2013 Health & Welfare
Open Enrollment Overview
Open Enrollment October 22 – November 7, 2012
Please note: The introduction of this benefits package for represented caregivers will be subject to bargaining obligations.
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2013 Benefits Program Overview
• Open Enrollment Key Facts • Eligible Dependents • Medical • HSA and FSA • New Wellness Program • Dental • Vision • Life and AD&D • Short and Long Term Disability • Questions
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Key Facts
• Open Enrollment Dates: October 22 – November 7
• Positive Enrollment =
All caregivers must enroll or opt out of coverage
• What happens if I don’t enroll or opt-out?
You will be enrolled in the following default coverage: • ABHP Medical Plan - Caregiver Only (initially without HSA) • Core Life • Core AD&D • Core Short- and Long- Term Disability
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Eligible Dependents
• Your Legal Spouse
• Your Qualified Domestic Partner
• Your Legally Domiciled Adult (LDA); eligible for medical, dental and vision coverage only
• Your Dependent children up to age 26
Additional dependent benefit eligibility details can be found under the Life Events - Family and Relationships section of MyHR.
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Two Medical Plan Options:
Preferred Provider Organization (PPO) and
Account Based Health Plan (ABHP)
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Medical Plan Highlights
Preferred and In-Network Provider Tier Summary
PPO
ABHP
Preventive Care • www.healthcare.gov
Covered 100% Preferred and In-Network Tiers
Covered 100% Preferred and In-Network Tiers
Annual Deductible • Single • Family
$500 $1,000
$2,000 $4,000
Co-Insurance Office visit (PCP and Specialist)
20% (deductible waived)
10% (after deductible)
Co-Insurance • Hospital Inpatient • Laboratory Services
20% Preferred Tier 30% In-Network Tier (after deductible)
10% Preferred Tier 20% In-Network Tier (after deductible)
Annual Out-of-Pocket Maximum (excludes deductible) • Single • Family
$2,500 $5,000
$3,000 $6,000
Annual Health Savings Account Not Applicable 2013 PH contributes up to: $1,200 Single coverage $2,000 Family coverage
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Pharmacy Plan Highlights
Preferred and In-Network Provider Tier Summary
PPO Preferred In-Network
ABHP Preferred In-Network
Generic $10 copay $15 copay 20% after
deductible* 30% after deductible*
Brand Formulary 20% Min = $25; Max = $75
30% Min = $30; Max = $90
20% after deductible*
30% after deductible*
Brand Non-Formulary 30% Min = $40; Max = $120
40% Min = $50; Max = $150
30% after deductible*
40% after deductible*
Prescription expenses do not count toward the medical deductible or annual out-of-pocket. Minimum and Maximum amounts apply to each script.
Medical deductible must be met first before coinsurance applies *The ABHP deductible is waived for many preventive and chronic prescription drugs.
• Out-of-Network not covered • Mail Order – 90-Day scripts at 2.5X 30-day retail price (after deductible for ABHP)
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Set aside pre-tax money in an HSA or FSA to cover qualified medical expenses; generally defined as any expense incurred to maintain an individual’s health or the health of their family, including:
– Doctor and hospital visits – Medical equipment – Dental care, braces, dentures – Vision care, glasses & contacts – Prescription medications
*A definition of Qualified Medical Expense is provided in Section 213(d) of Internal Revenue Code. A list of eligible medical expenses can be found in IRS Publication 502
www.irs.gov/pub/irs-pdf/p502.pdf.
A pre-tax dependent care FSA is also available for qualified work-related cost of care for a qualifying dependent.
Tax Advantaged Accounts
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HSA vs FSA
Health FSA HSA
Medical Plan Pairing Not eligible if enrolled in the ABHP with HSA
ABHP
PeaceHealth 2013 contributions
$0 Up to $1,200 Single Up to $1,800 Family
2013 Annual Contribution Limits
$2,500 $3,250 Single $6,450 Family
$1,000 Catch Up age 55+
Account Ownership PeaceHealth You
Use It Or Lose It Yes No, funds rollover year to year
Substantiation Yes – submit receipts at time of reimbursement
No – keep receipts in the event of individual tax audit
Option to Change Contributions
Only with qualifying event Yes – can change payroll deductions during the year (not to exceed IRS contribution limit)
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• Covered by another insurance coverage plan that is not a High Deductible Health Plan, including spouse’s insurance and/or TriCare
• Claimed as a dependent on another person’s tax return (such as being claimed on parent’s taxes)
• Enrolled in Medicare (Part A or B)
Caregivers who are enrolled in a PeaceHealth Account Based Health Plan (ABHP) are qualified to enroll in the Health Savings Account (HSA) unless they are:
HSA Eligibility
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• Tax-deferred, interest-accumulating account • Automatic enrollment at HSA Bank with ABHP
medical plan election • Initial contribution made by PeaceHealth in January 2013 • You can contribute money to the account on a pre-tax basis • Funds roll over from year to year – No “use it or lose it” • Portability - Funds go with you if you leave PeaceHealth or
change health plans • You control your healthcare dollars and decide when to use
your funds. Pay medical bills direct from this account through online banking or the HSA bank debit card or checks.
