SOLANCO SCHOOL DISTRICT EMPLOYEE HEALTHCARE PLAN ELECTION - FALL - - PowerPoint PPT Presentation

solanco school district employee healthcare plan election
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SOLANCO SCHOOL DISTRICT EMPLOYEE HEALTHCARE PLAN ELECTION - FALL - - PowerPoint PPT Presentation

SOLANCO SCHOOL DISTRICT EMPLOYEE HEALTHCARE PLAN ELECTION - FALL 2018 Plan Year = Calendar Year (January 1 - December 31) Plan Administrator - CoreSource Registration and Renewal Electronic via E - Elect Enrollment


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SLIDE 1

SOLANCO SCHOOL DISTRICT EMPLOYEE HEALTHCARE PLAN ELECTION - FALL 2018

  • Plan Year = Calendar Year (January 1 - December 31)
  • Plan Administrator - CoreSource
  • Registration and Renewal – Electronic via ‘E-Elect’
  • Enrollment period October 31 through November 19,

2018

  • ALL EMPLOYEES eligible for healthcare benefits must

complete enrollment process – including employees denying coverage

  • Healthcare Eligibility
  • Full-Time Employment (average 30 hours or more per week)
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SLIDE 2

PLAN ELECTIONS

  • Preferred Provider (PPO)
  • Deductibles
  • Preferred Providers - $500/Individual or $1,500/Family
  • Non-preferred Providers - $1,000/Individual or

$3,000/Family

  • Qualified High Deductible Healthcare Plan (HDHP)
  • Deductibles
  • Preferred Providers - $2,000/Individual or

$4,000/Family

  • Non-preferred Providers - $4,000/Individual or

$8,000/Family

  • Long-Term Substitutes not eligible for HDHP
  • Hires after April 1 not eligible for HDHP until

following plan year

  • Identical Medical Coverage
  • Different Deductibles/Co-Pays
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SLIDE 3

PPO PLAN

  • Employee responsible for all medical and RX

costs until deductible satisfied

  • Each family member must satisfy individual

deductible until overall family deductible satisfied

  • Employee/member responsible for co-pays
  • Employee may contribute to Flexible

Spending Account (FSA)

  • Exception: Spouse participates in HDHP &

contributes to HSA

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SLIDE 4

PPO Plan Deductibles and Co-pays

4

No Changes from 2018

2015 2016 2017 2018 2019 Deductibles 200/600 300/900 400/1000 500/1500 500/1500 Co-Pays: Physician $ 35.00 $ 35.00 $ 35.00 $ 35.00 $ 35.00 Specialist $ 45.00 $ 45.00 $ 45.00 $ 45.00 $ 45.00 ER $ 50.00 $ 75.00 $ 75.00 $ 100.00 $ 100.00 Chiropractic $ 25.00 $ 25.00 $ 25.00 $ 30.00 $ 30.00 Urgent Care $ 35.00 $ 35.00 $ 35.00 $ 40.00 $ 40.00 RX: Generic $ 10.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 Brand $ 30.00 $ 30.00 $ 30.00 $ 30.00 $ 30.00 Non-Formulary 50% to $75 50% to $75 50% to $75 50% to $75 50% to $75 Specialty N/A $ 75.00 $ 75.00 $ 100.00 $ 100.00

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SLIDE 5

HDHP

  • Employee responsible for all costs until

deductible satisfied

  • Overall plan deductible must be satisfied
  • Total $ deductible regardless of individual
  • Office visit co-pays waived until deductible

satisfied

  • Collected by many medical offices - applied

against deductible

  • Health Savings Account (HSA)
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SLIDE 6

HSA

  • School District Contributions
  • HSA contributions permitted to maximum IRS

limit (employer + employee)

