Manchester College 2010 Open Enrollment Meetings – November 17, 2009

Manchester College

2010 Open Enrollment Meetings – November 17, 2009

Today’s Agenda

• 2010 Manchester College Plan Options

• Reliance Standard Product Presentation

• HDHP / HSA Plan Overview• 2010 Exciting New Benefits!• Questions and Answers

2010 Manchester College Plan Options

$250 Plan I $750 Plan II HDHP / HSA Plan III

Deductible (Ind / Fam) $250 / $750 $750 / $2,250 $2,500 / $5,500

Maximum Out of Pocket (Ind / Fam) (In Net // Out Net)

$750 / $1,750 //$1,750 / $3,750

$2,750 / $6,250 //$4,750 / $10,250

$2,500 / $5,500 //$4,500 / $9,500

Coinsurance (In Net / Out Net)

90% / 70% 80% / 60% 100% / 60%

Office Visit Copay (In Net) $20 $20 None

Urgent Care Copay (In Net) $30 $30 None

Emergency Room Copay $100, then Deductible & Coinsurance

$100, then Deductible & Coinsurance

None

Prescription Drug Plan Copays

10% / 20% / 30% 10% / 20% / 30% None

Monthly Employee Premiums

Employee Only $258.62 $136.11 $ 43.69

Employee & Child(ren) $465.51 $245.00 $ 78.64

Employee & Spouse $543.12 $285.85 $ 91.74

Family $724.15 $381.14 $122.32

2010 Manchester College Plan Options

• For HDHP / HSA Plan III Participants, the College will deposit into your HSA:– Employee Only $300– Employee + Child$600– Employee + Spouse $600– Family $900

• HSA contributions will be made in 24 equal installments throughout the calendar year

Medical & Prescription Drug Plan Information

All Plans– Spousal Insurance Requirement Continues– 2009 Plan Year Changes

• Michelle’s Law• CHIP Reauthorization Act• Special COBRA Subsidy• Adult Immunizations• Domestic Partner Coverage• Removed Home Health Care Per Visit Payment Limit

– 2010 Plan Year Changes• Genetic Information Nondiscrimination Act (GINA)• Mental Health Parity• Covering All Forms of Birth Control

Vision Plan Information

• VSP Network• $10 Exam Copay• 10% Discount on Materials

Dental Plan Information

• Insurance Carrier Change– Effective January 1, 2010, Reliance Standard

will be the dental carrier

• Everyone who wants dental coverage must complete an enrollment form

• Dental Network is Reliance Standard• Out of Network Pays 80th Percentile of

Reasonable & Customary

Dental Plan Summary

Reliance Standard

Deductible (Ind / Fam) $25 / $75

Preventive Care Reimbursement 100%

Diagnostic Care 100%

Basic Care 90%

Major Care 50%

Orthodontia 50%

Calendar Year Maximum $1,000

Orthodontia Lifetime Maximum $1,000

Monthly Employee Premiums

Employee Only $26.50

Employee + Child(ren) $63.00

Employee + Spouse $63.00

Family $94.12

Dental Financial Example #1

Family Employee who incurs the following charges:8 Annual Exams & Cleanings $6002 Amalgams $230

$830

Employee Cost Share under each Plan option:

With Dental Insurance

Without Dental Insurance

Annual Employee Contribution $1,129.44 $0

8 Annual Exams & Cleanings $0 $ 600

2 Amalgams $45.50 $230

ANNUAL TOTAL $1,174.94 $830

Dental Financial Example #2

Family Employee who incurs the following charges:8 Annual Exams & Cleanings $6002 Amalgams $2301 Set of Braces $5,000

$5,830

Employee Cost Share under each Plan option:

With Dental Insurance

Without Dental Insurance

Annual Employee Contribution $1,129.44 $0

8 Annual Exams & Cleanings $0 $ 600

2 Amalgams $45.50 $230

1 Set of Braces $4,000 $5,000

ANNUAL TOTAL $5,174.94 $5,830

Life and AD&D Plan Information


will be the life carrier

• No Change to College provided Life Insurance or AD&D Benefits– 1.0 times Base Annual Earnings to $170,000

• No Change to College provided Dependent Life Insurance– $10,000 Spouse, $500 Child 14 Days to 6

