Health Care Plan Open Enrollment 2016-17 Agenda ACA Update - - PowerPoint PPT Presentation

Health Care Plan Open Enrollment 2016-17

Agenda

• ACA Update
• Benefits update
• Health Care plan review
• Tips to save health care dollars
• FSA – Open Enrollment
• Dental – Open Enrollment
• Vision – Open Enrollment

Employee Benefit Plan Updates 2016-17

• OWU will be renewing with Anthem
• Deductibles, coinsurance, and out-of-pocket

maximums will remain the same

• Medical and Rx co-pays will be changing
• The dental plans will be changing to Anthem

effective 7/1/16

• NEW FSA/DCA vendor, HRPro effective

7/1/16

• OWU will continue to offer The OWU Wellness Program

to all employees.

• Opportunity to reduce your health care premiums or earn

cash incentive for non-medical plan participants!

Employee Benefit Plan Updates 2016-17

5

• Employer Taxes Mandated by PPACA
• 1. Patient Centered Outcomes Research Fee
• Due July 31, 2016
• $2.08 per average covered member in 2015 ($1,595.36)

2. Transitional Reinsurance Fee

• Due January 15, 2017
• $2.25 per covered member per month in 2016

($11,191.50)

$12,786.86 July 16-June 17 – OWU’s approximate spend for PPACA

Taxes and Fees

Individual Obligations

If person chooses not to have insurance they will owe a tax: * Greater of 1% of income or $95 - 2014 * Greater of 2% of income or $325 - 2015 * Greater of 2.5% of income or $695, indexed - 2016 and later * Per adult; children 50%; family max of 3x individual

User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? Apply Inpatient Copay per Day? HSA/HRA Employer Contribution? Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? Use Separate OOP Maximum for Medical and Drug Spending? Indicate if Plan Meets CSR Standard? Desired Metal Tier Medical Drug Combined Medical Drug Combined Deductible ($) $1,000.00 $50.00 Coinsurance (%, Insurer's Cost Share) 90.00% 100.00% OOP Maximum ($) OOP Maximum if Separate ($) Click Here for Important Instructions Tier 1 Tier 2 Type of Benefit Subject to Deductible? Subject to Coinsurance? Coinsurance, if different Copay, if separate Subject to Deductible? Subject to Coinsurance? Coinsurance, if different Copay, if separate Medical Emergency Room Services $250.00 All Inpatient Hospital Services (inc. MHSA) Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X- rays) $30.00 Specialist Visit $60.00 Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services Imaging (CT/PET Scans, MRIs) Rehabilitative Speech Therapy Rehabilitative Occupational and Rehabilitative Physical Therapy Preventive Care/Screening/Immunization 100% $0.00 100% $0.00 Laboratory Outpatient and Professional Services X-rays and Diagnostic Imaging Skilled Nursing Facility Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Drugs Generics $10.00 Preferred Brand Drugs $35.00 Non-Preferred Brand Drugs $70.00 Specialty Drugs (i.e. high-cost) 25% Options for Additional Benefit Design Limits: Set a Maximum on Specialty Rx Coinsurance Payments? Specialty Rx Coinsurance Maximum: $250 Set a Maximum Number of Days for Charging an IP Copay? # Days (1-10): Begin Primary Care Cost-Sharing After a Set Number of Visits? # Visits (1-10): Begin Primary Care Deductible/Coinsurance After a Set Number of Copays? # Copays (1-10): Output Status/Error Messages: Calculation Successful. Actuarial Value: 80.40% Metal Tier: Gold Copay applies only after deductible? HSA/HRA Options Narrow Network Options Annual Contribution Amount: 2nd Tier Utilization: 1st Tier Utilization: Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Tier 1 Tier 2 $3,500.00 Calculate

2016-17 OWU Contribution Options

EE/Count Current/ Month Renewal/ Month

< $35,999 EE only 62 $39.00 $42.00 EE + SP 14 $167.00 $180.00 EE + Children 6 $151.00 $162.00 EE + Family 19 $265.00 $285.00 $36,000 - $59,999 EE only 71 $66.00 $71.00 EE + SP 15 $222.00 $239.00 EE + Children 5 $201.00 $216.00 EE + Family 36 $344.00 $370.00 $60,000 - $89,999 EE only 51 $92.00 $99.00 EE + SP 17 $278.00 $299.00 EE + Children 4 $251.00 $270.00 EE + Family 51 $422.00 $454.00 > $90,000 EE only 21 $118.00 $127.00 EE + SP 8 $333.00 $358.00 EE + Children 5 $301.00 $324.00 EE + Family 19 $500.00 $538.00

How Does OWU Compare?

