(HSA)? - Chandler Unified School District

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(HSA)? - Chandler Unified School District
READY. SET. GROW HEALTHY.
Your 2012-2013 UnitedHealthcare Plan Benefits
Chandler Unified School District
What We Will Cover Today
Medical Plan Options
• Choice Plus PPO Plan
• HDHP 1500 Plan
• HDHP 2700 Plan
UHC Tools and Resources
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Changes to the Choice Plus PPO
 Specialist copay increases from $35 to $50
 ER copay increases from $100 to $500
 Wellness Incentive -$200.00 (Paid on paycheck end of school year)
 Complete Health Risk Assessment 05/01/2012 – 06/30/2013
 Wellness Exams 05/01/2012 – 06/30/2013
United Health Care – Choice Plus PPO
Employee Only
Employee+Spouse
$201.73/pay
$703.09/pay
Employee+Child(ren)
$670.36/pay
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Employee+Family
$974.18/pay
Changes to the HDHP 1500
 Previously HSA1400 Plan
 Plan deductible increases from $1,400 to $1,500
 Individual Out of Pocket maximum will increase from $3,800
to $3,900
 Out-of-Network coinsurance reduced from 60% to 50%
 HSA contribution for will be $514
 Wellness Incentive - $200.00 (HSA Deposit)
 Health Risk Assessment 05/01/2012 – 06/30/2012
 Wellness Exams 05/01/2012 – 06/30/2012
United Health Care – HDHP1500
Employee Only
Employee+Spouse
Employee+Child(ren)
Employee+Family
$0.00
$208.36/pay
$193.64/pay
$322.91/pay
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Changes to the HDHP 2700
 Previously HSA2600 Plan
 Plan deductible increases from $2,600 to $2,700
 Individual Out of Pocket maximum will increase from
$4,550 to $4,650
 Out-of-Network coinsurance reduced from 60% to 50%
 HSA contribution for will be $1,824
 Wellness Incentive $200.00 (HSA Deposit)
 Health Risk Assessment 05/01/2012 – 06/30/2013
 Wellness Exams 05/01/2012 – 06/30/2013
United Health Care – HDHP2700
Employee Only
Employee+Spouse
Employee+Child(ren)
Employee+Family
$0.00
$156.00/pay
$145.64/pay
$237.82/pay
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Your Medical Benefits at a Glance
Choice Plus PPO Plan
Type of coverage
Physician’s office services
Network benefit
Non-network benefit
$25 co-payment
50% after deductible
Specialist office visit
$50 co-payment
50% after deductible
Urgent care center services
$50 co-payment
Emergency room services
$500 co-payment
$500 co-payment
Inpatient hospital stay
20% after $1,000
individual deductible,
$2000 family deductible
50% after $2,000 individual
deductible, $4000 family
deductible
$2,000 per individual,
$4,000 family per Plan
Year. (Deductibles and
copays do not apply)
$6,000 per individual,
$12,000 family per Plan Year
(Deductibles and copays do
not apply)
Out of Pocket Maximum
50% after deductible
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Choice Plus PPO Plan
Pharmacy Costs
Lowest
Cost
Retail
Mail order
Tier 1
$10 Member Cost
1-Month Supply
$25 Member Cost
3-Month Supply
Tier 2
$35 Member Cost
1-Month Supply
$87.50 Member Cost
3-Month Supply
Tier 3
$50 Member Cost
1-Month Supply
$125 Member Cost
3-Month Supply
Highest
Cost
Members are subject to $100 individual pharmacy deductible before copayment’s
apply.
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UnitedHealthcare
High Deductible Health Plan
(HDHP)
8
Consumer-driven health
We need to encourage more informed healthcare
decisions
• Health care costs are skyrocketing
• People are currently removed from the true
cost of health care
• There’s a need to save for future health
care costs
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Your Medical Benefits at a Glance
HDHP 1500 – Non-Embedded Plan*
Type of coverage
Physician’s office services
Network benefit
Non-network benefit
20% after deductible
50% after deductible
Specialist office visit
20% after deductible
50% after deductible
Urgent care center services
20% after deductible
Emergency room services
20% after deductible
20% after deductible
Inpatient hospital stay
20% after $1,500 single
deductible, $3,000 family
deductible* (single deductible
does not apply for families)
20% after $1,250 single
deductible, $2, 500 family
deductible* (single deductible
does not apply for families)
$3,900 single, $7,800 for
family coverage per Plan Year
(Deductibles and copays
apply)
$7,800 single, $15,600 for
family coverage per Plan Year
(Deductibles and copays
apply)
Out of Pocket Maximum
(single max does not apply
to families)
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50% after deductible
Your Medical Benefits at a Glance
HDHP 2700 – Embedded Plan*
Type of coverage
Physician’s office services
Network benefit
Non-network benefit
20% after deductible
50% after deductible
Specialist office visit
20% after deductible
50% after deductible
Urgent care center services
20% after deductible
Emergency room services
20% after deductible
20% after deductible
Inpatient hospital stay
20% after $2,700 individual,
$5,400 family deductible per
Plan Year (Individual
deductible applies for each
family member)
50% after $5,400 individual,
$10,800 family deductible per Plan
Year (Individual deductible applies
for each family member)
$4,650 per individual, $9,300
for family per Plan Year.
