Health Care
Update and
Changes
Gayln L Bowers
Agenda
Health Care Plan Data
Plan Changes
Questions and Answers
Health Care Plan Review
2004-2005 PUC left Adventist Risk Management
Health Care Plan and implemented the Pacific Union
College Self Insured Group Health Care Plan.
No employee contribution for the 2004-2005 plan
year.
PUC Group Health Care Plan is a bundled plan
inclusive of medical, prescription, dental and vision.
Health Care Plan Review
•
Health and Wellness Program enhanced
during the 2004-2005 plan year to
encompass a greater preventative strategy.
Health Care Plan Review
•
Employee Contribution Implemented July 1, 2005
• Employee Only - $30.00 per month
• Employee +One - $50.00 per month
• Employee + 2 or more - $75.00 per month
•
Employee Contribution Changed July 1, 2009
• Employee Only - $50.00 per month
• Employee +One - $80.00 per month
• Employee + 2 or more - $110.00 per month
Group Health Plan Costs – 2011-2012
Per Employee Per Month
Medical
$589.95
Prescription
$186.24
Dental
$107.72
Vision
$18.11
Admin/Re-insurance Fees
$218.00
Total
$1,120.49
Group Health Plan Costs – 2011-2012
Premium Equivalencies per Month
EE
2-Party
Family
PPO
$636.31
$1,251.64
$1,851.04
HDHP
$538.61
$1,059.46
$1,536.35
HSA Fund
$83.33
$166.67
$166.67
$61.85
$122.32
$217.59
$13.92
$27.39
$39.71
Medical & RX
Dental
PPO
Vision
Vision Plan
Employees
•
•
ALL employees working 37.5+ hours per
weeks are offered medical insurance.
We have 91 full-time faculty and 153 full-time
staff.
•
•
TOTAL of 244 full-time employees
100% of our full-time employees have picked
up the college’s health care plan
Health Care Coverage
• 100 % of full-time
faculty members are
on the College’s
health care plan
• 32 faculty members have the
single plan
• 26 faculty members have the
employee + one plan
• 33 faculty members have the
employee + two or more plan
• 100 % of full-time
staff members are
on the College’s
health care plan
• 60 staff members have the single
plan
• 44 staff members have the
employee + one plan
• 49 staff members have the
employee + two or more plan
Part-time Employees
• Total of 48 part-time
employees
• 9 Faculty Members
• 39 Staff Members
• Employees working
20+ hours are
eligible for a buy-in
to the health care
plan.
Why Plan Changes?
•
Unlimited Lifetime Maximum Benefit
•
No Pre-existing Exclusions
•
Dependent Coverage up to age 26
•
Affordable Care Act (ACA) Re-defines a full-time employee to at least 30 hours
per week
•
ACA establishes two fees Qualified Health Plans will be required to pay
•
Patient-Centered Outcomes Research Institute (PCORI) Fee
•
Transitional Reinsurance Program Fee
Plan Changes
Health Plan
• Medical
• Prescription
• Dental
• Vision
Vision
Dental
Medical & Prescription
• Base Plan
• Traditional
• High
Deductible
Base PPO Health Care Plan
In-Network
Annual Deductible
Coinsurance
Office Visit Copay
Annual Maximum Out-of-Pocket
Lifetime Maximum Benefit
Out-of-Network
$250 Individual
$500 Family
80%
50%
$25 per visit Primary Care, Deductible waived
$40 per visit Specialist, Deductible waived
$4,500 Individual
$9,000 Family
$8,000 Individual
$12,000 Family
Unlimited
Base PPO Health Care Plan
In-Network
Out-of-Network
Covered 100%, Deductible waived
50%
80%
50%
Outpatient & Inpatient Services
Preventive Care
Inpatient Hospital Services
Emergency Room
($50 copay waived if admitted)
Outpatient Services (Labs, X-rays)
Additional Services Covered (refer
to full plan summaries for benefits
and limitations)
$50 copay then covered 80%
(see full list for Level ER service copays)
80%
50%
Minimum Essential Benefits
Base PPO Health Care Plan
Prescriptions/Pharmacy
Retail-30 Day
Supply
Home Delivery- 90 Day
Supply
Generic
$10
$15
Brand
$40
$40
Non-Formulary
$55
$50
Special Medications
$85
$50
Base PPO Health Care Plan
Employee Monthly Contribution
Employee Only
$25.00
Employee + One
$40.00
Employee + Two or More
$55.00
Traditional PPO Health Care Plan
In-Network
Annual Deductible
Coinsurance
Office Visit Copay
Annual Maximum Out-of-Pocket
Lifetime Maximum Benefit
