Open Enrollment Benefits
2013-2014
April 22- May 24
Wylie ISD
Health Care Reform – What does it
mean for me?
• Individual mandate under the Affordable Care Act goes into effect on
January 1, 2014
• All individuals are required to have minimum essential coverage for
medical unless you qualify for an exemption
– Minimum essential coverage includes coverage under the following plans:
•
•
•
•
•
Employer sponsored coverage (TRS Active Care)
Individual coverage purchased by you
Medicare/Medicaid/CHIP
Certain types of Veterans health coverage
TRICARE
• Individuals will have access to insurance exchanges in 2014 – if coverage is
gained due to buying less expensive coverage through exchange – you can
drop TRS Active Care
• Individual mandate, by itself, going into effect on January 1 is not a
qualifying event to enroll in TRS Active Care
• Get more information on health care reform by going to
www.healthcare.gov
What’s new for TRS Active Care Plans?
• Active Care 1 will be discontinued
• Deductibles and out-of-pocket maximums will increase for Active
Care 1HD and Active Care 2
• Premiums increasing
• Non-contracting providers will be paid at BCBS of TX allowable
amount rather than at 50% of billed charges (more out of pocket for
participant if using out-of-network providers)
• New Benefits Value Advisor
• New Uniform Summary of Benefits Coverage
• New ID cards for medical if you make a plan change or are on Active
Care 1 currently
• New ID cards for prescriptions if you make a plan change or are on
Active Care 1HD and Active Care 2
TRS Active Care Plan Changes
TRS Active Care Plan 1
 Plan no longer offered in 2013-2014
 Employees currently on this plan will
automatically switch during open enrollment to
Active Care 1HD unless election is made for
another plan
TRS Active Care Plan Changes (cont.)
TRS Active Care Plan 1HD
 Family deductible from $2,400 to $4,800
 Individual Out-of-Pocket Max from $3,000 to $3,850
 Family Out-of-Pocket Max from $5,000 to $4,200
 Can utilize an HSA plan through your bank if you choose
this plan (contact your benefits specialist for more
information on HSA)
(Out-of-pocket max exclude deductibles)
TRS Active Care Plan Changes (cont.)
TRS Active Care Plan 2
 Individual deductible from $750 to $1,000
 Family deductible from $2,250 to $3,000
 Individual Out-of-Pocket Max from $2,000 to $4,000
 Family Out-of-Pocket Max from $6,000 to $8,000
 Increase all prescription co-pays by $5
(Out-of-pocket max exclude deductibles and copays)
TRS Active Care Plan 3
 No plan design changes
TRS Active Care Plan Rates
*Amounts reflected are after $225 contributed by state/district.
2013-2014
2013-2014
Active Care 1
Active Care 2
• No Longer Available
• EE Only
$304
• EE + Spouse
$978
• EE + Child(ren)
$616
• EE + Family
$1,098
Active Care 1 HD
Active Care 3
• EE Only
$100
• EE Only
$571
• EE + Spouse
$569
• EE + Spouse
$1,585
• EE + Child(ren)
$347
• EE + Child(ren)
$1,044
• EE + Family
$835
• EE + Family
$1,765
Medical Gap Plan
New Plan Offering for 2013-2014 through Specialty Insurance Service
Bridges the gap between Active Care 1HD and Active Care 2 benefits by:
• Paying $1,500 per year for each covered person for hospital confinement
• Paying $4,500 ($1,500 per occurrence) max per year for 3 occurrences of
outpatient services – includes ER visit, MRI, x-ray, lab, outpatient surgery (excludes
doctor office visit cost)
• Guaranteed issue
• No pre-existing condition if not subject to pre-existing condition on medical plan
• Also bridges the gap between Active Care 2 and Active Care 3 benefits
•
Employee Only
>40
$25.98
40-49 $34.21
50+
$71.85
Employee Spouse
$47.76
$62.85
$132.02
•Employee Children
$62.45
$67.22
$123.81
Employee Family
$83.64
$95.11
$182.41
Medical Gap Example 1
A Hospital Stay + Surgery = $18,000 Total Expenses (Employee Only at age 43)
Active Care 1HD
w/out Med Gap
Active Care 1HD
with Med Gap
Annual Premium
$1,200
$1,610.52
Deductible
$2,400
$2,400
Co-Insurance
$3,120
$3,120
n/a
n/a
$6,720
$7,130.52
Co-Pay
Total Out-of-Pocket
Med Gap Benefit
Total Cost
You save
$
-
$6,720
- $1,500
$5,630.52
$1,089.48
You also save $2,037.48 per year in premiums by electing Active Care 1HD with medical
gap rather than upgrading to Active Care 2.
