Midwestern State University
HUMAN RESOURCES DEPARTMENT
June 29, 2016
TEXAS EMPLOYEES GROUP BENEFITS PROGRAM (GBP)
SUMMER ENROLLMENT 2016-2017 PLAN YEAR
Please read the enclosed information regarding changes for benefit plan year 2016-2017 and take advantage of the annual opportunity to change your benefit enrollment. The Employees Retirement System (ERS) will mail a personal benefit enrollment summary to your home address in July. You can find the ERS 2016 Summer Enrollment Guide for Employees on the ERS Summer Enrollment page. It is recommended that employees register at this link for a Summer Enrollment webinar: Summer Enrollment Webinars. Webinar dates are highlighted in gray.
We encourage employees to make benefit changes online at http://www.ers.state.tx.us/. The ERS online Summer Enrollment period is July 11, 2016 through 7 p.m. CT on August 12, 2016. Although you may log on at any time during this period, to alleviate delayed processing time, ERS has designated a two week period for MSU employees to make changes on-line, July 24, 2016 through August 6, 2016. Online entry requires that you register an account with ERS. Instructions to register an account with ERS can be found on the On-Line Account Services page of the ERS website and on page 15 of this memo. It is not advisable to “play” in the ERS benefit screens, as benefit enrollment will be changed, even if the submit button is not keyed. If an address change is made at ERS online, the employee must also update the Human Resources address in Banner Self Service.
If you are completing a form with the Human Resources Department, you can do so from Monday, July 11, 2016 through 6 p.m. on Thursday, August 11, 2016. Forms can be completed in Hardin, Room 210.
All benefit changes are effective September 1, 2016.
Please note the following changes for the new plan year:
· HealthSelect premium rates increase by 7.1% (chart attached)
· HealthSelect out of pocket maximum increase
· NEW medical option – Consumer Directed High Deductible HealthSelect (CDHS)
· NEW – Health Savings Account (HSA) available only with enrollment in CDHS plan
· NEW – Limited Flexible Spending Account available only with enrollment in CDHS/HSA plan
· NEW – State of Texas Vision Plan
· Employees/dependents covered on medical who have not previously certified tobacco use in ERS online must certify tobacco use in ERS online
· State of Texas Dental Choice-10% increase to rates (chart attached)
· Dependent Eligibility Audit - all dependents added to health coverage during Summer Enrollment must have eligibility verified by ERS’ third party administrator, Aon Hewitt. Please review the verification process, as dependents not verified will be dropped from coverage by ERS.
SUMMER ENROLLMENT OPTIONS
Employees may make the following changes during Summer Enrollment:
· Enroll in a health plan from waived status;
· Change health plans if a different plan is available where they live or work;
· Select the Opt-Out Credit option if enrolled in comparable health coverage;
· Enroll in or change to one of the three dental plans offered;
· Enroll in vision plan;
· Enroll in or change Voluntary Accidental Death & Dismemberment (AD&D) Insurance;
· Drop employee and/or dependent coverage;
· Add or apply for dependent coverage;
· Apply for Short-term Disability, Long-term Disability, Dependent Term Life Insurance, or Optional Term Life Insurance (EOI is required for these benefits) and
· Drop, enroll in, or change TexFlex elections
If you do not wish to make any changes, you do not have to do anything.
Dependent Eligibility –As a reminder, if you have a family status change throughout the plan year that deems a dependent ineligible for coverage, it is your responsibility to drop the dependent within 30 days of the event. If you cover ineligible dependents, you risk losing your State of Texas coverage permanently and could face criminal penalties.
CONTACT H.R. AT EXT. 4784 OR VISIT ERS AT http://www.ers.state.tx.us
HEALTH BENEFITS
HealthSelect of Texas
Contribution rates for health insurance are set based on funding provided by the Texas Legislature.
• For PY17, effective January 1, 2017, the total network out-of-pocket maximum limit is $6,550 per individual, and $13,100 per family. This is for both in-area and out-of-area plans. There is no maximum on non-network services. Since the deductibles are based on calendar year, they reset on January 1, 2017.
• There is an individual limit of $6,550 per individual within the family, which means that no individual within the family will owe more than $6,550 for out-of-pocket expenses. Once the family reaches $13,100 in total network out-of-pocket expenses for the year, services are paid at 100% for the whole family.
• The Out-of-Pocket coinsurance maximum remains the same, $2,000 per person per calendar year for network services and $7,000 per person per calendar year for non-network services.
• Co-pays for network services remain the same, $25 for primary care office visit and $40 for specialist office visit.
