Open Enrollment 2014
PLAN YEAR: JANUARY 1, 2014-DECEMBER 31, 2014
CONNECTING YOU TO QUALITY HEALTH PLAN OPTIONS
1
Meeting Objectives
1. Share How Affordable Care Act (ACA) Affects You and
Emmis
2. Describe New Healthcare Quality & Cost Savings Tool
3. Discuss New Health Plan Option
4. Review Open Enrollment Steps
The Affordable Care Act (ACA)
Change is coming. Let’s break it down
In 2014:
• All Americans* will be required to
purchase a qualified health insurance
plan
• The health insurance marketplace
• We will continue to offer a company
health plan
• Our plan has some changes
*some exceptions apply
What’s new for 2014
Castlight – Addition of a healthcare
quality & cost comparison tool (Feb
2014)
High Deductible Plan with HSA - Addition
of a Consumer Driven High Deductible
Health Plan with Health Savings Account
Wellness –
 Increased incentive discount
 Spouses will be required to participate in
the wellness program
 Employees and spouses must complete the
screening and assessment by March 31st
4
THINGS TO
REMEMBER....
Go to urgent care centers instead of emergency rooms
Save $ Urgent Care visit versus going to the ER
Use in-network doctors
Save with a lower deductible and coinsurance
Pre-certify hospital services (PPO plans)
Call to pre-certify services
Use the Castlight “Quality/Cost Comparison” transparency tool
Find cost ranges for services and quality reviews for doctors
Save money with SpecialOffers
Get discounts on health-related products and services
Manage prescription costs
Use generic when available and mail order for maintenance Rx
5
INTRODUCING CASTLIGHT HEALTH
•
Use the online tool to compare innetwork doctors and medical services
in your area
•
See personalized cost estimates before
you go to the doctor
•
Review step-by-step explanations of
past medical spending
•
Receive recommendations about ways
to find high-quality care and save
money!
Choosing
your health plan
IT’S GOOD TO HAVE
OPTIONS
Your health care needs are unique
Select from 2 health plan options
Both plans include:
•
Access to one of the nation’s largest
networks of doctors
•
Prescription drug coverage with
money-saving mail service
•
100% coverage for preventive care, like
annual checkups and vaccinations
•
Dental coverage through Delta Dental
9
KEY TERMS
Deductible
The amount you pay each year before your plan starts to pay
Copay
A flat fee you pay for covered services like doctor visits
Coinsurance
Your share of health plan costs (a percentage of total cost) after meeting
your deductible
Out-of-pocket maximum
The most you have to pay out-of-pocket each year for health care services
Premium
The amount you pay to belong to a health plan
10
Current Option: Preferred Provider
Organization (PPO)
•Current plan option
•Includes deductibles, copays and coinsurance
•Discounted services for using in-network
providers
PPO Plan Option
How it works:
•
•
•
•
You pay a copay for in-network office visits and prescriptions without meeting
a deductible
After you meet your deductible you pay a percentage of the cost for all other
covered services until you reach the annual out of pocket maximum
You have a lower deductible to meet
before co-insurance applies
Flat $ copays apply for Rx &
doctor’s visits; you know your cost
•
•
•
You pay a higher bi-weekly premium in
the PPO option
If you use the plan minimally, you could
be paying more total out of pocket for
this plan option
Can’t take advantage of increased tax
savings with HSA
12
New Option: Consumer Driven Healthcare Plan
with Health Savings Account
(CDHP/HSA)
• Empowers employees to make informed health care choices
• Employees become more aware of quality and cost issues
• Gives employees the opportunity to use a pre-tax Health
Savings Account (HSA)
CDHP/HSA Option
How it works:
-
-
You pay the full in-network cost of an office visit and prescription
until you meet your deductible; use pre-tax HSA $ to pay for those
costs
You must meet a higher deductible before the plan pays its share
of coinsurance for services such as hospitalization
•
Your bi-weekly premium is lower than the
PPO plan option; minimal users save $
•
•
Funds you put into a pre-tax HSA account can
be used during the current year or saved for
future expenses regardless of where you
work
You have a higher deductible, so you pay the
first $2,000 EE only/$4,000 family out of
pocket (with the use of the HSA) until you
meet your deductible
•
You pay the full out-of-pocket discounted price
for all services, including prescriptions, until
you meet your deductible
•
Your HSA contribution is not taxed,
as long as you spend your funds on covered
services
CDHP/HSA Option
How a CDHP & HSA work together:
Health Savings Account
(HSA)
•
•
•
You can put money into your HSA,
pre-tax, to help pay for your
covered medical expenses, like
office visits, lab work and tests.
HSA funds are accessed via the
plan-provided debit card or online
bill pay.
