2015 Medical Plan Options, Health
Savings Accounts & Flexible Spending
PRESENTED TO:
PRESENTED BY:
Greg Biese
Vice President,
Senior Benefits Consultant
Associated Financial Group
Employee Benefits. Insurance. HR Solutions.
HEALTHCARE REFORM:
YESTERDAY, TODAY & TOMORROW
Cadillac
Tax
Fees
●
●
●
●
●
●
●
Individual Mandate
Private Exchanges
Medicaid Expansion
Play or Pay
(Employer Mandate)
Wellness Incentives
Government Reporting
Medical Access
Rules
Plan
Design
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
2015 MEDICAL ELIGIBILITY & RATES
Eligibility & Rates
Eligibility
Domestic Partner Coverage
PPO Plan
HDHP Plan (HSA)
.75 FTE (Grandfather those currently enrolled in the health plan) *
Same sex partners are now eligible for coverage
Monthly Rates (Employee)
Single
$105.00
$79.00
Employee +1
$209.00
$160.00
Family
$311.00
$237.00
Single
$1,260.00
$948.00
Employee +1
$2,508.00
$1,920.00
Family
$3,732.00
$2,844.00
Annual Rates (Employee)
Spousal Surcharge
$75 per month
* St. Norbert College reserves the right to change the eligibility requirements at any time.
Effective January 1, 2015, St. Norbert College’s medical will implement a Spouse Medical Insurance Coverage
Statement, requiring that an employee’s spouse enroll in at least single medical coverage through his/her employer
to serve as their primary insurance coverage, or pay an additional surcharge to enroll or maintain enrollment in St.
Norbert College’s medical plan as primary coverage. This additional surcharge is $37.50 twice a month ($900
annually)
All employees electing coverage for his/her spouse must complete the Spouse Medical Insurance Coverage
Statement. If your spouse is covered under the College’s medical plan currently and you do not return this coverage
statement, you will be assessed the additional surcharge until St. Norbert College receives the proper notification
from you.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
2015 BENEFIT HIGHLIGHTS
Benefit Highlights
PPO Plan
HDHP Plan (HSA)
Deductible
In-Network
Out-of-Network
Coinsurance
In-Network
Out-of-Network
Out-of-Pocket Max
In-Network
Out-of-Network
Embedded Deductible
$750 (Single); $1,500 (EE+1); $2,250 (Family)
$1,001 (Single); $2,002 (EE+1); $3,303 (Family)
Non-Embedded Deductible
$2,000 (Single); $4,000 (Family) (1)
$4,000 (Single); $8,000 (Family) (1)
80%
60%
Includes Deductible and Medical & Rx Copays
$1,500 (Single); $3,000 (EE+1); $4,500 (Family)
$3,000 (Single); $6,000 (EE+1); $9,000 (Family)
90%
70%
Includes Deductible
$4,000 (Single); $8,000 (Family) (1)
$8,000 (Single); $16,000 (Family) (1)
n/a
$500 (Single); $750 (Family)
$20 Copay; then Deductible, 80% Coinsurance
$20 Copay; then Deductible, 60% Coinsurance
Deductible, 90% Coinsurance
Deductible, 70% Coinsurance
100%
100%
100%
Deductible, 70% Coinsurance
Deductible, 80% Coinsurance
Deductible, 60% Coinsurance
Deductible, 90% Coinsurance
Deductible, 70% Coinsurance
Deductible, 80% Coinsurance
Deductible, 60% Coinsurance
Deductible, 90% Coinsurance
Deductible, 70% Coinsurance
HSA Annual Employer Contribution
Office Visits / Instacare
In-Network
Out-of-Network
Routine/Preventive Care
In-Network
Out-of-Network
Inpatient Hospital Services
In-Network
Out-of-Network
Outpatient Hospital Services
In-Network
Out-of-Network
(1) IMPORTANT HSA PLAN NOTICE: No individual family member's deductible or out-of-pocket is
considered satisfied until the Full-Family deductible and out-of-pocket has been met.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
