Open Enrollment. May 12 th and May 18 th, 2016

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1 Open Enrollment May 12 th and May 18 th, 2016

2 Agenda Medical Benefit Plan Designs Review Medical Benefit Plan Employee Deductions New Prague s Contribution Toward Employees VEBA Account HRA/VEBA s What are They? Dental Plan Design Review Dental Plan Employee Deductions ClearCost Health Open Enrollment Wrap-up 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 2

3 Open Enrollment Began May 6 th New Prague Area Schools is happy to announce there are no changes to the medical and dental benefit plan designs. Slight increase in premiums effective July 1, % increase on medical 2.08% increase on dental Election you make during this open enrollment will stay in effect until next years open enrollment, unless you experience a qualified family status change. All election changes must be submitted to Human Resources by or before Friday, May 27, GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 3

4 Benefit Plan Design Options Benefit Triple Gold $500 CMM VEBA Network In-network (PCC) Extended Network Out-of - Network In-network In-network Deductible N/A $200 per person $600 per family $500 per person $1,000 per family $1,200 per person $2,400 per family Medical Out-of-Pocket Maximum $500 per person $1,000 per family $2,500 per person $5,000 per family $1,200 per person $2,400 per family $1,200 per person $2,400 per family Rx Out-of-Pocket Maximum $2,000 per person $4,000 per family $300 per person $500 per family N/A Preventive Services 100% coverage Ded, then 80% Ded, then 75% 100% coverage 100% coverage Office Visit $15 copay, then 100% coverage Ded, then 80% Ded, then 75% Deductible, then 80% coverage Deductible, then 100% coverage Diagnostic Lab & X-ray 100% Ded, then 80% Ded, then 75% Deductible, then 80% coverage Deductible, then 100% coverage In/out-Patient Hospital 100% Ded, then 80% Ded, then 75% Deductible, then 80% coverage Deductible, then 100% coverage Emergency Room $40 copay, then 100% coverage Deductible, then 80% coverage Deductible, then 100% coverage Prescriptions $8 generic / $8 preferred brand / $12 non-preferred brand $8 generic / $16 preferred brand / $32 non-preferred Deductible, then 100% coverage 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 4

5 Employee Deductions Per Pay Period Medical Administration Transportation Clerical Food Service Pay Periods 24 PP 18 PP 24 PP 24 PP 19 PP 24 PP Triple Gold Single $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500 CMM Single $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 VEBA Single $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Triple Gold Family $39.79 $ $ $ $ $ $500 CMM Family $0.00 $ $ $ $ $ VEBA Family $0.00 $ $ $ $ $ Medical Custodial Support Staff Teachers Technicians Pay Periods 24 PP 19 PP 24 PP 18 PP 24 PP 24 PP Triple Gold Single $0.00 $0.00 $0.00 $ $ $36.58 $500 CMM Single $0.00 $0.00 $0.00 $86.39 $57.13 $0.00 VEBA Single $0.00 $0.00 $0.00 $ $83.13 $3.58 Triple Gold Family $ $ $ $ $ $ $500 CMM Family $ $ $ $ $ $ VEBA Family $ $ $ $ $ $ GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 5

6 New Prague s VEBA Contribution New Prague Area Schools will contribute to a HRA/VEBA for those employees who enroll in the high deductible health plan with VEBA. New Prague s Contribution Amount: $1,200 for those employees who enroll in single coverage. $2,400 for those employees who enroll in family coverage GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 6

7 Example 1 Single Enrollee under the Triple Gold Plan moves to the VEBA Plan Triple Gold Plan Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE premium is $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $ $73.16 Move to the VEBA Plan Monthly EE premium would be $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $ EE Savings of $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.82 $66.00 New Prague would contribute to your VEBA Monthly VEBA contribution Annual VEBA contribution Admin Transport Clerical Food Serv Custodial Support Teacher Tech $100 $100 $100 $100 $100 $100 $100 $100 $1,200 $1,200 $1,200 $1,200 $1,200 $1,200 $1,200 $1,200 Combined savings of Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE Savings $100 $100 $100 $100 $100 $100 $ $ Annual EE Savings $1,200 $1,200 $1,200 $1,200 $1,200 $1,200 $1,785 $1, GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 7

8 Example 2 Family Enrollee under the Triple Gold Plan moves to the VEBA Plan Triple Gold Plan Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE premium is $79.58 $ $ $ $ $ $ $1, Move to the VEBA Plan Monthly EE premium would be $0.00 $ $ $ $ $ $ $ EE Savings of $79.58 $ $ $ $ $ $ $ New Prague would contribute to your VEBA Monthly VEBA contribution Annual VEBA contribution Admin Transport Clerical Food Serv Custodial Support Teacher Tech $ $ $ $ $ $ $ $ $2,400 $2,400 $2,400 $2,400 $2,400 $2,400 $2,400 $2,400 Combined savings of Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE Savings $ $ $ $ $ $ $ $ Annual EE Savings $3,354 $3,888 $3,888 $3,888 $3,888 $3,888 $4,294 $4, GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 8

9 HRA / VEBA S WHAT ARE THEY? 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 9

10 HRA / VEBA s What Are They? HRA/VEBA s are an account that is funded by the employer to be used by the employee to reimburse them for certain expenses. Think of them as savings or checking accounts. In order to be eligible to have contributions to the account made by the employer. The employee must enroll in the employer s high deductible health plan (HDHP) GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 10

11 HRA / VEBA Contributions Who is Eligible? Employee must be enrolled in the HDHP and, Employee can be: Covered by other non-qualified HDHP including traditional health plans, FSA, HRA, or spouse s health and/or FSA plans. Enrolled in Medicare. Claimed as a dependent on another s tax return. Covered under TRICARE GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 11

