2013-2014 TRS ACTIVECARE BENEFIT COMPARISONS

Fall open enrollment: August 1-31, 2013

2013-2014 PLAN OPTIONS

• ACTIVECARE 1 HD (AC1 HD)

• ACTIVECARE 2 (AC2)

• ACTIVECARE 3 (only available to employees who were in this plan in 2012-2013)

Fall Open Enrollment

• August 1-31, 2013. Enroll by Aug. 21, 2013 to have proper deductions on your September checks.

• If you do not enroll you will be in the same plan next year, UNLESS you are in AC1

• If you are in AC1 and do not choose another plan, you will be enrolled in AC1 HD by TRS

• Flexible Spending Accounts (medical and dependent care) require annual enrollment

Significant Changes

• Elimination of ActiveCare 1

• Elimination of ActiveCare 3 for new employees

• Changes in deductibles, out-of-pocket maximums, and premiums for AC1 HD, AC2

• Change in premiums for AC3

The plans have changed, how do I compare them?

• Go beyond looking at the monthly premium cost

• Understand how the three plans work– AC 1HD primarily designed for catastrophic

coverage, large, immediate up-front cost

– AC 2 low-mid-level premium, designed to manage office visit/ER/pharmacy costs

– AC 3 high premium, designed to control cost

Compare Deductibles

*Above amounts reflect the deductibles for “employee only” coverage.

Compare Out-of-Pocket Maximums

*Above maximum amounts are in addition to deductibles and premiums.

Is Active Care 1 HD right for me?

• Premium cost is very low ($2.50 per paycheck, $5 per month)

• High deductible plan, no copays– For employee only coverage, you will pay out $2400 before the plan

pays anything (preventive care is still paid at 100% even if the deductible is not met – see list of preventive care)

• After the deductible is met, for employee only coverage, you will pay 20% of all expenses until you have paid out $3850

• In the worst case scenario, for employee only coverage, you might pay $6250 in addition to your monthly paycheck deduction.

• Plan design favors savvy healthcare consumers who “shop” healthcare costs, and those who anticipate few medical needs.

Sample Costs under AC 1 HD

You are enrolled in employee only coverage and have an accident that puts you in the hospital for 3 days. Your incurred claim is $15,000 in allowable expenses.

$15,000 $12,600 - 2400(Deductible) X 20% (Co-insurance) $12,600 $ 2520

You would be out:

$2400 (Deductible) $4920 +2520 (Co-Insurance) + 60 (annual premium) $4920 $4980

Is Active Care 2 right for me?

• Premium cost is $37.50 per paycheck or $75 per month

• Copays apply to office visits and prescriptions

• Plan design allows you to control and budget for basic medical costs like prescriptions and office visits.

• See Benefits website for plan details and cost comparison. Some costs have changed from 2012-13.

HELP!How do I know what is best for me?

• If you are still unsure, you can come to the Benefits Lab, August 19-30 or you can see if our worksheet will help you. Your campus has a few copies and it is the Benefits website.

• Worksheet (put together by us – not TRS) will allow you to get a rough idea of how possible costs might be paid by each plan – however, SBISD does not recommend any particular plan. Every situation is different and only you can make the final selection on what plan is best for you.

• We can’t guarantee the worksheet will fully compare your total cost or result in the same payment calculations that BCBS will arrive at due to numerous other considerations; however, you are welcome to use it for a very rough comparison – or compare the plans in your own way

If you want to use the worksheet, gather your information and a calculator!

• Estimated annual medical expenses

• Estimated annual prescription costs

• TRS ActiveCare Plan Highlights

• Knowledge of who you will want to cover

• Plan deductibles, out of pocket maximums, copays, etc. for the coverage level you will compare

Health Savings Account (HSA) vs. Flexible Spending Account (FSA)

• An extra cost you may want to add to the total cost is a contribution you make to an HSA or FSA account to prepare for large out of pocket costs

• HSA accounts are only available for the AC1HD plan

• Also, you may not contribute to both an HSA account and participate in the Medlink plan at the same time

Compare Costs: HSA vs. FSA

• Money contributed to an HSA is only available as contributed, but rolls from one year to the next

• Money allocated to an FSA is available upfront once contributions begin, but is lost if not used by the end of the time period

New Service Available 9/1/2013: Benefits Value Advisor (BVA)

• Will provide benefits information, find network providers, and provide the estimated cost at each provider for:

– CAT or CT Scans– MRIs– Endoscopy procedures– Colonoscopy procedures– Back or spinal surgery– Knee surgery– Shoulder surgery– Hip or joint replacement surgery– Bariatric surgery

Benefits Value Advisor (BVA)

• Helps in planning health care by:

– Helping you to better understand benefits– Giving a cost estimate for services or procedures– Scheduling a doctor or procedure appointment for

you– Helping with preauthorization

• More information to come

Make Your Decision

Time to choose which plan is best for you.

Look at the plan details on the Benefits website .

Contact Employee Benefits or HR if you need additional help or have questions.

benefits@springbranchisd.com

The Benefits Lab will be open Monday – Friday, August 19 – 30 from 8:00 AM until 4:30 PM in the Administration Building.

ENROLL!

Open enrollment: August 1-31, 2013

Affordable Care Act

2010 Legislation which imposes new duties on healthcare providers, health insurance plans, employers, and individuals.

Health Insurance Marketplace Notice

Notice will be sent to all employees, regardless of eligibility, by October 1, 2013

The notice will inform employees of:

• Insurance Marketplace• Premium Credit availability• Loss of Employer Contribution if insurance purchased

through Marketplace

Individual Mandate

Most individuals are required to enroll in health insurance by January 1, 2014, or pay a penalty.

SBISD employees will not be subject to the penalty until September 1, 2014

Some individuals are excluded from the requirement based on income.

TRS ActiveCare Enrollment

• TRS does not consider the Individual Mandate of the ACA to be a qualifying event.

• To obtain coverage with TRS ActiveCare, employees must enroll during open enrollment.

Individual Penalty for Not Having Coverage in 2014

Greater of:

• Percentage of individual’s excess income amount (defined as the difference between the taxpayer’s household income and the taxpayer’s filing threshold).

- 1% in 2014, 2% in 2015, 2.5% thereafter; or

• Flat dollar amount for each taxpayer and any dependents, with the total family penalty capped at 300% of the flat dollar amount. The amount for any dependent under 18 is ½ the stated amount.

- $95 in 2014, $325 in 2015, $695 in 2016

Life Insurance Changes

• New carrier – The Hartford• Lower premiums• Increased eligibility amount ($500,000 or 7x salary)• Ability to increase employee coverage by up to $60,000 (not

to exceed a total benefit of $220,000) with no evidence of insurability

• Ability to obtain employee coverage up to $60,000 if previously declined, with no evidence of insurability

• Ability to increase spouse coverage by up to $20,000 (not to exceed a total benefit of $40,000) with no evidence of insurability

THANK YOU!