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Agenda District #622 Health Plan Status JourneyWell

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Presentation on theme: "Agenda District #622 Health Plan Status JourneyWell"— Presentation transcript:

1 Open Enrollment & Overview of Insurance Plan 2013 A presentation for North St. Paul Schools ISD #622

2 Agenda District #622 Health Plan Status JourneyWell
ISD 622 Clinic High Deductible Health Plan VEBA Overview Health Savings Account Overview Plan Comparison Scenarios VSP – Vision Service Plan Flexible Spending Account Annual Open Enrollment

3 District #622 and HealthPartners 3 Year Agreement
District negotiated with HealthPartners 3 year rate deal: Year 1 (11-12): 4% Overall Increase to Rates Year 2 (12-13): 7% Overall Rate Cap to Rates—Overall increase was 5.5% Year 3 (13-14): 8% Overall Rate Cap to Rates July 1, 2013 renewal, Year 3, overall decrease is -3% District will continue to evaluate benefit design changes to mitigate rate increases. District focus on managing premiums and cost by encouraging healthy lifestyle through wellness programs and the ISD 622 Clinic JourneyWell will continue to be a part of the District benefit plan

4 JourneyWell If you participated and completed the Health Assessment and Wellness Program between July 1, 2012 and March 31, 2013, you will receive the preferred benefits effective July 1, 2013 The Preferred Benefit $200-$25: Differential of $20 on the office visit copay HDHP VEBA and HSA: Differential of $250 on the deductible Annual Program begins again July 1, 2013 through March 31, 2014, effective July 1, 2014 Employees and covered Spouses needed to complete the requirements to qualify for the preferred benefit Meetings to be held in all buildings in the Fall

5 Appointment Line 952-967-7481 or www.healthpartners.com/mychart
ISD 622 Clinic Scheduled to Open Mid-June & Open House at the end of May Hours Monday, Wednesday and Friday: 6:00am-2:00pm Tuesday and Thursday: 10:00am-6:00pm Private and Confidential Staffed by Physician’s Assistant On Site Pharmacy Available for employee and their dependents covered under the ISD 622 HealthPartners health insurance who is 18 months and older Appointment Line or

6 ISD 622 Clinic Preventions, Screening, Wellness Annual physicals Camp physicals Blood Pressure Cholesterol Nutrition Stress Management Smoking Cessations Conditions Minor illness Ear infections Sinus infections Minor skin infections Heartburn Stomach problems Pink Eye Styes Minor injuries Muscle strains Joint pain and sprains Minor burns Cuts and simple lacerations Employee Cost: $0 office visit copay and $0 prescriptions copay HSA Participants Only: $40 office visit including preventative prescriptions due to IRS regulations Appointment Line or

7 District 622 Health Plan Offerings
In-Network Benefits NationalOne NationalOne 2000/4000 VEBA* NationalOne 2400/4800 VEBA* NationalOne 2500/5000 HDHP-HSA Available to: ALL Units Teachers Paraprofessionals Clerical, Education Assistants, Local 70, Non Units, Principals Deductible $200 individual $600 family $2,000 individual $4,000 family $2,400 individual $4,800 family $2,500 individual $5,000 family Medical Out-of-pocket Maximum $500 individual $1,000 family Prescription Out-of-pocket Maximum $500 per person $750 per family Combined with Medical Out-of-Pocket Maximum Lifetime maximum Unlimited Preventive health care 100% coverage Office Visits Urgent Care $25 copay 100% coverage after deductible Convenience Clinics (Retail Clinics) $0 copay *Food Service VEBA is $1,150 deductible (no change from current) 7

8 NationalOne 2500/5000 HDHP-HSA
District 622 Health Plan Offerings NationalOne NationalOne 2000/4000 VEBA NationalOne 2400/4800 VEBA NationalOne 2500/5000 HDHP-HSA Inpatient, Outpatient hospital, Ambulance 100% after deductible Emergency Room $75 copay Durable medical equipment Home health care 80% after deductible Retail pharmacy: -- Generic preferred -- Brand preferred -- Non-preferred 34 day supply/100 units $8 copay $16 copay $32 copay 31 day supply Mail order pharmacy 2 copays for a 90 day supply Provider network and drug formulary the same for all plans 8

