PPOs, HDHPs & HSAs Center Grove Community School Corporation - - PowerPoint PPT Presentation

Center Grove Community School Corporation October 30, 2014

Health Insurance Meeting PPO’s, HDHP’s & HSA’s

Introductions

• Paul Gabriel, Center Grove CFO
• Glennda Watson, Center Grove Benefits Specialist
• Trevor Stevens, Consultant
• R. E. Sutton & Associates
• Diane Tichenell, Account Manager

Anthem Blue Cross and Blue Shield

• Ruste Pontenburger, HSA Sales Manager

The HSA Authority

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Annual Enrollment

• Annual Enrollment is an opportunity to

complete the following:

• Get information and enroll in the Delta Dental program
• Get information and enroll in the VSP Vision program
• Get information and enroll in the Anthem program.
• Change, drop or add dependents to your Health, Dental, or

Vision

• Enroll in or make changes to your Flexible Spending Account-

DECEMBER-AFA REPS WILL BE IN EACH BUILDING

• Enroll in the Group Term Life and/or Long Term Disability

programs – SUBJECT TO EVIDENCE OF INSURABILITY

• Review and update your beneficiary designations on group life

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Annual Enrollment (Cont.)

• If you do not make any enrollment

changes during Annual Enrollment:

–Participation in Medical, Dental and Vision will remain the same –You will not be enrolled in a Flexible Spending Account for 2015 –You must enroll each year to make pre-tax contributions for health and/or dependent care expenses

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How to Enroll

• Visit the Center Grove web site

(www.centergrove.k12.in.us/forms) and select “Insurance & Information.”

• Click on the “Annual Enrollment Change”

form.

• After completing the form, submit it via email

by clicking “Submit Form” or save the form and send it via email or interoffice mail to Glennda Watson (watsong@centergrove.k12.in.us).

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Remember

• All Annual Enrollment changes are effective

January 1, 2015.

• IRS regulations require that Annual Enrollment benefit elections

remain in place for the entire plan year unless you experience an IRS-defined change in status.

– A change in status, such as marriage, divorce, or the birth of a child, allows you to make a corresponding change to your elections within 30 days of the event.

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Deadline to complete enrollment changes:

NOVEMBER 30, 2014

All Annual Enrollment Changes are Effective

January 1, 2015

Let’s Define Some Terms

• PPO Health Plan – This is the traditional health

plan we have had for over 20 years. “PPO” stands for Preferred Provider Network

• High Deductible Health Plan (HDHP) – Our new

health plan with a $3,000-single and $6,000-family deductible

• Health Savings Account (HSA) – A bank account

you can use to pay health expenses

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Should you choose the PPO Plan

• r the HDHP Plan?

 Q1: What are you paying now?  Q2: What will your health care costs be in 2015?  Q3: What would your total costs be (premium and

• ut of pocket) under each plan?
• Every employee’s situation is different, so you will

have to decide for you and your family

• Toward the end of this meeting, we are going to run

through a few examples

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Center Grove Schools

January 1, 2015

Anthem’s Mission

Together, we are transforming health care with trusted and caring solutions.

Agenda  ID Cards  National Network – Blue Access  Deductible / Out of Pocket (OOP)  Plan Options Overview  Preventive Care  On-Line Services and Tools  Q&A

ID cards, EOBs and Certificates

• Goal is to have new ID cards in hand prior to January 1, 2015 for

new members and members making a plan change only..

• 2 ID cards per family – can order more if needed
• Tri-fold with ID cards to order Certificate Booklet. May also obtain
• n-line at www.Anthem.com
• EOBs are not sent to members with zero $ responsibility

National Provider Network

• Your coverage travels with you – in Indiana or outside of Indiana or outside
• f country
• YRP – signifies Indiana based member – each state has their own BCBS
• Blue Access is Indiana’s PPO network – up to 97 % of provider’s in state

participate in the Blue Access network

• How to find a doctor:

– Ask your doctor – On-line at www.Anthem.com – Call Member Services

Your 2015 Health Care Plan Options

• PPO Blue Access offerings:

– Standard PPO - – HDHP / HSA option

• High Deductible Health Plan - Blue Access for Health Savings

Account (PPO) combined with

• The tax advantages of a Health Savings Account (HSA)

Product Overview – Plan Options

• All plans medically speaking cover or don’t cover the

same things.

