1. Cape Girardeau Public School District No. 63
Medical Benefits 2011

2. Base PPO In Network Deductible - $2,500 individual /$7,500 family
Coinsurance – 20%
Maximum out of pocket - $5,000/$10,000
Office visit co-pays
Preventive care paid at 100%
Regular office visits $30
Diagnostic (non-routine) tests and labs $50
Urgent care $75 then deductible, then 20%
Emergency Room visit $200 then deductible, then 20%

3. Base Rx Plan Visiting Network Retail Pharmacies Anthem Mail Services
30-day supply
Tier Co pays: $15/$40/$60
25% up to $150
Annual maximum of $2,500
Pharmacist processes Rx through Anthem computer system
Anthem Mail Services
90-day supply
Tier Co pays: $15/$100/$180

4. Base PPO Out of Network Deductible - $5,000/$15,000 Coinsurance – 50%
Maximum out of pocket - $10,000/$20,000
No office visit co-pays must meet deductible then 50% to maximum out of pocket
Emergency Room visit $200 then deductible then 20%
Prescription
$15/$40/$60
Mail order (90 day) - $15/$100/$180/25% up to $150

5. Summary of Changes to Base PPO
Increase in diagnostic co-pay of $20 per visit
Individual deductible increase of $500
Family deductible increase of $1,000
Increase out of pocket maximum of $2,000
Urgent care co-pay decreased to $75 from deductible.
ER care co-pay decreased to $200 from deductible.
Prescription tier 1 increase of $5, tier 2 increase of $10.
Mail order tier 1 increase of $5, tier 2 increase of $25

6. Qualified High Deductible Health Plan
In Network
Deductible - $3,000 individual /$6,000 family
Coinsurance – 20%
Maximum out of pocket - $5,000/$10,000
No office visit co-pays
Preventive care pad at 100%
No prescription plan
Health Savings account employer annual contribution of $909.
Contribution will be used to offset spouse, child, or family premiums before being placed in HSA account.

7. Qualified High Deductible Health Plan
Out of Network
Deductible - $3,000 individual /$6,000 family
Coinsurance – 40%
Maximum out of pocket - $10,000/$20,000
No office visit co-pays
Preventive care pad at 100%
No prescription plan
Health Savings account employer annual contribution of $909.
Contribution will be used to offset spouse, child, or family premiums before being placed in HSA account.

8. Summary of Changes to QHDHP
In network
Addition of 20% coinsurance
Increase in individual out of pocket maximum of $2,000
Increase in family out of pocket maximum of $4,000
Out of network
Increase coinsurance by 10%
Increase in individual out of pocket maximum of $4,000
Increase in family out of pocket maximum of $8,000

9. Buy Up PPO In Network Deductible - $1,500 individual /$4,500 family
Coinsurance – 10%
Maximum out of pocket - $2,500/$5,000
Office visit co-pays
Preventive care paid at 100%
Regular office visits $30
Diagnostic (non-routine) tests and labs $30
Urgent care deductible then 10%
Emergency Room deductible then 10%

10. Buy Up Rx Plan Visiting Network Retail Pharmacies Anthem Mail Services
30-day supply
Tier Co pays: $10/$30/$60
25% up to $150
Annual maximum of $2,500
Pharmacist processes Rx through Anthem computer system
Anthem Mail Services
90-day supply
Tier Co pays: $10/$75/$180

11. Buy Up PPO Out of Network Deductible - $3,000/$6,000 Coinsurance – 30%
Maximum out of pocket - $6,000/$12,000
No office visit co-pays must meet deductible then 30% to maximum out of pocket
Prescription
$10/$30/$60
Mail order (90 day) - $10/$75/$180/25% up to $150

12. Summary of Changes Buy Up PPO
There are no changes being made to the buy up plan at this time.

13. Medical Benefits 2011 Monthly Premiums
Base Buy-Up QHDHP
Cost Cost Cost
Employee $ * $ $
Spouse $1, $1, $
Child(ren) $ $1, $
Family $1, $1, $1,302.92
*District funds $ of medical benefits.

14. Health Insurance Basics
HIPPA
(Health Insurance Portability and Accountability Act)
HIPAA improves the portability, security and privacy of protected health information.
When obtaining assistance regarding claims issues through the Benefits Office, employees must sign an authorization for release of information form.

