Open Enrollment 2019 November 8 November 26 Agenda Open - - PowerPoint PPT Presentation
Open Enrollment 2019 November 8 November 26 Agenda Open Enrollment Benefits Terminology Medical/Rx Health Savings Account Flexible Spending Account Dental Vision Retirement Life/Disability Long Term Care
November 8 – November 26
Open Enrollment Benefits Terminology Medical/Rx Health Savings Account Flexible Spending Account Dental Vision Retirement Life/Disability Long Term Care Travel Assist & Employee Assistance Plan
November 8 – November 26 This is an ACTIVE enrollment for medical!
in order to have medical benefits in 2019.
your medical benefits will be cancelled effective January 1, 2019.
(aside from copays that may apply) before insurance begins to cover all or a portion of your costs. Deductibles reset January 1st each year. Deductible
prescriptions in addition to what the insurance company covers. Copay
service until you reach your out-of-pocket maximum. Coinsurance
before your expenses are covered at 100% for in-network only services. Out-of-Pocket Maximum
PPO
HDHP
for coverage and apply coinsurance for additional services. Embedded Family Deductible
family can receive benefits (coinsurance can begin). Non-embedded Family Deductible
Note: In-network plan summary; refer to plan documents for full details
PPO HDP1 HDP2
Annual Deductible Single $500 $2,000 * $3,000 Family $1,000 $4,000* $6,000 Health Savings Account Funding Single N/A $500/$750** $350 Family N/A $1,000/$1,500** $700 Maximum Out-of-Pocket (Medical Services) Single $2,000 $4,000 $5,000 Family $4,000 $8,000 $10,000 Separate Maximum Out-of-Pocket (Prescriptions) Single $2,000 N/A N/A Family $4,000 N/A N/A Your Coinsurance 10% 15% 15% Preventative Care 0% 0% 0% Office Visit $25 Deductible/Coinsurance Deductible/Coinsurance Specialist Office Visit $50 Deductible/Coinsurance Deductible/Coinsurance Urgent Care $50 Deductible/Coinsurance Deductible/Coinsurance ER Copay $150 Deductible/Coinsurance Deductible/Coinsurance Retail Prescription Tier 1 $10 Deductible/$10 Deductible/$10 Tier 2 $30 Deductible/$40 Deductible/$40 Tier 3 $50 Deductible/$60 Deductible/$60 Mail Order Drug 2.5x Retail Deductible/2.5x Retail Deductible/2.5x Retail
*HDP1 deductible amounts are non-embedded which means that outside of Single coverage, the family deductible has to be met before the Coinsurance takes affect. ** Matching feature allows additional CU contributions up to the listed amount
PPO
Premium Cost Share Employee Employee Monthly Capital Monthly Biweekly Semi-Monthly Employee Only $88.24 $95.59 $191.18 $691.55 Employee & Spouse $258.55 $280.10 $560.19 $1,205.26 Employee & Child(ren) $204.26 $221.28 $442.56 $952.14 Family $333.53 $361.33 $722.65 $1,554.77
HDP1
Premium Cost Share Employee Employee Monthly Capital Monthly Biweekly Semi-Monthly Employee Only $45.14 $48.90 $97.80 $724.27 Employee & Spouse $172.36 $186.72 $373.44 $1,270.69 Employee & Child(ren) $136.16 $147.51 $295.01 $1,027.92 Family $222.34 $240.87 $481.74 $1,605.96
HDP2
Premium Cost Share Employee Employee Monthly Capital Monthly Biweekly Semi-Monthly Employee Only $18.90 $20.48 $40.95 $683.52 Employee & Spouse $100.80 $109.20 $218.40 $1,230.53 Employee & Child(ren) $79.80 $86.45 $172.89 $984.01 Family $129.79 $140.61 $281.22 $1,570.98
What is an HSA (Health Savings Account)?
