![Page 1: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/1.jpg)
2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS
Fall open enrollment: August 1-31, 2013
![Page 2: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/2.jpg)
2013-2014 PLAN OPTIONS
• ACTIVECARE 1 HD (AC1 HD)
• ACTIVECARE 2 (AC2)
• ACTIVECARE 3 (only available to employees who were in this plan in 2012-2013)
![Page 3: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/3.jpg)
Fall Open Enrollment
• August 1-31, 2013. Enroll by Aug. 21, 2013 to have proper deductions on your September checks.
• If you do not enroll you will be in the same plan next year, UNLESS you are in AC1
• If you are in AC1 and do not choose another plan, you will be enrolled in AC1 HD by TRS
• Flexible Spending Accounts (medical and dependent care) require annual enrollment
![Page 4: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/4.jpg)
Significant Changes
• Elimination of ActiveCare 1
• Elimination of ActiveCare 3 for new employees
• Changes in deductibles, out-of-pocket maximums, and premiums for AC1 HD, AC2
• Change in premiums for AC3
![Page 5: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/5.jpg)
The plans have changed, how do I compare them?
• Go beyond looking at the monthly premium cost
• Understand how the three plans work– AC 1HD primarily designed for catastrophic
coverage, large, immediate up-front cost
– AC 2 low-mid-level premium, designed to manage office visit/ER/pharmacy costs
– AC 3 high premium, designed to control cost
![Page 6: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/6.jpg)
Compare Deductibles
*Above amounts reflect the deductibles for “employee only” coverage.
![Page 7: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/7.jpg)
Compare Out-of-Pocket Maximums
*Above maximum amounts are in addition to deductibles and premiums.
![Page 8: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/8.jpg)
Is Active Care 1 HD right for me?
• Premium cost is very low ($2.50 per paycheck, $5 per month)
• High deductible plan, no copays– For employee only coverage, you will pay out $2400 before the plan
pays anything (preventive care is still paid at 100% even if the deductible is not met – see list of preventive care)
• After the deductible is met, for employee only coverage, you will pay 20% of all expenses until you have paid out $3850
• In the worst case scenario, for employee only coverage, you might pay $6250 in addition to your monthly paycheck deduction.
• Plan design favors savvy healthcare consumers who “shop” healthcare costs, and those who anticipate few medical needs.
![Page 9: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/9.jpg)
Sample Costs under AC 1 HD
You are enrolled in employee only coverage and have an accident that puts you in the hospital for 3 days. Your incurred claim is $15,000 in allowable expenses.
$15,000 $12,600 - 2400(Deductible) X 20% (Co-insurance) $12,600 $ 2520
You would be out:
$2400 (Deductible) $4920 +2520 (Co-Insurance) + 60 (annual premium) $4920 $4980
![Page 10: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/10.jpg)
Is Active Care 2 right for me?
• Premium cost is $37.50 per paycheck or $75 per month
• Copays apply to office visits and prescriptions
• Plan design allows you to control and budget for basic medical costs like prescriptions and office visits.
• See Benefits website for plan details and cost comparison. Some costs have changed from 2012-13.
![Page 11: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/11.jpg)
HELP!How do I know what is best for me?
• If you are still unsure, you can come to the Benefits Lab, August 19-30 or you can see if our worksheet will help you. Your campus has a few copies and it is the Benefits website.
• Worksheet (put together by us – not TRS) will allow you to get a rough idea of how possible costs might be paid by each plan – however, SBISD does not recommend any particular plan. Every situation is different and only you can make the final selection on what plan is best for you.
• We can’t guarantee the worksheet will fully compare your total cost or result in the same payment calculations that BCBS will arrive at due to numerous other considerations; however, you are welcome to use it for a very rough comparison – or compare the plans in your own way
![Page 12: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/12.jpg)
If you want to use the worksheet, gather your information and a calculator!
