University of Wisconsin System
Annual Benefit Enrollment
(ABE) Period
October 5 – 30, 2015
http://www.wisconsin.edu/abe
2016 Annual Benefit
Enrollment (ABE)
Health Insurance Changes
and Updates
3
Benefit Changes Allowed during
Annual Benefit Enrollment (ABE)
o All changes made during this period are effective January 1, 2016.
o If you do nothing, your existing benefit elections, with the exception of your
Flexible Spending Accounts (FSA), will continue in 2016.
Open
Enrollment
Change
Plan
Add
Dependents
Remove
Dependents
Cancel
Coverage
State Group
Health
Yes
Any Health Plan
Yes
Yes
Yes
EPIC Benefits+
No
Remove vision
No
Yes
Yes
Dental
Wisconsin
Yes
PPO
Yes
Yes
Yes
VSP Vision
Yes
N/A
Yes
Yes
Yes
No
Increase
current
coverage
No
Any time
Any time
Yes
Must re-enroll
every year
N/A
N/A
N/A
Plan
Individual &
Family Life
Insurance
Flexible
Spending
Accounts (FSA)
Select
Your Health Insurance Options
o For State Group Health, you may take the
following actions during ABE:
o
o
o
o
Enroll
Change health plans
Add or remove eligible dependents
May select health plan with or without Uniform
Dental coverage (default is with dental)
o Cancel coverage for 2016
o Health Insurance Opt-Out Incentive (through
paper application only)
o As always, confirm your current medical and
dental providers will still be available in
2016.
5
$2,000 Health Insurance
Opt-Out Incentive
If enrolled in State Group Health insurance (except
Craftworkers and Graduate Assistants) in 2015 can opt-out of
coverage for the 2016 plan year and receive a $2,000
Incentive.
o Must be enrolled (did not waive) for the 2015 year
o May not be covered under the State Group Health
insurance program as a dependent in 2016
o Must submit a State Group Health insurance PAPER
application during ABE to receive the opt-out incentive for
2016.
o How will the incentive be paid out?
o Paid out in installments throughout year
o Incentive will be considered taxable.
6
2016 Health Insurance Premiums
Premium Tier
Tier 1
Tier 2
(Access
Plan –
out of
state)
Tier 3
(Access
Plan)
Employees Covered
Employees Covered by
Employees Covered by the
by the WRS –
Grad Assistant/ShortWRS –
It’s Your Choice HDHP Term AS (It’s Your Choice
It’s Your Choice Health Plan
Health Plan
Health Plan only)
Single
Family
Single
Family
Single
Family
With
Dental
$86
$217
$32
$81
$44.50
$112.50
Without
Dental
$83
$209
$29
$73
$41.50
$104.50
With
Dental
$136
$341
$82
$205
$69.50
$174.50
Without
Dental
$133
$333
$79
$197
$66.50
$166.50
With
Dental
$253
$632
$199
$496
$128
$320
Without
Dental
$250
$624
$196
$488
$125
$312
Premiums listed do not apply to those who are required to pay the less than half-time
rates or the total premium.
7
2016 Health Insurance Name Changes
8
Previous Name
New Name for 2016
Coinsurance Uniform Benefits
(HMO/Regional PPO Uniform
Benefits)
Health Plan/IYC Health Plan
High Deductible Health Plan
High Deductible Health Plan
(HDHP)/ IYC High Deductible
Health Plan (HDHP)
Standard Plan
Access Health Plan/IYC Access
Health Plan
HDHP Standard Plan
Access HDHP/IYC Access HDHP
2016 Health Insurance Plan Changes
Health
Plan
Arise Health
Plan
Arise- Aspirus
Health Plan
Network
Health Plan
What’s New in 2016?
Combining service area
Offering new service area
Offering new service area in southeast part of
the state
Will NOT be providing coverage in following
service areas:
East: Florence, Fond du Lac, Forest, Jefferson,
Kenosha, Langlade, Lincoln, Marinette, Oneida,
WEA Trust
Price, Racine, Taylor, Vilas
PPO (all)
• Northwest Chippewa Valley: Burnett,
Sawyer, Trempealeau
• Northwest Mayo Clinic Health System:
Buffalo
Access Health Uniform Dental benefits will be included with
(Standard)
health coverage automatically. This was not
included in prior years.