9 How does it work? High Deductible Plan with a Reimbursement Account (HSA or VEBA)
1. You seek medical care, your provider submits the charges to HealthPartners 2. HealthPartners processes the claim, applies their discount and sends Explanation of Benefits to provider and you. 3. Provider sends you bill for amount you owe. 4. You pay the doctor using provided checks or Benny card (HSA) 4. You receive reimbursement from VEBA account 5. You pay the doctor (VEBA)

10 What is an HSA and VEBA? Both are accounts that you can use to pay medical expenses Must be in conjunction with a high-deductible health plan (HDHP) Tax-advantages: contribute pre-tax money (HSA only), funds accrue tax-free and withdraw funds tax-free (if they are for eligible medical expenses) You own the account Contributions HSA—Both you and your employer can contribute funds VEBA—Only the employer can contribute funds

11 Benefits of an HSA or VEBA
Tax advantage means you save money on your health care expenses Funds rollover each year, so you can use you’re the account to save tax-free money for retirement You own the account, even if you leave the District Lower monthly premiums than a traditional health plan

12 Qualified Medical Expenses
The IRS defines expenses that are considered “qualified medical expenses” for HSA/VEBA distributions Expenses must be primarily to treat or prevent a physical or mental defect or illness (HSA Only) If you use HSA funds for expenses beyond what the IRS defines as qualified, you will be subject to income tax on the distribution and an additional 20 percent penalty

13 Examples of qualified medical expenses include:
Most medical care that is subject to your deductible (copays, coinsurance, doctor visits, inpatient or outpatient treatment, etc.) Prescription drugs Over-the-counter drugs, only if you obtain a prescription Insulin (with or without a prescription) Dental and vision care Select insurance premiums COBRA, qualified long-term care insurance, health insurance premiums paid while receiving unemployment benefits, health insurance after you turn 65 except for a Medicare supplemental policy Examples of not considered “qualified medical expenses” include: Insurance premiums (other than the exceptions listed on the previous slide) Over-the-counter drugs (unless a prescription is retained from a physician – insulin is an exception) A full list of qualified medical expenses is available at corphealthsys.com or from the Benefits office

14 Distribution Rules Distributions are tax-free if they are taken for “qualified medical expenses” Accounts can only be used for expenses that are incurred on or after the date the account was established Funds can be used for expenses from a prior year, as long as the expenses incurred on or after the date the account was established

15 Distribution Rules cont.
Distributions can be taken for qualified medical expenses for the following people: The account holder (employee covered by the HDHP) Spouse of account holder (even if not covered by the HDHP) Dependent Children VEBA: To age 26 HSA: Tax Dependents of that individual

16 District #622 HSA/VEBA Vendor
Corporate Health is the third party administrator for the VEBA and HSA accounts.

17 Which plan is a good fit for me?
First let’s make some assumptions about the HDHP for the examples provided: The average office visit costs $110 Remember: Routine Preventative Physicals are covered 100% under all plans Plan has a prescription copay of $8 generic preferred, $16 brand preferred and $32 non preferred; an office visit copay of $25 and a $200 per person deductible (maximum of $400 per family). The Teacher VEBA plan has a deductible of $2,000 per person and a maximum of $4,000 per family. The Paraprofessional VEBA plan has a deductible of $2,400 per person and a maximum of $4,800 per family. The HSA plan has a deductible of $2,500 per person and a maximum of $5,000 per family.

18 Scenario 1: Low HealthCare User-Single HDHP VEBA (Teachers)
Mary is a single, healthy female who takes advantage of preventive care visits. In a typical year, she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs $120 (retail) and is filled twice per year. Plan 2000/4000 VEBA ($1600 VEBA Trust) *Annual premiums $918 $1,078 Office visits $50 $220 Rx drugs $32 $240 Total estimated maximum costs $1,000 $1,538 Reimbursable expenses in VEBA n/a $460 Cost after VEBA reimbursement VEBA Balance $1,140 *Annual premiums based on groups with highest District contribution. Teacher premiums will be adjusted after Open Enrollment based on employee enrollment. The premiums above are preliminary amounts.

