Dear Brown County Employee:
SEPTEMBER 2014
Brown County is dedicated to providing you and your family with a valuable benefit package. Each year we partner with M3 Insurance to evaluate different health insurance options that are valuable while combating the rising cost of health care.The market is expecting health care costs to increase at least 11% along with additional requirements associated with the Affordable Healthcare Act that will also impact the cost of health insurance plans. With these expected increases in health care costs, Brown County will be moving to an outcomes based premium tiering.
Due to the expected increases in health care costs changes will be made to the current Consumer Driven Health Plan (CDHP) and will go into effect January 1, 2015. These changes will be communicated at the Annual Benefits meetings. Please see the schedule below:
Brown County 2015 Benefit Enrollment
DATE LOCATION TIME(S)
Monday, 9/22/14 Central Library Auditorium 515 Pine St 10:00 AM 1:00 PM Monday, 9/22/14 Syble Hopp
755 Scheuring Road, DePere 3:15 PM
Tuesday, 9/23/14
Neville Public Museum Theater 210 Museum Place 1:00 PM 5:00 PM Tuesday, 9/23/14 CTC
Room 365 - Group Activity Room
3150 Gershwin Drive 3:00 PM Wednesday, 9/24/14 Public Safety/Jail EOC, 2nd Floor 3028 Curry Lane 6:00 AM 7:00 AM 1:00 PM 2:00 PM Thursday, 9/25/14 CTC
Room 365 - Group Activity Room 3150 Gershwin Drive
7:00 AM
Thursday, 9/25/14 Public Works Highway Main Shop 2198 Glendale Avenue
3:00 PM
NOTE: For Public Works Employees Only
Friday, 9/26/14
Sheriff ’ s Department 2nd Floor Training Room 2684 Development Drive
6:30 AM 2:30 PM
2 Medical:
UMR
1-877-233-1800 (or call the number on your ID card if issued) https://member-fhs.umr.com
Dental: Delta Dental 1-877-577-7449 www.deltadentalwi.com Dental Associates / CarePlus 1-800-318-7007 www.careplusdentalplans.com Vision: EyeMed 1-866-939-3633 www.eyemedvisioncare.com
Medical FSA & HRA Administration Genesis Employee Benefits 1-866-678-8322
www.GenesisBenefits.net
Long Term and Short Term Disability Insurance The Standard
1-866-756-8116 www.standard.com
Voluntary Critical Illness and Accident Insurance: United Healthcare
1-800-299-2070
www.unitedhealthcare.com
2015 Health Benefit Options—Brown County Employees
PLEASE NOTE: Medical, Dental, and Vision plans will allow dependent coverage through the end of the month in which the dependent turns 26.
1. Medical
No Health plan election is necessary if no changes are being made for 2015 a. HRA Funding for Employees hired BEFORE 1/1/2014
Family - $2,100 Annually ($525 Quarterly) Single - $1,050 Annually ($262.50 Quarterly) 2. Flexible Spending Account (FSA)
FSA elections must be made on-line at www.GenesisBenefits.net Please contact Genesis directly if you need to reset your password at 1 -866-678-8322.
a. FSA will terminate 12-31-14 if not re-enrolled.
Get the Most from Your FSA
By participating in the Brown County Flexible Spending Account (FSA) you can lower your taxable income and pay for health care expenses on a pre -tax basis. With an FSA, you agree to set aside a portion of your pre-tax salary in an FSA account. That money is deducted from your paycheck over the course of the year and can be used to pay for eligible out-of-pocket medical expenses like prescription drugs, eye glasses, acupuncture and more! Here are a few things to remember when it comes to your FSA:
FSA accounts are setup on a “use it or lose it” basis, so it’s important to carefully calculate how much money to set aside each year. The pre-tax dollars you contribute are not subject to social security, federal, state, or local income taxes, which adjusts your annual taxable
salary.
The annual maximum contribution to the health care reimbursement FSA is $2,500 per participant. The annual maximum contribution to the Dependent care reimbursement DCA is $5,000 per participant.
Eligible expenses include deductibles, copayments, immunizations and more. For a complete list of eligible expenses, refer to the attached handout.
3. Dental
Brown County offers two plans, Delta Dental and Dental Associates/Care Plus for employees to choose between. a. Please refer to the attached Dental Insurance Benefit Comparison for rates and plan designs. b. If continuing on your current Dental Plan, no form is needed.
If electing or changing Dental plans, please complete the enrollment form located at the back of the packet for the plan you wish to change to.
4. Vision
a. If electing Vision, please complete the enrollment form located at the back of the packet. b. If continuing on Vision, no election is necessary.
c. If you are currently on Vision and wish to end coverage, you must fill out the form located at the back of the packet. 5. Short Term and Long Term Disability Plans
Brown County provides its employees short-term and long-term disability benefits. Please refer to page #11 for an outline of benefits. 6. Voluntary Critical Illness and Voluntary Accident
The Voluntary Accident insurance plan can provide benefits for covered accidents that occur off the job. The Group Critical Illness insurance pro-vides a lump-sum benefit payment to cover out-of-pocket medical expenses and the costs associated with life-changes following a covered critical illness. If electing this voluntary insurance coverage, please complete the enrollment form located at the back of the packet and return to Human Resources.
