2016 Open Enrollment Benefits Presentation. Presented by: Benefits Team

2016 Open Enrollment Benefits Presentation Presented by: Benefits Team Agenda      Health Care Reform Update What’s new for 2016 Benefits Revi...
Author: Benjamin Neal
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2016 Open Enrollment Benefits Presentation Presented by: Benefits Team

Agenda     

Health Care Reform Update What’s new for 2016 Benefits Review Enrollment Instructions Q&A

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Open Enrollment Dates: November 16 thru November 30 3

Part-Time Open Enrollment  Dates – November 16 through November 30  Active Enrollment – need to enroll if they want medical, dental and vision for 2016  VBA will send information to current enrollees’ homes on how to re-enroll for 2016  VBA will send posters to the stores announcing Open Enrollment period and how to enroll (scheduled to arrive in stores around November 13) 4

Health Care Reform Update  ACA Reporting  Will receive a 1095-c form to include with your tax filing for 2015  You will not be taxed on the amounts that are on the form; the form is used to prove that you had coverage during the year and do not owe a penalty  Click below to see a sample of the form https://www.irs.gov/pub/irs-pdf/f1095c.pdf 5

What’s new for 2016    

Update to Diagnostic Services and Diagnostic X-rays New Tobacco/Nicotine User Definition 3% Rate Increase for Medical and Dental No Rate Increases for Vision or Voluntary Life

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Benefits Overview     

Medical/Prescription Drug Dental Vision Basic Life Insurance Voluntary Life Insurance and Accidental Death & Dismemberment  Short Term Disability  Long Term Disability  401(k) Retirement Savings Plan 7

Benefits Review  Update to Diagnostic Services (lab work)  40% coinsurance under the UHC Core plan  You do not need to meet your deductible first  Covers lab work that is not considered preventive care

 Update to Diagnostic X-rays  Covered in a doctor’s office, inpatient or outpatient setting through the Transamerica Gap plan if billed towards deductible  If billed as part of the office visit, covered by UHC core plan 8

Benefits Review  Tobacco/Nicotine User Definition  “Tobacco/Nicotine Use” means the use of any cigar, cigarette, pipe, snuff, chew as well as any tobacco or nicotine product used in e-cigarettes  “Tobacco/Nicotine User” means an employee or covered family member who uses tobacco or nicotine on a habitual or consistent basis, regardless of the number of times or the method of use  “Non-Tobacco/Nicotine User” means an employee and covered family members who are not Tobacco or Nicotine Users 9

Medical Coverage 2016 Medical Plan Comparison Benefits Summary Annual Deductible (calendar year) Coinsurance Medical Out-of-Pocket Maximum (includes deductible) Lifetime Maximum

UHC Core Plan In Network Out-of-Network

Outpatient Surgery, Diagnostic, and Therapeutic Services Urgent Care Emergency Room (waived if admitted) Mental Health (inpatient) Mental Health (outpatient)

UHC Core Plan w/Trans 2 In Network Out-of-Network

$6,350 Individual / $10,000 Individual / $6,350 Individual / $10,000 Individual / $6,350 Individual / $10,000 Individual / $12,700 Family $20,000 Family $12,700 Family $20,000 Family $12,700 Family $20,000 Family 100%

70% / 30%

100%

70% / 30%

100%

70% / 30%

$6,350 Individual / $12,700 Family

Unlimited

$6,350 Individual / $12,700 Family

Unlimited

$6,350 Individual / $12,700 Family

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Gap Coverage Preventive Care / Screenings / Immunizations (adults and children) Office and Specialist Copay Diagnostic Lab Services

UHC Core Plan w/ Trans 1 In Network Out-of-Network

No Gap

Covered at 100%

$2,000 Inpatient / $1,000 Outpatient

Covered at 100%

40% coinsurance

30% after deductible 30% after deductible

100% after deductible

Covered at 100%

Covered at 100%

$3,500 Inpatient / $1,750 Outpatient

Covered at 100%

Covered at 100%

40% coinsurance

30% after deductible 30% after deductible

40% coinsurance

30% after deductible 30% after deductible

30% after deductible

100% after deductible

30% after deductible

100% after deductible

30% after deductible

$50 copay

30% after deductible

$50 copay

30% after deductible

$50 copay

30% after deductible

$200 copay

$200 copay

$200 copay

$200 copay

$200 copay

$200 copay

100% after deductible

30% after deductible 30% after deductible

100% after deductible

30% after deductible 30% after deductible

100% after deductible

30% after deductible 30% after deductible

$25

$25 copay

$25

10 copay $25

$25

$25 copay

Understanding Your Coverage  What is gap coverage?  Pays a portion of your deductible related to:      

Inpatient hospital stays (excludes mental health) Inpatient surgery Physician charges (while in hospital) Outpatient surgery Radiological diagnostic testing (MRI, x-rays, ultrasounds, etc.) Emergency room and urgent care center treatment (for accidents)  Ambulance transportation – air or ground – accident only 11

Understanding Your Coverage UHC Plan Benefits Coverage

Doctor Visit

Urgent Care

Emergency Room

Inpatient / Outpatient

Visit

$25

$50

$200

100% after deductible

Diagnostic Services (lab work)

40%

40%

40%

40%

Diagnostic Testing (MRI, x-ray, ultrasound, CAT scan, PET scan, etc.)