  • 2019: Individuals - $3,500, Family - $7,000,

Age 55+ Catch-up additional $1,000

  • Contributions income tax exempt (Federal,

State, Local) SLC – 35% or more tax savings

  • Employee owned bank account
  • Pay current or future qualified medical

expenses

  • Refer to IRS Publication 502
  • HSA distribution may not apply against

deductible

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SLIDE 7

HSA Contributions - Front Load Employee Account

33 ***"Cohort" Contributions to H S A for Active Employees only Employee only Tier- Solanco Contributes Employee Premium

Contributes* Total Paid To H S A 2018 Max** 2019 Max** District Yr. 1 1,600 500 2,100 2,000 1,750 3,450 3,500 District Yr. 2 1,500 500 District Yr. 3 1,250 500 Deductible is : $ 2,000.00 Family Tier_ Solanco Contributes Employee Premium Contributes* Total Paid To H S A 2018 Max** 2019 Max** District Yr. 1 3,200 1,000 4,200 4,000 3,500 6,900 7,000 District Yr. 2 3,000 1,000 District Yr. 3 2,500 1,000 Deductible is : $ 4,000.00 * Employee = Employee share is the required amount, it is flowing from the Employees required Premium Share each employee is paying as per the CBA. These funds are collected by the district (as district funds) and returned to the Employee H S A account. **Maximum Excludes additional $1,000 an Employee can contribute in the year turning age 55 or if age 55 or older. *** Cohort means the "year" you elect in to the HDHCP. The yearly amounts require an employee to be 'in' the "Q" plan for the entire year. (IRS annual amounts are pro-rated if not completing an entire year) For year one, payments are paid in January to get the employee started. Years thereafter are paid in January and September at 65/35% ratio, and the employee must be actively employed to receive the second payment.

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SLIDE 8

HSA (Continued)

  • HEALTHEQUITY Administers HSA
  • VISA health account debit card
  • Investment income tax exempt
  • Investment options
  • Employee controlled or advisor managed
  • 20% Penalty on Non-Medical disbursements
  • Penalty waived after age 65 – Disbursement taxed as
  • rdinary income
  • IRS Form1099-SA issued to employee
  • Employee complete IRS form 8889
  • HSA governed by IRS regulations - Obey Rules
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SLIDE 9

HSA How To:

Doctors Visits

  • No co-pays billed until deductible

satisfied

  • CoreSource adjusts price

based on discounts

  • Pay doctor from HSA funds, if

funds are available. Pay out of pocket if funds aren’t available and reimburse yourself later or not.

  • NOTE: Who Pays or where funds

come from ---Physician or Health care provider DOES NOT MATTER....You choose HOW/what account to pay from.

*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.

Go to the doctor Doctor sends insurance carrier the bill Claim integrated into member portal

3 2 1

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SLIDE 10

Member HSAExperience

Medical Claims

Member goes to Doctor, shows CoreSource card Doctor sends visit details andcoding to CoreSource/ESI for claims adjudication CoreSource sends claims to HealthEquityfor record keeping andmember portal population When the member has claim activity, an EOB from CoreSource is sent for each

  • claim. Claim

information and monthly statements on HSA funds and account information is available on HealthEquity portal. If deductible has not been met, provider will bill member for their plan negotiated portion. If deductible has been met, plan will pay provider for

  • service. If

member owes coinsurance, provider will bill member for their portion.

daily daily

Member pays

  • utstanding

provider bill using funds

  • n HSA card
  • r personal

funds through member portal

daily

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SLIDE 11

HSA How T

  • Pharmacy Prescriptions

11

Show your CoreSource Express Scripts Card (ESI) card Pay with your HSA card Or Cash or other? Insurance carrier applies amount to your deductible— no paperwork needed

*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.