The 2015 Benefit Information will be available on the employee intranet at www.employees.co.brown.wi.us,
click on Departments, Human Resources, 2015 Annual Benefits Enrollment Information.
b. HRA Funding for Employees hired AFTER 1/1/2014 Family - $1,500 Annually ($375 Quarterly) Single - $750 Annually ($187.50 Quarterly)
4
Brown County
Your Consumer-Driven Health Plan……..Health care with a difference
VEBA: Providing high-quality, tax-advantaged health reimbursement plans for public employees
BROWN COUNTY CONSUMER -DRIVEN HEALTH PLAN
(CDHP) IMPORTANT INFORMATION
The CDHP plan can help cover medical and prescription ex-penses. Preventative care is covered at 100% when you use an in-network provider.
HRA Plan Advantages
You choose how your health care dollars are spent.
Your preventative care is covered at 100% when you see in-network providers.
For details, refer to your medical summary plan description, which is found on-line at
www.co.brown.wi.us .
Generally, you pay less if you choose a doctor from the network.
New in 2015: enhanced benefits when you select a UnitedHealth Premium Tier 1 Provider (when available) You can search for providers with this designation on the UMR member site.
There is a limit on how much you will pay each year.
Generally, emergencies are covered anywhere in the world.
Unused HRA dollars roll over to the following year, further reducing your out-of-pocket expense. Tools on www.myumr.com help you:
Check eligible expenses
Check costs for treatment ahead of time Find the best doctors and hospitals Manage your claims
Compare prescription drug costs
Online access to our Health and Wellness content and tools, online health assessment, health coaches, personal health record and automated messaging.
Health Tools and Resources
UMR offers many tools and resources to help you save money and get high quality care. Access these programs via the number on the back of your ID card or at myumr.com. (Also available on your Smart phone) Here is a sample of what’s available:
24 Hour Nurse Line: Contact a nurse anytime of the day when you are facing important health care decisions or need immedi-ate health information
New in 2015—Nurse Chat: This feature gives you convenient access to online nurses who can answer questions about: com-mon symptoms, illnesses and treatments, and information about preventive care.
Prescription Drug tools: Look up the cost of prescription drugs and get suggestions for saving money. Plus, you can find out if any of the prescription drugs, vitamins and over-the-counter medications you are taking have possible negative interactions.
My Personal Health Record: Build and store your own health chart to record your health conditions, medical tests,
medications and medical allergies. You can even print a copy to share with your doctor.
Hospital Comparison Tool: Find the facility near you that provides the highest quality service at the lowest price for a procedure or condition.
Health A to Z Encyclopedia: Provides in-depth information for major diseases, conditions and other lifestyle issues. It is designed to help you make educated health care decisions in partnership with your doctor.
UMR Decision Support Tools: Provides online access to a complete suite of decision making tools from financial impact, health topics, and medical treatments. Includes:
Health Plan Cost Estimator Health Education Library UMR Treatment Cost Calculator
Important updates and reminders……...
Several key pieces of information are available to you in one central location, the Brown County employee’s intranet. Click on 2015 Benefit Information on the home page www.employees.co.brown.wi.us, Brown County Intranet >> Departments >>Human Resources>>Employee Benefits Also on the Human Resources home page, click on Forms to find these important forms. Here you will find:
Fitness Reimbursement information (see Wellness tab) Beneficiary forms
HRA Reimbursement forms
FSA (Flexible Spending) Reimbursement forms
Benefit Plan
Health Carrier UMR
Provider Network UHC Choice Plus
Deductible Single Family
Tier 1 & 2 - In Network $2,000 $4,000
Out of Network $4,000 $8,000
Co-Insurance Percent of shared costs until Maximum out of pocket expense is met
Tier 1 - In Network 90% Employer / 10% member
Tier 2 - In Network 80% Employer / 20% member
Out of Network 50% Employer / 50% member
Out-of-Pocket Maximum Single (includes deductible) Family (includes deductible)
Tier 1 & 2 - In Network $4,000 $8,000
Out of Network $7,000 $14,000
Lifetime Maximum Unlimited
Office Visits
Tier 1 - In Network $15 copay, then 100%
Tier 2 - In Network $30 copay, then 80%
Out of Network Deductible and Coinsurance Apply
Retail Clinic
In Network $10 copay, then 100% Deductible and Coinsurance Apply
Routine/Preventive Care
In Network 100%
Out of Network Deductible and Coinsurance Apply
Prescription Drugs Generic / Brand / Non-Preferred (member share)
In Network 20% / 25% / 35%
$1,500 Single / $3,000 Family Annual Out of Pocket Maximum for Prescriptions
Emergency Services / Treatment
Urgent Care: $25 copay, then Deductible and Coinsurance Apply
Emergency Room / Emergency Physicians: $100 copay, then Deductible and Coinsurance - copay waived if true emergency
Hospital Services
In Network Deductible and Coinsurance Apply
Out of Network Deductible and Coinsurance Apply
Other
See Plan Document Deductible, then Coinsurance
90% Employer / 10% member in-network 80% Employer / 20% member in-network 50% Employer / 50% member out of network
Wellness
Opportunity to earn additional HRA Dollars
See details on page 6.
