Saint Louis University
2016 Annual Enrollment
November 1 to
November 20, 2015
Benefits Overview - Coverages Offered
 Medical/Prescription Drug
 Basic Term Life and AD&D
 Vitality Wellness Program
 Voluntary Term Life
 Voluntary Dental
 Voluntary AD&D
 Voluntary Vision
 Long Term Disability
 Health Savings Account
 Long Term Care
 Flexible Spending Accounts
 Business Travel Accident
 Voluntary Accident
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Medical/Prescription
Drug Benefits
2016 Annual Enrollment
Affordable Care Act Impact
 Affordable Care Act (ACA) was signed on 3/23/2010
 Plan Design Requirements:
o
o
o
o
Removal of annual and lifetime dollar limitations on essential health benefits
Removal of pre-existing condition limitations
Routine preventive care coverage at 100%
Medical and Rx copays apply to out-of-pocket maximum
 Eligibility Change:
o Dependent eligibility extension to age 26, regardless of student, marital, or dependent
status
 Taxes and Fees:
o
o
o
o
Transitional Reinsurance Fee
Patient Centered Outcomes Research Institute Fee
Industry sector taxes applied to drug and medical device manufacturers
Cadillac Tax (coming in 2018)
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Status of SLU’s Plan
 Plan Design:
o All ACA enhancements have been made
o The last reduction in benefits was in 2013
•
The deductible on the Plus Plan increased from $250 to $500
o Plan designs and administrators have remained unchanged in 2014, 2015, and 2016
o Benchmark information
•
•
SLU’s plans compares very well with other Higher Education employers
Outside of higher education, SLU’s plan designs are very rich
o Most employers have made considerable plan design changes to offset ACA costs
 Employee Contributions:
o This year’s increase is the first since 2012*
* Wellness participant’s last contribution change was 2012
* Non-Wellness participant’s last contribution change was 2013
o Very rare in post-ACA environment
 Outside of ACA:
o Medical trend continues to be 8-9% year over year
o Specialty pharmacy drugs are becoming a major cost to plans
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Highlights Effective January 1, 2016
 Medical - UnitedHealthcare
o Continue to have the option between two plans: Plus Plan and QHDHP Plan
o No plan design changes to either plan for 2016
 Prescription Drug – Express Scripts
o No plan change to prescription drug benefits
o No change to network
 The Vitality™ Wellness Program
o Health screenings and HRA completion are needed to receive wellness discount
o Wellness discount will remain the same
o
o
$50 for employees and $25 additional for covered spouses
If covering your spouse, both must complete requirements
o Deadline for completion is November 20
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Working Spouse Rule
 Effective January 1, 2016
 Applies to spousal eligibility on the medical plan only
 Spouses who have access to medical coverage through their employer will no
longer be eligible to enroll in SLU’s medical plan
o If your spouse is not employed or does not have access to coverage, they
are still eligible to enroll in SLU’s medical plan
o Spouses are still eligible for all other benefits
 All employees who currently have a spouse enrolled or who want to enroll a
spouse at open enrollment will need to complete the Spousal Health Care
Affidavit and return to Benefits
 If you do not complete this form, your spouse will not be enrolled for 2016
 A Frequently Asked Questions document and the Affidavit can be found on
SLU’s online open enrollment site
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2016 Medical Plan Options
Plus Plan
SLUCare
In-Network
QHDHP Plan
Out-ofNetwork
SLUCare
In-Network
Out-ofNetwork
Non-Embedded:
(One member can satisfy entire family deductible)
Deductible
Individual
$0
$500
$750
$1,500
$1,500
$3,000
Family
$0
$1,000
$1,500
$3,000
$3,000
$6,000
Coinsurance
0%
10%
40%
0%
10%
40%
Non-Embedded:
(One member can satisfy entire family OOP Max)
Out-of-Pocket Maximum (includes deductibles and all copays)
Individual
$1,500
$1,500
$4,750
$1,500
$3,000
$6,000
Family
$3,000
$3,000
$9,500
$3,000
$6,000
$12,000
10% after ded.
