Health FSA Open Enrollment Presentation

							Shawnee State University
       Health and FSA
 Overview for Open Enrollment
        November 2008
              Health Insurance
   Comprehensive Plan
      Medical

      Prescription

      Dental

      Vision

   Preferred Provider Organization (PPO)
   No Waiting Periods or Pre-existing Conditions
   Single and Family Coverage Available
   Dependents covered until age 25 if IRS eligible
                   Health Insurance
   Employee Premiums (Biweekly)
Employee Premiums               Single Coverage         Family Coverage

                                $5 - $10 per pay       $10 - $17.50 per pay
Support Staff (Salary Based)
                                ($120 - $240 Annual)    ($240 - $420 Annual)
                                 $15.71 per pay          $24.92 per pay
Administration/ATSS
                                   ($377 Annual)           ($598 Annual)
                                 $22.39 per pay          $36.11 per pay
Faculty (9 month pay-option)
                                   ($403 Annual)           ($650 Annual)
                                 $16.79 per pay          $27.08 per pay
Faculty (12 month pay-option)
                                   ($403 Annual)           ($650 Annual)


   Insurance Waiver Option
       Monthly Opt-out payments = $100 Single; $200 Family
       Must be able to show proof of other coverage
                 Health Insurance
   Largest Network in the Area
   Low Annual Deductibles
       $100 Individual
       $200 Family
   Limited Copays
       $60 Emergency Room Visit
   Generous Benefit Coverage
       90% In-Network Providers
       75% Out-Network Providers
                     Health Insurance
   Annual Out-of-Pocket Maximums*
          Plan Benefits          In-Network    Out-Network

             Individual            $ 500          $ 900

               Family              $ 1000        $ 1600
         *Including Deductible

   Lifetime Maximum Benefit
       $5,000,000 per covered person
   Enrollment Periods
       Initial 30 days of employment
       Within 30 days of a Qualifying Event
       Annual Open Enrollment in November
       Prescription Drug Coverage
                           No Deductible
                           Low Co-payment
                           Medco Network and Formulary

                                  Tier 1                  Tier 2                  Tier 3
Prescription Benefit
                                (Generic)             (Brand Name)            (Non-formulary)
Network Pharmacy            $7.00 - Admin & Staff:
                                                           $10.00                   $15.00
(up to 30 day supply)        $10.00 – Faculty *
Network Mail Service        $7.00 - Admin & Staff:   $7.00 - Admin & Staff:   $7.00 - Admin & Staff:
(up to 90 day supply)        $10.00 – Faculty *       $10.00 – Faculty *       $10.00 – Faculty *


* Denotes SEA-CBA Faculty Rx Copay Structure - Effective Jan. 1, 2009
                           Dental Benefits
   Annual Deductibles
           Deductible               In-Network           Out-Network
            Individual                    $50                 $50
             Family                       $150                $150


   Dental Coverage
    Dental Benefits                              In-Network Benefit    Out-Network Benefit
    Preventative & Diagnostic Services
                                                       100%            100% (R&C Fees)*
    (Oral exam, Cleanings, Sealants)
    Basic Dental Services
                                                       80%             80% (R&C Fees)*
    (Fillings, Root Canal, Extractions)
    Major Dental Services
                                                       50%             50% (R&C Fees)*
    (Crowns, Bridges, Dentures)


          *Out-Network: Members pay above R&C Fees
                    Dental Benefits
   Annual Max. Benefit
       $1,000 per Person


   Orthodontics
       60% coverage
       $1,000 lifetime max


   Preventative Services
       100% covered; No Deductible
       Free Cleaning every 6 months
                      Vision Benefits
Benefit Schedule                    In-Network                              Out-Network
Exam                                $10 copay                           up to $35 Benefit**
Material Costs                      $25 copay                            varies by product
 Pair of Lenses          Covered by materials copay*
  (Every 12 months)                                                    $25 - $105 Benefit**
                       Single vision, lined bifocals & trifocals

 Frames                  Covered by materials copay*
  (Every 24 months)                                                     up to $45 Benefit**
                            Up to $120 allowance

 Contact Lenses                No Material Copay
  (Every 12 months)                                                   Up to $105 Benefit**
                              Up to $120 allowance

                      * Discounts for costs above Standard Benefit   * * Reimbursed from Claim Receipt

                                  VSP Network
                                  Additional Special Discounts
           Flexible Spending Accounts
   Allows you to make Pre-Tax contributions from your salary to be used
    for Eligible, Out-of-Pocket Expenses.
        Health Care FSA         - $240-$3000 Annual Limit
        Dependent Care FSA      - $240-$5000 Annual Limit

   Must be Incurred within the Plan Year (Jan.1 - Dec.31) or Grace Period
    Extension (March 15th).
   IRS “Use-It or Loose-It” Provision – Unused funds are forfeited if not
    submitted according to Plan Provisions.
   Multiple Elected Reimbursement Methods:
     AmeriFlex Convenience Debit MasterCard

     Reimbursement Claim Submission

   Initial Employment (30 days) or Open Enrollment Period
        Questions???
Contact:
     Denise Gregory
     Phone: #3481
     Email: dgregory@shawnee.edu

     Chris Nourse
     Phone: #3163
     Email: cnourse@shawnee.edu


Or Stop by:
     Human Resources Office
     Administrative Building Rm 021
     Monday – Friday, 8:00am – 5:00pm