2 district #622 health plan status journeywell isd 622 well@work clinic high deductible health plan...

Open Enrollment & Overview of Insurance Plan

2013

A presentation for North St. Paul Schools ISD #622

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Agenda

District #622 Health Plan Status JourneyWell ISD 622 Well@Work Clinic High Deductible Health Plan

◦ VEBA Overview◦ Health Savings Account Overview

Plan Comparison Scenarios VSP – Vision Service Plan Flexible Spending Account Annual Open Enrollment

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District #622 and HealthPartners 3 Year Agreement

District negotiated with HealthPartners 3 year rate deal:◦ Year 1 (11-12): 4% Overall Increase to Rates◦ Year 2 (12-13): 7% Overall Rate Cap to Rates—Overall increase was 5.5%◦ Year 3 (13-14): 8% Overall Rate Cap to Rates

July 1, 2013 renewal, Year 3, overall decrease is -3%

District will continue to evaluate benefit design changes to mitigate rate increases.

District focus on managing premiums and cost by encouraging healthy lifestyle through wellness programs and the ISD 622 Well@Work Clinic

JourneyWell will continue to be a part of the District benefit plan

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If you participated and completed the Health Assessment and Wellness Program between July 1, 2012 and March 31, 2013, you will receive the preferred benefits effective July 1, 2013

The Preferred Benefit◦ $200-$25: Differential of $20 on the office visit copay

◦ HDHP VEBA and HSA: Differential of $250 on the deductible

Annual Program begins again July 1, 2013 through March 31, 2014, effective July 1, 2014◦ Employees and covered Spouses needed to complete the requirements

to qualify for the preferred benefit

◦ Meetings to be held in all buildings in the Fall

JourneyWell

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Scheduled to Open Mid-June & Open House at the end of May Hours

◦ Monday, Wednesday and Friday: 6:00am-2:00pm

◦ Tuesday and Thursday: 10:00am-6:00pm

Private and Confidential Staffed by Physician’s Assistant On Site Pharmacy Available for employee and their dependents covered under the

ISD 622 HealthPartners health insurance who is 18 months and older

ISD 622 Well@Work Clinic

Appointment Line 952-967-7481 or www.healthpartners.com/mychart

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ISD 622 Well@Work Clinic

ConditionsMinor illnessEar infectionsSinus infectionsMinor skin infectionsHeartburnStomach problemsPink EyeStyes

Minor injuriesMuscle strainsJoint pain and sprainsMinor burnsCuts and simple lacerations

Preventions, Screening, WellnessAnnual physicalsCamp physicalsBlood PressureCholesterolNutritionStress ManagementSmoking Cessations

Employee Cost: $0 office visit copay and $0 prescriptions copay

HSA Participants Only: $40 office visit including preventative prescriptions due to IRS regulations

Appointment Line 952-967-7481 or www.healthpartners.com/mychart

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District 622 Health Plan Offerings In-Network Benefits

NationalOne 200-25

NationalOne 2000/4000

VEBA*


VEBA*

NationalOne 2500/5000 HDHP-

HSA

Available to:ALL Units Teachers Paraprofessionals

Clerical, Education Assistants, Local 70, Non Units, Principals

Deductible $200 individual$600 family

$2,000 individual $4,000 family



Medical Out-of-pocket Maximum $500 individual

$1,000 family$2,000 individual



$5,000 family

Prescription Out-of-pocket Maximum

$500 per person $750 per family

Combined with Medical Out-of-

Pocket Maximum

Combined with Medical Out-of-

Pocket Maximum

Combined with Medical Out-of-Pocket

Maximum

Lifetime maximum Unlimited Unlimited Unlimited Unlimited

Preventive health care 100% coverage 100% coverage 100% coverage 100% coverage

Office VisitsUrgent Care

$25 copay100% coverage after deductible

100% coverage after deductible


Convenience Clinics (Retail Clinics)

$0 copay100% coverage after deductible



*Food Service VEBA is $1,150 deductible (no change from current)

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NationalOne 200-25


VEBA


VEBA

NationalOne 2500/5000 HDHP-HSA

Inpatient, Outpatient hospital, Ambulance

100% after deductible




Emergency Room$75 copay




Durable medical equipment





Home health care 80% after deductible




Retail pharmacy: -- Generic preferred-- Brand preferred-- Non-preferred

34 day supply/100 units

$8 copay$16 copay$32 copay

31 day supply


31 day supply


31 day supply


Mail order pharmacy 2 copays for a 90 day supply




District 622 Health Plan Offerings

Provider network and drug formulary the same for all plans

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How does it work?

