Upload
tom
View
24
Download
0
Embed Size (px)
DESCRIPTION
Open Enrollment Presentation for Milpitas Christian Schools Presented by. BenefitEdge Insurance Services, Inc. (888) 995-EDGE (3343) (408) 995-EDGE (3343) www.benefitedge.net Lic#0F37564. Who is BenefitEdge Insurance? - PowerPoint PPT Presentation
Citation preview
Open EnrollmentPresentation
for Milpitas Christian Schools
Presented by
BenefitEdge Insurance Services, Inc.
(888) 995-EDGE (3343)(408) 995-EDGE (3343)www.benefitedge.net
Lic#0F37564
Who is BenefitEdge Insurance?
We are the Benefits Broker for your Medical, Dental, Vision, Life, LTD, LTC Insurance Plans
We will work in support of your HR team to resolve any benefits related issues throughout the year
Reminder for 2010Website:
www.mcsihr.comEmail:
2010 Benefit Enhancements Changing dental, vision, life, and LTD/STD to Guardian – larger network, better plan design. All benefit eligible employees will receive $25,000 of basic life insurance Voluntary life insurance with guarantee issue up to $100,000. MCSI will contribution $50 per month for employees that choose a Health Savings Account Plan
Medical Insurance This is our open enrollment period and your opportunity to make changes to your plans.
Any requested changes after open enrollment will require a “qualifying event”.
Any changes will take effect on July 1, 2010.
Medical Insurance
There are currently medical insurance plan options provided through two different insurance carriers – Kaiser Permanente & HealthNet
Medical Insurance - HMO Kaiser plan, you have to use their facilities
HealthNet HMO - You must use a primary care physician (PCP) for each of your family members
Your PCP will provide all of your routine care and with a few exceptions, must provide a referral in order for you to receive care from a specialist
Medical HMO Kaiser Health NetGroup # 602272 J9514A B1002APlan $40 Plan HMO 25 HMO 35Deductible None None None Physician's Office CareOffice Visit Copay $40 $25 $35 Adult Preventive Care $40 $25 $35
Well Baby Care $5 $25 after 24 months $35 after 24 monthsLabs and Xrays No Charge No Charge No Charge Prescription DrugsGeneric $10 $15 $15 Brand Name $30 $150 ded, then $30 $200 ded, then $30 Hospital CareIn-Patient Hospital $500 per admit 20% 30%Out-Patient Services $40 20% 30%Urgent Care Emergency $40 $50 $50 Hospital Emergency $100 $100 Copay $100 Copay Maximum Out-of-PocketIndividual $1,500 $3,000 $4,000 Family $3,000 $6,000 $8,000 Max. Lifetime Benefit Unlimited No Maximum
HealthNet – With the PPO plan you can see any doctor of your choice and will save money using a contracted provider
You have access to a larger network of doctors and it also allows you to use non-contract physicians at a reduced coverage level
You do not need a referral to use a specialist. You may “self direct” your care as needed
Medical Insurance - PPO
HealthNet Medical PPO Traditional PlanGroup # K9557APlan PPO 1750
Contract Provider Non-Contract ProviderDeductible $1,750 EE / $3,500 FAM $3,500 EE / $7,000 FAM
Physicians Office CareOffice Visit Copay $35 50%Adult Preventive Care $35 ($250 max) Not CoveredWell Baby Care $35 Not CoveredLabs and Xrays 40% 50%
Prescription DrugsGeneric $15 50%Brand Name $30 + $200 ded (pp) 50% + $100 (pp)
Hospital CareIn-Patient Hospital 40% + Deductible 50% + Deductible Out-Patient Hospital 40% 50%Emergency $50 copay + 40%Hospital Emergency $100 copay + 40%
Maximum Out-of-PocketIndividual $5,000 $10,000 Family 2 per family 2 per familyMaximum Lifetime $5,000,000 combined with PPO & OON
Health Savings Account (H.S.A.)