• HSA Bank does not require you to submit receipts - keep receipts with tax filing paperwork for any IRS audit needs.
HSA Advantages
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2013 HSA Contribution Limits Medical Plan Enrollment Coverage Level
2013 IRS Limit
= PeaceHealth Contribution
+ Wellness Credit
+ What you can contribute
Individual $3,250 $1,000 $200 $2,050-$2,250
Family $6,450 $1,800 $200 $4,450-$4,650
Catch Up if age 55+ Additional $1,000
The IRS limits total contributions to an HSA each year; this includes dollars you contribute as well as those deposited by PeaceHealth. Remember, any unused dollars roll over from year to year.
HSA Contributions
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Using Your HSA
Pharmacy Applies network
discounts
Doctor Visit
Medical TPA
Applies network
discounts
Pharmacy Visit
Submit Claim
Fill Prescription
Sends EOB
Pay Doctor
Pay Pharmacy
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• They are not covered by another insurance coverage plan that is a High Deductible Health Plan paired with an HSA, including spouse’s insurance
• Spouse has not elected the annual maximum contribution under their own Health FSA (maximum of $2,500 is per household)
Caregivers are eligible if:
Dependent Care FSA is not linked to medical plan enrollments.
FSA Eligibility
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FSA Features - Health and Dependent Care
Annual Minimum Contribution Health Care FSA Annual Maximum Contribution Dependent Care FSA Annual Maximum Contribution
$100 $2,500 $5,000 or $2,500 (married filing separately)
• Use-It-Or-Lose-It; claim filing deadline April 30 of following year • Tax benefits on contributions • Health FSA can be used for qualifying medical expenses - see
IRS Publication 502: www.irs.gov/pub/irs-pdf/p502.pdf • Extended Grace Period: Unless enrolling in ABHP, Health FSA
reimbursement claims may be incurred between your benefit effective date and March 15 of the following year. ABHP enrollee deadline: end of plan year (12/31/12)
• Dependent Care FSA for daycare for children up to 12 years old, disabled dependents of any age, and elder care
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Pharmacy Applies network
discounts
Doctor Visit
Medical TPA
Applies network
discounts
Day Care Expense
Pharmacy Visit
Submit Claim
Fill Prescription
Sends EOB
Pay Day Care Provider submit receipts for
reimbursement
Pay Doctor with FSA debit
or submit receipts for
reimbursement
Using Your FSA
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Good health helps us live better lives at work and at home, and manage increasing health care costs for both you and our organization.
And we believe healthy caregivers deliver better and safer care to the communities we serve. Whether it’s getting your annual checkup, committing to regular exercise, or spending more time with family and friends — we can all take steps to improve our own health.
Why does Wellness matter?
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Our 2013 medical plans have been carefully designed to support continued good health for you and your family.
– Preventive services covered at 100%.
– ABHP deductible waived for a broader range of preventive and chronic condition prescription medications.
– Special support for caregivers or family members who have chronic conditions. In addition to coaching and support, PPO participants will be able to get their prescription drugs at a lower cost.
– Coordinated HealthCare. Our new health and wellness partner serves as your central point of contact and advocate when you need to navigate the health care system. They provide care coordination, disease management, care management, customer service and more.
