Valley View School District 365U

January 1, 2012 Employee Benefits Open Enrollment Presentation

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2012 Program Overview

• 2012 Program Overview

• Open Enrollment

• Health Care Reform 2011 Recap

• Medical, Prescription Drug, Dental and Vision Plan Summary

• FSA / Dependent Care Plan Summary

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2012 Program Overview

Medical / Prescription Drug BCBS of IL PPO Plan (Mail Order: Prescription Prime Therapeutics)

Dental BCBS of IL PPO Plan

Flexible Spending and Dependent CarePay Flex Flexible Spending Account

Pay Flex Dependent Care Account

Vision VSP Vision PPO Plan

Life SunLife Life AD&D Plan

Long Term Disability SunLife Long Term Disability Plan

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Open Enrollment

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Open Enrollment Process

Open Enrollment Period:

November 1st – November 30th

Current Enrollment Elections:

Medical and Dental elections will automatically continue with no paperwork required.

Federal Government requires annual re-enrollment in Flexible Spending and Dependent Care Accounts. Applications must be completed to enroll in accounts effective January 1, 2012.

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Enrollment Forms can be found at www.vvsd.org.

Elections are to be returned to Human Resources no later than Wednesday, November 30, 2011 11:59pm.

All Elections are effective January 1, 2012 – December 31, 2012.

Open Enrollment Process

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During the open enrollment period you are eligible to make the following enrollment changes to the medical and dental programs for a January 1, 2012 effective date:

Elect Coverage Previously Declined Add Spouse, Civil Union Partner or Eligible

Dependents Terminate Existing Coverage Terminate Spouse, Civil Union Partner or Eligible

Dependents

Open Enrollment Rights

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The only other times during the plan year when you are eligible to make changes to your current election(s) is when the following life events occur:

Birth Death Marriage / Civil Union Divorce / Civil Union Dissolution Adoption Loss of Coverage Spouse, Civil Partner, Dependents loss of coverage

Special Enrollment Rights

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Health Care Reform 2011 Recap

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Health Care Reform 2011 Recap

Effective LAST January 1, 2011:

1. Dependent Children Eligibility to age 26 Regardless Student, Residential or Marital Status.

2. Dependent Children (up to age 19) 3/12 Pre Existing Condition Limitation was Removed.

3. Flexible Spending Account Eligible Expenses Excludes over the Counter Medications unless in the case of Insulin or a Script from a Provider.

4. Health Plan Essential Benefit Lifetime and Annual Maximums were Removed or Converted to Visit Maximums.

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Health Care Reform 2011 Recap Essential Benefit Plan Maximums

Plan Maximums Prior Effective 01/01/11

Medical Plan Lifetime Maximum $5,000,000

Unlimited

TMJ Lifetime Maximum $2,500 Unlimited

Well Baby Care Annual Maximum (Eligibility: Birth Through 26 Months)

$1,500 Unlimited

Well Child & Adult Care Annual Maximum $500 Unlimited

Physical Therapy Annual Maximum $5,000 110 Visits

Occupational Therapy Annual Maximum $2,000 28 Visits

Speech Therapy Annual Maximum $2,000 19 Visits

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2012 Contractual Changes

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Contractual Changes

Civil Union Partner Eligibility

Applicable to the Medical, Prescription Drug, Dental and Vision Plans • Effective June 1, 2011 State Law was passed to allow for civil unions in the state of Illinois. Civil

union dependents from the state of Illinois or any other state are eligible for our medical, prescription drug, dental, and vision plans effective June 1, 2011. Civil union dependents are not eligible for our Section 125, FSA and Dependent Care Federally regulated programs. The Federal government does not recognize civil union dependents as eligible dependents.

Adult Pre-Existing Waiting Period

Applicable to the Medical Plan • The Health Plan has new enrollee pre-existing condition waiting periods for adults (age 19 or

older). Conditions treated in the 3 months prior to the effective date of the Plan are not be eligible for medical coverage for the first 6 months for employees and the first 12 months for adult dependents. 

• Effective January 1, 2012 pre-existing condition waiting periods can be reduced or waived by providing the Plan proof of prior credible coverage. The Plan will reduce the medical care pre-existing condition waiting period a month for every month of prior credible coverage.   

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Medical / Prescription Drug / Dental Plans

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BCBS of IL Medical & RX Plan Overview

Deductible has a 3 x Family Maximum. Out of Pocket has a 2 x Family Maximum.

