2016Benefit Overview

Meeting Agenda

Introduction

Benefit Review• Blue Cross Blue Shield of Kansas City• Prudential • Flexible Spending Accounts• EAP

Enrollment Schedule

Medical Plans (BCBS KC)

HMO (Health Maintenance Organization)• In-Network Only

PPO (Preferred Provider Organization)• In and Out-of-Network; National and International Coverage• Base and Buy-Up Options

High Deductible Health Plan (Preferred Provider Organization)• Similar features to the Traditional PPO Plans• Same network of physicians, hospitals and pharmacies• Eligible for Employee-Owned HSA (Health Savings Account)

BCBS will cover Preventive Care Services at 100%, according to established government guidelines:

• Annual Physicals• Childhood Immunizations• Well Women Exams• PSA Tests

Services MUST be Preventive and received by In-network providers

Also included ~Generic Contraceptive drugs at 100%

• Contraceptive implants, injectables & devices at 100%

• Breastfeeding support, supplies (pumps) and counseling at 100%

Office Visit: PCP: $30 copay (IM, GP, FP, Ped)Specialist: $60 copay (ENT, Allergist, OB/Gyn)

Urgent Care:Emergency Room:

$60 copay$200 copay

Deductible: N/A

Out-of-Pocket Maximum:Individual

$6,350

Out-of-Pocket Maximum:Family

$12,700

Routine Vision $10 copay

Hospital: Inpatient or Outpatient $500 copay per day / per occurrence up to $2,500 per calendar year

(applies to inpatient services at a hospital and outpatient surgeries at a hospital or an outpatient facility)

Inpatient Mental Illness/Substance Abuse

$500 copay per day / per occurrence up to $2,500 per calendar year

(Prior authorization required from New Directions)

MRI, MRA, CT and PET scans $200 copayOnly one copay will apply for each provider on a specified date of

service even if multiple scans are performedInpatient Hospice $250 copay per day up to $2,500 per calendar year (14 day lifetime

maximum)

HMO Plan

Base PPO PlanIn-Network Out-of-Network

Office Visit Deductible then 20% Deductible then 50%

Deductible: Individual $2,000

Deductible: Family $4,000

Coinsurance (your share): 20% 50%

Out-of-Pocket Maximum: Individual

$5,400 $15,200

Out-of-Pocket Maximum: Family

$10,800 $30,400

Routine Vision Deductible then 20% Deductible then 50%

Hospital: Inpatient or Outpatient

Deductible then 20% Deductible then 50%

Emergency Room $150 copay then deductible then 20%

Urgent Care Deductible then 20% Deductible then 50%

Buy-Up PPO PlanIn-Network Out-of-Network

Office VisitSpecialist

$30 copay$60 copay

Deductible then 40%

Deductible: Individual $1,500

Deductible: Family $3,000

Coinsurance (your share): 15% 40%

Out-of-Pocket Maximum: Individual $4,200 $12,600

Out-of-Pocket Maximum: Family $8,400 $25,200

Routine Vision $30 copay Deductible then 40%

Hospital: Inpatient or Outpatient Deductible then 15% Deductible then 40%

Outpatient Mental Illness/Substance Abuse

$30 copay Deductible then 40%

Emergency Room $150 copay then deductible then 100%

Urgent Care $60 copay Deductible then 40%

Chiropractic $60 copay Deductible then 40%

Prescription Drug Coverage

34 day supply

In-Network Pharmacy

Tier 1: $10

Tier 2: $50

Tier 3: $70

102 day supply

Mail-Order

Tier 1: $20

Tier 2: $100

Tier 3: $140

Worldwide Network of PPO Healthcare Providers

PPO Network

National Network Access through BlueCard®

• 1,177,194 Physicians• 6,776 Hospitals• Access in ALL 50

States• Includes MD Anderson

& Mayo Clinic

Welcomed in over 200

countries Worldwide

Lower monthly premiums

No copayments at doctor’s office you pay entire cost until deductible is met

No copayments at pharmacy; you pay the entire cost until deductible is met, then you are responsible for copays.