Ohio Wesleyan University Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2,338 627 750 1,546 <$35,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $42 $130 $126 $130 $103 $123 EE+1 EE+CH $162 $386 $346 $287 $358 $322 EE+SP $180 $490 $417 $343 $436 $395 Family $285 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 7.1% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 14.4% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 14.5% 47.9% 42.1% 37.7% 39.8% 37.3% Family 16.4% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2% EMLOYEE CONTRIBUTIONS

How Does OWU Compare?

Ohio Wesleyan University

Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2,338 627 750 1,546 $36,000-$59,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $71 $130 $126 $130 $103 $123 EE+1 EE+CH $216 $386 $346 $287 $358 $322 EE+SP $239 $490 $417 $343 $436 $395 Family $370 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 12.0% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 19.2% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 19.3% 47.9% 42.1% 37.7% 39.8% 37.3% Family 21.2% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

EMLOYEE CONTRIBUTIONS

How Does OWU Compare?

Ohio Wesleyan University

Survey Benchmarks Client Nationa l Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2,338 627 750 1,546 $60,000- $89,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $99 $130 $126 $130 $103 $123 EE+1 EE+CH $270 $386 $346 $287 $358 $322 EE+SP $299 $490 $417 $343 $436 $395 Family $454 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 16.8% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 24.1% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 24.1% 47.9% 42.1% 37.7% 39.8% 37.3% Family 26.1% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

EMLOYEE CONTRIBUTIONS

How Does OWU Compare?

Ohio Wesleyan University

Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2,338 627 750 1,546 >$90000 Employee Share of Premiums Monthly Employee Premium Share ($) Single $127 $130 $126 $130 $103 $123 EE+1 EE+CH $324 $386 $346 $287 $358 $322 EE+SP $358 $490 $417 $343 $436 $395 Family $538 $731 $604 $504 $686 $574 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 21.5% 27.7% 27.5% 30.8% 19.2% 24.5% EE+1 EE+CH 28.9% 44.8% 41.0% 37.6% 36.6% 35.1% EE+SP 28.9% 47.9% 42.1% 37.7% 39.8% 37.3% Family 30.1% 52.5% 44.0% 38.8% 45.7% 39.5% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%

EMLOYEE CONTRIBUTIONS

How Does OWU Compare?

Survey Benchmarks Client National Regional State Industry Group EE Size Category Number of Health Plans Reported 4 7,689 2,338 627 750 1,546 CoPays Primary Care Physician CoPay $30 $25 $25 $25 $20 $25 Specialty Care Physician CoPay $60 $35 $40 $35 $30 $30 Urgent Care CoPay $75 $50 $50 $50 $45 $40 Emergency Room CoPay $250 $150 $150 $200 $150 $100 Separate In-Hospital Admission CoPay $250 $250 $300 $225 $250 In-Network Benefits Deductible - Single $1,000 $1,000 $1,000 $1,000 $500 $750 Deductible - Family $2,000 $3,000 $2,000 $2,000 $1,500 $1,500 Plan Coinsurance 90% 80% 80% 80% 80% 80% Out-of-Pocket Maximum - Single $3,500 $3,000 $3,000 $2,500 $2,250 $2,500 Out-of-Pocket Maximum - Family $7,000 $7,500 $6,000 $5,000 $5,000 $6,000 Out-of-Network Benefits Deductible - Single $2,000 $2,000 $2,000 $2,000 $1,000 $1,000 Deductible - Family $4,000 $4,000 $4,000 $4,000 $2,000 $3,000 Plan Coinsurance 70% 60% 60% 60% 60% 60% Out-of-Pocket Maximum - Single $7,000 $6,000 $6,000 $6,000 $4,000 $5,000 Out-of-Pocket Maximum - Family $14,000 $14,000 $14,000 $13,000 $9,000 $10,500

Ohio Wesleyan University

PLAN DESIGN

Anthem PPO Plan What are the amounts of the co-payments?

Doctor Office Visits (In-Network)

• Primary Care

$30.00/visit

• Specialty Care

$60.00/visit

• Urgent Care Centers

$75.00/visit

(In/Out-of-Network)

• Emergency Room

$250.00 Co-pay/visit; Then you pay 10%

(In/Out-of/Network)

• All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including

prescription drugs.

Preventive Care Covered at 100% in-network

Preventive Care Covered at 100% in-network

Preventive Care Covered at 100% in-network

LiveHealth Online.

