Presentation on theme: "Employee Benefits Review January 1, 2013 CHANGES FOR 2013! Changing to 2 health plans – PCB and HMO Preferred Care members will be changed to the Preferred-Care."— Presentation transcript:
Employee Benefits Review January 1, 2013
CHANGES FOR 2013! Changing to 2 health plans – PCB and HMO Preferred Care members will be changed to the Preferred-Care Blue PPO Plan and Network effective January 1. Preferred Care Blue network includes Liberty Hospital and Truman Hospitals Women’s Preventive Care – Additional coverage Generic Contraceptive drugs 100% Contraceptive implants, injectables & devices at 100% Breastfeeding support, supplies (pumps) and counseling at 100% Voluntary Vision – Changing to EyeMed Same network of providers – EyeMed “Select” Network Similar Plan Options – Exam & Materials and Materials Only Plan FSA – Healthcare Reimbursement Account New 2013 IRS Maximum Limitation - $2,500 per employee; total family benefit of $5,000 Voluntary Short-Term Disability - Aflac This benefit provides you with a portion of your monthly salary if illness or injury keeps you from working
Health Care Reform Proposed for 2013 W-2 Reporting of the cost of healthcare (2013) William Jewell College will be required to report the annual cost ( employer cost) of the health coverage provided to their employees on the annual W-2 Form, starting with the 2012 W-2 and forward Uniform Summary of Benefits and Coverage (2013) All health plans will be required to provide a uniform summary of the plan’s benefits and coverage (SBC) and a uniform glossary of commonly used health insurance and medical terms to participants FSA – Healthcare Reimbursement Account (2013) IRS Maximum Limitation - $2,500 per employee; total family benefit of $5,000
2013 Medical Plan Options Preferred-Care Blue PPO (Preferred Provider Organization) No selection of a PCP (Primary Care Physician) Freedom of Choice Lower your out pocket expenses when using network PPO providers In and Out of Network Coverage National and International Coverage Deductible and coinsurance Blue-Care HMO (Health Maintenance Organization) Select a Primary Care Physician (PCP) In-Network Coverage Only In Metro Kansas City Area Coverage Only Coverage for Urgent and Emergency Care while Traveling No deductible or coinsurance
Select a PCP (FP, GP, IM, Ped) YES Office Visits $30 PCP* copay $60 Specialist** copay Inpatient Hospital Services /Outpatient Surgery $250 copay per day up to $1,250 per member per calendar year (applies to inpatient services at a hospital and outpatient surgeries at a hospital or an outpatient facility) MRI, MRA, CT and PET Scans – Physician’s Office, Imaging Center, Outpatient Setting $100 copay Only one copay will apply for each provider on a specified date of service even if multiple scans are performed Urgent Care (Minute Clinics, Take Care Centers) $60 copay (office visit/lab only) Emergency Care$100 copay if treated and released Blue-Care HMO
Annual Deductible$2,500 individual / $5,000 family Network Coinsurance Non-Network Coinsurance Member pays: 20% / BCBSKC pays: 80% Member pays: 40% / BCBSKC pays: 60% Out-of –Pocket Maximum$4,500 individual / $9,000 family $9,000 individual / $18,000 family (Includes Deductible + Coinsurance) Inpatient Hospital ServicesDeductible then coinsurance Office Visits$40 copay (includes lab services in physician’s office or network lab) Urgent Care (Minute Clinics, Take Care Centers) $40 copay (includes lab services in physician’s office or network lab) Emergency Care$100 copay* then deductible then coinsurance *Copays do not apply to deductible or OOP maximum Preferred-Care Blue
