Beyond the Product 2019 20 Benefits Presented By
“Beyond the Product” 2019 -20 Benefits Presented By: Bernie Lowe & Associates, Inc.
“Beyond the Product” HOW BLA CAN HELP ? CFI’s dedicated service team: Kathryn Polson kpolson@bernielowe. com Chrystal Damm cdamm@bernielowe. com Bernie Lowe & Associates, Inc. , is at your service Hours of Operation: 8: 00 am – 4: 30 pm CST (800) 942 -4718 If you have any questions concerning your employee benefits If you need any assistance in processing, disputing, or understanding a claim If you have a questions concerning provider access and/or directories If you need interpretation of a benefit provision or comparison of plans If you need an ID Card for you, your spouse, or a dependent All other employee benefit inquiries Bernie Lowe & Associates, Inc.
“Beyond the Product” What can YOU do to help? Take your Prescriptions as Prescribed Use Mail Order for Your Prescriptions Take Care of Yourself Get Your Preventative Checkups Use Network Providers Use Generics Review your EOB’s Ask Questions Bernie Lowe & Associates, Inc.
“Beyond the Product” Networks Blue Advantage Alliance Select (Gold & Silver Plans) - Iowa Only Plan Outside of Iowa – Emergency ONLY In-network benefits only Must elect a PCP and/or OB/GYN for preventative care only 100% of the hospitals and approximately 96% of the physicians in Iowa Bernie Lowe & Associates, Inc. (Bronze Plan) - National Plan In-network and out-of-network benefits 100% of the hospitals and approximately 99% of the physicians in Iowa
“Beyond the Product” Designating a PCP Only if you elect a Blue Advantage plan • Designate a PCP at Enrollment • Secondary PCP for Females • OB/GYN • Can Change Any Time (will go into effect the first day of the month after Wellmark receives your request) Bernie Lowe & Associates, Inc.
“Beyond the Product” MEDICAL COMPARISON Benefit Gold In-Network Silver In-Network Bronze HDHP In-Network Blue Advantage Alliance Select Must elect a PCP HSA Compatible $35 co-pay $20 co-pay deductible $200 20% of allowed charge after deductible Deductible Single $3, 000 Family $9, 000 Single $2, 500 Family $5, 000 Single $3, 500 Family $7, 000 Coinsurance Not Applicable 20% Not Applicable Out of Pocket Maximum (Includes Deductible) Single $3, 000 Family $9, 000 Single $5, 000 Family $10, 000 Single $3, 500 Family $7, 000 Lifetime Maximum Unlimited Emergency Room $150 co-pay 20% of allowed charge after deductible Emergency Physician deductible 20% of allowed charge after deductible Inpatient Hospital deductible 20% of allowed charge after deductible Outpatient Hospital deductible 20% of allowed charge after deductible Hearing Aids deductible Not covered Office Visit Other co-pay (CT, PET, MRI, MRA and Nuclear Medicine) Deductible then up to a lifetime max of Infertility Benefits $15, 000 Bernie Lowe & Associates, Inc. 20% of allowed charge after deductible Deductible (limited) This is a brief description only.
“Beyond the Product” Worst Case Scenario SINGLE Gold Silver Bronze Out-of-pocket Maximum $3, 000 $3, 500 Annual (single) Premium $2, 160 $2, 016 $1, 440 Total Annual Out-of. Pocket $5, 160 $7, 016 $4, 940 $5, 000 - FAMILY Gold Silver Bronze Out-of-pocket Maximum $3, 000 x 3 $5, 000 x 2 $3, 500 x 2 Annual (single) Premium $7, 800 $7, 080 $6, 528 Total Annual Out-of. Pocket $16, 800 - - - Bernie Lowe & Associates, Inc. $17, 080 $13, 528 - You have something major that applies to your deductible & out-ofpocket (OPM) Remember co-pays, including Rx co-pays apply to your OPM on Gold & Silver Bonze plan is HSA compatible and you pay 100% of all expenses up to your OPM: including office visits and prescriptions You have something major that applies to your deductible & out-ofpocket (OPM) It would take two or more members of your family to have medical expenses to hit your family OPM on either the Silver or Bronze Plan. It would take three or more members of your family to have medical expenses to hit your family OPM Gold Plan. A single family member’s maximum OPM is the single amount Remember co-pays, including Rx copays apply to your OPM
“Beyond the Product” PRESCRIPTION COMPARISON GOLD In-Network Silver In-Network Bronze In-Network Not applicable (waived for Tier 1 Drugs) $100 single $300 family Tier 1 $10 $8 deductible Tier 2 $30 $35 deductible Tier 3 $50 deductible Specialty $50 $100 deductible 2. 5 co-pays 3 co-pays deductible Benefit Deductible Retail (30 Day Supply) Tier 1 Mail Order (90 Day Supply) Tier 2 Tier 3 Specialty Product Selection Penalty Rule: When a brand drug is obtained and there is an equivalent generic drug available, the member is responsible for paying their payment obligation for the equivalent generic (i. e. lowest payment application) and any remaining cost difference up to the maximum allowed fee for the brand name drug. Rx Applies to your MEDICAL Out-of-pocket Maximum This is a brief description only. Refer to your Benefit Plan Summary for details. Bernie Lowe & Associates, Inc.
