Know Your Benefits Presentation

Report











April 2013 – Health Care Forum
May/June 2013 – Two All-Day Benefits Planning Meetings
July 2013 – RFP Preparation
Oct./Nov. 2013 – Request for Proposal
Nov 2013 – RFP Information Compiled by Hub International
Dec. 2013 – Faculty & Staff Survey
Dec. 2013/Feb. 2014 – Committee Review of Proposals
◦ Six, four-hour meetings
Jan. 2014 – Final Vendor Presentations
Feb. 2014 – Vendor Recommendations to President’s Council
Feb 2014 – HR Matters sent to employees
April 2014 – Health Care Forum II
2






Employee survey sought to discover the number one issue for
employees in regards to our health plan.
Employees were asked to rank three criteria from lowest to highest
priority.
◦ Cost: total yearly out-of-pocket costs including monthly
premiums, co-pays, and deductibles
◦ Access: Ability to be seen by a member of the provider network in
the nearby vicinity
◦ Choice: Ability to visit your preferred hospital, clinic, or health
professional
Survey collected 559 responses
370 ranked cost as their highest priority (66%)
141 ranked choice as their highest (25%)
48 ranked access as their highest priority (9%)
3
4




Nationwide network, with in-network
coverage outside of UT.
85% of employees live in UT county
UMR covers 96% of UVU’s top 200 providers
Out-of-network coverage leased through
First Health Network
5

Two network offerings
◦ United Healthcare Choice Plus and Options PPO

Choice Plus network mirrors our current
network facilities with EMI
◦ Intermountain Health Care Facilities

Options PPO covers IHC as well as the
University of Utah Hospital and IASIS facilities
◦ Jordan Valley, Davis Hospital, Pioneer Valley, and
Salt Lake Regional
◦ Mountain Star hospitals only offered as an out-ofnetwork facility
6
UHC Choice Plus
UHC Options PPO
Out-of-network
UVRMC
All UHC Choice Plus Facilities
HCA Facilities
American Fork
University of Utah Hospital Mountain View Hospital
Intermountain Medical Center
Huntsman Cancer Center
Orem Community Hospital
Jordan Valley
Primary Children's
Davis Hospital
Riverton Hospital
Pioneer Valley
Alta View Hospital
Salt Lake Regional
Heber Valley Medical
Central Utah Clinic of
American Fork Surgery
Center
St. Mark's Hospital
Timpanogos Regional
Hospital
Brigham City
Community Hospital
Lone Peak Medical
Campus
Ogden Regional Medical
Center
Central Utah Surgery
Center (Provo)
Orthopedic Specialty Hospital
Park City Medical
Dixie Regional
LDS Hospital
7


No increase in premiums, deductibles, copays, or co-insurance coverage for 2014-15
plan year
Consumerism tools available through UMR
◦
◦
◦
◦
◦
◦
◦
Healthcare Cost Estimator calculator
Teladoc
NurseLine
Maternity Management
Wellness
Disease and Case Management
Doc GPS app
8




Medical Claims Administration – UMR
◦ Best overall savings. Limited disruption for employees
Dental Claims Administration – EMI
◦ Deepest savings on network claims. Best overall savings.
◦ No disruption to employees.
Vision – United Healthcare
◦ Employee paid benefit
◦ Co-pays for glasses and contacts vs. current plan with reimbursement
limits.
◦ Lower premiums than current plan offerings, with richer benefit for
employees.
Pharmacy Benefit Manager – Envision RX
◦ Best overall savings.
◦ Large network offering (Walgreens, Walmart, Smiths, Costco, and more).
◦ Specialized care covering 7 million lives.
9
Choice Plus Network
White
Options PPO Network
Single
Two-Party
Family
Single
Two-Party
Family
Employee Premium
$45.38
$104.86
$151.42
$61.48
$142.05
$205.13
University Contribution
$408.48
$943.68
$1,362.90
$408.48
$943.68
$1,362.90
Single
Two-Party
Family
Single
Two-Party
Family
Employee Premium
$73.90
$170.74
$246.58
$91.01
$210.27
$303.67
University Contribution
$408.48
$943.68
$1,362.90
$408.48
$943.68
$1,362.90
High Deductible
Single
Two-Party
Family
Single
Two-Party
Family
Employee Premium
$0.00
$0.00
$0.00
$14.49
$33.47
$48.34
University Contribution
$408.48
$943.68
$1,362.90
$408.48
$943.68
$1,362.90
Green
10
White and Green Plan
HDHP:
 Some services are covered
 Every medical/prescription
outside the deductible through a
expense is subject to the
co-pay system (office visits, lab
deductible before insurance
work, emergency room,
payments begin, except for
prescriptions, etc.) All
preventative care services,
preventative care is covered
which is covered at 100%
100% by the plan.
 Once the deductible is met,
 Once the deductible is met,
insurance pays 80% of most
insurance pays 80% of most
services and employee pays
services and employee pays 20%
either a co-pay or co-insurance
up to the co-insurance
of 20%.
maximum.
 Two-party and family coverage
 Separate deductible and coall subject to $4,000 deductible.
insurance maximum for
prescriptions.
11
White Plan
Medical
Deductible
$1,000 - Individual
$2,000 - Family
Green Plan
$500 - Individual
$1,000 – Family
High Deductible
$2,000 - Single
only coverage
$4,000 - Family
$3,000 - Single
Medical Outof-Pocket
Maximum
$5,000 - Individual
$10,000 - Family
$4,500 - Individual
$9,000 - Family
$6,000 - Family
RX Deductible
$100 - Individual
$200 - Family
$100 - Individual
$200 - Family
Subject to Medical
RX CoInsurance
$2,000 - Individual
$4,000 - Family
$2,000 - Individual
$4,000 - Family
Subject to Medical
only coverage
12





