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!