What is an H.S.A?
Health Savings Accounts are tax-exempt accounts where funds grow to pay for medical expenses. They were created to help give control back to consumers and lower healthcare costs.
2 Parts
1. A High Deductible, IRS Approved Health Plan
2. A Health Savings Account (Bank Account)
Intended to cover serious illness or injury once the deductible has been met.
Used to cover all IRS approved medical expenses until the deductible is met.
Health Savings Account (H.S.A.)
Part 1
Medical HSA KaiserGroup # 602272Plan $1,500 PlanDeductible $1,500 / $3,000 Physician's Office CareOffice Visit Copay $0 after deductibleAdult Preventive Care $0Well Baby Care $0Labs and Xrays $0 after deductible Prescription DrugsGeneric $0 after deductibleBrand Name $0 after deductible Hospital CareIn-Patient Hospital $0 after deductibleOut-Patient Services $0 after deductibleUrgent Care Emergency $0 after deductibleHospital Emergency $0 after deductible Maximum Out-of-PocketIndividual $1,500 Family $3,000 Max. Lifetime Benefit Unlimited
Part 1
HSA Eligible PPO PlansGroup # K9558A K9559APlan PPO 3000 (H S A-Compatable) PPO 4000 (H S A-Compatable) Contract Provider Non-Contract Provider Contract Provider Non-Contract ProviderDeductible $3,000 EE / $6,000 FAM $4,000 EE / $8,000 FAM $4,000 EE / $8,000 FAM $5,000 EE / $10,000 FAM
Physicians Office CareOffice Visit Copay $25 50% $35 50%Routine Physicals $25 Not Covered $35 Not CoveredWell Baby Care $25 ded waived Not Covered $35 ded waived Not CoveredLabs and Xrays 30% 50% 40% 50%
Prescription DrugsGeneric $15 after ded 50% after ded $15 after ded 50% after dedBrand Name $30 after ded 50% after ded $30 after ded 50% after ded
Hospital CareIn-Patient Hospital 30% + $250 Ded 50% + $250 Ded 40% + $250 Ded 50% + $250 Ded Out-Patient Hospital 30% + $250 Ded 50% + $250 Ded 40% + $250 Ded 50% + $250 Ded Urgent Care Emergency $50 copay + 30% $50 copay + 40%Hospital Emergency $100 copay + 30% $100 copay + 40%
Maximum Out-Of-PocketIndividual $4,000 $4,000 $5,000 $5,000 Family $8,000 $8,000 $10,000 $10,000 Maximum Lifetime Benefit $5,000,000 combined with PPO & OON
Health Savings Account (H.S.A.)
Funds deposited and not used remain in your account and they roll over every year
Your H.S.A. funds can be used for any medically necessary expenses per IRS rules.
Part 2
Health Savings Account (H.S.A.)Who is Eligible?
Members covered by an HSA-compatible, IRS approved plan
Who is Not Eligible?
Anyone enrolled in Medicare or 65 or older If you are claimed as a dependent on another person’s tax return
Part 2
Acupuncture Chiropractic Blood testsBlood transfusionsContact Lenses Dental, Dental X-rays, DenturesDrugs (prescription) EyeglassesGum treatment