Single $200 Max (Adult Only) Family $400 Max (Adult Only)
Eligibility and Rates
Brown County Employees— See next page for Premiums
Sheriff Non Supervisory– 12% Premiums and no PHA required per contract
Note: Tier one copays only apply when a UnitedHealth Premium Tier 1 Provider is utilized.
This is a summary of benefits and features offered by Brown County and UMR. All benefits are subject to the limitations, and exclusions set forth in the Summary Plan Description.
Brown County Employees 2015 Health Insurance Benefit Information
6 Brown County will be offering to fund a portion of the Health Reimbursement Arrangement (HRA) if you are enrolled in their health plan. This account will be funded quarterly and can be used to pay for out of pocket expenses incurred by you or your spouse if spouse is covered under your health insurance plan.
Brown County values our employees and to this end you are being offered the opportunity to take control and own your own personal health care. The opportunities below are made available on your own time, to earn additional dollars into your HRA account. These will not be offered on Company paid time.
Employees can earn additional wellness dollars totaling $200 single / $400 employee/spouse
to your HRA account by participating in the following possible incentives
:Total Total Single EE/Spouse a. PHA Coaching sessions with Bellin RN ($25 each / maximum of 3 sessions)… $ 75.00 $150.00 b. Annual wellness exam with Primary Care Provider (PCP) ($100) ……… $100.00 $200.00 c. Stress management seminar attendance ($75 per series completed)……….. $ 75.00 $150.00 d. Dental cleanings ($25 each / maximum of 2 per year)………$ 50.00 $100.00
e. PHA participation with Bellin for Spouses ONLY $25.00
1. PHA coaching sessions can be scheduled by contacting the Occupational Health Nurse at 1-800-528-7883.
2. Stress Seminar Series schedules will be posted closer to the beginning of 2015 – watch for email announce-ments and information on the Brown County Intranet.
Brown County Employees 2015 Health Reimbursement and Wellness
Premium® Designation Program -
New for Brown County 1/1/15
Premium designation provides members with access to providers evaluated to meet
certain cost/quality measurements.
Members can find providers on the Choice Plus
provider look up site
.
Steps to Check Your Provider:
1.) Click on Find a Provider on the UMR website (www.umr.com)
2.) Scroll down to the letter “U” and select UnitedHealthcare Choice Plus Network from the list
of networks
3.) Click on Search for a Medical Provider
4.) Change the address to narrow down your selection by clicking on Change Address
5.) Use the search bar to type in your providers name, or chose from the options at the bottom to
search by type
There is also an option to search by UnitedHealth Premium Tier 1 Providers. Any Tier 1
Provid-ers will have the following symbol:
If you want to find a new provider you can select Get Started under the
Per-sonalized Physician Search option to locate providers in your area that meet
your specific criteria, including Premium Tier 1 Status.
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Brown County Employees 2015 Dental Insurance Benefit Information
These are summaries of benefits and features offered by Brown County, Delta Dental, and Dental Associates. All benefits are subject to the limitations, and exclusions set forth in the Summary Plan Description.
Dental Carrier: Delta Dental Care Plus
Exclusive Dental Associate providers only
Deductible
Single $0 $0
Family $0 $0
Annual Maximum
$1,250 per person $2,500 per person Preventive Services Oral Exams 100% 100% X-Rays 100% 100% Cleanings 100% 100% Topical Fluoride 100% 100% Sealants 100% 100% Space Maintainers 100% 100% Basic Services Oral Surgery 80% 100% Amalgam/Composite Fillings 80% 100%
Full & Partial Denture Repair 80% 100%
Stainless Steel Crowns 80% 100%
Simple Extraction 80% 100%
Major Services
Endondontics 80% 100%
Periodontics 80% 100%
Porcelain Crowns 80% 100%
Inlays/Onlays 80% Only re-cements covered
Partial or Complete Dentures 80% 100%
Removable or Fixed Bridgework 80% 100%
Implants 80% 80%
Orthodontics (per course or treatment)
50% to $1500 Lifetime Max. to age 26
50% to $2,500 Lifetime Max. to age 99
Eligibility and Rates
Employee $2.88/month $2.38/month
Brown County Employees 2015 Voluntary Vision Insurance Benefit Information
EyeMed
Plan Name Insight Plan H, Fixed Fee
Frequency Limitations
Eye Examination Once Every 12 Months
Lenses Once Every 12 Months
Frame Once Every 24 Months
Contact Lenses Once Every 12 Months
Deductible None
Copayment Exam Materials
$10 None
Benefits In Network Out of Network
Up To
Vision Examination $10 Copay None
Frames Up To $0 Copay, $120 Allowance, 20% off over $120 $60.00
Lenses (Clear, Standard, Glass, or Plastic)
Retail Value To
Single Vision $25 Copay $25.00
Bifocal $25 Copay $40.00
Trifocal $25 Copay $55.00
Contact Lenses
Retail Value To
Medically Necessary with Pre-Authorization
$0 Copay, Covered in Full
$200.00
Elective Not applicable
Eligibility and Rates
Employee $7.08/month
Family $18.03/month
These are summaries of benefits and features offered by Brown County and EyeMed. All benefits are subject to the limitations, and exclusions set forth in the Summary Plan Description.
