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Richmond Community Schools Open Enrollment November 10, 2015
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What is driving the cost? Claims Experience Medical Inflation and Trend Average increase is 8-10% per year. Technology Advances New Expensive Drugs ACA Requirements New Taxes – PCORI, TRF
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Affordable Care Act O Requirements Waiting period limitation Preventative care services paid at 100% Minimum Value Affordability Expanded Appeals process No pre-existing condition limitation Dependent child to age 26 We are experiencing cost increase!
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Cadillac Tax O Cadillac Tax (part of Affordable Care Act) Effective in 2018 Single cost maximum $10,200 Family cost maximum $27,500 Employer will pay 40% tax on cost over the threshold!
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Eligibility Working Spouse Rule – if spouse is eligible for other employer coverage, spouse must take it and then could be secondary under this plan. Spouse must live in same household effective 11/1/15 Adult Children covered until age 26, regardless of other available coverage
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Plan Design/Changes O Offer 2 plan options #1 – Traditional Deductible $1,000/$2,000 Ded. #2 – High Deductible $3,000/$6,000 Ded. with and HSA option NOTE: New Regulation – Individual deductible is embedded.
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Plan Design/Changes O Rx Copay 30 day90 day O Generic: $4 $6 Brand Preferred:< 20% or $20< 20% or $20 Brand Non-Preferred:< 30% or $30< 30% or $30 At CVS and Walgreen: O Generic: $8 $12 Brand Preferred:< 30% or $40< 30% or $80 Brand Non-Preferred:< 50% or $60 < 50% or $120
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Plan Design/Changes Additional Rx Changes: Specialty Rx limited to 30 days Value Specialty: 10%, $150 max Preferred Specialty: 30%, $250 max Non-Pref. Specialty: 50%, $400 max Implement Referenced Based Pricing
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Employee Contributions O Use 4 tier rates (Employee, Employee+Child(ren), Employee+Spouse and Family) Helps to lower premiums for EE+CH and EE+SP tiers. Helps Cadillac Tax calculation Traditional plan – higher premiums High deductible plan – lower premiums
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Employee Contributions Traditional HDHP EE$70.59$42.16 EE+CH$160.90$65.68 EE+SP$168.45$73.63 Family$173.45$105.84 Based on 24 pays
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Employee Contributions Dental Vision EE$1.68$1.50 EE+CH$15.88$1.50 EE+SP$13.41$1.50 Family$31.49$1.50 Based on 24 pays
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Flexible Benefits Annual Maximum for FSA: $2,550 Annual Maximum for Dep Care: $5,000 Use it or Lose it Carry over of $500 May be used to pay for qualified Out of Pocket expenses Optional Debit Card
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Health Savings Account Annual Contribution Maximum: Single: $3,350 Family: $6,750 Catch up contribution $1,000 for age 55 and older Must be covered by a qualified HDHP Distributions for qualified medical expenses are tax free. Earnings are tax free Distributions for other expenses subject to IRS tax and 20% penalty. (If over 65, penalty waived)
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New Tax Form Look for the new 1095 tax form in January! Attach your W-2 and 1095 forms to your tax returns 1095 form documents your insurance coverage for 2015
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Open Enrollment O Open Enrollment Starts today – November 10 Link will be on RCS website Deadline – December 4
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www.dunnbenefit.com (800) 880-9960 M:Renewal/2015/RichmondSchools/RCS Presentation 09232015.pptx
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