Employee Benefit Plans Update Effective July 1, 2014 Keystone Community Living Presented by: Robyn Steltz & Elizabeth Albright 1.

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Presentation transcript:

Employee Benefit Plans Update Effective July 1, 2014 Keystone Community Living Presented by: Robyn Steltz & Elizabeth Albright 1

Effective July 1, 2014 New Medical Insurance Carrier is Nippon Life Benefits Addition of third Plan Option Continuation of Health Reimbursement Arrangement (HRA) administered by HRA, Inc. on certain plan options Continuation of Catastrophic Fund (CAT) administered by HRA, Inc. on certain plan options. FSA Open Enrollment with $500 roll over 2

In Network Preventive Care Services Applies to All Plan Options Preventive Mammograms Preventive Colonoscopies Pediatric Immunizations Physical Exam Well Child Visits GYN Exam & Pap Test Women’s Health per PPACA law Covered 100%, No Deductible, No Co-pays 3

Option 4 - In Network Benefits $1,500 Single / $3,000 Family Deductible is January thru December Inpatient Hospitalization 80% after deductible Outpatient Hospital 80% after deductible Lab tests 100% at LabCard X-rays $20 at Dr.’s Office / $40 at Clinic Primary Care Office Visit $20 Copay Specialist Office Visit $40 Copay Emergency Care $100 Copay Prescription Copays $15 G / $30 B / $50 NPB CVS Caremark Network Out of Pocket Maximum $4,000 Single / $8,000 Family (includes deductible, medical co-payments) 4

Option 4 Out of Network Benefits $3,000 Single/ $6,000 Family Deductible 50% coinsurance after deductible $8,000 Single / $16,000 Family Out of Pocket Maximum (Out of Network providers may bill you for the difference between the total charge and the allowed amount in addition to deductible & co-insurance costs) 5

Option 6 - In Network Benefits $2,000 Single / $4,000 Family Deductible is January thru December Inpatient Hospitalization 70% after deductible Outpatient Hospital 70% after deductible Lab tests 100% at LabCard X-rays $20 at Dr.’s Office / $40 at Clinic Primary Care Office Visit $20 Copay Specialist Office Visit $40 Copay Emergency Care $100 Copay Prescription Copays $15 G / $30 B / $50 NPB CVS Caremark Network Out of Pocket Maximum $6,000 Single / $12,000 Family (includes deductible, medical co-payments) 6

Option 6 Out of Network Benefits $4,000 Single/ $8,000 Family Deductible 50% coinsurance after deductible $12,000 Single / $24,000 Family Out of Pocket Maximum (Out of Network providers may bill you for the difference between the total charge and the allowed amount in addition to deductible & co-insurance costs) 7

Option 8 - In Network Benefits $2,000 Single / $4,000 Family Deductible is January thru December Inpatient Hospitalization 60% after deductible Outpatient Hospital 60% after deductible Lab tests 100% at LabCard X-rays $25 at Dr.’s Office / $50 at Clinic Primary Care Office Visit $25 Copay Specialist Office Visit $50 Copay Emergency Care $50 Copay Prescription Copays $25 G / $50 B / $75 NPB CVS Caremark Network Out of Pocket Maximum $5,350 Single / $10,700 Family (includes deductible, medical co-payments) 8

Option 8 Out of Network Benefits $6,000 Single/ $18,000 Family Deductible 50% coinsurance after deductible $16,050 Single / $48,150 Family Out of Pocket Maximum (Out of Network providers may bill you for the difference between the total charge and the allowed amount in addition to deductible & co-insurance costs) 9

Health Reimbursement Account (HRA) Options 4 and 6 Only A reimbursement account that is funded by Keystone Community Living Only the employer can fund an HRA Covers First Dollar In Network Deductible Expenses for dates of service July 1, 2014 thru December 31, 2014 All funds available as of July 1, 2014 Debit Card provided Not Portable; Unused amounts do not Roll Over 10

Three Plan Options 11 Nippon Life Benefits - AETNA SM Network PPO %- Option 4PPO %- Option 6PPO %- Option 8 Calendar Year In Network $1,500 S / $3,000 F$2,000 S / $4,000 F $4,000 S / $8,000 F$6,000 S / $12,000 F$5,350 S / $10,700 F HRA: $750 S / $1,500 FHRA: $1,000 S / $2,000 F NO HRA CAT: $1,250 S /$2,500 FCAT: $2,000 S /$4,000 F NO CAT FUND 80% after deductible70% after deductible60% after deductible 80% after deductible70% after deductible60% after deductible $100 / $50 Copay $50 / $50 Copay Dr office/Clinic: $20/$40 Copay Dr office/Clinic: $25/$50 Copay 80% after ded.outpatient fac.70% after ded. outpatient fac.60% after ded. outpatient fac. MRI, CAT, PET and SPECTS 80%MRI, CAT, PET and SPECTS 70%MRI, CAT, PET and SPECTS 60% 100% at LabCard or Dr office/clinic: $20 /$50Other: $20 /$40; hospital 70%Other: $25 /$50; hospital 60% N / A $20 / $40 Copay $25 / $50 Copay No *CVS Caremark Network $15G / $30B / $50NPB $25G / $50B / $75NPB $30 G /$60B / $100 NPB $50 G /$100B / $150 NPB Out of Network $3,000 S / $6,000 F$4,000 S / $8,000 F$6,000 S / $18,000 F 50% $8,000 S / $16,000 F$12,000 S / $24,000 F$16,050 S / $48,150 F

