Employee Health & Benefits Proposal

Report
Employee Benefits
Open Enrollment Kick-Off
Meeting
Energized for Excellence Academy, Inc.
Energized for STEM Academy, Inc.
Inspired for Excellence Academy, Inc.
Memorial Hermann Hospital
7737 Southwest Freeway-Wilson Turner Auditorium
Friday, November 7, 2014
4:30 P.M. until 7:00 P.M.
Employee Meeting
Energizing, Happy, Healthy, Productive and Inspired Employees!
AGENDA
4:30 P.M. - 7:00 P.M.
I.
Check-in & Flu Shots
II.
Welcome & Opening Remarks
III.
Employee Milestone Anniversary Acknowledgements
IV.
Employee Quarterly Birthday Acknowledgements
V.
Benefit Presentations
VI.
Small Group Presentations & Enrollment Opportunities
VII.
Flu Shots & Refreshments
Employee Benefits
Planning Team

Ms. Argentina M. James, Human Capital Dept., Director

Mr. Monday Anigboro, Accountant

Ms. Jessica Roca, Payroll Dept., Manager

Ms. Vanessa Vidaurri, Human Capital Dept.
Administrative Assistant
Employee Benefits
Team Captains
 Ms. Claudette Davis
EEA Early Learning Center Campus 350
 Ms. Beverly Cage
EEA Elementary School Campus 364
 Ms. Sandra Brandyberg
EEA Elementary School Campus 364
 Ms. Elaine Vieira
EEA Elementary School Campus 364
 Ms. Cynthia Pope
EEA Middle School Campus 342
 Mr. George Pope
E-STEM Middle School Campuses 321/455
 Mr. Joe Nelson
E-STEM High School Campuses 390/459
 Ms. Elva Geward-Moore
Inspired Middle School Campus 300
 Ms. Cristina Opico
EEA/E-STEM Campuses Custodial Staff
 Ms. Jessica Roca
EEA/E-STEM Non-Instructional Support Staff
 Ms. Vanessa Vidaurri
Administrative Support at Jutland Campus
Employee Benefits Partners

AXA Advisors: Agent of Record & Retirement Program

Rogers Benefit Group: onboarding & benefits
administration services

Memorial Hermann Insurance: Medical Insurance

MetLife Plans: Dental, Vision, Life Insurance AD&D

Bay Bridge Administrators: Critical Illness, Cancer,
Hospital Indemnity, & Disability

TASE: 125 Plan (Pre-Tax) & Employer Compliance

LegalShield: Identity Theft Protection & Legal
Insurance

Insurance Agent of Record

Global Fortune 500 Company

16th Largest Corporation

Operate in 60+ Countries

Leader in Retirement Funds in K-12 Markets

$1.38 Trillion in Assets Under Management

$1.2 Million in Scholarships

Community Partner
Hermann Memorial Accolades
15 Top Health
Systems; Top 5
Large Health
Systems (2012 & John M. Eisenberg
National Patient
2013)
Safety & Quality
Award (2012)
America‘s #1
Quality
Hospital for Overall
Care
(2011 & 2012)
HealthGrades®
 America’s 50 Best
Hospitals (2010,
2011, 2012 & 2013)
National Quality
Forum National
Quality Healthcare
Award (2009)
Texas Hospital
TIRR Memorial
Hermann -- No. 3 in Association
rehabilitation
Bill Aston Quality
hospitals
Award (2011)
The Joint
Commission Top
Performer
(2012), Heart
Attack, Heart
2011 Texas
Failure,
Healthcare
Pneumonia, Foundation Quality
Surgical Care
Improvement
Awards (9
Memorial
Hermann
Campuses)
Memorial Hermann Insurance

Medical Plan Highlights

5 health plan options

5,500 physicians, 12 hospitals and growing

MD Anderson is within network*

33 Network Clinics* including: CVS Minute Clinics, RediClinics
and Walgreens Takes Care Clinics

Free generic prescription drugs* (no co-pay or deductible)

Free on-site flu shots upon request

Teledoc*-No cost co-pay per phone consultation with board
certified MD (get prescriptions fast, if required)
* Services Not included on Option I
Care Delivery Network MH Select PPO
Care Delivery: Indispensable market leader in health
delivery
212
Total
Sites
MD Anderson* is
now in our
network.
*not included in
Option 1
The Market Leader-MH Select PPO
$4.7B Total Assets
$4B Net Operating Revenue
Over $1.7B in Balance Sheet Liquidity
Over 21,000 Employees; Over 5,500 Medical Staff
212 Locations
Market Share Ranking
Inpatient Market Share
1st: Aggregate Market Share
1st: Burns
1st: Cardiology
1st: ENT
1st: General Medicine
1st: General Surgery
1st: Neurology
1st: Neurosurgery
1st: Ophthalmology
1st: Orthopedics
1st: Rehab
1st: Thoracic Surgery
1st: Urology
1st: Vascular
2nd: Gynecology
2nd: Obstetrics
2nd: Neonatology
2nd: Spine
2nd: Oncology
Greater Houston MSA 6.36 million population, projected to 6.9 million (2018)

Option #1
Select 6450-100 HSA HMO

Network: Memorial Hermann Select HMO

Preventive $0

$6,450 deductible, then 100%

RX + medical = $6450 Out-of-Pocket maximum

Must choose PCP; no referral needed for specialist
Summary for Illustrative purposes. Please refer to SBC for official details

Option #2
Select 6600-100 Standard

Network: Memorial
Hermann Select PPO

Preventive $0

PCP = $35


Outpatient Lab/x-ray=$35

MRI/Scans = $35

ER = $500
Chiro/PT/OT/Mental/

UC = $50
Substance Abuse
/Acupuncture = $35

Other: $6600 deductible,
then 100%

RX= $0 generic/ $40
preferred/ $75 nonpreferred

Specialist = $70

Hearing/Speech = $20
Summary for Illustrative purposes. Please refer to SBC for official details