(Deductibles and copays
apply)
$9,300 per individual, $18,600 for
family per Plan Year. (Deductibles
and copays apply)
Out of Pocket Maximum
50% after deductible
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HDHP Plan Pharmacy Costs
Lowest
Cost
Retail
Mail order
Tier 1
$10 Member Cost
1-Month Supply
$25 Member Cost
3-Month Supply
Tier 2
$30 Member Cost
1-Month Supply
$75 Member Cost
3-Month Supply
Tier 3
$50 Member Cost
1-Month Supply
$125 Member Cost
3-Month Supply
Highest
Cost
Members are subject to their Medical/Pharmacy deductible before copay’s apply.
Medications listed on Preventative Drug List are subject to copays.
12
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Introducing the HDHP
Combines a high-deductible health plan
that allows you the option to open a health
savings account (HSA)
High-deductible
health Plan
100%
network
preventive
care
Optional
health
Annual
savings
deductible
account
(HSA)
Annual outof-pocket
protection
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Personal
support and
messages,
health
coaches
What is a health savings
account (HSA)?
The District opens and funds a HSA on behalf of eligible
employees. Employees can also contribute into the account on a
pre-tax basis to help pay the plan deductible and other qualified
health care costs or let your account grow.
HSA
It’s yours
even if you
switch jobs or
plans
Triple tax
savings
Pay for
today’s $$ or
save for
tomorrow’s
Use for
qualified
expenses not
covered by
the plan
HSAs are designed to help you save
and pay for your health care
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Use it for
retirement,
investing*
What you should know about
the HSA
An HSA is not health insurance
Used to pay/reimburse qualified expenses
Each covered individual can open an HSA
No “use it or lose it” requirement
HSA is owned by you
15
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HSA eligibility requirements
You are eligible to open an HSA if:
• You are not covered by any other non-high deductible health plan,
•
•
•
•
•
such as a spouse’s plan
You are not enrolled in Medicare
You do not receive health benefits under TRICARE
You have not received Veterans Administration (VA) benefits
within the past three months
You cannot be claimed as a dependent on another person’s tax
return
You cannot be covered by a health care FSA or HRA
16
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Annual HSA contribution limits
Annual contribution limits are set by the IRS
Annual
Contribution
Rules
2012: $3,100 for individuals & $6,250 for
families
Additional
Funding
Those 55 years of age or higher, but not
entitled to Medicare benefits, can fund an
additional $1,000/year “catch-up”
contribution!
Amount of
Funding
Contributions above the annual limit are
subject to income taxes and a 20%
penalty.
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How you can use the HSA
Medical plan
deductibles and
coinsurance
Pharmacy,
dental, vision
care services
Use HSA
dollars to pay
for qualified
medical
expenses for
your spouse or
dependents
Any money you take out of your HSA for
eligible medical expenses is federal income-tax free
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How you can use the HSA
Other qualified expenses
1
Coverage while
receiving
unemployment
benefits
4
2
Medicare
premiums and
out-of-pocket
expenses
COBRA
continuation
coverage
3
Eligible longterm care
19
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How the HSA Helps You Save
1
2
3
4
The money Steve puts into his HSA is
federal income tax-deductible.
Any money Steve withdraws from his
HSA to pay for qualified medical
expenses is withdrawn federal income
tax-free.
Steve may earn interest on his account,
and it is not taxable.
The amount not spent during this year
carries over for use in future years.
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How Much Did Steve Save?
1
2
In 2012, Steve will deposit $6,250 into
his HSA, the maximum contribution for
family coverage.
Steve’s federal and state income
tax savings and FICA on his
contributions for the year are
$2,478.
Steve will withdraw $3,000 to pay for
qualified health care expenses for him
and his family.
