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Welcome to Open Enrollment!
Catholic Diocese offers you and your eligible family members a comprehensive and valuable benefits program. We encourage you to take the time to educate yourself about your options and choose the best coverage for you and your family.
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How to Enroll
Review your current benefit elections. Update your personal information as
necessary. Make your benefit elections. (Once you
make benefit elections, you will not be able to change them until the next open enrollment period, unless you have a qualified change of status).
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When to Enroll
The open enrollment period runs November 6, 2014 through November 21, 2014.
The benefits you elect during open enrollment will be effective from January 1, 2015 through December 31, 2015.
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How to Make ChangesUnless you have a qualified change in status, you cannot make changes to the benefits you elect until the next open enrollment period. Qualified changes in status include:
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Avera Health Plans
The Medical and RX Plan will renew with Avera Health Plans for 2015
Catholic Diocese uses a PPO (Preferred Provider Organization) – Provider Network of Physicians and Hospitals
Services incurred by a non-participating provider are subject to a higher deductible and coinsurance rate.
Avera Health Plans PPO Network:– www.averahealthplans.com
– 888.322.2115 or 605.322.4545
Plan Design OverviewCovered Services
High Deductible Health Plan/HSA Qualified
Traditional Health Plan Bronze Health Plan
Deductible - Calendar Year $2,500 Single$5,000 Family (Aggregate)
$750 Single$2,250 Family
$2,000 Single $4,000 Family
Coinsurance 0% 20% 50%
Out of Pocket - Calendar Year (includes deductible, coinsurance & copay)
$2,500 Single $5,000 Family (any combination)
$2,500 Single$6,750 Family
$6,530 Single $12,700 Family
Office Visit Services Primary Care Physician Specialist Care
Deductible – 0%Deductible – 0%
$25 Copay $50 Copay
$50 Copay 50% coinsurance
Wellness ServicesRoutine exams, women’s preventive health, colonoscopies, etc.
100% paid - Deductible Waived -No patient cost sharing
100% paid - Deductible Waived -No patient cost sharing
100% Paid – Deductible Waived - No patient cost sharing
Prescription Drug CoverageDeductible Generic FormularyNon-formulary
Deductible –0%$50 deductible $12 Copay Ded waived$35 Copay $50 Copay
$100 single $200 Family $0 Copay Ded waived$25 Copay $100 or $200 Copay
Employer $$ to HSA $750 Single $1,500 Family
None
Employee Cost Comparison
Coverage LevelHDHP/HSA
Traditional Plan
Bronze Plan
Employee Cost per Month
Employee Cost Per Month
Employee Cost Per Month
Single $227.62* $278.36 $176.14
Single + Child(ren)
$530.96* $649.49 $410.41
Family $598.89* $726.56 $454.45
*If you enroll in the HDHP and open a HSA with Discovery Benefits then the Insurance Fund will contribution up to $750 into your HSA if you elect single coverage and $1,500 if you elect employee +
child (ren) or family coverage. HDHP Savings over
Traditional Plan Per Month Annual
Single $50.74$608.88 + $750.00 Employer HSA $$
$1,358.88
Employee + Child(ren) $118.53$1,422.36 + $1,500 Employer HSA $$
$2,922.36
Family $127.67$1,532.04 + $1,500 Employer HSA $$
$3,032.04
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What is a HSA?
A HSA is an account that you can use to pay medical expenses.– Must be in conjunction with a high-deductible
health plan (HDHP)– Money in the HSA is owned by the individual
just like a bank account. Both you and your employer can contribute funds into this account.
– Tax-advantages: contribute pre-tax money, funds accrue tax-free and withdraw funds tax-free (if used for eligible medical expenses)
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What Are the Benefits of an HSA?
HSAs keep growing in popularity because: They are a powerful tax savings toolFunds roll over from year to yearAccounts are individually ownedHDHP/HSAs typically have lower monthly premiums
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Who is Eligible for a HSA?
Anyone who is:– Covered by a HDHP– Not enrolled in Medicare– Not another person’s tax dependent– Family unit is not enrolled in a FSA or HRA– Not covered under a traditional health
insurance plan*
* Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance
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Contribution Limits
Type of Coverage
2015 Limits
Self-only $3,350
Family $6,650
Individuals age 55 or older by the end of the year may contribute an additional $1,000
catch-up contribution.
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Rule: Annual HSA contributions cannot exceed the sum of the monthly limits in effect for each month the individual was HSA-eligible.
Example: Robert, age 25, has self-only coverage and is HSA-eligible for the first eight months of 2015. The annual maximum HSA contribution for self-only coverage for 2015 is $3,350. Robert’s maximum HSA contribution for 2015 is $2,233 (8/12 x $3,350).
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Contribution Limits
What is it?Exception to rule that HSA contribution limits are determined on a monthly basisApplies to individuals who are HSA-eligible on December 1
How does it work?An individual is treated as HSA-eligible for an entire calendar year if he or she both:–becomes eligible in a month other than January–is HSA-eligible on December 1 of that yearMust remain eligible during the 13-month testing period (with exceptions for death and disability)
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Full-Contribution Rule
HSA Distribution Rules
Distributions from your HSA are tax-free if they are taken for “qualified medical expenses.”
Your HSA can only be used for expenses that are incurred on or after the date the HSA was established.
However, HSA funds can be used for expenses from a prior year or as long as the expenses incurred on or after the date the HSA was established.
