WEA Employee Benefits Presentation...$10/$25 (then ded& coins) Other Copays (Emergency Room/Urgent Care) Deductible/Coinsurance $250/$100 (then ded & coins) Deductible (Single/Family)

Employee Benefits PresentationSCHOOL DISTRICT OF WEST DE PERE

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AgendaSchool District of West De Pere

Benefit Plan Options

Medical Visit Examples

Plan Selection

Questions?

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Option 1 - Current PlanSummary of Benefits Essential PPO

Network Trust Preferred In NetworkOffice Copay (Primary Care/Specialist) $10/$25 (then ded & coins)

Other Copays (Emergency Room/Urgent Care) Deductible/Coinsurance $250/$100 (then ded & coins)

Deductible (Single/Family) $400/$800Coinsurance 100%Pharmacy Copay $0/ $10/ $30/ $60 Total Out-of-Pocket (Deductible Medical) $1,400 single / $2,800 familyTotal Out-of-Pocket (Pharmacy) $2,000/$4,000Out of Network

Deductible (Single/Family) $800/$1,600Coinsurance 80%Total Out-of-Pocket (Deductible Medical) $2,800/$5,600

No changes to your benefits– same co-pays and deductibles

No increase in premium cost or contribution (July 1, 2020- June 30, 2021)

Employee Contribution (Contingent upon completion of Health Risk Assessment):

Single Plan: 0% ($0 annually)

Family Plan: 5% ($1350.48 annually)

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Option 1 - Current Plan: Key Highlights

Option 1 - Example of a Medical Visit: Ken

Ken Network Primary Care Office Visit

$325

Diagnostic Tests

Prescription Drug

Blood work: $225Chest X-ray: $300

Total Cost: $975

Tier 1 Script: $125

Ken would pay:

OV Co-pay: $10

Medical Deductible: $400

Rx Co-pay: $10

Total: $420 of the $975 billWEA Trust pays: $555

Option 1 - Example of a Medical Visit: Tina

Tina Specialist Office Visit

Diagnostic Tests

Child/ Delivery Professional

Services

Ultrasound

Blood work

Total Cost: $12,700

Tina would pay:

OV Co-pay: $50

Medical Deductible: $400

Total: $450 of the $12,700 billWEA Trust pays: $12,275

Child/ Delivery Facility Services

Ken and Tina would pay co-pays until each of their maximum out-of-pocket are met for medical services ($1,400) AND only co-pays until the maximum out-of-pocket for Rx is met ($2,000)

Family Plans: family members need to meet individual deductibles or a combination of dependents could meet the maximum out-of-pocket of ($2800) AND only co-pays until the maximum out-of-pocket for Rx is met ($4,000)

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Future Medical Visits for Ken and Tina

A High-Deductible Health Plan, or HDHP, is an arrangement that allows you to pay less in monthly premiums, in exchange for higher deductibles when you need care.

A qualified HDHP: Provides coverage for medical and Rx expenses. Does not pay any medical expenses (other than preventive) until the deductible is

satisfied. You are responsible for the first $1,500/$3,000 before plan coverage

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What is a High Deductible Health Plan?

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Option 2 - High Deductible Health Plan with HSASummary of Benefits Essential Qualified

Network Trust Preferred In NetworkOffice Copay (Primary Care/Specialist) $0/$0 (then ded & coins)

Other Copays (Emergency Room/Urgent Care) Deductible/Coinsurance $0/$0 (then ded & coins)

Deductible (single/family) $1,500/$3,000Coinsurance 100%Pharmacy Copays $0/ $0/ $0/ $0 CopaysTotal Out-of-Pocket (Includes Deductible and Medical/ Rx Copays) $1,500 single / $3,000 familyOut of NetworkDeductible (single/family) $3,000/$6,000Coinsurance 80%

