2010-11 benefits summary
DESCRIPTION
2010-11 BENEFITS SUMMARY. Disclaimer. These notes apply to all information contained or presented in this presentation. This presentation provides general information only and is not intended as legal advice. - PowerPoint PPT PresentationTRANSCRIPT
2010-11BENEFITS SUMMARY
Disclaimer
These notes apply to all information contained or presented in this presentation.
This presentation provides general information only and is not intended as legal advice.
In the case of any inconsistencies between the information presented here and the plan document, the plan document prevails.
For complete information, please see your plan document.
Health Care Reform, etc.
FSA Changes to Over-the-Counter (OTC) Drugs
Dependents to Age 26 (regardless of student status or marriage status)
2011 W-2: Reporting the “Value of Health Care” No taxation consequences
Traditional PPO Copayment (M05)
You pay a fixed
amount.
Insurance pays
the rest.
The provider is paid in full for
the service.
In-Network OnlyOffice VisitsPrescription Drugs
Deductible
Catastrophic Event• House hit by lightning• Deductible – What you pay before the
insurance pays
Catastrophic Event• Car accident• Deductible – What you pay before the
insurance pays
Catastrophic Event• Broken Arm• Deductible – What you pay before the
insurance pays
Deductible
Surgery(Yes, even mole removal!)
MRI, CT, Etc.(Big machines = Big
Expense)
Hospital(In-patient, Out-patient,
ER)
Out-of-Network(Yep, it’s catastrophic to the insurance company!)
CatastrophicEvent
Coinsurance Explained
Coinsurance
After your Deductibl
e
You pay a percentag
e
Insurance pays a
percentage
Until you reach your
coinsurance
maximum
PPO Health Insurance Plan
BCBSTX M05BlueChoice Network
2010-11 PlanIn-Network
Individual / Family Deductible $750 / $2,250
Preventive Care Visits $20
Office Visits $20
Coinsurance 80%
Prescription Drugs $15/$30/$45
Coinsurance Maximum $3,000/$9,000
Out-of-Pocket Maximum $3,750/ $11,250REMEMBER: Deductibles are CALENDAR YEAR (January-December)
HDHP/HSA Health Insurance Plan
BCBSTX MH1BlueChoice Network
2010-11 PlanIn-Network
Individual / Family Deductible $2,500 / $5,000
Wellness (Deductible Waived) 100%
Medical Services – Deductible 1st 100%
Coinsurance 100%
Prescription Drugs – Deductible 1st 100%
Coinsurance Maximum N/A
Out-of-Pocket Maximum $2,500 / $5,000REMEMBER: Deductibles are CALENDAR YEAR (January-December)
Money Saving Ideas Expert Advice
Stay In-NetworkUrgent care vs.
Emergency RoomDrugs
Therapeutic equivalents Target, Wal-Mart Rx
plansAsk the Expert!
Be a wise consumer!
Health Savings Account (HSA)Everything covered under your health plan goes towards the deductible first. There are no copayments for office visits or prescription drugs.
Wellness visits, like your annual exam and immunizations are covered at 100% and the deductible is waived, as long as you stay in-network.
Part 1:
HDHP
• BCBSTX health insurance plan.
Part 2:
HSA
• HSA Bank account that covers qualified medical expenses.
HSA
How to use your HSA
Health Savings Account Solution
Health Savings Account
ContributePre-Tax
Invest Tax-Free
AccumulateTax-Free
RemainTax-Free
Qualified ExpensesIRS 213 (d)LTC &
COBRA
High Deductible Health Plan
2010-11 HSA Eligibility & MaximumsMust be enrolled in a High Deductible Health Plan (HDHP)
Enrollment in a spouse’s Medical FSA will disqualify you, unless it is a Limited Purpose FSA.
May not be enrolled in Medicaid or Medicare.
Non-qualified expenses are taxed as income, plus a 10% penalty for 2010 and 20% penalty for 2011.
