January and February 2015
Insurance and Benefits Management

Insurance provided to employees is determined
by Collective Bargaining with the Unions
◦ TALC Article 14, SPACL Article 13
◦ Board Contribution (a.k.a. “Board Flex”) $6372 per year
◦ Board Paid Life Insurance - $20,000
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Insurance Task Force (TALC 14.09, SPALC 13.09)
◦ Representation
 8 Union Representatives (4 TALC, 4 SPALC)
 8 Management Representatives
◦ Purpose: to review current insurance programs and to
explore alternatives, improvements, changes, and
specifications to the existing insurance programs.
◦ Meets monthly
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RFPs (Request for Proposals)
◦ Draft RFP with specifications for the insurance
being sought.
◦ Release RFP to vendors.
◦ Vendors provide responses .
◦ Responses are evaluated by ITF Subcommittee.
◦ Recommendation is taken to the full ITF Committee.
◦ ITF recommendation is taken to the Board.
◦ Board takes final action to award the contract.
◦ I&B implements plans selected.
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Dental: Humana
◦ Same plans, HMO: same rates, PPO: 3% rate increase
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Vision: Avesis
◦ Same Plan, 1.3% rate decrease
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Cancer and Other Specified Disease: AllState
◦ Same plan options, same rates
◦ Evidence of Insurability (EOI) form REQUIRED if making
any changes.
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Life Insurance: Minnesota Life
◦ Same plan options, same rates
◦ Evidence of Insurability (EOI) form REQUIRED if making
any changes.
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Disability: Reliance Standard
◦ Same plan options
 Short Term Disability (14-day or 60-day elimination)
 Long Term Disability (90-day or 180-day elimination)
◦ Rates for Long Term and 60-day Short Term remain
the same.
◦ Rates for 14-day Short Term increase 20%
◦ Disability is calculated based on age and current
salary.
◦ Evidence of Insurability (EOI) form REQUIRED if
making any changes.

Flexible Spending: WageWorks
◦ Adjudication of claims is industry standard and will
continue. This protects both the employee and the
District.
◦ No cost to the employee to participate
◦ Employee elects amount to be set aside for
qualified expenses.
◦ IRS increased the annual maximum contribution to
$2,550.
◦ Requires Annual Election
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New Vendor: Aetna effective April 1, 2015
New Onsite Representative – Kim Murphy
Two current plans (Plan 5773 and Plan 3769)
◦ Same coverage
◦ Same rates

New Plan Option: High Deductible Health Plan
with a Health Savings Account.
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Fill current prescriptions NOW with Florida Blue!
◦ Filled at the 54 day mark
◦ Receive 90 days of medication
◦ 130+ days (4+ months) of medication on hand
New prescription drug provider: Aetna Rx
File Transfer of current prescription from Prime to Aetna Rx
Ineligible transfers
◦ Certain medications legally prohibited from transfer
◦ Expired prescriptions
◦ Prescriptions with no more refills
Mandatory Generics, mandatory mail, etc. still applicable
Maintenance Options
◦ Aetna Rx Mail Order
◦ CVS Option
 Mandatory mail prescriptions available for pick up at CVS
 90 day (3X) supply
 2X copay
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Different “plan type” than what has been
offered by SDLC in the past.
It is like a 401K for medical needs
◦ Money is put aside pre-tax.
◦ Employer (District) money is added to the account
each pay period.
◦ Money is withdrawn tax-free for qualified
expenses.
 IRS determines which expenses are “qualified”.
 Same list as the Flexible Spending Accounts.
 Eligible dependents are defined by IRS, NOT the health
plan.
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Must meet deductible for all services, including
Rx, except in-network preventative care, before
benefits apply.
You pay Deductible/Coinsurance for all services
(including Rx) except preventative care.
NO COPAYs APPLY for any services, including
drug copays. Members are responsible for the
full cost of the Aetna contracted (discounted)
rate.
Employees with Family coverage (covering at
least one other person on the plan) must meet
the FAMILY deductible before any benefits are
payable for non-preventative services.
To be eligible for an HSA, you:
 Must be covered under a high deductible health
plan.
 Must have no other health coverage.
 Must be 63 or younger to enroll.
 Must not be enrolled in Medicare (EE or
dependents).
 Must not be claimed as a dependent on some else’s
tax return.
 Must not have a standard (or full purpose) Flexible
Spending Account (FSA) or HRA.
AND
 Your spouse must not have a full purpose FSA.

Plan 3769 and 5773 are the same plan at the
same rates for the next plan year.
◦ District Contributes $6372 per year ($265.50 per
pay) toward employee medical premiums.

