City of Springfield Benefit Plan OfferingsPlan Changes effective March 2018

General Information and Education

Annual Open Enrollment will be held at the end of January. There

will be an education table to provide an overview of benefit

offerings effective March 1, 2018.

Additional information and education is available via:

Employee Self Services (ESS) https://ess.springfield.il.us/BenefitsHealth.aspx

Please review and if you still have questions please contact HR.

2018 Overview

3 medical plan options:

•Basic Select plan

•Point of Service plan

•High Deductible Health Plan (HDHP)/Health

Savings Account (HSA), includes HSA

employer contribution

Basic Select Coverage In-Network Out-of-Network

Individual / Family $500 / $1,500 $500 / $2,500

Individual / Family $1,000 / $3,000 Unlimited / Unlimited

PCP $40 copay per visit $40 copay per visit

Specialist $60 copay per visit $60 copay per visit

Preventive/Well Care 100% Not Covered

Emergency Room $150 copay, then 70% $150 copay, then 70%

Emergency Medical Transport 70% 70%

Coinsurance Levels

Outpatient Hospital $50 copay, then70% $50 copay then 60%

Hospital Inpatient $300 copay per admission, then 70% $300 copay per admission, then 60%

Other Covered Services 70% 60%

Individual Deductible $50 Not Covered

Family Deductible $150 Not Covered

Individual Out of Pocket $1,000 Not Covered

Family Out of Pocket $3,000 Not Covered

Specialty Drugs $50 copay Not Covered

Retail, 1-34 day supply

Generic/Preferred Brand/Non-Preferred Brand $15 / $25 / $45 Not Covered

Retail, 84-90 day supply

Generic/Preferred Brand/Non-Preferred Brand $45 / $75 /$135 Not Covered

Mail Order, 84-90 day supply

Generic/Preferred Brand/Non-Preferred Brand $25 / $50 / $100 Not Covered

Out-of-Pocket Maximum (includes deductible )

Deductible

Services/Treatment

Prescription Drug Benefits

Point of ServiceCoverage In-Network Tier 1 In-Network Tier 2 Out-of-Network

Individual / Family $200 / $600 $200 / $600 $500 / $1,500

Individual / Family $1,000 / $2,250 $1,000 / $2,250 Unlimited / Unlimited

PCP $20 copay per visit $20 copay per visit 70%

Specialist $40 copay per visit $40 copay per visit 70%

Preventive/Well Care 100% 100% Not Covered

Emergency Room $150 copay, then 85% $150 copay, then 85% $150 copay, then 85%

Emergency Medical Transport 85% 85% 85%

Coinsurance Levels

Outpatient Hospital $50 copay, then 85% $50 copay, then 80% $50 copay, then 70%

Hospital Inpatient 85% 80% 70%

Other Covered Services 85% 80% 70%

Individual Deductible Not Covered

Family Deductible Not Covered

Individual Out of Pocket Not Covered

Family Out of Pocket Not Covered

Specialty Drugs Not Covered

Retail, 1-34 day supply

Generic/Preferred Brand/Non-Preferred Brand Not Covered

Retail, 84-90 day supply

Generic/Preferred Brand/Non-Preferred Brand Not Covered

Mail Order, 84-90 day supply

Generic/Preferred Brand/Non-Preferred Brand Not Covered

Deductible

Out-of-Pocket Maximum (includes deductible)

Services/Treatment

$10 / $20 / $40

$30 / $60 /$120

$25 / $50 / $100

Prescription Drug Benefits

$50 copay

$3,000

$1,000

$150

$50

High Deductible Health Plan/Health Savings AccountCoverage In-Network Out-of-Network

Individual / Family $2,700 / $5,400 $4,500 / $10,800

Individual / Family $2,700 / $5,400 $10,800 / $21,600

PCP 100% after deductible 80% after deductible

Specialist 100% after deductible 80% after deductible

Preventive/Well Care 100%, deductible waived 80% after deductible

Emergency Room 100% after deductible 100% after deductible

Emergency Medical Transport 100% after deductible 100% after deductible

Coinsurance Levels

Outpatient Hospital 100% after deductible 80% after deductible

Hospital Inpatient 100% after deductible 80% after deductible

Other Covered Services 100% after deductible 80% after deductible

Specialty Drugs 100% after deductible Not Covered

Retail, 1-34 day supply

Generic/Preferred Brand/Non-Preferred Brand 100% after deductible Not Covered

Preferred Brand Drugs 100% after deductible Not Covered

Non-Preferred Brand Drugs 100% after deductible Not Covered

Retail, 84-90 day supply

Generic/Preferred Brand/Non-Preferred Brand 100% after deductible Not Covered

Preferred Brand Drugs 100% after deductible Not Covered

Non-Preferred Brand Drugs 100% after deductible Not Covered

Mail Order, 84-90 day supply

Generic/Preferred Brand/Non-Preferred Brand 100% after deductible Not Covered

Prescription Drug Benefits

Deductible

Out-of-Pocket Maximum (includes deductible)