40% after ded.
0% after ded.
10% after ded.
40% after ded.
Physician Office Visits
Primary Care
$10 copay
Specialist Care
$20 copay
Preventive Care
100%
100%
100%
100%
100%
100%
N/A
10% after ded.
40% after ded.
N/A
10% after ded.
40% after ded.
N/A
$100 copay
$100 copay
N/A
10% after ded.
10% after ded.
N/A
$50 copay
$50 copay
N/A
10% after ded.
40% after ded.
Inpatient Hospital
Emergency Room
Urgent Care Center
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2015 Pharmacy Plan Options
Plus Plan
QHDHP Plan
Express Scripts
Express Scripts
Express Scripts
Express Scripts
Retail
Mail Order
Retail
Mail Order
(34-day supply)
(90-day supply)
(34-day supply)
(90-day supply)
Tier 1
$8
$16
Medical Deductible and Coinsurance
Tier 2
$30
$60
Medical Deductible and Coinsurance
Tier 3
$50
$100
Medical Deductible and Coinsurance
Tier 4
20% to $150
N/A
Medical Deductible and Coinsurance
Preventive Medications
Priced according to the tier in which they fall
Covered at 100%, no copay or deductible
Under the QHDHP, certain preventive, or “maintenance,” medications
are covered at 100%... No deductible or coinsurance!
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2016 Cost Sharing: Monthly
Plan
Monthly Premium Deductions
With Monthly Wellness Discount
Plus Plan
Employee Only
$153.26
$103.26
Employee and Spouse
$418.49
$343.49
Employee and Child(ren)
$360.76
$310.76
Family
$565.68
$490.68
QHDHP Plan
Employee Only
$82.63
$32.63
Employee and Spouse
$270.14
$195.14
Employee and Child(ren)
$226.56
$176.56
Family
$353.78
$278.78
Plus Plan – Employees earning up to $37,000*
Employee Only
$50.00
$0
Employee and Spouse
$315.23
$240.23
Employee and Child(ren)
$257.50
$207.50
Family
$462.42
$387.42
* Increasing for 2016
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2016 Cost Sharing: Bi-Weekly
Plan
Bi-Weekly Premium Deductions
With Bi-Monthly Wellness Discount
Plus Plan
Employee Only
$70.74
$47.66
Employee and Spouse
$193.15
$158.53
Employee and Child(ren)
$166.50
$143.43
Family
$261.08
$226.47
QHDHP Plan
Employee Only
$38.14
$15.06
Employee and Spouse
$124.68
$90.06
Employee and Child(ren)
$104.57
$81.49
Family
$163.28
$128.67
Plus Plan – Employees earning up to $37,000*
Employee Only
$23.08
$0
Employee and Spouse
$145.49
$110.88
Employee and Child(ren)
$118.85
$95.77
Family
$213.42
$178.81
* Increasing for 2016
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Health Savings
Account
2016 Annual Enrollment
Health Savings Accounts
 Health Savings Accounts (HSAs) are designed to help you save and pay for
your healthcare now and when you retire
 Triple tax savings:
 Put money in pre-tax
 Grow your savings tax free
 Pay for qualified medical expenses income tax free
 Account is always yours
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HSA Eligibility for Account Holders only
 You are eligible to open and contribute to an HSA if you:
Are covered by a Qualified High Deductible Health Plan (QHDHP)
Are not covered by any other health plan that is not a QHDHP
Are not enrolled in Medicare, Medicaid, or TRICARE
Have not received VA benefits within the past 3 months
Are not claimed as a dependent on someone else’s tax return
Are not covered by a Health FSA
(Must have $0 in your Health FSA before contributing to an HSA)
 If you don’t meet one of these eligibility requirements, you can still enroll in the
QHDHP plan, you just cannot open and contribute to a Health Savings Account
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HSA Contributions
 2016 Maximum Contribution Limit
2016
IRS Maximum
SLU Seed Money
Individual
$3,350
$250
Family
$6,750
$500
(2015 Limits: $3,350 for Individual, $6,650 for Family)
 IRS maximum reflects a combined employer + employee contribution
 55+ can fund an additional $1,000/year; “catch-up” contribution
 Please note SLU will only put seed money into an OptumBank administered HSA. If you
choose to go to a financial institution of your choice, then you will not receive the seed
money.