New Premium Rates
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Medical FSA & HRA Qualified Expenses
? IRS Definition of Qualified Expenses and Premiums
Internal Revenue Code Section 213(d) defines qualified expenses, in part, as “medical care” amounts paid for insurance or “for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body…” To be eligible, these expenses must be to alleviate or prevent a physical defect or illness. Expenses solely for cosmetic reasons generally are not considered expenses for medical care.
“Dual-purpose Items” may have a medical purpose and a personal/cosmetic or general health purpose. In this case, attach a Letter of Medical Necessity to your claim submission from a licensed medical provider stating the beneficiary had a specific medical condition for which the item was purchased. “Excluded Items” are those used primarily for general health and well being. This is a summary of common eligible expenses; a comprehensive list of IRS Code 213(d) eligible expenses is located at www.GenesisBenefits.net.
MOST COMMON EXPENSES OTHER EXPENSES SERVICES and FEES Co-pays
Coinsurance Deductibles
OTC MEDICINES and DRUGS (* items require a prescription) Allergy medicines*
Antacids*
Anti-diarrhea medicines* Bandages
Blood sugar test kits Bug bite medication* Calamine lotion* Cold medicines* Cough drops*
Diaper rash ointments* Eye products (i.e. Visine®)* First aid kits
Hemorrhoid creams*
Menstrual pain & cramp relief* Motion sickness pills*
Muscle or joint ache pain relievers (i.e. BENGAY®)* Nicotine gum/patches* Pain relievers* Sinus medications* Sleeping aids* Sunburn ointments* Suppositories*
Wart removal treatments*
EXCLUDED ITEMS: Cosmetics Face creams
Feminine hygiene products Lip moisturizers (i.e. ChapStick®) Medicated shampoos
Soaps Toiletries
Tooth brushes (including electronic) Toothpastes
Vitamins
Adoption (medical expenses incurred before adoption is finalized)
Air conditioning and air filters used for alleviating illness
Alcoholism and drug treatment center costs Ambulance hire
Birth control pills
Contact lenses, solutions, etc. Eye glasses
Fertility treatments
Food & beverage for specific diseases Hearing aids & batteries
Immunizations Laser eye surgery
Learning disability (special school or specially trained educator, recommended by doctor
Lifetime care at medical facility Lodging (for medical care or treatment) Medical supplies and equipment Norplant insertion or removal Obstetrical expense Operations Organ transplants Orthodontia Physical therapy Prescription medicines
Retirement home (costs allocable to medical care)
Seeing-eye dog Stop smoking programs Student health fees Telephone for deaf (TTY) Therapy treatments
Transportation (subject to IRS limits) Vaccines Vasectomy Viagra Wheelchair X-rays Acupuncture Anesthetist Chiropractor Christian Science Dentist Eye exams Gynecologist Hospital Laboratory Naturopath Nursing Obstetrician Oral surgery Ophthalmologist Optometrist Orthodontist Osteopath Physicals Physician Physiotherapist Psychiatrist Psychologist Specialists
DUAL PURPOSE ITEMS (Letter of Medical Necessity required) Acne medications
Dietary supplements or herbal medicines
Glucosamine/Chondroitin for arthritis Health Club memberships
Massage Therapy
Orthopedic shoes & inserts St. John’s Wort
Sunscreens Weight loss drugs
FAX, EMAIL OR MAIL completed claim forms & supporting documentation to: Local Claims eFax: 952-460-1480
Toll-Free Claims eFax: 866-450-1480 Email: [email protected]
Genesis Employee Benefits, Inc. PO Box 1578
Minneapolis, MN 55440-1578
Local Phone: 952-653-4422 Toll-Free Phone: 866-678-8322
Check the status of your claim online at www.GenesisBenefits.net. Choose Participant Login in the upper right corner.
© Copyright 2012
Genesis Employee Benefits, Inc
Standard Insurance Company (The Standard) is our carrier for Short Term Disability (STD) and Long Term
Disability (LTD) Insurance. There will be no changes taking effect on January 1, 2015.
By offering partial income replacement, Disability Insurance can help to lighten the financial load if you
become unable to work due to a disability.
Short-term Disability
Current Plan
Elimination period - accident 0 days
Elimination period - sickness 7 calendar days
Family Member Not eligible
Percent of Wages Paid 60%
Duration 180 days
Amount Paid by Employer 100%
Long-term Disability
Current Plan
Monthly Benefit 66-2/3% to $5,000
Elimination period 180 days
Duration Normal Retirement Age
Definition of Disability *Own Occupation OR
Any Occupation
Amount Paid by Employer 100%
Brown County Employees 2015 Disability Insurance Benefit Information
*Own Occupation disability definition: a claimant will be considered disabled if unable to perform one, some or all of the material duties of his or her regular occupation.
