Annual Open Enrollment Benefits Presentation Benefits Effective December 1, 2017 Presenter: Sandy Urgel Brown & Brown Insurance Services of California, Inc. CA Insurance License # 0D04053
SPG Employee Benefits Package • 2017-18 Benefit Plan Offerings: • Medical Anthem Blue Cross and Kaiser • Dental Premier Access Dental • Vision Humana (EyeMed Network) • Life and AD&D UNUM • Voluntary Life and/or AD&D UNUM • Voluntary Long Term Disability UNUM • Flexible Spending Accounts Ameriflex • Commuter Program Ameriflex • Employee Assistance Program MHN • 401(k) Retirement Plan John Hancock
Open Enrollment 2017 Open Enrollment Period: November 1 - November 15, 2017 This is your “once a year” opportunity to: • Enroll/Waive Coverage • Change Medical Plans • Add/Remove Dependents • Apply for voluntary long-term disability or additional supplementary life insurance • Enroll in Health Care and/or Dependent Care Flexible Spending Accounts for 2018 (you MUST re-enroll and elect your annual contribution each year!) IMPORTANT! This year’s open enrollment will be an ACTIVE event! You MUST enroll, re-enroll, or waive your benefit elections through the SPG Employee Portal during the open enrollment period to have benefits for the upcoming 2017-18 plan year. Reminder: Most of these benefit elections are effective December 1, 2017, and will remain in effect through November 30, 2018. You will not be able to change your elections during the year unless you have a qualified life status change (also referred to as a “Qualifying Event”).
Qualifying Events What is a Qualifying Event? When enrolling for benefits or making changes, you are electing coverage for December 1, 2017, through November 30, 2018. Throughout the year, you may make changes to your elections only when you have one of the following “qualifying life events”, below. • The birth or adoption of your child or a change in child custody • Marriage, legal separation or divorce • A change in employment status for you, your spouse or dependent resulting in a loss or gain of coverage • The beginning or termination of your registered domestic partnership • The death of your spouse, registered domestic partner or child IMPORTANT! Please contact Camila Sanchez immediately if you experience a qualifying event. You must make changes to your coverage within 30 days of the qualified life event; otherwise, you will have to wait until the next open enrollment period to enroll or make changes to your benefits.
Employee Benefit Choices – Factors to consider • Understand how to use the benefits provided • Medical insurance can be complex; PPO, HMO, HSA, FSA, Specific Provider Networks, etc. • Dental, Vision, Life Insurance have limitations, rules on usage • Ask questions if something doesn’t feel “right” or before requesting a service so you know the estimated costs • Understand some of the nuances of your benefits before you use them • Use carrier websites & customer service numbers to help navigate your benefits • Evaluate how the benefits address your particular needs • Are you single, have a family, older or younger? • Do you have a chronic condition such as asthma, hypertension, etc.? • Ask for reasonable treatment from the providers, doctors, nurses, lab technicians, and other • Determine your cost comfort level - you are expected to pay certain amounts for receiving care • Contributionsfrom your paycheck • Co-pays ($35, $250, etc.) • Deductibles ($500, $1,500, $2,000, etc.) • Co-insurance (20%, 35%, 50%) • Your costs are “capped” during a calendar year (or benefit year) • You will not pay more than a certain total if using “network providers” • You will pay much more when using “non-network providers”
What’s driving the cost of health care? • Improvements in medical technology and drug therapies. • Medical Inflation - accounts for 51% of the growth in health care spending. • High cost of complying with government regulations - over 50% spent on regulatory costs such as filing and reporting requirements. • Patient lifestyles such as obesity, tobacco use, sedentary lifestyle and poor nutrition trigger the need for increased medical care and yield a higher level of cost. • Aging of the covered population.