 HSA must be established by November 20 in order to receive seed money on January 1
 Funds must physically be in your account before disbursements can be made
 Any money remaining in the account at the end of the calendar year rolls over into the
next year
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Taking Money OUT of an HSA
 Issues in Distributions
o Reimbursement of expenses for employee, spouse and Tax Code dependents are tax free
o Expense must be incurred on or after the date the HSA was established
 Qualified expenses include:
o
o
o
o
o
Health, dental and vision expenses
COBRA premiums
Medicare premiums
Qualified long-term care premiums
Retiree health insurance after age 65, but not Medigap/Supplement plans
 Other withdrawals are taxable
o
o
Income tax, plus…
Subject to 20% excise tax if withdrawn prior to age 65
o
After you turn 65, or enroll in Medicare, you may withdraw money for non medical purposes without a
penalty. The withdrawal is treated as retirement income and is subject to normal income tax.
 It is important to save your receipts in case you are audited by the IRS
o
Account is between you and the IRS; OptumBank does not substantiate your claims
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HSA & FSA Participation
 IRS guidelines prohibit participants from contributing to a Health Care FSA and
an HSA at the same time
o Spouses are ineligible to participate in their employer’s Health Care FSA
•
Ok if a Limited FSA – used for dental and vision expenses only
 In order for you to fund an HSA on January 1, there must be a $0 balance in
your Health Care FSA on December 31
 You can still enroll in the benefit plan, but cannot contribute to an HSA account
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Making Deposits
Payroll
Deduction
Arrange for an automatic payroll deduction
into your account
Mail a Check
Make a deposit at any time on OptumBank
from your checking or savings account
e-Contribute
Arrange a regular electronic transfer from
an account at another financial institution
17
Access Your HSA Funds
Use your UnitedHealthcare Health Savings Account
Debit MasterCard®
Sign up for automatic bill pay and online banking
Use HSA checks
Pay with personal funds and reimburse yourself from
your HSA
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myuhc.com
 Benefit summaries
 Deductible accumulator
 Treatment cost estimator
 Check statements
 Pay bills to health care providers
 Update personal information
 Learn about QHDHPs and HSAs
 HSA calculators
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Additional Programs
UnitedHealthcare:
 Diabetes Prevention and Control
o
o
Pre-diabetics work with YMCA lifestyle coaches to prevent the progression
Diabetics work with Shop N’ Save pharmacists face-to-face to help control and improve
prescription compliance, set goals, and review lab work
 Diabetes Health Plan
o
o
o
o
Members incentivized to comply with recommended Medical and Rx guidelines
Plus Plan: No office visit or pharmacy copays for diabetes-related eligible expenses
Available only when using SLUCare physicians
Website: www.uhctogether.com/SLU
Express Scripts:
 SLU continues to maintain and implement pharmacy initiatives aimed at controlling our program costs
and promoting internal efficiencies
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Vitality
2016 Annual Enrollment
www.powerofvitality.com
 Earn points by:
o
o
o
o
o
o
o
o
Review and activate your personal health goals
Update or confirm your email contact information
Complete an online Course to learn about a health topic
Complete a Vitality Check™ biometric screening with a Vitality partner
Schedule Healthy Habits and Preventive Screenings
Track your workouts using a Vitality-approved fitness device
Sign up at a Partner Health Club
Get CPR or first aid certified
 Once you build up your points, go spend them!
o Rewards in the Vitality Mall:
•
•
•
•
Amazon Gift Cards
iTunes gift cards
Movie theater ticket vouchers
Charity
Please note: This list does not cover the program in its entirety. Please refer to the web site for complete program
activities, rules and details.
