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2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY: Greg Biese Vice President, Senior Benefits Consultant.

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Presentation on theme: "2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY: Greg Biese Vice President, Senior Benefits Consultant."— Presentation transcript:

1 2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY: Greg Biese Vice President, Senior Benefits Consultant Associated Financial Group Employee Benefits. Insurance. HR Solutions.

2 Copyright 2014 by Associated Financial Group, LLC HEALTHCARE REFORM: YESTERDAY, TODAY & TOMORROW Individual Mandate Private Exchanges Medicaid Expansion Play or Pay (Employer Mandate) Wellness Incentives Government Reporting Medical Access Cadillac Tax Rules Plan Design Fees St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 1

3 Copyright 2014 by Associated Financial Group, LLC 2015 MEDICAL ELIGIBILITY & RATES St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 2

4 Copyright 2014 by Associated Financial Group, LLC 2015 BENEFIT HIGHLIGHTS 3 St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx (1) IMPORTANT HSA PLAN NOTICE: No individual family member's deductible or out-of-pocket is considered satisfied until the Full-Family deductible and out-of-pocket has been met.

5 Copyright 2014 by Associated Financial Group, LLC 2015 BENEFIT HIGHLIGHTS (CONT.) 4 St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx

6 Copyright 2014 by Associated Financial Group, LLC PPO PLAN EFFECTIVE JANUARY 1, 2015 St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx Preventive services unchanged All medical and Rx copays (1) apply to maximum out-of- pocket Deductible and maximum out-of-pocket increase Costs New generics drugs Prescription drug plan design unchanged UMR Contraceptive coverage outside of plan 5 (1) Due to Health Care Reform changes, beginning in 2015, all copays, including pharmacy copays, will apply to the out-of-pocket maximum.

7 Copyright 2014 by Associated Financial Group, LLC PREVENTIVE SERVICES St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx Certain services can be done for preventive or diagnostic reasons. Covered preventive services performed specifically for preventive screening with no known symptoms, illnesses or history are generally covered as preventive care, subject to age and gender guidelines and health status. 6

8 Copyright 2014 by Associated Financial Group, LLC DIAGNOSTIC SERVICES Diagnostic services are generally not covered under the preventive care benefit but may be covered under another portion of your medical benefit plan. Services are considered diagnostic when a person: –Has abnormalities found on previous preventive or diagnostic services that require further diagnostic services; or –Had abnormalities found on previous preventive or diagnostic services that would recommend a repeat of the same service within a shortened time period from the recommended preventive screening time period based on age and gender; or –Had a symptom(s) that required further diagnosis St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 7

9 Copyright 2014 by Associated Financial Group, LLC WHAT EXACTLY IS AN HSA? St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx PART 1: HIGH DEDUCTIBLE HEALTH PLAN (HDHP) PART 2: HEALTH SAVINGS ACCOUNT (HSA) HSAHSA TWO PARTS TO AN HSA Intended to cover serious illness or injury once the deductible is met. Used to cover expenses until the deductible is met. 8

10 Copyright 2014 by Associated Financial Group, LLC IMPORTANT INFORMATION REGARDING YOUR HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP) St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx There are NO office visit, emergency room, or prescription drug copays. All out-of-pocket expenses count towards the deductible out-of-pocket maximum. The preventive healthcare benefit is still covered at 100% (all participants); includes services under the Womens Care Act. Does not include contraceptive services. 9

11 Copyright 2014 by Associated Financial Group, LLC IMPORTANT INFORMATION REGARDING YOUR HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP) The deductible and coinsurance out-of-pocket maximum for family is a true family deductible and out-of-pocket maximum. St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 10

12 Copyright 2014 by Associated Financial Group, LLC WHO IS ELIGIBLE FOR HSAs? Any employee that: Is covered by an HDHP Is not covered by another non-HDHP health plan Is not enrolled in Medicare Cannot be claimed as a dependent on someone elses tax return St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 11

13 Copyright 2014 by Associated Financial Group, LLC ADVANTAGES OF AN HSA Ownership - you own the funds in your HSA Tax-free Portable No use it or lose it You may change your employee contribution amount throughout the year. You can choose to invest your savings in an investment account. St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 12

14 Copyright 2014 by Associated Financial Group, LLC HSA ANNUAL CONTRIBUTIONS – 2014 Annual contributions to the HSA are limited to $3,300 single / $6,540 family (2015 will be released in late summer) Benefits are subject to federal regulations –Deductibles, out-of-pocket and contribution maximums are determined annually Account holders age 55 and up may make additional contributions of $1,000 in St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 13

15 Copyright 2014 by Associated Financial Group, LLC CONTRIBUTING TO YOUR HSA You can elect how much money you want to put into your HSA. It is your responsibility to ensure that you do not exceed the maximum HSA contribution limit. Your employer will deduct this amount on the date of each payroll on a pre-tax basis and the money will be direct-deposited to your HSA account. You may also deposit funds directly into your bank account with post-tax dollars and claim the amount on your tax return. St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 14

16 Copyright 2014 by Associated Financial Group, LLC WHO DETERMINES WHETHER HSA DISTRIBUTIONS ARE USED EXCLUSIVELY FOR QUALIFIED MEDICAL EXPENSES? YOU! Your bank will submit information to the IRS each year to report contributions and withdrawals. You will need to report withdrawals on your federal income tax forms. Individuals who establish HSAs should maintain records of their medical expenses to show that the distributions have been made exclusively for qualified medical expenses. St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 15

17 Copyright 2014 by Associated Financial Group, LLC HSA WITHDRAWALS/DISTRIBUTIONS Federal tax treatment of funds used: St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 16