Plan
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Action Needed
during ABE
All Arise participants should
confirm provider network for
2016.
None.
Select new health plan if you
will be affected.
May select plan with or
without the Uniform Dental
benefit.
Plan Changes for 2016
o Elect or Waive Uniform Dental Benefits
o Increased Cost Sharing
o Added deductibles
o New office visit copayments
o Increased out-of-pocket limits
o Changes to pharmacy benefits
o $2,000 Health Insurance Opt-Out
Incentive
o Increased HSA Employer Contribution
10
Uniform Dental Benefits
New for 2016: Employees may enroll or waive the Uniform
Dental benefits as part of their State Group Health
Insurance election.
• Employees must be enrolled in State Group Health insurance
coverage in order to be eligible for the Uniform Dental Benefit plan.
Current State Group Health participants- Uniform Dental benefits
will be included automatically (including Access Plan).
• Employees must take action during the ABE period to select a
health plan without the dental option, if they wish to waive Uniform
Dental.
• Coverage level (single/family) must be the same as medical.
• Dental expenses, including those for HDHP plans, are separate
from medical benefits and will not be subject to a deductible and do
not count toward the OOPL.
• Employees should search Delta Dental’s website to determine if their
current providers are included in the coverage network.
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Uniform Dental Benefits 2016
(in conjunction with any covered service under the UDB)
Make sure your dental provider is in-network before receiving
dental services in 2016. No benefit for out-of-network providers
Search for in-network providers: www.deltadentalwi.com/state-of-wi
Uniform Dental Benefits
• Administered by Delta Dental of Wi (providers are no longer
determined by Health Plans)
• Two Delta Dental provider networks:
• Delta Dental PPO – best cost savings
• Delta Dental Premier
• ID Cards for 2016 are expected to be sent out in December,
2015
• Tools and resources at: DeltaDentalWI.com/state-of-wi
13
Deductibles
Q: What is a deductible?
A: A deductible is the amount you must pay out of pocket for the full cost of certain
health care services before your health plan begins to pay.
Certain preventive health services are covered 100% and are not subject to the
deductible.
Health Plan
Deductible
High
Deductible
Health Plan
(HDHP)
Access Health
Plan
(In-Network)
Access Health
Plan HDHP
(In-Network)
Single
Family
Single
Family
Single
Family
Single
Family
$250
$5001
$1,500
$3,0002
$250
$5001
$1,700
$3,4002
_______________________________________________
1 After an individual within a family plan meets the $250 deductible, medical services will be covered for that
individual.
2 The full family deductible must be met before any medical services are covered.
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Office Visit Copayments
Q: What is a Copayment (copay)?
A: A copay is a fixed amount you pay for certain covered health care services or
prescription drugs, usually due at the time you receive the service.
New for 2016: Copays will be applied to primary care and specialty care office visits
as well as Pharmacy
• Health Plan Copays will not count toward the deductible, but will count toward
the out-of-pocket limit.
• High Deductible Health Plan (HDHP) copays are applied after the deductible is
met.
• Additional services billed as part of the office visit (labs/x-ray)are subject to
deductible and/or coinsurance.
• Preventive services are covered 100% and are not subject to copays.
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Visit Type
Includes
Copayment
Counts Toward
Out-of-Pocket
Limit?
Primary Care
Office Visit
General Physician - Pediatrician
OB/GYN - Nurse Practitioner
Chiropractor
$15
Yes
Specialty Office
Visit
Specialty Providers - Urgent Care
Vision Exam in an office visit setting
$25
Yes
Emergency Room
Emergency Room
$75 (waived if
admitted)
Yes
Coinsurance
Q: What is coinsurance?