15. Health Insurance Basics
Health Insurance Opt Out Provisions
Employees can decline individual health coverage.
If opting out:
Employee premium dollars are not available
Cannot return to Anthem Blue Cross and Blue Shield until next annual open enrollment or IRS Qualifying Event
Must sign disclaimer form verifying intention to decline coverage

16. Health Savings Account (HSA) Definition
An interest bearing savings account owned by the employee to pay for current and future medical expenses.
Offered with a High Deductible Health Plan
Works similar to a flexible spending account, yet unused monies roll over year after year and continue drawing interest.
Portable

17. Health Savings Account (HSA) Account Contributions
Both employer and employee pre-tax contributions are permissible.
2010 maximum annual contribution
(employer and employee contributions combined)
$3,050 for employee only coverage
$6,150 for family coverage
Catch-up Provision at age 55: $1,000

18. Health Savings Account (HSA) Who is NOT Eligible?
Employees covered by Base or Buy Up Plan.
Employees covered by other medical insurance that is a non-high deductible health plan (at least $1,200).
Employees enrolled in Medicare coverage.
Employees claimed as a dependent child on someone else’s tax returns.

19. HSA Plan Cafeteria Plan Funding
Employer Cafeteria Plan Funding = $909/year
District funds 100% of employee Base Medical Plan premium.
Offset dependent premiums .
Contribution placed in Health Savings Account

20. Health Savings Account (HSA) Account Distributions
Tax-free if used for qualified medical expenses.
Qualified medical expenses incurred on or after account is established.
Withdrawal only for monies in the account at time of distribution.
Can apply qualified medical expenses of spouse and children, even if not covered by your medical insurance.

21. Health Savings Account (HSA) Account Distributions (continued)
Qualified Medical Expenses:
Deductibles, cost shares, and out of pocket costs on medical insurance claims.
COBRA continuation of coverage premiums.
Qualified long term care insurance premiums.

22. Health Savings Account (HSA) Account Features
HSA services through Mellon Bank.
Upon electing the HSA Plan coverage and electing an HSA, Welcome Kits will be mailed to home address.
Forms must be completed by the employee and returned to Mellon Bank ASAP.
Competitive mutual fund investment options available once account reaches $1,500.

23. Health Savings Account (HSA) Account Features (continued)
Online management access of personal benefits and HSA details.
Monthly account activity statements.
MasterCard – a debit card to pay for qualified medical expenses.
Checkbook Usage - initial 40 checks supply; free of charge.

24. Health Savings Account (HSA) Account Features (continued)
Questions:
Customer Service: (888)
My Account page

25. Health Savings Account (HSA) Incentives Program
Types of Incentives
Health Assessment - $50
Personal Health Coach - $100
$200 incentive when achieving goals through program
Smoking Cessation Program - $50
Weight Management Program - $50
All incentive programs available through the Anthem website:

26. Base or HSA Plan Which is Right for You?
Base Plan - $2,500 Deductible
HSA Plan - $3,000 Deductible
General Office Visits/Rx
4 Office Visits ($51/visit) = $
Annual Physical = $
4 Rx purchases ($100/Rx) = $
Total Cost = $
Less MRA Funding = $
Net Cost $
4 Office Visits ($51/visit) = $
Annual Physical = $
4 Rx purchases ($100/Rx) = $
Total Cost = $
Less HSA Funding = $ (909)
Net Cost = $ (305)
A $50,000 Surgery
4 Office Visits ($100/visit) = $
4 Labs ($150/lab) = $
4 Rx purchases ($100/Rx) = $
Deductible & OOP Maximum = $ 3,500
Total Cost = $ 3,980
Less MRA Funding = $
Net Cost = $ 3,980
4 Office Visits ($100/visit) = $
4 Labs ($150/lab) = $
4 Rx purchases ($100/Rx) = $
Deductible & OOP Maximum = $ 4,000
Total Cost = $ 5,400
Less HSA Funding = $ ( 909)
Net Cost = $ 4,491

27. Base or HSA Plan Which is Right for You?
Base Plan - $2,500 Deductible
HSA Plan - $3,000 Deductible
General Office Visits/Monthly Rx
4 Office Visits ($51/visit) = $ 120
Annual Physical = $
2 Monthly Generics ($25/Rx) = $ 360
1 Monthly Regular ($100/Rx) = $ 480
Total Cost = $
Less MRA Funding = $
Net Cost $
General Office Visits/ Monthly Rx
4 Office Visits ($51/visit) = $
Annual Physical = $
2 Monthly Generics ($25/Rx) = $
1 Monthly Regular ($100/Rx) = $ 1,200
Total Cost = $ 2,004
Less HSA Funding = $ (909)
Net Cost = $ 1,095

28. SIS Portal https://employee.captigers.com
Employee ID required (Contact Finance Dept.)
Allows access to:
Benefits and Deductions
Leave Balances
Pay Information
Tax Forms (W2 and W4 information)
Personal Information

29. Questions Visit our website Call us: (573) 335-1867
Departments – Business - Benefits
Call us: (573)
Lisa Smith – Benefits
DeRhonda Gosche – Personnel/Benefits
Robin Twiggs - Payroll