1 THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA/ACA/ OBAMACARE ) & ITS IMPACT ON MUHLENBERG 2015: What s changing and what s not!
2 Affordable Care Act (ACA)- Continued Impact in 2015 In 2011, ACA legislation allowed employers to elect Grandfathered status which we did through 12/31/14. We are dropping grandfathered status 1/1/15 as the advantages it once offered (to both the college and the plan participants) have significantly decreased over time Grandfathered plans: must keep same insurer, but had more flexibility in plan design elements and allowed delay of implementation for some ACA mandated benefits Non-grandfathered status: Flexibility to consider other insurers and make benefit changes, but must implement all plan design elements specified in ACA immediately.
3 Legislated Plan Provisions Now Applicable to All Plans No lifetime maximums Dependents up to age 26 allowed to ride on parent s health insurance (NOT dental) Not required to be a student, live with parent, or be on parent s tax return Can be married (but the dependent s spouse and/or children are not eligible) or employed, and can even have other coverage available through employer.
4 Muhlenberg s Plan Evolution What s changing (& what s not!) Office Visit Co-pays no change: Primary doctor $15; Specialist visits & Urgent Care $25; Retail Clinic (ex. CVS Minute Clinic ) $10 Emergency Room co-pay: increases to $75 (from $65), still waived if admitted to hospital. Prescription drug co-pays: up to 30 day supply of generics/brand/brand non-formulary = $10/$25/$40* *New category: Specialty drugs will have 10% co-pay, to a maximum of $150, for up to a 30-day supply. 90-day mail order RX co-pays: Generics - $25 (up from $20), Brand formulary $60 (up from $55), Brand non-formulary $100 (up from $90). Mandatory mail order for maintenance RX. Generic oral contraceptives covered with $0 co-pay (currently the regular Rx co-pay is charged for oral contraceptives) this change is
5 What Stays the Same Preventive services with zero co-pay Women s health services (including annual gyn visit) with zero co-pay ConnectCare 3 service (help in navigating and coordinating care for complicated/serious medical conditions) Physical Medicine pre-authorization NOT required (primarily impacting chiropractic services, this is a requirement for all fully-insured plans.) Pharmacy network remains Premier network
6 Plan Changes for January 1, 2015 Total Maximum Out-of-Pocket of $6,600 individual, $13,200 family (previously no total maximum out-of-pocket) Deductibles have not changed, so reaching this out-of-pocket in-network amount is extremely unlikely. Non-tobacco Users pay less for health insurance than tobacco users (previously no difference based on tobacco use) Wellness credit of $10/month for those employees who know their numbers free screenings in December, on campus potential for $120/year savings (previously $100/year max). Spousal surcharge ($50/month) applies for any spouse who is eligible to medicare or eligible to coverage offered by their own employer, regardless of plan cost-sharing (previously surcharged only if spouse s employer paid 70%+ of premium)
7 WELLNESS - DID YOU NOTICE HOW VALUABLE IT IS TO PAY ATTENTION TO YOUR HEALTH? The College continues to invest in Biometric Screening KNOW YOUR NUMBERS and save! Free on-site screening December 3 and 4, or visit your own physician What numbers? Blood sugar, HDL/LDL cholesterol, blood pressure, height, weight Save what? $10/month shows up as -$10 on the deduction side of your paystub just for certifying your participation in biometric screening. $120 savings possible for 2015! Be Tobacco Free campaign ran through summer 2014, with free cessation medication. Tobacco-free employees enjoy health insurance payroll deductions $75/mo. lower than tobacco users as of 1/1/15 Free flu shots with your insurance card Nov. 6 on site
8 Looking back at 2014, Looking ahead to 2015 We are self-funded, paying claims as we go. Total claims continued to average about $90,000 per week in 2014, as the consulting actuaries expected. More stop loss claims (claims over $80K) were filed than projected, impacting our 2015 stop loss insurance renewal. Fees/taxes (PCOR and Transitional Reinsurance) of PPACA are $64+ per covered person in Actuaries predict, with the minor benefit tweaks noted, plan will cost, in total,.7% more in payroll deductions will rise VERY slightly, after two years of no increase. ($1/month individual, $2/month 2-party $3/month 3-or-more)
9 Dental Plan No changes for 2015 in insurer or plan design. (Fulltime student dependents covered to age 23, then can continue via COBRA Health Care reform does NOT apply to dental plans!) For most value, use network dentists for cleaning and check-ups twice a year Discounts on caps, crowns, orthodontia Cost for 2015 is the same as last year (2 nd year of three year rate guarantee.)
