2014 OPEN ENROLLMENT
By:
Don Zimmerman
Director, Human Resources
Ana B. Graci, HIA
Kara Buell
Benefit Consultants
Hub International
Agenda
2014 Changes
Wellness Benefits
Be Smart About Your Benefits
Your Medical Benefits
Your Other Benefits
Your Costs
Websites
THINK TOURO!
2014 Changes
• Your current medical ID card will expire 12/31/2013
• Change in UHC Networks to the Choice Plus Options
Network
• New medical ID cards will be mailed to you in December
• Be sure to present your new ID card to your physician
• UMR will be the new administrator for FSA and will issue
new debit cards (new for CCPI)
• AlwaysCare is the new voluntary fully-insured vision
carrier and will issue ID cards
• Assurant dental is the new voluntary, fully-insured carrier
with 2 plan options - high and low (new for CCPI)
• NEW Wellness coverage – 100%, no office co-pays
Wellness Prevention
• Wellness Prevention services will be covered at 100%, no
co-pay, effective 2014
• Related readings and interpretations will also be covered
at 100%.
• There will no longer be any out-of-pocket related expenses
to you or your dependents for wellness check-ups.
• If you are enrolled in the Allstate Cancer plan, Allstate will
pay you a $50 wellness incentive for an annual check-up
Be Smart About Your Benefits (cont’d)
THINK TOURO:
• Touro offers two heath plan options.
• The base plan and enhanced plan.
• 92% of Touro employees participate in the
base plan. With this plan employees use Touro
facilities, such as Touro Outpatient Lab and the
Imaging Center EXCLUSIVELY! The
enhanced plan allows employees to choose
Touro facilities and any other provider covered
by United Healthcare.
Be Smart About Your Benefits (cont’d)
THINK TOURO!
• It is up to you to choose providers within the
coverage offered by your health plan.
• A base plan member should always ask to have
diagnostic testing and lab work done at Touro.
• Keeping the services at Touro helps the
hospital keep health expenses down and saves
you money.
Base Plan (EPO)… THINK TOURO!
Touro Hospital
& Children’s
Services NPAT
excluding Ochsner
and Tulane
Services NPAT
including Ochsner
and Tulane
Non-Network
Deductible
$0
$500 Individual
$1000 Family
$500 Individual
$1000 Family
Not Applicable
Office Co pay
N/A
$20
$20
Not Covered
Emergency Room
$100 (waived if
admitted)
$250 (waived if
admitted)
$250 (waived if
admitted)
$250 (waived if
admitted)
$50.00
$50.00
$50.00
$50.00
$20.00
$20.00
$20.00
$20.00
Coinsurance
Facility Charges
Hospital Copay inpt
90%
80% after deductible
80% after deductible
Not Covered
$100/Day $300/Admit
$150/Day - $450/Admit
$150/Day - $450/Admit
Therapies
90%
80% after deductible
80% after deductible
Out of Pocket
$3,000 Individual
$6,000 Family
$4,000 Individual
$8,000 Family
$4,000 Individual
$8,000 Family
No limit
Lifetime Maximum
Annual Maximum
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Ambulance Co pay
Urgent Care UHC Facility
NPAT – Not Provided at Touro
Base Plan (EPO)… THINK TOURO!
Touro Hospital &
Children’s
Prescription Drugs
Services NPAT
excluding Ochsner
and Tulane
Services NPAT
including Ochsner
and Tulane
$100
deductible/individual
$10 co pay (ded waived)
$30 co pay
$45 co pay
2 co pays for a 90 day
supply
$100
deductible/individual
$10 co pay (ded waived)
$30 co pay
$45 co pay
2 co pays for a 90 day
supply
Not Covered
80% after deductible
80% after deductible
Not Covered
$150/Day - $450/Admit
$150/Day - $450/Admit
80% after deductible
$20 Co pay
80% after deductible
$20 Co pay
100%
100%
100%
100%
100%
100%
50% after deductible
80% after deductible
100%
50% after deductible
50% after deductible
100%
N/A
Generic
Formulary
Brand
Mail Order
Mental & Nervous
and Substance Abuse
Inpatient
N/A
Outpatient
Routine Well Adult
and Child Care
Mammograms
Diagnostic lab
Reading &
Interpretation
Non-Network
Not Covered
Base Plan (EPO)… THINK TOURO!