Establish a HSA Bank Account Fund the account to pay for qualified
expenses (medical, dental, vision, etc.) Tax deductible on annual return or Pre-
Tax from your paycheck.
HSA Contribution Maximums Employee Only
$3,050 (2010 & 2011 Calendar year) Family Coverage
$6,150 (2010 & 2011 Calendar year)
Catch-Up Contributions Age 55 and above
$1,000 per year
Medical Premiums
Monthly PPO HSA
Employee Only $0.00 $0.00
Employee + Spouse $0.00 $0.00
Employee + Child(ren) $0.00 $0.00
Employee + Family $0.00 $0.00
HSA Contributions
Annual STRATFOR IRS Calendar Year Maximum
Employee Only $1,200 $3,050
EE + Spouse $2,400 $6,150
EE + Child(ren) $2,400 $6,150
EE + Family $2,400 $6,150
Note: The IRS calendar year maximum above is for January 1 to December 31.
Employees can choose to contribute to their HSA in on a pre-tax basis from their paychecks. Contributions can be in any frequency and amount (as long as you do not exceed the IRS Calendar Year Maximum).
Employee Only Example #1
Service/Negotiated Price HSA PPO
Well Check: $300 $0 $20
PCP: 3 x $75 $225 $60
Specialist: 2 x $150 $300 $40
Generic Rx: 2 x $25 $50 $30
Brand Rx: 2 x $125 $250 $60
Annual Premium $0 $0
TOTAL Expenses $825 $210
STRATFOR HSA Contribution $1,200 N/A
Total EE Cost* $0 $210*Employee carries over $375 in HSA funds to the next year
Employee Only Example #2
Service/Negotiated Price HSA PPO
Well Check: $300 $0 $20
PCP: 3 x $75 $225 $60
Specialist: 4 x $150 $600 $80
Generic Rx: 4 x $25 $100 $60
Brand Rx: 6 x $125 $750 $180
Surgery: $25,000 $825* $3,750
Annual Premium $0 $0
TOTAL Expenses $2,500 $4,150
STRATFOR HSA Contribution $1,200 N/A
Total EE Cost $1,300 $3,070*Point @ which employee met the individual deductible and 100% coverage begins.
Family Example #3
Service/Negotiated Price HSA PPO
Well Check: 4 x $300 $0 $80
PCP: 6 x $75 $450 $120
Specialist: 4 x $150 $600 $80
Generic Rx: 6 x $25 $150 $90
Brand Rx: 4 x $125 $500 $120
Annual Premium $0 $0
TOTAL Expenses $1,700 $490
STRATFOR HSA Contribution $2,400 N/A
Total EE Cost* $0 $490*Employee carries over $700 in HSA funds to the next year
Family Example #4
Service/Negotiated Price HSA PPO
Well Check: 4 x $300 $0 $80
PCP: 6 x $75 $450 $120
Specialist: 4 x $150 $600 $80
Generic Rx: 6 x $25 $150 $90
Brand Rx: 4 x $125 $500 $120
Surgery: $25,000 $2,125* $3,750
ER Visit: $2,000 $1,175** $1,080
Annual Premium $0 $0
TOTAL Expenses $5,000 $4,150STRATFOR HSA Contribution $2,400 N/A
Total EE Cost $2,600 $3,070*Point @ which employee met the individual deductible and 100% coverage begins.**Point @ which family deductible met and 100% coverage begins for everyone.
Why Does the HSA Makes Sense
Are you over-insured?How do you use your
benefits?IRA / 401K for health
expensesMore control over
expenseTax savings for future
medical expensesLong Term Care /
COBRA
ID/Debit Cards
BCBSTX ID Card
If lost or never received: Log onto: www.bcbstx.com Enter your username/password Print temporary ID card Or call: 800-521-2227 Or call CLS: 306-9300 / 877-306-9305
HSA Banking Account Inquiries
866-492-6434 https://healthbenefits.wellsfargo.com
Guardian Dental Plan
Value Plan NAP Plan
Preventive100% No deductibleNot included in CYM
Basic 100%After $50 deductible
Major 60%After $50 deductible
Ortho (child only)
50%$1,500 lifetime max
Calendar Year Maximum (CYM)
$1,500Per person on the plan
Preventive100% No deductibleNot included in CYM
Basic 80%After $50 deductible
Major 50%After $50 deductible
Ortho (child only)
50%$1,500 lifetime max
Calendar Year Maximum (CYM)
$1,500Per person on the planOut-of-Network Charges are reimbursed at a
lower negotiated fee. Balance bill will be higher when using Out-of-Network providers.
