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Open Enrollment Benefits 2014-2015 August 1 _ 31, 2014 Wylie ISD.

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Presentation on theme: "Open Enrollment Benefits 2014-2015 August 1 _ 31, 2014 Wylie ISD."— Presentation transcript:

1 Open Enrollment Benefits 2014-2015 August 1 _ 31, 2014 Wylie ISD

2 Agenda Outline changes to medical and prescription plan design Show side-by-side comparison of medical options Walk through dental, vision, and other benefit offerings Provide dates and times for onsite enrollers

3 CHANGES TO MEDICAL/RX PLAN DESIGN

4 Medical/Rx Plan Changes ActiveCare 1-HD Plan FeatureFrom 2013-2014 Plan Year To 2014-2015 Plan Year Individual Deductible$2,400$2,500 Family Deductible$4,800$5,000 Individual Out-of-Pocket Max Family Out-of-Pocket Max $3,850 $4,200 (Out-of-pocket maximums do not include medical copays & deductibles) $6,350 $9,200 (Out-of-pocket maximums include medical copays, deductibles, and coinsurance) Teladoc Physician ServicesN/A$40 consultation fee applies to deductible and OOP expenses

5 Medical/Rx Plan Changes ActiveCare 2 – “ActiveCare Select” Comparison Plan FeatureFrom 2013-2014 Plan Year To 2014-2015 Plan Year Plan NameActiveCare 2ActiveCare Select Individual Deductible$1,000$1,200 Family Deductible$3,000$3,600 Individual Out-of-Pocket Max Family Out-of-Pocket Max $4,000 $8,000 (Out-of-pocket maximums do not include medical copays & deductibles) $6,350 $9,200 (Out-of-pocket maximums include medical copays, deductibles, and coinsurance) Teladoc Physician ServicesN/A$40 consultation fee applies to deductible and OOP expenses Specialist Office Visit Copay$50$60 Retail Short-Term Brand Copay Retail Maintenance Brand Copay Mail Order & Retail-Plus Brand Copay Specialty Drugs $65 $80 $180 $200 per fill 50% coinsurance 20% coinsurance

6 Medical/Rx Plan Changes ActiveCare 2 Plan Feature2013-2014 Plan Year2014-2015 Plan Year Plan NameActiveCare 2 Individual Deductible$1000$1,000 Family Deductible$3000$3,000 Individual Out-of-Pocket Max Family Out-of-Pocket Max $4,000 $8,000 (Out-of-pocket maximums do not include medical copays & deductibles) $6,000 $12,000 (Out-of-pocket maximums include medical copays, deductibles, and coinsurance) Teladoc Physician ServicesN/A100% covered Primary Care Office Visit Copay Specialist Office Visit Copay $30 $50 $30 $50 Prescription Drug Deductible$0 for generic drugs, $200 per person for brand-name drugs Retail Short-Term (up to 31-day supply) Generic Copay Brand Copay (preferred list) Brand Copay (non-prefered list) $20 $40 $65 $20 $40 $65 Retail Maintenance (after second fill up to 31-day supply) Generic Copay Brand Copay (preferred list) Brand Copay (non-prefered list) $25 $50 $80 $25 $50 $80 Specialty Drugs$200 per fill$200 copay up to 31-day supply, $450 copay for 32-90 day supply

7 Medical/Rx Plan Changes ActiveCare 3 – “ActiveCare 2” Plan Feature2013-2014 Plan Year2014-2015 Plan Year Plan NameActiveCare 3ActiveCare 2 Individual Deductible$300$1,000 Family Deductible$900$3,000 Individual Out-of-Pocket Max Family Out-of-Pocket Max $4,000 $8,000 (Out-of-pocket maximums do not include medical copays & deductibles) $6,000 $12,000 (Out-of-pocket maximums include medical copays, deductibles, and coinsurance) Teladoc Physician ServicesN/A100% covered Primary Care Office Visit Copay Specialist Office Visit Copay $20 $30 $50 Prescription Drug Deductible$75 per person$0 for generic drugs, $200 per person for brand-name drugs Retail Short-Term (up to 31-day supply) Generic Copay Brand Copay (preferred list) Brand Copay (non-prefered list) $15 $35 $60 $20 $40 $65 Retail Maintenance (after second fill up to 31-day supply) Generic Copay Brand Copay (preferred list) Brand Copay (non-prefered list) $25 $50 $80 $25 $50 $80 Specialty Drugs$200 per fill$200 copay up to 31-day supply, $450 copay for 32-90 day supply

8 SIDE-BY-SIDE VIEW OF MEDICAL/RX PLAN DESIGN

9 Side-by-side comparison of 2014-2015 medical plan options

10 OVERVIEW OF DENTAL, VISION, & OTHER BENEFIT OFFERINGS

11 PPO Dental Plan Lincoln Benefit- High Option 100/80/50 Plan design option with $1000 maximum annual benefit Benefits for oral surgery, surgical extractions, and anesthesia will move from Type 2 coverage, covered at 80%, to type 3 coverage, covered at 50% Claims paid at 90 th percentile of usual & customary fees Coverage for dependent children up to age 26 Orthodontia included for children Premiums Employee Only$35.34 per month Employee & Spouse$76.44 per month Employee & Child$70.28 per month Employee & Family$123.28 per month

