Employee Benefits Review January 1, 2013 CHANGES FOR 2013! Changing to 2 health plans – PCB and...
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Employee Benefits Review January 1, 2013 CHANGES FOR 2013! Changing to 2 health plans – PCB and HMO Preferred Care members will be changed to the Preferred-Care
CHANGES FOR 2013! Changing to 2 health plans PCB and HMO
Preferred Care members will be changed to the Preferred-Care Blue
PPO Plan and Network effective January 1. Preferred Care Blue
network includes Liberty Hospital and Truman Hospitals Womens
Preventive Care Additional coverage Generic Contraceptive drugs
100% Contraceptive implants, injectables & devices at 100%
Breastfeeding support, supplies (pumps) and counseling at 100%
Voluntary Vision Changing to EyeMed Same network of providers
EyeMed Select Network Similar Plan Options Exam & Materials and
Materials Only Plan FSA Healthcare Reimbursement Account New 2013
IRS Maximum Limitation - $2,500 per employee; total family benefit
of $5,000 Voluntary Short-Term Disability - Aflac This benefit
provides you with a portion of your monthly salary if illness or
injury keeps you from working
Slide 4
Health Care Reform Proposed for 2013 W-2 Reporting of the cost
of healthcare (2013) William Jewell College will be required to
report the annual cost ( employer cost) of the health coverage
provided to their employees on the annual W-2 Form, starting with
the 2012 W-2 and forward Uniform Summary of Benefits and Coverage
(2013) All health plans will be required to provide a uniform
summary of the plans benefits and coverage (SBC) and a uniform
glossary of commonly used health insurance and medical terms to
participants FSA Healthcare Reimbursement Account (2013) IRS
Maximum Limitation - $2,500 per employee; total family benefit of
$5,000
Slide 5
2013 Medical Plan Options Preferred-Care Blue PPO (Preferred
Provider Organization) No selection of a PCP (Primary Care
Physician) Freedom of Choice Lower your out pocket expenses when
using network PPO providers In and Out of Network Coverage National
and International Coverage Deductible and coinsurance Blue-Care HMO
(Health Maintenance Organization) Select a Primary Care Physician
(PCP) In-Network Coverage Only In Metro Kansas City Area Coverage
Only Coverage for Urgent and Emergency Care while Traveling No
deductible or coinsurance
Slide 6
Select a PCP (FP, GP, IM, Ped) YES Office Visits $30 PCP* copay
$60 Specialist** copay Inpatient Hospital Services /Outpatient
Surgery $250 copay per day up to $1,250 per member per calendar
year (applies to inpatient services at a hospital and outpatient
surgeries at a hospital or an outpatient facility) MRI, MRA, CT and
PET Scans Physicians Office, Imaging Center, Outpatient Setting
$100 copay Only one copay will apply for each provider on a
specified date of service even if multiple scans are performed
Urgent Care (Minute Clinics, Take Care Centers) $60 copay (office
visit/lab only) Emergency Care$100 copay if treated and released
Blue-Care HMO
Slide 7
Annual Deductible$2,500 individual / $5,000 family Network
Coinsurance Non-Network Coinsurance Member pays: 20% / BCBSKC pays:
80% Member pays: 40% / BCBSKC pays: 60% Out-of Pocket Maximum$4,500
individual / $9,000 family $9,000 individual / $18,000 family
(Includes Deductible + Coinsurance) Inpatient Hospital
ServicesDeductible then coinsurance Office Visits$40 copay
(includes lab services in physicians office or network lab) Urgent
Care (Minute Clinics, Take Care Centers) $40 copay (includes lab
services in physicians office or network lab) Emergency Care$100
copay* then deductible then coinsurance *Copays do not apply to
deductible or OOP maximum Preferred-Care Blue
Slide 8
Hospital Locator www.bluekc.com Metro Hospitals HMO Blue Care
Network PPO Preferred Care Blue Network Center Point Medical Center
XX Childrens Mercy Hospitals XX KU Medical Center XX Lees Summit
Hospital XX Liberty Hospital XX Menorah Medical Center XX North
Kansas City Hospital XX St. Lukes (All Locations) NOX Olathe
Medical Center XX Overland Park Regional XX Providence Medical
Center XX Research Medical Center XX Shawnee Mission Medical Center
XX St. Joseph Medical Center XNO St. Marys Medical Center XNO
Truman Medical Center (Hospital Hill and Lees Summit) XX
Slide 9
Preventive Care: What to Know! Both BCBSKC plans will cover
Preventive Care Services at 100% Annual Physicals Childhood
Immunizations Well Women Exams PSA Tests Services MUST be