***Also pays for COBRA, long term care and Medicare part B & D premiums.
APPENDIX: SAMPLE OF HSA QUALIFIED EXPENSES (Short List)Source: IRS Code Sec 213(d) Publication 502 (WWW.IRS.GOV)
Hearing aids Hospital billsInsulin Lab testsOpticianOptometristOral surgeryPrenatal carePsychotherapyVaccinesVitamins (if prescribed)X-rays
Part 2
Accessing Funds
Signature Based Debit Visa CardReceived 2-3 weeks after account set up
Online AccessTrack deposits, balances, and claims
Part 2
Health Savings Account Limits
H.S.A. Deposit Limit Per IRS Code2010 Plan Year
IRS Annual LimitSingle $3,050 Family (2 or more) $6,150 Catch-UP (55 or older) $1,000
Part 2
MCSI will deposit $50 per month into your HSA bank account
HSA Comparison
Items for Consideration before making a change: Your monthly contributions from your paycheck Amount you typically spend out of pocket on
your medical expenses per year Medical plan deductible Medical plan out-of-pocket maximum
EE + SP Coverage
Current Plan HMO 40 HSA Plan 1500ACurrent Deductible $0 ADeductible $3,000BOut-of-Pocket Max $3,000 Out-of-Pocket Max $3,000
EE Monthly Cost $603 EE Monthly Cost $537CAnnual Cost $7,236 BAnnual Cost $6,444
Savings from PPO $792
MCSI HSA Contribution $0 MCSI HSA Contribution $600
C Total $1,392
Annual Scenarios Annual Scenarios
Worst Case (A+B+C) $7,736 Worst Case (A+B-C) $8,052
Low Utilization $7,236 Low Utilization $5,402
Family CoverageCurrent Plan HMO 40 HSA Plan 1500
ACurrent Deductible $0 ADeductible $3,000BOut-of-Pocket Max $3,000 Out-of-Pocket Max $3,000
EE Monthly Cost $1,005 EE Monthly Cost $895CAnnual Cost $12,060 BAnnual Cost $10,740
Savings from PPO $1,320MCSI HSA Contribution $0 MCSI HSA Contribution $600 C Total $1,920Annual Scenarios Annual Scenarios Worst Case (A+B+C) $15,060 Worst Case (A+B-C) $11,820Low Utilization $12,285 Low Utilization $9,170
Employee Only CoverageCurrent Plan HMO 25 HSA Plan 3000
ACurrent Deductible $0 ADeductible $3,000BOut-of-Pocket Max $3,000 Out-of-Pocket Max $4,000
EE Monthly Cost $82 EE Monthly Cost $0CAnnual Cost $984 BAnnual Cost $0
Savings from PPO $984
MCSI HSA Contribution $0MCSI HSA Contribution $600
C Total $1,584Annual Scenarios Annual Scenarios Worst Case (A+B+C) $3,984 Worst Case (A+B-C) $2,416Low Utilization $1,434 Low Utilization $16
Family Coverage
Current Plan HMO 35 HSA Plan 3000ACurrent Deductible $0 ADeductible $3,000BOut-of-Pocket Max $4,000 Out-of-Pocket Max $4,000
EE Monthly Cost $1,050 EE Monthly Cost $470CAnnual Cost $12,600 BAnnual Cost $5,640
Savings from PPO $6,960
MCSI HSA Contribution $0MCSI HSA Contribution $600
C Total $7,560
Annual Scenarios Annual Scenarios
Worst Case (A+B+C) $20,600 Worst Case (A+B-C) $6,080
Low Utilization $13,250 Low Utilization $80
New Dental Carrier – Guardian
Dental PPO $50 deductible which is waived for preventive care. Calendar year annual maximum is $3,000 in-network
and $2,000 out-of-network Preventive services are covered at 100% Orthodontia Benefit for Adult and Children
New Dental Carrier – Guardian
Dental PPO $50 deductible which is waived for preventive care. Calendar year annual maximum is $3,000 in-network
and $2,000 out-of-network Preventive services are covered at 100% Orthodontia Benefit for Adult and Children
New Dental Carrier – Guardian
Dental PPO $50 deductible which is waived for preventive care. Calendar year annual maximum is $3,000 in-network
and $2,000 out-of-network Preventive services are covered at 100% Orthodontia Benefit for Adult and Children
* Subject to UCR (Usual, Customary, Reasonable)
Guardian Dental, Group # 458105 Benefits Preferred Provider Non-Contract Provider
Annual Maximum $3,000 $2,000
Calendar Year Deductible $50 (3 per Family)Preventive Services: 100% 100%*Exam, X-rays, Cleaning General/Basic Services: 90% 80%*Fillings, Endo, Perio Major Services: 60% 50%*Crowns, Bridges, Dentures Orthodontic Services: 50% 50%Child and Adult YesOrthodontics Lifetime Max. $2,000 Your Cost Per Month
Employee $0.00
New Vision Insurance – Guardian VSP Guardian VSP, Group # 458105Benefits Contract Provider Non-Contract ProvdrExams $10.00 Materials $25.00 Lenses Single Vision Covered in Full $47 Bifocal Covered in Full $66 Trifocal Covered in Full $85 Contacts Medically Nec. Contacts Covered in Full $210 Cosmetic $120 Allowance $120 Frames $120 + 20% $47
Benefit FrequencyExam Every 12 Months Lenses Every 24 Months Frames Every 24 Months
New Life Insurance – Guardian
MCSI will provide $25,000 of Basic Life Insurance for all Employees.
