Health Insurance Power Point. 2015

Frenship ISD
Group Health
Insurance Plan
2014-2015 FISD
Health Insurance Committee
Terra Vista
Oak Ridge
North Ridge
Willow Bend
Central Office
Tate Casey
Lynn Mills
Katrina Smith
David Speer
Emily Wagner
Sanae Allison
Cyndy Heald
Tawni Stockton
Stacey Owen
Betsy Bucy
Bobbie Jo Williams
Stacey Price
Balt Padilla
Rudy , Derek Cobb, Allen Tanner
Rhonda Dillard, Pat Valdez, Jason Gossett,
Dr. Vroonland, Dr. McCord, Tim
Williams, Courtney Reeves
January 1, 2015 through
December 31, 2015
* Remember, Our Plan year…
Employee feedback indicates:
506 responses to the survey
Some negative responses about First Care
Some negative responses about ACA
Employees wanted better benefits at a lower
56% responded that they valued low cost or no
cost premium as their first priority
43% responded that they valued doctor copays
*First Care
*Blue Cross Blue Shield
*United Health Care declined to
provide a quote
*October 2 - The committee
unanimously voted to move to Blue
Cross Blue Shield.
*October 20 - The School board
reviewed and approved the
recommendation to move to Blue
Cross Blue Shield.
*More Doctors and hospitals
*Coverage everywhere you go
*Online resources and programs
*Personalized Customer Service
*Blue Access Mobile
*Health and Wellness programs
*Home Delivery Prescriptions – Must pre-
register at OR call Prime Mail at
1-877-357-7463 by phone
*On line access:
*Customer Service information on
the back of your medical ID card
*BlueCard Access 24/7
810-BLUE (2583)
- 1-800-
*Plan Options with
Blue Cross Blue Shield:
(In network and out of network coverage on every plan)
PPO 1 (PPO 1 and 2 combined)
PPO 2 (Employee only free plan)
PPO High Deductible plan (Health Savings
* Premiums Comparison
All Plans Side by Side
Note: All premiums INCLUDE $266/month that is paid by FISD and reflect YOUR monthly cost:
Employee Only
Emp. & Spouse
Emp. & Child
Emp. & Family
$ 53
**All employee incurred expenses go towards the deductible**
PPO 1 Plan
 Deductible
$3000 per member ( $6000/family) - In Network
 Co-Insurance – 20% in network/
meeting the deductible)
40% out of network (Employee pays after
 Out of network services at a higher cost share
 $45 Dr. visit
Co-pay ( $60 / specialist)
 RX - $10-$35-$75-$150 after $100 deductible
 Out-of-Pocket Maximum = $5500 per member – In Network
($11,000/family) – In Network (out of pocket max includes all copays)
 Hospital/Maternity – 20%/40% (Employee pays after deductible)
 Emergency room/ 20% after $150 copay (facility charges only)
Maternity – Pediatrician, delivery, and nursery are covered at 80% after the
$3000 deductible
PPO 2 Plan (free plan for employees)
 Deductible - $6000 per member / $12,000 family
 Out of network services at a higher cost share
 Co-Insurance – 100% (plan pays after deductible is met)
 $45 Dr. Visit Co-pay ($90 specialist)
 RX - 50%/preferred after $250 deductible
 Out-of-Pocket Maximum = $6000 individual/ $12,000 family
(out of pocket max includes all copays)
 Hospital/Emergency/Maternity – 100% after $6000 Deductible
is met
PPO/HSA – Health Savings Account
Deductible $3000 per member
( $6000 /family) – In-Network
Coinsurance – Employee pays all medical expenses until $3000
deductible is met.
No Dr. copays – Discounted office visits and plan pays 80% after
deductible is met
RX – Prescriptions are paid for by employee until deductible is met
Hospital/Maternity/Emergency – Employee pays 20% after deductible
is met
Out-of-Pocket Maximum - $6,350 per member
( $12,700 / family) - In Network
Money placed in HSA account is above and beyond the premium
HSA account must be set up prior to incurring claims in order to
have tax advantage.
Individual and/or family deductible must be met
before you are eligible for any insurance benefits.
You have the option to open a Health Savings
account. This money must be used on medical
expenses and is your money as long as the account
is open.
HSA account must be opened prior to accessing any
Maximum - $3350.00/Individual
In Network / Out of Network
In-network - The BCBS network is called Blue Choice.