Any Occupation disability definition: a claimant will be considered disabled if he/she is unable to work in any gainful occupation for which he/she is qualified by education, training or experience.
12
United Healthcare Voluntary Accident Insurance
Voluntary Accident insurance will help you with out of pocket medical expenses associated with an accident either on or off the job. It is designed to assist with the expenses that are not covered through your major medical insur-ance plan. Should you suffer an accident, you would be paid out based on a schedule of benefits. Below is the list of benefits through the Accident Plan.
Accident – Basic Benefit Dental Emergency
Accident Death/Dismemberment Broken Teeth ( crown ) $200
Life $20,000 Broken Teeth ( extraction ) $80
Both Hands or feet $20,000 Eye surgery $200
One hand or foot $10,000 Dislocations $80 - $3,200
Two or more finger or toes $4,000 Fractures $40 - $4,000
One finger or toe $2,000 Lacerations $30-$400
Accident al death – common carrier $80,000 Paralysis
Initial Care Quadriplegia $10,000
Ground Ambulance $200 Paraplegia $5,000
Air Ambulance $1,200 Hemiplegia $5,000
Emergency Room treatment $100 Tendons/Ligaments/Rotator/Knee Physicians Office/Urgent Care $40 Surgery to repair one $400 Hospital Care Surgery to repair more than one $800 Hospital admission $800 Exploratory without repair $140
Hospital confinement $160 Family Day Care $28 ( per day )
Hospital ICU admission $2,500 Family Lodging $140 ( per day )
Hospital ICU confinement $500 Transportation $400
Ruptured Disc $400
Accident Enhanced Benefit
Follow-up Care
Major diagnostic exam $160
Follow up physician visit $40
Medical appliances $140 Monthly Rates
Physical therapy $30 Base plan Enhanced plan
Prosthetic Employee: $6.24 Employee: $11.32
One device $500 Employee/Spouse: $10.16 Employee/Spouse: $18.04 Two or more devices $1,000 Employee/Children: $6.80 Employee/Children: $14.44
Rehabilitation Unit $80 Family: $10.72 Family: $21.16
Common Injuries
Blood/plasma/platelets $280
This is a summary of benefits and features
offered by Brown County and UHC.
All benefits are subject to the limitations
and exclusions set forth in the
Summary Plan Description.
Abdominal/Thoracic Surgery Surgery to repair $1,000 Exploratory without repair $100
Burns
2nd degree $500
3rd degree $1,000
3rd degree requiring skin grafts $8,000
Coma $10,000
United Healthcare Voluntary Critical Illness Insurance
This benefit is intended to help you with out of pocket medical expenses associated with a critical illness. Critical Illness coverage will assist you with the additional costs associated with the following high cost illness:
Cancer Cancer and carcinoma in situ
Cardiovascular Heart Attack, Stroke, Heart Transplant, Ruptured Aneurysm, and Coronary Bypass
Critical Illness – All Other Chronic Renal Failure, Paralysis, Severe Burns, Severe Brain Damage, Coma, and Major Organ Transplant ( except heart ) Employees have the option to purchase different amounts of Critical Illness coverage. Coverage can be elected on spouses and chil-dren. Please review the following for how to purchase coverage:
Increments in which you can purchase coverage: $1,000 Employee Minimum benefit $5,000 Employee Maximum benefit $20,000
Spouse Minimum benefit $5,000 Spouse Maximum benefit ( not to exceed 50% of employee election) $10,000
Child Flat Benefit ( not to exceed 50% of employee election ) $2,500
Benefit Waiting Period 30 Days
Pre-existing Condition Exclusion Period 12 Months / 12 Months Benefit Reduction 50% Reduction at age 70 Coverage Termination At Retirement
Monthly Rates
Rate Basis—Employee / Spouse voluntary benefit Age Banded Tobacco/NonTobacco rate per $1,000 Rate Basis—Child ( ren ) Composite Rates per $1,000 of Coverage
Monthly Rates
Monthly Rate — Child ( ren ) $0.20
Age Range Tobacco Non-Tobacco
Under 25 $0.29 $0.28 25-29 $0.47 $0.45 30-34 $0.58 $0.53 35-39 $0.78 $0.66 40-44 $1.17 $0.90 45-49 $1.84 $1.27 50-54 $2.80 $1.74 55-59 $4.20 $2.37 60-64 $6.18 $3.20 65-70 $9.31 $4.47 70-74 $11.31 $5.71 75+ $13.65 $7.89
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Department of Employee Trust Funds
WRS Contribution Rates for 2015 Set
Contribution rates for most Wisconsin Retirement System ( WRS ) employees and employers will change in 2015, the Employee Trust Funds Board announced. The following rate DECREASES were recommended by the WRS con-sulting actuary and approved by the Board on June 26, 2014:
0.4% of payroll for general category employees ( including teachers ) .01% of payroll for executive/elected official/judge category employees 0.8% of payroll for protective category employees covered by Social Security 0.8% of payroll for protective category employees not covered by Social Security
Core Trust Fund investment results are distributed over five years to soften the impact of year-to-year volatility of invest-ments. This also helps to keep WRS contribution rates stable. For example, over the past 25 years the rate for general category employees has deviated by just 2%.
