Cape Girardeau Public School District No. 63

Medical Benefits 2011

Base PPO

In Network Deductible - $2,500 individual /$7,500 family Coinsurance – 20% Maximum out of pocket - $5,000/$10,000 Office visit co-pays

Preventive care paid at 100% Regular office visits $30 Diagnostic (non-routine) tests and labs $50 Urgent care $75 then deductible, then 20% Emergency Room visit $200 then deductible, then 20%

Base Rx Plan Visiting Network Retail Pharmacies

30-day supply Tier Co pays: $15/$40/$60 25% up to $150 Annual maximum of $2,500 Pharmacist processes Rx through Anthem computer

system Anthem Mail Services

90-day supply Tier Co pays: $15/$100/$180 25% up to $150 Annual maximum of $2,500

Base PPO

Out of Network Deductible - $5,000/$15,000 Coinsurance – 50% Maximum out of pocket - $10,000/$20,000 No office visit co-pays must meet deductible then

50% to maximum out of pocket Emergency Room visit $200 then deductible then

20% Prescription

$15/$40/$60 Mail order (90 day) - $15/$100/$180/25% up to $150

Summary of Changes to Base PPO

Increase in diagnostic co-pay of $20 per visit Individual deductible increase of $500 Family deductible increase of $1,000 Increase out of pocket maximum of $2,000 Urgent care co-pay decreased to $75 from

deductible. ER care co-pay decreased to $200 from

deductible. Prescription tier 1 increase of $5, tier 2

increase of $10. Mail order tier 1 increase of $5, tier 2 increase

of $25

Qualified High Deductible Health Plan

In Network Deductible - $3,000 individual /$6,000 family Coinsurance – 20% Maximum out of pocket - $5,000/$10,000 No office visit co-pays Preventive care pad at 100% No prescription plan Health Savings account employer annual

contribution of $909. Contribution will be used to offset spouse, child, or family

premiums before being placed in HSA account.

Qualified High Deductible Health Plan

Out of Network Deductible - $3,000 individual /$6,000 family Coinsurance – 40% Maximum out of pocket - $10,000/$20,000 No office visit co-pays Preventive care pad at 100% No prescription plan Health Savings account employer annual

contribution of $909. Contribution will be used to offset spouse, child, or family

premiums before being placed in HSA account.

Summary of Changes to QHDHP

In network Addition of 20% coinsurance Increase in individual out of pocket

maximum of $2,000 Increase in family out of pocket maximum

of $4,000 Out of network

Increase coinsurance by 10% Increase in individual out of pocket

maximum of $4,000 Increase in family out of pocket maximum

of $8,000

Buy Up PPO

In Network Deductible - $1,500 individual /$4,500 family Coinsurance – 10% Maximum out of pocket - $2,500/$5,000 Office visit co-pays

Preventive care paid at 100% Regular office visits $30 Diagnostic (non-routine) tests and labs $30 Urgent care deductible then 10% Emergency Room deductible then 10%

Buy Up Rx Plan Visiting Network Retail Pharmacies

30-day supply Tier Co pays: $10/$30/$60 25% up to $150 Annual maximum of $2,500 Pharmacist processes Rx through Anthem computer

system Anthem Mail Services

90-day supply Tier Co pays: $10/$75/$180 25% up to $150 Annual maximum of $2,500

Buy Up PPO

Out of Network Deductible - $3,000/$6,000 Coinsurance – 30% Maximum out of pocket - $6,000/$12,000 No office visit co-pays must meet deductible then

30% to maximum out of pocket Prescription

$10/$30/$60 Mail order (90 day) - $10/$75/$180/25% up to $150

Summary of Changes Buy Up PPO

There are no changes being made to the buy up plan at this time.

Medical Benefits2011 Monthly Premiums

Base Buy-Up QHDHP

Cost Cost CostEmployee $ 524.13* $ 646.17 $ 448.38Spouse $1,153.08 $1,421.55 $ 988.42Child(ren) $ 995.83 $1,227.72 $ 853.64Family $1,519.95 $1,873.85 $1,302.92

*District funds $524.13 of medical benefits.

Health Insurance BasicsHIPPA(Health Insurance Portability and Accountability Act)

HIPAA improves the portability, security and privacy of protected health information.

When obtaining assistance regarding claims issues through the Benefits Office, employees must sign an authorization for release of information form.

Health Insurance BasicsHealth Insurance Opt Out Provisions

Employees can decline individual health coverage.

If opting out: Employee premium dollars are not available Cannot return to Anthem Blue Cross and Blue Shield

until next annual open enrollment or IRS Qualifying Event

Must sign disclaimer form verifying intention to decline coverage

Health Savings Account (HSA)Definition An interest bearing savings account owned by

the employee to pay for current and future medical expenses.

Offered with a High Deductible Health Plan

Works similar to a flexible spending account, yet unused monies roll over year after year and continue drawing interest.

Portable

Health Savings Account (HSA)Account Contributions Both employer and employee pre-tax

contributions are permissible.

2010 maximum annual contribution (employer and employee contributions combined) $3,050 for employee only coverage $6,150 for family coverage

Catch-up Provision at age 55: $1,000

Health Savings Account (HSA)Who is NOT Eligible? Employees covered by Base or Buy Up Plan.

Employees covered by other medical insurance that is a non-high deductible health plan (at least $1,200).

Employees enrolled in Medicare coverage.

Employees claimed as a dependent child on someone else’s tax returns.

HSA PlanCafeteria Plan Funding

Employer Cafeteria Plan Funding = $909/year

District funds 100% of employee Base Medical Plan premium.

Offset dependent premiums .

Contribution placed in Health Savings Account

Health Savings Account (HSA)Account Distributions Tax-free if used for qualified medical

expenses.

Qualified medical expenses incurred on or after account is established.

Withdrawal only for monies in the account at time of distribution.

Can apply qualified medical expenses of spouse and children, even if not covered by your medical insurance.

Health Savings Account (HSA)Account Distributions (continued)

Qualified Medical Expenses: Deductibles, cost shares, and out of pocket costs

on medical insurance claims.

COBRA continuation of coverage premiums.

Qualified long term care insurance premiums.

Health Savings Account (HSA)Account Features

HSA services through Mellon Bank.

Upon electing the HSA Plan coverage and electing an HSA, Welcome Kits will be mailed to home address.

Forms must be completed by the employee and returned to Mellon Bank ASAP.

Competitive mutual fund investment options available once account reaches $1,500.

Health Savings Account (HSA)Account Features (continued)

Online management access of personal benefits and HSA details.

Monthly account activity statements.

MasterCard – a debit card to pay for qualified medical expenses.

Checkbook Usage - initial 40 checks supply; free of charge.

Health Savings Account (HSA)Account Features (continued)

Questions:

Customer Service: (888) 224-4902

www.anthem.com, My Account page

Health Savings Account (HSA)Incentives Program Types of Incentives

Health Assessment - $50 Personal Health Coach - $100

$200 incentive when achieving goals through program

Smoking Cessation Program - $50 Weight Management Program - $50

All incentive programs available through the Anthem website: www.anthem.com

Base or HSA PlanWhich is Right for You?

Base Plan - $2,500 Deductible HSA Plan - $3,000 Deductible

General Office Visits/Rx4 Office Visits ($51/visit) = $ 120 Annual Physical = $ 0 4 Rx purchases ($100/Rx) = $ 160Total Cost = $ 280Less MRA Funding = $ 0 Net Cost $ 280

General Office Visits/Rx4 Office Visits ($51/visit) = $ 204Annual Physical = $ 04 Rx purchases ($100/Rx) = $ 400Total Cost = $ 604Less HSA Funding = $ (909) Net Cost = $ (305)

A $50,000 Surgery4 Office Visits ($100/visit) = $ 1204 Labs ($150/lab) = $ 2004 Rx purchases ($100/Rx) = $ 160 Deductible & OOP Maximum = $ 3,500 Total Cost = $ 3,980Less MRA Funding = $ 0 Net Cost = $ 3,980

A $50,000 Surgery4 Office Visits ($100/visit) = $ 4004 Labs ($150/lab) = $ 6004 Rx purchases ($100/Rx) = $ 400Deductible & OOP Maximum = $ 4,000 Total Cost = $ 5,400Less HSA Funding = $ ( 909)Net Cost = $ 4,491

Base or HSA PlanWhich is Right for You?

Base Plan - $2,500 Deductible HSA Plan - $3,000 Deductible

General Office Visits/Monthly Rx4 Office Visits ($51/visit) = $ 120 Annual Physical = $ 0 2 Monthly Generics ($25/Rx) = $ 3601 Monthly Regular ($100/Rx) = $ 480Total Cost = $ 960Less MRA Funding = $ 0 Net Cost $ 960

General Office Visits/ Monthly Rx4 Office Visits ($51/visit) = $ 204Annual Physical = $ 02 Monthly Generics ($25/Rx) = $ 6001 Monthly Regular ($100/Rx) = $ 1,200Total Cost = $ 2,004Less HSA Funding = $ (909) Net Cost = $ 1,095

SIS Portal

https://employee.captigers.com

Employee ID required (Contact Finance Dept.)

Allows access to: Benefits and Deductions Leave Balances Pay Information Tax Forms (W2 and W4 information) Personal Information

Questions

Visit our website http://www.capetigers.com

Departments – Business - Benefits

Call us: (573) 335-1867 Lisa Smith – Benefits DeRhonda Gosche – Personnel/Benefits Robin Twiggs - Payroll