HSA distribution for non-eligible expenses are subject to a 20% penalty and appropriate taxes
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HSA Distribution Rules HSA distributions can be taken for qualified medical
expenses for the following people:– The account holder (person covered by the HDHP)– Spouse of that individual (even if not covered by
the HDHP)– Tax dependents of the account holder (even if not
covered by the HDHP) For individuals age 65 and older, HSA distributions can be
used for non-qualified medical expenses without facing the 20% penalty.– However, income taxes will apply for non-medical
distributions.– This rule is regardless of whether the individual is
enrolled in Medicare
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HSA Vendor Health Savings Account through Discovery Benefits
www.discoverybenefits.com Debit card and online reimbursement requests Cash account –
• Funds default to the cash account. You need to set your HSA maximum if you want funds to automatically transfer to the higher interest account or Mutual Funds.
Higher interest bearing account
• Automatic transfer (48 hour turnaround) Mutual funds
• Automatic transfer (3 to 5 day turnaround)
Qualified Medical Expenses
The IRS defines expenses that are considered “qualified medical expenses” for HSA distributions.
Expenses must be primarily to treat or prevent a physical or mental defect or illness.
If you use HSA funds for expenses beyond what the IRS defines as qualified, you will be subject to income tax on the distribution and an additional 20% penalty.
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Qualified Medical Expenses
Examples of qualified medical expenses include:– Most medical care expenses – Prescription drugs – Over-the-counter drugs, only if you obtain a
prescription– Insulin (with or without a prescription)– Dental and vision care– Select insurance premiums
COBRA qualified long-term care insurance health insurance premiums paid while receiving
unemployment benefits health insurance after you turn 65 except for a Medicare
supplemental policy
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Qualified Medical Expenses
Expenses that are not considered “qualified medical expenses” include:– Insurance premiums (other than the exceptions
listed on the previous slide)– Over-the-counter drugs (unless a prescription is
retained from a physician – insulin is an exception)– Services purely for cosmetic reasons– Expenses covered by another insurance plan– General health items such as tissues, toiletries,
hand sanitizer
A full list of eligible and ineligible expenses can be found at www.discoverybenefits.com
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Recordkeeping
Whenever you use HSA funds to pay for a medical expense, you should keep your receipt.
You may need to demonstrate to the IRS that HSA distributions were for qualified medical expenses.
If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty.
IRS Form 8889 should be completed and submitted with your income tax filing.
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Health Care Costs
Factors include rising provider costs, aging population, the introduction of new medications and medical technology, government regulation.
The costs of your claims, and all your fellow employees’ claims, determine the price you and your employer pay for your health benefits.
Learn to be a good consumer
In the end, decisions you make directly affect the year
to year increases in your health
benefits cost.
What is Healthcare Consumerism?
Changing your behavior and becoming more involved in your health, taking more responsibility for making smart healthcare decisions and becoming more informed and eventually more financially responsible for the real costs of healthcare services.
Use healthcare services more efficiently by getting acquainted with the concept of “shopping around” for healthcare services.
Keeping costs down by avoiding unnecessary care and most importantly, it encourages the consumer to comparison shop – not just for quality, value and service, but for price, by negotiating lower fees with physicians or insisting on generic prescriptions.
Why is Healthcare Consumerism Important?
Good consumers take the time to understand the products and services they are buying. Whether you are talking about buying a house, car or healthcare, the quality and value of your purchase should be an important consideration.
In the case of healthcare, higher cost does not
necessarily mean better quality.
Healthcare costs can vary greatly depending on the type of procedure, where the care is provided (emergency room, outpatient clinic or doctor’s office), and where you live and receive care.
How can you become a good consumer?
Get preventive screenings. By having an annual exam, you can help avoid
a catastrophic or large claim in the future. Grab the phone before the car keys.
Call your doctor or nurse to see if they can recommend treatment (OTC med or rest) or if you should come in to see them for an evaluation
Share the formulary list with your provider. Ask for a generic drug instead of a brand name
drug Ask if there are any OTC options Ask for samples or discount coupons from your
Dr.
How can you become a good consumer?
Talk to your physician about treatment options and costs How much will my treatment cost? What treatment alternatives are available? Are there differences in cost and effectiveness? Can laboratory tests be performed in a clinic vs.
hospital? Can surgical services be performed in an
outpatient surgical facility? Get the results of any test or procedure and ask
what the results mean for your care. Take advantage of the free EAP services
instead of utilizing the MH benefits through plan
Make Wise Choices
Become familiar with your benefits – now. Don’t wait until you are sick!
Review your benefits and know your co-payments and coinsurance amounts for each setting available to you-- office visit, urgent care facility, or a hospital emergency room.
Know that every setting is not appropriate for every kind of care. You should pick the setting that will provide you the best, cost effective care for your condition.
What To Do Next
•Decide which plan works best for you and/or your family (HDHP/HSA, Traditional, or Bronze).•All employees must complete the 2015 Election form. •If you are changing your current election or are newly enrolling into the medical or dental plan an enrollment form must be completed.•If you are newly electing the HDHP complete the Discovery Benefits HSA Data Collection Worksheet. •Your current HSA payroll contributions will carry over unless you submit a HSA Contribution Change Form
Dates to Remember
Open Enrollment PeriodNovember 6, 2014
toNovember 21, 2014
DeadlinesIf you are NOT making any changes you will continue in the plan you have today.
Return all paperwork to your local benefit coordinator no later than November 21st
Please Note…
This benefit summary is intended only to provide you with a brief overview of your benefits. It is not a contract and should not be relied upon to fully determine your coverage. Refer to your Summary Plan Description for an exact description of the services/supplies that are covered, exclusions and other conditions of coverage.