ROCKFORD PUBLIC SCHOOLS 2019 OPEN ENROLLMENT 3 Plans PPO1000 - - PowerPoint PPT Presentation

ROCKFORD PUBLIC SCHOOLS 2019 OPEN ENROLLMENT

3 Plans

 PPO1000

 $1000 Individual Deductible

 High Deductible Health Plan (HDHP)

 $2500 Individual Deductible  Health Savings Account Component

(Admin Only)

 PPO3000

 $3000 Individual Deductible

3 Plan Designs

PPO 1000 PPO 3000 HDHP

In Out In Out In Out Office Visit $15 50% $35 50% Ded/Coins Ded/Coins Specialist $25 50% $50 50% Ded/Coins Ded/Coins Deductible Single $1,000 $1,000 $3,000 $6,000 $2,500 $5,000 Family $2,000 $3,000 $9,000 $18,000 $5,000 $10,000 Out of Pocket Max Single $4,000 $8000 $4,500 $14,000 $3,500 $7,000 Family $8,000 $16,000 $11,250 $30,000 $7,000 $14,000 Coinsurance 80% 50% 70% 50% 80% 50% The Out of Pocket Maximum Includes the Deductible

• In Network - 100% covered with no cost sharing (not subject to

deductible)

• Out of network – 50% covered (not subject to deductible)
• Preventative services include:
• Adults:
• Cholesterol screening, immunizations, mammography,

pap smear, colonoscopy, routine annual physical

• Children:
• Immunizations, routine annual physical

Preventive Care is Subject to Federal Guidelines as Laid Out by HHS Including Age and Frequency Limits.

Preventive Care – All Plans

Prescription Coverage - Express-Scripts

*Prescriptions filled at Walgreens and CVS will cost an additional $10.

• Mail order for maintenance drugs is mandatory after 3 fills at the local

pharmacy.

• Can access information on-line to:

www.express-scripts.com

• Check whether medication is covered.
• Compare mail order vs pharmacy cost.
• Check for generic equivalent or formulary alternatives.

Tier PPO1000* PPO3000* HDHP Tier 1 $15 $10 Ded./Coins. Tier 2 $40 20% (Min. $40) Ded./Coins. Tier 3 $60 30%(Min. $60) Ded./Coins. Mail Order 2x’s for 90 days 2x’s for 90 days Ded./Coins.

Prescription Co-pays

• Can use most independent Pharmacies
• Prescriptions purchased at CVS or Walgreens

will cost an additional $10 each.

• Possible less expensive alternatives:
• Wal-Mart
• Meijer
• Sam’s Club
• Schnucks

Mail order for maintenance drugs is mandatory. 90-day supply through mail order vs. 30-day supply at local pharmacy.

BlueCross Network Provider Options

 Physicians

 Per Online Directory  www.BCBSIL.com

 In-Network Hospitals

 OSF St. Anthony  Swedish American  Mercy/Javon Bea Hospitals (Rockton

Ave, Riverside Blvd)

1 Dental Plan

 Annual Deductible:

 $50 Individual, $150 Family  N/A to preventive /diagnostic

 Services paid at:

 Preventive

100%

 Basic

80%

 Major

50%

 Orthodontia

50%

 Annual Benefit Limit:

 $1,500

 Orthodontia Lifetime Limit (children up to age 19):

 $1,500

 Out of network is paid based on usual and customary.

Deductible and Annual Benefit Limit will reset as of July 1, 2019

Health Savings Accounts (H.S.A)

 Those who elect the HDHP are eligible to open a Health

Savings Account (H.S.A.).

 You can contribute pre-tax dollars:  $3,500 Individual annually per household  $7,000 family annually per household  District will make a contribution to YOUR account.  “Use it and keep it” - $$$ belongs to you.  Debit Card to pay co-pays, deductibles and other out-of-

pocket healthcare expenses.

 Additional information on the H.S.A is available on Employee

Online.

RPS Annual HSA Funding

• Those enrolling in the HDHP need to complete an application for an HSA

account with Associated Bank (no fees).

• RPS will transfer the amounts below into your Associated HSA bank

account based on medical enrollment status.

