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Southeast Missouri State University Benefits Orientation

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  1. Southeast Missouri State UniversityBenefits Orientation

  2. Your 2010 Benefits Your benefits are effective on your date of hire • Medical Insurance • Anthem Blue Cross & Blue Shield • Vision Insurance • Vision Service Plan • Dental Insurance • Delta Dental of Missouri • Flexible Spending Accounts • Health Savings Account

  3. Your 2010 Benefits (continued) • Life Insurance • Anthem Life • Retirement • MOSERS(Faculty & Staff) • CURP(Faculty only) • Educational Benefits • Employee Assistance Program **You will complete enrollment forms during orientation. You are allowed 31 days from date of hire to finalize benefit elections.**

  4. Medical Insurance Basics • Blue Access PPO Network • Nationwide access • Worldwide access • Unlimited lifetime maximum • Website: http://www.anthem.com • Pre-existing conditions: 12 months exclusion, can be waived by providing a HIPAA certification (a statement certifying proof of prior coverage)

  5. Medical Insurance Basics • Dependent Coverage • Up to age 25 regardless of student status • If not enrolled at employee’s date of hire – dependents can enroll during annual open enrollment • Dependents can enroll within 31 days of an IRS Qualifying Change in Family Status (e.g., marriage, divorce, birth of child, change in spouse’s coverage status, etc.) • Pre-existing conditions for 12 months unless a HIPAA certification is provided.

  6. Medical Insurance Basics • Coordination of Benefits • Anthem Blue Cross and Blue Shield will coordinate benefits with other group health coverage that you or your covered family members may have. • To ensure that Anthem has up-to-date information they may periodically ask members about other health insurance coverage. • If any information regarding your or your families health insurance changes, please fill out a coordination of benefit form and send to Anthem.

  7. Medical Insurance Basics • Problems with Claims? • Contact Anthem • Call physician’s office • View your claims online at: http://www.anthem.com • Contact the Human Resources Office for further assistance.

  8. Medical Insurance Basics HIPAA (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 Human Resources Office, employees must sign an authorization for release of information form.

  9. Medical Insurance Basics Prescription Drugs Coverage • Visiting Network Retail Pharmacies • 30-day supply • No RX Copays • Pharmacist processes Rx through Anthem computer system • 20% Cost share after deductible

  10. Medical Insurance Basics Prescription Drugs Coverage • Anthem Mail Services • 90-day supply • No RX Copays • Pharmacist processes Rx through Anthem computer system • 10% Cost share after deductible

  11. Medical Insurance Basics Prescription Drugs Coverage • Prior Authorization • Goal: To assist employees with cost control of medications • The process of obtaining approval of benefits before certain prescriptions may be filled. • Must be obtained by your physician in order to receive benefits • To find out which drugs require prior authorization visit: www.anthem.com

  12. Medical Insurance Basics Medical Insurance Opt Out Provisions • Employees can decline individual health coverage. • If opting out: • Employee’s 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

  13. Medical Insurance Basics Health Incentive Accounts (HIA) • Allows members to earn health care dollars through various plan incentives • Features within Medical Plans A and B • Medical Plan A – reduces plan deductible • Medical Plan B – payable to employee as gift cards • Unused health incentives carry over

  14. Medical Insurance Basics • 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: www.anthem.com

  15. Medical Plan A • Anthem Blue Cross and Blue Shield • Cafeteria Plan Funding for Plan A

  16. 2010 Medical InsuranceMedical Plan A • $500 Individual Deductible • $1,000 Family Deductible • 20%/80% after deductible met • Full Preventive Care coverage (well woman, PSA, mammogram, annual physical, immunizations, etc.)

  17. 2010 Medical InsuranceMedical Plan A • Office Visit Copays: • No Office Visit Copays (employee pays 100% of cost up to the deductible; then cost share applies) • Out of Pocket Maximum: • Individual: $3,500/year • Family: $7,000/year • All deductibles and coinsurance apply toward the out of pocket maximum including prescription drugs.

  18. Cafeteria Plan A Plan Summary

  19. Medical Plan A Cafeteria Plan Contributions • Employer Cafeteria Plan Funding: $750/year • You must be an employee with the University on December 31 to be eligible to receive the Cafeteria Plan Funding.  If you are hired mid year, this benefit will not be available until the next open enrollment period.

  20. Medical Plan A Cafeteria Plan Funding Employer Cafeteria Plan Funding = $750/year The University will use the cafeteria plan dollars first to pay for employee and dependent medical premiums; then vision, dental, MRA and DCAP. Dependent Care Assistance (DCAP) Part-time employee funding prorated by percent of assignment. Dependent Medical Employee & Dependent Dental Cafeteria Plan A Option Employee & Dependent Vision Medical Reimbursement Account (MRA)

  21. Medical Plan B • Anthem Blue Cross and Blue Shield • Cafeteria Plan Funding for Plan B

  22. 2010 Medical InsuranceMedical Plan B • $1,500 Individual Deductible • $3,000 Family Deductible • 20%/80% after deductible met • Full Preventive Care coverage (well woman, PSA, mammogram, annual physical, immunizations, etc.)

  23. 2010 Medical InsuranceMedical Plan B • Office Visit Copays: • No Office Visit Copays (employee pays 100% of cost up to the deductible; then cost share applies) • Out of Pocket Maximum: • Individual: $5,000/year • Family: $10,000/year • All deductibles and coinsurance apply toward the out of pocket maximum including prescription drugs.

  24. Cafeteria Plan B Plan Summary

  25. Medical Plan B Cafeteria Plan Contributions • Employer Cafeteria Plan Funding: $1,486.32 • You must be an employee with the University on December 31 to be eligible to receive the Cafeteria Plan Funding. If you are hired mid-year, this benefit will not be available until the next open enrollment period.

