TOURO INFIRMARY
2015 OPEN ENROLLMENT
Presented by:
HUB International
November 14, 2014
Agenda
2015 Changes
Wellness Benefits
Medical Benefits
Other Benefits
Costs
Websites
2015 Changes
• Merging the Base and Enhanced Plan into the Traditional
plan.
• Introducing a High Deductible Health Plan (HDHP) with a
Health Savings Account (HSA). Employer is contributing
towards the Health Savings Account.
• Covered with Services within LCMC Health or United
Healthcare Network only with exception: Emergency Services.
• Preventive Care will be covered at 100%
– Generic Oral Contraceptives
– Breast Pumps
– Immunizations as recommended by CDC
• All co-pays including prescription drug co-pays will accrue
towards the annual out of pocket maximum.
2015 Changes (cont’d)
• Flexible Spending Account – $500 Roll over feature no longer allowed
due to the Qualified High Deductible Plan and Health Savings Account
Offering.
• Increase in Flexible Spending Account for unreimbursed medical
expenses to $2,550 annually.
• Limited Purpose FSA available to employees who are participating in the
HDHP/HSA plan for dental and vision expenses only.
• LCMC Paid Short Term Disability with eligibility period of: 1st day of the
month following 6 months of employment. Available to both full and
part-time employees.
• LCMC Paid Long Term Disability plan with benefits payable for 5 years
for full-time. Employee Paid for Part-time.
• Long Term Disability buy-up option with benefits extending benefits to
your normal Social Security Retirement age. Available to full-time only.
• LTD Eligibility period: 1st day of the month following 6 months of
employment.
2015 Changes (cont’d)
• Hourly Employees - Increase in LCMC Paid Life Insurance and
AD&D from 1 x annual earnings to a maximum of $50,000 to
$75,000.
• New Spousal Surcharge - If your spouse is eligible to participate in
his/her employer’s medical plan but chooses to participate in the
LCMC Health plan, a surcharge of $50 per month will be added to
your premium. Spousal affidavit required.
• Dependent certification form also needs to be completed if you wish
to continue to cover your eligible dependents.
• New Program for Specialty Drugs.
• New ID cards will be issued for Medical and Vision.
Traditional Plan
Services
Deductible
- Individual
- Family
How Deductible Applies to Family
Members
Out-of-Pocket Limit Medical
- Individual
- Family
Out-of-Pocket Limit Rx
-Individual
-Family
Out-of-Pocket Limit Combined Medical and
Rx
- Individual
- Family
LCMC System Facilities
UHC Facility Providers
and Professional
Providers
(Excluding
Ochsner/Tulane)
Ochsner / Tulane
$500
$1,000
$500
$1,000
$3,000
$6,000
Deductibles are applied by individual and family unit. An individual may reach their
deductible and begin coinsurance. A family deductible can be met by one or all
family members. LCMC and UHC Network Combined; All cross apply.
$2,000 medical only
$4,000 medical only
$2,500 medical only
$5,000 medical only
$3,750
$7,500
$2,500 Rx only
$5,000 Rx only
$2,500 Rx only
$5,000 Rx only
$2,500 Rx only
$5,000 Rx only
$4,500
$9,000
$5,000
$10,000
$6,250
$12,500
Provider Office/Clinic Visit Co-pay
- Primary Care (not preventive)
- Specialist
- Preventive care/screening/immunization
$25
$40
Covered at 100%
$25
$40
Covered at 100%
$25
$40
Ded & Coinsurance may
apply to facility charge
Covered at 100%
Testing
- Lab Services
- Imaging, X-Rays (CT/PET scans, MRIs)
Covered at 100%
Ded. & 10% coinsurance
Ded. & 20% coinsurance
Ded. & 20% coinsurance
Ded. & 40% coinsurance
Ded. & 40% coinsurance
Traditional Plan (cont’d)
Services
LCMC System Facilities
UHC Facility Providers
and Professional
Providers
(Excluding
Ochsner/Tulane)
Therapies
- PT/OT/Speech
- Chemo/Radiation
Ded. & 10% coinsurance
Ded. & 10% coinsurance
Ded. & 20% coinsurance
Ded. & 20% coinsurance
Ded. & 40% coinsurance
Ded. & 40% coinsurance
Out-patient Surgery
- Facility Fee
- Physician/Surgeon Fees
Ded. & 10% coinsurance
Ded. & 10% coinsurance
Ded. & 20% coinsurance
Ded. & 20% coinsurance
Ded. & 40% coinsurance
Ded. & 40% coinsurance
$150 co-pay
$100 co-pay
$40 co-pay
$150 co-pay
$100 co-pay
$40 co-pay
$150 co-pay
$100 co-pay
$40 co-pay
Ded. & 10% coinsurance
Ded. & 10% coinsurance
Ded. & 20% coinsurance
Ded. & 20% coinsurance
Ded. & 40% coinsurance
Ded. & 40% coinsurance
Retail / Mail
$10/$22
$30/$65
$45/$100
$75/$165
Retail / Mail
$10/$22
$30/$65
$45/$100
$75/$165
Not covered outside of
network
Immediate Medical Attention
- Hospital Emergency Room Services
- Emergency Medical Transportation
- Urgent Care
Hospital Stay
- Facility Fee
- Physician/Surgeon Fees
Prescription Drugs - $100
deductible/individual
- Generic (ded. waived)
- Preferred
- Non-Preferred
- Specialty
Ochsner / Tulane
Specialty Drugs
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Specialty medications treat complex chronic conditions and have a high cost.
