Presented by:HUB InternationalNovember 14, 2014

TOURO INFIRMARY 2015 OPEN ENROLLMENT

Agenda

2015 Changes

Wellness Benefits

Medical Benefits

Other Benefits

Costs

Websites

2015 Changes

• Merging the Base and Enhanced Plan into the Traditional plan.

• Introducing a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA). Employer is contributing towards the Health Savings Account.

• Covered with Services within LCMC Health or United Healthcare Network only with exception: Emergency Services.

• Preventive Care will be covered at 100%– Generic Oral Contraceptives– Breast Pumps– Immunizations as recommended by CDC

• All co-pays including prescription drug co-pays will accrue towards the annual out of pocket maximum.

2015 Changes (cont’d)• Flexible Spending Account – $500 Roll over feature no longer allowed

due to the Qualified High Deductible Plan and Health Savings Account Offering.

• Increase in Flexible Spending Account for unreimbursed medical expenses to $2,550 annually.

• Limited Purpose FSA available to employees who are participating in the HDHP/HSA plan for dental and vision expenses only.

• LCMC Paid Short Term Disability with eligibility period of: 1st day of the month following 6 months of employment. Available to both full and part-time employees.

• LCMC Paid Long Term Disability plan with benefits payable for 5 years for full-time. Employee Paid for Part-time.

• Long Term Disability buy-up option with benefits extending benefits to your normal Social Security Retirement age. Available to full-time only.

• LTD Eligibility period: 1st day of the month following 6 months of employment.

2015 Changes (cont’d)

• Hourly Employees - Increase in LCMC Paid Life Insurance and AD&D from 1 x annual earnings to a maximum of $50,000 to $75,000.

• New Spousal Surcharge - If your spouse is eligible to participate in his/her employer’s medical plan but chooses to participate in the LCMC Health plan, a surcharge of $50 per month will be added to your premium. Spousal affidavit required.

• Dependent certification form also needs to be completed if you wish to continue to cover your eligible dependents.

• New Program for Specialty Drugs.• New ID cards will be issued for Medical and Vision.

Traditional Plan

Services LCMC System Facilities

UHC Facility Providers and Professional

Providers (Excluding

Ochsner/Tulane)

Ochsner / Tulane

Deductible- Individual- Family

$500$1,000

$500$1,000

$3,000$6,000

How Deductible Applies to Family Members

Deductibles are applied by individual and family unit. An individual may reach their deductible and begin coinsurance. A family deductible can be met by one or all

family members. LCMC and UHC Network Combined; All cross apply.

Out-of-Pocket Limit Medical- Individual- Family

$2,000 medical only$4,000 medical only

$2,500 medical only$5,000 medical only

$3,750$7,500

Out-of-Pocket Limit Rx-Individual-Family

$2,500 Rx only$5,000 Rx only

$2,500 Rx only$5,000 Rx only

$2,500 Rx only$5,000 Rx only

Out-of-Pocket Limit Combined Medical and Rx- Individual- Family

$4,500$9,000

$5,000$10,000

$6,250$12,500

Provider Office/Clinic Visit Co-pay- Primary Care (not preventive)- Specialist- Preventive care/screening/immunization

$25$40

Covered at 100%

$25$40

Covered at 100%

$25$40

Ded & Coinsurance may apply to facility charge

Covered at 100%

Testing- Lab Services- Imaging, X-Rays (CT/PET scans, MRIs)

Covered at 100%Ded. & 10% coinsurance

Ded. & 20% coinsuranceDed. & 20% coinsurance

Ded. & 40% coinsuranceDed. & 40% coinsurance

Traditional Plan (cont’d)

Services LCMC System Facilities

UHC Facility Providers and Professional

Providers (Excluding

Ochsner/Tulane)

Ochsner / Tulane

Therapies- PT/OT/Speech- Chemo/Radiation

Ded. & 10% coinsuranceDed. & 10% coinsurance

Ded. & 20% coinsuranceDed. & 20% coinsurance

Ded. & 40% coinsuranceDed. & 40% coinsurance

Out-patient Surgery- Facility Fee- Physician/Surgeon Fees

Ded. & 10% coinsuranceDed. & 10% coinsurance

Ded. & 20% coinsuranceDed. & 20% coinsurance

Ded. & 40% coinsuranceDed. & 40% coinsurance

Immediate Medical Attention- Hospital Emergency Room Services- Emergency Medical Transportation- Urgent Care