Medical Gap Example 2
Outpatient Benefit of $1,500 per occurrence up to 3 occurrences for
Employee and Family coverage with Employee at age 43
Active Care 1HD w/out
Med Gap
Active Care 1HD with
Med Gap
Deductible to meet
$4,800
$4,800
Annual Premium
$10,020
$11,161.32
Occurrence 1 – you pay
$1,000
$
Occurrence 2 – you pay
$2,000
$500
Occurrence 3 – you pay
$1,500
$
Total Out-of-Pocket
$14,520
You save
-
$11,661.32
$2,858.68
You also save $2,014.68 per year in premiums by electing Active Care 1HD with
medical gap rather than upgrading to Active Care 2.
PPO Dental Plan – High Option
New Carrier 2013-14- Lincoln Benefit- High Option
Lincoln will take over all currently insured dental plan members
100% for preventative care / 80% for basic services / 50% for major services with
$1000 maximum annual benefit
Benefits for oral surgery, surgical extractions, and anesthesia will move from Basic
type 2 services covered at 80%, to major type 3 services covered at 50%
Claims paid at 90th percentile of usual & customary fees rather than a MAC schedule
Coverage for dependent children up to age 26
Orthodontia included for children and adults
Premium will increase by 2% and are guaranteed for 2 years
• Employee Only
$35.34 per month
• Employee & Spouse
$76.44 per month
• Employee & Child
$70.28 per month
• Employee & Family
$123.28 per month
PPO Dental Plan – Low Option
New Carrier 2013-14- Lincoln Benefit- Low Option
Provides a lower more basic level of coverage.
100% for preventative services / 70% for basic services / 40% for major services with
$750 maximum annual benefit
Benefits for oral surgery, surgical extractions, and anesthesia will be covered as major
services at 40%
Claims paid at 90th percentile of usual & customary fees
Coverage for dependent children up to age 26
No Orthodontia coverage
Premium are guaranteed for 2 years
• Employee Only
$25.18 per month
• Employee & Spouse
$54.02 per month
• Employee & Child
$48.50per month
• Employee & Family
$85.22 per month
DHMO Dental Plan
New DHMO Carrier- 2013-14- Lincoln Benefit
Replaces current Safeguard , lower premiums
No co-pay on office visit; many other deeply discounted services
No annual maximum benefits or deductibles
Members must choose a provider from the network to receive benefits
Premiums guaranteed for 2 years
Coverage for dependent children to age 26
• Employee Only
$14.69 per month
• Employee & Spouse
$28.62 per month
• Employee & Child
$30.97 per month
• Employee & Family
$44.76 per month
Vision Plan
New Carrier - Block Vision – 2013-2014
Exam and eyewear co-pay of $15
Elective Contact lens allowance of $150; Paid in full if medically necessary
Frame allowance up to $125 retail value
$200 allowance on Lasik
Dependent children can be covered up to age 26
Employee Only
$7.40 per month
Employee & Spouse
$12.58 per month
Employee & Child
$13.30 per month
Employee & Family
$19.98 per month
Standard Insurance Disability
Same Carrier for 2013-2014
Premiums will remain the same for 2013
Open enrollment, guaranteed issue opportunity in 2013
Protects against a loss of income due to sickness or accident
1st Day hospital confinement benefit- Waives elimination period on 0/7, 14/14,
30/30 elimination period plans.
Insure up to 66.67% of annual salary- $8000 maximum monthly benefit.
Elimination Period
Rate Per $1000
0/7
$37.80
14/14
$33.30
30/30
$28.20
60/60
$18.30
90/90
$15.80
Basic & Voluntary Group Term Life Plan
New Carrier - Lincoln Benefit- Group Term Life Plan- 2013-14
$15,000 Life Insurance Coverage for all Employees- Provided at no cost by Wylie ISD
Additional voluntary coverage available at group rates.
ex: $50,000 Coverage
•Age 25- $4.75
•Age 35- $6.25
•Age 45- $13.00
•Age 55- $30.00
•Age 65- $65.50
Spouse Coverage also available, Child Life up to age 26
Guaranteed Issue Coverage to $200,000 employee, $50,000 Spouse
Annual increases of $20,000 up to the guaranteed issue limit on voluntary life each
year at open enrollment.
Any current coverage over the guaranteed issue amount will continue with new carrier
without having to provide proof of good health.
Coverage good while employed with Wylie ISD.
Fidelity Permanent Life Plan
Same Carrier for 2013-2014
Permanent, Guaranteed Issue, Life Time Protection, Term Life Insurance Policy.
Plus- Long Term Care Rider equal to 4% of death benefit, payable for 75 months.
Ex: $25,000 death benefit or $1000 monthly LTC benefit payable for 75 Months.
75 month LTC benefit is new for 2013, current policies include a 25 month LTC
benefit
Portable upon termination of employment- Premium remains the same
Insure yourself, spouse, and children
Guaranteed issue for all employees up to $100,000.