Unused HSA funds roll over from
year to year, as long as you remain
enrolled in the HSA plan.
Annual Deductible
• You are responsible for paying an
annual deductible before the plan
begins to pay a percentage of your
covered expenses.
• You can use the money in your HSA
to help meet your deductible.
Major Medical Coverage
(coinsurance)
•
•
•
After you meet your annual
deductible, you pay a percentage
of the cost of your covered
expenses, called coinsurance.
If you still have money in your HSA
after you've met your annual
deductible, you can use the funds
to pay your share of coinsurance.
Once you reach your annual
coinsurance maximum, the plan
pays 100 percent of any of your
remaining covered expenses for
the rest of the year.
What is a Health Savings Account (HSA)
• Health Savings Accounts (HSA) are tax-advantaged interest bearing
checking accounts
• The HSA money can be used to help pay the cost of out-of-pocket medical
and prescription drug expenses or for long term investment purposes
• HSAs must be coupled with an HSA-compatible high deductible health
plan (HDHP) in order to make contributions to the account
Who can open an HSA?
The IRS and the U.S. Department of the Treasury have specific
rules on who can open an HSA.
You can open an HSA if you:
• Are enrolled in the CDHP like the new option we’re offering
• Are not enrolled in Medicare
• Are not claimed as a dependent on another individual’s tax
return
• Are not active military
Note: You cannot open an HSA if you have coverage under any other health plan that is not an HSAcompatible health plan.
HSA Eligibility for Married Couples
Your spouse:
You:
Then, per the IRS:
Has PPO self + children
coverage
have CDHP self-only
coverage
you are treated as having single coverage
and only you may set-up an HSA . You may
contribute up to $3,300
Has CDHP self-only coverage
with a $1,500 deductible
have CDHP self + child
coverage with a $4,000
deductible
you are both treated as having family
coverage, and combined may contribute up
to $6,550 to an HSA
Has CDHP self + family
coverage with a $3,000
deductible
have CDHP self + spouse
coverage with a $3,000
deductible
you are both treated as having family
coverage, and combined may contribute up
to $6,550 to an HSA
Has PPO self-only coverage
with a $1,000 deductible
have PPO self + family with a
$1,250 deductible
neither of you may set-up an HSA
Is enrolled in Medicare
have CDHP self + family
coverage only
only you may set up an HSA. You may
contribute up to $6,550
Funding Your Health
Savings Account (HSA)
Making Contributions to Your HSA
There are several ways you can contribute to your account:
 Tax-free through payroll deductions
 Post-tax by personal check
 When you file your taxes, you can make an adjustment to your gross
income to receive the tax benefit
 You’ll receive deposit slips for your HSA in the mail
 Annual maximum contribution limits are:
 $3,300 for individual coverage
 $6,550 for family coverage
 $1,000 catch up contribution for those 55 or older
 Use of HSA for a non-qualified expense (e.g. not covered services or
qualified medical expenses) require you to pay tax on the expense and a
20% tax penalty on the amount.
Are There Any Fees Associated with My HSA?
Typical banking fees apply
Monthly account fee
Debit card transactions
ATM transactions
First 2 debit cards
Additional debit cards
Card replacement fee
Check Order
Non-sufficient funds
Stop check service
Copy of check
Mailed statements
Emmis paid
no charge
$1
Free
$5 per card
$12 per card
$10.65 per request
$25
$20 per occurrence
$10 per copy
$1.00
Does My HSA Earn Interest?
Can I Invest Money in My Account?
The HSA is an interest-bearing checking account
 Once you reach a minimum balance of $1,000, you can begin to
invest any additional funds into the available investment fund
options
 When you are ready to invest, all you need to do is go to
anthem.com and select the Chase Bank link for more details
HEALTH ACCOUNT OPTIONS:
PREFERRED PARTNER ORGANIZATION (PPO) PLAN + FSA OPTION
CONSUMER DRIVEN HEALTH PLAN + HSA (CDHP/HSA)
Eligibility, Funding & Usage
FSA (health care)
HSA
Qualified high deductible health plan
required
No
Yes
Pretax premium deduction
Yes
Yes
Eligibility
Employee who meets employer’s
eligibility requirements
Employee who meets employer’s eligibility
requirements and is covered by CDHP and no
other non high deductible plan coverage
Changes to Contributions
Only with qualifying life event
Yes
Balance Carry Over
No
Yes
IRS 2014 limit $2500
IRS 2014 limit:

Individual = $3,300

> Individual = $6,550
**Additional $1,000 for those 55 and older
Yes
Maximum contribution
Portable at termination
No
Not allowed
Yes, after death, disability or age 65, otherwise
will be included in gross income and subject to
20% excise tax.
