2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY: Greg Biese Vice President, Senior Benefits Consultant.

2015 Medical Plan Options, Health Savings Accounts & Flexible Spending

PRESENTED TO:

PRESENTED BY:Greg BieseVice President,Senior Benefits Consultant

Associated Financial GroupEmployee Benefits. Insurance. HR Solutions.

Copyright 2014 by Associated Financial Group, LLC

HEALTHCARE REFORM: YESTERDAY, TODAY & TOMORROW

● Individual Mandate

● Private Exchanges

● Medicaid Expansion

● Play or Pay (Employer Mandate)

● Wellness Incentives

● Government Reporting

● Medical Access

Cadillac Tax

Rules

Plan Design

Fees

St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

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2015 MEDICAL ELIGIBILITY & RATES

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Eligibility & Rates PPO Plan HDHP Plan (HSA)

Eligibility

Domestic Partner Coverage

Monthly Rates (Employee)

Single $105.00 $79.00

Employee +1 $209.00 $160.00

Family $311.00 $237.00

Annual Rates (Employee)

Single $1,260.00 $948.00

Employee +1 $2,508.00 $1,920.00

Family $3,732.00 $2,844.00

Spousal Surcharge

.75 FTE (Grandfather those currently enrolled in the health plan) *

$75 per month

Same sex partners are now eligible for coverage


* St. Norbert College reserves the right to change the eligibility requirements at any time.

Effective January 1, 2015, St. Norbert College’s medical will implement a Spouse Medical Insurance Coverage Statement, requiring that an employee’s spouse enroll in at least single medical coverage through his/her employer to serve as their primary insurance coverage, or pay an additional surcharge to enroll or maintain enrollment in St. Norbert College’s medical plan as primary coverage. This additional surcharge is $37.50 twice a month ($900 annually)

All employees electing coverage for his/her spouse must complete the Spouse Medical Insurance Coverage Statement. If your spouse is covered under the College’s medical plan currently and you do not return this coverage statement, you will be assessed the additional surcharge until St. Norbert College receives the proper notification from you.


2015 BENEFIT HIGHLIGHTS

4St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

(1) IMPORTANT HSA PLAN NOTICE: No individual family member's deductible or out-of-pocket is considered satisfied until the Full-Family deductible and out-of-pocket has been met.

Benefit Highlights PPO Plan HDHP Plan (HSA)

Deductible Embedded Deductible Non-Embedded DeductibleIn-Network $750 (Single); $1,500 (EE+1); $2,250 (Family) $2,000 (Single); $4,000 (Family)

(1)

Out-of-Network $1,001 (Single); $2,002 (EE+1); $3,303 (Family) $4,000 (Single); $8,000 (Family) (1)

CoinsuranceIn-Network 80% 90%Out-of-Network 60% 70%Out-of-Pocket Max Includes Deductible and Medical & Rx Copays Includes DeductibleIn-Network $1,500 (Single); $3,000 (EE+1); $4,500 (Family) $4,000 (Single); $8,000 (Family)

(1)

Out-of-Network $3,000 (Single); $6,000 (EE+1); $9,000 (Family) $8,000 (Single); $16,000 (Family) (1)

HSA Annual Employer Contribution n/a $500 (Single); $750 (Family)

Office Visits / InstacareIn-Network $20 Copay; then Deductible, 80% Coinsurance Deductible, 90% CoinsuranceOut-of-Network $20 Copay; then Deductible, 60% Coinsurance Deductible, 70% CoinsuranceRoutine/Preventive CareIn-Network 100% 100%Out-of-Network 100% Deductible, 70% CoinsuranceInpatient Hospital ServicesIn-Network Deductible, 80% Coinsurance Deductible, 90% CoinsuranceOut-of-Network Deductible, 60% Coinsurance Deductible, 70% CoinsuranceOutpatient Hospital ServicesIn-Network Deductible, 80% Coinsurance Deductible, 90% CoinsuranceOut-of-Network Deductible, 60% Coinsurance Deductible, 70% Coinsurance


