Employee Health Care Plan 2010 Meetings. © Butler Benefit Service, Inc. Today’s Presentation...

Employee Health Care Plan 2010 Meetings

© Butler Benefit Service, Inc.

Today’s Presentation

• Introduction to Butler Benefit Service, Inc. and Quad City Community Healthcare

• Medical and Prescription Drug Plan

• Flexible Spending Account• Butler Information Network• Questions


Self Funding Augustana College Health Plan

• Augustana College is its own “insurance company”

• $$$ spent on claims affect everyone on the health plan as well as the employer

• Insurance purchased for larger catastrophic claims

• Being a good consumer helps to keep costs low and benefits intact


What does Butler Benefit Service, Inc.do for you?

• Answer your questions• Receive and process claims• Release payments when approved• Review claims• Provide online access to your claims

information

Customer service is our priority!


• Quad City Community Healthcare is a Health Plan that offers a network of providers

• They coordinate and review utilization of your health care resources.

• Case Management is offered for catastrophic illnesses and injuries.

WWW.qcchealth.com

http://www.qcchealth.com/


Monthly Premiums Effective 9/1/10

• Medical Premium

– Single • $40

– Employee + Spouse• $425

– Employee + Child• $425

– Family• $600

• If you have single coverage, you may now waive coverage.

– Think carefully about waiving if you do not have any other coverage – you never know when an accident may occur

– Great option for those covered under another plan such as your spouse


Medical Benefit Summary

In Network Out of Network

Deductible DeductibleSingle $1,000 Single $2,000

Family $2,000 Family $4,000

Out of Pocket Out of NetworkSingle $1,500 Single $2,500

Family $3,000 Family $5,000

Deductible and out of pocket met to date in 2010 by Blue Cross Blue Shield of Illinois will be carried over to your new Health Plan.


Medical Benefit Summary

In Network Out of Network

Coinsurance Coinsurance80% 50%

Specialty Medication

10% coinsurance up to the out of pocket


Preventative Benefit

Children up to age 16$1,000 Annual Limit

$20 co-pay

Adults$600 Annual Limit$20 co-pay

Make sure you inform your physician at the time of service to file the claim as

preventative.


Mail Order Prescription Program • Available to all Health Plan members• Order a 3 month supply• Mail order is easy, convenient, and

saves you money• Best for drugs you take regularly

Prescription Drug Benefit Summary

Retail Pharmacy – per 34 day supply (90 day available)• Generic Drugs - $10 co-pay • Preferred Drugs - $30 co-pay• Non Preferred Drugs – $50 co-pay

Maintenance Prescription Drugs- Mail Order

Per 90 day supply Generic Drugs - $20 co-pay Preferred Drugs - $60 co-pay Non Preferred Drugs – $100 co-pay


Over The Counter Medication

• Over-the-counter Prilosec, Zantac, Claritin, Zyrtec, and their generic equivalents, with a physician prescription only: $10 Co-Pay

SAVES YOU MONEY!


Saving Money on Rxs

• Pill Splitting – Look for Rx’s in Bold– Lipitor – 10, 20, 40, & 80 mg doses– If you take 20mg per day, ask your doctor about a

40mg Rx that you can split in half– Ask about a Butler pill splitter– Pill Splitting saves you and the Plan money


Network of Providers

www.qcchealth.comor

Call 1-888-498-7224

To Find out if a provider is in the network:

http://www.qcchealth.com/


Network of Providers

Radiology Group will be paid in network if your x-rays are sent to the facility from a network provider. If you

physically go to the facility the service will be considered out of network.

Emergency treatment out of network will be paid at the network benefit.

You will need a referral from your primary network physician for University of Iowa and Mayo Clinic.


When do I pre-certify?

• Consult the Summary Plan Description for all pre-certification requirements. When in doubt, call Quad

City Community Healthcare.

If inpatient admissions are not pre-certified with Quad City Community Healthcare, benefits payable will be reduced by $300 per Covered

Individual per incident. The reduction in benefits does not apply to the Annual deductible or out of pocket.

- All non-emergency inpatient admissions must be pre-certified prior to the service; emergency inpatient admissions must be reported within 2 business days of admission

Most physicians will take care of this for you. It is still your responsibility to make sure you have pre-certified.


Identification Card

Throw your current BCBS of IL ID card away on September 1 and start using your new Augustana College ID card. Make sure to present to all providers and pharmacies.


ID card (Back)

To Pre-Certify services, call Quad City Community Healthcare


HIPAA Privacy Rights

– HR and BBSI will ask verifying questions

– Where issues of PHI are discussed– Written consent for release of PHI

(child 18 and older, or divorcee) “Designation of Authorized Representative”

– Request for explanation of use of PHI must be done in writing and response returned in writing

– Notice of Privacy Practices is in the Summary Plan Description


Section 125 of the IRS Tax Code allows Pre-Tax payroll deductions for:

• Certain insurance premiums• Health care expenses

– Medical, dental and vision– Up to $4,000 per year, with a

minimum of $100 per year.• Dependent care expenses

– up to $5,000 per year ($2,500 if married filing separately)

Flexible Spending Account


Would you like an extra paycheck?By setting aside healthcare funds pre-tax, you can

increase your savings and

ultimately your spending power.

Here is an example of the tax savings you could enjoy by taking advantage of

your Flex Plan.

