Benefits Open Enrollment
2015-2016
Jubilee Academic Center
Human Resource
Steps for Annual Benefits
Enrollment
www.esc20bc.net
Agenda
I.
II.
III.
IV.
Introduction
Online Enrollment
Medical Plans
Supplemental Plans
Refer to
www.esc20bc.net
Steps for Annual Benefits Enrollment
•Enrollment is Mandatory by all eligible staff
•Flexible Spending Accounts (Healthcare/Dependent Care)
and Health Saving Accounts are reset
•Access THEbenefitsHUB 24/7 from home, office, etc.
•If unable to enroll between August 1 – August 28
• Contact Human Resources or call (800) 583-6908.
Steps for Annual Benefits Enrollment
Passwords
Have Been Reset
Steps for Annual Benefits Enrollment
Review and update all information
• Fields in bold are required
• Dependent information required
‒ Social Security Numbers (by Affordable Care Act)
‒ Other missing information (ex: Date of Birth)
Videos available for most supplemental benefits
Elect/Waive each benefit
Complete required forms (if applicable):
• Evidence of Insurability (EOI)
• Voluntary Term Life Insurance (late enrollees/increasing coverage)
• Permanent Life
• Due in HRS by August 28, 2015.
Final Steps for Annual Benefits
Enrollment
Review/Update Beneficiary Information
Click Finish to submit enrollment
• HRS does not require a printed copy
Review Consolidated Enrollment Form
• Verify Flexible Spending Account and/or Health Savings
Account Amounts
Re-verify elections prior to Deadline: August 28, 2015.
TRS-ActiveCare
» Increase in Individual and Family Out-of-Pocket Maximums
» Now includes pharmacy copayments, coinsurance, and
deductibles
Allegian Health Plans
» Increase in Individual and Family Out-of-Pocket Maximums
Cigna Dental
» Increased rates for High and Low Plans
» Plan Design Change for Low Plan
ActiveCare Plan Highlights
2014-2015 Plan Year
2015-2016 Plan Year
TRS-AC 1-HD
Deductible
Employee/Family
$2,500/$5,000
$2,500/$5,000
Out-of Pocket Maximum*
Employee/Family
$6,350/$9,200
$6,450/$12,900
TRS-AC Select
Deductible
Individual/Family
$1,200/$3,600
$1,200/$3,600
Out-of Pocket Maximum*
Individual/Family
$6,350/$9,200
$6,600/$13,200
TRS-AC 2
Deductible
Individual/Family
$1,000/$3,000
Out-of Pocket Maximum*
Individual/Family
$6,000/$12,000
$1,000/$3,000
$6,600/$13,200
• Increased out-of-pocket maximums now include
• Pharmacy copayments, coinsurance, and deductibles (new)
ActiveCare 1-HD and 2
Network vs Non-Network
Always verify provider network statu s
Network:
Non-Network:
Statewide no need to:
– Select a Primary Care Physician
– Obtain referrals for specialist
care
• You pay more of the cost of
out-of-network benefits
• Higher deductibles, coinsurance
• You may need to file your
own claim
• You could be balance
billed for amounts
Receive highest level of benefits:
– Pay less for care
– No balance billing
No claim forms:
– Provider files claim for you
over allowed amount
ActiveCare Select
Always verify provider network status
Network Only Plan:
Non-Network:
No need to:
– Select a Primary Care Physician
– Obtain referrals for specialist
care
No coverage except in
a true emergency
Two Networks:
– Aetna Whole Health (ACO)
– Aetna Select (Open Access)
Receive highest level of benefits:
– No balance billing
No claim forms:
– Provider files claim for you
ActiveCare Plans
ActiveCare Plans
ActiveCare Select Doc Find
Select Plan
Aetna Open Access Network
Aetna Whole Health Network (ACO)
◦ Outside ACO Counties
◦ Bexar, Comal, Guadalupe, Kendall
or
Once plan is selected, pop up will
appear
TRSAetna Navigator
• Check benefits and claims
• Search for doctors in the network
• Order additional ID cards, or print a temporary ID card
• Cost of Care tools – Know the cost before you go
Aetna Mobile Secure Site – Log-in Required
• Find a network doctor
• Check your plan coverage
• Check on a claim
• Show you ID card
• Contact TRS-ActiveCare Customer
iTriage
Service
• Check a symptom
• Look up a conditions
• Find the right doctor
• Check on ER wait times
•Access 24/7/365
•ActiveCare 2 and Select plans, Co-Pay Waived
•ActiveCare 1-HD plan, $40 consultation fee
•Board certified providers (Family Practice, Internal Medicine,
and Pediatrics)
•Diagnosis and treat common conditions (ie: upper respiratory
infection, bronchitis, ear infections, and common cold)
•Guaranteed member call back within 60 minutes!
