Benefits Overview
Tier 2
The information contained in these slides is intended to be a summary only. Please refer to
the Summary Plan Description and/or insurance certificates for detailed information.
January 14, 2013
Benefit Carriers
BC/BS of Michigan-Simply Blue PPO
Medical/Prescription coverage
BC/BS of Michigan
Dental coverage
BC/BS (VSP) of Michigan
Vision coverage
Lincoln Financial Group
Life and AD&D, LTD, STD, and Accident Insurance
HelpNet
Employee Assistance Program
Deadlines
• Benefit Elections must be made within 30 days of
your date of hire.
• Dependent certification is due within 30 days of
your date of hire
• Benefit Elections go into effect on your 31st day of
employment.
Documentation
• Proper documentation is needed for all eligible
dependents that you would like to cover on the medical
& prescription, dental or vision plan.
• Copies are accepted and can be faxed or emailed to
human resources.
Child (Children can be covered until the day
before their 26th birthday.)
•
Birth Certification or Adoption order or court document
showing relationship.
Spouse (2 documents needed)
•
•
Marriage Certificate
Proof of current marriage (last year’s tax return or recent bill
coming to your name and spouse’s name at same address.
Premium Costs for Medical and
Prescription Insurance
• Single coverage = No cost to the employee
• 2-Person coverage = $210.76/bi-weekly
• Family coverage = $301.08/bi-weekly
*Premiums are based on 24 pays
Medical Deductible with BCBS
• Single = $1,250
Family = $2,500
• KRESA will be depositing a pro-rated amount of
the single coverage deductible into your Health
Savings Account (H.S.A.)
*This amount is pro-rated based on your start date after January 1, 2013
Medical Plan Overview
• Ability to choose
in-network or out-of-network
care for medical services or
supplies
In Network
Out-ofNetwork
$1,250 per member
$2,500 for family
$2,500/$5,000
100%
80%
Office Visit
Deductible
80% after deductible
Urgent Care
Deductible
80% after deductible
ER Visit
(waived if
admitted)
Deductible
80% after deductible
% Co-Insurance
100%
80%
% Co-Insurance
Maximum
Does not
Include
Deductible
In & out of
network does
not cross
accumulate
$1,000 per member
$2,000/family
$2,000/4,000
Deductible
In & out of network
does not cross
accumulate
Co-Insurance
• Choose in-network
whenever possible as cost
will be cheaper
•All medical and RX
expenses go towards the
deductible
•Once deductible is met
your medical expenses are
covered at 100% (Rx subject
to copay $10/$40/$80
Medical Plan Overview
Preventive Care Services
(generally one per calendar year)
In Network
Out-ofNetwork
Preventive Services Covered at 100%
Health maintenance exam, includes
chest x-ray, EKG, cholesterol
screening and other lab procedures
Covered 100%
N/A
Gynecological exam
Covered 100%
N/A
Pap smear—lab and pathology
Covered 100%
N/A
Well-baby & child care (see
multiple visit limits by age)
Covered 100%
N/A
Mammography screening
Covered 100%
N/A
Immunizations-pediatric & adult
Covered 100%
N/A
Medical Plan Overview
Other covered services
In Network
Out-ofNetwork
Allergy testing and therapy
100% after
deductible
80% after
deductible
Chiropractic manipulation--12 visits
per year
100% after
deductible
80% after
deductible
Outpatient physical, speech and
100% after
deductible
80% after
deductible
occupational therapy-30 combined visits per year
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No Pre-existing Conditions
No Lifetime Maximums
Prescription Plan Overview
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Cost of Prescription Applied to the Deductible
Once Deductible Met – Copay’s Apply
Once Copay’s Accumulate to the Out of Pocket Maximum $1,000 Single /
$2,000 Family plan pays 100%
Step Therapy
Prescription Drug Coverage In-Network Benefits (up to a 30 day supply)
– $10 (or less) co-pay: Generic
– $40 co-pay: Formulary (Preferred) Brand Name drugs
– $80 Non-Formulary (Non-Preferred) Brand Name drugs
– Oral and Injectable contraceptives – covered with applicable copay
– Applicable co-pay applies for elective drugs, i.e. infertility, weight loss &
sexual impotency
– Rx formulary can be found BCBSM web site on www.bcbsm.com and has
also been placed on the KRESA internal employee web site
Prescription Plan Overview
Mail Order
•
Mail Order: Prescription Drug Coverage In-Network Benefits home
delivery for a 31 to 90 day supply
•
Prescription Drugs will be subject to the following co-pay once the
Single / Family deductible has been met
– Generic drugs – $20 co-pay
– Formulary drugs - $80 co-pay
– Non formulary drugs $160 co-pay
•
Your plan also offers a retail 90 benefit. Members are able to obtain a 90
day supply of medication from a participating retail pharmacy. The
Retail-90 program offers you the same financial incentive as the mailorder program (buy 2 get 1 free).