2015 BENEFIT HIGHLIGHTS (CONT.)
Benefit Highlights
PPO Plan
HDHP Plan (HSA)
In-Network
$50 Copay; then Deductible, 100% Coinsurance
Deductible, 90% Coinsurance
Out-of-Network
$50 Copay; then Deductible, 100% Coinsurance
Deductible, 70% Coinsurance
$100 Copay; then Deductible, 100% Coinsurance
Deductible, 90% Coinsurance
Same as In-Network Benefit
Same as In-Network Benefit
Deductible, 100% Coinsurance
Deductible, 90% Coinsurance
25% ($10 Minimum, $50 Maximum)
Deductible, 90% Coinsurance
Generic
$30 Copay
Brand
$90 Copay
Deductible, 90% Coinsurance
Generic Preventive HSA Drugs are covered at
100% (Mail Order Only).
Urgent Care
Emergency Room
In-Network
Out-of-Network
Ambulance Services
In-Network / Out-of-Network
Retail Prescription Drugs
Generic
Brand / Formulary
Non-Formulary
Mail Order Prescription Drugs
Contraceptive Coverage
No coverage, but members legal right to access coverage will be accommodated through UMR
What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood
pressure, blood thinner, and beta blockers.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
PPO PLAN EFFECTIVE JANUARY 1, 2015
Preventive Services Unchanged
Increase to Deductible and Out-of-Pocket Maximums
• All medical and Rx copays (1) apply to maximum out-ofpocket
Prescription Drug Plan Design Unchanged
• Costs
• New generics drugs
Contraceptive Coverage Outside of Plan
• UMR & Optum Rx
(1) Due
to Health Care Reform changes, beginning in 2015, all copays, including
pharmacy copays, will apply to the out-of-pocket maximum.
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
HDHP PLAN (HSA) EFFECTIVE JANUARY 1, 2015
Preventive Services
• 100% Coverage (In-Network)
Deductible and Out-of-Pocket Maximums (Non-Embedded)
• No individual family member’s deductible or out-of-pocket is considered
satisfied until the ‘Full Family’ deductible and out-of-pocket has been met.
Prescription Drugs
• Retail & Mail Order – Subject to Deductible & 90% Coinsurance
• Generic Preventive Drugs covered at 100% when filled through Mail
Order.
Contraceptive Coverage Outside of Plan
• UMR & Optum Rx
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
PREVENTIVE SERVICES
Certain services can be done for
preventive or diagnostic reasons.
Covered preventive services performed
specifically for preventive screening with
no known symptoms, illnesses or history
are generally covered as preventive care,
subject to age and gender guidelines and
health status.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
DIAGNOSTIC SERVICES
• Diagnostic services are generally not covered under the preventive
care benefit but may be covered under another portion of your
medical benefit plan.
• Services are considered diagnostic when a person:
– Has abnormalities found on previous preventive or diagnostic
services that require further diagnostic services; or
– Had abnormalities found on previous preventive or diagnostic
services that would recommend a repeat of the same service
within a shortened time period from the recommended
preventive screening time period based on age and gender; or
– Had a symptom(s) that required further diagnosis
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
WHAT EXACTLY IS AN HSA?
PART 1:
H
S
A
HIGH DEDUCTIBLE
HEALTH PLAN
(HDHP)
PART 2:
TWO PARTS
TO AN HSA
HEALTH SAVINGS
ACCOUNT
(HSA)
Intended to cover
serious illness or
injury once the
deductible is met.
Used to cover
expenses until the
deductible is met.
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
IMPORTANT INFORMATION REGARDING YOUR
HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
There are NO office visit, emergency room, or
prescription drug copays.
All out-of-pocket expenses count towards the
deductible & out-of-pocket maximum.
The preventive healthcare benefit is still covered at
100% (all participants); includes services under the
Women’s Care Act. Does not include contraceptive
services.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
IMPORTANT INFORMATION REGARDING YOUR
HSA / HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
The deductible and coinsurance
out-of-pocket maximum for family
is a true family deductible and
out-of-pocket maximum.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
WHO IS ELIGIBLE FOR HSA’s?