Months, $10,000 Child 6 Months and older

Voluntary Life Plan Information


will be the voluntary life carrier

• No Change to Current Rates– Summary Handout Available

• Same Guarantee Issue Limit– $100,000 for Employees and $25,000 for

Spouses

• Current Amounts Grandfathered• All employees who want new coverage

amounts must complete an enrollment form

Voluntary Life Plan Rates

Age Reliance Standard Semi-Monthly Rate

Under 30 $0.03

30 – 34 $0.04

35 – 39 $0.0475

40 – 44 $0.0595

45 – 49 $0.0885

50 – 54 $0.144

55 – 59 $0.252

60 – 64 $0.3515

65 – 69 $0.635

70 & Over $1.067

Rate Guarantee Two Years

LTD Plan Information


will be the LTD carrier

• Plan Summary Handout Available• No Change to Rates

FSA Plan Information

• Limited and Unlimited Flexible Spending Accounts Continue

• Plan Summary Handout Available• Dependent Care Flexible Spending

Continues

Your Advocate will do 2 things:

1. Help you to navigate through the health care system.

2. Help you to become a better health care consumer.

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Who Receives Our Services?• Services are available as of January 1, 2010 for all

employees and dependents covered under Manchester College benefits

• Automatic eligibility - you do not need to enroll

• This benefit is free to you

You have an Advocate!

• Problem solver – not an insurance company • We assist with medical, dental and vision issues

– Flexible spending account (FSA)– Health reimbursement arrangement (HRA) – Health savings account (HSA)

• We are able to assist with new and old issues• We do not provide clinical or legal advice• We have Advocates who speak Spanish

Patient Care is completely confidential19

Advocates assist with:• Resolving billing/claims issues• Understanding your benefits and options• Understanding prescription drug options• Helping you find a doctor in your network• Negotiating with non-network providers to get a

discount when possible• Helping you become a better healthcare consumer

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Cost & Quality Information: How?

Call your Advocate 15 days prior to

scheduling a test or procedure.

Your Advocate will contact 2-3

providers in your network for cost

information.

Your Advocate will review cost and

quality information with you to make

an informed decision.

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WOW!Procedure: Knee ArthroscopyCPT code: 29873Physician who ordered or recommended procedure: Michael Anderson, M.D. Date procedure scheduled: May 11, 2008

Medical Provider Memorial Hospital St. Mary’s Hospital Baptist Hospital

Total Price $7,400.00 $14,350.00 $12,800.00

Discount Rate 12% 11% 11%

Actual Discount $888.00 $1,578.50 $1,408.00

Balance $6,512.00 $12,771.50 $11,392.00

Deductible to Meet $500.00 $500.00 $500.00

Member Coinsurance 20% 20% 20%

Coinsurance Payment $1,204.40 $2,454.30 $2,178.40

Member Responsibility $1,704.40 $2,954.30 $2,678.40

Employer Responsibility $4,807.60 $9,817.20 $8,713.60

Authorization (approval) for this procedure (choose one) is or is not required by your health plan.

Reference number XXXXXXXXXX has been issued by your plan.

We investigated outcome information for this procedure and there are no significant differences between these facilities. Please keep in mind that the most important aspect of the quality of your healthcare experience relates to your physician and you

have chosen to use Dr. Anderson, who will perform the surgery at any of these facilities.

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Quality is important!• Accepting new patients• Years in practice• Number of procedures performed annually• Hospital complies with safe practices• Hospital handles high risk procedures• ICU staffed by specialists• Computerized Physician Order Entry

633 W. Wisconsin Ave. #1310

Milwaukee, WI 53203

www.patientcare4u.com

1-866-253-2273

Monday – Friday 7 AM to 7 PM CST

Saturday 8 AM to 1 PM CST

Free Wellness Clinic!

• All enrolled employees and their dependents are eligible

• First meeting with Physician will be a 40 minute wellness exam and will include a Health Risk Assessment

• Free Primary Care Physician Services– Common Colds, Wellness Visits, etc.

