2016-17 Open Enrollment
Agenda
• Medical Benefit Plan Designs Review
• Medical Benefit Plan Employee Deductions
• New Prague’s Contribution Toward Employees VEBA Account
• HRA/VEBA’s – What are They?
• Dental Plan Design Review
• Dental Plan Employee Deductions
• ClearCost Health
Open Enrollment Began May 6
th
• New Prague Area Schools is happy to announce there are no changes to the
medical and dental benefit plan designs.
– Slight increase in premiums effective July 1, 2016
• 2.1% increase on medical
• 2.08% increase on dental
• Election you make during this open enrollment will stay in effect until next
years open enrollment, unless you experience a qualified family status change.
• All election changes must be submitted to Human Resources by or before
Benefit Plan Design Options
Benefit Triple Gold $500 CMM VEBA
Network In-network
(PCC)
Extended Network
Outof
-Network In-network In-network
Deductible N/A $200 per person
$600 per family
$500 per person $1,000 per family
$1,200 per person $2,400 per family Medical Out-of-Pocket
Maximum
$500 per person $1,000 per
family
$2,500 per person $5,000 per family
$1,200 per person $2,400 per family
$1,200 per person $2,400 per family Rx Out-of-Pocket
Maximum
$2,000 per person $4,000 per family
$300 per person
$500 per family N/A
Preventive Services 100% coverage Ded, then
80%
Ded, then
75% 100% coverage 100% coverage
Office Visit $15 copay, then
100% coverage
Ded, then 80%
Ded, then 75%
Deductible, then 80% coverage
Deductible, then 100% coverage
Diagnostic Lab & X-ray 100% Ded, then
80%
Ded, then 75%
Deductible, then 80% coverage
Deductible, then 100% coverage
In/out-Patient Hospital 100% Ded, then
80%
Ded, then 75%
Deductible, then 80% coverage
Deductible, then 100% coverage
Emergency Room $40 copay, then 100% coverage Deductible, then 80%
coverage
Deductible, then 100% coverage
Employee Deductions Per Pay Period
Medical Administration Transportation Clerical Food Service Pay Periods 24 PP 18 PP 24 PP 24 PP 19 PP 24 PP Triple Gold – Single $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $500 CMM – Single $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 VEBA – Single $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Triple Gold – Family $39.79 $560.84 $444.00 $417.67 $560.84 $444.00 $500 CMM – Family $0.00 $430.11 $340.50 $314.17 $430.11 $340.50 VEBA – Family $0.00 $482.53 $382.00 $355.67 $482.53 $382.00
Medical Custodial Support Staff Teachers Technicians
Pay Periods 24 PP 19 PP 24 PP 18 PP 24 PP 24 PP Triple Gold – Single $0.00 $0.00 $0.00 $143.39 $107.54 $36.58 $500 CMM – Single $0.00 $0.00 $0.00 $86.39 $57.13 $0.00 VEBA – Single $0.00 $0.00 $0.00 $110.83 $83.13 $3.58 Triple Gold – Family $444.00 $560.84 $444.00 $418.44 $313.83 $551.58 $500 CMM – Family $340.50 $430.11 $340.50 $280.44 $210.33 $448.08 VEBA – Family $382.00 $482.53 $382.00 $313.17 $234.88 $473.33
New Prague’s VEBA Contribution
• New Prague Area Schools will contribute to a HRA/VEBA for those
employees who enroll in the high deductible health plan with VEBA.
• New Prague’s Contribution Amount:
– $1,200 for those employees who enroll in single coverage.
