Presentation on theme: "1 2012: Enrollment Presentation. 2 Costs of Healthcare U.S. Renal Care costs are expected to average $8,918 per employee per year in 2011. At this rate,"— Presentation transcript:
1 2012: Enrollment Presentation
2 Costs of Healthcare U.S. Renal Care costs are expected to average $8,918 per employee per year in At this rate, our costs will almost double in the next 5 years. This is simply not sustainable.
3 Costs of Healthcare Nearly 1 in 3 adults has high blood pressure and does not know it Chronic diseases related to lifestyle or personal behavior account for 87% of total healthcare spending Heart disease is the #1 killer in the United States Tobacco use continues to be the leading cause of preventable death in the U.S. and can lead to serious illness, disability and decreased quality of life An estimated 66% of U.S. adults are either overweight or obese U.S. Renal Care is very interested in the health and well- being of its employees which is why we are investing in programs to keep you healthy and better manage chronic conditions.
4 Whats New in 2012? General: Spouses who have access to employer sponsored group coverage elsewhere are no longer allowed to participate in the USRC medical plans – regardless of the price or quality of the other coverage. A spousal affidavit will be required to enroll a spouse in a USRC medical plan USRC strives to keep healthcare costs as low as possible for its employees. Historically, spouses have accounted for 18% of our medical claims and one-half of our large claims.
5 Whats New in 2012? Medical: Greater emphasis on wellness and chronic condition management A spousal affidavit will be required to enroll a spouse in a USRC medical plan Pharmacy Tobacco cessation drugs will be moved to Tier 1 of the formulary USRC will be launching additional wellness programs during 2012 so please watch your mailbox!
6 Benefit Costs – Who Pays for What? BenefitWho Pays?Premium Taxation MedicalU.S. Renal Care & YouPre-Tax DentalU.S. Renal Care & YouPre-Tax VisionYouPre-Tax Basic Life InsuranceU.S. Renal CarePre-Tax* Supplemental Life and AD&D Insurance YouPost-Tax Employee Assistance ProgramU.S. Renal CareN/A Short-Term DisabilityU.S. Renal Care & YouEE Portion – Post-Tax USRC Portion – Pre-Tax Long-Term DisabilityU.S. Renal CarePre-Tax Flexible Spending AccountsYouPre-Tax *Premium for coverage amounts over $50,000 are shown as imputed income on your W2
7 Medical Benefits U.S. Renal Care will offer two medical plans through Aetna POS II – traditional network-based plan that allows members to choose any healthcare provider POS II with Health Savings Account Plan – a high-deductible health plan with the added benefit of a Health Savings Account (HSA) Aetna BenefitsPOS II In Network POS II w/ HSA In Network Annual Health Savings Account Single Family N/A $500 $1,000 Annual Deductible Single Family $1,000 $3,000 $2,000 $4,000 Out-of-Pocket Maximum Single Family $3,000 $9,000 $4,000 $8,000 Office Visit PCP Specialist $30 $40 80% after deductible
8 POS II Plan A POS plan uses a network of providers A lower level of coverage is provided for care received outside the network No primary care physician referral required to visit specialist Copay and coinsurance This plan offers increased benefits but costs more than the POS with HSA plan
9 POS II Plan – Consider This… Of the employees currently enrolled in the POS II plan single coverage Only 31% have reached single deductible ($1,000) Only 39% have paid $500 or greater toward their deductible 27% have paid less than $100 of the $1,000 deductible Of the employees currently enrolled in the POS II plan family coverage Only 3 people have reached the family deductible ($3,000) Only 7% have paid $1,500 or greater toward their deductible 42% have paid less than $100 of the $3,000 deductible Fast Fact: You should consider your annualized contributions when selecting the plan you enroll. If you are not meeting the deductible in the POS II plan, you may less out of pocket in the HSA plan. *data thru September 30, 2011 in-network benefits only.