There are many complex factors that affect WRS contribution rates, such as investment performance, legislative adjust-ments to benefit levels, demographics, etc. It is important to remember, WRS investment experience is smoothed over a course of five years to prevent large swings in WRS contribution rates. For more information about the reasons for the 2015 rate decrease, the actuary ’ s full presentation is available on ETF ’ s Website at:
http://etf.wi.gov/boards/agenda-items-2014/etf0626/etf/item4a.pdf
The new rates ( shown below ) go into effect January 1, 2015. Rates may be different for employees who have collective bargaining arrangements. Other mandatory employer contributions for duty disability, the states
Accumulated Sick Leave Conversion Credit Program, or unfunded liabilities are not included and vary by employer.
Employee Category
Total
Rate
2014
Total
Rate
2015
Employee
Contribution
for 2015
Employer
Contribution
for 2015
General/Teacher
14%
13.6%
6.8%
6.8%
Elected Official/
Executive/Judge
15.5%
15.4%
7.7%
7.7%
Protective with
Social Security
17.1%
16.3%
6.8%
9.5%
Choose the right health care setting
Where you go for medical services can make a big difference in how much you
Type of Care
Wait time
Cost
NurseLine
®-
1-866-494-4502You may speak by phone with a registered nurse any time of day, seven days a week.
When to call
Help choosing the right health care setting for illness or injury
Information about common health problems or injuries
36 seconds
Call answered, on average
None
Retail clinic/convenient care clinic
Retail clinics, sometimes called convenient care clinics, are locat-ed in retail stores, supermarkets and pharmacies.15 minutes
or less, on aver-age$10
Copay$89
Approximate cost per serviceWhen to go
Colds or flu Sinus infections Allergies
Vaccinations or screenings Minor sprains, burns or rashes Headaches or sore throats
Urgent care/walk-in clinic
Urgent care centers, sometimes called walk-in clinics, are often open in the evenings and on weekends.
20 to 30
minutes
Approximate wait time$25
Copay Then Deductible and 20% Coinsurance$156
Average cost When to goSprains and strains Mild asthma attacks Sore throats
Minor broken bones or cuts Minor infections or rashes Earaches
Clinical care
(your
doctor’s office)Seeing your doctor is important. Your doctor knows your medical history and any ongoing health conditions.
When to go
Preventive services and vaccinations
Medical problems or symptoms that are not an immediate, serious threat to your health or life
1 week or
more
Approximate waittime for an ap-pointment
$15 Tier 1
Copay$30 Tier 2
Copay Then Deductible and 20% Coinsurance$166
Average costEmergency room (ER)
Visit the ER only if you are badly hurt. If you are not seriously ill or hurt, you could wait hours. The Copay is applied when services are for non- True emergency ER visits.
3 to 12
hours
Approximate wait time for non-critical cases
$100
Copay Then Deductible and 20% Coinsurance$570
Average cost When to go Sudden change in vision
Sudden weakness or trouble talking Large, open wounds
Difficulty breathing Severe head injury
Heavy bleeding Spinal injuries Chest pain Major burns Major broken bones
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Aurora QuickCare Retail Clinics
DePere Green Bay Oshkosh Kenosha
1415 Lawrence Drive 2440 W. Mason Street 351 S. Washington Street 2801 14th Place (920) 339-4328 (920) 499-5917 (920) 232-0718 (262) 553-9325 Mon-Fri 9 am – 6:30 pm Mon-Fri 9 am – 6:30 pm Mon-Fri 9 am – 6:30 pm Mon-Fri 9 am - 6:30 pm Sat 9 am – 4:30 pm Sat 9 am – 4:30 pm Sat 9 am – 4:30 pm Sat-Sun 9 am - 2:30 pm Sun 10 am - 3:30 pm Sun 10 am - 3:30 pm Sun 10 am - 3:30 pm
Mukwonago Pewaukee Greendale Mequon
250 E. Wolf Run 411 Pewaukee Road 5300 S. 76th Street 10932 N. Port Washington (262) 363-4751 (262) 695-4439 (414) 423-5538 (262) 241-0169
Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 7 pm Sat 9 am - 4:30 pm Sat 9 am - 4:30 pm Sat-Sun 10 am - 3:30 pm Sat 9 am - 5 pm
Sun 10 am - 3:30 pm Sun 10 am - 3:30 pm Sun 9 am - 3 pm
Brookfield Sheboygan
95 N. Moorland Road 3711 S. Taylor Drive (262) 786-9037 (920) 457-2915 Mon-Fri 9 am - 6:30 pm Mon-Fri 9 am - 6:30 pm Sat-Sun 10 am - 3:30 pm Sat 9 am - 4:30 pm
Sun 10 am - 3:30 pm
Bellin Health
(located in Shopko)- ThedaCare Retail Clinics
[Note: Patients must be 18 months or older]Green Bay/Ashwaubenon Green Bay East Green Bay/Suamico Shawano (in Shawano Med Ctr) 301 Bay Park Square 2430 E. Mason Street 2318 Lineville Road 309 N. Bartlett Street
(920) 445-7377 (920) 445-7377 (920) 445-7377 (715) 526-8110
Mon-Fri 8:30 am - 8:30 pm Mon-Fri 8:30 am - 8:30 pm Mon-Fri 8:30 am - 8:30 pm Mon-Fri 8:30 am - 8:30 pm Sat 8:30 am - 5 pm Sat 8:30 am - 5 Pm Sat 8:30 am - 5 pm Sat 8:30 am—5 pm Sun 10 am - 5 pm Sun 10 am - 5 pm Sun 10 am - 5 pm Sun 8:30 am - 5 pm Holiday 10 am - 2 pm Holiday 10 am - 2 pm Holiday 10 am - 2 pm Holiday 10 am - 2 pm