12 PPO Dental Plan Lincoln Benefit- Low Option Provides a lower more basic level of coverage. 100/70/40 Plan design option with $750 maximum annual benefit Benefits for oral surgery, surgical extractions, and anesthesia will be covered as Type 3 coverage, covered at 50% Claims paid at 90 th percentile of usual & customary fees Coverage for dependent children up to age 26 No Orthodontia coverage Premium are guaranteed for 2 years Employee Only$25.18 per month Employee & Spouse$54.02 per month Employee & Child$48.50per month Employee & Family$85.22 per month

13 DHMO Dental Plan Lincoln Benefit- DHMO No co-pay on office visit; many other deeply discounted services No annual maximum benefits or deductibles Members must choose a provider from the network to receive benefits Employee Only$16.80 per month Employee & Spouse$32.09 per month Employee & Child$33.80 per month Employee & Family$52.37 per month

14 Cancer Plan Colonial Cancer Single plan option including Cancer coverage, ICU rider, Specified Disease Coverage, and 1 st Occurrence Benefit Hospital Confinement Benefit Radiation/Chemo Surgery Schedule Benefit Initial Diagnosis Screening Rebate $300 per day $300 per day with $10,000 per year Up to $4,500 max $5,000 $100 Open Enrollment, Guarantee issue coverage. Employee Only$29.85 per month Employee & Family$49.55 per month

15 Vision Plan Block Vision Exam and eyewear co-pay of $15 Elective Contact lens allowance of $150; Paid in full if medically necessary Frame allowance up to $125 retail value $200 allowance on Lasik Employee Only$7.40 per month Employee & Spouse$12.58 per month Employee & Child$13.30 per month Employee & Family$19.98 per month

16 Basic & Voluntary Group Term Life Plan Lincoln Benefit $15,000 Life Insurance Coverage for all Employees- Provided at no cost by Wylie ISD Additional voluntary coverage available at group rates. ex: $50,000 Coverage Age 25- $4.75 Age 35- $6.25 Age 45- $13.00 Age 55- $30.00 Age 65- $65.50 Spouse Coverage also available, Child Life up to age 26 Guaranteed Issue Coverage to $200,000 employee, $50,000 Spouse Annual increases of $20,000 up to the guaranteed issue limit on voluntary life each year at open enrollment. Coverage good while employed with Wylie ISD.

17 Disability Insurance Standard Insurance Open enrollment, guaranteed issue opportunity in 2014 Protects against a loss of income due to sickness or accident 1 st Day hospital confinement benefit- Waives elimination period on 0/7, 14/14, 30/30 elimination period plans. Insure up to 66.67% of annual salary- $8000 maximum monthly benefit. Elimination PeriodRate Per $1000 0/7$37.80 14/14$33.30 30/30$28.20 60/60$18.30 90/90$15.80

18 Permanent Life Plan Fidelity Life Permanent, Guaranteed Issue, Life Time Protection, Term Life Insurance Policy. Plus- Long Term Care Rider equal to 4% of death benefit, payable for 75 months. Ex: $25,000 death benefit or $1000 monthly LTC benefit payable for 75 Months. 75 month LTC benefit is new for 2013, current policies include a 25 month LTC benefit Portable upon termination of employment- Premium remains the same. Insure yourself, spouse, and children. Guaranteed issue for all employees up to $100,000. Rates Based on age at issue, guaranteed for life ex: $25,000 Non-Smoker Benefit, monthly premium: Age 35- $15.77 Age 45- $26.27 Age 55- $47.50

19 Medical Gap Plan Specialty Insurance Services Bridges the gap between Active Care 1HD and Active Care 2 benefits by: Paying $1,500 per year for each covered person for hospital confinement Paying $4,500 ($1,500 per occurrence) max per year for 3 occurrences of outpatient services – includes ER visit, MRI, x-ray, lab, outpatient surgery (excludes doctor office visit cost) Guaranteed issue No pre-existing condition if not subject to pre-existing condition on medical plan Also bridges the gap between Active Care 2 and Active Care 3 benefits Employee Only Employee Spouse >40 $25.98 $47.76 40-49 $34.21 $62.85 50+ $71.85 $132.02 Employee Children Employee Family $62.45 $83.64 $67.22 $95.11 $123.81 $182.41

20 Flexible Spending Account TASC Medical Expense Reimbursement and Dependent Care Reimbursement Debt Card Smart Phone and Tablet Apps MyCash Account Medical Expense ReimbursementDependent Care Expense Reimbursement Dr. Visit Co-paysDay Care Expenses Deductible expensesElderly Care Expenses Rx Co-pays Uninsured Dental/Vision Expenses

21 ONSITE ENROLLMENT SCHEDULE

22 DateTimeLocation August 4 th 11a.m. – 6p.m.ESC Building August 5 th – August 7 th 8a.m. – 5p.m.ESC Building August 8 th 11a.m. – 6p.m.ESC Building August 11 th – August 15 th 8a.m. – 5p.m.ESC Building ESC is located at: 951 S. Ballard Avenue Wylie, TX 75098 Open Enrollment - Enrollers Onsite Third Party Administrator, US Employee Benefits 972-636-9944


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