18 Copyright 2014 by Associated Financial Group, LLC ELIGIBLE MEDICAL EXPENSES FOR TAX- FREE DISTRIBUTIONS Qualifying medical expenses - IRS Publication 502 Dental and vision care expenses Long-term care insurance Premiums for coverage while receiving unemployment compensation St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 17

19 Copyright 2014 by Associated Financial Group, LLC BANK INFORMATION At the end of the year, the bank will send each account beneficiary a statement with the fair market value of the HSA and forms with the total contributions and distributions: Form 1099-SA (distributions) Form 5498-SA (contributions, rollover deposits and fair market value for each calendar year) This information is reported to the IRS. You will need to complete form 8889 and file with your personal income tax return. St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 18

20 Copyright 2014 by Associated Financial Group, LLC WAYS TO BE A MORE COST CONSCIOUS CONSUMER OF HEALTH CARE Get Healthy and Stay Healthy! Use Appropriate Levels of Care – Fast Care/Urgent Care/Emergency Room Use In-Network Providers Consider Generic or Mail Order prescriptions Consider $4 Generic Programs at Target & Wal-Mart Stores Ask doctors and pharmacists questions o Most effective treatment o Cost of treatment o Alternatives to treatment Support and participate in company sponsored wellness and disease management initiatives 19 St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx

21 Copyright 2014 by Associated Financial Group, LLC LEVELS OF CARE SAMPLE St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx Emergency Room Complex chest pain, trauma Urgent Care Clinic Sprains, strains, sutures; typically hospital-based Primary Care Provider Wellness/preventive/screening services, comprehensive management of acute and chronic conditions Convenience – Walk-In Care Clinic Colds, flu, quick service Nurse Line Health and first aid questions, premium provider search, guidance on appropriate facility and location to meet care needs Available extended hours & weekends Available extended hours & weekends in some cases Available extended hours & weekends No Cost Available 24/7 COST $500+ $200+ $125+ $49- $69 $0 20

22 Copyright 2014 by Associated Financial Group, LLC PRESCRIPTION COST AND SAVINGS OPPORTUNITIES - $4 PRESCRIPTIONS St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx WHAT IS IT? Many retail pharmacies have recently created new and innovative programs to help control prescription drug costs for consumers. One of the most popular is the $4 prescription drug program, which has allowed consumers to take advantage of tremendous savings for their everyday prescriptions needs. This program is offered at many national and regional pharmacies, including those shown above, and typically includes hundreds of medications in a variety of therapeutic classifications. Other programs that may be available in your area may include free antibiotics and various 90-day supply discounts for maintenance medications. Many pharmacies also have low-cost membership programs that allow you to access significant savings. It is likely that there will be new programs and enhancements to existing programs in the future as pharmacies continue to compete for the right to fill your prescriptions. Interaction with insurance - continue to provide your insurance information to ensure you receive the deepest discount and that your coinsurance is applied to your deductible and/or out-of-pocket maximum. If your insurance company has negotiated a deeper discount than $4 (or the pharmacys discount rate) for the prescribed medication, you will be charged the lesser of the two prices. KEEP MONEY IN YOUR BANK! 21

23 Copyright 2014 by Associated Financial Group, LLC HEALTH SAVINGS ACCOUNTS (HSA) AND FLEX SPENDING ACCOUNTS (FSA) One of the qualifications to have an HSA is that you are not covered by any other low deductible insurance – this includes an FSA. Therefore, if you enroll in the HDHP Plan and open an HSA Account, you may not participate in a Standard FSA Plan. However, you may enroll in a Limited FSA which can be used to reimburse Dental & Vision expenses ONLY. Effective You may still participate in the dependent care account. St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 22

24 Copyright 2014 by Associated Financial Group, LLC Flexible Spending Account (FSA) Update New Plan Administrator Employee Benefits Corporation (EBC) will replace M&I (BMO Harris) as your FSA Administrator Your current FSA plan year will end on Please continue to submit all claims to M&I (BMO Harris) for reimbursement. You will have 90 days after the end of the current plan year to submit claims incurred between through –We will running a short plan year ( to ) –Your next plan year will start on January 1, 2015 What does this mean for you? –Enrollment Forms will be required effective and then again effective St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx

25 Copyright 2014 by Associated Financial Group, LLC FSA Short Plan Year ( – ) The short-plan year (4 months) will allow you to submit claims incurred between and Please keep in mind the following: –The Health Care FSA maximum for the short plan year must be pro-rated. Participants will be allowed to contribute 1/4 th of the annual limit of $2,500. 1/4 th of the Annual Limit is $ –The Dependent Care FSA limit is $5,000 per calendar year. To calculate your allowable amount subtract your 2014 contributions (January 1 st - through August 31 st ) from the $5,000 annual limit. Example 1: Between January 1 st – August 31 st, Jane Smith contributed $4,000 to her Dependent Care FSA account. She may contribute an additional $1,000 to her Dependent Care FSA between – Example 2: Jane Smith did not participate in the Dependent FSA in the Plan Year. She may contribute up to $5,000 to her Dependent Care FSA account between – St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx Jesse will be sending additional communication regarding these changes to the SNC community in May 2014.

26 Copyright 2014 by Associated Financial Group, LLC EBC FEATURES: Submitting claims is EASY My Mobile Account Assistant –For Android and iPhone –Camera scans documentation –Upload with claim information –Receive notification when a claim is processed –Use the app to review FSA account information Submit claims online or using paper My Account Assistant –Your secure web portal lets you review all aspects of your account online at –Submit claims and documentation –Receive notification when a claim is processed Claim Form –Mail or fax a paper form with attached documentation 25 St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx

27 Copyright 2014 by Associated Financial Group, LLC QUESTIONS? St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx 26


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