• Generic Prescriptions Dispensed Free• 24/7 Nurse Line • 20 Minute Appointments Made Online or

through Nurse Line

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HDHP / HSA Overview

• A Health Savings Account (HSA) is a special account owned by an employee where tax-free deposits into the account are used to pay for current and future medical expenses

• You can only contribute to an HSA if you participate in only “High Deductible Health Plan(s)” (HDHP)

HDHP & PPO Similarities

• 100% Wellness Coverage– Periodic Health Evaluations (e.g. annual

physicals)– Screening services (e.g. mammograms)– Routine adult and well-child care– Immunizations

• Network Discounts, so pay providers only from your EOB to obtain discounts

• Claim filing procedures• Customer service with Group

Administrators• Online view of claim activity

www.groupadministrators.com

HDHP & PPO Differences

• Higher Deductibles• You pay 100% of your medical and

prescription costs up to the deductible• No copays with HDHPs

HSA Contribution Rules

• Deposits to an HSA can be made by the employer or the employee, or both, or any other person or entity

• Deposits are not considered taxable income to the employee, except if they are withdrawn for non-qualified expenses

• Maximum amount that can be deposited to your HSA in 2010 from all sources is:– $3,050 Single– $6,150 Family

HSA Contribution Rules

• For employees age 55 and older, additional “catch-up” contributions to your HSA are allowed at $1,000 per year

• For spouses age 55 and older, their catch up contribution is only available in their own account

• Deposits must stop once an employee is enrolled in Medicare

HSA Withdrawals

• HSA Monies are tax-free if taken for “qualified medical expenses”– For a complete list, search for Publication 502

on www.irs.gov– Includes over-the-counter drugs

• Medical expenses can be paid from your HSA account for:– Employee covered by the high deductible plan– Spouse– Any dependent

HSA Withdrawals

If you use your HSA monies for expenses other than qualified medical expenses, you will pay payroll taxes and a 10% penalty on the money unless you are over social security normal retirement age, then no penalty

HSA Accounts

• Accounts can grow through investment earnings, just like an IRA

• Investment income is non-taxable• Accounts can be withdrawn for any

purpose after retirement age with no penalty, only income taxes

HSA Summary

• No “use it or lose it rules” like Flexible Spending Arrangements (FSAs)

• All monies in the HSA are fully vested• Unspent balances remain in the account• Unspent balances remain with the

employee if they leave employer• Encourages account holders to spend their

funds more wisely on medical and prescription services

• For medical and prescription services, you can have an FSA or HSA, but not both

Financial Example #1

Single Employee who incurs the following charges:1 Complete Routine Physical $ 4503 PCP Office Visits $ 6002 Generic Prescriptions $ 34

$1,084Employee Cost Share under each Plan option:

PPO Plan I PPO Plan II HDHP / HSA Plan

Annual Employee Contribution

$3,103 $1,633 $ 524

1 Routine Physical $ 20 $ 20 $ 0

3 PCP Office Visits $ 60 $ 60 $ 600

2 Generic Rxs $ 20 $ 20 $ 34

Employer HSA Credit

$ 0 $ 0 ($ 300)

ANNUAL TOTAL $3,203 $1,733 $ 858


Family Employee, covering a spouse and two children, who incur the following charges:3 Complete Routine Physicals $1,3506 PCP Office Visits $1,2002 ER Visits $ 4005 Generic Prescriptions $ 852 Brand Formulary Prescriptions $ 140

$3,175Employee Cost Share under each Plan option:

PPO Plan I PPO Plan II HDHP / HAS Plan


$ 8,690 $ 4,574 $ 1,468

3 Routine Physicals $ 60 $ 60 $ 0

6 PCP Office Visits $ 120 $ 120 $ 1,200

2 ER Visits $ 200 $ 200 $ 400

5 Generic Rxs $ 50 $ 50 $ 85

2 Brand Formulary Rxs $ 40 $ 40 $ 140.

Employer HSA Credit $ 0 $ 0 ( $900)

ANNUAL TOTAL $ 9,160 $ 5,044 $ 2,393


Employee, covering a spouse only, who incur the following charges:2 Complete Routine Physicals $ 9008 PCP Office Visits $ 1,6003 ER Visits $ 1,2001 12-day Inpatient Hospital Stay $ 43,50024 Generic Prescriptions $ 40812 Brand Formulary Prescriptions $ 840

$ 48,448Employee Cost Share under each Plan option:

PPO Plan I PPO Plan II HDHP / HSA Plan III


$ 6,517 $ 3,430 $ 1,101



3 ER Visits $ 300 $ 300 $ 1,200

1 12-Day Inpatient Stay $ 750 $ 2,750 $ 2,700

24 Generic Rxs $ 240 $ 240 $ 0 (Deductible Met)

12 Brand Formulary Rxs $ 240 $ 240 $ 0 (Deductible Met)

Employer HSA Credit $ 0 $ 0 ($ 600)

