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Benefits Annual Enrollment Meeting Effective January 1, 2014. Agenda. Consumerism Tips & Resources Healthcare Reform General Information Medical and Prescription Plan Dental Plan Vision Plan Flexible Spending Accounts Supplemental Life Insurance. What Impacts Your Health Plan Cost?.

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Benefits annual enrollment meeting effective january 1 2014

Benefits Annual Enrollment Meeting Effective January 1, 2014


  • Consumerism Tips & Resources

  • Healthcare Reform

  • General Information

  • Medical and Prescription Plan

  • Dental Plan

  • Vision Plan

  • Flexible Spending Accounts

  • Supplemental Life Insurance

What Impacts Your

Health Plan Cost?

  • Healthcare Reform Legislation

  • New Mandates

  • High Utilization of Benefits

  • Unhealthy Lifestyle Choices

  • Plan Designs

  • New Brand Name Drugs

  • New Technologies & Treatments

  • Aging Population

  • Defensive Medicine / Malpractice

What Can You Do?

  • Use your benefits wisely!

  • Use In-Network Providers

  • Use Generic Rx

  • Get your Annual Check-ups

  • Get your Flu Shot

  • Urgent Care Clinic vs. ER

  • …and of course EAT HEALTHY AND EXERCISE!

How much does that cost?

Is this procedure really necessary?

Is there a less expensive option?

Is there a Generic Rx?

Has anybody out there had this before?

(Do your own research online!)

Five Smart Questions to Ask:

Resources – Low Cost Rx

  • Low-Cost / Free Generic Drugs

    • Low-cost or free antibiotics available at some locations

    • For low cost Rx - Do NOT use your medical ID card, just present your doctor’s prescription

    • EXCELLENT time to review your brand name medication and check with your doctor to see if you can switch to the generic

Resources convenient care clinics
Resources – Convenient Care Clinics

  • Designed for non-emergency care such as:

    • Respiratory Illnesses

    • Skin Conditions

    • Minor Injuries

    • Vaccinations

  • Staffed by Nurse Practitioner or Physician’s Assistant

  • Care typically available for an office visit copay

  • Clinics are available in Dayton & Columbus areas

Health care reform1
Health Care Reform

  • Health Care Reform- also called Patient Protection and Affordable Care Act or PPACA became law in 2010.

  • PPACA changes already in place:

    • No pre-existing conditions for children

    • Full coverage for preventive care

    • Extended coverage for adult dependent children

    • No limits on plan benefits

  • Beginning in 2014 PPACA requires most individuals to obtain acceptable health insurance for themselves and their family members or pay a penalty. The penalty will start at $95 per person or up to 1% of household income.

  • Wittenberg’s benefit plan is affordable and meets the minimum value as required under PPACA.

  • Since the Wittenberg plan is affordable and meets the minimum value, Wittenberg employees will not be eligible for a subsidy through the healthcare marketplace exchanges.

  • Ppaca reminder women s preventive care enhancements
    PPACA Reminder: Women’s Preventive Care Enhancements

    • The following benefits are covered in full when utilizing Anthem network providers:

      • Screening for gestational diabetes

      • Testing for human papillomavirus (HPV)

      • Counseling for sexually transmitted infections

      • Screening for counseling for Human immunodeficiency virus (HIV)

      • FDA-approved contraception methods and contraceptive counseling

      • Breastfeeding support, supplies and counseling

      • Screening and counseling for interpersonal and domestic violence

    General information1
    General Information

    • Plan is effective 01/01/2014

    • Self-Funded Plan subject to ERISA and plan document

    • Partnering with Anthem Blue Cross & Blue Shield

    • Blue Access PPO network – national network

    • 4 Plan Types: Employee plan, Employee + spouse plan,

    • Employee + child(ren) plan, & Family plan

    General information cont
    General Information, cont.

    • 2014 Annual Enrollment runs from Oct. 14 through Nov. 8

    • On an annual basis you can enroll in a plan or make benefit changes during the annual enrollment period.

    • Qualifying Event – You can join a plan or make benefit changes within 31 days of a qualifying life event as defined by the IRS.

      • Examples: change in marital status, birth or adoption of a child, change in spouse’s employment status.

      • Contact Human Resources to complete an enrollment form within 31 days of a qualifying event.

    Glossary of terms
    Glossary of Terms

    • Co-pay – The amount you pay each time you see a doctor, get a prescription filled, or get other services. A copay is a flat fee ($20) for medical services.

    • Deductible – The amount you must pay each year before your plan pays anything toward co-insurance.

    • Co-insurance – A percentage that you pay after you have met your plan’s deductible. The plan pays a certain percentage (90%) and you pay a certain percentage (10%).

    • Out-of- pocket limit – The most you have to pay each year for expenses covered by your plan. It traditionally includes the deductible and coinsurance amounts. Once you reach this amount, you do not pay anything for most services.

      New for 2014: $20 Co-payments will apply toward the out-of pocket limit.

    • .

    Blue access ppo health plan
    Blue Access PPO Health Plan

    • In-Network Benefit

    • member pays:

    • Deductible $400 individual /$800 family

    • Out-of-Pocket Limit $1,200 individual /$2,000 family

    • Physician Office visits $20 co-pay

    • Preventive Care visits Covered at 100%

    • Urgent Care $20 co-pay

    • Inpatient/Outpatient Services 10% co-insurance after deductible

    • Emergency Room Services 10% co-insurance after deductible

    Blue access ppo health plan cont
    Blue AccessPPOHealth Plan, cont.

    • Out-of-network benefit

    • member pays:

    • Out-of- Pocket Limit $1,300 individual /$2,200 family

    • Physician Office visits 30% after deductible

    • Preventive Care visits

    • Urgent Care

    • Inpatient/Outpatient Services

    • Balance billing: Providers and hospitals who are out-of-network will bill you for the difference between the amount the plan pays and their billed charges.

    Deductibles and out of pocket limit
    Deductibles and Out-of-Pocket Limit


    The $400/$800 deductible simultaneously applies to both in and out-of-network services. In other words, there is not a separate deductible for out-of-network.

    • Out-of-Pocket Limit (“OOPL”)

    • There is a separate out-of-pocket limit for in-network and out-of-network co-insurance expenses.

    • Co-insurance and copay costs for services received in-network only apply to the in-network OOPL. The in-network OOPL is $1,200/$2,000

    • Co-insurance costs for services received out-of- network only apply to the out-of-network OOPL. The out-of –network OOPL is $1,300/$2,200

    Prescription benefit
    Prescription Benefit

    Prescription Drug Retail copay $10/$25/$40

    (30-day supply)

    Prescription Drug Mail Order $20/$50/$80

    (90-day supply through Express Scripts)

    Prescription co-pay OOPL limit $1,200 single/$2,000 family

    Note: Prescription OOPL is completely separate and unrelated to the OOPL for medical.

    How to find a provider
    How to Find a Provider


    • Click on “Find a Doctor”

    • Choose the search option of your choice

    • Choose the state that you want to search

    • Choose a Plan (PPO)

    • You can then search by provider name, address, zip code, etc.

    • Or call the customer service number listed on the back of your ID card

    Dental blue complete plan
    Dental Blue Complete Plan


    • Deductible $25 single /$75 family

    • Annual Maximum (per member) $1,500

    • Diagnostic and Preventive No Charge to member

    • Minor Restorative 20% co-insurance after deductible

    • Oral Surgery 20% co-insurance after deductible

    • Endodontic Services 20% co-insurance after deductible

    • Periodontal Services 20% co-insurance after deductible

    • Prosthodontic Services 50% co-insurance after deductible

    • Orthodontic Services 50% co-insurance no deductible

    • Orthodontic Lifetime Maximum $1,000

    • Orthodontic Age Limit Child to age 19

    Blue view vision plan
    Blue View Vision Plan

    Network Benefits

    Routine Eye Exam (once every 12 months) $10 co-payEyeglass Frames (once every 24 months) $100 allowance/20% off the remaining balance

    Eyeglass Lenses (standard)Standard Plastic Single vision lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Bifocal lenses (1 pair) $15 co-pay, then covered in fullStandard Plastic Trifocal lenses (1 pair) $15 co-pay, then covered in full

    Additional co-pays apply for eyeglass lens upgrades

    Contact Lenses Elective Conventional Lenses $105 allowance/15% off the remaining balanceElective Disposable Lenses $105 allowance (no additional discount) Non-Elective contact Lenses Covered in Full

    2014 monthly vision contributions
    2014 Monthly Vision Contributions

    • Plan Type Employee Monthly

    • Single $3.00

    • Employee Plus One $6.00

    • Family $10.00

    Enrollment medical dental vision
    Enrollment medical, dental & vision

    Medical dental and vision enrollment
    Medical, Dental and Vision Enrollment

    • You need to complete an enrollment form if:

    • You want to enroll in the Medical, Dental, or Vision plans for the first time;

    • You want to add or drop your spouse or dependents from your coverage;

    • You want to change one or more of the plans you currently participate in;

    • You want to cancel one or more of the plans you currently participate in;

    • You DO NOT need to complete any paperwork if:

    • You are not making any changes to your benefit elections or adding/deleting dependents.

    • Reminder: Employees can enroll in the Medical, Dental, and Vision plans independently.

