University of Wisconsin System
Annual Benefit Enrollment
(ABE) Period
October 5 – 30, 2015
www.wisconsin.edu/abe
Benefit Changes Allowed during
Annual Benefit Enrollment (ABE)
o All changes made during this period are effective January 1, 2016.
o If you do nothing, your existing benefit elections, with the exception of your
Flexible Spending Accounts (FSA), will continue in 2016.
Open
Enrollment
Change
Plan
Add
Dependents
Remove
Dependents
Cancel
Coverage
State Group
Health
Yes
Any Health Plan
Yes
Yes
Yes
EPIC Benefits+
No
Remove vision
No
Yes
Yes
Dental
Wisconsin
Yes
PPO
Yes
Yes
Yes
VSP Vision
Yes
N/A
Yes
Yes
Yes
No
Increase
current
coverage
No
Any time
Any time
Yes
Must re-enroll
every year
N/A
N/A
N/A
Plan
Individual &
Family Life
Insurance
Flexible
Spending
Accounts (FSA)
Select
2016 Open Enrollment
Health & Savings Opportunities
o Health Insurance
o Dental Wisconsin
o VSP
o Flexible Spending Accounts(FSA) &
Limited Purpose Flexible Spending
Accounts (LPFSA)
o Health Savings Accounts (HSA)
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How to Enroll
o Use eBenefits to make your benefits
elections online by logging into My UW
System portal https://my.wisconsin.edu/
o Use paper applications, submitted to your
institution’s benefits office by 4:30 p.m. on
Friday, October 30, 2015 (UW Madison only)
https://www.wisconsin.edu/abe/apps/
Complete Information at: www.wisconsin.edu/abe October 5 – 30, 2015
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Health Insurance
o Plan Names
Current Health Plan Option Name
New Health Plan Option Name
Uniform Coinsurance Benefits Plan
It’s Your Choice (IYC) Health Plan
High Deductible Health Plan (HDHP)
It’s Your Choice (IYC) HDHP
Standard Plan
It’s Your Choice (IYC) Access Health Plan
Standard Plan High Deductible Health
It’s Your Choice (IYC) Access HDHP
o Uniform Dental
o Increased Cost Sharing
o $2,000 Opt-Out Incentive
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2016 Health Insurance Provider Changes
Health
Plan
Arise Health
Plan
Arise- Aspirus
Health Plan
Network
Health Plan
What’s New in 2016?
Combining service area
Offering new service area
Offering new service area in southeast part of
the state
Will NOT be providing coverage in following
service areas:
East: Florence, Fond du Lac, Forest, Jefferson,
Kenosha, Langlade, Lincoln, Marinette, Oneida,
WEA Trust
Price, Racine, Taylor, Vilas
PPO (all)
• Northwest Chippewa Valley: Burnett,
Sawyer, Trempealeau
• Northwest Mayo Clinic Health System:
Buffalo
Access Health Uniform Dental benefits will be included with
(Standard)
health coverage automatically. This was not
included in prior years.
Plan
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Action Needed
during ABE
All Arise participants should
confirm provider network for
2016.
None.
Select new health plan if you
will be affected.
May select plan with or
without the Uniform Dental
benefit.
Uniform Dental
New for 2016 – Delta Dental
Included automatically with State Group Health
 Must be enrolled in State
Group Health insurance
coverage in order to be
eligible for the Uniform Dental
Benefit plan
 Dental expenses (including
those for HDHP plans) will not
be subject to a deductible and
do not count toward the
OOPL
 Must take action during ABE
to waive Uniform Dental
 Two Delta Dental Provider
Networks:
 Coverage level (single/family)
must be the same as medical
 Automatically included
benefits are included with
Access Plan, formerly
Standard Plan)
 Delta Dental PPO
 Delta Dental Premier
 New ID cards will be sent in
December 2015
Go to deltadentalwi.com/state-of-wi for more information
7
Uniform Dental
Summary & Benefits Included
Approved Provider Network: Delta Dental PPO or Delta Dental Premier Providers
 Annual Maximum Benefit
$1,000 per year per person
 $0 Deductible
 Diagnostic & Preventative
Services are covered at
100%
o Exams, Cleanings, X-rays
Sealants & fluoride treatments
 Restorative Services are
covered at 100%
o Amalgam (silver) fillings
 Other Services are at 80%
o Anesthesia (in conjunction with
other services), Periodontics &
Emergency Palliative Care (to
relieve pain)
 Orthodontic Services at 50%
o Individual Lifetime Maximum of
$1,500; Dependents eligible to
age 19
 Non-Covered Service
Examples
o Crowns, bridges, dentures
implants, root canals etc.