•Prescriptions sent to your pharmacy
•Alternate option: MDLive
Health and Wellness Resources
For personal help with health conditions, challenges and goals
Simple Steps To A Healthier Life®
Aetna Health Connections
Beginning Right® Maternity Program
Aetna Care Advocate Team
National Medical Excellence Program®
◦ 24-Hour Nurse Information Line 1-800-556-1555
◦ Aetna Discount Program
◦ Discounts on health-related products/services (e.g., vision and
hearing care, gym memberships, weight management, etc.)
• Benefit includes both a
retail and mail component
• Caremark has its own
mail-order pharmacy
Caremark Service Overview
Features
Drug Deductible
(per person, per plan year)
ActiveCare 1-HD
Subject to
plan year deductible
Retail Short-Term
(up to 31-day supply)
Tier 1 (Generic)
Tier 2 (Preferred Brand)
Tier 3 (Non-Preferred Brand)
Retail Maintenance
(after first fill, up to 31-day supply)
Tier 1 (Generic)
Tier 2 (Preferred Brand)
Tier 3 (Non-Preferred Brand)
20% coinsurance
after deductible
Mail Order % Retail-Plus
(up to 90-day supply)
Tier 1 (Generic)
Tier 2 (Preferred Brand)
Tier 3 (Non-Preferred Brand)
Specialty Medications
(retail or mail)
20% coinsurance
after deductible
ActiveCare Select
$0 generic;
$200 brand
ActiveCare 2
$0 generic;
$200 brand
$20
$40*
50% coinsurance
$20
$40*
$65*
$25
$50*
50% coinsurance
$25
$50*
$80*
$45
$105*
50% coinsurance
$45
$105*
$180*
20% coinsurance per fill
$200 per fill
(up to 31-day supply)
$450 per fill
(32-to 90-day supply)
Caremark Participant Website
• Check prescription status
• Download forms
• My Rx Choices® / Price a Medication
•
Locate a participating pharmacy
• Order mail order refills, receive refill alerts (remaining, last, past due)
Pre-log in functions
• Scan to refill multiple Rx checkout
• Pill identifier
• Drug interaction checker
After log in functions available
•
•
•
•
•
Find drug costs
Find a pharmacy in network
View digital ID card
See prescription orders and history
Refill prescriptions
Employee
Monthly Cost
Employee
Semi- Monthly
Cost
Employee Only
Employee /Spouse
TRS ActiveCare 1-HD
$341
$341
$914
$341
$0
$573
$0
$286.50
Employee /Child(ren)
$615
$274
$137.00
$890
$445.00
$132
$781
$66.00
$390.50
$341
$421
$210.50
$341
TRS ActiveCare 2
$341
$341
$990
$495.00
$273
$1,137
$136.50
$568.50
Covered Members
Employee /Family
Employee Only
Employee/Spouse
Employee/Child(ren)
Total Monthly
Premium
$341
TRS ActiveCare Select
$473
$341
$1,122
$341
$762
$1,331
Employee Only
Employee/Spouse
$614
$1,478
Employee/Family
$341
$1,231
Employee/Family
Employee/Child(ren)
JAC Contribution
$992
$341
$651
$325.50
$1,521
$341
$1,180
$590.00
JAC will be contribute $341 per employee/ per month.
Supplemental Benefits
Review
Section 125 Plan
A Section 125 plan allows an employer to offer employees a choice between
taxable and nontaxable benefits.
A cafeteria plan is a plan maintained by an employer that provides participants an
opportunity to receive certain benefits on a pre-tax basis.
