PRESENTED BY:

PEG HARMS &

GINGER VERMEERSCH

Insurance Services Open Enrollment Informational Session

Objectives

If you are unsure whether you should change plans or continue with your current coverage, we are here to help you make this important decision.

The Open Enrollment Process is for the following:

Health Insurance • CoPay Plan

or• (HDHP) High Deductible

Health Plan

Dental Insurance

Flexible Spending Account

CoPay Health Plan High Deductible Health Plan (HDHP)

$500 deductible per individual per calendar year ***

$1500 deductible per family per calendar year ***

$2500 out of pocket (OOP) maximum per individual per calendar year

$5000 out of pocket (OOP) maximum per family per calendar year

$1500 deductible per individual per calendar year ***

$3000 deductible per family per calendar year ***

$3500 out of pocket (OOP) maximum per individual per calendar year

$7000 out of pocket (OOP) maximum per family per calendar year

Benefit Limits

****Deductible goes toward out-of-pocket maximum*** ***Deductible Carryover Applies

CoPay Health Plan High Deductible Health Plan (HDHP)

$50 Emergency Room copay Deductible not applied

$30 office visit copay Deductible not applied

Other medical services – 80% coverage after deductible

80% coverage after deductible

Benefits

Preventive Care Routine Vision Exams (1 per person per calendar year)

Routine Medical Exam

Well Child Care

Standard Immunizations

Routine Cancer Screening

High Deductible Health Plan (HDHP)

or

CoPay Plan

Prescription Drug

CoPay Health Plan

$12 Generic Co-pay

$30 Brand/Formulary Co-pay

$55 Non-Formulary Co-pay

$60 Specialty Co-pay

CoPay - $1500 individual OOP Maximum/$3000 family per calendar year

HDHP - $1500 individual OOP Maximum/$3000 family per calendar year (this amount also applies to your medical OOP)

High Deductible

(HDHP)

New for 2016

Spousal Surcharge

Birthday Rule

Spousal Surcharge

If your spouse declines his/her employer’s insurance, spousal surcharge may apply

Birthday Rule

It means whichever parent’s birth month is first in the calendar year will determine the order of benefits for the dependent child(ren) if children are covered under both parents health insurance

HealthTeachers Only

Employee CostCoPay Plan

District CostCoPay Plan

Employee CostHDHP

District CostHDHP

Single $23.00 $756.00 $0 $648.00

Family $296.54 $1286.46 $17.54 $1286.46

HealthAll Other Staff

Employee CostCoPay Plan

District CostCoPay Plan

Employee CostHDHP

District CostHDHP

Single $62.00 $717.00 $0 $648.00

Family $357.80 $1225.20 $78.80 $1225.20

Dental Employee Cost District Cost

Single $0 $39.00

Family $0 $97.00

Open Enrollment

October 21 –

November 6

2015

ACTION

REQUIRED: 

Health & Dental Insurance:

Even if you currently have benefits with the district you are required to

SELECT one of the following:• No Change• Decline• Single and/or Family Health • Single and/or Family Dental

Flexible Spending Account: Health Account – You may carryover

$500.00 from your 2016 account to be used after you exhaust your 2017 account.

Dependent Care Account – No carryover allowed

Q & A TIME

Understanding Your EOB

Total You Owe is your responsibility

Provider Responsibility is the provider's discount

Total payment is the amount your insurance paid the provider

You can claim Total You Owe on your Flexible Spending Account (FSA) or your Health Reimbursement Account (HRA).

DentalNew for 2016

Dependent

children -

Will be covered to

the age of 26

 You may add your

dependents on the

dental plan during

Open Enrollment

New for 2016! Diagnostic/Preventive Services -

1st visit of coverage year paid at 100%Included is bitewing x-rays, fluoride treatment, prophylaxis, oral evaluation/exam charge Prophylaxis –

Adult & Child - 2 per calendar yearAdditional visits may be covered if recommended by dentistDeductible and coinsurance would apply for these visits 

Calendar Year Maximum

The Plan pays up to a maximum of $1,200.00 for each covered person per calendar year.

Deductible $25.00 deductible per covered person

Basic Services 80% after deductible – cleanings 2 per calendar year – fluoride 1 per calendar year

Major Services 50% after deductible – crowns, bridges, implants, root canals, etc.

Orthodontia Benefit (Separate Benefit)

Appliances paid at 50% $50 per person lifetime deductible – waiting periods & maximums apply

Your HRA & How to Submit to MidAmerica

MidAmerica's

customer service line

is 1-800-430-7999 or

visit them online at

www.midamerica.biz

Reimbursements:

Participants must exhaust any funds available in the Health Flexible Spending Account (FSA) prior to receiving reimbursement from the MidAmerica (HRA) Health Reimbursement Account.

Your HRA is integrated with the (HDHP) High Deductible Health Plan.

Participants may request reimbursements from their accounts as soon as the accounts are funded, but only for medical expenses incurred subsequent to becoming eligible to participate in the Plan.

Funds in a participant’s account at the end of each year shall be rolled into the following year.

Claim Forms can be found on the Insurance Services webpage

What happens if I don’t spend all my money?

You can have pre-tax dollars deducted from your paycheck.

Your flex spending dollars can cover dependent daycare expenses or medical/dental bills your insurance doesn’t cover.

Expenses must be incurred within the Plan Year to be eligible for reimbursement.

Any unused health care funds (up to $500.00) can be carried over to the next calendar year. Any unused amount over $500.00 will

be forfeited.

No carryover for dependent daycare expenses Any unused amounts will be forfeited

Forms available at: www.rochester.k12.mn.us/insurance

Flexible Spending Plan

What is a Flexible Spending Plan?

Q & A TIME