School District of Beloit Health and Prescription Benefits Overview - PowerPoint PPT Presentation

School District of Beloit Health and Prescription Benefits Overview

SDB Health Care Plan Options • The School District of Beloit offers em ployees the choice betw een tw o health plans: – An HRA plan where the School District funds $1500 per single contract; $3000 per family contract to pay for first dollar deductible expenses a covered plan participant may incur during the plan year. If an employee leaves the health plan, these funds stay with the School District. – An HSA plan where the School District makes an annual deposit of $1500 per single contract; $3000 per family contract into a Health Savings Account (HSA) that is owned by the employee. In this plan, unused funds are kept by the employee. • For mid-year enrollees, HRA/ HSA contributions will be calculated on a pro-rata basis with 1/ 12 th per month of the anticipated service period being pre-funded on the 1 st of the month following the enrollment in the Employer Sponsored Group Health Plan. • SDB reviews HRA/ HSA employer contributions on an annual basis.

SDB Major Plan Difference: • The first m ajor difference betw een the plans is the prescription drug benefit outlined below : – Under the HRA plan, prescription drugs are subject to a $7 generic copay; $16 preferred brand copay; and a 50% coinsurance for non-preferred brands per 1-month supply. – Under the HSA plan, all prescription drugs are subject to a combined medical/ prescription drug plan year deductible of $2500 per single/ $5000 per family, before the prescription drug card copay benefit applies. (Remember the School District provides you with $1500/ $3000 in an HSA account to assist in covering these expenses) • Therefore one m ajor factor for determ ining w hich plan best fits your individual/ fam ily needs is your personal utilization of prescription drugs.

Prescription Plan Design - Restat Prescription Drug Card Benefit – Copay Per 1 Month Supply Align Pharmacies Only Generic Copay $7 Preferred Brand Copay $16 Non-Preferred Brand Copay 50% • To receive coverage for your prescriptions you m ust utilize the services of an Align pharm acy. A list of pharm acies is included at w w w .restat.com . – A Mail Order Benefit is also available and inform ation pertaining to this benefit is available at w w w .catam aranhom edelivery.com • For the HSA Plan, the copaym ents apply AFTER your deductible has been m et. • Please refer to the SDB Health Plan Docum ent located online for specific plan lim itations/ exclusions.

SDB Major Plan Difference: • The other m ajor difference betw een the plans is how the fam ily deductible is applied: – Under the HRA plan, all individuals covered under your plan are limited to a per individual deductible of $2000* , with a family cap for all members of $4000* . Again, the School District provides you with $3000 per family contact to fund this deductible amount. – Under the HSA plan, there is no individual deductible cap. Therefore one family member may satisfy the full family deductible of $5,000* . Again, the School District provides $3,000 in an HSA account owned by you to help pay these deductible expenses. • So if a fam ily m em ber has an ongoing m edical condition, this w ill be som ething you w ant to consider. * Assumes utilization of PPO Network Providers Only.

SDB PPO Provider Office Visit Copays: • Both the HRA and the HSA plans have the follow ing office visit copaym ents for services obtained at a PPO Netw ork Provider . You are responsible for the copay, in addition to the plan deductibles, for each date of service. – W ellness Benefits – Paid at 1 0 0 % under both plans as required by the USPSTF recommendations. – Physician Office Copay - $ 2 0 per visit (copay waived at BHS) (includes Specialists, Therapies and Chiropractic Care) – Urgent Care Copay - $ 3 0 per visit (copay waived at BHS) – Em ergency Room Copay - $ 7 5 per visit (copayment is waived if admitted) • Under the HRA plan, you would be responsible for the copayment, as the HRA money can only be used for deductible expenses. You may elect to put money in an FSA account to pay for these copays. • Under the HSA plan, you are also responsible for the copayment, however HSA money can be used to pay these expenses.

SDB Health Care Plan Com parison HRA Plan HSA Plan Non-PPO Non-PPO PPO Provider Provider PPO Provider Provider Deductible Individual $2,000 $4,000 $2,500 $5,000 Family* $4,000 $8,000 $5,000 $10,000 Coinsurance Paid By the Plan 100%, no 100%, no Not Covered Not Covered Wellness deductible deductible 100%, after 70%, after 100%, after 70%, after Basic Benefits deductible deductible deductible deductible 80%, after 70%, after 80%, after 70%, after Major Benefits deductible deductible deductible deductible Out-of-Pocket Maximum** Individual $4,000 $8,000 $5,000 No Limit Family $8,000 $16,000 $10,000 No Limit * Under the HSA Plan option, one family member can satisfy the full family deductible. **The out-of-pocket includes: medical copayments, coinsurance and deductible expenses. Once the out-of-pocket maximum has been met the plan pays 100% of eligible expenses.

SDB Deductible Plan Analysis/ Rollover HRA Plan HSA Plan PPO Provider Non-PPO Provider PPO Provider Non-PPO Provider Deductible Individual $2,000 $4,000 $2,500 $5,000 Family* $4,000 $8,000 $5,000 $10,000 HRA/HSA Funding Individual $1,500 $1,500 Family $3,000 $3,000 IF you use SDB HRA/HSA funds for your deductible expenses, your liability would be as follows: Individual $500 $2,500 $1,000 $3,500 Family* $1,000 $5,000 $2,000 $7,000 IF you do not use the full HRA/HSA Funded by SDB, any unused funds up to the following amount will ROLLOVER and be available for you to use in future plan years. Individual $500 per year $1500 per year Family $1000 per year $3000 per year To a Maximum Accumulation** of: Individual $3000 Balance Unlimited Family $6000 Balance Unlimited * Under the HSA Plan option, one family member can satisfy the full family deductible. **HRA Accumulations can only be used for deductible expenses.

Health Plan Claim s Processing: • The SDB Health Care Plan is self-funded with Prairie State Enterprises (PSE) administering the claims out of Sheboygan, WI. • PSE will administer medical plan payments for the HRA and HSA health plans. • PSE will also administer the additional deductible payments eligible under the HRA plan. In most cases , this will be an automatic claims process with no manual intervention required by the plan participant. • Additional HRA deductible payments made on your behalf will be funded by SDB and paid directly to the provider. • PSE makes medical, HRA and FSA claim payments on a weekly basis. • At the end of the month, PSE mails a consolidated Explanation of Benefits (EOB) of all medical plan payments and HRA deductible plan payments to your home. Should you wish to have access to your EOBs sooner, you can access those online.

HRA Plan Claim s Processing: • HRA payments made under this plan are secondary to any Other Coverage you may have as a participant under any other medical plan. • PSE will pend claims received to verify whether Other Coverage is available. • Once a year you will be asked by PSE to update your “Other Coverage” information. • If you do have Other Coverage, and are covered under the HRA plan, you will need to submit the Explanation of Benefits (EOB) under that Other Coverage, prior to benefits being payable under the HRA plan. • Why? Benefits from the HRA account are tax free to you as the employee. The IRS does not allow for distribution of funds under the HRA that might result in a profit to the employee as the result of duplicate payment under multiple plans.

Detailed Health Plan I nform ation: • This presentation was meant as a high level overview of your benefits, with some practical advise on how to evaluate which plan would work best for you. • Each year you will be provided with an Open Enrollment opportunity to elect which health plan option best meets your needs. • Each of you are receiving the Summary of Benefits and Coverages (SBC) for each plan you are eligible to enroll in. • For a complete list of coverages, limitations and exclusions, please refer to the School District of Beloit Health Care Plan Document located on the School website and also on the Prairie States website.

Health Plan Questions?

What is an HSA? • A health savings account ( HSA) is an account that you can use to pay m edical expenses. – Must be in conjunction with a high-deductible health plan (HDHP) – You own the account, but both you and your employer can contribute funds – Tax-advantages: contribute pre-tax money, funds accrue tax-free and withdraw funds tax- free (if used for eligible medical expenses)

Benefits of an HSA • Triple tax advantage means you save money on your health care expenses • Funds rollover each year, so you can use your HSA to save tax-free money for retirement • You own the account, even if you leave the company