Presentation on theme: "2010-11 OPEN ENROLLMENT OCTOBER 12, 2010. Disclaimer These notes apply to all information contained or presented in this presentation. This presentation."— Presentation transcript:
OPEN ENROLLMENT OCTOBER 12, 2010
Disclaimer These notes apply to all information contained or presented in this presentation. This presentation provides general information only and is not intended as legal advice. In the case of any inconsistencies between the information presented here and the plan document, the plan document prevails. For complete information, please see your plan document.
Agenda Open Enrollment Open Enrollment Medical Benefits HSA Review Plan Examples Sample IRS Forms Other Benefits Questions
Health Care Reform, etc. FSA Changes to Over-the-Counter (OTC) Drugs Dependents to Age 26 (regardless of student status or marriage status) 2011 W-2: Reporting the “Value of Health Care” No taxation consequences
Open Enrollment Overview November 1 st, 2010 Open Enrollment Begins Now Qualifying Events BenefitProvider MedicalBCBSTX: No Changes DentalGuardian: No Changes VisionGuardian: No Changes Short Term Disability LFG: N0 Changes Long Term Disability LFG: No Changes Life/AD&D LFG: No Changes HSA Banking Wells Fargo: No Changes FSA FlexCorp: No Changes
Traditional PPO Copayment (M05) You pay a fixed amount. Insurance pays the rest. The provider is paid in full for the service. In-Network Only Office Visits Prescription Drugs
Deductible Catastrophic Event House hit by lightning Deductible – What you pay before the insurance pays Catastrophic Event Car accident Deductible – What you pay before the insurance pays Catastrophic Event Broken Arm Deductible – What you pay before the insurance pays
Deductible Surgery (Yes, even mole removal!) MRI, CT, Etc. (Big machines = Big Expense) Hospital (In-patient, Out-patient, ER) Out-of-Network (Yep, it’s catastrophic to the insurance company!) Catastrophic Event
PPO Health Insurance Plan BCBSTX M05 BlueChoice Network Plan In-Network Individual / Family Deductible$750 / $2,250 Preventive Care Visits$20 Office Visits$20 Coinsurance80% Prescription Drugs$15/$30/$45 Coinsurance Maximum$3,000/$9,000 Out-of-Pocket Maximum$3,750/ $11,250 REMEMBER: Deductibles are CALENDAR YEAR (January-December)
HDHP/HSA Health Insurance Plan BCBSTX MH1 BlueChoice Network Plan In-Network Individual / Family Deductible$2,500 / $5,000 Wellness (Deductible Waived) 100% Medical Services – Deductible 1 st 100% Coinsurance100% Prescription Drugs – Deductible 1 st 100% Coinsurance MaximumN/A Out-of-Pocket Maximum$2,500 / $5,000 REMEMBER: Deductibles are CALENDAR YEAR (January-December)
Money Saving Ideas Expert Advice Stay In-Network Urgent care vs. Emergency Room Drugs Therapeutic equivalents Target, Wal-Mart Rx plans Ask the Expert! Be a wise consumer!
Health Savings Account (HSA) Everything covered under your health plan goes towards the deductible first. There are no copayments for office visits or prescription drugs. Wellness visits, like your annual exam and immunizations are covered at 100% and the deductible is waived, as long as you stay in-network. BCBSTX health insurance plan. HSA Bank account that covers qualified medical expenses.
How to use your HSA Health Savings Account Solution Health Savings Account Contribute Pre-Tax Invest Tax-Free Accumulate Tax-Free Remain Tax-Free Qualified Expenses IRS 213 (d) LTC & COBRA High Deductible Health Plan
HSA Eligibility & Maximums Must be enrolled in a High Deductible Health Plan (HDHP) Enrollment in a spouse’s Medical FSA will disqualify you, unless it is a Limited Purpose FSA. May not be enrolled in Medicaid or Medicare. Non-qualified expenses are taxed as income, plus a 10% penalty for 2010 and 20% penalty for Establish a HSA Bank Account Fund the account to pay for qualified expenses (medical, dental, vision, etc.) Tax deductible on annual return or Pre-Tax from your paycheck. HSA Contribution Maximums Employee Only $3,050 (2010 & 2011 Calendar year) Family Coverage $6,150 (2010 & 2011 Calendar year) Catch-Up Contributions Age 55 and above $1,000 per year
Medical Premiums MonthlyPPOHSA Employee Only $0.00 Employee + Spouse $0.00 Employee + Child(ren) $0.00 Employee + Family $0.00
HSA Contributions AnnualSTRATFOR IRS Calendar Year Maximum Employee Only$1,200$3,050 EE + Spouse$2,400$6,150 EE + Child(ren)$2,400$6,150 EE + Family$2,400$6,150 Note: The IRS calendar year maximum above is for January 1 to December 31. Employees can choose to contribute to their HSA in on a pre-tax basis from their paychecks. Contributions can be in any frequency and amount (as long as you do not exceed the IRS Calendar Year Maximum).
