2015 annual benefits enrollment -...

2015 Annual Benefits Enrollment

November 2014

Today’s Objectives

Health Care Reform – What’s New for 2015

2015 Benefit Changes & Rates

Year One in the Private Exchange: What We’ve Learned

Enrollment: Key Dates & Resources

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Health Care Reform –

What’s New for 2015

Health Care Reform – Employer Obligations

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Affordable Care Act (ACA)

What Employers Must

Do Next Year:

― Consider any associate

working 30 hours or more over

a pre-determined six month period

as Full-Time

― Ensure Associate Only level

coverage in the lowest cost plan

(Bronze) meets the “affordability

threshold”

Individual Mandate Still In Play

You Must Maintain Minimum Essential Coverage for Yourself and

Your Dependents.

What Happens if You Don’t Have Coverage?

― Tax penalty – increases each year

Health Care Reform – Employee Obligation

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$325 per adult &

$162.50per child

up to $975 per

family

2% of family

income

% of

Household

Income Adult Child

Family

Maximum

2014 1.0% $95 47.50$ $285

2015 2.0% $325 162.50$ $975

2016 2.5% $695 347.50$ $2,085

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Year One In the Exchange-

What Have We Learned?

It’s A Journey

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Choice Is Valued & Appreciated

Results From Post Annual Enrollment Survey (all exchange client responses)

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Price Matters, But Not Exclusively

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Learnings From Annual Enrollment

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What We’ve Learned What We’ve Done

All carriers were not fully

prepared to answer questions

about the new exchange plans

Misunderstanding of the

differences in covered services

between metallic plans

Aon has provided assistance: • Shared training materials with

carriers

• Encouraged each carrier to

designate an exchange specific

customer service team

• Implemented a “secret shopper”

program

• Consumer ratings solicited &

available during enrollment

• Enhanced carrier microsites

• Payless has a seat on the

Exchange Advisory Board

Education during Annual

Enrollment meetings & in

resource materials

Key Learnings Throughout the Year

Carriers Are the “Source of Truth” for Networks

― On-line tools reflect contracted names only which can make locating a

provider/facility challenging and may lead to incorrect assumptions about the

network – When in doubt, call the carrier directly

Midyear Network/Pharmacy Changes Possible

― Not all providers are contracted on a calendar year basis and networks may

change throughout the year

― Carriers may re-evaluate their drug tiers periodically and may implement drug

therapy programs

― Not different from our prior plans

― Always check before securing services/filling a script

We Must Expect to Be a Consumer of Health Care

― Ask questions, research, stay engaged

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2015 Benefit Options & Changes

Private Health Exchange Expands

30 large employers

850,000+ employees & family members

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2015 Carrier Options

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Medical

Dental

Vision

5 Plan Choices

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BRONZE BRONZE

PLUS SILVER GOLD PLATINUM

Out-of-pocket cost to you at time of service

Impact to Paycheck $ $$$

High Deductible Traditional

No deductible, co-pay or co-insurance changes for 2015

What’s Changing?

Medical & Prescription Drug Changes

― Out-of-network deductibles & annual out-of-pocket maximums now

separate from in-network deductibles & annual maximums

― Treatment of Rx drugs may have changed

― Separate lifetime maximums for fertility drugs and services

― Many sexual dysfunction drugs will be covered next year

Dental

― Gold level plan will offer adult orthodontic coverage

Vision

― New carrier: EyeMed

Health Savings Account Limits

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Health Savings Accounts

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What Is A Health Savings Account (HSA)? ― Way to save for qualified expenses like deductibles and

coinsurance on a pre-tax basis

― Maximum 2015 pre-tax contributions: $3,350 for individual coverage

$6,650 for you and your dependents

$1,000 additional if you are age 55 or older

― To be eligible, you must: Be enrolled in the Bronze or Bronze Plus medical plan level

Not be covered by Medicare or TRICARE

Not be claimed as a dependent on someone else’s tax return

Not be covered by any other health insurance plan, such as a spouse’s plan

Flexible Spending Accounts (FSA)

What Is A Flexible Spending Account (FSA)?

