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Health Care Open Enrollment (coverage effective 1/1/2010) 1.

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Presentation on theme: "Health Care Open Enrollment (coverage effective 1/1/2010) 1."— Presentation transcript:

1 Health Care Open Enrollment (coverage effective 1/1/2010) 1

2 Benefit Summary You may review your current benefits summary by: Clicking on myUT at the top of the homepage Sign in to myUT Click on Benefit Summary in the left-hand column of the Employee tab Then click the select button 2

3 Open Enrollment Pharmacy will now be bundled with medical for both campuses (no longer available as a stand alone election except for AFSCME) Main Campus Full re-enrollment Health Science Campus Full re-enrollment 3

4 Open Enrollment Website No packets will be mailed – post card notification only If you do not have computer access, you can pick up a packet in HR Click on Open Enrollment Option Read general directions Click on either Main Campus, Health Science Campus Non-Union or AFSCME Click each needed form and type in the information, then print the form and go on to the next form to complete Turn in all completed forms at one time as one packet to Human Resources HR is located on the Main Campus in the Transportation Center and is open M-F 7:30 AM to 5:00 PM 4

5 Main Campus Health Insurance Choices… Ohio Benefit Administrators/FrontPath PPO 90/10 FrontPath & PHCS networks – (Promedica & Mercy) 70/30 Out-of-network Paramount Employer Select 100 UTMC, UTP, UT community faculty The following teaching facilities: Defiance, Flower, Fostoria, Lima, Toledo Hospital & Toledo Childrens Hospital for inpatient services and outpatient surgeries Tier 1 list is available on the websitehttp://hr.utoledo.edu 90/10 Paramount & PHCS networks 70/30 Out-of-network Medical Mutual of Ohio CDHP 100 UTMC & UTP Tier 1 list is available on the websitehttp://hr.utoledo.edu 90/10 MMO (Mercy & Paramount) & PHCS (and Cofinity for Michigan) networks 70/30 Out-of-network 5

6 Health Science Campus Health Insurance Choices… Paramount Employer Select 100 UTMC, UTP, UT community faculty The following teaching facilities: Defiance, Flower, Fostoria, Lima, Toledo Hospital & Toledo Childrens Hospital for inpatient services and outpatient surgeries Tier 1 list is available on the websitehttp://hr.utoledo.edu 90/10 Paramount & PHCS networks 70/30 Out-of-network Medical Mutual of Ohio CDHP 100 UTMC & UTP Tier 1 list is available on the websitehttp://hr.utoledo.edu 90/10 MMO (Mercy & Paramount) & PHCS (and Cofinity for Michigan) networks 70/30 Out-of-network 6

7 Main Campus OBA/FrontPath Co-Pays FrontPath & PHCS Networks Out of Network Office Visit Co-Pay: $15 Office Visit covered 70% after deductible Specialist Visit Co-Pay: $30 Specialist Visit covered 70% after deductible 7

8 Main Campus OBA/FrontPath Deductibles FrontPath & PHCS Networks Out of Network $100 Single $200 Single + 1 $300 Family $300 Single $600 Single + 1 $900 Family 90% Coverage 70% Coverage 8

9 Main & Health Science Campus Paramount ES Co-Pays Tier 1 UTMC & Tier 1 Providers Tier 2 Paramount & PHCS Networks Tier 3 Out of Network Office Visit Co-Pay: $10 Office Visit Co-Pay: $20 Office Visit covered 70% after deductible Specialist Visit Co-Pay: $25 Specialist Visit Co-Pay: $35 Specialist Visit covered 70% after deductible 9

10 Main & Health Science Campus Paramount ES Deductibles Tier 1 UTMC & Tier 1 Facilities Tier 2 Paramount & PHCS Networks Tier 3 Out of Network No Deductible$100 Single $150 Single + 1 $200 Family $500 Single $750 Single + 1 $1,000 Family 100% Coverage 90% Coverage 70% Coverage 10

11 Paramount ES 2010 Changes No longer requires selection of Primary Care Physician (PCP) No longer requires referrals Rates have decreased 11% Non-network co-insurance now 70%/30% rather than 60%/40% 11

12 What is a Consumer Directed Health Plan? Consumer Directed Health Plans (CDHPs) are made up of three elements: 1. A health plan 2. 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 decisions Cannot 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 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 annually 13

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 deductibles Braces Dental care Contact lenses Prescription drugs Hearing aids LASIK eye surgery Eyewear 14

15 CDHP Design Highlights Deductible $1,200 Single $2,400 Family Health Savings Account Employer Contribution $800 Single $1,600 Family 15

16 CDHP Highlights Meet the plan deductible then pay coinsurance Prescription drug costs count towards deductible Out-of-pocket maximum limits amount you pay annually Preventive care not subject to the deductible and covered at 100% with UTMC providers, 90% with MMO Providers 16

17 Must be enrolled in HSA-compatible health plan to open & contribute to HSA What is an HSA? 17 © 2009 Wells Fargo Bank, N.A. All rights reserved. For public use. Pay for Qualified Medical expenses with Tax Free dollars No use it or lose it provision – like Flexible Spending Accounts Your balance plus investment earnings carry over year to year - Tax Free 17

18 Triple tax savings * Pay for qualified medical expenses tax free Interest and investment earnings are tax free Contributions are pre-tax or tax deductible 18 Increase your spending and savings power * All taxes are at the federal level. State taxes vary. Please consult a tax advisor. 18