High Deductible Plan with a Reimbursement Account (HSA or VEBA)

2. HealthPartners processes the claim, applies their discount

and sends Explanation of Benefits to provider

and you.

1. You seek medical care, your provider submits

the charges to HealthPartners

3. Provider sends you bill

for amount you owe.

4. You receive reimbursement

from VEBA account5. You pay

the doctor

4. You pay the doctor using

provided checks or Benny card

(HSA)

(VEBA)

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What is an HSA and VEBA?

Both are accounts that you can use to pay medical expenses◦ Must be in conjunction with a high-deductible health

plan (HDHP)◦ Tax-advantages: contribute pre-tax money (HSA only),

funds accrue tax-free and withdraw funds tax-free (if they are for eligible medical expenses)

◦ You own the account◦ Contributions

HSA—Both you and your employer can contribute funds VEBA—Only the employer can contribute funds

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Benefits of an HSA or VEBA

Tax advantage means you save money on your health care expenses

Funds rollover each year, so you can use you’re the account to save tax-free money for retirement

You own the account, even if you leave the District

Lower monthly premiums than a traditional health plan

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Qualified Medical Expenses

The IRS defines expenses that are considered “qualified medical expenses” for HSA/VEBA distributions

Expenses must be primarily to treat or prevent a physical or mental defect or illness

(HSA Only) If you use HSA funds for expenses beyond what the IRS defines as qualified, you will be subject to income tax on the distribution and an additional 20 percent penalty

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Examples of qualified medical expenses include:◦ Most medical care that is subject to your deductible (copays,

coinsurance, doctor visits, inpatient or outpatient treatment, etc.)◦ Prescription drugs ◦ Over-the-counter drugs, only if you obtain a prescription◦ Insulin (with or without a prescription)◦ Dental and vision care◦ Select insurance premiums

COBRA, qualified long-term care insurance, health insurance premiums paid while receiving unemployment benefits, health insurance after you turn 65 except for a Medicare supplemental policy

Examples of not considered “qualified medical expenses” include:◦ Insurance premiums (other than the exceptions listed on the previous

slide)◦ Over-the-counter drugs (unless a prescription is retained from a physician

– insulin is an exception)

A full list of qualified medical expenses is available at corphealthsys.com or from the Benefits office

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Distribution Rules

Distributions are tax-free if they are taken for “qualified medical expenses”

Accounts can only be used for expenses that are incurred on or after the date the account was established

Funds can be used for expenses from a prior year, as long as the expenses incurred on or after the date the account was established

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Distribution Rules cont.

Distributions can be taken for qualified medical expenses for the following people:◦ The account holder (employee covered by the

HDHP)◦ Spouse of account holder (even if not covered by

the HDHP)◦ Dependent Children

VEBA: To age 26 HSA: Tax Dependents of that individual

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District #622 HSA/VEBA Vendor

Corporate Health is the third party administrator for the VEBA and HSA accounts.

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First let’s make some assumptions about the HDHP for the examples provided:◦ The average office visit costs $110

Remember:◦ Routine Preventative Physicals are covered 100% under all plans

◦ 200-25 Plan has a prescription copay of $8 generic preferred, $16 brand preferred and $32 non preferred; an office visit copay of $25 and a $200 per person deductible (maximum of $400 per family).

◦ The Teacher VEBA plan has a deductible of $2,000 per person and a maximum of $4,000 per family.

◦ The Paraprofessional VEBA plan has a deductible of $2,400 per person and a maximum of $4,800 per family.

◦ The HSA plan has a deductible of $2,500 per person and a maximum of $5,000 per family.

Which plan is a good fit for me?

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Mary is a single, healthy female who takes advantage of preventive care visits. In a typical year, she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs $120 (retail) and is filled twice per year.

200-25 Plan 2000/4000 VEBA ($1600 VEBA Trust)

*Annual premiums $918 $1,078

Office visits $50 $220

Rx drugs $32 $240Total estimated maximum costs $1,000 $1,538

Reimbursable expenses in VEBA n/a $460

Cost after VEBA reimbursement $1,000 $1,078

VEBA Balance n/a $1,140

Scenario 1: Low HealthCare User-SingleHDHP VEBA (Teachers)

*Annual premiums based on groups with highest District contribution. Teacher premiums will be adjusted after Open Enrollment based on employee enrollment. The premiums above are preliminary amounts.

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Cindy’s family includes two children under the age of 6 and her husband. During the year there are a total of 15 visits to the doctor and 2 prescriptions per month between all the family members. The prescriptions filled included 12 preferred generic and 12 preferred brand ($1,500 total retail cost).