Flexible Spending Account


How It Works

• An FSA is an account your employer sets up so you can pay for a variety of healthcare needs such as insurance co-pays, deductibles, and even dental and vision-care costs. But here’s the best part: Your FSA is funded entirely by your pre-tax income.

• You decide the amount to pledge into your FSA account.

• Although your FSA will be deducted through your payroll, you’ll have access to your entire Health FSA election on the first day of your plan year. That means you can cover all your healthcare costs without waiting to accumulate funds throughout the year.


How It Works

• The IRS generally only allows expenses that have already been incurred – pre-paid services (such as maternity) may not be reimbursed until the service is provided – ask for itemized bill from the healthcare provider and submit with receipts.

• For Dependent Care FSA the money must be in the account in order to receive reimbursement.


Grace Period

• Expenses incurred from September 1, 2010 through October 15, 2011 are eligible. (2 ½ extra months to incur claims)

• Submit claims for reimbursement up to November 30, 2011.

• Claims are processed in order received; will not be re-processed to take advantage of grace period


Introducing . . .

The Benefits Card makes using your FSAdollars simple and easy!


Not all

FSAs

are created equal.

MasterCard® is a registered trademark of MasterCard International Incorporated.

Yours can be accessed via the Benefits Card MasterCard®, provided by your employer.

Benefits Debit Card


Benefits Debit Card

• The Card deducts each payment directly from your FSA account. So it’s as convenient as using an ordinary credit card.

• The Benefits Card virtually eliminates the paperwork and reimbursement wait time that used to make FSAs so complex and cumbersome. All you have to do is save receipts for all your FSA purchases in the event they are requested by your Plan Administrator.

• For optimal convenience, your Benefits Card offers 24/7 online access, so you can check your account balance and other vital information with a single click.


You can request an extra card for a dependent to use.

• Provide the dependent’s full name, date of birth and Social Security Number on the election form.

Benefits Debit Card


• First, its use is limited to specific merchants based on the benefit account you have selected, and to expenses deemed eligible by your Benefit Plan.

• Second, you cannot use it at an ATM, or to obtain “cash back” when making a purchase.

• Third, you are not given a PIN with this card. Should a merchant or provider ask you for a PIN, just explain that this particular card does not have one. When given the option between debit and credit at the terminal, choose “CREDIT.”

In most ways, your card works just like any debit card. There are three important differences:


Save your receipts!

• You may be asked to submit them if questions arise about your claims.

• It enables you to track what you spent on healthcare and/or dependent care for the year, which can help you plan for next year’s FSA contributions .

• The IRS requires that you save all of your itemized receipts for expenses paid for by your FSA Accounts.


Eligible Services and Products

• Basically the same items as paper claims: deductibles, co-pays, coinsurance and other items not paid by your insurance

• IIAS: Inventory information approval system (some eligible items may not be on list)


Where Can I Use the Card?

• Approved Merchant Category Code (MCC): Medical Care Providers– Physician, Dentist– Vision care office– Hospital

• Other merchants that use IIAS– Drug stores and pharmacies– Discount stores


When the Card should NOT work:

• Ineligible items, such as cookies, gasoline, clothing, etc.

• Non-medical care provider without IIAS• Dual purpose items (submit paper claims)


IRS Rules for ImproperCard Payments

• Card will be deactivated• Letter demanding repayment will

be sent to the employee• Withhold from employee’s wages• Claims substitution• Treat as any other business

indebtedness


You are not required to use the Benefits Card,

paper claim to receive reimbursement for those expenses.

but if you don’t use it to pay for FSA-eligible expenses, you must submit a

Benefits Debit Card


Filing a Paper Claim

• Claim form included in your SPD• Claims processed weekly• Submit EOB or itemized

statements to BBSI• Claims received at least 4 days

before scheduled processing date will be processed and mailed in same cycle


FSA Paper Claim Form


Use it or Lose it

How Do I Decide How Much to Contribute?It's important to give some thought to calculating

how much money to contribute for the year, because if you put in more money than you need, by law, you lose it. You have three months after the end of the year to submit claims for eligible expenses incurred during the previous calendar year . To determine how much to contribute, make a list of the expected out-of-pocket medical expenses for you and your dependents for the next year. Be conservative so you don't risk forfeiting any money.

Consider this:Let’s assume you are taxed 15% on your salary,

and you elect to put $1,000 into your flex account. You automatically save $150 by doing so because you haven’t been taxed on $1,000. Even if you only spend $900, you’re still ahead by $50.


You have online access to your health insurance information through theButler Information Network (BIN).

• Explanation of Benefits, including the option of Electronic EOBs

• Claim History, with claim status

• Summary Plan Description in Electronic format

• Links to PPO website and other important links

• Secure Correspondence to BBSI

• Verification of Benefits

Butler Information Network (BIN)


Go to www.bbsionline.com and follow the instructions to “Register New User”

http://www.bbsionline.com/


Claims Information


Document Library


• Each time claims are processed, an email will be sent notifying you of a new EOB, which can be accessed via the BIN

• EOBs are in the Adobe .pdf format - you can print these, or save them to your home computer

Electronic EOB (EEOB) option


Questions?

Employee Health Care Plan 2010 Meetings. © Butler Benefit Service, Inc. Today’s Presentation...

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Transcript of Employee Health Care Plan 2010 Meetings. © Butler Benefit Service, Inc. Today’s Presentation...