A: Coinsurance is the member’s share of the costs of a
covered health care service or prescription drug,
calculated as a percent of the amount for the service
or cost of the drug.
o Coinsurance amounts are based on the total cost of a drug or service.
o For the Health Plan and In-Network HDHP, once the deductible is
met, a 10% coinsurance will be charged for all non-copayment-related
services beyond the charge for the office visit. Exception: A 20%
coinsurance applies to covered durable and disposable medical
equipment, certain hearing aids, and cochlear implants.
o Federally preventive services are not subject to a deductible, copays,
or coinsurance.
o Medical coinsurance amounts count towards the OOPL.
16
Pharmacy Benefits
New for 2016: Increased pharmacy out-of-pocket limits. Costs for Levels 2, 3 and 4
prescriptions will change from copay to coinsurance, up to a specified maximum.
2016 Prescription Copays, Coinsurance, and Out-of-Pocket Limits
(It’s Your Choice Health Plan)
Prescription Drug Level
Member Costs
Annual RX OOPL*
Level 1
$5 per fill
$600 individual / $1,200 family
Level 2
20% ($50
maximum per fill)
$600 individual / $1,200 family
Level 3
40% ($150
maximum per fill)
Does not apply to Rx OOPL. Only applies to
Federal maximum out-of-pocket limits
(MOOP): $6,850 individual / $13,700 family
Level 4 Preferred Specialty Drug
• Filled at a Preferred Specialty
$50 per fill
Pharmacy (e.g. Diplomat Specialty
Pharmacy)
•
Filled at any other pharmacy
$1,200 individual / $2,400 family
40% ($200
maximum per fill)
*HDHP Plans: Members are responsible for the full cost of prescriptions until their annual
deductible has been met. Once the deductible is met, the member costs in the table above will
apply. See the HDHP Combined OOPL amount for each plan at www.Wisconsin.edu/abe
17
How to Determine Prescription Costs
Coinsurance is a percentage of total cost (for Level 2, 3 and 4
drugs); the cost of the drug will impact how much you pay.
o Option 1: Contact your pharmacist and ask what the total cost of your
prescription is. If you take this approach, show your pharmacist your
Navitus ID card if necessary and be sure to inform your pharmacist that:
1. You are a State Group Health insurance program member
2. Navitus Health Solutions is your Pharmacy Benefit Manager
3. You need to know the Navitus discounted cost of the drug– not the
full retail cost.
o Option 2: You may also find the total cost of your prescribed drug on the
documents and/or receipts you receive with your prescription.
o Option 3: If enrolled in SGH for 2015, review your medication history via
the Members portal on Navitus’ website. Log in to the members section
of navitus.com to view the current formulary and determine levels
18
Out-of-Pocket Limits (OOPL)
Q: What is an out-of-pocket limit?
A: An out-of-pocket limit (OOPL) is a plan provision that limits the
member’s cost-sharing. It is the maximum amount that a member will pay
for in-network, covered services during a plan year.
Once the OOPL is met, coinsurance and copayments no longer apply for health.
o
Reminder: There are separate medical and prescription out-of-pocket limits (except
for HDHP plans).
Increased Medical OOPL for Health Plans and Access Health
Plan in 2016; No change to HDHP plans.
2016
OOPL
Health Plan
High Deductible
Health Plan
(HDHP)
Access Health
Plan
(In-Network)
Access Health
Plan HDHP
(In-Network)
Single
Family
Single
Family
Single
Family
Single
Family
$1,250
$2,5001
$2,500
$5,0002
$1,000
$2,0001
$3,500
$7,0002
_______________________________________________
1 After an individual within a family plan meets the single OOPL, medical services will be
covered at 100%.
2 The full family OOPL must be met before medical services will be covered at 100%.
20
Is the HDHP/HSA Right for You?
o Considerations when deciding to enroll in the
HDHP/HSA option
o The HDHP has higher out-of-pocket costs
o The HDHP has a lower monthly premium
o The HSA provides a way to set aside pre-tax
monies into a savings account that can earn
interest
o Your employer will contribute $750 for single or
$1,500 for family coverage to your HSA in 2016
22
23
COST SHARING EXAMPLE: HEALTH PLAN
o
You enroll in a single Health Plan with a local HMO for 2016.
o
VISIT #1: You visit your doctor in January 2016 and have minor surgery (such as
removing a precancerous mole) while you are in the office. This is not
considered preventive medical services. This is your first doctor visit of the year
and nothing has been applied to your deductible for 2016.