– An HSA is an individually (employee) owned savings account that accompanies a qualified high deductible health plan (HDHP) – An HSA allows you to set aside pre-tax dollars from your paycheck to pay for eligible healthcare expenses
What are the advantages of an HSA (Health Savings Account)?
– As an employee owned account, employees choose how and when the money is spent (either for current or future qualified healthcare expenses, or to save for retirement) – HSA funds rollover – it is NOT ‘Use it or Lose it” like an FSA – The HSA is portable
Who is eligible to open & receive contributions to an HSA (Health Savings Account)?
– Employee must be covered by a qualified HDHP – Employee may NOT be covered by any of the following:
– Employee may NOT be claimed as a dependent on someone else’s tax return *If you have a balance in your Healthcare FSA after 12/31/18, you will not be able to open/fund your HSA until 3/16/19 (after your grace period) at the earliest – FSA funds MUST be exhausted prior to opening an HSA
Capital will contribute to employees that enroll in the HDP1 or HDP2 plan’s HSA
– For the HDP1: Capital will contribute $500 for individual and $1,000 for family coverage levels into your HSA if enrolled in the HDP1 plan and open a PNC HSA; additionally there is a matching option for an additional $250 for individual or $500 for family coverage levels. – For the HDP2: Capital will contribute $350 for individual and $700 for family coverage levels into your HSA if enrolled in the HDP1 plan and open a PNC HSA. – You must open an HSA account with PNC to make pre-tax contributions and receive the HSA contribution from Capital. Capital contributions are spread over the course of the year, deposited monthly in to the HSA.
Remember the IRS mandated annual maximums are $3,500 for individual coverage or $7,000 for family coverage levels
– To determine how much you can contribute, subtract Capital’s contribution from the annual maximum – If you are 55 or older, you can contribute an additional $1,000 “catch-up” contribution every year
Your HSA can also be used on more than medical expenses
– For a complete list of eligible expenses, visit this IRS publication
John is a single employee of Capital University. He is generally healthy – taking advantage of his annual preventive visit. During the year he has to use urgent care for a sprained ankle. When needing an Rx he always chooses generic if possible. He does not contribute to a FSA/HSA.
Above example assumes employee only coverage & assumes employee uses HSA funds to pay for cost of care
PPO HDP1 HDP2
Monthly Contribution $191.18 $97.80 $40.95 Preventative ($120/visit) # of Visits: 1 $0 $0 $0 Urgent Care ($200/visit) # of Visits 1 $50 $200 $200 Generic Rx ($20/rx) # of RXs: 1 $10 $20 $20 Total Cost of Care $60 $220 $220 Total Annual Payroll Contributions $2,294 $1,174 $491 Capital HSA Contribution N/A $500 $350
May want to consider: HDP2 Reason: Out of Pocket/Paycheck spending is only $491 (vs. PPO: $2,354 or HDP1: $1,174), and a remaining balance in the HSA of $130.
Adam only needs individual medical coverage. He is generally healthy – taking advantage of his annual preventive visit. During the year he has a major accident. He does not contribute to a FSA/HSA.
Above example assumes employee only coverage & assumes employee uses HSA funds to pay for cost of care
PPO HDP1 HDP2
Monthly Contribution $191.18 $97.80 $40.95 Preventative ($120/visit) # of Visits: 1 $0 $0 $0 ER ($75,000/accident) # of Visits 1 $2,000 $4,000 $5,000 Total Cost of Care $2,000 $4,000 $5,000 Total Annual Payroll Contributions $2,294 $1,174 $491 Capital HSA Contribution N/A $500 $350
May want to consider: PPO Reason: Out of Pocket/Paycheck spending is only $4,294 (vs. HDP1: $4,674 or HDP2: $5,141).
Megan has 2 children
During the year one person has a surgery and everyone else only has preventative visits. Megan also sets aside money in FSA/HSA’s regardless of which medical plan she chooses.