Region 20 benefits that qualify for pre-tax deduction are:
•
•
•
•
Accident
Cancer
Dental
Flexible Spending Accounts
• Medical Reimbursement
• Dependent Care Reimbursement
•
•
•
•
Health savings accounts
Limited Benefit Medical Supplement
Medical (TRS-ActiveCare)
Vision
Supplemental Benefit Options
 HSA – Provided by HSA Bank
 Flex Accounts – Provided by NBS
 MEDLink Supplement (Gap Plan) – Provided by American Public Life
 Accident – Provided by American Public Life
 Cancer – Provided by American Public Life
 Dental – Provided by Cigna
 Disability – Provided by UNUM
 Identity Theft – Provided by ID Watchdog
 Group Term Life and AD&D – Provided by Cigna
 Permanent Life – Provided by TexasLife
 Telehealth – Provided by MDLive
 Vision – Provided by Superior Vision
Benefits effective 9/1/2015 – 8/31/2016
Health Saving Account (HSA)
What is a Health Savings Account (HSA)?
An HSA works with a High Deductible Health Plan (HDHP) and allows you to set aside a portion of your paycheck
– before taxes – into a bank account to help you pay for medical expenses before you reach your deductible or that
aren’t covered by your plan.
HSA Advantages:
Tax-deductible
Contributions to the HSA are 100% deductible (up to the legal limit) — just like an IRA.
2015 Calendar Year Maximum Deduction
$3,350/year – single
$6,650/year - family
Tax-free
Withdrawals to pay qualified medical expenses, including dental and vision, are never taxed.
Tax-deferred
Interest earnings accumulate tax-deferred, and if used to pay qualified medical expenses, are tax-free.
HSA money is yours to keep
Unused money in your HSA rolls over from year to year; it continues to grow tax-deferred; you can take it with you
even if you change jobs.
You are eligible to enroll in an HSA if you are enrolled in TRS-ActiveCare 1-HD.
Health Saving Account (HSA)
HSA Eligibility & Plan Highlights
 You must participate in a High Deductible Health Plan (HDHP) to be eligible to contribute
to an HSA (TRS-ActiveCare 1-HD).
 Lump Sum deposits are available as well as monthly contributions through payroll
deduction.
 You will be issued a Visa Debit card you can use to pay for approved medical expenses.
 An HSA works differently than an FSA - you only have access to the balance of funds in
your account (similar to a checking account). Monies are not front-loaded for the year.
 You’ll be given access to a secure, easy-to-use web portal to track your account balance.
 Request reimbursement distributions online for purchases not made with your debit card
(payment will be made based on your available funds).
 An employee making contributions to an HSA is only eligible to participate in a LimitedPurpose Healthcare Flexible Spending Account (FSA).
Flexible Spending Accounts (FSA)
An FSA allows an employee to set aside a portion of earnings to pay for qualified expenses such as
medical and dependent care. Money deducted from an employee’s pay into an FSA is not subject to
payroll taxes, resulting in payroll tax savings.
Advantage of an FSA: plan year funds available when plan begins.
Disadvantage of an FSA: Limited to $500 rollover!
Plan Year for Flexible Spending Accounts (FSA) – 9/1/2015 - 08/31/2016
Web portal for participants to view balance and claim information.
Toll Free Number to call and check your FSA balance even after normal business hours by calling
800.274.0503 (must have your social security number).
Must re-elect every year – will not rollover.
Any amount over $500 is lost!
Flexible Spending Accounts: NBS
Plan Year: 09/01/2015 – 08/31/2016
 Medical Reimbursement
• $2,550/ plan year maximum
• Advance allowed
 Dependent Care Reimbursement
• $5,000/plan year maximum (married filing jointly)
• $2,500/plan year maximum (filing single)
• Advance NOT allowed
 The NBS flex card will be provided to all participants of the Medical Reimbursement
Account. The flex card is provided to you at NO COST!
 Flex cards are valid for 3 years. Remember to keep your itemized receipts in the
event you are asked to substantiate a card swipe.
 Flex Accounts are allowed a maximum of $500 rollover per each plan and amounts
must be re-elected every year – they will not rollover.
