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Group Health Insurance Plan 2015 Frenship ISD. CAMPUS REPRESENTATIVES : FHS Tate Casey Reese Lynn Mills FMS Katrina Smith Terra Vista David Speer HMSEmily.

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Presentation on theme: "Group Health Insurance Plan 2015 Frenship ISD. CAMPUS REPRESENTATIVES : FHS Tate Casey Reese Lynn Mills FMS Katrina Smith Terra Vista David Speer HMSEmily."— Presentation transcript:

1 Group Health Insurance Plan 2015 Frenship ISD

2 CAMPUS REPRESENTATIVES : FHS Tate Casey Reese Lynn Mills FMS Katrina Smith Terra Vista David Speer HMSEmily Wagner Bennett Sanae Allison Crestview Cyndy Heald Oak RidgeTawni Stockton LegacyStacey Owen North Ridge Betsy Bucy Westwind Bobbie Jo Williams Willow Bend Stacey Price CustodiansBalt Padilla MaintenanceRudy, Derek Cobb, Allen Tanner Central Office Rhonda Dillard, Pat Valdez, Jason Gossett, Dr. Vroonland, Dr. McCord, Tim Williams, Courtney Reeves

3 * Remember, Our Plan year… January 1, 2015 through December 31, 2015

4 Employee feedback indicates:  506 responses to the survey  Some negative responses about First Care  Some negative responses about ACA  Employees wanted better benefits at a lower cost  56% responded that they valued low cost or no cost premium as their first priority  43% responded that they valued doctor copays

5 * First Care * Blue Cross Blue Shield * Aetna * United Health Care declined to provide a quote

6 * October 2 - The committee unanimously voted to move to Blue Cross Blue Shield. * October 20 - The School board reviewed and approved the recommendation to move to Blue Cross Blue Shield.

7 * More Doctors and hospitals * Coverage everywhere you go * Online resources and programs * Personalized Customer Service * Blue Access Mobile * Health and Wellness programs * Home Delivery Prescriptions – Must pre- register at bcbstx.com OR call Prime Mail at by phone

8 * On line access: bcbstx.com * Customer Service information on the back of your medical ID card * BlueCard Access 24/ BLUE (2583)

9 * Plan Options with Blue Cross Blue Shield: (In network and out of network coverage on every plan) PPO 1 (PPO 1 and 2 combined) PPO 2 (Employee only free plan) PPO High Deductible plan (Health Savings Acct) PPO 1 (PPO 1 and 2 combined) PPO 2 (Employee only free plan) PPO High Deductible plan (Health Savings Acct)

10 Coverage PPO1 PPO2 PPO/HSA** Employee Only $126 $0 $ 53 Emp. & Spouse $713 $412 $494 Emp. & Child $470 $243 $242 Emp. & Family $797 $470 $527 **All employee incurred expenses go towards the deductible** Coverage PPO1 PPO2 PPO/HSA** Employee Only $126 $0 $ 53 Emp. & Spouse $713 $412 $494 Emp. & Child $470 $243 $242 Emp. & Family $797 $470 $527 **All employee incurred expenses go towards the deductible** Note: All premiums INCLUDE $266/month that is paid by FISD and reflect YOUR monthly cost:

11  Deductible $3000 per member ( $6000/family) - In Network  Co-Insurance – 20% in network/ 40% out of network (Employee pays after meeting the deductible)  Out of network services at a higher cost share  $45 Dr. visit Co-pay ( $60 / specialist)  RX - $10-$35-$75-$150 after $100 deductible  Out-of-Pocket Maximum = $5500 per member – In Network ($11,000/family) – In Network (out of pocket max includes all copays)  Hospital/Maternity – 20%/40% (Employee pays after deductible)  Emergency room/ 20% after $150 copay (facility charges only) Maternity – Pediatrician, delivery, and nursery are covered at 80% after the $3000 deductible  Deductible $3000 per member ( $6000/family) - In Network  Co-Insurance – 20% in network/ 40% out of network (Employee pays after meeting the deductible)  Out of network services at a higher cost share  $45 Dr. visit Co-pay ( $60 / specialist)  RX - $10-$35-$75-$150 after $100 deductible  Out-of-Pocket Maximum = $5500 per member – In Network ($11,000/family) – In Network (out of pocket max includes all copays)  Hospital/Maternity – 20%/40% (Employee pays after deductible)  Emergency room/ 20% after $150 copay (facility charges only) Maternity – Pediatrician, delivery, and nursery are covered at 80% after the $3000 deductible

