ELECTION - FALL 2019 Plan Year = Calendar Year (January 1 - December - - PowerPoint PPT Presentation

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ELECTION - FALL 2019 Plan Year = Calendar Year (January 1 - December - - PowerPoint PPT Presentation

SOLANCO SCHOOL DISTRICT EMPLOYEE HEALTHCARE PLAN ELECTION - FALL 2019 Plan Year = Calendar Year (January 1 - December 31) Plan Administrator - Trustmark (CoreSource) Registration and Renewal Electronic via E - Elect


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SLIDE 1

SOLANCO SCHOOL DISTRICT EMPLOYEE HEALTHCARE PLAN ELECTION - FALL 2019

  • Plan Year = Calendar Year (January 1 - December 31)
  • Plan Administrator - Trustmark (CoreSource)
  • Registration and Renewal – Electronic via ‘E-Elect’
  • Enrollment period November 1 through November 18,

2019

  • ALL EMPLOYEES eligible for healthcare benefits must

complete enrollment process – including employees denying coverage

  • Healthcare Eligibility
  • Full-Time Employment (average 30 hours or more per week)
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SLIDE 2

PLAN ELECTIONS

  • Preferred Provider (PPO)
  • Deductibles
  • Preferred Providers - $500/Individual or $1,500/Family
  • Non-preferred Providers - $1,000/Individual or

$3,000/Family

  • Qualified High Deductible Healthcare Plan (HDHP)
  • Deductibles
  • Preferred Providers - $2,000/Individual or

$4,000/Family

  • Non-preferred Providers - $4,000/Individual or

$8,000/Family

  • Long-Term Substitutes not eligible for HDHP
  • Hires after April 1 not eligible for HDHP until

following plan year

  • Identical Medical Coverage
  • Different Deductibles/Co-Pays
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SLIDE 3

PPO PLAN

  • Employee responsible for all medical and RX

costs until deductible satisfied

  • Each family member must satisfy individual

deductible until overall family deductible satisfied (Maximum 3 members)

  • Employee/member responsible for co-pays
  • Employee may contribute to Flexible

Spending Account (FSA)

  • Exception: Spouse participates in HDHP &

contributes to HSA

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SLIDE 4

PPO Plan Deductibles and Co-pays

4

Changes from 2019

2015 2016 2017 2018 2019

Deductibles 200/600 300/900 400/1000 500/1500 500/1500 Co-Pays: Physician $35.00 $35.00 $35.00 $35.00 $35.00 Specialist $45.00 $45.00 $45.00 $45.00 $45.00 ER $50.00 $75.00 $75.00 $100.00 $110.00 Chiropractic $25.00 $25.00 $25.00 $30.00 $30.00 Urgent Care $35.00 $35.00 $35.00 $40.00 $40.00 RX: Generic $10.00 $10.00 $10.00 $10.00 $15.00 Brand $30.00 $30.00 $30.00 $30.00 $35.00 Non- Formulary 50% to $75 50% to $75 50% to $75 50% to $75 50% to $75 Specialty N/A $75.00 $75.00 $100.00 $100.00

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SLIDE 5

HDHP

  • Employee responsible for all costs until

deductible satisfied

  • Overall plan deductible must be satisfied
  • Total $ deductible regardless of individual
  • Office visit co-pays waived until deductible

satisfied

  • Collected by many medical offices - applied

against deductible

  • Health Savings Account (HSA)
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SLIDE 6

HSA

  • School District Contributions
  • HSA contributions permitted to maximum IRS

limit (employer + employee)

  • 2020: Individuals - $3,550; Family - $7,100,

Age 55+ Catch-up additional $1,000

  • Contributions income tax exempt (Federal,

State, Local) SLC – 35% or more tax savings

  • Employee owned bank account
  • Pay current or future qualified medical

expenses

  • Refer to IRS Publication 502
  • HSA distribution may not apply against

deductible

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SLIDE 7

HSA ACCOUNTS

  • HSA connected to healthcare plan election
  • Family or Employee Only
  • Family = Spouse or Dependent
  • Spousal direct H S A contributions may be

made through Health Equity portal via Individual Contribution Form or bank EFT account debit Health Equity: 866-346-5800