2015 BENEFIT HIGHLIGHTS (CONT.)


Urgent Care

In-Network $50 Copay; then Deductible, 100% Coinsurance Deductible, 90% Coinsurance

Out-of-Network $50 Copay; then Deductible, 100% Coinsurance Deductible, 70% Coinsurance

Emergency Room

In-Network $100 Copay; then Deductible, 100% Coinsurance Deductible, 90% Coinsurance

Out-of-Network Same as In-Network Benefit Same as In-Network Benefit

Ambulance Services

In-Network / Out-of-Network Deductible, 100% Coinsurance Deductible, 90% Coinsurance

Retail Prescription Drugs

Generic

Brand / Formulary

Non-Formulary

Mail Order Prescription Drugs

Generic $30 Copay

Brand $90 Copay

Contraceptive Coverage

25% ($10 Minimum, $50 Maximum) Deductible, 90% Coinsurance

No coverage, but members legal right to access coverage will be accommodated through UMR

Deductible, 90% CoinsuranceGeneric Preventive HSA Drugs are covered at

100% (Mail Order Only).

What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood pressure, blood thinner, and beta blockers.

Benefit Highlights PPO Plan HDHP Plan (HSA)


PPO PLAN EFFECTIVE JANUARY 1, 2015


Preventive Services Unchanged

• All medical and Rx copays (1) apply to maximum out-of-pocket

Increase to Deductible and Out-of-Pocket Maximums

• Costs• New generics drugs

Prescription Drug Plan Design Unchanged

• UMR & Optum Rx

Contraceptive Coverage Outside of Plan

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(1) Due to Health Care Reform changes, beginning in 2015, all copays, including pharmacy copays, will apply to the out-of-pocket maximum.


HDHP PLAN (HSA) EFFECTIVE JANUARY 1, 2015


• 100% Coverage (In-Network)

Preventive Services

• No individual family member’s deductible or out-of-pocket is considered satisfied until the ‘Full Family’ deductible and out-of-pocket has been met.

Deductible and Out-of-Pocket Maximums (Non-Embedded)

• Retail & Mail Order – Subject to Deductible & 90% Coinsurance• Generic Preventive Drugs covered at 100% when filled through Mail

Order.

Prescription Drugs

• UMR & Optum Rx

Contraceptive Coverage Outside of Plan

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PREVENTIVE SERVICES


Certain services can be done for preventive or diagnostic reasons.

Covered preventive services performed specifically for preventive screening with no known symptoms, illnesses or history are generally covered as preventive care, subject to age and gender guidelines and

health status.

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DIAGNOSTIC SERVICES

• Diagnostic services are generally not covered under the preventive care benefit but may be covered under another portion of your medical benefit plan.

• Services are considered diagnostic when a person:

– Has abnormalities found on previous preventive or diagnostic services that require further diagnostic services; or

– Had abnormalities found on previous preventive or diagnostic services that would recommend a repeat of the same service within a shortened time period from the recommended preventive screening time period based on age and gender; or

– Had a symptom(s) that required further diagnosis


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WHAT EXACTLY IS AN HSA?


PART 1:

HIGH DEDUCTIBLEHEALTH PLAN

(HDHP)

PART 2:

HEALTH SAVINGSACCOUNT

(HSA)

HSA

TWO PARTSTO AN HSA

Intended to cover serious illness or injury once the deductible is met.

Used to cover expenses until the deductible is met.

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IMPORTANT INFORMATION REGARDING YOUR HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP)


There are NO office visit, emergency room, or prescription drug copays.

All out-of-pocket expenses count towards the deductible & out-of-pocket maximum.

The preventive healthcare benefit is still covered at 100% (all participants); includes services under the Women’s Care Act. Does not include contraceptive services.