$150 co-pay$100 co-pay$40 co-pay

$150 co-pay$100 co-pay$40 co-pay

$150 co-pay$100 co-pay$40 co-pay

Hospital Stay- Facility Fee- Physician/Surgeon Fees

Ded. & 10% coinsuranceDed. & 10% coinsurance

Ded. & 20% coinsuranceDed. & 20% coinsurance

Ded. & 40% coinsuranceDed. & 40% coinsurance

Prescription Drugs - $100 deductible/individual- Generic (ded. waived)- Preferred- Non-Preferred- Specialty

Retail / Mail$10/$22 $30/$65

$45/$100$75/$165

Retail / Mail$10/$22 $30/$65

$45/$100$75/$165

Not covered outside of network

Specialty Drugs

• Specialty medications treat complex chronic conditions and have a high cost. They often require special storage, handling and administration.

• If you take a specialty drug, LCMC Health has contracted with special pharmacies to provide these drugs at a lower cost. Three pharmacies have been contracted with: Avita New Orleans Pharmacy; Walgreens Specialty Rx; and Accredo. If you obtain your specialty medication from one of these pharmacies, your co-pay will be $50 instead of $75 at other pharmacies.

• Avita New Orleans• Phone: (504) 822-8013 or (877) 424-2930; 24 Hour Help Line 1-888-284-8279• www.avitapharmacy.com • Walgreens Specialty Rx• Phone: Specialty Pharmacy & Care Team: 1-888-782-8443• www.walgreens.com/pharmacy/specialtypharmacy.jsp • Accredo• Phone: 1-888-608-9010• www.accredo.com/patients/getting-started-with-accredo#sthash.YWlOPyGz.dpuf

Traditional Premiums

Monthly Rate EE Contribution LCMC Contribution

Employee $404.65 $138.92 $265.73

Employee & Spouse $809.29 $277.83 $531.46

Employee & Child(ren) $728.37 $250.05 $478.32

Family $1,157.29 $397.30 $759.99

2014 Plan 2015 Plan EE Only EE & Spouse EE & Children

Family

Enhanced Traditional ($51.41) ($135.47) ($115.40) ($193.73)

Basic Traditional $15.48 $5.45 ($1.93) $44.30

What is a HDHP Plan?

• A high-deductible health plan is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. Being covered by an HDHP is also a requirement for having a Health Savings Account.

• If family coverage is elected, the full family deductible must be met before the health plan reimburses.

• Preventive Expenses are covered at 100%• Preventive generic prescriptions are covered at 100%• All Other medical services including office visits and

prescriptions apply towards the deductible and out of pocket maximum at a discount rate.

What is an HSA Plan?

• Medical “IRA”• Contributions are tax deductible• Earnings grow tax-free• Qualified distributions are tax-free• All IRS 213(d) expenses are eligible for reimbursement• IRS form 8889 filing with tax return• Both you and your employer can contribute to the HSA account• An account will be opened on your behalf and you will be

provided with a debit card through HSA Bank• The maximum contribution (employee + employer) for 2015 is

as follows:– Single $3,350– Family $6,650

• Additional Catch up contributions of $1,000 annually if age 55 - 64

Who is eligible for HSA’s?

• Any individual that:– Is covered by a HDHP– Is not covered by other health insurance

• does not apply to specific injury insurance and accident, disability, dental care, vision care, long-term care

– Is not eligible for Medicare– Cannot be claimed as a dependent on someone else’s

tax return– Cannot run unreimbursed medical expenses through

an FSA– You must open an HSA account with HSA Bank

HSA Distributions

• Distributions are tax-free if taken for:– person covered by the high deductible– spouse of the individual– any dependent of the individual

• Spouse and dependents don’t need to be covered by the HDHP

• If not used for qualified medical expenses, then amount is included in income

• 20% additional tax if taken for non-medical expenses, except when taken after:– Individual dies or becomes disabled– Individual is eligible for Medicare – age 65

LCMC Annual Contribution toyour Health Saving Account

Coverage Tier Dollar Amount

Employee $500

Employee & Spouse $750

Employee & Child(ren) $1,000

Family $1,500

50% of the contribution will be deposited into your HSA Bank Account January 2015 and the Remainder will be deposited in July 2015. Can only access funds available.