Employees can still receive medications at a pharmacy counter
Wide coverage throughout the state from large chain stores to
smaller local pharmacies
Provides deepest discount on Rx
Mail order available through online account
Diabetic Testing Supplies now available at pharmacy
Pharmacy Plan
Deductible
Co-insurance
Generic Co-pay
Formulary
Coverage
Non-formulary
Coverage
White/Green
$100/$200
$2,000/$4,000
$4 (30-day supply)/$8 mail
order (doesn’t apply to
deductible)
HDHP
Subject to medical
Subject to medical
$4/$8 mail order (after
deductible)
30%
30%
50%
50%
13





Plan will remain with EMI Health
No disruption for employees
Same premiums and plan design as 2013 -14
$50 deductible per person up to $150 per
family
$1500 calendar year limit per person
Dental Plan
Single
Two-Party
Family
Employee Premium
University
Contribution
$12.48
$15.96
$23.22
$49.94
$63.86
$92.94
14





New benefit plan
Lower premiums with richer benefit!
$30 copay for materials (glasses, contacts, etc.)
$100 frame benefit
Lenses, frames, and contacts (in lieu of glasses) every 24
months
Vision Plan
Single
Two-Party
Family
Employee Premium
$2.98
$5.96
$9.69
15

Will provide UVU administration for:
◦ Flexible Spending Account (FSA)
◦ Health Savings Account (HSA)
◦ COBRA


EZ receipts app and better tools for
employees
Smart card for auto-adjudication of claims
16



A medical plan that must meet certain IRS annual
deductible minimums and maximum out-of-pocket
limits.
All covered benefits, with the exception of
preventive benefits, apply to the plan deductible,
including prescriptions drugs.
Plan covers either Employee Only coverage or
Family coverage.
◦ Family coverage - one family member or a combination of
all family members’ claims must meet the deductible
amount before the plan will pay towards covered health
care services.
17

An employee owned tax-free savings
account (triple tax savings).
1. Payroll contributions to account are on a pretax basis and reduce employee’s annual taxable
income.
2. Tax-free withdrawals if used to help pay for
qualified out-of-pocket medical, dental, and
vision expenses, such as co-pays, deductibles,
and coinsurance.
3. Earns interest tax-free.
 Investment threshold of $1,000 with BNY Mellon
18

To be eligible for an HSA, an individual has to:
•
•
•
•
Be covered by a Qualified *HDHP
Not covered by a “*traditional” health insurance plan
Not enrolled in Medicare nor Tricare
Not claimed as a dependent on someone else’s tax return
*Traditional plan – Insurance plan helps pay from the first day
*HDHP plan – Deductible must be met before insurance payments begin
19

Since the account is owned by the employee, not
the employer, the employee decides:
◦ Whether he or she will contribute and how much to
contribute;
◦ How much to use for qualified expenses;
◦ Which expenses to pay for from the account;
◦ Whether to pay from the account or save for future use;
◦ Which company will hold the account;
◦ What type of investments to grow the account (when
qualified).

Employer cannot restrict use of HSA distributions.
20

No “use it or lose it” rules like Flexible Spending
Accounts.
◦ All amounts are fully vested.
◦ Unspent balance in account remains in account until spent
(rollover).