    Claims assistance
    Claims Assistance

    • If you are having trouble resolving a medical, dental or vision claim issue USI Insurance can assist you.

    • If you have reached out to Anthem and your questions were not answered or it is a complex claim issue please contact USI’s Benefit Resource Center at 1-855-USI-6699 or you can email [email protected]

    Flexible spending account fsa
    Flexible Spending Account (FSA)

    A flexible spending account (FSA), is a tax-advantaged financial

    account that allows an employee to set aside a portion of earnings to

    pay for qualified medical and dependent care expenses. Money

    deducted from an employee's pay into an FSA is not subject to

    payroll taxes resulting in substantial payroll tax savings. One

    significant disadvantage to using an FSA is that funds not used by

    the end of the plan year are lost to the employee, known as the

    "use it or lose it" rule.


    Third Party Administrator

    Flexible spending account cont
    Flexible Spending Account, cont.

    • Estimate your expenses carefully:

      • On an annual basis, determine how much you want to contribute toward your FSA account(s) for the calendar year.

      • You cannot change your election(s) during the calendar year unless you have a qualifying event.

      • You cannot transfer money from one account to another.

      • You have a grace period of three months after the end of the calendar year to submit claims for eligible expenses incurred during the previous calendar year. Funds left in your account after the three month grace period will be forfeited (often called the “use-it-or-lose-it” rule).

    Health care fsa
    Health Care FSA

    • $2,500 annual contribution limit

    • You have immediate access to your full election at the beginning of the calendar year even though the full election has not been deducted from your pay.

      Click here to view a list of eligible expenses: FSA Eligible Expenses

    Dependent care fsa
    Dependent Care FSA

    • If married, spouse must work or attend school full-time

    • Annual contribution limit - $5,000 for single or married filing joint tax return, $2,500 married filing separate return

    • Under IRS guidelines, you can only be reimbursed for dependent care that has already taken place. Also, you can only be reimbursed for the amount you have already contributed to your dependent care FSA.

    • Eligible expenses include dependent care expenses for children under age 13, a disabled spouse, and/or a disabled relative or household member who depends on the account holder for at least half of his orher support.

    Fsa reimbursement
    FSA Reimbursement

    • TASC is going green! No need to fax or mail paper forms – simply submit reimbursement requests electronically:

      • Online Request for Reimbursement Wizard at

      • Download the MyTASC Mobile App (for Apple and Android devices) at

      • Text message TASC RFR, service code, service provider, and reimbursement amount to 41411

      • Use the TASC Card (even order one for your spouse!) and avoid the reimbursement process entirely! Use the TASC card when incurring an eligible expense and the card automatically pays and substantiates most expenses at the point-of-purchase.

    • 24-hour turnaround on almost all “green” and TASC Card reimbursement methods via direct deposit

    • If a paper form is required, download a Request for Reimbursement form from your MyTASC account at and submit it via fax (608) 663-2762 or mail to TASC, PO Box 7308, Madison WI 53707-7308

    • Contact Customer Care for assistance at 800-422-4661

    Fsa enrollment
    FSA Enrollment

    • If you want to participate in an FSA you must enroll or re-enroll for 2014.

      • If you were enrolled in 2013: You’ll get an email with re-enrollment information and you can re-enroll online. Please keep your existing TASC cards (no new cards will be sent unless your card is set to expire in 2013).

      • If you are enrolling for the first time: You’ll need to complete a paper enrollment form. Information and a TASC card will be mailed to the new enrollees home address about 10 days after enrolling.

    Voluntary life insurance1
    Voluntary Life Insurance

    • Employee

      • $10,000 increments to a maximum of $1,000,000 not to exceed 3x annual earnings ($50,000 for ages 70 or older prior to age reductions)

    • Additional Features: Portability and Accelerated Death Benefit

    • Spouse (includes domestic partners)

      • $5,000 increments up to $100,000 not to exceed 50% of the employees elected coverage amount.

    • Children

      • 6 months and older can receive $10,000 benefit for each child (up to age 19, or 25 if full-time student).

      • Coverage from 14 days to 6 months is $250.

        The Employee must elect coverage to enroll Spouse and/or Dependent Children.

    • Voluntary Life Insurance Enrollment

    • You need to complete an enrollment form if:

    • You want to enroll in the Voluntary Life insurance for the first time;

    • You want to cancel the Voluntary Life insurance you currently have;

    • You want to change the volume of the Voluntary life Insurance you currently have.

    • You DO NOT need to complete any paperwork if:

    • You are not making any changes to your Voluntary Life insurance

    Thank you for your time

    • Reminder: The Enrollment Deadline is NOVEMBER 8th.

    • For general plan questions, please contact the USI Benefit Resource Center.

    • For enrollment specific questions, please email DeAnna Sullivan at [email protected]