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Voluntary Dental
Benefits
2016 Annual Enrollment
Voluntary Dental Benefits
 Coverage will remain with Delta Dental
 Continue to have the choice between two dental plans
 Option 1: Flex Plan
o No benefit changes
•
In 2014 the maximum was increased from $1,000 to $1,500
 Option 2: Basic Plus
o No benefit changes
•
•
Combination of previous Basic Plus and Basic Plan
Both in and out of network benefits
 Find a provider on www.deltadentalmo.com
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Voluntary Dental Plan—Delta Dental
Flex Option
Basic Plus
PPO Network
Out-of-Network
PPO Network
Out-of-Network
Individual
$50
$50
$25
$25
Family
$150
$50
$75
$75
$1,500
$1,500
$1,000
$1,000
0% no deductible
0% no deductible
50% no deductible
30% after deductible
30% after deductible
65% after deductible
40% after deductible
60% after deductible
60% after deductible
80% after deductible
$1,000
$1,000
$1,000
$1,000
50%
For adults and children to
age 26
60%
For adults and children
to age 26
50%
For children to age 19
only
75%
For children to age 19
only
Deductible
Calendar Year Maximum
Per person
Preventive Care (Member Responsibility Shown)
0% no deductible
Basic Restorative Care ( Member Responsibility Shown)
10% after deductible
Major Restorative Care (Member Responsibility Shown)
Orthodontia
Lifetime maximum (per person)
Orthodontia
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2016 Dental Contributions
Flex
Basic Plus
Single
$36.01
$21.07
Two-person
$70.49
$40.52
Family
$120.69
$72.60
Single
$16.62
$9.72
Two-person
$32.53
$18.70
Family
$55.70
$33.51
Monthly
Bi-Weekly
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Voluntary Vision
Benefits
2016 Annual Enrollment
Voluntary Vision Benefits
 Offered through Vision Service Plan (VSP)
 No plan design changes
 Plan includes benefits for eye exam, frames, contacts, etc.
 In-Network vs. Out-of-Network
o In-Network = no claim forms to complete
o Out-of-Network = must submit claim form for reimbursement
 VSP.com
o Find a provider
• Network: Choice
o Register and review benefit information
o Discounts available
o Print an ID card (not necessary to use benefits)
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Voluntary Vision Plan—VSP
Vision Plan
In-Network
Out-of-Network
$10 copay
Up to $45 allowance
Single
$10 copay
Up to $30 allowance
Bifocal
$10 copay
Up to $50 allowance
Trifocal
$10 copay
Up to $65 allowance
$150 allowance for a wide selection of
frames; $170 allowance for featured
frame brands; 20% on the amount
over your balance
Up to $70 allowance
$150 allowance for contacts; including
the contact lens exam (fitting and
evaluation)
Up to $105 allowance
Exam
Wellvision Exam
Lenses
Frames
Contacts (in lieu of glasses)
Frequency
Exam/Lenses/Contacts (in lieu of
glasses)
Frames
Every calendar year
Every other calendar year
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2016 Vision Contributions
Vision Plan
Monthly
Employee Only
$7.02
Employee and Spouse
$12.76
Employee and Child(ren)
$13.38
Family
$20.33
Bi-Weekly
Employee Only
$3.24
Employee and Spouse
$5.89
Employee and Child(ren)
$6.18
Family
$9.54
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Voluntary Accident
Benefits
2016 Annual Enrollment
Voluntary Accident Benefits
 Offered through Voya Financial
 No change to benefits
 Plan helps reimburses expenses that occur due to an accident
 Coverage is guarantee issue – no health questions asked
 No “Network”
 When you have an expense, you must submit a claim form; reimbursement
will then be mailed as a check
 24-hour coverage – accidents on or off the job are eligible
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Voluntary Accident Plan—Voya
Below is a sample list of benefits, it does not include all the benefits available under the policy.
