1 / 19

Open Enrollment

Open Enrollment. 2013-2014 Employee Benefits. November 7 th , 2013. Medical Insurance. Plan Choices Blue Shield HMO Premier 35 Plan (CA Only) Blue Shield PPO 1000 Value Plan Blue Shield Base PPO 40 Blue Shield Simple Saving 3500/7000 PPO-HSA (PPO Health Savings Account)

york
Télécharger la présentation

Open Enrollment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Open Enrollment 2013-2014 Employee Benefits November 7th , 2013

  2. Medical Insurance • Plan Choices • Blue Shield HMO Premier 35 Plan (CA Only) • Blue Shield PPO 1000 Value Plan • Blue Shield Base PPO 40 • Blue Shield Simple Saving 3500/7000 PPO-HSA (PPO Health Savings Account) • Kaiser HMO $30/$3,000 HSA Plan (CA Only) • Kaiser HMO $40/$3,000 (CA Only) • Employee’s Share of Premium • Varies by plan • Dependent Coverage to age 26 • Available on all medical plans • Refer to contribution rate sheet for premium amount

  3. Blue Shield (CA Only)Access + HMO Premier 35 Plan • Plan Highlights • No annual deductible • $35 co-pay for PCP office visits • No charge for professional services, lab, x-ray • Emergency room: $100 co-pay (waived if admitted) • Hospital: $350/ day - 3 day maximum per admission • Annual out-of-pocket maximum: $3,500 individual / $7,000 family • Prescriptions • $10 Generic/ $30 formulary , $50 Non formulary • Primary Care Physician Assignment is mandatory • No charge or copay for Preventive Care • Employee Share of Premium • $155 per month, pre-tax • Dependent coverage available at additional employee paid premiums * Refer to summary of benefits for plan details

  4. Blue ShieldPPO 1000 Value Plan • Plan Highlights • Annual deductible: $1,000 per member • $20 co-pay for initial 3 in-network office visits (calendar year) • 30% coinsurance in-network • 50% coinsurance out-of-network • $5,000 annual out-of-pocket maximum per member (in-network) • $250 brand-name drug deductible • 2-tier prescription co-pays: $15 / $30 or 30% • Non-formulary not covered • No charge or copay for Preventive Care • Employee Share of Premium • $110 per month, pre-tax • Dependent coverage available at additional employee paid premiums * Refer to summary of benefits for plan details * Refer to summary of benefits for plan details

  5. Blue Shield Base PPO 40 • Plan Highlights • Annual deductible: $4,000 individual / $8,000 family • $40co-pay for all office visits (deductible does not apply) • 40% coinsurance in-network • 50% coinsurance out-of-network • $6,000 / $12,000 annual out-of-pocket maximum (in-network) • $300 brand-name drug deductible • 3-tier prescription co-pays: $10 / $30/ $50 • No charge or copay for Preventive Care • Not H.S.A. compatible • Employee Share of Premium • $85 per month, pre-tax • Dependent coverage available at additional employee paid premiums * Refer to summary of benefits for plan details

  6. Blue ShieldSS 3500/7000 PPO-HSA Plan • Plan Highlights • Annual deductible in-network: $3,500 individual / $7,000 family • Preventive care not subject to deductible – No charge or copay • Deductible applies to all other covered benefits • 20% co-insurance in-network after deductible • 50% co-insurance out-of-network after deductible • Annual out-of-pocket maximum: $4,500 individual / $9,000 family • After deductible - 3-tier Prescription co-pays: • $10 / $30 / $50 • Employee Share of Premium • $100 per month, pre-tax • Dependent coverage available at additional employee paid premiums * Refer to summary of benefits for plan details

  7. Kaiser Permanente$30 / $3,000 HSA Plan (CA Only) • Plan Highlights • Annual deductible: $3,000 individual / $6,000 family • Preventive care not subject to deductible – No charge or copay • Deductible applies to all other covered benefits • $30 office visit copay after deductible • 30% for most major medical after deductible • Annual out-of-pocket maximum: $5,950 individual / $11,900 family • After deductible - 2-tier prescription co-pays: • $10 / $30; non-formulary not covered • Must obtain all services at a Kaiser facility • Employee Share of Premium • $90per month, pre-tax • Dependent coverage available at additional employee paid premiums * Refer to summary of benefits for plan details

  8. Kaiser Permanente $40/$3000 (Not HSA Eligible) • Plan Highlights • Annual deductible: $3,000 individual / $6,000 family • Preventive care not subject to deductible – No charge or copay • Deductible is waived for office visits and prescriptions • $40 office visit copay • 30% for most major medical after deductible • Annual out-of-pocket maximum: $6,000 individual / $12,000 family • After deductible - 2-tier prescription co-pays: • $10 / $35; non-formulary not covered • Must obtain all services at a Kaiser facility • Employee Share of Premium • $95 per month, pre-tax • Dependent coverage available at additional employee paid premiums

