Welcome Catholic Diocese of Sioux Falls Employee Benefits Enrollment Guide 2016 Presented by Nancy Petersen 1

Agenda  Open enrollment  Health plan – Avera Health Plans  Health Savings Account (HSA) – continuing education  Consumerism 2

How to Enroll 3  Review your current benefit elections  Update your personal information as necessary  Make your benefit elections (once you make benefit elections, you will not be able to change them until the next open enrollment period unless you have a qualified change of status)

When to Enroll  The open enrollment period runs from November 2, 2015 through November 18, 2015  The benefits you elect during open enrollment will be effective from January 1, 2016 through December 31,

How to Make Changes 5  Unless you have a qualified change in status, you cannot make changes to the benefits you elect until the next open enrollment period –Qualified changes in status include:  Marriage  Divorce  Legal separation  Status change  Birth or adoption of a child  Change in child’s dependent status  Death of a spouse, child or other qualifying dependent  Change in residence due to an employment transfer  Commencement or termination of adoption proceedings  Change in your spouse’s benefits or employment status

2016 Health Benefits 6

Avera Health Plans 7  The administration of our self-funded health plan will renew with Avera Health Plans for 2016  Catholic Diocese uses a preferred provider organization (PPO) – provider network of physicians and hospitals  Services incurred by a non-participating provider are subject to a higher deductible and coinsurance rate  Avera Health Plans PPO network: – – or

Covered Services High-Deductible Health Plan (HDHP)/HSA Qualified Traditional Health Plan Bronze Health Plan Deductible – calendar year $2,500 single $5,000 family (aggregate) $750 single $2,250 family $2,000 single $4,000 family Coinsurance0%20%50% Out of pocket – calendar year (includes deductible, coinsurance and copay) $2,500 single $5,000 family (any combination) $3,000 single $7,500 family $6,530 single $12,700 family Office visit services Primary care physician Specialist care 0% deductible $25 copay $50 copay $50 copay 50% coinsurance Wellness services – routine exams, women’s preventive health, colonoscopies, etc. 100% paid; deductible waived; no patient cost sharing 100% paid – deductible waived; no patient cost sharing Prescription drug coverage Deductible Generic Formulary Non-formulary Out-of-pocket maximum 0% deductible $100/$200 deductible $12 copay deductible waived $35 copay $50 copay $1,000/$2,000 $100 single; $200 family $0 copay; deductible waived $25 copay $100 or $200 copay Employer dollars to HSA $750 single $1,500 family None Plan Design Overview 8

Employee Cost Comparison 9 *If you enroll in the HDHP and open an HSA with Discovery Benefits then the insurance fund will contribute up to $750 into your HSA if you elect single coverage and $1,500 into your HSA if you elect employee plus child(ren) or family coverage Coverage Level HDHP/HSA No Change Traditional Plan 3% Increase Bronze Plan 3% Increase Employee Cost per Month Single$227.62*$286.71$90.00 Employee plus child(ren)$530.96*$668.98$ Family$598.89*$748.36$ HDHP Savings over Traditional Plan Premium Savings Per Month Annual Savings Single$59.09$ $750 employer HSA dollars = $1, Employee plus child(ren)$138.02$1, $1,500 employer HSA dollars = $3, Family$149.47$1, $1,500 employer HSA dollars = $3, This example is assuming a 50% employee/employer premium cost split

HSA Basics 10

What is an HSA? 11  An HSA is an account that you can use to pay medical expenses –Must be in conjunction with an HDHP –Money in the HSA is owned by the individual just like a bank account  Both you and your employer can contribute funds into this account –Tax advantages: Contribute pre-tax money, funds accrue tax-free and withdraw funds tax-free (if used for eligible medical expenses)

12 What are the Benefits of an HSA?  HSAs keep growing in popularity because: –They are a powerful tax savings tool –Funds roll over from year to year –Accounts are individually owned –HSAs/HDHPs typically have lower monthly premiums

13 Who is Eligible for an HSA?  Anyone who is: –Covered by an HDHP –Not enrolled in Medicare –Not another person’s tax dependent –Family unit is not enrolled in an FSA or health reimbursement arrangement (HRA) –Not covered under a traditional health insurance plan* *Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance

14 HSA Contributions

15 Contribution Limits  Individuals age 55 or older by the end of the year may contribute an additional $1,000 catch-up contribution Type of Coverage2015 Limits2016 Limits Single$3,350 Family$6,650$6,750

16 Contribution Limits  Rule: Annual HSA contributions cannot exceed the sum of the monthly limits in effect for each month the individual was HSA-eligible  Example: Robert, age 25, has single coverage and is HSA-eligible for the first eight months of 2015 –The annual maximum HSA contribution for single coverage for 2015 is $3,350 –Robert’s maximum HSA contribution for 2015 is $2,233 (8/12 x $3,350)

17 HSA Distribution Rules

18 HSA Distribution Rules  Distributions from your HSA are tax-free if they are taken for “qualified medical expenses”  Your HSA can only be used for expenses that are incurred on or after the date the HSA was established  However, HSA funds can be used for expenses from a prior year or as long as the expenses incurred on or after the date the HSA was established  HSA distribution for non-eligible expenses are subject to a 20% penalty and appropriate taxes