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your
employer, your state may have a premium assistance program that can help pay for coverage, using funds from
their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be
eligible for these premium assistance programs but you may be able to buy individual insurance coverage
through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below,
contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your
dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1
-877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has
a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible
under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already
enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of
being determined eligible for premium assistance. If you have questions about enrolling in your employer
plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
If you live in one of the following states, you may be eligible for assistance paying your employer health
plan premiums. The following list of states is current as of January 31, 2014. Contact your State for
more information on eligibility –
WISCONSIN – Medicaid
Website: http://www.badgercareplus.org/pubs/p-10095.htm
Phone: 1-800-362-3002
To see if any other states have added a premium assistance program since January 31, 2014, or for more
information on special enrollment rights, contact either:
U.S. Department of Labor
U.S. Department of Health and Human Services
Employee Benefits Security Administration
Centers for Medicare & Medicaid Services
www.dol.gov/ebsa
www.cms.hhs.gov
1-866-444-EBSA (3272)
1-877-267-2323, Menu Option 4, Ext. 61565
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What is provided by the Women’s Health and Cancer Rights Act of 1998?
The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides
protections to patients who choose to have breast reconstruction in connection with a
mastectomy. This law applies generally both to persons covered under group health plans and
persons with individual health insurance coverage. But WHCRA does NOT require health
plans or issuers to pay for mastectomies. If a group health plan or health insurance issuer
chooses to cover mastectomies, then the plan or issuer is generally subject to WHCRA
requirements.
If WHCRA applies to you and if you are receiving benefits in connection with a mastectomy
and you elect breast reconstruction, coverage must be provided for
· reconstruction of the breast on which the mastectomy has been performed;
· surgery and reconstruction of the other breast to produce a symmetrical appearance;
· prostheses (e.g., breast implant); and
· treatment for physical complications of the mastectomy, including lymphedema.
Contact your state's insurance department to find out about whether protections in addition to
WHCRA will apply to your coverage if you are NOT in a self-insured health plan.
The WHCRA requires group health plans and health insurance issuers, including insurance
companies and health maintenance organizations (HMOs), to notify individuals regarding
coverage required under the law. Notification is required at three separate times
1. After enactment of WHCRA
2. Upon enrollment
3. Annually
For further information about WHCRA or to ask questions about how it relates to your specific
circumstances, you can e-mail us at [email protected]. Or you may call us at
1-877-267-2323, ext. 61565.
http://www.cms.hhs.gov/healthinsreformforconsume/06_thewomen%
27shealthandcancerrightsact.asp
Aurora Urgent Care:
Aurora BayCare Health Center Aurora Health Center Aurora BayCare Medical Center 2253 W. Mason Street 1881 Chicago Street 2845 Greenbrier Road
Green Bay DePere Green Bay
Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm 24 hours - 7 days a week
Closed Holidays Weekends: 9 am to 5 pm 920-288-4040
920-327-7240 920-403-8291
Prevea Urgent Care:
Prevea - Ashwaubenon Prevea - Howard Prevea - East DePere
2502 S. Ashland Avenue 2793 Lineville Road 3860 Monroe Road
Green Bay Green Bay DePere
Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm Weekends: 8 am to 4 pm Weekends: 8 am to 4 pm Weekends: 8 am to 4 pm
920-496-4700 920-496-4700 920-496-4700
Prevea - Plymouth Prevea - East Mason Community Memorial Hospital -
825 Walton Drive 3021 Voyager Drive Oconto Falls
Plymouth Green Bay 835 South Main Street
Mon - Fri: 8 am to 8 pm Mon - Fri: 8 am to 8 pm Oconto Falls
Weekends: 8 am to 4 pm Weekends: 8 am to 4 pm Mon - Fri: 5 pm to 10 pm
920-892-4322 920-496-4700 Weekends: 8 am to 4 pm
888-277-3832
(Bellin does not have any Urgent Care locations)
Using In-Network Retail (Fast Care) Clinics (LOWEST COST)
Retail clinics are the lowest cost option for you and the health plan.