“Beyond the Product” HEALTH SAVINGS ACCOUNTS (HSA) What is an HSA? • Allows participants to use tax-free dollars for qualified medical expenses Features of an H. S. A? • Must be enrolled in a qualifying High Deductible Health Plan (HDHP) Bronze • Maximum contributions amounts in H. S. A Single - $3, 450 Family - $6, 850 Catch Up Contribution (over 55): $1, 000 per a year • Preventive coverage paid at 100% • Eligible expenses same as flexible spending account • Must be under 65 to establish an account Who has ownership and responsibility? • You open your account & manage your account • You self-direct healthcare expenses What are the risks? • Upfront expenses of deductible and out-of-pocket maximum on the Bronze Plans • You are responsible for validity of qualified expenses Bernie Lowe & Associates, Inc.
“Beyond the Product” Cost Comparison Average treatment cost = $118 in a physician’s office vs. $667 in an emergency room Receiving ER treatments for non-emergency medical conditions is a major contributor to the rising cost of health care Bernie Lowe & Associates, Inc.
“Beyond the Product” Go Mobile Bernie Lowe & Associates, Inc.
“Beyond the Product” Please set up a time to go over the Colonial Life Benefits that are on the next 5 slides, even if you want to waive, a waiver form needs to be completed. Please contact: Dick Ginther at 515 -205 -9660 or rjginsurance@gmail. com http: //www. visityouville. com/en/CFIowa/benefits-overview Bernie Lowe & Associates, Inc.
Accident Insurance “Beyond the Product” On and Off-The-Job-Coverage • Emergency Treatment; Hospital Admission/Confinement; Doctor Office; X-ray/MRI; Fracture / Dislocation; Surgery, Transportation; Physical / Occupation Treatment; Wellness Benefit / Covered Person • Single; Employee + Spouse; Employee + Children; Family • Optional Spouse Disability Rider Up To $1, 500/Month • Benefits Paid Directly To You – Non-Integrated Coverage • Plans Are Portable At The Same Rates & Same Benefits Bernie Lowe & Associates, Inc.
Medical Bridge “Beyond the Product” Hospital Confinement Option 1 Option 2: HSA Compatible Pick $1500 or $2000 for Hospital Pick $2000 or $2500 for Confinement Hospital Confinement Surgical procedures Health Screening $50 • Benefits Coverage Includes Illness and Injuries • On-And Off-the-Job Coverage • Benefits Paid Directly to You Bernie Lowe & Associates, Inc.
