2020 BENEFITS OPEN ENROLLMENT Open Enrollment April 15 th , 2020 - - PowerPoint PPT Presentation

ROCKFORD PUBLIC SCHOOLS 2020 BENEFITS OPEN ENROLLMENT

 April 15th , 2020 through April 30th, 2020 (No later than

5:00pm)

 Changes will take effect July 1, 2020

Allowed enrollment changes

◼ Choose Between Available Health Plans ◼ Make/Change Annual FSA Elections ◼ Elect/waive medical/dental coverage ◼ Add/remove dependents from medical/dental coverage ◼ Add voluntary term life insurance effective July 1, 2020

Open Enrollment

2 Health Plans Available

 PPO1000

 $1000 Individual Deductible

 High Deductible Health Plan (HDHP)

 $2500 Individual Deductible  Health Savings Account Component The PPO 3000 Plan Will Not Be Offered After July 1st,

• 2020. Any Current PPO 3000 Plan Participants Who Do

Not Log In and Make a Change Will Automatically be

Enrolled onto the HDHP/H.S.A. Plan For July 1, 2020

Health Plan Design Options

PPO Plan HDHP Plan Office Visits In Network Out of Network In Network Out of Network Primary Care $15 50% Ded./Coins. Ded./Coins. Specialist $25 50% Ded./Coins. Ded./Coins. Deductible Single $1,000 $1,000 $2,500 $5,000 Family $2,000 $3,000 $5,000 $10,000 Out of Pocket Max* Single $4,000 $8,000 $3,500 $7,000 Family $8,000 $16,000 $7,000 $14,000 Coinsurance 80% 50% 80% 50% Emergency Room $200 50% Ded./Coins. Ded./Coins.

*Out of Pocket Maximum Includes Deductible

Enrolling in The High Deductible Health Plan (HDHP Plan) allows you to open a Health Savings Account (HSA)

What is a Health Savings Account (H.S.A.)

 A tax-preferred method for funding uninsured medical

expenses

 Unused funds do rollover and are kept by the employee. USE IT

OR KEEP IT

 “Portability” Can be rolled over into another H.S.A.. “The

healthcare equivalent of the 403b”

 Can be cashed out but will be subject to income tax plus a

20% penalty (if < Age 65)

What is a Health Savings Account (H.S.A.) cont…

 H.S.A. accounts enjoy a triple tax advantage:  Pre-tax dollars going into the account  Interest earned is NOT taxed  In general, distributions used for medical/dental/vision claims or certain

plan premiums are also NOT taxed

 This is an account that belongs to the employee regardless of

who contributes and is put into an Associated Bank account with a debit card.

With tax advantages come IRS rules

HSA Eligibility

Anyone who is:

• Covered by a “qualifying” HDHP
• Not covered by other health insurance

(unless it is also a “qualifying” HDHP)

– Doesn’t apply to specific injury insurance, accident, disability, dental, vision, long-term care – Includes spouse’s plan or a retirement health plan

• Not enrolled in Medicare or Medicaid

The $2,500 deductible

• ption is a

qualified HDHP

Contributions/Distributions?

Contributions for Accounts

 Employer and/or employee can contribute to an H.S.A.  You can make contributions via payroll similar to the FSA.

Even better, you can change/vary your contributions during the year.

 Maximum contribution for 2020 is limited to $3,550

single / $7,100 family.

 Allowable “Catch Up” contributions for American’s 55

years and older of $1,000/yr

Contributions for Accounts

 Rollover from an another H.S.A is allowed.  Additional contributions can be made on your own

and are written off on personal taxes as an “above line deduction”

 You have up until April 15th of the following year to

contribute for the current year

H.S.A. Distributions

 Pays for qualified medical expenses under Section

213(d)

 Traditional PPO medical expenses AND expenses such as

dental, vision, etc.

 Includes expenses incurred due to COVID19  Spouse or dependent medical expenses eligible – even if

not covered on your plan

 H.S.A contributions can also be used for:  COBRA premiums  Long-term care coverage  CASH! Subject to taxes and a 20% penalty <Age 65

On to the High-Deductible Plan or HDHP

High Deductible Health Plan Basics

 Based on same BCBS PPO Network

 Pharmacy Network will be Prime Therapeutics

 Major differences to traditional PPO:

 Higher deductible  Actual costs of your medical expenses (after BlueCross

discounts) are subject to this high deductible such as doctor office visits, lab, x-ray, hospital, surgery, Emergency Room, and prescription drugs…etc. Concept of Copay is removed.

