Open Enrollment Meeting October 16, 2019 - Open Enrollment
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Open Enrollment Meeting
October 16, 2019
Open Enrollment
2020 Stephanie Riesch-Knapp
Employee Benefit Consultant
Agenda
2020 Benefits Overview
Coverage Insurance Carrier/Vendor
Health Plan & WEA Resources WEA Trust
Employee Wellness Program Vitality
Dental Plan Delta Dental
Vision Plan Superior Vision
HRA/ FSA & Dependent Care Diversified Benefit Services
Opt Out HRA Diversified Benefit Services
2
Health Plan
2020 Medical
Plan Renewal
Received a 4.8% Increase
Remaining with WEA
• Renewing our Current Health Plans
• Base Plan
• Optional Plan
4
Select between two
available plans!
The Optional Plan
provides a Health
Reimbursement
Arrangement (HRA)
for Wellness
Participants!
5
Your Plan Choices: In Network Benefits Only Shown
1 2
Base Copay Plan Optional Copay Plan
Single: $3,000 Single: $1,500
Per-Member Deductible
Family: $6,000 Family: $3,000
80% Plan Pays 80% Plan Pays
Coinsurance
20% Member pays 20% Member pays
HRA Eligible? No Yes, for Wellness Participants
Preventive Covered at
Yes Yes
100%?
Smaller, fixed copay amounts Smaller, fixed copay amounts
Office Visits
(no deductible) (no deductible)
Urgent Care & Emergency Copay + Deductible & Copay + Deductible &
Room Coinsurance Coinsurance
Prescriptions Smaller, fixed copay amounts Smaller, fixed copay amounts
(no deductible) (no deductible)
Single: $6,000 Single: $3,000
Out of Pocket Maximum
Family: $12,000 Family: $6,000
Family Deductible & Out of
Embedded Embedded
Pocket Max Accumulation
6
Health Reimbursement Arrangement (HRA)
Who is Eligible?
Wellness Participants on Optional Health Plan Only!
Coverage Level You Pay HRA Reimburses
Employee-Only First $1,500 of deductible Next $1,500 of
Coinsurance
Maximum 2 per family for Coinsurance Reimbursement
Employees, spouses, and children covered under the NSFD Optional Medical
Plan are eligible for reimbursement.
The
reimbursement Need to Submit
program is for Claims into DBS Reimburses
in-network Diversified Benefit you directly
Coinsurance Services (DBS)
expenses only
7
Embedded Deductible: Base Copay Plan
Sophia: $3,000 in
$3,000 Single Deductible /
Medical Bills in March
$6,000 Family Deductible
meeting her single
deductible moving into
coinsurance mode
Samuel
Rosa Note: Sophia does not
need to meet the family
deductible of $6,000
Sophia -
$3,000 Travis
Remainder of family
will continue to incur
deductible until
$3,000 family balance
is met moving the
entire family into
coinsurance mode
In Network Benefits Only Shown
8
Reminder:
Preventive Care Preventive Care services are paid at
Paid at 100% 100%, not subject to deductible:
• Must be billed/coded by the provider as
“preventive”
No-cost preventive
• Must be received from an In-Network physician
care services are
determined by the
Federal Well-baby and Well-child Preventive Care
Government
Adult Preventive Care
Includes Lab Work, Immunizations and
other Health Screening Services
Oral Contraceptives for Females
9
Monthly Medical Plan Contributions Effective 2020
Base Plan Optional Plan Line Optional Plan
and Chief Administration
Single $35.08 $103.82 $81.11
Employee
Family $86.87 $258.74 $202.14
Coverage
❖ Deducted the 1st Payroll of each month
❖ An Opt Out of the NSFD continues to be eligible for
an Opt out amount of 30% of the base plan you are
electing not to take
10Claim Example 1
Maggie is a Line associate who participates in the wellness program and has
single coverage. Poor Maggie injures her hip on a ski vacation. The injury
requires surgery with an in-network provider. The costs associated with her
procedure total $60,000. What does Maggie pay?
Base Plan Optional Plan
Deductible $3,000 $1,500
Coinsurance $3,000 $1,500
Less HRA N/A ($1,500)
Maggie’s Medical Cost $6,000 $1,500
Maggie’s Annual Premium $420.96 $1,245.84
Maggie’s Total Costs $6,420.96 $2,745.84
11Claim Example 2
Tom is a Line associate who participates in the wellness program with single
coverage. Tom takes a Tier 3 medication monthly. He also goes to a Specialist
twice a year for a check-up. What does Tom pay for these in-network services?
