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Cape Girardeau Public School District No. 63

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

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Cape Girardeau Public School District No. 63

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  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 • 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 • 25% up to $150 • Annual maximum of $2,500

  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 • 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 • 25% up to $150 • Annual maximum of $2,500

  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 Benefits2011 Monthly Premiums BaseBuy-Up QHDHP CostCostCost Employee $ 524.13* $ 646.17 $ 448.38 Spouse $1,153.08 $1,421.55 $ 988.42 Child(ren) $ 995.83 $1,227.72 $ 853.64 Family $1,519.95 $1,873.85 $1,302.92 *District funds $524.13 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 PlanCafeteria 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) 224-4902 • www.anthem.com, 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: www.anthem.com

  26. Base or HSA PlanWhich is Right for You?

  27. Base or HSA PlanWhich is Right for You?

  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 • http://www.capetigers.com • Departments – Business - Benefits • Call us: (573) 335-1867 • Lisa Smith – Benefits • DeRhonda Gosche – Personnel/Benefits • Robin Twiggs - Payroll

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