 Preventative care is NOT subject to the deductible

and is covered at 100% in-network at a $0 Copay.

HDHP and H.S.A. Funding - How do they work together to pay your medical expenses?

RPS Annual HSA Funding

Single Employee Plus Spouse Employee Plus Child(ren) Family Standard $400 $700 $600 $800 Wellness $250 $500 $550 $700 Total (W) $650 $1200 $1150 $1500

• Amounts are made available on the first day of the new plan

year

• Those enrolling in the $2,500 HDHP will need to complete an

application for an HSA account with Associated Bank.

• RPS will transfer the amounts below into your Associate HSA

bank account based on medical enrollment status

Day To Day Workings Of An H.S.A.

Claims – How To Use

 Just like today, always show your medical ID card  Whenever possible especially In Network – DON’T pay up

front – BlueCross (BCBS) and Associated Bank (bank) are 2 separate companies

 Provider will send claim to BCBS so they can apply the discount  Once you receive the Explanation of Benefits (EOB), it will

show you what you owe the provider which you may then pay from your H.S.A. Bank Account with your Associated debit card

 Pharmacy already has discounts in their system at the time of

• purchase. Can use Associated Bank debit card.

H.S.A Savings Opportunity

Annual PPO Paycheck Cost H.S.A Contrib. + Premium Costs Upfront Savings by Choosing the H.S.A* Single $606 $650 $1,256 EE + Spouse $2,319 $1,200 $3,519 EE + Child(ren) $2,181 $1,150 $3,331 Family $3,354 $1,500 $4,854

*Before claims are taken into account

Money You Keep if you have no claims

The number listed in the green box represent the amount

• f money you save in paycheck contributions plus the

dollars the district will put in your H.S.A. account if you choose the HDHP plan.

Preventive Care, Prescription Drugs, and Wellness: PPO vs HSA

• In Network - 100% covered with no cost sharing (not subject to

deductible)

• Out of network – 50% covered (not subject to deductible)
• Preventative services include but are not limited to:
• Adults: Cholesterol screening, immunizations, mammography,

pap smear, colonoscopy, routine annual physical

• Children: Immunizations, routine annual physical

Preventive Care is Subject to Federal Guidelines as Laid Out by HHS Including Age and Frequency Limits.

Preventive Care – All Plans

Prescription Coverage - Express-Scripts

*Prescriptions filled at Walgreens and CVS will cost an additional $10.

• Mail order for maintenance drugs is mandatory after 3 fills at the local

pharmacy.

• Can access information on-line to:

www.express-scripts.com

• Check whether medication is covered.
• Compare mail order vs pharmacy cost.
• Check for generic equivalent or formulary alternatives.

Tier PPO1000* HDHP Tier 1 $15 Ded./Coins. Tier 2 $40 Ded./Coins. Tier 3 $60 Ded./Coins. Mail Order 2x’s for 90 days Ded./Coins.

Prescription Co-pays

• Can use most independent Pharmacies
• Prescriptions purchased at CVS or Walgreens (PPO
• nly) will cost an additional $10 each.
• Possible less expensive alternatives:
• Wal-Mart
• Meijer
• Sam’s Club

Mail order for maintenance drugs is mandatory. 90-day supply through mail order vs. 30-day supply at local pharmacy.

Claim Example: No Claims- Single Coverage

Annual Pay Check Contribution Plus District H.S.A Contribution Including Wellness Incentive

$+650 (Given by RPS) $650 That You Keep! No Claims Cost

*H.S.A Dollars Based on Participating in Wellness Program

$-606 (Annual Cost to Employees) No Claims Costs You Pay $606

1000 PPO PLAN HDHP Plan Claims Cost Total Plan Cost HDHP Saves $1,256

Claim Example: $1,500 In Medical Claims – Single

Coverage.

Annual Pay Check Contribution Plus District H.S.A Contribution Including Wellness Incentive

$+650 (Given by RPS) HDHP Saved $856 $850

*H.S.A Dollars Based on Participating in Wellness Program

$-606 (Annual Cost to Employees) $1000 $1706

1000 PPO PLAN HDHP Plan Deductible Cost After HDHP Contributions Total Plan Cost Including Paycheck Contrib.

$100

Coinsurance

$0 $850

Claim Example: $15,000 In Medical Claims – Single

Coverage.

