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Henley USA Employee Benefits Plan Overview Meeting Date: 09/20/2016
Henley USA Employee Benefits Plan OverviewMeeting Date: 09/20/2016
Meeting Agenda 9/20/2016
� Overview / Role of LBG Advisors
� Open Enrollment Period / Qualifying Events
� Medical Plan Highlights / Review (PPO/H.S.A)
� Locating In-Network Providers
� Health Savings Account (HSA)- Program Overview
� Life, STD, LTD Overview
� Eye-Med Vision Overview (NEW)
� Life-Map Dental Overview (NEW)
� Employee Assistance Program from Life-Map
(NEW)
Overview/ LBG Advisors
Overview / Role of LBG Advisors
� LBG Advisors Has worked with Henley for 5 years
� Our Role:� Help design benefit plan, � Negotiate on companies behalf� Help implement all programs� Provide on-going education and support to employees moving
forward � We are your advocate!
All Contact information posted:
www. HenleyUSABenefits.com
Lead Consultant Account Manager Claims Assistance Office Location
Matt [email protected]
Kris [email protected]
Stacie [email protected]
Lynnwood WA
425.778.2800
Open Enrollment Information
Enrollment or Coverage Change Summary
Open Enrollment
� The 1x per year each employee can change their coverage levels without a qualifying event.� Next open enroll Sept 2017
Qualifying Event
� Any time you have a life event in your family you have 30 days to notify Human Resources and make a change to your enrollment
� Qualified Events include:
Newborn baby or adoption
Marriage or divorce
Child is on their own plan or over age 26 and is no longer considered a dependent
� If you fail to make this update you must wait until the next open enrollment period to make the change
Medical Plan Highlights
2016-2017 Plan Summary
� 2 Plan Options: H.S.A. or PPO (same as 2015/2016)
� Annual premium share approximate difference for PPO Plan vs H.S.A. plan (Family $2148, Employee/Spouse $1219, Employee/Children $937)
� Henley contributes to account for H.S.A. ($500- $1,000)
Medical Plan Overview PPO Plan HSA/High Deductible
Health Plan (HDHP)
Rate Information See rate sheets See rate sheets
Plan Design co-pay / co-insurance PPO Pay all expenses up until
deductible met (then
generally 80/20 until max
our of pocket)
Network Same as prior year plan Same as prior year plan
Henley continues to pay 100% of employee premium on all benefit lines
Account n/a $500- $1,000 account
contribution by Henley
Select Schedule of Medical Benefits
Disclaimer: Please see provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document. See SBC for out of network benefit levels. Above are in-network only.
In-Network Comparison PPO Plan H.S.A. / HDHP (New)
Office Visit- Primary Care $30 co-pay (see Regence SBC) Deductible, then plan pays 80%
Office Visit- Specialist $30 co-pay (see Regence SBC) Deductible, then plan pays 80%
Chiropractic 20% co-insurance (plan pays 80%) Deductible, then plan pays 80%
Rx (Generic, Brand, Specialty) Co-pay of $10 / $35 / $75 Deductible, then plan pays 80%
Urgent Care $30 co-pay preferred/ $45 co-pay participating Deductible, then plan pays 80%
Ambulance 20% co-insurance Deductible, then plan pays 80%
Emergency Room $100 co-pay then 20% co-insurance Deductible, then plan pays 80%
Hospital Room 20% co-insurance Deductible, then plan pays 80%
X-Ray / Blood Work No Charge first $400 / then 20% co-pay Deductible, then plan pays 80%
Imaging (CT, PET, MRI) No Charge first $400 / then 20% co-pay Deductible, then plan pays 80%
ACA PreventativeNo Charge In-Network
(see list on Regence.com)
No Charge In-Network
(see list on Regence.com)
Deductible (Individual / Family) $1,000 / $3,000
$1,500 / $3,000
(If on non-individual plan, must meet family
deductible amount for any benefits to begin –
See Regence SBC)
Max out of pocket (Ind. / Fam.) $4,500 / $9,000 $5,000 / $10,000
New HSA/HDHP plan overview
What is a Health Saving Account (HSA)/ HDHP?
� A Health Savings Account (HSA):� Set aside a portion of your paycheck—before taxes—into an account
� Rolls from year to year
� It is your account – even if you leave Henley
� Help you pay for qualified medical expenses for you and your dependents!