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IMPORTANT INFORMATION REGARDING YOUR HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP)

The deductible and coinsurance out-of-pocket maximum for family is a true family deductible and out-of-pocket maximum.


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WHO IS ELIGIBLE FOR HSA’s?

Any employee that:• Is covered by an HDHP• Is not covered by another

non-HDHP health plan• Is not enrolled in Medicare• Cannot be claimed as a

dependent on someone else’s tax return


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ADVANTAGES OF AN HSA

Ownership - you own the funds in your HSA

Tax-free

Portable

No “use it or lose it”

You may change your employee contribution amount throughout the year.

You can choose to invest your savings in an investment account.


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HSA ANNUAL CONTRIBUTIONS – 2015

• Annual contributions to the HSA are limited to $3,350 single / $6,650 family (Employer & Employee Contributions Combined)

• St. Norbert College - Annual HSA Contribution

o $500 - Single Coverage; $750 - Family Coverage

o Employer contributions will be deposited twice per year

Single: $333 (1st Payroll in January); $167 (1st payroll in September)

Family: $500 (1st payroll in January); $250 (1st payroll in September)

• Benefits are subject to federal regulations. Minimum deductibles, maximum out-of-pocket limits and contribution maximums are determined annually

• Account holders age 55 and up may make additional contributions of $1,000 in 2015.


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CONTRIBUTING TO YOUR HSA

• You can elect how much money you want to put into your HSA.

– It is your responsibility to ensure that you do not exceed the maximum HSA contribution limit.

• Your employer will deduct this amount on the date of each payroll on a pre-tax basis and the money will be direct-deposited to your HSA account.

• You may also deposit funds directly into your bank account with post-tax dollars and claim the amount on your tax return.


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WHO DETERMINES WHETHER HSA DISTRIBUTIONS ARE USED EXCLUSIVELY FOR QUALIFIED MEDICAL EXPENSES?

• YOU!

• Your bank will submit information to the IRS each year to report contributions and withdrawals.

• You will need to report withdrawals on your federal income tax forms.

• Individuals who establish HSAs should maintain records of their medical expenses to show that the distributions have been made exclusively for qualified medical expenses.


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HSA WITHDRAWALS / DISTRIBUTIONS

• Federal tax treatment of funds used:


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Expense Type Age Tax Treatment

Qualified medical expense Any Tax-free

Non-medical expense Over 65 Ordinary tax

Non-medical expense Under 65Ordinary tax + 20% penalty


ELIGIBLE MEDICAL EXPENSES FOR TAX-FREE DISTRIBUTIONS

• Qualifying medical expenses - IRS Publication 502• Dental and vision care expenses

• Long-term care insurance

• Premiums for coverage while receiving unemployment compensation


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BANK INFORMATION

Form 1099-SA (distributions)

Form 5498-SA (contributions,

rollover deposits and fair market value for each calendar year)


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WAYS TO BE A MORE COST CONSCIOUS CONSUMER OF HEALTH CARE

• Get Healthy and Stay Healthy!

• Use Appropriate ‘Levels of Care’ – Fast Care/Urgent Care/Emergency Room

• Use In-Network Providers

• Consider Generic or Mail Order prescriptions

• Consider $4 Generic Programs at Target & Wal-Mart Stores

• Ask doctors and pharmacists questions

o Most effective treatment

o Cost of treatment

o Alternatives to treatment

• Support and participate in company sponsored wellness and disease management initiatives



LEVELS OF CARE SAMPLE


Emergency RoomComplex chest pain,

trauma

Urgent Care ClinicSprains, strains, sutures; typically hospital-based

Primary Care ProviderWellness/preventive/screening services, comprehensive management of acute

and chronic conditions

Convenience – Walk-In Care ClinicColds, flu, quick service

Nurse LineHealth and first aid questions, premium provider search,

guidance on appropriate facility and location to meet care needs

Available extended hours & weekends


Available extended hours & weekends in some cases


No CostAvailable 24/7

COST

$500+

$200+

$125+

$49-$69

$0

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PRESCRIPTION COST AND SAVINGS OPPORTUNITIES - $4 PRESCRIPTIONS


SAVE on Prescription Drug Costs & Copays!

