Welcome

Catholic Diocese of Sioux FallsEmployee Benefits

Enrollment Guide 2016

Presented by Nancy Petersen

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Agenda

Open enrollment Health plan – Avera Health Plans Health Savings Account (HSA) –

continuing education Consumerism

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How to Enroll

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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)

When to Enroll

The open enrollment period runs from November 2, 2015 through November 18, 2015

The benefits you elect during open enrollment will be effective from January 1, 2016 through December 31, 2016

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How to Make Changes

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Unless 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:

Marriage Divorce Legal separation Status change Birth or adoption of a child Change in child’s dependent status Death of a spouse, child or other qualifying

dependent Change in residence due to an employment

transfer Commencement or termination of adoption

proceedings Change in your spouse’s benefits or employment

status

2016 Health Benefits

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Avera Health Plans

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The administration of our self-funded health plan will renew with Avera Health Plans for 2016

Catholic Diocese uses a preferred provider organization (PPO) – 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

Covered ServicesHigh-Deductible Health Plan

(HDHP)/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 and copay)

$2,500 single $5,000 family

(any combination)

$3,000 single$7,500 family

$6,530 single $12,700 family

Office visit services• Primary care physician• Specialist care

0% deductible0% deductible

$25 copay $50 copay

$50 copay

50% coinsurance

Wellness services – routine 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 coverage• Deductible • Generic • Formulary• Non-formulary• Out-of-pocket maximum

0% deductible

$100/$200 deductible $12 copay deductible waived

$35 copay $50 copay

$1,000/$2,000

$100 single; $200 family $0 copay; deductible waived

$25 copay $100 or $200 copay

Employer dollars to HSA$750 single

$1,500 family None

Plan Design Overview

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Employee Cost Comparison

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* If you enroll in the HDHP and open an HSA with Discovery Benefits then the insurance fund will contribute up to $750 into your HSA if you elect single coverage and $1,500 into your HSA if you elect employee plus child(ren) or family coverage

Coverage Level

HDHP/HSA No Change

Traditional Plan 3% Increase

Bronze Plan 3% Increase

Employee Cost per Month

Employee Cost per Month Employee Cost per Month

Single $227.62* $286.71 $90.00Employee plus child(ren) $530.96* $668.98 $422.72Family $598.89* $748.36 $468.08

HDHP Savings over Traditional Plan

Premium Savings

Per MonthAnnual Savings

Single $59.09 $709.08 + $750 employer HSA dollars = $1,459.08

Employee plus child(ren) $138.02 $1,656.24 + $1,500 employer HSA dollars = $3,156.24

Family $149.47 $1,793.64 + $1,500 employer HSA dollars = $3,293.64

This example is assuming a 50% employee/employer premium cost split

HSA Basics

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What is an HSA?

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An HSA is an account that you can use to pay medical expenses– Must be in conjunction with an 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 tool– Funds roll over from year to year– Accounts are individually owned– HSAs/HDHPs typically have lower

monthly premiums

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Who is Eligible for an HSA?

Anyone who is:– Covered by an HDHP– Not enrolled in Medicare– Not another person’s tax dependent– Family unit is not enrolled in an FSA or health

reimbursement arrangement (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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HSA Contributions

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Contribution Limits

Individuals age 55 or older by the end of the year may contribute an additional $1,000 catch-up contributionType of Coverage 2015 Limits 2016 Limits

Single $3,350 $3,350

Family $6,650 $6,750

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Contribution Limits

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 single coverage and is HSA-eligible for the first eight months of 2015– The annual maximum HSA contribution for

single 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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HSA Distribution Rules

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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

HSA 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 (three- to five-day turnaround)

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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 Internal Revenue Service (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

Qualified Medical Expenses

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Qualified Medical Expenses

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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

Qualified Medical Expenses

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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

Qualified Medical Expenses

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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 and hand sanitizer

A full list of eligible and ineligible expenses can be found at www.discoverybenefits.com

Healthcare Consumerism

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How Can You Become a Good Consumer?

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Get preventive screenings– An annual exam can help avoid a catastrophic or

large claim in the future Grab the phone before the car keys

– Call “ASK-A-NURSE” at 800.658.3535 – Call your doctor or nurse

Share the formulary list with your provider– Ask for a generic drug versus a brand name drug – Ask if there are any OTC options– Ask for samples/discount coupons from your

doctor– GoodRx – mobile app and internet site to assist

you with price shopping for your prescriptions https://plus.google.com/+Goodrx1/posts

Services at a Reduced Cost

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AveraNow – telemedicine visit with a $49 charge for patients experiencing basic symptoms– http://www.avera.org/mobile/averanow– Symptoms and conditions treated:

Headache Fever Vomiting Diarrhea Rashes Pink eye

– This visit is not filed with insurance, but you can use your HSA or FSA dollars to pay for this visit

Acid reflux Cold sores Cold Flu Sinus infection Seasonal allergies

Services at a Reduced Cost

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CURAquick Clinic – for minor medical care – Vaccinations– Sports and pre-employment physicals– Allergies– Flu– Sinusitis– Strep throat– Upper respiratory ailments– Skin irritations– Office visit charge – $70 versus $150 at

urgent care– $25 copay will apply on traditional plan– Located in Hy-Vee on Minnesota Avenue

How Can You Become a Good Consumer?

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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

versus 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

Employee Assistance Program (EAP)

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Take advantage of the free EAP through Avera Health Plans instead of utilizing the mental health benefits through the plan

The EAP program offers five (5) free counseling sessions per family member per year

You must be enrolled in the health plan to be eligible for the EAP

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Next Steps

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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 2016 BenefitElection 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 an HSA Contribution Change Form

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Dates to Remember

Open enrollment period– November 2, 2015 through November 18,

2015– Return all paperwork to your local benefit

coordinator no later than November 18

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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

Thank you!