2015 Benefit Enrollment Presentation
November 2014
The Affordable Care Act
• Requires employers to provide affordable insurance
to all eligible employees
• Requires Insurance premiums that do not exceed
9.5% of eligible employees annual income
• Plans must offer dependent coverage (spouse is
not defined as a dependent)
• Imposes a tax penalty on individuals who are
not enrolled in an insurance plan. The penalty
progresses over a three year period.
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The Affordable Care Act
(cont’d)
Tax Penalty:
‾ 2014: the greater of 1% of adjusted household income or $95
per adult plus $47.50 per child;
‾ 2015: the greater of 2% of adjusted household income or $325
per adult plus $162.50 per child; and thereafter
‾ The greater of 2.5% of adjusted household income or $695 per
adult plus $347.50 per child
• Established the Health Insurance Marketplace (Exchange) to shop
for insurance plans. www.healthcare.gov
• Provides premium tax credits to eligible individuals who purchase
insurance through the Exchange. Tax credits are determined by the
federal government using your prior year’s income, as noted on the
prior year’s tax return (meaning 2013 tax return will determine 2014
tax credit).
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DecisionPathHR MV Plan
• Meets all the requirements of the Affordable Care Act
• Offered through EssentialStaffCARE
• Provides coverage for employees and dependents
• Offers a “Buy Up” option for flat rate benefits for inpatient
and outpatient care
• Includes Employer contributions for employee only
premium costs
THE MV PLAN DOES NOT PROVIDE SUBSTANTIAL
IN-HOSPITALIZATION AND PHYSICIAN SERVICES
BENEFITS
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Eligibility
• Full time employees working an average of 30 hours per
week or an average of 130 hours per month. This is
determined in the first 60 days of employment (waiting
period). Coverage begins for full time eligible employees
after 90 days of employment.
• Dependent children of enrolled employees, up to age 26
• Spouse of enrolled employees who are not eligible for
medical coverage through their own employer
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Premium Payments
• Premiums are paid one month in advance
• Premiums are not payroll deducted
• Premiums are direct billed to employee’s debit,
credit, or Global cash card by EssentialStaffCARE
• Premiums for January 1, 2015 effective date will be
charged to your cash, credit or debit card the first
week in December 2014
• Failure to make payments will result in benefit
termination
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Basic MV Plan Benefits
MVP
MVP Covered Benefits
Network
Non-Network
Deductible
$0 / $0
Coinsurance
Out of Pocket Maximum
100%
$1,850 /
$12,700
Network
$500 /
$1,000
40%
N/A
MVP Covered Benefits
PPO Network
Emergency Room Services
Primary Care Visit to Treat an Injury
or
Illness
(exc.
Well
Baby,
Preventive, and X-rays)
Specialist Visit
Imaging (CT, PET Scans, MRIs)
Laboratory Outpatient and Professional Services
X-rays and Diagnostic Imaging
Preventive Care/Screening/Immunization (MEC)
Chronic Disease Management Benefit
Non-Network
Multiplan
$400 Copay
$400 Copay
$15 Copay
Ded/Coins
$25 Copay
$400 Copay
$50 Copay
$50 Copay
100%
Covered
100%
Covered
Ded/Coins
Ded/Coins
Ded/Coins
Ded/Coins
Ded/Coins
$15 Copay
$25 Copay
$75 Copay
Ded/Coins
Ded/Coins
Ded/Coins
Ded/Coins
Prescription Drugs
Generics
Preferred Brand Drugs
Non-Preferred Brand Drugs
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MV Plan Buy Up Benefit Option
Benefit Paid
Per Day
Days Per
Year
Inpatient Benefits
Hospital Indemnity
$ 300
150
Intensive Care
$ 600
30
Inpatient Surgical (Flat Rate Benefit)
$ 300
1
Anesthesia Benefit
$
75
1
Outpatient Surgical (Flat Rate Benefit)
$ 200
-
Anesthesia Benefit
$
50
-
Outpatient Surgical Facility
$ 200
-
Outpatient Benefits
(Outpatient Maximum $1,000)
THE MV PLAN DOES NOT PROVIDE SUBSTANTIAL
IN-HOSPITALIZATION AND PHYSICIAN SERVICES BENEFITS
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Employee Cost
Employee Hourly Rate $7.25 - $9.99
Basic Plan
Monthly
Buy Up Option
Monthly
$ 89.54
$114.14
Employee +
Child(ren)
$170.52
$207.75
Employee + Spouse
$174.20
$226.51
Employee + Family
$259.79
$324.65
Employee Only
(After Employer Contribution)
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Employee Cost
Employee Hourly Rate $10.00 and Up
Basic Plan
Monthly
Employee Only
Buy Up Option
Monthly
$116.78
$141.38
Employee + Child(ren)
$197.76
$234.99
Employee + Spouse
$201.44
$253.75
Employee + Family
$287.03
$351.89
(After Employer Contribution)
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Cost of Coverage While Not On Assignment
• You can continue your coverage while you are not working
• You will be responsible for the entire cost of the coverage
Basic Plan
Monthly
Employee Only
$169.78
$194.38
Employee +
Child(ren)
$250.76
$287.99
Employee +
Spouse
$254.44
$306.75
Employee + Family
$340.03
$404.89
(No Employer Contribution)
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Buy Up Option
Monthly
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Supplemental Benefit Options
• You may enroll in supplemental insurance for the
following benefits through EssentialStaffCARE Fixed
Indemnity Plan:
- Dental Insurance
‾ Disability Insurance
‾ Life Insurance
• Supplemental benefit premiums are payroll
deducted on a weekly basis
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Wrap Up
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•
You are eligible for coverage under the MV Plan after working an
average of 30 hours per week or an average of 130 hours per month
during your first 60 days of employment (60 day waiting period)
•
Your premiums are deducted one month in advance from benefit start
date
•
Premiums for January 1, 2015 benefit effective date will be charged to
your credit or debit card during the first week of December 2014.
•
You have 30 days from your eligibility period to make any changes to
your enrollment election
•
Your coverage begins 30 days after the 60 day eligibility period
•
You can continue your coverage while not on an assignment. It is your
responsibility to contact EssentialStaffCARE if you do not want to
continue your coverage while you are not working.
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Final Note
• This presentation highlights DecisionPathHR’s Employee
benefits. While every effort has been made to ensure
accuracy, if any discrepancies exist between this
presentation and the governing plan documents, the
governing documents will prevail.
• If you need legal, financial or other professional advice, you
should seek the service of a competent professional.
• While DecisionPathHR intends to continue offering
coverage, it retains the right to change, suspend or
discontinue any of its benefits programs.
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