Go to deltadentalwi.com/state-of-wi for provider network
8
Understanding the Definitions
Copayment: A fixed amount you pay for a covered health care
service, usually when you receive the service. The amount can
vary by the type of covered health care service.
Coinsurance: Your share of the costs of a covered health care
service, calculated as a percent (for example, 20%) of the
allowed amount for the service. You pay co-insurance plus any
deductibles you owe.
Deductible: The amount you owe for health care services your
health insurance or plan covers before your health insurance or
plan begins to pay.
Out-of-Pocket Limit (OOPL): An out-of-pocket limit (OOPL) is a
plan provision that limits the member’s cost-sharing. It is the
maximum amount that a member will pay for in-network, covered
services during a plan year.
9
Increased Cost Sharing
o Added deductibles
_______________________________________________
1
After an individual within a family plan meets the $250 deductible, medical services will be
covered for that individual.
2 The full family deductible must be met before any medical services are covered.
 Deductibles are new for 2016 with the Health Plans and
Access Health
 Deductibles were in place in 2015 for the HDHP
10
Increased Cost Sharing
o Increased out-of-pocket limits
Increased Medical OOPL for Health Plans and Access
Health Plan in 2016; No change to HDHP plans.
Reminder: There are separate medical and prescription
out-of-pocket limits except for HDHP plans
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Increased Cost Sharing-Pharmacy Benefits
Increased pharmacy out-of-pocket limits. Costs for Levels 2, 3 and 4
prescriptions will change from copay to coinsurance, up to a specified maximum.
2016 Prescription Copays, Coinsurance, and Out-of-Pocket Limits
(It’s Your Choice Health Plan)
Prescription Drug Level
Member Costs
Annual RX OOPL*
Level 1
$5 per fill
Level 2
20% ($50 maximum
per fill)
Level 3
Does not apply to Rx OOPL. Only applies to
40% ($150 maximum
Federal maximum out-of-pocket limits
per fill)
(MOOP): $6,850 individual / $13,700 family
Level 4 Preferred Specialty Drug
• Filled at a Preferred Specialty
$50 per fill
Pharmacy (e.g. Diplomat
Specialty Pharmacy)
•
Filled at any other pharmacy
$600 individual / $1,200 family
$1,200 individual / $2,400 family
40% ($200 maximum
per fill)
*HDHP Plans: Members are responsible for the full cost of prescriptions until their annual
deductible has been met. Once the deductible is met, the member costs in the table above will
apply. See the HDHP Combined OOPL amount for each plan at www.wisconsin.edu/abe
12
How to Determine Prescription Costs
1) Review the Formulary and determine what level your
drugs will be charged
2) Determine the Navitus Discounted Cost of the drug
a) Contact the pharmacy and ask the cost
b) Check your documents, some have the price listed
c) Review you medication history via the Members portal on
Navitus’ website
3) Multiple by the ‘Level’ percentage (20%, 40% or 50%)
Example: Level 2 Formulary Fill
$300 (Navitus discounted cost) x .20 = $60
You pay = $50 (because Level 2 has a $50 maximum)
13
Increased Cost Sharing
o New office visit copayments
o Copays will be applied to primary care and specialty care office visits
as well as Pharmacy
14
•
Health Plan Copays will not count toward the deductible, but will count
toward the out-of-pocket limit.
•
High Deductible Health Plan (HDHP) copays are applied after the deductible
is met.
•
Additional services billed as part of the office visit (labs/x-ray)are subject to
deductible and/or coinsurance.
•
Preventive services are covered 100% and are not subject to copays.