Steve will not have to pay income
taxes on the $3,000 as long as he
uses it to pay for qualified
expenses.
Steve earns interest on his account.
Steve does not have to pay federal
income taxes on his interest.
Steve will carry over $3,250 HSA dollars.
With a traditional plan, Steve
wouldn’t have this carryover option,
which helps him save for the future.
3
4
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How the HSA Plan Works
HSA Payment Process
Present ID card to
network doctor
Doctor sends
claim to
UnitedHealthcare
Doctor bills you
for payment
1. You can use
your HSA to pay
UnitedHealthcare
applies network
discount and
notifies doctor of
amount you may
owe.
When you have
claim activity,
you will receive a
EOB.
2. Or you can
choose to pay
another way (cash,
credit card) and
reimburse yourself
later
TIP: Use your HSA to help you pay qualified expenses
22
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Explanation of Benefits (EOBs)
You may have noticed some
changes on your EOBs. You will
see more information on:
– Appeal rights
– Consumer assistance
programs
The EOB has been designed for
easier readability.
We encourage you to access your
EOBs online at myuhc.com.
23
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Comparing an HSA with an FSA
HSA
Limited-Purpose FSA
• Owned by employee
• Owned by employer
• Funded by the employee
and employer
• Funded by the employee
• Funds automatically
rollover to next plan year
• Qualified expenses
determined by IRS and
employer
• Automatic enrollment
• All funds must be used
by the end of the plan
year or grace period
• Only vision & dental care
are reimbursable
• Must enroll each year
enrollment
24
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Common HSA Questions
1
• Enroll during your Open Enrollment period
How do I enroll?
• Check your employer benefit information for
details
Can I take the funds in my HSA
with me if I leave the company?
Yes. Funds belong to you even if you leave
your job, change health plans or retire.
Can others contribute to my
HSA?
Yes. Anyone can contribute to your HSA.
Keep in mind that annual contribution limits
above what is allowed are subject to income
taxes and a penalty.
2
3
4
How do I access the funds in
my account?
• Use your HSA debit card
• Pay by check, cash or credit card and
reimburse yourself later from your HSA
25
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OptumHealthSM Bank, Member FDIC
UnitedHealthcare’s health care bank of choice
• FDIC-insured so you know your money is
safe
• Dedicated to helping people save for health
care
• One of the nation’s leading HSA custodians
• Offers a Health Savings Account Debit
MasterCard®
Only OptumHealth
Bank offers the
convenience of
HSA banking
through
myuhc.com
Pay bills
Make deposits
Reimburse yourself
Track spending
• Account holders will receive Health Savings
News e-newsletter
26
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See your tax savings
And more
Choose the Right Mix of Fees and
Interest
Understand the rates, fees and features for each account type:
Health eAccess
Health eSaver
Monthly
Maintenance Fee
$0 if balance exceeds $500
$1 if balance is $1-$499.99
$0 if balance exceeds $5,000
$3 if balance is $1-$4,999.99
Balance Required
to Obtain APY
Annual Percentage Yield (APY)
Annual Percentage Yield (APY)
Health eInvestor
$0 if balance exceeds $5,000
$3 if balance is $1-$4,999.99
Annual Percentage Yield (APY)
$0-$499.99
0.00%
$500-$999.99
0.00%
$1,000-1,999.99
0.00%
$2,000-$4,999.99
0.00%
$5,000-$14,999.99
0.00%
$15,000+
0.00%
Investment
Threshold
$2,000
$2,000
$500
Monthly Investment
Fee
$3
$0
$2.50
Variable based on balance
Variable based on balance
Investments are not FDIC-Insured, are not guaranteed, and may
lose value.
27
How the High Deductible
Plan Works
28
How the HDHP Works
*From www.healthcarelane.com
29
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
How the HDHP 2700 Plan Works
Chris chooses the HSA Plan for himself
because:
• No cost monthly premiums
• His employer is contributing $1,824
• Chance to use HSA to save for future
expenses
Here is what Chris’s plan looks like:
Employer deposits $1,824 in HSA
Chris deposits $1,000 in HSA
$2,700
Annual
deductible
*From www.healthcarelane.com
80%/20%
network
coinsurance
100%
network
coverage
$4,650
Out-of-pocket
maximum
Chris is a fictitious person used to illustrate UnitedHealthcare products.
30
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How the HDHP Plan Works
1 preventive exam per member
$400
1 visit to urgent care
$200
1 doctor visits
$100
2 prescriptions
$100
Non-preventive total
$400
Paid 100% by plan
And Chris still has
$2,424 in his HSA!
