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2012 Employee Benefits
2012 Open
p Enrollment
Kelly Miller
Benefits & rates will be effective 1/1/12-12/31/12
Opening Comments
• Cretcher Heartland…your advocate
• What is Open Enrollment?
• 2012 Benefits: GREAT NEWS!
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Medical: Blue Cross Blue Shield of Kansas City
Dental: Delta Dental
Vision: Assurant/VSP
Life: Assurant
NEW BENEFITS:
BENEFITS
• Voluntary Life: Assurant
• Voluntary Long Term Disability: Assurant
– Flexible Spending Account: TASC
• New Rates for 2012
• Checklist for 2012 Open Enrollment
• What do we do for Pinnacle Career Institute?
• Your Service Team & Your Advocate
with the Insurance Carriers!
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Erin
E
i Logan
L
Martha Bennett
Kelly Miller
Randy Sinclair
• Welcome Letter & 2012 Benefit Packet
• Claim Issue Report
Claim Issue Report
What is Open Enrollment?
• DECISION TIME for 2012
– Opportunity to select benefits for 2012
– Opportunity
pp
y to change
g enrollment status
• Qualifying Event – notify HR within 31 days
•
•
•
•
•
Birth/Adoption
p
Death
Divorce
Marriage
Gain or Loss of Group Benefits: Employee, Spouse or Children
• It is
i th
the responsibility
ibilit off th
the EMPLOYEE tto notify
tif HR
of any Qualifying Event within 31 days. If you notify
HR after
ft 31 days,
d
your benefits
b fit will
ill be
b effective
ff ti
January 1, 2013.
MEDICAL
Bl e Cross Bl
Blue
Blue
e Shield of Kansas City
Cit
Dependent Eligibility: Until the end of
the calendar year child turns 26
Travel with Your PPO Health Plans
As a Blue Cross Blue Shield PPO Member,
you can take your healthcare benefits with
you across the country and around the world.
world
The BlueCard PPO Program gives you access to
over 6,000 hospitals and 800,000 physicians
around the country, giving you the peace of mind
that you can take charge of your health, wherever
you are.
Visit www.bluekc.com click for all other plans and locations, click
BlueCard Provider Directory, click Continue. Login using the ID
number on the front of your BCBSKC ID Card.
Or call (800) 810-BLUE (2583) to receive a complete list of
network hospitals and physicians.
www bluekc com
www.bluekc.com
View Your Own Claims,
Print a Temporary ID
card & Find Rx Info
Earn up to $250 through
A Healthier You per
calendar year!
Points to Blue
Learn about Value Added
Services detailed in your
packet: Prenatal,
Alternative, Nurse Line
Networks: KC Metro
Preferred Care Blue PPO Network
Preferred Care Blue PPO Plans
50 Metro-Area Hospitals
and 4,000 Physicians Including:
Centerpoint Medical Center
Children’s Mercy Hospitals
KU Medical Center
Lee’s Summit Hospital
Menorah Medical Center
N h Kansas
North
K
Ci
City
Olathe Medical Center
Overland Park Regional
Providence Medical Center
Research Medical Center
Shawnee Mission Medical
Center
Saint Luke’s Hospitals
St. Joseph Medical Center, St. Mary’s, Liberty
and Truman Hospitals ARE NOT in the PPO
network
www.bcbs.com
(Outside KC Metro & Worldwide)
Prefix on ID Card: YBC
Preferred Care Blue - PPO
In-Network
Out-of-Network
Office Visit
$35 Copay
Deductible + 20% of R&C
Deductible: Individual
$2,000
Deductible: Family
$4,000
Coinsurance
100% / 0%
80% / 20% of R&C
Out of Pocket: Individual
$2,000
$4,000 of R&C
Out of Pocket: Family
$4,000
$8,000 of R&C
Covered at 100%
Deductible + 20% of R&C
$35 Copay
Deductible + 20% of R&C
Preventive Care
Urgent Care
E
Emergency
Room
R
$150 C
Copay + D
Deductible
d ibl
Hospital: Inpatient or
Outpatient
Deductible
Deductible + 20% of R&C
Retail Prescriptions
$10/$30/$50
Copay + 50% of R&C
Mail Order Prescriptions
$20/$60/$100
N/A
*Copay includes Office Charge & Lab services in Physician’s office or Independent Lab
R&C: Any amount over the Reasonable & Customary charges will be the member’s responsibility.
