Presentation on theme: "Left Image 3 h 7.16 w Color Block 3 h 2.78 w Valley View School District 365U January 1, 2012 Employee Benefits Open Enrollment Presentation."— Presentation transcript:
Left Image 3 h 7.16 w Color Block 3 h 2.78 w Valley View School District 365U January 1, 2012 Employee Benefits Open Enrollment Presentation
Program Overview Open Enrollment Health Care Reform 2011 Recap Medical, Prescription Drug, Dental and Vision Plan Summary FSA / Dependent Care Plan Summary
Program Overview Medical / Prescription Drug BCBS of IL PPO Plan (Mail Order: Prescription Prime Therapeutics) Dental BCBS of IL PPO Plan Flexible Spending and Dependent Care Pay Flex Flexible Spending Account Pay Flex Dependent Care Account Vision VSP Vision PPO Plan Life SunLife Life AD&D Plan Long Term Disability SunLife Long Term Disability Plan
4 Open Enrollment
5 Open Enrollment Process Open Enrollment Period: November 1 st – November 30 th Current Enrollment Elections: Medical and Dental elections will automatically continue with no paperwork required. Federal Government requires annual re-enrollment in Flexible Spending and Dependent Care Accounts. Applications must be completed to enroll in accounts effective January 1, 2012.
6 Enrollment Forms can be found at Elections are to be returned to Human Resources no later than Wednesday, November 30, :59pm. All Elections are effective January 1, 2012 – December 31, Open Enrollment Process
7 During the open enrollment period you are eligible to make the following enrollment changes to the medical and dental programs for a January 1, 2012 effective date: Elect Coverage Previously Declined Add Spouse, Civil Union Partner or Eligible Dependents Terminate Existing Coverage Terminate Spouse, Civil Union Partner or Eligible Dependents Open Enrollment Rights
8 The only other times during the plan year when you are eligible to make changes to your current election(s) is when the following life events occur: Birth Death Marriage / Civil Union Divorce / Civil Union Dissolution Adoption Loss of Coverage Spouse, Civil Partner, Dependents loss of coverage Special Enrollment Rights
9 Health Care Reform 2011 Recap
10 Health Care Reform 2011 Recap Effective LAST January 1, 2011: 1.Dependent Children Eligibility to age 26 Regardless Student, Residential or Marital Status. 2.Dependent Children (up to age 19) 3/12 Pre Existing Condition Limitation was Removed. 3.Flexible Spending Account Eligible Expenses Excludes over the Counter Medications unless in the case of Insulin or a Script from a Provider. 4.Health Plan Essential Benefit Lifetime and Annual Maximums were Removed or Converted to Visit Maximums.
11 Health Care Reform 2011 Recap Essential Benefit Plan Maximums Plan Maximums PriorEffective 01/01/11 Medical Plan Lifetime Maximum $5,000,000 Unlimited TMJ Lifetime Maximum $2,500Unlimited Well Baby Care Annual Maximum (Eligibility: Birth Through 26 Months) $1,500Unlimited Well Child & Adult Care Annual Maximum $500Unlimited Physical Therapy Annual Maximum $5, Visits Occupational Therapy Annual Maximum $2,00028 Visits Speech Therapy Annual Maximum $2,00019 Visits
13 Contractual Changes Civil Union Partner Eligibility Applicable to the Medical, Prescription Drug, Dental and Vision Plans Effective June 1, 2011 State Law was passed to allow for civil unions in the state of Illinois. Civil union dependents from the state of Illinois or any other state are eligible for our medical, prescription drug, dental, and vision plans effective June 1, Civil union dependents are not eligible for our Section 125, FSA and Dependent Care Federally regulated programs. The Federal government does not recognize civil union dependents as eligible dependents. Adult Pre-Existing Waiting Period Applicable to the Medical Plan The Health Plan has new enrollee pre-existing condition waiting periods for adults (age 19 or older). Conditions treated in the 3 months prior to the effective date of the Plan are not be eligible for medical coverage for the first 6 months for employees and the first 12 months for adult dependents. Effective January 1, 2012 pre-existing condition waiting periods can be reduced or waived by providing the Plan proof of prior credible coverage. The Plan will reduce the medical care pre-existing condition waiting period a month for every month of prior credible coverage.
