2019-20 Benefits Presented By: - PowerPoint Presentation

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2019-20 Benefits

Presented By:

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How

BLA

can help ?

CFI’s dedicated service team:Kathryn Polsonkpolson@bernielowe.comChrystal Dammcdamm@bernielowe.com

Bernie Lowe & Associates, Inc., is at your serviceHours of Operation: 8:00am – 4:30pm CST(800) 942-4718If you have any questions concerning your employee benefitsIf you need any assistance in processing, disputing, or understanding a claimIf you have a questions concerning provider access and/or directoriesIf you need interpretation of a benefit provision or comparison of plansIf you need an ID Card for you, your spouse, or a dependentAll other employee benefit inquiries

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What can YOU do to help?

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Networks

Blue Advantage(Gold & Silver Plans)

Iowa Only PlanOutside of Iowa – Emergency ONLYIn-network benefits only

Must elect a PCP and/or OB/GYN for preventative care only

100% of the hospitals and approximately 96% of the physicians in Iowa Alliance Select(Bronze Plan)National PlanIn-network and out-of-network benefits100% of the hospitals and approximately 99% of the physicians in Iowa

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Designating a PCP

Designate a PCP at Enrollment

Secondary PCP for Females

OB/GYN

Can Change Any Time (will go into effect the first day of the month after Wellmark receives your request)

Only if you elect a Blue Advantage plan

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MEDICAL COMPARISON

This is a brief description only.

Benefit

Gold

In-NetworkSilver In-Network

Bronze - HDHP In-NetworkNetworkBlue AdvantageBlue AdvantageAlliance Select

Must elect a PCP

Must elect a PCP

HSA Compatible

Office Visit

$35 co-pay

$20 co-pay

deductible

Other co-pay

(CT, PET, MRI, MRA and Nuclear Medicine)

$200

20% of allowed charge after deductible

deductible

Deductible

Single $3,000

Family $9,000

Single $2,500

Family $5,000

Single $3,500

Family $7,000

Coinsurance

Not Applicable

20%

Not Applicable

Out of Pocket Maximum

(Includes Deductible)

Single $3,000

Family $9,000

Single $5,000

Family $10,000

Single $3,500

Family $7,000

Lifetime Maximum

Unlimited

Unlimited

Unlimited

Emergency Room

$150 co-pay

20% of allowed charge after deductible

deductible

Emergency Physician

deductible

20% of allowed charge after deductible

deductible

Inpatient Hospital

deductible

20% of allowed charge after deductible

deductible

Outpatient Hospital

deductible

20% of allowed charge after deductible

deductible

Hearing Aids

deductible

Not covered

Not covered

Infertility Benefits

Deductible then up to a lifetime max of $15,000

20% of allowed charge after deductible (limited)

Deductible (limited)

Routine Eye Exam

$35 co-pay

$20 co-pay

Not Covered

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Worst Case Scenario

SINGLE

Gold

Silver

BronzeOut-of-pocket Maximum$3,000$5,000

$3,500Annual (single) Premium$2,160$2,016$1,440Total Annual Out-of-Pocket$5,160$7,016$4,940FAMILY

GoldSilverBronzeOut-of-pocket Maximum$3,000 x 3$5,000 x 2$3,500 x2Annual (single) Premium$7,800$7,080$6,528Total Annual Out-of-Pocket$16,800$17,080$13,528You have something major that applies to your deductible & out-of-pocket (OPM)Remember co-pays, including Rx co-pays apply to your OPM on Gold & Silver.

Bonze plan is HSA compatible and you pay 100% of all expenses up to your OPM: including office visits and prescriptions

You have something major that applies to your deductible & out-of-pocket (OPM)

It would take two or more members of your family to have medical expenses to hit your family OPM on either the

Silver

or

Bronze

Plan.

It would take three or more members of your family to have medical expenses to hit your family OPM

Gold

Plan.

A single family member’s maximum OPM is the single amount

Remember co-pays, including Rx co-pays apply to your OPM

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PRESCRIPTION COMPARISON

This is a brief description only. Refer to your Benefit Plan Summary for details.

Benefit

GOLD

In-NetworkSilver

In-NetworkBronze In-NetworkDeductible(waived for Tier 1 Drugs)

$100 single

$300 family

Not applicable

Not applicable

Retail

(30 Day Supply)

Tier 1

$10

$8

deductible

Tier 2

$30

$35

deductible

Tier 3

$50

$50

deductible

Specialty

$50

$100

deductible

Mail Order(90 Day Supply)Tier 12.5 co-pays3 co-paysdeductibleTier 2Tier 3Specialty

Rx Applies

to your MEDICAL

Out-of-pocket Maximum

Product Selection Penalty Rule: When a brand drug is obtained and there is an equivalent generic drug available, the member is responsible for paying their payment obligation for the equivalent generic (i.e. lowest payment application) and any remaining cost difference up to the maximum allowed fee for the brand name drug.

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Health

Savings

Accounts

(HSA) What is an HSA?Allows participants to use tax-free dollars for qualified medical expensesFeatures of an H.S.A? Must be enrolled in a qualifying High Deductible Health Plan (HDHP) Bronze Maximum contributions amounts in H.S.A  Single - $3,450  Family - $6,850Catch Up Contribution (over 55): $1,000 per a yearPreventive coverage paid at 100% Eligible expenses same as flexible spending accountMust be under 65 to establish an account

Who has ownership and responsibility? You open your account & manage your account You self-direct healthcare expensesWhat are the risks?Upfront expenses of deductible and out-of-pocket maximum on the Bronze PlansYou are responsible for validity of qualified expenses

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Cost Comparison

Average treatment cost =

$118 in a

physician’s office

vs. $667 in an emergency room Receiving ER treatments for non-emergency medical conditions is a major contributor to the rising cost of health care

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Go Mobile

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Please set up a time to go over the Colonial Life Benefits that are on the next 5 slides, even if you want to waive, a waiver form needs to be completed.

Please contact:

Dick Ginther at

515-205-9660

or rjginsurance@gmail.comhttp://www.visityouville.com/en/CFIowa/benefits-overview

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Accident Insurance

On and Off-The-Job-Coverage

Emergency Treatment; Hospital Admission/Confinement; Doctor Office; X-ray/MRI; Fracture / Dislocation; Surgery, Transportation; Physical / Occupation Treatment; Wellness Benefit / Covered Person

Single; Employee + Spouse; Employee + Children; Family

Optional Spouse Disability Rider Up To $1,500/MonthBenefits Paid Directly To You – Non-Integrated CoveragePlans Are Portable At The Same Rates & Same Benefits

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Medical Bridge

Hospital Confinement

Benefits Coverage Includes Illness and Injuries

On-And Off-the-Job Coverage

Benefits Paid Directly to YouOption 1Option 2: HSA CompatiblePick $1500 or $2000 for Hospital Confinement Pick $2000 or $2500 for Hospital Confinement Surgical proceduresHealth Screening $50Health Screening $50

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Tier 2

BreastBreast reductionCardiacAngioplasty

Cardiac catherizationDigestiveExploratory laparoscopy

Laparoscopic appendectomy

Laparoscopic cholecystectomyEar, nose, throat, mouthEthmoidectomyMastoidectomySeptoplastyStapedectomyTympanoplastyTympanotomyEyeCataract surgeryCorneal surgery (penetrating keratoplasty)Glaucoma surgery (trabeculectomy)VitrectomyGynecologicalMyomectomyMusculoskeletal systemArthroscopic knee surgery with menisectomy (knee cartilage repair)Arthroscopic shoulder surgeryClavicle resectionDislocations (open reduction with internal fixation)Fracture (open reduction with internal fixation)Removal or implantation of cartilageTendon/ligament repairThyroidExcision of a mass

BreastAxillary node dissectionBreast capsulotomyBreast reconstructionLumpectomyCardiacPacemaker insertionDigestiveColonoscopyFistulotomyHemorrhoidectomy (external)Lysis of adhesionsSkin

Laparoscopic hernia repairSkin graftingEar, nose, throat, mouthAdenoidectomyRemoval of oral lesionsMyringotomyTonsillectomyTracheostomyGynecologicalDilation and curettage (D&C)Endometrial ablationLysis of adhesionsLiverParacentesisMusculoskeletal systemCarpal/cubital repair or releaseDislocation (closed reduction treatment) other than a finger or toeFoot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair)Fracture (closed reduction treatment) other than a rib, finger or toeRemoval of orthopedic hardwareRemoval of tendon lesionTier 1Medical Bridge: Outpatient Surgical Procedures

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Critical Illness

Pays Benefits For Major Critical Illness Directly To You

Heart Attach, Stroke, Major Organ Failure ….Pays Benefits For Subsequent Diagnosis for Critical Illness

Benefits From $10,000 to $30,000 Simplified Issued

Spouse Coverage Without Employee Purchasing FirstCompatible with an HSA

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Colonial Health Screening Benefit

Blood test for triglyceridesBonne marrow testingBreast ultrasoundCA 15-3 (blood test for breast cancer)

CA 125 (blood test for ovarian cancer)CEA (blood test for colon cancer)Carotid DopplerChest X-rayColonoscopy

Echocardiogram (ECHO)

Electrocardiogram (EKG, ECG)Fasting blood glucose testFlexible sigmoidoscopyHemoccult stool analysisMammographyPap smearPSA (blood test for prostate cancer)Serum cholesterol test for HDL and LDL levelsSerum protein electrophoresis (blood test for myeloma)Skin cancer biopsyStress test on a bicycle or treadmillThermographyThinPrep pap testVirtual colonoscopy$50 per a calendar year

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Voluntary Dental Plan

This is a brief description only.

Benefit

Coverage Amount

Insurance Carrier

Delta Dental PPO DeltaDelta Dental Premier / Non Par

Deductible$15 single / $45 family(waived for preventive)$25 single / $75 family(waived for preventive)PreventivePlan pays 100%; you pay 0%

Plan pays 100%; you pay 0%

Basic

You pay deductible plus 10%

You pay deductible plus 20%

Major

You pay deductible plus 50%

You pay deductible plus 50%

Orthodontia - (children only under age 19)

You pay deductible plus 50%

You pay deductible plus 50%

Calendar Year Benefit

Plan pays up to $1,000

Plan pays up to $1,000

Orthodontia Lifetime Benefit

Plan pays up to $1,000

Plan pays up to $1,000

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VOLUNTARY VISION PLAN

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Employee Shared Costs

Medical Cost

Per Pay Check (Based on 24 pay periods)

Gold

Silver

Bronze

Employee Only

$92

$88

$67

$14.87

$3.80

Employee + Spouse

$224

$214

$170

$41.80

$7.23

Employee + Child(

ren

)

$224

$214

$170

$41.80

$7.61

Family

$330

$300

$280$41.80$11.18Group Life and Long Term Disability are provided to you at NO cost.Your Medical premiums are SUBSIDIZED by Children & Families of Iowa. Dental, Vision, STD, & Voluntary Life is 100% employee paid.Your portion of the Medical, Dental, & Vision premiums will be pre-tax.

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Group Life/AD&D Insurance

Benefit

Coverage Amount

Insurance Company

UNUM

Basic Life Insurance(Employee)

1-times annual salary up to $50,000Accidental Death & DismembermentEqual to Basic Life InsuranceCoverage ReductionReduces by 33% at age 65; reduces by an additional 22% at age 70

This is a brief description only. Details are in your enrollment package.

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̊

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Voluntary Life Insurance

Benefit

Employee Coverage Amount

Insurance Company

UNUM

Employee Life Insurance

Increments of $10,000 to $500,000Guarantee Issue$200,000 (if coverage applied for within 31-days of eligibility)Coverage ReductionReduces by 33% at age 65; reduces by an additional 22% at age 70

This is a brief description only. Details are in your enrollment package.

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Slide23

Voluntary Dependent Life Insurance

Benefit

Dependent Coverage Amount

Insurance Company

UNUM

Spouse Life Insurance

Increments of $5,000 to $250,000Guarantee Issue$30,000Benefit ReductionBenefits terminated at spouse age 70

Child(

ren

) Life Insurance

Birth to 6 months of age: $500

Age 6 months to 19 unless full-time student then up to age 26: Increments of $1,000 to maximum of $10,000

This is a brief description only. Details are in your enrollment package.

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̊

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Long-Term Disability

Benefit

Coverage Amount

Insurance Company

UNUM

Monthly Benefit

60%Maximum Benefit$4,500 per monthWaiting Period90 days

Benefit Duration

Social Security Normal Retirement Age (SSNRA)

Own Occupation

24 months

This is a brief description only. Details are in your enrollment package.

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̊

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Voluntary Short-Term Disability

Benefit

Coverage Amount

Insurance Company

Lincoln Financial Group

Monthly Benefit

60%Maximum Benefit$1,000 per weekWaiting Period15th day for Accident15th day for Sickness

Benefit Duration

11 weeks

This is a brief description only. Details are in your enrollment package.

NO Changes

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Links

www.wellmark.com for medical planAlliance Select PPO

Services in Iowa the network is Alliance SelectServices outside of Iowa – network is National Blue Card PPO. Blue Advantage

Services in Iowa the network is Blue Advantage

www.deltadentalia.com for the dental planwww.eyemed.com for the vision planwww.tasconline.com for the FSA plan

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Your Flexible Spending Account

Flexible Spending Accounts (FSA’s) provide a simple way to save money on eligible health care and/or dependent care expenses.

Advantages:

More money in your pocket

Reduces current taxable earningsSave on income tax at the end of the yearDebit card convenienceThe pre-tax savings you set aside in your FSA must be used for eligible expenses.USE IT OR LOSE IT!

Calculate conservatively when making your 2018-19 FSA elections. IRS regulations require that any money left over in your FSA at the end of the plan year be forfeited.Hang onto your current card, you will receive a new ID card one month prior to the expiration date.

* If you are re-electing & currently have a debit card DO NOT THROW AWAY. To re-issue your card, it will cost $10.00

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FSA Eligible Expenses

Medical Care Expenses

($2,000 max.)

Office visit copay

Health care deductiblePrescription copayPrescription eyeglass/contact lensesOrthodontia expensesHearing aidsBlood pressure monitor

For a complete list of eligible expenses and other helpful information, please visit www.tasconline.com. A complete list of eligible and ineligible expenses is listed on your FSA website. The following is a partial list of eligible expenses:

Dependent Care Expenses ($5,000 max.)If married, both spouses must work or one must be a full time studentChild care or before or after school care for children up to age 13Nanny ServiceElder care for adult tax dependentExpenses may be paid to relative (child, parent or grandparent of participant) if:Caregiver is not under age 19;Caregiver is not a tax dependent of the participant.

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HOW LOGIN TO

MyTasc

http://portal.sliderocket.com/BOORR/TC_1012_082715-How-to-Log-in-to-MyTASC

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Flex Plan Overview

Flex Increased Income

$71

per Month -

$852 Annually!

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Qualifying Life Events

please note that elections can only be changed during the plan year if you have a life event that causes a change in status under Internal Revenue Code rules – examples are marriage, divorce, birth or adoption of a child, death of a dependent.

Changes must be made within 31 days of the life event.

Marriage

Birth or adoption

Divorce

Change in Spouse’s Job / Loss of Spousal CoverageDeath

Examples of Life Events

Please provide documentation with changes. Ex: Marriage License, Birth Certificate, Adoption Decree, Divorce Decree, etc.

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Questions may be directed to

Kathryn Polsonat (800) 942-4718 or

kpolson@bernielowe.com

QUESTIONS ???

Thank You!!!