Out of network services will be billed at a higher cost share to the
When traveling outside of Texas you will ask if they take “Blue
Preauthorization may be required for some services. It is
always best to check before receiving major services. This
information will be on the back of your insurance card.
*In Network / Out of
Options to cover Family or
Health Insurance Market Place /
Affordable Care Act / 1-800-318-2596
Individual policy with independent
*Affordable Care Act (ACA)
*Public Marketplace
*Guaranteed issue / No Pre-existing limitations
*Sold through, Ashmore & Associates,
Aycock and Fowler, independent agents and other
*Policies and rates are identical on both public and
private marketplaces.
*Only licensed agents can assist consumers with actual
purchase decisions.
*Navigators are licensed to assist with the completion
of the application.
*Subsidies and Tax credits are
available through the public
marketplace – ONLY if your employer
does NOT offer you a compliant plan
as an option.
*FISD plans comply with all the
minimum benefit and affordability
If at all possible, go to a provider that is contracted with
BCBS Choice networks so that claims are paid in network.
Prescriptions – Always ask for generic, check at least three
pharmacies for best price, check local pharmacies to see if
the meds are FREE, Google prescription for coupons and
discounts, and ask Doctor for samples.
Lab work and x-rays done in conjunction with the office
visit are included in your office visit copay.
Other class of diagnostic tests are subject to your
deductible. (Ex. MRI)
Ways to manage your
Telehealth & Wellness solution plan - $9.00 per month covers
the entire family
Compliments the medical plans and saves on medical claims
3 easy steps to speak to a physician anytime anywhere online
or by phone
Prescriptions are called in to the pharmacy of your choice –
(Must accept Blue Cross Blue Shield)
Online tool provided to shop for the best price on
prescriptions in your area
You must complete medical history on line
Covers most common conditions including but not limited to:
allergies, bronchitis, earache, sore throat, sinusitis, pink eye,
strep throat, upper respiratory infection, urinary tract
*Healthiest You
All Insurance plans cover
Preventative Care at 100%!!
This could include: annual routine physicals, routine immunizations, well
baby and well child care, routine eye/speech/hearing screenings for
children when performed in the office, examination and testing for the
detection of prostate cancer…
Coverage provided in network at 100% with no copay or deductible
**Lab tests related to an illness or condition are not considered preventative**
Blue Cross Blue Shield list of Preventative Care is posted on the
HR website
Additional Contributions
FISD provides $20,000 of Life
Insurance on all employees
The group life coverage was offered on a guarantee
issue basis to all employees during the first year.
If you want to increase your group live coverage, you
now have to apply for the additional coverage.
You will have the opportunity to talk to an FBS
representative during enrollment about supplemental
FISD Cafeteria Plan (Section 125)
“Why should I participate?”
Section 125 is the tax code which allows participating
employees to place certain financial expenses into an
account PRIOR to taxes being withheld.
The only entity to benefit from your participation
is YOU.
The district does not profit from #125
No insurance agent or company benefits
Individual enrollments @ your campus
FISD Cafeteria Plan
Child Care Reimbursement Plan
Medical Reimbursement Plan
Cancer/Intensive Care Insurance
Accident Insurance
Dental Reimbursement Plan – Must file paper
Medical Insurance
Medical Reimbursement Account
NBS Flex card
Money can be taken from your check before taxes each month and
placed in a medical reimbursement account.
You will use an NBS Flex Visa credit card preloaded with the amount of
money that you will put in for the year. (Ex. $50 x 12 = $600) This money
can only be used for medical expenses. Additional cards are $5.00 each.
The NBS Flex card cannot be used for dental expenses.
submit a claim form with receipt for reimbursement.
You must
Maximum - $2550 per year (you must use it or lose it at the end of each
FISD – 2 ½ month grace period to spend funds in flexible account.
90 day run out period – can file claims up to 90 days after plan year
Your Insurance plan
You can learn more about the advantages of the PPO1,
* Contacting The Ashmore Agency or Aycock & Fowler Insurance
Agency for a consultation.
* Visiting with an Insurance representative on the day of
enrollment from 8:30 – 10:00 to discuss your insurance
Consultations Available
NOTE: If you are going to meet your deductible for any
reason please call:
Ashmore and Associates Aycock & Fowler -
You will get one-on-one assistance to help you know what is
ahead of you (i.e. – know what your plan is paying and what
you should pay.
Frenship ISD Brokers
Beth Ashmore
Ashmore & Associates
Brent Aycock
Aycock& Fowler Insurance Agency

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