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SLIDE 8

HSA Contributions - Front Load Employee Account

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COHORT*** EMPLOYEE ONLY Employee Healthcare Premium Reimbursement Contributions* Total Solanco HSA Contribution 2019 Max** 2020 Max** Contributions to H S A for Active Employees only Solanco Direct HSA Contribution District Yr. 1 1,600 500 2,100 3,500 3,550 District Yr. 2 1,500 500 2,000 District Yr. 3 1,250 500 1,750 District Yr. 4 1,000 500 1,500 Deductible is : $2,000.00 FAMILY LEVEL Employee Total Solanco HSA Contribution 2019 Max** 2020 Max** Solanco Direct HSA Contribution Healthcare Premium Reimbursement Contributions* District Yr. 1 3,200 1,000 4,200 7,000 7,100 District Yr. 2 3,000 1,000 4,000 District Yr. 3 2,500 1,000 3,500 District Yr. 4 2,000 1,000 3,000 Deductible is : $4,000.00

* Employee = Employee share is the required amount, it is flowing from the Employees required Premium Share each employee is paying as per the CBA. These funds are collected by the district (as district funds) and returned to the Employee H S A account. **Maximum Excludes additional $1,000 an Employee can contribute in the year turning age 55 or if age 55 or older. *** Cohort means the "year" you elect in to the HDHCP. The yearly amounts require an employee to be 'in' the "Q" plan for the entire year. (IRS annual amounts are pro-rated if not completing an entire year) For year one, payments are paid in January to get the employee started. Years thereafter are paid in January and September at 65/35% ratio, and the employee must be actively employed to receive the second payment.

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SLIDE 9

HSA (Continued)

  • HEALTHEQUITY Administers HSA
  • VISA health account debit card
  • Investment income tax exempt
  • Investment options
  • Employee controlled or advisor managed
  • 20% Penalty on Non-Medical disbursements
  • Penalty waived after age 65 – Disbursement taxed as
  • rdinary income
  • IRS Form1099-SA issued to employee
  • Employee complete IRS form 8889
  • HSA governed by IRS regulations - Obey Rules
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SLIDE 10

HSA How To:

Doctors Visits

  • No co-pays billed until deductible

satisfied

  • CoreSource adjusts price

based on discounts

  • Pay doctor from HSA funds, if

funds are available or pay out of pocket if prefer not to spend HSA

  • funds. Have option to reimburse

yourself later.

  • NOTE: Who Pays or where funds

come from ---Physician or Health care provider DOES NOT MATTER....You choose HOW/what account to pay from.

Go to the doctor Doctor sends insurance carrier the bill Claim integrated into member portal

3 2 1

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SLIDE 11

Member HSAExperience

Medical Claims

Member goes to Doctor, shows CoreSource card Doctor sends visit details andcoding to CoreSource/ESI for claims adjudication CoreSource sends claims to HealthEquityfor record keeping andmember portal population When the member has claim activity, an EOB from CoreSource is sent for each

  • claim. Claim

information and monthly statements on HSA funds and account information is available on HealthEquity portal. If deductible has not been met, provider will bill member for their plan negotiated portion. If deductible has been met, plan will pay provider for

  • service. If

member owes coinsurance, provider will bill member for their portion.

daily daily

Member pays

  • utstanding

provider bill using funds

  • n HSA card
  • r personal

funds through member portal

daily

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SLIDE 12

HSA How T

  • Pharmacy Prescriptions

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Show your CoreSource Express Scripts Card (ESI) card Pay with your HSA card Or Cash or other? Insurance carrier applies amount to your deductible— no paperwork needed

Pharmacy applies discount Pharmacy sends claim to insurance carrier

3 2 1

Go to pharmacy

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SLIDE 13

HSA Member Experience

Pharmacy Claims

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Member goes to Pharmacy and shows CoreSource/ESIcard Pharmacyand HSA card send payment information to ESI HealthEquity for record keeping and account tracking. When the member has claim activity, they will receive an EOB from ESI for each claim. Claim information and monthly statements on HSA funds and account information is available

  • n each member’s

HealthEquityportal. Pharmacy verifies eligibility. If out of pocket max is not met, member can pay using HSA card or out of pocket.

immediate daily daily

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SLIDE 14

DRUG MANUFACTURER DISCOUNTS

  • Use with Caution
  • Drug manufacturer discounts/coupons not

processed through healthcare plan

  • Not applied against plan deductible
  • No co-pay applied
  • Compare reduced cost of drug to

inability to apply cost against plan deductible

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SLIDE 15

PREVENTIVE CARE

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Both PPO and HDHP cover In-Network Preventive Care, Screenings, Immunizations at 100% - (No Co-Pays, Deductible Not Applicable)

  • Periodic health evaluations (e.g., annual physicals)
  • Screening services (e.g., mammogram, pap test,

colonoscopy)

