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General Information and Education
Annual Open Enrollment will be held at the end of January. There
will be an education table to provide an overview of benefit
offerings effective March 1, 2018.
Additional information and education is available via:
Employee Self Services (ESS) https://ess.springfield.il.us/BenefitsHealth.aspx
Please review and if you still have questions please contact HR.
2018 Overview
3 medical plan options:
•Basic Select plan
•Point of Service plan
•High Deductible Health Plan (HDHP)/Health
Savings Account (HSA), includes HSA
employer contribution
Basic Select Coverage In-Network Out-of-Network
Individual / Family $500 / $1,500 $500 / $2,500
Individual / Family $1,000 / $3,000 Unlimited / Unlimited
PCP $40 copay per visit $40 copay per visit
Specialist $60 copay per visit $60 copay per visit
Preventive/Well Care 100% Not Covered
Emergency Room $150 copay, then 70% $150 copay, then 70%
Emergency Medical Transport 70% 70%
Coinsurance Levels
Outpatient Hospital $50 copay, then70% $50 copay then 60%
Hospital Inpatient $300 copay per admission, then 70% $300 copay per admission, then 60%
Other Covered Services 70% 60%
Individual Deductible $50 Not Covered
Family Deductible $150 Not Covered
Individual Out of Pocket $1,000 Not Covered
Family Out of Pocket $3,000 Not Covered
Specialty Drugs $50 copay Not Covered
Retail, 1-34 day supply
Generic/Preferred Brand/Non-Preferred Brand $15 / $25 / $45 Not Covered
Retail, 84-90 day supply
Generic/Preferred Brand/Non-Preferred Brand $45 / $75 /$135 Not Covered
Mail Order, 84-90 day supply
Generic/Preferred Brand/Non-Preferred Brand $25 / $50 / $100 Not Covered
Out-of-Pocket Maximum (includes deductible )
Deductible
Services/Treatment
Prescription Drug Benefits
Point of ServiceCoverage In-Network Tier 1 In-Network Tier 2 Out-of-Network
Individual / Family $200 / $600 $200 / $600 $500 / $1,500
Individual / Family $1,000 / $2,250 $1,000 / $2,250 Unlimited / Unlimited
PCP $20 copay per visit $20 copay per visit 70%
Specialist $40 copay per visit $40 copay per visit 70%
Preventive/Well Care 100% 100% Not Covered
Emergency Room $150 copay, then 85% $150 copay, then 85% $150 copay, then 85%
Emergency Medical Transport 85% 85% 85%
Coinsurance Levels
Outpatient Hospital $50 copay, then 85% $50 copay, then 80% $50 copay, then 70%
Hospital Inpatient 85% 80% 70%
Other Covered Services 85% 80% 70%
Individual Deductible Not Covered
Family Deductible Not Covered
Individual Out of Pocket Not Covered
Family Out of Pocket Not Covered
Specialty Drugs Not Covered
Retail, 1-34 day supply
Generic/Preferred Brand/Non-Preferred Brand Not Covered
Retail, 84-90 day supply
Generic/Preferred Brand/Non-Preferred Brand Not Covered
Mail Order, 84-90 day supply
Generic/Preferred Brand/Non-Preferred Brand Not Covered
Deductible
Out-of-Pocket Maximum (includes deductible)
Services/Treatment
$10 / $20 / $40
$30 / $60 /$120
$25 / $50 / $100
Prescription Drug Benefits
$50 copay
$3,000
$1,000
$150
$50
High Deductible Health Plan/Health Savings AccountCoverage In-Network Out-of-Network
Individual / Family $2,700 / $5,400 $4,500 / $10,800
Individual / Family $2,700 / $5,400 $10,800 / $21,600
PCP 100% after deductible 80% after deductible
Specialist 100% after deductible 80% after deductible
Preventive/Well Care 100%, deductible waived 80% after deductible
Emergency Room 100% after deductible 100% after deductible
Emergency Medical Transport 100% after deductible 100% after deductible
Coinsurance Levels
Outpatient Hospital 100% after deductible 80% after deductible
Hospital Inpatient 100% after deductible 80% after deductible
Other Covered Services 100% after deductible 80% after deductible
Specialty Drugs 100% after deductible Not Covered
Retail, 1-34 day supply
Generic/Preferred Brand/Non-Preferred Brand 100% after deductible Not Covered
Preferred Brand Drugs 100% after deductible Not Covered
Non-Preferred Brand Drugs 100% after deductible Not Covered
Retail, 84-90 day supply
Generic/Preferred Brand/Non-Preferred Brand 100% after deductible Not Covered
Preferred Brand Drugs 100% after deductible Not Covered
Non-Preferred Brand Drugs 100% after deductible Not Covered
Mail Order, 84-90 day supply