Services/Treatment

2018 Employee Medical Contributions

Contributions

Monthly

Premium:

Basic Select

You Pay

Point of

Service

You Pay

HDHP

You Pay

HSA Annual

Employer

Contribution

Employee Only

with Wellness$80.00 $147.84 $0.00 $500*

Family with

Wellness$232.50 $339.78 $240.62 $2,000

* If Wellness is completed

COS Leadwell Clinic can provide Wellness screenings at no cost

HSA annual contribution only available if enrolled in HDHP

2018 Health Savings Account Contribution Limits

2018 HSA Contribution Limits

Individual

CoverageFamily Coverage

Catch-up Contributions

(age 55 & older)

$3,450 $6,850*On March 5, 2018, the IRS changed the

H.S.A. family maximum contribution limit

from $6,900 to $6,850

$1,000

» Family deductible is an embedded deductible – No individual will pay more than their individual deductible and

Maximum out of pocket

» Prescription drugs are subject to the deductible

» Contribution limits include employer and employee amounts

2018 Medical Plan Option ComparisonWellness premiums

Employee Only Coverage

Employee Only BASIC POS HDHP/HSA

Employee's Monthly Premium Cost $80.00 $147.84 $0.00

Employee's Annual Premium Cost $960.00 $1,774.08 $0.00

Employer HSA Contribution $500.00

Employee's Total Cost

(EE annual premium - ER HSA contribution) $960.00 $1,774.08 ($500.00)

Family Coverage

Employee Only BASIC POS HDHP/HSA

Employee's Monthly Premium Cost $232.50 $339.78 $240.62

Employee's Annual Premium Cost $2,790.00 $4,077.36 $2,887.44

Employer HSA Contribution $2,000.00

Employee's Total Cost

(EE annual premium - ER HSA contribution) $2,790.00 $4,077.36 $887.44

What is an Health Savings Account?

Tax-Exempt

Savings

Account

(HSA)

HSA

Account

High Deductible

Health Plan

(HDHP)

Component #1 – High Deductible Health Plan (HDHP)

» A medical plan with a higher deductible threshold than most traditional PPO plans

mandated by the IRS

» Almost all medical expenses are paid for by you at 100%, less carrier discounts, prior

to meeting your deductible

» Doctor’s visits

» Specialist visits

» Emergency Room/Urgent Care visits

» Prescriptions

» An HDHP utilizes the same PPO network you’ve grown accustom to

» Same doctors and hospitals

» No disruption in medical services and care

Component #2: What is an Health Savings Account?» An HSA (Health Savings Account) is a tax-exempt savings account funded with tax-

free dollars, and used exclusively to pay for qualified medical expenses and/or provide

savings for the future also tax free

» Individuals can deduct the dollars they contribute to their HSA from their gross income

» Lower taxable income

» Tax-free medical dollars (for qualified expenses)

» You are eligible for an HSA if:

» You are covered under a High Deductible Health Plan (HDHP)

» You are not covered by any other health coverage that is not an HDHP

» You are not enrolled/eligible in Medicare (under age 65)

» You are not claimed as a dependent on someone else’s tax return

How does it really work?» You should avoid paying at the point of service when at all possible

» Making sure the carrier discounts are applied to your medical services will be key

before paying the bill

• The one exception to paying at the point of service is at the pharmacy

» Following these simple steps should help…

Go to the doctor and

present your carrier ID

card

Doctor submits the

bill with your

services to the carrier

The carrier adjusts

pricing to reflect the network discount

The carrier posts the EOB

to your member portal and/or sends you a copy of it in the mail

Check for billing errors!

Make sure the EOB

and bill from your doctor

match

Pay your doctor directly

with either pre-tax funds

from your HSA or out of your pocket if funds are not

available

To Contribute to a Health Savings Account

You cannot:

❖ Enroll in a medical plan that is not a High Deductible Health Plan

❖ Enroll in Medicare

❖ Be claimed as a dependent on someone else’s tax return

❖ Children cannot establish their own Health Savings Accounts

❖ Spouses can establish their own Health Savings Accounts, if eligible

❖ Participate in a health care Flexible Spending Account

What is a qualified medical expense?