• Only other differences between plans are dollar amounts

– deductibles, out of pockets, co-insurances, co-pays and premiums

• If in doubt of procedure coverage, submit Pre-

Determination for guarantee of benefits. Contact Customer Service

Deductible / Out of Pocket (OOP)

• Deductible Rule of Thumb – Percentage benefits such

as office visits, in-patient/out-patient services apply to deductible first, then payable at percentage up to OOP.

• All Deductibles and copays apply to OOP
• Once OOP is met all covered in-network medical

services paid at 100%.

• HDHP/HSA Prescription coinsurance do apply medical

deductible and OOP. Once deductible is met, OOP is met, covered prescriptions pay at 100%.

Preventive Care

100% Coverage NO Dollar $ Maximum on Preventive Care Services

 Keep healthy people healthy  Identify problems early

Product Overview – Plan Options

Network Non-Network $500/$1000 $750/$1500

20% 40%

$1000/$2000 $2600/$5000 Unlimited Unlimited $30/$40 Deduct./Coins. No Copay/Coins Deduct./Coins. $200 $50 Deduct./Coins. Deduct./Coins.

Prescription Drugs separate Out of Pocket maximum - $4,000 single / $8,000 family

$15 $25 50% $50 $30 $50 Not Covered $100 Network Non-Network $3,000/$6,000 $6,000/$12,000

0% 40%

$3,000/$6,000 $12,000/$24,000 Unlimited Unlimited Deduct./Coins. Deduct./Coins. No Copay/Coins Deduct./Coins. Deduct./Coins. Deduct./Coins. Deduct./Coins. Deduct./Coins. Deduct./Coins. Deduct./Coins. 0% 50% $0 Not Covered

Center Grove Community School Corporation

Summary of Benefits

PPO

HDHP

Deductible (Single/Family) Coinsurance Out-of-Pocket Limit (Single/Family) Lifetime Maximum Physician Office Visits (PCP/SCP) Preventive Care Emergency Room Urgent Care Behavioral Health (MH SUD) Prescription Drugs - Pharmacy Generic Brand Non-formulary Mail Order Generic Brand Non-formulary

Deductibles Apply to covered services listed with a percentage (%) coinsurance.

Anthem 360º Health Management

MyHealth Advantage

Proactive identification provides targeted and individualized messaging to members and providers about potential opportunities to:

• Improve health
• Avoid critical ongoing safety

issues

• Improved compliance with

evidence based guidelines

• Rapid response to urgent issues
• Customized health information

from the Harvard Medical School

• Telephonic support from trained

nurses

Getting Started

Log on to www.anthem.com to access a wide array of tools and resources to help manage your health and benefits – Go to www.Anthem.com – Upper right go to Members Log in and click Register Now – Complete simple form with your ID card information – Receive user ID and password via e-mail within minutes.

Confidential access to tools, resources and information about the health benefits and services available to you.

Anthem.Com

SpecialOffers

Online discounted offers available to Anthem members only for health related products and services, such as:

– Jenny Craig – Fitness Clubs – Get Fit – Cosmetic Dentistry – TruVision – LensCrafters – Butt Out (Smoking Cessation Program) – Eat Right – Hearing – Complementary Medicine Shop online for discounted health related products and services

MyAnthem Discounts

Q &A

• Questions about your Anthem Health Plan: 1-800-295-4119
• Questions about your Health Savings Account: Your Financial Institution
• Questions about tax rules and qualified medical expenses: IRS website at

www.IRS.gov

THANK YOU!

