Benefits
Overview
2012
Best Choice Plus – PPO
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Preferred Provider Organization (PPO)
Features both in-network and out-of-network benefits.
The in-network approach allows members to seek care
without having to designate a primary care physician. As a
result, it is not necessary to obtain a referral before
visiting another physician or specialist.
The out-of-network portion of the plan provides the
participant with the ability to see any physician or
hospital, but at a greater cost.
Out-of-network ER is paid in-network if visit is a
911/emergency.
Uses Broward Health hospitals and physicians as innetwork providers.
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Broward Health
Best Choice Plus Plan Design
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In-network inpatient hospital benefits are paid at 100%
after a $100 per-confinement co-pay.
In-network ER is covered at 100% after a $50 co-pay.
In-network Outpatient surgery 100% after $50 co-pay.
In-network outpatient /office lab co-pay is $5
In-network outpatient /office rehab co-pay is $5
In-network outpatient /office radiology co-pay is $10
In-network Physician office visit co-pay is $20.00.
Rx co-pays are $10 generic/$25 brand formulary/$40 and
non-formulary/$50 specialty.
Out of network paid at 60% of allowable after deductible.
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Broward Health
Aetna Select - EPO
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Exclusive Provider Organization (EPO)
In-network benefits only; except emergency.
Authorizations not required for diagnostic treatment or
specialist visit.
Nationwide coverage.
Open Access Plan.
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Broward Health
Aetna Select Plan Design
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Inpatient hospital benefits are paid at 100% after a $250
per-confinement co-pay.
ER is covered at 100% after a $75 co-pay.
Outpatient surgery 100% after $100 co-pay.
Outpatient diagnostic (i.e. lab, radiology, rehab etc.)
services are paid at 90% of the negotiated fee after the
plan deductible has been met.
Primary care/mental health provider office visit co-pay is
$20.00.
Specialist office visit co-pay is $30.00.
Rx co-pays are $10 generic/$30 brand formulary/$50
brand non-formulary/$75 specialty.
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Broward Health
Reliance Standard Dental - PPO
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PPO plan provides payment for dental treatment in- and
out-of-network.
This plan will cover 80 percent of the cost of eligible
treatment subject to plan allowable for in-network dental
services.
Where the cost of the dental treatment for the individual
has not been fully covered by insurance, the patient makes
up the difference.
The dollar amount of coverage provided is subject to a
maximum dollar benefit ($1,000) per person.
Rollover feature provides an opportunity to carry over up
to $350 per year with a cap of $1,000.
Offers in-network and out-of-network benefits
nationwide.
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Broward Health
Safeguard Dental - HMO
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Each enrolled family member may choose their own
dentist from the SafeGuard directory
There are no waiting periods, calendar year maximums or
deductibles and no claim forms.
There are no out-of-network benefits.
If the cost of the dental treatment for the individual is not
fully covered by insurance, the patient makes up the
difference. Co-pays are required for many procedures
such as root canal, crowns, etc.
The network is supported by over 10,700 dentists in
California, Florida, and Texas.
In 2008 Safeguard was acquired by MetLife.
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Broward Health
Disability
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VOLUNTARY SHORT TERM DISABILITY
– This will be an opportunity for eligible employees to purchase short-term
disability coverage for up to 60% of basic weekly earnings subject to preexisting condition limitation. This is a Voluntary Program offered by Reliance
Standard. Program features include: 29 day elimination period, payments up to 9
weeks and $2,000.00 maximum weekly benefit (maximum salary limit:
$173,334). The cost per $100.00 of salary is 72 cents. For an employee earning
$25,000.00 per year, the employee’s bi-weekly payroll deduction will be: $6.92.
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VOLUNTARY LONG TERM DISABILITY
– This will be an opportunity for eligible employees to purchase long term
disability coverage subject to pre-existing condition which provides for up to
60% of basic monthly earnings. Disability payments start after 90 days and
continue until you are able to return to work or up to your Social Security
Normal Retirement Age if you remain disabled. This is a Voluntary Program
offered by Reliance Standard. The maximum monthly staff benefit is $8,000
(maximum salary limit: $160,000). Physicians and management are subject to
other benefit provisions. Broward Health pays 50% of the cost for this insurance
plan; however, ½ of the disability payment will be taxed due to Broward
Health’s contribution towards this benefit. The cost per $100.00 of salary is 92
cents for an employee earning $25,000.00 per year, the employee’s bi-weekly
payroll deduction will be: $4.43.