See a doctor 24/ 7 with LiveHealth Online

• Meet with a doctor via video, chat or phone
• Choice of credentialed providers
• Accessibility anytime, anywhere
• No appointments or waiting rooms

co-branding logo here

Anthem Plan Benefits

Prescription Drug Benefit Retail $10 Co-Pay for Tier 1 Drugs $35 Co-Pay for Tier 2 Drugs $70 Co-Pay for Tier 3 Drugs 25% to a Max of $250 for Tier 4 Drugs

$50 deductible applies then copays Maximum 30 day supply per prescription *Anthem formulary list of all 4 copay tiers is available on the OWU HR web page.

Anthem Plan Benefits

Prescription Drug Benefit Mail Order* $10.00 Co-Pay for Tier 1 Drugs $70.00 Co-Pay for Tier 2 Drugs $140.00 Co-Pay for Tier 3 Drugs 25% to a Max of $250 for Tier 4 Drugs

Maximum 90 day supply per prescription; Tier 4 30 day supply, includes diabetic test strips *Anthem formulary list of all 4 copay tiers is available on the OWU HR web page.

Tips To Save $$$

• Verify your doctor and the provider is in Anthem’s network
• Remind the receptionist that your co-pay for a preventive care visit is $0
• Confirm preventive care procedures are eligible prior to the appointment & that

it will be billed as a preventive when leaving the provider’s office

• Verify physician referrals to labs/facilities are in the network
• Utilize Anthem’s transparency tool to save money
• Request in-office tests such as lab/x-ray be sent to an in-network lab or

physician for evaluation

• Always reference Anthem’s Explanation of Benefits (EOB) prior to paying the

provider

• Take the Preferred Drug List with you to the doctor visit
• Request generic drug when available
• Request drug samples from your doctor

OWU PPO Plan

Calendar Year Deductible Co-Insurance after the Deductible (Per Calendar Year) Insurance Company Pays (Per Calendar Year) $1,000 Per Person $2,000 Family Maximum

90% of next $25,000

10%

• f next

$25,000

100%

Your Individual Out-of-Pocket Expenses

$2,500 $1,000

$3,500

Total Out-of-Pocket Expense Per Person ($7,000 Family Maximum)

+

All deductibles, copayments and coinsurance apply toward the out-of-pocket maximum including prescription copayments.

Anthem PPO Plan

Diagnostic Testing Services In-Network

• MRI’s

100%

• CT Scans

100%

• PET Scans

100%

• Nuclear Medicine

100%

• X-Ray’s/Radiology

100%

ANTHEM PPO PLAN

In-Network Deductible $1,000 Per Person $2,000 Family maximum

Out of Pocket*

$3,500 Per Person

(including deductible)

$7,000 Family maximum

(including deductible)

Out-of-Network Deductible $2,000 Per Person $4,000 Family maximum

Out of Pocket*

$7,000 Per Person

(including deductible)

$14,000 Family maximum

(including deductible)

*Out-of-Pocket maximums include co-payments in-network

ConditionCare

• Receive guidance on following

your care plan

• Consult with nurse coaches
• Better manage your health

HEALTH MANAGEMENT TOOLS

ConditionCare helps participants manage the following conditions:

• Asthma (Pediatric & Adult)
• Chronic Obstructive Pulmonary Disease
• Coronary Artery Disease
• Diabetes (Pediatric & Adult; Types 1 & 2)
• Heart Failure

• Receive instant

health care information

• Consult with registered nurses
• Available by phone

24 hours a day, toll-free

24/7 NurseLine

31

Tools to help you choose

Open Enrollment book

Read this guide to help compare your plan options

Find a Doctor

Search for information about doctors in your area

Interactive Videos

Learn more about your health plan and how to effectively use it

Estimate Your Cost

Find cost estimates for common inpatient,

• utpatient and diagnostic services

32

ANTHEM

Dependent Age Status

• End of the month in which the dependent

turns 26 unless the dependent is eligible for another employer-sponsored health plan

• ther than that of a parent

WHO TO CALL WITH QUESTIONS

Anthem Member Services: 1-888-290-9164

• Benefit Information
• Claim Inquiries
• Provider Searches
• Changes to member data
• ID Cards, Provider Directories

FLEXIBLE SPENDING ACCOUNT

PLAN DETAILS

Ohio Wesleyan University Sponsored Plan Allowing Faculty and Staff to Make Pre-Tax Contributions for:

• Health Care Account

$2,550 Annual Election Maximum

• Dependent Care Account

$5,000 Annual Election Maximum

Eligibility Requirements

• All full time Faculty and Staff
• Do not need to participate in the Medical; Dental or Vision Plan
• Annual Voluntary Election
• May not have a HSA and a Health Care FSA (IRS Rule)

Plan year will begin July 1, 2016 – June 30, 2017

• Your employer offers a limited use FSA Benefits Card for you to use to pay

for your FSA eligible expenses.

