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Open Employee Forum - Medical Plans Strategies for 2012 August 8, 2011.

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Presentation on theme: "Open Employee Forum - Medical Plans Strategies for 2012 August 8, 2011."— Presentation transcript:

1 Open Employee Forum - Medical Plans Strategies for 2012 August 8, 2011

2 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Current State of Affairs Health care costs continue to rise—current inflation is 10% Reasons for double-digit increases include: ▫ Aging population ▫ Increased utilization ▫ New technologies ▫ Government mandates ▫ Lifestyle choices (approximately 2/3 of claims), particularly…  Tobacco usage  Obesity  High blood pressure  High cholesterol  Heart disease  Diabetes  COPD

3 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx 2012 Objectives Maintain competitive medical/prescription drug benefits Provide a plan at an affordable cost to both employees and SLU

4 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Projected Medical/Rx Costs 2011 Current Primary/Plus 2012 Renewal Primary/Plus 2012 Proposed HSA/Primary 2012 Proposed HSA/Plus Total Projected Medical/Rx Costs Projected Employee Contribution $8.3 Million$9.2 Million$8.9 Million $9.4 Million Projected Employer Contribution $25.9 Million$28.7 Million$27.0 Million $28.6 Million Maintains 75% University contribution

5 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx 2012 Medical/Prescription Drug Benefits SLU will continue to offer two programs:  Plus PPO Plan (with a modified Rx component)  Health Savings Account (HSA) Qualified Plan

6 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx What is a Health Savings Account (HSA)? An HSA is: A consumer-owned, tax-advantaged savings account, created to pay health care expenses It is always combined with a qualified high deductible health plan Provides the consumer an incentive (it’s your money!) to better plan your utilization of health care resources To be eligible to contribute to an HSA, you: Must be enrolled in a qualified High Deductible Health Plan (HDHP) Do not have benefits from another non-qualified health plan Are not enrolled in Medicare/Medicaid benefits Are not claimed on another’s tax return

7 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Health Savings Account—How does it work? Each calendar year, you can contribute money to your HSA, subject to maximum annual contributions An eligible employee and his or her eligible covered dependents can use the money in the HSA to pay for qualified health care expenses, tax- advantaged Any money remaining in the account at the end of the calendar year rolls over into the next year; there is NO ‘use it or lose it’ penalty You keep it if you leave the University

8 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Things to know about an HSA Flexible use – consumers choose whether or when to use the account for health HSA allowable charges Tax-free contributions Tax-free growth of interest or investment earnings with your choice of investment funds/portfolios Tax-free disbursements to pay for qualified expenses, now or later Withdraw funds at any time, as long as they are for qualified expenses Withdraw funds with an HSA debit card or by writing a check Funds must be in your account before disbursements can be made

9 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Health Savings Account Qualified Reimbursements Expenses not covered by the health plan, such as deductibles, coinsurance, copayments, etc. Premiums for COBRA coverage Retiree health insurance premiums (not Medicare supplements) Premiums for qualified long term care insurance

10 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx 2012 Proposed Medical Plan Options Plus PlanHSA Plan SLUCareIn-NetworkOut-of-NetworkSLUCareIn-NetworkOut-of-Network DeductibleNon-Embedded: (One member can satisfy entire family deductible) Individual$0$250$750$1,500 $3,000 Family$0$500$1,500$3,000 $6,000 Coinsurance0%10%40%0%10%40% Out-of-Pocket Maximum (includes deductibles)Non-Embedded: (One member can satisfy entire family OOP Max) Individual$0$1,250$4,750$3.000$3,000$6,000 Family$0$2,500$9,500$6,000 $12,000 Physician Office Visits Primary Care$10 copay 10% after ded.40% after ded.0% after ded.10% after ded.40% after ded. Specialist Care$20 copay Inpatient Hospital 10% after ded.40% after ded.10% after ded.40% after ded. Emergency Room $100 copay 10% after ded.40% after ded. Urgent Care Center $50 copay 10% after ded.40% after ded.

11 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx 2012 Proposed Pharmacy Plan Options Plus PlanHSA Plan Express Scripts Retail (34-day supply) Express Scripts Mail Order (90-day supply) Express Scripts Retail (34-day supply) Express Scripts Mail Order (90-day supply) Tier 1$8$16Medical Deductible and Coinsurance Tier 2$30$60Medical Deductible and Coinsurance Tier 3$50$100Medical Deductible and Coinsurance Tier 420% to $150Medical Deductible and Coinsurance Preventive MedicationsPriced according to the tier in which they fallCovered at 100%, no copay or deductible NEW! Under the proposed HSA plan, certain preventive, or “maintenance,” medications would be covered at 100%... NO copay or deductible would need to be satisfied by you or your family! Information on which drugs qualify as preventive will be distributed during open enrollment.

