Open Enrollment Benefits2014-2015

August 1_31, 2014

Wylie ISD

Agenda

• Outline changes to medical and prescription plan design

• Show side-by-side comparison of medical options

• Walk through dental, vision, and other benefit offerings

• Provide dates and times for onsite enrollers

CHANGES TO MEDICAL/RX PLAN DESIGN

Medical/Rx Plan ChangesActiveCare 1-HD

Plan Feature From 2013-2014 Plan Year

To 2014-2015 Plan Year

Individual Deductible $2,400 $2,500

Family Deductible $4,800 $5,000

Individual Out-of-Pocket MaxFamily Out-of-Pocket Max

$3,850$4,200

(Out-of-pocket maximums do not include medical copays & deductibles)

$6,350$9,200

(Out-of-pocket maximums include medical copays,

deductibles, and coinsurance)

Teladoc Physician Services N/A $40 consultation fee applies to deductible and

OOP expenses

Medical/Rx Plan ChangesActiveCare 2 – “ActiveCare Select” Comparison

Plan Feature From 2013-2014 Plan Year

To 2014-2015 Plan Year

Plan Name ActiveCare 2 ActiveCare Select

Individual Deductible $1,000 $1,200

Family Deductible $3,000 $3,600

Individual Out-of-Pocket MaxFamily Out-of-Pocket Max

$4,000$8,000

(Out-of-pocket maximums do not include medical copays &

deductibles)

$6,350$9,200

(Out-of-pocket maximums include medical copays, deductibles, and

coinsurance)

Teladoc Physician Services N/A $40 consultation fee applies to deductible and OOP expenses

Specialist Office Visit Copay $50 $60

Retail Short-Term Brand CopayRetail Maintenance Brand CopayMail Order & Retail-Plus Brand CopaySpecialty Drugs

$65$80

$180$200 per fill

50% coinsurance50% coinsurance50% coinsurance20% coinsurance

Medical/Rx Plan ChangesActiveCare 2

Plan Feature 2013-2014 Plan Year 2014-2015 Plan Year

Plan Name ActiveCare 2 ActiveCare 2

Individual Deductible $1000 $1,000

Family Deductible $3000 $3,000

Individual Out-of-Pocket MaxFamily Out-of-Pocket Max

$4,000$8,000

(Out-of-pocket maximums do not include medical copays & deductibles)

$6,000$12,000

(Out-of-pocket maximums include medical copays, deductibles, and coinsurance)

Teladoc Physician Services N/A 100% covered

Primary Care Office Visit CopaySpecialist Office Visit Copay

$30$50

$30$50

Prescription Drug Deductible $0 for generic drugs, $200 per person for brand-name drugs

$0 for generic drugs, $200 per person for brand-name drugs

Retail Short-Term (up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)

$20$40$65

$20$40$65

Retail Maintenance (after second fill up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)

$25$50$80

$25$50$80

Specialty Drugs $200 per fill $200 copay up to 31-day supply, $450 copay for 32-90 day supply

Medical/Rx Plan ChangesActiveCare 3 – “ActiveCare 2”

Plan Feature 2013-2014 Plan Year 2014-2015 Plan Year

Plan Name ActiveCare 3 ActiveCare 2

Individual Deductible $300 $1,000

Family Deductible $900 $3,000

Individual Out-of-Pocket MaxFamily Out-of-Pocket Max

$4,000$8,000

(Out-of-pocket maximums do not include medical copays & deductibles)

$6,000$12,000

(Out-of-pocket maximums include medical copays, deductibles, and coinsurance)

Teladoc Physician Services N/A 100% covered

Primary Care Office Visit CopaySpecialist Office Visit Copay

$20$30

$30$50

Prescription Drug Deductible $75 per person $0 for generic drugs, $200 per person for brand-name drugs

Retail Short-Term (up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)

$15$35$60

$20$40$65

Retail Maintenance (after second fill up to 31-day supply)• Generic Copay• Brand Copay (preferred list)• Brand Copay (non-prefered list)

$25$50$80

$25$50$80

Specialty Drugs $200 per fill $200 copay up to 31-day supply, $450 copay for 32-90 day supply

SIDE-BY-SIDE VIEW OFMEDICAL/RX PLAN DESIGN

Side-by-side comparison of 2014-2015 medical plan options

OVERVIEW OF DENTAL, VISION, & OTHER BENEFIT OFFERINGS

PPO Dental Plan Lincoln Benefit- High Option

100/80/50 Plan design option with $1000 maximum annual benefit

Benefits for oral surgery, surgical extractions, and anesthesia will move from Type 2 coverage, covered at 80%, to type 3 coverage, covered at 50%Claims paid at 90th percentile of usual & customary fees

Coverage for dependent children up to age 26

Orthodontia included for children

Premiums

• Employee Only $35.34 per month

• Employee & Spouse $76.44 per month

• Employee & Child $70.28 per month

• Employee & Family $123.28 per month

PPO Dental Plan Lincoln Benefit- Low Option

Provides a lower more basic level of coverage.

