Download presentation
Presentation is loading. Please wait.
Published byAgatha Ford Modified over 8 years ago
1
Open Enrollment
2
Agenda Health Benefits Overview –Glossary of Terms –2013 Plan Options Health Savings Account Dental Renewal Vision Renewal Open Enrollment Process Questions
3
Things to Remember All LFUCG employees have an annual benefit pool credit and a health plan supplement, as approved by the LFUCG budget All 4 medical plans provide the same services, access to the same medical providers and prescription benefits; however, the way each service is covered is different with each plan Employees have access to dental coverage through Delta Dental of Kentucky A full vision rider, through Humana, is embedded into all medical plans A Stand alone vision plan is available through EyeMed, if you do not have the medical plan but want to have vision coverage
4
Fundamental Insurance Terms Co-Pays: The flat dollar amount that you pay for a specified medical service. There are co-pays in the PPO options so be sure to take the co-pays into consideration when planning your out of pocket costs. Co-pays do not accumulate toward your Deductible or Maximum out of Pocket and do not go away after those are met. Deductible: The deductible is the amount you need to pay out-of-pocket for covered health expenses before your plan begins to pay a percentage of costs (co-insurance) Single Deductible: The single deductible is the most any one person will pay in deductible services during a calendar year, regardless of whether they have a single, employee/spouse, employee/child(ren) or family plan. Family Deductible: The family deductible is the most a family will pay in deductible services during a calendar year. This can be satisfied by two people meeting their single deductible, or a combination of covered multiple family members’ deductible expenses. Even under the family deductible, no one person will ever be subject to more than a single deductible amount.
5
Fundamental Insurance Terms (con’t) Co-insurance: The percentages of the total medical bill that you and the plan pay once you meet your deductible. As an example of this, refer to HSA 2. The plan will cover you at 80% and you will pay 20% after your deductible. Co-insurance applies to the out of pocket maximum Out of Pocket Maximum: After your deductible is satisfied, you begin to work toward your Out of Pocket Maximum through the coinsurance. Single and Family Out of Pocket Maximums are satisfied the same way as deductibles. Health Savings Account (HSA): Tax-free bank account which belongs to the employee and from which funds may be used to pay for qualified expenses on a tax-free basis. You must be covered under a qualified health plan in order to contribute into an HSA.
6
Who is Eligible for an HSA? You are eligible: –If you are covered under HSA 1 or HSA 2 plans (not the PPO Plans) You are not eligible: –If you or your spouse contribute to a general purpose health Flexible Spending Account –If you are entitled to a government sponsored medical plan (Medicare, Medicaid, VA, etc.) –Individuals receiving benefits at the VA are entitled to enroll in an HDHP and establish an HSA. However, IRS guidance states they cannot make a contribution to their HSA for 3 months after each use of VA medical or prescription drug services.
7
2013 Health Plans & Monthly Premiums
8
2013 Benefit Pool & LFUCG Supplement by Division as of January 1, 2013
9
New for 2013: Non-Tobacco Premium Credit Single / Employee + children: $25 monthly credit Employee/Spouse or Family: $50 monthly credit You must be willing to sign an Affidavit indicating that you and/or your family are non-tobacco users Tobacco cessation classes/products will be made available
10
PPOHSA Only certain charges apply to the deductible Once the deductible is met, only certain charges go toward your Maximum out of Pocket in the form of co- insurance. Once the Maximum out of Pocket is reached, co-pays still apply and do not end. All eligible expenses apply toward the deductible Once the deductible is met, all eligible charges go to your Maximum out of Pocket in the form of co-insurance. However, under HSA 1, there is no further cost-share after the deductible. One the Maximum out of Pocket is reached all eligible expenses are covered at 100%. PPO / HSA Plan Differences
11
PPOHSA Flexible Spending Accounts (FSA) can be used with the PPO Plans to set aside money for eligible medical expenses; however, the funds must be used within the plan year or forfeited. Health Savings Accounts (HSAs) can be used with HSA 1 and HSA 2 plans to set aside tax free money for eligible medical expenses; This money accumulates and remains yours even if you leave LFUCG. You can continue to use those funds in the future for medical expenses. Flex Spending or Health Savings Accounts
12
HSA: General Concepts Balance rolls over from year to year and there is no maximum on the rollover amount; however, there is a maximum on the amount that can be deposited each year. For 2013, these amounts are: $3,250 for Single coverage; $6,450 for E/S, E/C & Family coverage Interest earnings are not taxed 100% owned by employee LFUCG will be making a $500 annual contribution for Employee Only coverage and $1,000 annual contribution for all other levels of coverage (50% funded in January and July)
13
How Do You Use an HSA? You will receive a Humana ID card with a Visa logo that can be used to pay providers You can only spend what is in your Health Savings Account HSA funds can be used to pay for medical expenses for spouse/dependents not covered on your medical plan An HSA dependent must be a tax dependent You will be responsible for maintaining records for tax purposes
14
What medical plan should I choose? Co-pays often disguise the true cost of medications…call your pharmacy or the on-site pharmacy to find out the true cost of your current prescriptions outside of a co-pay plan to gauge your monthly out of pocket costs. Go to www.humana.com to find out how much medical care you used in 2012 as a reference in making a decision for 2013. Take time to review your family’s healthcare spending over the last 12 months before making a plan decision.www.humana.com HSA options may be more attractive as a savings vehicle since the funds set aside in your Health Savings Account roll over and remain yours to spend for eligible medical expenses. Note that you may be responsible for more up-front expenses than you are used to. This is particularly true of prescription medications. Reminder, Preventive Care is covered at 100% on all 4 plans. All participants ages 6 & up may use the Health Center at no cost. All plan participants may use the City Center Pharmacy.
15
Plan Provisions (Pharmacy) No change in Pharmacy Vendors: Bluegrass Family Health/Express Scripts for PPO options and Humana for the HSA options Walgreens will remain OUT of network under the BGFH/ESI prescription coverage You will receive the appropriate card for your pharmacy benefits based on the plan you elect Additional pharmacy savings may be available at the Samuel Brown Health Center
16
Wellness Center & On-Site Pharmacy Available as an option for all LFUCG employees, dependents ages 6 and up and retirees covered by any of the health plans (Pharmacy available for all ages) No co-pays or cost share for physician visit Wholesale cost for prescriptions filled at the On-Site Pharmacy Personalized attention customized for LFUCG Can continue to use current physicians exclusively or in conjunction with care at the Center All care is completely confidential
17
Delta Dental
18
Humana Vision Rider Vision rider is included with all medical plans.
19
EyeMed Vision Plan The EyeMed Vision Plan is a stand alone plan which can be purchased without medical.
20
Resources Employee Benefits Booklet Worksheets Help Sessions Intranet (HR and Frequently Used Forms)
21
Open Enrollment Process Employee Enrollment Options: Online from any computer with internet access (home or LFUCG) Enroll online at the Peoplesoft Enrollment Website: https://hcm.lexingtonky.gov https://hcm.lexingtonky.gov If assistance is needed, help sessions will be scheduled (details on availability will be communicated specifically for your department or group) When Enrolling You Will Need Peoplesoft password Social Security Numbers/DOB’s for you and all dependents Send your questions to LFUCG-2013 Employee Health Insurance Q & A link. LFUCG-2013 Employee Health Insurance Q & A link If you fail to enroll on-line or provide proof of coverage to waive benefits, you will be enrolled in PPO 2 (Employee Only, no non-tobacco credit)
Similar presentations
© 2024 SlidePlayer.com Inc.
All rights reserved.