you will be required to complete a health statement.
During this open enrollment you can increase coverage up to a total of $2,500 without a health statement. Should you wish to increase coverage for an amount over $2,500 a health statement is required.
A health statement is a series of medical questions the insurance company will review and base your approved amount upon the conditions.
PRE‐EXISTING CONDITIONS
No benefits are payable for disabilities that commence within 12 months of your effective date if you received medical treatment, consultation, care or services, including
diagnostic measures, or took prescribed drugs or medicines for the disabling condition in the 12 months just prior to your effective date.
MHNMHN
Employee Employee Assistance Assistance
Program (EAP)Program (EAP)
MHN Employee Assistance MHN Employee Assistance Program (EAP) – 100% Paid by Program (EAP) – 100% Paid by
Dysart!!!Dysart!!!
Your EAP provides 3 face-to-face counseling sessions, 24/7 counseling over the phone, and a wide range of emotional health,
family and work issues, including:
CONFIDENTIAL Marriage, relationship and family problems Domestic violence Alcohol and drug dependency Stress and anxiety Depression Grief and loss Childcare and eldercare assistance Financial services Legal counseling
Note: Any employee or anyone in your household may use the EAP.
800-977-7593
Aetna Aetna
Flexible Flexible Spending Spending AccountAccount
Flexible Spending AccountFlexible Spending Account
Contribute up to:– $2,500 per year to the Health FSA (down from $3,000 due to healthcare reform)– $5,000 per year to the Dependent FSA
Money is deducted from your paycheck on a “before tax” basis to cover the cost of eligible items such as: copays, glasses, dental work, prescriptions, daycare for your children, etc.
Don’t forget the use-it-or-lose-it rule
If you enroll in the $1,500 HSA medical plan the IRS requires you use the HSA savings account for medical expenses. Keep in mind the HSA can also be used for dental and vision. You have the option to enroll in the FSA and HSA but you can only receive reimbursement for dental and vision under the FSA….
MetLifeMetLife
Life InsuranceLife Insurance
Basic & Supplemental Life/AD&DBasic & Supplemental Life/AD&D
Basic Life/AD&D 1 x your base annual salary up to $100,000 maximum (100% paid by Dysart!!!) Under the Basic Life/AD&D you have the option to elect Basic Dependent Life Spouse
coverage in the amount of $1,000 and Child coverage in the amount of $100 for children 15 days old to 6 months and $1,000 for children 6 months and older.
Supplemental Life Employee: 1 to 5 times your basic annual earnings, to a maximum of $500,000 Spouse/Domestic Partner: $5,000 to $250,000 in $5,000 increments, up to 50% of your
Supplemental Life coverage amount Children: 15 days to 6 months = Flat $100, 6 months up to age 26 = choice of $1,000,
$5,000, or $10,000*If you do not enroll when you are first eligible you will be required to complete a series of medical
questions (Evidence of Insurability aka EOI) and your requested amount will be reviewed and approved by the insurance company based on medical conditions.
Dysart Sick Leave BankDysart Sick Leave Bank
Election is made using BenefitCONNECT during May’s benefit enrollment period; not during the month of August as in the past.
The benefit period is from July 1, 2012 to June 30, 2013.
Employees can donate 1 to 5 days to the bank.
AFLACAFLAC
AFLAC Products OfferedAFLAC Products Offered
Hospital protection plan
Specified health protection plan
Accident plan
Cancer Plan
457/403b457/403b
Don’t forget to contribute to supplement your retirement!
Annual Open EnrollmentAnnual Open Enrollment
The Dysart open enrollment period for the 2012 employee benefit plan year will begin May 1, 2012 and conclude on May 18, 2012.
Open enrollment changes will be effective July 1, 2012.
This is your once a year opportunity to add, drop or change existing coverage.
Next opportunity to make a change without a qualifying event will be May 2013 for a July 1, 2013 effective date.
Questions?Questions?