Encourages consumerism
◦ Encourages account holders to spend their funds more
wisely.
◦ Encourages account holders to shop around for the best
value for their health care dollars.

Accounts can grow through investment earnings.
◦ Same investment options and investment limitations as IRAs.
◦ Same restrictions on self-dealing as with IRAs.
21




Contribution made by the employee reduces their
annual taxable income and the contribution is not
taxable to the HSA.
Contributions from all sources count toward the
annual contribution limit. The contribution limits
are: 2014 - $3,300 employee only: $6,550 family.
Catch-up $1,000 – age 55 by end of tax year.
Employee can make a one-time transfer from their
IRA to an HSA (subject to annual contribution limits).
22


Elections for payroll contributions run
through a cafeteria plan, unlike Flexible
Spending Accounts, employee can change
their election amount on a month-bymonth basis.
Distribution is tax-free if taken for qualified
expenses incurred on or after the date the
HSA was established.
23


Distributions can be taken for the
employee, the spouse of the employee, and
generally any tax dependent of the
employee.
Distributions can be taken for non-qualified
expenses. Distribution will be subject to:
◦ Income tax; and
◦ 20% additional tax penalty.
24
Health Savings Account (HSA)
Flexible Spending Account (FSA)
Availability of funds
Funds available as employees
make payroll contributions
Full funding amounts available on
the first day of the plan year.
Who may fund the
account
Employee, employer, or any third
party
Typically the employee
Who owns the
account?
The employee/account holder
Employer
Is there an annual
contribution limit?
For 2014, $3,300 employee only;
$6,550 family.
Catch up $1,000 – age 55 by end
of tax year.
$2,500.
Can unused fund
rollover from year to
year?
Yes
No
Do claims have to be
substantiated for
reimbursement?
No
Yes
25






Ineligible Medical Expenses Include:
Insurance premiums (other than the ones
listed under the qualified medical expenses)
Over-the-counter drugs (unless a
prescription is obtained from a physician or if
the drug is insulin)
Cosmetic surgery
Expenses covered by another insurance plan
General health items such as tissues,
toiletries, hand sanitizer, etc
26


UVU will organize a mass transfer of accounts
Account holders have three options:
◦ Spend down funds to $0
◦ Transfer money from Optum Bank to BNY Mellon
account
◦ Keep both accounts open
 Account holders will be charged a fee for Optum
Bank/Tango account
 $4 to keep Tango functionality
 $1 for Optum Bank
27

For employees who had an FSA during 201314
Grace period in effect until 09/15/2014
Will be administered by National Benefit Service
Debit cards will not work after 06/30/2014
Employees wishing to open an HSA with a
remaining FSA balance as of 7/1/14 will have to
wait until 10/1/14 to contribute to an HSA
28




All enrollments entered online through
UVLINK
No paper forms for Medical, Dental, Vision,
and Flex-Spending
Remember to check coverage boxes for
dependents
Verify coverage level
29



Will need to fill out UMR survey and inform
them of other coverage
All employees must complete, even if they
have no other insurance plans
Form can be completed by:
◦ Returning form included in mailer with ID cards
◦ Calling UMR and verifying coverage
◦ Logging into UMR member portal and entering
other coverage information
30











UMR Medical Benefit Training: Facilitated by UMR
Wednesday, April 23, 2014, 11:00am – 12:00 pm, SC 213 AB
Wednesday, May 14, 2014, 1:00 pm – 2:00 pm, BA 207 (Webinar)
WageWorks HSA and FSA Training: Facilitated by WageWorks
Wednesday, April 23, 2014, 1:00 pm – 2:00 pm, SC 213 AB
Tuesday, April 29, 3014, 1:00 pm – 2:00 pm, BA 207 (Webinar)
Tuesday, May 6, 2014, 11:00 am – 12:00 pm. SB 134
EnvisionRx Pharmacy Benefit Training: Facilitated by EnvisionRx
Wednesday, April 23, 2014, 12:00 pm – 1:00 pm, SC 213 AB
Tuesday, May 13, 2014, 2:00 pm – 3:00 pm, SB 134
Benefit Fair trainings are available on the Open Enrollment
site.
31

Supplemental Benefit Options
◦
◦
◦
◦
◦

Minnesota Life
AFLAC
Hyatt Legal
Met-Life
MedAmerica
Re-enroll in FSA
◦ Must make new election each plan year

Open Enrollment
◦ April 21 – May 16
32
Thank you and questions!

similar documents