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Ball State University Brandi McGlothin Payroll & Employee Benefits Open Enrollment 2011
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PPACA (Patient Protection and Affordable Care Act) Changes Advisory Board Changes Deductibles Out-of-Pocket (OOP) Maximums New Rates Flexible Spending Accounts (FSA) Health Savings Accounts (HSA) Other Changes
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◦ Elimination of the current lifetime maximum benefit of $2.0M ◦ Elimination of pre-existing condition limitations for enrollees younger than age 19 ◦ Elimination of the requirement that coverage for children of employees who are younger than age 26 is for IRS-qualified dependents only As a grandfathered plan we will still require that, when available, these individuals obtain coverage from their employer or spouse’s employer ◦ Elimination of annual maximum benefit for pediatric dental (up to age 18) Our Plan is “Grandfathered”
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Changes – Effective July 1, 2011: Specialty Drug Sourcing - Accredo Preauthorization for Non-Emergency MRI and CT Scans Preauthorization Required Prior to Non- Emergency Orthopedic Surgery Preferred Drug Step Therapy (PDST) Who is The Advisory Board Company? They are the leading provider of comprehensive performance improvement services to the health care and education sectors. *Just to clarify – these changes apply to non-emergency situations and there is an appeals process in place
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Health Plan OptionsCoverage TiersDeductibles FromTo Low Deductible PPOEmployee only$300$350 Employee & Child(ren) or Family$750$875 High Deductible WellnessEmployee only$1000No Change Employee & Child(ren) or Family$2500No Change HSA Qualified Plan*Employee only$1500$1725 Employee & Child(ren) or Family$3750$4325
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Health Plan Options Providers & FacilitiesOut of Pocket Maximums Per Person FromTo Low Deductible PPO Plan (does not include deductible) In Network/Endorsed Provider/Encircle Facility$1500$1725 Combination of In Network/Non-Endorsed Provider/Non-Encircle Facility $2250$2600 Out of Network$3000$3450 Prescription (mail-order only)$1500$1725 High Deductible Wellness (does not include deductible) In Network/Endorsed Provider/Encircle Facility Per Person $2500No change Combination of In Network/Non-Endorsed Provider/Non-Encircle Facility $3750No change Out of Network$6000No change Prescription (mail-order only)$1500$1725
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High Deductible/ HSA Qualified Plan (includes deductible) Medical/Prescription Expenses Combined In Network/Endorsed Provider/Encircle Facility Individual Coverage $2500$2875 Combination of In Network/ Non- Endorsed Provider/Non-Encircle Facility Individual Coverage $3000$3450 Out of Network Individual Coverage $3500$4025 In Network/Endorsed Provider/Encircle Facility Employee & Child(ren) or Family Coverage $5000$5750 Combination of In Network/ Non- Endorsed Provider/Non-Encircle Facility Employee & Child(ren) or Family Coverage $6000$6900 Out of Network Employee & Child(ren) or Family Coverage $7000$8050
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Low Deductible PPOHigh Deductible WellnessHigh Deductible/HSA Qualified Plan BiweeklyMonthlyBiweeklyMonthlyBiweeklyMonthly 18 pays24 pays 10 pays 12 pays 18 pays 24 pays 10 pays 12 pays 18 pays 24 pays 10 pays 12 pays Single$140.39$105.29$252.70$210.58$56.03$42.02$100.85$84.04$24.55$18.42$44.20$36.83 EE + Child (ren) $266.73$200.05$480.12$400.10$106.45$79.84$191.62$159.68$46.65$34.99$83.98$69.98 Family$364.42$273.32$655.96$546.63$145.44$109.08$261.79$218.16$63.74$47.81$114.73$95.61
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◦ Plan Year is July 1, 2011 – June 30, 2012 ◦ Grace period extends time for incurring claims to September 15, 2012 ◦ Maximum annual election is $5,000 each for General Purpose and Dependent Care FSAs ◦ New Feature – direct deposit for FSA reimbursement ◦ Reminder: Over-the-Counter medications now require a prescription ◦ Eligible expenses may now be submitted for “adult children” up to age 26
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Effective January 1, 2012, Ball State will begin “seeding,” or contributing to employee HSAs Seeding will done on a calendar year basis due to tax concerns Employees must open an account with HSABank in order to begin receiving the seed Ball State will pay the monthly maintenance fee for the HSABank accounts Ball State is currently looking at an alternative contribution “vehicle” for employees in the HDHP who do not meet HSA eligibility requirements
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HSA Qualified Plan Bi-Weekly Contribution 26-Pays Bi-Weekly Contribution 18-Pays Monthly Contribution 12-Pays Monthly Contribution 10-Pays Maximum 2012 CY University Contribution Individual Coverage Jan. 1 – June 30 $29.46 $38.30 (10 Pays) $63.83$76.60 $574.50 Individual Coverage July 1 – Dec. 31 $14.73 $23.93 (8 Pays) $31.92$38.30 Employee & Child(ren)/Family Coverage Jan. 1 – June 30 $73.84 $96.00 (10 Pays) $160$192 $1440 Employee & Child(ren)/Family Coverage July 1 – Dec. 31 $36.92 $60.00 (8 Pays) $80$96
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Three-Year Commitment Rule lifted for this Open Enrollment period Effective January 1, 2012, the Retail Refill Allowance (RRA) Penalty will be implemented for the High Deductible/HSA Qualified Plan ◦ 15% penalty after 3 rd fill of maintenance drug at retail (penalty does not apply to OOP maximum) ◦ OOP maximums could increase with continued retail pharmacy use to: $5,950 for Single Coverage $11,900 for EE+Child(ren) or Family Coverage
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Plan Changes Effective July 1, 2011 Need Forms or Assistance? Email: peb@bsu.edu peb@bsu.edu PEB Website: www.bsu.edu/payroll www.bsu.edu/payroll Call 765-285-8461 Deadline for Submitting Enrollment Forms Wednesday, May 18 th, 2011 Wednesday, May 18 th, 2011
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