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
Employee Benefit Plan Updates 2016-17 • 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!
Taxes and Fees • 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 5
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 $695, indexed - 2016 and later * Per adult; children 50%; family max of 3x individual
User Inputs for Plan Parameters Use Integrated Medical and Drug Deductible? HSA/HRA Options Narrow Network Options Apply Inpatient Copay per Day? HSA/HRA Employer Contribution? Blended Network/POS Plan? Apply Skilled Nursing Facility Copay per Day? 1st Tier Utilization: Annual Contribution Amount: Use Separate OOP Maximum for Medical and Drug Spending? 2nd Tier Utilization: Indicate if Plan Meets CSR Standard? Desired Metal Tier Tier 1 Plan Benefit Design Tier 2 Plan Benefit Design Medical Drug Combined Medical Drug Combined Deductible ($) $1,000.00 $50.00 Coinsurance (%, Insurer's Cost Share) 90.00% 100.00% OOP Maximum ($) $3,500.00 OOP Maximum if Separate ($) Click Here for Important Instructions Tier 1 Tier 2 Tier 1 Tier 2 Subject to Subject to Coinsurance, if Copay, if Subject to Subject to Coinsurance, if Copay, if Type of Benefit Copay applies only after deductible? Deductible? Coinsurance? different separate Deductible? Coinsurance? different separate Medical All All All All All All Emergency Room Services $250.00 All Inpatient Hospital Services (inc. MHSA) Primary Care Visit to Treat an Injury or Illness (exc. Preventive, and X- $30.00 rays) 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 All All All All All All 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 Calculate Status/Error Messages: Calculation Successful. Actuarial Value: 80.40% Metal Tier: Gold
2016-17 OWU Contribution Options Current/ Renewal/ EE/Count Month Month $39.00 $42.00 EE only 62 $167.00 $180.00 EE + SP 14 < $35,999 $151.00 $162.00 EE + Children 6 $265.00 $285.00 EE + Family 19 $66.00 $71.00 EE only 71 $222.00 $239.00 EE + SP 15 $36,000 - $59,999 $201.00 $216.00 EE + Children 5 $344.00 $370.00 EE + Family 36 $92.00 $99.00 EE only 51 $278.00 $299.00 EE + SP 17 $60,000 - $89,999 $251.00 $270.00 EE + Children 4 $422.00 $454.00 EE + Family 51 $118.00 $127.00 EE only 21 $333.00 $358.00 EE + SP 8 > $90,000 $301.00 $324.00 EE + Children 5 $500.00 $538.00 EE + Family 19
How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Industry EE Size National Regional State Client Survey Benchmarks Group Category 7,689 2,338 627 750 1,546 Number of Health Plans Reported 4 <$35,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $130 $126 $130 $103 $123 $42 EE+1 EE+CH $386 $346 $287 $358 $322 $162 EE+SP $490 $417 $343 $436 $395 $180 Family $731 $604 $504 $686 $574 $285 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 27.7% 27.5% 30.8% 19.2% 24.5% 7.1% EE+1 EE+CH 44.8% 41.0% 37.6% 36.6% 35.1% 14.4% EE+SP 47.9% 42.1% 37.7% 39.8% 37.3% 14.5% Family 52.5% 44.0% 38.8% 45.7% 39.5% 16.4% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%
How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Industry EE Size National Regional State Client Survey Benchmarks Group Category 7,689 2,338 627 750 1,546 Number of Health Plans Reported 4 $36,000-$59,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $130 $126 $130 $103 $123 $71 EE+1 EE+CH $386 $346 $287 $358 $322 $216 EE+SP $490 $417 $343 $436 $395 $239 Family $731 $604 $504 $686 $574 $370 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 27.7% 27.5% 30.8% 19.2% 24.5% 12.0% EE+1 EE+CH 44.8% 41.0% 37.6% 36.6% 35.1% 19.2% EE+SP 47.9% 42.1% 37.7% 39.8% 37.3% 19.3% Family 52.5% 44.0% 38.8% 45.7% 39.5% 21.2% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%
How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Nationa Industry EE Size Regional State Client Survey Benchmarks l Group Category 7,689 2,338 627 750 1,546 Number of Health Plans Reported 4 $60,000- $89,999 Employee Share of Premiums Monthly Employee Premium Share ($) Single $130 $126 $130 $103 $123 $99 EE+1 EE+CH $386 $346 $287 $358 $322 $270 EE+SP $490 $417 $343 $436 $395 $299 Family $731 $604 $504 $686 $574 $454 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 27.7% 27.5% 30.8% 19.2% 24.5% 16.8% EE+1 EE+CH 44.8% 41.0% 37.6% 36.6% 35.1% 24.1% EE+SP 47.9% 42.1% 37.7% 39.8% 37.3% 24.1% Family 52.5% 44.0% 38.8% 45.7% 39.5% 26.1% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%
How Does OWU Compare? EMLOYEE CONTRIBUTIONS Ohio Wesleyan University Industry EE Size National Regional State Client Survey Benchmarks Group Category 7,689 2,338 627 750 1,546 Number of Health Plans Reported 4 >$90000 Employee Share of Premiums Monthly Employee Premium Share ($) Single $130 $126 $130 $103 $123 $127 EE+1 EE+CH $386 $346 $287 $358 $322 $324 EE+SP $490 $417 $343 $436 $395 $358 Family $731 $604 $504 $686 $574 $538 Family (Composite Non-Single) $522 $447 $381 $410 $401 Monthly Employee Premium Share (%) Single 27.7% 27.5% 30.8% 19.2% 24.5% 21.5% EE+1 EE+CH 44.8% 41.0% 37.6% 36.6% 35.1% 28.9% EE+SP 47.9% 42.1% 37.7% 39.8% 37.3% 28.9% Family 52.5% 44.0% 38.8% 45.7% 39.5% 30.1% Family (Composite Non-Single) 45.4% 38.3% 35.8% 32.3% 33.2%
How Does OWU Compare? PLAN DESIGN Ohio Wesleyan University Industry EE Size National Regional State Survey Benchmarks Client Group Category 7,689 2,338 627 750 1,546 Number of Health Plans Reported 4 CoPays Primary Care Physician CoPay $25 $25 $25 $20 $25 $30 Specialty Care Physician CoPay $35 $40 $35 $30 $30 $60 Urgent Care CoPay $50 $50 $50 $45 $40 $75 Emergency Room CoPay $150 $150 $200 $150 $100 $250 Separate In-Hospital Admission CoPay $250 $250 $300 $225 $250 In-Network Benefits Deductible - Single $1,000 $1,000 $1,000 $500 $750 $1,000 Deductible - Family $3,000 $2,000 $2,000 $1,500 $1,500 $2,000 Plan Coinsurance 80% 80% 80% 80% 80% 90% Out-of-Pocket Maximum - Single $3,000 $3,000 $2,500 $2,250 $2,500 $3,500 Out-of-Pocket Maximum - Family $7,500 $6,000 $5,000 $5,000 $6,000 $7,000 Out-of-Network Benefits Deductible - Single $2,000 $2,000 $2,000 $1,000 $1,000 $2,000 Deductible - Family $4,000 $4,000 $4,000 $2,000 $3,000 $4,000 Plan Coinsurance 60% 60% 60% 60% 60% 70% Out-of-Pocket Maximum - Single $6,000 $6,000 $6,000 $4,000 $5,000 $7,000 Out-of-Pocket Maximum - Family $14,000 $14,000 $13,000 $9,000 $10,500 $14,000
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
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