Base Plan Optional Plan
Deductible $0 $0
Coinsurance N/A N/A
Less HRA N/A N/A
Office Visit Copays $100 $50
Prescriptions $720 $720
Tom’s Medical Cost $820 $770
Tom’s Premium $420.96 $1,245.84
Tom’s Total Costs $1,240.96 $2,015.84
12WEA Trust Resources
24/7 Self Service
Customer Service:
800-279-4000
14Link still
requires a
separate
sign-on
into
Medimpact
15Using the Medimpact.com Website
• Convenient and easy to use
• Compare prices of medication at different pharmacies
• Find lower cost alternative medications
• Find locations of pharmacies
• Check status of preauthorization
• You need to
create a user
name and
password
• Once logged in,
all information is
specific to you!
16No Cost
Value Choice
Drugs!
• Separate list for
members age 40-75
• Many
Contraceptives are
covered at no cost
• Mail Order available
for two copays for a
90 day supply
17Virtual Visits
What can telehealth
through
doctors/therapists treat?
AMWELL
Urgent Care
Video session with a • Flu/Fever
board-certified doctor • Sinusitis
or licensed therapist • Allergies
• $0 Cost per e-visit! • Ear Infections
• 24/7 availability • Urinary tract infections
• Requires a • Pink-eye
smartphone, tablet
or laptop
Online Therapy
• Depression
• Panic Attacks
• Stress
• Anxiety
• Eating Disorders
• PTSD
➢ Go to WEAtrust.Amwell.com, or download the
Amwell app to your device.
➢ Choose “Sign Up” & Type “Trust” as the Service Key
18Smart Choice MRI – Visa Card Incentive!
• An MRI Costs $700 or less at Smart Choice MRI
• Roughly half the cost of an MRI performed in a hospital
setting
• Convenient Hours Open Nights and Weekends
• Earn a $100 Visa Card for using!
Website: https://smartchoicemri.com/
Phone: 844-633-3674
19WEA Trust Low Back Pain Program
‣ 5 Minute online screening
‣ Individualized plan
‣ Evidence-based care
‣ Use on mobile devices
‣ Education and virtual
coaching
‣ Introduced in January, great
success reducing members
lower back pain!
20NOVO Health - Provider Partnership
➢ Affordable
• Bundled pricing on orthopedic procedures
➢ High quality
• 90 day warranty on all procedures
➢ Located in Appleton
➢ Earn a $250 Visa Gift Card for Using!
2122
WEA Trust + CancerCARE
‣ Improving outcomes with high
quality care
• Diagnosis verification
• Center of Excellence for difficult
to treat and rare cancers
• Treatment reviews
‣ Improve member experience
• Expert Oncology Nurse guidance
and support for entire family
23Consumer Programs Outside of the Health Plan
Finding Your Best
Pharmacy Drug Value
Consider a “$4 Generic” from
Walmart or “Free” Medications
from Meijer!
25GoodRx Price Finder
• You may use GoodRx
instead of the health
insurance plan
• Can’t be combined with
Insurance
26Wellness Program
Employee Wellness Program
Complete Vitality Health Review Survey Step 1
• Improve your health
Receive Your Vitality Age! Step 2
and earn points!
• The higher your Earn Vitality Points! Step 3
status the more • Begin at Bronze Status and move up levels!
Vitality Bucks you • Many Options for Earning Points!
earn! • Silver: 2,000 Wellness Points
• Gold: 4,000 Wellness Points
• Platinum: 7,000 Wellness Points
• Know Your Health
• Improve Your Health
• Enjoy the Rewards!
28Wellness Made Easy
VITALITY WELLNESS PROGRAM
Personalized
approach and
rewards
fulfillment
Vitality Age
engages members
and motivates
healthy choices
Easy to use
mobile app &
portal
29Flexible Spending Accounts
Open Enrollment2020 Flex You must re-enroll annually to participate in
Elections the new plan year for Flex
Health FSA
• $2,750 maximum election for Health FSA
• Carry Over of $500 Allowed
• “Use-it-or-lose-it”
Dependent Care
• $5,000 maximum election
• No Carry Over Allowed
Don’t need to be • “Use-it-or-lose-it”
enrolled in the
NSFD Health plan 26 Deductions Per Year
to enroll in this
benefit! • Can only change election based on a qualifying event
31FSA-Eligible
Insurance
Expenses* deductibles and
Prescription
drug co-pays
co-payments
Use your Health FSA
Orthodontic
account for medical,
Contact lenses dental services
dental, and vision
and solution (including adult
expenses orthodontics)
Dental services,
Mileage to the
crowns, bridges,
doctor or dentist
dentures, root
office
canals, etc.
Vision exams,
Hearing aids
eye glasses and
* Examples per IRC 213(d) and batteries
lasik eye surgery
32Dependent
Care Account Annual Election
(DCA) • Participants elect a separate amount for day
care expenses.
