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-
NetworkDeductibleIndividual $250 $500 $1,000 $0 $250 $750Family $500 $1,000 $2,000 $0 $500 $1,500Coinsurance 0% 20% 40% 0% 10% 40%Out-of-Pocket Maximum (includes deductibles)Individual $1,250 $2,500 $5,000 $0 $1,250 $4,750Family $2,500 $5,000 $10,000 $0 $2,500 $9,500Physician Office VisitsPrimary Care $10 copay 20% after
deductible40% after deductible
$10 copay 10% after deductible
40 % after deductibleSpecialist Care $20 copay $20 copay
Inpatient Hospital 10% after
deductible20% after deductible
40% after deductible
0% after deductible
10% after deductible
40% 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
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UnitedHealthcare Plans
Primary Plan Plus PlanExpress ScriptsRetail Network
Pharmacy (34-day supply)
Mail Order(90-day supply)
Express ScriptsRetail 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
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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:Primary Plan Plus Plan
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
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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
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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
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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
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Medical Payroll DeductionsPrimary Plus
MonthlyWITH
WellnessWITHOUTWellness
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-WeeklyWITH
WellnessWITHOUTWellness
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
Annual Enrollment 2011
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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%
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Voluntary Dental Plan—Delta Dental Flex Option Basic Plus Basic
In-NetworkOut-of-
NetworkIn-Network
OnlyIn-Network
OnlyDeductibleIndividual $50 $50 $25 $25 Family $150 $50 $75 $75 Calendar Year MaximumPer person $1,000 $1,000 $1,000 $750Preventive Care
0% no deductible
0% no deductible
0% no deductible
0% no deductible
Basic Restorative Care10% after deductible
30% after deductible
30% after deductible
30% after deductible
Major Restorative Services40% after deductible
60% after deductible
65% after deductible Not covered
OrthodontiaLifetime 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
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Dental Payroll Deductions
Flex Basic Plus Basic
MonthlySingle $31.01 $20.24 $14.45
Two-person $60.70 $38.42 $28.08
Family $103.91 $65.36 $50.23
Bi-WeeklySingle $14.31 $9.34 $6.67
Two-person $28.02 $17.73 $12.96
Family $47.96 $30.17 $23.18
Flexible Spending Accounts
Annual Enrollment 2011
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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
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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
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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!
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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
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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
Annual Enrollment 2011
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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 electionsBenefits department must be notified within 31 days of life change
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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