19 Increase your buying power Your HSA Contribution Tax savings from your HSA contribution * Increased Buying Power $500$125$625 $1,000$250$1,250 $2,000$500$2, 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. 19

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 name You will receive a confirmation letter mailed to your home, including: Web site information Toll-free customer service number Your Visa HSA Debit Card card will arrive separately Activate the card before you use it Sample of the envelope the HSA Visa Debit card comes in. 20

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 21

22 MMO CDHP Plan Plan Design FeatureTier 1 University Medical Center Tier 2 MMO Network Providers Tier 3 Out of Network UT HSA Contribution$800 Single $1,600 Family Employee HSA Contribution $2,250 Single $4,550 Family Deductible$1,200 Single $2,400 Family Out-of-Pocket Maximum (Includes Deductible) $2,000 Single $4,000 Family Coinsurance (Most Services) Subject to deductible 100%90% / 10%70/30 Preventive Care Not subject to deductible100%90% / 10%70% / 30% 22

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 Drugs 30 day supply90 day supply UT pharmacies or at any MMO network Pharmacy. Deductible does not apply to certain preventive medications. $5 generic 20% formulary (up to $80 max per prescription) 30% non-formulary $10 generic 20% formulary (up to $200 max per prescription) 30% non-formulary Once the out-of-pocket maximum has been met, all prescriptions are covered at 100%. 23

24 Preventive Drugs (partial listing) not subject to CDHP deductible Antiasthmastics drugs & supplies Antidiabetic drugs & supplies Antiemetics/antivertigo agents Antiestrogens Anti-infectives Antimalarials Anti-ulcer agents Antivirals Blood Thinning Agents Contraceptives, oral Estrogen replacement products Gout High Cholesterol drugs Hypertension drugs Osteoporosis drugs Prenatal vitamins Prescription vitamins Smoking Cessation medications 24

25 Spousal/Domestic Partner Provision (for full-time and part-time employees) Does not apply to the MMO CDHP Must be completed annually if covering a spouse/domestic partner on health insurance For Spouse to be Primary: Unemployed, Self-Employed, Retired, No other benefits offered Or makes less than $25,000/yr and benefits cost more than $75/month for a single plan Spouse may be Secondary HSC AFSCME will continue to use existing HSC spousal/domestic partner provision 25

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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. 28

29 Dependent Coverage For 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. 29

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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 tiers Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-Preferred Brand Formulary can be found at 31

32 Prescription Cost Sharing UT 30-day supply co-pays: (except for AFSCME) TIER 1: $6.60 per prescription TIER 2: $16.50 per prescription TIER 3: $33.00 per prescription 32

33 Prescription Cost Sharing UT 90-day supply co-pays: (except for AFSCME) TIER 1: $16.50 per prescription TIER 2: $30.80 per prescription TIER 3: $61.10 per prescription 33

34 Prescription Cost Sharing Main Campus Retail co-pays for a 30 day supply: Tier 1: $11 Tier 2: 20% Tier 3: 40% Health Science Campus Non-Union Retail co-pays: Tier 1: Only a 10 day emergency supply is Tier 2: Only a 10 day emergency supply is Tier 3: Only a 10 day emergency supply is 34

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 period Minor & Major work covered at 80% $100 deductible per calendar year per person Orthodontia (dep <19) at 60% ($1500 lifetime max) Main Campus $3,000 annual max per person Health Science Campus $1,500 annual max per person 35

36 HSC Dental (Non-Union) CurrentNew per person per year max$750$1,500 crowns50%80% periodontic services50%80% oral surgery50%80% prosthodontic services50%80% implants50%80% orthodontic services50%60% ortho lifetime limit$500$1,500 deductible$50$100 36

37 HSC Dental (Non-Union) Old Charged 50/50crown$ 800$400employee cost New 80/20crown$ 800$160employee cost Old 50/50oral surgery$1,200$600employee cost New 80/20oral surgery$1,200$240employee cost old cap$ 750 new cap$1,500 37

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 months Every 12 months for students & children Prescription lenses once every 24 months Every 12 months for students & children Frames/Contacts allowance of $120 every 24 months 38

39 HSC Vision (Non-Union) CurrentNew exam$15$10 lens (student & child)every 24 moevery 12 mo exam (student & child)every 24 moevery 12 mo Contacts/lenses (student & child)every 24 moevery 12 mo 39

40 Flexible Spending Account Must be set up annually Allows you to set aside additional money on a pre-tax basis May be used for out-of-pocket medical and/or dependent care expenses You will be reimbursed for charges incurred once claim form is submitted Reimbursements may be direct deposited Account DOES NOT rollover Reminder: If electing MMO CDHP medical coverage, you are only eligible for dependent care. 40

41 Main Campus Employee Clinic Location: Main Campus Medical Center Phone Number: Clinic Hours: Monday - Friday 8:15 am - 11:00am and 1:00pm - 4:00 pm Can generally be seen the same day, if not then within 24 hours No office visit co-pay 41

42 Health Science Campus Employee Clinic Location: Room 2410, Dowling Hall Phone Number: (419) Clinic Hours: Monday - Friday 7:30 am - 4:30 pm Can generally be seen the same day, if not then within 24 hours No office visit co-pay 42

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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 issue Benefits vendor contact information is available on the benefits website or on the back of your ID cardhttp://hr.utoledo.edu 49

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 50


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