Anderson University
Employee Benefits Presentation
January, 2016
2016 Medical Plan Overview
• Medical
– Carrier: GuideStone
– Slight change $3500/$7000 plan
Health Saver 2500/5000 Plan Summary
Effective
Network Benefits
Non-Network Benefits
Your costs are summarized below
Deductible
Individual
$ 2,500
$ 2,500
Family
$ 5,000
$ 5,000
10%
40%
Individual
$ 3,000
$ 5,000
Family
$ 6,000
$ 10,000
Physician Office Visit
10% after deductible
40% after deductible
Specialist Office Visit
10% after deductible
40% after deductible
0%
40% after deductible
Coinsurance
Out-of-Pocket Maximum
Preventive Care
Health Saver 2500/5000 Plan Summary
Effective
Network Benefits
Non-Network Benefits
Your costs are summarized below
Retail Prescription Drugs
Generic Formulary
10% after deductible
40% after deductible
Brand Formulary
10% after deductible
40% after deductible
Non-Formulary
10% after deductible
40% after deductible
Generic Formulary
10% after deductible
Not Covered
Brand Formulary
10% after deductible
Not Covered
Non-Formulary
10% after deductible
Not Covered
Hospital Services
10% after deductible
40% after deductible
Out-Patient Services
10% after deductible
40% after deductible
Maternity Services
10% after deductible
40% after deductible
Mail Order Prescription Drugs
Emergency Room Services
Urgent Care Centers
10% after deductible
10% after deductible
20% after deductible
Health Saver 3500/7000 Plan Summary
Effective
Network Benefits
Non-Network Benefits
Your costs are summarized below
Deductible
Individual
$ 3,500
$ 3,500
Family *($6,850 per Individual)
$ *7,000
$ 7,000
20%
40%
Individual
$ 4,000
$ 4,500
Family *($6,850 per Individual)
$ *8,000
$ 9,000
Physician Office Visit
20% after deductible
40% after deductible
Specialist Office Visit
20% after deductible
40% after deductible
0%
40% after deductible
Coinsurance
Out-of-Pocket Maximum
Preventive Care
Health Saver 3500/7000 Plan Summary
Effective
Network Benefits
Non-Network Benefits
Your costs are summarized below
Retail Prescription Drugs
Generic Formulary
20% after deductible
40% after deductible
Brand Formulary
20% after deductible
40% after deductible
Non-Formulary
20% after deductible
40% after deductible
Generic Formulary
20% after deductible
Not Covered
Brand Formulary
20% after deductible
Not Covered
Non-Formulary
20% after deductible
Not Covered
Hospital Services
20% after deductible
40% after deductible
Out-Patient Services
20% after deductible
40% after deductible
Maternity Services
20% after deductible
40% after deductible
Mail Order Prescription Drugs
Emergency Room Services
Urgent Care Centers
20% after deductible
20% after deductible
20% after deductible
What is an HSA
• Tax-advantaged checking account that
works in conjunction with your CDHP
• Allows you to save for future medical
expenses or pay current ones
Health Savings Accounts
Overview
To Qualify for a Health Savings Account (HSA) you must
meet the following:
– HSA’s can only be offered with a Consumer Driven Health Plan
(CDHP).
– Cannot be covered under traditional health plan, including
Medicare, Tricare, or an FSA Medical Reimbursement plan.
– Cannot be claimed as a dependent on someone’s tax return.
HSA Features
Tax Advantages
– Tax free way to save for current and future medical expenses.
– Contributions are pre-tax or tax-deductible up to annual HSA
limits.
– All earnings and interest are tax free.
– Qualified withdrawals are tax free. Once reach age 65,
nonmedical withdrawals are taxed at your current tax rate, like
an IRA.
HSA Features
• HSA is fully Portable.
• Ability to Accumulate funds – “Use it or Keep it!”.