They often require special storage, handling and administration.
If you take a specialty drug, LCMC Health has contracted with special pharmacies to
provide these drugs at a lower cost. Three pharmacies have been contracted with:
Avita New Orleans Pharmacy; Walgreens Specialty Rx; and Accredo. If you obtain your
specialty medication from one of these pharmacies, your co-pay will be $50 instead of
$75 at other pharmacies.
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Avita New Orleans
Phone: (504) 822-8013 or (877) 424-2930; 24 Hour Help Line 1-888-284-8279
www.avitapharmacy.com
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Walgreens Specialty Rx
Phone: Specialty Pharmacy & Care Team: 1-888-782-8443
www.walgreens.com/pharmacy/specialtypharmacy.jsp
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Accredo
Phone: 1-888-608-9010
www.accredo.com/patients/getting-started-with-accredo#sthash.YWlOPyGz.dpuf
Traditional Premiums
Monthly Rate
EE Contribution
LCMC Contribution
Employee
$404.65
$138.92
$265.73
Employee & Spouse
$809.29
$277.83
$531.46
Employee & Child(ren)
$728.37
$250.05
$478.32
Family
$1,157.29
$397.30
$759.99
2014 Plan
2015 Plan
EE Only
EE & Spouse
EE &
Children
Family
Enhanced
Traditional
($51.41)
($135.47)
($115.40)
($193.73)
Basic
Traditional
$15.48
$5.45
($1.93)
$44.30
What is a HDHP Plan?
• A high-deductible health plan is a health insurance plan
with lower premiums and higher deductibles than a
traditional health plan. Being covered by an HDHP is
also a requirement for having a Health Savings Account.
• If family coverage is elected, the full family deductible
must be met before the health plan reimburses.
• Preventive Expenses are covered at 100%
• Preventive generic prescriptions are covered at 100%
• All Other medical services including office visits and
prescriptions apply towards the deductible and out of
pocket maximum at a discount rate.
What is an HSA Plan?
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Medical “IRA”
Contributions are tax deductible
Earnings grow tax-free
Qualified distributions are tax-free
All IRS 213(d) expenses are eligible for reimbursement
IRS form 8889 filing with tax return
Both you and your employer can contribute to the HSA
account
• An account will be opened on your behalf and you will be
provided with a debit card through HSA Bank
• The maximum contribution (employee + employer) for 2015 is
as follows:
– Single
– Family
$3,350
$6,650
• Additional Catch up contributions of $1,000 annually if age 55 64
Who is eligible for HSA’s?
• Any individual that:
– Is covered by a HDHP
– Is not covered by other health insurance
• does not apply to specific injury insurance and
accident, disability, dental care, vision care, longterm care
– Is not eligible for Medicare
– Cannot be claimed as a dependent on someone else’s
tax return
– Cannot run unreimbursed medical expenses through
an FSA
– You must open an HSA account with HSA Bank
HSA Distributions
• Distributions are tax-free if taken for:
– person covered by the high deductible
– spouse of the individual
– any dependent of the individual
• Spouse and dependents don’t need to be covered by the
HDHP
• If not used for qualified medical expenses, then amount
is included in income
• 20% additional tax if taken for non-medical expenses,
except when taken after:
– Individual dies or becomes disabled
– Individual is eligible for Medicare – age 65
LCMC
Annual Contribution to
your Health Saving Account
Coverage Tier
Dollar Amount
Employee
$500
Employee & Spouse
$750
Employee & Child(ren)
$1,000
Family
$1,500
50% of the contribution will be deposited into your HSA Bank Account January 2015 and the
Remainder will be deposited in July 2015. Can only access funds available.
High Deductible Health
Plan with HSA
Services
Deductible
- Individual
- Family
How Deductible Applies Across Network
Tiers
How Deductible Applies to Family Members
Coinsurance
Out-of-Pocket Max
- Individual
- Family
Preventive Services
Provider Office/clinic visits and all other
medical services
Prescription Drugs – AFTER DEDUCTIBLE
- Generic
- Preferred
- Non-Preferred
- Specialty
LCMC System Facilities
UHC Facility Providers
and Professional
Providers
(Excluding
Ochsner/Tulane)
Ochsner / Tulane
$1,500
$3,000
$1,500
$3,000
$4,000
$8,000
LCMC and UHC Network Combined; All cross apply.
Deductibles are applied by family unit. The deductible is not met for any individual
until the entire family deductible is met.