Preventive and received by In-network providers Effective January
1, 2013: Generic Contraceptive drugs at 100% Contraceptive
implants, injectables & devices at 100% Breastfeeding support,
supplies (pumps) and counseling at 100% Refer to the Routine
Preventive Services flier for additional services
Slide 10
Prescription Drug Coverage Retail and Mail-Order Certain drugs
may require prior authorization, have quantity limitations or
require step therapy (Generics First). Refer to the Prescription
Drug List in your packet for additional details. Up to 34 day
supply In-Network Pharmacy Tier 1: $10 Tier 2: $50 Tier 3: $70 Up
to 102 day supply (Save 1 months copay) Mail-Order Tier 1: $20 Tier
2: $100 Tier 3: $140
Slide 11
Disease Management Program from Blue Cross Blue Shield of
Kansas City The Healthy Companion TM program provides information,
education and one-on-one telephonic support for Blue KC members who
have been diagnosed with the following conditions: Asthma Chronic
Obstructive Pulmonary Disease (COPD) Depression Diabetes Heart
Disease Heart Failure High Blood Pressure Stress and Anxiety
(LiveWell) How do you enroll? Automatic enrollment member can
choose to opt out of the program Self-enrollment Contact Healthy
Companion at 816-395-2076 or toll free 1-866-859-3813 Email to
[email protected]@BlueKC.com
Slide 12
Points to Blue Deadline Points to Blue will end on December 31,
2012. Remember you MUST redeem your Points to Blue by December
31,2012. My Rewards will begin January 1, 2013.
Slide 13
2013 My Rewards Program Step 1*Complete the Onsite Health
Screening (or alternate means screening form) for 25 Points Step
2*Take the Health Risk Assessment (HRA) for 25 Points *Steps 1 and
2 must be completed to be eligible to redeem My Rewards. Step
3Engage In Additional Activities for 25 Points You may earn
additional points by participating in the following activities:
Lifestyle Coaching (goals met) Self-Directed Coaching Assessments
Tobacco Cessation Program A Healthier You Worksite Wellness
Programs Healthy Companion Condition Management (goals met) Little
Stars Prenatal Assessment My Rewards: Policy holders and spouses
can redeem up to a total of $75 when 75 points are achieved.
Slide 14
www.bluekc.com View Your Claims, Print a Temporary ID card
& Find Rx Info
Slide 15
24-Hour Nurse Line Access to Care Advisors to help you with
symptoms or answer health-related questions How Can They Help? Gain
convenient access to quality care Become better informed about
healthcare Gain confidence when speaking to providers Become
educated on self-care for non-urgent situations Improve knowledge
of drugs and medications 24 hours a day365 days a year!
877-852-5422
Slide 16
Exclusively For Our Members Blue365 online resources include:
Tools to help employees make the best choices about their health
Select discounts and savings on products and services they can use
to improve and maintain health Select companies include:
Independent companies that do not provide Blue Cross and/or Blue
Shield products or services and are solely responsible for the
services provided. YMCA, Discover Vision and Sabates Eye Care
provide discounts in the Kansas City metropolitan area only.
Slide 17
Type IType IIType IIIType IV DeductibleNone$50 / $150None Blue
Cross Pays (Preferred-Care Dental and Out-Of-Area Providers)
100%80%50% Blue Cross Pays (Non-Preferred-Care Dental Providers
within our Operating Area) 80%70%40%50% Covered Services Dental
X-rays Routine Oral Exam Cleaning two each calendar year Root Canal
Tooth Extraction Bridge Recementing Complete or Partial Dentures
Surgery of Gums Periodontal Scaling Orthodontia ( to age 19):
Cephalometric X-rays. Diagnostic casts. Calendar Year Maximum
$1,000 per person for all servicesN/A Lifetime MaximumNone$1,000
Preferred Preferred-Care Dental BluePremier Network
Slide 18
Flexible Spending Accounts Information + Enrollment = Savings
WILLIAM JEWELL COLLEGE
Slide 19
What is an FSA anyway? An FSA adds spendable income and covers
many expenses. You may redirect part of your paycheck into a pretax
account. 18 FSA Benefit Buckets Available: 1- HEALTHCARE FSA:
Medical, Dental, Vision, Pharmacy & approved OTC. $2,500 New
2013 IRS Maximum Limitation and/or 2- DEPENDENT CARE FSA: Daycare
expenses. $5,000 You can participate in one or both types of
FSA
Slide 20
19 How will it benefit me? Paycheck Advantages: - Increased
take-home pay - Lower income taxes $$ Double benefit $$ Average
family of four in the U.S. can save hundreds of dollars in taxes. .