Deductible Credit Nippon Life Benefits will be giving you credit for claims applied towards your 2014 Horizon deductible. To get this credit, you must send a recent Horizon E.O.B. to Nippon which shows the amount of deductible that has been met. 12

HRA - Employer Funding Option 4 $750 Single / $1,500 Family Option 6 $1,000 Single / $2,000 Family For 1 st Dollar In-Network Deductible Expenses only. Please retain E.O.B.’s that are mailed to you from Nippon. You will need these to substantiate your HRA. 13

What is a Catastrophic Fund (CAT Fund)? The Catastrophic Fund reimburses the second half of the In Network Out of Pocket Maximum. Funded by Keystone Community Living Reimburses Medical Copays and Coinsurance It does not reimburse prescription co-pays 14

CAT Fund - Employer Funding Option 4 $1,250 Single / $2,500 Family Option 6 $2,000 Single / $4,000 Family For second half of In network out of pocket maximum. You must submit a HRA Claim Form and All pages of the Nippon E.O.B. to receive reimbursement. 15

Voluntary Flexible Spending Accounts Up to $2,500 per working spouse Pay qualified expenses with Pre-tax $$$ Medical deductibles and co-pays Prescription co-pays Dental and Vision expenses Over The Counter Medicines (with a prescription) Expenses must be submitted within 60 days of the end of the Plan year. 16

Tax Savings 17 Money that goes into a Flexible Spending Account is not taxed as income $70 after tax equals $100 pre-tax How much will you and your family spend out of pocket this year? $1,000, $1,500 or up to $2,500

INCOME TAX EXAMPLE 18 FIT (Federal) 18% FICA 7.65% State 3.35% Local 1% Total 30% $30 saved in taxes for every $100 you put into the Flexible Spending Account !

FSA Roll Over; 2014 to Current FSA participants will have until September 15, 2014 to incur expenses At the end of Plan year 2014 – which is June 30, 2015, unused amounts up to $500 will ROLL OVER to the next plan year You will no longer have the 2 ½ month grace period to incur FSA expenses. Claims for the 2014 benefit period must be submitted within 60 days of the end of the Plan year.

Payroll Contributions – Per Pay Medical/RxOption 4Option 6Option 8 Single $ $ $20.00 Parent/Child $ $ $ Employee/Spouse $ $ $ Family $ $ $ Contributions made on a pre-tax basis reduce effective cost an average of 30% 20

HRA Debit Cards Options 4 and 6 Only You must participate in the FSA to receive a debit card for HRA and FSA expenses. You must substantiate ALL debit card swipes or your cards will be suspended The Nippon Explanation of Benefits (E.O.B)is required for HRA substantiations – do not throw away your E.O.B.’s! Debit Cards can be used until the expiration date shown on the card MasterCard will automatically issue new cards 30 days before the expiration date shown on the card 21

Receiving Reimbursements 1. Fax or mail Nippon E.O.B. for HRA & CAT fund and itemized receipt for FSA expenses to Human Resource Administrators. 2. Submit claim using your computer. Go to – register and sign in. Then go to Online Claims Entry. Complete online claim form and scan and upload E.O.B. or receipts. 3. Submit claims using Smartphone or tablet by downloading myRSC mobile app via iTunes App Store or Google Playstore. 22

Have Questions or Need Assistance? Nippon Life Benefits Member services phone number is on the back of your ID Card. HR Administrators, Inc. Lisa Harbits P.O. Box 8 Center Valley, PA (610) / (800) Fax: (610) (610) / (800) Fax: (610) JP Warner Associates, Inc. Debbie Walling (610) / (877) Fax: (610)

Open Enrollment Instructions 24 Fill out an Election form to elect or waive:  Choose Option 4, 6 or 8  Adding or removing dependents  Waiving coverage If you are enrolling in the FSA, a new enrollment form must be completed. You will not automatically be enrolled. You may not change your election during the plan year, unless you have a qualifying event.

Questions & Discussion 25