Presentation on theme: "Health Care Open Enrollment (coverage effective 1/1/2010)"— Presentation transcript:
1 Health Care Open Enrollment (coverage effective 1/1/2010)
2 Benefit Summary You may review your current benefits summary by: Clicking on myUT at the top of the homepageSign in to myUTClick on Benefit Summary in the left-hand column of the Employee tabThen click the select button
3 Open EnrollmentPharmacy will now be bundled with medical for both campuses (no longer available as a stand alone election except for AFSCME)Main CampusFull re-enrollmentHealth Science Campus
4 Open Enrollment Website No packets will be mailed – post card notification onlyIf you do not have computer access, you can pick up a packet in HRClick on Open Enrollment OptionRead general directionsClick on either Main Campus, Health Science Campus Non-Union or AFSCMEClick each needed form and type in the information, then print the form and go on to the next form to completeTurn in all completed forms at one time as one packet to Human ResourcesHR is located on the Main Campus in the Transportation Center and is open M-F 7:30 AM to 5:00 PM
5 Main Campus Health Insurance Choices… Ohio Benefit Administrators/FrontPath PPO90/10 FrontPath & PHCS networks – (Promedica & Mercy)70/30 Out-of-networkParamount Employer Select100 UTMC, UTP, UT community facultyThe following teaching facilities: Defiance, Flower, Fostoria, Lima, Toledo Hospital & Toledo Children’s Hospital for inpatient services and outpatient surgeriesTier 1 list is available on the website90/10 Paramount & PHCS networksMedical Mutual of Ohio CDHP100 UTMC & UTP90/10 MMO (Mercy & Paramount) & PHCS (and Cofinity for Michigan) networks
6 Health Science Campus Health Insurance Choices… Paramount Employer Select100 UTMC, UTP, UT community facultyThe following teaching facilities: Defiance, Flower, Fostoria, Lima, Toledo Hospital & Toledo Children’s Hospital for inpatient services and outpatient surgeriesTier 1 list is available on the website90/10 Paramount & PHCS networks70/30 Out-of-networkMedical Mutual of Ohio CDHP100 UTMC & UTP90/10 MMO (Mercy & Paramount) & PHCS (and Cofinity for Michigan) networks
8 Main Campus OBA/FrontPath Deductibles FrontPath & PHCS NetworksOut of Network$100 Single$200 Single + 1$300 Family$300 Single$600 Single + 1$900 Family90%Coverage70%
9 Main & Health Science Campus Paramount ES Co-Pays Tier 1UTMC &Tier 1 ProvidersTier 2Paramount & PHCS NetworksTier 3Out of NetworkOffice VisitCo-Pay: $10Co-Pay: $20Office Visit covered 70%after deductibleSpecialist Visit Co-Pay: $25Specialist Visit Co-Pay: $35Specialist Visit covered 70% after deductible
10 Main & Health Science Campus Paramount ES Deductibles Tier 1UTMC &Tier 1 FacilitiesTier 2Paramount & PHCS NetworksTier 3Out of NetworkNo Deductible$100 Single$150 Single + 1$200 Family$500 Single$750 Single + 1$1,000 Family100%Coverage90%70%
11 Paramount ES 2010 ChangesNo longer requires selection of Primary Care Physician (PCP)No longer requires referralsRates have decreased 11%Non-network co-insurance now 70%/30% rather than 60%/40%
12 What is a Consumer Directed Health Plan? Consumer Directed Health Plans (CDHPs) are made up of three elements:1. A health plan2. A fund or account that you can use to help pay for qualified, out-of-pocket medical expenses (known as a Health Savings Account or HSA)3. Interactive tools and information to help you make more informed health care decisionsCannot be enrolled in another health plan as secondary unless it is also a high deductible health plan. No one enrolled in the CDHP may be covered by Medicare.12
13 How Much May I Contribute to my HSA? The University of Toledo contributions ($800/single, $1,600/family) will be accessible on January 4th in 2010.You may contribute by payroll deduction on a pre-tax basis.Payroll contributions you make are prorated over 24 pay periods but can be changed throughout the year by contacting UT HR.Your HSA contribution limits are $3,050 for persons with individual coverage and $6,150 for persons with family coverage. This includes contributions made by UT.Individuals age 55 to 64 may contribute an additional $1,000 annually13
