Welcome to Widget Industries’Open Enrollment November 2012
Melissa DeWeese, Benefit Advisor Beneflex Insurance Services, Inc.
What we will cover in this session:
Healthcare Trends/Benchmarks
Medical Plans
Ben-e-lect
Dental
Vision
Open Enrollment Process
Life
BenAssist
Open Enrollment Period
• Specific period of time wherein you can change plans, add or delete coverage, add or delete dependents.
• During the plan year these changes can only be made if there is a “Qualifying Event.”
• Widget Industries’ Open Enrollment Period: November 15th thru November 30th.
Health Care Trends in the U.S.UBA National Healthcare Survey
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
$8,000
$9,000
$3,604$4,027
$4,739
$8,219
Average Annual Cost:
CA
Region
Nation
WI’s
Average annual medical premium cost per employee paid by Widget Industries’ is higher than Regional, National, and State Benchmarks
Health Care Trends in the U.S.UBA National Healthcare Survey
Average Employee Paid Medical Premium Cost (Average – Displayed in Dollar Amount)
$92
$94
$96
$98
$100
$102
$104
$106
$108
$110
Single
National, $107
Region, $98
State, $116
Industry, $110
$0
$100
$200
$300
$400
$500
$600
$700
Family
National, $561
Region, $666
State, $489
Industry, $516
Benefit Package Overview
• Anthem Blue Cross Medical•Elements Preferred PPO
• Benelect HRA• Lincoln Dental DHMO and PPO Options• VSP Vision Insurance• Lincoln Financial Life &Disability Insurance
Anthem Elements PPO
Coverage Benefit (In-Network Only)Deductibles $1,250 Ind / $2,500 Fam
Max Out of Pocket / Year Ind/Family
$5,000 Ind / $10,000 Fam
Office Visit Co-Pay50% (no copay for preventative)
Plan pays:
80%
Rx Co-Pays (Separate $250 Rx Ded.)Tier 1Tier 2 (includes diabetic supplies)Tier 3 Tier 4 (Specialty drugs)Mail Order NOTE
$10 (ded. waived)$35$5030% up to $150 copay$10/$70/$100- 90 day supplyWhen member selects a brand name drug when a generic is available, and the physician does not write a “DAW”, the member is responsible for the copay + the cost difference between the brand and the generic drug
Maximum Lifetime Benefit Unlimited
Anthem Elements PPO withBenelect HRA
Coverage Benefit (In-Network Only)Deductibles None
Max Out of Pocket / Year Ind/Family
$550 Ind / $850 Fam
Office Visit Co-Pay $20 (no copay for preventative)
Plan pays:
100%, and additional 10% after ded.Total after ded coverage of 90%
Rx Co-Pays GenericBrandMail Order (90 day supply)NOTE
$10$25$30/$75 (after ded. is met $10/$70/$100)When member selects a brand name drug when a generic is available, and the physician does not write a “DAW”, the member is responsible for the copay + the cost difference between the brand and the generic drug
Maximum Lifetime Benefit / Member
Unlimited
Health Care Trends in the U.S.UBA National Healthcare Survey
$0$100$200$300$400$500$600$700$800$900
$1,000
Single
CA, $500
Region, $750
Nation, $1,000
WI's, $0
Average PPO Plan Deductibles for In-Network Services (Area Based)
Lincoln Dental PPO
Coverage PPO (Contract Rate) Non PPO Cal Yr. Deductible Ind/Family
$50 /$150 (waived for preventative)
Preventive (x-rays/cleanings/exams)
100% 100% of Eligible Expenses
Basic (Periodontal/Endodontic)
80% 80% of Eligible Expenses
Major (Root canals/fillings/Bridges)
50% 50% of Eligible Expenses
Max Annual Benefit/Person
$1,000 per member
Lincoln Dental HMO
Coverage DHMO (In-Network ONLY)
Cal Yr. Deductible Ind/Family None
Routine Office Visit $5
Preventive - x-rays/cleanings/oral evaluations $0 - $45
Basic / Restorative - Resin-based composite $0 - $225
Endodontics / Periodontics - including root canal $0 - $270
Max Annual Benefit/Person Unlimited
Lincoln Dental PPOEmployee Share of Premium
Category of Coverage Monthly Rate
Single $24.96
Employee + Spouse $58.51
Employee + Child/ren $68.39
Employee + Family $112.79
Employee pays the
difference between the
DHMO premiums and the DPPO
premiums. Widget
Industries’ pays 100%
of employee premiums
for the DHMO
Lincoln Dental DHMOEmployee Share of Premium
Category of Coverage Monthly Rate
Single $0
Employee + Spouse $11.16
Employee + Child/ren $13.04
Employee + Family $24.09
Employee pays the
difference between the
DHMO premiums and the DPPO
premiums. Widget
Industries’ pays 100%
of employee premiums
for the DHMO
Vision Service Plan (VSP)Monthly Employee Share of Premium
Category of Coverage
VSP Vision
Single $0.00
Employee + 1 $5.50
Employee + 2 or more
$14.55
$25 copay for eye examExam – once every 12 months
Lenses – once every 12 monthsFrames – once every 24 months
Allowance for frames OR contacts is $130
Lincoln Life and AD&D and Long Term Disability
• Lincoln Financial is your Life, AD&D and LTD Carrier effective December 1, 2009
• Core Life amount for all employees is 150% of Annual Salary rounded to the next higher $1,000. This includes Accidental Death and Dismemberment. Maximum Benefit is $200,000. GI amount is $200,000.
• Should you become disabled, Long Term Disability (LTD) covers 60% of your salary up to $5,000 per month up to Social Security Age
• 90 Day elimination period before benefits begin from the date of disability
Lincoln Employee Assistance Program
• Access to EmployeeConnect• Personal referrals to specialists• Financial counseling and investment guidance• The Legal Reference Program
BenAssist™ Will Handle All Core Employee Benefit Related Questions
• Clarification of benefits/rates• Claims issues• Finding a doctor• Prescriptions• Benefit change support• Medical referrals• Copies of plan information• HSA Questions
Let us help you!
Questions
Recommended