Scenario 2: High Healthcare User-FamilyHDHP VEBA (Teachers)

200-25 Plan2000/4000 VEBA Plan

*Annual premiums $4,708 $4,066

Office visits $375 $1,650

Rx drugs $288 $1,500Total estimated maximum costs $5,371 $7,216

Reimbursable expenses in VEBA n/a $3,150

Cost after Employer VEBA reimbursement $5,371 $4,066

VEBA Balance n/a $50

*Annual premiums based on groups with highest District contribution. Teacher premiums will be adjusted after Open Enrollment based on employee enrollment. The premiums above are preliminary amounts.

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Mary is a single, healthy female who takes advantage of preventive care visits. In a typical year, she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs $120 (retail) and is filled twice per year.

200-25 Plan 2400/4800 VEBA ($1920 VEBA Trust)

*Annual premiums $1,172 $1,755


Rx drugs $32 $240Total estimated maximum costs $1,254 $2,215

Reimbursable expenses in VEBA n/a $460

Cost after VEBA reimbursement $1,254 $1,755

VEBA Balance n/a $1,460

Scenario 3: Low HealthCare User-SingleHDHP VEBA (Paraprofessional)

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200-25 Plan2500/5000 HSA Plan

($1,127 District Contribution to HSA)

*Annual premiums $619 $0^


Rx drugs $32 $240Total estimated maximum costs $701 $460

Reimbursable expenses in HSA n/a $460

Cost after HSA reimbursement $701 $0

HSA Balance n/a $667

Scenario 4: Low Healthcare User-SingleHDHP HSA (Clerical, EA, Local 70, Non Units, Principals)

*Annual premiums based on groups with highest District contribution.

^The HSA premiums will vary based on individual contribution to the HSA account (the higher contribution the higher health premium)

Maggie is a single, healthy female who takes advantage of preventive care visits. In a typical year, she usually sees the doctor twice. She has a preferred brand prescription for Singulair that costs $120 (retail) and is filled twice per year.

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200-25 Plan2500/5000 HSA Plan

($750 District Contribution to HSA)

*Annual premiums $3,908 $0^

Office visits $375 $1,650

Rx drugs $288 $1,500Total estimated maximum costs $4,571 $3,150

Reimbursable expenses in HSA n/a $750

Cost after HSA reimbursement $4,571 $2,400

HSA Balance n/a $0

*Annual premiums based on groups with highest District contribution.

^The HSA premiums will vary based on individual contribution to the HSA account (the higher contribution the higher health premium)

Carol’s family includes two children under the age of 6 and her husband. During the year there are a total of 15 visits to the doctor and 2 prescriptions per month between all the family members. The prescriptions filled included 12 preferred generic and 12 preferred brand ($1,500 total retail cost).

Scenario 5: High Healthcare User-FamilyHDHP HSA (Clerical, EA, Local 70, Non Units, Principals)

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VEBA Overview

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Who is Eligible for a VEBA?

Anyone who is covered by the:• High Deductible Health Plan, NationalONE $2000-

100% (Teachers only)• High Deductible Health Plan, NationalONE $2400-

100% (Para Professionals only)• High Deductible Health Plan, NationalONE $1150-

100% (Food Service only)

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Contributions to the VEBA account are set amounts determined by the bargaining units and the District. The contribution amounts can’t be individualized or modified during the year.

Teacherso Contribution to $2000/$4000 VEBA Plan is 80% of Deductibleo Single contribution is $1,600 -- $500 deposited in VEBA account in July 2013 with deposits of $100

each month thereaftero Family contribution is $3,200 -- $1000 deposited in VEBA account in July 2013 with deposits of $200

each month thereafter

Paraprofessionalso Contribution to $2400/$4800 VEBA Plan is 80% of Deductibleo Single contribution is $1,920 -- $576 deposited in VEBA account in July 2013 with deposits of $122.18

each month thereaftero Family contribution is $3,840 -- $1,152 deposited in VEBA account in July 2013 with deposits of

$244.36 each month thereafter

Food Service Group continues to have the $1150 VEBA plan and the VEBA contribution will be:◦ Single contribution is $617.16 ($51.43/month)◦ Family contribution is $1,646.40 ($137.20/month)

VEBA Contribution

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The monthly administration fee is $3.09/month and will be deducted quarterly from the VEBA account.

Benny Card option

Reimbursements are made by completing a claim form, attaching the proper documentation. Typically this is an Explanation of Benefit (EOB) and submitting to Corporate Health Systems (CHS).

