JCPS-HEALTH INSURANCE
OPEN ENROLLMENT 2014-15
FY15 Health Insurance Changes
• Changes in Board Contribution
– NONE!!!
• Changes in Employee Contributions
– NONE!!!
• Changes in Dependent Contributions
– NONE!!!
• Changes in Plan Benefits
– NONE!!!
Open Enrollment
• May 9 – May 22 – Online Enrollment
– Everyone must make a plan selection
– Even people planning to leave the District
• Last check pays for the next months insurance
• Example-If your last check is in August, your
district insurance is in place until September 30.
– Even if you are declining health insurance.
3 Health Insurance Choices
• Base Plan
– $1,000 Individual/$2,000 Family Deductible
– 80% Co-Insurance after deductible
– $3,000 Ind/$6,000 Fam-Max Out of Pocket(MOOP)
• Co-Pays DO NOT apply to MOOP
• Co-Pays CONTINUE after MOOP is reached
– $10/$30/$50/$75-$125 Drug Card
– $25/$35 Primary/Specialist Office Visit Co-Pay
– Employee Only Monthly Premium
• $30 With Wellness/$60 Without Wellness
3 Health Insurance Choices
• Buy-up Plan
– $500 Individual/$1,000 Family Deductible
– 90% Co-Insurance after deductible
– $1,500 Ind/$3,000 Fam-Max Out of Pocket(MOOP)
• Co-Pays DO NOT apply to MOOP
• Co-Pays CONTINUE after MOOP is reached
– $10/$30/$50/$75-$125 Drug Card
– $25/$35 Primary/Specialist Office Visit Co-Pay
– Employee Only Monthly Premium
• $75 With Wellness/$105 Without Wellness
3 Health Insurance Choices
• Health Savings Account
– $1,500 Individual/$3,000 Family Deductible
– 100% Co-Insurance after deductible
– $3,000 Ind/$6,000 Fam-Max Out of Pocket (MOOP)
• Co-Pays DO apply to MOOP (Only Costs After Ded)
• Co-Pays STOP after MOOP is reached
– $10/$30/$50/$75-$125 Rx Card-Only After Ded.
– $25/$35 Primary/Specialist Office Visit Co-PayOnly After Deductible
– Employee Only Monthly Premium
• $0 ($20 in H.S.A.) W/Wellness/$10 W/out Wellness
Health Savings Account
• Required to have a High Deductible Health
Plan (HDHP)
– Our plan has $1,500 deductible
– Only covered costs prior to meeting deductible
are for preventative care
• Pay actual discounted costs for all care and Rx instead
of co-pays.
– After reaching the deductible
• 100% Co-Insurance vs. 90% Buy-up and 80% Base
• Co-pays exactly like the other 2 plans kick in.
Health Savings Account
• $3,000 Max Out of Pocket - MOOP
– Only costs after $1,500 deductible are Co-pays
– Co-pays stop after MOOP in H S A but they continue in
Base and Buy-up
– Co-pays count toward MOOP in H S A but they do not
in Base or Buy-up
• Balances in H.S.A. are yours to keep if you
don’t use them.
– All the money you pay for the insurance coverage is
gone whether you use the insurance or not.
Health Savings Account
• Family Deductibles work differently
– If you enroll your spouse or children; family
deductible needs to be met before full benefits
take over
• Contributions into H.S.A. are done
monthly so there could be a cash flow
issue
– Large claim in July but $ won’t get into account
until later in the year.
Health Savings Account
• Open H.S.A. Savings Account
– Central Bank
– Interest Bearing/No Fee Account
• Annual Contribution Limit
– $3,300 for Individuals
– $6,550 for Members with Dependents
• Don’t submit receipts to anybody.
– You are responsible to make sure you spend the money on
appropriate expenses.
– List of Qualifying Expenses:
http://www.jcschools.us/Page/10309
– Keep receipts in case you are audited
Health Savings Account
• If you want to put money in your H.S.A.
savings account:
– Can’t Contribute to a Medical Flexible
Spending Account (FSA).
• Can still Contribute to Dependent Care FSA
– Can’t have other health insurance coverage.
Plan Choices-3 Choices
H.S.A.
BASE
BUY-UP
$20 into Employee’s
H.S.A.
