salt lake community college open enrollment 2015-2016
TRANSCRIPT
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Salt Lake Community College
Open Enrollment 2015-2016
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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
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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
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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.
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EMI Health VSP Vision Plan
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Vision Plan
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Customer Service
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Medical & Dental Benefits
Open Enrollment 2015-2016
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DENTAL RATES 2015-2016
2014/15 2015/16
Employee $2.25 $2.25
Two-Party $3.75 $3.75
Family $5.95 $5.95
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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
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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
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ONLINE ENROLLMENT
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ONLINE ENROLLMENT
• Maintain personal information• View important benefit information• Compare plans• Initial changes throughout the year• Manage account information• Link to other benefit websites
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NETWORK OPTIONS
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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
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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
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DENTAL PROVIDERS
1,275 GENERAL DENTISTS
291 SPECIALISTS
OVER 100,000 ACCESS POINTS NATIONWIDE
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BENEFITS
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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
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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
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Optimum Value
Value-based medications
Deductible waived on QHDHP for medications used to prevent or manage chronic conditions:
DepressionCardiovascular Disease
DiabetesHigh Cholesterol
OsteoporosisAsthma
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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
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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
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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
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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
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EMPLOYEE TOOLS
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HEALTHSPARQ
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Shopping Tools do Work
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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
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Components of health care shoppingbalance cost, quality, convenience, and social content
costquality
convenience social
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Enable Transactions and Services
Online appointment scheduling
Conveniences
Toll-free concierge services50 N Medical Drive, Salt Lake City, UT 84108
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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.
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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.
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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
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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.
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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
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Examples of Medical Benefits That Make Someone Ineligible for an HSA?
• Medicare• Tricare Coverage• Flexible Spending Arrangements• Health Reimbursement Arrangements
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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
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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.
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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.
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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.
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Contacts / Questions
• Please email questions to:
• Kristi Egbert – [email protected] • Shelley Currey – [email protected] • Patti Williams – [email protected]