• With Virtual Visits, HealthSelect of Texas participants and eligible dependents can consult with a licensed physician from their mobile device without leaving their home or office. This 24- hour online service can be used, for a $10 co-pay, to diagnose and treat such non-emergency medical conditions as sinus problems, sore throat, pink eye and bronchitis.
• Real Appeal is a new online weight loss program available to eligible HealthSelect of Texas participants not enrolled in Medicare Part B – employees, retirees and their covered dependents ages 18 and over – with a body mass index (BMI) of 23 or higher.
• HealthSelect participants can now complete Health Risk Assessments by registering for Rally, a new online health management program. Log into your personal account the MYUHC website, click the Health and Wellness tab, and click on Rally to set up an account.
A link to the Employee Health Plan Comparison Chart for PY17 can be found on the ERS Summer Enrollment page.
HEALTH BENEFITS
Consumer Directed HealthSelect
Consumer Directed HealthSelect, a new health insurance option is available to employees and retirees not eligible for Medicare. It includes two parts - a high-deductible health plan (HDHP) and a health savings account (HSA). This plan is an option; no one is required to enroll in this plan.
• UnitedHealthcare will administer the HDHP part of Consumer Directed HealthSelect. The provider network will be the same as the current HealthSelect of Texas plan. Participants pay less if they use network providers. While you won’t need to name a primary care physician (PCP) and won’t need referrals to see specialists, out of pocket expenses for non-preventive services will be higher.
• Participants will be responsible for more out-of-pocket expenses and will have a large deductible before the plan begins to pay for any health or prescription benefits, except preventive care. Preventive care like annual checkups and vaccinations are covered at 100% even if the deductible is not met.
• Preventive services received from a non-network provider are subject to the deductible.
• The plan deductibles and out-of-pocket maximums are based on the calendar year. If your coverage starts on September 1, 2016, your deductibles and out-of-pocket maximums will start over on January 1, 2017.
Plan Year 2017 deductible / Individual coverage / Family coverageIn-Network / $2,100 / $4,200
Out-of-Network / $4,200 / $8,400
• The chart below shows the out-of-pocket maximums for all the health plans. The in-network out-of-pocket maximum is the same for all health plans. There’s no out-of-network maximum in HealthSelect of Texas.
Calendar Year / In-Network Out-of-Pocket Maximum Consumer Directed HealthSelect, HealthSelect of Texas/ Out-of-Network Out-of-Pocket Maximum Consumer Directed HealthSelect Only
2016 / Individual: $6,450, Family: $12,900 / Individual: $12,900, Family $25,800
2017 / Individual: $6,550, Family: $13,100 / Individual: $13,100, Family $26,200
Out-of-pocket maximums are based on federal regulations and might change from year to year.
Once the deductible is met the plan pays:
• 80% for in-network health and prescription services (participant pays 20%) and
• 60% for out-of-network health and prescription services (participant pays 40%).
Because there is a possibility of much higher out-of-pocket costs, you should think carefully before signing up for Consumer Directed HealthSelect. You should understand all costs and benefits before deciding if the plan is right for you and your family. If you cannot afford thousands of dollars in upfront out-of-pocket costs before the plan starts paying for any covered health services and prescriptions (except preventive care), you probably should not enroll in Consumer Directed HealthSelect. A link to the Employee Health Plan Comparison Chart for PY17 can be found on the ERS Summer Enrollment page.
Please understand that while premiums for dependent coverage are slightly less on the HDHP plan, there is a potential for much higher out-of-pocket costs. Except for preventive services, you will pay the full individual deductible or family deductible, dependent upon enrollment level, for medical services and prescriptions before the plan will pay anything. This plan is an option to the current HealthSelect of Texas plan. No one is required to enroll in the new plan.
HEALTH BENEFITS
Health savings account (HSA) - Available only if enrolled in the Consumer Directed High Deductible HealthSelect Plan
• Optum Bank, a subsidiary of UnitedHealthCare Services, Inc will administer the HSA program. Eligible participants (those enrolled in the HDHP) are encouraged to open an HSA to prepare for out-of-pocket health care expenses and save money on income taxes.
• Every month, the state will contribute a certain amount to the HSA of eligible participants, on a pre-tax basis. The participant can also contribute pre-tax money in to their own account up to the annual maximum set by the U.S. Internal Revenue Service (IRS) and use the funds to pay for any qualified out-of-pocket expenses incurred before and after the deductible is met. For tax year 2016, the annual maximum is $3,350 for individual account and $6,750 for family account.
