Group Health Insurance Plans

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2005-2006 Frenship ISD

• Group Health Insurance Plans

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ATTENTIONChanges to dates

• FISD Health plan has traditionally run October 1
  - September 30.
• We will convert our annual health plan to
  January 1 December 31, beginning January 1,
  2006
• Sowhat does that mean?

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Plan year changes.

• We will have a short year for this plan (October
  1, 2005 December 31, 2005.)
• For the new plan beginning in January- we will
  have another enrollment period prior to
  Thanksgiving Holidays.

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Plan year changes.

• You may elect one plan for the 3 mos. short plan
  year and for the full 12 mos. plan and not see an
  increase in premiums for 15 months. -OR-
• You may choose one plan for this 3 month period
  and totally change plans for the new year. For
  example.

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Plan year changes.for example

• Through December, you may elect to cover just
  yourself (employee only) on a PPO plan, let
  your spouse cover your children, and in January
  cover your entire family on HMO.
• Or, you may elect to get on PPO 1 and just stay
  there for 15 months.

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Plan year changes.

• All plans contain some sort of deductiblethat
  deductible will begin again in January.
• The cafeteria plan (Section 125) will also have
  two plan years Oct Dec 2005, then a full 12
  months beginning in January.
  discussed in detail later

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Contribution Changes

• 2005-06
• 180.00/month from FISD toward premium
  (NOTE30/mo New this year)
• 75.00/month from State toward premium
• 255.00 total per month that will be applied to
  your monthly premiums

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Vision Plan (included in all plans)

• Exam _at_ 10 Copay
• Materials _at_ 20 Copay
• Spectacle Lenses (See Handout)
• Frames (See Handout)
• Contact Lenses (See Handout)

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Fall Plan Options ? UMC now included ?

• ? HMO
• ? PPO 1000 (PPO 1)
• ? PPO 2000 (PPO 2)

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? HMO Plan ?

• 25 Dr. Visit Co-pay (50 specialist)
• RX - 10-20-40/20 (Tier 4 drugs _at_ 20 w/
  3,000 out-of-pocket max)
• Co-Insurance 100
• Out-of-Pocket Maximum 750 Co-pay (150/day)
  500 deductible 1250 max
• Maternity750 Co-pay (150/day) 500
  deductible 1250 max

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Premium Comparison ? HMO Plan ?

• Coverage TRS Plan FISD
• Employee Only 446.00 373.10
• Emp. Spouse 753.00 887.99
• Emp. Child 527.00 593.24
• Emp. Family 828.00 925.30

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HMO Plan Premiums
Note All premiums INCLUDE your 255/month and
reflect YOUR monthly cost

• Employee Only 123.25 per month (15.01)
• Employee Spouse 642.54 per month (77.14)
• Employee Child 347.79 per month (41.57)
• Employee Family 684.25 per month (81.64)

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PPO 1000 Plan (PPO 1)

• (1,000 deductible) before 70/50
• 20 Co-pay
• RX - 10-20-40/20 (Tier 4 drugs _at_ 20 w/3,000
  out of pocket max)
• Co-Insurance 70/50
• Out-of-Pocket Maximum 2,500 plus a deductible
  of 1,000 (3,500)
• Maternity - 3500 max (mom) Baby costs
• 70/50 In network / Out-of-network

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Premium Comparison ? PPO 1 Plan ?

• Coverage TRS Plan FISD
• Employee Only 331.00 301.88
• Emp. Spouse 753.00 679.22
• Emp. Child 527.00 543.38
• Emp. Family 828.00 830.16

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• Employee Only 52.03 per mo. (16.60)
• Employee Spouse 433.77 per mo. (74.83)
• Employee Child 297.93 per mo. (53.87)
• Employee Family 589.11 per mo. (98.12)

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PPO 2000 Plan (PPO 2)

• (2,000 deductible) before 70/50
• 25 Copay
• RX ?10-25-50/20 - 100 deductible (Tier 4
  drugs _at_ 20 w/3,000 out of pocket max)
• Co-Insurance 70/50
• Out-of-Pocket Maximum - 5,000 plus the 2,000
  deductible (7,000)
• Maternity - 7,000 max (mom) Baby costs
• 70/50 Network / Out-of-network

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Premiums Comparison ? PPO 2 Plan ?

• Coverage TRS Plan FISD Plan
• Employee Only 249 230.30
• Emp. Spouse 566 506.88
• Emp. Child 396 405.50
• Emp. Family 623 619.48

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• Employee Only -0- per mo. (- 0 - )
• Employee Spouse 261.43 per mo. (40.64)
• Employee Child 160.05 per mo. (26.51)
• Employee Family 378.43 per mo. (56.29)

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Coming Attraction.

• ? There will be a FOURTH plan offered for next
  year beginning January 1.
• ? Explained in detail during the November
  enrollment.

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Additional Contributions

• FISD provides 20,000 of Life Insurance
  (2.20/month)
• You can apply to purchase additional coverage -
  up to 100,000 of guarantee issue (new employees)
• (no physical, no blood work, no differentiation
  between smoker and non-smoker)

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FISD Cafeteria Plan (Section 125) Why should I
participate?

• The only entity to benefit from your
  participation is YOU.
• The district profits nothing
• No insurance agent or company benefits
• Individual enrollments _at_ your campus

Section 125 is the tax code which allows
participating employees to place certain
financial expenses into an account PRIOR to taxes
being withheld.
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For Example (Employee Family)

• Without Sec. 125 With Sec. 125
• ? Salary 30,000 30,000 Insurance
  Premiums - 7,200
• Child Care (500/mo) - 6,000
• Dr. Copays _at_ 8 _at_ 25.00 RX - 450
• 4 Maintenance RX (for three family members) -
  960
• ? Taxable Income 30,000 15,390
• Generated Taxes 8,400 4,309
• Net Pay 21,600 25,691
• ? SAVINGS - 0 - 4,091

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FISD Cafeteria Plan OPTIONS

• Cancer/Intensive Care Insurance
• Dental Insurance (rates remained same this year)
• Disability Insurance
• If you could not physically work after today, is
  your TRS retirement enough?

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Plan Carefully.

• What you do not use you lose! (This is very
  difficult to do) however
• New Treasury rules allow you to spend the money 2
  ½ months beyond the plan year! (Beginning Oct. 1,
  2005)

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Plan Carefully.

• Keep in mind you are planning for two plan years.
  
• 1st for the Oct, Nov, Dec 2005 period
• 2nd for Jan 2006 Dec 2006.

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Consultations by our broker..

• Beth Ashmore 745-8358 (Ashmore Agency)
  
• Insurance 101 Understanding insurance terms
  ? Tuesday 6th
  -Bennett Choir Room
• An in-depth look at our plans
• Question Answer Period
• HIPAA????

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Consultations by our broker..

• NOTE If ANYTHING is going to lead to you meeting
  your deductible, CALL the ASHMORE AGENCY PRIOR
  (if possible).
• You will get one-on-one assistance to help you
  know what is ahead of you (i.e. know what your
  plan is paying and what you should pay.