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 ClinicHigh Deductible Health PlanVEBA OverviewHealth Savings Account OverviewPlan Comparison ScenariosVSP – Vision Service PlanFlexible Spending AccountAnnual 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 RatesYear 2 (12-13): 7% Overall Rate Cap to Rates—Overall increase was 5.5%Year 3 (13-14): 8% Overall Rate Cap to RatesJuly 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 ClinicJourneyWell will continue to be a part of the District benefit plan
4 JourneyWellIf 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, 2013The Preferred Benefit$200-$25: Differential of $20 on the office visit copayHDHP VEBA and HSA: Differential of $250 on the deductibleAnnual Program begins again July 1, 2013 through March 31, 2014, effective July 1, 2014Employees and covered Spouses needed to complete the requirements to qualify for the preferred benefitMeetings to be held in all buildings in the Fall
5 Appointment Line 952-967-7481 or www.healthpartners.com/mychart ISD 622 ClinicScheduled to Open Mid-June & Open House at the end of MayHoursMonday, Wednesday and Friday: 6:00am-2:00pmTuesday and Thursday: 10:00am-6:00pmPrivate and ConfidentialStaffed by Physician’s AssistantOn Site PharmacyAvailable for employee and their dependents covered under the ISD 622 HealthPartners health insurance who is 18 months and olderAppointment Line or
6 ISD 622 ClinicPreventions, Screening, WellnessAnnual physicalsCamp physicalsBlood PressureCholesterolNutritionStress ManagementSmoking CessationsConditionsMinor illnessEar infectionsSinus infectionsMinor skin infectionsHeartburnStomach problemsPink EyeStyesMinor injuriesMuscle strainsJoint pain and sprainsMinor burnsCuts and simple lacerationsEmployee Cost:$0 office visit copay and $0 prescriptions copayHSA Participants Only: $40 office visit including preventative prescriptionsdue to IRS regulationsAppointment Line or
7 District 622 Health Plan Offerings In-Network BenefitsNationalOneNationalOne 2000/4000 VEBA*NationalOne 2400/4800 VEBA*NationalOne 2500/5000 HDHP-HSAAvailable to:ALL UnitsTeachersParaprofessionalsClerical, Education Assistants, Local 70, Non Units, PrincipalsDeductible$200 individual$600 family$2,000 individual$4,000 family$2,400 individual$4,800 family$2,500 individual$5,000 familyMedical Out-of-pocket Maximum$500 individual$1,000 familyPrescription Out-of-pocket Maximum$500 per person$750 per familyCombined with Medical Out-of-Pocket MaximumLifetime maximumUnlimitedPreventive health care100% coverageOffice VisitsUrgent Care$25 copay100% coverage after deductibleConvenience 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 OfferingsNationalOneNationalOne 2000/4000 VEBANationalOne 2400/4800 VEBANationalOne 2500/5000 HDHP-HSAInpatient, Outpatient hospital, Ambulance100% after deductibleEmergency Room$75 copayDurable medical equipmentHome health care80% after deductibleRetail pharmacy:-- Generic preferred-- Brand preferred-- Non-preferred34 day supply/100 units$8 copay$16 copay$32 copay31 day supplyMail order pharmacy2 copays for a 90 day supplyProvider network and drug formulary the same for all plans8
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 HealthPartners2. 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 account5. You pay the doctor(VEBA)
10 What is an HSA and VEBA?Both are accounts that you can use to pay medical expensesMust 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 accountContributionsHSA—Both you and your employer can contribute fundsVEBA—Only the employer can contribute funds
11 Benefits of an HSA or VEBA Tax advantage means you save money on your health care expensesFunds rollover each year, so you can use you’re the account to save tax-free money for retirementYou own the account, even if you leave the DistrictLower monthly premiums than a traditional health plan
12 Qualified Medical Expenses The IRS defines expenses that are considered “qualified medical expenses” for HSA/VEBA distributionsExpenses 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 drugsOver-the-counter drugs, only if you obtain a prescriptionInsulin (with or without a prescription)Dental and vision careSelect insurance premiumsCOBRA, qualified long-term care insurance, health insurance premiums paid while receiving unemployment benefits, health insurance after you turn 65 except for a Medicare supplemental policyExamples 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 RulesDistributions 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 establishedFunds 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 ChildrenVEBA: To age 26HSA: 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 $110Remember:Routine Preventative Physicals are covered 100% under all plansPlan 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.Plan2000/4000 VEBA ($1600 VEBA Trust)*Annual premiums$918$1,078Office visits$50$220Rx drugs$32$240Total estimated maximum costs$1,000$1,538Reimbursable expenses in VEBAn/a$460Cost after VEBA reimbursementVEBA 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).Plan2000/4000VEBA Plan*Annual premiums$4,708$4,066Office visits$375$1,650Rx drugs$288$1,500Total estimated maximum costs$5,371$7,216Reimbursable expenses in VEBAn/a$3,150Cost after Employer VEBA reimbursementVEBA 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.Plan2400/4800 VEBA ($1920 VEBA Trust)*Annual premiums$1,172$1,755Office visits$50$220Rx drugs$32$240Total estimated maximum costs$1,254$2,215Reimbursable expenses in VEBAn/a$460Cost after VEBA reimbursementVEBA 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.Plan2500/5000 HSA Plan($1,127 DistrictContribution to HSA)*Annual premiums$619$0^Office visits$50$220Rx drugs$32$240Total estimated maximum costs$701$460Reimbursable expenses in HSAn/aCost after HSA reimbursement$0HSA 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).Plan2500/5000 HSA Plan($750 DistrictContribution to HSA)*Annual premiums$3,908$0^Office visits$375$1,650Rx drugs$288$1,500Total estimated maximum costs$4,571$3,150Reimbursable expenses in HSAn/a$750Cost after HSA reimbursement$2,400HSA 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)
