Manchester College 2010 Open Enrollment Meetings – November 17, 2009.
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Manchester College
2010 Open Enrollment Meetings – November 17, 2009
Today’s Agenda
• 2010 Manchester College Plan Options
• Reliance Standard Product Presentation
• HDHP / HSA Plan Overview• 2010 Exciting New Benefits!• Questions and Answers
2010 Manchester College Plan Options
$250 Plan I $750 Plan II HDHP / HSA Plan III
Deductible (Ind / Fam) $250 / $750 $750 / $2,250 $2,500 / $5,500
Maximum Out of Pocket (Ind / Fam) (In Net // Out Net)
$750 / $1,750 //$1,750 / $3,750
$2,750 / $6,250 //$4,750 / $10,250
$2,500 / $5,500 //$4,500 / $9,500
Coinsurance (In Net / Out Net)
90% / 70% 80% / 60% 100% / 60%
Office Visit Copay (In Net) $20 $20 None
Urgent Care Copay (In Net) $30 $30 None
Emergency Room Copay $100, then Deductible & Coinsurance
$100, then Deductible & Coinsurance
None
Prescription Drug Plan Copays
10% / 20% / 30% 10% / 20% / 30% None
Monthly Employee Premiums
Employee Only $258.62 $136.11 $ 43.69
Employee & Child(ren) $465.51 $245.00 $ 78.64
Employee & Spouse $543.12 $285.85 $ 91.74
Family $724.15 $381.14 $122.32
2010 Manchester College Plan Options
• For HDHP / HSA Plan III Participants, the College will deposit into your HSA:– Employee Only $300– Employee + Child$600– Employee + Spouse $600– Family $900
• HSA contributions will be made in 24 equal installments throughout the calendar year
Medical & Prescription Drug Plan Information
All Plans– Spousal Insurance Requirement Continues– 2009 Plan Year Changes
• Michelle’s Law• CHIP Reauthorization Act• Special COBRA Subsidy• Adult Immunizations• Domestic Partner Coverage• Removed Home Health Care Per Visit Payment Limit
– 2010 Plan Year Changes• Genetic Information Nondiscrimination Act (GINA)• Mental Health Parity• Covering All Forms of Birth Control
Vision Plan Information
• VSP Network• $10 Exam Copay• 10% Discount on Materials
Dental Plan Information
• Insurance Carrier Change– Effective January 1, 2010, Reliance Standard
will be the dental carrier
• Everyone who wants dental coverage must complete an enrollment form
• Dental Network is Reliance Standard• Out of Network Pays 80th Percentile of
Reasonable & Customary
Dental Plan Summary
Reliance Standard
Deductible (Ind / Fam) $25 / $75
Preventive Care Reimbursement 100%
Diagnostic Care 100%
Basic Care 90%
Major Care 50%
Orthodontia 50%
Calendar Year Maximum $1,000
Orthodontia Lifetime Maximum $1,000
Monthly Employee Premiums
Employee Only $26.50
Employee + Child(ren) $63.00
Employee + Spouse $63.00
Family $94.12
Dental Financial Example #1
Family Employee who incurs the following charges:8 Annual Exams & Cleanings $6002 Amalgams $230
$830
Employee Cost Share under each Plan option:
With Dental Insurance
Without Dental Insurance
Annual Employee Contribution $1,129.44 $0
8 Annual Exams & Cleanings $0 $ 600
2 Amalgams $45.50 $230
ANNUAL TOTAL $1,174.94 $830
Dental Financial Example #2
Family Employee who incurs the following charges:8 Annual Exams & Cleanings $6002 Amalgams $2301 Set of Braces $5,000
$5,830
Employee Cost Share under each Plan option:
With Dental Insurance
Without Dental Insurance
Annual Employee Contribution $1,129.44 $0
8 Annual Exams & Cleanings $0 $ 600
2 Amalgams $45.50 $230
1 Set of Braces $4,000 $5,000
ANNUAL TOTAL $5,174.94 $5,830
Life and AD&D Plan Information
• Insurance Carrier Change– Effective January 1, 2010, Reliance Standard
will be the life carrier
• No Change to College provided Life Insurance or AD&D Benefits– 1.0 times Base Annual Earnings to $170,000
• No Change to College provided Dependent Life Insurance– $10,000 Spouse, $500 Child 14 Days to 6
Months, $10,000 Child 6 Months and older
Voluntary Life Plan Information
• Insurance Carrier Change– Effective January 1, 2010, Reliance Standard
will be the voluntary life carrier
• No Change to Current Rates– Summary Handout Available
• Same Guarantee Issue Limit– $100,000 for Employees and $25,000 for
Spouses
• Current Amounts Grandfathered• All employees who want new coverage
amounts must complete an enrollment form
Voluntary Life Plan Rates
Age Reliance Standard Semi-Monthly Rate
Under 30 $0.03
30 – 34 $0.04
35 – 39 $0.0475
40 – 44 $0.0595
45 – 49 $0.0885
50 – 54 $0.144
55 – 59 $0.252
60 – 64 $0.3515
65 – 69 $0.635
70 & Over $1.067
Rate Guarantee Two Years
LTD Plan Information
• Insurance Carrier Change– Effective January 1, 2010, Reliance Standard
will be the LTD carrier
• Plan Summary Handout Available• No Change to Rates
FSA Plan Information
• Limited and Unlimited Flexible Spending Accounts Continue
• Plan Summary Handout Available• Dependent Care Flexible Spending
Continues
Your Advocate will do 2 things:
1. Help you to navigate through the health care system.
2. Help you to become a better health care consumer.
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Who Receives Our Services?• Services are available as of January 1, 2010 for all
employees and dependents covered under Manchester College benefits
• Automatic eligibility - you do not need to enroll
• This benefit is free to you
You have an Advocate!
• Problem solver – not an insurance company • We assist with medical, dental and vision issues
– Flexible spending account (FSA)– Health reimbursement arrangement (HRA) – Health savings account (HSA)
• We are able to assist with new and old issues• We do not provide clinical or legal advice• We have Advocates who speak Spanish
Patient Care is completely confidential19
Advocates assist with:• Resolving billing/claims issues• Understanding your benefits and options• Understanding prescription drug options• Helping you find a doctor in your network• Negotiating with non-network providers to get a
discount when possible• Helping you become a better healthcare consumer
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Cost & Quality Information: How?
Call your Advocate 15 days prior to
scheduling a test or procedure.
Your Advocate will contact 2-3
providers in your network for cost
information.
Your Advocate will review cost and
quality information with you to make
an informed decision.
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WOW!Procedure: Knee ArthroscopyCPT code: 29873Physician who ordered or recommended procedure: Michael Anderson, M.D. Date procedure scheduled: May 11, 2008
Medical Provider Memorial Hospital St. Mary’s Hospital Baptist Hospital
Total Price $7,400.00 $14,350.00 $12,800.00
Discount Rate 12% 11% 11%
Actual Discount $888.00 $1,578.50 $1,408.00
Balance $6,512.00 $12,771.50 $11,392.00
Deductible to Meet $500.00 $500.00 $500.00
Member Coinsurance 20% 20% 20%
Coinsurance Payment $1,204.40 $2,454.30 $2,178.40
Member Responsibility $1,704.40 $2,954.30 $2,678.40
Employer Responsibility $4,807.60 $9,817.20 $8,713.60
Authorization (approval) for this procedure (choose one) is or is not required by your health plan.
Reference number XXXXXXXXXX has been issued by your plan.
We investigated outcome information for this procedure and there are no significant differences between these facilities. Please keep in mind that the most important aspect of the quality of your healthcare experience relates to your physician and you
have chosen to use Dr. Anderson, who will perform the surgery at any of these facilities.
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Quality is important!• Accepting new patients• Years in practice• Number of procedures performed annually• Hospital complies with safe practices• Hospital handles high risk procedures• ICU staffed by specialists• Computerized Physician Order Entry
633 W. Wisconsin Ave. #1310
Milwaukee, WI 53203
www.patientcare4u.com
1-866-253-2273
Monday – Friday 7 AM to 7 PM CST
Saturday 8 AM to 1 PM CST
Free Wellness Clinic!
• All enrolled employees and their dependents are eligible
• First meeting with Physician will be a 40 minute wellness exam and will include a Health Risk Assessment
• Free Primary Care Physician Services– Common Colds, Wellness Visits, etc.