• HSA funds can be used for items not covered by
health plan such as; dental, vision etc. Same as
an FSA plan.
• Lower health plan premiums than traditional
PPO plans.
Funding Your HSA
The HSA can be funded:
– In one or more payments
– Via payroll deductions
• Elections can be stopped, started, and/or changed anytime
– By the employee, employer, or any other person on the
employee’s behalf
– Prior to the individual’s tax filing deadline (generally, April 15th of
the following year)
AU’s Annual HSA
Contribution for 2016
Employee
Employee + 1
Employee + 2
$ 500
$ 750
$1,000
HSA Contributions
• IRS Maximum 2016 contributions
– Self
• $3,350
– Family
• $6,750
– Catch up contribution
• $1,000 for those 55 and older
Who is Eligible to Use my
HSA Funds
You can spend your HSA dollars on qualifying expenses
for:
– Yourself
– Your spouse
– Anyone you claim as a dependent on your personal
income tax
(Your child(ren) may qualify to be covered under your medical plan but NOT qualify to use your HSA
funds).
Note: Your spouse and dependent(s) do NOT have to be covered under your CDHP plan
to be eligible to use funds from your HSA account.
HSA Distributions
Pre-65 HSA owner:
•
Qualified Distributions will be tax free. Non-Qualified
Distributions will require individual to pay their
personal tax rate on purchase and a 20% penalty.
Post-65 HSA owner:
•
Qualified Distributions will be tax free. Non-Qualified
Distributions will require individual to pay their
personal tax rate on purchase (No IRS Penalty)
What Happens if I Am Enrolled in
the CDHP When I Turn 65
At age 65, you have two options:
• You may enroll in Medicare Part A; however, you will
NOT be eligible to make or receive HSA account
contributions from that point forward. You may be able
to receive the AU contribution to an FSA account.
• You may choose NOT to enroll in Medicare Part A, and
you will still be able to make and receive contributions to
your HSA account.
Rx ‘n Go
– You will continue to have the option to receive up to a 90
days’ supply of preventive generic maintenance drugs by
mail at no cost to you through Rx ‘n Go.
– Over 500 generic drugs are available on the Anderson
University Preventive Drug List. Generic prescription
drugs covered by our Preventative Drug List and available
through Rx ‘n Go will be provided to you at no cost.
– To learn what drugs are on our Preventative Drug List
please see http://hr.anderson.edu/ or call 888.697.9646 to
speak to a Rx ‘n Go customer service associate.
2016 Dental Benefit Overview
• Dental
– New Carrier: Delta Dental
– Larger network of providers (two provider levels)
– No change in premium contributions
– Generic ID cards will be distributed by Human Resources
– Dependent children are eligible to age 19 or to age 24 if a fulltime student
– Search for providers at:
http://www.deltadental.com/DentistSearch/DentistSearchControll
er.ccl
Dental Plan Summary
Effective
Network Benefits
Non-Network Benefits
Your costs are summarized below
Deductible (Applies only to Major Services)
Individual
$
50
$
50
Family
$
150
$
150
$
900
$
900
Annual Plan Maximum
Preventive Services
Diagnostic Services
80%
80%
Preventive Services
80%
80%
Emergency Palliative Treatment
80%
80%
X-rays
80%
80%
Oral Surgery
80%
80%
Endodontics
80%
80%
Basic Services
Dental Plan Summary
Effective
Network Benefits
Non-Network Benefits
Your costs are summarized below
Major Services
50%
Prosthodontics
50%
Major Restorative
50%
50%
Separate Ortho Deductible
60%
60%
Ortho Lifetime Max
$ 900
$ 900
Child, 19 years or younger
Orthodontia
Ortho Eligibility
Non-network charges are subject to reasonable and customary fees.
Charges above R&C are the patient's responsibility.