– Biometric and health risk screenings
Wellness in Medical Plans
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1. Complete an online Wellness Assessment
2. Take part in the Biometrics Screening: Total Cholesterol; Height, Weight, BMI; Blood
Pressure ; HDL, TC/HDL Ratio; Waist
Circumference and A1C (blood sugar)
3. Enroll in one of the two medical plans
4. Complete all of the above? Receive additional $200 HSA
contribution (for ABHP participants) or a $200 premium
reduction (PPO participants)
5. You are then eligible to take part in the PeaceHealth / Virgin HealthMiles program. You will receive a pedometer/ accelerometer and be able to take part in fitness challenges, set individual goals, monitor your progress and compete for prizes
Wellness Participation and Incentives
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Dental Plan Highlights
Washington Dental Service (WDS) Benefit
Maximum Benefit per person per calendar year $2,000
Annual Deductible per Individual/Family $50/$150
Preventive Services: Routine Exams, Cleaning, X-rays Covered in full
Basic Restorative: Fillings, Root Canals, Oral Surgery, Endodontics, Periodontics
20% after deductible
Major Restorative: Crowns, Dentures, Bridges, Implants 50% after deductible
Orthodontia 50% after deductible
$2,000 Lifetime Maximum Benefit per covered member
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Northwest Benefit Network (NBN)
In-Network Out-Of-Network Frequency
Routine Eye Exam 100% $50 allowance 12 months
Material Copay $25 $25
Basic Lenses 12 months
Single Vision Bifocal Trifocal
100% (after copay) 100% (after copay) 100% (after copay)
$50 allowance $75 allowance $100 allowance
Frames $150 allowance $70 allowance 24 months
Elective Contact Lens Allowance
$150 allowance $105 allowance 12 months
Vision Plan Highlights
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Core Life and AD&D 2x Base Annual Salary up to $200,000 maximum
Caregiver Supplemental Life and AD&D Additional 1x to 3x Base Annual Salary to $1,000,000 maximum
Spouse Supplemental Life and AD&D $10,000 - $100,000 in $10,000 increments
($50,000 Guarantee Issue)
Child Supplemental Life and AD&D – $10,000 or $15,000
Open Enrollment Evidence of Insurability Approval Requirements – Supplemental Life • New Supplemental Caregiver/Spouse coverage and Spouse amounts above Guarantee Issue • Increase in Caregiver Supplemental Life from 1X to 3X
Life and AD&D Highlights
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Core Short Term Disability (STD)
• 66 2/3% base salary continuation up to $1,500 weekly benefit
• 7 calendar day waiting period; available PTO/EIB to be used during this time
• After waiting period: must exhaust all EIB hours before STD benefits will apply; option to use 33 1/3% PTO in addition to STD benefit
• Continues for up to 6 months (integrates with long term disability)
• For those who have less than 12 months of continuous STD coverage prior to 1/1/2013, pre-existing condition limitations apply
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Long Term Disability (LTD)
• Core LTD - Provides 50% of base salary continuation up to $15,000 monthly
- Fully paid by PeaceHealth
• Supplemental LTD - Caregivers may purchase additional 16 2/3% of LTD for total coverage of 66 2/3% of base salary continuation up to $20,000 per month
• Benefit begins after continuous, approved disability of 180 days
Open Enrollment Evidence of Insurability Approval Requirements – Supplemental LTD No requirements during Open Enrollment this year. Evidence of Insurability required for supplemental coverage newly elected in future years.
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Caregivers may be eligible for the following benefits if they have worked for PeaceHealth for at least 6 months and meet the financial requirements for total household income: • Medical Premium Assistance Program Eligible caregivers may receive financial assistance to help
cover 100% of the cost of their health care premiums for them and their families (ABHP enrollment). Applications accepted during Open Enrollment.
• Emergency Loan Program Eligible caregivers may receive an interest-free loan (maximum
$500) to be repaid within 1 year. • Enhanced Tuition Assistance Eligible caregivers may have part or all of their school tuition
paid for by PeaceHealth. Additional details can be found under the My Other Benefits section of myHR.
Special Benefits Program
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How to Enroll
1. Log onto myHR (from work or home) and select the “Open Enrollment” button to bring up the OE home page
2. Use check list on the OE home page to get ready
3. Click on “Enroll Now” to start your 2013 enrollment
4. If you are using a shared computer, be sure to log out for security.
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myHR/AskHR – https://myhr.peacehealth.org Caregiver Resource Center (CRC)
• AskHR email ([email protected]) via MyHR or
• Phone 855-333-6947
Resources/Questions
myHR Open Enrollment Home Page Links • eCascade Newsletters • E-Learning Modules • Plan Summaries • Calculator tools • Premium and Eligibility documents