salt lake community college open enrollment 2015-2016
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Salt Lake Community College
Open Enrollment 2015-2016
WHAT’S NEW FOR 2015-2016
Voluntary Vision Plan – EMI HealthVRX - Pharmacy Administrator for Traditional Plans Qualified High Deductible Health Plan (QHDHP)HealthSparq – Comparison Tool (All Plans)Health Savings Account – NBS
Employee OptionsMay 1st – May 22nd
• Enroll or make changes to your health insurance
• Enroll in a Health Savings Account (HSA) or Reenroll in the Flexible Spending Account (FSA)
• Enroll in the Voluntary Vision Plan• Enroll or increase coverage for Voluntary Life
OPEN ENROLLMENT
May 1st THROUGH May 22nd
IF YOU DO NOT MAKE A MEDICAL AND/OR DENTAL ELECTION PRIOR TO MAY 22nd, YOU AND ANY ENROLLED DEPENDENTS WILL REMAIN IN THE SAME PLAN/NETWORK FOR THE 2015/2016 PLAN YEAR.
OPEN ENROLLMENT ELECTIONS CANNOT BE MADE AFTER MAY 22, 2015.
EMI Health VSP Vision Plan
Vision Plan
Customer Service
Medical & Dental Benefits
Open Enrollment 2015-2016
DENTAL RATES 2015-2016
2014/15 2015/16
Employee $2.25 $2.25
Two-Party $3.75 $3.75
Family $5.95 $5.95
MEDICAL RATES 2015-2016PAR TRADITIONAL PLAN QHDHP
2014/15 2015/16 2014/15 2015/16
Employee $48.50 $51.21 N/A $36.92
Two-Party $109.00 $115.10 N/A $82.91
Family $152.00 $160.50 N/A $115.50
PVC TRADITIONAL PLAN QHDHP
2014/15 2015/16 2014/15 2015/16
Employee $25.00 $26.53 N/A $13.42
Two-Party $56.00 $59.44 N/A $29.91
Family $77.50 $82.27 N/A $41.00
PFP TRADITIONAL PLAN QHDHP
2014/15 2015/16 2014/15 2015/16
Employee $7.50 $7.50 N/A $0
Two-Party $17.00 $17.00 N/A $0
Family $23.50 $23.50 N/A $0
ONLINE ENROLLMENT• Click the Regence Online Enrollment link on
the HR website – May 1st – May 22nd • Click “Create an Account”• Identify yourself and then create a User ID and
Password• Begin open enrollment process
Online Enrollment Assistance 5 a.m. to 5 p.m. MDT
855-216-8125
ONLINE ENROLLMENT
ONLINE ENROLLMENT
• Maintain personal information• View important benefit information• Compare plans• Initial changes throughout the year• Manage account information• Link to other benefit websites
NETWORK OPTIONS
HOSPITALS
Participating Traditional Preferred ValueCare Focal Point
100%
82%
23%
Includes all IHC hospitals + all others in
UtahIncludes the
UofU, Mtn Star, IASIS,
independent and rural IHC
Includes UofU & Mtn. Star
All networks include Huntsman Cancer and Primary Children's
PROVIDERS
Participating Traditional Preferred ValueCare Focal Point
9220
3433
9400
Includes all IHC InstaCare and KidsCare
Clinics
Includes After Hours Medical and
First Med Urgent Care
Centers
DENTAL PROVIDERS
1,275 GENERAL DENTISTS
291 SPECIALISTS
OVER 100,000 ACCESS POINTS NATIONWIDE
BENEFITS
CHANGES FOR 2015-2016TRADITIONAL PLANS
DEDUCTIBLEIn-network changing from $200/$400 to $400/$800Out-of-network changing from $500/$1,000 to $1,000/$2,000
OUT-OF-POCKET MAXIn-network changing from $2,700/$5,400 to $2,900/$5,800Out-of-network changing from $4,500/$9,000 to $5,000/$10,000
OFFICE COPAYMENTSPrimary/Specialists changing from $25 per visit to $30 per visit
OTHEROut-of-network Inpatient Admits through ER paid as in-network
Covered Service In-Network Out-of-Network
Deductible $1,500 single$3,000 family
$3,000 single$6,000 family
Out-of-Pocket Max $3,000 single$6,000 family
$6,000 single$12,000 family
Coinsurance After deductible, you pay 10% After deductible, you pay 30%*
Office/Urgent Care After deductible, you pay 10% After deductible, you pay 30%*
Preventive Care Covered at 100% After deductible, you pay 30%*
Retail Mail-order
After deductible, you pay:
Generic $7 $7
Preferred 25% to a max of $150 25% to a max of $300
Non-Preferred 30% to a max of $175 30% to a max of $437.50
Specialty 10% to a max of $250 for generic & preferred15% to a max of $300 non-preferred
*balance billing applies
NEW QHDHP
Optimum Value
Value-based medications
Deductible waived on QHDHP for medications used to prevent or manage chronic conditions:
DepressionCardiovascular Disease
DiabetesHigh Cholesterol
OsteoporosisAsthma
Traditional Plan HDHP
Annual PremiumFamily Coverage
$3,852 PAR$1,975 PVC$564 PFP
$2,772 PAR$984 PVC
$0 PFPDeductible $400 per individual
$800 family$100 / $300 pharmacy
$1,500 single$3,000 family
N/ACoinsurance 80/20% 90/10%
Out-of-Pocket max $2,900 per individual$5,800 family
$2000 / $6000 pharmacy
$3,000 single$6,000 family
N/A2015-2016 SLCC Annual HSA Contribution*
N/A $1,200*
*SLCC will contribute $100 per month into an employees HSA account for employees enrolled as single or family coverage in the QHDHP.