14 Using Your HSA:You may use HSA funds towards your medical plan deductible or any coinsurance or copayments.You may use your HSA funds for qualified health care expenses as allowed by the IRS. The following list provides some typical examples:Medical deductiblesBracesDental careContact lensesPrescription drugsHearing aidsLASIK eye surgeryEyewear14
16 CDHP Highlights Meet the plan deductible then pay coinsurance Prescription drug costs count towards deductibleOut-of-pocket maximum limits amount you pay annuallyPreventive care not subject to the deductible and covered at 100% with UTMC providers, 90% with MMO Providers
18 Triple tax savings* Increase your spending and savings power Pay for qualified medical expenses tax freeInterest and investment earnings are tax freeContributions are pre-tax or tax deductible* All taxes are at the federal level. State taxes vary.Please consult a tax advisor.1818
19 Increase your buying power Your HSA ContributionTax savings from your HSA contribution*Increased Buying Power$500$125$625$1,000$250$1,250$2,000$2,500By using your HSA to pay for qualified medical expenses—from insurance copayments, doctor’s fees and dental work to prescription and over-the-counter medications—you can increase the power of your healthcare spending dollars.For example, when you contribute money to your HSA to pay for out-of-pocket medical expenses tax-free, you can increase your total buying power.The money you would have normally paid on income tax can be contributed to your HSA and used to pay for more qualified medical expenses now, or saved for future use. Once you put money in your HSA, it’s yours to use, save and grow tax-free.This example is for illustrative purposes only. Tax consequences may differ based on individual circumstances. Please consult your tax advisor regarding your individual situation. This chart assumes all distributions are used for qualified medical expenses.*Estimated federal tax savings of 25% based on 2008 tax table for a single taxpayer with income of $60,000. For more information, go to and click on “Health Savings Accounts (HSAs).” Please consult your tax advisor.1919
20 What you receive with your new Wells Fargo HSA If you elect the Medical Mutual product a Wells Fargo HSA will be opened in your nameYou will receive a confirmation letter mailed to your home, including:Web site informationToll-free customer service numberYour Visa HSA Debit Card card will arrive separatelyActivate the card before youuse itSample of the envelope the HSA Visa Debit card comes in.
21 Rollover process to Wells Fargo for Employees with an existing HSA account Employee completes and signs Wells Fargo rollover form provided in packet.Send completed form to University of Toledo Human Resources Benefits.Money will be transferred to Wells Fargo HSA for new plan enrollment year.Questions contact: (University of Toledo HR)wellsfargo.com/hsa
22 University Medical Center MMO CDHP PlanPlan Design FeatureTier 1University Medical CenterTier 2MMO Network ProvidersTier 3Out of NetworkUT HSA Contribution$800 Single$1,600 FamilyEmployee HSA Contribution$2,250 Single$4,550 FamilyDeductible$1,200 Single$2,400 FamilyOut-of-Pocket Maximum(Includes Deductible)$2,000 Single$4,000 FamilyCoinsurance (Most Services)Subject to deductible100%90% / 10%70/30Preventive CareNot subject to deductible70% / 30%
23 CDHP Prescription Drug Coverage When you fill prescriptions you pay the cost of the prescription until the deductible has been met. Once the deductible has been met you pay the copay or coinsurance detailed below:Prescription Drugs30 day supply90 day supplyUT pharmacies or at any MMO network Pharmacy.Deductible does not apply to certain preventive medications.$5 generic20% formulary(up to $80 maxper prescription)30% non-formulary$10 generic(up to $200 max per prescription)Once the out-of-pocket maximum has been met, all prescriptions are covered at 100%.
