open enrollment 2012 bellarmine employees’ open enrollement 2013 presented by: laura kuczenski...
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OPEN ENROLLMENT 2012BELLARMINE EMPLOYEES’
OPEN ENROLLEMENT 2013
Presented By: Laura Kuczenski
925-385-5305; [email protected]
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BENEFITS
• Medical• Blue Shield of California• Kaiser
• Dental – Assurant• Vision – VSP• Life/Disability – Sun Life• Long Term Care – Unum• FSA – Pension Dynamics• HSA – Sterling
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WHAT IS OPEN ENROLLMENT?
OPEN ENROLLMENT
Open Enrollment is a once-a-year opportunity to make election changes
Change plans Add or drop coverage for yourself Add or drop coverage for your dependents
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MID-YEAR QUALIFYING EVENTS
What changes can I make outside of Open Enrollment?
The only ti me you can make an electi on or enrollment change outside of your open enrollment period is if you experience an eligible qualifying event as defi ned by the IRS.
Common examples of qualifying events include, but are not l imited to, the following:
Marriage Divorce or legal separationBirth or adoptionGain or loss of coverage
OPEN ENROLLMENT
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IMPORTANT DATESMEDICAL COVERAGE
• 11/12/12 to 12/17/12 - Open enrollment • 1/1/2013 – Your plan changes become effective • 1/1/13 – 12/31/13 – The “Plan Year”
IMPORTANT FACTS• Deductibles and out of pocket maximums are the Plan
Year (aka Calendar Year)• Dependent children covered up to age 26
• They are then COBRA eligible
• Opt-out medical incentive: $166.67 per month • With proof of other medical coverage
OPEN ENROLLMENT
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• Largest nationwide network
• Not-for-profit organization
• 24/7 nurse line• Access to free programs
including MyHealth Coach, Future Moms, and more
• Can choose any doctor; however, in-network doctors will provide greater savings
• Email your doctor, online lab results
• Access to free programs including health management, weight loss support, quitting smoking
• Doctor must be in Kaiser community
• All Kaiser doctors have access to your medical records
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• No plan changes; however, some carrier- mandated benefit changes• Carriers required certain changes to plan designs
across the board for all fully insured clients. • Bellarmine did not have any say in the changes
• Selected Carrier Mandated changes highlighted in red• This presentation is an overview. Complete “Benefit
Modification” summaries can be found on the website
MEDICAL RENEWAL
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Plan Features In-Network Non-Network
Deductible Per Member Per FamilyOut of Pocket Max Per Member Per Family
$0$0
$1,000$3,000
$500Maximum of 3
$3,000$9,000
Preventive Care Routine exam, screenings $0 Not covered
Office / Specialist Visits $10 / $10 30%
Diagnostic Lab & X-ray $10 30%
Coinsurance 10% 30%
Hospital Services $200/day for 5 days 30%
Emergency Services $100 copay + 10%
Prescription Medication Tier 1 Tier 2 Tier 3 Tier 4
$10$20$35
30%
25% of billed amount plus copays
BLUE SHIELD – PREMIER PPOMEDICAL PLAN DESIGNS
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BLUE SHIELD – SPECTRUM PPOMEDICAL PLAN DESIGNS
Plan Features In-Network Non-Network
Deductible Per Member Per Family
$500$1,500
Out of Pocket Max Per Member Per Family
$2,000$6,000
$5,000$15,000
Preventive Care Routine exam, screenings $0 Not Covered
Office Visits $15 30%
Diagnostic Lab & X-ray $15 30%
Hospital Services 10% 30%
Emergency Services $100 + 10% after deductible
Prescription Medication Tier 1 Tier 2 Tier 3 Tier 4
$10$20$35
30%
25% of billed amounts plus copays
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Plan Features In-Network Non-Network
Deductible Per Member Per Family
$2,250$4,500
Out of Pocket Max Per Member Per Family
$3,000$6,000
$6,000$12,000
Preventive Care Routine exam, screenings $0 Not Covered
Office Visits 20% after deductible 50% after deductible
Diagnostic Lab & X-ray 20% after deductible 50% after deductible
Hospital Services $100 + 20% after deductible
50% after deductible
Emergency Services $100 + 20% after deductible
Prescription Medication Tier 1 Tier 2 Tier 3 Tier 4
After deductible$10$25$40
30%
After deductible
25% of billed amounts plus copays
BLUE SHIELD – 2250/4500 HSAMEDICAL PLAN DESIGNS
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HSA BASICS WHAT IS AN HSA?
Individual Tax-favored health savings account
You own your account, and funds roll over each year – NO “use it or lose it” rules FSA has a “use it or lose it” policy
WHO IS ELIGIBLE FOR AN HSA? Must be enrolled in qualifying High Deductible Health Plan such as Kaiser and Blue Shield HSA
Not covered under any other health insurance
Not enrolled in Medicare or receiving VA benefits
Not another person’s dependent
MAXIMUM CONTRIBUTIONS 2012: $3,100 individuals / $6,250 families
2013: $3,250 individuals / $6,450 families
For Both Years: $1,000 “catch-up” contributi on for individuals over 55 years of age
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HSA - STERLING
STERLING HSA Employees must open an HSA account through Sterling to receive direct contributions from
Bellarmine, and to set aside pre-tax dollars through payroll
WHAT DOES THE COMPANY CONTRIBUTE?