Annual Pay Check Contribution Plus District H.S.A Contribution Including Wellness Incentive

$+650 (Given by RPS) HDHP Saved $1716 $1850

*H.S.A Dollars Based on Participating in Wellness Program

$-606 $1000 $4566

1000 PPO PLAN HDHP Plan Deductible Cost Total Plan Cost Including Paycheck Contrib.

$3000

Coinsurance

$1000 $2850

H.S.A. – Other tips

 Timing of claims

 You can only spend what you have  RPS will front load your annual fund of $400 single / $800

family in month one. (Plus any additional wellness funds for which you qualify)

 Should funds not be immediately available you may s be

able to set up payment plan with your medical provider

 Advise maintaining an H.S.A. envelope for receipts, EOB’s,

account information. (May be required if audited by the IRS)

Responsibility is all yours!

Flexible Spending Account

 You must complete an FSA enrollment every open enrollment

period to participate in any of the FSA Plans:

❑ Medical/Dental Flexible Spending Account, $2,750 period

maximum contribution.

❑ Limited Flexible Spending Account is for dental/vision

expenses only. Used only for those who enroll in a HDHP with a HSA, $2,750 period maximum contribution.

❑ Day Care Flexible Spending Account, $5,000 period

maximum contribution.

 Enrollment is required each plan period for eligibility. No

elections roll over between plan periods.

Final Thoughts

 Take some or all of your contribution savings and invest in

yourself.

 For those whose H.S.A. balance exceeds $1000 there are

investment options. 16 different funds to choose from.

 Unlike the PPO, the H.S.A. allows you to accumulate tax

preferred dollars for retirement

 Over time employees can build a positive balance in the

H.S.A. that can eliminate future out of pocket costs.

TELADOC

How it works:

❑ Contact Teladoc

❑

Access via phone, video or mobile app.

❑ Talk with a physician

❑

Physician will review the medical history.

❑ Resolve the issue

❑

Physician will diagnose and prescribe medication, if necessary.

❑ U.S. Board Certified

Physicians in internal medicine, family practice, emergency medicine or pediatrics.

❑ U.S. residents and state

licensed.

24/7/365 ACCESS TO PHYSICIANS TELADOC PHYSICIANS

Gaining popularity as you can see a doctor without having to be exposed to others who are sick

Conditions Treated

$15/$45 Co-pay due at time of service.

1 Dental Plan

❑ Annual Deductible:

❑ $50 Individual, $150 Family ❑ N/A to preventive /diagnostic

❑ Services paid at:

❑ Preventive

100%

❑ Basic

80%

❑ Major

50%

❑ Orthodontia

50%

❑ Annual Benefit Limit:

❑ $1,500

❑ Orthodontia Lifetime Limit (children up to age 19):

❑ $1,500

❑ Out of network is paid based on usual and customary.

Deductible and Annual Benefit Limit will reset as of July 1, 2020

Wellness

• All new hires (hired after July 1)

automatically receive wellness premiums. HDHP participants receive wellness contribution to a Health Savings Account.

• Must earn 100 points to keep the lower

wellness premiums.

• Points are earned from June 1 – March

31.

• Points must be entered on a website by

the employee.

Wellness – How To Earn Points

• Biometric Screening (free) – 50 points
• Health Assessment – 10 points
• Participate in Challenges – 10 points each (4 challenges

scheduled)

• Participate in a Local Event – 5 points each/30 point max
• Complete preventive exams – 5 points each/20 point max
• Log exercise – 30 point max
• And more…

◼ Other than during Open Enrollment, you must have a

qualifying event to make changes

Marriage, divorce, legal separation, annulment, death of spouse, birth, adoption, permanent legal guardianship, spouse open enrollment.

◼ Information regarding Online Enrollment will be distributed

via District email.

Online Open Enrollment

 We will use Employee Online for Open Enrollment.  You will be able to make the following Changes:  Add or drop dependent(s)  Add or drop your Dental or Health plan(s)  Change health plans  Elect Flexible Spending Plan (Annual enrollment)  Add voluntary term life insurance  Please note that Employee Online is used to confirm or

enroll the changes to the items listed above. All changes you make in Employee Online will be saved and applied on the 7/1/2020 effective date.

Open Enrollment Process

Open Enrollment “How To”

Open Enrollment “How To”

Points to Remember

 Open Enrollment needs to be completed

through Employee Online by April 30th, 2020 at 5:00pm.

 Now is the only time to make changes for

fiscal year July 1, 2020 through June 30, 2021 without a qualifying event.

 You have 30 days after a qualifying event

to make allowed changes to your benefits.

 Spousal Coverage Rule.  All medical and dental changes will be

effective July 1, 2020.

There is only one Open Enrollment period for Medical and Dental, this will be your only

• pportunity to make

benefit elections for July 1, 2020 through June 30, 2021!

Questions? Thank you for your time!