$30/Mo
$75/Mo
$10
$60/Mo
$105/Mo
Deductible-Ind
$1,500
$1,000
$500
Deductible-Family
$3,000
$2,000
$1,000
Co-Insurance
100%
$80%
90%
MOOP-Ind
$3,000
$3,000
$1,500
MOOP-Family
$6,000
$6,000
$3,000
100% of discounted
price
Co-Pays
Co-Pays
Rx After Deductible
is Met
Co-Pays
Co-Pays
Co-Pays
Rx After Max Out-ofPocket is met
100% Covered
Co-Pays
Co-Pays
Employee Cost with
Wellness
Employee Cost
without Wellness
Rx Before
Deductible is Met
Full Summary of Benefits
• Base Plan
– http://jcschools.schoolwires.net/Page/140
• Buy-Up Plan
– http://jcschools.schoolwires.net/Page/141
• H.S.A. Plan
– http://jcschools.schoolwires.net/Page/144
Monthly Employee Contributions
Election
Base Plan
W/
Wellness
Buy-up Plan
W/out
Wellness
W/
Wellness
W/out
Wellness
H.S.A.
W/
W/out
Wellness Wellness
Employee-Only
$30
$60
$75
$105
0**
$10
Emp+Child(ren)
$390
$420
$470
$500
$310
$340
Emp+Spouse
$560
$590
$650
$680
$460
$490
Emp+Family
$920
$950
$1,045
$1,075
$790
$820
** The board will contribute $20/month into employee’s personal H.S.A.
H S A vs. Base – Employee Only
BASE
Employee Only Premium-W/Wellness
HSA
$360
$360*
$0
$600**
Deductible
$1,000
$1,500
Deductible minus $ in H S A
$1,000
$900
20%
0%
$ Available in Individual H S A
Co-Insurance after Deductible
* Put same employee contribution into H S A account. Actual employee
contribution for insurance is $0.
** Board contributes $20/mo. into H S A account
H S A vs. Base – Family Plan
BASE
Family Premium-W/Wellness
HSA
$11,040
$11,040*
$0
$1,560**
Deductible
$2,000
$3,000
Deductible minus $ in H S A
$2,000
$1,440
20%
0%
$ Available in Individual H S A
Co-Insurance after Deductible
* Put same employee contribution into H S A account. Actual employee
contribution for insurance is $0.
** The difference in annual insurance costs.
H S A vs. Buy-up – Employee Only
Buy-Up
Employee Only Premium-W/Wellness
HSA
$900
$900*
$0
$1,140**
Deductible
$500
$1,500
Deductible minus $ in H S A
$500
$360
Co-Insurance after Deductible
10%
0%
$ Available in Individual H S A
* Put same employee contribution into H S A account. Actual employee
contribution for insurance is $0.
** Board contributes $20/mo. into H S A account
H S A vs. Buy-up – Family Plan
BUY-UP
Family Premium-W/Wellness
HSA
$12,540
$12,540*
$0
$3,060**
Deductible
$1,000
$3,000
Deductible minus $ in H S A
$1,000
-$60
10%
0%
$ Available in Individual H S A
Co-Insurance after Deductible
* Put same employee contribution into H S A account. Actual employee
contribution for insurance is $0.
** The difference in annual insurance costs.
H.S.A. vs. PPO plans
• Different Concept
• Factor Monthly Premiums into Costs
• Estimate Rx costs and Office Visits
– How many times do you think you will go to the
Dr. x $x per visit
– What maintenance drugs do you use x
discounted price
• Calculate what costs will be if you are hospitalized
• Online Decision Calculator:
https://www.mywealthcareonline.com/mvphealthcare/Resource
s/HSAResources/WhichHSAPlanisRightforme.aspx
Dental/Vision/Life
• All benefit designs remain exactly the
same.
• Rates for these plans increased by 8%.
• Open Enrollment for these products also
– If purchasing additional life insurance you will
have to prove “Evidence of Insurability”.
Flexible Spending Account (FSA)
• Also known as Cafeteria Plan
• Annual Election – Online Enrollment
• 2 Different Plans
– Unreimbursed Medical
• Only for PPO Plans
• Use it or Lose it
– New this year is a $500 carryover
• $2,500 Annual Maximum
– Dependent Care
• $5,000 Annual Maximum
District Provided Benefits
• The Board will continue to provide
– Long Term Disability
• 60% of pay after 90 calendar days of disability
• The benefit is paid tax-free
– Life Insurance
• 1 times annual salary
– Board Health Insurance Contributions
• $6,000/yr. with wellness
• $5,640/yr. without wellness
WELLNESS
• NO COACHING
• In order to receive your $30/mo. discount
– Biometric Screening
– Complete On-line Health Risk Assessment
• Additional opportunities to earn money
Other Voluntary Plans
• Guardian
– Personal Accident Indemnity
– Cancer Care
– Critical Illness
– Short Term Disability
• Reps from Wallstreet will be around to
explain benefits at every building.
• This is not part of online enrollment so
if you want to make changes it will be
done by the onsite reps.
Conclusion
• Complete Online Enrollment
• 5/9/2014 – 5/22/2014
• Questions
• Angie Sturm – Ext 3014
• Jason Hoffman – Ext 3023
• Tonya Berhorst (WallStreet) – 636-3222