Pike County School Corporation 2019 Medical Benefits Open - - PowerPoint PPT Presentation
Pike County School Corporation 2019 Medical Benefits Open Enrollment 2 2019 MEDICAL OPEN ENROLLMENT Welcome to Open Enrollment We understand that balance must be individualized. What is right for one person may not be appropriate for
We understand that balance must be individualized. What is right for one person may not be appropriate for another. It is our goal to offer choices allowing you to tailor your benefits plan specifically to what is best for you and your family members.
Full time employees who work 30 hours per week are eligible for
coverage, when the employee elects coverage. 2
When to Enroll
Medical benefits chosen are in effect from January 1, 2019 – December 31,
5th – Friday, November 16th. Election forms must be returned to Chelsea Yon by 5pm. on Friday, November 16th. If election form is not received, current medical and vision coverage elections will carry over from 2018. Once you have made your elections, you will not be able to change them unless you have a qualified change in status.
child or other qualified dependent, commencement or termination of adoption proceedings, or change in spouse’s benefits or employment status. 3
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What Isn’t Changing?
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HDHP Plan Copay Plan Services In Network In Network
Deductible
$3,000 $6,000 $750 $2,250 Co-Insurance (Plan / Employee) 100% / 0% 80% / 20% Out of Pocket Max
$4,000 $8,000 $3,000 $6,000 Physician Visit Deductible $30 Copay Specialist Visit Deductible $50 Copay Preventive Care Paid at 100% Paid at 100% Emergency Room Deductible $250 Copay then 20% Urgent Care Deductible $75 Copay Prescription Drugs
Retail $10 Copay $30 Copay $60 Copay 20% w/ $200 max Mail Order $10 Copay $75 Copay $180 Copay 25% up to $250 Retail $10 Copay $30 Copay $60 Copay 25% up to $150 Mail Order $10 Copay $75 Copay $180 Copay 25% up to $150
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Can ONLY be paired with a CDHP (Core) Owned by YOU! Can be funded by the employee AND the employer You can contribute up to $3,450 single or $6,900 for a family PRE-TAX – You may change the amount during the year Funds automatically rollover to the next plan year…it’s your money! All healthcare, vision and dental expenses are reimbursable. Qualified expenses determined by IRS. Automatic Enrollment annually after initial enrollment. Can use as a secondary source of retirement savings. (IF you use for something other than medical expenses, you get charged taxes + a 20% penalty)
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IRS 213(d) services qualify for tax-exempt distributions from an HSA. This includes items that are qualified under a Flexible Spending Account.
* Items are eligible for reimbursement even if they are not eligible to be applied to the Qualified Health Plan Deductible. ** With a prescription only
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Medical Semi-Monthly Rates for 2019
Plan Type Employee Only Employee & Family Core Plan (HDHP) $18.40 $41.81 Buy-Up Plan (PPO) $87.45 $230.68 Per Pay Difference $69.05 $188.87 Annual Difference $1,657.20 $4,532.88 Potential HSA Funding $1,657.20 $4,532.88
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11 24/7 NurseLine
Offers members access to trained registered nurses any time of the day or night. Toll-free at 1- 888-279-5449 to get information & support when you need it
MyHealth@Anthem
Provides access to tools such as the Health Risk Assessment & Personal Health Record to help members take charge of their own health
ConditionCare
Addresses chronic conditions such as asthma, COPD, diabetes, and so on with coaching & self- management tools
ComplexCare
Proactively engages members with multiple health issues to maximize the member’s health & reduce hospitalizations & costs associated with illness
Future Moms
Provides individualized support to expectant moms to achieve healthier pregnancies & deliveries
12 See a doctor from the comfort of your home:
days a year
mobile device with Internet access(at home, in the office or on the go)
doctors and licensed behavioral health professionals
pharmacies
American Express and Discover
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Lab work Mammograms Colonoscopies Bone Density Scans Hip Replacement MRI CT Scan Ultrasound Upper GI exam … and more
MRI = $150 Knee Surgery = $250 CT Scan = $150
Earn money for procedures that you were already planning. SmartShopper pays incentives for completing procedures , such as:
SAMPLE INCENTIVES
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How about less than 5 minutes?
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Announcing a New Health Benefit Designed To Help You Save on Prescriptions….A Concierge Prescription Drug Advocacy Service called RX Help Centers.
Current Out of Pocket Cost With RxHC Assistance Savings Jack $1,607 $884 45% Jill $2,424 $1,690 30% Joe $4,500 $0 Can’t beat FREE
Example: rxhelpcenters.com / (866)478-9593
Shop online for medication pricing options at Goodrx.com
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17 Services In-Network Benefits* Frequency
Vision Exam $10 Copay Every 12 months Lenses (Single, Bifocal, Trifocal, Lenticular) $25 Copay Every 12 months Frames $25 Copay Every 24 months Elective Contact Lenses Up to $130 benefit in lieu of glasses Every 12 months
*Copay applies to a complete pair of glasses or to frames, whichever is selected
Your Cost Per Pay Employee Employee/Spouse Employee/Child(ren) Family $4.22 $9.10 $7.36 $12.24
* - VSP Network
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Open enrollment for medical benefits for 2019 is Monday, November 5th – Friday, November 16th. Election forms must be returned to Chelsea Yon by 5pm. on Friday, November 16th.
Beth Hancock Phone: (812) 461-9023 Email: tamika.wilson@onirisk.com Ben Schmitt Phone: (812) 464-1444 Email: ben.schmitt@onirisk.com Calvin Conerly Phone: (317) 706-9512 Email: calvin.conerly@onirisk.com
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