Any employee that:
• Is covered by an HDHP
• Is not covered by another
non-HDHP health plan
• Is not enrolled in Medicare
• Cannot be claimed as a
dependent on someone
else’s tax return
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
ADVANTAGES OF AN HSA
Ownership - you own the funds in your HSA
Tax-free
Portable
No “use it or lose it”
You may change your employee contribution amount
throughout the year.
You can choose to invest your savings in an investment
account.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
HSA ANNUAL CONTRIBUTIONS – 2015
• Annual contributions to the HSA are limited to $3,350 single / $6,650
family (Employer & Employee Contributions Combined)
• St. Norbert College - Annual HSA Contribution
o
$500 - Single Coverage; $750 - Family Coverage
o
Employer contributions will be deposited twice per year

Single: $333 (1st Payroll in January); $167 (1st payroll in September)

Family: $500 (1st payroll in January); $250 (1st payroll in September)
• Benefits are subject to federal regulations. Minimum deductibles,
maximum out-of-pocket limits and contribution maximums are
determined annually
• Account holders age 55 and up may make additional contributions of
$1,000 in 2015.
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
CONTRIBUTING TO YOUR HSA
• You can elect how much money you want to put into your HSA.
– It is your responsibility to ensure that you do not exceed the
maximum HSA contribution limit.
• Your employer will deduct this amount on the date of each payroll
on a pre-tax basis and the money will be direct-deposited to your
HSA account.
• You may also deposit funds directly into your bank account with
post-tax dollars and claim the amount on your tax return.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
WHO DETERMINES WHETHER HSA DISTRIBUTIONS
ARE USED EXCLUSIVELY FOR QUALIFIED MEDICAL
EXPENSES?
• YOU!
• Your bank will submit information to the IRS each year to report
contributions and withdrawals.
• You will need to report withdrawals on your federal income tax
forms.
• Individuals who establish HSAs should maintain records of their
medical expenses to show that the distributions have been made
exclusively for qualified medical expenses.
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
HSA WITHDRAWALS / DISTRIBUTIONS
• Federal tax treatment of funds used:
Expense Type
Age
Tax Treatment
Qualified medical expense
Any
Tax-free
Non-medical expense
Over 65
Ordinary tax
Non-medical expense
Under 65
Ordinary tax +
20% penalty
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
ELIGIBLE MEDICAL EXPENSES FOR TAXFREE DISTRIBUTIONS
• Qualifying medical expenses - IRS Publication 502
•
Dental and vision care expenses
• Long-term care insurance
• Premiums for coverage while receiving
unemployment compensation
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
BANK INFORMATION
At the end of the year, the bank will
send each account beneficiary a
statement with the fair market value of
the HSA and forms with the total
contributions and distributions:
This
information is
reported to
the IRS.
You will need to
complete form
8889 and file with
your personal
income tax return.
Form 1099-SA
(distributions)
Form 5498-SA
(contributions,
rollover deposits
and fair market
value for each
calendar year)
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
WAYS TO BE A MORE COST CONSCIOUS
CONSUMER OF HEALTH CARE
• Get Healthy and Stay Healthy!
• Use Appropriate ‘Levels of Care’ – Fast Care/Urgent Care/Emergency Room
• Use In-Network Providers
• Consider Generic or Mail Order prescriptions
• Consider $4 Generic Programs at Target & Wal-Mart Stores
• Ask doctors and pharmacists questions
o Most effective treatment
o Cost of treatment
o Alternatives to treatment
• Support and participate in company sponsored wellness and disease
management initiatives
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
LEVELS OF CARE SAMPLE
Available extended hours & weekends
Available extended hours & weekends
Available extended hours & weekends
in some cases
Available extended hours &
weekends
No Cost
Available 24/7
COST
Emergency Room
Complex chest pain,
trauma
Urgent Care Clinic
Sprains, strains, sutures;
typically hospital-based
Primary Care Provider
Wellness/preventive/screening services,
comprehensive management of acute
and chronic conditions
Convenience – Walk-In Care Clinic
Colds, flu, quick service
$500+
$200+
$125+
$49$69
Nurse Line
Health and first aid questions, premium provider search,
guidance on appropriate facility and location to meet care
needs
$0
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
PRESCRIPTION COST AND SAVINGS
OPPORTUNITIES - $4 PRESCRIPTIONS
SAVE on Prescription Drug Costs & Copays!
