New Health Care Plan
For Active Employees
Effective Oct. 1, 2010
© 2010 Wittenberg University Springfield, Ohio 45501
Agenda
General Information
I.
II.
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Medical/Dental Insurance
Plan Design Review
Employee Contributions
Anthem Resources
Anthem.com
Look up providers, manage prescriptions etc.
III. Vision Plan- New!
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Plan Design Review
Employee Contributions
IV. Flexible Spending Account
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V.
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What is it?
Reimbursements
Healthcare Reform OTC Change
Enrollment Process and Deadlines
Medical and Dental
Vision
Supplemental Life
Voluntary Benefits through Integra Benefits Group
© 2010 Wittenberg University Springfield, Ohio 45501
General Information
• New Plan is Effective 10/1/2010
• Self-Funded Plan subject to ERISA and plan document
• Partnering with Anthem Blue Cross & Blue Shield
Blue Access PPO network – national network
• 4 Plan Types: Employee plan, Employee + spouse plan,
Employee +children plan, & Family plan
© 2010 Wittenberg University Springfield, Ohio 45501
General Information
• Dental continues to be a part of the Medical Plan
• Your deductible accrual that started on January 1, 2010
will remain intact. In other words, plan members will not
need to restart their deductible accumulations with the
Oct. 1 onset of the Anthem plan.
• The healthcare plan will continue to operate on a
calendar year. Deductibles, out-of-pocket maximums
etc. will be calculated based on the calendar year.
© 2010 Wittenberg University Springfield, Ohio 45501
General Information
• Annual Open Enrollment for 2010- Aug. 25th - Sept. 15th
• Qualifying Event – You can only join the plan or make benefit
election changes during the annual open enrollment period
unless you experience a qualifying life event change as defined
by IRS.
• Examples: change in marital status, birth or adoption of a child,
change in spouse’s employment status. You must contact Human
Resources to complete a health care application within 31 days
of the event.
• Addition of Vision Plan for Active Employees
(plan is separate from health & dental)
© 2010 Wittenberg University Springfield, Ohio 45501
Glossary of Terms
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Co-pay – a flat dollar amount that is paid at the time of service. Co-pay
does not apply to the deductible
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Deductible – annual amount of money a member must pay before
benefits are paid at the co-insurance % .
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Co-insurance – a percentage that a member pays for services received
after they have met their deductible. Member pays in full
until deductible is met.
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Out-of- pocket limit – the most an employee would pay in deductible
and co-insurance during a plan year (Jan-Dec) for
healthcare services excluding prescription drugs.
Services with a % = Co-insurance
Services with a $ = Co-pay
.
© 2010 Wittenberg University Springfield, Ohio 45501
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Wittenberg’s
Blue Access PPO Health Plan
MEMBER PAYS
Deductible
Emergency Room Services
$400 individual /$800 family
10% after deductible
In-Network Benefit
Out-of-Pocket Limit
Physician Office visits
Preventive Care visits
Urgent Care
Inpatient/Outpatient Services
$1,200 individual /$2,000 family
$20 co-pay
Covered at 100%
$20 co-pay
10% after deductible
© 2010 Wittenberg University Springfield, Ohio 45501
Wittenberg’s PPO Health Plan
Out-of-network benefit
Out-of- Pocket Limit
$1,300 individual /$2,200 family
Physician Office visits
Preventive Care visits
Urgent Care
Inpatient/Outpatient Services
30% after deductible
Balance billing: Providers and hospitals who are out-of-network
will bill you for the difference between the amount the plan pays and
the usual and customary amount.
© 2010 Wittenberg University Springfield, Ohio 45501
Deductibles and Out-of-Pocket Limit
Deductible
The $400/$800 deductible simultaneously applies to both in and out-of-network
services. In other words, there is not a separate deductible for out-of-network.
Out-of-Pocket Limit (“OOP”)
There is a separate out-of-pocket limit for in-network and out-of-network
co-insurance expenses.
Co-insurance costs for services received in-network only apply to
the in-network OOP. Co-insurance costs for services received out-ofnetwork only apply to the out-of-network OOP.
In-network - $1,200/$2,000
Out-of-network - $1,300/$2,200
© 2010 Wittenberg University Springfield, Ohio 45501
Deductibles and Out-of-Pocket Limit
Three Possible Scenarios
Illustration: OOP costs based on an Individual Member
1. Member receives all services from in-network providers
= $1,200 per individual OOP limit.
($400 deductible + $800 additional co-insurance expenses)
2. Member receives all services from out-of-network provider
= $1,300 per individual OOP limit plus any balance billing.
($400 deductible + $900 additional co-insurance expenses…plus balance billing)
© 2010 Wittenberg University Springfield, Ohio 45501
Deductibles and Out-of-Pocket Limit
3. Individual Member receives in-network AND out-of -network services.
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Member must satisfy OOP limit under each benefit.
OOP limit = $1,200-$2,100 depending on the cost of the out-of-network
service.
$1,200 in-network OOP limit plus the cost of the out-of-network service up
to a maximum of $900 additional cost. Plus any balance billing.
© 2010 Wittenberg University Springfield, Ohio 45501
Tiered Prescription Benefit
Prescription Drug Retail
Express Scripts
Prescription Drug Mail Order
$10/$25/$40
$20/$50/$80
3-month supply
Anthem Tiered Drug List
You will need a new script to initiate the new mail order service
Prescription co-pay OOP limit: $1,200 single/$2,000 family
Note: This OOP limit is completely separate and unrelated to the
OOP for medical.
© 2010 Wittenberg University Springfield, Ohio 45501
Wittenberg Dental Plan
Deductible
Annual Maximum (per covered member)
Diagnostic and Preventive
Minor Restorative
Oral Surgery
Endodontic Services
Periodontal Services
Prosthodontic Services
Orthodontic Services
Orthodontic Lifetime Maximum
Orthodontic Age Limit
© 2010 Wittenberg University Springfield, Ohio 45501
MEMBER PAYS
$25 single /$75 family
$1,500
No Charge to member
20% after deductible
20% after deductible
20% after deductible
20% after deductible
50% after deductible
50% no deductible
$1,000
Child to age 19
80/20 Contribution
Medical/Dental Plan
© 2010 Wittenberg University Springfield, Ohio 45501
80/20 Contribution
Medical/Dental Plan
Nationally, Healthcare Costs will continue to trend up.
Expect Future Rate Increases
© 2010 Wittenberg University Springfield, Ohio 45501
Anthem.com website
• Your Personal Account Summary
• Manage your Prescription Benefit – Express Scripts
• Information about the plan benefits and PPO providers
• Valuable Tools
• Health and Wellness Discounts and Special Offers
• You must Register to have access to the website
Anthem
© 2010 Wittenberg University Springfield, Ohio 45501
Registration
Registering for anthem.com is quick and easy and designed to ensure
that your personal information is kept safe and secure.
First, go to anthem.com.
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© 2010 Wittenberg University Springfield, Ohio 45501
Click on the Register link.
How to Find a Provider
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www.anthem.com
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Click on “Find a Doctor” on the right side of the page
Choose the state that you want to search
Choose the Blue Access PPO for the Medical Plan network
Choose the type of Provider you want to find
You can then search by provider name, address, zip code etc.
© 2010 Wittenberg University Springfield, Ohio 45501
Anthem Blue View Vision Benefit Plan
for Active Employees
Network Benefits
Routine Eye Exam (once every 12 months)
Eyeglass Frames (once every 24 months)
$10 co-pay
$100 allowance/20% off the remaining balance
Eyeglass Lenses (standard)
Standard Plastic Single vision lenses (1 pair)
Standard Plastic Bifocal lenses (1 pair)
Standard Plastic Trifocal lenses (1 pair)
$15 co-pay, then covered in full
$15 co-pay, then covered in full
$15 co-pay, then covered in full
Eyeglass lens upgrades
Standard Polycarbonate
Standard Progressive
Anti reflective coating
Other add-ons and services
$15 co-pay per upgrade
$40 co-pay
$65 co-pay standard
$45 co-pay
20% off retail price
Contact Lenses Elective
Conventional Lenses
Elective Disposable Lenses
Non-Elective contact Lenses
$105 allowance/15% off the remaining balance
$105 allowance (no add’l discount)
Covered in Full
UV coating, Tint, Standard Scratch-Resistance
© 2010 Wittenberg University Springfield, Ohio 45501
Active Employee Monthly Contributions
Vision Plan
Plan Type
Single
Employee Plus One
Family
Contributions are tax -sheltered
© 2010 Wittenberg University Springfield, Ohio 45501
Employee Monthly
$3.00
$6.00
$10.00
Flexible Spending Account (FSA)
For Active Employees
PAY LESS TAXES - An FSA allows you to set aside PRE-TAX money
to pay for qualified out-of-pocket healthcare and dependent care expenses.
TASC
Third Party Administrator
tasconline.com
© 2010 Wittenberg University Springfield, Ohio 45501
FSA - What is it?
• Two FSA Accounts- Healthcare & Dependent Care. Every year you set aside
funds in an FSA to cover your medical or dependent care costs. You need to
decide upfront how much money you want to elect for the calendar year.
• Voluntary election of payroll deductions on a pre-tax basis. Savings of nearly
30% is the Rule of Thumb – Use the TASC On-line Tax Savings Calculator
to estimate your tax savings. http://www.tasconline.com/buytasc/flexsystem/
• You cannot change your election unless you have a qualifying event. Also,
you cannot transfer money from one account to another.
• “Use it or Lose it” - You have a grace period of three months after the end
of the calendar year to submit claims for eligible expenses incurred during
the previous calendar year. Any money left in your account after the three
months will be forfeited.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA - Enroll Now
for Jan. 1, 2011 effective date
Healthcare FSA
• $3,000 annual maximum limit
• You have immediate access to your full election at the onset
of the calendar year even though the full election has not
been deducted from your pay.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA - Enroll Now
for Jan. 1 2011 effective date
Dependent Care FSA
• If married, spouse must work or attend school full-time
• Maximum - $5,000 for single or married filing joint tax return,
$2,500 married filing separate return
• Under IRS guidelines, you can only be reimbursed for dependent care
that has already taken place. Also, you can only be reimbursed for the
amount you have already contributed to your dependent care FSA.
• Eligible expenses include dependent care expenses for children under
age 13, a disabled spouse, and/or a disabled relative or household
member who depends on the account holder for at least half of his or
her support.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA
Reimbursement
• You can request reimbursement by fax, mail, or on-line.
• 24-hour turnaround on reimbursements via Direct Deposit.
• Use the FlexSystem Claim Card for seamless real-time payments.
You can also order a card for your spouse.
• Instant account status availability on-line or via FlexSystem’s voice
response system.
• Toll-free customer service assistance
© 2010 Wittenberg University Springfield, Ohio 45501
FSA Card
How to use your Claim Card:
You may use the card like a credit card when you pay for eligible
expenses at the point of service. The funds are automatically deducted from your
Flex Account balance. It is important to remember that you may still need to
submit substantiation upon request.
Where to use the card:
• Medical and dental physicians
• Vision care providers
• Medical facilities
• Drug stores and in-store pharmacies
• Hospitals including emergency rooms
• Dependent care providers who accept Visa
© 2010 Wittenberg University Springfield, Ohio 45501
Over-the-Counter FSA Eligible Expenses Change
Effective January, 2011
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As of January 1, 2011, over-the-counter (OTC) medicines/drugs
will not be eligible FSA expenses, unless you retain a prescription
(or Letter of Medical Necessity) from your physician, or if it’s
insulin.
•
OTC health-related supplies continue to be FSA eligible.
© 2010 Wittenberg University Springfield, Ohio 45501
Open Enrollment Process
Sept. 15th Deadline
Medical/Dental Insurance Enrollment
•Currently Enrolled? You do not need to fill out a form. Contracts for
current participants will be electronically transferred from Principal to
Anthem.
•If you are enrolling for the first time, adding or dropping dependents or
canceling your coverage, you need to complete an enrollment form
ASAP and no later than Sept. 15th.
Anthem ID cards will be mailed to your home addresses. Please watch
for them in the mail towards the end of September.
© 2010 Wittenberg University Springfield, Ohio 45501
Open Enrollment Process
Sept. 15th Deadline
You need to complete an enrollment form to enroll in:
•Vision Insurance
•Supplemental Voluntary Life Insurance – Age-banded program.
Can add additional coverage of 1, 2, or 3 times salary.
•Voluntary Insurance – ex. Cancer, long-term disability, accidental
Deadline To Turn In Enrollment Forms is SEPTEMBER 15th. To insure
timely receipt of your new benefit card, we recommend that you turn in
your enrollment form as soon as possible.
Anthem ID cards will be mailed to your home addresses. If you purchase
vision insurance, that benefit will be loaded onto your medical card.
© 2010 Wittenberg University Springfield, Ohio 45501
FSA Open Enrollment
Nov. 16th Extension
Enrollment Forms will be sent to you electronically.
If you are enrolled THIS YEAR, you can enroll on-line.
HR will send current enrollee’s a summary sheet via
campus mail with your password and current year election.
© 2010 Wittenberg University Springfield, Ohio 45501