Getting The Most From Your HSA For the employees of: Center Grove Community School Corporation

The HSA Concept

HSA-Qualified Health Plan (High Deductible Health Plan)

Pays the medical bills once the deductible has been met

HEALTH SAVINGS ACCOUNT

Tax advantaged checking account to pay current medical expenses or to save for future ones

Health Insurance

Major Medical Policy

Bank Account

You and Your Employer Fund

HSAs and Health Insurance

• HSAs are separate from your health insurance
• Expenses processed through your health insurance provider will

track towards your deductible and will be eligible to be paid from your HSA.

• Doctor and hospital visits
• Prescriptions
• Expenses that are not processed through your health insurance

provider do not track towards your deductible but are still eligible to be paid from your HSA.

• Dental
• Vision

• Individual account – you own and manage it
• Funds accumulate year-to-year – no “use it or lose it”

provision

• HSAs are portable – you keep your account and 100% of the

funds when you change jobs or retire

• Tax savings
• Contributions are pre-tax or tax deductible
• Earnings are non-taxable
• Qualified distributions are tax-free

Advantages of an HSA

Tax Savings Example

No HSA With HSA Individual Adjusted Gross Income $50,000 $50,000 Subtract HSA Contributions (from all sources)

• 0-

$2,000 = Taxable Income $50,000 $48,000 Average Tax Rate 25% $12,500 $12,000 = Tax Savings

• 0-

$500 Individual tax savings will vary depending on tax rate.

HSA Eligibility

• Must be enrolled in an HSA-qualified health plan
• May not be enrolled in any other non-HSA qualified health

plan

• Cannot be claimed as a dependent on another person’s taxes
• May not be enrolled in Medicare, Medicaid or Tricare
• Must not have used VA benefits in past

three months

• Other than preventive services

Spouse’s Medical Plan or FSA

• Spouse can be enrolled in any type of insurance plan
• Will not affect your eligibility to contribute
• If you are covered by your spouse’s traditional medical plan,

you cannot participate in an HSA

• If you are covered by a general medical Flexible Spending

Account (FSA), you cannot contribute to an HSA

• Limited purpose FSA (limited to vision, dental,
• r dependent care) is allowable

Qualified Medical Expenses

• In general, you can spend tax-free from your Health Savings

Account on all medical, prescription drug, dental and vision

• expenses. To be a qualified medical expense, the expense

has to be primarily for the prevention or alleviation of a physical or mental defect or illness.

• Please note
• Over-the-Counter (non-prescription) medications are not

eligible to be paid from your HSA unless you obtain a prescription from your physician

• 20% penalty for using your HSA funds for non-eligible

expenses until age 65

Non-Eligible Expenses

• Costs associated with non-medically necessary treatments
• Cosmetic surgery
• Improve appearance
• Teeth whitening
• Items meant to improve general health, but not due to illness,

injury, or disease

• Health club dues
• Non-prescription vitamins
• Nutritional supplements

• Insurance premiums are normally not an allowed expense

except for:

• Cobra premiums
• Qualified long-term care insurance premiums
• Premiums for medical insurance while receiving federal or state

unemployment benefits

• Medicare Premiums and other health care premiums

after age 65 (with the exception of Medicare supplemental policies such as Medigap)

Non-Eligible Expenses (cont.)

HSA Distributions

• You can use your HSA funds for the following people:
• Yourself and spouse
• All dependents claimed on your tax returns
• Even if not covered under your HDHP and/or have other coverage

For exceptions or more information, please refer to IRS Publication 502 or consult a tax advisor

HSA Contributions

• IRS annual contribution limits (from all sources)
• If one or both spouses are age 55 or older, the additional

$1,000 catch-up contribution may be made on behalf of each eligible spouse.

• Must be placed in separate accounts
• A testing period may apply to those making the maximum

contribution if entering the plan later than January 1st.

• Mid year changes to your insurance coverage may result in a

prorated maximum.

Insurance Coverage Level 2014 2015 Individual $3,300 $3,350 Family $6,550 $6,650

Managing Your HSA Contributions

• How do I contribute to my HSA at Old National Bank?
• Authorize funds to be deducted from your paycheck
• Make lump sum contributions by check – can be mailed or dropped off

in person at any branch office

• Initiate a one-time rollover from an IRA
• Transfer funds from another HSA
• The contribution deadline for a calendar year is generally April 15th of

the following year

Keep in mind that HSA contributions made through payroll are typically pre-tax, but contributions made directly by you (outside of payroll) are tax deductible on your personal tax returns.

