PRESENTED BY: PEG HARMS & GINGER VERMEERSCH Insurance Services Open Enrollment Informational Session

Objectives If you are unsure whether you should change plans or continue with your current coverage, we are here to help you make this important decision. The Open Enrollment Process is for the following:  Health Insurance CoPay Plan or (HDHP) High Deductible Health Plan  Dental Insurance  Flexible Spending Account

CoPay Health Plan High Deductible Health Plan (HDHP) $500 deductible per individual per calendar year *** $1500 deductible per family per calendar year *** $2500 out of pocket (OOP) maximum per individual per calendar year $5000 out of pocket (OOP) maximum per family per calendar year $1500 deductible per individual per calendar year *** $3000 deductible per family per calendar year *** $3500 out of pocket (OOP) maximum per individual per calendar year $7000 out of pocket (OOP) maximum per family per calendar year Benefit Limits ****Deductible goes toward out-of-pocket maximum ******Deductible Carryover Applies

CoPay Health Plan High Deductible Health Plan (HDHP) $50 Emergency Room copay  Deductible not applied $30 office visit copay  Deductible not applied Other medical services –  80% coverage after deductible 80% coverage after deductible Benefits

Preventive Care Routine Vision Exams  (1 per person per calendar year) Routine Medical Exam Well Child Care Standard Immunizations Routine Cancer Screening High Deductible Health Plan (HDHP) or CoPay Plan

Prescription Drug CoPay Health Plan $12 Generic Co-pay $30 Brand/Formulary Co-pay $55 Non-Formulary Co-pay $60 Specialty Co-pay CoPay - $1500 individual OOP Maximum/$3000 family per calendar year HDHP - $1500 individual OOP Maximum/$3000 family per calendar year (this amount also applies to your medical OOP) High Deductible (HDHP)

New for 2016 Spousal Surcharge Birthday Rule Spousal Surcharge  If your spouse declines his/her employer’s insurance, spousal surcharge may apply Birthday Rule  It means whichever parent’s birth month is first in the calendar year will determine the order of benefits for the dependent child(ren) if children are covered under both parents health insurance

Health Teachers Only Employee Cost CoPay Plan District Cost CoPay Plan Employee Cost HDHP District Cost HDHP Single$23.00$756.00$0$ Family$296.54$ $17.54$ Health All Other Staff Employee Cost CoPay Plan District Cost CoPay Plan Employee Cost HDHP District Cost HDHP Single$62.00$717.00$0$ Family$357.80$ $78.80$ DentalEmployee CostDistrict Cost Single$0$39.00 Family$0$97.00

Open Enrollment October 21 – November ACTION REQUIRED: Health & Dental Insurance: E ven if you currently have benefits with the district you are required to SELECT one of the following: No Change Decline Single and/or Family Health Single and/or Family Dental Flexible Spending Account: Health Account – You may carryover $ from your 2016 account to be used after you exhaust your 2017 account. Dependent Care Account – No carryover allowed

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Understanding Your EOB Total You Owe is your responsibility Provider Responsibility is the provider's discount Total payment is the amount your insurance paid the provider You can claim Total You Owe on your Flexible Spending Account (FSA) or your Health Reimbursement Account (HRA).

Dental New for 2016 Dependent children - Will be covered to the age of 26 You may add your dependents on the dental plan during Open Enrollment New for 2016! Diagnostic/Preventive Services - 1st visit of coverage year paid at 100% Included is bitewing x-rays, fluoride treatment, prophylaxis, oral evaluation/exam charge Prophylaxis – Adult & Child - 2 per calendar year Additional visits may be covered if recommended by dentist Deductible and coinsurance would apply for these visits Calendar Year Maximum The Plan pays up to a maximum of $1, for each covered person per calendar year. Deductible$25.00 deductible per covered person Basic Services80% after deductible – cleanings 2 per calendar year – fluoride 1 per calendar year Major Services50% after deductible – crowns, bridges, implants, root canals, etc. Orthodontia Benefit (Separate Benefit) Appliances paid at 50% $50 per person lifetime deductible – waiting periods & maximums apply

Your HRA & How to Submit to MidAmerica MidAmerica's customer service line is or visit them online at Reimbursements: Participants must exhaust any funds available in the Health Flexible Spending Account (FSA) prior to receiving reimbursement from the MidAmerica (HRA) Health Reimbursement Account. Your HRA is integrated with the (HDHP) High Deductible Health Plan. Participants may request reimbursements from their accounts as soon as the accounts are funded, but only for medical expenses incurred subsequent to becoming eligible to participate in the Plan. Funds in a participant’s account at the end of each year shall be rolled into the following year. Claim Forms can be found on the Insurance Services webpage

What happens if I don’t spend all my money? You can have pre-tax dollars deducted from your paycheck. Your flex spending dollars can cover dependent daycare expenses or medical/dental bills your insurance doesn’t cover. Expenses must be incurred within the Plan Year to be eligible for reimbursement. Any unused health care funds (up to $500.00) can be carried over to the next calendar year.  Any unused amount over $ will be forfeited. No carryover for dependent daycare expenses  Any unused amounts will be forfeited Forms available at: Flexible Spending Plan What is a Flexible Spending Plan?

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