If HDHP/HSA is elected, employee still
receives the $6372 per year, but split
between premium and the HSA.
 $4,887.60 toward premium ($203.65 per pay)
 $1484.40 into the HSA ($61.85 per pay)
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In-Network Deductibles (Employee/Family)
◦ 3769 Plan:
◦ 5773 Plan:
◦ HDHP Plan:
$500/$1,500
$1000/$3,000
$2,500/$5,000
◦ 3769 Plan:
◦ 5773 Plan:
◦ HDHP Plan:
$3,000/$6,000
$4,000/$8,000
$6,250/$12,500
Out of Pocket Maximums (Employee/Family)
Maximum HSA Contribution (2015)
◦ $3,350 Individual (employee only)
◦ $6,650 Family (employee + anyone)
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Employees can use only the amount in their account
at the time of service.
Owned and controlled by employee, portable, not
forfeited, at termination, or if you change medical
plans. Employee decides how to invest and spend the
money.
◦ Pay for current qualified medical, dental and vision
expenses.
◦ Save for future medical and retirement health care
expenses that won’t be subject to federal tax.
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Accumulated HSA funds rollover
Triple tax advantage
◦ Contributions (individuals/employers) are tax exempt
◦ No taxes on qualified withdrawals
◦ No taxes on account interest and earnings
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Currently,$265.50 per check is added to your
check under the “Board Flex” code.
Medical, Dental, Vision, and Cancer Insurance are
deducted pre-tax.
Life Insurance and Disability Insurance are
deducted post-tax.
If you elect the HDHP/HSA, your paycheck will
look different.
◦ Board Flex will be $203.65 (instead of $265.50)
◦ The balance of the Board Contribution ($61.85) will be a
new row titled “HSA” under “Employer Paid Benefits” box
Plan 3769
Plan 5773
High Deductible
Health Plan
(HDHP)**
Employee Only
$272.70
$255.96
$203.65
Employee /
Spouse
$660.33
$618.21
$552.35
Employee /
Child
$409.70
$384.00
$326.89
Employee /
Children
$574.56
$538.06
$475.20
Employee/
Family
$832.43
$779.04
$707.17
Tiers
Employee Only - Low Cost Scenario
Service
# of
Covered
Services Amount
HSA Fund
Preventive Visit (Well Adult)
PCP OV (sick visit)
Specialist OV
Generic - Retail
Brand Formulary - Retail
Employee Subtotal
HSA Used
Total Employee OOP Expense
Annual Premium
1
1
1
1
2
$220
$100
$160
$25
$110
Total
Cost
2015 Employee Cost
3769
5773
HSA
$220
$100
$160
$25
$220
$725
$0
$0
$25
$60
$0
$50
$135
$0
$0
$35
$85
$0
$50
$170
$1,484
$0
$100
$160
$25
$220
$505
$505
$135
$173
$170
$0
$0
$0
$725
HSA Balance
$979
True Employee OOP Cost with
$308
$170
$0
Premium
Assumes services are in-network, occur sequentially, and all ER HSA contributions are available at
the time of service.
Employee Only - High Cost Scenario
Service
HSA Fund
Preventive Visit (Well Adult)
PCP OV (sick visits)
Specialist OV (Orthopedic
Surgeon)
IP Hospital (3 days);
Musculoskeletal
Physical Therapy
Generic - Retail
Brand Formulary - Retail
Employee Subtotal
HSA Used
# of
Services
Covered
Amount
2015 Employee Cost
Total
Cost
3769
5773
HSA
$0
$0
$105
$1,484
$0
$300
1
3
$220
$100
$220
$300
$0
$0
$75
3
$160
$480
$180
$255
$480
1
20
10
2
$25,000
$95
$25
$110
$25,000
$1,900
$250
$220
$28,370
$2,745
$0
$0
$0
$3,000
$3,640
$0
$0
$0
$4,000
$4,048
$172
$50
$44
$5,094
$1,484
$28,370
$3,000
$173
$4,000
$0
$3,610
$0
Total Employee OOP
Expense
Annual Premium
HSA Balance
True Employee OOP Cost with Premium
$0
$3,173
$4,000
$3,610
Assumes services are in-network, occur sequentially, and all ER HSA contributions are available at the time of
service.
Employee + Family - Low Claims Scenario
Service
HSA Fund
Preventive Visit (2 Well Adult; 2
well child)
PCP OV (sick visits)
Specialist OV
Generic - Retail
Employee Subtotal
HSA Used
Total Employee OOP Expense
Annual Premium
HSA Balance
True Employee OOP Cost with
Premium
# of
Covered
Services Amount
Total
Cost
2015 Employee Cost
3769
5773
HSA
$0
$0
$1,484
4
$220
$880
$0
$0
$0
2
2
12
$100
$160
$25
$200
$320
$300
$1,700
$50
$120
$0
$170
$70
$170
$0
$240
$200
$320
$300
$820
$820
$1,700
$170
$13,606
$240
$12,324
$0
$12,085
$664
$13,776
$12,564
$12,085
Assumes services are in-network, occur sequentially, and all ER HSA contributions are
available at the time of service.
Employee + Family - High Cost Scenario
Service
# of
Services
Covered
Amount
Total
Cost
HSA Fund
(4) Preventive Visits (2 Well Adult; 2 well
child)
PCP OV (sick visits)
Specialist OV (Cardiologist,
Endorinologist)
Inpatient Hospital (4 days) - heart attack
Generic - Retail
Brand Rx Retail *
2015 Employee Cost
3769
5773
HSA
$0
$0
$1,484
4
$220
$880
$0
$0
$0
3
$100
$300
$75
$105
$300
11
$160
$1,760
$660
$935
$1,760
1
24
24
$185,000
$25
$145
$185,000
$600
$3,480
$2,340
$0
$600
$3,065
$0
$600
$7,940
$120
$696
Employee Subtotal
HSA Used
$192,020
$3,075
$4,705
$10,816
$1,484
Total Employee OOP Expense
$192,020
$3,075
$4,705
$9,332
$13,606
$12,324
$12,085
Annual Premium
HSA Balance
True Employee OOP Cost with
Premium
$0
$16,681
$17,029
Assumes services are in-network, occur sequentially, and all ER HSA contributions are available at the
time of service.
$21,416