  • Routine pre-natal and well-child care
  • Child and adult immunizations
  • Tobacco cessation programs
  • Obesity weight loss programs
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SLIDE 16

PENDING E-ELECT COMMUNICATION

  • Be alert for email issued from

SolancoBenefitElections@coresource.com

  • Worksheet attachment
  • Encrypted worksheet password is:

‘employee’s home address zip code’

  • Worksheet contains link to www.eelect.com
  • Follow worksheet instructions to complete

enrollment

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SLIDE 17

Worksheet Attachment WORKSHEET ATTACHMENT

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SLIDE 18

HEALTHCARE PLAN PREMIUMS

24 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $10,669.56 $17,071.32 $24,540.00 EMPLOYEE % SHARE 9.0% 10.0% 11.0% EMPLOYEE $ SHARE $960.26 $1,707.13 $2,699.40 PER PAY DEDUCTION $40.01 $71.13 $112.48 EMPLOYEE SHARE WELLNESS PROGRAM REDUCTION – 2% 7.0% 8.0% 9.0% WELLNESS PER PAY DEDUCTION $31.12 $56.90 $92.03

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SLIDE 19

WELLNESS PROGRAM REDUCTION

24 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

WELLNESS PER PAY PREMIUM REDUCTION $8.89 $14.23 $20.45 ANNUAL WELLNESS PREMIUM REDUCTION $213.36 $341.52 $490.80

EMPLOYEE/SPOUSE MUST COMPLETE BIOMETRIC SCREENINGS AND FLU SHOT DURING 2019 (OR SUBMIT APPROPRIATE DOCUMENTATION FROM PHYSICIAN) TO RECEIVE 2020 HEALTHCARE PREMIUM REDUCTION

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SLIDE 20

HEALTHCARE PLAN PREMIUMS

19 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $10,669.56 $17,071.32 $24,540.00 EMPLOYEE % SHARE 9.0% 10.0% 11.0% EMPLOYEE $ SHARE $960.26 $1,707.14 $2,699.40 PER PAY DEDUCTION $50.54 $89.85 $142.07 EMPLOYEE SHARE WELLNESS PROGRAM REDUCTION – 2% 7.0% 8.0% 9.0% WELLNESS PER PAY DEDUCTION $39.31 $71.88 $116.24

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SLIDE 21

WELLNESS PROGRAM REDUCTION

19 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

WELLNESS PROGRAM PER PAY REDUCTION $11.23 $17.97 $25.83 ANNUAL WELLNESS PROGRAM REDUCTION $213.37 $341.43 $490.77

EMPLOYEE MUST COMPLETE BIOMETRIC SCREENINGS AND FLU SHOT DURING 2018 (OR SUBMIT APPROPRIATE DOCUMENTATION FROM PHYSICIAN) TO RECEIVE 2019 HEALTHCARE PREMIUM REDUCTION

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SLIDE 22
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SLIDE 23

HEALTHCARE PLAN PREMIUMS -

RETIREES

RETIREES – PPO PLAN EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $10,669.56 $17,071.32 $24,540.00 MONTHLY PREMIUM $889.13 $1,422.61 $2,045.00

RETIREES – HDHP EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $8,109.00 $12,974.28 $18,650.64 MONTHLY PREMIUM $675.75 $1,081.19 $1,554.22

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SLIDE 24

SPOUSAL ELIGIBILITY

  • Spouses NOT eligible to participate in

Solanco’s healthcare plan if the spouse

  • ffered healthcare through their employer.
  • Certification form downloaded from E-Elect

system

  • Spouse’s employer must certify healthcare offer
  • Audits will be performed to verify accuracy
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SLIDE 25

EMPLOYEE HEALTHCARE/RX PLAN ID ID CARD

  • TRUSTMARK CARD
  • ONE CARD - MEDICAL AND RX PLANS
  • NEW CARD ISSUED FOR 2020 - WATCH FOR CARD
  • EMPLOYEE – 1 CARD, FAMILY - 2 CARDS
  • EXPRESS SCRIPTS ADMINISTERS RX PLAN
  • CARD CONTAINS
  • CO-PAYS
  • PRE-CERTIFICATION REQUIREMENTS
  • CUSTOMER SERVICE PHONE #s
  • BENEFIT QUESTIONS/CONCERNS/ISSUES
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SLIDE 26
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SLIDE 27

PRICE SHOP YOUR PRESCRIPTIONS TO REDUCE YOUR HEALTHCARE COSTS - GOODRX ANOTHER COST COMPARISON WEBSITE

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SLIDE 28

What is a Flexible Spending Account (FSA)?

