SULLIVAN UNIVERSITY SYSTEM

About This Presentation

Title:

SULLIVAN UNIVERSITY SYSTEM

Description:

... Term Care Insurance Includes coverage for custodial, supervisory or skilled care Services can be provided at home, adult day care, ... (Tenant Only) Civil ... – PowerPoint PPT presentation

Number of Views:12

Avg rating:3.0/5.0

Slides: 37

Provided by: xup6

Learn more at: http://system.sullivan.edu

more less

Transcript and Presenter's Notes

Title: SULLIVAN UNIVERSITY SYSTEM

1
SULLIVAN UNIVERSITY SYSTEM OPEN ENROLLMENT FOR
PLAN YEAR 2015
2
2015 HIGHLIGHTS

Maintaining health insurance plans with Bluegrass
Family Health (BGFH)
Continuing to offer 3 health plans, Premier,
Standard Plus and Value Plus
Premier Plan no longer available to NEW
participants
If you have the Premier plan you will be able to
keep it
SUS will continue the current cost sharing
structure
Premiums have increased about 18 for Premier
Plan
Premiums have increased about 26for the Standard
Plan. Premiums have increased about 27 for the
Value Plan
Vision Exam and Vision hardware will continue to
be covered by BGFH - 100 for materials
Only the Premier Plan continues to be considered
Grandfathered health plans under Health Care
Reform
All changes previously required under Health Care
Reform remain in effect and pre-existing
condition exclusions no longer apply
Spouses no longer eligible to participate in
Sullivan University Systems health plan or HRA if
spouse works and is eligible for health insurance
coverage from their own employer, includes
spouses working for Sullivan University Systems.

3
2015 HIGHLIGHTS

Change in plan design to both the Standard Plan
and the Value Plan
Standard Plan annual deductible changing from
500 to 750 per person
Value Plan annual deductible changing from 2,500
to 3,000 per person
Standard Plan coinsurance changing from 80/20 to
70/30
Standard Plan out of pocket maximum changing from
1,670 to 2,430 per person
Value Plan out of pocket maximum changing from
2,500 to 3,000 per person
Both the Standard Plans and the Value Plans
copay for Emergency Room is changing from 100 to
150
Both the Standard Plans and the Value Plans
copay for Tier 2 prescriptions is changing from
30 to 40 and Tier 3 prescriptions is changing
from 60 to 80

4
2015 HIGHLIGHTS Continued

BGFH Compass Choice Rewards is being continued
Easy to Use allows members to shop online or by
phone for specific health care services. Takes
less than 2 minutes to get the information
members need to become smarter health care
shoppers
Provides Choice members are presented with
cost-effective options in their area that qualify
for financial rewards
Rewards Cost-Effective Decisions members are
rewarded with financial incentives by using
cost-effective locations
Over 100,000 in savings were possible during the
last 12 month experience period by using Compass
Choice Rewards
Up to 300.00 paid directly to you for using
Compass Choice Rewards and most cost-effective
option for services

5
2015 HIGHLIGHTS Continued

No changes in Schedule of Benefits or premiums
for
Delta Dental Plans
Humana Vision Plan
Dearborn National Short and Long Term Disability
Plans
Hyatt Legal Plan
Colonial Life Plans
MetLife Employee and Dependent Voluntary Life
plan and Voluntary Accidental Death.
MetLIfe Voluntary Life cost may change if moving
into older age bracket
Long Term Care plan to help pay cost of Home
Health Care and Nursing Home Expenses continues
to be available.
Continuing the TELADOC benefit that gives you
24/7/365 access to U.S. board-certified doctors
who can resolve many of your medical issues via
phone or online video at no cost, 100 no co-pay.
Continuing the Sullivan University Systems Health
Reimbursement Account (HRA) for employees
enrolling in the Standard or Value Plan

6
BGFH Medical Coveragesand Sullivan University
Systems HRA

Medical Premier Standard Plus Value Plus
Deductible
Single 250 750 3,000
Family 500 1,500 6,000
Doctor Co-Pay 20 30 30
In-Patient 250 30 CIFAD
Out-Patient
Surgery 75 30 CIFAD
Other 20 30 CIFAD
Emergency Room 75 150 150
Urgent Care 35 75 75
Prescriptions
Level 1 10 10 10
Level 2 30 40 40
Level 3 60 80 80
Out of Pocket Max
Single 1,000 2,430 3,000
Family 2,000 4,860 6,000

7
Notes

Deductible (s) apply only to covered services
listed with a percentage.
Deductibles and co-insurance amounts are included
in the out of pocket max under the Premier Plans.
Deductible, co-insurance and copay amounts apply
to the Out of Pocket Maximum for all medical
services under the Standard Plan and Value Plan.
In-Network Only. For out of network covered
benefits see Summary of Benefits.
Dependent children may be covered to age 26.
CIFAD means Covered In Full After Annual
Deductible.
Deductible and Out of Pocket Maximums are on a
Calendar Year basis, January 1st through December
31st.
Therapy Services and Vision Hardware benefits and
limitations are on a PLAN YEAR basis of March 1st
through February 28th
Benefits illustrated include amounts paid for you
by Sullivan University Systems under the Health
Reimbursement Account (HRA)

8
MEDICAL PREMIUMS

Employee Rates Per Pay
Premier Standard Value
Single 210.75 149.90 100.13
Employee/Spouse 514.02 313.12 186.09
Employee/Child(ren) 440.90 268.61 148.99
Family 684.66 417.20 272.82
Based on 24 pay checks per year

9
Sullivan University System Employees
Annualized Premium Difference by
Plan (Savings) Premier vs.
Standard Premier vs. Value Standard vs. Value
SINGLE 1,460.40 2,654.88 1,1
94.48 EE/SP 4,821.60 7,870.32 3,0
48.72 EE/CH 4,134.96 7,005.84 2
,870.88 FAM 6,419.04 9,884.16 3,46
5.12
10
Sullivan University System Claims Example
1 Office Visit and Prescription
Medication Single Employee Premier
Standard Value Office Visit
20.00 30.00
30.00 TIER 1 10.00
10.00
10.00 4 TIER 2 30.00
40.00 40.00 8 Total EE Share
60.00 80.00
80.00 Premium Expense
5,058.00 3,597.60
2,403.12 Grand Total
5,118.00 3,677.60
2,483.12 Family Coverage Office and Rx
720.00 960.00
960.00 Premium
16,431.84 10,012.80
6,547.68 Grand Total
17,151.84 10,972.80
7,507.68 Family example based on 4 people and
each month someone in the family goes to the
doctor and buys both a generic and formulary
brand prescription. (Annual total of 12 OV and
24 Prescriptions)
11
Sullivan University System Claims Example
1A Office Visit and Prescription
Medication Single Employee Premier
Standard Value Office Visit
20.00 30.00
30.00 TIER 1 10.00
10.00
10.00 TIER 2 30.00
40.00 40.00 Total EE Share
60.00 720.00
80.00 960.00 80.00
960.00 Premium Expense
5,058.00 3,597.60
2,403.12 , Grand Total
5,778.00
4,557.60
3363.12 Family Coverage Office and Rx
720.00 1,440.00 960.00
1,920.00 960.00 1,920.00 Premium 1
6,431.84 10,012.80
6,547.68 Grand Total 17,871.84 11,932.80
8,467.68 Family example
based on 4 people and each month 2 people in the
family go to the doctor and buys both a
generic and formulary brand prescription.
(Annual total of 24 OV and 48 Prescriptions) WSC
Claimex107
12
Sullivan University System Claims Example
2 Office Surgery Single
Employee Premier Standard Value Office
Surgery 1,800.00 1,800.00 1,800.00 Allowed
Amount 1,200.00 1,200.00 1,200.00 Deductib
le 0 0 0 Co-insurance 0 0 0 Total
EE Share 20.00 Copay 30.00 Copay 30.00
Copay Please note Some physicians may have
their own freestanding surgical facility where
services are provided on an ambulatory basis.
Claims are paid based on the place-of-service
billed by the provider. Claims filed for
outpatient surgical procedures with place of
service other than the physicians office will be
processed under the outpatient benefit.
WSCClaimex307
13
Sullivan University System Claims Example
3 Outpatient Surgery Single
Employee Premier Standard Value
Billed Charges 2,700.00 2,700.00
2,700.00 Allowed Amount 1,750.00
1,750.00 1,750.00 Deductible/Copay
75.00 750.00 3,000.00 1,000.00
1,750.00 Co-insurance 0
30 0
300.00 1,750.00 Deductible (add)
0 750.00 0
Total EE Share 75.00 1,050.00
1,750.00 Premium Cost 5,058.00 3,597.60
2,403.12 Grand Total 5,133.00 4,647.60
4,153.12 Family Coverage    Total EE Share
75.00 1,050.00 1,750.00 Premium
Cost 16,431.84 10,012.80 6,547.68 Grand
Total Cost 16,506.84 11,062.80 8,297.68
14
Sullivan University System Claims Example
4 Diagnostic Testing at Physicians Office or
Outpatient Setting Single Employee Premier
Standard Value
Billed Charges 2,700.00 2,700.00
2,700.00 Allowed Amount 1,750.00
1,750.00 1,750.00 Deductible 0
750.00 3,000.00 1,750.00 1,000.00
1,750.00 Co-insurance 20
30 0
350.00 300.00 1,750.00 Deductible
(add) 0 750.00
0 Total EE Share 350.00
1,050.00 1,750.00 Premium Cost 5,058.00
3,597.60 2,403.12 Grand Total 5,408.00
4,647.60 4,153.12 Family Coverage    Total
EE Share 350.00 1,050.00
1,750.00 Premium Cost 16,431.84 10,012.80
6,547.68 Grand Total Cost 16,781.84 11,062.80
8,297.68
15
Sullivan University System Claims Example
5 In-Patient Hospital / Surgery Single
Employee Premier Standard
Value Billed Charges 220,000.00
220,000.00 220,000.00 Allowed Amount
110,000.00 110,000.00 110,000.00 Deductible/Co
pay 250.00 750.00
3,000.00 Total EE Share 250.00
2,430.00 3,000.00 Premium Cost
5,058.00 3,597.60 2,403.12 Grand
Total 5,308.50 6,027.60
5,403.12 Family Coverage    Total EE Share
250.00 2,430.00
3,000.00 Premium Cost 16,431.84
10,012.80 6,547.68 Grand Total
16,681.80 12,442.88 9,547.68 WS
CClaimex307
16
Deductible and Out of Pocket ReportJanuary 1,
2014 through November 31, 2014

Standard Value Grand Total
Average Membership 291 458 749
Deductible (Single) 500 2,500
Deductible Satisfied 93 45 138
Percent of Membership 31.96 9.83 18.43
Out of Pocket (Single) 1,680 2,500
Out of Pocket Met 10 45 55
Percent of Membership 3.44 9.83 7.35

17
How it Works

STANDARD PLAN with THE SUS HRA
What is a Health Reimbursement Arrangement (HRA)?
A Health Reimbursement Arrangement is an account
funded by your employer, Sullivan University
System, to help cover health insurance deductible
and maximum out of pocket expenses incurred by
you and your dependents.
HRA Benefit
For all In-Network Deductible Services the HRA
benefit is activated after you pay the first 750
of Deductible expenses. After that, the HRA will
pay 70 (you pay 30). Your total out of pocket
maximum, including the first 750 of the
individual deductible, is 2,430.
How it works
First, claims are be submitted by your provider
to Bluegrass Family Health.
Bluegrass Family Health will automatically send
your processed claims to ConnectYourCare for HRA
reimbursement.
ConnectYourCare will send HRA payments minus your
responsibility directly to your provider.
Below is an outline of how your HRA works to pay
part of the Bluegrass Family Health Individual
Annual Deductible amount of 6,350 for covered
medical services

HRA Responsibility Employees Responsibility

First 750 of Deductible Expenses Nothing 750
Remaining 5,600 of Deductible Expenses 70, maximum of 3,920 30, maximum of 1,680
Total Maximum Out of Pocket Expense 3,920 2,430 (7501,680)
18
How it Works

VALUE PLAN with THE SUS HRA
What is a Health Reimbursement Arrangement (HRA)?
A Health Reimbursement Arrangement is an account
funded by your employer, Sullivan University
System, to help cover health insurance deductible
and maximum out of pocket expenses incurred by
you and your dependents.
HRA Benefit
For In-Network Deductible Services the HRA
benefit is activated after you pay the first
3,000 of deductible expenses. After that, the
HRA will pay 100 (you pay 0) of the remaining
BFH deductible. Your total individual out of
pocket maximum is 3,000
How it works
First, claims are be submitted by your provider
to Bluegrass Family Health.
Bluegrass Family Health will automatically send
your processed claims to ConnectYourCare for HRA
reimbursement.
ConnectYourCare will send HRA payments minus your
responsibility directly to your provider.
Below is an outline of how your HRA works to pay
part of the Bluegrass Family Health Individual
Annual Deductible amount of 6,350 for covered
medical services

HRA Responsibility Employees Responsibility

First 3,000 of Deductible Expenses Nothing 3,000
Remaining 3,350 of Deductible Expenses 3,350 Nothing
Total Maximum Out of Pocket Expense 3,350 3,000
19
(No Transcript)
20
(No Transcript)
21
Benefit Marketing SolutionsFlexible Spending
Plans https//www.myflexonline.com/Login/Welcome.a
spx

The Flexible spending account is a way to pay for
eligible health care expenses not covered under
your health insurance plan. Eligible expenses
include Annual medical and dental plan
deductibles, co-payments, uncovered dental
expenses, eyeglasses, contacts and solutions, and
eye exams. Visit the website listed below for a
complete listing of eligible expenses.
http//www.bmsllc.net
New participants will receive a VISA debit card
to use when paying for eligible expenses. You may
choose to use the card or pay the expense and
submit a request for reimbursement form and
receipts for reimbursement. You may receive the
full amount elected for the year or the entire
balance of your account at any time if you have
eligible expense at any time during the plan
year. The maximum you are allowed to contribute
for the plan year is 2,550.
You must keep receipts as you may be asked to
submit documentation for expenses paid for with
the card.
500 will rollover to the next plan year if you
are unable to use the funds you elect throughout
the year. Any balance beyond that amount will be
forfeited.
All forms are available on the website.

22
Dependent Care Spending Accounts https//www.myfle
xonline.com/Login/Welcome.aspx

The Dependent Care Spending Account reimburses
you for care provided by eligible caregivers to
dependents.
Your dependent child or children age 12 and
under.
Any dependent of any age if he or she lives with
you and cannot care for himself or herself, such
as an elderly parent or disabled child.
A caregiver can be anyone over the age of 19
other than a person you claim as a dependent on
your federal income tax return.
To seek reimbursement, you will submit a form and
receipts. You cannot be reimbursed for more than
the balance in your account. The maximum you are
allowed to contribute for the plan year is
5,000.

Life Insurance
Basic Group Life available from MetLife
Sullivan University System pays 50 of cost for
group life.
Benefit available is 1 x Annual Salary rounded to
next higher 1,000.00.
Your cost with Sullivans contribution is only
.065/month/1,000.00 of coverage.
For example An employee with an annual salary
of 39,500.00 may purchase 40,000.00 of coverage
for a monthly cost of 2.60 or 1.30 per
paycheck.
Pays double in event of accidental death.
Guarantee issue if timely applicant, if not, may
apply subject to health questionnaire called
EVIDENCE OF INSURABILITY. May be DECLINED if
untimely applicant.
Timely applicant is prior to 90th day of
employment.
Additional coverage available for employee,
spouse and children at very affordable group
rates, up to a maximum of 300,000.00 from
MetLife
Voluntary Accidental Death and Dismemberment
coverage now available to employees and
dependents.
Additional 25,000 guaranteed to all employees
currently participating in the MetLife Voluntary
Life plan, if current amount of coverage is not
more than guarantee issue amount of 150,000.00.

Voluntary Dental Insurance
3 Plans available Value, Standard and Premier
Value Dental HMO/Exclusive Provider Options,
named Delta Care. Benefits available only
through providers who are contracted in the Delta
Care Network.
No waiting period for any covered services.
No annual maximum benefit
Standard Preferred Provider Plan named Delta
Dental PPO
Over 55 of dentists in Kentucky participate,
over 76,900 nationally, in 126,000 locations
100 coverage for Diagnostic and Preventive
Services
Other services subject to 50 calendar year
deductible
Minor Services covered at 50
Major Services covered at 40
500 maximum benefit per person each calendar
year
500 Lifetime maximum for Orthodontic services.
Diagnostic and Preventive Services do not apply
to annual maximum
12 month waiting period for Major Services and
Orthodontics if not currently covered under
Sullivan University Systems Delta Dental Plans.

Voluntary Dental Insurance Continued
Premier Preferred Provider Plan named Delta
Dental PPO Plus Premier
Over 89 of dentists in Kentucky participate,
over 135,700 nationally, in 231,300 locations
100 coverage for Diagnostic and Preventive
Services
Other services subject to 50 calendar year
deductible
Minor Services covered at 80
Major Services covered at 50
1,000 maximum benefit per person each calendar
year
1,000 Lifetime maximum for Orthodontic services.
Diagnostic and Preventive Services do not apply
to annual maximum
Reminders
Employee pays entire cost of plan chosen.
Very affordable rates, single as low as 5.02 per
paycheck.
May apply when initially eligible, at time of
qualifying event or during annual open
enrollment.
12 months participation required, or until March
1st , plan anniversary date if earlier.
12 month waiting period for Major Services and
Orthodontics if not covered under Sullivan
University Systems Delta Dental plans on or
before July 1, 2011.

Voluntary Short Term Disability Insurance
Choice of two plans from Fort Dearborn Life, 26
week or 52 week benefit period
Benefits payable following 15 days of disability.
No benefits are payable for disabilities lasting
less than 15 days. After 15 days benefits are
payable from the 16th day of disability for
either 26 weeks or 52 weeks depending on the plan
selected.
Choose benefit level desired, from 433.00/month
up to a maximum of 3,250.00/month, or maximum of
70 of pay.
Rates based on benefit amount selected and
benefit period selected.
Eligible FOM following 90 days and each annual
open enrollment thereafter.
May apply when initially eligible or during
annual open enrollment.
Pre-existing condition exclusion applies to any
sickness or injury for which you received medical
advise or treatment within 90 days prior to your
effective date.
Pre-existing condition exclusion ends 12 months
after your effective date.

Voluntary Long Term Disability Insurance
Plan pays 50 of monthly earnings up to 5,000
Benefits begin after 360 days of disability
Benefits payable until age 65
Rates based on age
Eligible FOM following 90 days and each annual
open enrollment thereafter.
May apply when initially eligible or during
annual open enrollment (subject to evidence of
insurability if applying when not initially
eligible).
Pre-existing condition exclusion applies to any
sickness or injury for which you received medical
advise or treatment within 12 months prior to
your effective date and your disability begins in
the first 24 months after your effective date due
to a pre-existing condition

Voluntary Vision Insurance
Eye exam every 12 months for 10.00 Co-pay.
Lenses available every 12 months for 20.00
Co-pay.
Frames available every 24 months for 20.00
Co-pay.
Contact lenses allowance of 105.00 in place of
all other benefits
Rates as low as 3.41 per paycheck for employee,
qualifies under Section 125.
May apply when initially eligible or during
annual open enrollment.
12 months participation required, or until March
1st anniversary date if earlier.

29
Key Events
Marriage Birth Divorce Reaching Dependent Age
Limit of 26 Change in employment status of
employee, spouse or dependent Change in coverage
under other employers plan. Must notify within
30 days or must wait until next Open
Enrollment Contact Rachel Maguire at
rmaguire_at_sullivan.edu or Melissa Lowe at
mlowe_at_sullivan.edu in the Human Resource
Department at 502-456-0058 to make changes.
30
MetLife Auto Home Group Insurance Program

Special group rates and discounts
Rewards for Safe Drivers
Teen Driver Program and Good Student Discount
Identity Theft Resolution Service included in
home and auto policies - at no additional cost
Convenient online access for free quotes,
information, and service
1-800-GET-MET 8 toll-free access for quotes.

Available in most states. See your policy for
limitations. Deductible Savings Benefit is not
available in New York and certain other states.
31
MetLaw for Sullivan University System Covers

Sale, Purchase or Refinancing of Primary
Residence
Eviction Defense (Tenant Only)
Civil Litigation Defense
Traffic Ticket Defense (No DUI)
Personal Bankruptcy

Wills, Living Wills Living Trusts
Powers of Attorney Demand Letters
Living Wills Living Trusts
Uncontested Adoption Guardianship
Name Change
Consumer Protection Matters
Document Preparation Review
Affidavits, Deeds, Demand Letters, Mortgages
Notes, Immigration Assistance

Plus Telephone Office Consultations on other
personal legal issues
32
Choice of Attorneys

Hyatt lets you choose your lawyer
More than 9,000 attorneys nationwide
Plan Attorneys must meet a stringent selection
criteria and have
an average of more than 19 years of legal
experience
The Legal Plan also gives you the flexibility
to use an attorney
who is not a participating Plan Attorney for
services that are
covered by the plan. If you choose to do so,
you will be
reimbursed according to a established fee
schedule.

33
Just Pennies a Day

One low payroll deduction covers you, your spouse
and dependent children.

Cost 9.00 per pay period deduction
34
Long Term Care Insurance

Includes coverage for custodial, supervisory or
skilled care
Services can be provided at home, adult day care,
Assisted living facility or nursing home facility
Benefit bank of 75,000 to 1,000,000 available
Monthly benefit access limit of 750 to 30,000
Simplified Underwriting during 2013 Open
Enrollment
Cost based on age when you apply
Premium discounts available
Fully portable coverage, you own your policy