2013 Benefit Open Enrollment. Benefit Overview Medical Anthem continues as our carrier for 7/1/13...
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![Page 1: 2013 Benefit Open Enrollment. Benefit Overview Medical Anthem continues as our carrier for 7/1/13 Choice of Traditional PPO and HDHP No plan design changes.](https://reader036.fdocuments.us/reader036/viewer/2022081603/56649e015503460f94aea74e/html5/thumbnails/1.jpg)
2013 Benefit Open Enrollment
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Benefit Overview
Medical• Anthem continues as our carrier for 7/1/13• Choice of Traditional PPO and HDHP• No plan design changes or contribution increases
Dental• Delta Dental continues as our carrier for 7/1/13• No plan design changes
Vision• Anthem will replace Cigna as our vision carrier
effective 7/1/13• Similar plan design and slight decrease in premiums
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Medical
• Still two medical plan options from which to choose:o Traditional PPO – No plan design changeso High Deductible Health Plan – No plan
design changes
• Find a network provider at www.anthem.com - choose Blue Access PPO
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Blue Access PPOMedical Plan In-Network Out-of-NetworkAnthem Network (www.anthem.com)Deductible – Individual $ 1,000 $ 2,000Deductible – Family $ 3,000 $ 4,000Coinsurance 80% / 20% 60% / 40%
Out-of-Pocket Maximum – Individual (includes deductible) $ 3000 $ 6000
Out-of-Pocket Maximum – Family (includes deductible) $ 6000 $ 12,000
Primary Care Visit Copay $ 25 40% after deductibleSpecialty Care Visit Copay $ 50 40% after deductibleUrgent Care Center Copay $100 Copay 40% after deductiblePreventive Care 100% coverage 40% after deductibleEmergency Room $200 CopayHospital Services 20% after deductible 40% after deductibleOut-Patient Services 20% after deductible 40% after deductibleMaternity Services 20% after deductible 40% after deductibleMental & Nervous Care Inpatient 20% after deductible 40% after deductible Outpatient 20% after deductible 40% after deductibleLifetime Maximum UnlimitedPrescription Drugs RETAIL
Generic $10 40% after deductible Preferred Brand (Tier 2) 30%; $40 max 40% after deductible Non-Preferred Brand (Tier 3) 55%; $55 max 40% after deductible
MAIL ORDER Generic $20 Not covered
Preferred Brand (Tier 2) 30%; $80 max Not covered
Non-Preferred (Tier 3) $55; $110 max Not covered
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Blue Access HDHP/HSA
Medical Plan In-Network Out-of-NetworkAnthem Network (www.anthem.com)Deductible – Individual $2,000 $4,000Deductible – Family (family coverage requires the full family deductible be met before coinsurance applies) $4,000 $8000
Coinsurance 80% / 20% 60% / 40%Out-of-Pocket Maximum – Individual (includes deductible) $4,000 $8,000Out-of-Pocket Maximum – Family (includes deductible) $8,000 $16,000Primary Care Visit Copay 20% after deductible 40% after deductibleSpecialty Care Visit Copay 20% after deductible 40% after deductibleUrgent Care Center Copay 20% after deductiblePreventive Care 100% Coverage 40% after deductibleEmergency Room 20% after deductibleHospital Services 20% after deductible 40% after deductibleOut-Patient Services 20% after deductible 40% after deductibleMaternity Services 20% after deductible 40% after deductibleMental & Nervous Care Inpatient 20% after deductible 40% after deductible Outpatient 20% after deductible 40% after deductibleLifetime Maximum UnlimitedPrescription Drugs RETAIL
Generic 0% after deductible 40% after deductible Preferred (Tier 2) 40% after deductible 40% after deductible Non-Preferred (Tier 3) 50% after deductible 40% after deductible
MAIL ORDER Generic 0% after deductible Not covered Preferred (Tier 2) 40% after deductible Not covered Non-Preferred (Tier 3) 50% after deductible Not covered
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Anthem Plan Highlights
• ALL mammograms paid at 100%
• Eligible smoking cessation medications (ex. Chantix or Wellbutrin) covered under the Anthem Rx plan
• Access to a Worldwide network. Search for providers at www.bluecares.com
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Anthem Website
A demonstration of the Anthem website.
www.anthem.com
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What is an HSA
Tax-advantaged checking account
Allows you to save for future medical expenses or pay current ones
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HSA Eligibility
An HSA can be established by an individual who:
• Is covered under a high deductible health plan (HDHP)
• Is not covered by any other health plan that is not an HDHP
• Is not enrolled for benefits under any part of Medicare
• Is not claimed as a dependent on another person’s tax return
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HSA Features
• Tax Advantages Tax free way to save for current and future
medical expenses. Contributions are pre-tax or tax-deductible up to
annual HSA limits. All earnings and interest are tax free. Qualified withdrawals are tax free. Once reach
age 65, non-medical withdrawals are taxed at your current tax rate, like an IRA.
• HSA is fully Portable.Ability to Accumulate funds – “Use it or Keep it!”.
• HSA funds can be used for items not covered by health plan such as; dental, vision etc. Same as an FSA plan.
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HSA Contributions Options
The HSA can be funded
• In one or more payments
• Payroll deduction will be available for all DePauw University employees
Elections can be stopped, started, changed on a monthly basis
• Contributions can be made by the employee, employer, or any other person on the employee’s behalf.