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EOI (Evidence of Insurability) is waived if enrolling in Short-Term or Long-Term
Disability insurance during Open Enrollment 2012 or when enrolling as a new hire
during general orientation.
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Broward Health
Voluntary Life
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VOLUNTARY LIFE INSURANCE – WHOLE LIFE
– This will be an opportunity for eligible employees to
purchase additional life insurance coverage for
themselves and/or dependents/domestic partner.
Policies are initiated for employees and dependents
according to age limitations of the life insurance
product and medical insurability. Broward Health
provides Term Life Insurance at no cost to employees
(1 x annual salary).
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Broward Health
TCA’s Flexible Spending Accts
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Health/Medical Care FSA
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You may set aside pre-tax dollars from your paychecks to pay for
out-of-pocket health care expenses that will not be paid by insurance
or reimbursed from any other source. The money you set aside in the
account is available for your expenses and the expenses of anyone
you claim as a dependent on your tax return. You can set aside from
$5 to $192 per paycheck, up to a maximum of $5,000 a year for
eligible expenses including prescription drugs co-pays and other
medical, dental and vision expenses.
Dependent Day Care FSA
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You may set aside pre-tax dollars from your paychecks for day care
expenses you have for your eligible dependents while you and your
spouse work or your spouse goes to school full-time. Your eligible
dependents are: 1) Children under age 13 who you claim as
dependents on your tax return; or 2) Anyone age 13 or older who
lives with you at least eight hours a day and needs supervised care,
such as an elderly parent or disabled spouse or dependent. In most
cases, you can set aside up to $5,000 annually.
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Broward Health
Flexible Spending Account
Administration
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Reimbursement will occur for qualifying expenses incurred during the
2012 plan year. However, you will have until March 31, 2013 to file claims
for expenses incurred for the 2012 plan year. If you terminate employment
you may choose to continue your health care FSA through COBRA. Any
monies remaining in a flexible spending account after the 2012 plan year
claim deadline of March 31, 2013 will be forfeited. This "use it or lose it"
rule is based upon Internal Revenue Services (IRS) regulations. FSA
dollars are not invested and do not earn interest.
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Effective in 2011, over-the-counter drugs are not reimbursable via an FSA.
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If you have any questions about potential tax savings, you should consult
your tax advisor before enrolling in either program.
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Broward Health
Aetna Choice - HDHP
Health Savings
Account
High Deductible
Health Plan
On Line
Tools
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Broward Health
High Deductible Health Plan
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A High Deductible Health Plan (HDHP) provides
comprehensive coverage for medical events and a taxadvantaged way to help you build savings for future medical
expenses.
Also called CDHP – Consumer Driven Health Plan.
The HDHP gives you flexibility and discretion over how you
use your health care benefits.
The $1,500 single and the $3,000 family in-network
deductible must be met before any medical claims (including
RX claims) are paid, except for preventive care.
There are higher deductibles for out-of-network care.
Preventive care and preventive RXs are not subject to the
deductible.
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Broward Health
Preventive Care
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Medical
– Routine Physical
– Immunizations
– Well Child
– Gynecological
– Mammograms
– Colorectal/Prostate
RXs
– Hypertension
– Diabetes
– Cholesterol
– Asthma
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Broward Health
BENEFITS OF A HDHP
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Preventive care is covered at 100% with no deductible.
Using in-network providers will save you money.
There is out-of-network coverage too.
Less expensive bi-weekly payroll deductions
Allows employee to have a health savings account to save
for future medical claims.
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Broward Health
HDHP Deductibles
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There are higher deductibles and out-of-pocket limits when you
use out-of-network providers.
The HDHP has minimum deductibles of:
– $1,500 self and $3,000 family for in network coverage
– $3,000 self and $6,000 for out-of-network.
Out-of–pocket limits $5,000 self and $10,000 family in
network/$10,000 self and $20,000 family out-of-network .
Out-of-pocket limits include the deductible.
Once family deductible is met all family members will be
considered as having met their deductible.
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Broward Health
AETNA Choice (POS II)
Health Fund - HDHP
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Nationwide coverage and utilizes the services of over 50 hospitals in the
tri-county area.
In most cases, in-network hospital benefits are paid at 80% of allowable
and out-of-network benefits are paid at 60% of allowable; after
deductible.
Pre-certification is required for hospital admissions; however, specialist
referrals and diagnostic authorizations are not required.
The in-network physician office co-insurance is 80% of allowable.
Preventive care (in-network) is paid at 100% and deductible is waived.
In-network RX co-insurance is 80% of allowable; after deductible except
for preventive RX.
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Broward Health
Health Savings Account
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A Health Saving Account is used to set aside dollars pre-tax to pay
for qualified medical expenses. IRS rules state that in order to open
an HSA and make tax deductible contributions, you must be enrolled
in a high-deductible health plan.
You can use your HSA funds to pay for eligible medical expenses for
anyone you claim as a dependent for tax purposes (typically excludes
domestic partners), whether or not they are enrolled in your Medical
Plan coverage option.
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Broward Health
HSA Administration
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The money in your HSA belongs to you and you keep it if you
change jobs or enroll in another medical plan.
You don't have to worry about "use it or lose it" rules - in fact, the
HSA operates with a "use it or keep it" philosophy. This makes it
different than a Flexible Spending Account. HSA account
balances "carry forward" - letting you save for future healthcare
expenses, even retiree healthcare costs.
After you leave Broward Health, and you are no longer covered
by a high-deductible medical plan, you cannot continue to
contribute to your HSA. However, the HSA is still yours and you
can use the money or save it to pay for future qualified medical
expenses.
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Broward Health
HSA Benefits
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Voluntary payroll deductions are pre-tax.
Tax-deferred interest bearing account or investment options.
Tax-free withdrawals for qualified medical expenses.
Unused balance rolls over year to year.
Portability; the account is owned by you and is yours to keep - even
when you retire, change jobs or health plans.
Provides a tax-advantaged way to save for future medical expenses.
Your own HSA contribution is deductible on your income tax return if
you make additional post-tax non-payroll deductions on your own.
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Broward Health
More HSA Benefits
Account entirely owned by Employee.
Employees can choose to pay health care expenses from their
account or save dollars for future use.
While employed, the monthly administrative fee your HSA is paid
by Broward Health. Employee may incur charges related to ATM
withdrawals, checks, etc.
Don’t pay taxes on withdrawals as long as they are used to pay for
qualified health care expenses.
Employees should consult with their tax advisor to determine
eligibility requirements and tax advantages for participating in the
HSA plan.
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Broward Health
Aetna Choice - HDHP
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Enrollment in either the HDHP or the HSA is voluntary.
You can be in a HDHP and not have an HSA.
You can not contribute to a HSA without a HDHP.
You can not have TCA’s Health Care/FSA and contribute to
Aetna’s HSA concurrently.
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Broward Health
How Much May I Contribute
to my HSA?
 You contribute pre-tax by a payroll deduction.
 Payroll contributions you make are prorated over 26 pay periods
 You may also make personal (not via payroll deduction) tax-deductible
lump sum deposits directly to your HSA at any time during the year, up
to the IRS maximum allowable amount
 Contributions for single/individuals up to $3,100 and family $6,250
 Individuals age 55 to 64 may make catch up contributions of $1,000.
 Contribution limit maximums are typically adjusted by the Federal
Government/IRS each year.
 If enrolled in Medicare you may not contribute to an HSA.
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Broward Health
Using Your HSA
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You may use your HSA
towards your medical plan
deductible or any coinsurance
or copayments.
