January 2016 Joffe MediCenter Summary of Benefits Effective January 1, 2016.

January 2016

Joffe MediCenterSummary of BenefitsEffective January 1, 2016

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Agenda

1. Benefits Overview • Medical – Provided through Aetna• Health Savings Accounts – Administered directly with BNY

Mellon, under the brand BenefitWallet• Dental – Provided through Delta Dental• Vision – Provided through EyeMed• Flexible Spending Accounts – Administered by Custom Benefits

Design• Life and Disability – Provided by Lincoln Financial Group

2. Other Programs• Teladoc• EAP• Wellness• Mobile Applications

3. Next Steps• General announcement• Open Enrollment• Instructions

This document contains confidential and proprietary information which may not be reproduced or transmitted without the express written consent of USI.

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Health Care Reform

Health Care Reform – also called Patient Protection and Affordable Care Act or PPACA (ACA) became law in 2010.

Beginning in 2014, ACA requires most individuals to obtain acceptable heath insurance for themselves and their family members or pay a penalty. The penalty for 2016 will be $695 per adult and $347.50 per child, up to a maximum of $2,085 per household OR 2.5% of the household taxable income, whichever is greater.

JMC’s new 2016 benefits plan for full-time associates are affordable and meet at least the minimum value as required under ACA.

Since JMC’s plans for full-time associates are affordable and meet at least the minimum value, JMC’s full-time associates will not be eligible for a subsidy through the healthcare marketplace exchanges.

If your employment status is other than full-time, you would need to obtain coverage through a private broker or through the marketplace exchanges in order to avoid the penalty.

It should be noted, for medical benefits only, ACA requires employers to offer medical benefits to all employees who work 30 or more hours a week over an employer determined look-back period (up to 12 months). JMC uses a 12 month look back.


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Medical Plan Choice

Plan Type

JMC Contribution to HSA1

Deductible (Individual / Family Maximum)

Calendar or Policy Year

Coinsurance

Out-of-Pocket (ded. incl.) (Individual or Family Maximum)

Inpatient & Outpatient Hospital

Primary Care/ Specialist Office Visit

Preventive Services

Emergency Room / Urgent Care

Prescription Drugs

$300 for single coverage $600 for family coverage

$10/$30/$50/$100Deductible then

$10/$35/$60

$250 / $75 copay Deductible, then 100%/0%

Covered in full Covered in full

$30/$60 copayDeductible, then 100%/0%

80/20%, after Deductible 100%, after Deductible

$6,000/$12,000 $6,350/$12,700

80/20% 100/0%

Calendar Calendar

$2,000/$4,000 $3,000/$6,000

None

PPO HDHP

All copays on both plans apply towards the out of pocket maximum as required by healthcare reform.1. HSA replaces the HRA

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HSA vs. HRA

For Those who select the HDHP: JMC Deposits $300 for single, or $600 for all other levels (spouse, children or family coverage) into your HSA Bank Account (Benefit Wallet)

HRA – Use it for covered expenses each year or lose it. It is the company’s account.

HSA – It is your own account and will accumulate in your account if you don’t use it. Rolls over year over year. You can make additional pre-tax contributions. Account earns interest.

Spouses who are eligible for other coverage may participate in our medical plan, however they will pay the full cost of the spousal coverage.


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Preventive Services

One of the biggest changes from ACA was the mandatory coverage of preventative health services.

Preventive visits are grouped into three categories: All adults Women Children

The best resource for finding out what is covered as preventative is: www.healthcare.gov/coverage/preventive-care-benefits/

Some examples of preventative services include: Immunization Vaccines Mammograms (age restrictions can apply) Blood pressure and cholesterol screenings Colonoscopies (age restrictions can apply) Vision screenings for children Contraceptions (exemptions can apply)


http://www.healthcare.gov/coverage/preventive-care-benefits/

http://www.healthcare.gov/coverage/preventive-care-benefits/

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2016 Associate Contribution Rates

Your Current Contributions

Contribution Per Pay Period(26 Pays)

Coverage HRA PPO HDHP

Associate $51.13 $71.54 $35.54

Associate + Spouse/Domestic Partner $147.98 $142.15 $69.69

Associate + Child(ren) $103.82 $127.38 $62.77

Family $200.68 $198.00 $96.92

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Why an Associate Might Consider a HDHP with an HSA

Tax-advantaged Savings – reduces your taxable incomeTax-free GrowthTax-free Distributions for qualified medical expenses (section 213 of

the IRS code) – similar to FSAsFlexibility – You can stop, start or change your contributions quarterlyFree Money – JMC contributes $300 Single / $600 FamilyThe Money is Yours – never lost or forfeited, even if you leave or

retire from the companyEligible Expenses – include Dental, Vision, Long-Term Care, Wellness Important Rule: You cannot have other non-qualified coverage, e.g.,

Medicare, VA Benefits, or a Health FSAYou can have a Dependent Care account and/or a limited use (vision

and dental only) FSA in addition to the HSA.