Employee Only Example #1 Service/Negotiated Price HSAPPO Well Check: $300$0$20 PCP: 3 x $75$225$60 Specialist: 2 x $150$300$40 Generic Rx: 2 x $25$50$30 Brand Rx: 2 x $125$250$60 Annual Premium$0 TOTAL Expenses$825$210 STRATFOR HSA Contribution $1,200N/A Total EE Cost*$0$210 *Employee carries over $375 in HSA funds to the next year
Employee Only Example #2 Service/Negotiated Price HSAPPO Well Check: $300$0$20 PCP: 3 x $75$225$60 Specialist: 4 x $150$600$80 Generic Rx: 4 x $25$100$60 Brand Rx: 6 x $125$750$180 Surgery: $25,000$825*$3,750 Annual Premium$0 TOTAL Expenses$2,500$4,150 STRATFOR HSA Contribution $1,200N/A Total EE Cost$1,300$3,070 which employee met the individual deductible and 100% coverage begins.
Employee Only Example: Tax Savings HSA Salary (single)$60,000 Salary (joint married)$100,000 Tax Bracket (single filer)25% Tax Bracket (joint filer)25% Example #1 OOP$1,300 Maximum HSA Contribution$1,850 Tax Savings Example #1$325 Tax Savings Example #2$462
Family Example #3 Service/Negotiated Price HSAPPO Well Check: 4 x $300$0$80 PCP: 6 x $75$450$120 Specialist: 4 x $150$600$80 Generic Rx: 6 x $25$150$90 Brand Rx: 4 x $125$500$120 Annual Premium$0 TOTAL Expenses$1,700$490 STRATFOR HSA Contribution $2,400N/A Total EE Cost*$0$490 *Employee carries over $700 in HSA funds to the next year
Family Example #4 Service/Negotiated Price HSAPPO Well Check: 4 x $300$0$80 PCP: 6 x $75$450$120 Specialist: 4 x $150$600$80 Generic Rx: 6 x $25$150$90 Brand Rx: 4 x $125$500$120 Surgery: $25,000$2,125*$3,750 ER Visit: $2,000$1,175**$1,080 Annual Premium$0 TOTAL Expenses$5,000$4,150 STRATFOR HSA Contribution $2,400N/A Total EE Cost$2,600$3,070 which employee met the individual deductible and 100% coverage begins. which family deductible met and 100% coverage begins for everyone.
Family Example: Tax Savings HSA Salary (joint married)$100,000 Tax Bracket (joint filer)25% Example #1 OOP$2,600 Maximum HSA Contribution$3,750 Tax Savings Example #3$650 Tax Savings Example #4$938
Why Does the HSA Makes Sense Are you over-insured? How do you use your benefits? IRA / 401K for health expenses More control over expense Tax savings for future medical expenses Long Term Care / COBRA
Sample: Individual 1040 Tax Return
Sample: IRS Form 8889
ID/Debit Cards BCBSTX ID Card If lost or never received: Log onto: Enter your username/password Print temporary ID card Or call: Or call CLS: / HSA Banking Account Inquiries https://healthbenefits.wellsfargo.com https://healthbenefits.wellsfargo.com
Deductible Credit REMEMBER: Medical deductibles run on a calendar year (January- December). If you elect to change medical plans, any deductible you have satisfied as of January 1, 2010, will carry forward and be credited under your new medical election for the remainder of 2010 (9/1- 12/31). All deductibles will reset back to $0 on January 1, 2011 (unless you qualify for 4 th qtr carryover on the PPO).