Medical Plan

High Deductible Health Plan (PPO)

Full cost of a doctor visit is $140

BCBSKC has negotiated a fee of $65 using Preferred Care Blue Doctors

You pay nothing at the visit

Your doctor sends a bill for $140 to your home, but you don’t pay it

You receive the Explanation of Benefits (EOB) from BCBSKC indicating that you owe $65

You pay your doctor $65

HDHP Claim Flow Example

In-Network Out-of-Network

Calendar Year Deductible: Individual $2,600

Embedded Calendar Year Deductible: Family

$5,200

Coinsurance (your share): 20% 40%

Out of Pocket Maximum: Individual $3,500 $7,000

Out of Pocket Maximum: Family $7,000 $14,000

Office Visit Deductible then 20% Deductible then 40%

Hospital: Inpatient or OutpatientDeductible then 20% Deductible then 40%

Emergency Room Deductible then 20%

Urgent Care Deductible then 20% Deductible then 40%

Retail Prescriptions (34 day supply)

Deductible then$10 / $50 /$70

Deductible then 40%

Mail-Order Prescriptions (102 day supply)

Deductible then$20 / $100 /$140 N/A

Qualified High Deductible Health Plan PPO

Per IRS guidelines for an embedded deductible, must be $2,600 for individual.

Owned by you Used for eligible expenses Helps pay for deductible and Rx (dental and vision as well) Tax savings

No “use it or lose it” rule Administered by UMB ($2.50 per month, waived if daily average account balance is $3,000 or more).

Health Savings Account (HSA)

High Deductible Health Plan (PPO)

Eligibility to Open an HSAYou must be covered by the $2,600 High Deductible Health Plan (HDHP);

You cannot have any “other coverage” such as:o A plan that is not an HSA-qualified HDHPo Spouse’s plan that is not a HDHPo Medicare or Medicaido Tricare Coverage (military health care)o Health Flexible Spending Account (not to include Flexible Spending

Account for Dependent Day Care)o Health Reimbursement Arrangement (HRA)o Veterans Administration Health Benefits

You cannot be claimed as a dependent on someone else’s tax return.

(Health Savings Account)

oMoney may be contributed to your HSA by you, or anyone else, as long

as the total doesn’t exceed the IRS annual maximum:

oCatch up of an additional $1,000 if 55 years of age or older. oNo expenses may be reimbursed for services incurred before the HSA is set up,

regardless of when the QHDP was effective.oKeep Employer Contribution in mind when calculating annual maximum

contribution

Contributions to your HSA

$3,350 individual$6,750 family

Qualified Expenses

Use the HSA funds to pay for IRS “qualified medical expenses” permitted under Federal Tax law including:

Medical out-of-pocket expenses Dental treatments Hearing aids including batteries Prescription drugs Eye exams, eyeglasses, and contact lenses Chiropractic Care and Acupuncture Premiums for qualified long term care insurance and COBRA Medicare premiums Health plan coverage while receiving Federal or State unemployment

benefits

Pay for expenses for yourself and your spouse or tax dependent children even if only enrolled in employee only on HDHP.

(Excludes HMO Plan)

Dental Plan

Broad Network Protection

BlueKC Dental PPO Network

BCBS of KC Contracted Providers Discounted Fees In-Network No Balance Billing No Claim Forms BCBS of KC Pays Dentist Directly

Non-Participating

Not Under Contract With BCBS of KC No Discounted Fees Balance Billing is Possible Dentists May Not File Claims BCBS of KC Pays Patient

BlueKC Dental PPO ←Greatest Patient Savings

Least Patient Savings→

BCBS KC Network Dentist

Non-Participating Dentist

Co-Insurance (Plan Pays)

Type A: Diagnostic and Preventive Services (exams, cleanings, x-rays, fluoride, sealants)

100% 100%

Type B: Basic Restorative Services(fillings, extractions, periodontics, endodontics)

90% 90%

Type C: Major Restorative Services(crowns, dentures, bridges)

60% 60%

Type D: Child Orthodontic Services (to age 19)

50% 50%

Calendar Year Deductible $50 single / $150 family

Applies to: Type B & C Services only

Calendar Year Benefit Maximum $1,000 per person

Separate Lifetime Orthodontic Maximum $1,500 per child to age 19

Dependent Age Limit End of the calendar year in which dependents turn 26

Self-serve features:

Network dentistsClaims status and historyCopy of EOBBenefit designTrack use of maximumsPrint ID cards Request an ID card

Vision(VSP)

VSP Exam Plus Plan – Low Plan

WellVision Exam®- $20 copay- Once every calendar year

Prescription Glasses Discounts- 20% discount when a complete pair of glasses

Contacts- 15% discount off the contact lens exam

VSP Signature Plan – High Plan

Contact Lenses

• Once every calendar year

• $130 allowance (includes fitting and evaluation)

Your Coverage with a VSP Doctor

WellVision Exam® $20 copay Once every calendar year

Prescription Glasses- $20 copay Includes:

Lenses: Once every calendar year

• Single vision, lined bifocal, and lined trifocal lenses

• Polycarbonate lenses for dependent children

Frame: Once every calendar year

• $130 allowance

• 20% off the amount over your allowance

OR

Life/AD&D(Prudential)

Basic Employer Paid Life/AD&D

Coverage Amount

1 times your annual salary, up to a maximum of $200,000

Reductions At age 65, your benefit reduced to 65%. At age 70, it

will reduce to 50%

Optional Employee Life

Coverage Amount

Up to $500,000 Not to exceed 7x your annual earnings

Guaranteed Amount

Up to $150,000 with no medical questions asked

Reductions Coverage will be reduced as you age 35% at age 65, and 50% at age 70

If you are currently enrolled, you may increase your coverage by $40,000 without providing an EOI.  

Optional Dependent Term Life

Spouse Coverage

Up to $250,000, not to exceed 50% of employee coverage

The guaranteed issue amount for spousal coverage is $20,000

Children Coverage

Increments of $2,000 to $10,000

Through the end the calendar year in which they turn age 26

One premium no matter how many children

Log on to: www.prudential.com/EZLifeNeeds

Flexible Spending Accounts(AmeriFlex)

Plan Overview For Plan Year 1/1/2016 – 12/31/2016

• Healthcare - $2,550

• Dependent Care - $5,000($2,500 if married and filing separate)

Grace Periods:

• To incur expenses – 75 days (March 15, 2017)

• To file claims – 90 days (March 30, 2017)

FSA Debit Card

• Does not expire for THREE years!

• Keep all receipts as you may be asked to substantiate some claims

• If your card is lost or stolen, you can request an additional card online, or contact AmeriFlex

Member Services

Bring balance to your life.

New DirectionsEmployee Assistance Program

We help find answers to problems you may face in your personal life and at work.

• 6 visits per incident

Face to Face Counseling

Telephonic Counseling

• Financial Information

• Legal Referrals

• 24 hour telephonic intervention

What does an Employee Assistance Program Do?

How do I Access the Program?

Call: (913) 982-8398 or (800) 624-5544.

OR

www.ndbh.com

Employee Assistance Member

Login code: MWSU

Crisis Leave Policy

Purpose

Provide additional paid leave for employees who have exhausted their accrued leave benefits as a result of their own life-threatening, emergent or serious illness or injury or the need to care for a spouse, child, or parent who is suffering from a life-threatening, emergent or serious illness or injury.

Eligibility

Must be a full-time or part-time benefit eligible employee in a leave-earning position

Must have worked at least 1-year and 1250 hours in a benefit eligible position

Must have exhausted all sick, vacation, personal, compensatory time, and short term disability

Must not be receiving long term disability or worker’s compensation payments

Donations Crisis Leave is funded by employees volunteering

to donate their sick and/or vacation hours Donations occur one time per year, during the

annual benefit open enrollment period (Nov 10-20) Minimum sick leave balance of 240 hours to

donate sick leave Sick leave donated will not be reported to

MOSERS upon your separation from MWSU Maximum amount of donation is 40 hours Complete donation form and submit to HR

Requesting Leave

Exhaust all leaves: sick, vacation, personal, compensatory time, short term disability

Complete request form and submit to HR Must also have requested FMLA

Forms available on the HR website

How to Enroll

• Online (self service)

• https://www.benefitsconnect.net/mwsu• See page 5 of Benefit Guide for Username • Passwords have been reset to your social security

number

Enrollment

Questions?