“Beyond the Product” Medical Bridge: Outpatient Surgical Procedures • Breast – – • • Tier 1 Axillary node dissection Breast capsulotomy Breast reconstruction Lumpectomy Tier 2 • Breast • Cardiac – – – Cardiac – Pacemaker insertion Digestive – Colonoscopy – Fistulotomy – Hemorrhoidectomy (external) – Lysis of adhesions Skin – Laparoscopic hernia repair – Skin grafting Ear, nose, throat, mouth – Adenoidectomy – Removal of oral lesions – Myringotomy – Tonsillectomy – Tracheostomy Gynecological – Dilation and curettage (D&C) – Endometrial ablation – Lysis of adhesions Liver – Paracentesis Musculoskeletal system – Carpal/cubital repair or release – Dislocation (closed reduction treatment) other than a finger or toe – Foot surgery (bunionectomy, exostectomy, arthroplasty, hammertoe repair) – Fracture (closed reduction treatment) other than a rib, finger or toe – Removal of orthopedic hardware – Removal of tendon lesion Bernie Lowe & Associates, Inc. • • • Breast reduction Angioplasty Cardiac catherization Digestive – Exploratory laparoscopy – Laparoscopic appendectomy – Laparoscopic cholecystectomy Ear, nose, throat, mouth – Ethmoidectomy – Mastoidectomy – Septoplasty – Stapedectomy – Tympanoplasty – Tympanotomy Eye – Cataract surgery – Corneal surgery (penetrating keratoplasty) – Glaucoma surgery (trabeculectomy) – Vitrectomy Gynecological – Myomectomy Musculoskeletal system – Arthroscopic knee surgery with menisectomy (knee cartilage repair) – Arthroscopic shoulder surgery – Clavicle resection – Dislocations (open reduction with internal fixation) – Fracture (open reduction with internal fixation) – Removal or implantation of cartilage – Tendon/ligament repair Thyroid – Excision of a mass
“Beyond the Product” Critical Illness • Pays Benefits For Major Critical Illness Directly To You • Heart Attach, Stroke, Major Organ Failure …. • Pays Benefits For Subsequent Diagnosis for Critical Illness • Benefits From $10, 000 to $30, 000 Simplified Issued • Spouse Coverage Without Employee Purchasing First • Compatible with an HSA Bernie Lowe & Associates, Inc.
“Beyond the Product” Colonial Health Screening Benefit • • • • • • Blood test for triglycerides Bonne marrow testing Breast ultrasound CA 15 -3 (blood test for breast cancer) CA 125 (blood test for ovarian cancer) CEA (blood test for colon cancer) Carotid Doppler Chest X-ray Colonoscopy Echocardiogram (ECHO) Electrocardiogram (EKG, ECG) Fasting blood glucose test Flexible sigmoidoscopy Hemoccult stool analysis Mammography Pap smear PSA (blood test for prostate cancer) Serum cholesterol test for HDL and LDL levels Serum protein electrophoresis (blood test for myeloma) Skin cancer biopsy Stress test on a bicycle or treadmill Thermography Thin. Prep pap test Virtual colonoscopy Bernie Lowe & Associates, Inc. $50 per a calendar year
“Beyond the Product” Voluntary Dental Plan Benefit Coverage Amount Insurance Carrier Delta Dental PPO Delta Dental Premier / Non Par Deductible $15 single / $45 family (waived for preventive) $25 single / $75 family (waived for preventive) Preventive Plan pays 100%; you pay 0% Basic You pay deductible plus 10% You pay deductible plus 20% Major You pay deductible plus 50% Orthodontia - (children only under age 19) You pay deductible plus 50% Calendar Year Benefit Plan pays up to $1, 000 Orthodontia Lifetime Benefit Plan pays up to $1, 000 This is a brief description only. Bernie Lowe & Associates, Inc.
“Beyond the Product” VOLUNTARY VISION PLAN Bernie Lowe & Associates, Inc.
“Beyond the Product” Employee Shared Costs Medical Cost Per Pay Check (Based on 24 pay periods) Gold Silver Bronze Employee Only $92 $88 $67 $14. 87 $3. 80 Employee + Spouse $224 $214 $170 $41. 80 $7. 23 Employee + Child(ren) $224 $214 $170 $41. 80 $7. 61 Family $330 $300 $280 $41. 80 $11. 18 • • Group Life and Long Term Disability are provided to you at NO cost. Your Medical premiums are SUBSIDIZED by Children & Families of Iowa. Dental, Vision, STD, & Voluntary Life is 100% employee paid. Your portion of the Medical, Dental, & Vision premiums will be pre-tax. Bernie Lowe & Associates, Inc.
“Beyond the Product” Group Life/AD&D Insurance un u m Benefit Coverage Amount Insurance Company UNUM Basic Life Insurance (Employee) 1 -times annual salary up to $50, 000 Accidental Death & Dismemberment Equal to Basic Life Insurance Coverage Reduction Reduces by 33% at age 65; reduces by an additional 22% at age 70 This is a brief description only. Details are in your enrollment package. Bernie Lowe & Associates, Inc.
“Beyond the Product” Voluntary Life Insurance un u m Benefit Employee Coverage Amount Insurance Company UNUM Employee Life Insurance Increments of $10, 000 to $500, 000 Guarantee Issue $200, 000 (if coverage applied for within 31 -days of eligibility) Coverage Reduction Reduces by 33% at age 65; reduces by an additional 22% at age 70 This is a brief description only. Details are in your enrollment package. Bernie Lowe & Associates, Inc.