Immediate availability of Healthcare account funds
Slide 21
20 Expenses covered? Medical & Dental Deductibles &
co-pays Prescription drugs Vision (exams, glasses, laser eye
surgery, contact lens solution) Diabetic supplies Hearing Aids
Medical travel expenses Chiropractic services Dental (cleanings,
fillings, orthodontia, dentures) And many more! *Over the
counter.what qualifies. Dependent Care Daycare (child under age 13)
Private Nanny or Babysitter Adult Daycare
Slide 22
21 How to submit claims Option 2: Paper Claims. Fax or mail a
claim form to Phillips Resource Network with an Explanation of
Benefits (EOB) and/or receipt. Receipts must include a patient
name, date of service, type of service and dollar amount. 2012 PLAN
YEAR: On January 1, 2013, your Benny Card will be loaded with your
new plan year dollars. Please DO NOT use your card to go back and
pay for any services in 2012. 2013 PLAN YEAR: 75 day extension on
allowable expenses with an additional 30 days to submit claims from
any monies remaining from the 2013 bucket. Services must be
incurred while actively employed and will be applied to the
applicable plan year. Option 1: The Benny Card. The card is used at
the point of service at hospitals, doctors offices and pharmacies.
The card cannot be used to purchase over-the counter medication
without a prescription. Save all receipts as you may be asked to
substantiate your expense. Keep your Benny Cards! NEW !! Grace
Period is now available on Benny Card Swipes and Manual Claims for
75 days For the 2013 plan year, the last day to use your 2013 funds
is March 16, 2014
Slide 23
22 Things to remember Choose plan election amounts carefully
Use it or Lose it Rule Contribution amounts can only be changed
during the plan year due to a qualifying event (i.e., marriage or
birth of a child) Expenses are reimbursed through an FSA after they
are incurred; pre- payments are reimbursed as services are received
Participation at any level will increase your take home pay!
Slide 24
23 Were here to help! PLEASE DIRECT QUESTIONS TO PHILLIPS
RESOURCE NETWORK, INC. OUR PHONE NUMBER AND EMAIL ADDRESS IS ON
EVERY CLAIM FORM. REMEMBER BY ENROLLING IN THIS PLAN, THE MONEY YOU
REDIRECT IS NOT SUBJECT TO FEDERAL, STATE, OR SOCIAL SECURITY
TAXES! Every employee must complete a 2013 FLEX form even if
waiving coverage or not making any changes
Slide 25
William Jewell College Employer Paid Benefits Basic Life
Insurance 1 times annual salary for employees $50,000 minimum
amount to $150,000 maximum Dependent Life Insurance if Enrolled in
Family BCBS Health Insurance $2,000 benefit for spouse $1,000
benefit for children from 14 days to 20 (26 if full time student)
years of age Basic Accidental Death and Dismemberment $25,000 for
employees Long Term Disability 60% of monthly salary to $5,000
maximum benefit Payable after 120 days of disability Payable to
later of age 65 or SSNRA
Slide 26
William Jewell College Voluntary (Employee Paid) Options
Voluntary Life Choice of $10,000 increments of coverage not to
exceed the lesser of 5 times salary or $500,000 maximum benefit for
employees. Choice of $5,000 increments of coverage not to exceed of
employee amount or $250,000. Choice of $2,500 increments of
coverage for children after 6 months of age to a maximum benefit of
$10,000. You or your spouse may elect or increase coverage by two
increment levels on a guaranteed acceptance basis during your
companys defined annual open enrollment period, provided that you
or your spouse have not been previously declined for coverage.
Voluntary AD&D Choice of $25,000 increments of coverage not to
exceed 10 times salary or $500,000 maximum benefit for the
employees on the Employee Only Plan or Family Plans Spouse provided
60% of employee amount when children are not covered on the Family
Plan. Spouse provided 50% of employee amount when Children are
covered for 10% of the employee amount not to exceed $15,000 on the
Family Plan. There is an annual open enrollment for coverage on
Voluntary AD & D.