High Deductible HealthPlan with HSA

Services LCMC System Facilities

UHC Facility Providers and Professional

Providers (Excluding

Ochsner/Tulane)

Ochsner / Tulane

Deductible- Individual- Family

$1,500$3,000

$1,500$3,000

$4,000$8,000

How Deductible Applies Across Network Tiers LCMC and UHC Network Combined; All cross apply.

How Deductible Applies to Family Members Deductibles are applied by family unit. The deductible is not met for any individual until the entire family deductible is met.

Coinsurance 15% 25% 50%

Out-of-Pocket Max- Individual- Family

$4,000$8,000

$4,500$9,000

$6,250$12,500

Preventive Services Covered at 100% Covered at 100% Covered at 100%

Provider Office/clinic visits and all other medical services Ded. & 15% coinsurance Ded. & 25% coinsurance Ded. & 50% coinsurance

Prescription Drugs – AFTER DEDUCTIBLE- Generic- Preferred- Non-Preferred- Specialty

Retail / Mail$10/$22 $30/$65

$45/$100$75/$165

Retail / Mail$10/$22 $30/$65

$45/$100$75/$165

Not covered outside of network

HDHP Premiums

Monthly Rate EE Contribution LCMC Contribution

Employee $393.41 $95.34 $298.07

Employee & Spouse $786.83 $190.68 $596.15

Employee & Child $708.14 $171.61 $536.53

Family $1,125.16 $277.57 $847.59

2014 Plan 2015 Plan EE Only EE & Spouse EE & Children Family

Enhanced HDHP/HSA ($94.99) ($222.62) ($193.84) ($313.46)

Basic HDHP/HSA ($28.10) ($81.70) ($80.37) ($75.43)

Low Option High Option

Calendar Year Maximum $1,000 per Individual $1,500 per Individual

Calendar Year Deductible $0 $25 per Individual

Preventive Care 85% 100% (deductible waived)

Basic Expenses 50% 80%

Major Expenses 30% 50%

Orthodontia (child only)

N/A 50% to $1,000 Lifetime Maximum

Dental Benefits through Assurant

Dental Premiums

Coverage LevelLow Option High Option

Single $17.47/Month$8.74/PP

$29.97/Month$14.99/PP

Employee & Spouse $34.17/Month $17.09/PP

$60.71/Month$30.36/PP

Employee & Child(ren) $39.65/Month$19.83/PP

$67.11/Month$33.56/PP

Family $59.45/Month$29.73/PP

$100.82/Month$50.41/PP

To maximize your benefits use the Assurant network

Voluntary Vision Planthrough Always Care

Coverage Level

Frequency Co-PaysIn-Network

Out-of-Network

Exam 12 Months $10 Co-pay Up to $40 Allowance

Frames 24 Months $25 Co-pay up to $130 Allowance Up to $50 Retail Allowance

Lenses 12 Months $25 Co-pay Allowances: $40 Single/$60 Bifocal/$80 Trifocal

Contacts12 Months $25 Co-Pay up to $130

Allowance Up to $105 Allowance

To maximize your benefits use the Always Care network

Vision Premiums

Coverage LevelEmployee PremiumFull-Time $/Month

$/Pay Period

Single $5.47/Month$2.74/PP

Employee & Spouse $10.48/Month$5.24/PP

Employee & Child(ren) $10.96/Month$5.48/PP

Family $16.80/Month$8.40/PP

• Pre-Tax Premium Contributions• Health Flexible Spending Account (FSA)

– Un-reimbursed Medical Expenses ($2,550.00 max).– Common items for reimbursement:

• Deductibles, co pays, out-of-pocket expenses, laser eye surgery, dental fees.

– Dependent Care Flexible Spending Account (FSA)– Dependent Care/Child Care ($5,000.00 max);– Daycare expenses for PRE-KINDERGARTEN and UNDER.– Before and After School expenses for any child 12 yrs of age and under (No

overnight camps - only day camps).– Elder Care expenses for a parent who lives with you and needs round the

clock care.• Limited Purpose FSA (dental and vision only) $2,550 maximum for employees

who are enrolled in the HDPD/HSA Plan. • Employee’s who have balances up to $500 will be rolled over into a limited FSA

account if you are participating in the HDHP/HSA plan or a Standard FSA account if you are participating in the Traditional Plan.

Flexible Spending Accounts - UMR

How Does Flexible Spending Work?

• Voluntary Participation

• Annual Enrollment – Calendar Year

• Careful Planning Required

• Annual amount divided by 24 paychecks

• Reimbursements are administered through a third party administrator - UMR

• Medical & Dependent FSA Debit Cards – Your current debit cards will be replenished with your new allocation.