10 Medical Benefits - HSA Give employees access to a fund they can use for their current or future healthcare expenses Employees become better informed and more involved in making decisions about their own care Employees will spend the money wisely Unused money will rollover and grow over time Money in your fund earns interest Your account is portable – if you change health benefits, insurance plans or jobs, your HSA goes with you Can be funded by the employer, employee or both Federal government mandates the maximum amount that can be contributed each year Money is put in fund pre-tax USRC funds: $500 a year for individual; or $1,000 a year for family You may contribute up to the 2012 maximum: $3,100 individual; or $6,250 family
11 Medical Benefits - HSA Amount that needs to be satisfied before health coverage begins Protects you from high costs Coinsurance similar to traditional plans Out-of-pocket maximums are in place for added peace of mind Option to reimburse from this account Receive tax-free interest earnings while your money remains in your HSA If HSA funds are used for eligible expenses, then withdrawals are tax free. Health Coverage (ex. 80% In- Network) HSA Fund ($500 Single / $1,000 Family) Annual Deductible (ex: $2,000 Single / $4,000 Family) Preventive Care As you go up the stairs of the health care house, youll incur expenses that go towards your deductible. Once you reach upstairs, or your deductible, then your 80% health coverage is applied. You can use your HSA to save tax dollars on medical expenses you incur. Money in your HSA can also be invested! Preventive Care covered 100% (ex: Annual Physical)
12 Medical Plans Contributions POS IIPOS II w/ HSA Employee Bi-Weekly Cost USRCs Bi-Weekly Cost Total Bi- Weekly Cost Employee Bi-Weekly Cost USRCs Bi- Weekly Cost Total Bi- Weekly Cost Employee Only$40.39$201.08$241.47$29.76$191.41$ Employee + Spouse $140.55$389.99$530.53$82.32$403.62$ Employee + Child(ren) $122.47$371.24$493.72$72.40$379.82$ Family$226.41$556.31$782.72$127.71$589.22$ Per Pay Period Contributions
13 Medical Plans Contributions Plan Comparison Calculator ExponentHR Plan Information Website Links Select Calculator
14 Prescription Drugs Prescription drug coverage is included with the medical plans offered U.S. Renal Care encourages all employees to save money by selecting generics when available 76% of brand name drugs have a therapeutic generic equivalent Generic medications are a safe and cost-effective alternative to brand-name drugs Ask your doctor for a generic brand of the drug prescribed If you must use a brand-name drug, ask your doctor for a drug that is a preferred brand Aetna BenefitsPOS II In Network POS II w/ HSA In Network Deductible Retail (30 Day Supply) Generic Brand Non Formulary No Deductible $15 $35 $50 After Deductible $10 $30 $50 Deductible Mail (90 Day Supply) Generic Brand Non Formulary No Deductible $45 $105 $150 After Deductible $20 $60 $100
15 Medical Plans: Condition Management The Aetna medical plans include access to Health Connections – a condition management program to help employees manage certain chronic conditions The program provides access to a nurse who provides one-on-one education and support Conditions include: Vascular:Diabetes, congestive heart failure, coronary artery disease, hypertension, hyperlipidemia, Pulmonary:Asthma, COPD Cancer:Breast, lung, prostate, colorectal, lymphoma / leukemia GastrointestinalGastro esophageal reflux disease (GERD), peptic ulcer disease, chronic hepatitis, inflammatory bowel disease Orthopedic / rheumatologic: Osteoporosis, rheumatoid arthritis NeurologicalGeriatrics, migraines, seizure disorders, Parkinson's Other:Chronic Kidney disease, end stage renal, cystic fibrosis, HIV, chronic low back pain, sickle cell anemia, weight management
16 Dental Benefits U.S. Renal Care offers two PPO dental benefit plans through Aetna The PPO buy-up plan includes adult and child orthodontia Aetna BenefitsPPO BasicPPO Buy-Up with Adult and Child Orthodontia Annual Deductible (for Basic & Major) Single Family $50 $150 $50 $150 Services Diagnostic and Preventive Basic Major Orthodontia 100% 80% 50% Not Covered 100% 80% 50% Annual Maximum$1,500 Orthodontia Lifetime MaximumNot Covered$1,500 Employee Contributions (Per Pay Period) Employee Only Employee + Spouse Employee + Child(ren) Family $6.12 $12.25 $13.78 $19.91 $8.78 $17.55 $19.74 $28.52
17 Vision Benefits U.S. Renal Care offers a vision plan through VSP You pay 100% of the costs for vision care VSP BenefitsVision Plan In-Network Frequency Limitations Eye Exams Lenses Frames Contact Lenses 1 per 12 Months 1 per 24 Months Eye Exam Copay$10 Materials Allowance Frames Contacts $100 Allowance $115 Allowance Employee Contributions (Per Pay Period) Employee Only Employee + Spouse Employee + Child(ren) Family $1.96 $3.91 $4.19 $6.69
18 Disability Benefits U.S. Renal Care offers short and long-term disability through MetLife Short-term disability benefits are paid 50% by U.S. Renal Care and 50% by you Long-term disability benefits are provided by U.S. Renal Care at no cost to you MetLifeShort Term Disability Benefit Percentage60% Elimination Period (Accident & Sickness)14 Days Weekly Maximum$1,000 Benefit Duration11 Weeks Monthly Employee Contributions (Per $10 Weekly Benefit) $0.123 MetLifeLong Term Disability Benefit Percentage60% Elimination Period90 Days Monthly Maximum$10,000 Employee ContributionsNone – Paid by U.S. Renal Care