You can elect to receive your reimbursement funds either by check or direct deposit.

You can check your account information via the CHS website (www.corphealthsys.com)

Money that remains in your account at the end of the plan year will be rolled into the next plan year after the run-out period has expired

In the event of the death of the participant, tax dependents will be able to continue to submit claims for medical expenses until the balance is exhausted

VEBA Information

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Benny™ Prepaid Benefits Card for all your eligible VEBA expenses

‣ Easy – a simple swipe of the Card makes it hassle free!

‣ Automatic – funds are immediately transferred from your VEBA at the time you incur the expense.

‣ Convenient – there are no manual claim forms to submit.

‣ Simple to track – your current balance is available 24/7 at the web site listed on the back of your Card.

Cost to you: $18.00 Annually

BennyCard

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Health Savings Account Overview

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Who is Eligible for an HSA?

Anyone who is:• Covered by the High Deductible Health Plan,

NationalONE $2500-100%• Not enrolled in Medicare• Not covered under other health insurance*

Cannot be covered by any other health insurance that reimburses you for health expenses you incur, unless it is another HSA-qualified HDHP.

• Not another person’s tax dependent

*Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance

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Eligibility for HSA and Coordination of other Reimbursement Accounts

Flexible Spending Accounts (FSAs) and VEBA accounts may make you ineligible for an HSA unless they are designated as “Limited purpose,” meaning they are limited to dental, vision, and child care.

Acceptable VEBA accounts set aside money only for retiree health expenses are suspended

To preserve the eligibility for the HSA plan, the District FSA Medical plan will be a “Limited” plan for employees participating on the HDHP HSA. Limited purpose medical FSA is limited to only allow for dental and

vision expenses to be reimbursed.

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To preserve the eligibility for the HSA plan contributions, your VEBA account will need to be changed:

• VEBA plan participant can implement a Suspension that will limit eligible expenses to dental and vision only each plan year

Election must be made each plan year

Eligibility for HSA for District Employees With VEBA Account

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Eligibility Scenarios -- Acceptable Situations:

Single employee enrolled in HDHP no medical flex no HRA/VEBA limited medical flex limited HRA/VEBA suspended HRA/VEBA not on Medicare

Married employee enrolled in HDHP not enrolled in spouse’s medical

plan spouse doesn’t have a traditional

medical flex spouse doesn’t have an HRA/VEBA spouse has an HRA/VEBA that is

limited to spouse’s expenses limited HRA/VEBA suspended HRA/VEBA not enrolled in Medicare

Spend Down Approach:Employee elects HDHP and wishes to spend down their HRA/VEBA balance. The first of the month following when the VEBA balance is $0, the participant could establish an HSA account, assuming they are not enrolled in the traditional flex plan or have any other coverage that would make them ineligible for an HSA account.

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Some scenarios Eligibility Scenarios -- Problem Situations:

Single employee enrolled in non HDHP, doesn’t suspend or limit existing VEBA Gets married, want to enroll in HDHP and HSA. Can’t start HSA as long as HRA/VEBA has funds remaining or until next plan year

when the HRA/VEBA can be limited or suspended

Single employee enrolled in non HDHP, doesn’t have HRA/VEBA, but elects traditional medical flex

Gets married, want to enroll in HDHP and HSA. Can’t start HSA until next flex plan as flex creates HSA ineligibility

Married employee enrolled in non HDHP, doesn’t suspend or limit existing HRA/VEBA

Wishes to enroll in HDHP and HSA due to spouse plan change/cost. Can’t start HSA as long as HRA/VEBA has funds remaining or until next plan year

when the HRA/VEBA can be limited or suspended

Married employee enrolled in non HDHP, doesn’t have VEBA, but elects traditional medical flex

Wishes to enroll in HDHP and HSA due to spouse plan change/cost. Can’t start HSA until next flex plan as flex creates HSA ineligibility

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HSA Contribution Each year, the IRS sets contribution limits

◦ These limits are for the total funds contributed, including company contributions, your contributions and any other contributions

You are allowed to contribute the entire year’s limit whenever you first become eligible for the HSA (even if that is in December)

However, you must remain eligible for at least 12 months after that date, or you will be subject to taxes and penalties on the amount you contributed

2013 2014

Individual $3,250 $3,300

Family $6,450 $6,550

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Catch-Up Contributions

For individuals ages 55 and older, the IRS allows additional “catch-up contributions”

Eligible individuals may contribute an extra $1,000 for the year (for 2013)

This is to help save additional money for retirement

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Distributions – Age 65-plus

For individuals age 65 and older, HSA distributions can be used for non-qualified medical expenses without facing the 20 percent penalty◦ However, income taxes will apply for non-medical

distributions◦ This rule is regardless of whether the individual is

enrolled in Medicare

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Recordkeeping

Whenever you use HSA funds to pay for a medical expense, you should keep your receipt

Different from the VEBA, you are responsible for demonstrating to the IRS that HSA distributions were for qualified medical expenses

If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty

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District #622 HSA/VEBA Vendor

Corporate Health is the third party administrator collecting the contributions. Corporate Health uses Bancorp.