2016 Health Insurance
Opt-Out Incentive
If enrolled in State Group Health insurance in 2015 can optout of coverage for the 2016 plan year and receive a $2,000
Incentive.
o Must be enrolled (did not waive) for the 2015 year
o May not be covered under the State Group Health insurance
program as a dependent in 2016
o Must submit a State Group Health insurance PAPER
application during ABE to receive the opt-out incentive for
2016.
o Paid out in installments throughout year
o Incentive will be considered taxable.
o Craftworkers and Graduate Assistants are not eligible
15
2016 Health Insurance Premiums
Premium Tier
Tier 1
Tier 2
(Access
Plan –
out of
state)
Tier 3
(Access
Plan)
Employees Covered by the Employees Covered
Employees Covered by
WRS –
by the WRS –
Grad Assistant/ShortIt’s Your Choice Health
It’s Your Choice HDHP
Term AS (It’s Your
Plan
Health Plan
Choice Health Plan only)
Single
Family
Single
Family
Single
Family
With
Dental
$86 $
$217 $
$32
$81
$44.50 $
$112.50 $
Without
Dental
$83
$209
$29
$73
$41.50
$104.50
With
Dental
$136
$341
$82 #
$205 #
$69.50 #
$174.50 #
Without
Dental
$133
$333
$79
$197
$66.50
$166.50
With
Dental
$253 $
$632 $
$199 $
$496 $
$128 $
$320 $
Without
Dental
$250
$624
$196
$488
$125
$312
Premiums listed do not apply to those who are required to pay the less than half-time
rates or the total premium.
16
Cost Sharing for Health Plans
(Not for High Deductible Health Plans)
17
Is the HDHP/HSA Right for You?
o Considerations when deciding to enroll in the
HDHP/HSA option
 The HDHP has higher out-of-pocket costs
 The HDHP has a lower monthly premium
 The HSA provides a way to set aside pre-tax
monies into a savings account that can earn
interest
 Your employer will contribute $750 for single or
$1,500 for family coverage to your HSA in 2016
18
COST SHARING EXAMPLE VISIT #1:
HEALTH PLAN
You enroll in a single coverage with a local Health Plan for
2016.
o OFFICE VISIT #1: You visit your doctor in January 2016 and have minor
surgery (such as removing a precancerous mole) while you are in the
office. This is not considered preventive medical services. This is your
first doctor visit of the year and nothing has been applied to your
deductible for 2016.
The doctor bills the following:
• Office Visit:
$100
• Minor Surgery: $300
• Total:
$400
o Your insurance coverage includes:
 $15 Primary Care Visit copay
 $250 calendar year deductible
 10% coinsurance for medical services
19
COST SHARING EXAMPLE VISIT #1:
HEALTH PLAN
The Doctor Bills
Office Visit:
$100
Minor Surgery: $300
TOTAL:
$400
Copay
Deductible
Coinsurance
You Pay
$15
n/a
n/a
$15
Insurance
Pays
$85
$50 x 10% = $5
$255
$45
$5
$270
$130
n/a
$250
$15
$250
Total after deductible = $50
TOTAL AMOUNT PAID BY YOU: $270
The Out-of-Pocket-Limit (OOPL) for 2016 = $1,250
Your amount towards the OOPL
= $ 270
Remaining amount towards the OOPL = $ 980
20
COST SHARING EXAMPLE VISIT #2:
HEALTH PLAN
o Following OFFICE VISIT #1, You visit the Emergency Room in
February 2016 and get admitted to the hospital for appendicitis. You
end up having an appendectomy and staying in the hospital for a day.
This is not considered preventive medical services.
The doctor bills the following:
• Emergency Room:
• Imaging:
• Surgery:
• Hospital Stay:
o Total:
$ 200
$ 600
$30,000
$ 4,200
$35,000
o Your insurance coverage includes:
 $75 Emergency Room copay
 $250 calendar year deductible
 10% coinsurance for medical services
21
COST SHARING EXAMPLE VISIT #2:
HEALTH PLAN
The Doctor Bills
Emergency Room $200
Imaging, Surgery &
Hospital Stay $34,800
TOTAL:
$35,000
Deductible
Coinsurance
You Pay
Insurance
Pays
n/a
n/a
$0
$200
n/a
$0
(previous
fulfilled)
34,800 x 10%
= $3,480
OOPL = $980
$980
$33,820
$0
$0
$980
$980
$34,020
Copay
$0 (waived
because of
admission)
TOTAL AMOUNT PAID BY YOU: $980
The Out-of-Pocket-Limit (OOPL) for 2016 = $1,250
Your amount towards the OOPL
= $ 980
Remaining amount towards the OOPL = $
0
You have met your cost sharing for 2016
22
Member Health Plan Medical Costs
Overview
Person pays for
medical costs until
they reach their
deductible.