ANNUAL TOTAL $ 8,247 $7,160 $ 6,001


Employee, covering children and spouse only, who incur the following charges split among family members:4 Complete Routine Physicals $ 1,80025 PCP Office Visits $ 5,0003 ER Visits $ 1,2002 12-day Inpatient Hospital Stay $ 87,00024 Generic Prescriptions $ 40812 Brand Formulary Prescriptions $ 840


PPO Plan I PPO Plan II HDHP / HSA Plan III


$ 8,690 $ 4,574 $ 1,468



3 ER Visits $ 300 $ 300 $ 500

2 12-Day Inpatient Stay $ 1,750 $ 6,250 $ 0 (Deductible Met)

24 Generic Rxs $ 240 $ 240 $ 0 (Deductible Met)

12 Brand Formulary Rxs $ 240 $ 240 $ 0 (Deductible Met)

Employer HSA Credit $ 0 $ 0 ($ 900)

ANNUAL TOTAL $ 11,800 $ 12,184 $ 6,068


Single Employee who incurs the following charges:1 Complete Routine Physical$ 4501 ER Visit $ 8508 PCP Office Visits $ 1,6002 Generic Prescriptions $ 34


PPO Plan I PPO Plan II HDHP / HSA Plan


$ 3,103 $ 1,633 $ 524

1 Routine Physical $ 20 $ 20 $ 0

1 ER Visit $ 100 $ 100 $ 850


2 Generic Rxs $ 20 $ 20 $ 34

Employer HSA Credit

$ 0 $ 0 ($ 300)

ANNUAL TOTAL $ 3,403 $ 1,933 $ 2,708

Best Case Scenarios

PPO Plan I$250 Deductible


Total MinimumEmployee Liability

Employee Only $3,103 $ 3,103

Employee + Child(ren) $5,586 $ 5,586

Employee + Spouse $6,517 $ 6,517

Family $8,690 $ 8,690

PPO Plan II$750 Deductible



Employee Only $1,633 $ 1,633

Employee + Child(ren) $2,940 $ 2,940

Employee + Spouse $3,430 $ 3,430

Family $4,574 $4,574

HDHP Plan III$2,500 Deductible


Annual College HSA Deposit


Employee Only $ 524 ($300) $224

Employee + Child(ren)

$ 944 ($600) $344

Employee + Spouse

$1,101 ($600) $501

Family $1,468 ($900) $568

* Maximum Out of Pocket (In Net) does not include copayments for office visits or prescription drugs.

Worst Case Scenarios

PPO Plan I$250 Deductible


Maximum Out of Pocket (In Net)*

Total Annual Potential Employee Liability

Employee Only $3,103 $ 750 $ 3,853

Employee + Child(ren) $5,586 $1,750 $ 7,336

Employee + Spouse $6,517 $1,500 $ 8,017

Family $8,690 $1,750 $10,440

PPO Plan II$750 Deductible


Maximum Out of Pocket (In Net)*


Employee Only $1,633 $2,750 $ 4,383

Employee + Child(ren) $2,940 $6,250 $ 9,190

Employee + Spouse $3,430 $5,500 $ 8,930

Family $4,574 $6,250 $10,824

HDHP Plan III$2,500 Deductible


Maximum Out of Pocket (In Net)

Annual College HSA Deposit


Employee Only $ 524 $2,500 ($300) $2,724

Employee + Child(ren)

$ 944 $5,500 ($600) $5,844

Employee + Spouse

$1,101 $5,000 ($600) $5,501

Family $1,468 $5,500 ($900) $6,068

* Maximum Out of Pocket (In Net) does not include copayments for office visits or prescription drugs.

Treasury Assistance

• Web site – www.treas.gov (Click on “Health Savings Accounts”) – contains:– All treasury guidance– Frequently asked questions– IRS forms and publications– HSA Statute– Examples of tax savings from HSA

contributions– Links to other useful sites

• Still have questions?– E-mail address: [email protected]– Voice mailbox: 202.622.4HSA

http://www.treas.gov/

mailto:[email protected]

Complete Enrollment Form for Any New Voluntary Life Coverage

Complete Enrollment Form for Any Dental Coverage

Complete Health Change Forms only if you have 2010 Health Changes

All Due to Lindsey Wertz no later thanNoon on Monday, December 7

What To Do Next

Questions and Answers

Documents

Manchester College 2010 Open Enrollment Meetings – November 17, 2009