Dental Plan Overview
•
Member’s responsibility (co-pays and dollar maximums)
•
Can use both provider networks (Dental Network of America or
Traditonal Plus) found on BCBSM web site.
•
Dollar maximums
Annual maximum (for Class I, II and III services)
$1,000 per member
Lifetime maximum (for Class IV services)
$1,500 per member
Class I services
Class II services
Class III services
Class IV services
-
25% of approved amount
25% of approved amount
50% of approved amount
50% of approved amount
**Review your Dental summary for specific services
Premium Costs for Dental
Insurance
• Single coverage = No cost to the employee
• 2-Person coverage = $18.41/bi-weekly
• Family coverage = $26.30/bi-weekly
*Premiums are based on 24 pays
Blue Vision SM Choice with VSP
•
Annual Vision Exam - $10
•
Lenses & Frames - $25 copay
– Lenses every 12 months
– Frames every 12 months
•
Contact Lenses - $25 copay
– Medically necessary
– Elective $130 allowance
– 12 months
•
VSP (Vision Service Plan Network)
•
Discounts on additional pairs of prescription and nonprescription
glasses, including sunglasses
•
Laser VisionCareSM program
Discounts on LASIK and PRK 15% off or 5% off promotional offers
.
Premium Costs for Vision
Insurance
• Single coverage = No cost to the employee
• 2-Person coverage = $3.82/bi-weekly
• Family coverage = $5.45/bi-weekly
*Premiums are based on 24 pays
Flexible Spending Account
Dependent Care
FSAs give you a convenient way to pay for eligible healthcare and/or day care
(child and adult) expenses
• Set aside pre-tax dollars through convenient
payroll deductions
• Use your debit card for eligible
expenses
• Save money on taxes
• Contribute $100 - $5,000
• If you do not use it you do lose it
Health Savings Accounts (HSAs) –
Health Equity
Health Savings Accounts – What Is It?
• Tax-advantaged savings accounts available to individuals who have a high
deductible health plan and no other first dollar medical coverage
• Contributions can be made by employer, employee, employer and employee
and/or third party
• You can stop or start contributing at any point in time.
KRESA will be depositing this amount into your Health Savings Account
(H.S.A.)
• This amount is pro-rated based on your start date after January 1, 2013
2013 Maximum Contributions:
Single $3250**
Family $6450**
** Includes KRESA employer contribution
What are the advantages of an
HSA?
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Flexibility
– You can use the funds in your account to pay for current medical expenses,
including expenses that your insurance may not cover, or save the money
in your account for future needs, such as:
• Health insurance or medical expenses if unemployed
• Medical expenses after retirement (before Medicare)
• Out-of-pocket expenses when covered by Medicare
• Long-term care expenses and insurance
Savings
– You can save the money in your account for future medical expenses and
grow your account through investment earnings.
Portability
– Accounts are completely portable, meaning you can keep your HSA even if
you:
• Change jobs
• Change your medical coverage
• Become unemployed
• Move to another state
• Change your marital status
What are the advantages of an
HSA?