Pharmacy applies discount Pharmacy sends claim to insurance carrier

3 2 1

Go to pharmacy

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SLIDE 12

HSA Member Experience

Pharmacy Claims

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Member goes to Pharmacy and shows CoreSource/ESIcard Pharmacyand HSA card send payment information to ESI HealthEquity for record keeping and account tracking. When the member has claim activity, they will receive an EOB from ESI for each claim. Claim information and monthly statements on HSA funds and account information is available

  • n each member’s

HealthEquityportal. Pharmacy verifies eligibility. If out of pocket max is not met, member can pay using HSA card or out of pocket.

immediate daily daily

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SLIDE 13

PREVENTIVE CARE

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Both PPO and HDHP cover In-Network Preventive Care, Screenings, Immunizations at 100% - (No Co-Pays, Deductible Not Applicable)

  • Periodic health evaluations (e.g., annual physicals)
  • Screening services (e.g., mammogram, pap test,

colonoscopy)

  • Routine pre-natal and well-child care
  • Child and adult immunizations
  • Tobacco cessation programs
  • Obesity weight loss programs
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SLIDE 14

PENDING E-ELECT COMMUNICATION

  • Be alert for email issued from

SolancoBenefitElections@coresource.com

  • Worksheet attachment
  • Encrypted worksheet password is:

‘employee’s home address zip code’

  • Worksheet contains link to www.eelect.com
  • Follow worksheet instructions to complete

enrollment

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SLIDE 15

Worksheet Attachment

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SLIDE 16

HEALTHCARE PLAN PREMIUMS

24 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $9,614.28 $15,382.80 $22,112.76 EMPLOYEE SHARE 8.0% 9.0% 10.0% MONTHLY PREMIUM $801.19 $1,281.90 $1,842.73 PER PAY DEDUCTION $32.05 $57.69 $92.14 EMPLOYEE SHARE WELLNESS PROGRAM REDUCTION – 2% 6.0% 7.0% 8.0% WELLNESS PER PAY DEDUCTION $24.04 $44.87 $73.71

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SLIDE 17

WELLNESS PROGRAM REDUCTION

24 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

WELLNESS PER PAY PREMIUM REDUCTION $8.01 $12.82 $18.43 ANNUAL WELLNESS PREMIUM REDUCTION $192.24 $307.68 $442.32

EMPLOYEE/SPOUSE MUST COMPLETE BIOMETRIC SCREENINGS AND FLU SHOT DURING 2018 (OR SUBMIT APPROPRIATE DOCUMENTATION FROM PHYSICIAN) TO RECEIVE 2019 HEALTHCARE PREMIUM REDUCTION

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SLIDE 18

HEALTHCARE PLAN PREMIUMS

19 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $9,614.28 $15,382.80 $22,112.76 EMPLOYEE SHARE 8.0% 9.0% 10.0% MONTHLY PREMIUM $801.19 $1,281.90 $1,842.73 PER PAY DEDUCTION $40.48 $72.87 $116.38 EMPLOYEE SHARE WELLNESS PROGRAM REDUCTION – 2% 6.0% 7.0% 8.0% WELLNESS PER PAY DEDUCTION $30.36 $56.67 $93.11

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SLIDE 19

WELLNESS PROGRAM REDUCTION

19 - PAY EMPLOYEES EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

WELLNESS PROGRAM PER PAY REDUCTION $10.12 $16.20 $23.27 ANNUAL WELLNESS PROGRAM REDUCTION $192.24 $307.68 $442.32

EMPLOYEE MUST COMPLETE BIOMETRIC SCREENINGS AND FLU SHOT DURING 2018 (OR SUBMIT APPROPRIATE DOCUMENTATION FROM PHYSICIAN) TO RECEIVE 2019 HEALTHCARE PREMIUM REDUCTION

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SLIDE 20
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SLIDE 21

HEALTHCARE PLAN PREMIUMS -

RETIREES

RETIREES – PPO PLAN EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $9,614.28 $15,382.80 $22,112.76 MONTHLY PREMIUM $801.19 $1,281.90 $1,842.73

RETIREES – HDHP EMPLOYEE ONLY EMPLOYEE + 1 FAMILY

ANNUAL PREMIUM $7,306.92 $11,91.12 $16,806.00 MONTHLY PREMIUM $608.91 $974.26 $1,400.50

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SLIDE 22

SPOUSAL SURCHARGE

  • Fee assessed for dependent spouse covered on

school district’s healthcare plan when spouse eligible for his/her employer’s healthcare plan.