You may use your HSA for
qualified health care expenses
as allowed by the IRS. The
following list provides some
typical examples:
Medical
deductibles
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Braces
Dental care
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Contact lenses
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Prescription
drugs
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Hearing aids
LASIK eye
surgery
 Acupuncture
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Eyewear
OTC/Vitamins
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Broward Health
Eligibility Requirements
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Must be enrolled in a high deductible health plan
Cannot be enrolled in another health plan as secondary unless it’s a
high deductible health plan
Flexible Spending Account
– You or Spouse may NOT enroll in a HC/Medical Spending
Account.
– You may be enrolled in a Dependent Care Account.
You can not be claimed as a dependent on someone’s tax return
Can not be covered by VA benefits and have used VA medical
services within 3 months.
You cannot be enrolled in Medicare Part A or Part B.
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Broward Health
How Do I Access My HSA?
Each employee will be issued an HSA debit card:
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Broward Health
HSA Prescription Drug
Payment Process
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Present your ID card when obtaining a prescription.
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The pharmacist submits the claim to Aetna and the
prescription is available to you.
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If there is member payment due you may:
– Utilize the debit card or HSA checks (optional) to pay for the
prescription.
– Pay out of pocket if there are not sufficient funds in the HSA
account or if you want to save HSA funds.
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Broward Health
HSA Medical Claims
Payment Process
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Present your ID card when seeking medical care
The provider submits the claim to Aetna.
– Aetna processes the claim and issues an explanation of benefits
to the member identifying the claim payment.
– If there is member payment due the provider will bill the
member.
 The member may issue payment by utilizing the debit card
or HSA checks (optional).
 The member may pay out of pocket if there are not
sufficient funds in the HSA account or if the member wants
to save HSA funds.
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Broward Health
Claims and Customer Service
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Customer Service is available from 8:00 a.m. – 6:00 p.m. EST, Monday
through Friday.
Call Customer Service Toll Free at 877-245-1813.
Once enrolled, you may e-mail Customer Service through Navigator,
your personal Aetna website.
Your voluntary contribution is made directly to an IRS approved trustee
(J P Morgan Chase) administering the HSA.
You may also open a non-Aetna HSA; however you may not use the
convenient payroll deduction option.
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Broward Health
Internal Revenue Service
(IRS)
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Neither Aetna nor Broward Health monitors your use of your HSA. You are
responsible for making sure that your HSA funds are spent on qualified medical
expenses, and for paying any applicable taxes and/or penalties if your funds are
not spent on qualified medical expenses.
The IRS has the right to audit your use of HSA dollars, so keep receipts for the
medical services you pay for, or are reimbursed for, from your HSA.
The IRS has not set a limit on the total amount of money that can be accumulated
in an HSA over your life time.
More information at www.treasury.gov (click on health savings accounts)
Use of an HSA for non-qualified medical expenses is taxable.
Effective in 2011, withdrawals that cannot be substantiated by medical
expenses are also subject to a 20% penalty up to the age of 65.
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Broward Health
Tools and Information
Aetna Navigator™
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Secure, personal website
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Find a doctor, view claims, e-mail customer service
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Health information on conditions & alternative options
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Quality of participating providers
Simple Steps To A Healthier Life®
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Interactive Online Health and Wellness Program
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Health Risk Assessment Tool
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Personalized Action Plan
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Wellness counseling
Informed Healthline®
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Speak to a registered nurse, 24 x 7 availability
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Health and wellness information
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Promotes healthy lifestyles and disease prevention
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Promotes communication with physicians
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Broward Health
Enrolling
•You must complete your enrollment (including dependent
documentation) form and return it to Human Resources by November
18th.
•BH Health Application
•Required for all health & dental plans.
•Payroll Deduction Form for Aetna’s HSA (and enrollment kit.)
•Payroll Deduction Form for STD, LTD & Life Ins.
•Evidence of Insurability form for staff LTD.
•Payroll Deduction for TCA’s FSA.
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Broward Health
Benefits Open Enrollment
Customer Service Lines
•BEST CHOICE PLUS 954-767-5500
•AETNA 877-245-1813
•WWW.BrowardHealth.ORG, for Employees, Employee
Benefits.
•Intranet – HR/Benefits.
•Contact your HR Dept if you have additional questions.
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Broward Health