25 Spousal/Domestic Partner Provision (for full-time and part-time employees) Does not apply to the MMO CDHPMust be completed annually if covering a spouse/domestic partner on health insuranceFor Spouse to be Primary:Unemployed, Self-Employed, Retired, No other benefits offeredOr makes less than $25,000/yr and benefits cost more than $75/month for a single planSpouse may be SecondaryHSC AFSCME will continue to use existing HSC spousal/domestic partner provision
28 Please note…If you and your spouse are both employed by UT and are both eligible for benefits coverage, you may either enroll together on one form or separately on individual forms, but not both.Your dependent children may only be enrolled on one form, either yours or your spouses, but not both.
29 Dependent CoverageFor dependents age (25 for the CDHP), they must be claimed as an IRS dependent by the UT employee, be a full time student and unmarried to be eligible for benefits.As long as a dependent meets this criteria they may remain covered on your plans until the end of the year in which they reach age 24 (25 for the CDHP).A Dependent Verification Affidavit must be completed annually.Same requirements will be used for Fee Waiver eligibility.Dependents under age 19 do not need a form.
31 Prescription AFSCME will remain on current HSC plan SXC changing their name to “Informed Rx a division of SXC”Bundled with Medical Coverage (except for AFSCME)Co-pays go by tiersTier 1 – GenericTier 2 – Preferred BrandTier 3 – Non-Preferred BrandFormulary can be found at
32 Prescription Cost Sharing UT 30-day supply co-pays:(except for AFSCME)TIER 1: $6.60 per prescriptionTIER 2: $16.50 per prescriptionTIER 3: $33.00 per prescription
33 Prescription Cost Sharing UT 90-day supply co-pays:(except for AFSCME)TIER 1: $16.50 per prescriptionTIER 2: $30.80 per prescriptionTIER 3: $61.10 per prescription
34 Prescription Cost Sharing Main Campus Retail co-pays for a 30 day supply:Tier 1: $11Tier 2: 20%Tier 3: 40%Health Science Campus Non-Union Retail co-pays:Tier 1: Only a 10 day emergency supply isTier 2: Only a 10 day emergency supply isTier 3: Only a 10 day emergency supply is
35 Dental Plan AFSCME will remain on current HSC plan Enhanced for HSC non-union (same plan as MC except for annual maximum)Preventive Services covered at 100%2 cleanings in 12-month periodMinor & Major work covered at 80%$100 deductible per calendar year per personOrthodontia (dep <19) at 60% ($1500 lifetime max)Main Campus $3,000 annual max per personHealth Science Campus $1,500 annual max per person
36 HSC Dental (Non-Union) CurrentNewper person per year max$750$1,500crowns50%80%periodontic servicesoral surgeryprosthodontic servicesimplantsorthodontic services60%ortho lifetime limit$500deductible$50$100
38 Vision Coverage AFSCME will remain on current HSC plan Enhanced for HSC non-union (same plan as MC)Eye examination with a $10 co-pay once every 24 monthsEvery 12 months for students & childrenPrescription lenses once every 24 monthsFrames/Contacts allowance of $120 every 24 months
40 Flexible Spending Account Must be set up annuallyAllows you to set aside additional money on a pre-tax basisMay be used for out-of-pocket medical and/or dependent care expensesYou will be reimbursed for charges incurred once claim form is submittedReimbursements may be direct depositedAccount DOES NOT rolloverReminder: If electing MMO CDHP medical coverage, you are only eligible for dependent care.
41 Main Campus Employee Clinic Location: Main Campus Medical CenterPhone Number:Clinic Hours: Monday - Friday 8:15 am - 11:00am and 1:00pm - 4:00 pmCan generally be seen the same day, if not then within 24 hoursNo office visit co-pay
42 Health Science Campus Employee Clinic Location: Room 2410, Dowling Hall Phone Number: (419)Clinic Hours: Monday - Friday 7:30 am - 4:30 pmCan generally be seen the same day, if not then within 24 hoursNo office visit co-pay
49 HIPAA additional changes Due to additional changes to HIPAA that were effective 9/23/2009, you will need to contact the vendors personally when you have a claims issueBenefits vendor contact information is available on the benefits website or on the back of your ID card
50 Open Enrollment Website Please remember Open Enrollment runs from October 15 to November 13. All forms must be turned into HR and time stamped by 5:00 pm on November 13.Any questions that may come up can be ed to