Understanding Your Avon Insurance Choices

Transcription

1 Understanding Your Avon Insurance Choices B R O U G H T T O Y O U B Y : T H E A V O N C O M M U N I T Y S C H O O L C O R P O R A T I O N I N S U R A N C E C O M M I T T E E

2 Introducing Your ACSC Insurance Committee Jeff Osterman Maryjane Smallwood Terri Golay Jenny Bates Roger Dreher Kris Taylor Brock Bowsher Jackie Berkley Sherry Nelson Mike Whitman Trevor Stevens Wes Steele Katy Esser

3 The Purpose of this Meeting To provide background knowledge of insurance terms To help you understand your 2015 Avon Health Care options To provide you with the details of your three options and with a cost analysis To provide examples of each of the options and how it might influence your health care choices

4 Let s Begin with an Alphabet and Vocabulary Lesson! PPO: Preferred Provider Option FSA: Flex Spending: Section 125 (Optional) CDHP: Consumer Driven Health Plan Embedded HSA: Health Saving Account (Optional) In Network Out of Network Open Enrollment The Wellness Clinic

5 PPO: Preferred Provider Option FSA: Flexible Spending Account PPO: Preferred Provider Option A managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's High quality of service to employees

6 PPO: Preferred Provider Option FSA: Flexible Spending Account FSA: Flexible Spending Account (Section 125) Is a special account you put money into that you use to pay for certain out-of-pocket health care costs. You don't have to pay taxes on this money. Single/Family: Up to $2,500 per year Funds Available January 1 st Use it or lose it! Debit Card Format

7 CDHP: Consumer Driven Health Plan CDHP: Consumer Driven Health Plan Provides patients greater control over their own health budgets Policies cost less, but the user pays routine medical claims to a set deductible HSA: Health Savings Account (Optional) Embedded: A method of reaching a deductible

8 CDHP: Consumer Driven Health Plan CDHP: Consumer Driven Health Plan Instead of paying higher premiums, you agree to pay the FIRST portion of your medical expenses Two choices for out of pocket responsibilities: $3000/$6000 Individual/Family $6000/$12000 Individual/Family Guarantees a maximum fixed medical cost for the year Premiums + Out of Pocket

9 CDHP: Consumer Driven Health Plan HSA: Health Savings Account Works in tandem with a CDHP A tax-advantaged medical/savings account available to taxpayers who are enrolled in a CDHP The funds contributed to an account are not subject to federal income tax at the time of deposit Available at Teacher Credit Union (.75% interest rate) Accumulates over time

10 Why should I establish an HSA? Lower health insurance premiums (CDHP) Tax advantages Contributions, earnings, and distributions are tax free Flexible and portable No use it or lose it rule Savings for future

11 Who is Eligible to Contribute to Your HSA? Anyone w/cdhp You Your family members Or a combination of all Maximum annual contribution $3,350 Individual Check on current rates!!!!!! $6,650 Family $1,000 catch-up contribution (55 and older)

12 How is money deposited into my HSA? Payroll deduction option Lump sum After-tax dollars Deductible on income tax return Above-the-line deduction Example $50,000-$2,500=Tax Liability

13 What Care Expenses Does My HSA Cover? Doctor visits Hospital stays Prescription drugs Dental expenses Vision expenses And much more!

14 What health care expenses doesn t my HSA cover? Refer to IRS Publication 502 * Child Care * Over the counter medications * Nutritional Supplements.

15 Who manages the HSA? YOU!!! Keep track of your HSA balance Save all receipts You manage! You save!

16 Examples of How CDHP & HSA Work Doctor office visit Provide Insurance card at appointment Receive Explanation of Benefits Receive bill from provider & pay directly to provider No co-pay or additional charges at the Health Clinic Prescription Drug Not a co-pay discounted rate Pay using your HSA card No co-pay at the Wellness Clinic!!!!

17 CDHP: Consumer Driven Health Plan Embedded CDHP: Embedded Consumer Driven Health Plan Embedded CDHP Deductible The deductible works in two ways: The family as a whole Each individual member of the family

18 CDHP: Consumer Driven Health Plan Embedded CDHP: Embedded Consumer Driven Health Plan If a member of the family reaches his or her individual deductible, benefit coverage starts for that person. In order for other family members to get benefit coverage, they ll need to either: Reach their own individual deductible, or The family reaches the family deductible by any combination of family members

19 CDHP: Consumer Driven Health Plan Embedded Deductible For example, you have a $6000 family deductible. When one family member reaches $3,000 in deduction, they immediately get full coverage at that point. Once the family deductible has been met ($6,000), all family members get benefit coverage.

