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Employee Health Care Plan
2010 Meetings
Today’s Presentation
• Introduction to Butler
Benefit Service, Inc. and
Quad City Community
Healthcare
• Medical and Prescription
Drug Plan
• Flexible Spending Account
• Butler Information Network
• Questions
© Butler Benefit Service, Inc.
Self Funding
Augustana College Health Plan
• Augustana College is
its own “insurance
company”
• $$$ spent on claims
affect everyone on the
health plan as well as
the employer
• Insurance purchased
for larger catastrophic
claims
• Being a good consumer
helps to keep costs low
and benefits intact
© Butler Benefit Service, Inc.
What does Butler Benefit Service, Inc.
do for you?
•
•
•
•
•
Answer your questions
Receive and process claims
Release payments when approved
Review claims
Provide online access to your claims
information
Customer service is our priority!
© Butler Benefit Service, Inc.
WWW.qcchealth.com
• Quad City Community
Healthcare is a Health
Plan that offers a
network of providers
• They coordinate and
review utilization of your
health care resources.
• Case Management is
offered for catastrophic
illnesses and injuries.
© Butler Benefit Service, Inc.
Monthly Premiums Effective 9/1/10
• Medical Premium
– Single
• $40
– Employee + Spouse
• $425
– Employee + Child
• $425
• If you have single coverage, you
may now waive coverage.
– Think carefully about waiving if
you do not have any other
coverage – you never know
when an accident may occur
– Great option for those covered
under another plan such as
your spouse
– Family
• $600
© Butler Benefit Service, Inc.
Medical Benefit Summary
In Network
Deductible
Out of Network
Deductible
Single $1,000
Family $2,000
Single $2,000
Family $4,000
Out of Pocket
Out of Network
Single $1,500
Family $3,000
Single $2,500
Family $5,000
Deductible and out of pocket met to date in 2010 by Blue Cross Blue
Shield of Illinois will be carried over to your new Health Plan.
© Butler Benefit Service, Inc.
Medical Benefit Summary
In Network
Coinsurance
Out of Network
Coinsurance
80%
50%
Specialty Medication
10% coinsurance up to the out of pocket
© Butler Benefit Service, Inc.
Preventative Benefit
Children up to age 16
$1,000 Annual Limit
$20 co-pay
Adults
$600 Annual Limit
$20 co-pay
Make sure you inform your physician at the
time of service to file the claim as
preventative.
© Butler Benefit Service, Inc.
Prescription Drug Benefit Summary
Retail Pharmacy – per 34 day supply (90 day available)
•Generic Drugs - $10 co-pay
•Preferred Drugs - $30 co-pay
•Non Preferred Drugs – $50 co-pay
Maintenance Prescription Drugs- Mail Order
Per 90 day supply
Generic Drugs - $20 co-pay
Preferred Drugs - $60 co-pay
Non Preferred Drugs – $100 co-pay
Mail Order Prescription Program
• Available to all Health Plan members
• Order a 3 month supply
• Mail order is easy, convenient, and
saves you money
• Best for drugs you take regularly
© Butler Benefit Service, Inc.
Over The Counter Medication
• Over-the-counter Prilosec, Zantac, Claritin,
Zyrtec, and their generic equivalents, with a
physician prescription only: $10 Co-Pay
SAVES YOU MONEY!
© Butler Benefit Service, Inc.
Saving Money on Rxs
• Pill Splitting – Look for Rx’s in Bold
– Lipitor – 10, 20, 40, & 80 mg doses
– If you take 20mg per day, ask your doctor about a
40mg Rx that you can split in half
– Ask about a Butler pill splitter
– Pill Splitting saves you and the Plan money
© Butler Benefit Service, Inc.
Network of Providers
To Find out if a provider is in the network:
www.qcchealth.com
or
Call 1-888-498-7224
© Butler Benefit Service, Inc.
Network of Providers
You will need a referral from your primary network physician for
University of Iowa and Mayo Clinic.
Radiology Group will be paid in network if your x-rays are
sent to the facility from a network provider. If you
physically go to the facility the service will be considered
out of network.
Emergency treatment out of network will be paid at the
network benefit.