Plan Benefits In Network Out of Network

Lifetime Maximum Unlimited Unlimited

Calendar Year Deductible (In and out of Network Amounts Cross Apply)

$250 $500

Calendar Year Out of Pocket Maximum (In and out of Network Amounts Cross Apply)

$1,000 $3,000

Coinsurance 90% 70%

Office Visit Services (Consultation Only)

$25 70% after Deductible

Emergency Room $75; 90% after Deductible $75; 90% after Deductible

Urgent Care Facility 90% after Deductible 90% after Deductible

Pharmacy Prescription Drug Coverage (Generic / Brand Formulary / Brand Non Formulary)

$5 / $15 / $30 Copay; 75% after Deductible

Mail Order Prescription Drug Coverage (Generic / Brand Formulary / Brand Non Formulary)

$10 / $30 / $60 N/A

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BCBS of IL Dental Plans Overview

Annual Deductible has a 3 x Family Maximum. Orthodontia deductible has no Family Maximum.

Plan Benefits Dental Plan 1 Dental Plan 2

Eligibility TAs, Maintenance, Transportation & Food Service

Administrators & Secretaries

Annual Deductible $25 Per Member $25 Per Member

Annual Maximum $2,000 Per Member $2,000 Per Member

In Network Versus Out of Network In Network: Maximum Allowance

Out Network: Usual and Customary

In Network: Maximum Allowance Out Network: Usual and Customary

Preventive Services 100% 100%

Basic Services 80% 85%

Major Services 50% 50%

Orthodontia Services (Children up to age 23)

Not Covered 50%

Orthodontia Deductible Per Member Not Covered $50 Per Member

Orthodontia Lifetime Maximum Not Covered $1,000 Per Member

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BCBS of IL “Blue Access” For Members

Online Internet Site Provider Finder

News & Updates

Formulary RX List / Forms

View Current Enrollment

View Explanation of Benefits

Order ID Cards

Access to Blue Care Connection

Blue Points Redeemable for Prizes

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BCBS of IL “Blue Extras” Services For Members

24 Hour / 7 Day a Week Nurseline

Blue Care Advisors

Access to Health & Wellness

Special Beginnings

Tobacco Cessation

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BCBS of IL “Blue Extras” Discounts For Members

Alternative Medicine 35,000 providers

Vitamins / Herbal Supplements / Health Magazines

Weight Management Seattle Sutton, Jenny Craig, Lifetime Fitness

Vision Davis Vision

Hearing TruHearing

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Vision Plan

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VSP Vision Plan Overview

Plan Benefits In Network Out of Network

Eye Exam $10 Copay Up to $45 Allowance

Prescription Glasses $25 Copay Up to $70 Allowance

Frames Up to $130 Allowance Up to $70 Allowance

Lenses: Single Vision

Lenses: Bifocal Vision

Lenses: Trifocal Vision

Lenses: Lenticular Vision

$25 Copay

$25 Copay

$25 Copay

$25 Copay

Up to $30 Allowance

Up to $50 Allowance

Up to $65 Allowance

Up to $100 Allowance

Contact Lenses Up to $130 Allowance Up to $105 Allowance

Frequency: Exam

Frequency: Lenses

Frequency: Frames

Once Every 12 Months

Once Every 12 Months

Once Every 24 Months

Once Every 12 Months

Once Every 12 Months

Once Every 24 Months

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Flexible Spending Plan

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PayFlex

Plan Details Valley View School District 365U provides you the opportunity

to pay for out-of-pocket medical dental, vision, and dependent care expenses with pre-tax dollars.

Flexible Spending Account Annual Maximum Election: $2,500

Dependent Care Account Household Annual Maximum Election: $5,000

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PayFlex Transition FSA – HealthCare Expenses

Examples of Eligible Expenses Prescriptions Deductibles Copayments Coinsurance Vision Care Expenses Medical Care Expenses Dental Care Expenses

Examples of Ineligible Expenses Health care premiums

Expenses reimbursed by any other plan

Expenses you incur before you enroll in the plan

Expenses you claim as a deduction or credit on your federal income taxes

Over the counter equivalents (Unless Insulin or script from a provider)

Where can you find a list of eligible expenses?

Visit http://www.irs.gov/publications/p502/index.html

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Open Enrollment Recap

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Open Enrollment Recap

Open Enrollment Period: November 1st – November 30th

Medical and Dental elections will automatically continue with no paperwork required. Federal Government requires annual re-enrollment in FSA and Dependent Care accounts.

Forms are available at www.vvsd.org.

Elections are to be returned to Human Resources no later than Wednesday, November 30th 11:59pm. Effective Date of Elections are January 1, 2012.

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Questions?

Please Contact:

Lorrie Alsobrooks Administrative Assistant for Employee BenefitsValley View School District 365UPhone: 815-886-2700 x 233Email: alsobrooksl@vvsd.org

Renee Formell Insurance Consultant Mesirow Financial Insurance ServicesPhone: 312-595-7341Email: rformell@mesirowfinancial.com