New Voluntary Life Insurance – Guardian
Additional life insurance up to $300,000 Guarantee issue up to $100,000, any amount
above $100,000 will be subject to underwriting Life insurance available for spouse and children Employee paid through payroll deductions
New LTD and STD Carrier - GuardianLong Term Disability Guardian, Group # 458105
LTD Benefit % 60% of Predisability EarningsMaximum Monthly Benefit $6,000 a monthElimination Period 180 DaysShort Term Disability Guardian, Group # 458105STD Benefit 66 2/3% to a maximum of $1,000 per month
Elimination Period 15 Days
LTD and STD is 100% Paid by Milpitas Christian School, Inc.
Long Term Care Insurance
Covers Expenses In the Event You are Disabled and Need Assistance With the Functions of Daily Life
Base Plan Provided By Milpitas Christian School After 10 Years of Service
You Can Increase the Coverage Level on a Voluntary Basis and Contribute the Difference in Premium
You May Also Purchase Voluntary Coverage Prior to Your 10 Year Anniversary
These Plans are available on a VOLUNTARY basis
Cancer ProtectionIntensive Care
Personal AccidentPersonal Life Insurance
Personal RecoveryMedical Bridge – HMO, PPO, HSA
Voluntary Benefits
Unlimited letters written on your behalfDirect access to a local law-firmVarious of hours of legal support based upon
your total length of time with PPL
Pre-Paid Legal Services
Five Common Types of Identity Theft
Drivers License
Medical FinancialSocial Security
Character/ Criminal
Monitor your credit on a monthly basisIdentifies possible breeches in your identityIf identity is stolen will work to repair your credit
Identity Theft Response
Pre-Paid Legal and Identity Theft Cost
Prepaid Legal - $15.95 per monthIdentity Theft - $12.95 per monthBoth - $25.90 per month
Flexible Spending Account - FSA
Optional FSA Plan Available
Personal Pre-Tax Contributions may be made to your FSA up to $3,000 for
Medical and $5,000 for Dependent Care.
Plan year begins July 1, 2010 through June 30, 2011
Thank you for your time.
Please make sure to submit your changes before May 21 to Leslie.
We look forward to serving you and helping with any benefit related issues.
Please don’t hesitate to call.
Frequently Asked Questions:How long will it take to receive my cards? It will take 2-3 weeks
What if I need to see a Doctor? If you need to see a Doctor before you receive your member cards, you may have your doctor contact our office to verify coverage. Also, the temporary card will suffice until the permanent one arrives.
What if I need a prescription? Try to refill prescription prior to June 30 if you are changing plans or carriers. If you need a prescription before you receive your member cards, you may need to pay the cost of the prescription and then do one of the following;
1. If you receive your member card with 1-2 weeks of purchasing the prescription, most pharmacies will allow you to present your member card and they will provide you with a refund.
2. If the pharmacy will not refund your cost, you can submit a claim directly to the insurance carrier. We will provide you with the claim form and assist you.