© 2010 wittenberg university springfield, ohio 45501 new health care plan for active employees...

© 2010 Wittenberg University Springfield, Ohio 45501

New Health Care Plan For Active Employees

Effective Oct. 1, 2010


Agenda

I. Medical/Dental Insurance Plan Design Review Employee Contributions

II. Anthem Resources Anthem.com Look up providers, manage prescriptions etc.

III. Vision Plan- New! Plan Design Review Employee Contributions

IV. Flexible Spending Account What is it? Reimbursements Healthcare Reform OTC Change

V. Enrollment Process and Deadlines Medical and Dental Vision Supplemental Life Voluntary Benefits through Integra Benefits Group

General Information


General Information

• New Plan is Effective 10/1/2010

• Self-Funded Plan subject to ERISA and plan document

• Partnering with Anthem Blue Cross & Blue Shield

Blue Access PPO network – national network

• 4 Plan Types: Employee plan, Employee + spouse plan,

Employee +children plan, & Family plan


General Information

• Dental continues to be a part of the Medical Plan

• Your deductible accrual that started on January 1, 2010 will remain intact. In other words, plan members will not need to restart their deductible accumulations with the Oct. 1 onset of the Anthem plan.

• The healthcare plan will continue to operate on a calendar year. Deductibles, out-of-pocket maximums etc. will be calculated based on the calendar year.


General Information• Annual Open Enrollment for 2010- Aug. 25th - Sept. 15th

• Qualifying Event – You can only join the plan or make benefit election changes during the annual open enrollment period unless you experience a qualifying life event change as defined by IRS.

• Examples: change in marital status, birth or adoption of a child, change in spouse’s employment status. You must contact Human Resources to complete a health care application within 31 days of the event.

• Addition of Vision Plan for Active Employees (plan is separate from health & dental)


Glossary of Terms• Co-pay – a flat dollar amount that is paid at the time of service. Co-pay

does not apply to the deductible

• Deductible – annual amount of money a member must pay before benefits are paid at the co-insurance % .

• Co-insurance – a percentage that a member pays for services received after they have met their deductible.

Member pays in full until deductible is met.

• Out-of- pocket limit – the most an employee would pay in deductible and co-insurance during a

plan year (Jan-Dec) for healthcare services excluding prescription drugs.

Services with a % = Co-insurance .

Services with a $ = Co-pay .


Wittenberg’s Blue Access PPO Health Plan

MEMBER PAYS

Deductible $400 individual /$800 family

Emergency Room Services 10% after deductible

In-Network BenefitOut-of-Pocket Limit $1,200 individual /$2,000

familyPhysician Office visits $20 co-payPreventive Care visits Covered at 100%Urgent Care $20 co-payInpatient/Outpatient Services 10% after deductible


Wittenberg’s PPO Health PlanOut-of-network benefit

Out-of- Pocket Limit $1,300 individual /$2,200 family

Physician Office visits 30% after deductiblePreventive Care visitsUrgent CareInpatient/Outpatient Services

Balance billing: Providers and hospitals who are out-of-network will bill you for the difference between the amount the plan pays and the usual and customary amount.


Deductibles and Out-of-Pocket Limit

Deductible The $400/$800 deductible simultaneously applies to both in and out-of-network services. In other words, there is not a separate deductible for out-of-network.

Out-of-Pocket Limit (“OOP”) There is a separate out-of-pocket limit for in-network and out-of-network co-insurance expenses.

Co-insurance costs for services received in-network only apply tothe in-network OOP. Co-insurance costs for services received out-of- network only apply to the out-of-network OOP.

In-network - $1,200/$2,000Out-of-network - $1,300/$2,200



Three Possible Scenarios

Illustration: OOP costs based on an Individual Member

1. Member receives all services from in-network providers

= $1,200 per individual OOP limit. ($400 deductible + $800 additional co-insurance expenses)

2. Member receives all services from out-of-network provider

= $1,300 per individual OOP limit plus any balance billing. ($400 deductible + $900 additional co-insurance expenses…plus balance billing)



3. Individual Member receives in-network AND out-of -network services.

Member must satisfy OOP limit under each benefit.