• Debit Card transactions require substantiation of qualified expenses. You may receive notification from UMR requesting proof of qualified expenses.

FSA Qualifying Event

♦ Marriage♦ Divorce or legal separation♦ Birth/adoption of child♦ Part-time/full-time status♦ Termination/commencement of employment♦ Loss of a dependent♦ SCHIP eligibility

You can change your expense election during the plan year if there is a major change in your family status due to:

Life Insurance & AD&D Exempt Employees

Directors and Above

Hourly employees

Full-time employees only1.5 x annual earnings to a maximum of $300,000

3 x annual earnings

1 x annual earnings to a maximum of $75,000

Accelerated Benefits Up to 80% of life benefitSubject to maximum

LCMC PaidLife Insurance through the Hartford

Benefit 60% of your base weekly earnings to a maximum of $1,500 per week

Payable 15th Day Accident15th Day Sickness

Maximum Up to 26 Weeks

LCMC Paid Short Term Disability

Provided for full-time and part-time employees. Eligibility: 1st day of the month following6 months of employment.

Monthly Benefit Maximum $10,000

Elimination Period 180 days

Benefit 60% of Monthly Earnings

Duration of Benefits 5 years

Mental & Nervous Maximum 2 years

Alcohol & Drug Abuse Maximum 2 years

Pre-Existing Condition 3 months prior /12 months after

Survivor Benefit 3 months

LCMC Paid LTDthrough the Hartford

Option to buy-up and extend the duration of benefits to your normal Social Security Retirement age. Rates are based on age and income. Available to full-time employees only.Part-time employees have the option of purchasing a 5 year benefit at their own cost.

Life Insurance & AD&D Can be purchased in increments of $10,000 or 5 times your annual

earnings to a maximum of $500,000

Guaranteed issue amount $250,000

Amounts in excess of $250,000 will require evidence of insurability.

Voluntary Life Insurance and AD&D the throughthe Hartford

Rates are age rated

Life Insurance and AD&D A spouse is eligible for an amount in increments of $5,000 or up to 50% of

the employee’s voluntary amount . Guarantee issue amount $50,000.

Amounts greater than $50,000 requires EOI.

Dependent Children $10,000 for children age 6 months to 21 years or to 25 if full-time student. $250 for children age 14 days to 6

months, newborn children to age 14 days are not eligible for a benefit

Voluntary Dependent Lifeand AD&D through theHartford

Rates are age rated

• Covers you and your family for internal cancer.• Includes 29 other illnesses.• Pays you a benefit of $2,000 for first occurrence of

internal cancer.• Daily benefit for hospitalization• Radiation, chemo and experimental treatments.• Wellness benefit of $50 per year/member• Rates - $15.70 single; $26.34 family per month.• New Hires are guaranteed issue – not required to

complete evidence of insurability

Allstate Voluntary Cancer Protection

REMINDER

• Enrolling for the first time or enrolling in the High Deductible Health Plan• Adding or dropping dependent coverage• Enrolling in new Dental and Vision plans• Increasing life insurance coverage• Participation in the Flexible Spending Account (FSA)• Dependent certification form• Spousal Affidavit is needed if you are covering your spouse on the health plan. If

form not received by 12/1/2014, a $50 monthly surcharge will be applied to your premium

• Waiving coverage • All forms are due in Human Resources no later than 12/01/2014• IF NO CHANGE FORMS ARE RECEIVED BY THE END OF THE OPEN

ENROLLMENT PERIOD FOR YOUR MEDICAL, YOU WILL BE DEFAULTED INTO THE TRADITIONAL HEALTH PLAN.

Benefit Choices That Require Action

Websites

Medical - UMR • www.umr.com / 1-800-826-9781

Pharmacy Benefit Manager – CVS/Caremark• www.caremark.com / 1-800-334-8134

Dental - Assurant• www.assurant.com / 1-800-442-7742

Vision – AlwaysCare• www.alwayscarebenefits.com / 1-888-729-5433

Life, Long and Short Term Disability - The Hartford • www.groupbenefits.thehartford.com / 1-888-563-1124

Flexible Spending Account Plan - UMR• www.umr.com / 1-800-826-9781

HSA Bank• www.hsabank.com / 1-866-357-5322

LCMC Health will continue to provide a high quality level of benefits to our employees at a cost that is competitive among

the local healthcare market.

Questions