The doctor bills the following:
• Office Visit: $100.00
• Minor Surgery: $300.00
o Total: $400.00
25
o
Your insurance coverage includes a $15 Primary Care Visit copay, a $250
calendar year deductible and a 10% coinsurance for medical services.
o
You will pay
• Copay: $15 - Office Visit
• Deductible: $250 of the $300 Minor Surgery
• Coinsurance: $5 (10% of the remaining $50)
• TOTAL AMOUNT PAID BY YOU: $270.00
• You paid $270 in medical costs towards your OOPL of $1,250 in
January, leaving $980.00 remaining
o
The remaining $130 will be covered by your insurance according to your policy
terms.
COST SHARING EXAMPLE VISIT #2: HEALTH PLAN
o
Following Visit #1, You visit the Emergency Room in February 2016 and get admitted to
the hospital for appendicitis. You end up having an appendectomy and staying in the
hospital for a day. This is not considered preventive medical services.
The doctor bills the following:
• Emergency Room: $200.00
• Imaging: $600.00
• Surgery: $30,000.00
• Hospital Stay: $4,200.00
o Total: $35,000
26
o
Your insurance coverage includes a $75 Emergency Room copay, a $250 calendar
year deductible and a 10% coinsurance for medical services. The out-of-pocket limit
for your plan is $1,250, for an individual.
o
o
o
o
TOTAL AMOUNT PAID BY YOU: $980.00.
Copay: $0 – Waived if admitted.
Deductible: $0 - Met in January in Visit #1
Coinsurance: $980 (10% of $34,800 for Imaging, Surgery and Hospital Stay is $3,480),
capped at OOPL limit of $1,250. You paid $270 in medical costs towards your OOPL of
$1,250 in January, leaving $980 remaining in your OOPL for Medical.
o
The remaining $34,020 will be covered by your insurance according to your policy
terms. You have met your cost sharing for 2016.
COST SHARING EXAMPLE: HDHP
o
You enroll in a single HDHP with a local HMO for 2016.
o
You visit your doctor in January 2016 and have minor surgery (such as
removing a precancerous mole) while you are in the office. This is not
considered preventive medical services. This is your first doctor visit of the
year and nothing has been applied to your deductible for 2016.
The doctor bills the following:
• Office Visit: $100.00
• Minor Surgery: $300.00
o Total: $400.00
27
o
Your insurance coverage includes a $1,500 calendar year deductible and a
$15 primary care visit copay along with a 10% coinsurance for medical
services, after the deductible is met.
o
TOTAL AMOUNT PAID BY YOU: $400 – All of this will be applied towards
your deductible. You will have $1,100 remaining to meet your deductible.
o
Your insurance will not provide payment for this service according to
your policy terms.
COST SHARING EXAMPLE VISIT #2: HDHP
o
Following Visit #1, You visit the Emergency Room in February 2016 and get
admitted to the hospital for appendicitis. You end up having an
appendectomy and staying in the hospital for a day. This is not
considered preventive medical services.
The doctor bills the following:
• Emergency Room: $200.00
• Imaging: $600.00
• Surgery: $30,000.00
• Hospital Stay: $4,200.00
o Total: $35,000
28
o
Your insurance coverage includes a $1,500 calendar year deductible, a $75
Emergency Room copay, and a 10% coinsurance for medical services,
after the deductible is met. You have $1,100 remaining to meet your
deductible following visit #1. The Annual Out of Pocket Limit for the HDHP
plan is $2,500.
o
TOTAL AMOUNT PAID BY YOU: $2,100
o Copay: $0 – Waived if admitted (only applies after deductible)
o Deductible: $1,100 remaining to reach the full $1,500 annual
deductible.
o Coinsurance: $1,000 (10% of $33,900 for ER, Imaging, Surgery and
Hospital Stay is $3,390), capped at OOPL limit of $2,500. You paid
$1500 in medical costs towards your OOPL of $2,500, leaving $1,000
left to reach your OOPL.
o
The remaining $32,900 will be covered by your insurance according to
your policy terms. You have met your cost sharing for 2016.