Then, person pays
coinsurance amounts
while their insurance
covers the remainder of
medical care costs.
COPAYS are separate
from the deductible and
apply toward the OOPL
23
Insurance covers
expenses at 100% after
reaching the out-ofpocket limit (OOPL) or,
if applicable, the federal
maximum out of pocket
(MOOP).
Your Health Insurance Options
For health insurance, you may take the
following actions during ABE:
Complete Information at:
 Enroll
 Change health plans
www.wisconsin.edu/abe
October 5 – 30, 2015
 Add or remove eligible dependents
 May select health plan with or without Uniform Dental
coverage (default is with dental)
 Cancel coverage for 2016
 Health Insurance Opt-Out Incentive (through paper
application only)
o As always, confirm your current medical and dental
providers will still be available in 2016.
24
Things to Consider
o All health plans come with Uniform Dental benefits.
May select health plan without Uniform Dental
benefits.
o Vision exam under health plans are subject to $25
specialty office visit copay.
o If dental and vision coverage offered by your health
plan doesn’t meet your needs, consider one of our
optional dental or vision plans. See Comparison
Charts.
o If elected, you must remain enrolled in the plan for
the entire calendar year.
Complete Information at: www.wisconsin.edu/abe October 5 – 30, 2015
25
Let’s Talk About Savings
 Flexible Spending Accounts (FSA)
 Limited Purpose Flexible Spending Accounts (LPFSA)
 Health Savings Accounts (HSA)
26
FSA Plan Descriptions
FSA Type
Health Care
FSA
Eligible
Expenses
Eligible Dependents
Medical, dental,
vision &
prescription
You, your spouse (same
or opposite-sex),
qualifying child or relative
After school care,
adult or child
Dependent Day
daycare,
Care FSA
preschool
Limited
Purpose FSA
(for employees
enrolled in the
HDHP)
Dental, vision &
post-deductible
expenses
Your spouse (same or
opposite-sex), qualifying
child or relative
You, your spouse (same
or opposite-sex),
qualifying child or relative
Yearly Contribution
Limits
Min: $100
Max: $2,550
Min: $100
Max: $5,000 —
dependent on tax
filing status
Min: $100
Max: $2,550
Flexible Spending Accounts (FSA)
o You must re-enroll every year if you want to
continue the coverage
o To Enroll for the FSA, LPFSA plans:
partners.tasconline.com/ETFEmployee
o All enrollees will receive a new TASC card in 2016
o Do not use 2015 TASC card for expenses in 2016, as of 1/1/2016
o MyCash balance will remain on 2015 TASC card if funds are not
moved to bank account.
o Employees should consider moving My Cash balance to
bank account
Complete Information at: www.wisconsin.edu/abe October 5 – 30, 2015
28
Health Savings Account (HSA)
(Only for Employees Enrolled in HDHP)
New in 2016: Increased Employer Contribution
Annual Contribution Information for HSA
HDHP Enrollment
Employer
Contribution
(including ER contribution)
Single
$750/year
$3,350*
Family
$1,500/year
$6,750*
2016 Limit
o *If you are 55-65 years of age, you may contribute an additional $1,000
“catch-up” per year to your HSA.
o The employer contribution will be paid throughout year.
o If you do not enroll for the HSA, you are not eligible for the HDHP.
o Will follow up prior to processing application for HDHP, to ensure
HSA is accepted.
o Craftsworkers are not eligible to receive the annual employer contribution to
an HSA but must still enroll in the HSA if electing an HDHP.