• Generic Prescriptions Dispensed Free• 24/7 Nurse Line • 20 Minute Appointments Made Online or
through Nurse Line
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HDHP / HSA Overview
• A Health Savings Account (HSA) is a special account owned by an employee where tax-free deposits into the account are used to pay for current and future medical expenses
• You can only contribute to an HSA if you participate in only “High Deductible Health Plan(s)” (HDHP)
HDHP & PPO Similarities
• 100% Wellness Coverage– Periodic Health Evaluations (e.g. annual
physicals)– Screening services (e.g. mammograms)– Routine adult and well-child care– Immunizations
• Network Discounts, so pay providers only from your EOB to obtain discounts
• Claim filing procedures• Customer service with Group
Administrators• Online view of claim activity
www.groupadministrators.com
HDHP & PPO Differences
• Higher Deductibles• You pay 100% of your medical and
prescription costs up to the deductible• No copays with HDHPs
HSA Contribution Rules
• Deposits to an HSA can be made by the employer or the employee, or both, or any other person or entity
• Deposits are not considered taxable income to the employee, except if they are withdrawn for non-qualified expenses
• Maximum amount that can be deposited to your HSA in 2010 from all sources is:– $3,050 Single– $6,150 Family
HSA Contribution Rules
• For employees age 55 and older, additional “catch-up” contributions to your HSA are allowed at $1,000 per year
• For spouses age 55 and older, their catch up contribution is only available in their own account
• Deposits must stop once an employee is enrolled in Medicare
HSA Withdrawals
• HSA Monies are tax-free if taken for “qualified medical expenses”– For a complete list, search for Publication 502
on www.irs.gov– Includes over-the-counter drugs
• Medical expenses can be paid from your HSA account for:– Employee covered by the high deductible plan– Spouse– Any dependent
HSA Withdrawals
If you use your HSA monies for expenses other than qualified medical expenses, you will pay payroll taxes and a 10% penalty on the money unless you are over social security normal retirement age, then no penalty
HSA Accounts
• Accounts can grow through investment earnings, just like an IRA
• Investment income is non-taxable• Accounts can be withdrawn for any
purpose after retirement age with no penalty, only income taxes
HSA Summary
• No “use it or lose it rules” like Flexible Spending Arrangements (FSAs)
• All monies in the HSA are fully vested• Unspent balances remain in the account• Unspent balances remain with the
employee if they leave employer• Encourages account holders to spend their
funds more wisely on medical and prescription services
• For medical and prescription services, you can have an FSA or HSA, but not both
Financial Example #1
Single Employee who incurs the following charges:1 Complete Routine Physical $ 4503 PCP Office Visits $ 6002 Generic Prescriptions $ 34
$1,084Employee Cost Share under each Plan option:
PPO Plan I PPO Plan II HDHP / HSA Plan
Annual Employee Contribution
$3,103 $1,633 $ 524
1 Routine Physical $ 20 $ 20 $ 0
3 PCP Office Visits $ 60 $ 60 $ 600
2 Generic Rxs $ 20 $ 20 $ 34
Employer HSA Credit
$ 0 $ 0 ($ 300)
ANNUAL TOTAL $3,203 $1,733 $ 858
Financial Example #2
Family Employee, covering a spouse and two children, who incur the following charges:3 Complete Routine Physicals $1,3506 PCP Office Visits $1,2002 ER Visits $ 4005 Generic Prescriptions $ 852 Brand Formulary Prescriptions $ 140
$3,175Employee Cost Share under each Plan option:
PPO Plan I PPO Plan II HDHP / HAS Plan
Annual Employee Contribution
$ 8,690 $ 4,574 $ 1,468
3 Routine Physicals $ 60 $ 60 $ 0
6 PCP Office Visits $ 120 $ 120 $ 1,200
2 ER Visits $ 200 $ 200 $ 400
5 Generic Rxs $ 50 $ 50 $ 85
2 Brand Formulary Rxs $ 40 $ 40 $ 140.
Employer HSA Credit $ 0 $ 0 ( $900)
ANNUAL TOTAL $ 9,160 $ 5,044 $ 2,393
Financial Example #3
Employee, covering a spouse only, who incur the following charges:2 Complete Routine Physicals $ 9008 PCP Office Visits $ 1,6003 ER Visits $ 1,2001 12-day Inpatient Hospital Stay $ 43,50024 Generic Prescriptions $ 40812 Brand Formulary Prescriptions $ 840
$ 48,448Employee Cost Share under each Plan option:
PPO Plan I PPO Plan II HDHP / HSA Plan III
Annual Employee Contribution
$ 6,517 $ 3,430 $ 1,101
2 Routine Physicals $ 40 $ 40 $ 0
8 PCP Office Visits $ 160 $ 160 $ 1,600
3 ER Visits $ 300 $ 300 $ 1,200
1 12-Day Inpatient Stay $ 750 $ 2,750 $ 2,700
24 Generic Rxs $ 240 $ 240 $ 0 (Deductible Met)
12 Brand Formulary Rxs $ 240 $ 240 $ 0 (Deductible Met)
Employer HSA Credit $ 0 $ 0 ($ 600)
ANNUAL TOTAL $ 8,247 $7,160 $ 6,001
Financial Example #4
Employee, covering children and spouse only, who incur the following charges split among family members:4 Complete Routine Physicals $ 1,80025 PCP Office Visits $ 5,0003 ER Visits $ 1,2002 12-day Inpatient Hospital Stay $ 87,00024 Generic Prescriptions $ 40812 Brand Formulary Prescriptions $ 840
$ 96,248Employee Cost Share under each Plan option:
PPO Plan I PPO Plan II HDHP / HSA Plan III
Annual Employee Contribution
$ 8,690 $ 4,574 $ 1,468
4 Routine Physicals $ 80 $ 80 $ 0
25 PCP Office Visits $ 500 $ 500 $ 5,000
3 ER Visits $ 300 $ 300 $ 500
2 12-Day Inpatient Stay $ 1,750 $ 6,250 $ 0 (Deductible Met)
24 Generic Rxs $ 240 $ 240 $ 0 (Deductible Met)
12 Brand Formulary Rxs $ 240 $ 240 $ 0 (Deductible Met)
Employer HSA Credit $ 0 $ 0 ($ 900)
ANNUAL TOTAL $ 11,800 $ 12,184 $ 6,068
Financial Example #5
Single Employee who incurs the following charges:1 Complete Routine Physical$ 4501 ER Visit $ 8508 PCP Office Visits $ 1,6002 Generic Prescriptions $ 34
$ 2,934Employee Cost Share under each Plan option:
PPO Plan I PPO Plan II HDHP / HSA Plan
Annual Employee Contribution
$ 3,103 $ 1,633 $ 524
1 Routine Physical $ 20 $ 20 $ 0
1 ER Visit $ 100 $ 100 $ 850
8 PCP Office Visits $ 160 $ 160 $ 1,600
2 Generic Rxs $ 20 $ 20 $ 34
Employer HSA Credit
$ 0 $ 0 ($ 300)
ANNUAL TOTAL $ 3,403 $ 1,933 $ 2,708
Best Case Scenarios
PPO Plan I$250 Deductible
Annual Employee Contribution
Total MinimumEmployee Liability
Employee Only $3,103 $ 3,103
Employee + Child(ren) $5,586 $ 5,586
Employee + Spouse $6,517 $ 6,517
Family $8,690 $ 8,690
PPO Plan II$750 Deductible
Annual Employee Contribution
Total MinimumEmployee Liability
Employee Only $1,633 $ 1,633
Employee + Child(ren) $2,940 $ 2,940
Employee + Spouse $3,430 $ 3,430
Family $4,574 $4,574
HDHP Plan III$2,500 Deductible
Annual Employee Contribution
Annual College HSA Deposit
Total MinimumEmployee Liability
Employee Only $ 524 ($300) $224
Employee + Child(ren)
$ 944 ($600) $344
Employee + Spouse
$1,101 ($600) $501
Family $1,468 ($900) $568
* Maximum Out of Pocket (In Net) does not include copayments for office visits or prescription drugs.
Worst Case Scenarios
PPO Plan I$250 Deductible
Annual Employee Contribution
Maximum Out of Pocket (In Net)*
Total Annual Potential Employee Liability
Employee Only $3,103 $ 750 $ 3,853
Employee + Child(ren) $5,586 $1,750 $ 7,336
Employee + Spouse $6,517 $1,500 $ 8,017
Family $8,690 $1,750 $10,440
PPO Plan II$750 Deductible
Annual Employee Contribution
Maximum Out of Pocket (In Net)*
Total Annual Potential Employee Liability
Employee Only $1,633 $2,750 $ 4,383
Employee + Child(ren) $2,940 $6,250 $ 9,190
Employee + Spouse $3,430 $5,500 $ 8,930
Family $4,574 $6,250 $10,824
HDHP Plan III$2,500 Deductible
Annual Employee Contribution
Maximum Out of Pocket (In Net)
Annual College HSA Deposit
Total Annual Potential Employee Liability
Employee Only $ 524 $2,500 ($300) $2,724
Employee + Child(ren)
$ 944 $5,500 ($600) $5,844
Employee + Spouse
$1,101 $5,000 ($600) $5,501
Family $1,468 $5,500 ($900) $6,068
* Maximum Out of Pocket (In Net) does not include copayments for office visits or prescription drugs.
Treasury Assistance
• Web site – www.treas.gov (Click on “Health Savings Accounts”) – contains:– All treasury guidance– Frequently asked questions– IRS forms and publications– HSA Statute– Examples of tax savings from HSA
contributions– Links to other useful sites
• Still have questions?– E-mail address: HSAInfo@do.treas.gov– Voice mailbox: 202.622.4HSA
Complete Enrollment Form for Any New Voluntary Life Coverage
Complete Enrollment Form for Any Dental Coverage
Complete Health Change Forms only if you have 2010 Health Changes
All Due to Lindsey Wertz no later thanNoon on Monday, December 7
What To Do Next
Questions and Answers
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