NO CHANGE FROM 2012
Blue Shield of CA HSA: Single: $242
Employee Family: $485
Kaiser HSA: Single: $900
Family: $1,800
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KAISER HMO $10MEDICAL PLAN DESIGNS
Plan Features In-Network Only
DeductibleOut of Pocket Max Per Member Per Family
none
$1,500$3,000
Preventive Care Routine exam, screenings $0
Office Visits $10
Specialist Visits $10
Diagnostic Lab & X-ray No charge
Hospital Services No charge
Emergency Services $50 copay (waived if admitted)
Prescription Medication Generic and Brand $10
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Plan Features In-Network Only
Deductible Per Member Per Family
$1,500$3,000
Out of Pocket Max Per Member Per Family
$1,500$3,000
Preventive Care Routine exam, screenings $0
Office Visits 0% after deductible
Diagnostic Lab & X-ray 0% after deductible
Hospital Services 0% after deductible
Emergency Services 0% after deductible
Prescription Medication $0 after deductible
KAISER – HSAMEDICAL PLAN DESIGNS
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NEW PREVENTIVE CARE GUIDELINES FOR WOMEN COVER THE
FOLLOWING SERVICES (COVERED AT 100% WITHOUT COST
SHARING) Well-women visits
Gestational diabetes screening
HPV DNA Testing for women 30 and older
Sexually Transmitted infection counseling; HIV screening and counseling
FDA approved contraception methods and counseling
Breastfeeding support, supplies, and counseling
Domestic Violence support, supplies, and counseling
FOR ADDITIONAL DETAILS www.healthcare.gov/law/provisions/preventive/index.html
PREVENTIVE CARE FOR WOMEN
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DENTAL PLAN DESIGN
DEDUCTIBLE $50 individual / $150 family
COVERAGE ( in-network/out-of-network) Diagnostic and Preventive (deductible waived): 100% / 100%
Basic (ex: Fillings, simple extractions): 90% / 80%
Major (ex: crowns, dentures): 60% / 50%
Orthodontia: 50% (child-only)
PLAN MAXIMUMS $1,000 calendar year max. per person
$1,000 orthodontia lifetime max.
BELLARMINE PAID
DENTAL “ACTIVE” PPO
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VSP SIGNATURE NETWORK Only available to Blue Shield members
Kaiser members have their own vision plan
COPAYS $20 exam copay
Lenses: $20 Copay
Frames: Up to $120 + 20% of additional costs
Contact Lenses: Up to $120 for contact and contact lens exam.
SERVICE FREQUENCIES Exams: every 12 months
Lenses (for glasses or contacts): every 24 months
Frames: every 24 months
BELLARMINE PAID
VISIONVISION PLAN DESIGN
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LIFE AND DISABILITY
LIFE AND AD&D INSURANCE Insured by Sun Life Financial
2x Salary to $200,000
Benefits reduction: 65% at 70 years of age
50% at 74 years for age
BELLARMINE PAID
LONG TERM DISABILITY Insured by Sun Life Financial
Benefit is 66.67% of pre-disability earning to $8,000 per month
90-day elimination period
BELLARMINE PAID
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LONG-TERM CARE BASE PLAN
Insured by Unum
3-year benefit duration
$3,000 monthly facility benefit; 70% Residential Care facility
$36,000 life-time benefit
BELLARMINE PAID
BUY UP OPTIONS – OUTSIDE OF INITIAL ELIGIBILITY Open to you and your family
ALL buy-up requires medical questi onnaire (See HR for the forms)
Increase monthly benefit amount
Increase lifetime maximum
Increase benefit duration (6 years or unlimited)
Add inflation protection
EMPLOYEE PAID
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HEALTH CARE FSA – UP TO $2,500 ANNUALLY IRS CHANGED THE MAXIUM FROM $10,000 IN 2012 TO $2,500 IN 2013
LIMITED PURPOSE FSA – UP TO $2,500 ANNUALLYIRS CHANGED THE MAXIUM FROM $10,000 IN 2012 TO $2,500 IN 2013
DEPENDENT CARE FSA – UP TO $5,000 ANNUALLY
FSAs help you pay eligible healthcare and dependent care expenses on a pre-
tax basis (lowering your overall taxable income).
If you are enrolled In The Anthem HMO, PPO, or Kaiser HMO, then you may
enroll in a full FSA
IF YOU HAVE AN HSA Account, you may only enroll in a Limited Purpose FSA
(Dental and vision expenses)
Dependent Care FSA is not affected by your medical plan
U S E- I T-O R -LO S E- I T RU L E : U N U S E D DO LLA RS A R E N OT R E T U R N E D TO YOU !