Service
Benefit Amount
Accident Hospital Care
Surgery (open abdominal, thoracic)
Hospital Confinement
Coma (14 or more days)
Service
Benefit Amount
Common Injuries – Dislocations
$1,200
$250/day up to 365 days
$6,000
Hip Joint
$2,400/$4,800
Knee
$1,200/$2,400
Shoulder
$360/$720
Common Injuries – Fractures
Follow-Up Care
$120
Hip
$1,800/$3,600
Physical Therapy
$30/treatment (6 max)
Leg
$960/$1,920
Prosthetic Device
$6,000
Medical Equipment
Emergency Care
Ankle
$360/$720
Kneecap
$360/$720
$120/$240
Ground Ambulance Transport
$120
Nose
Air Ambulance Transport
$600
Other Benefits
Emergency Room Treatment
$180
Wellness Benefit
(completion of health screening test)
$100/employee or spouse
$50/child (max of 4)
Sickness Hospital
Confinement Benefit
$100/day for employee or
spouse
$75/day for children
Common Injuries
Burns, Laceration, Torn Knee
Cartilage, Paralysis,
Tendon/Ligament/Rotator Cuff
Varies
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2016 Accident Contributions
Accident Plan
Monthly
Employee Only
$24.74
Employee and Spouse
$41.90
Employee and Child(ren)
$39.62
Family
$56.78
Bi-Weekly
Employee Only
$11.42
Employee and Spouse
$19.34
Employee and Child(ren)
$18.29
Family
$26.21
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Flexible Spending
Accounts
2016 Annual Enrollment
Flexible Spending and Dependent Care Accounts
 Administration will remain with ConnectYourCare
 You must make a new election for the 2016 plan year; current elections cannot
be carried forward
 Debit card allows direct payment
o Eases payment, but does not substantiate claims – receipts may still be needed!
o Use at authorized vendors (medical facilities, hospitals, pharmacies, etc.)
 Remember if you are electing the QHDHP plan and open an HSA, the IRS
requires your Health FSA balance to be $0.00 on January 1, 2016 before
contributing to an HSA
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Flexible Spending and Dependent Care Accounts
 Annual maximum for the Health FSA will increase to $2,550 for 2016
 Annual maximum for the Dependent Care Account will remain at $5,000
($2,500 if married and filing separate returns)
 For the Health FSA
o Total election amount less previous reimbursements is available at the time of
transaction
 For the Dependent Care FSA
o Only the cash balance in your account is available at the time of transaction
 You cannot roll over unused balances from one year to the next
o Use it or lose it rule applies
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Eligible Health FSA Expenses
 Copays, coinsurance and deductibles for medical, prescription and dental plans
 Eye exams, contacts and eyeglasses
 Laser eye surgeries
 Hearing aids
 Over-the-counter medical supplies
o Bandages, splints, contact lens solution, etc.
 Over-the-counter medical medications must be accompanied by a prescription
 Insulin
 Some expenses not covered by your medical plan
38
2016 Annual
Enrollment
2016 Annual Enrollment
 Plan elections are binding for the 2016 plan year, unless you experience a
qualifying life event:
o
o
o
o
o
o
Marriage
Birth/adoption
Divorce
Death
Change in employment status
Change in dependent status
 Life status changes allow you to make benefit election changes
 The Benefits Department must be notified within 31 days of life change
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2016 Annual Enrollment
 Open Enrollment will be held from November 1 through 20
 If making changes, do so through Banner Self-Service
o Current medical, dental, vision, and accident elections will carry forward
o
If you are enrolling a Spousal Health Care Affidavit must be completed
o New and existing HSA, Dependent Care and Health FSA participants will need to make
an election for 2016. Current deductions will not carry forward.
o New HSA participants will also need to establish an OptumBank account by November
20 in order to receive seed money
 Update beneficiary information if necessary
 All enrollment elections must be completed online no later than Friday,
November 20, 2015
 Contact benefits@slu.edu or wellness@slu.edu with questions!
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Questions?
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