• Money elected for day care can only be used
for day care.
General Plan Rules
Election Deducted Per Pay Period
“Use-It-or-Lose-It” Applies
Change In Family Status Applies
Maximum Day Care Election
• $5,000 per year
33Dental Plan
Dental Plan
Renewal No changes to your
current dental benefits
Rates did increase
Open Enrollment
35Dental Plan
2020
No benefit
changes to the
current plan
36Delta Maximum • A Portion of your unused annual Maximum may be
Benefit Bonus placed into your MBB for use in future years!
(MBB)
• You need to have been covered for one full benefit
year & submitted at least one claim that applied
Like a Savings toward your annual maximum
Account for your
Mouth! • The total cost of the claim applied to your Annual
Maximum must be below the threshold
• Each of your insured dependents maintain their own
separate MBB
Claims Threshold $875
Maximum Benefit Bonus – Premier & Non-Network $437.50
Maximum Benefit Bonus – PPO Claims Only $612.50
Maximum Benefit Bonus Account Limit $1,750
37The Delta Dental
Network PPO Advantage!
The Nation’s Largest Dental Network
Delta Dental’s dental plans are backed by the largest network of contracted PPO Dentist Using an In-
Network PPO Dentist provides several important advantages to you, as shown in the table below.
Advantages of Delta Dental Network Dentists Delta Dental PPO
Dentists
Fee Schedule Savings
Dentist agrees to a reduced fee schedule. Saves out-of-pocket
expenses for the patient.
Convenient Claims Processing
Dentist is required to file claims on the patient’s behalf, which
means less hassle for the subscriber. Claim payments go
directly to the dentist.
Treatment Guarantees
Examples: repair or replace dental restorations or sealants
should they fail within 24 months.
38Dental Plan Active Employees
Contributions Coverage Level Per Month
2020 Employee $14.04
Family $42.66
Monthly dental • Premium Change from current year:
premium deductions • Single Coverage - $1.50 more per month
effective 01/01/20: • Family Coverage - $4.57 more per month
Retirees
Coverage Level Per Month
Employee $31.20
Family $94.80
• Next Open Enrollment Opportunity:
January 1, 2021
39Delta Dental
Phone App
• Provider search
• Access ID Cards!
• View claims
40Vision Plan
Vision Plan No changes to your current vision
Renewal benefits or rates
Open Enrollment
‘Full Service’ vision plan benefits
• Eye exam (every 12 months)
• Eyeglass lenses (every 12 months)
• Eyeglass frames -- up to retail allowance
(every 24 months)
• Contact lenses* (every 12 months)
*The Contact Lenses benefit is in lieu of eyeglass benefit
42Vision Plan
Coverage Level Per Month
Costs Remain
The Same for Employee Only $8.32
2020! Emp + Limited Family $16.64
Family $22.05
Open Enrollment
for January 1, 2020
Effective Date • Same cost for both Active and Retiree
• Next Open Enrollment Opportunity:
January 1, 2021
4344
Vision Renewal
Overview
No change in your
vision plan
premium
contribution!
44Superior Vison
How to find
a network
provider
Superior
Select
Midwest
Network
45“Opt-Out” Health Reimbursement Arrangement (HRA)
The 2020 “Opt-Out”
Health Reimbursement Account (HRA)
Who Qualifies? Active Employees that opt out of the health plan must
be covered under another Employer Sponsored Group Health Plan
HRA Eligible
expenses include:
• Medical • Up to $750*
deductibles,
coinsurance, co-
Single • Reimbursed by the HRA
pays and
prescriptions
• Post-tax group
health insurance
• Up to $2,000*
premiums
Family • Reimbursed by the HRA
* = If you enter the plan after 1/1, reimbursements will
be prorated per month of participation
47How to “Enroll” in Your
BenefitsEE Navigator
Online
benefits
elections
• Open
Enrollment
• Qualifying
Events
49Employee Navigator –
Make Your Benefit Elections Online
… it’s also the time to:
Log in to Employee • Review your current mailing
address and other contact
Navigator to elect or info
waive benefits
employeenavigator.com
50Reminders
and Next Begin by reviewing your Benefits &
Steps… Enrollment Guide to help you decide
what’s best for you!
Next, go into Employee Navigator to
select and enroll into the Plans
The Plans you
select will be in Open Enrollment: Begins 11/01 @ 8am
place for 2020!
CST to 11/30 @ 5pm
51Have Questions About
Your Benefits?
Call or Email Your Insurance
Concierge Team!
• Jen Dash
• Stephanie Riesch-Knapp
R&R Insurance Services, Inc.
262.574.7000
N14 W23900 Stone Ridge Drive
Waukesha, WI 53188
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