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Employee Benefits July 1, 2014 Janice L. Wavra Corporate Benefits Specialist.

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Presentation on theme: "Employee Benefits July 1, 2014 Janice L. Wavra Corporate Benefits Specialist."— Presentation transcript:

1 Employee Benefits July 1, 2014 Janice L. Wavra Corporate Benefits Specialist

2 Agenda  What Does HRA Mean To Me?  Group Health Insurance Plan Options  Health Reimbursement Arrangement Plans  Cost Savings Ideas  Group Dental Insurance Plan  Flexible Spending Account Plan (FSA)  Claims Filing Deadlines  Open Enrollment  Recap & Questions

3 The Insurance Center  Locally Owned, Established in 1960  Located at 701 Sand Lake Road, Onalaska WI Your Experienced Service Team:  Janice Wavra (22 years)  Kim Ness (19 years)  Nancy Silbaugh (28 years)  Stacy Sila (16 years)  Brenda Manke (17 years)

4 What Does “HRA” Mean to Me?  Health Reimbursement Arrangement Plan HRA Plan #1: Co-Insurance Plan HRA Plan #2: Wellness Incentive Plan  Health Risk Assessment Healics

5 Health Insurance Plan Options Note: Deductible Year: July 1, 2014 – June 30, 2015

6 6 Sample “Copay” Claim – Plan #1 “Status Quo” 1 st Claim of New Plan Year: In-Network Provider  Office Visit: $158  Diagnosis Test/X-Ray: $500 Claim Processed:  Office Visit: $25 Copay applied to Maximum Out-of-Pocket  Office Visit balance of $133 and Diagnosis Test/X-Ray claim of $500 applied to the Deductible, with balance applied to Co-Insurance. Who Pays:  Employee pays $25 Office Visit Copay  Employee pays $500 in Deductible expenses  Health plan pays $ (90%) in Co-Insurance expenses  HRA plan pays $13.30 (10%) in Co-Insurance expenses

7 7 Sample “Copay” Claim – Plan #1 “Status Quo” 1 st Claim After Max Out-of-Pocket Met: In-Network Provider  Deductible Met: $500  Co-Insurance: 90%  Maximum Out-of-Pocket Met: $1,000 ($250 paid by the District’s HRA Plan) Claim After Reaching $1,000 Maximum Out-of-Pocket:  Office Visit: $158  Diagnosis Test/X-Ray: $800 Claim Processed:  Office Visit Copay of $25, applied to the Additional $1,000 out-of- pocket maximum (copays only)  Balance of Office Visit & Diagnosis Test/X-Ray paid at 100%

8 Health Plan #1: What is My Maximum Out-of-Pocket Exposure? Health Plan In-Network HRA PaysEmployee Pays Deductible ** $500 Single $1,000 Family $0 Single $0 Family $500 Single $1,000 Family Coinsurance 90% $500 Single $1,000 Family $250 Single $500 Family $250 Single $500 Family Maximum Out-of- Pocket $1,000 Single $2,000 Family $250 Single $500 Family $750 Single $1,500 Family Maximum Out-of- Pocket Copays ONLY $1,000 Single $2,000 Family $0 Single $0 Family $1,000 Single $2,000 Family Note: Deductible Year: July 1, 2014 – June 30, 2015

9 Health Plan #2: What is My Maximum Out-of-Pocket Exposure? Health Plan In-Network HRA PaysEmployee Pays Deductible ** $500 Single $1,000 Family $0 Single $0 Family $500 Single $1,000 Family Coinsurance 90% $1,000 Single $2,000 Family $250 Single $500 Family $750 Single $1,500 Family Maximum Out-of- Pocket $1,500 Single $3,000 Family $250 Single $500 Family $1,250 Single $2,500 Family Maximum Out-of- Pocket Copays ONLY $1,000 Single $2,000 Family $0 Single $0 Family $1,000 Single $2,000 Family Note: Deductible Year: July 1, 2014 – June 30, 2015

10 Monthly Premiums Full-Time Employees  Plan #1 “Status Quo” Single: $ Family: $  Plan #2: “Reduced Premium” Single: $ Family: $  Premium Savings Between Plan #1 vs. Plan #2 Single: $89.52/month = $1,074.24/annual Family: $202.82/month = $2,433.84/annual

11 HRA Plan #1 Co-Insurance Plan The HRA plan is 100% funded and paid by the District so there is no additional cost to you and your family.  Single Coverage: The HRA plan will reimburse up to the maximum of $250 in coinsurance expenses.  Family Coverage: The HRA plan will reimburse up to the maximum of $500 coinsurance expenses.  In order to be eligible for the HRA plan, you must be enrolled in the District’s group health plan with WCA Group Health Trust.  The plan year July 1, 2014 – June 30, 2015

12 When receiving a service, you must present your WCA ID card to the health care provider. WCA reviews and processes the claim and provides you with the Explanation of Benefits (EOB). Your health care provider submits the claim to WCA. You must submit your claim for reimbursement to EBC by completing, signing, and dating an EBC HRA Claim Form and attaching a copy of the EOB from WCA. How to Use the HRA Plan

13 Explanation of Benefits “EOB” Patient Network

14 “EOB” Continued 90% Coin surance BC A A minus B minus C = Coinsurance Maximum HRA Plan #1 Benefit: $250 Single ~ $500 Family

15 How to File a HRA Claim  Fax   Online  Mail Employee Benefit Corporation PO Box Madison, WI  Phone Support or M-F 8:00-5:00 Central

16 EBC’S HRA Claim Form Name Employer Name Code “H” Code “HF”

17 HRA Plan #2 Wellness Incentive Plan The HRA plan is 100% funded and paid by the District so there is no additional cost to you and your family. Employees on the District’s group health plan that take the Healics Health Risk Assessment and have a minimum score of 71 or improve their score by 5 will qualify for Plan #2 HRA Wellness Incentive.  Single Coverage: $500  Family Coverage: $1,000 (Note: Both the employee and the spouse must participate in the Healics Health Risk Assessment and both must meet the required scoring to receive the family HRA benefit.)  The plan year July 1, 2014 – June 30, 2015  The HRA dollars will roll forward each year  The HRA dollars may be used for eligible expenses under Section 213  In order to be eligible for the HRA plan, you must be enrolled in the District’s group health plan with WCA Group Health Trust.