Out-of-Network
$350 Individual
$700 Family
80%
50%
$25 per visit Primary Care, Deductible waived
$40 per visit Specialist, Deductible waived
$3,000 Individual
$6,000 Family
$5,000 Individual
$10,000 Family
Unlimited
Traditional PPO Health Care Plan
In-Network
Out-of-Network
Covered 100%, Deductible waived
50%
80%
50%
Outpatient & Inpatient Services
Preventive Care
Inpatient Hospital Services
Emergency Room
($50 copay waived if admitted)
Outpatient Services (Labs, X-rays)
Additional Services Covered (refer
to full plan summaries for benefits
and limitations)
$50 copay then covered 80%
(see full list for Level ER service copays)
80%
50%
Physical, Occupational & Speech Therapy
Vision Therapy and Care Durable Medical Equipment Organ & Tissue
Transplant Refractive Eye Surgery
Traditional PPO Health Care Plan
Prescriptions/Pharmacy
Retail-30 Day
Supply
Home Delivery- 90 Day
Supply
Generic
$10
$15
Brand
$35
$40
Non-Formulary
$40
$50
Special Medications
$80
$50
Traditional PPO Health Care Plan
Employee Monthly Contribution
Employee Only
$50.00
Employee + One
$80.00
Employee + Two or More
$110.00
High Deductible Health Plan
with Health Savings Account
In-Network
Out-of-Network
Employer HSA Funding
$1,000 Individual
$2,000 Family
Annual Deductible
$2,000 Individual
$4,000 Family
Coinsurance
Office Visit Copay
Annual Maximum Out-of-Pocket
Lifetime Maximum Benefit
90%
50%
$25 per visit Primary Care
$40 per visit Specialist
$3,000 Individual
$6,000 Family
$5,000 Individual
$10,000 Family
Unlimited
High Deductible Health Plan
with Health Savings Account
In-Network
Out-of-Network
Covered 100%, Deductible waived
50%
90%
50%
Outpatient & Inpatient Services
Preventive Care
Inpatient Hospital Services
Emergency Room
($50 copay waived if admitted)
Outpatient Services (Labs, X-rays)
Additional Services Covered (refer
to full plan summaries for benefits
and limitations)
$50 copay then covered 90%
(see full list for Level ER service copays)
90%
50%
Physical, Occupational & Speech Therapy
Vision Therapy and Care Durable Medical Equipment Organ & Tissue
Transplant Refractive Eye Surgery
High Deductible Health Plan
with Health Savings Account
Prescriptions/Pharmacy
Retail Delivery – 30 Day
Supply
Home Delivery- 90 Day
Supply
Generic
$10
$15
Brand
$35
$40
Non-Formulary
$40
$50
Special Medications
$80
$50
Dental Plan
Annual Deductible
Coinsurance
Preventive Care
Annual Maximum
Orthodontia
$75 Individual
$150 Family
80%
Covered 100%, Deductible waived
$3000 Individual
$6000 Employee + One
$9000 Employee + Family
50% Coinsurance
$2400 Lifetime Maximum
Covered up to age 26
Employee Monthly Contribution
Employee Only
$15.00
Employee + One
$30.00
Employee + Two or More
$60.00
Vision Plan
Annual Deductible
None
Coinsurance
80%
Preventive Care
N/A
Annual Maximum
$560
Employee Monthly Contribution
Employee Only
$5.00
Employee + One
$10.00
Employee + Two or More
$15.00
Enrollment Form
GROUP HEALTH PLAN ENROLLMENT/CHANGE FORM
EMPLOYEE ENROLLMENT
Male
Female
Last Name
First Name
MI
Social Security Number
Street # & Name
Telephone Number
City, State, Zip Code
Date of Birth

New
Enrollment

Qualifying
Event

Change
Eff.
Date:
SELECT ONE FROM EACH DEPENDENT SELECTION
 Medical
 Traditional Plan
 Employee Only
 High Deductible Plan
 Employee + One
 Base Plan
 Employee + Family
 Waived
 Dental
 Employee Only
 Employee + One
 Employee + Family
 Waived
 Vision
 Employee Only
 Employee + One
 Employee + Family
 Waived
Enrollment Form
DEPENDENT ENROLLMENT (Complete, if enrolling, for each eligible dependent)
Relationship
First and Last Name of Dependent
Social Security Number
Gender
Date of Birth
Coverage Elected
Husband
Wife
Male
Female
Medical/Rx
Dental
Vision
Child
Step-Child
Other: please specify
Male
Female
Medical/Rx
Dental
Vision :
Child
Step-Child
Other: please specify
Male
Female
Medical/Rx
Dental
Vision
Child
Step-Child
Other: please specify
Male
Female
Medical/Rx
Dental
Vision
Does dependent have other group coverage including Medicare or Medicaid? If yes, please complete information on opposite page.
Questions