19 HSA Distribution Rules  HSA distributions can be taken for qualified medical expenses for the following people: –The account holder (person covered by the HDHP) –Spouse of that individual (even if not covered by the HDHP) –Tax dependents of the account holder (even if not covered by the HDHP)  For individuals age 65 and older, HSA distributions can be used for non-qualified medical expenses without facing the 20% penalty –However, income taxes will apply for non-medical distributions –This rule is regardless of whether the individual is enrolled in Medicare

20 HSA Vendor  HSA through Discovery Benefits  Debit card and online reimbursement requests  Cash account –Funds default to the cash account –You need to set your HSA maximum if you want funds to automatically transfer to the higher interest account or mutual funds  Higher interest bearing account – Automatic transfer (48-hour turnaround)  Mutual funds – Automatic transfer (three- to five-day turnaround)

21 Recordkeeping  Whenever you use HSA funds to pay for a medical expense, you should keep your receipt  You may need to demonstrate to the Internal Revenue Service (IRS) that HSA distributions were for qualified medical expenses  If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty  IRS Form 8889 should be completed and submitted with your income tax filing

Qualified Medical Expenses 22

Qualified Medical Expenses 23  The IRS defines expenses that are considered “qualified medical expenses” for HSA distributions  Expenses must be primarily to treat or prevent a physical or mental defect or illness  If you use HSA funds for expenses beyond what the IRS defines as qualified, you will be subject to income tax on the distribution and an additional 20% penalty

Qualified Medical Expenses 24  Examples of qualified medical expenses include: –Most medical care expenses –Prescription drugs –Over-the-counter drugs, only if you obtain a prescription –Insulin (with or without a prescription) –Dental and vision care –Select insurance premiums  COBRA  Qualified long-term care insurance  Health insurance premiums paid while receiving unemployment benefits  Health insurance after you turn 65 except for a Medicare supplemental policy

Qualified Medical Expenses 25  Expenses that are not considered “qualified medical expenses” include: –Insurance premiums (other than the exceptions listed on the previous slide) –Over-the-counter drugs (unless a prescription is retained from a physician – insulin is an exception) –Services purely for cosmetic reasons –Expenses covered by another insurance plan –General health items, such as tissues, toiletries and hand sanitizer  A full list of eligible and ineligible expenses can be found at

Healthcare Consumerism 26

How Can You Become a Good Consumer? 27  Get preventive screenings –An annual exam can help avoid a catastrophic or large claim in the future  Grab the phone before the car keys –Call “ASK-A-NURSE” at –Call your doctor or nurse  Share the formulary list with your provider –Ask for a generic drug versus a brand name drug –Ask if there are any OTC options –Ask for samples/discount coupons from your doctor –GoodRx – mobile app and internet site to assist you with price shopping for your prescriptions 

Services at a Reduced Cost 28  AveraNow – telemedicine visit with a $49 charge for patients experiencing basic symptoms – –Symptoms and conditions treated:  Headache  Fever  Vomiting  Diarrhea  Rashes  Pink eye –This visit is not filed with insurance, but you can use your HSA or FSA dollars to pay for this visit  Acid reflux  Cold sores  Cold  Flu  Sinus infection  Seasonal allergies

Services at a Reduced Cost 29  CURAquick Clinic – for minor medical care –Vaccinations –Sports and pre-employment physicals –Allergies –Flu –Sinusitis –Strep throat –Upper respiratory ailments –Skin irritations –Office visit charge – $70 versus $150 at urgent care –$25 copay will apply on traditional plan –Located in Hy-Vee on Minnesota Avenue

How Can You Become a Good Consumer? 30  Talk to your physician about treatment options and costs –How much will my treatment cost? –What treatment alternatives are available? –Are there differences in cost and effectiveness? –Can laboratory tests be performed in a clinic versus hospital? –Can surgical services be performed in an outpatient surgical facility? –Get the results of any test or procedure and ask what the results mean for your care

Employee Assistance Program (EAP) 31  Take advantage of the free EAP through Avera Health Plans instead of utilizing the mental health benefits through the plan  The EAP program offers five (5) free counseling sessions per family member per year  You must be enrolled in the health plan to be eligible for the EAP

32 Next Steps

33 What to Do Next  Decide which plan works best for you and/or your family (HDHP/HSA, Traditional or Bronze)  All employees must complete the 2016 Benefit Election Form  If you are changing your current election or are newly enrolling into the medical or dental plan, an Enrollment Form must be completed  If you are newly electing the HDHP, complete the Discovery Benefits HSA Data Collection Worksheet  Your current HSA payroll contributions will carry over unless you submit an HSA Contribution Change Form

34 Dates to Remember  Open enrollment period –November 2, 2015 through November 18, 2015 –Return all paperwork to your local benefit coordinator no later than November 18

35 Please Note…  This benefit summary is intended only to provide you with a brief overview of your benefits  It is not a contract and should not be relied upon to fully determine your coverage  Refer to your summary plan description for an exact description of the services/supplies that are covered, exclusions and other conditions of coverage

Thank you!