Employee Benefits SAINT LOUIS UNIVERSITY 2011 Annual Enrollment.

Employee BenefitsSAINT LOUIS UNIVERSITY2011 Annual Enrollment

Medical/Pharmacy Benefits

Annual Enrollment 2011

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Highlights Effective January 1, 2011

The Vitality™ Wellness Program– Save on premium and earn

rewards!– Health screenings are needed

to participate in the Vitality program

Medical changes– Lifetime maximum on both

plans will be unlimited– Preventive care is covered at

100%– Pricing will be done on four

tiers: Employee, Employee & Spouse, Employee & Child(ren), or Family

No Dental plan design changes

Eligibility Changes:– You can now cover adult

children to age 26 regardless of student or marital status on both the medical and dental insurance

Express Scripts– Ninety-day prescriptions will

no longer be available at retail pharmacies but can still be obtained via mail order

Flexible Spending Accounts (FSAs)– Over-the-counter (OTC)

Medication will no longer be reimbursable under FSA programs due to Federal health care reform

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Primary Plan Plus Plan

SLUCare In-NetworkOut-of-

Network SLUCare In-NetworkOut-of-

Network

Deductible

Individual $250 $500 $1,000 $0 $250 $750

Family $500 $1,000 $2,000 $0 $500 $1,500

Coinsurance 0% 20% 40% 0% 10% 40%

Out-of-Pocket Maximum (includes deductibles)

Individual $1,250 $2,500 $5,000 $0 $1,250 $4,750

Family $2,500 $5,000 $10,000 $0 $2,500 $9,500

Physician Office Visits

Primary Care $10 copay 20% after deductible

40% after deductible

$10 copay 10% after deductible

40 % after deductible

Specialist Care $20 copay $20 copay

Inpatient Hospital




0% after deductible



Emergency Room

$100 copay $100 copay $100 copay $100 copay

Urgent Care Center

$50 copay $50 copay $50 copay $50 copay

UnitedHealthcare Plans


UnitedHealthcare Plans


Express Scripts

Retail Network Pharmacy

(34-day supply)

Mail Order

(90-day supply)

Express Scripts

Retail Network Pharmacy

(34-day supply)

Mail Order

(90-day supply)

Tier 1 $10 $20 $10 $20

Tier 2 $25 $50 $25 $50

Tier 3 $40 $80 $40 $80

For more information on your prescription drug coverage, please visit: www.express-scripts.com

http://www.express-scripts.com/


Copays

You only have copays in THREE scenarios:1) Physician office visits for SLUCare ONLY!

Both the Primary and Plus plans offer $10 primary care physician and $20 specialist office visit copays.

All other UHC in-network physician office visits are billed at the discounted rate and apply to your deductible and coinsurance

2) Urgent Care and Emergency Room Facilities Both the Primary and Plus plans offer $50 urgent care facility and

$100 emergency room copays both in- and out-of-network.

3) Rx Drugs Both the Primary and Plus plans offer copays for Rx drugs:


Rx Retail (30 Days) Mail Order (90 Days) Retail (30 Days) Mail Order (90 Days)

Generic $10 $20 $10 $20

Preferred Brand

$25 $50 $25 $50

Non-Preferred Brand

$40 $80 $40 $80


Illustrative Medical Scenario

You visit a SLUCare doctor at a UHC-contracted hospital for an inpatient surgery; $1,250 in Physician charges and $5,000 in facility charges (after UHC discounts)– PRIMARY PLAN

Doctor’s Charges: $250 deductible (SLUCare specific, cross applies to in-network deductible), then 10% coinsurance (10% x $1,000 = $100)– $250 + $100 = $350

Facility Charges: $500 deductible (UHC in-network deductible, cross applies with SLUCare deductible; only $250 remains), then 20% coinsurance (20% x $4,750 = $950)– $250 + $950 = $1,200

TOTAL = $1,550, leaving $950 on your out-of-pocket maximum ($900 on the SLUCare specific out-of-pocket maximum)

– PLUS PLAN Doctor’s Charges: $0 deductible (SLUCare specific), 0% coinsurance

– $0 + $0 = $0 Facility Charges: $250 deductible (UHC in-network deductible), then

10% coinsurance (10% x $4,750 = $475)– $250 + $475 = $725

TOTAL = $725, leaving $525 on your out-of-pocket maximum


Tips For You to Help Save Money

As an employee, you can take ownership in you and your family’s health care

Consumers can control costs by:– Using less expensive and more efficient providers (i.e., in-

network)– Using appropriate providers (i.e., urgent care versus emergency

room for non-emergencies)– Requesting generic prescriptions or prescriptions on lower tiers

when available– Using mail order for maintenance prescriptions


UnitedHealthcare’s Member Website

www.myuhc.com:

Find participating providers

Check claim status and history

Learn more about your benefits

Track deductibles, out-of-pocket expenses and lifetime maximums

Estimate and compare treatment costs


Medical Payroll Deductions

Primary Plus

Monthly

WITHWellness

WITHOUTWellness

WITHWellness

WITHOUTWellness

Single $39.62 $59.62 $68.97 $88.97

Employee & Spouse $236.98 $256.98 $298.63 $318.63

Employee & Child(ren) $214.41 $234.41 $270.19 $290.19

Family $338.55 $358.55 $426.61 $446.61

Subsidy Coverage $0.00 $20.00

Bi-Weekly

WITHWellness

WITHOUTWellness

WITHWellness

WITHOUTWellness

Single $18.29 $27.52 $31.83 $41.06

Employee & Spouse $109.38 $118.61 $137.83 $147.06

Employee & Child(ren) $98.96 $108.19 $124.70 $133.93

Family $156.25 $165.48 $196.90 $206.13

Subsidy Coverage $0.00 $9.23

Voluntary Dental Benefits



Voluntary Dental Benefits

Coverage will continue through Delta Dental

Choose between three dental plan options

Benefits will remain the same for 2011

Contributions increasing 7%


Voluntary Dental Plan—Delta Dental

Flex Option Basic Plus Basic

In-Network

Out-of-Network

In-Network Only

In-Network Only

Deductible

Individual $50 $50 $25 $25

Family $150 $50 $75 $75

Calendar Year Maximum

Per person $1,000 $1,000 $1,000 $750

Preventive Care

0% no deductible

0% no deductible

0% no deductible

0% no deductible

Basic Restorative Care





Major Restorative Services




Not covered

Orthodontia

Lifetime maximum (per person) $1,000 $1,000 $1,000 Not covered

Orthodontia 50%

For adults and children

60% For adults and

children

50%For children

onlyNot covered


Dental Payroll Deductions

Flex Basic Plus Basic

Monthly

Single $31.01 $20.24 $14.45

Two-person $60.70 $38.42 $28.08

Family $103.91 $65.36 $50.23

Bi-Weekly

Single $14.31 $9.34 $6.67

Two-person $28.02 $17.73 $12.96

Family $47.96 $30.17 $23.18

Flexible Spending Accounts



Flexible Spending and Dependent Care Accounts

Administration will remain with ConnectYourCare

You must make a new election for the 2011 Plan Year; current elections cannot be carried forward

Due to National Health Care Reform, as of January 1, 2011, over-the-counter (OTC) medicines are no longer eligible for purchase with an FSA unless you have a prescription from your doctor

You can continue to use your FSA funds to purchase OTC items that are not considered a medicine or drug (e.g. bandages, splints, contact lens solutions, etc.)

Take these new rules into consideration when estimating the dollar amount you will put in your FSA in the upcoming plan year


Flexible Spending and Dependent Care Accounts

Annual maximum for the health care FSA will remain at $5,000

Annual maximum for the Dependent Care Account Contribution will remain at $5,000 ($2,500 if married and filing separate returns)

For the health care FSA, your total election amount less previous reimbursements is available at the time of transaction

For the Dependent Care FSA, only the cash balance in your account is available at the time of transaction

You cannot roll over unused balances from one year to the next; carefully estimate your expenses for the next plan year… especially in light of the new OTC rules


Flexible Convenience Card

Can be used at authorized vendors (medical facilities, hospitals, pharmacies, etc.)

Allows direct payment at time of service

If you have a prescription for an OTC medication, you must pay out-of-pocket (NOT with your FSA debit / convenience card) and submit a manual claim requesting reimbursement

Cards are good for three years! So, if you currently have a Flexible Convenience Card, hold on to it! It

will be reloaded with any election you make for 2011!


Eligible Traditional Medical FSA Expenses

Copays, co-insurance and deductibles for medical, prescription and dental plans

Eye exams, contacts and eyeglasses

Laser eye surgeries

Hearing aids

Over-the-counter medical supplies (but not medications)– Bandages, splints, contact lens solution, etc.

Insulin

Some expenses not covered by your health care plan


Advantages of FSAs—Tax Savings Example

Without FSA Pretax Savings

With FSA Pretax Savings

Annual Base Pay $25,000 $25,000

Health Care Account Expenses -$0 -$1,000

Dependent Care Account Expenses -$0 -$2,000

Annual Taxable Income $25,000 $22,000

Estimated Federal Income Taxes -$3,750 -$3,300

After-tax Cost of Expenses -$3,000 -$0

Annual Net Pay $18,250 $18,700

Tax Savings $450

Assumes individual filer w/federal income tax rate of 15%; example does not include state, city, or other taxes



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Elections Are Binding For The Plan Year Unless There Is A Life Status Change

Marriage

Birth/adoption

Divorce

Death

Change in employment status

Change in dependent status

Life status change allows you to make benefit election changes and adjust your FSA elections

Benefits department must be notified within 31 days of life change



What Next?

Enrollment season is November 1st through 30th

All employees must enroll or make changes through Banner Self-Service

Update beneficiary information if necessary

Return all materials to the benefits office no later than Tuesday, November 30th, 2010

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Employee Benefits SAINT LOUIS UNIVERSITY 2011 Annual Enrollment.

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