WHAT IS IT?
Many retail pharmacies have recently created new and innovative programs to help control prescription drug
costs for consumers. One of the most popular is the $4 prescription drug program, which has allowed
consumers to take advantage of tremendous savings for their everyday prescriptions needs. This program is
offered at many national and regional pharmacies, including those shown above, and typically includes
hundreds of medications in a variety of therapeutic classifications.
Other programs that may be available in your area may include free antibiotics and various 90-day supply
discounts for maintenance medications. Many pharmacies also have low-cost membership programs that
allow you to access significant savings. It is likely that there will be new programs and enhancements to
existing programs in the future as pharmacies continue to compete for the right to fill your prescriptions.
Interaction with insurance - continue to provide your insurance information to ensure you receive the
deepest discount and that your coinsurance is applied to your deductible and/or out-of-pocket maximum. If
your insurance company has negotiated a deeper discount than $4 (or the pharmacy’s discount rate) for the
prescribed medication, you will be charged the lesser of the two prices.
KEEP MONEY
IN YOUR BANK!
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
HEALTH SAVINGS ACCOUNTS (HSA) AND
FLEX SPENDING ACCOUNTS (FSA)
One of the qualifications to have an HSA is that you are not
covered by any other low deductible insurance – this includes an
FSA.
Therefore, if you enroll in the HDHP Plan and open an HSA
Account, you may not participate in a Standard FSA Plan.
However, you may enroll in a Limited FSA which can be
used to reimburse Dental & Vision expenses ONLY.
You may still participate in the dependent care account.
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Flexible Spending Account (FSA)
Healthcare FSA
 Annual limit of $2,500 (capped per IRS regulations)
 Pre-tax dollars used to pay for qualified medical, dental & vision
expenses
 New: Limited Flex (reimbursement for dental & vision expenses only)
for those enrolled in the HDHP Plan (HSA)
 New: $500 Roll-Over Feature. Allows Health Care FSA participants
to roll-over up to $500 of their previous year’s funds and add them to
the new year plan. Rollover funds can only be used after the dollars
from the new year’s plan have been used up. (Unused FSA funds in
2015 will roll-over into 2016)
Dependent Care FSA
 Annual limit of $5,000 (pre-tax dollars used to pay for daycare
expenses)
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
EBC FEATURES: Submitting claims is EASY
My Mobile Account Assistant
– For Android and iPhone
– Camera scans documentation
– Upload with claim information
– Receive notification when a claim is processed
– Use the app to review FSA account information
Submit claims online or using paper
• My Account Assistant
– Your secure web portal lets you review
all aspects of your account online at www.ebcflex.com
– Submit claims and documentation
– Receive notification when a claim is processed
• Claim Form
– Mail or fax a paper form with attached documentation
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
1/1/2015 CHECKLIST
• New ID cards issued – new member and group number
• Other Insurance Questionnaire
• Re-Register on UMR.com
• Same Network – Choice Plus
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
Better information, better decisions,
better health on UMR.com
UMR.com gives members
access to:
• Health cost estimator tools
MyHCE (My Healthcare Cost
Estimator)
• Provider search capability to
identify quality and cost
efficient providers classified
as Tier 1.
• Health Education Library
• Resources on healthy living
• Access to OptumRx
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
SECURE Mobile Web Access
(No Download Necessary)
What’s new
Find out about new tools
and information to help
you live a healthier life.
Simplified navigation
Need help?
Home: Return to the main menu.