Preventive Care1 Physical Exam (100%) $ 0

Non-Preventive4 Rx (approx. cost $50)- tier 2-$30 copay $ 1201 Urgent care visit ($75 copay) 751 Physician’s sick visit ($30 copay) 30Total $ 225

Annual Paycheck Premium/Wellness$ 1,860

JMC HSA Funding 0Total Cost $ 2,085

PPO Plan


Non-Preventive4 Rx (approx. cost $50) $ 2001 Urgent care visit 801 Physician’s sick visit 85Total $ 365

Annual Paycheck Premium/Wellness $ 924JMC HSA Funding ($300)Total Cost $ 989HSA Balance $ 0

HDHP Plan

Example – Single Coverage

Examples are for illustrative purposes only. Actual costs for services will vary.

Preventive Care4 Physical Exams (100%) $ 0

Non-Preventive8 Prescriptions (approx cost $50)-tier 2-$30 copay) $ 2402 Urgent care visits ($75 copay) 1503 Physician’s sick visits ($30 copay) 9010 Physical therapy ($60 copay) 600Total $ 1,080

Annual Paycheck Premium $ 5,148JMC HSA Funding 0Total Cost $ 6,228

PPO Plan


Non-Preventive8 Prescriptions (approx. cost $50) $ 4002 Urgent care visits 1603 Physician’s sick visits 25510 Physical therapy 850Total $ 1,665

Annual Paycheck Premium $ 2,520JMC HSA Funding ($600)Total Cost $ 3,585HSA Balance Remaining $ 0

HDHP Plan

Examples are for illustrative purposes only. Actual costs for services will vary.

Example – Family Coverage (Family of 4)


Non-Preventive2 Urgent care visits ($75 copay) 1506 Specialist visits ($60 copay) 360Heart Surgery ($60,000) 5,49020 Prescriptions (approx. cost $50 )-tier 2-$30 copay) $ 0Total $ 6,000*


PPO Plan


Non-Preventive2 Urgent care visits 1606 Specialist visits 900Heart Surgery ($60,000) 1,94020 Prescriptions tier 2 after ded. $35 700

Total $3,700

Annual Paycheck Premium $ 924JMC HSA Funding ($300)Total Cost $ 4,324HSA Balance Remaining $ 0

HDHP Plan

Example – Single Coverage, Catastrophic Claim

* Assumes the single out of pocket is reached on the PPO plan. All copays apply to the out of pocket maximum as required by healthcare reform. Examples are for illustrative purposes only. Actual costs for services will vary.


Non-Preventive12 Prenatal Vitamin Rx $ 100OB/Gyn Office Visit 30Delivery- approx cost $8,000 3,200OB/Gyn Office Vist 30Total $ 3,360


PPO Plan


Non-Preventive12 Prenatal Vitamin Rx $ 100OB/Gyn Office Visit 85Delivery- approx cost $8,000 2,815OB/Gyn Office Visit 30Total $ 3,030


HDHP Plan

Example – Family Coverage, Pregnancy

* All copays apply to the out of pocket maximum except for prescription copays as required by healthcare reform. Examples are for illustrative purposes only. Actual costs for services will vary.

First the deductible$9000 bill, you pay $4000 $ 4000

Then co-insurance$5000 balance, you pay 20% $ 1000Insurance pays 80% ($4000)Total $ 5,000


PPO PlanFirst the deductible$9000 bill, you pay $6000 $ 6000



HDHP Plan

Example – Family Coverage, Pregnancy


Labor and Delivery - $9000

First the deductible$4000 bill, you pay $250 copay $ 250

Then remaining balance$3750 balance, you paid copay $ 0Insurance pays balance ($3750)Total $ 250


PPO PlanFirst the deductible$4000 bill, you pay $3000 $ 3000



HDHP Plan

Example – Family Coverage, ER Trip


ER Trip- $4000

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HSA Bank Account

HSA Bank Accounts are established with Benefit Wallet. No monthly fees as long as HSA statements are viewed online and paper is