20 Network Coverage In Network vs. Out of Network Coverage: If the doctor, hospital or health care facility you visit is part of Anthem insurance company's network, you'll get your health care at lower prices. But if you go out of your network for health care, it can become a lot more expensive. In Network Same physicians for all three plans (PPO, CDHP1, CDHP2) Always check with your health care provider and Anthem before you elect a physician or procedure

21 Open Enrollment 2015 What is Open Enrollment The period of time during which individuals who are eligible to enroll in ACSC Insurance Plans. For coverage starting in 2015, the Open Enrollment Period is November 15, 2014 February 15, Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events. Year-long lock in: Can t cancel mid-year Qualifying Events

22 The Health Clinic This is the secret weapon for health insurance savings.. Available to ALL Avon Insured Employees and their eligible dependents No-Pay Visits No-Pay Generic Medications Easy On-Line Appointment Scheduler On-Campus Location

23 Alphabet and Vocabulary Review PPO: Preferred Provider Option FSA: Flex Spending: Section 125 (Optional) CDHP: Consumer Driven Health Plan Embedded HSA: Health Savings Account (Optional) In Network Out of Network Open Enrollment The Wellness Clinic

24 So! What is this Going to Cost Me? You Have Choices! Deductible (S/F) PPO Network CDHP 1 Network CDHP 2 Network $500/$1000 $3000/$6000 $6000/$12000 Co- Insurance Out of Pocket S/F 20% 0% 0% $3000/$6000 $3000/$6000 $6000/$12000 Office Visit $25 Deductible then 100% Coverage Deductible then 100% Coverage Emergency Room $150 Deductible then 100% Coverage Deductible then 100% Coverage

25 So! What is this Going to Cost Me? You Have Choices! Prescription Drugs PPO Network CDHP 1 Network CDHP 2 Network Generic $10 0% 0% Brand $30 0% 0% Non- Formulary $60 0% 0% Wellnes Clinic Many no-cost generic Many no-cost generic Many no-cost generic

26 So! What is this Going to Cost Me? You Have Choices! Mail Order PPO Network CDHP 1 Network Generic $20 Deductible then 100% Coverage CDHP 2 Network Deductible then 100% Coverage Brand $70 Deductible then 100% Coverage Deductible then 100% Coverage Non- Formulary $150 Deductible then 100% Coverage Deductible then 100% Coverage Health Clinic Many no-cost generic Many no-cost generic Many no-cost generic

27 So! What is this Going to Cost Me? You Have Choices! Rates PPO Network CDHP 1 Network CDHP 2 Network Employee $1,588 $1,306 $1,110 Employee/ Spouse $7,945 $6,531 $5,553 Employee/ Children Employee/ Family $6,809 $5,596 $4,757 $8,670 $7,126 $6,056

28 Max Out of Pocket PPO Single - $3000 Employee & Family - $6,000 CDHP Single - $3,000 or $6000 Employee & Family - $6,000 or $12,000 Total Health Care Cost? Premium + Max Out of Pocket

29 Overall Premium Savings PPO vs. CDHP 1 & 2 PPO CDHP 1 Savings CDHP 2 Savings Employee $1,588 +$282 +$478 Employee/ Dependent Employee/ Spouse Employee/ Family $7,945 +$1,414 +$2,392 $6,809 +$1,213 +$2,052 $8,670 +$1544 +$2,614

30 Should You Choose the PPO or CDHP Q1: What were your health care costs in 2014? Q2: What will your health care costs be in 2015? Q3: What would you pay with the PPO vs. CDHP? Every employee s situation is different, so you will have to decide for you and your family

31 Did You Know? Avon Community School Corporation Pays: 83% of the cost for a Single Health Care Policy? 63% of the cost for an Employee and Spouse Coverage? 68%: no dental $63% of the cost for an Employee and Child(ren) Coverage? 68%: no dental $68% of the cost for the Family Plan?

32 Other Ideas and Questions

33 Make Yourself a Deal!!!! Switch to the CDHP plan for one year. If you don t like it then you can switch back to the PPO next year during open enrollment.

34 More Information For more information, please refer to the United States Department of Treasury website: Jackie Berkley