WHAT IS IT?Many retail pharmacies have recently created new and innovative programs to help control prescription drug costs for consumers. One of the most popular is the $4 prescription drug program, which has allowed consumers to take advantage of tremendous savings for their everyday prescriptions needs. This program is offered at many national and regional pharmacies, including those shown above, and typically includes hundreds of medications in a variety of therapeutic classifications.

Other programs that may be available in your area may include free antibiotics and various 90-day supply discounts for maintenance medications. Many pharmacies also have low-cost membership programs that allow you to access significant savings. It is likely that there will be new programs and enhancements to existing programs in the future as pharmacies continue to compete for the right to fill your prescriptions.

Interaction with insurance - continue to provide your insurance information to ensure you receive the deepest discount and that your coinsurance is applied to your deductible and/or out-of-pocket maximum. If your insurance company has negotiated a deeper discount than $4 (or the pharmacy’s discount rate) for the prescribed medication, you will be charged the lesser of the two prices.

KEEP MONEYIN YOUR BANK!

2323

http://sites.target.com/site/en/health/page.jsp?contentId=PRD03-004319

http://www.walmart.com/catalog/catalog.gsp?cat=546834


HEALTH SAVINGS ACCOUNTS (HSA) AND FLEX SPENDING ACCOUNTS (FSA)

One of the qualifications to have an HSA is that you are not covered by any other low deductible insurance – this includes an FSA.

Therefore, if you enroll in the HDHP Plan and open an HSA Account, you may not participate in a Standard FSA Plan. However, you may enroll in a Limited FSA which can be used to reimburse Dental & Vision expenses ONLY.

You may still participate in the dependent care account.


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Flexible Spending Account (FSA)


Healthcare FSA Annual limit of $2,500 (capped per IRS regulations)

Pre-tax dollars used to pay for qualified medical, dental & vision expenses

New: Limited Flex (reimbursement for dental & vision expenses only) for those enrolled in the HDHP Plan (HSA)

New: $500 Roll-Over Feature. Allows Health Care FSA participants to roll-over up to $500 of their previous year’s funds and add them to the new year plan. Rollover funds can only be used after the dollars from the new year’s plan have been used up. (Unused FSA funds in 2015 will roll-over into 2016)

Dependent Care FSA Annual limit of $5,000 (pre-tax dollars used to pay for daycare

expenses)


EBC FEATURES: Submitting claims is EASY

My Mobile Account Assistant– For Android and iPhone

– Camera scans documentation

– Upload with claim information

– Receive notification when a claim is processed

– Use the app to review FSA account information

Submit claims online or using paper• My Account Assistant

– Your secure web portal lets you review all aspects of your account online at www.ebcflex.com

– Submit claims and documentation

– Receive notification when a claim is processed

• Claim Form

– Mail or fax a paper form with attached documentation


• New ID cards issued – new member and group number• Other Insurance Questionnaire• Re-Register on UMR.com • Same Network – Choice Plus

1/1/2015 CHECKLIST

St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx27

Better information, better decisions, better health on UMR.com

St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx28

UMR.com gives members access to:

• Health cost estimator tools MyHCE (My Healthcare Cost Estimator)

• Provider search capability to identify quality and cost efficient providers classified as Tier 1.

• Health Education Library

• Resources on healthy living

• Access to OptumRx

In two

clicks

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SECURE Mobile Web Access(No Download Necessary)

Log in

Enter your username

and password for instant

access to all our mobile

inquiry tools.

Find a provider

Need to find a doctor fast?

Access an alphabetical listing

of network providers.

What’s new

Find out about new tools and

information to help you live a

healthier life.

Check your benefits

View medical and/or

dental benefits, as well as

persons covered.View, scan or fax your ID card

View your ID card, allow your provider to

scan the on-screen bar code for instant

access to your benefit information, and/or

fax it to a provider.