• Estimated annual medical expenses
• Estimated annual prescription costs
• TRS ActiveCare Plan Highlights
• Knowledge of who you will want to cover
• Plan deductibles, out of pocket maximums, copays, etc. for the coverage level you will compare
![Page 13: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/13.jpg)
Health Savings Account (HSA) vs. Flexible Spending Account (FSA)
• An extra cost you may want to add to the total cost is a contribution you make to an HSA or FSA account to prepare for large out of pocket costs
• HSA accounts are only available for the AC1HD plan
• Also, you may not contribute to both an HSA account and participate in the Medlink plan at the same time
![Page 14: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/14.jpg)
Compare Costs: HSA vs. FSA
• Money contributed to an HSA is only available as contributed, but rolls from one year to the next
• Money allocated to an FSA is available upfront once contributions begin, but is lost if not used by the end of the time period
![Page 15: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/15.jpg)
New Service Available 9/1/2013: Benefits Value Advisor (BVA)
• Will provide benefits information, find network providers, and provide the estimated cost at each provider for:
– CAT or CT Scans– MRIs– Endoscopy procedures– Colonoscopy procedures– Back or spinal surgery– Knee surgery– Shoulder surgery– Hip or joint replacement surgery– Bariatric surgery
![Page 16: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/16.jpg)
Benefits Value Advisor (BVA)
• Helps in planning health care by:
– Helping you to better understand benefits– Giving a cost estimate for services or procedures– Scheduling a doctor or procedure appointment for
you– Helping with preauthorization
• More information to come
![Page 17: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/17.jpg)
Make Your Decision
Time to choose which plan is best for you.
Look at the plan details on the Benefits website .
Contact Employee Benefits or HR if you need additional help or have questions.
The Benefits Lab will be open Monday – Friday, August 19 – 30 from 8:00 AM until 4:30 PM in the Administration Building.
ENROLL!
Open enrollment: August 1-31, 2013
![Page 18: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/18.jpg)
Affordable Care Act
2010 Legislation which imposes new duties on healthcare providers, health insurance plans, employers, and individuals.
![Page 19: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/19.jpg)
Health Insurance Marketplace Notice
Notice will be sent to all employees, regardless of eligibility, by October 1, 2013
The notice will inform employees of:
• Insurance Marketplace• Premium Credit availability• Loss of Employer Contribution if insurance purchased
through Marketplace
![Page 20: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/20.jpg)
Individual Mandate
Most individuals are required to enroll in health insurance by January 1, 2014, or pay a penalty.
SBISD employees will not be subject to the penalty until September 1, 2014
Some individuals are excluded from the requirement based on income.
![Page 21: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/21.jpg)
TRS ActiveCare Enrollment
• TRS does not consider the Individual Mandate of the ACA to be a qualifying event.
• To obtain coverage with TRS ActiveCare, employees must enroll during open enrollment.
![Page 22: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/22.jpg)
Individual Penalty for Not Having Coverage in 2014
Greater of:
• Percentage of individual’s excess income amount (defined as the difference between the taxpayer’s household income and the taxpayer’s filing threshold).
- 1% in 2014, 2% in 2015, 2.5% thereafter; or
• Flat dollar amount for each taxpayer and any dependents, with the total family penalty capped at 300% of the flat dollar amount. The amount for any dependent under 18 is ½ the stated amount.
- $95 in 2014, $325 in 2015, $695 in 2016
![Page 23: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/23.jpg)
Life Insurance Changes
• New carrier – The Hartford• Lower premiums• Increased eligibility amount ($500,000 or 7x salary)• Ability to increase employee coverage by up to $60,000 (not
to exceed a total benefit of $220,000) with no evidence of insurability
• Ability to obtain employee coverage up to $60,000 if previously declined, with no evidence of insurability
• Ability to increase spouse coverage by up to $20,000 (not to exceed a total benefit of $40,000) with no evidence of insurability
![Page 24: 2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS Fall open enrollment: August 1-31, 2013](https://reader030.vdocuments.site/reader030/viewer/2022032605/56649e7f5503460f94b82a19/html5/thumbnails/24.jpg)
THANK YOU!