19 Scenario 2: High Healthcare User-Family
HDHP VEBA (Teachers) Cindy’s family includes two children under the age of 6 and her husband. During the year there are a total of 15 visits to the doctor and 2 prescriptions per month between all the family members. The prescriptions filled included 12 preferred generic and 12 preferred brand ($1,500 total retail cost). Plan 2000/4000 VEBA Plan *Annual premiums $4,708 $4,066 Office visits $375 $1,650 Rx drugs $288 $1,500 Total estimated maximum costs $5,371 $7,216 Reimbursable expenses in VEBA n/a $3,150 Cost after Employer VEBA reimbursement VEBA Balance $50 *Annual premiums based on groups with highest District contribution. Teacher premiums will be adjusted after Open Enrollment based on employee enrollment. The premiums above are preliminary amounts.

20 Scenario 3: Low HealthCare User-Single HDHP VEBA (Paraprofessional)
Mary is a single, healthy female who takes advantage of preventive care visits. In a typical year, she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs $120 (retail) and is filled twice per year. Plan 2400/4800 VEBA ($1920 VEBA Trust) *Annual premiums $1,172 $1,755 Office visits $50 $220 Rx drugs $32 $240 Total estimated maximum costs $1,254 $2,215 Reimbursable expenses in VEBA n/a $460 Cost after VEBA reimbursement VEBA Balance $1,460

21 Scenario 4: Low Healthcare User-Single HDHP HSA (Clerical, EA, Local 70, Non Units, Principals)
Maggie is a single, healthy female who takes advantage of preventive care visits. In a typical year, she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs $120 (retail) and is filled twice per year. Plan 2500/5000 HSA Plan ($1,127 District Contribution to HSA) *Annual premiums $619 $0^ Office visits $50 $220 Rx drugs $32 $240 Total estimated maximum costs $701 $460 Reimbursable expenses in HSA n/a Cost after HSA reimbursement $0 HSA Balance $667 *Annual premiums based on groups with highest District contribution. ^The HSA premiums will vary based on individual contribution to the HSA account (the higher contribution the higher health premium)

22 Scenario 5: High Healthcare User-Family HDHP HSA (Clerical, EA, Local 70, Non Units, Principals)
Carol’s family includes two children under the age of 6 and her husband. During the year there are a total of 15 visits to the doctor and 2 prescriptions per month between all the family members. The prescriptions filled included 12 preferred generic and 12 preferred brand ($1,500 total retail cost). Plan 2500/5000 HSA Plan ($750 District Contribution to HSA) *Annual premiums $3,908 $0^ Office visits $375 $1,650 Rx drugs $288 $1,500 Total estimated maximum costs $4,571 $3,150 Reimbursable expenses in HSA n/a $750 Cost after HSA reimbursement $2,400 HSA Balance $0 *Annual premiums based on groups with highest District contribution. ^The HSA premiums will vary based on individual contribution to the HSA account (the higher contribution the higher health premium)

23 VEBA Overview

24 Who is Eligible for a VEBA?
Anyone who is covered by the: High Deductible Health Plan, NationalONE $ % (Teachers only) High Deductible Health Plan, NationalONE $ % (Para Professionals only) High Deductible Health Plan, NationalONE $ % (Food Service only)

25 VEBA Contribution Contributions to the VEBA account are set amounts determined by the bargaining units and the District. The contribution amounts can’t be individualized or modified during the year. Teachers Contribution to $2000/$4000 VEBA Plan is 80% of Deductible Single contribution is $1, $500 deposited in VEBA account in July 2013 with deposits of $100 each month thereafter Family contribution is $3, $1000 deposited in VEBA account in July 2013 with deposits of $200 each month thereafter Paraprofessionals Contribution to $2400/$4800 VEBA Plan is 80% of Deductible Single contribution is $1, $576 deposited in VEBA account in July 2013 with deposits of $ each month thereafter Family contribution is $3, $1,152 deposited in VEBA account in July 2013 with deposits of $ each month thereafter Food Service Group continues to have the $1150 VEBA plan and the VEBA contribution will be: Single contribution is $ ($51.43/month) Family contribution is $1, ($137.20/month)

