YOU MATTER! 2015 WOOD LANE EMPLOYEE HEALTH BENEFITS PLAN
WELCOME: WOOD LANE EMPLOYEE HEALTH BENFITS PLAN Time for Change • Separate Wood Lane from Residential Services • Affordable Care Act (ACA) pushes and pulls • Potential for long-term budgetary savings • Buy Into Wellness Programming • Board of County Commissioners Serving as Plan Administrators • Mirrors Wood County’s Plan • Minor exceptions due to Affordable Care Act (ACA) • Long T erm Strategy •
ABOUT THE PLAN Plan Philosophy: Pay Now or Pay Later • Invest in Employees • Employer Sponsored Health Plan, Preferred Provider Organization • (PPO), Self-Insured, Non-Federal Governmental, Non-ERISA, Trustees believe that this Plan is a “grandfathered” health plan • within the meaning of section 1251 of the Affordable Care Act (ACA) Plan provides minimum essential coverage; and • Meets the minimum value standard for the benefits it provides •
FOUNDATION OF THE PLAN Committee Members Employee Health Benefits Wellness Sub-Committee Spousal Eligibility Exception Sub-Committee Insurance Consultant Jason Beaver Plan Third Party Administrators Administrators/ Health: Stacey Kelley, Meritain Health Trustees Prescription: Tammie Wormley, PDMI Board of County Dental: Karen Chapman, Delta Dental Commissioners Administrative Support James Carter Cheryl Albrecht, Rachel Richmond, Steve Puffer, Doris Herringshaw Janese Diem, Pamela Boyer, Andrew Kalmar Joel Kuhlman Wood Lane Insurance Group Representative Sue Dauer Engaged Members You
PLAN FUNDING WOOD LANE INSURANCE TRUST Employer 85% Payment of Claims Employee 15% Be an engaged consumer when pulling money out of our trust fund pocket.
2015 MONTHLY RATES Coverage T otal Employer Employee* Health & Prescription $583.04 $495.59 $87.46 Single Vision $14.22 $12.08 $2.14 Dental $40.02 $34.02 $6.00 Life $14.60 $14.60 $0 T otal Single $651.88 $556.28 $95.60 2014 Rates $737.73 $627.71 $100.02 Health & Prescription $1,515.92 $1,288.54 $227.38 Family Vision $36.98 $31.44 $5.54 Dental $104.02 $88.42 $15.60 Life (employee only) $14.60 $14.60 $0 T otal Family $1,671.52 $1,423.00 $248.52 2014 Rates $2,178.36 $2,038.28 $293.08 * Split between first and second pay dates of the month. May be deducted on a pre-tax basis. Employees are responsible to pay 15% of the total cost for coverage. Spousal & Adult Child Premium rates are in addition to a family contract.
IMPACT OF FEDERAL HEALTH CARE REFORM • Shared Responsibility No requirement to change eligibility in 2015 (safe harbor) • Reporting requirement to Federal Government in 2016 • Requires monthly eligibility and enrollment by SS# per employee • • Certificate of Credible Coverage no longer needed • Summary of Benefits and Coverage (SBC) available on employee intranet • ACA Fees Patient-Centered Outcomes Research Institute Fee (PCORI through 2019) : • Approx. $572 ($2 ea.) • Transitional Reinsurance Fee (TRF through 2016) : • Approx. $18,018 ($63 ea.) •
ELIGIBILITY EMPLOYEE SPOUSE DEPENDENTS
EMPLOYEE ELIGIBILITY • Eligibility Guide • Initial Eligibility • Permanent employee (working 35 hours per week) • Grandfathering employees currently on coverage • Ongoing Eligibility • Continued permanent status working 35 hours per week • Full active pay status the first working day of the month • Full active pay status 30 days prior or following the first day of the month, unless protected by FMLA • Qualifying Events offering Special Enrollment Reported within 30 days of event •
SPOUSAL ELIGIBILITY Lawful spouses may be covered on Vision and Dental • Spousal eligibility for primary coverage is based upon spouses’ annual • adjusted gross income and must be certified on an annual basis in a form acceptable to the Plan 2015 eligibility is based on tax return documenting 2013 income completed • in 2014 Less than $26,700 • Spouse can remain as primary, • a spousal premium will not apply. $26,700 to $58,400 • Spouse can remain as primary, • a spousal premium will apply. Greater than $58,400 • Spouse may remain as secondary at no additional cost. • No primary coverage available. Employees may request an exception of their spousal eligibility after the • initial review based on reduction of income. Forms for the Eligibility Review Process available on the employee website.
DEPENDENT ELIGIBILITY: HEALTH AND PRESCRIPTION Age 2 Ag 26 Stat State La e Law w Birth Bir Age 28* e 28* Federal La ederal Law w Age 26* e 26* ELIGI ELIGIBLE: ELIGI ELIGIBLE: Unmarried Unmarried Biological son or daughter Natural, st Natural, step, or adopt ep, or adopted child of em child of emplo ployee Adopted son or daughter (includes placement for adoption) Resident sident of Ohio or a full time student of Ohio or a full time student Stepson or daughter Not eligible f No t eligible for r their o their own n em emplo ployer er NOT E NO T ELIG IGIB IBILE: ILE: sponsore sponsored gr group health plan oup health plan The spouse of dependent Not eligible under No t eligible under Me Medicare or Medicaid dicare or Medicaid The child of dependent CANNO NNOT C T COND NDITIO ITION E N ELIG IGIB IBILIT ILITY O Y ON: Emplo Em ployees must elect t ees must elect to continue benef continue benefits ts Student Status for co r covere red depe depend ndents within 30 da ts within 30 days ys Marital Status of attaining age 26. of attaining age 26. Residence with employee Adult Child Premium Applies ult Child Premium Applies Financial dependence on employee Eligibility in other employer sponsored group health plan Coverage by other parent * T o birthdate
DEPENDENT ELIGIBILITY: VISION & DENTAL Plan R Plan Rules les Ag Age 1 19* Bir Birth Plan Rules Plan R les Age 23* e 23* Ag Age 1 19 Natural, legally adopted children or children placed in Must meet Plan rules as list Must mee Plan rules as listed ed on on anticipation of adoption who are: lef left Unmarried Full time ll time student at an accred student at an accredit ited ed Not employed on a regular full time basis school school until the end of the calend until the end of the calendar ar Not covered under the Plan as an employee year in ar in which the which they rea reach the h the limiting limiting Dependent on the covered employee or the covered age of 23 age of 23 employee’s Spouse for more than 50% of their financial Full-time student co ll-time student coverage continues rage continues support only bet between s een semest ster ers/quar arters if if Dependent claimed for tax exemption purposes under the student is enrolled the student is enr lled as a full-time as a full-time Section 152 of the Internal Revenue Code student in the ne student in the next regular xt regular Includes a stepchild or child under legal guardianship of a semest ster/q er/quar uarter er. covered employee or covered employee’s spouse who: Meets all the requirements listed above Depende Dependent childre t children with with a a totally tally Lives in the covered employee’s home for more than half disabling ph disabling physical handicap or ysical handicap or of each calendar year in a regular parent-child relationship developmental disability ma de lopmental disability may q y qualify alify. Is wholly dependent on the covered employee for financial See Plan Document f See Plan Document for additional r additional support information. inf rmation. Is claimed by the employee as a dependent for tax exemption purposes under Section 152 of the Internal * T o end of calendar year Revenue Code
ELIGIBILITY CERTIFICATION PROCESS • Spousal Certification Required for Primary Coverage Vision/Dental Requires Tax Return and Forms from 2013 (filed in 2014) • • Dependent Certification Required for Dependents 20 to 27 years old in 2015 Plan Year Required for All Types of Coverage • Student Certification • Based on Type of Coverage and Age • • Health/Prescription: 26 to 28 (birthdate) if living outside of Ohio • Vision/Dental: 19 to 23 (end of calendar year) Adult Child Premium applies for Ages 26 and 27 • Refer to the Summary Plan Description for Rates • 13
ELIGIBILITY • Coordination of Benefits • Contract Holder is Primary on their coverage, secondary on other coverage • Children use birthday rule if dual coverage • Report Other Insurance
ELIGIBILITY QUESTION & ANSWER SESSIONS • One-on-One Assistance • November 24 at 10 a.m. – Room 2 & 3 • November 24 at 3 p.m. – Room 2 & 3 • Use Eligibility Guide to Assist with Navigation of Eligibility Rules and Required Forms • Enrollment in Life Insurance is mandatory 15
COVERAGE HEALTH PRESCRIPTION VISION DENTAL LIFE
COVERAGE SUMMARY Health & Prescription Benefits • Similar Schedule of Benefits & Plan Design • Expanded Network of Providers • Free Over-the Counter (OTC) Medications • New Vision Benefits • Dental Benefit • Expanded Network of Providers • Wellness Benefits • Designed for Early Detection/Prevention • Free Confidential Wellness Screening with Wellness Coaching • Wellness Programming with Rewards •
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