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/14/Misc/2015 Plan Options & HSA Education.pptx

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2015 MEDICAL ELIGIBILITY & RATES


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Eligibility & Rates PPO Plan Health Savings Account (HSA) Plan

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 on Health Plan)

$75 per month

Same sex partners are now eligible for coverage


2015 BENEFIT HIGHLIGHTS

4St. Norbert College/14/Misc/2015 Plan Options & HSA Education.pptx

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); $4,000 (EE+1); $6,000 (Family) $4,000 (Single); $8,000 (Family)

(1)

Out-of-Network $3,000 (Single); $8,000 (EE+1); $12,000 (Family) $8,000 (Single); $16,000 (Family) (1)

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

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

(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.


2015 BENEFIT HIGHLIGHTS (CONT.)


Benefit Highlights

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).


PPO PLAN EFFECTIVE JANUARY 1, 2015


Preventive services unchanged

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

Deductible and maximum out-of-pocket increase

• Costs• New generics drugs

Prescription drug plan design unchanged

• UMR

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.


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 – 2014

• Annual contributions to the HSA are limited to $3,300 single / $6,540 family (2015 will be released in late summer)

• Benefits are subject to federal regulations

– Deductibles, out-of-pocket and contribution maximums are determined annually

• Account holders age 55 and up may make additional contributions of $1,000 in 2014.


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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

At the end of the year, the bank will send each account beneficiary a

statement with the fair market value of the HSA and forms with the total contributions and distributions:

Form 1099-SA (distributions)

Form 5498-SA (contributions,

rollover deposits and fair market value for each calendar year)

This information is reported to

the IRS.

You will need to complete form

8889 and file with your personal

income tax return.


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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!

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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. Effective 1.1.15

You may still participate in the dependent care account.


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Flexible Spending Account (FSA) UpdateNew Plan Administrator 9.1.2014

Employee Benefits Corporation (EBC) will replace M&I (BMO Harris) as your FSA Administrator

Your current FSA plan year will end on 8.31.2014. Please continue to submit all claims to M&I (BMO Harris) for reimbursement. You will have 90 days after the end of the current plan year to submit claims incurred between 9.1.2013 through 8.31.2014.

– We will running a ‘short’ plan year (9.1.2014 to 12.31.2014)

– Your next plan year will start on January 1, 2015

What does this mean for you?

– Enrollment Forms will be required effective 9.1.2014 and then again effective 1.1.2015



FSA Short Plan Year (9.1.2014 – 12.31.2014)

The short-plan year (4 months) will allow you to submit claims incurred between 9.1.2014 and 12.31.2014. Please keep in mind the following:

– The Health Care FSA maximum for the ‘short plan year’ must be pro-rated. Participants will be allowed to contribute 1/4th of the annual limit of $2,500.

• 1/4th of the Annual Limit is $833.33

– The Dependent Care FSA limit is $5,000 per calendar year. To calculate your allowable amount subtract your 2014 contributions (January 1st - through August 31st ) from the $5,000 annual limit.

Example 1: Between January 1st – August 31st, Jane Smith contributed $4,000 to her Dependent Care FSA account. She may contribute an additional $1,000 to her Dependent Care FSA between 9.1.2014 – 12.31.2014

Example 2: Jane Smith did not participate in the Dependent FSA in the 2013-2014 Plan Year. She may contribute up to $5,000 to her Dependent Care FSA account between 9.1.2014 – 12.31.2014 .


Jesse will be sending additional communication regarding these changes to the SNC community in May 2014.


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



QUESTIONS?


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Documents

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