Touro Monthly
Contribution
$ FT/$PT
Employee
Full-Time $/Month
$/Pay Period
Employee
Part-Time $/Month
$/Pay Period
Single
$277.26 Full-Time
$217.70 Part-Time
$123.44/Month
$61.72/PP
$183.00/Month
$91.50/PP
Employee &
Spouse
$529.03 Full-Time
$384.32 Part-Time
$272.38/Month
$136.19/PP
$417.09/Month
$208.55/PP
Employee &
Child(ren)
$389.17 Full-Time
$266.59 Part-Time
$251.96/Month
$125.98/PP
$374.54/Month
$187.27/PP
Family
$793.01 Full-Time
$610.43 Part-Time
$353.00/Month
$176.50/PP
$535.58/Month
$267.79/PP
Coverage Level
Enhanced Plan (PPO)
Touro Hospital
Children’s
In-Network
excluding Ochsner
and Tulane
In-Network
including Ochsner
and Tulane
Non-Network
Deductible
$0
$500 Individual
$1000 Family
$750 Individual
$1500 Family
$750 Individual
$1500 Family
Office Copay
N/A
$20
$20
Not Covered
Emergency Room (Life or Limb
Threatening)
$100 (waived if
admitted)
$250 (waived if
admitted)
$250 (waived if
admitted)
$250 (waived if
admitted)
Ambulance Copay
Urgent Care UHC Facility
$50.00
$20.00
$50.00
$20.00
$50.00
$20.00
$50.00
$20.00
Coinsurance
Facility Charges
Hospital Copay
90%
$100/day-$300/admit
80% after deductible
$150/day-$450/admit
50% after deductible
$500/confinement
50% after deductible
$500/confinement
Therapies
90%
80% after deductible
50% after deductible
50% after deductible
Out of Pocket
$3,000 Individual
$6,000 Family
$4,000 Individual
$8,000 Family
$80,000 Individual
$160,000 Family
No Limit
Lifetime Maximum
Annual Maximum
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Unlimited
Enhanced Plan (PPO)
Touro Hospital &
Children’s
Prescription Drugs
In-Network
excluding Ochsner and
Tulane
In-Network
including Ochsner
and Tulane
$100 deductible/individual
(waived for generic)
$10 co pay
$30 co pay
$45 co pay
2 co pays for a 90 day
supply
$100
deductible/individual
(waived for generic)
$10 co pay
$30 co pay
$45 co pay
2 co pays for a 90 day
supply
Not Covered
80% after deductible
$250/confinement
80% after deductible
50% after deductible
$500/confinement
50% after deductible
50% after deductible
$500/confinement
50% after deductible
$20 co pay
$20 co pay
N/A
100%
100%
100%
100%
100%
100%
50% after deductible
80% after deductible
100%
50% after deductible
50% after deductible
100%
N/A
Generic
Formulary
Brand
Mail Order
Mental & Nervous and
Substance Abuse
Inpatient
N/A
Outpatient
Routine Well Adult and
Child Care
Mammograms
Diagnostic lab
Reading &
Interpretation
Non-Network
Not Covered
Enhanced Plan (PPO)
Coverage Level
Touro Monthly
Contribution
$ FT/$PT
Employee
Full-Time $/Month
$/Pay Period
Employee
Part-Time $/Month
$/Pay Period
Single
$321.68 Full-Time
$229.21 Part-Time
$190.33/Month
$95.17/PP
$282.80/Month
$141.40/PP
Employee &
Spouse
$610.72 Full-Time
$404.06 Part-Time
$413.30Month
$206.65/PP
$619.96/Month
$309.98/PP
Employee &
Child(ren)
$453.77 Full-Time
$271.05 Part-Time
$365.45/Month
$182.73/PP
$548.17/Month
$274.09/PP
Family
$873.33 Full-Time
$593.36 Part-Time
$591.03/Month
$295.52/PP
$871.00/Month
$435.50/PP
Dental Benefits through Assurant
Low Option
High Option
Calendar Year Maximum
$1,000 per Individual
$1,500 per Individual
Calendar Year Deductible
$0
$25 per Individual
Preventive Care
85%
100% (deductible
waived)
Basic Expenses
50%
80%
Major Expenses
30%
50%
Orthodontia
(child only)
N/A
50% to $1,000 Lifetime
Maximum
2014 Voluntary Dental Premiums
Low Option
High Option
Single
$17.47/Month
$8.74/PP
$29.97/Month
$14.99/PP
Employee & Spouse
$34.17/Month
$17.09/PP
$60.71/Month
$30.36/PP
Employee &
Child(ren)
$39.65/Month
$19.83/PP
$67.11/Month
$33.56/PP
Family
$59.45/Month
$29.73/PP
$100.82/Month
$50.41/PP
Coverage Level
Greater benefits are received by using the Assurant network
Voluntary Vision Plan through AlwaysCare
Frequency
Co-Pays
In-Network
Out-of-Network
Exam
12 Months
$10 Co-pay
Up to $40 Allowance
Frames
24 Months
$25 Co-pay up to $130
Allowance
Up to $50 Retail Allowance
Lenses
12 Months
$25 Co-pay
Allowances: $40 Single/$60
Bifocal/$80 Trifocal
12 Months
$25 Co-Pay up to $130
Allowance
Up to $105 Allowance
Coverage
Level
Contacts
Greater benefits are received by using the AlwaysCare network
Voluntary Vision Premiums
Coverage Level
Employee
Full-Time $/Month
$/Pay Period
Single
$5.47/Month
$2.74/PP
Employee & Spouse
$10.48/Month
$5.24/PP
Employee &
Child(ren)
$10.96/Month
$5.48/PP
Family
$16.80/Month
$8.40/PP
Flexible Spending Accounts - UMR
• Pre-Tax Premium Contributions
• Health Flexible Spending Account (FSA)
– Un-reimbursed Medical Expenses ($2,500.00 max).