Rates Based on age at issue, guaranteed for life
ex: $25,000 Non-Smoker Benefit, monthly premium:
• Age 35- $15.77
• Age 45- $26.27
• Age 55- $47.50
Cancer Plan
New Carrier - Colonial Cancer Plan- 2013-14
Single plan option including Cancer coverage, ICU rider, Specified Disease Coverage, and
1st Occurrence Benefit
•
•
•
•
•
Hospital Confinement Benefit
Radiation/Chemo
Surgery Schedule Benefit
Initial Diagnosis
Screening Rebate
$300 per day
$300 per day with $10,000 per year
Up to $4,500 max
$5,000
$100
Open Enrollment, Guarantee issue coverage. Take over of current insured participants
Dependent children can be covered up to age 26
Credit for time insured for those with the current cancer plan, no pre-existing
limitations on take over if you have been covered previously for 12 months
Employee Only
$29.85 per month
Employee & Family
$49.55 per month
Flexible Spending Accounts
• Maximum allowable election amount per year is
now $2,500 per participant for the medical FSA
• Maximum allowable election for dependent care
FSA remains $5,000 per family
• New administrator will be TASC – get a debit card,
improved technology with smart phone app that
allows you to take a picture of your receipt and
file the claim immediately for reimbursement.
403(b) and 457(b)
•
•
•
•
•
•
New Administrator as of 9/1/13 – Omni
No more fees
Easy accessibility to accounts
Seamless change for 403(b)
Minimal change for 457(b)
More information to come on change to new
carrier
In-Roll for Online Enrollment
Log-In Instructions for In Roll
Site Access- To access your employer on-line enrollment site, InRoll, you can click on the Employee
benefit Website provided by your employer or simply log in to www.in-roll.com. Once at this location
you will see a screen like the one shown below.
User Name- Every employee will have a system assigned user name to enable them to access the InRoll
sight. Your user name will be the first initial of the legal name on record with your employer, followed
by your entire last name, followed by the last 4 digits of your SS#.
Ex: employee name- Robert Smith, SS# 123-45-6789
User Name will be: rsmith6789
Default Password- Your default password for the initial log in will be wisd
In-Roll for Online Enrollment
Welcome Page- Please read the information and instructions included on the Welcome Page. This page
includes important information about your new benefits and how to enroll in the coverage. Once you have
read the Welcome Page, click on the link at the bottom of the page to continue your enrollment.
In-Roll for Online Enrollment
Verify Information- This page contains information about yourself. Your name, address, date of birth etc. will be listed on this page. Please check
for accuracy. This is also the page where you will enter dependent information. InRoll will not allow you to enroll dependents for coverage if you
do not enter each dependent’s information. Once you have entered all required information and confirmed it for accuracy, click the link at the
bottom of the page to submit and continue.
Dependent Enrollment- Many of your benefit offerings will include options to enroll your spouse and children for coverage. If you do not see an
option to enroll your spouse or child, you have not entered their information on the Verify Information page in InRoll. You will need to return to
the Verify Information page and enter the information for each dependent. Do this by clicking on the Add Dependent link and entering the RED
items on the Dependents page. Once entered, click the Submit Information button at the bottom of the page. Repeat this process for each
dependent. Once all dependents are entered, return to the enrollment screen you were on by clicking on the green plan name link on the left
side of the page under the Status Bar.
In-Roll for Online Enrollment
Benefit Enrollment- Your employer provides you with a selection of supplemental benefits that you can choose
from, and pay for, on payroll deduction. Each of these benefits will be outlined in detail in the InRoll system
with Plan Specific information on each benefit page. Simply follow the instructions on each page to enroll in or
decline coverage. Once you make your choice, and submit your election, you will move to the next benefit
page. Some benefits will require responses on multiple pages. This will typically be for verification of your
benefit election, identification of insured dependents, or completion of any required applications.
In-Roll for Online Enrollment
Confirmation Statement- Once you have completed your enrollment, you will see a “Confirmation Statement”.
This page shows you the benefit selections made, the cost of these benefits, and dependents entered into the
system. Click the “Print and Save” button at the bottom of this page to create a printable version of this
document. Once the printable version appears, click file/print to print a copy for your records. Note: If you
have a valid email address in the system, you can also request to have a copy of your Confirmation Statement
emailed to you. If the option to email a statement does not appear, return to the Verify Information screen
and make sure you have a valid email address entered in InRoll. After this document prints, click the Exit link at
the top of the page to close your enrollment site.
You Have Resources!
You have several resources to assist you in making good
benefit choices:
• Wylie ISD Benefits Booklet
• Vendor websites (you can always register and view claims and eligibility
information for yourself and your dependents) – all websites can be found in the
Benefits Booklet or on the Payroll/Benefits website under http://payroll-benefits.wylieisd.schoolfusion.us
• Wylie ISD Benefits Portal
• Employee benefits website at www.in-roll.com
• Janie Emmert, Benefits Specialist, 972-429-3046 or janie.emmert@wylieisd.net
• US Employee Benefits Services Group, 972-636-9944 or www.usebsg.com