12 PPO 2 Plan (free plan for employees)  Deductible - $6000 per member / $12,000 family  Out of network services at a higher cost share  Co-Insurance – 100% (plan pays after deductible is met)  $45 Dr. Visit Co-pay ($90 specialist)  RX - 50%/preferred after $250 deductible  Out-of-Pocket Maximum = $6000 individual/ $12,000 family (out of pocket max includes all copays)  Hospital/Emergency/Maternity – 100% after $6000 Deductible is met

13  Deductible $3000 per member ( $6000 /family) – In-Network  Coinsurance – Employee pays all medical expenses until $3000 deductible is met.  No Dr. copays – Discounted office visits and plan pays 80% after deductible is met  RX – Prescriptions are paid for by employee until deductible is met  Hospital/Maternity/Emergency – Employee pays 20% after deductible is met  Out-of-Pocket Maximum - $6,350 per member ( $12,700 / family) - In Network  Money placed in HSA account is above and beyond the premium  HSA account must be set up prior to incurring claims in order to have tax advantage.  Deductible $3000 per member ( $6000 /family) – In-Network  Coinsurance – Employee pays all medical expenses until $3000 deductible is met.  No Dr. copays – Discounted office visits and plan pays 80% after deductible is met  RX – Prescriptions are paid for by employee until deductible is met  Hospital/Maternity/Emergency – Employee pays 20% after deductible is met  Out-of-Pocket Maximum - $6,350 per member ( $12,700 / family) - In Network  Money placed in HSA account is above and beyond the premium  HSA account must be set up prior to incurring claims in order to have tax advantage.

14 Individual and/or family deductible must be met before you are eligible for any insurance benefits. You have the option to open a Health Savings account. This money must be used on medical expenses and is your money as long as the account is open. HSA account must be opened prior to accessing any funds. Maximum - $ /Individual $ /Family

15 In Network / Out of Network In-network - The BCBS network is called Blue Choice. Out of network services will be billed at a higher cost share to the employee. When traveling outside of Texas you will ask if they take “Blue Card”. Preauthorization may be required for some services. It is always best to check before receiving major services. This information will be on the back of your insurance card.

16  Health Insurance Market Place / Affordable Care Act healthcare.gov /  Individual policy with independent company  CHIPS – KID-SNOW  CHIPSMEDICAID.org

17 * Public Marketplace * Guaranteed issue / No Pre-existing limitations * Sold through healthcare.gov, Ashmore & Associates, Aycock and Fowler, independent agents and other entities * Policies and rates are identical on both public and private marketplaces. * Only licensed agents can assist consumers with actual purchase decisions. * Navigators are licensed to assist with the completion of the application.

18 * Subsidies and Tax credits are available through the public marketplace – ONLY if your employer does NOT offer you a compliant plan as an option. * FISD plans comply with all the minimum benefit and affordability standards.