OOP limit = $1,200-$2,100 depending on the cost of the out-of-network service.

$1,200 in-network OOP limit plus the cost of the out-of-network service up to a maximum of $900 additional cost. Plus any balance billing.


Tiered Prescription Benefit

Prescription Drug Retail $10/$25/$40

Express Scripts Prescription Drug Mail Order $20/$50/$80

3-month supply Anthem Tiered Drug List

You will need a new script to initiate the new mail order service

Prescription co-pay OOP limit: $1,200 single/$2,000 family

Note: This OOP limit is completely separate and unrelated to the OOP for medical.

http://www.anthem.com/health-insurance/customer-care/forms-library


Wittenberg Dental Plan MEMBER PAYS

Deductible $25 single /$75 family

Annual Maximum (per covered member) $1,500

Diagnostic and Preventive No Charge to member

Minor Restorative 20% after deductible

Oral Surgery 20% after deductible

Endodontic Services 20% after deductible

Periodontal Services 20% after deductible

Prosthodontic Services 50% after deductible

Orthodontic Services 50% no deductible

Orthodontic Lifetime Maximum $1,000

Orthodontic Age Limit Child to age 19


80/20 Contribution Medical/Dental Plan


80/20 Contribution Medical/Dental Plan

Nationally, Healthcare Costs will continue to trend up.

Expect Future Rate Increases


Anthem.com website

• Your Personal Account Summary

• Manage your Prescription Benefit – Express Scripts

• Information about the plan benefits and PPO providers

• Valuable Tools

• Health and Wellness Discounts and Special Offers

• You must Register to have access to the website

Anthem

http://www.anthem.com/health-insurance/home/overview


RegistrationRegistering for anthem.com is quick and easy and designed to ensurethat your personal information is kept safe and secure.

1

1

1

First, go to anthem.com.

Click on the Register link.

http://www.anthem.com/health-insurance/home/overview


How to Find a Provider

• www.anthem.com

• Click on “Find a Doctor” on the right side of the page• Choose the state that you want to search• Choose the Blue Access PPO for the Medical Plan network• Choose the type of Provider you want to find • You can then search by provider name, address, zip code etc.

http://www.anthem.com/


Anthem Blue View Vision Benefit Plan for Active Employees

Network BenefitsRoutine Eye Exam (once every 12 months) $10 co-payEyeglass Frames (once every 24 months) $100 allowance/20% off the remaining balance

Eyeglass Lenses (standard)Standard Plastic Single vision lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Bifocal lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Trifocal lenses (1 pair) $15 co-pay, then covered in full

Eyeglass lens upgradesUV coating, Tint, Standard Scratch-Resistance $15 co-pay per upgradeStandard Polycarbonate $40 co-payStandard Progressive $65 co-pay standard Anti reflective coating $45 co-payOther add-ons and services 20% off retail price

Contact Lenses Elective Conventional Lenses $105 allowance/15% off the remaining balanceElective Disposable Lenses $105 allowance (no add’l discount) Non-Elective contact Lenses Covered in Full


Active Employee Monthly Contributions Vision Plan

Plan Type Employee Monthly

Single $3.00

Employee Plus One $6.00

Family $10.00

Contributions are tax -sheltered


Flexible Spending Account (FSA)For Active Employees

TASC Third Party Administrator

tasconline.com

PAY LESS TAXES - An FSA allows you to set aside PRE-TAX money to pay for qualified out-of-pocket healthcare and dependent care expenses.


FSA - What is it?• Two FSA Accounts- Healthcare & Dependent Care. Every year you set aside

funds in an FSA to cover your medical or dependent care costs. You need to decide upfront how much money you want to elect for the calendar year.