15%
25%
50%
$4,000
$8,000
$4,500
$9,000
$6,250
$12,500
Covered at 100%
Covered at 100%
Covered at 100%
Ded. & 15% coinsurance
Ded. & 25% coinsurance
Ded. & 50% coinsurance
Retail / Mail
$10/$22
$30/$65
$45/$100
$75/$165
Retail / Mail
$10/$22
$30/$65
$45/$100
$75/$165
Not covered outside of
network
HDHP Premiums
Monthly Rate
EE Contribution
LCMC Contribution
Employee
$393.41
$95.34
$298.07
Employee & Spouse
$786.83
$190.68
$596.15
Employee & Child
$708.14
$171.61
$536.53
Family
$1,125.16
$277.57
$847.59
2014 Plan
2015 Plan
EE Only
EE & Spouse
EE & Children
Family
Enhanced
HDHP/HSA
($94.99)
($222.62)
($193.84)
($313.46)
Basic
HDHP/HSA
($28.10)
($81.70)
($80.37)
($75.43)
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
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
To maximize your benefits use the Assurant network
Voluntary Vision Plan
through Always Care
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
To maximize your benefits use the Always Care network
Vision Premiums
Coverage Level
Employee Premium
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
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Pre-Tax Premium Contributions
Health Flexible Spending Account (FSA)
– Un-reimbursed Medical Expenses ($2,550.00 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.
Limited Purpose FSA (dental and vision only) $2,550 maximum for employees
who are enrolled in the HDPD/HSA Plan.
Employee’s who have balances up to $500 will be rolled over into a limited FSA
account if you are participating in the HDHP/HSA plan or a Standard FSA
account if you are participating in the Traditional Plan.
How Does Flexible
Spending Work?
• Voluntary Participation
• Annual Enrollment – Calendar Year
• Careful Planning Required
• Annual amount divided by 24 paychecks
• Reimbursements are administered through a third party administrator
- UMR
• Medical & Dependent FSA Debit Cards – Your current debit
cards will be replenished with your new allocation.
• 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 or legal separation
Birth/adoption of child
Part-time/full-time status
Termination/commencement of employment
Loss of a dependent
SCHIP eligibility
LCMC Paid
Life Insurance
through the Hartford
Life Insurance & AD&D
Exempt Employees
Full-time employees only
1.5 x annual earnings to a
maximum of $300,000
Directors and Above
3 x annual earnings
Hourly employees
1 x annual earnings to a
maximum of $75,000
Accelerated Benefits
Up to 80% of life benefit
Subject to maximum
LCMC Paid
Short Term Disability
Benefit
60% of your base weekly earnings
to a maximum of $1,500 per week
Payable
15th Day Accident
15th Day Sickness
Maximum
Up to 26 Weeks
Provided for full-time and part-time employees. Eligibility: 1st day of the month following
6 months of employment.
LCMC Paid LTD
through the Hartford
Monthly Benefit Maximum
$10,000
Elimination Period
180 days
Benefit
60% of Monthly Earnings
Duration of Benefits
5 years
Mental & Nervous
Maximum 2 years
Alcohol & Drug Abuse
Maximum 2 years
Pre-Existing Condition
3 months prior /12 months after
Survivor Benefit
3 months
Option to buy-up and extend the duration of benefits to your normal Social Security
Retirement age. Rates are based on age and income. Available to full-time employees only.
Part-time employees have the option of purchasing a 5 year benefit at their own cost.
Voluntary Life Insurance
and AD&D the through
the Hartford
Life Insurance & AD&D
Rates are age rated
Can be purchased in increments of
$10,000 or 5 times your annual
earnings to a maximum of
$500,000
Guaranteed issue amount
$250,000
Amounts in excess of $250,000 will
require evidence of insurability.
Voluntary Dependent Life
and AD&D through the
Hartford
Life Insurance and AD&D
Dependent Children
Rates are age rated
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 $50,000.
Amounts greater than $50,000 requires
EOI.
$10,000 for children age 6 months to
21 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
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
REMINDER
Benefit Choices That Require Action
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Enrolling for the first time or enrolling in the High Deductible Health Plan
Adding or dropping dependent coverage
Enrolling in new Dental and Vision plans
Increasing life insurance coverage
Participation in the Flexible Spending Account (FSA)
Dependent certification form
Spousal Affidavit is needed if you are covering your spouse on the health plan. If
form not received by 12/1/2014, a $50 monthly surcharge will be applied to your
premium
Waiving coverage
All forms are due in Human Resources no later than 12/01/2014
IF NO CHANGE FORMS ARE RECEIVED BY THE END OF THE OPEN
ENROLLMENT PERIOD FOR YOUR MEDICAL, YOU WILL BE DEFAULTED
INTO THE TRADITIONAL HEALTH PLAN.
Websites
Medical - UMR
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www.umr.com / 1-800-826-9781
Pharmacy Benefit Manager – CVS/Caremark
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www.caremark.com / 1-800-334-8134
Dental - Assurant
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www.assurant.com / 1-800-442-7742
Vision – AlwaysCare
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www.alwayscarebenefits.com / 1-888-729-5433
Life, Long and Short Term Disability - The Hartford
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www.groupbenefits.thehartford.com / 1-888-563-1124
Flexible Spending Account Plan - UMR
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www.umr.com / 1-800-826-9781
HSA Bank
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www.hsabank.com / 1-866-357-5322
LCMC Health 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