None
Medicare, COBRA, Qualified LTC
Non-medical withdrawals
Qualified retiree insurance
COMPARING
PLANS
MEDICAL PLANS
PPO
CDHP/HSA
In-Network
Out-of-Network
In-Network
Out-of-Network
Employee
$1,250
$2,500
$2,000
$4,000
Employee + 1
$2,500
$5,000
$4,000
$8,000
Employee + Family
$2,500
$5,000
$4,000
$8,000
Doctor
$25
50%
20%
coinsurance
50%
coinsurance
Specialist
$40
50%
20%
coinsurance
50%
coinsurance
Urgent Care
$35
50%
30%
coinsurance
50%
coinsurance
20%
coinsurance
50%
coinsurance
Employee
$4,250
$8,500
$4,000
$8,000
Employee + 1
$8,500
$17,000
$8,000
$16,000
Employee + Family
$8,500
$17,000
$8,000
$16,000
$30/$50/$70
NA
20%
Coinsurance
50%
coinsurance
$60/$100/$14
0
NA
20%
Coinsurance
NA
% = after deductible
Deductible
Office Visits
Coinsurance
Out of pocket
maximum
Retail
Prescription
Drugs
Mail-Order
Comparing plans - Bi-weekly premium
Premiums Tier II - $30,001 - $60,000
Wellness (PPO)
Employee Only
Employee + 1
Family
Wellness (HSA)
$39.18
88.48
150.42
Non-Wellness (PPO)
Employee Only
Employee + 1
Family
$27.40
61.87
105.19
Non-Wellness (HSA)
Employee Only
$79.18
Employee Only
$67.40
Employee + 1
128.48
Employee + 1
101.87
Family
190.42
Family
145.19
Premiums Tier III - $60,001 - $90,000
Wellness (PPO)
Wellness (HSA)
Employee Only
$53.09
Employee Only
Employee + 1
118.82
Employee + 1
Family
192.13
Family
Non-Wellness (PPO)
$37.12
83.09
134.36
Non-Wellness (HSA)
Employee Only
$93.09
Employee Only
$77.12
Employee + 1
158.82
Employee + 1
123.09
Family
232.13
Family
174.36
Comparing plans
Use Anthem’s Coverage Advisor to compare your PPO vs. CDHP costs
ANTHEM PREENROLLMENT WEBSITE
Use the pre-enrollment
website:
Coverage Advisor Tool
2014 Benefits and Open
Enrollment Summary
Web Overview eTutorials
The Basics of Health Insurance
HSA Basics
Anthem website overview
Open enrollment presentation
Links to Ceridian self-service
HrHelp contact information
27
NO CHANGES in Dental Coverage for 2014!
Maximum Benefit =
$1,500 per person per
calendar year for Basic and
Major Services; $1,500 per
person lifetime for
Orthodontic Services
Deductible = $50 per person
per calendar year limited to
$150 per family per
calendar year
WELLNESS for 2014
Employees &
Spouses
What’s Changing?
• Spouses will also be
required to complete the
following for employees to
receive discount:
• Health Assessment
• Biometric Screening
• Preventative Care
• Employees and spouses
must complete
assessment and
screening by 3/31/14.
Life Insurance
• Emmis offers company paid Basic Life insurance and
Accidental Death & Dismemberment at 1x your annual
salary to a maximum of $100,000
• In addition to the basic life insurance Emmis offers, you
can purchase additional life insurance at competitive
rates
• Enroll or change your election during open enrollment
• You can purchase life insurance for your spouse and/or
dependents without purchasing for yourself
*See the Wave or Open Enrollment Summary Booklet for more details
Flexible Spending Accounts
(HCFSA and DCFSA)
• Can contribute pre-tax money for
health care and dependent care
expense:
→ $260-$2,500 for medical
expenses
→ $260-$5,000 for dependent care
expenses
• Simple Reimbursement Methods
• Wageworks debit card (Only
available for HCFSA)
• “Pay Me Back” process
• “Pay My Provider” process
• 14 ½ - month plan year to use funds
• Use it or Lose it!
IMPORTANT DATES:
Spend it by:
3/15/15
Claim it by:
3/31/15
No exceptions!
November 4th – 13th
Open Enrollment
ENROLLING IS
EASY
Log in to Ceridian Self-Service
Choose your benefits options
Submit your plan selections
Print your confirmation of benefits
and check for errors
Your plan goes into effect 1/1/2014
ENROLL USING CERIDIAN SELF-SERVICE
EMMIS ALSO
OFFERS:
Employee Assistance Program
Leave pay
Holidays
Vacation
Adoption Assistance
Employee Referral Program
401(k) Plan
Auto & Homeowners Insurance
Q&A