– Common items for reimbursement:
• Deductibles, co pays, out-of-pocket expenses, laser eye surgery,
dental fees.
– Dependent Care Flexible Spending Account (FSA)
– Dependent Care/Child Care ($5,000.00 max);
– Daycare expenses for PRE-KINDERGARTEN and UNDER.
– Before and After School expenses for any child 12 yrs of age and
under (No overnight camps - only day camps).
– Elder Care expenses for a parent who lives with you and needs
round the clock care.
How Does Flexible Spending Work?
• Voluntary Participation
• Annual Enrollment – Calendar Year
• Careful Planning Required
• No longer use it or lose it! Funds can now be rolled over up to
$500 maximum for the medical FSA only.
• Annual amount divided by 24 paychecks
• Reimbursements are administered through a third party
administrator - UMR
• Medical & Dependent FSA Debit Cards – New Debit Cards will be
issued for 2014!
• Debit Card transactions require substantiation of qualified
expenses. You may receive notification from UMR requesting proof
of qualified expenses.
FSA Qualifying Event
You can change your expense election during the plan year if there is a
major change in your family status due to:
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Marriage
Divorce
Birth/adoption of child
Part-time/full-time status
Termination/commencement of employment
Loss of a dependent
SCHIP eligibility
The benefits below will remain the
same for the 2014 plan year
• Touro Medical Plans – Based and Enhanced
• Life Insurance and AD&D through The Hartford.
• Voluntary Life, Employee, Spouse and Child Insurance through
The Hartford.
• Short and Long Term Disability through The Hartford.
• Cancer Benefit through Allstate Workplace Benefits.
• MetLife Tax Savings Annuity (TSA)
– Base limit employee deferral amount will remain at $17,500 for 2014
– Age 50+ deferral amount will remain at $5,500.00 for 2014
REMINDER:
Benefit Choices That Require Action
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Enrolling for the first time
Adding or dropping dependent coverage
Changing medical plans (Base to Enhanced or vice versa)
Enrolling in new Dental and Vision plans
Increasing life insurance coverage
Participation in the Flexible Spending Account (FSA)
Waiving coverage
All forms are due in Human Resources no later than 11/22/2013.
You must complete the proper enrollment forms and submit them to Human
Resources for changes to take effect on January 1, 2014.
REMINDER ~ NO ACTION IS REQUIRED:
If you are currently enrolled in medical, cancer, or life and disability and
are not changing your coverage, you and your dependents coverage(s)
will remain the same for 2014.
Websites
Medical - UMR
•
www.umr.com / 1-800-826-9781
Pharmacy Benefit Manager – CVS/Caremark
•
www.caremark.com / 1-800-334-8134
Dental - Assurant
•
www.assurant.com / 1-800-442-7742
Vision – AlwaysCare
•
www.alwayscarebenefits.com / 1-888-729-5433
Life, Long and Short Term Disability - The Hartford
•
www.groupbenefits.thehartford.com / 1-888-563-1124
Flexible Spending Account Plan - UMR
•
www.umr.com / 1-800-826-9781
MetLife Tax Sheltered Annuity
•
Julian Good, Financial Advisor - 504-224-2793
Touro Infirmary will
continue to provide a high
quality level of benefits to
our employees at a cost that
is competitive among the
local healthcare market.