18 Cost Savings Ideas  Utilize your 100% Preventive Care Services  Call Nurse Helpline as your first step unless emergency  Utilize the Neighborhood Family Clinic and Community Care Clinic  Use Urgent instead of Emergency Average Urgent Care Visit: $250 Emergency Room: $800  Ask about low cost Generic Programs at your pharmacy  Purchase 90 day supply on your maintenance scripts Save 1 copay per 90 day supply  Utilize the Flexible Spending Account Plan (FSA)  Utilize In-Network Providers

19 Preventive Care 100% Coverage for:  Preventive Care Exams  Well-Child Care  Well-Woman Gynecological Exams  Mammograms  Adult and Child Immunizations  Hearing Exam (1 per calendar year)  Vision Exam (1 per calendar year)

20 Neighborhood Family Clinics No bills, insurance forms or hassle. WCA Group Health Trust has a special contract with the Neighborhood Family Clinic. All services are paid at 100%. You will not be responsible for any charges at a NFC facility. The deductibles, copays, and co-insurance are waived! 1526 Rose Street La Crosse, WI Mon-Fri: 8am – 6pm Sat: 8am - Noon

21 Community Care Clinic 1202 County Road PH Onalaska WI No bills, insurance forms or hassle. WCA Group Health Trust has a special contract with the Community Care Clinic. All services are paid at 100%. You will not be responsible for any charges at a Community Care Clinic. The deductibles, copays, and co-insurance are waived!

22 Urgent Care vs Emergency Room Average Urgent Care Visit $250 Average Emergency Room Visit $800 Gundersen Lutheran 1900 South Avenue, La Crosse, M-F: 7am – 9pm, Sat-Sun: 9am – 7pm 3111 Gundersen Drive, Onalaska, M-F: 7am – 9pm, Sat-Sun: 9am – 5pm Franciscan Skemp ** West Ave & Market, La Crosse, Daily: 6am – Midnight 191 Theater Road, Onalaska, M-F: 5pm – 9pm, Sat-Sun: 9am – 5pm 1303 Main, Holmen, M-Thur: 7am – 7pm, Fri: 7am – 5pm Winona Health M-Thur: 8am – 8pm, Fri-Sun: 8am – 5pm ** Services at this location may be billed as emergency room.

23 Health Care Access 23 Express CareUrgent CareEmergency Room Bladder, urinary tract infections Non-life threatening illness or injury Life threatening illness or serious injury BronchitisAfter regular clinic hoursChest pain, heart attack Common WartsColds, sore throatBroken bones Ear pain, infections or excess wax Cuts, scrapes, bruises, skin rash, minor burns Numbness or weakness on one side, stroke symptoms Flu, influenzaBack painSevere headache Insect, tick bitesStrains, sprainsLoss of consciousness Mononucleosis Your primary care provider is not available Shortness of breath, confusion, dizziness Pink eyeSevere abdominal pain Sinus infections

24 WCA Group Health Trust In-Network Providers  Website:  Click on: “Find A Provider”  Then, “Medical”, “Medical Provider Search”, Select “U”  Select a Plan “United Healthcare Option”  Click on, “Medical, click here to access the UHC Provider Search Application”  Select State, City, Physician, or Facility OR Call UMR:  , Press Option #1. Have your Member ID number and Group Number available.

25 WCA Group Health Trust Dental Plan Benefits Deductible** $25 Per Person $75 Per Family Annual Maximum Per person$1,000 Preventive Services100% Basic Services80% Major Services50% Orthodontia50% $1,500 Lifetime maximum ** Deductible Year: July 1, 2014 – June 30, 2015

26 What is a FSA Plan? A great way to help you increase your spendable income while reducing your payroll taxes! A Flexible Benefit Plan is a pre-tax payroll deduction plan that allows you to set aside dollars for eligible insurance, medical, dental, optical and daycare expenses before Federal, State, and Social Security taxes are applied. Flexible Spending Account Plan (FSA)

27 New FSA Benefits Rollover Benefit up to $500 “Benny” Card

28 FSA Plan Limits  Plan Year: July 1, 2014 – June 30, 2015  General Purpose Medical: $2,500  Dependent Care Calendar Year: $5, Note: The 2-1/2 month “Grace Period” will end on September 15, 2014.

29 Reminders: Claim Filing Deadlines for Plans ending June 30th  Flexible Spending Account Plan (FSA) September 30, 2014  Heath Reimbursement Arrangement Plan (HRA) September 30, 2014

30 Open Enrollment Plans:  Group Health Insurance Plan  Group Dental Insurance Plan  Flexible Spending Account (FSA) Plan Forms:  WCA Employee Enrollment Form This form is only required if you are changing your current health and/or dental elections.  Employee Election Form Required: States your election for the health insurance plan effective July 1, 2014  EBC Best Flex Enrollment Form Required: States your election to Enrolling or Waiving

31 Questions All forms must be returned to Ben Miller, in the District Business Office no later than June 9, 2014


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