― Way to save for qualified expenses like deductibles and coinsurance on a pre-tax basis

No Change to Current Limits:

― $5,000 for Dependent Care FSA

― $2,500 for Health Care FSA

Substantiation Obligation Exists with the IRS

― You must maintain adequate records to prove you’ve used your FSA contributions for

eligible expenses

― Your Spending Account (YSA) is required to request this documentation

― All expenses that don’t match a co-pay or a multiple of a co-pay for the exchange plans

must be substantiated

Make It Easy

― Download the ‘Reimburse Me’ app for your smart phone

― Scan and upload directly to the YSA site

― Fax or mail

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Tobacco Surcharge Changing

Tobacco Surcharge Will Be Increasing Next Year

― Benchmark is $100 - $150/month

― Current surcharge is $50/month per household

― 2015 surcharge will increase to $75/month per household

― 2016 surcharge will increase to $100/month per household

Surcharge applies to the following:

― Cigarettes, pipes, cigars, chewing tobacco, vapor/e-cigarettes

Want to Quit?

― Check out the resources provided by the carriers

― Surcharge can be removed anytime during the year as long you have been

tobacco-free for 12 months

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Voluntary Benefits Available in 2015

Voluntary Benefits

― Discounted Auto & Home Insurance

Coverage options include: Auto, home, renter’s, condominium,

recreational vehicles, boat, mobile home & rental properties

Offered through MetLife

― Pet Insurance

Policies cover many medical problems & conditions related to accidents,

emergencies and illnesses

Offered through Healthy Paws

― Benefits offered by the carrier directly

― Payment arrangements made directly with the carrier

― Enroll at https://payless.benefitsnow.com

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2015 Benefit Premiums

Medical Premiums

Medical premiums vary depending on where you live

Dental and vision premiums do not differ based on geography

Rates for each metallic plan and carrier will be visible on the

enrollment site at https://payless.benefitsnow.com beginning

November 10

The company subsidy will also be visible for each option offered

in your area

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Enrollment Experience

Same Shopping Experience

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-Network and Rx (formulary)

-Premium/Price

-Brand/Reputation/Experience

Aetna

United

Kaiser

HealthNet

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Key Dates & Resources

Resources

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Start with the Make It Yours website

Go to the Make It Yours website at www.makeityoursource.com/payless to:

―Watch videos

―Review plan details

―Read the Reference Guide

―Learn more about how you can save

money through an HSA

―Get answers—browse FAQs

―Prepare for enrollment

Communications

Change for 2015:

― Fewer printed communications

― Fewer mailings to the home

Enrollment checklist

Reference & Users Guides available at mypayless.com &

https://payless.benefitsnow.com

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On-Line Enrollment

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Enroll between November 10 and November 26, 2014

― Log on to https://payless.benefitsnow.com

― Click Enroll! and follow the prompts

Before You Enroll

― Know how it works

― Do your homework

― Get a personalized suggestion

‘Need Help Deciding’ to narrow choices

From the medical, dental, and vision pages:

Choose who you want to cover

Choose your plan level

Choose your insurance carrier

Make your pre-tax savings

account election(s)

Be sure to use the online tools!

Review your elections!

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Resources to help you make your choices

Need help enrolling? Call customer service

― Payless Benefits Center at 1-855-564-6152

― Representatives are available Monday through Friday, from 9 a.m. to 6 p.m. ET

Questions about coverage? Call the insurance carrier

― They know their plans best

― They have final authority on claims, billing disputes, etc.

Have an issue? Call a health care advocate

― Available through the Payless Benefits Center

at 1-855-564-6152 to assist with tough issues like claims and billing disputes

― Representatives are available Monday through Friday, from 9 a.m. to 6 p.m. ET

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If You Need Help…

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Health Care Advocates Help Before, During, and After Enrollment

Education Can someone help

me understand?

Problem Resolution

I need help and don’t know where

to turn.

Coordination How do I know

what to do next?

Navigation How do I access my

benefits?

Decision Support I’m confused about

all of the options available to me.

Life & Disability

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Increase your current optional or dependent life insurance

coverage level by 1x without answering any medical questions

Optional life up to 4x your eligible base salary

Spouse life either $5,000, $10,000 or $25,000

Dependent life either $2,500 or $5,000

Enroll through MyInfo at mypayless.com

Great time to verify/update your beneficiaries & emergency

contact information

No changes to your life or disability

elections?

If you do not wish to make any changes to your life and

disability elections, you do not need to take any action

through MyInfo.

Annual Enrollment: November 10 - November 26, 2014

You must take action if you want:

― Medical, dental, and vision coverage

― Prescription drug coverage

― To save money with an HSA or FSA

No action necessary for life

& disability elections

ID cards will be mailed in

December (if applicable)

2015 benefit deductions begin

on the paycheck we receive on

January 9th

Don’t Forget

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Remember to Enroll!

November 2014

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