12 HRA / VEBA Contributions Pre-tax employer contributions on behalf of the employee. Contributions are made to a tax exempt, employer trust account, e.g., Voluntary Employee Beneficiary Arrangement (VEBA) Tax-free withdrawals for qualified expenses only, no cash out Employer establishes the contribution as a designated amount 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 12

13 HRA / VEBA with FSAs Employees who enroll in the HDHP with HRA/VEBA plan are eligible to also participate in the Flexible Spending Account. Full FSA (flexible spending account) for all medical, dental and vision expenses is allowable. Spouse may also have a full FSA. Dependent Care allowable GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 13

14 HRA / VEBA s How Do I Use the Money? Cross-over After you visit your doctor their office will submit a claim to BlueCross. The claim will be processed were the eligible patient responsibility is electronically submitted to SelectAccount. SelectAccount processes the claim from your medical spending account(s) and reimburses you directly. Debt Card Simply swipe your debit card at the pharmacy. If the funds are available in your reimbursement account, your account will automatically be debited for the claim. Direct deposit is available GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 14

15 HRA / VEBA The crossover feature should not be selected if you or any of your covered dependents have more than one health plan (private or Medicare), or if you have a debit card. New enrollees into the HDHP with HRA/VEBA plan will receive a welcome kit from SelectAccount in the mail. Visit SelectAccount.com to sign up for a user name and password to manage all of your reimbursement accounts. You have 24 hours access to all of your information via Customer Service is also available at (651) or (800) GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 15

16 HRA / VEBA Withdrawals Withdrawals are for qualified expenses only and are tax-free May be reimbursed for expenses for yourself, spouse and dependents up to the age of 26 Must prove you had an eligible expense at time of reimbursement Employee enrolls in HDHP Employer funds HRA Employee incurs an expense Employee submits expense to HRA administrator Administrator reimburses expense from available funds Employee uses funds to pay provider In addition to qualified expenses, after termination, can be used to pay for most insurance premiums including Medicare Supplement premiums 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 16

17 HRA / VEBA Considerations Sponsored solely by the employer established a trust (VEBA). No requirements other than employer plan design choice. Employer funded only no employee contributions. All 213(d) expenses and certain insurance premiums Medicare Supp premiums allowed. May be continued under COBRA (spend down feature). Claims will need to be substantiated. Participants will not be reimbursed for amounts that exceed the balance in their HRA/VEBA. Beneficiary designations are now allowed GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 17

18 Benefit Plan Design Dental Plan Highlights In-network Out-of-network Annual Maximum $1,000 per calendar year $1,000 per calendar year Implant Maximum $500 per calendar year $500 per calendar year Deductible (applies to basic care, special care & prosthetics) $25 per person, $75 per family $25 per person, $75 per family Preventive and Diagnostic Care 100% coverage 100% coverage Basic Care I Fillings (amalgam and anterior composite 80% coverage 80% coverage Posterior composite (white filings) 50% coverage 50% coverage Simple extractions 80% coverage 80% coverage Non-Surgical periodontics 80% coverage 80% coverage Endodontics 80% coverage 80% coverage Basic Care II Surgical periodontics 50% coverage 50% coverage Complex oral surgery 50% coverage 50% coverage Special care (restorative crowns & onlays) 50% coverage 50% coverage Prosthetics 50% coverage 50% coverage Orthodontic services 50% coverage up to a lifetime maximum of $1, GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 18

19 Employee Deductions Per Pay Period Dental Administration Clerical Custodial Food Service Pay Periods 24 PP 24 PP 24 PP 19 PP 24 PP Single $0.00 $1.24 $1.24 $4.20 $3.33 Family $10.86 $32.52 $32.52 $43.71 $34.61 Dental Support Staff Teachers Tech Transportation Pay Periods 19 PP 24 PP 18 PP 24 PP 24 PP 19 PP 24 PP Single $2.89 $2.29 $0.49 $0.37 $1.24 $4.20 $3.33 Family $42.40 $33.57 $42.20 $31.65 $32.52 $14.24 $ GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 19

20 ClearCost Health Free service offered to all members enrolled in New Prague Area Schools medical insurance. ClearCost is an online tool that allows members to comparison shop for health care services using an easy-to-use online tool. Empowers members to lower their out-of-pocket healthcare costs by being able to compare the price and value prior to incurring claims. Allows members to search the cost of prescriptions. Registration is easy and takes about 5 minutes Visit Or call a.m. to 7 p.m. CST 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 20

21 Open Enrollment Ends May 27 th? s Ask Human Resources 2016 GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 21

22 Gallagher Benefit Services, Inc. Disclaimers and Disclosures Coverage Notice This analysis is an outline of the coverage proposed by the carrier(s), based on information provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request. Legal Notice The intent of this analysis is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area. Renewal-Financial Notice This analysis is for illustrative purposes only, and is not a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. Please see your policy or contact us for specific information or further details in this regard. Financial Rating Notice While GBS does not guarantee the financial viability of any health insurance carrier or market, it is an area we recommend that clients closely scrutinize when selecting a health insurance carrier or HMO. There are a number of rating agencies that can be referred to including, A.M. Best, Fitch, Moody s, Standard & Poor s, and Weiss Ratings (TheStreet.com). Generally, agencies that provide ratings of U.S. Health Insurers, including traditional insurance companies and other managed care (e.g., HMO) organizations, reflect their opinion based on a comprehensive quantitative and qualitative evaluation of a company s financial strength, operating performance and market profile. However, these ratings are not a warranty of any insurer s current or future ability to meet its contractual obligations GALLAGHER BENEFIT SERVICES, INC. ARTHUR J. GALLAGHER & CO. BUSINESS WITHOUT BARRIERS 22