• Voluntary election of payroll deductions on a pre-tax basis. Savings of nearly 30% is the Rule of Thumb – Use the TASC On-line Tax Savings Calculator to estimate your tax savings. http://www.tasconline.com/buytasc/flexsystem/

• You cannot change your election unless you have a qualifying event. Also, you cannot transfer money from one account to another.

• “Use it or Lose it” - You have a grace period of three months after the end of the calendar year to submit claims for eligible expenses incurred duringthe previous calendar year. Any money left in your account after the three months will be forfeited.

http://www.tasconline.com/buytasc/flexsystem/


FSA - Enroll Now for Jan. 1, 2011 effective date

Healthcare FSA

• $3,000 annual maximum limit

• You have immediate access to your full election at the onset of the calendar year even though the full election has not been deducted from your pay.


FSA - Enroll Now for Jan. 1 2011 effective date

Dependent Care FSA

• If married, spouse must work or attend school full-time

• Maximum - $5,000 for single or married filing joint tax return, $2,500 married filing separate return

• Under IRS guidelines, you can only be reimbursed for dependent care that has already taken place. Also, you can only be reimbursed for the amount you have already contributed to your dependent care FSA.

• Eligible expenses include dependent care expenses for children under age 13, a disabled spouse, and/or a disabled relative or household member who depends on the account holder for at least half of his orher support.


FSA Reimbursement

• You can request reimbursement by fax, mail, or on-line.

• 24-hour turnaround on reimbursements via Direct Deposit.

• Use the FlexSystem Claim Card for seamless real-time payments. You can also order a card for your spouse.

• Instant account status availability on-line or via FlexSystem’s voice response system.

• Toll-free customer service assistance


FSA Card How to use your Claim Card:

You may use the card like a credit card when you pay for eligibleexpenses at the point of service. The funds are automatically deducted from your Flex Account balance. It is important to remember that you may still need to submit substantiation upon request.

Where to use the card:•Medical and dental physicians•Vision care providers•Medical facilities•Drug stores and in-store pharmacies •Hospitals including emergency rooms•Dependent care providers who accept Visa


Over-the-Counter FSA Eligible Expenses Change Effective January, 2011

• As of January 1, 2011, over-the-counter (OTC) medicines/drugs will not be eligible FSA expenses, unless you retain a prescription (or Letter of Medical Necessity) from your physician, or if it’s insulin.

• OTC health-related supplies continue to be FSA eligible.


Open Enrollment Process Sept. 15th Deadline

Medical/Dental Insurance Enrollment

•Currently Enrolled? You do not need to fill out a form. Contracts for current participants will be electronically transferred from Principal to Anthem.

•If you are enrolling for the first time, adding or dropping dependents or canceling your coverage, you need to complete an enrollment form ASAP and no later than Sept. 15th.

Anthem ID cards will be mailed to your home addresses. Please watch for them in the mail towards the end of September.


Open Enrollment Process Sept. 15th Deadline

You need to complete an enrollment form to enroll in:

• Vision Insurance

• Supplemental Voluntary Life Insurance – Age-banded program. Can add additional coverage of 1, 2, or 3 times salary.

• Voluntary Insurance – ex. Cancer, long-term disability, accidental

Deadline To Turn In Enrollment Forms is SEPTEMBER 15th. To insure timely receipt of your new benefit card, we recommend that you turn in your enrollment form as soon as possible.

Anthem ID cards will be mailed to your home addresses. If you purchase vision insurance, that benefit will be loaded onto your medical card.


FSA Open Enrollment Nov. 16th Extension

Enrollment Forms will be sent to you electronically.

If you are enrolled THIS YEAR, you can enroll on-line. HR will send current enrollee’s a summary sheet via campus mail with your password and current year election.

© 2010 wittenberg university springfield, ohio 45501 new health care plan for active employees...

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