  • Employee Certification for Spousal Rule Surcharge

form must be completed and returned.

  • Certification form downloaded from E-Elect system
  • 2019 annual Spousal Surcharge is $1,845.94
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SLIDE 23

EMPLOYEE HEALTHCARE/RX PLAN ID ID CARD

  • CORESOURCE CARD
  • ONE CARD - MEDICAL AND RX PLANS
  • EXISTING CARD VALID FOR 2019
  • EMPLOYEE – 1 CARD, FAMILY - 2 CARDS
  • EXPRESS SCRIPTS ADMINISTERS RX PLAN
  • CARD CONTAINS
  • CO-PAYS
  • PRE-CERTIFICATION REQUIREMENTS
  • CUSTOMER SERVICE PHONE #s
  • BENEFIT QUESTIONS/CONCERNS/ISSUES
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SLIDE 24

PRICE SHOP YOUR PRESCRIPTIONS TO REDUCE YOUR HEALTHCARE COSTS - GOODRX ANOTHER COST COMPARISON WEBSITE

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SLIDE 25

CoreSource Information

25

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SLIDE 26
  • 2+ million members
  • $3 billion benefits paid in 2016
  • Largest independent administrator of self-funded health plans
  • 11 regional offices employing approximately 1,000 employees
  • 40+ years benefit administrators experience
  • $11M claims and 2M calls handled per year
  • Experienced partner with multiple school district clients

CORESOURCE FAST FACTS:

100-65,000

Client employee lives

32 years

Longest Client Tenure

9.7 years

Average Client Tenure

50

Licensed states to administer benefit plans

97.8%

Client Retention

Profile, Experience, Expertise

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SLIDE 27
  • 1,000+ benefit professionals
  • Average tenure, 9.2 years
  • Education
  • 58.5% post-secondary
  • 10% registered nurses
  • 100% of Staff participate in Customer Service

Excellence training

  • Comprehensive QA oversight
  • Random at > of statistical significance or 2% monthly
  • All claims exceeding staff authority limits reviewed
  • Ties in with Critical Claims Unit and all large claims
  • Quality Service Standards
  • Member Service

Speed to answer inbound calls, 29.5 seconds 98% First call resolution 94% Health Coaching satisfaction rate 97.5% Large Case Management satisfaction rate

  • ClaimProcessing

8. % claims processed <14 days

  • Clean claims @ 6.6 days

99.6% Financial Accuracy 99.7% Procedural Accuracy

CoreSource Operations

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SLIDE 28

CoreSource

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SLIDE 29

Better Connected. More Engaged.

CoreSource’s digital communication tools can help reduce members’ anxiety about financial risk from healthcare and the complexity of what they need to understand—we help them feel smart, informed, and confident. myCoreSourceWire

While employees aren’t thinking about their benefits, we are. The Wire sends

convenient messages and guidance to members’ mobile phones.

myCoreSource Mobile App

Allows members quick and convenient access to ID cards, claims, customer service, and more.

myCoreSource Online Portal

Gives members online self-service of their benefits and plan resources anytime.

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SLIDE 30

Digital Engagement – DrivingAction

ID card carrier

  • Leverage Credit Card

Conditioning

  • Stickered ID cards for

myCoreSourceWire

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SLIDE 31

myCoreSourceWire

Preventive screenings reminders Any incentiveprograms their employeroffers Understanding health spendingaccounts Personalized gaps in care reminders Plan benefits and networks Personalized notices about choosing more cost- effective providers Seasonal healthcaretips Cost-effective Rx tips

Through myCoreSourceWire we can send members messages about:

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SLIDE 32

myCoreSource Mobile App

See the status of their deductible and out-of- pocket maximum View family info and benefits Show their ID card to providers Contact CoreSource by phone View and filter claims for quickreference Access important benefits info Easily access member-specific Filter claims bydependent

