Att G3 - 2021 Dunn County OE Presentation.pdf
PDF 2 MB Posted
- Attached to
- RFP #2021-03 Health and Wellness Services
- Solicitation number
- 2021 - 03
- Issued by
- Wisconsin
About this file
This is a 2021 Open Enrollment Presentation for Health and Wellness Services provided by M3 Insurance on behalf of Dunn County, Wisconsin. The presentation outlines employee health insurance options, wellness programs, and ancillary benefits for county employees and their families. Dunn County offers two primary medical plan options through Medica, including Mayo Clinic-based coverage and national Passport network coverage, along with dental plans through Anthem Blue Cross Blue Shield, flexible spending accounts administered by Employee Benefits Corporation, and supplemental worksite plans through The Standard. The open enrollment period runs from October 1, 2020, through October 30, 2020, with all applications and forms required to be submitted by 4:30 p.m. on the closing date. Employees must complete a new 2021 Benefits Election Form for any changes to health and dental coverage or to add accident and critical illness insurance, with forms available on the Dunn County website at www.co.dunn.ws.us or through the Human Resources Department at 715-232-2429 or admin_hr@co.dunn.wi.us.
The medical plan options feature monthly employee premiums ranging from $44.48 to $127.68 for individual coverage and $96.02 to $264.92 for family coverage, with different rates for public safety employees. Dunn County provides a monthly waiver incentive payment of $50 to $75 for eligible full-time employees who waive or elect alternative coverage and provide proof of such coverage. The plans include Health Savings Account eligibility with individual contribution limits of $3,600 and family limits of $7,200 for the 2021 calendar year, supplemental accident insurance ranging from $7.39 to $19.93 monthly, and critical illness insurance offering up to $50,000 in benefits for employees. Additional wellness programs include Medica's My Health Rewards program with Virgin Pulse fitness tracking, Healthy Savings food discount program, virtual care options through AmWell and Virtuwell, and access to Dunn County's Employee Assistance Program.
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© 2020 M3 Insurance®
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE
DUNN COUNTY
2021 Open Enrollment Meetings
October 2020
AGENDA
Opening from our HR Director
Understanding Self Funding
Medical Plan Options and Cost
Health, Flexible and Dependent Care Accounts
Dental Plans
Worksite Plans
© 2020 M3 Insurance CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE
BACKGROUND INFORMATION
Self-Funded Plan
• Must maintain a fund balance
• Fund balance declining
• Annual rate increases are not sustainable
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE4
FOOD FOR THOUGHT
Do you have car insurance?
Have you ever been in an accident?
Have you ever had a windshield replaced?
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE5
DO YOU HAVE CAR INSURANCE?
FOR MOST, YES…
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE6
HAVE YOU EVER BEEN IN AN ACCIDENT?
Three quotes
Lowest cost/best quality
What happens to the rates at next renewal?
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE7
HAVE YOU EVER HAD A WINDSHIELD
REPLACED?
Cost compare
Pay cash vs. use insurance
WHY?
WHY NOT HEALTH INSURANCE?
OPEN ENROLLMENT
*NEW* All employees must complete the Benefits Election 2021 Form
Election changes to your health and/or dental insurance plans or to add accident and/or critical illness you will need to complete a new application
If you don’t want to make changes, check waive on the 2021 Election Form
If you are receiving the monthly incentive and would like to apply to receive it in 2021 please complete an updated form and provide proof of other coverage
If you are currently contributing, want to make a change, or start contributing to a Health Savings Account, you will need to submit a 2021 Contribution Authorization Form.
October 1, 2020-October 30th, 2020
All application and forms will be available on the Dunn County website at www.co.dunn.wi.us | 715-232-2429 | admin_hr@co.dunn.wi.us
All applications and forms must be received by 4:30 on October 30th http://www.co.dunn.wi.us/
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE10
SELF-FUNDING DEFINED
WHAT IS SELF-FUNDING (AKA ‘SELF INSURANCE’)?
Alternative method of providing employee health care benefits which offers greater opportunities to control costs
Employer responsible for funding medical claims
Could result in substantial savings for employers with a favorable (or at least predictable) history of claims experience
Cash flow works to the advantage of the plan/organization, rather than that of an insurance company or other provider
Self Funding Review
Non- Refundable
Premium
Admin Costs
Self Funded Insurance
Actual Claims
POTENTIAL
SAVINGS
$500,000.00
$1,000,000.00
$1,500,000.00
$2,000,000.00
$2,500,000.00
$3,000,000.00
$3,500,000.00
$4,000,000.00
$4,500,000.00 Fully Funded -vs- Self-Funded
MAIN STREET MEDICA
• Log on to http://www.mainstreetmedica.com/
• Click on the Service you need under Procedures, Diseases & Conditions (i.e. Outpatient Services)
• Select the Name of the procedure you are inquiring about (i.e. Adenoid and Tonsil Removal)
• A list will appear with the providers, locations and their average costs. Based on the key Medica utilizes, you can quickly decipher the Cost http://www.mainstreetmedica.com/
VIRTUAL CARE OPTIONS* | CONVENIENT
AND COST EFFECTIVE ONLINE TREATMENT
CLINIC-BASED AMWELL VIRTUWELL CallLink Nurse Line
Many clinics offer virtual care, online care or e-visits
24/7 online clinic available in every state
Includes coverage for medical and behavioral health care services
24/7 online clinic available in select states
Available 24/7
Prices vary Medical: Each visit is $59 or less
Behavioral health: Price varies by type of service
Medical: Each visit is $59 or less
FREE
Check with your clinic to see if they offer virtual care and how you can connect with your provider online
Mobile, web and phone visits with a board-certified doctor
Online visits with a certified nurse practitioner
Phone visits with a certified nurse practitioner
Clinic’s website Amwell.com Virtuwell.com https://www.medica.com/ wellness/nurse-line
*Virtual care options can vary by your plan’s network. Check care options at medica.com/findadoctor.
MEDICAL PLAN SUMMARY OF CHANGES
Plan 1 o Coinsurance to 80% o Increase to Out of network deductible to $6,000/12,000 o Increase to Out of Network Out of Pocket Maximum to $12,000/$24,000
Plan 2 o Coinsurance to 80% o Increase to Out of network deductible to $10,000/$20,000 o Increase to Out of Network Out of Pocket Maximum to $15,000/$30,000
HEALTH INSURANCE OVERVIEW
NETWORK | OUR NATIONAL NETWORK-
MEDICA CHOICE® PASSPORT
OVERVIEW
Seamless benefit administration 12,000+ employer groups and over 2 million members nationwide Fully integrated through Express Scripts
• 68,000+ pharmacies including 24-hour pharmacies
Convenience care and urgent care
Virtual Care: AmWell or Virtuwell
Medica Choice® Passport national open access network
Co-branded ID cards
See any network provider without a referral
MEDICA CONTRACTED SERVICE AREA
UHG CONTRACTED SERVICE AREA
27K Primary care physicians
>4K Clinics, offices and hospitals
>800K National providers
>5,300K National hospitals
>60K National pharmacies
20 hospitals/medical centers
60 primary and specialty care clinics
Medica’s standard networks for chiropractic, behavioral health, pharmacy
Primary service area:
Southern Minnesota and western Wisconsin
MEDICA COMPLETEHEALTH℠ (FEATURING
CARE AT MAYO CLINIC) | QUICK FACT
When you visit a network provider, you receive:
The best coverage under your plan
The Medica discounted rate
When you visit a non-network provider, you receive:
Lower coverage under your plan
Your share of the costs based on the provider’s full charges
WHY CHOOSE AN IN-NETWORK PROVIDER?
2021 EMPLOYEE HEALTH INSURANCE PREMIUMS
MONTHLY RATES
OPTION 1
Mayo
Option 1
Passport
OPTION 2
Mayo
Option 2
Passport
Employee $78.58 $127.68 $44.48 $106.74
Family $158.96 $264.92 $96.02 $144.02
Public Safety
Employee $78.58 $78.58 $44.48 $71.16
Public Safety Family $158.96 $212.54 $96.02 $192.04
MONTHLY INCENTIVE PAYMENT
The monthly waiver payment applies to two groups.
Proof of alternative coverage is required.
• Full-Time employees with dependents that waive the County’s family health insurance plan, who provide proof of alternative coverage, will receive $75 a month
• Full-Time employees with dependents electing to take the County’s single health insurance or single employees electing to completely waive medical coverage will receive monthly amount of $50
Healthy Savings makes eating healthier easier and more affordable.
The program is easy-to-use, members simply shop, scan and save instantly!
Discounts on healthy foods of more than $250 per month
Foods qualified by a third party based on nutrient density – only healthiest 1/3 qualify
No clipping or downloading coupons needed; all promotions are automatically loaded onto barcode
Available to members within 30 miles of participating retailer
Coming Soon:
Participating Retailers:
HEALTHY SAVINGS | DISCOUNTS ON
HEALTHY FOODS
Small steps to change
BEHAVIOR CHANGE
LEARN DO BECOME
MY HEALTH REWARDS | CREATING DAILY
SUCCESS ROUTINES
https://www.medica.com/members/group/video-my-health-rewards-getting-started https://www.medica.com/members/group/video-my-health-rewards-getting-started
MY HEALTH REWARDS | APPS
Well-being in the palm of your hands
1 Complete cards, track healthy habits, view challenges, and more.
2 3View stats including steps, workouts, and active minutes.
Detailed program progress, points, and REWARDS.
Wirelessly sync your Max or Buzz activity tracker.
Available for iOS and Android.
MY HEALTH REWARDS | Virgin Pulse Max Buzz
Max Buzz - Sync Device Option
The Max Buzz (fitness tracker) will be available to members through the Virgin Pulse store for just for a reduced price of just $9 (plus tax).
Members interested in a fitness tracker can choose to use their $10 reward to purchase the Max Buzz.
MY HEALTH REWARDS | VIRGIN PULSE
MAX BUZZ
LEVEL POINTS EARNED REWARD
1 2,000 $10
2 10,000 $20
3 25,000 $30
4 40,000 $40
Members 18 years and older can earn up to $100 in gift cards funded by Medica
MY HEALTH REWARDS | INCENTIVES FOR
DAILY ACTIVITY
SAVE FOR YOUR DEDUCTIBLE!
By making HSA contributions, you can save for your out-of-pocket expense without paying taxes on that money.
SAVE with HSA Dollars Plan Deductible To Cover Your Portion of
Deductible
Single $3,000 $250/Month
Family $6,000 $500/Month
Use it or keep it! Your HSA money rolls over from year to year!
Contributions can be made as needed throughout the year
Contributions are always excluded from employees’ income:
Pre-tax through payroll OR deduction on personal taxes at year end
For individuals aged 55 and over, an additional “catch-up” contributions to the
HSA is allowed: Amount: $1,000 per year
Save receipts to show proof of expense.
Must stop once an individual is enrolled in any type of Medicare
Cannot contribute if covered by any other non-HDHP Health Plan
HSA Funds roll over from year to year – use it or keep it!
The maximum amount that can be contributed to an HSA from ALL Sources
Individual:$3,600
2021 CALENDAR YEAR HSA CONTRIBUTION
Family: $7,200
HSA Funds can be used for medical expenses for:
• The HSA owner (employee)
• Spouse (even if not covered by the HDHP)
• Any tax-qualified dependent of the individual (per IRS guidelines)
• Amount of distribution is taxable
AND
• 20% additional penalty
If distribution is not used for qualified medical expenses
• Individual dies or becomes disabled
• Individual is age 65 or over
There is no additional penalty if http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCP6gzJ6hn8cCFU98kgodYzkBHQ&url=http://livhomeblog.com/tag/healthy-living/&ei=0_zIVb7rIc_4yQTj8oToAQ&bvm=bv.99804247,d.aWw&psig=AFQjCNF_uGrGxhBLXDyeaVpc2Ojw_Jh3GA&ust=1439321605731027 http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCP6gzJ6hn8cCFU98kgodYzkBHQ&url=http://livhomeblog.com/tag/healthy-living/&ei=0_zIVb7rIc_4yQTj8oToAQ&bvm=bv.99804247,d.aWw&psig=AFQjCNF_uGrGxhBLXDyeaVpc2Ojw_Jh3GA&ust=1439321605731027
FLEXIBLE SPENDING ACCOUNTS
EBC is the administrator
Limited Purpose Medical Flexible Spending -
Limit of $2,700
Dental and Vision expenses only
Use it or lose it
Dependent Care Account – Available to all benefit-eligible employees.
Limit of $5,000
Gives you the opportunity to redirect a portion of your annual pay on a pre-tax basis to pay for dependent care expenses
The Dentacare DHMO covers:
Preventive and diagnostic services – like cleanings and X-rays – at 100%
Basic Services like amalgam and anterior composite fillings, simple endodontics, oral surgery, periodontics
Major Services like complex endodontics, Oral Surgery, periodontics
Very rich coverage, but managed care only available through one assigned in-network Primary Dentist
$695 copay for Ortho – Child and Adult, the rest is covered – at 100%
Dentacare 100 DHMO
The Dental Blue – Indemnity covers:
Maximum of $1,000 per person
Most preventive and diagnostic services
– like cleanings and X-rays – at 100%
Basic Services - amalgam & anterior composite fillings, simple endodontics, oral surgery, periodontics at 50%
Major Services - complex endodontics, Oral Surgery, periodontics at 50%
A PPO of dentists and specialists, no assignment or referrals required
Ortho treatment for Children to Age 19 – 50% - $800 Separate Lifetime Max
Dental Blue Freestanding
DENTAL COMPLETE
Chart lists benefits for doctors in your plan only.
Dental plans Dentacare 100 Dental Blue Freestanding
Deductible No Deductible $0 Single/Family In or Out of Network
Preventive care (oral exams, teeth X-rays, cleanings)
No copayment/coinsurance No copayment/coinsurance
Annual maximum No Annual Maximum $1000
Basic care (fillings)
No copayment/coinsurance 50% In & Out of Network
Major care (crowns)
No copayment/coinsurance (except for lab fees)
50% In & Out of Network
Orthodontics (braces) 50% of charges per Orthodontic treatment to $695. No Maximum – Adults and Dependent Children to Age 19
50% In & Out of Network, $800 Lifetime Orthodontic Maximum per member – Dependent Children to Age
ACCIDENT INSURANCE
Accident insurance is an affordable way to cover the gap between what Medical insurance pays and what you’d owe out of pocket if you or a family member were to get injured.
• Pays benefits following treatment for a wide range of accidents – 100+
• Lump sum benefits paid directly to employees
• Money can be used wherever you need it most:
– Deductibles/Copays
– Medical Bills
– Daily Expenses
• Premiums are automatically deducted
• Affordable monthly group rates through Dunn County
– Employee Only: $7.39
– Employee + Spouse: $10.67
– Employee + Children: $13.05
– Employee + Family: $19.93
ACCIDENT INSURANCE
Benefit Highlights
• Lacerations/Cuts (size) $50-$400
• Dislocations (NS/S) $100- $3000
• Fractures (NS/S) $75-$5500
• Knee Surgery $400
• Ruptured Disc $400
• Chiropractic $25/day
• Physical Therapy $50/day
• Lodging $150/day
• Transportation $100/trip
• Accidental Death (EE) $25,000
• Spouse $12,500
• Child $6,250
• Ambulance (Ground) $200
• Emergency Room $100
• Urgent Care $50
• Hospital Admission $500
• Hospital Confinement $100/day
• Critical Care Admission $500
• Critical Care Confinement $200/day
• Major Diagnostic Exam $100
• Burns $100-$7500
• Concussion $100
• Eye Injury $150
• Coma $5000
• Youth organized sports benefit pays an additional 25% benefit
• Robust and flexible AD&D benefits
• Line of Duty Benefit provides an additional 100% of the AD&D benefit or Accidental Impairment benefit to public safety officers
• Policy pays benefits for each fracture and/or dislocation
• No Termination age for employee or spouse
• Group policy with portability at same rates even if master contract terminates
• No medical underwriting
ACCIDENT INSURANCE FEATURES
CRITICAL ILLNESS INSURANCE
It’s estimated that almost 1.7 million new cases of cancer will be diagnosed in 2018 in the U.S.
Every 40 seconds, someone in the U.S. has a heart attack
Critical Illness insurance pays a lump sum benefit to help fill the gap as a result of out of pocket costs from a serious injury, creating a financial safety net for you and your family
• Critical Illness is Protection from “What If?”
• Employees elect a benefit amount that pays a lump sum upon the diagnosis of a covered critical illness — up to $50,000 for employees, $30,000 for spouses
• $20,000 Guarantee Issue for Employees and $10,000 for Spouses – Additional amounts require Evidence of Insurability (EOI)
• Dependent children are automatically covered at 25% of employee amount
• Rates are Attained Age Rates
• See Benefit Booklet or Decision Support Tool for rates
CRITICAL ILLNESS INSURANCE
• Heart Attack
• Stroke
• Cancer
• End Stage Renal Failure
• Major Organ Failure
• Carcinoma in Situ1
• Severe Coronary Artery
Disease with recommendation for surgery1
• 21 Covered Childhood
Diseases
• Booklet Page 13
Covered Conditions
• Health Maintenance Screening Benefit - $50
• Reoccurrence Benefit after 12 months treatment-free – 25%
• Dependent children automatically covered at 25% of employee amount – No additional cost
• No lifetime maximum
• No age reduction or diagnosis waiting periods
• Take coverage with you
• 6/12 pre-existing condition limitation
• EOI required for late applicants
CRITICAL ILLNESS FEATURES
Dunn County
EAP services
Dunn County
EAP services
CONFIDENTIAL - DO NOT REPRODUCE OR DISTRIBUTE42
OPEN ENROLLMENT
*NEW* All employees must complete the Benefits Election 2021 Form
Election changes to your health and/or dental insurance plans or to add accident and/or critical illness you will need to complete a new application
If you don’t want to make changes, check waive on the 2021 Election Form
If you are receiving the monthly incentive and would like to apply to receive it in 2021 please complete an updated form and provide proof of other coverage
If you are currently contributing, want to make a change, or start contributing to a Health Savings Account, you will need to submit a 2021 Contribution Authorization Form.
October 1, 2020-October 30th, 2020
All application and forms will be available on the Dunn County website at www.co.dunn.wi.us | 715-232-2429 | admin_hr@co.dunn.wi.us
All applications and forms must be received by 4:30 on October 30th http://www.co.dunn.wi.us/
QUESTIONS AND WHO TO CONTACT
Medical Carrier:
MEDICA
www.medica.com 952.883.5000
Flexible Spending Accounts Employee Benefits Corporation www.ebcflex.com 1.800.346.2126
Dental Carrier Anthem Blue Cross Blue Shield www.anthem.com 1.866.589.0582
Worksite Plans Carrier The Standard www.standard.com/edu/dunn-county/44031
Dunn County Human Resources
Admin_hr@co.dunn.wi.us
715.232.2429
Website www.co.dunn.wi.us http://www.medica.com/ http://www.ebcflex.com/ http://www.anthem.com/ http://www.standard.com/edu/dunn-county/44031
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