BCBSKC Prescription Drug List
-Certain drugs may require pre-authorization, have quantity limitations or
require step therapy before approval. Information listed in PDL.
Tier 1: $10 per month (all generics)
Tier 1: $20 MAIL ORDER
Tier 2: $30 per month
Tier 2: $60 MAIL ORDER
Tier 3: $50 per month
Tier 3: $100 MAIL ORDER
DENTAL
Delta Dental
Dependent Eligibility: Until the end of
the calendar year child turns 25
www.deltadentalmo.com
Delta
Dental PPO
Network for
richest
benefits
Type I – Preventive
PPO
Premier
Out-of-Network
100% (deductible
waived))
100% (deductible
waived))
100% of R&C
Deductible
$50 Individual/$150 Family
Type II – Basic
90%
80%
80% of R&C
Type III – Major
60%
50%
50% of R&C
Annuall Benefit
A
B
fit
Maximum
Late Entrant Waiting
Periods
$1 000*
$1,000*
Anniversary Enrollment Only
*Exams, X-rays, Cleanings and Fluoride do not apply to Annual Benefit Maximum.
R&C: Any amount over the Reasonable & Customary charges will be the member’s responsibility.
VISION
Assurant/VSP: Vision Service Plan
Dependent Eligibility: Until the end of
the month child turns age 26
www vsp com
www.vsp.com
Frequency
In-Network
In
Network
Out-of-Network
Out
of Network
$10 copay
$52 allowance
Routine Eye Exam
12 months
Single Vision Lenses
12 months
$55 allowance
Lined Bifocal Lenses
12 months
$75 allowance
Lined Trifocal Lenses
12 months
Frames
24 months
$25 copay ($130
allowance)
$57 allowance
Contacts & Contact Exam
12 months
No copay ($130
allowance)
ll
)
$105 allowance
$25 copay
$95 allowance
You may choose either lenses or contacts every 12 months.
You will NOT have an ID card for this benefit.
LIFE & AD&D
Assurant
Pinnacle Sponsored
Life and AD&D
Assurant
Benefit*
Life Coverage
$25,000
AD&D Coverage
$25,000
*S bj t tto an age reduction
*Subject
d ti schedule.
h d l
Don t forget to update your beneficiary if you have a
Don’t
Qualifying Event! You can update this at any time
throughout the year by contacting your HR
Department.
VOLUNTARY LIFE
Assurant
Benefit
Increments
Guarantee
Issue^
Maximum
Employee
Coverage
Up to 5
times salary
$10,000
$130,000
$500,000
Spouse
Coverage*
Up to 50%
of employee
$5,000
$50,000
$250,000
Child(ren)
Coverage*+
Up to 50%
of employee
$10,000
$10,000
$10,000
*To purchase Spouse &/or Child(ren) coverage,
coverage you must purchase coverage on yourself.
yourself
^Guarantee Issue is applicable at your initial eligibility.
~Subject to an age reduction schedule.
+Children are covered from Live Birth to age 19, 25 if full-time student.
**MUST MEET GROUP PARTICIPATION REQUIREMENT TO BE OFFERED**
REASONS TO CONSIDER VOLUNTARY LIFE:
1. Guarantee Issue – no medical questions at Open Enrollment
2. Convenience of Payroll Deduction
3. Children Life Rate of $1.82 per month regardless of the number of children covered
4. Portability
VOLUNTARY
Long Term Disability
A
Assurant
t
Elimination Period
Benefit
B
Benefit
fit
90 days
60% of monthly earnings
to a maximum of $5,000
Own Occupation
24 months
Benefit Duration
Later of age 65 or 24 months
Pre-Existing Limitation
See Summary for Details (3/12/12)
REASONS TO CONSIDER VOLUNTARY LTD:
LTD
1. Guarantee Issue – no medical questions at Open Enrollment
2. Convenience of Payroll Deduction
3. Income Protection
4. Group Rates
**MUST MEET GROUP PARTICIPATION REQUIREMENT TO BE OFFERED**
Flexible Spending Account
Flex$ystem
Fl
$ t
a division of TASC
Fl ibl SSpending
Flexible
di A
Account
• What is an FSA? 4 Ways to Save!