© Butler Benefit Service, Inc.
When do I pre-certify?
If inpatient admissions are not pre-certified with Quad City Community
Healthcare, benefits payable will be reduced by $300 per Covered
Individual per incident. The reduction in benefits does not apply to the
Annual deductible or out of pocket.
- All non-emergency inpatient admissions must be pre-certified prior to the
service; emergency inpatient admissions must be reported within 2
business days of admission
Most physicians will take care of this for you. It is still your
responsibility to make sure you have pre-certified.
• Consult the Summary Plan Description for all precertification requirements. When in doubt, call Quad
City Community Healthcare.
© Butler Benefit Service, Inc.
Identification Card
Throw your current BCBS of IL ID card away on September 1 and start
using your new Augustana College ID card. Make sure to present to all
providers and pharmacies.
© Butler Benefit Service, Inc.
ID card (Back)
To Pre-Certify services, call Quad City Community
Healthcare
© Butler Benefit Service, Inc.
HIPAA Privacy Rights
– HR and BBSI will ask verifying
questions
– Where issues of PHI are discussed
– Written consent for release of PHI (child
18 and older, or divorcee) “Designation
of Authorized Representative”
– Request for explanation of use of PHI
must be done in writing and response
returned in writing
– Notice of Privacy Practices is in the
Summary Plan Description
© Butler Benefit Service, Inc.
Flexible Spending Account
Section 125 of the IRS Tax Code
allows Pre-Tax payroll deductions
for:
• Certain insurance premiums
• Health care expenses
– Medical, dental and vision
– Up to $4,000 per year, with a
minimum of $100 per year.
• Dependent care expenses
– up to $5,000 per year ($2,500 if
married filing separately)
© Butler Benefit Service, Inc.
Flexible Spending Account
Would you like an
extra paycheck?
By setting aside
healthcare funds
pre-tax, you can
increase your
savings and
ultimately your
spending power.
Here is an example
of the tax savings
you could enjoy by
taking advantage of
your Flex Plan.
© Butler Benefit Service, Inc.
How It Works
• An FSA is an account your employer sets up so
you can pay for a variety of healthcare needs
such as insurance co-pays, deductibles, and
even dental and vision-care costs. But here’s
the best part: Your FSA is funded entirely by
your pre-tax income.
• You decide the amount to pledge into your FSA
account.
• Although your FSA will be deducted through
your payroll, you’ll have access to your entire
Health FSA election on the first day of your plan
year. That means you can cover all your
healthcare costs without waiting to accumulate
funds throughout the year.
© Butler Benefit Service, Inc.
How It Works
• The IRS generally only allows
expenses that have already been
incurred – pre-paid services (such as
maternity) may not be reimbursed until
the service is provided – ask for
itemized bill from the healthcare
provider and submit with receipts.
• For Dependent Care FSA the money
must be in the account in order to
receive reimbursement.
© Butler Benefit Service, Inc.
Grace Period
• Expenses incurred from September 1, 2010 through
October 15, 2011 are eligible. (2 ½ extra months to
incur claims)
• Submit claims for reimbursement up to November 30,
2011.
• Claims are processed in order received; will not be
re-processed to take advantage of grace period
© Butler Benefit Service, Inc.
Introducing . . .
The Benefits Card makes using your FSA
dollars simple and easy!
© Butler Benefit Service, Inc.
Benefits Debit Card
Not all
FSAs
are created
equal.
Yours can be accessed via the Benefits Card
MasterCard®, provided by your employer.
MasterCard® is a registered trademark of MasterCard International Incorporated.
© Butler Benefit Service, Inc.
Benefits Debit Card
• The Card deducts each payment directly from your
FSA account. So it’s as convenient as using an
ordinary credit card.
• The Benefits Card virtually eliminates the paperwork
and reimbursement wait time that used to make FSAs
so complex and cumbersome. All you have to do is
save receipts for all your FSA purchases in the event
they are requested by your Plan Administrator.
• For optimal convenience, your Benefits Card offers
24/7 online access, so you can check your account
balance and other vital information with a single click.
© Butler Benefit Service, Inc.
Benefits Debit Card
You can request an extra card
for a dependent to use.
• Provide the dependent’s full name, date of
birth and Social Security Number on the
election form.
© Butler Benefit Service, Inc.
In most ways, your card works just like any debit
card. There are three important differences:
• First, its use is limited to specific
merchants based on the benefit account
you have selected, and to expenses
deemed eligible by your Benefit Plan.
• Second, you cannot use it at an ATM, or
to obtain “cash back” when making a
purchase.
• Third, you are not given a PIN with this
card. Should a merchant or provider ask
you for a PIN, just explain that this
particular card does not have one. When
given the option between debit and credit
at the terminal, choose “CREDIT.”
© Butler Benefit Service, Inc.
Save your receipts!
• You may be asked to submit them if questions
arise about your claims.
• It enables you to track what you spent on
healthcare and/or dependent care for the year,
which can help you plan for next year’s FSA
contributions .
• The IRS requires that you save all of your itemized
receipts for expenses paid for by your FSA
Accounts.
© Butler Benefit Service, Inc.
Eligible Services and Products
• Basically the same items as
paper claims: deductibles, copays, coinsurance and other
items not paid by your
insurance
• IIAS: Inventory information
approval system (some eligible
items may not be on list)
© Butler Benefit Service, Inc.
Where Can I Use the Card?
• Approved Merchant Category Code
(MCC): Medical Care Providers
– Physician, Dentist
– Vision care office
– Hospital
• Other merchants that use IIAS
– Drug stores and pharmacies
– Discount stores
© Butler Benefit Service, Inc.
When the Card should NOT work:
• Ineligible items, such as cookies, gasoline,
clothing, etc.
• Non-medical care provider without IIAS
• Dual purpose items (submit paper claims)
© Butler Benefit Service, Inc.
IRS Rules for Improper
Card Payments
• Card will be deactivated
• Letter demanding repayment will
be sent to the employee
• Withhold from employee’s wages
• Claims substitution
• Treat as any other business
indebtedness
© Butler Benefit Service, Inc.
Benefits Debit Card
You are not required to
use the Benefits Card,
but if you don’t use it to pay for FSAeligible expenses, you must submit a
paper claim to receive
reimbursement for those
expenses.
© Butler Benefit Service, Inc.
Filing a Paper Claim
• Claim form included in your SPD
• Claims processed weekly
• Submit EOB or itemized
statements to BBSI
• Claims received at least 4 days
before scheduled processing date
will be processed and mailed in
same cycle
© Butler Benefit Service, Inc.
FSA Paper Claim Form
© Butler Benefit Service, Inc.
Use it or Lose it
How Do I Decide How Much to Contribute?
It's important to give some thought to calculating
how much money to contribute for the year, because if
you put in more money than you need, by law, you lose
it. You have three months after the end of the year to
submit claims for eligible expenses incurred during the
previous calendar year . To determine how much to
contribute, make a list of the expected out-of-pocket
medical expenses for you and your dependents for the
next year. Be conservative so you don't risk forfeiting
any money.
Consider this:
Let’s assume you are taxed 15% on your salary,
and you elect to put $1,000 into your flex account. You
automatically save $150 by doing so because you
haven’t been taxed on $1,000. Even if you only spend
$900, you’re still ahead by $50.
© Butler Benefit Service, Inc.
Butler Information Network (BIN)
You have online access to your health
insurance information through the
Butler Information Network (BIN).
• Explanation of Benefits,
including the option of
Electronic EOBs
• Claim History, with
claim status
• Summary Plan Description
in Electronic format
• Links to PPO website and
other important links
• Secure Correspondence to
BBSI
• Verification of Benefits
© Butler Benefit Service, Inc.
Go to www.bbsionline.com and follow the instructions to
“Register New User”
© Butler Benefit Service, Inc.
Claims Information
© Butler Benefit Service, Inc.
Document Library
© Butler Benefit Service, Inc.
Electronic EOB (EEOB) option
•Each time claims are
processed, an email
will be sent notifying
you of a new EOB,
which can be
accessed via the BIN
•EOBs are in the
Adobe .pdf format you can print these, or
save them to your
home computer
© Butler Benefit Service, Inc.
Questions?
© Butler Benefit Service, Inc.