Member Health Plan Medical Costs
Overview
Person pays for
medical costs until
they reach their
deductible.
Then, person pays
coinsurance amounts
while their insurance
covers the remainder of
medical care costs.
COPAYS are separate
from the deductible and
apply toward the OOPL
29
Insurance covers
expenses at 100% after
reaching the out-ofpocket limit (OOPL) or,
if applicable, the federal
maximum out of pocket
(MOOP).
Calculate Estimated Prescription Cost
1.
ADD the amount your plan paid to the amount that you paid for the
prescription in 2015
2.
Multiply the total from step #1 by the coinsurance percentage found on
your benefit schedule to determine estimated member copay based on
2016 benefit design and formulary coverage Level. Note the Maximum
copay amounts.
EXAMPLE (using 2015 Rx amounts to estimate cost in 2016)
• Formulary coverage Level = 2 (20% with $50 maximum copay). In
example, you would pay $50, not $60.
Plan paid
$285
33
+
You paid
$15
Level 2
Coinsurance
(20%)
Total Drug Cost
=
$300
x 0.20
=
Your
COPAY
$50
($50 maximum)
*NOTE: Drug prices and contracted rates can change daily. All cost calculations will be estimates.
FSA Plan Descriptions
FSA Type
Health Care
FSA
Eligible
Expenses
Eligible Dependents
Medical, dental,
vision &
prescription
You, your spouse (same
or opposite-sex),
qualifying child or relative
After school care,
adult or child
Dependent Day
daycare,
Care FSA
preschool
Limited
Purpose FSA
(for employees
enrolled in the
HDHP)
Dental, vision &
post-deductible
expenses
Your spouse (same or
opposite-sex), qualifying
child or relative
You, your spouse (same
or opposite-sex),
qualifying child or relative
Yearly Contribution
Limits
Min: $100
Max: $2,550
Min: $100
Max: $5,000 —
dependent on tax
filing status
Min: $100
Max: $2,550
Health Savings Account (HSA)
(Only for Employees Enrolled in HDHP)
New in 2016: Increased Employer Contribution
Annual Contribution Information for HSA
HDHP Enrollment
Employer
Contribution
(including ER contribution)
Single
$750/year
$3,350*
Family
$1,500/year
$6,750*
2016 Limit
o
*If you are 55-65 years of age, you may contribute an additional $1,000 “catch-up”
per year to your HSA.
o
The employer contribution will be paid throughout year.
o If you do not enroll for the HSA, you are not eligible for the HDHP.
o Will follow up prior to processing application for HDHP, to ensure HSA is
accepted.
35
o
Craftsworkers are not eligible to receive the annual employer contribution to an
HSA but must still enroll in the HSA if electing an HDHP.
o
Grad/Short-term Academic Staff participants are not eligible for the HDHP
Flexible Spending Accounts (FSA)
o You must re-enroll every year if you want to
continue the coverage
o To Enroll for the FSA, LPFSA plans:
https://partners.tasconline.com/ETFEmployee
o All enrollees will receive a new TASC card in 2016
o Do not use 2015 TASC card for expenses in 2016, as of 1/1/2016
o MyCash balance will remain on 2015 TASC card if funds are not
moved to bank account.
o Employees should consider moving My Cash balance to
bank account
36
Health Care and Limited Purpose
FSA Carry-Over
o The plan year is from January 1, 2016 to December
31, 2016.
o Up to $500 remaining in your Health Care or Limited
Purpose FSA can carry over to the following plan
year. Anything over $500 will be forfeited.
o Current Participants: If you have any unused funds in
your 2015 Health Care or Limited Purpose FSA on
December 31, 2015, up to $500 will carry over to 2016.
o You will have until March 30, 2016 to file your 2015
claims.
37
2016 Annual Benefit
Enrollment (ABE)
Additional Enrollment
Options
38
Dental & Vision Insurance Options
o All health plans offer Uniform Dental
benefits. May select health plan without
Uniform Dental benefits.
o Vision exam under health plans are subject
to $25 specialty office visit copay.
o If dental and vision coverage offered by
your health plan doesn’t meet your needs,
consider one of our optional dental or
vision plans. See comparison Charts.
o Dental or Vision
o If elected, you must remain enrolled in the
plan for the entire calendar year.