10 Flexible Spending Accounts The Basics Elect to participate Determine appropriate amount Payroll deduction taken before taxes Use debit card at doctor s office or submit claims to reimburse yourself for medical services Full year medical FSA amount available 1/1/2015 Dependent FSA funds available as deposited
11 Why establish an FSA? Reduce Taxable Income, saving Federal Income Taxes State Income Taxes Local Income Taxes FICA (Social Security) & Medicare Taxes Increase Spendable Income
12 Legislative Impact: Flexible Spending Accounts 2015 Maximum Medical FSA will increase to $2,550. Note: Legislation allows for modest increases in the medical FSA maximum in future years. Dependent care FSA maximum remains $5,000. No longer Use it or lose it up to $500 of unused medical FSA from 2014 can be carried over to 2015 and used for expenses incurred in Up to $500 of your medical FSA for 2015 can be carried over to 2016.
13 Medical Care FSA Eligible Expenses Deductibles Co-payments Co-insurance amounts Rx (pharmacy & mail order) payments Dental expenses, including orthodontia Vision care, including Lasik surgery Non-prescription items such as rubbing alcohol, band-aids, contact lens solution
14 Dependent Care FSA Eligible Expenses Children Through Age 12 Day Care (in-home or licensed day care facility) Pre-School Before and After School care Summer day camps Other dependents on your tax return Elder Care Physically disabled dependents Mentally disabled dependents
15 Dependent Care FSA Details Care provider must report income on their tax return Reimbursement requires that you provide the provider s SS# or Tax ID # Provider must meet licensing requirements Can still claim the federal child care tax credit for expenses beyond the FSA (but no double-counting the same expenses.)
16 Important FSA Facts You do not have to be on Muhlenberg s health or dental plan to have a FSA Up to $500 in unused medical FSA funds can be carried over. (We still suggest that you estimate conservatively, but there s now less risk!) Election amount may only be changed if you have a qualifying event (ex. birth of child)
17 Should I set up a medical FSA? If you have some level of predictable medical or dental expense, the answer is YES! Do you have regular doctor visits or a pattern of hitting your deductible each year? Do you have planned medical or dental procedures coming up? Do you have maintenance medications that make it easy to estimate your Rx expenses? Do you wear contacts or eyeglasses and expect to replace them this year?
18 How El$e Can I $ave? Ask, ask, ask! Ask your doctor if the test he/she suggests is diagnostic or screening (many screening tests are not covered!) Get the diagnosis code! Ask Highmark if a test your doctor suggests is covered (have that diagnosis code on hand)
19 What about saving on prescriptions? Ask your doctor if a generic medication (or therapeutically equivalent alternative) could be substituted for non-formulary brand name Rx Ask if your doctor has samples, especially when beginning a new medication Once established, any maintenance Rx regimen must be written for 90-day supply - mail order saves you money Ask if your grocery store or discount store offers lowcost generics for short-term prescriptions
20 Paperwork Required (health & dental) All insured employees must complete: Section 125 (pre-tax election) Spouse form (if you cover a spouse) If spouse is eligible to their own employer s coverage or is medicare-eligible, $50/month surcharge will apply If adding or dropping a dependent: Enrollment change form
21 Paperwork Required (FSA) Flexible Spending accounts are annual elections Complete 2015 FSA Enrollment Form Complete direct deposit info online if you want your reimbursements sent to your bank electronically Remember the TASC debit card is available as an option, if you prefer
22 QUESTIONS? Visit the Human Resources Office or View info, links and forms on the HR website Come to Open Enrollment Nov. 6, Miller Forum, 10 a.m. 2 p.m. Complete forms ASAP. Soft deadline is November 30. Absolute deadline is December 3, 2014.
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