• The FSA Benefits Card allows employees participating

in a FSA (medical or dependent care) to pay for eligible expenses at point of service

• No more paying cash, and waiting for reimbursement
• The FSA Benefits Card can be used at eligible merchant locations such as:
• Doctor and Dentist offices
• Pharmacies
• Vision service locations
• Dependent care facilities

(available funds are limited to actual account balance)

FSA BENEFITS CARD

• File claims online at

hrpro.biz and click on the “Login” button in the top right corner

• Complete paper claim form and

fax, mail or email with itemized receipts or provider Explanation of Benefits (EOBs) to HRPro: Fax: (248) 543-2296 Email: accounts@hrpro.biz Mail: 1423 East 11 Mile Road Royal Oak, MI 48067

HOW TO FILE A CLAIM

HOW TO SET UP DIRECT DEPOSIT

• Complete the Direct Deposit

Authorization Form

• For checking accounts, attach a

voided check (or photocopy of a check)

• For savings accounts, attach a

deposit slip

• Once complete, fax all information

to HRPro at 1-888-989-8329

• There is a mobile app available to view your

account balance from your smartphone.

• You are able to upload your itemized receipts

and attach them to claims on the Employee Portal or from your smartphone. This works for claims you submit for reimbursement and debit card transactions requiring documentation for substantiation.

SMARTPHONE MOBILE APP

ELIGIBLE EXPENSES

Health Care Account

• Medical, Dental and Vision expenses
• Deductible
• Coinsurance
• Co-payments for office visits, prescription drugs, etc.
• Some Expenses not covered by insurance

Dependent Care Account

• Daycare expenses during work hours
• Daycare/babysitting for children under 13
• Preschool programs
• After-school care
• Home care for disabled dependent age 13 and over

ELIGIBLE EXPENSES

• Day Care expense must be to provide gainful

employment

• If married, spouse must also be employed
• Dependent must reside with employee
• Payment for providing care may not be made to

another dependent

• Care provider must disclose TAX ID #

DENTAL PLANS

KEY FEATURES OF THE DENTAL PLANS

• Your choice of a Low and High Plan
• 100% for Routine Preventive services(1)
• Administrated by the Anthem

Benefits are subject to Anthem Contract Limitations

KEY FEATURES OF THE DENTAL PLANS

• Receive your care from the Dentist of your choice
• No Network Requirement
• Optional network of dentists to receive a discount for

services

Benefits are subject to Anthem Contract Limitations

LOW DENTAL PLAN

Preventive

Plan Pays 100% In-Network 90% Out-of-Network (No Deductible) Oral Exams Teeth Cleanings X-Rays

Deductible Amount = $50.00/Person/year; Family Max (3)

Basic

Plan Pays 80% In-Network 60% Out-of-Network Amalgam fillings Front composite fillings Simple Extractions Calendar Year Maximum Amount $1,000 per person

Major

Plan Pays 50% in-network 25% out-of-network Periodontics Endodontics Oral Surgery Crowns Dentures Bridges Dental implants

Those who are actively managed in the Anthem Diabetic or Maternal Health Care Management programs will be eligible for an additional dental cleaning or periodontal maintenance procedure per benefit period.

HIGH DENTAL PLAN

Deductible Amount = $50.00/Person/year; Family Max (3)

Preventive

Plan Pays 100% In-Network 100% Out-of-Network (No Deductible) Oral exams Teeth cleaning X-Rays

Basic

Plan Pays 90% In-Network 80% Out-of-Network Sealants Amalgam Filling From Composite Filling Back Composite Filling Simple Extractions

Major

Plan Pays 60% In-Network 50% Out-of-Network Periodontics Endodontics Oral Surgery Crowns Dentures Bridges Dental Implants Calendar year max amount $1,500 (Anthem Dental Providers) Calendar year max amount $1,000 Orthodontics 50% $1,000 Child only Lifetime max

Those who are actively managed in the Anthem Diabetic or Maternal Health Care Management programs will be eligible for an additional dental cleaning or periodontal maintenance procedure per benefit period.