Single Enrollee under the Triple Gold Plan moves to the VEBA Plan
Example 1 –
Triple Gold Plan Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE premium is $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $215.08 $73.16 Move to the VEBA Plan
Monthly EE premium would be
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $166.26 7.16
EE Savings of $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $48.82 $66.00
New Prague would contribute to your VEBA
Admin Transport Clerical Food Serv Custodial Support Teacher Tech
Monthly VEBA contribution
$100 $100 $100 $100 $100 $100 $100 $100
Annual VEBA contribution
$1,200 $1,200 $1,200 $1,200 $1,200 $1,200 $1,200 $1,200
Combined savings of Admin Transport Clerical Food Serv Custodial Support Teacher Tech
Monthly EE Savings $100 $100 $100 $100 $100 $100 $148.82 $166.00
Example 2 –
Family Enrollee under the Triple Gold Plan moves to the VEBA Plan
Triple Gold Plan Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE premium is $79.58 $888.00 $835.34 $888.00 $888.00 $888.00 $627.66 $1,103.16 Move to the VEBA Plan
Monthly EE premium would be
$0.00 $764.00 $711.34 $764.00 $764.00 $764.00 $469.76 $946.66
EE Savings of $79.58 $124.00 $124.00 $124.00 $124.00 $124.00 $157.90 $156.50
New Prague would contribute to your VEBA
Admin Transport Clerical Food Serv Custodial Support Teacher Tech
Monthly VEBA contribution
$200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00
Annual VEBA contribution
$2,400 $2,400 $2,400 $2,400 $2,400 $2,400 $2,400 $2,400
Combined savings of Admin Transport Clerical Food Serv Custodial Support Teacher Tech Monthly EE Savings $279.58 $324.00 $324.00 $324.00 $324.00 $324.00 $357.90 $356.50 Annual EE Savings $3,354 $3,888 $3,888 $3,888 $3,888 $3,888 $4,294 $4,278
HRA / VEBA’s ― What Are They?
• HRA/VEBA’s are an account that is funded by the employer to be used by
the employee to reimburse them for certain expenses.
– Think of them as savings or checking accounts.
• In order to be eligible to have contributions to the account made by the employer. The employee must enroll in the employer’s high deductible health plan (HDHP).
HRA / VEBA Contributions ― Who is
Eligible?
• Employee must be enrolled in the HDHP and,
• Employee can be:
– Covered by other non-qualified HDHP including traditional health plans, FSA, HRA, or spouse’s health and/or FSA plans.
– Enrolled in Medicare.
– Claimed as a dependent on another’s tax return.
HRA / VEBA Contributions
• Pre-tax employer contributions on behalf of the employee.
• Contributions are made to a tax exempt, employer trust account, e.g.,
Voluntary Employee Beneficiary Arrangement (VEBA)
• Tax-free withdrawals for qualified expenses only, no “cash out”
HRA / VEBA with FSAs
• Employees who enroll in the HDHP with HRA/VEBA plan are eligible to
also participate in the Flexible Spending Account.
• Full FSA (flexible spending account) for all medical, dental and vision
expenses is allowable.
• Spouse may also have a full FSA.
HRA / VEBA’s – How Do I Use the
Money?
• Cross-over
– After you visit your doctor their office will submit a claim to BlueCross.
– The claim will be processed were the eligible patient responsibility is electronically submitted to SelectAccount.
– SelectAccount processes the claim from your medical spending account(s) and reimburses you directly.
• Debt Card
– Simply swipe your debit card at the pharmacy. If the funds are available in your reimbursement account, your account will automatically be debited for the
claim.
ARTHUR J. GALLAGHER & CO. | BUSINESS WITHOUT BARRIERS™
HRA / VEBA
• The crossover feature should not be selected if you or any of your covered
dependents have more than one health plan (private or Medicare), or if you have a debit card.
• New enrollees into the HDHP with HRA/VEBA plan will receive a
welcome kit from SelectAccount in the mail.
• Visit SelectAccount.com to sign up for a user name and password to
manage all of your reimbursement accounts.
• You have 24 hours access to all of your information via
www.SelectAccount.com
• Customer Service is also available at (651) 662-5065 or (800) 859-2144.
HRA / VEBA Withdrawals
• Withdrawals are for qualified expenses only and are tax-free
– May be reimbursed for expenses for yourself, spouse and dependents up to the age of 26
– Must prove you had an eligible expense at time of reimbursement
• In addition to qualified expenses, after termination, can be used to pay for most insurance premiums including Medicare Supplement premiums
Employee enrolls in HDHP
•Employer funds HRA
Employee incurs an expense
•Employee submits expense to HRA administrator
Administrator
reimburses expense from available funds •Employee uses
funds to pay provider
HRA / VEBA Considerations
• Sponsored solely by the employer – established a trust (VEBA).