12 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx 2012 Proposed Cost Sharing If you enroll in the HSA Qualified Plan for 2012, SLU will contribute funds to help you build your balance:  $250 for Single Enrollees  $500 for Enrollees with Family Members Wellness Incentive increased from $20 to $30 for 2012 Plus Plan Monthly Payroll DeductionsWith Wellness IncentiveWithout Wellness Incentive Single$94.34$124.34 Employee and Spouse$313.79$343.79 Employee and Child(ren)$283.90$313.90 Family$448.26$478.26 HSA Qualified Plan Monthly Payroll DeductionsWith Wellness IncentiveWithout Wellness Incentive Single$29.81$59.81 Employee and Spouse$178.28$208.28 Employee and Child(ren)$161.30$191.30 Family$254.68$284.68

13 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx 2012 Proposed Cost Sharing Annual Contribution Difference vs. 2011 Plus Plan Plus Plan Annual Difference in Payroll DeductionsWith Wellness Incentive Single$304.44 Employee and Spouse$181.92 Employee and Child(ren)$164.52 Family$259.80 HSA Qualified Plan Annual Difference in Payroll DeductionsWith Wellness Incentive Single($469.92) Employee and Spouse($1,444.20) Employee and Child(ren)($1,306.68) Family($2,063.16) If you enroll in the HSA Qualified Plan for 2012, SLU will contribute funds to help you build your balance: ▫ $250 for Single Enrollees ▫ $500 for Enrollees with Family Members

14 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Eligible Dependents Definition of an Eligible Dependent Legal spouse or dependent child under 26 years of age of the employee or the employee's spouse. The term child includes any of the following: A natural child A stepchild A legally adopted child A child placed for adoption A child for whom legal guardianship has been awarded to the employee or the employee's spouse

15 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Dependent Eligibility Audit SLU has a responsibility to:  Administer the plan as stated in the plan document  Administer the plan consistently for all employees  Monitor the costs of the plan SLU will complete a Dependent Eligibility Audit in early 2012  Employees will be asked to provide verification for enrolled dependents  Ineligible dependent will be removed from the plan  Claims paid for ineligible dependents may be recovered and the expenses would become the responsibility of the employee Additional information will be provided

16 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Vitality Program Activity Distribution ▫ Members completing 2-5 activities  April: 60% of total population  May:55% of total population  June:52% of total population ▫ Members completing over 10 activities  April: 5% of total population  May:10% of total population  June:12% of total population Vitality Status Earned (YTD) ▫ April/May/June  Blue: 1,874/1,897/1,868  Bronze: 740/722/757  Silver: 1,694/1,733/1,752  Gold: 16/20/28  Platinum:1/4/6 Verified Workouts ▫ April: 46 ▫ May: 334 Added Simon Rec Center ▫ June: 427 Education Activities ▫ April: 306 ▫ May: 342 ▫ June: 365 Healthy Living Activities ▫ April: 40 ▫ May: 63 ▫ June: 70 Prevention Activities ▫ April: 79 ▫ May: 118 ▫ June: 142

17 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Vitality Communication Toni Sullivant (25 years of service) has been one of the most active Vitality members at the University since it started last fall. She tells SLULife how she used the program to conquer life-long weight issues: “I always wanted to do something about my weight but never had the incentive or the money to join a gym. “After joining Vitality, I used the website daily to take advantage of the fitness and weight- loss programs. When I learned about the fitness subsidy, I was ecstatic! I joined Curves in January and have since lost over 30 pounds and 28 inches (at 4’10” tall!), and because my Vitality Status is Platinum, the membership fee is fully covered!” “People at the University definitely noticed me slimming down. I want to motivate—I’m a ‘Walk to Madrid’ leader, and I’ve got coworkers joining gyms and getting Fitbugs." “I’ve been asked if Vitality pays me! But really, I’m saving money, feeling better, and couldn't be happier. “I feel blessed and hope my story inspires those with weight issues to make the most of Vitality and share my success!” Do you have a success story you would like to share? Please contact wellness@slu.edu!

18 \EB\STLUN\2011\Employee Open Forum 7-7-11.pptx Contact Information Please email questions or comments to: benefits@slu.edu or benefits@slu.edu wellness@slu.edu Your feedback is important!!!


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