2014 Employee Benefits

Enrollment

Open Enrollment

– Changes effective January 1, 2014

– It’s the time of the year you can:Add or change Medical and Dental plan Add or delete dependentsEnroll in Flexible Spending Accounts for 2014

– Changes must be received by November 22nd

Obamacare

PPACA

Affordable Care Act

Health Care Reform

A word of caution!

With the opening of the Exchange, there have been reports of telemarketers calling people trying to sell insurance for their “companies”. This is a scam!

Don’t give out your personal information over the phone!

HCR: What you need to think about

First…. Do you have to have insurance?– Technically yes. If you don’t have insurance in 2014

either through your employer, the Exchange, Medicare or Medicaid or other qualified health plans you will be subject to a penalty. Penalty in 2014 is max of $285 per family or 1% of income over the tax filing threshold.

What is the Exchange? – Exchange is a marketplace for those without insurance to

go to purchase insurance.– NY’s exchange can be found at

www.nystateofhealth.ny.gov

How much will coverage through the Exchange cost?– That depends on the type of plan you want. However

because your employer provides affordable coverage you will not be eligible for a government subsidy.

Is there anywhere else I can get help?– Yes. NY State has expanded the Medicaid

income thresholds. – 2014 Single Rate is $15,800, Family of 4 is

$32,500– Medicaid plans have very low if any cost

sharing.

How do I know if I qualify for Medicaid?– Contact the local Department of Social

Services at 855-693-6765 or apply through the Exchange at www.nystateofhealth.ny.gov

Will the Exchange cost less than my employer’s plan?– Probably not. Let’s look at an example:– In the Syracuse District the second lowest cost single

premium for the Silver plan on the Exchange is $341.34 per month through NY Fidelis.

– Silver Plan pays an Actuarial Value of around 70% of claims. So for every $1 in claims, you would have to pay $.30.

– Your employers plan is more of an 85%-90% Actuarial Value.

– If you had $10,000 in claims under the Silver plan, you would pay approximately $3,000 out of pocket vs $1,000 to $1,500 under your employers plan.

– So you would pay more in premium and more out of pocket in the Exchange!

What about the lowest cost plans in the Exchange?

– There are lower costing plans within the Exchange. However the network of Physicians is VERY limited.

Where can I go for more information?– www.nystateofhealth.ny.gov – www.healthcare.gov– www.health.ny.gov/health_care/medicaid – Local Dept of Social Services 855-693-6765

Flexible Spending Account Flexible Spending Account

Flexible Spending Accounts

• Participation in an FSA reduces the taxes you pay to Uncle Sam

• “Use It or Lose It” – Prepare by budgeting your predictable expenses

• You Must re-enroll each year in order to participate

• Maximum Annual Election is $ 2,500 for Health Care FSA and $ 5,000 for Dependent Care FSA

• Voluntary plans – you are not required to participate

• CHANGE For 2014 – You must be FT/Medical plan eligible to enroll in FSA

Health Care FSASample Eligible Expenses (see pg 38):

Flexible Spending Account Budget:Medical Expenses:

Co-Pays/Deductibles $ 700Prescription Drugs/Over the Counter $ 650Hearing Exams/Hearing Aids $

Dental Expenses:Deductibles and Co-Insurance $ 150Orthodontia $

Vision Care Expenses:Exams $ 20Eyeglasses/Contact Lenses/Supplies $ 215Lasek Surgery $

Total Estimated Health Care Expenses: $ $1,735Annual Total $1,735 divided by 26 pays = $66.73 per pay

You DON’T pay taxes on $1,735 that is going to be spent!

Health Care FSATax

Savings would be

$394

http://www.aetnafsa.com/fsa/index.php

Dependent Care FSA

• Pre-Tax Funding of Dependent Daycare Expenses

• Participate only if care is necessitated for work or school-related expense

• Maximum Election is $5,000• $$ must be in account prior to

reimbursement• Provider must have a Tax ID #• Can’t use Childcare Tax credit & Dependent

Care – talk to your tax advisor!

Keep Your current Benny Card

• You will need to sign up for a debit card if:

If you did not receive a card in 2013

If you lost your card and did not order a new one there is a $5 charge

Debit Cards

Debit Cards can be used for FSA and HRA Expenses

“All Claims MUST be substantiated!” So says the IRS!

When a purchase is NOT automatically substantiated (ie, vision), FBS will request receipts…* Do not use your debit card at the Dentist’s office

Please Respond!First Receipt Request

If you do NOT respond after two letters?

1.FBS will block your card 2.Your employer will garnish.

IRS Rules!

How to Respond to a Letter Requesting Debit Substantiation?

• Debit Substantiation Procedures• 1-Return a copy of the letter along

with the requested receipts.

• 2-Receipts must meet IRS acceptable “5-Point” receipt requirements

• 3-Reply directly by fax (585-641-7500) or US Mail as indicated on the letter.

Tired of Having Your Claims Denied?

What do we need to process a claim?Detailed Receipts!

For Over the Counter Items:1.Date of Purchase2.Store Name3.Eligible Item Purchased4.Amount Due by Employee5.Prescription if Medication

For Rx Claims:1.Employee or Dependent Name2.Fill Date3.Provider4.Amount Due by Employee5.Drug Name

Pull receipt off the bag!For Dental/Vision:1.Employee or Dependent Name2.Date of Purchase3.Provider4.Services Rendered5.Amount Due by Employee6.Amount paid by insurance

MetLife Dental Plan

MetLife Dental PlanPlan Features• Deductible $50 (3 per family) for Basic & Major

Services only• $1,000 annual maximum• Dependent/Student - 19/25

• REMEMBER, while you can enroll for 1/1/2014, you would have waiting periods if not newly eligible :• 6 months on Basic Restorative (Fillings)• 12 months on all other Basic Services• 24 months on Major Services

Single Family

$3.68 $25.12

Per 26 Pay Costs

MetLife Dental Plan

Dependents to 20/26 – different than dental

In-Network

Exam – once per 12 months

$10 co-pay

Lenses – once per 12 months

$25 co-paySingleBifocalTrifocal

Lenticular

Frames – once per 24 months

$25 co-pay ($130 allowance)

Contacts – once per 12 months

$130 allowance

MetLife Vision Plan

MetLife Vision Plan

Vision Plan Employee Costs Per Pay (26) Single: $3.84 Family: $9.20

Life and Disability PlansCore - Company Paid Benefits

• Group Term Life & AD&D Insurance

– 1 times your annual salary to maximum of $150,000

• Statutory NYS Short Term Disability

– 50% of you weekly salary to a maximum of $170 per week

• Long Term Disability

– 60% of your monthly salary after 180 days of disability

• 14 day elimination period

• 40% of weekly salary up to $1,000 per week

• Does not integrate with NYS Disability

• 3/6 Pre-existing condition

• All employees will be Guarantee Issue – no medical questions

Lincoln Short Term Disability

Voluntary Short Term Disability Example

• Sam Jones, $1500 monthly salary or $346 weekly salary

• Monthly benefit $600• This is in ADDITION to NYS

Disability• Per 26 Pay Deduction $6.20

(same rate $.97 per $10 regardless of age )

Sam’s Disability Payment

$1200

$1000

$800

$600

$400

$200

$0

After-TaxPaycheck$1,085

After-TaxPaycheck$1,085

VoluntaryShort-TermDisability$600

VoluntaryShort-TermDisability$600

NYSDisability$533

NYSDisability$533

Total Disability Payment $1,133

Total Disability Payment $1,133

Monthly Salary $1,500

ING Whole Life Insurance

• Qualified Issue Coverage for all eligible employees.–Qualified Issue Coverage Levels:–Employees – 3x salary to $100,000 max–Spouses – Death benefit amount what $5/wk will

purchase Children – Individual Polices for $10,000 or Term Riders for

$10,000• Affordable Level Premium(30 yr. old/$25,000/$4.65 wk)

• Loan Provision Cash Value Accumulation($9,025)

• Flexible Convenient Payroll Deduction• Portable

Cancer InsuranceIf you or a family member were diagnosed with

cancer, your medical insurance would cover your hospital and medical expenses, but not your "Indirect Costs".

Indirect costs can include:• Medical Related Expenses

– Co-payments• Non-medical Expenses

– Travel Expenses − Meals– Lodging − Care giver loss of income

• Out-of-Pocket Expenses– Car Payments − Mortgage or Rent

Payments– Utility Bills − Health Insurance

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