Look up claims

Look up a claim for

yourself or an authorized

dependent.

.

Need help?

Click the question mark any time you

are confused about a term or benefit

and get an explanation.

Home: Return to the main menu.Menu: Display the menu.Gear: Log out or learn more.


Simplified navigation

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 30

PPO Plan vs. HDHP/HSA Plan (OptumRx)

PPO Plan HDHP Plan (HSA)

Deductible No Deductible on Rx $2,000 Single $4,000 Family

Maximum Out-of- Pocket (Includes Medical & Rx)

$1,500 Single$3,000 EE+1$4,500 Family

$4,000 Single $8,000 Family

Copayment / Coinsurance

Retail: 25% ($10 Min / $50 Max)

Mail Order: $30 Copay (Generic) $90 Copay (Brand)

Deductible, 90% coinsurance

Generic Preventive HSA Medication n/a 100% coverage if filled at mail

order

What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood pressure, blood thinner and beta blockers.


Contraceptive Services Only (CSO)coverage for Eligible Organizations

Coverage for contraceptives services only (both medical and/or Rx, as provided by insurer/TPA) as required by PPACA.

Provides 100% coverage for standard, eligible preventive contraceptive services

Separate from the customer’s medical policy

No cost to employer – not passed on through ASO administrative fees

Must be prescribed (even OTC contraceptives) and filled at a network pharmacy

Cover certain female birth control drugs and services only

All female members, no matter their age, will have birth control available to them

Age limits not applied because:

1. The age that a woman is no longer able to have children is different for everyone.

2. It is up to the family, not the health insurance company, to decide if or at what age a young woman might get birth control.

3. Health insurance companies are required by the health reform law to provide this benefit to ALL females.

Eligible Organization

Medical/Rx (non CSO) coverage

Contraceptive Services Only

(CSO) coverage

Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

www.optumrx.com

32

• Review benefit highlights and coverage

• Access to Mail Service Pharmacy prescriptions

• My Prescription Dashboard to refill, renew and manage prescriptions

• My Medicine Cabinet to manage and price prescription and OTC medications

• Locate a retail pharmacy

• Explore lower-cost alternatives and options

• Download order forms

• Access general health information

http://welcometomyuhc.com/optumrx/demo-optum/

http://welcometomyuhc.com/demo2013/


www.optumrx.com

Personalized Rx Dashboard

Visual Image of All Drugs

– Quickly identify Refills

– View drugs for renewal

– Check Order Status

At-a-Glance Calendar for expiration and refill dates

Quick drop down box to change account for Household/Caregiver view

Simple tab design and quick links to improve navigation and user experience.

Mobile Website


REQUIRED FORMS TO BE COMPLETED


Deadline for enrollment forms is November 26, 2014. Return completed forms to your Human Resources Department.

UMR Enrollment Form (New Enrollees, Adding/Removing Dependents, Enrolling in the HDHP/HSA Plan, Dropping Coverage) Not required if you are keeping your current coverage

Spouse Medical Insurance Coverage Statement. Required if you have a spouse covered under the SNC plan.

Associated Bank Health Savings Account (for those enrolling in the HDHP/HSA Plan) Complete application and applicable forms to open your HSA bank account

and start contributing!

Delta Dental Enrollment Form (New Enrollees, Adding/Removing Dependents Only, Dropping Coverage)

EBC - FSA Enrollment Form Enrollment does not carry over - employees who wish to participate must

enroll again for 2015


QUESTIONS?


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2015 Medical Plan Options, Health Savings Accounts & Flexible Spending PRESENTED TO: PRESENTED BY: Greg Biese Vice President, Senior Benefits Consultant.

Documents

medical plan options

norbert colleges medical

single medical coverage

llc hdhp plan hsa effective

important hsa plan notice

llc ppo plan effective

primary coverage

primary insurance coverage