Out-of-Network Charges are reimbursed at the 90th% of UCR. Balance bill will be lower when using Out-of-Network providers.
Dental Reminders
Preventive Care excluded from CYMDependent Coverage
Up to age 26 if F/T studentRollover of Unused Benefit
$350 per year/per person Maximum of $1,250 per person
Dual Option Plan Same Price Regardless of Plan Selection
National PPO Network 70,000+ Providers www.glic.com – DentalGuard Preferred
How To Find a Guardian Provider
www.glic.com1. Choose Provider Online Search2. Click “FIND A DENTIST”3. Select Your Dental Plan = PPO4. Enter Search Criteria & Click Continue5. Select Your Dental Network = DentalGuard Preferred6. Select Type of Dentist = General or Specialist7. Click Continue8. Results Will Be Displayed on the Following Page9. You Can Choose to Print Results or Have Them Emailed
Guardian Vision Insurance
Service In-Network Out-of-NetworkExam $10 copay
Reimbursement Varies by Services Received
Single Vision Lenses $10 copay
Bifocal Lenses $10 copayTrifocal Lenses $10 copayLenticular Lenses $10 copay
Frames$120 allowance + 20%
off balance over allowance
Elective Contacts* Up to $120 (copay waived)
VSP Network www.glic.com
Frequency 12 month exam / 12 month lenses / 24 month frames
*Contact lenses are in lieu of glasses.
How To Find a Guardian Provider
www.glic.com1. Choose Provider Online Search2. Click “FIND A VISION PROVIDER”3. Select Your Vision Plan = VSP4. Enter Search Criteria & Click Continue5. Enter Additional Preferences (or Skip This Step)6. Click Continue7. Results Will Be Displayed on the Following Page8. You Can Choose to Print Results or Have Them Emailed
Guardian Premiums
Monthly Dental Vision
Employee Only $0.00 $0.00
Employee + Spouse $0.00 $0.00
Employee + Child(ren) $0.00 $0.00
Employee + Family $0.00 $0.00
Short Term Long Term
LFG Life and Disability Plans
Employer Paid = Taxable Benefit
Benefit % 60%Weekly Max $2,500Benefit Duration 13 weeksElimination Period
0 days/7 days Accident/Illness
Gross Up = Tax-Free BenefitBenefit % 60%Monthly Max $10,000Elimination Period
90 Days
Benefit Duration SSNRAOwn Occupation 2 YearsGroup Life/AD&D
Employer PaidLife 1x Salary to $250,000AD&D 1x Salary to $250,000
LFG Voluntary Life Plan
Employee PaidEmployee Increments of $10kEE Maximum 5x Salary or $300kEE Guarantee Issue $80k*Spouse Increments of $5kSP Maximum 50% of EE or $100kSP Guarantee Issue 50% of EE or $30k*Child(ren) $10,000**
* Guarantee Issue (GI) will only apply to NEW employees. If you did not enroll when first offered, you will be required to answer medical questions before you are approved for any amount – GI does not apply.
** Child coverage is up to age 19 or 25 if a full-time student.
Section 125 Plan/FSA
Maximum Annual Election
Premium Only Plan Medical, Dental and Vision
Medical Expenses* $1,500
Dependent Daycare $5,000
• If you elect the HSA medical plan, you may only use the Section 125 plan for dental, vision and dependent daycare expenses.
•Effective January 1, 2011, OTC items are no longer considered to be an eligible expense under the plan.