OTHER KEY PIECES OF THE PREFERRED DENTAL PLAN

• In most cases, the dentist will directly bill

Anthem for services

• Annual Maximum Benefit is $1,000 per person
• Optional Network of Dentists available to receive

discounts

• Annual Maximum Benefit increases to $1,500

per person when services are provided in Anthem’s Network of Dentists

HOW THE OPTIONAL NETWORK SAVES YOU MONEY

• Go to www.Anthem.com (click find a doctor)
• Select the Dental Complete network
• View network of Dentists in your area
• Visit participating Dentists and receive treatment
• Dentist will directly bill Anthem at a lower pre-

negotiated rate and receive their payment directly from Anthem

• The Dentist can not charge the difference between the

negotiated rate and their normal fee (the plan’s benefits will apply toward the negotiated rate)

ANTHEM DENTAL PLANS

Monthly Payroll Deductions (1) Effective July 1, 2016

Employee Employee + One Dependent Family $23.26 $45.60 $74.49 $32.50 $64.39 $104.70 Basic Plan Preferred Plan

(1) Pre-tax deductions. Actual net cost will be reduced based upon IRS

Section 125 election and personal income tax bracket.

VISION PLANS

BASIC VISION PLAN

• Exam every 12 months, $20 co-pay
• Prescription glasses every 24 months, $20 co-pay
• Contacts, no co-pay applies ( 24 months)
• Coverage from a VSP Doctor

PREFERRED VISION PLAN

• Exam every 12 months, $10 co-pay
• Prescription lenses every 12 months, covered in full
• Contacts, no co-pay applies ( 12 months)
• Frames every 24 months, $25.00
• $140.00 Allowance
• Coverage from a VSP Doctor

FIND A VSP PROVIDER

• Go to www.vsp.com
• View Network of Doctors in your area
• Visit participating Doctors and receive treatment
• Call 1-800-877-7195

VSP PLANS

Payroll Deductions (1) Effective July 1, 2016

Employee Family $22.87 $8.09 $26.82 $9.49 Basic Plan Preferred Plan

(1) Pre-tax deductions. Actual net cost will be reduced based upon IRS

Section 125 election and personal income tax bracket. 4 year rate guarantee!

OPEN ENROLLMENT

• You may add or remove dependents
• Enroll or terminate from plan
• Election is effective 7/1/16
• Election is in effect until 6/30/17; unless a qualified

change in your status occurs

• Open Enrollment will be April 29th through May

20th 2016

QUALIFIED CHANGE IN YOUR STATUS?

• Change in marital status
• Change of dependents
• Involuntary loss of coverage through spouse’s

employer

• Change of spouse’s employment resulting in loss
• f coverage
• Must notify Human Resources within 30 days of

change!

OWU WELLNESS PROGRAM OVERVIEW

What’s the big idea?

• Our lifestyle decisions impact our

long-term health, wellbeing and productivity

• Our healthcare costs are

impacted by the lifestyle decisions we make

• OWU continues its

commitment to encouraging well-thought-out decisions regarding healthcare solutions, and to promoting a healthy family life

Where’s the “gain”?

• OWU benefits when its employees are healthy,

and able to carry-out their work responsibilities efficiently and effectively

• Employees benefit by leading healthy lifestyles,

and are therefore happier, more stable, more dependable, more satisfied

• Everyone benefits when human resource costs

are under control (both insurance premiums and productivity)

OWU WELLNESS PROGRAM OVERVIEW

OW U W ellness Program

Where’s the “hook”?

• $25 one time premium credit for the year or

$25 through payroll for completing the wellness assessment

• One time $75 premium credit for the year or

$75 through payroll for achieving 34 credits OWU WELLNESS PROGRAM OVERVIEW

OW U W ellness Program

HOW DO I “SIGN-UP”?

w w w .UBAw ellnessw orks.com

OWU Wellness www.ubawellnessworks.com P/W = OWU

Monthly Seminars

WELLNESSWORKS PROGRAMS…

Health Risk Assessment Quarterly Challenges

BASIC PROGRAM – TRACKING (APRIL-MARCH TRACKING CYCLE)

Activity Credit Value Annual Max

Wellness Assessment 6 6 Physical Exam / Biometric Screening 6 6 Virtual Coaching 5 10 Online Monthly Seminars 1 12 Get Heart Smart Challenge (February 1-29) 5 5 Stretch and Go Challenge (May 1-31) 5 5 Keeping Your Cool Challenge (August 1-31) 5 5 Dump the Junk Challenge (November 1-30) 5 5 Community Event 3 6 Local Discretionary Activity 3 6 End of Year Survey 2 2 Total Credit Opportunity 68

Earn 3 4 + Credits in 1 2 - m onth period to earn incentive

QUESTIONS?