Presentation on theme: "November 11 th, 2014 Benefits Effective Date: January 1, 2015."— Presentation transcript:
November 11 th, 2014 Benefits Effective Date: January 1, 2015
Aetna’s Benefits Overview Benefit 2015 Plans Medical Primary Care Physician Referrals are not required. 100% Preventive Care Visits Dental Remains the same and still includes 90 th percentile for out of network benefits VisionAetna will provide administration of the Vision Benefits
Aetna’s Benefits Overview Benefit 2015 Plan Basic Life & AD&D, Supplemental Life and Long Term Disability Plan attributes remain unchanged, however Aetna will administrator the benefits.
Brenau Medical Employee Contributions (Per Pay Period) Enrollment TierWeekly PremiumsMonthly Premiums EE Only$ 22.00$96.00 EE + Spouse$ $ EE + Child(ren)$ $ Family$ $
Brenau University Dental Employee Contributions (Per Pay Period) Enrollment TierWeekly PremiumsMonthly Premiums EE Only$ 8.98$38.91 EE + Spouse$ 18.39$79.68 EE + Child(ren)$ 18.07$78.29 Family$ 28.72$124.45
Aetna – POS Medical POS 100% Coinsurance In Network / 70% Out of Network In NetworkOut of Network Deductible: $1,000 Single / $2,000 FamilyDeductible: $2,000 Single / $4,000 Family Out of Pocket Maximums (Include Deductible & Copays) $6,350 Single / $12,700 Family Out of Pocket Maximums (Include Deductible & Copays) $10,000 Single / $12,000 Family Preventive Care: 100% No DeductiblePreventive Care: 60% After Deductible Physician Visit $25 Copay Specialist Visit $35 Copay Physician Visit & Specialist 60% After Deductible Urgent Care $50 Copay ER Copay $100 Copay Urgent Care 60% After Deductible ER Copay $100 Copay Hospital (In and Out Patient) 80% After Deductible Hospital (In and Out Patient) 60% After Deductible Unlimited Lifetime Maximum
Aetna Dental Benefits Basis of Network Reimbursement In Network Benefit (Negotiated PDP Fee) Out of Network Benefit (Reasonable and Customary – R&C) 90 th Percentile Type A Preventive Care100% After Deductible Type B Basic Restorative80% After Deductible Type C Major Restorative50% After Deductible Annual Deductible per covered Member/Family$50 / $150 Calendar Year Maximum (per covered Member)$1,000 Orthodontic Lifetime Maximum (Adult / Child)$1,000
Aetna Vision Benefits Basis of Network Reimbursement In Network BenefitOut of Network Benefit Exam (Once every 12 months) $20 copayUp to $25 Reimbursement Lenses Single Bifocal Trifocal & Lenticular (Once every 12 months) $20 copay $15 Reimbursement $30 Reimbursement $60 Reimbursement Frames (Once every 24 months)$130 allowaance; additional 20% off balance over allowance $90 Reimbursement Contact Lenses Coventional Disposable Medically Necessary $130 allowance; additional 20% off balance over allowance $130 allowance $0 copay $90 Reimbursement $200 Reimbursemet
Aetna – Member Resources (Information Available) Aetna Navigator® member website DocFind® online provider directory Simple Steps To A Healthier Life® Personal Health Record Plan For Your Health Member Services Informed Health® Line
Aetna – Online Self Tools ~ Navigator Access to Aetna’s internet resources DocFind® Coverage Policy Bulletins Rx formulary and Pharmacy benefits Online Mail Order Information on products Estimate The Cost of Care tool Member self-service Secure personalized information Enriched credible health content and hospital information for registered members Push technology – notifications Contacts to member services via state-of- the-art contact management tool Health History Report
Aetna Mobile App – DocFind, Claims, PHR and more…. Mobile web - Over 2.9 million unique visitors -- Over 17 million page views and growing… iPhone app -Over 260K downloads -- Available for iPhone, iPod or iPad Android App - Over 66K downloads - Available for all Android 2.0+ OS Phones
12 Features functionality View coverage and benefits Find a Doctor or Facility Claims Coverage & Benefits Personal Health record ID Card Information Price a Drug I want to…
13 Features functionality View ID card info Find a Doctor or Facility Claims Coverage & Benefits Personal Health record ID Card Information Price a Drug I want to…
14 Features functionality Apps deliver an engaging user-experience and often use device-specific functions of smartphones such as: GPS location awareness for map use and turn-by-turn directions
Disability. What is it? You are limited from working in your occupation as a result of: Illness or Injury What is a disability? Many people use disability leave for: Surgery A medical problem like a heart attack or stroke Cancer treatment Could this happen to you?
A disability could last for weeks, months or even longer Could you pay your bills for months without a paycheck? Most people can’t afford it. 1 Would you: Be able to access money you have saved? Borrow from friends or family? Run up credit card debt? Would other insurance help? Most often it does not. Medical insurance doesn’t replace lost income Workers’ compensation only covers job-related issues Social Security disability only helps if your disability is terminal or is expected to last at least a year. 1
How much coverage can you get? Benefit amount Executive employees: Your monthly long term disability benefit amount equals 60% of your basic monthly earnings, up to $14,000 to age 65. All other employees: Your monthly long term disability benefit amount equals 60% of your basic monthly earnings, up to $10,000 to age 65. This benefit is paid for by Brenau University.
What else do I need to know? Your coverage begins 01/01/2015 There is an elimination period of 90 days.
Basic Life Insurance & AD&D This benefit is paid for by Brenau University All employees are eligible for Basic Life insurance and AD&D – 2.5 x salary to maximum of $500,000 Basic Dependent Life – Spouse $2,000 and Child(ren) $1,000 Accelerated Death Benefit included under the Basic and Supplemental Life programs AD&D coverage is equal to 100% of your basic life benefits AD&D pays for accidental death or dismemberment in addition to your Basic Life benefit
Supplemental Life Insurance & AD&D This benefit is available on a voluntary basis and paid for by employees Employee may choose to elect a benefit in increments of $10,000 up to maximum of $300,000 (or 5x your annual salary) Guarantee issue amount lesser of 3 x salary or $100,000 Spouse increments of $10,000 to a maximum of $100,000(not to exceed employee amount) Guarantee issue amount of $20,000 Child increments of $2,000 to a maximum of $10,000 & is all GI
Flexible Spending Account (FSA) Beneficial tool for saving money on health care. Pay for qualified medical/dental expenses using pre- tax dollars. $2,550 maximum contribution for Medical FSA Reimburse for Dependent Care expenses up to $5,000 Contribute money via payroll deductions Distributions are tax-free 90 days after Dec. 31, 2015 to file for reimbursement Up to $500 carryover available