� It can also help you plan for future medical expenses
� Reduces Taxable Income (w2 decrease through payroll / tax form if direct contribution)*
� Funds may be invested in mutual funds yielding tax free earnings* (details to be provided by new H.S.A. administrator – min balance $2,000)
An HSA PLAN is made up of two parts:
� High Deductible Health Plan (min of $1300/$2600 min for 2016)
� Health Savings Account
*LBG Advisors are not tax advisors. Please consult your tax advisor for details.
NEW: Health Saving Account (HSA) Details
� Henley USA will fund $500- $1,000 into the HSA account for employees
� Pro-rated for new employees (see Mary Kirkpatrick for chart)
� $500 minimum contribution
� Both employers and employee can contribute to HSA
� 2017 Limit $3,400 Ind. / $6750 Family (Pro-Rated may apply if you are not participating in H.S.A. medical plan as of 12/1/17 – see IRS pub 502)
� If over 55, add $1,000 to limits above
� Employees:
� Control HSA disbursements (not a reimbursement program)
� Will receive a debit card for HSA funds or can use bill-pay feature online
� Will be responsible to save all receipts for tax audit purposes
� If you are disabled or reach age 65, you can receive non-medical distributions without penalty, but you must report the distribution as taxable income.
The list later in this PowerPoint shows common examples of qualified medical expenses. Complete lists of eligible and non-eligible expenses can be found in IRS Publication 502, which can be ordered from the IRS by calling 1-800-TAX-FORM (1- 800-829-3676) or by visiting www.irs.gov.
Acne treatment*AcupunctureAllergy & Sinus medication*Antacids*Antibiotic ointment*Anti-diarrheal*Antifungal foot cream*Anti-gas medication*Anti-itch cream/gel*Antiseptic* Asthma treatment*Bandages/gauzeBirthing classes or LamazeBlood pressure monitor Braces (knee, ankle, wrist)Breast pumpBurn cream*Chiropractic servicesCoinsurance Cold/hot packCold sore treatment*Cold/cough medication*Compression stockings
Contacts & solutionsCopaysCPAP machineCrutchesDeductiblesDental services Diabetic suppliesDiaper rash ointment*Digestive Aids*Drug addiction treatmentEar wax removal kits*Eye dropsFeminine Anti-Fungal/Anti-Itch*First Aid KitFlu shotsGroup therapyHearing aids & suppliesHemorrhoid medication*Hormone therapyHospital feesHumidifiersImmunizationsIncontinence supplies Individual counseling
Insect bite treatment*Lab workLactation ConsultantLactose intolerance pills*Laser eye surgeryLaxative*Lice treatment products*Massage therapyMedical records Motion sickness relief*Nasal stripsNaturopathic visitsOrthodontiaOrthotic insertsOxygen and equipmentPain relievers*Parasitic treatment*Physical examsPhysical therapy Pregnancy testPrenatal vitaminsPrescription drugsPrescription glassesReading glassesRespiratory Treatments*
Saline nasal spraySleep Aids & Sedatives*Sleep deprivation treatmentSmoking cessation products*Smoking cessation programs Speech therapyStool softener*ThermometerThroat lozenges*Vision careWalker Wart treatment*Wheelchair & repairX-rays
Here is a common list of expenses that are approved. Items marked with an asterisk (*) are considered over-the-counter (OTC) medicines or drugs and require a prescription for reimbursement.
Eligible Expenses
� Keep Your Receipts!
Eligibility Rules
You are not eligible to contribute to H.S.A if:
� If you are claimed as a dependent on someone else’s taxes
� You are covered by any other health insurance policies that are not considered High-Deductible Health Plans (HDHPs)
� You are currently on Medicare (previous H.S.A. funds can pay Medicare premiums A/B)
� If you participate in an unlimited FSA or HRA through your employer oryour spouse’s employer, (Limited or Dependent FSA is allowed with H.S.A)
� You and your spouse can each have an HSA if you both have high deductible coverage. If you have family HDHP coverage (Min deductible $1300 individual or $2600 family), the maximum contribution is split equally unless you and your spouse agree on a different division.
H.S.A. vs PPO (Example #1)
� Employee Only Coverage – 2 office visits per year (low usage)� For office visit, PPO costs $30 per and H.S.A. would cost amount that is billed less
network discount (up until deductible is hit- for this example, lets say $125 after discount)
� On PPO, employee would pay $60� On H.S.A., employee would pay $250
� PPO has co-pay and $1,000 deductible � H.S.A. has no co-pays and $1500 deductible� On H.S.A. company contributes $1,000 (This turns $1500 deductible into net $500
deductible)� Any funds left of $1,000 are employees to keep and roll-forward. If they leave
Henley, they own account� In addition to $1,000, employee could fund another $2,400 into account thus
lowering their taxable income (similar to 401k deduction)
� In example above, PPO would have paid $60 and H.S.A. would have paid $250 however with Henley $1,000 contribution, the $250 is covered and $750 is left over in account.
