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Open Enrollment Benefits 2014-2015 August 1 _ 31, 2014 Wylie ISD
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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
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CHANGES TO MEDICAL/RX PLAN DESIGN
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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
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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
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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
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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
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SIDE-BY-SIDE VIEW OF MEDICAL/RX PLAN DESIGN
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Side-by-side comparison of 2014-2015 medical plan options
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OVERVIEW OF DENTAL, VISION, & OTHER BENEFIT OFFERINGS
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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ONSITE ENROLLMENT SCHEDULE
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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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