Deductibles & Out of Pocket Maximums – How They Work • SPG plans have “Embedded” Deductibles: • Each covered family member only needs to satisfy his or her individual deductible, not the entire family deductible, prior to receiving plan benefits. • SPG’s benefit plans run from December through November; however, medical plan deductibles accrue over the course of a calendar year - January through December. If you have already satisfied the deductible for your current medical plan, and you elect a new plan with the same carrier that has a higher deductible, you will need to satisfy the difference between the amount of the deductible you have already paid and your new plan’s deductible amount, effective 12/1/17. For example: • You are currently enrolled in the Anthem Gold PPO 500 Plan and have already satisfied the $500 deductible. Effective 12/1/17, you enroll in the Anthem Silver Plan, which has a deductible of $2,000. • If services subject to the deductible are obtained in the month of December, 2017, you will need to satisfy the difference in deductibles ($1,500) before certain benefits are covered under your new plan. • Effective 1/1/18, the deductible will reset to $0, and you will need to satisfy the full $2,000 deductible before certain benefits are covered. If you elect a new plan with a different carrier, you will be required to meet the entire deductible in the month of December before certain benefits are covered. On 1/1/18, that deductible will reset, and you will be responsible for satisfying the entire deductible before certain benefits are covered. The above rationale applies to Out-of-Pocket maximums when electing a new medical plan during Open Enrollment.
Kaiser HMO Gold 0/30 Plan with Child Dental (Previously HMO Gold 0/35 Plan)
Kaiser Gold 500/35 Plan with Child Dental (Previously HMO Gold 500/30 Plan)
What are HSAs? • What are HSAs? • A special bank account into which you may contribute pre-tax money to use to pay for your out-of-pocket health insurance expenses, such as deductibles, co-payments and co-insurance for medical, prescription, dental and vision coverage. • No “use-it or lose-it” provision - funds roll over year to year • You may invest the money in your account, if you choose. The same types of investments permitted for an IRA are allowed for an HSA. • Interest and distributions for qualified expenses are tax free (with the exception of state tax in CA, AL, and NJ) • IRS Publication 502 Section 213(d) – www.irs.govfor a full list of qualified expenses • Annual Federal Contribution Limit (2018): • $3,450 – Individual (when only Employee is covered by the medical plan) • $6,900 – Family (when Employee plus dependent(s) are covered by the medical plan) • Additional $1,000 catch-up is allowed for Employee and covered Spouse age 55+
HSA - Eligibility • Account holder must be covered by HSA compatible High Deductible Health Plan. • HSA is an option only to employees electing Anthem Blue Cross Silver PPO with HSA. • Patelco Credit Union administers SPG’s HSAs; newly participating employees will need to complete Patelco HSA application forms. • Account holder cannot have dual (non-HSA compatible) health coverage. • Account holder cannot be eligible for Medicare (including Medicare Part A). • Account holder cannot be claimed as a dependent on someone else’s tax return. • Account holder cannot have a general purpose Health Care Flexible Spending Account (FSA).
Anthem Pharmacy Tiers • All SPG medical plans include prescription coverage comprised of several FDA-approved brand-name and generic drugs. Anthem and Kaiser categorize covered drugs, and the drug’s category determines your cost share (co-pays, co-insurance). The specific medications in each category may vary from Anthem to Kaiser. • Anthem uses a tier system. Several factors determine the placement of a specific medication within a tier such as: • Whether the drug is generic or brand-name • Cost of the drug • Cost of the drug compared to other drugs used for the same treatment • Availability of over-the-counter options • The following tier structure will apply to our Anthem plans as of 12/1/17: • Drugs on the lowest tier have the lowest cost share (what you pay). Drugs on higher tiers will cost you more. • Tier 1a: Lowest cost share. Typically preferred generic drugs that offer the greatest savings compared to other drugs that treat the same conditions. • Tier 1b: Low cost share. Typically preferred generic drugs but have a higher cost than Tier 1a drugs. • Tier 2: Medium cost share. May be preferred brand drugs. May be newer, more expensive generic drugs. • Tier 3: Higher cost share. Generally include non-preferred brand and generic drugs or drugs recently approved by the FDA. There may be drugs available on lower tiers used to treat the same condition. • Tier 4: Highest cost share. Typically specialty drugs (brand and generic) used to treat complex, chronic conditions and may need special handling. May include drugs recently approved by the FDA. There may be drugs available on lower tiers used to treat the same condition.
UNUM Group Life AD & D Insurance Life Insurance and Accidental Death & Dismemberment benefits protect employees’ families in the event of an untimely death or accidental injury.
