Open Enrollment
2015
Arch Ford Education Service Co-op
Plans for 2015
•Premium, Classic and Basic
•ALL plans now have deductible
•All plans have the same Wellness/Preventive
Health benefits
http://portal.arbenefits.org/coveragePolicies/A
RB0357.pdf
•Premium plan is the only plan with Pharmacy
co-pays
School Employee Health Insurance Task Force
The Task Force met to discuss the changes in the health insurance plan for
school employees as mandated by recent legislation in the June Special Session
and by recent changes in plan designed implemented by EBD.
• Part-time school employees (those that work less than 30 hours per week)
will no longer eligible for school health insurance effective January 1, 2015.
• Spouses of school employees will no longer be eligible to be on school health
insurance if they are eligible for health insurance through their employer.
• There is now a limit, established in legislation, on the cost of diagnosis and
treatment for morbid obesity (bariatric surgery) to the Insurance Plan.
• Participants in a consumer-driver health insurance plan option offered under
the Public and State Employees Insurance Plans will now be required to
establish a health savings account.
Qualifying Event Documentation
Documentation must be sent with the election form for all
qualifying event changes. Here are some examples:
• Adding spouse due to marriage requires a copy of a marriage license.
• Adding a newborn due to birth requires a copy of the hospital or birth
certificate.
• Enrolling in coverage and/or adding a spouse or dependent due to loss of
other group coverage requires a copy of a Certificate of Credible Coverage
(COCC).
All qualifying events, including new hires, have a 60 day window from the
time of the qualifying event to enroll in health coverage. The effective date
of coverage will begin the first day of the month following the date of
application.
Submission of the Enrollment or Change form is final. Once the form is
received, changes may only be made during the next open enrollment or
for a qualifying event.
PUBLIC SCHOOL ACTIVE EMPLOYEES MONTHLY PREMIUMS
WITH WELLNESS VISIT
2015 Plan Year Rates - Effective January 1, 2015 - December 31, 2015
Total Monthly Employee Cost
Premium
Employee Only
$179.38
Employee & Spouse
Employee & Child(ren)
$812.72
$460.08
Employee & Family
Classic
Employee Only
$814.92
Employee & Spouse
$346.74
Employee & Child(ren)
$154.90
Employee & Family
Basic
Employee Only
$350.36
Employee & Spouse
Employee & Child(ren)
Employee & Family
$266.72
$119.16
$269.50
$45.00
$11.00
State Contribution is funded by Act 1842 of 2005 and Act 1421 of 2009
Plan Contribution is funded by PSE Trust Fund as Claims Reserve Allocation
PUBLIC SCHOOL ACTIVE EMPLOYEES MONTHLY PREMIUMS
WITHOUT WELLNESS VISIT
2015 Plan Year Rates - Effective January 1, 2015 - December 31, 2015
Total Monthly Employee Cost
Premium
Employee Only
$254.38
Employee & Spouse
$887.72
Employee & Child(ren)
Employee & Family
Classic
Employee Only
Employee & Spouse
$535.08
$889.92
Employee & Child(ren)
$229.90
Employee & Family
Basic
Employee Only
$425.36
Employee & Spouse
Employee & Child(ren)
Employee & Family
$341.72
$194.16
$344.50
$120.00
$421.74
$86.00
State Contribution is funded by Act 1842 of 2005 and Act 1421 of 2009
Plan Contribution is funded by PSE Trust Fund as Claims Reserve Allocation
Definitions
• Deductible-A deductible is a specific amount that a member must pay out of
pocket each year before the plan begins to pay its portion
• Co-Pay- A co-payment, also known as a co-pay, is a set amount you must pay
when you receive a particular service, such as an office visit, a trip to the
emergency room or a prescription filled. These do count toward your out of
pocket expenses. They do not count toward your deductible
• Co-insurance is the amount you pay after the insurance company
has paid their portion. Co-insurance is often expressed as a
percentage of the allowable charges. You must satisfy your
deductible before your co-insurance will begin. This counts toward
your yearly maximum out of pocket expenses
Premium Plan (former Silver Plan)
• The Premium plan is a Point Of Service (POS) plan. It has a
deductible, co-insurance and co-pays.
• Deductible only applies to certain services (inpatient services,
hospitalization, various testing, etc..)
Individual
Family
$1,000
$2,000
Annual Co-Pay Limit $2,500
$5,000
Max Out of Pocket
$7,000
Deductible
$3,500
**Pays 80% after deductible has been met
Premium Plan (cont.)
Service
Co-Pay Amount
Office Visit
$25
Specialist Visit
$50
Emergency Room Visit
$250
Urgent Care Center
$100
Chiropractic Visit
$25
Vision Screening
$50
Prescription Co-Pay
Tier I (Generic)
$15
Tier 2(Preferred)
$40
Tier 3 (Non-Preferred)
$80
Tier 4 (Specialty)
$100
*RX Out-of-Pocket Max
$3,100/$6,200
*Reference Priced drugs do not count towards RX
Out-of-Pocket Max or Brand with Generic available
Classic Plan (former Bronze Plan)
• The Classic plan is the equivalent of a High Deductible PPO Plan. It
has a deductible and co-insurance (20%).
• No co-pays
• Prescriptions count towards deductible (no tiers)
• HSA Required
Individual
Family
Deductible
$2,000
$3,000
Annual Co-Pay Limit
$4,450
$6,675
Max Out of Pocket
$6,450
$9,675
Basic Plan
• The Basic plan -is also the equivalent of a High Deductible PPO Plan
with the highest deductible.
• Similar to Classic plan, only higher deductibles
• No co-pays
• Prescriptions count towards deductible (no tiers)
• HSA Required
Individual
Family
Deductible
$4,250
$8,500
Annual Co-Pay Limit
$2,200
$4,400
Max Out of Pocket
$6,450
$12,900
What do you need to do?
• You may enroll online or by paper form (choose one, not
both)
• I can send in your paper form, if you enroll online you must do
so yourself
• Paper forms must be brought to me by 10/24/2014
• Bring to me as soon as it is complete, please do not wait until
the last minute to enroll!!
• Everyone must fill out a form– even if declining coverage
Pharmacy Claims
Many have asked how they can find out if their prescriptions
are going towards their deductible. Here is how to do that:
• To view all pharmacy claims that applies towards the deductible, go
online to https://www.mycatamaranrx.com/PortalCentral/index.jsp
• Register using your insurance card (you will need to put a zero
before the last number of your member ID)
• When you get in you can see all of your pharmacy claims and the
amount that has been applied to your deductible.
Mandatory Health Savings Account
• Arkansas Code 21-5-418 (a) A health savings account shall be a
component of a consumer-driven health insurance plan option
adopted by the State and Public School Life and Health Insurance
Board
• After the 2015 plan year begins, letters will be sent to members to
confirm enrollment in an HSA for member on the Classic and Basic
plans.
• If you enroll in the Classic or Basic plan and do not enroll in an HSA
it could result in termination of your insurance
• The state is not contributing anything toward the HSA for PSE
members
• You will not be eligible for a Flex account if enrolled in the Classic or
Basic plan, it must be an HSA
HSA (cont.)
• There is not a minimum that has to be contributes, maximum
amount guidelines are set by the IRS
• Health Savings Accounts can be obtained through Data Path
or American Fidelity.
• Annual limits for 2015 are $3,350 for single, $6,650 for family.
If you are 55+ you can contribute an additional $1,000 per
year.
Minnesota Life (Group Life)
• Rates are not changing
• Changes may be made during Open Enrollment (increase or
decrease)
• Make sure you have current and correct Beneficiaries on file
Dental Insurance
• 12 month waiting period for MAJOR services
• Deductible $50.00 per year (waived for all Preventative Services)
• Calendar Year Maximum $1,000 (increases by $250 after 12
consecutive months of coverage, to a maximum of $1,750)
• Rates are not changing
• If you cancel coverage, you MUST complete a termination form
Employee Only
$28.93-monthly
Employee + 1 Dependent
$53.02-monthly
Employee + Family
$92.44-monthly
Vision Insurance
• Superior Vision www.superiorvision.com
• No waiting period
• No rate changes
• If you cancel coverage, you MUST complete a termination form
Employee Only
$4.28-monthly
Employee + 1 Dependent
$9.24-monthly
Employee + Family
$14.04-monthly
American Fidelity
• Enrollment will be during the first week of December
• Everyone will be mailed an appointment card
• These changes will go into effect January 1 st, 2015
• This is when you can enroll or make changes to:
• Cancer policy
• HSA
• Flex
• Texas Life
• Disability
• Accident
REMINDERS
• All enrollments must be turned into Lindsay by 10/24/2014
• EVERYONE, even those declining coverage must complete the
proper forms and turn into Lindsay by 10/24/2014
• Coverage that meets the minimum requirements has been
offered to you, if you decline coverage (and do not get
coverage elsewhere) please be aware you will be penalized by
the IRS.
• QUESTIONS???