Hospital Locator Metro Hospitals HMO Blue Care Network PPO Preferred Care Blue Network Center Point Medical Center XX Children’s Mercy Hospitals XX KU Medical Center XX Lee’s Summit Hospital XX Liberty Hospital XX Menorah Medical Center XX North Kansas City Hospital XX St. Luke’s (All Locations) NOX Olathe Medical Center XX Overland Park Regional XX Providence Medical Center XX Research Medical Center XX Shawnee Mission Medical Center XX St. Joseph Medical Center XNO St. Mary’s Medical Center XNO Truman Medical Center (Hospital Hill and Lee’s Summit) XX
Preventive Care: What to Know! Both BCBSKC plans will cover Preventive Care Services at 100% – Annual Physicals – Childhood Immunizations – Well Women Exams – PSA Tests Services MUST be Preventive and received by In-network providers Effective January 1, 2013: – Generic Contraceptive drugs at 100% – Contraceptive implants, injectables & devices at 100% – Breastfeeding support, supplies (pumps) and counseling at 100% Refer to the Routine Preventive Services flier for additional services
Prescription Drug Coverage Retail and Mail-Order Certain drugs may require prior authorization, have quantity limitations or require step therapy (Generics First). Refer to the Prescription Drug List in your packet for additional details. Up to 34 day supply In-Network Pharmacy Tier 1: $10 Tier 2: $50 Tier 3: $70 Up to 102 day supply (Save 1 month’s copay) Mail-Order Tier 1: $20 Tier 2: $100 Tier 3: $140
Disease Management Program from Blue Cross Blue Shield of Kansas City The Healthy Companion TM program provides information, education and one-on-one telephonic support for Blue KC members who have been diagnosed with the following conditions: Asthma Chronic Obstructive Pulmonary Disease (COPD) Depression Diabetes Heart Disease Heart Failure High Blood Pressure Stress and Anxiety (LiveWell) How do you enroll? Automatic enrollment –member can choose to opt out of the program Self-enrollment Contact Healthy Companion at or toll free to
Points to Blue Deadline Points to Blue will end on December 31, Remember you MUST redeem your Points to Blue by December 31,2012. My Rewards will begin January 1, 2013.
2013 My Rewards Program Step 1*Complete the Onsite Health Screening (or alternate means screening form) for 25 Points Step 2*Take the Health Risk Assessment (HRA) for 25 Points *Steps 1 and 2 must be completed to be eligible to redeem My Rewards. Step 3Engage In Additional Activities for 25 Points You may earn additional points by participating in the following activities: Lifestyle Coaching (goals met) Self-Directed Coaching Assessments Tobacco Cessation Program A Healthier You Worksite Wellness Programs Healthy Companion Condition Management (goals met) Little Stars Prenatal Assessment My Rewards: Policy holders and spouses can redeem up to a total of $75 when 75 points are achieved.
View Your Claims, Print a Temporary ID card & Find Rx Info
24-Hour Nurse Line Access to Care Advisors to help you with symptoms or answer health-related questions How Can They Help? ◦ Gain convenient access to quality care ◦ Become better informed about healthcare ◦ Gain confidence when speaking to providers ◦ Become educated on self-care for non-urgent situations ◦ Improve knowledge of drugs and medications 24 hours a day…365 days a year!
Exclusively For Our Members ▪ Blue365 online resources include: Tools to help employees make the best choices about their health Select discounts and savings on products and services they can use to improve and maintain health ▪ Select companies include: Independent companies that do not provide Blue Cross and/or Blue Shield products or services and are solely responsible for the services provided. YMCA, Discover Vision and Sabates Eye Care provide discounts in the Kansas City metropolitan area only.
