Town of Granby OPEN ENROLLMENT - Effective Date: July 1st, 2021 - Granby CT
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Town of Granby
OPEN ENROLLMENT
Effective Date: July 1st, 2021
John E. Hardy, CEBS / Area Senior Vice President
Karen Whitehead / Area Vice President
Trish Crofts / Senior Account Manager
Gallagher Benefit Services, Inc.
Agenda
• Open Enrollment begins on 6/2/2021 and ends on 6/15/2021
• Plan Year is Effective for 7/1/2021 – 6/30/2022
• Open Enrollment
• PPO Versus HDHP Plan Designs
• Definitions: HDHP & HSA
• HDHP: Basic Structure
• HSA: Basic Structure
• Covered Expenses / Qualified Expenses
• Making contributions to the HSA
• Using the HDHP + HSA for Medical and Pharmacy Expenses
• HDHP & PPO Plan Designs
• Delta Dental Plan
• Discussion
2Open Enrollment
• All forms, plan summaries, cost sheets are available on the Town of Granby
website under Finance Department: https://www.granby-ct.gov/finance-
department/pages/health-and-dental-insurance-open-enrollment
• Only employees making changes for the 2021-2022 plan year, need to submit
forms
• All changes must be submitted by June 15, 2021 to Town of Granby Finance
Department
• Only employees making changes will receive a new card
• Open enrollment is the one time each year you can enroll or make benefit changes
without a qualifying change in family status. If you are enrolling due to a qualifying
event, you must enroll within 31 days of the date of the event.
• Plan Deductibles, Out-of-Pocket Maximums and benefit limits (ex. Chiropractic
Visits, Physical Therapy visits, etc.) reset on 7/1/2021.
3PPO Versus HDHP Plan Designs
• Both the PPO and HDHP plans offer the same coverage. The difference is in how
you pay for the coverage.
• All plans include preventive care services covered at no cost.
• For the PPO plan, employees pay a higher premium for the plan via payroll
deductions, but pay lower amounts for the services they receive, copays instead of
service being subject to a deductible.
• For the HDHP plan, employees pay a lower premium for the plan via payroll
deductions, but all services are subject to a plan deductible. Once the deductible is
met all services are covered in full by Anthem.
• All plans include out-of-pocket maximums that are the most an employee and/or
family will have to pay for the entire plan year, from 7/1/2021 to 6/30/2022.
• The Town of Granby will make a contribution to the HSA bank account according to
the union contracts for those electing the HDHP plan.
4Definitions: HDHP & HSA
• Introduced in 2005 by legislation during the G.W. Bush administration
• An “HSA Plan” has two components:
1. High Deductible Health Plan (HDHP): the insurance plan
• For Granby, an Anthem plan
2. Health Savings Account (HSA): the financial (“bank”) account
• Parameters for both components regulated by the IRS.
• HSA Contribution Limits are defined by the IRS each calendar year.
• The HDHP works on a standard insurance platform
– Same network of providers and pharmacies as the PPO
• The HSA is owned by the participant
– Employee owns the money, always – no exceptions
– No “use it or lose it.”
– Balance goes with the employee if/when they leave Granby employmentBasics of the High Deductible Health Plan (HDHP)
• Anthem HDHP has the same network as your current PPO with both in & out-of-
network benefits
• Anthem High Deductible Plan (In-Network)
$2,000 Plan Year Deductible for single coverage
$4,000 Plan Year Deductible for family coverage
• Preventive services paid at 100% (in-network); not charged to deductible
– Screenings, immunizations, physical exams
• All services are subject to the Plan Year Deductible
– Medical: No copays / coinsurance in-network
– Prescription Drugs: Covered at 100% after deductible is met
– 20% coinsurance out-of-network (same as PPO)
• Out-of-Pocket Maximum (In-Network)
$2,000 Plan Year Deductible for single coverage
$4,000 Plan Year Deductible for family coverage
• HDHP Deductible and Out-of-Pocket Maximums are accumulated on an aggregate
basis. Meaning for family contracts, all members must meet the family deductible
amount before any one member is considered as having met the deductible or out-of-
pocket maximum.Basics of the Health Savings Account (HSA)
• Employees must open an HSA Bank Account if they want to receive Town of Granby
contributions.
• Town of Granby contributions and Employee contributions to HSA funds are not
subject to tax
• Amounts withdrawn for IRS qualified services for a member or dependent are not
taxable
• IRS regulates HSA eligibility
• If you are enrolled in any other non-HDHP benefit option you are not eligible to
contribute to an HSA (or receive employer contributions).
– Impacts your Dependents as well
– Includes Flexible Spending Accounts! (If you elect the HDHP plan for 7/1/2021,
you will need to spend down your FSA medical spending account by
7/1/2021)
• Individuals enrolled in Medicare Part A or Medicare Parts A & B are not eligible to
contribute to, or receive contributions to, an HSA.
7“Covered” vs. “Qualified” Medical Expenses
Covered Expenses
• Services covered under the HDHP insurance component (medical, prescriptions)
• Includes services counting towards the deductible as well as those actually
reimbursed by the plan
• Same covered items as the PPO plan
Qualified Expenses
• Health care expenses eligible for HSA reimbursement on a tax-free basis
• Identified by the IRS as “Qualified” (see Publication 502 @ www.irs.gov)
– Similar to Qualified Expenses under health care Flexible Spending Accounts
• Includes expenses relating to medical, prescription drugs, dental, vision, certain
OTC items
8Making Tax-Free Contributions
Ways to contribute to your HSA account (beyond Town of Granby’s contributions)
• Pre-tax through payroll deductions
• Post-tax by personal check
When you file your taxes, you’ll make an adjustment to your gross income to
receive the tax benefit
You will receive deposit slips for your HSA
• HSA tax contributions are defined by the IRS each calendar year. The Federal
annual maximums for 2021 are (per household):
$3,600 for individual coverage
$7,200 for family coverage
Age 55 or older, additional $1,000 / year allowed
Note: Town contributions count toward annual maximums (on a CALENDAR
year basis)
9Using the HDHP / HSA for Pharmacy
When you visit a pharmacy
• Show your ID card.
• Until you have satisfied your annual deductible, you will pay for prescription drugs at
Anthem’s discounted prices.
• You can use your HSA funds, as long as there are sufficient funds available in your
HSA account.
• Once you satisfy your deductible, prescriptions will be covered at 100%.
• For the lowest costs, visit www.anthem.com to learn about generics and other cost
saving measures.
Or order your prescriptions by mail (through Anthem’s IngenioRx)
• If you have not met your deductible, you will pay for the medications at Anthem’s
discounted rate.
• If you have met your deductible, prescriptions will be covered at 100%.
• Order a 90-day supply.
• Take advantage of convenience of home delivery and possibly save money.
10HDHP vs. PPO
Medical Plan Comparison Chart
Carrier Name Anthem
Plan Name HDHP $2,000 (HSA Compatible) PPO 1 - $15/$15 Copay PPO 2 - $25/$400/$150/$150
Network Access In-Network In-Network In-Network
Plan Year Deductibles (PYD) Your Responsibility Your Responsibility Your Responsibility
Individual $2,000 N/A N/A
Family $4,000 N/A N/A
Your Benefit Plan
Individual Out-of-Pocket Maximum $2,000 $6,600 $6,600
Family Out-of-Pocket Maximum $4,000 $13,200 $13,200
Professional Services
Primary Care Physician (PCP) Visit $0 after PYD $15 copay $30 copay
Specialist Office Visits $0 after PYD $15 copay $40 copay
Preventive Care Visit No Charge No Charge No Charge
Urgent Care and Emergency Room
Urgent Care Facility $0 after PYD $25 copay $50 copay
Emergency Room (waived if admitted) $0 after PYD $25 copay $125 copay
Diagnostic Services
Laboratory $0 after PYD No Charge No Charge
Radiology $0 after PYD No Charge No Charge
MRI, MRA, CT & PET Scans
$0 after PYD No Charge $75 copay
(Independent Diagnostic Testing Center)
Hospital / Facility Services
Inpatient Hospital $0 after PYD No Charge $400 per admit
Outpatient Hospital $0 after PYD No Charge $300 per admit
Out-of-Network Coverage
Plan Year Deductible (Individual/Family) $2,000/$4,000 $100/$200/$300 $600/$1,200/$1,800
Coinsurance 20% 20% 20%
Out-of-Pocket Maximum $4,000/$8,000 $500/$1,000/$1,500 $2,100/$4,200/$6,300
Pharmacy Services Rx Benefits After CYD Rx Benefits After CYD
Tier 1 $0 copay after deductible $8 copay $8 copay
Tier 2 $0 copay after deductible $10 copay $30 copay
Tier 3 $0 copay after deductible $10 copay $45 Copay 11
Tier 4 $0 copay after deductible $10 copay $45 CopayThe Town of Granby – Group # 4730
Delta Dental PPO plus PremierTM
If a Delta Dental If a Delta Dental
PPOSM Network Premier® or Non-
Dentist is Used Network Dentist is
Used
Calendar Year Deductible
• Per Person $25 $25
• Family Aggregate Maximum $75 $75
Plan Pays: Plan Pays:
Preventive & Diagnostic (No Deductible) 100% 100%
• Exams, Cleanings, Bitewing X-Rays (2 per calendar
year per person)
• Fluoride Treatment (for children to age 19)
• Sealants (To age 16)
Remaining Basic (After Deductible) 80% 80%
• Fillings, Extractions & Root Canals (Endodontics)
• Periodontal & Oral Surgery
• Repair of Dentures
Crowns & Prosthodontics (After Deductible) 70% 70%
• Crowns & Gold Restorations
• Bridgework,
• Full & Partial Dentures
Calendar Year Maximum (Per Person) $1,500 $1,500
Orthodontia (Adult & Children)
• Lifetime Deductible $50 $50
• Coinsurance 60% 60%
• Lifetime Maximum $2,000 $2,000
Dependent children are covered to age 19 (23 if enrolled as a full-time student in an accredited school or university).