Chris uses HSA to pay
HSA paid total
Chris paid
$2,824
$2,424 in HSA
$2,700
Annual
deductible
$4,650
Out-of-pocket
maximum
*From www.healthcarelane.com
31
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$400
$400
How the HDHP 2700 Works
Jane chooses the single HSA Plan
because:
• No monthly premiums
• Typically has few health expenses
• Ability to open and save with an HSA
• Tax savings
Here is what Jane’s plan looks like:
District funds $1,824 in HSA
80%/20%
network
coinsurance
$2,700
Annual
deductible
100%
network
coverage
$4,650
Out-of-pocket
maximum
*From www.healthcarelane.com
32
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Jane is a fictitious person used to illustrate UnitedHealthcare products.
How the HDHP Works
All other expenses are covered
100% for the rest of the year
Emergency surgery
$100,000
6 Doctor visits
$824
11 Prescriptions
$1,000
Total actual cost
Insurance pays (80%)
Jane to pay
(20%)
But she pays only $2,826
to get to her $4,650 maximum.
$101,824
Jane pays
District deposits $1,824 HSA
Reaches deductible
Jane uses HSA to meet a portion
of her deductible
Remaining bill
$100,000
$2,700
Annual
deductible
80%/20%
$4,650
Out-of-pocket
maximum
*From www.healthcarelane.com
33
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$2,826
100%
Jane compares plans…
Choice Plus Plan
HDHP 1500
HDHP 2700
$0
$514
$1,824
Member Deductible
$1,000
$1,500
$2,700
Out of Pocket Maximum
$2,000
$3,900
$4,650
$750
$0
$0
Premium
$4,438
$0
$0
Total Member Pays
$8,188
$3,386
$2,826
Member costs
District Funded HSA Pays
Copays
34
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Wellness Tools
35
myuhc.com
Find network
doctors/hospitals
Estimate costs
Track claims status
Build a health
improvement program
Keep a Personal
Health Record
Get health product
discounts
Review plan details
36
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Large National Network
More than:
660,000
doctors
1,000
5,100
hospitals
60,000
convenience pharmacies
care clinics
And world-wide
emergency care coverage
37
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Our Large National Network
Your doctor is likely already in our network.
Available to
Includes
98% 2
of Americans
More than
3
out of
providers
Includes
1,000 95,000
convenience
care clinics
Specialists designated
for their quality and
cost efficiency based
on national standards
38
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Promoting Quality & Affordable
Health Care
The UnitedHealth Premium® program evaluates
doctors for quality and cost efficiency to help you
choose a doctor with confidence
Doctors who meet both quality and cost-efficiency
guidelines receive two stars, and those who meet
quality receive one star
Quality Care
+
UnitedHealthcare
awards one star to
physicians who meet
national standards for
quality care.
Cost-efficient Care
UnitedHealthcare
awards a second star to
physicians who meet
local area benchmarks
for cost-efficient use of
resources in delivering
health care.
=
UnitedHealth Premium
Two-Star Physicians
Two-star physicians have been
recognized for providing
quality and cost-efficient care
to their patients. They meet or
exceed nationally recognized
guidelines, and they’re likely to
recommend the right tests and
treatments for a variety of
conditions.
39
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Take Advantage Of Your
Preventive Care Coverage
Certain preventive services are covered without charging
a deductible, copayment or coinsurance when these
services are provided by a network provider.
It’s important to review your plan documents for the
preventive services included in your specific benefit
plan.
Regular preventive care may help
• Reduce risk of disease
• Detect health problems early
• Protect you from higher costs down the road
www.uhcpreventivecare.comfor age and gender-specific
guidelines
40
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Health Assessment
Take a free, online questionnaire about your health
from the University of Michigan
Program includes interactive online health coaching
Feedback on progress toward living a healthier life
Recommendations for online health and wellness services
Information to help members have productive
conversations with doctor
41
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Care24 Nurseline and EAP
Connect with a registered nurse and highly
experienced counselors
Get help with legal, financial and emotional needs
Prepare yourself before you seek a doctor’s care
Access recorded messages on health topics
Communicate in live, one-to-one Nurse Chats
at myuhc.com
Care24 1-866-271-7340
42
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Healthy Pregnancy Program
Get support through every stage of pregnancy
Nurses available, toll-free, 24/7
Personalized pregnancy assessment
Educational materials and resources
No Additional Cost Gifts and Savings
–Your Journey Through Pregnancy, a book
that will help you learn more about your
nine-month journey.