Many services can be rendered and common medical conditions can be treated at retail clinics like:
Monospots Pregnancy Tests Rapid Strep Urinalysis
Allergies (6 yrs. & up) Bladder Infections Sports/Camp Physical Cold/Flu Symptoms Cold Sores (females 12 yrs. & up) Ear Infections Impetigo
Insect Bites Laryngitis Minor Burns & Rashes Mononucleosis
Pharyngitis Poison Ivy (3 yrs. & up) including sunburn) Sinus Infection
Styes Upper Respiratory
Infection
Uncertain? You can Ask A Nurse by calling the 24/7 Nurse Line at 888-758-7373
A listing of in-network retail clinics is included.
Urgent Care Locations in Greater Green Bay Area
***Urgent care visits are not covered under the retail clinic copayment. You are still required to meet your deductible should you use an Urgent Care facility***
20
2015 Enrollment Instructions
Timeline for enrollment is November 1 to November 21, 2014
If you are not making any changes to the following coverage, no plan election forms are necessary for the
following:
Medical
Dental (Delta Dental)
Vision
If you are adding, changing, or terminating coverage:
Medical
- Elections can be made online at www.umr.com
Flex Spending
Elections can be made online at www.GenesisBenefits.net
The Genesis website will open for enrollment changes on November 1, 2014
Dental
(please select only one of the two dental options below)
- Delta Dental - complete enrollment form on page 21
- Dental Associates (CarePlus Form)- complete enrollment form on page 23
Voluntary Vision - complete Enrollment/Change Form on page 25
Voluntary Accident - complete enrollment form on page 27 (Accident Insurance Section)
Voluntary Critical Illness - complete enrollment form on page 27 (Critical Illness Insurance
Section)
For any changes made due to marriage, divorce, birth, adoption, etc., throughout the year,
documen-tation of dependent status is required and must be submitted to Human Resources within 30 days of
the qualifying event date or coverage could be affected. Required documents can be found on the
Human Resources intranet site.
Terms and Conditions
1. All statements and answers in this application are representations made by the member on behalf of himself/herself and other persons named in the appli-cation, if any, to induce the issuance of the dental contract applied for.
2. The Applicant, on behalf of himself/herself and other persons named in the application, if any, consents, authorizes and directs any physician, dentist, consultant, hospital or other person or corporation by whom or in which any diagnosis, medical, surgical or dental treatment or advice is being, shall be or shall have been rendered to furnish and make available to Care-Plus Dental Plans, Inc., all such medical, surgical and dental reports, records and other information as they may request, at no cost to them.
3. The contract applied for will become effective only upon the acceptance of this application by Care-Plus Dental Plans, Inc. to be evidenced by the issuance of Identification Card(s) which will be delivered to the Group or to the Member designated herein as the Applicant.
4. The member authorizes the Group as his remitting agent to deduct from his wages or salary a sufficient amount to provide for the regular and timely repay-ment of the prevailing subscription fees that are not otherwise contributed for the contract applied for, and to remit the same for him on his behalf to Care-Plus Dental Plans, Inc. as specified in the agreement between Care-Care-Plus Dental Plans, Inc. and the Group.
EMPLOYER INFORMATION: To be Completed by Employer Group Number
9802166 Employer Name BROWN COUNTY VISION PLAN Effective Date 01/01/2015 EMPLOYEE INFORMATION A: Add (enroll) T: Terminate C: Change (change of name, address or phone)
□ ADD □ TERM □ CHG Sex □ M □ F Member ID
Last Name (Employee or sub-scriber) First Name M.I. Date of Birth Social Security Number
Home Street Address
City/State/Zip Home Phone
( ) FAMILY INFORMATION (Only those eligible may be enrolled.) A: Add (enroll) T: Terminate
□ A
□ T
Sex
□ M
□ F
Last Name (spouse) First Name M.I. Date of Birth
Social Security Number □ A □ T □ C Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number □ A □ T □ C Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number □ A □ T □ C Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number □ A □ T □ C Sex □ M □ F
Last Name (dependent) First Name M.I. Date of Birth
Social Security Number
Employee Signature: _____________________________________________________ Date: _________________________
6
1
Enrollment/Change Form
Please print and complete all sections.
See instructions below.
Underwritten by Fidelity Security Life Insurance Company
of Kansas City, Missouri
Instructions:
Employer Name: Legal name of the employer.Group Number: Provided by EyeMed or EyeMed representative.
Location code: Optional field for employers to track multiple locations.
Effective date: Date set by employer in accordance with EyeMed proposal. Employer also sets effective date for new
adds during contract period.
Family Information: List only eligible family members who are enrolling.
Dependent eligibility is the same as employer’s health plan. (A) Add: Open (group enrollment or new (individual) enrollment during the contract period.
(T) Terminate: To terminate enrollment.
(C) Change: A change of name, employee address or employee phone.
Once you elect EyeMed vision coverage, you cannot cancel for a 12-month period based upon your enrollment date.
Deductions are adjusted according to payroll frequency.
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32 BRO WN CO UNTY HUM AN RES OURC ES treet ut S aln . W E 305 Gree n B ay, W i 54 301 PRESO RTED FIRST -CLASS M AIL U.S. PO STAGE PAID UMS If A tte nding En roll men t Mee tin g, Plea se Bri ng T his Pa cke t