Provider Directory
www.deltadental.com
Delta Dental Network
Delta Dental Network
Delta Dental PPO
• significant discounts
• no balance billing
• acceptance of processing policies
• 108,000 dentist locations
Delta Dental Premier
PPO Dentist
Class II payment example for:
Filling - Amalgam Restoration/One Surface
(assuming any applicable deductible has been
met)
Nonparticipating
• negotiated fees
• no balance billing
• acceptance of processing policies
• 186,000 dentist locations
Submitted Fee:
$120.00
• no discounts
• balance billing
Premier Dentist
Nonparticipating Dentist
Submitted Fee:
$120.00
Submitted Fee:
$120.00
PPO Fee Schedule amount:
$68.00
Maximum Approved Fee:
$111.00
Nonparticipating Dentist Fee:
$92.00
Delta Dental pays 80% of the
PPO Fee Schedule amount:
Member pays:
$54.40
$13.60
Delta Dental pays 80% of the
Maximum Approved Fee:
$88.80
Member pays:
$22.20
Delta Dental pays 80% of the
Nonparticipating Dentist Fee:
Member pays:
$73.60
$46.40
The Premier dentist cannot charge the $9
difference between the Maximum Approved
Fee and his/her fee.
Because the dentist does not participate, you
are responsible for the difference between Delta
Dental’s payment and his/her fee.
The PPO dentist cannot charge the $52
difference between the PPO Fee Schedule
amount and his/ her fee.
2016 Vision Plan Overview
• Vision
– Carrier: Superior Vision
– No change in plan design
– Children eligible to age 26
Vision Plan Summary
Member In-Network
Cost
Your costs are
summarized below
Exam – Every 12 months
Ophthalmologist
Optometrist
$ 10 Co-Pay
$10 Co-Pay
Frames – Every 24 months
$130 allowance
Standard Plastic Lenses – Every 12 month
Single Vision
Bifocal
Trifocal
Contacts (in lieu of glasses)
$25 Co-Pay
$25 Co-Pay
$25 Co-Pay
$120 allowance
Flexible Savings Account
(FSA)
• With an FSA plan, you elect to have a certain dollar
amount withheld from your paycheck so you can pay
for health care and dependent care expenses with pretax money.
• Eligible expenses include your unreimbursed medical
expenses, including deductibles, co-pays, coinsurance, and childcare expenses!
• “Use it or Lose it Rule” – If you do not use all of your
FSA funds they will be forfeited at the end of the plan
year.
2016 FSA Accounts Cond’t
• Flexible Spending Accounts
– Unreimbursed Medical FSA Account
• Employee who waive medical coverage
• Employees who enroll in a medical plans option but do not qualify to
make or receive HSA contributions
– Limited Purpose FSA Account
• Employee who have an HSA account (Dental and Vision expenses
only)
– Dependent Daycare FSA Account
• All employees with qualified daycare expenses
AU’s Annual FSA
Contribution for 2016
Employee
Employee + 1
Employee + 2
$ 500
$ 750
$1,000
Employees who enroll in one of AU’s medical plan options but do not
qualify to make and receive contributions to an HSA, AU will make a
contribution, based on the above schedule, to an FSA account.
IRS Form 1095-B
• As mandated by the
Affordable Care Act,
all employees eligible
for medical benefits in
2015 will receive IRS
Form 1095-B at the
beginning of 2016
• This form will provide
information to be
utilized in the filing of
your 2015 income tax
return
27
Dependent Social Security Numbers
• In order for GuideStone to provide form 1095-B,
they must have Social Security Numbers for
your covered dependents
• If you have not provided the correct Social
Security Numbers for your covered dependents
in the benefitsCONNECT system, please add
this information during open enrollment
Enrollment Instructions
• On-line enrollment system: benefitsConnect
hosted by Transcend Technology Systems
• Passive enrollment – All 2015 election rolled
over for 2016 with the exception of HSA and
FSA elections. These must be elected for
2016.
• Open Enrollment: 11/2/15 – 12/2/15
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