Option #3
Select Standard Copay

Network: Memorial Hermann
Select PPO

MRI/Scans= $700

Outpatient surgery= $1,500
facility; Physician= $0

Hospitalization= $1,500/day
for 1st 3 days; then 100%

Preventive: $0

PCP= $50

Specialist= $100

Emergency Room= $700

Chiro/PT/OT/Acupuncture =
$100

Urgent Care= $100

Durable Medical Equipment=
no charge

Hospice= no charge

RX= $0 generic/$65 preferred/
$130 non-preferred

Mental/Substance abuse = $50

Outpatient Lab = $50

Outpatient X-Ray= $100
Summary for Illustrative purposes. Please refer to SBC for official details

Option #4
Select Standard Copay – “Buy Up”

Network: PHCS

MRI/Scans= $700

Preventive: $0


PCP= $50
Outpatient surgery= $1500
facility; Physician= $0


Specialist= $100
Hospitalization= $1500/day for
1st 3 days; then 100%

Chiro/PT/OT/Acupuncture
= $100

Emergency Room= $700

Urgent Care= $100

Mental/Substance abuse =
$50

Durable Medical Equipment= no
charge

Outpatient Lab = $50

Hospice= no charge

Outpatient X-Ray= $100

RX= $0 generic/$65 preferred/
$130 non-preferred
Summary for Illustrative purposes. Please refer to SBC for official details

Option #5
Select 500-85 PPO

Network: Memorial
Hermann Select PPO

Preventive $0

PCP = $15

PT/OT/Mental/Substance
abuse = $30

Specialist = $30

Hearing/Speech = $15

Outpatient Lab/x-ray=$15

MRI/Scans = 15% After
Deductible

ER = $500, then 15%

UC = $50

Other: $500 deductible,
then 85%

RX= $0 generic/ $40
preferred/ $80 nonpreferred
Summary for Illustrative purposes. Please refer to SBC for official details
Disclaimer
This is only a summary for illustrative purposes.
Please refer to the official Summary of Benefits and Coverage
for complete details.
How to look up a provider:
www.healthplan.memorialhermann.org
PPO: “Select”
1-888-594-0671
HMO: “HMO”
Buy-up: “PHCS”
Federal Non-Compliance Individual Penalty

For 2015, $325 per uninsured person or 2 percent of household
income over the filing threshold, whichever is greater.

For 2016 and beyond, $695 per uninsured person or 2.5 percent of
household income over the filing threshold, whichever is greater.
There is a family cap on the flat dollar amount (but not the
percentage of income) of 300 percent, and the overall penalty is
capped at the national average premium of a bronze level plan
purchased through an exchange. For individuals under 18 years old,
the applicable per person penalty is half of the amounts listed
above.

Beginning in 2017, the penalties will be increased by the cost-ofliving adjustment.

If qualified plan is offered by employer, individuals may not be
eligible for government subsidies through the Marketplace
Exchange.
DPPO

Preventive – 100%

Basic Restorative – 80%

DHMO

Select a Primary Dentist
from the Network
Major Restorative – 50%

Office Visit Co-Pay - $5

Child Ortho – 50%


Deductible - $50 (Basic
& Major)
All services subject to
corresponding Co-Pay

No Annual Maximums

Annual Max - $1,250


Ortho Max - $1,000
Ortho available for Child
& Adult
Vision Benefits

Eye Exam - $10 once per 12 months

Lenses or Contacts - $25 once per 12 months

Frames - $25 once per 24 months

Laser Surgery Discounts available
Employer Sponsored
Supplemental Term Life

$50,000 Life & AD&D

1 or 2 x’s Salary

Guaranteed Issue

Employee Guaranteed
Issue Amount - $100,000

Spouse Guaranteed Issue
Amount - $25,000

Child Guaranteed Issue
Amount - $10,000
Premium Only Plan
(P.O.P. 125)
Dependent Care (Flex)

Eligible Expenses (must be
employment related)

• FICA/FUTA taxes of dependent
care provider.

• Nanny expenses attributed to
dependent care.

• Nursery school (preschool).

• Late pick up fees.

• Day care when one parent is
working and the other is sleeping
during daytime hours.
Web-based Benefits Enrollment

Accident Insurance Including Disability Riders

Critical Illness

Cancer & Specified Disease Insurance
Legal Services
Identity Theft Protection

Creation of Wills

Credit Report

Power of Attorney

Personal Credit Score

Divorce, Child Support,
Custody

Continuous Monitoring

Identity Consultation

Safeguard For Minors

Restoration Services

All Forms of Identity

Purchases/Foreclosure

Moving Violation/
Accidents

IRS Audits Representation
Employee Responsibility


Employee selects a health plan

Effective January 1, 2015

Employees are not required to use company insurance for their
spouse or dependents on the employee offered plan

Employees with qualifying income and have dependent children
can still receive CHIP coverage.
Employee declines health coverage

Must decline in writing and will be subject to a $325 per
uninsured person or 2 percent of household income over the
filing threshold, whichever is greater.

Show proof of insurance coverage other than public market
exchange coverage with subsidies
OR
Employee Benefits
Open Enrollment Kick-Off
Meeting
Energized for Excellence Academy, Inc.
Energized for STEM Academy, Inc.
Inspired for Excellence Academy, Inc.
Memorial Hermann Hospital
7737 Southwest Freeway-Wilson Turner Auditorium
Friday, November 7, 2014
4:30 P.M. until 7:00 P.M.

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