Pre-tax benefit account that pays for eligible expenses not covered by insurance

Health Care FSA

Covers medical, prescription, dental and vision expenses

Dependent Care FSA

Covers dependent care expenses including daycare, nursery school and day camp for children, and services for adult dependents who cannot care for themselves

Limited Purpose Medical FSA

Covers dental and vision expenses only

(for compliance with a health savings account)

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SLIDE 29

Trustmark Administers Solanco’s FSA

  • Reimbursement plans
  • Medical FSA available - PPO plan only
  • Medical - $2,500 annual maximum

for Solanco

  • Dependent Care - $5,000 annual

maximum

  • Must use annual contribution or lost –

no carry over

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SLIDE 30

ADDITIONAL SOLANCO HEALTHCARE BENEFITS

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  • Diabetes Counseling Program
  • Life Insurance - Beneficiary in E-Elect

➢ Pension information is not in E-elect...must go to PSERS web site direct

  • 2019-20 Dental/Vision Reimbursement: $2,250
  • FSA and HSA: IRS Tax advantaged accounts

including premium share

  • TelaDoc Program....must enroll...see Trustmark

and / or E-elect material

  • Carebridge -- Employee Assistance Plan – EAP

▪ Benefits detailed on Solanco website

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SLIDE 31

Trustmark Information

31

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SLIDE 32

CoreSource is changing their brand name to Trustmark Health Benefits. This name change does not affect your benefits. Between now and January 1, 2020, you’ll start seeing the name Trustmark Health Benefits in places like:

  • New ID card
  • Explanation of benefits (EOB)
  • Letters and communications
  • Your web portal
  • Mobile app
  • Customer Service

1/1/20

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SLIDE 33
  • 2+ million members
  • $3 billion benefits paid in 2016
  • Largest independent administrator of self-funded health plans
  • 11 regional offices employing approximately 1,000 employees
  • 40+ years benefit administrators experience
  • $11M claims and 2M calls handled per year
  • Experienced partner with multiple school district clients

CORESOURCE FAST FACTS:

100-65,000

Client employee lives

32 years

Longest Client Tenure

9.7 years

Average Client Tenure

50

Licensed states to administer benefit plans

97.8%

Client Retention

Profile, Experience, Expertise

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SLIDE 34
  • 1,000+ benefit professionals
  • Average tenure, 9.2 years
  • Education
  • 58.5% post-secondary
  • 10% registered nurses
  • 100% of Staff participate in Customer Service

Excellence training

  • Comprehensive QA oversight
  • Random at > of statistical significance or 2% monthly
  • All claims exceeding staff authority limits reviewed
  • Ties in with Critical Claims Unit and all large claims
  • Quality Service Standards
  • Member Service

Speed to answer inbound calls, 29.5 seconds 98% First call resolution 94% Health Coaching satisfaction rate 97.5% Large Case Management satisfaction rate

  • ClaimProcessing

8. % claims processed <14 days

  • Clean claims @ 6.6 days

99.6% Financial Accuracy 99.7% Procedural Accuracy

Trustmark Operations

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SLIDE 35
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SLIDE 36

Telemedicine - Teladoc

Step 1

Complete medical history

Step 2

Request consult

Step 3

Talk with a physician

Step 4

Resolve the issue

Step 5

Continuity

  • f care

Step 6

Reconcile account if necessary

When the physician is unavailable: no appointments; after hours Schedule doesn’t permit traveling to see your physician (work, etc.) On vacation or a business trip For refill of recurring prescription (short term) Geographical barriers (distances to a provider’s office) Pediatric care for any age

48

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SLIDE 37

Telemedicine: Convenient and Affordable

  • Providing solutions for three of the biggest issues in

healthcare:

  • Timely access
  • Lower cost
  • Quality Care

Employee / Member satisfaction is one of the many benefits of addressing these issues

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SLIDE 38

Network

  • Access to one of the largest

carrier-owned networks in the country

  • Includes legacy HealthAmerica

provider network as well as Institutes of Excellence and Quality Hospitals

  • Top tier provider contracting

terms lending both Plan and Member value

Our arrangement with Aetna provides 100% of all negotiated savings with Providers and Hospitals back to both the Client and Member.

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SLIDE 39

Additional Resources

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  • District website > Departments >

Business Office and Employee Portal

  • www.mycoresource.com
  • https://express-scripts.com
  • https://healthequity.com
  • https://teladoc.com
  • https://medicare.gov
  • Internal Revenue Service Publications
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SLIDE 40

QUESTIONS? Thank You!!