HSA is Interest Bearing Account

Investments Available when Balance is $2,500 ◦ Investment Transactions Costs Apply

Monthly Administration Fee: $3.50◦ Deducted from your account monthly

Online Access: at www.thebancorphsa-eb.com

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HSA – Tools to Manage Your Account

You will receive checks and a Benny™ Card so that you can easily access the funds in your account.

Corporate Health is the administrator collecting the contributions.

Corporate Health uses Bancorp.

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Signature Plan

Network VSP NetworkNew: Includes retail chain affiliates such as:

Costco, Visionworks

Frequency Exam/Lenses/Frame 12/12/24

Copayments – Exam/Materials $0/$10

Exam Covered in full

Covered LensesSingle Vision, Lined Bifocal and Trifocal, Polycarbonate

lenses for Dependents

Retail Frame Allowance $150

Elective Contact Lens Allowance (Material copay does not apply)

$150

Lens Options

AR, Scratch, UV and Color Coatings, Photochromic, mirror, tints and dyes and rimless lenses.

Cost-controlled pricing on all others in which members save an average 35-40%

VSP Vision PlanVision coverage is bundled with the health election.

www.vsp.com 1-800-877-7195

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A Flexible Spending Account (FSA) allows you to use pre-tax dollars to pay for eligible health care and dependent day care expenses

Flexible Spending enrollment for Medical and Dependent Care is the 12 month period from:

July 1, 2013 through June 30, 2014

Maximum Per Calendar Year Health FSA: $2,500 Dependent Care FSA: $5,000

Third Party Administer: Corporate Health Systems

Flexible Spending Account

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What you need to do--Annual Open Enrollment

Health/Vision Plans

All groups:If you do not want to make a change to your current coverage, you do not need to do anything; you will automatically be reenrolled for July 1, 2013. Current elections will rollover to the new plan year.

Add Coverage, Change Plans or Drop Coverage: If you want to make a change to your plan (i.e. move from 200-25 to the VEBA or HSA) or enroll or drop yourself or your eligible family members, please make your election on SmartBen.

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Flexible Spending Account‣If you want to participate in the FSA medical or dependent care accounts for the July 1, 2013 through June 30, 2014 plan year, you must designate a benefit amount through the online enrollment portal, SmartBen.

‣Previous year’s elections will not rollover.

‣Remember that the Medical Reimbursement will be a “Limited” plan for individuals signing up for the qualified HSA-HDHP

CIGNA Dental Plans (EA, Food Service, Paraprofessionals, Part-Time Local 70, Part-Time Clerical)

‣If you want to make a change to your plan (enroll, add or drop yourself or your eligible family members) please make your election on SmartBen.

What you need to do--Annual Open Enrollment

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Open Enrollment = Your opportunity to make benefit elections for the 2013-14 plan year

Enrollment Dates = May 7th through June 3rd Benefit elections take effect July 1, 2013

Open Enrollment Window

May 2013S M T W Th F S

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

June 2013S M T W Th F S

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 30

24 25 26 27 28 29

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Open Enrollment Rules

Employees are allowed to add or drop coverage during open enrollment. The only changes allowed after the open enrollment period are for qualified events or status changes.

Qualified Events/Status Changes include:1. Marriage2. Birth or Adoption of Child3. Divorce, Legal Separation, Termination of Employment, Reduction of Number of Hours Worked or Death of

Spouse (making them ineligible for their employers’ group benefit plan) 4. Loss of coverage under Medicaid or a state child health plan 5. Gaining eligibility for coverage under Medicaid or a state child

health plan

Employees must notify HR Department within 30 days of qualifying events in items 1, 2 and 3; and within 60 days in items 4 and 5.

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District Benefits Office (651) 748-7425

www.isd622.org/benefits

HealthPartners Member Services @ (952) 883-5000 or 1-800-883-2177

Any Questions?

http://www.isd622.org/benefits

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If you have additional questions about the benefit plans offered by the District, please contact HR.

Thank you for your attention!

2 district #622 health plan status journeywell isd 622 well@work clinic high deductible health plan...

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