group health insurance plan 2014 frenship isd. campus representatives : fhs tate casey reese lynn...

Group Health Insurance Plan

2014 Frenship ISD

2013-2014 FISD Health Insurance Committee

CAMPUS REPRESENTATIVES:

FHS Tate Casey Reese Lynn Mills FMS Katrina Smith Terra Vista David SpeerHMS Emily WagnerBennett Sanae AllisonCrestview Cindy York/Kathy Dawson Oak RidgeShane LangenNorth Ridge Betsy BucyWestwind Bobbie Jo WilliamsWillow Bend Stacey PriceCustodians Balt PadillaMaintenance Alex Diaz, Derek Cobb, Allen TannerCentral Office Rhonda Dillard, Pat Valdez, Greg Cartwright,

Dr. Vroonland, Michelle McCord, Tim Williams, Courtney Reeves

* Remember, Our Plan year…

January 1, 2014 through

December 31, 2014

*Plan Options: (In Network Includes UMC & Covenant )

HMO (free plan for employees) PPO 1 PPO 2 High Deductable/HSA (Health Savings Acct.)

* Premiums Comparison All Plans Side by Side

Coverage HMO PPO1 PPO2 HSA Employee Only $ 0 $313 $ 42 $ 21 Emp. & Spouse $399 $1112 $504 $417Emp. & Child $234 $655 $313 $191Emp. & Family $456 $1170 $570 $446

**Increases in premiums reflects a portion of the 4.3% tax as required by

the Affordable Care Act**

Note: All premiums INCLUDE $266/month that is paid by FISD and reflect YOUR monthly cost:

HMO Plan (free plan for employees)

Deductible - $4000 per member

Co-Insurance – 100% (plan pays after deductible)

$40 Dr. Visit Co-pay ($80 specialist)

RX - $10/generic - 50%/preferred after $250 deductibleTier 4 drugs 50% ($4000 addl. out of pocket maximum)

Out-of-Pocket Maximum = $4000 individual/ $8000 family

Hospital/Emergency/Maternity – 100% after $4000 Deductible is met

PPO 1 Plan Deductible $1500 per member ( $3000/family) - In Network

Co-Insurance – 80% in network/ 60% out of network (plan pays after deductible)

$30 Dr. visit Co-pay ( $60 / specialist)

RX - $10-$35-$60 after $100 deductible Tier 4 drugs @ 20% ($4000 addl. out of pocket)

Out-of-Pocket Maximum = $4000 per member ($8000/family) – In Network

Hospital/Maternity – 80%/60% (Emergency room/ 80% after deductible)

• Maternity –Pediatrician, delivery, and nursery are covered at 80% after the $1500 deductible

PPO 2 Plan Deductible $2500 per member ( $5000 /family) – In Network

Co-Insurance – 70% in network / 50% out of network (plan pays after deductible)

$35 Dr. visit Copay ( $70 /specialist)

RX - $10 generic / 30% preferred after $250 deductibleTier 4 drugs / 30% ($4000 max. out of pocket)

Out-of-Pocket Maximum - $4,000 per member ( $8000 / family) - In Network

Hospital/Maternity – 70%/50% (Emergency room/ 70% after deductible)

Maternity – Pediatrician, delivery, and nursery charges are covered at 70% after the $2500 deductible.

* In Network / Out of Network

In Network / Out of Network

In-network - Any provider that accepts First Care.

Outside Lubbock area –

PHCS / Multiplan

When seeking services with these networks, you will need preauthorization. This information is on the back of your insurance card.

HSA PlanHealth Savings Account

Deductible - $2,500 per member ($5000/family)No Copay…Discounted Dr. office visits and 80% after

deductible is metRX – 80% after deductible is metOut-of-Pocket Maximum - $5,200 per member

($10,400/family)Maternity - $5000 max. out of pocket for mom

(Routine Facility charges covered under mom/ Professional service provider applies to baby’s deductible)

All coverage starts after member has met deductible or max. out of pocket. Money placed in HSA account is above and beyond premium.

HSA account must be set up prior to incurring claims in order to have tax advantage.

*HSA

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 funds.

Maximum - $3300.00/Individual

$6550.00/Family

Options to cover Family or Children…

Health Insurance Market Place / Affordable Care Act

healthcare.gov / 1-800-318-2596Individual policy with independent companyCHIPS – 1-877-KID-SNOWCHIPSMEDICAID.org

*Affordable Care Act (ACA)

*Public Marketplace

*Guaranteed issue / No Pre-existing limitations

*Sold through healthcare.gov, Ashmore & Associates, Aycock and Fowler, independent agents and other entities

*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

standards.

Ways to manage your insurance…

If at all possible, go to a provider that takes First Care so that claims are paid in network.

Prescriptions – Always ask for generic, check at least three pharmacies for best price, check United 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)

*Healthiest You

Telehealth & Wellness solution plan - $9.00 per month covers the entire family

Compliments the medical plans and saves on medical claims3 easy steps to speak to a physician anytime anywhere online

or by phonePrescriptions are called in to the pharmacy of your choice –

(Must accept First Care)Online tool provided to shop for the best price on prescriptions

in your areaYou 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 infection….

* Preventative Care

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…

First Care 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 benefits.

FISD Cafeteria Plan (Section 125)“Why should I participate?”

The only entity to benefit from your participation is YOU.

The district does not profit from #125No insurance agent or company benefitsIndividual enrollments @ your campus

Section 125 is the tax code which allows participating employees to place certain financial expenses into an account PRIOR to taxes being withheld.

FISD Cafeteria Plan OPTIONS

Child Care Reimbursement PlanMedical Reimbursement PlanCancer/Intensive Care InsuranceVisionAccident InsuranceDental Reimbursement Plan – Must file paper copy

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. You must submit a claim form with receipt for reimbursement.

Maximum - $2500 per year (you must use it or lose it at the end of each year)

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 ends.

“UNDERSTANDING” Your Insurance plan

You can learn more about the advantages of the PPO1, PPO2, HMO and High Deductible/HSA by:

*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 options.

Consultations Available

NOTE: If you are going to meet your deductible for any reason please call:

Ashmore and Associates - 806-745-8358 Aycock & Fowler - 806-798-2700

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

745-8358

Ashmore & Associates

Brent Aycock

798-2700

Aycock& Fowler Insurance Agency