PLAN COMPARISON
EXAMPLE 1 - SINGLE Traditional HDHP
Example: $2,000 in medical expenses
Individual Deductible/Coinsurance
Deductible: $40020% Coinsurance: $320Member Total = $720
Deductible: $1,50010% Coinsurance = $50Member Total = $1,550
2015-2016 SLCC HSA Contribution
N/A $1,200*
Insurance Pays ($1,280) ($450)
HSA Pays N/A ($1,200)*
Member Balance $720 $350
Member Savings N/A $370
Annual Premium-Single Coverage - ValueCare
$637 $315
Annual Premium Savings N/A $322
*SLCC will contribute $100 per month into the employee ‘s HSA account
EXAMPLE 2 - FAMILY Traditional HDHP
Example: $35,000 in medical expenses
Individual Deductible/Coinsurance
Deductible: $80020% Coinsurance: $5,000Member Total = $5,800
Deductible: $3,00010% Coinsurance $3,000Member Total = $6,000
2015-2016 SLCC HSA Contribution
N/A $1,200*
Insurance Pays ($29,200) ($29,000)
HSA Pays N/A ($1,200)*
Member Balance $5,800 $4,800
Member Savings N/A $1,000
Annual Premium-Family Coverage – ValueCare
$1,975 $984
Annual Premium Savings N/A $991
*SLCC will contribute $100 per month into the employee ‘s HSA account
Example 3 - PharmacyEXAMPLE 3 – PHARMACY Traditional HDHP
Example: Symbicort – Preferred/Formulary Medication
Pharmacy Deductible $100 per individual$300 per family
Subject to medical deductible
$1,500 single$3,000 family
Average Cost of Medication $272 per script $272 per script
Patient Balance Deductible: $10025% Coins = $43
Member total = $143
Deductible = waived = Optimum Value 25% Coins = $68
Member total cost = $68
2015-2016 SLCC Annual HSA Contribution
N/A $1,200
HSA Balance N/A $1,132
*SLCC will contribute $100 per month into the employee ‘s HSA account
EMPLOYEE TOOLS
HEALTHSPARQ
Shopping Tools do Work
Affordable care options exist today
Central Utah Surgical Center
Total: $1,300 - $2,200
OOP: $750
Ogden Regional Medical Ctr
Total: $4,200 - $6,100
OOP: $1,450
St Marks Outpatient Surg Ctr
Total: $2,100 - $2,500
OOP: $850
Tonsillectomy and adenoidectomy (Under age 12) in Utah
Components of health care shoppingbalance cost, quality, convenience, and social content
costquality
convenience social
Enable Transactions and Services
Online appointment scheduling
Conveniences
Toll-free concierge services50 N Medical Drive, Salt Lake City, UT 84108
High-Deductible Health Plan
• HSAs can only be offered with a high-deductible health plan (HDHP).
• Though the deductible is higher for a HDHP plan than a traditional plan, your monthly premium is lower, and HSA funds can pay for medical expenses subject to the deductible.
Employer Contribution
• For 2015-2016, SLCC will contribute $50 per paycheck into each employee’s HSA effective July 1, 2015.
• Future SLCC contributions will be evaluated on a year to year basis.
Benefits of an HSA
• Triple tax advantage means you save money on your health care expenses
• Funds rollover each year, so you can use your HSA to save tax-free money for retirement
• You own the account, even if you leave the company
• Lower monthly premiums for a HDHP than a traditional health plan
How Does The HSA/HDHP Work?
• You and your employer contribute money to the HSA (either a lump sum payment or monthly through payroll deductions).
• You can use HSA dollars to pay your health insurance deductible, along with other qualified medical expenses such as dental or vision services.
• Once you meet your deductible, your insurance pays additional covered expenses in accordance with our plan.
Who is Eligible for an HSA?• Anyone who is:
– Covered by an HDHP– 18 years or older– Not enrolled in Medicare– Not covered under other health insurance*– Not another person’s tax dependent
* Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance
Examples of Medical Benefits That Make Someone Ineligible for an HSA?
• Medicare• Tricare Coverage• Flexible Spending Arrangements• Health Reimbursement Arrangements
Ineligible Medical Expenses
• Expenses that are not considered “qualified medical expenses” include:– Insurance premiums (other than the exceptions
listed previously)– Over-the-counter drugs (unless a prescription is
retained from a physician – insulin is an exception)– Surgery purely for cosmetic reasons– Expenses covered by another insurance plan– General health items such as tissues, toiletries,
hand sanitizer
Definition of Dependent
• For health insurance a dependent can be covered to age 26 regardless of status.
• HSA funds cannot be used for medical expenses incurred by a child who is not claimed as a dependent on your tax return.
• Those dependents can still be covered on your HDHP.
Recordkeeping
• Whenever you use HSA funds to pay for a medical expense, you should keep your receipt.
• You may need to demonstrate to the IRS that HSA distributions were for qualified medical expenses.
• If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty.
Administration Fee
• There is a $1.50 per paycheck administration fee, if you enroll in the FSA, Dependent Day Care FSA or the HSA.
• If you already have a debit card from last year, your funds will be loaded onto that card on July 1st.
Contacts / Questions
• Please email questions to:
• Kristi Egbert – kristi.egbert@slcc.edu • Shelley Currey – shelley.currey@slcc.edu • Patti Williams – patti.williams@slcc.edu
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