Guardian Dental Plan Value PlanNAP Plan Preventive 100% No deductible Not included in CYM Basic 100% After $50 deductible Major 60% After $50 deductible Ortho (child only) 50% $1,500 lifetime max Calendar Year Maximum (CYM) $1,500 Per person on the plan Preventive 100% No deductible Not included in CYM Basic 80% After $50 deductible Major 50% After $50 deductible Ortho (child only) 50% $1,500 lifetime max Calendar Year Maximum (CYM) $1,500 Per person on the plan Out-of-Network Charges are reimbursed at a lower negotiated fee. Balance bill will be higher when using Out-of-Network providers. Out-of-Network Charges are reimbursed at the 90th% of UCR. Balance bill will be lower when using Out-of-Network providers.
Dental Reminders Preventive Care excluded from CYM Dependent Coverage Up to age 26 if F/T student Rollover of Unused Benefit $350 per year/per person Maximum of $1,250 per person Dual Option Plan Same Price Regardless of Plan Selection National PPO Network 70,000+ Providers – DentalGuard Preferred
How To Find a Guardian Provider 1. Choose Provider Online Search 2. Click “FIND A DENTIST” 3. Select Your Dental Plan = PPO 4. Enter Search Criteria & Click Continue 5. Select Your Dental Network = DentalGuard Preferred 6. Select Type of Dentist = General or Specialist 7. Click Continue 8. Results Will Be Displayed on the Following Page 9. You Can Choose to Print Results or Have Them ed
Guardian Vision Insurance ServiceIn-NetworkOut-of-Network Exam$10 copay Reimbursement Varies by Services Received Single Vision Lenses$10 copay Bifocal Lenses$10 copay Trifocal Lenses$10 copay Lenticular Lenses$10 copay Frames $120 allowance + 20% off balance over allowance Elective Contacts*Up to $120 (copay waived) VSP Networkwww.glic.com Frequency12 month exam / 12 month lenses / 24 month frames *Contact lenses are in lieu of glasses.
How To Find a Guardian Provider 1. Choose Provider Online Search 2. Click “FIND A VISION PROVIDER” 3. Select Your Vision Plan = VSP 4. Enter Search Criteria & Click Continue 5. Enter Additional Preferences (or Skip This Step) 6. Click Continue 7. Results Will Be Displayed on the Following Page 8. You Can Choose to Print Results or Have Them ed
Guardian Premiums MonthlyDentalVision Employee Only $0.00 Employee + Spouse $0.00 Employee + Child(ren) $0.00 Employee + Family $0.00
Short Term Long Term LFG Life and Disability Plans Employer Paid = Taxable Benefit Benefit %60% Weekly Max$2,500 Benefit Duration13 weeks Elimination Period 0 days/7 days Accident/Illness Gross Up = Tax-Free Benefit Benefit %60% Monthly Max$10,000 Elimination Period90 Days Benefit DurationSSNRA Own Occupation2 Years Group Life/AD&D Employer Paid Life1x Salary to $250,000 AD&D1x Salary to $250,000
LFG Voluntary Life Plan Employee Paid EmployeeIncrements of $10k EE Maximum5x Salary or $300k EE Guarantee Issue$80k* SpouseIncrements of $5k SP Maximum50% of EE or $100k SP Guarantee Issue50% of EE or $30k* Child(ren)$10,000** * Guarantee Issue (GI) will only apply to NEW employees. If you did not enroll when first offered, you will be required to answer medical questions before you are approved for any amount – GI does not apply. ** Child coverage is up to age 19 or 25 if a full-time student.
Section 125 Plan/FSA Maximum Annual Election Premium Only PlanMedical, Dental and Vision Medical Expenses*$1,500 Dependent Daycare$5,000 If you elect the HSA medical plan, you may only use the Section 125 plan for dental, vision and dependent daycare expenses. Effective January 1, 2011, OTC items are no longer considered to be an eligible expense under the plan.
CLS | Partners Service Support Reliable Guidance Assistance Consistent Dependable ALL ENROLLMENT/CHANGE FORMS ARE DUE BACK BY: October 15, 2010 RETURN FORMS TO: Leticia Pursel