100% after deductible

100% after deductible

100% after deductible

100% after deductible

Outpatient Surgery and Therapeutic Services

100% after deductible

100% after deductible

100% after deductible

100% after deductible

If the service applies to your UHC deductible, it may be covered under Gap 12

Understanding Your Coverage  How does it work?  Present your UHC and Transamerica cards at the time of service  Tell the person taking your insurance information that you have primary and secondary coverage  Saying gap coverage is confusing terminology

 Pay any copay or coinsurance amount or you will be billed for it later  Claims are paid directly to the provider OR you can pay the claim yourself and file for reimbursement 13

Understanding Your Coverage  Important things to know:  Transamerica does not coordinate with UHC to determine what to pay  If it gets applied to the deductible, it may be covered under Gap  If there is a copay or coinsurance amount that you owe, it is not covered under Gap

 You need to contact both UHC and Transamerica to find out how a procedure will be covered  The Benefits Team is here to help – contact us with questions or concerns 14

Consumerism  Did you know:  50% of our Emergency Room visits could have been handled by a Primary doctor or Urgent Care facility  Less expensive for you and the company

 You can ask your doctor for treatment alternatives  Just because an MRI is mentioned; doesn’t mean that you really need one; 75% of all MRIs are inconclusive

 You can use the UHC expense estimator to find a less expensive facility  MRI’s vary in cost from $500 to $5,000 throughout the US; since the test is all the same; look for a less expensive facility 15

Prescription Drug Coverage  Included with medical plan election  Mandatory Mail Order program for maintenance medications  Maintenance medications are prescriptions you take on an ongoing basis  If you do not participate in this program, you will pay the tier 3 cost of your maintenance medication 2016 Prescription Drug Plan Benefits Summary Retail (31 days)

Mail Order (90 days)

3 Tiers of Coverage Tier 1 - $15 Tier 2 - $40 Tier 3 - $95 or 40% whichever is greater Tier 1 - $37.50 Tier 2 - $100 Tier 3 - $237.50 or 40% whichever is greater 16

Medical/Prescription Drug 2016 Bi-Weekly Rates Core Plan

Core Plan w/Trans 1

Coverage Type

Non-Tobacco / Tobacco / Nicotine User Nicotine User Employee Only $51.82 $93.87 Employee + Spouse $132.48 $228.90 Employee + Children $138.76 $242.98 Family $171.24 $295.74

Coverage Type

Non-Tobacco / Tobacco / Nicotine User Nicotine User Employee Only $75.11 $130.32 Employee + Spouse $157.22 $281.26 Employee + Children $144.73 $260.55 Family $188.04 $339.49

Core Plan w/Trans 2 Coverage Type

Non-Tobacco / Tobacco / Nicotine User Nicotine User Employee Only $89.04 $156.05 Employee + Spouse $195.47 $348.36 Employee + Children $181.80 $325.61 Family $235.12 $422.32

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Dental Coverage 2016 Dental Plan Benefit Summary

In Network

Out-of-Network

Annual Deductible (calendar year) Maximum Benefit Preventive & Diagnostic Services Basic Restorative Services

$50 Individual / $150 Family $1,000 / calendar year Covered at 100%

Major Restorative Services

50% after deductible

$50 Individual / $150 Family $1,000 / calendar year Covered at 100% (limited to usual & customary fees) 20% after deductible (limited to usual & customary fees) 50% after deductible (limited to usual & customary fees) 50% (limited to usual & customary fees) $1,000 / lifetime

20% after deductible

Orthodontic Services (up to age 19) Orthodontic Maximum Benefits

50% $1,000 / lifetime

2016 Bi-Weekly Dental Rates Coverage Type Employee Only Employee + Spouse Employee + Children Family

Rate $4.70 $9.66 $12.52 $18.54

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Vision Coverage 2016 Vision Plan Copays

In-Network $10 copay on exam $25 copay on materials 100% after copay Up to $160

Exam Frame Allowance Frequency Exam Lenses or Contact Lenses 12 months Frames Lenses Single Vision Bifocal 100% after copay Trifocal Contacts Lenses (instead of frames) Contact Lens Exam $60 copay Contact Lenses Allowance Up to $160

2016 Bi-Weekly Vision Rates Coverage Type Rate Employee Only $3.02 Employee + Spouse $6.04 Employee + Children $6.46 Family $10.33

Out-of-Network N/A Up to $45 Up to $70 Same as in-network options Up to $30 Upt to $50 Up to $65 N/A Up to $105

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Other Benefits  Basic Life Insurance  Provided at no cost to you  One times your annual base pay

 Supplemental Life with Accidental Death and Dismemberment (AD&D)  Employee coverage - $10,000 to $500,000  Evidence of Insurability (EOI) is required  Rates based on age and level of coverage 20

Other Benefits  Short Term Disability (STD)  Pays you if you are unable to work due to a non-work related illness or injury - up to 12 weeks  Automatically enrolled  No cost to you

 Long Term Disability (LTD)  Begins 90 days after date of disability or illness; monitored by MetLife  Automatically enrolled  No cost to you 21

Other Benefits  401(k) Retirement Savings Plan  Contributions are pre-tax  2016 limit is $18,000; catch-up for age 50 and older is $6,000  Company match is offered after one year of continuous employment  Company match is $0.25 on the dollar up to 8% based on your contribution amount

 You are 100% vested in your contributions; company contributions are based on years of service 22

Enrollment for 2016  Same as previous years through ESS

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Enrollment for 2016  Benefit information will be available on the site to assist you with any questions you may have about your benefit plans

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Who to Contact  Katrina Petkovic – [email protected] 888-465-6300 Ext. 1051  Shawna Jenkins – [email protected] 888-465-6300 Ext. 1270

 Cindy Terry – [email protected] 888-465-6300 Ext. 1021  Email Benefits for assistance – [email protected] 25

What questions do you have?