Open Enrollment 2019 November 8 – November 26
Agenda Open Enrollment Benefits Terminology Medical/Rx Health Savings Account Flexible Spending Account Dental Vision Retirement Life/Disability Long Term Care Travel Assist & Employee Assistance Plan
Open Enrollment November 8 – November 26 This is an ACTIVE enrollment for medical! You must actively participate in open enrollment in order to have medical benefits in 2019. If you do not participate in open enrollment, your medical benefits will be cancelled effective January 1, 2019.
Benefits Terminology Deductible • A deductible is the set amount you must pay for medical or dental expenses (aside from copays that may apply) before insurance begins to cover all or a portion of your costs. Deductibles reset January 1 st each year. Copay • A copay (or copayment) is a set, flat fee that you pay for medical services or prescriptions in addition to what the insurance company covers. Coinsurance • Once the deductible is met, coinsurance is the percentage you pay of each service until you reach your out-of-pocket maximum. Out-of-Pocket Maximum • An out-of-pocket maximum is a limit to the amount of money that you must pay before your expenses are covered at 100% for in-network only services.
Benefits Terminology PPO • Preferred Provider Organization HDHP • High Deductible Health Plan Embedded Family Deductible • When one member can satisfy his or her individual deductible for coverage and apply coinsurance for additional services. Non-embedded Family Deductible • When the family deductible must be met before anyone in the family can receive benefits (coinsurance can begin).
Medical/Rx UnitedHealthcare PPO HDP1 HDP2 Annual Deductible Single $500 $2,000 * $3,000 Family $1,000 $4,000* $6,000 Health Savings Account Funding Single N/A $500/$750** $350 Family N/A $1,000/$1,500** $700 Maximum Out-of-Pocket (Medical Services) Single $2,000 $4,000 $5,000 Family $4,000 $8,000 $10,000 Separate Maximum Out-of-Pocket (Prescriptions) Single $2,000 N/A N/A Family $4,000 N/A N/A Your Coinsurance 10% 15% 15% Preventative Care 0% 0% 0% Office Visit $25 Deductible/Coinsurance Deductible/Coinsurance Specialist Office Visit $50 Deductible/Coinsurance Deductible/Coinsurance Urgent Care $50 Deductible/Coinsurance Deductible/Coinsurance ER Copay $150 Deductible/Coinsurance Deductible/Coinsurance Retail Prescription Tier 1 $10 Deductible/$10 Deductible/$10 Tier 2 $30 Deductible/$40 Deductible/$40 Tier 3 $50 Deductible/$60 Deductible/$60 Mail Order Drug 2.5x Retail Deductible/2.5x Retail Deductible/2.5x Retail *HDP1 deductible amounts are non-embedded which means that outside of Single coverage, the family deductible has to be met before the Coinsurance takes affect. ** Matching feature allows additional CU contributions up to the listed amount Note: In-network plan summary; refer to plan documents for full details
Medical/Rx UnitedHealthcare PPO Employee Employee Capital Premium Cost Share Monthly Monthly Biweekly Semi-Monthly Employee Only $88.24 $95.59 $191.18 $691.55 Employee & Spouse $258.55 $280.10 $560.19 $1,205.26 Employee & Child(ren) $204.26 $221.28 $442.56 $952.14 Family $333.53 $361.33 $722.65 $1,554.77 HDP1 Employee Employee Capital Premium Cost Share Biweekly Semi-Monthly Monthly Monthly Employee Only $45.14 $48.90 $97.80 $724.27 Employee & Spouse $172.36 $186.72 $373.44 $1,270.69 Employee & Child(ren) $136.16 $147.51 $295.01 $1,027.92 Family $222.34 $240.87 $481.74 $1,605.96 HDP2 Employee Employee Capital Premium Cost Share Biweekly Semi-Monthly Monthly Monthly Employee Only $18.90 $20.48 $40.95 $683.52 Employee & Spouse $100.80 $109.20 $218.40 $1,230.53 Employee & Child(ren) $79.80 $86.45 $172.89 $984.01 Family $129.79 $140.61 $281.22 $1,570.98
Health Savings Account (HSA) What is an HSA (Health Savings Account)? – An HSA is an individually (employee) owned savings account that accompanies a qualified high deductible health plan (HDHP) – An HSA allows you to set aside pre-tax dollars from your paycheck to pay for eligible healthcare expenses What are the advantages of an HSA (Health Savings Account)? – As an employee owned account, employees choose how and when the money is spent (either for current or future qualified healthcare expenses, or to save for retirement) – HSA funds rollover – it is NOT ‘Use it or Lose it” like an FSA – The HSA is portable Who is eligible to open & receive contributions to an HSA (Health Savings Account)? – Employee must be covered by a qualified HDHP – Employee may NOT be covered by any of the following: • A health plan that is not qualified (like the PPO plan) • Medicare or Tri-Care • Healthcare FSA* • HRA • Received VA benefits within the last 3 months – Employee may NOT be claimed as a dependent on someone else’s tax return *If you have a balance in your Healthcare FSA after 12/31/18, you will not be able to open/fund your HSA until 3/16/19 (after your grace period) at the earliest – FSA funds MUST be exhausted prior to opening an HSA
Health Savings Account (HSA) Capital will contribute to employees that enroll in the HDP1 or HDP2 plan’s HSA – For the HDP1: Capital will contribute $500 for individual and $1,000 for family coverage levels into your HSA if enrolled in the HDP1 plan and open a PNC HSA; additionally there is a matching option for an additional $250 for individual or $500 for family coverage levels. – For the HDP2: Capital will contribute $350 for individual and $700 for family coverage levels into your HSA if enrolled in the HDP1 plan and open a PNC HSA. – You must open an HSA account with PNC to make pre-tax contributions and receive the HSA contribution from Capital. Capital contributions are spread over the course of the year, deposited monthly in to the HSA. Remember the IRS mandated annual maximums are $3,500 for individual coverage or $7,000 for family coverage levels – To determine how much you can contribute, subtract Capital’s contribution from the annual maximum – If you are 55 or older, you can contribute an additional $1,000 “catch-up” contribution every year Your HSA can also be used on more than medical expenses – For a complete list of eligible expenses, visit this IRS publication
Medical/Rx Scenarios
Example 1 PPO HDP1 HDP2 $191.18 $97.80 $40.95 Monthly Contribution John is a single Preventative employee of Capital # of Visits: 1 $0 $0 $0 ($120/visit) University. Urgent Care # of Visits 1 $50 $200 $200 ($200/visit) He is generally healthy – Generic Rx # of RXs: 1 $10 $20 $20 taking advantage of his ($20/rx) annual preventive visit. Total Cost of Care $60 $220 $220 $2,294 $1,174 $491 Total Annual Payroll Contributions During the year he has to N/A $500 $350 use urgent care for a Capital HSA Contribution sprained ankle. May want to consider : HDP2 When needing an Rx he always chooses generic if possible. Reason : Out of Pocket/Paycheck spending is only $491 (vs. PPO: $2,354 or HDP1: $1,174), and a remaining balance in He does not contribute to the HSA of $130. a FSA/HSA . Above example assumes employee only coverage & assumes employee uses HSA funds to pay for cost of care
PPO HDP1 HDP2 Example 2 $191.18 $97.80 $40.95 Monthly Contribution Preventative # of Visits: 1 $0 $0 $0 ($120/visit) Adam only needs ER # of Visits 1 $2,000 $4,000 $5,000 ($75,000/accident) individual medical coverage. Total Cost of Care $2,000 $4,000 $5,000 Total Annual Payroll Contributions $2,294 $1,174 $491 He is generally healthy N/A $500 $350 Capital HSA Contribution – taking advantage of his annual preventive visit. During the year he has May want to consider : PPO a major accident. Reason : Out of Pocket/Paycheck spending is only $4,294 He does not contribute (vs. HDP1: $4,674 or HDP2: $5,141). to a FSA/HSA . Above example assumes employee only coverage & assumes employee uses HSA funds to pay for cost of care
PPO HDP1 HDP2 Example 3 $442.56 $295.01 $172.89 Monthly Contribution Preventative # of Visits: 3 $0 $0 $0 ($120/visit) Hospitalization Megan has 2 children # of Visits: 1 $2,000 $4,000 $5,000 and Services ($25,000/visit) on her coverage. Total Cost of Care $2,000 $4,000 $5,000 During the year one $5,311 $3,540 $2,075 Total Annual Payroll Contributions person has a surgery N/A $1,500 $700 Capital HSA Contribution and everyone else only has preventative visits. Megan also sets aside May want to consider : HDP1 money in FSA/HSA’s regardless of which Reason : Out of Pocket/Paycheck spending is only $6,040 (vs. medical plan she PPO: $7,311 or HDP2: $6,375). chooses. Above example assumes family coverage & assumes employee uses HSA funds to pay for cost of care
Flexible Spending Account FSAs allow a pre-tax amount of money to be placed into a spending account for the year Capital offers both healthcare FSA’s and dependent care FSA’s – Reminder: Dependent care is for eligible children to age 13 or elder care services only 2019 maximum amount: – Healthcare FSA - $2,650 – Dependent Care FSA - $5,000 Funded with full annual contribution in January If you don’t use it, you lose it!
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