Open Enrollment 2016 – Temple Israel Medical and Dental Plans
We are pleased to announce Open Enrollment for our Oxford Medical and Aetna Dental Plans.
We will maintain our current carriers and offerings within those carriers for the 2016‐2017 plan year.
There are two plans: Oxford Freedom EPO – Bronze and Oxford Freedom POS – Gold. The primary plan is the in‐network only EPO/HRA plan and it offers the best value to our employees. A summary of benefits on the EPO plan is attached and employee contribution rates are found in the Election Waiver form. The bi‐weekly payroll deductions for the EPO Plans are unchanged for Single coverage but increasing 7.49% for Couple, Employee & Children and Family coverages.
The EPO/HRA plan has a deductible of $5,000 Single and $10,000 Family and the HRA allowance will continue to be $3,750 Single and $7,500 Family. The POS plan has a deductible of $1,000 Single and $2,000 Family and the HRA allowance is also $3,750 Single and $7,500 Family. All medical expenses will go towards the deductible including prescriptions. Employees will be responsible for the gap between the HRA allowance and deductibles stated above.
Once the deductible has been met, Oxford will use the three tier drug co‐pays on the benefit summary and will pay 80% of all other medical expenses, with the patient paying 20% till the plan out of pocket maximums stated on the benefit summary are met. Then Oxford pays 100%.
The chart below outlines the employer paid expenses (HRA Pays) and employee paid (deductible in excess of HRA allowance and coinsurance) for the EPO – Bronze plan.
|Deductible||HRA Pays||Emplyee Pays||Coinsurance % and Max|
|$5,000/ Single||$3,750||$1,250||20% Emp./ $1,300|
|$10,000/Family||$7,500||$2,500||20% Fam./ $2,700|
Employee Maximum Out of Pocket
Single – $2,550
Family – $5,200
The Family deductible will be satisfied by all medical and prescription expenses of all family members added together. It can be satisfied by one family member with high utilization or by various family members contributing. Family out of pocket expenses for deductible and coinsurance outlined above begin after $7,500 of the HRA funding is exhausted. The Plan will pay expenses after a Family has paid $2,500 of the remaining deductible expense. The Plan will initially pay 80% with the Family paying 20% till family has paid their $2,700 in coinsurance expense. After the deductible and coinsurance expense has been satisfied the family plan will pay 100% for the balance of the plan year.
The Single deductible met by single employee, with cash flow as above, utilizing deductible, HRA and coinsurance expenses is similarly outlined in the chart above.
Please note that in compliance with ACA regulations, the pharmacy prescription co‐payments will also accumulate towards meeting the out of pocket maximum. This new feature adds additional protection to you against high medical costs.
As always Open Enrollment choices to enroll or dis‐enroll employee and/or dependents are final and cannot be changed until the following year open enrollment, except in situations of certain life events.
You must complete your Election/Waiver form and sign, indicating your choice of plans for 2016/2017 Plan year. Even if you waive coverage we must have the form returned indicating you are waiving coverage and providing the information if you will be covered under another plan.
These choices are effective May 1, 2016, and the Election/Waiver form must be returned to me by Monday, April 18, 2016.