By downloading the myCoreSource app, members can:

Find a doctor Ask questions and receive answers from CoreSource services in their benefitplan andtype

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SLIDE 33

myCoreSource Online Portal

See all healthcare bills in

  • ne place and pay them
  • nline

View tailoredemployer messages Quickly view, filter and sort claims for easy reference View secure electronic Check account balances Contact CoreSource customerservice Create separate logins for Quickly view each family

By logging on to myCoreSource.com, members can:

member’scoverage explanation of benefits familymembers

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SLIDE 34

Telemedicine - Teladoc

Step 1

Complete medical history

Step 2

Request consult

Step 3

Talk with a physician

Step 4

Resolve the issue

Step 5

Continuity

  • f care

Step 6

Reconcile account if necessary

When the physician is unavailable: no appointments; after hours Schedule doesn’t permit traveling to see your physician (work, etc.) On vacation or a business trip For refill of recurring prescription (short term) Geographical barriers (distances to a provider’s office) Pediatric care for any age

48

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SLIDE 35

Telemedicine: Convenient and Affordable

  • Providing solutions for three of the biggest issues in

healthcare:

  • Timely access
  • Lower cost
  • Quality Care

Employee / Member satisfaction is one of the many benefits of addressing these issues

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SLIDE 36

Health Engagement

Health & Wellness Strategies & Promotions

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SLIDE 37

Network

  • Access to one of the largest

carrier-owned networks in the country

  • Includes legacy HealthAmerica

provider network as well as Institutes of Excellence and Quality Hospitals

  • Top tier provider contracting

terms lending both Plan and Member value

Our arrangement with Aetna provides 100% of all negotiated savings with Providers and Hospitals back to both the Client and Member.

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SLIDE 38

Easy, Integrated Enrollment with eElect

  • eElect Makes Enrollment Easy and Convenient

With eElect, CoreSource combines security, simplicity, speed, and convenience to streamline your enrollment process. Our flexible online system can handle all your benefit offerings, and gives you the self-service ability to quickly and easily make your benefit selections.

  • Integrated for Better Member Experience

With eElect, members can choose from the appropriate benefits and level of coverage based on their status. You also have online access to enrollment data and a comprehensive summary of your enrollment elections, including information on dependents and beneficiaries and for coordination of benefits. After employees enter their elections into eElect, they are sent directly to your HR and payroll systems.

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SLIDE 39

What is a Flexible Spending Account (FSA)?

Pre-tax benefit account that pays for eligible expenses not covered by insurance

Health Care FSA

Covers medical, prescription, dental and vision expenses

Dependent Care FSA

Covers dependent care expenses including daycare, nursery school and day camp for children, and services for adult dependents who cannot care for themselves

Limited Purpose Medical FSA

Covers dental and vision expenses only

(for compliance with a health savings account)

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SLIDE 40

CoreSource Administers Solanco’s FSA

  • Reimbursement plans
  • Medical FSA available - PPO plan only
  • Medical - $2500 annual maximum for

Solanco

  • Dependent Care - $5000 annual

maximum

  • Must use annual contribution or lost –

no carry over

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SLIDE 41

ADDITIONAL SOLANCO HEALTHCARE BENEFITS

41

  • Diabetes Counseling Program
  • Life Insurance—Beneficiary in E-Elect

– Note: Pension information is not in E-elect...must go to PSERS web site direct

  • Dental and Vision $2,250 for 2018-19
  • FSA and HSA: IRS Tax advantaged accounts

including premium share

  • TelaDoc Program....must enroll...see CoreSource

and / or E-elect material

  • Carebridge -- Employee Assistance Plan – EAP
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SLIDE 42

Additional Resources

42

  • District website > Departments >

Business Office and Employee Portal

  • www.mycoresource.com
  • https://express-scripts.com
  • https://healthequity.com
  • https://teladoc.com
  • https://medicare.gov
  • Internal Revenue Service Publications
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SLIDE 43

QUESTIONS? Thank You!!