26 VEBA Information The monthly administration fee is $3.09/month and will be deducted quarterly from the VEBA account. Benny Card option Reimbursements are made by completing a claim form, attaching the proper documentation. Typically this is an Explanation of Benefit (EOB) and submitting to Corporate Health Systems (CHS). You can elect to receive your reimbursement funds either by check or direct deposit. You can check your account information via the CHS website (www.corphealthsys.com) Money that remains in your account at the end of the plan year will be rolled into the next plan year after the run-out period has expired In the event of the death of the participant, tax dependents will be able to continue to submit claims for medical expenses until the balance is exhausted

27 BennyCard Benny™ Prepaid Benefits Card for all your eligible VEBA expenses Easy – a simple swipe of the Card makes it hassle free! Automatic – funds are immediately transferred from your VEBA at the time you incur the expense. Convenient – there are no manual claim forms to submit. Simple to track – your current balance is available 24/7 at the web site listed on the back of your Card. Cost to you: $18.00 Annually

28 Health Savings Account Overview

29 Who is Eligible for an HSA?
Anyone who is: Covered by the High Deductible Health Plan, NationalONE $ % Not enrolled in Medicare Not covered under other health insurance* Cannot be covered by any other health insurance that reimburses you for health expenses you incur, unless it is another HSA- qualified HDHP. Not another person’s tax dependent *Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance

30 Eligibility for HSA and Coordination of other Reimbursement Accounts
Flexible Spending Accounts (FSAs) and VEBA accounts may make you ineligible for an HSA unless they are designated as “Limited purpose,” meaning they are limited to dental, vision, and child care. Acceptable VEBA accounts set aside money only for retiree health expenses are suspended To preserve the eligibility for the HSA plan, the District FSA Medical plan will be a “Limited” plan for employees participating on the HDHP HSA. Limited purpose medical FSA is limited to only allow for dental and vision expenses to be reimbursed.

31 Eligibility for HSA for District Employees With VEBA Account
To preserve the eligibility for the HSA plan contributions, your VEBA account will need to be changed: VEBA plan participant can implement a Suspension that will limit eligible expenses to dental and vision only each plan year Election must be made each plan year

32 Eligibility Scenarios -- Acceptable Situations:
Single employee enrolled in HDHP no medical flex no HRA/VEBA limited medical flex limited HRA/VEBA suspended HRA/VEBA not on Medicare Married employee enrolled in HDHP not enrolled in spouse’s medical plan spouse doesn’t have a traditional medical flex spouse doesn’t have an HRA/VEBA spouse has an HRA/VEBA that is limited to spouse’s expenses not enrolled in Medicare Spend Down Approach: Employee elects HDHP and wishes to spend down their HRA/VEBA balance. The first of the month following when the VEBA balance is $0, the participant could establish an HSA account, assuming they are not enrolled in the traditional flex plan or have any other coverage that would make them ineligible for an HSA account.

33 Some scenarios Eligibility Scenarios -- Problem Situations:
Single employee enrolled in non HDHP, doesn’t suspend or limit existing VEBA Gets married, want to enroll in HDHP and HSA. Can’t start HSA as long as HRA/VEBA has funds remaining or until next plan year when the HRA/VEBA can be limited or suspended Single employee enrolled in non HDHP, doesn’t have HRA/VEBA, but elects traditional medical flex Can’t start HSA until next flex plan as flex creates HSA ineligibility Married employee enrolled in non HDHP, doesn’t suspend or limit existing HRA/VEBA Wishes to enroll in HDHP and HSA due to spouse plan change/cost. Married employee enrolled in non HDHP, doesn’t have VEBA, but elects traditional medical flex Some scenarios

34 HSA Contribution Each year, the IRS sets contribution limits
These limits are for the total funds contributed, including company contributions, your contributions and any other contributions You are allowed to contribute the entire year’s limit whenever you first become eligible for the HSA (even if that is in December) However, you must remain eligible for at least 12 months after that date, or you will be subject to taxes and penalties on the amount you contributed 2013 2014 Individual $3,250 $3,300 Family $6,450 $6,550

35 Catch-Up Contributions
For individuals ages 55 and older, the IRS allows additional “catch-up contributions” Eligible individuals may contribute an extra $1,000 for the year (for 2013) This is to help save additional money for retirement