19 Basic Life and AD&D Benefits U.S. Renal Care offers Basic Life and Accidental Death and Dismemberment (AD&D) insurance through Prudential Basic Life and AD&D benefits are provided by U.S. Renal Care at no cost to you PrudentialBasic Life and AD&D Basic Life and AD&D Coverage1 Times Annual Earnings Maximum$300,000 Employee ContributionsNone – Paid by U.S. Renal Care
20 Supplemental Life and AD&D Benefits U.S. Renal Care offers Supplemental Life and Accidental Death and Dismemberment (AD&D) insurance through Prudential Supplemental Life and AD&D benefits are paid for by you PrudentialSupplemental Life and AD&D Supplemental Life Benefit Amount Employee Spouse Child(ren) $10,000 Increments to a maximum of $300,000 or 5 times salary $5,000 Increments to a maximum of $150,000, not to exceed 50% of employees amount $1,000 increments to a maximum of $10,000 not to exceed 10% of employees amount* Guarantee Issue Employee Spouse Child(ren) Lesser of $100,000 or 3 times basic annual earnings $25,000 $10,000 Annual Enrollments Increases Employee Spouse Child(ren) $10,000 Increments to a maximum of $40,000** All increases subject to EOI All amount Guaranteed Issue Supplemental AD&D Amount Employee Spouse Child(ren) Same as Supplemental Life Varies based on Employee amount Employee ContributionsContributions are based on age. Please refer to benefits guide for pricing. *Amounts may be lower for children younger than 6 months. **During the annual enrollment period, current employees who previously waived coverage or those currently enrolled may select/increase coverage as noted w/o EOI, up to the lifetime maximum without regard to the GI limit. Employees previously denied due to unsatisfactory EOI remain late entrants and EOI will be required from first dollar.
21 Flexible Spending Accounts Flexible Spending Account (FSA) administration will be provided by Discovery Benefits USRC offers two types of FSA accounts: Healthcare* & Dependent Care Healthcare Flexible Spending AccountDependent Care Flexible Spending Account Annual Maximum$2,000$5,000 Types of ExpensesMedical, dental, vision copays and deductibles, hearing aides, eye glasses, contact lens Day care, preschool, after school programs, elder care * Participants enrolled in the POS w/ HSA plan are eligible to enroll in the Limited Health Care FSA which can be used once you meet that plans medical deductible. REMEMBER: As part of Health Care Reform, over-the-counter medications (excluding insulin) purchased January 1, 2011 or after are ineligible for reimbursement under the Healthcare Spending Account unless prescribed by your physician. Doctors prescription or letter of medical necessity must be submitted with itemized receipt at the time of the claim.
22 Employee Assistance Program (EAP) U.S. Renal Care offers an Employee Assistance Program (EAP) through Prudential as part of the Basic Life offering The program is available to all full-time employees and their family members at no cost Services include: up to 3 telephonic calls per issue for: Personal Counseling: depression, marital and family conflicts, job pressure, stress / anxiety, grief, loss, etc. Legal Guidance: divorce and family law, bankruptcy, criminal actions, civil suits, real estate transactions, contracts, etc. Financial Advisors: saving for college, getting out of debt, retirement planning, estate planning, tax questions, etc. The EAP is 100% confidential. U.S. Renal Care will not receive any specific detail regarding who is accessing the program or why.
23 How You Can Manage Costs Proactively manage your health If you have a chronic condition, enroll in the Health Connections program Purchase generic drugs when possible Consider where you seek treatment EventAverage Cost Primary care physician visit$117 Specialist (physician) visit$137 Urgent care*$164 Convenience care clinic visit**$74 Emergency room visit$798 Aetna NurselineFree * Urgent care clinics are care centers primarily used to treat patients who have an injury or illness that requires immediate care, but is not serious enough to warrant a visit to an emergency room. ** Convenience care clinics are health care clinics located in retail stores, supermarkets and pharmacies that treat uncomplicated minor illnesses and provide preventative health care services.
24 What To Do Next? Open Enrollment runs from 11/14/2011 – 11/28/2011 For additional information, please visit ExponentHR Choose the Benefits button Click on 2012 Benefits Guide Print if desired For detailed plan designs, please visit ExponentHR Choose the Benefits button Click on Plan Information Click on drop down and choose appropriate plan Print if desired Enroll via ExponentHR Directions on page 15 of the Benefits Guide See your Administrator or call the Benefits Department for more information Visit AetnaNavigator.com for other tools to help manage your health Drug & Hospital comparison tools Cost estimators Online health education tools
25 The information contained in this presentation is intended as an overview. If there are any differences between this information and the official Plan Documents, the Plan Documents will govern.