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?