School Employees Benefit Board (SEBB) Fall 2019 Upcoming Health - PowerPoint PPT Presentation

School Employees Benefit Board (SEBB) Fall 2019

Upcoming Health Benefit Changes The State will now manage health benefits for all school districts, ESDs and Charter Schools • Medical • Flexible spending accounts (FSA) • Dental • Dependent care assistance program (DCAP) • Vision • Life and Accidental Death & • Long-term disability (LTD) Dismemberment (AD&D) • The School Employees Benefits Board (SEBB) of the Washington State Health Care Authority (HCA) will manage the program • Districts are required to be part of SEBB and are no longer able to offer their own benefit plans • Districts may offer limited optional supplemental benefits • SEBB coverage begins January 1, 2020

Why SEBB? • Standardize benefits, rules, and costs • Transparency and accountability in state expenditures for school employee benefits • Provide health benefits to more people • Reduce the cost of health benefits for school employees • Consolidate collective bargaining for school employee benefits

Am I Eligible? • Employees will be eligible on 1/1/20 if: • They have a 630-hour or more contract with the Pasco School District. • If not initially eligible as listed above, employees will be eligible when: • They reach 630 work hours (hours worked accumulate beginning 9/1/19) • Letters will be sent to each employee stating their anticipated eligibility status

Medical Plans Plans shown are those available in Benton and Franklin Counties Employee Employee Employee Cost Employee & Spouse & Child(ren) Full Family Kaiser Permanente $13.00 $26.00 $23.00 $39.00 WA Core 1 Kaiser Permanente $19.00 $38.00 $33.00 $57.00 WA Core 2 Kaiser Permanente $89.00 $178.00 $156.00 $267.00 WA Core 3 Premera $70.00 $140.00 $123.00 $210.00 High PPO Premera $22.00 $44.00 $39.00 $66.00 Standard PPO $33.00 $66.00 $58.00 $99.00 UMP Achieve 1 $98.00 $196.00 $172.00 $294.00 UMP Achieve 2 UMP $25.00 $50.00 $44.00 $75.00 High Deductible Surcharges* $25.00 $25.00 $25.00 $25.00 Tobacco Surcharge $50.00 $50.00 $50.00 $50.00 Spousal Surcharge *Employees may be subject to the above surcharges Amounts will be withheld from your paycheck starting January 31, 2020 District pooling and benefit allotments end as of 12/31/19

Kaiser Permanente Medical Plans (True HMO Plan, Requires Referrals from PCP, No Out of Network Benefits) Core 1 Core 2 Core 3 Provider Network Core HMO Core HMO Core HMO Deductible Individual $1,250 $750 $250 Family $3,750 $2,250 $750 Coinsurance 20% 20% 20% Medical Out-of-pocket Maximum Individual $4,000 $3,000 $2,000 Family $8,000 $6,000 $4,000 Primary Care/Specialty Care $30 / $40 Copay $25 / $35 Copay $20 / $30 Copay Diagnostic Lab & Imaging 20% over $500 20% over $500 20% After Deductible Inpatient Services 20% After Deductible 20% After Deductible 20% After Deductible Ambulance 20% After Deductible 20% After Deductible 20% After Deductible Emergency Room $150 + 20% After Ded. $150 + 20% After Ded. $150 + 20% After Ded. Urgent Care $30 Copay $25 Copay $20 Copay Spinal Manipulations $30 Copay $25 Copay $20 Copay Mental Health Office Visit $30 Copay $25 Copay $20 Copay $35 Copay Outpatient Rehab (PT,OT,ST) $40 Copay $30 Copay Prescription Drugs RX Deductible (Individual/Family) $0 /$0 $0 /$0 $0 / $0 RX Out of Pocket Maximum Combined w/ Medical Combined w/ Medical Combined w/ Medical Value NA NA NA Generic $5 Copay $10 Copay $10 Copay Preferred Brand $25 Copay $25 Copay $25 Copay Non-preferred Brand $50 Copay $50 Copay $50 Copay Specialty 50% up to $150 50% up to $150 50% upto $150 This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board. TRIOS is out of Network for this provider.

Uniform Medical Plans – Regence Blue Shield (Largest PPO Network) Achieve 1 Achieve 2 High Deductible UMP Plus** Regence Blue Shield Regence Blue Shield Regence Blue Shield Regence Blue Shield Provider Network Deductible-Medical Yakima Co. ONLY Individual $750 $250 $1,400 $125 Family $2,250 $750 $2,800 $375 Coinsurance 20% 15% 15% 15% Medical Out-of-pocket Maximum Individual $3,500 $2,000 $4,200 $2,000 Family $7,000 $4,000 $8,400 $4,000 Primary Care/Specialty Care 20% After Deductible 15% After Deductible 15% After Deductible $0 Copay/15% After Ded. Diagnostic Lab & Imaging 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible Inpatient Services $200 / Day to $600+20% $200 / Day to $600+ 15% 15% After Deductible $200 / Day to $600 + 15% Ambulance 20% After Deductible 20% After Deductible 20% After Deductible 20% After Deductible Emergency Room $75 + 20% After Ded. $75 + 15% After Ded. 15% After Deductible $150 + 15% After Ded. Urgent Care 20% After Ded. 15% After Ded. 15% After Deductible 15% After Deductible Spinal Manipulations 20% After Ded. 15% After Ded. 15% After Deductible 15% After Deductible Mental Health Office Visit 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible Outpatient Rehab (PT,OT,ST) 20% After Deductible 15% After Deductible 15% After Deductible 15% After Deductible Prescription Drugs RX Deductible(Individual/Family) $250 / $750* $100 / $300* Combined w/ Medical $0 / $0 RX Out-of-Pocket Maximum $2,000 / $4,000 $2,000 / $4,000 Combined w/ Medical $2,000 / $4,000 Value 5% up to $10 5% up to $10 15% After Deductible 5% up to $10 Generic 10% up to $25 10% up to $25 15% After Deductible 10% up to $25 Preferred Brand 30% up to $75 30% up to $75 15% After Deductible 30% up to $75 Non-preferred Brand NA NA NA NA Specialty 30% up to $75 30% up to $75 15% After Deductible 30% up to $75 * Prescription Deductible waived for Generics ** UMP Plus Requires referrals from a PCP and has no out of network benefits for non-emergency care. This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board. Kadlec, Lourdes, & TRIOS are in network for these plans.

Premera Blue Cross Medical Plans (Kadlec Hospital is out of network) High PPO Standard PPO Provider Network PRIME PRIME Deductible Individual $750 $1,250 Family $1,875 $3,125 Coinsurance 25% 20% Medical Out-of-pocket Maximum Individual $3,500 $5,000 Family $7,000 $10,000 Primary Care/Specialty Care $20 / $40 Copay $20 / $40 Copay 25% After Ded. 20% After Ded. Diagnostic Lab & Imaging 25% After Deductible 20% After Deductible Inpatient Services 25% After Deductible 20% After Deductible Ambulance $150 + 25% After Ded. $150 + 20% After Ded. Emergency Room 25% After Ded. 20% After Ded. Urgent Care 25% After Ded. 20% After Ded. Spinal Manipulations $20 Copay $20 Copay Mental Health Office Visit Outpatient Rehab (PT,OT,ST) $40 Copay $40 Copay Prescription Drugs RX Deductible (Individual/Family) $125 / $312 $250 / $750* RX Out of Pocket Maximum Combined w/ Medical Combined w/ Medical Value NA NA Generic $7 Copay $7 Copay Preferred Brand $30 Copay 30% Non-preferred Brand 30% 50% $50 Copay 40% Specialty * RX Deductible is waived for Generic Drugs This is a summary, and is not inclusive of all covered services. Figures, plans, and carriers shown are subject to legislation funding and final decisions by the SEB Board.

Dental Plans Benefit Uniform Dental Delta Care Willamette Annual Maximum $1,750 No Maximum No Maximum Annual Deductible $50 Ind / $150 Family $0 $0 Preventive Visits 0% 0% 0% Basic Services Fillings 20% $10 - $50 Copay $10 - $50 Copay Root Canals 20% $100 - $150 Copay $100 - $150 Copay Oral Surgery 20% $10 - $50 Copay $10 - $50 Copay Major Services Crowns 50% $100 - $175 Copay $100 - $175 Copay 50% of $1,750; Orthodontia Then remainder of cost over $1,500 per case $1,500 per case $1,750 This is a summary, and is not inclusive of all covered services. Figures shown are subject to legislative funding and final decisions by the SEB Board.

Vision Plans Benefit Davis Vision EyeMed MetLife Routine Eye Exam $0 $0 $0 (1 Per Calendar Year) Lenses $0 $0 $0 (Every 24 Months) Progressive Lenses $50 - $140 $55 - $175 $0 - $175 (Every 24 Months) Conventional $0 of First $150; Then 85%. $0 of First $150; Then 85%. $0 of First $150; Then 100%. Contacts Disposable Contacts Up to 4 Boxes $0 of First $150; Then 100%. $0 of First $150; Then 100%. Frames $0 of First $150; Then 80%. $0 of First $150; Then 80%. $0 of First $150; Then 80%. (Every 24 Months) This is a summary, and is not inclusive of all covered services. Figures shown are subject to legislative funding and final decisions by the SEB Board.

SEBB Life and Supplemental Life Insurance MetLife Employer Paid Life MetLife Basic Benefit $35,000 Accidental Death & Dismemberment $5,000 Benefit Employee Spouse Child Employee Paid Supplemental Life Benefit Increments $10,000 $5,000 $5,000 Up to 50% of Benefit Maximum $1,000,000 $20,000 Employee Election Guarantee Issue – No Health $500,000 $100,000 $20,000 Questions (Children from 2 weeks old to age 26) Employee Paid Supplemental AD&D Benefit Increments $10,000 $10,000 $5,000 Benefit Maximum $250,000 $250,000 $25,000 Guarantee Issue $250,000 $250,000 $25,000 * Supplemental Life and AD&D Rates are based on age and tobacco use.