Questions
Touro Paid Life Insurance through Hartford
Life Insurance & AD&D
Exempt Employees
Full-time employees only
1.5 x annual earnings to a
maximum of $300,000
Senior Management
3 x annual earnings
Hourly employees
1 x annual earnings to a
maximum of $50,000
Accelerated Benefits
Up to 80% of life benefit
Subject to maximum
Touro Paid LTD through Hartford – Exempt Employees
Monthly Benefit Maximum
Class I – Executives
Class II – All Other Exempt
$15,000
$ 7,000
(one year eligibility period)
Elimination Period
90 days
Benefit
60% of Monthly Earnings
Duration of Benefits
SSNRA
Mental & Nervous
Maximum 2 years
Alcohol & Drug Abuse
Maximum 2 years
Pre-Existing Condition
3
Survivor Benefit
3 months
months prior
/12
months after
Hartford Voluntary Life Insurance and AD&D
Life Insurance & AD&D
Can be purchased in increments of
$10,000 or 5 times your annual
earnings to a maximum of
$300,000. Guaranteed issue
amount $100,000
Amounts in excess of $100,000 will
require evidence of insurability.
Employee must purchase voluntary
life in order to cover spouse and/or
dependents.
Hartford Voluntary Dependent Life Insurance
and AD&D
Life Insurance and AD&D
A spouse is eligible for an amount in
increments of $5,000 or up to 50% of
the employee’s voluntary amount .
Guarantee issue amount $30,000.
Amounts greater than $30,000
requires EOI.
Dependent Children
$10,000 for children age 6 months to
19 years or to 25 if full-time student.
$250 for children age 14 days to 6
months, newborn children to age 14
days are not eligible for a benefit
How to Calculate the Monthly Life Insurance Premium
Age
Rate/1000
<30
$0.066
30 - 34
$0.075
35 – 39
$0.093
40 – 44
$0.120
45 – 49
$0.193
50 – 54
$0.284
55 – 59
$0.420
60 – 64
$0.685
65 – 69
$1.160
70 – 74
$1.840
75 – 99
$4.070
AD&D *
$0.040
Child(ren)
$1.00/mo
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Life Insurance Example
Employee age 36
$100,000 Life Insurance
Rate per $1,000 = $0.093
$100,000 x $0.093=$9,300
$9,300 divided by $1,000= $9.30
$9.30 monthly premium
*AD&D rate of $0.040 is included with life
rates.
Hartford Voluntary Short Term Disability
Benefit
66 2/3% to a maximum of
$1,500 per week
Payable
15th Day Accident
15th Day Sickness
Maximum
11 Weeks
(must exhaust EI & ETO)
How to Calculate the Monthly Short Term
Disability Premium
Age
Rate per
$10 of
Benefit
<30
$0.482
30 - 34
$0.448
35 – 39
$0.407
40 – 44
$0.366
45 – 49
$0.366
50 – 54
$0.399
55 – 59
$0.457
60 – 64
$0.548
65 +
$0.615
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$30,000 Annual Earnings
Employee age 36
$30,000 divided by 52 =
$576.92 Weekly Earnings
$576.92 x .6666= $384.57
$384.57 x .407 = $156.52
$156.52 / 10 = $15.65
Weekly Benefit = $384.57
Monthly Premium = $15.65
Hartford Voluntary Long Term Disability
Benefit
Waiting Period
Payable
OPTION 1
OPTION 2
60% of earnings in
increments of $500
to a monthly
maximum of $5,000,
minimum of $500
60% of earnings in
increments of $500
to a monthly
maximum of $5,000,
minimum of $500
90 days
90 days
Up to 5 Years
Up to SSNRA
Pre-Existing Condition : 3 months prior/12 months treatment free / 24 months after.
How to Calculate the Monthly Long Term Disability Premium
Option1
5 years
Option 2
To 65
<30
$0.264
$0.378
30 - 34
$0.343
$0.528
35 – 39
$0.484
$0.774
40 – 44
$0.598
$1.082
45 – 49
$1.109
$1.954
50 – 54
$1.681
$2.614
55 – 59
$3.018
$3.626
60 – 64
$4.630
$5.570
65 – 69
$4.140
$1.954
70 – 74
$1.408
$1.267
75 +
$1.522
$1.382
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LTD Example (Option 2)
Employee age 36
$30,000 Annual Earnings
$2,500 Monthly Earnings
$2,500 x .774 = $1,935
$1,935 / 100 = $19.35
$2,500 x .60 = $1,500
Monthly Benefit = $1,500
Monthly Premium = $19.35
Allstate Voluntary Cancer Protection
• Covers you and your family for internal cancer.
• Includes 29 other illnesses.
• Pays you a benefit of $2,000 for first occurrence of
internal cancer.
• Daily benefit for hospitalization
• Radiation, chemo and experimental treatments.
• Wellness benefit of $50 per year/member
• Rates - $15.70 single; $26.34 family per month.
• New Hires are guaranteed issue – not required to
complete evidence of insurability
Questions