29
o Grad/Short-term Academic Staff participants are not eligible for the HDHP
Health Care and Limited Purpose
FSA Carry-Over
o The plan year is from January 1, 2016 to December
31, 2016.
o Up to $500 remaining in your Health Care or Limited
Purpose FSA can carry over to the following plan
year. Anything over $500 will be forfeited.
o Current Participants: If you have any unused funds in
your 2015 Health Care or Limited Purpose FSA on
December 31, 2015, up to $500 will carry over to 2016.
o You will have until March 30, 2016 to file your 2015
claims.
30
2016 Annual Benefit
Enrollment (ABE)
Additional Enrollment
Options
31
Dental Wisconsin
www.wisconsin.edu/ohrwd/benefits/med/dentalwi/
Two plans:
o Select Plan & PPO - both offer partial coverage for;
 Fillings and major dental services (crowns, implants, etc.)
up to the annual $1,000 maximum
• PPO covers annual cleanings and x-rays
 Orthodontic services (up to $1,000 lifetime maximum)
 Vision discount program through Davis Vision
 Waiting periods apply for new enrollees:
 Basic: 3 months (i.e. fillings)
 Major: 3 months (i.e. crowns, implants)
 Orthodontics: 12 months
Waiting periods may be waived if you had prior comparable coverage (no gap
in coverage).
32
VSP Vision
www.wisconsin.edu/ohrwd/benefits/med/vision/
o VSP Vision offers partial coverage for:
o Annual vision exam
o Eyeglass lenses or Contact Lenses every
calendar year
o Eyeglass frames every other year
o Discounts on laser vision correction
o KidsCare program (eyeglasses more often for
children)
o No benefit changes for 2016.
33
2016 Dental WI & VSP Premiums
www.wisconsin.edu/ohrwd/benefits/premiums
No change in premiums from 2015 to 2016
Employee
34
Employee + Employee +
Spouse/DP Child(ren)
Family
Select
$20.52
$42.19
$48.68
$71.59
PPO
$25.49
$53.96
$60.34
$91.21
Monthly
Employee + Employee +
Premiums for Employee
Spouse/DP Child(ren)
2016
Family
VSP Vision
$23.54
$6.54
$13.08
$14.73
Individual & Family Life Insurance–
ANNUAL INCREASE OPTION
o If covered by the Individual and Family Life insurance plan on
October 1st, may increase coverage level by the following
amounts:
o Employee: $5,000; $10,000; $15,000 or $20,000
o Spouse/Domestic Partner: $5,000 or $10,000
o Child(ren): $2,500
o Increase with eBenefits or Annual Increase Option form
o Maximum Levels:
o Employee: $300,000 - Spouse/Domestic Partner:
$150,000 - Child(ren): $25,000
NOTE: Spouse/Domestic Partner or Child coverage cannot
exceed employee coverage. Decreases and cancellations
may only be completed with an application only.
35
Wisconsin Retirement System (WRS)
2016 Contribution Rates
2015 and 2016 WRS Contribution Rates
General/Teacher
Executives
Protectives w/
Social Security
Employee
Contribution
6.60%
6.60%
6.60%
Employer
Contribution
6.60%
6.60%
9.40%
Total
13.20%
13.20%
16.00%
Category
o This change will occur on the first check payable in 2016
o Monthly – 1/4/16
o Biweekly – 1/7/16
36
Additional Information
o University Insurance Association Life (UIA) – Annual
Process 10/1/15
o Income Continuation Insurance (ICI)
• 20% Premium Increase
o State Group Life (SGL) – No Change
o ICI & SGL – New coverage effective dates for new
employees
o Accidental Death & Dismemberment (AD&D) – No
changes, may enroll at any time
o Tax Sheltered Annuity (TSA) & Wisconsin Deferred
Compensation (WDC) – We Encourage Savings!
o Long-Term Care – Transmerica is a new option in
addition to United of Omaha
37
Important Reminders
1. All benefit enrollments or changes made during
the ABE period are effective January 1, 2016.
2. You have until October 30, 2015 at 4:30 p.m. to
submit your paper applications to your institution’s
benefits office or make your elections using
eBenefits.
3. Visit www.wisconsin.edu/abe for detailed Annual
Benefit Enrollment (ABE) information.
4. Contact your institution’s benefits office if you
have any questions or need assistance.
38