Type IType IIType IIIType IV DeductibleNone$50 / $150None Blue Cross Pays (Preferred-Care Dental and Out-Of-Area Providers) 100%80%50% Blue Cross Pays (Non-Preferred-Care Dental Providers within our Operating Area) 80%70%40%50% Covered Services Dental X-rays Routine Oral Exam Cleaning – two each calendar year Root Canal Tooth Extraction Bridge Recementing Complete or Partial Dentures Surgery of Gums Periodontal Scaling Orthodontia ( to age 19): Cephalometric X-rays. Diagnostic casts. Calendar Year Maximum $1,000 per person for all servicesN/A Lifetime MaximumNone$1,000 Preferred Preferred-Care Dental BluePremier Network
Flexible Spending Accounts Information + Enrollment = Savings WILLIAM JEWELL COLLEGE
What is an FSA anyway? An FSA adds spendable income and covers many expenses. You may redirect part of your paycheck into a pretax account. 18 FSA Benefit Buckets Available: 1- HEALTHCARE FSA: Medical, Dental, Vision, Pharmacy & approved OTC. $2,500 New 2013 IRS Maximum Limitation and/or 2- DEPENDENT CARE FSA: Daycare expenses. $5,000 You can participate in one or both types of FSA
19 How will it benefit me? Paycheck Advantages: - Increased take-home pay - Lower income taxes $$ Double benefit $$ Average family of four in the U.S. can save hundreds of dollars in taxes. …. Immediate availability of Healthcare account funds
20 Expenses covered? Medical & Dental Deductibles & co-pays Prescription drugs Vision (exams, glasses, laser eye surgery, contact lens solution) Diabetic supplies Hearing Aids Medical travel expenses Chiropractic services Dental (cleanings, fillings, orthodontia, dentures) And many more! *Over the counter….what qualifies…. Dependent Care Daycare (child under age 13) Private Nanny or Babysitter Adult Daycare
21 How to submit claims Option 2: Paper Claims. Fax or mail a claim form to Phillips Resource Network with an Explanation of Benefits (EOB) and/or receipt. Receipts must include a patient name, date of service, type of service and dollar amount PLAN YEAR: On January 1, 2013, your Benny Card will be loaded with your new plan year dollars. Please DO NOT use your card to go back and pay for any services in PLAN YEAR: 75 day extension on allowable expenses with an additional 30 days to submit claims from any monies remaining from the 2013 bucket. Services must be incurred while actively employed and will be applied to the applicable plan year. Option 1: The Benny Card. The card is used at the point of service at hospitals, doctor’s offices and pharmacies. The card cannot be used to purchase over-the counter medication without a prescription. Save all receipts as you may be asked to substantiate your expense. Keep your Benny Cards! NEW !! Grace Period is now available on Benny Card Swipes and Manual Claims for 75 days For the 2013 plan year, the last day to use your 2013 funds is March 16, 2014
22 Things to remember… Choose plan election amounts carefully Use it or Lose it Rule Contribution amounts can only be changed during the plan year due to a qualifying event (i.e., marriage or birth of a child) Expenses are reimbursed through an FSA after they are incurred; pre- payments are reimbursed as services are received Participation at any level will increase your take home pay!
23 We’re here to help! PLEASE DIRECT QUESTIONS TO PHILLIPS RESOURCE NETWORK, INC. OUR PHONE NUMBER AND ADDRESS IS ON EVERY CLAIM FORM. REMEMBER BY ENROLLING IN THIS PLAN, THE MONEY YOU REDIRECT IS NOT SUBJECT TO FEDERAL, STATE, OR SOCIAL SECURITY TAXES! Every employee must complete a 2013 FLEX form even if waiving coverage or not making any changes
William Jewell College Employer Paid Benefits Basic Life Insurance 1 times annual salary for employees $50,000 minimum amount to $150,000 maximum Dependent Life Insurance if Enrolled in Family BCBS Health Insurance $2,000 benefit for spouse $1,000 benefit for children from 14 days to 20 (26 if full time student) years of age Basic Accidental Death and Dismemberment $25,000 for employees Long Term Disability 60% of monthly salary to $5,000 maximum benefit Payable after 120 days of disability Payable to later of age 65 or SSNRA
William Jewell College Voluntary (Employee Paid) Options Voluntary Life Choice of $10,000 increments of coverage not to exceed the lesser of 5 times salary or $500,000 maximum benefit for employees. Choice of $5,000 increments of coverage not to exceed ½ of employee amount or $250,000. Choice of $2,500 increments of coverage for children after 6 months of age to a maximum benefit of $10,000. You or your spouse may elect or increase coverage by two increment levels on a guaranteed acceptance basis during your company’s defined annual open enrollment period, provided that you or your spouse have not been previously declined for coverage. Voluntary AD&D Choice of $25,000 increments of coverage not to exceed 10 times salary or $500,000 maximum benefit for the employees on the Employee Only Plan or Family Plans Spouse provided 60% of employee amount when children are not covered on the Family Plan. Spouse provided 50% of employee amount when Children are covered for 10% of the employee amount not to exceed $15,000 on the Family Plan. There is an annual open enrollment for coverage on Voluntary AD & D.
