Presentation is loading. Please wait.

Presentation is loading. Please wait.

Health Care Update and Changes Gayln L Bowers. Agenda Health Care Plan Data Plan Changes Questions and Answers.

Similar presentations


Presentation on theme: "Health Care Update and Changes Gayln L Bowers. Agenda Health Care Plan Data Plan Changes Questions and Answers."— Presentation transcript:

1 Health Care Update and Changes Gayln L Bowers

2 Agenda Health Care Plan Data Plan Changes Questions and Answers

3 2004-2005 PUC left Adventist Risk Management Health Care Plan and implemented the Pacific Union College Self Insured Group Health Care Plan. No employee contribution for the 2004-2005 plan year. PUC Group Health Care Plan is a bundled plan inclusive of medical, prescription, dental and vision. Health Care Plan Review

4 Health and Wellness Program enhanced during the 2004-2005 plan year to encompass a greater preventative strategy. Health Care Plan Review

5 Employee Contribution Implemented July 1, 2005 Employee Only - $30.00 per month Employee +One - $50.00 per month Employee + 2 or more - $75.00 per month Employee Contribution Changed July 1, 2009 Employee Only - $50.00 per month Employee +One - $80.00 per month Employee + 2 or more - $110.00 per month Health Care Plan Review

6 Per Employee Per Month Medical$589.95 Prescription$186.24 Dental$107.72 Vision$18.11 Admin/Re-insurance Fees$218.00 Total$1,120.49 Group Health Plan Costs – 2011-2012

7 EE2-PartyFamily Medical & RX PPO$636.31$1,251.64$1,851.04 HDHP$538.61$1,059.46$1,536.35 HSA Fund$83.33$166.67 Dental PPO$61.85$122.32$217.59 Vision Vision Plan$13.92$27.39$39.71 Group Health Plan Costs – 2011-2012 Premium Equivalencies per Month

8 ALL employees working 37.5+ hours per weeks are offered medical insurance. We have 91 full-time faculty and 153 full-time staff. TOTAL of 244 full-time employees 100% of our full-time employees have picked up the college’s health care plan Employees

9 100 % of full-time faculty members are on the College’s health care plan 100 % of full-time staff members are on the College’s health care plan 32 faculty members have the single plan 26 faculty members have the employee + one plan 33 faculty members have the employee + two or more plan 60 staff members have the single plan 44 staff members have the employee + one plan 49 staff members have the employee + two or more plan Health Care Coverage

10 Total of 48 part-time employees 9 Faculty Members 39 Staff Members Employees working 20+ hours are eligible for a buy-in to the health care plan. Part-time Employees

11 Unlimited Lifetime Maximum Benefit No Pre-existing Exclusions Dependent Coverage up to age 26 Affordable Care Act (ACA) Re-defines a full-time employee to at least 30 hours per week ACA establishes two fees Qualified Health Plans will be required to pay Patient-Centered Outcomes Research Institute (PCORI) Fee Transitional Reinsurance Program Fee Why Plan Changes?

12 Plan Changes

13 Health Plan Medical Prescription Dental Vision

14 Medical & Prescription Base Plan Traditional High Deductible DentalVision

15 Base PPO Health Care Plan In-NetworkOut-of-Network Annual Deductible$250 Individual $500 Family Coinsurance80%50% Office Visit Copay$25 per visit Primary Care, Deductible waived $40 per visit Specialist, Deductible waived Annual Maximum Out-of-Pocket$4,500 Individual $9,000 Family $8,000 Individual $12,000 Family Lifetime Maximum BenefitUnlimited

16 Base PPO Health Care Plan In-NetworkOut-of-Network Outpatient & Inpatient Services Preventive CareCovered 100%, Deductible waived50% Inpatient Hospital Services80%50% Emergency Room ($50 copay waived if admitted) $50 copay then covered 80% (see full list for Level ER service copays) Outpatient Services (Labs, X-rays)80%50% Additional Services Covered (refer to full plan summaries for benefits and limitations) Minimum Essential Benefits

