Open Enrollment

2015

Arch Ford Education Service Co-op

Plans for 2015•Premium, Classic and Basic•ALL plans now have deductible•All plans have the same Wellness/Preventive Health benefits http://portal.arbenefits.org/coveragePolicies/ARB0357.pdf

•Premium plan is the only plan with Pharmacy co-pays

School Employee Health Insurance Task Force

The Task Force met to discuss the changes in the health insurance plan for school employees as mandated by recent legislation in the June Special Session and by recent changes in plan designed implemented by EBD.  

• Part-time school employees (those that work less than 30 hours per week)

will no longer eligible for school health insurance effective January 1, 2015. 

• Spouses of school employees will no longer be eligible to be on school health insurance if they are eligible for health insurance through their employer.  

• There is now a limit, established in legislation, on the cost of diagnosis and treatment for morbid obesity (bariatric surgery) to the Insurance Plan.  

• Participants in a consumer-driver health insurance plan option offered under the Public and State Employees Insurance Plans will now be required to establish a health savings account.  

Qualifying Event DocumentationDocumentation must be sent with the election form for all qualifying event changes.  Here are some examples:• Adding spouse due to marriage requires a copy of a marriage

license.• Adding a newborn due to birth requires a copy of the hospital or

birth certificate.• Enrolling in coverage and/or adding a spouse or dependent due

to loss of other group coverage requires a copy of a Certificate of Credible Coverage (COCC).

All qualifying events, including new hires, have a 60 day window from the time of the qualifying event to enroll in health coverage. The effective date of coverage will begin the first day of the month following the date of application.

Submission of the Enrollment or Change form is final. Once the form is received, changes may only be made during the next open enrollment or for a qualifying event.

PUBLIC SCHOOL ACTIVE EMPLOYEES MONTHLY PREMIUMS

WITH WELLNESS VISIT 2015 Plan Year Rates - Effective January 1, 2015 - December 31, 2015

Total Monthly Employee Cost

Premium Employee Only $179.38

Employee & Spouse $812.72

Employee & Child(ren) $460.08

Employee & Family $814.92 Classic Employee Only $45.00

Employee & Spouse $346.74

Employee & Child(ren) $154.90

Employee & Family $350.36 Basic Employee Only $11.00

Employee & Spouse $266.72

Employee & Child(ren) $119.16

Employee & Family $269.50

State Contribution is funded by Act 1842 of 2005 and Act 1421 of 2009

Plan Contribution is funded by PSE Trust Fund as Claims Reserve Allocation

PUBLIC SCHOOL ACTIVE EMPLOYEES MONTHLY PREMIUMS

WITHOUT WELLNESS VISIT 2015 Plan Year Rates - Effective January 1, 2015 - December 31, 2015

Total Monthly Employee Cost

Premium Employee Only $254.38

Employee & Spouse $887.72

Employee & Child(ren) $535.08

Employee & Family $889.92 Classic Employee Only $120.00

Employee & Spouse $421.74

Employee & Child(ren) $229.90

Employee & Family $425.36 Basic Employee Only $86.00

Employee & Spouse $341.72

Employee & Child(ren) $194.16

Employee & Family $344.50

State Contribution is funded by Act 1842 of 2005 and Act 1421 of 2009

Plan Contribution is funded by PSE Trust Fund as Claims Reserve Allocation

Definitions• Deductible-A deductible is a specific amount that a member must

pay out of pocket each year before the plan begins to pay its portion

• Co-Pay- A co-payment, also known as a co-pay, is a set amount you must pay when you receive a particular service, such as an office visit, a trip to the emergency room or a prescription filled. These do count toward your out of pocket expenses. They do not count toward your deductible

• Co-insurance is the amount you pay after the insurance company has paid their portion. Co-insurance is often expressed as a percentage of the allowable charges. You must satisfy your deductible before your co-insurance will begin. This counts toward your yearly maximum out of pocket expenses

Premium Plan (former Silver Plan)• The Premium plan is a Point Of Service (POS) plan. It has a deductible, co-insurance and co-pays.

• Deductible only applies to certain services (inpatient services, hospitalization, various testing, etc..)