HSA - FSA Comparison Chart 2015
Health Savings
Account(HSA)
Flexible Savings
Account (FSA)
Available as they are deposited
(not front-loaded)
Money is loaded upfront
High Deductible health plan
None
$3,350 Single
$6,650 Family
$2,550 (Medical)
Year-to-year rollover of
account balance
Yes
$500 Max
Account Earns Interest
Yes
No
Portable
Yes
No
Permitted, but subject to current
tax rate plus 20% penalty
(waived after age 65)
Not Permitted
Funds (Money in Account)
Underlying Insurance
Requirements
Max Deductions
Cash-Outs of Unused
Amounts (if no medical
expenses)
Medical Expense Supplement
“Gap” Insurance
MEDlink - American Public Life
Designed to supplement your medical plan. This plan provides supplemental coverage to
help offset out-of-pocket costs that you may experience due to deductibles and
coinsurance for an inpatient hospital stay.
In-Hospital Benefit
Pays expenses you incur as an Inpatient (at least 18 continuous hours) up to $1,500 or
$2,500 per confinement (based on plan you select).
Out-patient Benefit
Pays up to $200.00 per treatment in:
(Emergency Room, Outpatient Surgery, Diagnostic testing)
Physician Benefit
Physician visits for sickness, or injury due to an accident: $25.00 per visit, maximum
five visits per family per calendar year, for treatment received. (Physician’s office,
Hospital Outpatient Clinic, Free-standing Emergency Care Clinic)
Accident Plan – American Public Life
Accident insurance is designed to be a supplement and helps pay for out-ofpocket costs not covered by your medical insurance. This plan pays actual
charges per accident (up to $500 maximum) for physician’s treatment,
surgery, x-rays, reduction of fractures and dislocations or other emergency
treatment expenses.
There is a $50 deductible for emergency room expenses, per occurrence.
Expenses must commence within 60 days of the covered accident.
Plan Benefits also Include:
• $75 Hospital confinement benefit (up to 30 days)
• Ambulance benefit up to $1,250 (within 21 calendar days of a covered
accident)
• $5,000 Accidental death benefit
Cancer Plan – American Public Life
Cancer insurance is designed to be a supplement and helps pay for out of pocket costs not covered
by your medical insurance. This coverage is offered on a guarantee issue basis, however, no
benefits are payable for any loss during the first year of a Covered Person’s coverage as the result of
a Pre-Existing Specified Disease.
Plan Benefit Options:
• Option 1 (Low Plan): $500/month Radiation/Chemo benefit, and a $100 daily room benefit
• Option 2 (Low Plan): Option 1 with an Intensive Care Unit Rider
• Option 3 (High Plan): $1,500/month Radiation/Chemo benefit, and a $300 daily room benefit
• Option 4 (High Plan): Option 3 with an Intensive Care Unit Rider
Standard Benefit in all plans:
• A $2,500 Lump Sum Critical Illness benefit for Cancer or Heart/Stroke.
• Reimburses up to $50 per calendar year for each insured person for cancer screening tests.
Intensive Care Unit Rider:
• $600 per day.
JAC Pays
$10.80
Dental Plan – Cigna
There are 3 plan options available: DHMO Plan, Low Dental PPO, and High Dental PPO.
PPO High Plan
• Allows you to visit any dentist!
• Has a $50 deductible and $1,500 annual maximum benefit.
• Children under age 19 have a $1,000 lifetime max for Orthodontics.
• Covers 100% Preventative, 80% Basic, and 50% Major & Ortho.
• No Waiting Periods.
Low Plan (MAC)
• In-Network is Highly Recommended. Out-of-Network benefits are based on
Maximum Allowable Charge (MAC). Patients who visit a non-participating dentist
will have a higher balance-billing. The patient will pay the difference between the out
of network maximum and the dentist’s fee.
• Has a $50 deductible and $750 annual maximum benefit.
• Covers 100% Preventative, 60% Basic, and 40% Major (No Ortho Benefit).
• No Waiting Periods.
DHMO Plan
• High quality features & benefits while minimizing employee cost.
• No waiting periods, no maximums, and a large group of providers.
• Must see a contracted Cigna Dental Provider – designate choice through online
enrollment.
