Saint Louis University November 1 to November 20, 2015 2016 Annual Enrollment.

Saint Louis University

November 1 to November 20,

2015

2016 Annual Enrollment

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Benefits Overview - Coverages Offered

Medical/Prescription Drug

Vitality Wellness Program

Voluntary Dental

Voluntary Vision

Health Savings Account

Flexible Spending Accounts

Voluntary Accident

Basic Term Life and AD&D Voluntary Term Life Voluntary AD&D Long Term Disability Long Term Care Business Travel Accident

Medical/Prescription Drug Benefits


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Affordable Care Act Impact

Affordable Care Act (ACA) was signed on 3/23/2010

Plan Design Requirements:o Removal of annual and lifetime dollar limitations on essential health benefitso Removal of pre-existing condition limitations o Routine preventive care coverage at 100% o Medical and Rx copays apply to out-of-pocket maximum

Eligibility Change:o Dependent eligibility extension to age 26, regardless of student, marital, or

dependent status

Taxes and Fees:o Transitional Reinsurance Feeo Patient Centered Outcomes Research Institute Feeo Industry sector taxes applied to drug and medical device manufacturerso Cadillac Tax (coming in 2018)

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Status of SLU’s Plan

Plan Design:o All ACA enhancements have been madeo The last reduction in benefits was in 2013

• The deductible on the Plus Plan increased from $250 to $500o Plan designs and administrators have remained unchanged in 2014, 2015,

and 2016o Benchmark information

• SLU’s plans compares very well with other Higher Education employers• Outside of higher education, SLU’s plan designs are very rich

o Most employers have made considerable plan design changes to offset ACA costs

Employee Contributions:o This year’s increase is the first since 2012*

* Wellness participant’s last contribution change was 2012* Non-Wellness participant’s last contribution change was 2013

o Very rare in post-ACA environment

Outside of ACA: o Medical trend continues to be 8-9% year over yearo Specialty pharmacy drugs are becoming a major cost to plans

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Highlights Effective January 1, 2016

Medical - UnitedHealthcareo Continue to have the option between two plans: Plus Plan and QHDHP Plano No plan design changes to either plan for 2016

Prescription Drug – Express Scriptso No plan change to prescription drug benefits o No change to network

The Vitality™ Wellness Programo Health screenings and HRA completion are needed to receive wellness

discounto Wellness discount will remain the same

o $50 for employees and $25 additional for covered spouseso If covering your spouse, both must complete requirements

o Deadline for completion is November 20

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Working Spouse Rule

Effective January 1, 2016

Applies to spousal eligibility on the medical plan only

Spouses who have access to medical coverage through their employer will no longer be eligible to enroll in SLU’s medical plano If your spouse is not employed or does not have access to

coverage, they are still eligible to enroll in SLU’s medical plano Spouses are still eligible for all other benefits

All employees who currently have a spouse enrolled or who want to enroll a spouse at open enrollment will need to complete the Spousal Health Care Affidavit and return to Benefits

If you do not complete this form, your spouse will not be enrolled for 2016

A Frequently Asked Questions document and the Affidavit can be found on SLU’s online open enrollment site

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2016 Medical Plan Options

Plus Plan QHDHP Plan

SLUCare In-NetworkOut-of-

Network SLUCare In-NetworkOut-of-

Network

DeductibleNon-Embedded:

(One member can satisfy entire family deductible)

Individual $0 $500 $750 $1,500 $1,500 $3,000

Family $0 $1,000 $1,500 $3,000 $3,000 $6,000

Coinsurance 0% 10% 40% 0% 10% 40%

Out-of-Pocket Maximum (includes deductibles and all copays)Non-Embedded:

(One member can satisfy entire family OOP Max)

Individual $1,500 $1,500 $4,750 $1,500 $3,000 $6,000

Family $3,000 $3,000 $9,500 $3,000 $6,000 $12,000

Physician Office Visits

Primary Care $10 copay10% after ded. 40% after

ded.0% after ded. 10% after ded. 40% after

ded.Specialist Care $20 copay

Preventive Care 100% 100% 100% 100% 100% 100%

Inpatient Hospital

N/A 10% after ded.40% after

ded. N/A 10% after ded.40% after

ded.

Emergency Room

N/A $100 copay $100 copay N/A 10% after ded.10% after

ded.

Urgent Care Center

N/A $50 copay $50 copay N/A 10% after ded.40% after

ded.

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2015 Pharmacy Plan Options

Plus Plan QHDHP Plan

Express Scripts

Retail

(34-day supply)

Express Scripts

Mail Order

(90-day supply)

Express Scripts

Retail

(34-day supply)

Express Scripts

Mail Order

(90-day supply)

Tier 1 $8 $16 Medical Deductible and Coinsurance



Tier 4 20% to $150 N/A Medical Deductible and Coinsurance

Preventive Medications Priced according to the tier in which they fall Covered at 100%, no copay or deductible

Under the QHDHP, certain preventive, or “maintenance,” medications

are covered at 100%... No deductible or coinsurance!

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2016 Cost Sharing: Monthly

Plan Monthly Premium Deductions With Monthly Wellness Discount

Plus Plan

Employee Only $153.26 $103.26

Employee and Spouse $418.49 $343.49

Employee and Child(ren) $360.76 $310.76

Family $565.68 $490.68

QHDHP Plan




Family $353.78 $278.78

Plus Plan – Employees earning up to $37,000*

Employee Only $50.00 $0



Family $462.42 $387.42* Increasing for 2016

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2016 Cost Sharing: Bi-Weekly

Plan Bi-Weekly Premium Deductions With Bi-Monthly Wellness Discount

Plus Plan




Family $261.08 $226.47

QHDHP Plan




Family $163.28 $128.67

Plus Plan – Employees earning up to $37,000*

Employee Only $23.08 $0



Family $213.42 $178.81* Increasing for 2016

Health Savings Account


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Health Savings Accounts

Health Savings Accounts (HSAs) are designed to help you save and pay for your healthcare now and when you retire

Triple tax savings: Put money in pre-tax Grow your savings tax free Pay for qualified medical expenses income tax free

Account is always yours

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HSA Eligibility for Account Holders only

You are eligible to open and contribute to an HSA if you:

If you don’t meet one of these eligibility requirements, you can still enroll in the QHDHP plan, you just cannot open and contribute to a Health Savings Account

Are covered by a Qualified High Deductible Health Plan (QHDHP)

Are not covered by any other health plan that is not a QHDHP

Are not enrolled in Medicare, Medicaid, or TRICARE

Have not received VA benefits within the past 3 months

Are not claimed as a dependent on someone else’s tax return

Are not covered by a Health FSA(Must have $0 in your Health FSA before contributing to an

HSA)

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HSA Contributions

2016 Maximum Contribution Limit

(2015 Limits: $3,350 for Individual, $6,650 for Family)

IRS maximum reflects a combined employer + employee contribution

55+ can fund an additional $1,000/year; “catch-up” contribution

Please note SLU will only put seed money into an OptumBank administered HSA. If you choose to go to a financial institution of your choice, then you will not receive the seed money.

HSA must be established by November 20 in order to receive seed money on January 1

Funds must physically be in your account before disbursements can be made

Any money remaining in the account at the end of the calendar year rolls over into the next year

2016 IRS Maximum SLU Seed Money

Individual $3,350 $250

Family $6,750 $500

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Taking Money OUT of an HSA

Issues in Distributions o Reimbursement of expenses for employee, spouse and Tax Code dependents

are tax freeo Expense must be incurred on or after the date the HSA was established

Qualified expenses include: o Health, dental and vision expenseso COBRA premiumso Medicare premiumso Qualified long-term care premiumso Retiree health insurance after age 65, but not Medigap/Supplement plans

Other withdrawals are taxable o Income tax, plus…o Subject to 20% excise tax if withdrawn prior to age 65o After you turn 65, or enroll in Medicare, you may withdraw money for non medical purposes

without a penalty. The withdrawal is treated as retirement income and is subject to normal income tax.

It is important to save your receipts in case you are audited by the IRSo Account is between you and the IRS; OptumBank does not substantiate your claims

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HSA & FSA Participation

IRS guidelines prohibit participants from contributing to a Health Care FSA and an HSA at the same timeo Spouses are ineligible to participate in their employer’s Health Care

FSA • Ok if a Limited FSA – used for dental and vision expenses only

In order for you to fund an HSA on January 1, there must be a $0 balance in your Health Care FSA on December 31

You can still enroll in the benefit plan, but cannot contribute to an HSA account

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Making Deposits

Payroll Deduction

Arrange for an automatic payroll deduction into your account

Mail a CheckMake a deposit at any time on OptumBank from your checking or savings account

e-ContributeArrange a regular electronic transfer from an account at another financial institution

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Access Your HSA Funds

Use your UnitedHealthcare Health Savings Account Debit MasterCard®

Sign up for automatic bill pay and online banking

Use HSA checks

Pay with personal funds and reimburse yourself from your HSA

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myuhc.com

Benefit summaries

Deductible accumulator

Treatment cost estimator

Check statements

Pay bills to health care providers

Update personal information

Learn about QHDHPs and HSAs

HSA calculators

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Additional Programs

UnitedHealthcare:

Diabetes Prevention and Controlo Pre-diabetics work with YMCA lifestyle coaches to prevent the progressiono Diabetics work with Shop N’ Save pharmacists face-to-face to help control and

improve prescription compliance, set goals, and review lab work

Diabetes Health Plano Members incentivized to comply with recommended Medical and Rx guidelineso Plus Plan: No office visit or pharmacy copays for diabetes-related eligible

expenseso Available only when using SLUCare physicianso Website: www.uhctogether.com/SLU

Express Scripts: SLU continues to maintain and implement pharmacy initiatives aimed at controlling our

program costs and promoting internal efficiencies

Vitality


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www.powerofvitality.com

Earn points by:o Review and activate your personal health goalso Update or confirm your email contact informationo Complete an online Course to learn about a health topico Complete a Vitality Check™ biometric screening with a Vitality partnero Schedule Healthy Habits and Preventive Screeningso Track your workouts using a Vitality-approved fitness deviceo Sign up at a Partner Health Clubo Get CPR or first aid certified

Once you build up your points, go spend them!o Rewards in the Vitality Mall:

• Amazon Gift Cards• iTunes gift cards• Movie theater ticket vouchers• Charity

Please note: This list does not cover the program in its entirety. Please refer to the web site for complete program activities, rules and details.

Voluntary Dental Benefits


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Voluntary Dental Benefits

Coverage will remain with Delta Dental

Continue to have the choice between two dental plans

Option 1: Flex Plano No benefit changes

• In 2014 the maximum was increased from $1,000 to $1,500

Option 2: Basic Plus o No benefit changes

• Combination of previous Basic Plus and Basic Plan• Both in and out of network benefits

Find a provider on www.deltadentalmo.com

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Voluntary Dental Plan—Delta Dental

Flex Option Basic Plus

PPO Network Out-of-Network PPO Network Out-of-Network

Deductible

Individual $50 $50 $25 $25

Family $150 $50 $75 $75

Calendar Year Maximum

Per person $1,500 $1,500 $1,000 $1,000

Preventive Care (Member Responsibility Shown)

0% no deductible 0% no deductible 0% no deductible 50% no deductible

Basic Restorative Care ( Member Responsibility Shown)

10% after deductible 30% after deductible 30% after deductible 65% after deductible

Major Restorative Care (Member Responsibility Shown)

40% after deductible 60% after deductible 60% after deductible 80% after deductible

Orthodontia

Lifetime maximum (per person) $1,000 $1,000 $1,000 $1,000

Orthodontia 50%

For adults and children to age 26

60% For adults and

children to age 26

50%For children to age 19

only

75%For children to age

19 only

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2016 Dental Contributions

Flex Basic Plus

Monthly

Single $36.01 $21.07

Two-person $70.49 $40.52

Family $120.69 $72.60

Bi-Weekly

Single $16.62 $9.72

Two-person $32.53 $18.70

Family $55.70 $33.51

Voluntary Vision Benefits


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Voluntary Vision Benefits

Offered through Vision Service Plan (VSP)

No plan design changes

Plan includes benefits for eye exam, frames, contacts, etc.

In-Network vs. Out-of-Networko In-Network = no claim forms to completeo Out-of-Network = must submit claim form for reimbursement

VSP.como Find a provider

• Network: Choiceo Register and review benefit informationo Discounts availableo Print an ID card (not necessary to use benefits)

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Voluntary Vision Plan—VSP

Vision Plan

In-Network Out-of-Network

Exam

Wellvision Exam $10 copay Up to $45 allowance

Lenses

Single $10 copay Up to $30 allowance

Bifocal $10 copay Up to $50 allowance

Trifocal $10 copay Up to $65 allowance

Frames

$150 allowance for a wide selection of frames; $170

allowance for featured frame brands; 20% on the amount over

your balance

Up to $70 allowance

Contacts (in lieu of glasses)

$150 allowance for contacts; including the contact lens exam

(fitting and evaluation)Up to $105 allowance

Frequency

Exam/Lenses/Contacts (in lieu of glasses)

Every calendar year

Frames Every other calendar year

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2016 Vision Contributions

Vision Plan

Monthly

Employee Only $7.02

Employee and Spouse $12.76

Employee and Child(ren) $13.38

Family $20.33

Bi-Weekly

Employee Only $3.24



Family $9.54

Voluntary Accident Benefits


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Voluntary Accident Benefits

Offered through Voya Financial

No change to benefits

Plan helps reimburses expenses that occur due to an accident

Coverage is guarantee issue – no health questions asked

No “Network”

When you have an expense, you must submit a claim form; reimbursement will then be mailed as a check

24-hour coverage – accidents on or off the job are eligible

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Voluntary Accident Plan—Voya

Service Benefit Amount

Accident Hospital Care

Surgery (open abdominal, thoracic)

$1,200

Hospital Confinement $250/day up to 365 days

Coma (14 or more days) $6,000

Follow-Up Care

Medical Equipment $120

Physical Therapy $30/treatment (6 max)

Prosthetic Device $6,000

Emergency Care

Ground Ambulance Transport $120

Air Ambulance Transport $600

Emergency Room Treatment $180

Common Injuries

Burns, Laceration, Torn Knee Cartilage, Paralysis, Tendon/Ligament/Rotator Cuff

Varies

Service Benefit Amount

Common Injuries – Dislocations

Hip Joint $2,400/$4,800

Knee $1,200/$2,400

Shoulder $360/$720

Common Injuries – Fractures

Hip $1,800/$3,600

Leg $960/$1,920

Ankle $360/$720

Kneecap $360/$720

Nose $120/$240

Other Benefits

Wellness Benefit(completion of health screening test)

$100/employee or spouse$50/child (max of 4)

Sickness Hospital Confinement Benefit

$100/day for employee or spouse

$75/day for children

Below is a sample list of benefits, it does not include all the benefits available under the policy.

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2016 Accident Contributions

Accident Plan

Monthly

Employee Only $24.74



Family $56.78

Bi-Weekly

Employee Only $11.42



Family $26.21

Flexible Spending Accounts


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Flexible Spending and Dependent Care Accounts

Administration will remain with ConnectYourCare

You must make a new election for the 2016 plan year; current elections cannot be carried forward

Debit card allows direct paymento Eases payment, but does not substantiate claims – receipts may still be

needed!o Use at authorized vendors (medical facilities, hospitals, pharmacies, etc.)

Remember if you are electing the QHDHP plan and open an HSA, the IRS requires your Health FSA balance to be $0.00 on January 1, 2016 before contributing to an HSA

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Flexible Spending and Dependent Care Accounts

Annual maximum for the Health FSA will increase to $2,550 for 2016

Annual maximum for the Dependent Care Account will remain at $5,000 ($2,500 if married and filing separate returns)

For the Health FSAo Total election amount less previous reimbursements is available at the time

of transaction

For the Dependent Care FSAo Only the cash balance in your account is available at the time of transaction

You cannot roll over unused balances from one year to the nexto Use it or lose it rule applies

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Eligible Health FSA Expenses

Copays, coinsurance and deductibles for medical, prescription and dental plans

Eye exams, contacts and eyeglasses

Laser eye surgeries

Hearing aids

Over-the-counter medical supplieso Bandages, splints, contact lens solution, etc.

Over-the-counter medical medications must be accompanied by a prescription

Insulin

Some expenses not covered by your medical plan

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Plan elections are binding for the 2016 plan year, unless you experience a qualifying life event:

o Marriageo Birth/adoptiono Divorceo Deatho Change in employment statuso Change in dependent status

Life status changes allow you to make benefit election changes

The Benefits Department must be notified within 31 days of life change

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Open Enrollment will be held from November 1 through 20

If making changes, do so through Banner Self-Serviceo Current medical, dental, vision, and accident elections will carry forward

o If you are enrolling a Spousal Health Care Affidavit must be completed o New and existing HSA, Dependent Care and Health FSA participants will

need to make an election for 2016. Current deductions will not carry forward.

o New HSA participants will also need to establish an OptumBank account by November 20 in order to receive seed money

Update beneficiary information if necessary

All enrollment elections must be completed online no later than Friday, November 20, 2015

Contact [email protected] or [email protected] with questions!

mailto:[email protected]

mailto:[email protected]

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Questions?

Saint Louis University November 1 to November 20, 2015 2016 Annual Enrollment.

Documents

Transcript of Saint Louis University November 1 to November 20, 2015 2016 Annual Enrollment.