• Funds are available to you on day one of the plan year.
• Pretax payroll deductions are allowed – contact HR for information.
• Interest earned grows tax free.
• Mutual fund options are available at a nominal fee.

Single Employee Plus Spouse Employee Plus Child(ren) Family Standard $400 $700 $600 $800 Wellness $250 $500 $550 $700 Total (W) $650 $1200 $1150 $1500

Amounts in Purple are additional dollars provided to those who participate in the wellness program

RBMA, HI and EOPA Funding is Slightly Higher

Flexible Spending Account

 You must enroll in Flexible Spending each year through

Employee Online to participate.

 Medical/Dental Flexible Spending Account:

 $2,700 annual maximum contribution per family.

 Dependent/Day Care Flexible Spending Account:

 $5,000 annual maximum contribution per family.

 Limited Flexible Spending Account: for dental/vision

expenses only:

 Must be enrolled in the HDHP with a HSA.  $2,700 annual maximum contribution per family.

Medical Plan - ER Visits PPO1000/PPO3000

This is the amount you pay for emergency room visits:

• In-Network
• $200 co-pay
• Co-pay is waived if admitted.
• Deductible and co-insurance apply to

additional services.

A True Emergency Will Always Be considered In-

• Network. Also, Immediate Care is covered at

Office Visit copay

TELADOC

How it works:

 Contact Teladoc



Access via phone, video or mobile app.

 Talk with a physician



Physician will review the medical history.

 Resolve the issue



Physician will diagnose and prescribe medication, if necessary.

 U.S. Board Certified

Physicians in internal medicine, family practice, emergency medicine or pediatrics.

 U.S. residents and state

licensed.

24/7/365 ACCESS TO PHYSICIANS TELADOC PHYSICIANS

Conditions Treated

$15/$45 Co-pay due at time of service.

Wellness

• All new hires (hired after July 1)

automatically receive wellness premiums. HDHP participants receive wellness contribution to a Health Savings Account.

• Must earn 100 points to keep the lower

wellness premiums.

• Points are earned from June 1 – March

31.

• Points must be entered on a website by

the employee.

Wellness – How To Earn Points

• Biometric Screening (free) – 50 points
• Health Assessment – 10 points
• Participate in Challenges – 10 points each (4 challenges

scheduled)

• Participate in a Local Event – 5 points each/30 point max
• Complete preventive exams – 5 points each/20 point max
• Log exercise – 30 point max
• And more…

 April 1st, 2019 through April 23rd, 2019 (No later than

5:00pm)

 Changes will take effect July 1, 2019

• Allowed enrollment changes

 Choose Between Available Health Plans  Make/Change Annual FSA Elections  Elect/waive medical/dental coverage  Add/remove dependents from medical/dental coverage

Online Open Enrollment

 Other than during Open Enrollment, you must have a

qualifying event to make changes

Marriage, divorce, legal separation, annulment, death of spouse, birth, adoption, permanent legal guardianship, spouse open enrollment.

 Information regarding Online Enrollment will be distributed

via District email. For IT/email support, contact the Help Desk, M-F 8AM to 5PM at (815) 966-3112, Select Option 1

Online Open Enrollment

 We will use Employee Online for Open Enrollment.  You will be able to make the following Changes:  Add or drop dependent(s)  Add or drop your Dental or Health plan(s)  Change health plans  Elect Flexible Spending Plan (Annual enrollment)  Please note that Employee Online is used to confirm or

enroll the changes to the items listed above. All changes you make in Employee Online will be saved and applied on the 7/1/2019 effective date.

Open Enrollment Process

Open Enrollment “How To”

Open Enrollment “How To”

Points to Remember

 Open Enrollment needs to be completed

through Employee Online by April 23rd, 2019 at 5:00pm.

 Now is the only time to make changes for

fiscal year July 1, 2019 through June 30, 2020 without a qualifying event.

 You have 30 days after a qualifying event

to make allowed changes to your benefits.

 Spousal Coverage Rule.  All medical and dental changes will be

effective July 1, 2019.

There is only one Open Enrollment period for Medical and Dental, this will be your only

• pportunity to make

benefit elections for July 1, 2019 through June 30, 2020!

Questions? Thank you for your time!