– Insurance Premiums from Paycheck
– Non Employer Sponsored Premiums
– Healthcare Expenses: $2,000
– Dependent Care Expenses: $5,000
Healthcare Qualifying Expenses
•
•
•
•
Most Medical, Dental & Vision Expenses
D d tibl C
Deductibles,
Copays & C
Coinsurance
i
p
Drugs
g
Prescription
Glasses, Contacts, Lens Solution, LASIK,
Prescription Sunglasses
• Orthodontia & Dental Expenses
• Over-the-Counter Medications require a
Letter of Medical Necessity”
Necessity in order to be
“Letter
eligible expenses.
Example of Eligible Medical/Related Expenses
(Thi list
(This
li is
i to serve as a reference
f
only.
l It
I is
i not a complete
l
list
li off deductible
d d ibl expenses,
nor is it an item-by-item approved list of expenses by the IRS.)
Acupuncture
Alcoholism
Ambulance hire
Artificial limbs/teeth
Birth control pills
Birth prevention surgery
Braces
Braille – books and magazines
Care for handicapped child
Chiropractors
Christian Science fees
Co-insurance
Communication equipment/deaf
Contact lenses/cleaning solution
Crutches
Deductibles
Dental fees
Dentures
Diagnostic fees
Drug and medical supplies
Education for the blind
Eyeglasses, including exam fee
Healing service fee
Hearing devices and batteries
Home improvements motivated
by medical consideration
Hospital bills/hospitalization
Insulin
Laboratory fees
Lasik eye surgery
Laetrile by prescription
Lead base paint removal for
children with lead poisoning
Membership fee in association
with furnishing medical services,
hospitalization and clinical care
Needed medical supplies,
prescribed by a doctor
Nurses’ fees
Obstetrical expenses
Operations
Orthodontia
Orthopedic shoes
Osteopaths
Over-the-counter drugs for specific
medical condition
Oxygen
Prescribed medications (including
over-the-counter)
Psychiatric care
Psychologist fees
Routine physicals and other nondiagnostic services and treatments
“Seeing Eye” dog and its upkeep
Sterilization fees
Stop Smoking programs
Surgical fees
Therapeutic care for drug/alcohol
addiction
Therapy treatments
Transportation expenses
Tuition at special school for
handicapped
Wheelchair
Wigs (prescribed by a doctor)
X-rays
Dependent Care Qualifying Expenses
• Child daycare for children up to the age of 13
•
Ca e must
Care
ust be necessary
ecessa y for
o tthee eemployee
p oyee &/o
&/or tthee spouse to
work
OR
•
Care must be necessary because the employee/spouse is
physically unable to care for their children.
• Elder
Eld Care
C
if th
thatt individual
i di id l is
i a dependent
d
d t
• IRS limitation is $5,000 per year per household
(($2,500 if married filingg separately).
p
y)
Fl ibl SSpending
Flexible
di A
Account
• What is an FSA?
–
–
–
–
Insurance Premiums from Paycheck
Healthcare Expenses: $2,000
D
Dependent
d
Care
C
Expenses:
E
$5 000
$5,000
Non-Employer Sponsored Premiums
• Advantages
– Tax Savings of $0.25-$0.35 per dollar
– More “Take
Take Home Pay
Pay”
– Flex System Claim Card (Reloaded)
• Disadvantage
– “Use it or Lose it” Rule
– You are unable to change
g y
your FSA amount
during the year unless you have a Qualifying
Event
U It O L
Use-It-Or-Lose-It-Rule
It R l
Money not used by the end of the Plan Year (between
1/1/2012-3/16/2013) to reimburse qualified expenses
incurred duringg the year
y
is lost.
• Precautionary steps to avoid having large
amounts left in the Section 125 Plan at
year-end:
d
– Be conservative. Set aside only dollars you will
actually use.
– Check account balance on-line, via text or phone
p
Flexible Spending Account Guidelines
• You are unable to change your FSA amount during
the year unless you have a Qualifying Event.
Event
• 2012 Plan Year
– Runs from 1/1/2012 – 3/16/2013
– Claims must have a during the 2012 Plan Year
– Can
C reimburse
i b
your claims:
l i
• With the FlexSystem Claim Card
• Paper Claim
• Reimburse by direct deposit – sign up online for
faster reimbursement!!
•
www.tasconline.com
1-800-422-4661
Checklist for 2012 Open Enrollment
• Review your benefit options, rates & your
packet
– New Rate Sheet for 2012
• REQUIRED FORMS
• PCI 2012 Benefit Enrollment Form
• Assurant Enrollment Form/Beneficiary Form
*RETURN FORMS TO HR BY 11/18/2011
Q
QUESTIONS?
Thank You