H.S.A. vs PPO (Example #2)
� Employee Only Coverage – 2 office visits per year + 4 fills of $1,000 medication
� For office visit, PPO costs $30 per and H.S.A. would cost whatever is billed less network discount (up until deductible is hit- for this example, lets say $125 after discount)
� For medication, PPO costs $75 per and H.S.A. would cost amount billed up to $1,500 then employee pays 20% until they hit max out of pocket $5,000
� On PPO, employee would pay $60 office and $300 Rx for total of $360� On H.S.A., employee would pay $250 office, $1,000 for first Rx, $250 for
second Rx (part) $150 for second Rx (20% part), $200 for 3rd Rx, and $200 4th Rx. Total paid is $2,050 however Henley pays $1,000 of this for a net of $1,050. If employee funds H.S.A. with $1,050 to pay amount due and is at 20% tax rate, the net amount is $840 (save $210 in tax)
� In example above, PPO would have been better option with total cost being $360 vs. $840.
H.S.A. vs PPO (Example #3)
� Family Coverage – 2 office visits per year per member(low usage)� For office visit, PPO costs $30 per and H.S.A. would cost amount that is billed less network
discount (up until deductible is hit- for this example, lets say $125 after discount)� On PPO, employee would pay $60 x 4 =$240� On H.S.A., employee would pay $250 x 4 = $1,000
� PPO has co-pay and $1,000 deductible � H.S.A. has no co-pays and $1500 deductible
� On H.S.A. company contributes $1,000 (This turns $1500 deductible into net $500 deductible)� Any funds left of $1,000 are employees to keep and roll-forward. If they leave Henley, they own
account� In addition to $1,000, employee could fund another $5,750 into account thus lowering their
taxable income by substantial amount (similar to 401k deduction)
� In example above, PPO would have paid $240 and H.S.A. would have paid $1,000 however with Henley $1,000 contribution, the full $1,000 is covered leaving employee with no cost. In addition, annual family premium share is approximately $2148 lower on H.S.A. than PPO
H.S.A. vs PPO (Example #4)
� Family Coverage – 2 office visits per year per member + large facility bill such as pregnancy (high usage)
� For office visit, PPO costs $30 per and H.S.A. would cost amount that is billed less network discount (up until deductible is hit- for this example, lets say $125 after discount)
� For large facility, example for cost is $10,000
� On PPO, employee would pay $60 x 4 =$240 for office and $2,000 for pregnancy (20% of $10k)� On H.S.A., employee would pay $250 x 4 = $1,000 for office and $2400 for pregnancy
� PPO has co-pay and $1,000 deductible � H.S.A. has no co-pays and $1500 deductible� On H.S.A. company contributes $1,000 (This turns $1500 deductible into net $500 deductible)� Any funds left of $1,000 are employees to keep and roll-forward. If they leave Henley, they own
account� In addition to $1,000, employee could fund another $5,750 into account thus lowering their
taxable income by substantial amount (similar to 401k deduction)
� In example above, PPO would have paid $2,240 and H.S.A. would have paid $3,400 however with Henley $1,000 contribution and $2148 lower annual premiums, net H.S.A. amount is $252
� Important to Remember on H.S.A: Family deductible must first be satisfied for additional benefits to apply (i.e. one person could use up the entire $3,000), then 80/20 formula applies
Ineligible Expenses
� Generally speaking, things that are hygienic or cosmeticin nature are not eligible.� Some Items that are hygienic:
� Toothbrushes
� Toothpaste
� Toiletries
� Some items that are cosmetic:
� Veneers
� Teeth whitening / bleaching
� Cosmetic Surgery
Locating A Provider: Medical
Finding In-Network Provider
Step 1: www.Regence.com
Step 2: Click “Find a Doctor”
Step 3: Sign in as member (or Visitor Find A Doctor)
Step 4: WA – select Preferred Innova or H.S.A 2.0
Step 4: TX – select National Bluecard PPO
Alternative for Texas or When Traveling:
Step 1: http://provider.bcbs.com/Step 2: Enter first 3 digits of card or Select Blue Card PPO / EPO
*It’s critical that you ensure your doctors are covered in network to receive in-network benefits and discount pricingUtilizing Out of Network providers will result in lower benefits and balanced billing to participant.