Slide 27
EyeMed Exam & Materials Plan In Network Members Cost Out of
Network Allowance Exam with dilation as necessary$10 copay$30
Frequency: Examination Lenses or Contact Lenses Frame Once every 12
months Once every 24 months Exam Options: Standard Contact Lens Fit
and Follow-Up:* Premium Contact Lens Fit and Follow-Up:** Up to $40
10% off retail price N/A Frames: Any available frame at provider
location $130 allowance, 20% off balance$65 Standard Plastic
Lenses: Single Vision Bifocal Trifocal Standard Progressives $25
copay $90 $25 $40 $60 $40 Lens Options UV Coating Tint (Solid and
Gradient) Standard Scratch-Resistance Standard Polycarbonate
Standard Polycarbonate-Kids under 19 Standard Anti-Reflective
Coating Other Add-Ons and Services $15 $40 $45 20% off retail N/A
Contact Lenses (Materials Only) Conventional Disposable Medically
Necessary $130 allowance, 15% off balance over $130 $130 allowance,
plus balance over $130 $0 copay, paid-in-full $104 $200
Slide 28
EyeMed Materials Only Plan Materials Only PlanIn Network
Members Cost Out of Network Allowance Frequency: Lenses or Contact
Lenses Frame Once every 12 months Once every 24 months Frames: Any
available frame at provider location &0 Copay ; $130 allowance,
20% off balance over $130$65 Standard Plastic Lenses: Single Vision
Bifocal Trifocal Standard Progressives Premium Progressives
Lenticulars $0 copay $65 $65,80%of charge less $120 allowance $0
copay $25 $40 $63 $40 $63 Lens Options UV Coating Tint (Solid and
Gradient) Standard Scratch-Resistance Standard Polycarbonate
Standard Polycarbonate-Kids under 19 Standard Anti-Reflective
Coating Other Add-Ons and Services $15 $40 $45 20% off retail N/A
Contact Lenses (Materials Only) Conventional Disposable Medically
Necessary $0 Copay $130 allowance, 15% off balance over $130 $130
allowance, plus balance over $130 $0 copay, paid-in-full $104
$200
Slide 29
EyeMed Providers One of the largest, and most diverse vision
panels Includes thousands of private practice optometrists,
ophthalmologists and opticians Composition of panel 75%
independent, 25% retail Includes the nations top optical retailers,
including :
Slide 30
EyeMeds -Unmatched Value Separate fit/follow-up and contact
lens allowances allows members to only pay up to $40 for their
fit/follow-up and use their contact lens allowance in full for the
purchase of contact lenses 20% discount on any balance that exceeds
frame allowance 15% discount on any balance that exceeds contact
lens allowance 40% off additional unlimited pairs of eyeglasses
after initial benefit is used 15% off retail price of LASIK or PRK
procedures at US Laser Vision locations or 5% off any promotional
price Consistent pricing at all provider locations
Slide 31
Online Management for Members Once registered online at
www.eyemedvisioncare.com the member will be able
to:www.eyemedvisioncare.com Locate a provider choose the Select
network View benefit details Order replacement ID card View
claims
Slide 32
New Benefit Offering for William Jewell College Employees
Guaranteed-issue Short-Term Disability Guaranteed, renewable to age
70 Benefits paid regardless of any other insurance 3-Month Benefit
for illness or off-the-job accident $500 to $3000 in monthly
benefit guaranteed issue Waiting period defined by each individuals
needs Partial disability benefit Payroll deduction
Slide 33
Income Replacement Example Jewell employees are provided
long-term disability that begins after 120 days for an illness or
off-the-job accident. Aflac short-term disability can be purchased
to provide income replacement for the first 90 days, reducing the
income gap to only 30 days
Slide 34
Example: $34,000 Annual Salary Age: 18 - 49 14/14 14 calendar
days waiting for an off-the-job accident 14 calendar days waiting
for an illness 3 Month Benefit period Qualify for $1,700 Monthly
Benefit $28.73 monthly premium
Slide 35
Example: $50,000 Annual Salary Age: 18 - 49 14/14 14 calendar
days waiting for an off-the-job accident 14 calendar days waiting
for an illness 3 Month Benefit period Qualify for $2,500 Monthly
Benefit $42.25 monthly premium
Slide 36
Commerce Bank Special employee banking benefits No ATM fee when
using the on-campus ATM located in Yates-Gill College Union
Slide 37
The End! IMPORTANT Forms to turn in: 2013 FLEX form Enrollment
forms for Aflac or EyeMed Any changes to other benefits Open
Enrollment: November 2 through November 20th *ALL applications and
changes must be turned in no later than November 20th Examples of
changes include: Changing plan options Adding or Removing
dependents Address or phone number changes Changing beneficiary
designation If you have any additional questions please contact the
Office of Human Resources.