100/70/40 Plan design option with $750 maximum annual benefit

Benefits for oral surgery, surgical extractions, and anesthesia will be covered as Type 3 coverage, covered at 50%Claims paid at 90th percentile of usual & customary fees

Coverage for dependent children up to age 26

No Orthodontia coverage

Premium are guaranteed for 2 years

• Employee Only $25.18 per month

• Employee & Spouse $54.02 per month

• Employee & Child $48.50per month

• Employee & Family $85.22 per month

DHMO Dental PlanLincoln Benefit- DHMO

No co-pay on office visit; many other deeply discounted services

No annual maximum benefits or deductibles

Members must choose a provider from the network to receive benefits

• Employee Only $16.80 per month

• Employee & Spouse $32.09 per month

• Employee & Child $33.80 per month

• Employee & Family $52.37 per month

Cancer PlanColonial Cancer

Single plan option including Cancer coverage, ICU rider, Specified Disease Coverage, and 1st Occurrence Benefit

• Hospital Confinement Benefit• Radiation/Chemo• Surgery Schedule Benefit• Initial Diagnosis• Screening Rebate

$300 per day$300 per day with $10,000 per yearUp to $4,500 max$5,000$100

Open Enrollment, Guarantee issue coverage.

Employee Only $29.85 per month

Employee & Family $49.55 per month

Vision PlanBlock Vision

Exam and eyewear co-pay of $15

Elective Contact lens allowance of $150; Paid in full if medically necessary

Frame allowance up to $125 retail value

$200 allowance on Lasik

Employee Only $7.40 per month

Employee & Spouse $12.58 per month

Employee & Child $13.30 per month

Employee & Family $19.98 per month

Basic & Voluntary Group Term Life PlanLincoln Benefit

$15,000 Life Insurance Coverage for all Employees- Provided at no cost by Wylie ISD

Additional voluntary coverage available at group rates. ex: $50,000 Coverage• Age 25- $4.75• Age 35- $6.25• Age 45- $13.00• Age 55- $30.00• Age 65- $65.50

Spouse Coverage also available, Child Life up to age 26

Guaranteed Issue Coverage to $200,000 employee, $50,000 SpouseAnnual increases of $20,000 up to the guaranteed issue limit on voluntary life each year at open enrollment.

Coverage good while employed with Wylie ISD.

Disability InsuranceStandard Insurance

Open enrollment, guaranteed issue opportunity in 2014

Protects against a loss of income due to sickness or accident

1st Day hospital confinement benefit- Waives elimination period on 0/7, 14/14, 30/30 elimination period plans.

Insure up to 66.67% of annual salary- $8000 maximum monthly benefit.

Elimination Period Rate Per $1000

0/7 $37.80

14/14 $33.30

30/30 $28.20

60/60 $18.30

90/90 $15.80

Permanent Life PlanFidelity Life

Permanent, Guaranteed Issue, Life Time Protection, Term Life Insurance Policy.

Plus- Long Term Care Rider equal to 4% of death benefit, payable for 75 months. Ex: $25,000 death benefit or $1000 monthly LTC benefit payable for 75 Months.75 month LTC benefit is new for 2013, current policies include a 25 month LTC benefit

Portable upon termination of employment- Premium remains the same.

Insure yourself, spouse, and children.

Guaranteed issue for all employees up to $100,000.

Rates Based on age at issue, guaranteed for lifeex: $25,000 Non-Smoker Benefit, monthly premium:

• Age 35- $15.77 • Age 45- $26.27• Age 55- $47.50

Medical Gap PlanSpecialty Insurance Services

Bridges the gap between Active Care 1HD and Active Care 2 benefits by:

• Paying $1,500 per year for each covered person for hospital confinement

• Paying $4,500 ($1,500 per occurrence) max per year for 3 occurrences of outpatient services – includes ER visit, MRI, x-ray, lab, outpatient surgery (excludes doctor office visit cost)

• Guaranteed issue

• No pre-existing condition if not subject to pre-existing condition on medical plan

• Also bridges the gap between Active Care 2 and Active Care 3 benefits

• Employee Only Employee Spouse >40 $25.98 $47.7640-49 $34.21 $62.8550+ $71.85 $132.02

•Employee Children Employee Family $62.45 $83.64 $67.22 $95.11 $123.81 $182.41

Flexible Spending AccountTASC

Medical Expense Reimbursement and Dependent Care Reimbursement

Debt Card

Smart Phone and Tablet Apps

MyCash Account

Medical Expense Reimbursement Dependent Care Expense Reimbursement

Dr. Visit Co-pays Day Care Expenses

Deductible expenses Elderly Care Expenses

Rx Co-pays

Uninsured Dental/Vision Expenses

ONSITE ENROLLMENT SCHEDULE

Date Time LocationAugust 4th 11a.m. – 6p.m. ESC Building

August 5th – August 7th 8a.m. – 5p.m. ESC Building

August 8th 11a.m. – 6p.m. ESC Building

August 11th – August 15th 8a.m. – 5p.m. ESC Building

ESC is located at: 951 S. Ballard Avenue

Wylie, TX 75098

Open Enrollment - Enrollers Onsite

Third Party Administrator, US Employee Benefits 972-636-9944