Life, STD/LTD Overview
Life Insurance
� No Change in Coverage-Switching from Metlife to Life-Map
� Company pays 100% of employee premium
� Disclaimer: Please see LifeMap provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document.
Benefit Information
Life / AD&D 1 x Covered Annual Earnings
Overall Maximum $225,000
Employee Leaves Coverage is terminated
Age Reduction Formula Please see Official LifeMap Benefit Overview
Short Term Disability
� No Change in Coverage-Changing from Metlife to LifeMap
� Company pays 100% of employee premium
� Disclaimer: Please see LifeMap provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document.
Benefit (weekly) Information
Elimination Period 14 days
Weekly Max Benefit $2,000
Benefit Percentage 60%
Max Disability Period 11 weeks
Long Term Disability
� No Change in Coverage- Changing from Metlife to LifeMap
� Company pays 100% of employee premium
� Long term disability begins after short-term disability ends. You can receive up to 60% of your pre-tax monthly earnings to a maximum of $6,000 a month. These benefits will last until your social security normal retirement age (SSNRA)
� Disclaimer: Please see LifeMap provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document.
Benefit Information
Elimination Period 90 DAYS
Monthly Max Benefit $6,000
Benefit Percentage 60%
Max Disability Period SSNRA
Vision Overview
Eye-Med Vision
� Changing from VSP to EyeMed
� Company pays 100% of employee premium
� For provider assistance: EyeMed.com or 866.800.5457
� New retailers to be added in-network: Pearle Vision, Lens Crafters, Target, Sears, JCP, Fred Meyer, Glasses.com, ContactsDirect.com, Macys (coming soon)
Disclaimer: Please see Eye-Med provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions. Summary Plan Description supersedes any information found in this employee benefits guide / education power-point. This is only a partial illustration or overview of the policy and is not a legal document.
Benefit Information Information
Well Vision Exam 1 Per 12 months Co-pay $10
Frames 1 per 24 months $175 allowance (up from $150)
Lens 1 per 12 months included in prescription
Contacts 1 per 12 months $175 Allowance (up from $150)
Dental Overview
Life Map Dental – Ortho Added
Plan Summary Payment Levels
In-Network Out of Network
(90% of reasonable and customary)
Class A – Diagnostic & Preventive
Exams, Prophys, X-rays 100% 100%
Class B – Restorative
Restorations, Endodontics, Periodontics, (including
Periodontal Maintenance). Oral Surgery
80% 80%
Class C – Major
Crowns, Dentures, Partials, Bridges 50% 50%
Annual Maximum Per Person
effective/end date$2000 $2000
Deductible
Per person/per benefit period
Annual family maximum
(Applies to B&C Above)
$50
$150
$50
$150
Child Ortho (New in 2016/2017)$1500 $1500
(paid at 90th percentile unc)
LifeMap Dental
Pre-Authorization Process
If your dental care will be extensive, you may ask your dentist to complete and submit a request for an estimate, sometimes called a “predetermination of benefits.”
This will allow you to know in advance what procedures are covered, the amount LifeMap Dental will pay and your financial responsibility.
A predetermination of benefits is not a guarantee of payment.
EAP Overview
LifeMap: Employee Assistance Program
Unlimited telephone access to EAP professionals 24 hours a day, seven days a week for items including:
� Emotional well-being
� Family and relationships
� Legal and financial
� Healthy lifestyles
� Work and life transitions
� Stress and resiliency
� Depression
� Grief
� Gambling and other addictive behavior
� Legal assistance and financial services
� Will preparation
� Legal library & online forms
� Dependent and Elder Care assistance & referral services
Contact / Support Information
LBG Advisors
Matt Christensen or Kris Kirkpatrick
T: 425-778-2800 or 877-485-2120
www.HenleyUSABenefits.com
Contact Tab
Submit a Question through website
LBG Advisors Disclaimers
Employee Benefits Guide / Employee Education PPT
� Please see provider insurance booklets and Summary Plan Description (SPD) for the detailed benefit description and exclusions
� This guide / power-point overview is not a guarantee of coverage or benefits
� Summary Plan Description supersedes any information found in this employee benefits guide / education power-point
� This is only a partial illustration or overview of the policy and is not a legal document
� LBG Advisors does not provide coverage
� While this guide is believed to be accurate as of the date of first use, plan designs, coverages and vendors may change during or at the end of the plan year. Please consult your HR department for updates to your plan and coverage
� LBG Advisors does not provide legal or tax advice