Managing Your HSA Contributions

• The IRS imposes a 6% penalty plus tax on excess

contributions.

• YOU (account holder) are responsible to track your contributions to

ensure that you do not over-contribute to your HSA.

• To remove an excess amount and avoid penalty, please contact

The HSA Authority at Old National Bank for assistance.

Record Keeping

• You are responsible for keeping documentation to verify all

withdrawn funds were eligible expenses.

• If audited by IRS, you may be asked to provide records
• Details can be found in IRS Publications or consult a

professional tax advisor

• www.irs.gov/publications/p502
• www.irs.gov/publications/p969

HSAs at Tax Time

• What will I receive from The HSA Authority?
• In January - Form 1099 SA – Distribution (withdrawal) total and a

Fair Market Value Statement – Contribution (deposit) total

• In May - Form 5498 SA – complete Contribution (deposit) total to

keep with your tax records (will include deposits made Jan- Apr for prior year)

• Are there any forms I need to file with my taxes?
• Yes. The IRS requires you to complete and submit Form 8889

with your tax return using the figures from the forms listed above.

Account Features

• No monthly maintenance or setup fees
• No fee for Debit Card, Check or Bill Pay transactions
• No minimum deposit requirements
• Allows account opening prior to first funding date
• Free Visa debit card
• Checks available – 30 for $20.00
• Free monthly online or paper statements
• Nationwide ATM access – free at ONB ATMs
• 24/7 telephone and online banking
• FDIC insured deposit, up to FDIC limit

HSA Investments

• What investment options are available for my HSA?
• Certificates of Deposit – FDIC Insured
• $500.00 minimum to open
• Call our Client Care Center for current rates and terms
• Investments – Not FDIC Insured
• Mutual Fund Investment Options Available
• $1,000.00 balance in HSA Checking required to open
• $36.00 Annual Fee – no Per Trade fees
• Complete Investment Enrollment Form or call Client Care to open

HSA Support & Assistance

• What if I have questions regarding my HSA?
• Client Care Center: 888.472.8697
• Representatives are available Monday-Friday 8am - 9pm and

Saturday 9am – 4pm ET

• Telephone Banking: 800.731.2265
• Website: www.theHSAauthority.com
• Email: info@theHSAauthority.com
• What if I have a change of address or name?
• For updates to your account such as change of address or

name, adding an authorized signer, or updating a beneficiary, please visit our website at www.theHSAauthority.com and select the Forms tab from the top of the page

Open Your HSA

• Open your HSA online at theHSAauthority.com after making

your insurance elections (this only needs to be done the first year)

Open Your HSA

• Select the first option, “If you have been instructed…” and

enter the 6 digit code provided by your employer.

Center Grove Community School Corporation Employer Code:

143908

Account Opening Tips

You will need:

• Unexpired government issued ID for yourself and any authorized signer you

elect

• Social Security Number and date of birth for your beneficiary(s)
• Social Security Number and date of birth for any authorized signer you elect

You will receive:

• Confirmation number at the end of application
• Welcome letter with account number and further information approximately
• ne week later in the mail
• Debit Cards will arrive 7-10 business days after Welcome Letter
• If Checks are requested, the order is held and processed when the account is

funded

Questions?

Thank You!

Employee Expenses PPO Plan HDHP Plan HSA Account for 2015 Premium deducted from paycheck $2,568 $1,800 Deposited by CGCSC = $1,428 FSA/HSA deducted from paycheck $1,000 $1,572 Deposited by Employee = $1,572 Total deducted from paycheck $3,568 $3,372 Out-of-pocket costs (Maximum minus FSA/HSA amount) $-0- $-0- Total in account for 2014 = $3,000 Drug co-pays $100 $-0- Balance at the end

• f 2014 = $-0-

Total costs for the year 2014 $3,668 $3,372

• Single employee, with ongoing health issues
• On the single plan with at least $1,000 out-of-pocket costs
• How do the PPO and HDHP compare?