EyeMed Exam & Materials Plan In Network Member’s Cost Out of Network Allowance Exam with dilation as necessary$10 copay$30 Frequency: Examination Lenses or Contact Lenses Frame Once every 12 months Once every 24 months Exam Options: Standard Contact Lens Fit and Follow-Up:* Premium Contact Lens Fit and Follow-Up:** Up to $40 10% off retail price N/A Frames: Any available frame at provider location $130 allowance, 20% off balance$65 Standard Plastic Lenses: Single Vision Bifocal Trifocal Standard Progressives $25 copay $90 $25 $40 $60 $40 Lens Options UV Coating Tint (Solid and Gradient) Standard Scratch-Resistance Standard Polycarbonate Standard Polycarbonate-Kids under 19 Standard Anti-Reflective Coating Other Add-Ons and Services $15 $40 $45 20% off retail N/A Contact Lenses (Materials Only) Conventional Disposable Medically Necessary $130 allowance, 15% off balance over $130 $130 allowance, plus balance over $130 $0 copay, paid-in-full $104 $200
EyeMed Materials Only Plan Materials Only PlanIn Network Member’s Cost Out of Network Allowance Frequency: Lenses or Contact Lenses Frame Once every 12 months Once every 24 months Frames: Any available frame at provider location &0 Copay ; $130 allowance, 20% off balance over $130$65 Standard Plastic Lenses: Single Vision Bifocal Trifocal Standard Progressives Premium Progressives Lenticulars $0 copay $65 $65,80%of charge less $120 allowance $0 copay $25 $40 $63 $40 $63 Lens Options UV Coating Tint (Solid and Gradient) Standard Scratch-Resistance Standard Polycarbonate Standard Polycarbonate-Kids under 19 Standard Anti-Reflective Coating Other Add-Ons and Services $15 $40 $45 20% off retail N/A Contact Lenses (Materials Only) Conventional Disposable Medically Necessary $0 Copay $130 allowance, 15% off balance over $130 $130 allowance, plus balance over $130 $0 copay, paid-in-full $104 $200
EyeMed – Providers One of the largest, and most diverse vision panels Includes thousands of private practice optometrists, ophthalmologists and opticians Composition of panel – 75% independent, 25% retail Includes the nation’s top optical retailers, including :
EyeMed’s -Unmatched Value Separate fit/follow-up and contact lens allowances allows members to only pay up to $40 for their fit/follow-up and use their contact lens allowance in full for the purchase of contact lenses 20% discount on any balance that exceeds frame allowance 15% discount on any balance that exceeds contact lens allowance 40% off additional unlimited pairs of eyeglasses after initial benefit is used 15% off retail price of LASIK or PRK procedures at US Laser Vision locations or 5% off any promotional price Consistent pricing at all provider locations
Online Management for Members Once registered online at the member will be able to:www.eyemedvisioncare.com – Locate a provider – choose the “Select” network – View benefit details – Order replacement ID card – View claims
New Benefit Offering for William Jewell College Employees Guaranteed-issue Short-Term Disability Guaranteed, renewable to age 70 Benefits paid regardless of any other insurance 3-Month Benefit for illness or off-the-job accident $500 to $3000 in monthly benefit guaranteed issue Waiting period defined by each individual’s needs Partial disability benefit Payroll deduction
Income Replacement Example Jewell employees are provided long-term disability that begins after 120 days for an illness or off-the-job accident. Aflac short-term disability can be purchased to provide income replacement for the first 90 days, reducing the income gap to only 30 days
Example: $34,000 Annual Salary Age: /14 – 14 calendar days waiting for an off-the-job accident – 14 calendar days waiting for an illness 3 Month Benefit period Qualify for $1,700 Monthly Benefit $28.73 monthly premium
Example: $50,000 Annual Salary Age: /14 – 14 calendar days waiting for an off-the-job accident – 14 calendar days waiting for an illness 3 Month Benefit period Qualify for $2,500 Monthly Benefit $42.25 monthly premium
Commerce Bank Special employee banking benefits No ATM fee when using the on-campus ATM located in Yates-Gill College Union
The End! IMPORTANT Forms to turn in: 2013 FLEX form Enrollment forms for Aflac or EyeMed Any changes to other benefits Open Enrollment: November 2 through November 20th *ALL applications and changes must be turned in no later than November 20th Examples of changes include: Changing plan options Adding or Removing dependents Address or phone number changes Changing beneficiary designation If you have any additional questions please contact the Office of Human Resources.