Individual Family

Deductible $1,000 $2,000

Annual Co-Pay Limit

$2,500 $5,000

Max Out of Pocket

$3,500 $7,000

**Pays 80% after deductible has been met

Premium Plan (cont.)Service Co-Pay

Amount

Office Visit $25

Specialist Visit $50

Emergency Room Visit $250

Urgent Care Center $100

Chiropractic Visit $25

Vision Screening $50Prescription Co-Pay

Tier I (Generic) $15

Tier 2(Preferred) $40

Tier 3 (Non-Preferred) $80

Tier 4 (Specialty) $100

*RX Out-of-Pocket Max $3,100/$6,200

*Reference Priced drugs do not count towards RX Out-of-Pocket Max or Brand with Generic available

Classic Plan (former Bronze Plan)• The Classic plan is the equivalent of a High Deductible PPO Plan. It has a deductible and co-insurance (20%).

• No co-pays• Prescriptions count towards deductible (no tiers)• HSA Required

Individual Family

Deductible $2,000 $3,000

Annual Co-Pay Limit

$4,450 $6,675

Max Out of Pocket

$6,450 $9,675

Basic Plan • The Basic plan -is also the equivalent of a High Deductible PPO Plan with the highest deductible.

• Similar to Classic plan, only higher deductibles• No co-pays• Prescriptions count towards deductible (no tiers)• HSA Required

Individual Family

Deductible $4,250 $8,500

Annual Co-Pay Limit

$2,200 $4,400

Max Out of Pocket

$6,450 $12,900

What do you need to do?• You may enroll online or by paper form (choose one, not both)

• I can send in your paper form, if you enroll online you must do so yourself

• Paper forms must be brought to me by 10/24/2014• Bring to me as soon as it is complete, please do not wait until the last minute to enroll!!

• Everyone must fill out a form– even if declining coverage

Pharmacy ClaimsMany have asked how they can find out if their prescriptions are going towards their deductible. Here is how to do that:

• To view all pharmacy claims that applies towards the deductible, go online to https://www.mycatamaranrx.com/PortalCentral/index.jsp

• Register using your insurance card (you will need to put a zero before the last number of your member ID)

• When you get in you can see all of your pharmacy claims and the amount that has been applied to your deductible.

Mandatory Health Savings Account• Arkansas Code 21-5-418 (a) A health savings account shall be a component of a consumer-driven health insurance plan option adopted by the State and Public School Life and Health Insurance Board

• After the 2015 plan year begins, letters will be sent to members to confirm enrollment in an HSA for member on the Classic and Basic plans.

• If you enroll in the Classic or Basic plan and do not enroll in an HSA it could result in termination of your insurance

• The state is not contributing anything toward the HSA for PSE members

• You will not be eligible for a Flex account if enrolled in the Classic or Basic plan, it must be an HSA

HSA (cont.)• There is not a minimum that has to be contributes, maximum amount guidelines are set by the IRS

• Health Savings Accounts can be obtained through Data Path or American Fidelity.

• Annual limits for 2015 are $3,350 for single, $6,650 for family. If you are 55+ you can contribute an additional $1,000 per year.

Minnesota Life (Group Life)• Rates are not changing• Changes may be made during Open Enrollment (increase or decrease)

• Make sure you have current and correct Beneficiaries on file

Dental Insurance• 12 month waiting period for MAJOR services• Deductible $50.00 per year (waived for all Preventative Services)

• Calendar Year Maximum $1,000 (increases by $250 after 12 consecutive months of coverage, to a maximum of $1,750)

• Rates are not changing• If you cancel coverage, you MUST complete a termination form

Employee Only $28.93-monthly

Employee + 1 Dependent $53.02-monthly

Employee + Family $92.44-monthly

Vision Insurance

• Superior Vision www.superiorvision.com• No waiting period• No rate changes• If you cancel coverage, you MUST complete a termination formEmployee Only $4.28-monthly

Employee + 1 Dependent $9.24-monthly

Employee + Family $14.04-monthly

American Fidelity• Enrollment will be during the first week of December• Everyone will be mailed an appointment card• These changes will go into effect January 1st, 2015• This is when you can enroll or make changes to:

• Cancer policy

• HSA

• Flex

• Texas Life

• Disability

• Accident

REMINDERS

• All enrollments must be turned into Lindsay by 10/24/2014

• EVERYONE, even those declining coverage must complete the proper forms and turn into Lindsay by 10/24/2014

• Coverage that meets the minimum requirements has been offered to you, if you decline coverage (and do not get coverage elsewhere) please be aware you will be penalized by the IRS.

• QUESTIONS???