Example #1 - Single

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Example #1 Summary

• If 2015 is exactly as predicted, the HDHP plan will

save you $296.

• If 2015 is better than predicted and your health costs

are less, the HDHP plan will still save you $296 and you will have some money left in your HSA at the end

• f the year.
• If 2015 is worse than predicted and your health costs

are very high, the HDHP plan will still save you $296 and your HSA account will be zero at the end of the year

• The HDHP plan is clearly better than the PPO plan in

this example

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Employee Expenses PPO Plan HDHP Plan HSA Account for 2015 Premium deducted from paycheck $6,264 (family) $4,344 (Empl.+1) Deposited by CGCSC = $2,827 FSA/HSA deducted from paycheck $-0- $-0- Deposited by Employee = $-0- Total deducted from paycheck $6,264 $4,344 Out-of-pocket costs (Maximum minus FSA/HSA amount) $100 $-0- Total in account for 2014 = $2,827 Drug co-pays $100 $-0- Balance at end of 2014 = $2,527 Total costs for the year 2014 $6,464 $4,344

Example #2 – Employee+1

• Married employee (no children), with few health issues
• On the family plan and uses the clinic to avoid most expenses
• How do the PPO and the HDHP compare?

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Example #2 Summary

• If 2015 is exactly as predicted, the HDHP plan will

save you $2,120 and you will have $2,527 in your HSA at the end of the year.

• If 2014 is better than predicted, the HDHP plan

will still save you $2,120 and you will have more than $2,527 in your HSA at the end of the year.

• If 2014 is worse than predicted and your health

costs are very high (>$6,000), you will have out-of- pocket expenses, and the PPO plan would have saved you $1,353.

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Employee Expenses PPO Plan HDHP Plan HSA Account for 2015

Premium deducted from paycheck $6,264 $4,968 Deposited by CGCSC = $2,289 FSA/HSA deducted from paycheck $2,400 $-0- Deposited by Employee = $-0- Total deducted from paycheck $8,464 $4,968 Out-of-pocket costs (Maximum minus FSA/HSA amount) $-0- $3,711 Total in account for 2014 = $2,289 Drug co-pays $500 $-0- Balance at the end

• f 2014 = $-0-

Total costs for the year 2014 $8,964 $8,679

Example #3 - Family

• Married employee (with kids)
• On the family plan with moderate annual health expenses
• Has an auto accident with major injury in 2015
• How does the PPO and HDHP compare?

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Example #3 Summary

• This is a worst case example, with very high health

care costs in one year. The HDHP plan will still save you $285, but will have nothing in your HSA at the end of the year.

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Traditional PPO Plan High Deductible HDHP Plan CGCSC HSA Contribution

SINGLE: Payroll deduction $2,568 $1,800 $1,428 SINGLE: Deductible (in network & Out network) $500/$750 $3,000/$6,000 SINGLE: Out-of-pocket max. (in network & out network) $1,000/$2,600 $3,000/$6,000 EMPLOYEE+1: Payroll deduction N/A $4,344 $2,827 EMPLOYEE+1: Deductible (in network & Out network) N/A $6,000/$12,000 EMPLOYEE+1: Out-of-pocket max. (in network & out network) N/A $6,000/$12,000 FAMILY: Payroll deduction $6,264 $4,968 $2,289 FAMILY: Deductible (in network & Out network) $1,000/$1,500 $6,000/$12,000 FAMILY: Out-of-pocket max. (in network & out network) $2,000/$5,000 $6,000/$12,000

Rates That You Need to Know

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Thank You !

• For more information about our health plans, go to:

www.centergrove.k12.in.us/annualenrollment

• For the enrollment form and instructions, go to:

www.centergrove.k12.in.us/forms

• For assistance, contact:

Glennda Watson

• 317-881-9326 x 1614
• watsong@centergrove.k12.in.us

Available Resources