• Prior to the individual’s federal tax filing date (generally April 15)
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HSA Contribution Maximums
IRS Maximum 2013 contributions
• Self - $3,250
• Family - $6,450
• Catch up contribution - $1,000 for those 55 and older
Note: Maximums include contributions made by DePauw
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HSA University Contributions
DePauw University’s Annual HSA Contribution
Employee $1,000Employee + Dependent(s) $2,000
Note: Employee’s will receive one-fourth of the
University’s contribution each quarter.
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HSA Distributions
Pre-65 HSA owner:• Qualified Distributions will be tax free. Non-
Qualified Distributions will require individual to pay their personal tax rate on purchase and a 20% penalty.
Post-65 HSA owner:• Qualified Distributions will be tax free. Non-
Qualified Distributions will require individual to pay their personal tax rate on purchase (No IRS Penalty)
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Dental
• Carrier: Delta Dental
• Passive PPO plan:o Three levels of providers
• Find a network provider at www.deltadentalin.com
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Dental Plan Design
Dental Benefits Services Deductible Coinsurance
Benefit Maximum
Class I Exams, cleanings, x-rays, sealants, emergency treatment
$50 individual/ $100 family, per calendar
year
100%
$1,250 maximum
per plan year
Class II Minor Restorative – fillings, root canals, extractions, gum disease
80%
Class II TMJ ($750 lifetime maximum per person) 80%
Class III Major Restorative – crowns, bridges, dentures, implants 50%
Class IV Orthodontics – braces (To Age 19) 50%
$1,000 lifetime
maximum
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Delta Dental Premier• negotiated fees• no balance billing• acceptance of processing policies• 186,000 dentist locations
Nonparticipating• no discounts• balance billing
Delta Dental NetworkDelta Dental PPO• significant discounts• no balance billing• acceptance of processing policies• 108,000 dentist locations
Delta Dental Network
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PPO Dentist Premier Dentist Nonparticipating Dentist
Class II payment example for: Filling - Amalgam Restoration/One Surface (assuming any applicable deductible has been met)
Submitted Fee: $120.00
PPO Fee Schedule amount: $68.00
Delta Dental pays 80% of thePPO Fee Schedule amount: $54.40Member pays: $13.60
The PPO dentist cannot charge the $52 difference between the PPO Fee Schedule amount and his/ her fee.
Submitted Fee: $120.00
Maximum Approved Fee: $111.00
Delta Dental pays 80% of the Maximum Approved Fee: $88.80Member pays: $22.20
The Premier dentist cannot charge the $9 difference between the Maximum Approved Fee and his/her fee.
Submitted Fee: $120.00
Nonparticipating Dentist Fee: $92.00
Delta Dental pays 80% of the Nonparticipating Dentist Fee: $73.60Member pays: $46.40
Because the dentist does not participate, you are responsible for the difference between Delta Dental’s payment and his/her fee.
Delta Dental Payment Example
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Delta Dental Monthly Premium Contributions
Enrollment Tier Employee Contribution
Employee Only $10.92
Employee + Spouse/SSPD $21.63
Employee + Child(ren) $29.93
Family $42.86
Dental Rates
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Vision Plan Design
Service FrequencyIn-Network Benefit Out-of-Network
BenefitEye Exam 12 Months $10 Copay Up to $42 Allowance
Lenses 24 MonthsCovered in full after
$10 Copay $42-$80 Allowance
Frames 24 Months $130 Allowance $45 Allowance
Contact Lenses (in lieu of lenses and frames)
24 Months If elective$130 Allowance
If elective$105 Allowance
If necessaryCovered in Full
If Necessary$210 Allowance
To receive greater benefits, utilize a network provider: www.anthem.com.
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Anthem Vision Monthly Premium Contributions
Enrollment Tier Employee Contribution
Employee Only $4.49
Employee + Spouse/SSPD $7.87
Employee + Child(ren) $8.54
Family $13.04
Vision Rates
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• With an FSA plan, you elect to have a certain dollar amount withheld from your paycheck so you can pay for health care and dependent care expenses with pre-tax money.
• Eligible expenses include your unreimbursed medical expenses, including deductibles, co-pays, co-insurance, and childcare expenses!
• “Use it or Lose it Rule” – If you do not use all of your FSA funds they will be forfeited at the end of the plan year.
• If you elect the HDHP then you can enroll in FSA for Dependent Care Only.
Reminder: Over-the-counter medications no longer eligible for reimbursement without a prescription.
2013-2014 FSA Annual Plan Limits:Health Care: $2,500
Dependent Care: $5,000
What is a Flexible Spending Account (FSA)
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• Your FSA debit card can be used at providers offices, hospitals, pharmacies, etc.
• If you receive a bill at home, you can write your debit card number on the bill to make payment like any other credit/debit card.
• If your childcare provider accepts Visa, you can use your debit card for childcare expenses as well
• You can also file claims online, using a smartphone app, or via mail
Important Note: You still need to keep receipts and AdminPro will request them under certain circumstances
FSA Debit Card
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Remember:
• All benefit-eligible employees must elect or waive coverage and assign beneficiaries to life insurance plans no later than May 15, 2013.
• Enrollment will be completed in the ADP portal at https://portal.adp.com.
Employee Action