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 ContributionContributions 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.TeachersContribution to $2000/$4000 VEBA Plan is 80% of DeductibleSingle contribution is $1, $500 deposited in VEBA account in July 2013 with deposits of $100 each month thereafterFamily contribution is $3, $1000 deposited in VEBA account in July 2013 with deposits of $200 each month thereafterParaprofessionalsContribution to $2400/$4800 VEBA Plan is 80% of DeductibleSingle contribution is $1, $576 deposited in VEBA account in July 2013 with deposits of $ each month thereafterFamily contribution is $3, $1,152 deposited in VEBA account in July 2013 with deposits of $ each month thereafterFood 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 InformationThe monthly administration fee is $3.09/month and will be deducted quarterly from the VEBA account.Benny Card optionReimbursements 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 expiredIn 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 BennyCardBenny™ Prepaid Benefits Card for all your eligible VEBA expensesEasy – 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
29 Who is Eligible for an HSA? Anyone who is:Covered by the High Deductible Health Plan, NationalONE $ %Not enrolled in MedicareNot 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 accountsset aside money only for retiree health expensesare suspendedTo 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 yearElection must be made each plan year
32 Eligibility Scenarios -- Acceptable Situations: Single employee enrolled in HDHPno medical flexno HRA/VEBAlimited medical flexlimited HRA/VEBAsuspended HRA/VEBAnot on MedicareMarried employee enrolled in HDHPnot enrolled in spouse’s medical planspouse doesn’t have a traditional medical flexspouse doesn’t have an HRA/VEBAspouse has an HRA/VEBA that is limited to spouse’s expensesnot enrolled in MedicareSpend 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 VEBAGets 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 suspendedSingle employee enrolled in non HDHP, doesn’t have HRA/VEBA, but elects traditional medical flexCan’t start HSA until next flex plan as flex creates HSA ineligibilityMarried employee enrolled in non HDHP, doesn’t suspend or limit existing HRA/VEBAWishes 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 flexSome 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 contributionsYou 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 contributed20132014Individual$3,250$3,300Family$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 penaltyHowever, income taxes will apply for non-medical distributionsThis rule is regardless of whether the individual is enrolled in Medicare
37 RecordkeepingWhenever you use HSA funds to pay for a medical expense, you should keep your receiptDifferent from the VEBA, you are responsible for demonstrating to the IRS that HSA distributions were for qualified medical expensesIf 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 AccountInvestments Available when Balance is $2,500Investment Transactions Costs ApplyMonthly Administration Fee: $3.50Deducted from your account monthlyOnline 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 PlanNetworkVSP NetworkNew: Includes retail chain affiliates such as:Costco, VisionworksFrequency Exam/Lenses/Frame12/12/24Copayments – Exam/Materials$0/$10ExamCovered in fullCovered LensesSingle Vision, Lined Bifocal and Trifocal, Polycarbonate lenses for DependentsRetail Frame Allowance$150Elective Contact Lens Allowance(Material copay does not apply)Lens OptionsAR, 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 expensesFlexible Spending enrollment for Medical and Dependent Care is the 12 month period from:July 1, 2013 through June 30, 2014Maximum Per Calendar YearHealth FSA: $2,500Dependent Care FSA: $5,000Third Party Administer: Corporate Health Systems
42 What you need to do--Annual Open Enrollment Health/Vision PlansAll 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 AccountIf 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-HDHPCIGNA 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 yearEnrollment Dates = May 7th through June 3rdBenefit elections take effect July 1, 2013May 2013SMTWThF12345678910111213141516171819202122232425262728293031June 2013SMTWThF123456789101112131415161718192021222330242526272829
45 Open Enrollment RulesEmployees 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. Marriage2. Birth or Adoption of Child3. Divorce, Legal Separation, Termination of Employment,Reduction of Number of Hours Worked or Death ofSpouse (making them ineligible for their employers’group benefit plan)4. Loss of coverage under Medicaid or a state child health plan5. Gaining eligibility for coverage under Medicaid or a state childhealth planEmployees must notify HR Department within 30 days of qualifying events in items 1, 2 and 3; and within 60 days in items 4 and 5.4545
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.