• No requirements other than employer plan design choice.
• Employer funded only – no employee contributions.
• All 213(d) expenses and certain insurance premiums – Medicare Supp
premiums allowed.
• May be continued under COBRA (spend down feature).
• Claims will need to be substantiated.
• Participants will not be reimbursed for amounts that exceed the balance in
their HRA/VEBA.
Benefit Plan Design Dental
Plan Highlights In-network Out-of-network
Annual Maximum $1,000 per calendar year $1,000 per calendar year
Implant Maximum $500 per calendar year $500 per calendar year
Deductible (applies to basic care, special care & prosthetics)
$25 per person, $75 per family $25 per person, $75 per family
Preventive and Diagnostic Care 100% coverage 100% coverage
Basic Care I
Fillings (amalgam and anterior composite 80% coverage 80% coverage
Posterior composite (white filings) 50% coverage 50% coverage
Simple extractions 80% coverage 80% coverage
Non-Surgical periodontics 80% coverage 80% coverage
Endodontics 80% coverage 80% coverage
Basic Care II
Surgical periodontics 50% coverage 50% coverage
Complex oral surgery 50% coverage 50% coverage
Special care (restorative crowns & onlays) 50% coverage 50% coverage
Prosthetics 50% coverage 50% coverage
Employee Deductions Per Pay Period
Dental Administration Clerical Custodial Food Service Pay Periods 24 PP 24 PP 24 PP 19 PP 24 PP
Single $0.00 $1.24 $1.24 $4.20 $3.33
Family $10.86 $32.52 $32.52 $43.71 $34.61
Dental Support Staff Teachers Tech Transportation
Pay Periods 19 PP 24 PP 18 PP 24 PP 24 PP 19 PP 24 PP Single $2.89 $2.29 $0.49 $0.37 $1.24 $4.20 $3.33 Family $42.40 $33.57 $42.20 $31.65 $32.52 $14.24 $11.27
ClearCost
Health
• Free service offered to all members enrolled in New Prague Area Schools
medical insurance.
• ClearCost is an online tool that allows members to comparison shop for
health care services using an easy-to-use online tool.
• Empowers members to lower their out-of-pocket healthcare costs by being
able to compare the price and value prior to incurring claims.
• Allows members to search the cost of prescriptions.
• Registration is easy and takes about 5 minutes
• Visit www.clearcosthealth.com
Open Enrollment Ends May 27
th
Gallagher Benefit Services, Inc.
Disclaimers and Disclosures
• Coverage Notice This analysis is an outline of the coverage proposed by the carrier(s), based on information
provided by your company. It does not include all of the terms, coverage, exclusions, limitations, and conditions of the actual contract language. The policies and contracts themselves must be read for those details. Policy forms for your reference will be made available upon request.
• Legal Notice The intent of this analysis is to provide you with general information regarding the status of, and/or potential concerns related to, your current employee benefits environment. It does not necessarily fully address all of your specific issues. It should not be construed as, nor is it intended to provide, legal advice. Questions
regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area.
• Renewal-Financial Notice This analysis is for illustrative purposes only, and is not a guarantee of future expenses, claims costs, managed care savings, etc. There are many variables that can affect future health care costs including utilization patterns, catastrophic claims, changes in plan design, health care trend increases, etc. This analysis does not amend, extend, or alter the coverage provided by the actual insurance policies and contracts. Please see your policy or contact us for specific information or further details in this regard.
• Financial Rating Notice While GBS does not guarantee the financial viability of any health insurance carrier or market, it is an area we recommend that clients closely scrutinize when selecting a health insurance carrier or HMO. There are a number of rating agencies that can be referred to including, A.M. Best, Fitch, Moody’s, Standard & Poor’s, and Weiss Ratings (TheStreet.com). Generally, agencies that provide ratings of U.S. Health Insurers, including traditional insurance companies and other managed care (e.g., HMO) organizations, reflect their opinion based on a comprehensive quantitative and qualitative evaluation of a company’s financial strength, operating performance and market profile. However, these ratings are not a warranty of any insurer’s current or future ability to meet its contractual obligations.