  9. HSA Overview • Also known as a “Medical IRA” • Provides vehicle for employees to set aside pre-tax funds (outside of plan premiums) for payment of medical expenses • No time limitation for use of funds • Funds accrue and accumulate (roll-over) year to year • Funds are FDIC insured and accrue interest • Investment options are available • Contributions are made pre-tax from payroll • Interest and distributions for qualified expenses are tax-free* • Use tax-free* funds to pay for medical expenses(and non-covered dental and vision expenses) * Federal Tax-free only – CA state taxes still apply Note: Government regulations prevent HSA participants from having dual-coverage (i.e. participants are not eligible to also be covered under their spouse’s plan)

  10. HSA Logistics • Self-Managed Health Care • Responsible for payment of all medical bills, including prescriptions up to the plan deductible • Once deductible is met, “traditional” aspect of plan takes affect with respective in-network or out-of-network co-insurance • Contributions • aap3 contributes $20 per month to participant’s HSA account • You may contribute up to the IRS allowable amount less the company contributed amount each calendar year: • $3,300 individual maximum / $6,550 family maximum for 2014 • You can change your contribution election any given month • HSA Account • May never “withdraw” (reimburse) more than what is in the account at the time of reimbursement • Visa Debit Card vs. Paper reimbursement request

  11. Co-Insurance based on In-Network or Out-of-Network Services 100% Annual Deductible Pre-Annual Deductible Insured pays 100% of negotiated costs from H.S.A. (Except preventative care and wellness benefits) 0% How Does theHSA Work?

  12. GuardianPPO Dental Plan • Plan Highlights: • 100% paid for preventive services • 80% paid for basic services • 50% paid for major services • $50 deductible (waived for preventive care) • $2,000 annual benefit maximum per person • $1,500 lifetime orthodontia benefit • Employee Share of Premium • $20 per month, pre-tax • Dependent coverage available at additional employee paid premiums * Refer to summary of benefits for plan details

  13. Guardian – VSP 12/24 Vision Care Plan • Plan Highlights: • Exam & lenses available every 12 months • Frames available every 24 months • $10 co-pay – exams • $25 co-pay – glasses or lenses • Employee Share of Premium • $5 per month, pre-tax • Dependent coverage available at additional employee paid premiums • Guardian vision enrollment will match current enrollment unless new vision enrollment form is submitted * Refer to summary of benefits for plan details

  14. GuardianEmployee Assistance Program • Available to all employees • Access to licensed counselors for: • 3 face to face sessions with a counselor free of charge • Licensed counselors available by phone 24/7 • Masters level counselors • Unlimited telephone calls for counseling • Online assessments (health / wellness / stress)

  15. GuardianDisability & Life • Short-Term Disability • Benefit is 60% of weekly salary • Maximum benefit is $1,500 /wk • Benefit is offset by state disability or other earnings • 8 day elimination period • Benefit duration is 12 weeks • Long-Term Disability • Benefit is 67% of monthly salary • Maximum benefit is $8,000/mo • Elimination period is 91 days • Own Occupation for life of benefit • Benefit is offset by state disability or other earnings • Life Insurance Benefit • Flat $50,000 • AD&D $50,000 • Conversion privileges included • Living benefits option

  16. Timing, Paperwork & Contacts Benefits Program 2013

  17. Making Changes? • All new members must complete an Enrollment Application • Employees electing a new plan or changing dependent status must complete the Subscriber Change Request Form • Vision/ Dental plan paperwork only needed for changes in election/decline • Complete and submit all forms to aap3 HR by 12:00pm Noon (PST) on: Thursday, November 21, 2013 • Fax: 1-408-886-9424 • Email: hrus@aap3.com • Benefits Plan premium contribution rates will reflect in the December 2013 payroll cycle

  18. Who to Contact About Benefits? • Overall Benefit Program or Benefit Plan Questions • aap3 HR (HRUS@aap3.com) • Individual Specific Insurance Plan & Coverage Questions • Bedrosian & Associates • Alex Bedrosian , Acct Mgr(650) 367-0259alex@bedrosian-associates.com • Forms & Insurance Plan Information • aap3 HR • Primary Plan Provider Websites: • Blue Shield (Medical) • www.blueshield.com / www.blueshieldca.com • Kaiser (Medical) • www.kaiserpermanente.org • HSA Bank (HSA) • www.hsabank.com • Guardian (Dental, EAP, Disability & Life) • www.guardian life.com • VSP (Vision) • www.vsp.com

  19. Any Questions? 2013 - 2014 Benefit Plans – Open Enrollment November 7th , 2013

More Related