19  If at all possible, go to a provider that is contracted with BCBS Choice networks so that claims are paid in network.  Prescriptions – Always ask for generic, check at least three pharmacies for best price, check local pharmacies to see if the meds are FREE, Google prescription for coupons and discounts, and ask Doctor for samples.  Lab work and x-rays done in conjunction with the office visit are included in your office visit copay.  Other class of diagnostic tests are subject to your deductible. (Ex. MRI)

20  Telehealth & Wellness solution plan - $9.00 per month covers the entire family  Compliments the medical plans and saves on medical claims  3 easy steps to speak to a physician anytime anywhere online or by phone  Prescriptions are called in to the pharmacy of your choice – (Must accept Blue Cross Blue Shield)  Online tool provided to shop for the best price on prescriptions in your area  You must complete medical history on line  Covers most common conditions including but not limited to: allergies, bronchitis, earache, sore throat, sinusitis, pink eye, strep throat, upper respiratory infection, urinary tract infection….

21 All Insurance plans cover Preventative Care at 100%!! This could include: annual routine physicals, routine immunizations, well baby and well child care, routine eye/speech/hearing screenings for children when performed in the office, examination and testing for the detection of prostate cancer… Coverage provided in network at 100% with no copay or deductible **Lab tests related to an illness or condition are not considered preventative** Blue Cross Blue Shield list of Preventative Care is posted on the HR website

22 Additional Contributions FISD provides $20,000 of Life Insurance on all employees  The group life coverage was offered on a guarantee issue basis to all employees during the first year.  If you want to increase your group live coverage, you now have to apply for the additional coverage.  You will have the opportunity to talk to an FBS representative during enrollment about supplemental benefits. FISD provides $20,000 of Life Insurance on all employees  The group life coverage was offered on a guarantee issue basis to all employees during the first year.  If you want to increase your group live coverage, you now have to apply for the additional coverage.  You will have the opportunity to talk to an FBS representative during enrollment about supplemental benefits.

23  The only entity to benefit from your participation is YOU.  The district does not profit from #125  No insurance agent or company benefits  Individual your campus Section 125 is the tax code which allows participating employees to place certain financial expenses into an account PRIOR to taxes being withheld.

24 FISD Cafeteria Plan OPTIONS  Child Care Reimbursement Plan  Medical Reimbursement Plan  Cancer/Intensive Care Insurance  Vision  Accident Insurance  Dental Reimbursement Plan – Must file paper copy  Medical Insurance  Child Care Reimbursement Plan  Medical Reimbursement Plan  Cancer/Intensive Care Insurance  Vision  Accident Insurance  Dental Reimbursement Plan – Must file paper copy  Medical Insurance

25  Money can be taken from your check before taxes each month and placed in a medical reimbursement account.  You will use an NBS Flex Visa credit card preloaded with the amount of money that you will put in for the year. (Ex. $50 x 12 = $600) This money can only be used for medical expenses. Additional cards are $5.00 each.  The NBS Flex card cannot be used for dental expenses. You must submit a claim form with receipt for reimbursement.  Maximum - $2550 per year (you must use it or lose it at the end of each year)  FISD – 2 ½ month grace period to spend funds in flexible account.  90 day run out period – can file claims up to 90 days after plan year ends.

26 You can learn more about the advantages of the PPO1, PPO2, PPO/HSA: * Contacting The Ashmore Agency or Aycock & Fowler Insurance Agency for a consultation. * Visiting with an Insurance representative on the day of enrollment from 8:30 – 10:00 to discuss your insurance options. You can learn more about the advantages of the PPO1, PPO2, PPO/HSA: * Contacting The Ashmore Agency or Aycock & Fowler Insurance Agency for a consultation. * Visiting with an Insurance representative on the day of enrollment from 8:30 – 10:00 to discuss your insurance options.

27 Consultations Available  NOTE: If you are going to meet your deductible for any reason please call: Ashmore and Associates Aycock & Fowler  You will get one-on-one assistance to help you know what is ahead of you (i.e. – know what your plan is paying and what you should pay.  NOTE: If you are going to meet your deductible for any reason please call: Ashmore and Associates Aycock & Fowler  You will get one-on-one assistance to help you know what is ahead of you (i.e. – know what your plan is paying and what you should pay.

28 Frenship ISD Brokers Beth Ashmore Ashmore & Associates Brent Aycock Aycock& Fowler Insurance Agency


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