–A booklet from Johnson & Johnson:
What’s Next?: The magic unfolding
of the first days of life.
43
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Personalized information on-the-go
supports better health care decisions
UnitedHealthcare Health4Me™ is
designed to make it simpler for
members to manage their health and:
– View each plan member independently
– Personalize with member photos
– Find doctors and facilities anytime,
anywhere
– Check claims, benefits, and account
balances
– View and share health plan ID card in
the doctor’s office or at the pharmacy
44
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
myHealthcare Cost Estimator
• Designed to calculate and
compares cost differences for
treatments between providers,
locations and facility types,
including both plan and member
expenses for each treatment
45
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45
Explore Health Care Lane Today!
A fun and interactive way to learn about health insurance
healthcarelane.com/VSEBT
46
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Health plan ID cards
• Mailed to new members
within 30 days of enrolling
• Includes your plan
information
• Lets providers know how to
bill
Mary Winters
Fred Winters, spouse
Ann Winters, dependent
Susan Winters, dependent
47
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Voluntary Delta Dental Plan
•All employees who work 20 hours or more per week are
eligible to enroll in dental benefits.
Enhancements
•Deductible is waived for preventative services
•The cost of preventative services does not count toward
your calendar year max
•Potential additional benefit of $300 per person per
calendar year
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Voluntary Dental
Premier Plan
Core Plan
No Orthodontics
6 month waiting period
Preventative 100%
Basic Services - 70%
Excludes sealants
Major Services - 40%
Calendar Year Max - $1500
Orthodontics
Lifetime Max - $750
Preventative - 100%
Basic Services - 80%
Includes sealants
Major Services - 50%
Calendar Year Max - $1500
Dental
Plan
Employee
Only
Employee + Spouse
Employee+Child(ren)
Employee+Family
Core
$14.12
$27.23
$30.99
$50.47
Premier
$20.03
$39.35
$44.87
$73.61
Vision - VSP
Covers eye exams once every year.
Lenses are covered 100% after a $20 co-pay.
Frame allowance $130.
Contacts in lieu of lenses and frames allowance $130.
Premium based on 22 payroll deductions.
Employee Only
Employee+1
Employee+2 or more
$4.29
$6.21
$11.14
Sun Life
Life Insurance
• Basic life insurance provided to all benefit eligible employees in the
amount of $50,000
• Additional voluntary life insurance coverage available to purchase,
premiums based on age and amount of coverage
• Spouse/child coverage available
• If you are not currently enrolled in voluntary life insurance coverage
but wish to enroll now, OR if you wish to increase your current
coverage level during this year’s Open Enrollment, you must provide
Sun Life with evidence of your good health, by completing the Sun
Life Evidence of Insurability form.
51
Assurant
Short Term Disability
• For new coverage, if coverage amount elected is less than $3,000,
evidence of insurability is not required. Individuals currently covered can
move up one step without EOI.
• The policy does not pay for disabilities within 12 months of your initial
enrollment plan, if you received medical treatment, consultation, care or
services (including diagnostic measures), or took prescribed drugs or
medicines for the disabling condition during the 12 months prior to your
initial enrollment date.
• To be eligible during pregnancy, you cannot be pregnant prior to the
benefit effective date.
• The plan provides monthly benefits ranging from $360 to $5,000, based
on your annual salary, not to exceed 66 2/3% of your salary.
52
BASIC
Flexible Spending Accounts
• An election must be made every year if you wish to enroll in a Flex
•
•
•
•
53
Plan
Medical Flexible Spending account limit for 2012-13 plan year is
$2,500
Dependent Care Flexible Spending account limit will remain at
$5,000 maximum.
If you are enrolled in an HSA plan you are only able to use your
medical flex spending account for dental and vision expenses
When making flex account elections please keep in mind that if
you do not use the funds by June 30, 2012 you will forfeit all
remaining money in the account
Long Term Care
•District provides to full-time employees working 30 hours or more a
base plan free of charge to the employee
•Provides a monthly benefit to help offset the cost of personal and
medical care for an individual who is unable to carry out the normal
activities of daily living, such as dressing, bathing, eating, moving or
when someone suffers a severe cognitive impairment.
•$2000/month for up to 2 years
•100% benefit for nursing home or assisted living facility
•50% licensed professional care
•Max benefit of $48,000
•Employees who work 20-29 hours may elect to purchase benefit at
their own cost
•All employees electing to purchase additional coverage are required to
submit proof of good health.
QUESTIONS

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