“turned off.” Includes a convenient Debit Card. You will earn interest on your account balance. Once HSA balance reaches $1,000, funds can be invested online (monthly fee

applies). This is YOUR account. JMC only deposits money (your payroll contributions and

JMC’s contribution of $300 or $600). The annual maximum contribution for 2015 is $3,350 for an individual or $6,750

for a family. This includes the funding from JMC. Keep receipts. The IRS will request copies if you are audited. You are responsible

for maintaining records. Tax forms will be provided by Benefit Wallet. Distributions that cannot be substantiated are taxable as ordinary income and are

subject to a 20% excise tax. HSA Funds are to be used solely your qualifying expenses and for tax dependents

covered under the plan. Domestic partners do not qualify.

Coverage Type Network Non-NetworkPreventive (2 visits/yr) 100% 100%Basic Restorative 90% after Deductible 80% after DeductibleMajor Restorative 60% after Deductible 50% after DeductibleDeductible $25 Single / $75 Family $25 Single / $75 FamilyAnnual Max Per Person $1,000 $1,000Child Ortho 50% after Deductible 50% after DeductibleOrtho Lifetime Max Per Person $1,000 $1,000

Dental Plan – Delta Dental

Dental Rates 2016 Per Pay CostSingle $9.69Associate + Spouse $20.31Associate + Child(ren) $20.31Family $33.69

Dental Plan – Delta Dental

www.toolkitsonline.com– Delta Dental

Mobile App– Delta Dental

Coverage Type Network Non-NetworkEye Exam $10 Copay $30 AllowanceFrames $130 Allowance, 20% off

balance$65 Allowance

Single/Bifocal/Lenticular Lenses

$25 Copay $25, $40, $60 Allowance

Contacts $150 allowance, 15% off balance

$120 Allowance

Frequency Every 12 Months for examsEvery 12 Months for lensesEvery 24 Months for frames

Every 12 Months for examsEvery 12 Months for lensesEvery 24 Months for frames

Vision Plan– EyeMed

Vision Rates 2016 Per Pay CostAssociate $1.38Associate + Spouse $3.23Associate + Child(ren) $2.31Family $4.62

• JMC allows you to elect up to $2,550 to be contributed on a pre-tax basis via payroll deductions throughout the plan year into a Flexible Spending Account (FSA).

• FSA funds are best used to pay for predictable out-of-pocket expenses, because any funds contributed that are not used by the end of the plan year are forfeited under the IRS “Use It or Lose It Rule”.

• These funds can be used for all IRS-eligible expenses including health plan deductible expenses, dental, vision, and much more. An extensive list of eligible expenses can be found at: https://www.wageworks.com/employees/benefits/healthcare-flexible-spending-accounts-fsa/fsa-eligible-expenses.aspx

• An HSA cannot be combined with a healthcare FSA account. Associates with an HSA are eligible for a limited purpose FSA account. Limited purpose FSA accounts can be used for dental and vision expenses.

Flexible Spending Account – Custom Design Benefits

https://www.wageworks.com/employees/benefits/healthcare-flexible-spending-accounts-fsa/fsa-eligible-expenses.aspx

https://www.wageworks.com/employees/benefits/healthcare-flexible-spending-accounts-fsa/fsa-eligible-expenses.aspx

• JMC allows you the option to contribute money on a pre-tax basis via payroll deductions through the plan year into a Dependent Care Account.

• The maximum contribution per household is $5,000 if you are single or you are married and filing a joint tax return, or $2,500 if you are married filing separate tax returns (per IRS guidelines).

Dependent Care Account – Custom Design Benefits

• Basic Life (employer paid)– Life Insurance

• 1x salary up to $50,000 of coverage per Associate– Accidental Death and Dismemberment Insurance

• 1x salary up to $50,000 of coverage per Associate• Partial benefits available for loss of limb or eye sight

• Supplemental Life (associate paid) can be purchased– Supplemental life insurance may be purchased in increments of

$10,000 to a maximum of $300,000• Short Term Disability (employer paid)

– 60% of monthly lost income up to $1,000 a week– 7 day waiting period– 12 week benefit duration

• Long Term Disability (50% associate paid)– 60% of monthly salary up to $10,000 a month– 90 day waiting period– Benefit paid until Social Security Normal Retirement Age

Life Insurance & Disability Insurance – Lincoln Financial Group

• Rates

Life Insurance & Disability Insurance – Lincoln Financial Group

Life and additional AD&D (Age bands)