•
Ownership
– Funds in your HSA belong to you and are always 100% vested.
– Unlike other medical spending accounts HSA funds can remain in the
account year to year. There are no “use it or lose it” rules for HSAs.
•
Tax Savings
– Contributions to your HSA can be made on a pre-tax basis. HSA
earnings grow tax-free and, as long as the funds are used for qualified
medical expenses, withdrawals from your HSA are also tax-free.
– If you spend any of your HSA money on non-qualified medical
expenses prior to age 65, you will pay ordinary income tax on those
funds and will have to pay a 20% IRS penalty.
Who is NOT eligible for an HSA?
• Examples of “1st dollar” medical benefits that make
someone ineligible for an H.S.A. per IRS guidelines
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*Medicare
SSID (social security disability insurance)
Tricare Coverage
Full Medical Flexible Spending Arrangements (HRA)
Adult Children – that do not qualify as a your tax dependent (IRS
Publication 502)
– Covered by a spouses FSA or HRA plan (you cannot have an HSA if you
are covered by your spouses plan that can pay for any of your medical
expenses with an FSA or HRA before your HSA health plans deductible is
met)
*If an eligible person isn’t enrolled in Medicare, even though that individual has reached
age 65, the person can contribute to an HSA until the month they enroll in Medicare.
Also can contribute “catch up” contributions until enrolled in Medicare. (you can
continue to use your HSA care expenses, but you can no longer make contributions
to your HSA savings account)
• View balance
Member Portal
• Review account activity
•Transfer HSA funds
•Pay bills online
•View Insurance
Information
•Online account
statements
•Online tutorials
•Online support links
•Calculators
•Forms
**You will receive a welcome kit along with your debit card
shortly after your benefits begin.
Accessing Funds
Funds from the spending accounts are disbursed in the following ways:
– Debit card
– Online bill payment
– Online reimbursement
2 Debit Cards
Lincoln Financial
Group
Lincoln Financial Group
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Employer Paid Life Insurance
Employer Paid Long Term Disability
Voluntary Life Insurance
Voluntary AD&D Insurance
Voluntary Short Term Disability
Voluntary Accident Plan Benefit
Employer Paid Life and Long
Term Disability
•
Life Insurance Benefit
– $20,000 Employee Term Life Insurance
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Long Term Disability Benefit
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60% of your wages +
10% progressive Income benefit
70% total income benefit up to $6000/month
Benefit begins on 91st day
Employee Voluntary Coverage
Options
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Voluntary Life Insurance
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Employee - $10K increments up to 5x salary - $500k max
Spouse - $5K increments up to 2.5x emp salary - $250k max
Dependent Children – 4 options - $2500 $5000 $7,500 $10,000
Guaranteed issue amount is $140,000 for employees and $25,000 for a
spouse
Voluntary AD&D Insurance
– Employee - $10k increments but no more than 5x salary
– Spouse - $5k increments up to 100% of employee election
– Dep Children - $2k increments up to $10,000
•
Voluntary Short Term Disability Benefit
– 60% of your wages min $100/wk – max $1,200/wk
– Begins 1st day accident / 8th day of Illness
– Benefit duration is 13 weeks
Employee Assistance Plan
HelpNet
• FREE to you and anyone living in the same household
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Savings Center
Work/Life Balance
Trainings/Development
Financial Resources
• Strictly confidential
• Limited counseling services
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Addictions
Emotional Problems
Legal and financial concerns
Careers
Relationships
Stress, Anxiety and depression
Aging Parents
Marital and family issues
Wellness
•
Wellness at KRESA
– Ways to get involved
•
Wellness Committee
– The wellness committee exists to raise awareness of our
wellness program as well as create opportunities for our
colleagues to learn about and live a healthier lifestyle.
What needs to be COMPLETED?
Enrollment Form
Lincoln Beneficiary Form
Lincoln Evidence of Insurability
If electing over the guaranteed issuing amount
QUESTIONS AND ANSWERS