17 Prescriptions/PharmacyRetail-30 Day Supply Home Delivery- 90 Day Supply Generic$10$15 Brand$40 Non-Formulary$55$50 Special Medications$85$50 Base PPO Health Care Plan

18 Employee Monthly Contribution Employee Only$25.00 Employee + One$40.00 Employee + Two or More$55.00

19 Traditional PPO Health Care Plan In-NetworkOut-of-Network Annual Deductible$350 Individual $700 Family Coinsurance80%50% Office Visit Copay$25 per visit Primary Care, Deductible waived $40 per visit Specialist, Deductible waived Annual Maximum Out-of-Pocket$3,000 Individual $6,000 Family $5,000 Individual $10,000 Family Lifetime Maximum BenefitUnlimited

20 Traditional PPO Health Care Plan In-NetworkOut-of-Network Outpatient & Inpatient Services Preventive CareCovered 100%, Deductible waived50% Inpatient Hospital Services80%50% Emergency Room ($50 copay waived if admitted) $50 copay then covered 80% (see full list for Level ER service copays) Outpatient Services (Labs, X-rays)80%50% Additional Services Covered (refer to full plan summaries for benefits and limitations) Physical, Occupational & Speech Therapy Vision Therapy and Care Durable Medical Equipment Organ & Tissue Transplant Refractive Eye Surgery

21 Traditional PPO Health Care Plan Prescriptions/PharmacyRetail-30 Day Supply Home Delivery- 90 Day Supply Generic$10$15 Brand$35$40 Non-Formulary$40$50 Special Medications$80$50

22 Traditional PPO Health Care Plan Employee Monthly Contribution Employee Only$50.00 Employee + One$80.00 Employee + Two or More$110.00

23 High Deductible Health Plan with Health Savings Account In-NetworkOut-of-Network Employer HSA Funding$1,000 Individual $2,000 Family Annual Deductible$2,000 Individual $4,000 Family Coinsurance90%50% Office Visit Copay$25 per visit Primary Care $40 per visit Specialist Annual Maximum Out-of-Pocket$3,000 Individual $6,000 Family $5,000 Individual $10,000 Family Lifetime Maximum BenefitUnlimited

24 High Deductible Health Plan with Health Savings Account In-NetworkOut-of-Network Outpatient & Inpatient Services Preventive CareCovered 100%, Deductible waived50% Inpatient Hospital Services90%50% Emergency Room ($50 copay waived if admitted) $50 copay then covered 90% (see full list for Level ER service copays) Outpatient Services (Labs, X-rays)90%50% Additional Services Covered (refer to full plan summaries for benefits and limitations) Physical, Occupational & Speech Therapy Vision Therapy and Care Durable Medical Equipment Organ & Tissue Transplant Refractive Eye Surgery

25 High Deductible Health Plan with Health Savings Account Prescriptions/PharmacyRetail Delivery – 30 Day Supply Home Delivery- 90 Day Supply Generic$10$15 Brand$35$40 Non-Formulary$40$50 Special Medications$80$50

26 Annual Deductible$75 Individual $150 Family Coinsurance80% Preventive CareCovered 100%, Deductible waived Annual Maximum$3000 Individual $6000 Employee + One $9000 Employee + Family Orthodontia50% Coinsurance $2400 Lifetime Maximum Covered up to age 26 Employee Monthly Contribution Employee Only$15.00 Employee + One$30.00 Employee + Two or More$60.00 Dental Plan

27 Annual DeductibleNone Coinsurance80% Preventive CareN/A Annual Maximum$560 Employee Monthly Contribution Employee Only$5.00 Employee + One$10.00 Employee + Two or More$15.00 Vision Plan

28 Enrollment Form

29

30 Questions


Download ppt "Health Care Update and Changes Gayln L Bowers. Agenda Health Care Plan Data Plan Changes Questions and Answers."

Similar presentations


Ads by Google