Disability Plan - UNUM
Designed to provide a monthly income to an individual that is disabled due to an
accident or illness. The disability benefit replaces a portion of your pre-disability
earnings, less the income you may receive from other sources. The benefit amount is up
to 66 2/3% of your monthly earnings. Pre-existing Condition Exclusion (3/12).
•0/7*
•14/14*
•30/30*
•60/60
•90/90
•180/180
* If , because of your disability, you are hospital confined as an inpatient, benefits
begin on the first day of inpatient confinement.
Identity Theft Protection – ID
Watchdog
This plan monitors your personal information
for threats of identity theft:
•Monthly reporting alerts
•Full resolution services should your identity
be compromised while utilizing IDWatchdog
services
•At the end of open enrollment, IDWatchdog
will contact enrollees via email or a letter with
instructions on activating your account. Be
sure to update your email in the online
benefits enrollment system.
Permanent Life Insurance:
TexasLife
•Voluntary Permanent Life Insurance can be an ideal compliment to your Group
Term Life Insurance (Cigna).
•It is designed to be enforced when you die, is yours to keep, even when you change
jobs or retire, as long as you pay the premium.
•Minimum cash value.
•Long guarantees.
• Enjoy the assurance of the policy that has a guaranteed death benefit to age 121.
•Refund of premium
• Offers a refund of 10 years’ premium should you surrender the policy if the
premium you pay when you buy the policy is ever increased.
•Accelerated Death Benefit
• Should you be diagnosed with a terminal illness, you will have the option to
receive a portion of the death benefit.
•Simplified Medical Underwriting Form (3 questions)
Permanent Life Insurance:
TexasLife
Contact FBS
(800) 583-6908
JAC Pays
$10,000
Voluntary Group Term Life
Insurance - Cigna
•This plan offers you and your dependents an excellent opportunity to purchase
affordable group term life insurance on a payroll deduction basis. Employees must
elect coverage on themselves in order to cover dependents. The premium you pay for
coverage is based on your age each year.
•Employees may apply for up to 7 times annual salary (up to $500,000) on themselves.
You may also insure spouses for up to 100% of the employee benefit, and dependent
children up to $10,000.
•Accidental Death and Dismemberment coverage may also be elected for employee or
family coverage (eligible family members are covered at a percentage of the employee
face amount).
New Hire Guarantee Issue Amounts
• $200,000 for employee
• $50,000 for spouse
• $10,000 for children
Telehealth - MDLive
24/7/365 on-demand access to affordable, quality healthcare, anytime, anywhere.
Offers on-demand access to a national network of board-certified doctors that can
diagnose, recommend, and prescribe medication.
What can be treated?
• Allergies
• Asthma
• Bronchitis
• Cold and Flu
• Ear Infections
• Joints Aches and Pain
• Respiratory infection
• Sinus Problems
• And More
$5.00/semi-month
Employee & Family Coverage
JAC Pays
for Vision
Vision – Superior Vision
•In-network co-pay is $10 for exams and $25 for materials. The
insured is responsible for paying charges in excess of plan
allowances.
•Out-of-network vision services are reimbursed up to a certain
dollar amount for covered expenses.
•Benefits are covered for Exam, Lenses and Frames once every
12 months.
•The plan covers contacts in lieu of glasses.
◦ ID Cards
• Mailed August 15th
• Family Style – up to five members listed; additional card if
needed
◦ 24-Hour Nurse Information Line 1-800-556-1555
◦ Customer Service
◦ Affordable Care Act (ACA)
• Jan 1, 2014 – Individual mandate for healthcare coverage took
effect. Everyone in the U.S. (limited exceptions apply)is required
to have health insurance.
• Penalty applied to federal income tax if not covered by health
insurance.
What if I Have Questions?
TRS-ActiveCare - Aetna/Caremark
• 1-800-222-9205 (Mon – Fri, 8:00 a.m. – 6:00 p.m. CST)
Supplemental Benefit Plans - Financial Benefits Services
• 1-800-583-6908 (Mon – Fri, 7:00 a.m. – 6:00 p.m. CST)
Enrollment Deadline: August 28, 2015
Benefit Elections Effective
September 1, 2015 - August 31, 2016