Above example assumes family coverage & assumes employee uses HSA funds to pay for cost of care
PPO HDP1 HDP2
Monthly Contribution $442.56 $295.01 $172.89 Preventative ($120/visit) # of Visits: 3 $0 $0 $0 Hospitalization and Services ($25,000/visit) # of Visits: 1 $2,000 $4,000 $5,000 Total Cost of Care $2,000 $4,000 $5,000 Total Annual Payroll Contributions $5,311 $3,540 $2,075 Capital HSA Contribution N/A $1,500 $700
May want to consider : HDP1 Reason: Out of Pocket/Paycheck spending is only $6,040 (vs. PPO: $7,311 or HDP2: $6,375).
FSAs allow a pre-tax amount of money to be placed into a spending account for the year Capital offers both healthcare FSA’s and dependent care FSA’s – Reminder: Dependent care is for eligible children to age 13 or elder care services only 2019 maximum amount: – Healthcare FSA - $2,650 – Dependent Care FSA - $5,000 Funded with full annual contribution in January If you don’t use it, you lose it!
Note: In-network plan summary; refer to plan documents for full details
Delta Dental of Ohio
Annual Deductible $50 Employee Only (Excludes preventative care) $150 Family Annual Benefit Maximum $1,000 Per Person Your Coinsurance for Preventative Care 0% Basic Treatment 20% Major Treatment 50% Orthodontics (for children to age 19) Lifetime Maximum $1,000 Coinsurance 50%
Note: In-network plan summary; refer to plan documents for full details
NEW! EyeMed Vision
Frequency 12/12/12 (Exam/Lenses/Frames) Can have contact lenses or lenses every 12 months Exam Copay $10 Frames Copay/Allowance $0/$150 (20% off balance over $150) Lenses Starting at $25 (Standard plastic
Contact Lenses Standard Fit &Follow up $40 Medically Necessary Copay $0/Paid in full Standard Copay/Allowance $0/$150 Allowance (15% off balance over $150)
Premium Cost Share
Employee Employee Monthly Capital Monthly Biweekly Semi- Monthly
Employee Only
$3.56 $3.86 $7.72 $26.27
Employee & Spouse
$9.37 $10.16 $20.31 $42.43
Employee & Child(ren)
$12.11 $13.12 $26.23 $54.81
Family
$18.27 $19.80 $39.59 $82.71
Premium Cost Share
Employee Employee Monthly Capital Monthly Biweekly Semi- Monthly
Employee Only
$3.30 $3.58 $7.16 $0.00
Employee & Spouse
$6.28 $6.81 $13.61 $0.00
Employee & Child(ren)
$6.61 $7.16 $14.32 $0.00
Family
$9.72 $10.53 $21.06 $0.00
University contributions to the TIAA accounts of current employees will remain consistent for FY2019 at 9%.
2019 maximum amount is $19,000; for employees
New employees, joining Capital University on or after January 1, 2019, will have a 12-month waiting period before receiving University TIAA contributions
5% contribution for years 2-5 After 5 years they will receive the same University TIAA contribution as existing employees.
Basic Life/AD&D
(Minimum: $25k – Maximum: $250k)
Voluntary Life/AD&D
yourself, your spouse or your dependent child
employee, $30k for spouse & $10k for dependent children
(See benefit website for details)
Short Term Disability
$1,000
Long Term Disability
up to $8,000
Disability is exhausted
Note: Refer to plan documents for full details
Voluntary Long Term Care is available for you to purchase for yourself, your spouse or your parents (and other extended family). This is coverage for care received in your home or a facility when assistance is needed for daily living activities. See the benefits website for rates and details.
Note: Refer to plan documents for full details
Travel Assist Travel Assist through Mutual of Omaha (AXA Assistance) can assist with many unexpected travel emergencies in the U.S. and abroad. Employee Assistance Program The EAP provides employees and the members of their household assistance with the everyday challenges of work and
completely confidential.
Note: Refer benefits website for full details