Rate per $1,000 annual

Rate per $1,000 per pay

Under 25 $0.48 $0.01825-29 $0.48 $0.01830-34 $0.60 $0.02335-39 $0.84 $0.03240-44 $1.20 $0.04645-49 $2.04 $0.07850-54 $3.24 $0.12555-59 $5.64 $0.21760-64 $9.00 $0.34665-69 $16.68 $0.64270-74 $36.00 $1.38575+ $37.80 $1.454AD&D $0.24 $0.009Child Life $0.24 $0.009

2. Other Programs

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Employee Assistance Program (EAP)

• Available beginning on January 1, 2016• Employee Assistance Program (EAP) – 3

sessions, per issue, per year Confidential counseling and referral service

• Worklife services Resources and referral service on a variety of

life balance topics• Legal services• Financial services• Identity theft resolution consultation

services

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EAP Benefit Features

• Cost-free benefit • Confidential• National provider network• Covers you, anyone in your household

and dependents up to age 26• Unlimited telephonic consultations,

24/7• Services offered through the

Organizational Risk Management Center (Management Program)

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Reasons to consider calling EAP

Psychological

Stress

Drug or alcohol issues

Marital/relationship

Career/job issues

Grief and loss

Family issues

Retirement

Financial consultation

Legal consultation

Member orientation

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EAP Worklife Services by telephone

• Resource and referral service by phone, such as child care, elder care, education planning, pet care, household needs

• Worklife counselor will research and pre-screen options

• Worklife counselor will provide referrals, resources and educational materials that address your specific needs

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EAP Financial services

• Budgeting• Debt • Retirement • College funding• Buying vs. leasing• Mortgages/refinancing • Financial planning• Tax questions and tax preparation• IRS matters

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EAP ID theft resolution consultation services

• Free telephone consultation with a certified fraud resolution specialist (per each new issue)

• Specialist assists you with ID theft breaches and identity restoration

• Free “emergency response kit” provided upon identity breach (sent by e-mail, mail, or fax)

• Counseling on “preventive steps” to take to avoid future ID theft losses and damages to your credit score and reputation

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EAP Website

• Addictions• Personal and emotional issues• Martial/relationships• Family• Legal/financial• Health and wellness• Personal growth• Informative webinars• Workplace Information

Self-assessments, information and links to other websites for:

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Employee Assistance Program (EAP)

Login Information for 2016 access will be provided to Associates in

December.

EAP Member Choice for EAP Access

Member choose the way they want to connect with us:

• Counseling over video-conference or phone

• Worklife support over the phone

• Counseling face-to-face

• Access to resources and information via our website

• LifeMart discount center

• Tool to track one’s mood, promote well-being or email a service request via our mobile app

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All material proprietary and confidential. Presented by Teladoc, Inc.

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Teladoc® is a national network of U.S. board-certified doctors available on-demand 24/7/365 to diagnose, treat and prescribe medication, if necessary, for many of your medical issues. It's

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Talk to a anytime

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• In 2016, we will hold a wellness event, both in person and virtually, which will help people take charge of their own health and wellness.

• The Wellness Program can include: – Free biometric screenings– Online health assessments– Regular communications– Wellness coaching– Outreach programs

• There are rewards for employees from this program• We anticipate this to be a spring event

Aetna Healthy Commitments Wellness Program

3. Next Steps

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2015 Open Enrollment Process`

During this enrollment, it will be a paper enrollment Paper forms will go out allowing employees to elect their desired benefits and

coverage.

Enrollment will be open from: November 16, 2015 to November 30, 2016.

If an HDHP is elected, the employee must open an HSA bank account with Benefit Wallet/BNY Mellon Instructions are sent from Lisa Ruehrwein

For questions, call Alice Blaney. If Alice is not available, call Jenn Newton Alice Blaney: [email protected] OR 513-577-8223 Jenn Newton: [email protected] OR 513-354-5822

mailto:[email protected]



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2016 Open Enrollment Process

2016 Benefits are effective

Open Enrollment Ends midnight EST

Open Enrollment Begins 9amEST

Summary Communication(4th) and Open Enrollment Meeting (11th)

Dec 15-31st Nov 30th Jan 1, 2016Nov 4th and Nov 11th

Will be mailed to home address

Delivery of new ID cards

Nov 16th

January 2016 Joffe MediCenter Summary of Benefits Effective January 1, 2016.

Documents

Transcript of January 2016 Joffe MediCenter Summary of Benefits Effective January 1, 2016.