36 Distributions – Age 65-plus
For individuals age 65 and older, HSA distributions can be used for non-qualified medical expenses without facing the 20 percent penalty However, income taxes will apply for non-medical distributions This rule is regardless of whether the individual is enrolled in Medicare

37 Recordkeeping Whenever you use HSA funds to pay for a medical expense, you should keep your receipt Different from the VEBA, you are responsible for demonstrating to the IRS that HSA distributions were for qualified medical expenses If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty

38 District #622 HSA/VEBA Vendor
Corporate Health is the third party administrator collecting the contributions. Corporate Health uses Bancorp. HSA is Interest Bearing Account Investments Available when Balance is $2,500 Investment Transactions Costs Apply Monthly Administration Fee: $3.50 Deducted from your account monthly Online Access: at

39 HSA – Tools to Manage Your Account
You will receive checks and a Benny™ Card so that you can easily access the funds in your account. Corporate Health is the administrator collecting the contributions. Corporate Health uses Bancorp.

40 VSP Vision Plan Vision coverage is bundled with the health election.
Signature Plan Network VSP Network New: Includes retail chain affiliates such as: Costco, Visionworks Frequency Exam/Lenses/Frame 12/12/24 Copayments – Exam/Materials $0/$10 Exam Covered in full Covered Lenses Single Vision, Lined Bifocal and Trifocal, Polycarbonate lenses for Dependents Retail Frame Allowance $150 Elective Contact Lens Allowance (Material copay does not apply) Lens Options AR, Scratch, UV and Color Coatings, Photochromic, mirror, tints and dyes and rimless lenses. Cost-controlled pricing on all others in which members save an average 35-40%

41 Flexible Spending Account
A Flexible Spending Account (FSA) allows you to use pre-tax dollars to pay for eligible health care and dependent day care expenses Flexible Spending enrollment for Medical and Dependent Care is the 12 month period from: July 1, 2013 through June 30, 2014 Maximum Per Calendar Year Health FSA: $2,500 Dependent Care FSA: $5,000 Third Party Administer: Corporate Health Systems

42 What you need to do--Annual Open Enrollment
Health/Vision Plans All groups: If you do not want to make a change to your current coverage, you do not need to do anything; you will automatically be reenrolled for July 1, Current elections will rollover to the new plan year. Add Coverage, Change Plans or Drop Coverage: If you want to make a change to your plan (i.e. move from to the VEBA or HSA) or enroll or drop yourself or your eligible family members, please make your election on SmartBen. 42

43 What you need to do--Annual Open Enrollment
Flexible Spending Account If you want to participate in the FSA medical or dependent care accounts for the July 1, 2013 through June 30, 2014 plan year, you must designate a benefit amount through the online enrollment portal, SmartBen. Previous year’s elections will not rollover. Remember that the Medical Reimbursement will be a “Limited” plan for individuals signing up for the qualified HSA-HDHP CIGNA Dental Plans (EA, Food Service, Paraprofessionals, Part-Time Local 70, Part-Time Clerical) If you want to make a change to your plan (enroll, add or drop yourself or your eligible family members) please make your election on SmartBen. 43

44 Open Enrollment Window
Open Enrollment = Your opportunity to make benefit elections for the plan year Enrollment Dates = May 7th through June 3rd Benefit elections take effect July 1, 2013 May 2013 S M T W Th F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 June 2013 S M T W Th F 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 30 24 25 26 27 28 29

45 Open Enrollment Rules Employees are allowed to add or drop coverage during open enrollment. The only changes allowed after the open enrollment period are for qualified events or status changes. Qualified Events/Status Changes include: 1. Marriage 2. Birth or Adoption of Child 3. Divorce, Legal Separation, Termination of Employment, Reduction of Number of Hours Worked or Death of Spouse (making them ineligible for their employers’ group benefit plan) 4. Loss of coverage under Medicaid or a state child health plan 5. Gaining eligibility for coverage under Medicaid or a state child health plan Employees must notify HR Department within 30 days of qualifying events in items 1, 2 and 3; and within 60 days in items 4 and 5. 45 45

46 Any Questions? District Benefits Office (651) 748-7425
HealthPartners Member (952) or

47 Thank you for your attention!
If you have additional questions about the benefit plans offered by the District, please contact HR.


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