“Beyond the Product” Voluntary Dependent Life Insurance un u m Benefit Dependent Coverage Amount Insurance Company UNUM Spouse Life Insurance Increments of $5, 000 to $250, 000 Guarantee Issue $30, 000 Benefit Reduction Benefits terminated at spouse age 70 Child(ren) Life Insurance Birth to 6 months of age: $500 Age 6 months to 19 unless full-time student then up to age 26: Increments of $1, 000 to maximum of $10, 000 This is a brief description only. Details are in your enrollment package. Bernie Lowe & Associates, Inc.
“Beyond the Product” Long-Term Disability un u m Benefit Coverage Amount Insurance Company UNUM Monthly Benefit 60% Maximum Benefit $4, 500 per month Waiting Period 90 days Benefit Duration Social Security Normal Retirement Age (SSNRA) Own Occupation 24 months This is a brief description only. Details are in your enrollment package. Bernie Lowe & Associates, Inc.
“Beyond the Product” Voluntary Short-Term Disability NO es g an h C Benefit Coverage Amount Insurance Company Lincoln Financial Group Monthly Benefit 60% Maximum Benefit $1, 000 per week Waiting Period 15 th day for Accident 15 th day for Sickness Benefit Duration 11 weeks This is a brief description only. Details are in your enrollment package. Bernie Lowe & Associates, Inc.
“Beyond the Product” Links – www. wellmark. com for medical plan • Alliance Select PPO – Services in Iowa the network is Alliance Select – Services outside of Iowa – network is National Blue Card PPO. • Blue Advantage – Services in Iowa the network is Blue Advantage – www. deltadentalia. com for the dental plan – www. eyemed. com for the vision plan – www. tasconline. com for the FSA plan Bernie Lowe & Associates, Inc.
“Beyond the Product” YOUR FLEXIBLE SPENDING ACCOUNT § Flexible Spending Accounts (FSA’s) provide a simple way to save money on eligible health care and/or dependent care expenses. USE IT OR LOSE IT! § Advantages: § Calculate conservatively when making your 2018 -19 FSA elections. IRS regulations require that any money left over in your FSA at the end of the plan year be forfeited. § More money in your pocket § Reduces current taxable earnings § Save on income tax at the end of the year § Debit card convenience The pre-tax savings you set aside in your FSA must be used for eligible expenses. Hang onto your current card, you will receive a new ID card one month prior to the expiration date. Bernie Lowe & Associates, Inc.
“Beyond the Product” FSA ELIGIBLE EXPENSES A complete list of eligible and ineligible expenses is listed on your FSA website. The following is a partial list of eligible expenses: Medical Care Expenses ($2, 000 max. ) § Office visit copay § Health care deductible § Prescription copay § Prescription eyeglass/contact lenses § Orthodontia expenses § Hearing aids § Blood pressure monitor Dependent Care Expenses ($5, 000 max. ) § If married, both spouses must work or one must be a full time student § Child care or before or after school care for children up to age 13 § Nanny Service § Elder care for adult tax dependent § Expenses may be paid to relative (child, parent or grandparent of participant) if: – Caregiver is not under age 19; – Caregiver is not a tax dependent of the participant. For a complete list of eligible expenses and other helpful information, please visit www. tasconline. com. Bernie Lowe & Associates, Inc.
“Beyond the Product” HOW LOGIN TO My. Tasc • http: //portal. sliderocket. com/BOORR/TC _1012_082715 -How-to-Log-in-to. My. TASC Bernie Lowe & Associates, Inc.
“Beyond the Product” Flex Plan Overview Flex Increased Income $71 per Month - $852 Annually! Bernie Lowe & Associates, Inc.
“Beyond the Product” QUALIFYING LIFE EVENTS – please note that elections can only be changed during the plan year if you have a life event that causes a change in status under Internal Revenue Code rules – examples are marriage, divorce, birth or adoption of a child, death of a dependent. § Changes must be made within 31 days of the life event. Examples of Life Events Please provide documentation with changes. Ex: Marriage License, Birth Certificate, Adoption Decree, Divorce Decree, etc. Marriage Birth or adoption Bernie Lowe & Associates, Inc. Divorce Change in Spouse’s Job / Loss of Spousal Coverage Death
“Beyond the Product” QUESTIONS ? ? ? Questions may be directed to Kathryn Polson at (800) 942 -4718 or kpolson@bernielowe. com Bernie Lowe & Associates, Inc.
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