39
Dental Wisconsin
o Dental Wisconsin offers two plans – the PPO plan and the
Select plan. You may enroll in one of these two plans.
These plans provide partial coverage for:
o Fillings and major dental services (crowns, implants, etc.) up to
the annual $1,000 maximum
o PPO covers annual cleanings and x-rays
o Orthodontic services (up to $1,000 lifetime maximum)
o Vision discount program through Davis Vision
o Waiting periods apply for new enrollees:
o Basic: 3 months (i.e. fillings)
o Major: 3 months (i.e. crowns, implants)
o Orthodontics: 12 months
Waiting periods may be waived if you had prior comparable coverage (no gap in
coverage).
40
2016 Dental Wisconsin Premiums
o No change in premiums from 2015 to 2016
Monthly
Premiums for Employee
2016
41
Employee + Employee +
Spouse/DP Child(ren)
Family
Select
$20.52
$42.19
$48.68
$71.59
PPO
$25.49
$53.96
$60.34
$91.21
VSP Vision
o VSP Vision offers partial coverage for:
o Annual vision exam, $15 copay
o Eyeglass lenses every calendar year and
eyeglass frames every other year
o Contact lenses every year instead of
eyeglasses or eyeglass lenses
o Discounts on laser vision correction
o KidsCare program (eyeglasses more often for
children)
o No benefit changes for 2016.
42
2016 VSP Vision Premiums
o No change in premiums from 2015 to 2016
Monthly
Premiums for Employee
2016
VSP Vision
43
$6.54
Employee + Employee +
Spouse/DP Child(ren)
$13.08
$14.73
Family
$23.54
Individual & Family Life Insurance–
ANNUAL INCREASE OPTION
o If covered by the Individual and Family Life insurance plan
on October 1st, may increase coverage level by the following
amounts:
o Employee: $5,000; $10,000; $15,000 or $20,000
o Spouse/Domestic Partner: $5,000 or $10,000
o Child(ren): $2,500
o Coverage maximums:
o Employee: $300,000
o Spouse/Domestic Partner: $150,000
o Child(ren): $25,000
NOTE: Spouse/Domestic Partner or Child coverage cannot
exceed employee coverage.
44
Individual & Family Life Insurance
o Coverage INCREASES for Individual and Family
can be made either through:
o eBenefit election, or
o Annual Increase Option form
o Decreases and cancellations of coverage cannot
be done through eBenefits, you MUST complete a
paper application and return it to your benefits
office.
45
Didn’t we miss a few plans??
o LIFE AND AD&D
o AD&D – No Change
o UIA – Annual Process 10/1/15 (FASL employees only)
o SGL – Effective/Termination Coverage Date Change
o ICI –
o 20% Premium Increase
o Effective Coverage Date Change
o TSA/WDC – Encourage savings!
o Long-Term Care – Transmerica is a new option in
addition to United of Omaha
46
Important Reminders
1. All benefit enrollments or changes made during
the ABE period are effective January 1, 2016.
2. You have until October 30, 2015 at 4:30 p.m. to
make your elections using eBenefits.
3. Visit www.wisconsin.edu/abe for detailed Annual
Benefit Enrollment (ABE) information.
4. Contact your institution’s benefits office if you
have any questions or need assistance.
47
E-Benefits/Self Service
48
E-Benefits/Self Service
E-Benefits Quick Start Guide
https://www.wisconsin.edu/abe/download/ebenefitsquick-start-guide.pdf
Get one on one E-Benefits Assistance in the
Human Resources Office (203 Admin)
Mondays in October 9:00 a.m. to 11:30 a.m.
Wednesdays in October 1:30 p.m. to 3:00 p.m.
Thursdays in October 9:00 a.m. to 11:30 a.m.
49
UW-Stout Health & Benefits Fair
Thursday, October 8
10 a.m. to 2:30 p.m.
Ballrooms A/B, MSC
50