Delta Dental has two networks available under this plan. The Delta Dental Premier® network is the largest of the Delta Dental networks
with over 339,000 participating dentist offices nationally (80%+). Delta Dental PPOTM is a smaller, but more discounted network with
over 269,000 participating dentist offices nationwide. Delta Dental’s network discounts average 25% to 35% less.
You may use any fully licensed dentist under this plan, but it is to your advantage to use a network dentist, especially PPO, since
they accept the Delta Dental allowance as their maximum charge and cannot bill Delta Dental patients for amounts above this level.
Delta Dental PPO dentists offer the lowest fees of our networks.
Participating dentists will be paid directly by Delta Dental for covered services. Non-participating dentists will bill you directly, and Delta
Dental may make claim payment directly to you. You will maximize benefits and reduce paperwork by using a Delta Dental participating
dentist.
If you do not have a dentist, you may obtain a current listing of participating dentists in any area, by calling 1-800 DELTA OK (1-800-
335-8265). Provide your zip code to the representative and a directory for that area will be mailed to your home. If you have
Internet access, you may also visit our website at deltadentalct.com to locate participating dentists.
At the time of your first appointment, tell the dentist that you are covered under this program and provide your group number and ID
number. Your dependents, if covered, should provide the employee’s ID number.
Claim questions and other information needs should be directed to Delta Dental’s customer service department at 1-800-452-9310.
This overview contains a general description of your dental care program for your use as a convenient reference. Complete details of your program appear in the group
contract between your plan sponsor and Delta Dental of New Jersey, Inc. which governs the benefits and operation of your program. In CT, Delta Dental of Connecticut
writes dental coverage on an insured basis and Delta Dental of New Jersey administers self-funded dental benefit programs. The group contract would control if there
should be any inconsistency or difference between its provisions and the information in this overview.
4/15/19Delta Dental PPO Plus Premier™ Nationwide Networks
• If you use a Delta Dental PPO™ dentist
• Your out-of-pocket costs will be lowest for services if you use a participating
PPO dentist.
• Your Annual maximum stretches further because the dentists fees are lower
• Participating dentists may not charge more than Delta Dental’s allowed
charges, and are paid directly by Delta Dental for covered services
• If you use a Delta Dental Premier® Dentist
• Our largest nationwide network.
• Your out-of-pocket costs will be higher, and your plan maximum will not go as
far, since Premier dentists fees are higher than PPO dentists
• Participating dentists may not charge more than Delta Dental’s allowed
charges, and are paid directly by Delta Dental for covered services
• You may use dentists that do not participate with Delta Dental
• You are responsible for submitting the claim
• You are responsible for making payment to the dentist
• Your out-of-pocket costs are highest when you use non-participating dentistsYour Resources – Connect with
Delta Dental
• Delta Dental
• (Granby Town & Board of
Education - Group # 4730)
• Customer Service 800-452-9310
• Call, go online or download our
mobile app for these services:
• Verify eligibility
• Review benefits
• Look up claim payments
• Find a dentist
• Cost Estimator – on mobile app
• Print an ID card – or have it on your
phone
• Website: www.deltadentalct.comYou can also read