14 Medical / Prescription Drug / Dental Plans
15 BCBS of IL Medical & RX Plan Overview Deductible has a 3 x Family Maximum. Out of Pocket has a 2 x Family Maximum. Plan BenefitsIn NetworkOut of Network Lifetime MaximumUnlimited Calendar Year Deductible (In and out of Network Amounts Cross Apply) $250$500 Calendar Year Out of Pocket Maximum (In and out of Network Amounts Cross Apply) $1,000$3,000 Coinsurance90%70% Office Visit Services (Consultation Only) $2570% after Deductible Emergency Room$75; 90% after Deductible Urgent Care Facility90% after Deductible Pharmacy Prescription Drug Coverage (Generic / Brand Formulary / Brand Non Formulary) $5 / $15 / $30Copay; 75% after Deductible Mail Order Prescription Drug Coverage (Generic / Brand Formulary / Brand Non Formulary) $10 / $30 / $60N/A
16 BCBS of IL Dental Plans Overview Annual Deductible has a 3 x Family Maximum. Orthodontia deductible has no Family Maximum. Plan BenefitsDental Plan 1Dental Plan 2 Eligibility TAs, Maintenance, Transportation & Food Service Administrators & Secretaries Annual Deductible$25 Per Member Annual Maximum$2,000 Per Member In Network Versus Out of Network In Network: Maximum Allowance Out Network: Usual and Customary Preventive Services100% Basic Services80%85% Major Services50% Orthodontia Services (Children up to age 23) Not Covered50% Orthodontia Deductible Per MemberNot Covered$50 Per Member Orthodontia Lifetime MaximumNot Covered$1,000 Per Member
17 BCBS of IL Blue Access For Members Online Internet Site Provider Finder News & Updates Formulary RX List / Forms View Current Enrollment View Explanation of Benefits Order ID Cards Access to Blue Care Connection Blue Points Redeemable for Prizes
18 BCBS of IL Blue Extras Services For Members 24 Hour / 7 Day a Week Nurseline Blue Care Advisors Access to Health & Wellness Special Beginnings Tobacco Cessation
19 BCBS of IL Blue Extras Discounts For Members Alternative Medicine 35,000 providers Vitamins / Herbal Supplements / Health Magazines Weight Management Seattle Sutton, Jenny Craig, Lifetime Fitness Vision Davis Vision Hearing TruHearing
20 Vision Plan
21 VSP Vision Plan Overview Plan BenefitsIn NetworkOut of Network Eye Exam$10 CopayUp to $45 Allowance Prescription Glasses$25 CopayUp to $70 Allowance FramesUp to $130 AllowanceUp to $70 Allowance Lenses: Single Vision Lenses: Bifocal Vision Lenses: Trifocal Vision Lenses: Lenticular Vision $25 Copay Up to $30 Allowance Up to $50 Allowance Up to $65 Allowance Up to $100 Allowance Contact LensesUp to $130 AllowanceUp to $105 Allowance Frequency: Exam Frequency: Lenses Frequency: Frames Once Every 12 Months Once Every 24 Months Once Every 12 Months Once Every 24 Months
22 Flexible Spending Plan
23 PayFlex Plan Details Valley View School District 365U provides you the opportunity to pay for out-of-pocket medical dental, vision, and dependent care expenses with pre-tax dollars. Flexible Spending Account Annual Maximum Election: $2,500 Dependent Care Account Household Annual Maximum Election: $5,000
24 PayFlex Transition FSA – HealthCare Expenses Examples of Eligible Expenses Prescriptions Deductibles Copayments Coinsurance Vision Care Expenses Medical Care Expenses Dental Care Expenses Examples of Ineligible Expenses Health care premiums Expenses reimbursed by any other plan Expenses you incur before you enroll in the plan Expenses you claim as a deduction or credit on your federal income taxes Over the counter equivalents (Unless Insulin or script from a provider) Where can you find a list of eligible expenses? Visit
25 Open Enrollment Recap
26 Open Enrollment Recap Open Enrollment Period: November 1 st – November 30 th Medical and Dental elections will automatically continue with no paperwork required. Federal Government requires annual re-enrollment in FSA and Dependent Care accounts. Forms are available at Elections are to be returned to Human Resources no later than Wednesday, November 30 th 11:59pm. Effective Date of Elections are January 1, 2012.
27 Questions? Please Contact: Lorrie Alsobrooks Administrative Assistant for Employee Benefits Valley View School District 365U Phone: x Renee Formell Insurance Consultant Mesirow Financial Insurance Services Phone: