Open Enrollment and
Wellness Update
Learning Tuesday
November 18, 2014
Learning Objectives
• Learn about how open enrollment impacts me
• New rates / Compare Plans
• Lower premiums on Deductible PPO
• New online enrollment through Employee Self
Service
• Flexible Spending Account (FSA) changes
• New Administrator
• New Debit Card for Medical FSA
Learning Objectives
• Learn how to get paid for making smart health choices
• Wellness Plan
• Surgery Second Opinion
• Gym Reimbursement (PPO Plan)
Open Enrollment
• New Rates / Compare Plans
• What changes can I make?
• Dramatically lower rates for Deductible PPO Plan
• How the Deductible PPO plan compares to the Traditional PPO
• Features that are different (in-network deductible)
• Features that are the same (gym reimbursement, prescriptions)
What changes can I make?
• Medical, Dental and Vision Coverage
• Add or remove dependents
• Enroll in, or waive coverage
• Change health plans
• Life insurance
• Update beneficiary
• Enroll in Flexible Spending Accounts
• Required every year – no rollovers
2015 Employee Rates
• New lower rate for Deductible PPO
2015
Employee Biweekly Rates
Individual
Individual + Spouse/DP
Individual + Child(ren)
Family
Traditional
PPO
47.33
151.73
119.78
235.86
Deductible
PPO
22.93
102.93
75.86
162.67
Blue
Choice
40.34
145.16
173.52
173.52
CDPHP
45.15
135.44
134.58
207.67
IHA
41.93
159.35
109.03
192.90
MVP
59.75
147.11
190.26
232.07
Traditional or Deductible PPO?
BENEFITS
Traditional PPO
Deductible PPO
Deductible
NONE -plan payments start right away
Co-insurance
Annual Out of Pocket Limit
you pay 0%, plan pays 100%
Most services covered 100% after copay. Now
copays won’t exceed $4,224 individual or $10,560
family in accordance with ACA rules.
$20 copay
$20 copay
After $100 per admission, you pay 0%, plan pays
100%
$50 copay
$20 copay
$500 per person ($1,250 family cap) – plan doesn’t
start paying until you incur $500 in charges, EXCEPT
for those items covered by a copay.
you pay 10%, plan pays 90%
Most services subject to deductible and coinsurance. $1,500 per year (family cap $3,750) –
after that plan pays 100%
$30 copay
$30 copay
deductible and co-insurance
Routine Office Visit
Routine Office Visit to Specialist
Inpatient Hospital
Emergency Room
Outpatient care
Outpatient Surgery
Inpatient surgery
Retail Prescriptions (Express
Scripts, up to 30 day supply)
Mail Order Prescriptions (Express
Scripts, up to 90 day supply)
$0 copay
$0 copay (after $100 admission payment above)
$10/$25/$45 copays
$10/$50/$90 copays
$50 copay
$30 copay for exams and evaluations; other
services deductible and co-insurance
deductible and co-insurance
deductible and co-insurance
$10/$25/$45 copays
SAME AS TRADITIONAL
$10/$50/$90 copays
SAME AS TRADITIONAL
Flexible Spending Account (FSA) Changes
• New Administrator – Conexis
• How do Flexible Spending Accounts work?
• Health Care Spending Accounts – set aside up to $2,500 pre-tax
dollars to pay for qualified medical expenses that are not covered
by insurance
• Dependent Care Spending Accounts – set aside up to $5,000* pretax dollars to pay for eligible dependent care expenses such as day
care services, before and after school care, etc.
* Annual maximum is determined by your tax filing status
Flexible Spending Account (FSA) Changes
 New Debit Card for Health FSA
 Provides instant access to the money in your health care FSA
 Use your debit card to make common health care purchases such
as copayments, co-insurance, deductibles, prescription drugs,
glasses, etc.
 Most transactions which have a standard copayment will not
require any documentation to be submitted.
 Important Transition Reminders
 Claims for your 2014 FSA account should be submitted to
WageWorks
 Claims for your 2015 FSA account should be submitted to Conexis
Flexible Spending Account (FSA) Changes
 Important Information
 Open Enrollment ends on November 30, 2014
 You must enroll in Employee Self Service at www.rfsuny.org
 Employees will receive an FSA confirmation statement from
Conexis confirming your 2015 annual election towards the
end of December.
 After you receive this confirmation statement, register for an
account with Conexis at https://mybenefits.conexis.com
 Employees enrolling in Health Care Spending will receive
their debit card around January 1, 2015
Conexis Presentation
Online Enrollment
• Visit www.rfsuny.org, Select Information For
Employees
Online Enrollment
• Select Self Service
Employee Self Service Guide
Online enrollment guide
(Insert screen shots of navigation and
enrollment guide
Break
Get paid to make smart health choices
• New Wellness Plan
• Earn up to $400 a year
• Earn points for healthy activities and logging nutrition
• Surgery Second Opinion
• Earn a $400 gift card for using the ConsumerMedical program if
you are planning to have one of 5 major surgeries
• Gym Reimbursement (PPO Plans)
• Up to $300/yr in gym reimbursements
New Wellness Plan
• Launched October 1, 2014
• Over 850 RF participants to date, and growing
• Join anytime at join.virginpulse.com/rfsuny
• Get up to $100 in cash during each quarterly game
• Taxable benefit
• Participate in challenges or create your own
• Social network
Virgin Pulse Presentation
Surgery Second Opinion
• $400 Gift card for participating in a second opinion
program for any of the following five surgeries:
•
•
•
•
•
Knee Replacement
Hip Replacement
Gastric Bypass
Hysterectomy
Back Surgery
• www.myconsumermedical.com
• 1-888-361-3944 (toll-free)
• M-F, 8:30 a.m. to 6:00 p.m. ET
Who is ConsumerMedical?
• Consumer Medical provides comprehensive, current,
objective, and personalized information on over 100
diagnoses and medical topics. Information that can help you
and your family, with your doctor, make some of the most
important decisions of your life. And if you need a second
opinion, Consumer Medical can also identify top physician
experts for any diagnosis anywhere in the U.S. As a Research
Foundation employee, you are eligible to sign up for access
to Consumer Medical.
•
Gym Reimbursement (PPO Plans)
• Earn up to $150 per family every six months
• Taxable benefit
• Must make 50 visits to gym in six month period
(about twice a week)
• Submit reimbursement form with log printout from
gym
How to get more information?
• Employee Self Service
• www.rfsuny.org/selfservice
• Benefits Bulletin
• www.rfsuny.org/benefits and select the Open Enrollment or
Benefits Publications Quick Link
• Conexis
• 866-279-8385
• https://mybenefits.conexis.com
• Wellness program
• Sign up at http://join.virginpulse.com/rfsuny
Questions from our viewers