FLEXIBLE SPENDING ACCOUNTS (FSA)
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Examples of Eligible ExpensesHealth Care Limited Purpose
• Hearing services, including hearing aids and
• Batteries• Prescription and office visit copays• Dental and orthodontia
• Dental and Orthodontia• Hearing services not covered by your
medical plan• Lasik Surgery• Other vision expenses
Dependent Care
• The cost of child or adult dependent care (must be tax dependent)• Nursery schools and preschools (excluding kindergarten)• The cost for an individual to provide care either in or out of your house
FLEXIBLE SPENDING ACCOUNTS
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CONTRIBUTION STRATEGY
EMPLOYEE CONTRIBUTIONS
BLUE SHIELDPremier PPO
$0/$500
2012 EE/PP
2013 EE/PP
2012 EE Cost/Yr
2013 EE Cost/Yr
Single Employee $168.22 $177.04 $4,037 $4,249
Employee + 1 Dependent $463.55 $485.33 $11,125 $11,648
Employee + Family (2 or
more)$641.32 $671.91 $15,392 $16,126
Numbers may vary due to rounding
BLUE SHIELDSpectrum PPO
$500/$1,000
2012 EE/PP
2013 EE/PP
2012 EE Cost/Yr
2013 EE Cost/Yr
Single Employee $124.66 $131.87 $2,992 $3,165
Employee + 1 Dependent $370.76 $389.08 $12,297 $9,338
Employee + Family (2 or
more)$508.02 $533.66 $12,192 $12,808
Numbers may vary due to rounding
BLUE SHIELDHSA
$2,250/$4,500
2012 EE/PP
2013 EE/PP
2012 EE Cost/Yr
2013 EE Cost/Yr
2012Paid by ER to HSA
2013 Paid by ER to HSA
Single Employee $22.35 $25.41 $536 $610 $242 $242
Employee + 1 Dependent $151.57 $161.04 $3,638 $3,865 $485 $485
Employee + Family (2 or
more)$184.31 $197.20 $4,423 $4,733 $485 $485
Numbers may vary due to rounding
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EMPLOYEE CONTRIBUTIONS
KAISERHMO $0 2012 EE/PP 2013 EE/PP 2012 EE
Cost/Yr2013 EE Cost/Yr
Single Employee $6.26 $6.37 $150 $153
Employee + 1 Dependent $80.06 $82.16 $1,921 $1,972
Employee + Family (2 or more) $77.58 $79.58 $1,862 $1,910
Numbers may vary due to rounding
KAISER HSA$1,500/$3,000
2012 EE/PP
2013 EE/PP
2012 EE Cost/Yr
2013 EE Cost/Yr
2012Paid by ER to HSA
2013 Paid by
ER to HSA
Single Employee $14.72 $24.58 $353 $590 $900 $900
Employee + 1 Dependent $96.97 $118.58 $2,327 $2,846 $1,800 $1,800
Employee + Family (2 or
more)$70.39 $99.95 $1,689 $2,399 $1,800 $1,800
Numbers may vary due to rounding
CONTRIBUTION STRATEGY
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EMPLOYEE BENEFITS WEB PORTAL
FILICE HAS DESIGNED A CUSTOMIZED WEBSITE THAT
ALLOWS EMPLOYEES AND DEPENDENTS TO ACCESS
INFORMATION AS NEEDED. Plan Overviews
Physician Directories
Group Numbers and Carrier Contact Information
HR Forms and Required Postings
Account Manager Contact Information
www.filice.com/benefits/bcp
OUR BROKER – FILICE INSURANCE
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All electi ons wil l automati cally transfer. No action needed if you are not changing your medical; however: All
medical waivers must be accompanied by a recent copy of your medical
card to HR. Incentive payments will not begin unti l a copy of the medical
card is received.
FSA AND HSA BENEFITS MUST BE RENEWED WITH HR All changes must be made by December 17, 2012.
All changes will go into effect January 1, 2013.
WHAT NOW?
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OPEN ENROLLMENT INSTRUCTIONSO P E N E N R O L L M E N T B E G I N S
M o n d a y, N o v e m b e r 1 2 , 2 0 1 2 t h r o u g h D e c e m b e r 1 7 , 2 0 1 2
You wil l be able to access your benefi ts and change them, if you desire, on the ADP website. Remember to reenroll in
your F lexible Spending and HSA Accounts! To access your account:
1. Go to this URL: htt ps://portal.adp.com
2. Enter your User ID: (your fi rst initi al and last name)@bellarmine
3. Enter the password you created when you registered
If you forgot your password, hit the “Forgot Password” and it wil l take you through the steps to setup a new password.
I f that doesn’t work, please contact Christi ne Carbone to help you get into the site.
At the top you wil l see tabs.
1) Cl ick on the “Benefi ts” tab
2) A dropdown menu wil l appear
3) Scrol l down to “Review/Change Benefi ts”
4) You wil l then be asked to select one of the fol lowing:
• Walk me through the process
• I know what changes I want to make.
• Review my benefits coverage.
5) CONGRATULATIONS!! You are now in “Open Enrol lment ”. Make your desired changes now.
6) If you have any questi ons or need help, don’t hesitate to cal l (x228) or email Christi ne
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YOUR QUESTIONS?
?You can contact your Fi l ice
Account Manager:
Laura Kuczenski
laura@fi lice.com 925-385-5305