Menu: Display the menu.
Gear: Log out or learn more.
Click the question mark any time
you are confused about a term or
benefit and get an explanation.
Log in
Enter your username
and password for instant
access to all our mobile
inquiry tools.
Look up claims
Look up a claim for
yourself or an
authorized dependent.
Check your benefits
View medical and/or
dental benefits, as well as
persons covered.
Find a provider
Need to find a doctor fast?
Access an alphabetical
listing of network
providers.
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View, scan or fax your ID card
.
View your ID card, allow your provider
to scan the on-screen bar code for
instant access to your benefit
information, and/or fax it to a provider.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
PPO Plan vs. HDHP/HSA Plan (OptumRx)
Deductible
Maximum Out-ofPocket (Includes
Medical & Rx)
Copayment /
Coinsurance
Generic Preventive
HSA Medication
PPO Plan
HDHP Plan (HSA)
No Deductible on Rx
$2,000 Single
$4,000 Family
$1,500 Single
$3,000 EE+1
$4,500 Family
$4,000 Single
$8,000 Family
Retail: 25% ($10 Min / $50 Max)
Mail Order: $30 Copay (Generic)
$90 Copay (Brand)
n/a
Deductible, 90% coinsurance
100% coverage if filled at mail
order
What are examples of preventive drugs: medications used for diabetes, heart disease,
cholesterol, blood pressure, blood thinner and beta blockers.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Contraceptive Services Only (CSO)
coverage for Eligible Organizations

Coverage for contraceptives services only (both medical and/or Rx, as provided by
insurer/TPA) as required by PPACA.







Provides 100% coverage for standard, eligible preventive contraceptive services
Separate from the customer’s medical policy
No cost to employer – not passed on through ASO administrative fees
Eligible
Organization
Contraceptive
Services Only
(CSO) coverage
Must be prescribed (even OTC contraceptives) and filled at a network pharmacy
Cover certain female birth control drugs and services only
Medical/Rx
(non CSO)
coverage
All female members, no matter their age, will have birth control available to them
Age limits not applied because:
1.
The age that a woman is no longer able to have children is different for everyone.
2.
It is up to the family, not the health insurance company, to decide if or at what age a
young woman might get birth control.
3.
Health insurance companies are required by the health reform law to provide this benefit
to ALL females.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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www.optumrx.com
• Review benefit highlights
and coverage
• Access to Mail Service
Pharmacy prescriptions
• My Prescription Dashboard
to refill, renew and manage
prescriptions
• My Medicine Cabinet to
manage and price
prescription and OTC
medications
• Locate a retail pharmacy
• Explore lower-cost
alternatives and options
• Download order forms
• Access general health
information
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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www.optumrx.com
Personalized Rx Dashboard
Visual Image of All Drugs
– Quickly identify Refills
– View drugs for renewal
– Check Order Status
At-a-Glance Calendar for
expiration and refill dates
Quick drop down box to change
account for
Household/Caregiver view
Simple tab design and quick
links to improve navigation
and user experience.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Mobile Website
REQUIRED FORMS TO BE COMPLETED
Deadline for enrollment forms is November 26, 2014. Return
completed forms to your Human Resources Department.
 UMR Enrollment Form (New Enrollees, Adding/Removing
Dependents, Enrolling in the HDHP/HSA Plan, Dropping Coverage)
 Not required if you are keeping your current coverage
 Spouse Medical Insurance Coverage Statement.
 Required if you have a spouse covered under the SNC plan.
 Associated Bank Health Savings Account (for those enrolling in the
HDHP/HSA Plan)
 Complete application and applicable forms to open your HSA bank account
and start contributing!
 Delta Dental Enrollment Form (New Enrollees, Adding/Removing
Dependents Only, Dropping Coverage)
 EBC - FSA Enrollment Form
 Enrollment does not carry over - employees who wish to participate must
enroll again for 2015
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St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx
QUESTIONS?
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Copyright 2014 by Associated Financial Group, LLC
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx