Partnership Open Enrollment 2021 - Presented by Tacha Merritt FiliceInsurance Agency - Filice Insurance
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Partnership Open Enrollment 2021 P r e s e n t e d b y Ta c h a M e r r i t t Filice Insurance Agency
2021 Benefits
•MEDICAL:
o Blue Shield of CA | HMO and PPO and H.S.A. options
o Kaiser Permanente | High HMO Plan and H.S.A option
o Western Health Advantage (WHA) | HMO Plan
•DENTAL | Direct Dental
•VISION | Vision Service Plan (VSP)
•LIFE & DISABILITY | Mutual of Omaha
•FLEXIBLE SPENDING ACCOUNT | Navia
•EMPLOYEE ASSISTANCE PROGRAM | Claremont
•PET INSURANCE | Petplan
Key terms
•Deductible
The amount you pay each year before your plan starts to pay
•Copay
A flat fee you pay for covered services like doctor visits
•Coinsurance
Your share of health plan costs (a percentage of total cost) after meeting
your deductible
•Out-of-pocket maximum
The most you have to pay out-of-pocket each year for health care services. Check your
plan details to see if your deductible is part of your Out-of-Pocket maximum
•Premium
The amount you pay to belong to a health plan
How an HMO works
How it works:
- You pay a copay for doctors’ visits and services performed during visits
- You pay coinsurance for most other services, such as outpatient surgery, hospital care or specialized tests
- Once you reach the annual coinsurance maximum, the plan pays
100% of any remaining covered expenses, excluding copays
• Many costs are predictable • No out-of-network benefits
• Your out-of-pocket costs are • Referrals needed to see specialists
typically lower when you use • More limited choice of doctors and
care facilities
How a PPO works
How it works:
- You pay a copays for in-network office visits and Rx and a percentage of the cost (20%) for all other care until
you reach the annual coinsurance maximum
- You must meet a deductible before the plan pays its share of coinsurance (80%)
• Freedom to seek care from any • If you seek care from an out-of-network
doctor, in- or out-of-network doctor, you’ll pay a greater percentage of
• You don’t need a referral to see costs
a specialist • Annual premiums are typically the highest
of all of your health plan options
How an HSA PPO works
How it works:
- You pay the full negotiated cost of all services until you meet the deductible. Coinsurance applies for all
services only after you meet the large deductible until you reach the annual out of pocket maximum
-
• You get H.S.A. funds to pay for • You have to manage all your bills until you
your deductible meet the large deductible
• You keep all unused H.S.A • You may have to pay out of pocket for
funds services until your H.S.A has been 100%
• Same freedom of PPO plan funded
2021
Access+ HMOSM Per Admit 20-250
Annual Deductible None
Calendar-year $2,000 per Individual
Copayment maximum $4,000 per Family
Preventive Care $0
Office Visits $20/ visit
Inpatient Hospital $250/admission
Outpatient Services $200
Ambulance Services $100
Emergency Services
No direct admission $150/visit
Direct admission No charge
Drug Deductible $0
Drug Copayments $10/$30/$50
Mail Service Prescriptions $20/$60/$100
This chart is intended to provide a high level summary of plan benefits. The Evidence of Coverage and Plan Contract should be consulted for a complete
Chiropractic
description of plan&benefits
Acupuncture
and coverage. $10 copay; 30 combined visits
8Custom PPO Combined Deductible 20-500 80/60
Preferred Providers Non-Preferred Providers
Annual Deductible $500/$1,000 $500/$1,000
Calendar-year $3,500 per Individual $10,500 per Individual
Copayment maximum $7,000 per Family $21,000 per Family
Office Visits $20/visit 40%
Inpatient Hospital $100 then 20% 40%
Outpatient Services 20% 40%
Ambulance Services 20% 20%
Emergency Services
No direct admission $100 + 20% $100 + 20%
Urgent Care $20 40%
Chiropractic Services $25/visit; 20 visits per calendar year 40%; 20 visits per calendar year
Acupuncture Services $25/visit; 20 visits per calendar year 40%; 20 visits per calendar year
Drug Deductible $0 $0
Drug Copayments $10/$30/$50 25%
Mail Service Prescriptions $20/$60/$100 Not Covered
This chart is intended to provide a high-level summary of plan benefits. The Evidence of Coverage and Plan Contract should be consulted for a complete description of plan benefits
and coverage.
9Full PPO Savings Two-Tier Embedded Deductible
2250/2800/4500 (H.S.A.- compatible)
Preferred Providers Non-Preferred Providers
Annual Deductible $2,250/$2,800/$4,500 $2,250/$2,800/$4,500
Calendar-year $3,500 per Individual $6,000 per Individual
Copayment maximum $7,000 per Family $12,000 per Family
Office Visits 20% 50%
Inpatient Hospital 20% 50%
Outpatient Services 20% 50%
Ambulance Services 20% 20%
Emergency Services
No direct admission $150 + 20% $150 + 20%
Urgent care 20% 50%
Chiropractic Services 20%; 20 visits per calendar year 50%; 20 visits per calendar year
Acupuncture Services 20%; 20 visits per calendar year 50%; 20 visits per calendar year
Drug Deductible Combined with medical Combined with medical
Drug Copayments $10/$25/$40 Not Covered
Mail Service Prescriptions $20/$50/$80 Not Covered
This chart is intended to provide a high-level summary of plan benefits. The Evidence of Coverage and Plan Contract should be consulted for a complete description of plan benefits
and coverage.
10Health Savings Accounts through H.S.A Bank
A Health Saving Account (HSA) can help you manage the rising costs of
health care. You can pay for qualified medical expenses with pre-tax funds.
• Put aside Federally pre-taxed dollars for medical expenses
• H.S.A’s roll over from year to year, and are portable
• Combined only with Kaiser or Blue Shield HDHP plans compatible a Health
Savings Account (HSA)
11Health Savings Accounts (cont.)
Key Features:
• Partnership will contribute $192.50 for individuals or $385 for families towards your
Blue Shield annual deductible of $2,250/$4,500.
• The total annual funding of $2,310 for individuals or $4,620 for families exceeds the
HDHP deductible and can be used for copay expenses, etc. once the plan
deductible has been met.
• 2021 IRS deposit limits: $3,600 for individuals/$7,200 for families. Account holders
who are 55 years of age or older can contribute an additional $1,000 for “catch-up”
contribution purposes.
*State taxes apply in AL,CA and NJ
12(In Limited Counties Only)
Personalized care at convenient locations
Most of our facilities offer multiple services
under one roof—
▪ primary care
▪ lab and X-ray
▪ pharmacy
—so you can take care of many of your health needs in a
single trip.
Access to your medical record information on KP.org
14Kaiser Permanente (CA Only)
Traditional HMO Plan
•$20 Traditional HMO Plan:
►Deductible: None
►Well Baby Preventive Care: $0
►Primary/Specialty visits: $20/$35 per visit
►RX Generic: $10 for 30-day supply
RX Brand name: $30 for 30-day supply
►Emergency: $100
►In Patient Hospitalization: $250 admission
►Outpatient Surgery: $100 per procedure
►Out of Pocket Maximum: $1,500 Single / $3,000 Family
►Chiropractic & Acupuncture Benefit: $10; up to 30 visitsKaiser Permanente (CA Only)
High Deductible Plan (H.S.A-compatible)
•HSA – Qualified Deductible HMO Plan:
►Deductible: $2,000 single / $4,000 family
►Well Baby Preventive Care: $0
►Primary/Specialty visits: $30 after deductible
►RX Generic: $10 for 30-day supply after deductible
RX Brand name: $30 for 30-day supply after deductible
►Emergency: $100 after deductible
►In Patient Hospitalization: $250 per admit after deductible
►Outpatient Surgery: $150 per procedure after deductible
►Out of Pocket Maximum: $3,000 Single / $6,000 FamilyHealth Savings Accounts
Key Features:
• Partnership will contribute $192.50 for individuals or $385 for families towards your
Kaiser annual deductible of $2,000/$4,000.
• The total annual funding of $2,310 for individuals or $4,620 for families exceeds the
HDHP deductible and can be used for copay expenses, etc. once the plan
deductible has been met.
• 2021 IRS deposit limits: $3,600 for individuals/$7,200 for families. Account holders
who are 55 years of age or older can contribute an additional $1,000 for “catch-up”
contribution purposes.
*State taxes apply in AL,CA and NJ
172021 WESTERN HEALTH ADVANTAGE
PREMIER HMO 20 • Out of Pocket Maximum: $1,500 individual / $2,500 Family • Deductible: $0 • Prevention Care: Free • Office Visits: $20 • Lab –X-rays: $0 • Outpatient Hospitalization: $100 • Inpatient Hospitalization: $0 • Urgent Care: $35 • Emergency Room; $100 • Prescription Drugs: $10 / $30 / $50 (or mail Order 90 day) $25/ $75 / $125
Online Resources MyWHA.org • Member specific login • ID card reorder • Change Primary Care Physician • View and audit claim accumulator • Price medication and services • MyWHA Wellness tools • WHA Mobile App • Medical Group Specific App and online portal
DIRECT DENTAL
PPO Out of
Dental PPO In Network
Network
Preventive Care 100% ( 3 cleanings a year)
Basic care 90% after deductible 80% after deductible
Major Care 60% after deductible 50% after deductible
Orthodontia 50% adult and child 50% adult and child
Deductible $50 per person, $150 per family
Maximum Benefit $3,000 per calendar year per member
Ortho Maximum
$1,500 Lifetime Maximum (per member)
Benefit
www.directdentalplans.com to find a DHA network dentist near you!• Exam / Material Co-pay $20
• Frequency
- Exams every 12 months
- Lenses every 12 months
- Frames every 24 months
- Contacts (instead of glasses) every 12 months
- Frame Allowance $150 (covers anti-reflective coating)
• Benefits
- Most services and materials covered in full with In-Network Providers
- Reimbursement benefits available with use of Out-of-Network Providers
- Laser Vision Correction discountsEmployer Funded Life Insurance, Short-Term Disability, and Long-Term Disability Programs
Life and Disability Life and AD&D • 1 x salary to a maximum of $150,000 • Accelerated death benefit of $112,500 • Integrated EAP and Travel Assistance program Short Term Disability • Elimination Period: 7 Days • Benefit Duration: 25 Weeks • Weekly Benefit: 60% of your weekly earnings up to $2,310 Long Term Disability • Elimination Period: 180 Days • Monthly Benefit: 60% of your monthly earnings up to $10,000
2021 FLEXIBLE SPENDING ACCOUNTS
• Administered by Navia Benefits
• Pay for out-of-pocket health care and dependent day care expenses with pre-
tax dollars
• You can save significantly on taxes as these amounts are deducted from your
salary before tax withholdings are calculated
• All participants receive a debit card to conveniently pay for your eligible
expenses throughout the year
• Three types of accounts: health care, limited purpose, and dependent care2021 FLEXIBLE SPENDING ACCOUNTS
Health Care FSA - Annual contribution is $2,750
Dependent Care FSA - Annual contribution is $5,000
Limited Purpose Health Care FSA - Annual contribution is $2,750
o For HSA Plan participants only
o For dental and vision expenses onlyHOW YOU CAN SAVE!
Your Estimated Tax Savings
Without Health Care FSA With Health Care FSA
Gross annual pay $60,000 Gross annual pay $60,000
Tax rate (30%) - $18,000 FSA contribution -$2,600
Net annual pay = $42,000 Adjusted gross pay = $57,400
Annual heath care expenses - $2,600 Tax rate (30%) - $17,220
Final take-home pay = $39,400 Final take-home pay = $40,180
Take home this much more with a Health Care FSA $780
Actual savings will vary based on your income and individual tax situation.FSA RULES AND TIMELINES
• Require an active election for each plan year
• If you currently participate, you must enroll again if you want to contribute in
2021
• “Use it or lose it rule” but 2 ½ grace period applies
2021 Plan Year Health Care and LP Dependent Care
Grace Period Applies Not Applicable
Use it by… March 15, 2022 December 31, 2021
Claim it by… March 31, 2022 March 31, 2022Responding to the human factor in the world of work .
EAP
Partnership HealthPlan of CaliforniaWhat is an EAP?
• A proactive problem-solving resource
that provides:
– Assistance with a wide variety of
personal concerns
– An easy way to get help before an issue
turns into a bigger problem
– A positive resource that we all may need
to use from time to time
31Counseling
• 5 visits per incident, per rolling 12 months
• Help with any problem:
– Marital/family/relationship issues
– Emotional issues like stress, anxiety, depression, grief
– Work concerns
– Substance Abuse
• Panel of licensed clinicians in private practice
• Day and evening appointments available
• Referrals to specialist close to work or home
32Confidentiality
• Confidentiality is vital to effectiveness
• No information disclosed without signed
written consent
• Legal exceptions to confidentiality:
– Suspected child or elder abuse
– Danger to oneself
– Threats of violence
33Claremont Personal Advantage
To register visit:
www.ClaremontEAP.com
Company Name: Partnership
HealthPlan
34PET INSURANCE Petplan | Health insurance for pets
How it works… Petplan takes the worry out of paying for the care your pet deserves. The plan covers: • Accidents and illnesses • Chronic and hereditary conditions • Prescription medications • Diagnostic testing • Non-routine dental treatment • MRI, CAT scan, & ultrasound imaging • Specialist treatments, and more!
How do I get a quote?
Visit GoPetplan.com/offer/EBP2767
or call 866-467-3875 and mention
code EBP2767 to get a quote on
coverage for your pet
• Receive up to a 10% discount
on coverage
• 24-hour call center for pricing or
policy features
• Customize the policy that works
best for you and your pet2021 Employee Costs Per Pay Period
BS HMO BS PPO BS H.S.A * K High HMO K H.S.A** WHA HMO
EE $12.93 $13.33 $11.97 $8.81 $9.01 $9.68
EE + 1 $100.83 $104.00 $90.37 $73.04 $70.40 $75.47
EE + 2 $156.41 $161.33 $131.28 $123.37 $107.55 $117.07
Medical Waive Credit: $138.50 per pay period
Dental/Vision Waive Credit: $18.50 per pay period
* Includes H.S.A monthly contributions of $192.50/$385.00 month for Blue Shield HSA members
** Includes H.S.A monthly contributions of $192.50/$385.00 month for Kaiser HSA members
Dental, Vision, Life, Disability, EAP includedWhat to do next?
Upcoming Deadlines and Dates
Open Enrollment via ADP Self-Service | November 9 – November 22
Even if there are no changes, employees must review their elections and confirm their
enrollments/dependents for 2021Thank you! For more information, please visit: benefits.filice.com/partnership
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