Presentation on theme: "Employee Benefits July 1, 2014"— Presentation transcript:
1 Employee Benefits July 1, 2014 Janice L. WavraCorporate Benefits Specialist
2 Agenda What Does HRA Mean To Me? Group Health Insurance Plan Options Health Reimbursement Arrangement PlansCost Savings IdeasGroup Dental Insurance PlanFlexible Spending Account Plan (FSA)Claims Filing DeadlinesOpen EnrollmentRecap & Questions
3 The Insurance Center Locally Owned, Established in 1960 Located at 701 Sand Lake Road, Onalaska WIYour 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 PlanHRA Plan #1: Co-Insurance PlanHRA Plan #2: Wellness Incentive PlanHealth Risk AssessmentHealics
5 Health Insurance Plan Options Note: Deductible Year: July 1, 2014 – June 30, 2015
6 Sample “Copay” Claim – Plan #1 “Status Quo” 1st Claim of New Plan Year: In-Network ProviderOffice Visit: $158Diagnosis Test/X-Ray: $500Claim Processed:Office Visit: $25 Copay applied to Maximum Out-of-PocketOffice 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 CopayEmployee pays $500 in Deductible expensesHealth plan pays $ (90%) in Co-Insurance expensesHRA plan pays $13.30 (10%) in Co-Insurance expenses
7 Sample “Copay” Claim – Plan #1 “Status Quo” 1st Claim After Max Out-of-Pocket Met: In-Network ProviderDeductible Met: $500Co-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: $158Diagnosis Test/X-Ray: $800Claim 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? In-NetworkHRA PaysEmployee PaysDeductible **$500 Single$1,000 Family$0 Single$0 FamilyCoinsurance 90%$250 Single$500 FamilyMaximum Out-of-Pocket$1,000 Single$2,000 Family$750 Single$1,500 FamilyMaximum Out-of-Pocket Copays ONLYNote: Deductible Year: July 1, 2014 – June 30, 2015
9 Health Plan #2: What is My Maximum Out-of-Pocket Exposure? In-NetworkHRA PaysEmployee PaysDeductible **$500 Single$1,000 Family$0 Single$0 FamilyCoinsurance 90%$1,000 Single$2,000 Family$250 Single$500 Family$750 Single$1,500 FamilyMaximum Out-of-Pocket$1,500 Single$3,000 Family$1,250 Single$2,500 FamilyMaximum Out-of-Pocket Copays ONLYNote: Deductible Year: July 1, 2014 – June 30, 2015
10 Monthly Premiums Full-Time Employees Plan #1 “Status Quo”Single: $209.48Family: $474.60Plan #2: “Reduced Premium”Single: $119.96Family: $271.78Premium Savings Between Plan #1 vs. Plan #2Single: $89.52/month = $1,074.24/annualFamily: $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 Your health care provider submits the claim to WCA. How to Use the HRA PlanYour health care provider submits the claim to WCA.When receiving a service, you must present your WCA ID card to the health care provider.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.WCA reviews and processes the claim and provides you with the Explanation of Benefits (EOB).
14 A minus B minus C = Coinsurance Maximum HRA Plan #1 Benefit: “EOB” Continued90%CoinsuranceBCAA minus B minus C = CoinsuranceMaximum HRA Plan #1 Benefit:$250 Single ~ $500 Family
15 How to File a HRA Claim Fax 608-831-4790 Email OnlineMailEmployee Benefit CorporationPO Box 44347Madison, WIPhone SupportorM-F 8:00-5:00 Central
16 EBC’S HRA Claim FormNameNameEmployerCode “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: $500Family 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, 2015The HRA dollars will roll forward each yearThe HRA dollars may be used for eligible expenses under Section 213In 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 emergencyUtilize the Neighborhood Family Clinic and Community Care ClinicUse Urgent instead of EmergencyAverage Urgent Care Visit: $250 Emergency Room: $800Ask about low cost Generic Programs at your pharmacyPurchase 90 day supply on your maintenance scriptsSave 1 copay per 90 day supplyUtilize the Flexible Spending Account Plan (FSA)Utilize In-Network Providers
19 Preventive Care 100% Coverage for: Preventive Care Exams Well-Child CareWell-Woman Gynecological ExamsMammogramsAdult and Child ImmunizationsHearing 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, andco-insurance are waived!1526 Rose StreetLa Crosse, WIMon-Fri: 8am – 6pmSat: 8am - Noon
21 co-insurance are waived! Community Care Clinic1202 County Road PHOnalaska WI 54650No 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, andco-insurance are waived!
22 Urgent Care vs Emergency Room Average Urgent Care Visit $250Average Emergency Room Visit $800Gundersen Lutheran1900 South Avenue, La Crosse, M-F: 7am – 9pm, Sat-Sun: 9am – 7pm3111 Gundersen Drive, Onalaska, M-F: 7am – 9pm, Sat-Sun: 9am – 5pmFranciscan Skemp** West Ave & Market, La Crosse, Daily: 6am – Midnight191 Theater Road, Onalaska, M-F: 5pm – 9pm, Sat-Sun: 9am – 5pm1303 Main, Holmen, M-Thur: 7am – 7pm, Fri: 7am – 5pmWinona HealthM-Thur: 8am – 8pm, Fri-Sun: 8am – 5pm** Services at this location may be billed as emergency room.Urgent Care vs Emergency Room
23 Health Care Access Express Care Urgent Care Emergency Room Bladder, urinary tract infectionsNon-life threatening illness or injuryLife threatening illness or serious injuryBronchitisAfter regular clinic hoursChest pain, heart attackCommon WartsColds, sore throatBroken bonesEar pain, infections or excess waxCuts, scrapes, bruises,skin rash, minor burnsNumbness or weakness on one side, stroke symptomsFlu, influenzaBack painSevere headacheInsect, tick bitesStrains, sprainsLoss of consciousnessMononucleosisYour primary care provideris not availableShortness of breath, confusion, dizzinessPink eyeSevere abdominal painSinus 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 FacilityOR Call UMR:, Press Option #1. Have your Member ID number and Group Number available.
25 WCA Group Health Trust Dental Plan BenefitsDeductible**$25 Per Person$75 Per FamilyAnnual Maximum Per person$1,000Preventive Services100%Basic Services80%Major Services50%Orthodontia$1,500 Lifetime maximum**Deductible Year: July 1, 2014 – June 30, 2015
26 Flexible Spending Account Plan (FSA) 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.
27 New FSA BenefitsRolloverBenefit up to$500“Benny” Card
28 FSA Plan Limits Plan Year: July 1, 2014 – June 30, 2015 General Purpose Medical:$2,500Dependent Care Calendar Year:$5,000.00Note: 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, 2014Heath Reimbursement Arrangement Plan (HRA)
30 Open Enrollment Group Health Insurance Plan Plans:Group Health Insurance PlanGroup Dental Insurance PlanFlexible Spending Account (FSA) PlanForms:WCA Employee Enrollment FormThis form is only required if you are changing your current healthand/or dental elections.Employee Election FormRequired: States your election for the health insurance plan effective July 1, 2014EBC Best Flex Enrollment FormRequired: States your election to Enrolling or Waiving
31 Questions June 9, 2014 All forms must be returned to Ben Miller, in the District Business Officeno later thanJune 9, 2014