Generic/Preferred Brand/Non-Preferred Brand 100% after deductible Not Covered
Prescription Drug Benefits
Deductible
Out-of-Pocket Maximum (includes deductible)
Services/Treatment
2018 Employee Medical Contributions
Contributions
Monthly
Premium:
Basic Select
You Pay
Point of
Service
You Pay
HDHP
You Pay
HSA Annual
Employer
Contribution
Employee Only
with Wellness$80.00 $147.84 $0.00 $500*
Family with
Wellness$232.50 $339.78 $240.62 $2,000
* If Wellness is completed
COS Leadwell Clinic can provide Wellness screenings at no cost
HSA annual contribution only available if enrolled in HDHP
2018 Health Savings Account Contribution Limits
2018 HSA Contribution Limits
Individual
CoverageFamily Coverage
Catch-up Contributions
(age 55 & older)
$3,450 $6,850*On March 5, 2018, the IRS changed the
H.S.A. family maximum contribution limit
from $6,900 to $6,850
$1,000
» Family deductible is an embedded deductible – No individual will pay more than their individual deductible and
Maximum out of pocket
» Prescription drugs are subject to the deductible
» Contribution limits include employer and employee amounts
2018 Medical Plan Option ComparisonWellness premiums
Employee Only Coverage
Employee Only BASIC POS HDHP/HSA
Employee's Monthly Premium Cost $80.00 $147.84 $0.00
Employee's Annual Premium Cost $960.00 $1,774.08 $0.00
Employer HSA Contribution $500.00
Employee's Total Cost
(EE annual premium - ER HSA contribution) $960.00 $1,774.08 ($500.00)
Family Coverage
Employee Only BASIC POS HDHP/HSA
Employee's Monthly Premium Cost $232.50 $339.78 $240.62
Employee's Annual Premium Cost $2,790.00 $4,077.36 $2,887.44
Employer HSA Contribution $2,000.00
Employee's Total Cost
(EE annual premium - ER HSA contribution) $2,790.00 $4,077.36 $887.44
What is an Health Savings Account?
Tax-Exempt
Savings
Account
(HSA)
HSA
Account
High Deductible
Health Plan
(HDHP)
Component #1 – High Deductible Health Plan (HDHP)
» A medical plan with a higher deductible threshold than most traditional PPO plans
mandated by the IRS
» Almost all medical expenses are paid for by you at 100%, less carrier discounts, prior
to meeting your deductible
» Doctor’s visits
» Specialist visits
» Emergency Room/Urgent Care visits
» Prescriptions
» An HDHP utilizes the same PPO network you’ve grown accustom to
» Same doctors and hospitals
» No disruption in medical services and care
Component #2: What is an Health Savings Account?» An HSA (Health Savings Account) is a tax-exempt savings account funded with tax-
free dollars, and used exclusively to pay for qualified medical expenses and/or provide
savings for the future also tax free
» Individuals can deduct the dollars they contribute to their HSA from their gross income
» Lower taxable income
» Tax-free medical dollars (for qualified expenses)
» You are eligible for an HSA if:
» You are covered under a High Deductible Health Plan (HDHP)
» You are not covered by any other health coverage that is not an HDHP
» You are not enrolled/eligible in Medicare (under age 65)
» You are not claimed as a dependent on someone else’s tax return
How does it really work?» You should avoid paying at the point of service when at all possible
» Making sure the carrier discounts are applied to your medical services will be key
before paying the bill
• The one exception to paying at the point of service is at the pharmacy
» Following these simple steps should help…
Go to the doctor and
present your carrier ID
card
Doctor submits the
bill with your
services to the carrier
The carrier adjusts
pricing to reflect the network discount
The carrier posts the EOB
to your member portal and/or sends you a copy of it in the mail
Check for billing errors!
Make sure the EOB
and bill from your doctor
match
Pay your doctor directly
with either pre-tax funds
from your HSA or out of your pocket if funds are not
available
To Contribute to a Health Savings Account
You cannot:
❖ Enroll in a medical plan that is not a High Deductible Health Plan
❖ Enroll in Medicare
❖ Be claimed as a dependent on someone else’s tax return
❖ Children cannot establish their own Health Savings Accounts
❖ Spouses can establish their own Health Savings Accounts, if eligible
❖ Participate in a health care Flexible Spending Account
What is a qualified medical expense?