Out-of-Pocket (Includes Deductible ER, UC & Rx Copays) $5,000/$10,000

Effective July 1, 2020 – June 30, 2021

Stay with current network and providers

Seamless transition

No co-pays

No separate RX deductible

Smaller monthly premium

You are responsible for the first $1,500/$3,000 before plan coverage

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Option 2 - High Deductible Health Plan: Key Highlights

Employee Contribution (Contingent upon completion of Health Risk Assessment):

Single Plan: 0% ($0)

Family Plan: 5% ($1098.48 annually - $252 less than Option 1)

District will provide Health Savings Account (HSA) contribution:

$1,000 Single or $2,000 Family

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Option 2 - High Deductible Health Plan: Key Highlights (Continued)

Option 2 - Example of a Medical Visit: Ken w/ HDHP

Ken Network Primary Care Office Visit

$325

Diagnostic Tests

Prescription Drug

Blood work: $225Chest X-ray: $300

Total Cost: $975

Tier 1 Script: $125

Ken would pay:

Total cost of $975*

*He would then need to satisfy an addition $525 before WEA Trust starts paying*If Ken was on a family plan = $3,000 ($2,025)

Maximum Out-of-Pocket Satisfied at $1,500/$3,000

Option 2 - Example of a Medical Visit: Tina w/ HDHP

Tina Specialist Office Visit

Diagnostic Tests

Child/ Delivery Professional

Services

Ultrasound

Blood work Total Cost: $12,700

Tina would pay:

Deductible Cost: $3,000

Total: $3,000 of the $12,700 billWEA Trust pays: $9,700

Family plan: one member can meet the full family deductible

Child/ Delivery Facility Services

In these examples:

Single Plan: Ken would need to satisfy an additional $525 in deductible before benefits can be paid. Meeting a total of $1,500 single deductible.

Family Plans: When two or more are insured under a qualified HDHP, the full family ($3,000) deductible must be satisfied before benefits can be paid. This means one person may be required to satisfy the full family deductible.

Once the plan deductible is met, medical and prescription benefits will pay according to plan policy.

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Future Medical Visits for Ken and Tina

Health savings account, or HSA, allows an individual to set aside pre-tax dollars for qualified medical expenses.

The funds are in a separate bank account in your name. It is your money.

The funds can roll over from year to year and you can also take them with you if you change jobs.

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What is a health savings account (HSA)?

Account holders get a triple tax savings! Deposits into HSA accounts are exempt from Income Tax Savings continue to grow in accounts Tax-Free Money spent on Qualified Medical Expenses are not taxed

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What is the benefit of an HSA?

Option 1 - Current Plan

Employee Contribution (Contingent upon completion of Health Risk Assessment):

Single Plan: 0% ($0 annually)

Family Plan: 5% ($1,350.48 annually)

Member Out of Pocket Costs:

Deductible Medical: Single $400 Family $800

Copays: Medical and Pharmacy

Max Out of Pocket (Medical): Single $1,400 Family $2,800

Pharmacy Out of Pocket (Rx): Single $2,000 Family $4,000

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Cost ComparisonOption 2 – High Deductible Health Plan w/HSA

Employee Contribution (Contingent upon completion of Health Risk Assessment):

Single Plan: 0% ($0 annually)

Family Plan: 5% ($1,098.48 annually)

Member Out of Pocket Costs:

Deductible (Medical & Pharmacy) Single $1,500 Family $3,000

Pharmacy Out of Pocket: None

Copays: None

Max Out of Pocket (Medical and RX) Single $1,500 Family $3,000

District Health Savings Account Contribution:

$1,000 Single or $2,000 Family

Plan selection form due: June 5th, 2020

If you do not turn in an enrollment or change form, all current elections (or waivers) will remain in place for the next plan year.

New dependent, marriage, divorce, child reaching age 26, etc.

It is your responsibility to let us know during this annual enrollment time OR within 30 days of a qualifying event

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Plan Selection

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Plan Selection Form

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Questions?Submit your questions via the Zoom chat function or via email to Kim Vande Hey [email protected]