» Distribution is tax-free for

qualified medical expenses

• Medical services, procedures and treatments

• Diagnostic services

• Drugs

• Prescriptions

• Vision (includes LASIK)/Hearing

• Medical Equipment

• Psychiatric care

• Assistance for disabled

• Dental (includes orthodontia)

• Long Term Care premiums

• Medicare copays, deductibles and coinsurance

• Medicare Cost- except for Medigap plans

Examples of

qualified medical

expenses under

Section 213(d) of the

IRS code

Consult your tax advisor for items not on the listhttp://www.irs.gov/pub/irs-pdf/p502.pdf

Advantages of your Health Savings Account

» Unused funds rollover from year to year

» It’s not use it or lose, it’s use it or keep it

» Infinite growth in your account

» There’s a triple tax savings

» You do not pay taxes on funds going into this account

» You do not pay taxes on interest or dividends earned

» You do not pay taxes when used for qualified medical expenses

» Account is portable

» If you change between plans, retire or even leave the company – the account

goes with you

» You’re the owner and manager of this account – it’s solely yours

Save money with Wellness

Complete Wellness and take advantage of lower monthly premiums

Wellness screening Health Risk Assessment Money

If you don’t have a PCP or cannot get an appointment with your PCP call the COS LeadWell Clinic.

Wellness screenings provided at COS LeadWell Clinic, no cost.

Wellness screening and Health Risk Assessment must be completed by 12/31/2018, to take advantage of Wellness premiums that are effective March 1, 2019.

COS LeadWell ClinicFree services to all participating members in any of the medical plans.

Walk In or appointments available.

» Treatment for acute illness/minor injuries (examples)

• Severe Sore Throat/ Sinus infection

• Bronchitis

• Ear Infections/Swimmer Ear

• Pink Eye

• Mononucleosis

• Sprains/Strains

• Pointe of Care/Full Lab Testing(Blood, Urinary Tract Infections, etc.)

» Wellness Services

• Physical Exams ( Men, Women, Children 5 years and up)

• Adult Immunization/Flu Shots

• School/Sport Physicals

• TB Testing

• Health Screenings

• Skin Screenings

» Prescription Medication Dispensing

• Commonly prescribed medications for non-emergency health concerns.

COS LeadWell Clinic Clinic Hours

Monday: 8:00 a.m. to 5:30 p.m.

Tuesday: 8:00 a.m. to 5:30 p.m.

Wednesday: 8:00 a.m. to 5:30 p.m.

Thursday: CLOSED

Friday: 8:00 a.m.to 5:30 p.m.

Saturday 8:00 a.m. to noon

Clinic Phone Number

1-217-993-0998

Clinic Location

FitClub Building

3631 S. 6th Street

Springfield, IL 62703

Tips to save money

Preventive/Wellness Exams are covered at 100% in-network under all plans.

» Preventive care is equal to one annual physical exam per year per enrolled member

• Females get an annual well-woman exam covered at 100% in addition to their annual exam

» Preventive exams include age-specific tests, blood work and more

» No deductible expenses apply – the exam is completely no cost to you

• Lab tests related to an already established condition such as diabetes or asthma – are not considered preventive and are covered under applicable deductible and coinsurance levels

» All participating members age 5 and up can visit the COS LeadWell Clinic and receive Free Preventive Services.

Tips to save money

Emergency Room

» ER average cost is well over $1,000

» Urgent Care average cost is $200

» Doctor’s office average cost is $125

» Minute Clinic or Take Care Clinic average cost is $79

» City of Springfield LeadWell Clinic- $0

High cost scans, x-rays and tests

» MRIs, PET scans, CT scans, etc. are nearly 2/3 less costly at free-standing imaging centers than at hospitals

» Finding an in-network free standing imaging center saves you loads of $$$

Tips to save money

Prescription drugs

» Ask your doctor is there is a generic version of the medication they’re

prescribing or you’re taking• Generic equivalent medications have the same active ingredient as their Brand name counterpart

» Take advantage of the Generic Prescriptions Savings Programs out there• Walmart, Target, Meijer, etc.

» Mail Order and 90 Day Supply

» Ask about free samples and/or manufacturer rebates

» www.goodrx.com