• Employees can make pre-tax contributions directly from their paychecks or post-tax contribution they can claim later when filing their income tax. Total annual contributions, both pre-tax and post-tax (including state contribution), cannot exceed the annual maximum. Employees are responsible for monitoring their contribution amounts in regards to the IRS limits. Neither MSU nor ERS will be responsible for monitoring contribution amounts.
• Withdrawals or reimbursements from the account do not have to be approved by the program administrator. It is the employee’s responsibility to insure that withdrawals or reimbursements are eligible per IRS guidelines.
• Participants will receive a debit card from Optum Bank to pay for health expenses. Participants have access only to the amount of money that has accumulated in their account. Participants do not have access to money that has been pledged but not yet deposited in the HSA.
• HSA funds cannot be used to reimburse health expenses incurred before the account was opened. So, it’s important for eligible participants to open an HSA as soon as possible after enrolling in Consumer Directed HealthSelect. Participants must contact Optum Bank to complete the account application, the Benefits Coordinator cannot open your Optum Bank account. If you enroll in the Consumer Directed HealthSelect plan through ERS On-line, you will automatically be redirected to the Optum Bank application form on the Optum Bank website.
HSA Contributions and Limits* for 2016 (September 1, 2016 – December 31, 2016)
Health and Prescription Services / Member Only Plan / Family Plan (Spouse, Children, or Spouse and Children)Annual Maximum Contribution (per IRS) / $3,350 / $6,750
Annual State Contribution / $5,40 ($45 monthly) / $1,080 ($90 monthly)
Annual Maximum Participant Contribution / $2,810 / $5,670
*HSA contributions and limits may change from year to year, based on eligibility requirements and the participant’s age. Maximums are set by the IRS and include both pre-tax and post-tax contributions to an HSA.
ERS will be discussing both the Consumer Driven HealthSelect plan and the Health Savings Account in multiple webinars in July. Employees are encouraged to attend one of these webinars. You can register at the link below. Webinar dates are highlighted in gray.
Summer Enrollment Webinars
HEALTH BENEFITS
Limited flexible spending account (LFSA) - Available only if you enroll in Consumer Directed High Deductible HealthSelect Plan & HSA
Because Consumer Directed HealthSelect participants will get state contributions to their HSAs, they cannot have traditional health FSAs, like the health care reimbursement account offered through TexFlex. They can enroll in a limited spending flexible account (LFSA), which lets them set money aside for eligible vision and dental care only, pre-tax from their paycheck.
• The participant can elect a minimum of $180 up to a maximum $2,550 of annual contribution amount to be deducted pre-tax monthly, in equal amounts throughout the year from paycheck.
• Employees currently enrolled in TexFlex health care accounts (FSA) who enroll in Consumer Directed HealthSelect during Summer Enrollment will automatically have an LFSA opened for them if they have a balance in the FSA on August 31, 2016.
• Participants have until December 31, 2016 to file claims for eligible expenses incurred through August 31, 2016 to use the balance funds from PY16 TexFlex health care accounts.
• If an employee enrolls in the Consumer Directed HealthSelect plan, any balance of funds between $25 and $500 in TexFlex health care accounts will roll into an LFSA on September 1, 2016. Any amount over $500 will be forfeited.
• Any amount less than $25 will be forfeited if they choose not to enroll.
HEALTH BENEFITS
Tobacco User Certification
Texas state law authorizes higher health care premiums for people who use tobacco. ERS requires that all participants who are age 18 or over by September 1, 2016, enrolling in GBP health plans, be certified as to whether or not they use tobacco. Those who already certified their tobacco use need not re-certify - unless status has changed.
During Summer Enrollment, ERS asks everyone enrolled in GBP health plans to be certified as a tobacco user or non-user via ERS OnLine. New participants who enrolled in GBP health plans after Summer Enrollment were asked to certify upon enrollment. Also, if a new employee did not elect any benefits, he or she did not have the opportunity to certify whether or not they use tobacco. In some cases, dependents under 18 years of age might not have been certified. All dependents who turned or will turn 18 years old between September 1, 2015 and August 31, 2016, and who were not previously certified, will need to be certified during Summer Enrollment. Any participant age 18 or older who is not certified as a non-user will be charged the $30 per month *Tobacco User Premium- even if they don’t use tobacco–beginning September 1, 2016. Please note that the maximum monthly premium per household is $90, and the maximum monthly premium for dependent children is $30, no matter how many children in the family use tobacco or how many adult children are not certified. Uncertified dependent children under age 18 are not subject to the Tobacco User Premium. Dependent children of any age – adults and minors – who are certified as tobacco users are subject to the $30 monthly premium.