» Distribution is tax-free for
qualified medical expenses
• Medical services, procedures and treatments
• Diagnostic services
• Drugs
• Prescriptions
• Vision (includes LASIK)/Hearing
• Medical Equipment
• Psychiatric care
• Assistance for disabled
• Dental (includes orthodontia)
• Long Term Care premiums
• Medicare copays, deductibles and coinsurance
• Medicare Cost- except for Medigap plans
Examples of
qualified medical
expenses under
Section 213(d) of the
IRS code
Consult your tax advisor for items not on the listhttp://www.irs.gov/pub/irs-pdf/p502.pdf
Advantages of your Health Savings Account
» Unused funds rollover from year to year
» It’s not use it or lose, it’s use it or keep it
» Infinite growth in your account
» There’s a triple tax savings
» You do not pay taxes on funds going into this account
» You do not pay taxes on interest or dividends earned
» You do not pay taxes when used for qualified medical expenses
» Account is portable
» If you change between plans, retire or even leave the company – the account
goes with you
» You’re the owner and manager of this account – it’s solely yours
Save money with Wellness
Complete Wellness and take advantage of lower monthly premiums
Wellness screening Health Risk Assessment Money
If you don’t have a PCP or cannot get an appointment with your PCP call the COS LeadWell Clinic.
Wellness screenings provided at COS LeadWell Clinic, no cost.
Wellness screening and Health Risk Assessment must be completed by 12/31/2018, to take advantage of Wellness premiums that are effective March 1, 2019.
COS LeadWell ClinicFree services to all participating members in any of the medical plans.
Walk In or appointments available.
» Treatment for acute illness/minor injuries (examples)
• Severe Sore Throat/ Sinus infection
• Bronchitis
• Ear Infections/Swimmer Ear
• Pink Eye
• Mononucleosis
• Sprains/Strains
• Pointe of Care/Full Lab Testing(Blood, Urinary Tract Infections, etc.)
» Wellness Services
• Physical Exams ( Men, Women, Children 5 years and up)
• Adult Immunization/Flu Shots
• School/Sport Physicals
• TB Testing
• Health Screenings
• Skin Screenings
» Prescription Medication Dispensing
• Commonly prescribed medications for non-emergency health concerns.
COS LeadWell Clinic Clinic Hours
Monday: 8:00 a.m. to 5:30 p.m.
Tuesday: 8:00 a.m. to 5:30 p.m.
Wednesday: 8:00 a.m. to 5:30 p.m.
Thursday: CLOSED
Friday: 8:00 a.m.to 5:30 p.m.
Saturday 8:00 a.m. to noon
Clinic Phone Number
1-217-993-0998
Clinic Location
FitClub Building
3631 S. 6th Street
Springfield, IL 62703
Tips to save money
Preventive/Wellness Exams are covered at 100% in-network under all plans.
» Preventive care is equal to one annual physical exam per year per enrolled member
• Females get an annual well-woman exam covered at 100% in addition to their annual exam
» Preventive exams include age-specific tests, blood work and more
» No deductible expenses apply – the exam is completely no cost to you
• Lab tests related to an already established condition such as diabetes or asthma – are not considered preventive and are covered under applicable deductible and coinsurance levels
» All participating members age 5 and up can visit the COS LeadWell Clinic and receive Free Preventive Services.
Tips to save money
Emergency Room
» ER average cost is well over $1,000
» Urgent Care average cost is $200
» Doctor’s office average cost is $125
» Minute Clinic or Take Care Clinic average cost is $79
» City of Springfield LeadWell Clinic- $0
High cost scans, x-rays and tests
» MRIs, PET scans, CT scans, etc. are nearly 2/3 less costly at free-standing imaging centers than at hospitals
» Finding an in-network free standing imaging center saves you loads of $$$
Tips to save money
Prescription drugs
» Ask your doctor is there is a generic version of the medication they’re
prescribing or you’re taking• Generic equivalent medications have the same active ingredient as their Brand name counterpart
» Take advantage of the Generic Prescriptions Savings Programs out there• Walmart, Target, Meijer, etc.
» Mail Order and 90 Day Supply
» Ask about free samples and/or manufacturer rebates
» www.goodrx.com
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