Flexible Spending Account (FSA) - Ameriflex Flexible Spending Accounts (FSAs) are valuable benefits that allow you to set aside pre-tax earnings to pay for qualified health care and dependent care expenses. If you wish to participate in a Flexible Spending Account, you MUST enroll during Open Enrollment, as your current elections will not carry overto the next year. SPG’s FSA plan year runs January 1 through December 31 • Health Care FSA election: up to $2,650 annually • Dependent Care FSA election: up to $5,000 annually • Enrollment in the FSA(s): SPG’s Employee Portal will guide you through your Open Enrollment options. The amounts in the FSA tabs will be blank. If you wish to participate, you will input your desired annual contribution into the appropriate tab. If you do not wish to participate, you’ll click WAIVE THIS OPTION for each FSA plan you wish to decline. • Please plan carefully! FSA elections are fixed for the year and cannot be changed unless you have a qualifying life event. Unused amounts in your health care or dependent care account(s) at the end of the year will be forfeited. • REMINDER! Most over-the-counter (OTC) medicines are no longer eligible for reimbursement under the Health Care FSA without a prescription from a physician.
Employee Assistance Program (EAP) - MHN • Employees have access to as many telephonic or web-video consultations as needed. You are also entitled to a total of 3 face-to-face clinical consultants (per incident), at no cost. • Clinical Support – An MHN intake representative can refer you to licensed professionals who can help you with the following: • Marriage, relationship and family issues • Problems in the workplace • Domestic violence • Alcohol and drug dependency • Stress, anxiety and sadness • Changes in mood • Grief and loss • Response to traumatic events • Work & Life Services – MHN’s experts can help you with work-life balance. Examples of information and assistance the EAP can provide include: • Childcare and eldercare assistance • Financial Services • Legal Services • Identity Theft Recovery Services • Daily Living Services
Health Care Exchange Options for 2018 The Affordable Care Act (ACA) requires everyone to have medical coverage or face a tax penalty. If you don’t have coverage already and are not participating in an SPG medical plan, you may purchase coverage on your own or through a state exchange. Each state is required to have a competitive exchange for individuals to have an opportunity to purchase health insurance if they choose to do so. On November 1, 2017, the Health Exchanges “opened” to allow individuals to purchase coverage. Newly elected coverage from the health exchange will be effective as of January 1, 2018. If you choose to purchase insurance on the state health exchange and wish to cancel your SPG medical plan, you may drop SPG’s plan during an annual open enrollment period or when you have a qualifying life event. To research options available through the Health Care Exchanges, visit www.healthcare.gov or www.coveredca.com for Covered California.
What You Need to Do… ALL FULL-TIME EMPLOYEES MUST PARTICIPATE IN OPEN ENROLLMENT. SPG provides full-time employees with group life insurance, so at a minimum, full-time employees must confirm their life insurance beneficiary designation(s). • Step 1 – Login to the SPG Employee Portal (the same site where you do your timesheet entry; use the same User Name and Password as you use to complete your timesheets). Go to: My Account > My Benefits > Review/Select Benefits > Open Enrollment Event. • Step 2 – Make your benefit elections for the upcoming Plan Year (12/1/2017 – 11/30/2018). You MUST make these elections between November 1 - November 15, 2017, before 5:00 p.m. PST. • Review the Open Enrollment video available on the SPG Website (Human Resources > Benefit Enrollment) for guidance about changing benefit elections, dependents, etc. • Even if opting out of SPG benefit plans, you must still go into the SPG Employee Portal to “Waive Coverage” for the plans you choose to decline. • Step 3 – If you have questions or need assistance, please contact Camila in Human Resources. IMPORTANT REMINDERS FOR FSA PARTICIPATION! • You MUST affirmatively re-enroll in the FSA plans each and every year you wish to participate. Your FSA elections will NOT roll over!!! All benefit changes (except FSA) will be effective December 1, 2017. FSA changes will be effective January 1, 2018.
Questions? Contact your dedicated account team at SPG’s insurance broker, Brown & Brown (formerly Sitzmann Morris & Lavis). Our Brown & Brown account team is comprised of knowledgeable benefit professionals who are equipped to answer your questions and provide assistance with your benefit concerns. • Benefit Questions • Enrollment Assistance • Claim Issues • Eligibility Issues • ID Cards Charlene Pantaleon (800) 733-3131 ext. 1238 email@example.com Jennifer Hansford (800) 733-3131 ext. 1246 firstname.lastname@example.org