  26. Medical Plan B Cafeteria Plan Contributions Employer Cafeteria Plan Funding = $1,486.32/year The University will first fund the HSA; then dependent medical premium, vision, dental and/or DCAP. Dependent Care Assistance (DCAP) Dependent Medical Part-time employee funding prorated by percent of assignment. Employee & Dependent Dental Cafeteria Plan B Option Employee & Dependent Vision Health Savings Account (HSA)

  27. Medical Insurance 2010 Monthly Premiums Medical Insurance – Anthem Blue Cross and Blue Shield Medical Plan AMedical Plan B w/MRA option w/HSA option CostCost Employee $512.68* Employee $437.50* Spouse $512.68 Spouse $437.44 Children $384.44 Children $328.08 Family $897.14 Family $765.56 * Full-time employee premium 100% funded * Effective July 1, 2009, new hire part-time employee premium funding is prorated by percentage of assignment.

  28. Medical Plan A or BAn Analysis -Which is right for you?

  29. Vision Insurance Plan Summary

  30. Vision Insurance • Vision Service Plan (VSP) • Two Plan Options • Exam Plus Plan A – Low Option • Enhanced Plan B – High Option • Extra Discounts & Savings • Laser Vision Correction • Prescription Glasses • Contacts

  31. Vision Insurance Exam Plus Plan A • In-Network providers: • Annual eye exam with a $10 copay • 20% discount on lenses and frames • 15% discount off the contact lens fitting and evaluation exam. This exam is in addition to your vision exam.

  32. Vision Insurance Enhanced Plan B • In-Network providers: • Annual eye exam with a $10 copay • Lenses covered in full–every 12 months • Frames – every other plan year (frames of your choice covered up to $120, plus 20% off any out-of-pocket costs) or • Contact Lens care-every 12 months • No copay applies • Prescription glasses-$25 copay

  33. Vision Insurance 2010 Monthly Premiums Vision Insurance – Vision Service Plan Plan A-Exam PlusPlan B-Signature Plan Cost*Cost* Employee $2.88 Employee $10.80 Spouse $4.06 Spouse $17.32 Children $4.12 Children $17.68 Family $6.10 Family $28.52 *Total premium includes employee only cost.

  34. Dental Insurance Plan Summary

  35. Dental Insurance • Delta Dental of Missouri • Two Plan Options • Plan A – Low Option • Plan B – High Option (with orthodontia) • Annual Maximum (per person/year): $1,000 • Utilize Delta Premier Network providers • Listing of Network providers can be located at: http://www.deltadentalmo.com

  36. Dental Insurance • Preventive Plan A – Low Option • Coverage A only at 100% of UCR • Oral exams – twice in any benefit year • Fluoride patients under age 14 – once in any benefit year • Molar sealants for dependent children under age 16 – once in 5 years • Bitewings x-rays: one set in any benefit period

  37. Dental Insurance • Plan B – High Option • Individual Deductible: $50 • Waived for Coverage A Dental Services • Includes Coverage A, B, C and D • Coverage A Services (100% of UCR) • Oral exams – twice in any benefit year • Fluoride patients under age 14 – once in any benefit year • Molar sealants for dependent children under age 16 – once in 5 years • Bitewing x-rays: one set in any benefit period

  38. Dental Insurance • Coverage B Services • Fillings, extractions, Full-mouth x-rays at 80% after $50 deductible • Coverage C Services • Periodontics, endodontics, surgical extractions, crowns, complex oral surgery, bridges at the following schedule: • 1st year – 10% • 2nd year – 25% • 3rd year and beyond – 50%

  39. Dental Insurance • Coverage D Services • Orthodontia care for dependent children to age 19 at 50% • Maximum: $1,500, available starting in 3rd year of coverage • Orthodontics is not covered for care started prior to the 3rd year of benefits

  40. Dental Insurance 2010 Monthly Premiums Dental Insurance – Delta Dental of Missouri Plan A-Low OptionPlan B-High Option Cost*Cost* Employee $12.30 Employee $28.42 Spouse $26.38 Spouse $56.12 Children $40.96 Children $71.14 Family $54.22 Family $102.50 *Total premium includes employee only cost.

  41. Flexible Spending Accounts Plan Summary

  42. Flexible Spending Accounts • Medical Reimbursement Account (MRA) • Tax-deferred payroll reduction: $5,000 annual maximum • Applicable expenses: Deductibles, copays, coinsurance, Rx, vision, dental, certain over-the-counter items • Dependent Care Assistance Program (DCAP) • Tax-deferred payroll reduction: $5,000 annual maximum • Applicable expenses: day care for children and elder care for adults

  43. Flexible Spending Accounts • PowerGroup Administrators • Account feature • Direct Deposit Option for Dependent Care • Print Form from website: www/myflexonline.com • Debit Card for Medical Reimbursement Account • Submitting Claims • Expenses incurred through 12/31 of current year • Claims filing deadline: 03/31 of upcoming year • Claim forms can be faxed or mailed

  44. Flexible Spending Accounts • PowerGroup’s Contact Information • Claims filing email address: pgaclaimsfaxes@pgcompanies.com • Customer Service: (800) 847-0038 • Flex Account Hotline: (913) 789-4600 • Fax: (913) 491-6379

  45. Health Savings Account (HSA) Plan Summary

  46. 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 – Medical Plan B • Works similar to a flexible spending account, yet unused monies roll over year after year and continue drawing interest • Portable

  47. 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 • Employee contributions can be changed mid-year via form completion in Human Resources office

  48. Health Savings Account (HSA)Who is NOT Eligible? • Employees covered by Medical Plan A • 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

  49. 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

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