Health insurance plans are changing for 2019 – what are my choices?Sep. 26, 2018, 7:46 AM
Vanderbilt’s Open Enrollment is Oct. 17-31.
This year, during Open Enrollment, eligible employees must elect a health plan or they will default to the new Choice Consumer-Driven Health Plan (Choice CDHP) at their current individual or family coverage level.
Vanderbilt University is committed to providing high-quality benefits to serve the diverse and changing needs of faculty and staff. To help faculty and staff make the best decision for themselves and their families, the 2019 health plan options and changes are outlined below. At the end of this article, links to additional tools and information, as well as dates and locations for benefits discussion forums, are provided.
What are my options?
For calendar year 2019, Vanderbilt will have two health plan offerings: the Select PPO (Preferred Provider Organization) and the Choice CDHP (Consumer-Driven Health Plan). While the two plans are quite different, they share several important common features. Both plans will continue to use the existing “Tier 1” VHAN (Vanderbilt Health Affiliated Network) and “Tier 2” Aetna network of health care providers, and both provide preventive care at 100 percent coverage. The monthly premium for both plans will continue to be based on a three-tier salary band approach established in 2018 – premiums are adjusted for salary level, and higher-paid employees have higher premiums.
Any fully benefits-eligible faculty or staff member who waived coverage in 2018 will continue to be waived for 2019 unless they make a different election during Open Enrollment. Partially benefits-eligible employees may enroll in the Choice CDHP or may choose to waive coverage.
Select PPO plan features
- Higher monthly premiums, with lower deductibles, than the Choice CDHP.
- The deductibles and out-of-pocket maximums will not increase for 2019.
- For prescription drugs, in the Select PPO plan the employee covers only the designated co-insurance or co-pay. In contrast, the Choice CDHP has the employee pay 100 percent out of pocket for prescription drugs until the Choice CDHP deductible limit is met.
- Employee co-payments are $20/visit for primary care physicians and $35/visit for specialist visits.
- Once the deductible amount is met, the Select PPO plan provides co-insurance at the 90 percent level (employee to pay 10 percent) until the out-of-pocket maximum is reached. Upon reaching out-of-pocket maximums, like the Choice CDHP, the Select PPO plan pays 100 percent of qualified expenses for the remainder of the plan year.
- The Select PPO may be paired with a health care Flexible Spending Account (FSA) that can be used for qualified medical expenses during the plan year. During Open Enrollment, the employee chooses an amount to contribute in 2019 and then makes voluntary pre-tax contributions up to annual IRS limits. The funds in a health care Flexible Spending Account do not roll over from year to year; if funds are not used, they are forfeited. Vanderbilt does not contribute to health care FSA accounts.
- Lower monthly premiums, with higher deductibles, than the Select PPO plan.
- The Choice CDHP is paired with a Health Savings Account (HSA) – an investment account into which the IRS allows annual contributions of up to a maximum of $3,500 for individuals and $7,000 for families in 2019.
- For 2019, Vanderbilt will make a contribution into each fully-benefits-eligible faculty and staff member’s HSA. Vanderbilt will contribute $750 for those with single coverage ($375 in January and $375 in July), and $1500 for those with family coverage ($750 in January and $750 in July). Vanderbilt’s contribution counts toward the IRS maximum.
- Those 55 or older may make an additional $1,000 annual contribution to the HSA.
- Funds that the employee and Vanderbilt contribute to the HSA roll over from year to year if they are not used, and may be used tax-free for qualified medical expenses (as defined by the IRS, see “Medical and Dental Expenses”), either in the same year or in the future.
- HSA funds are considered to be “triple-tax advantaged.” This means any money put into the HSA account is contributed on a pre-tax basis, any earnings on the investments are not taxed, and any funds withdrawn for qualified medical expenses are not taxed. The HSA is an account owned by the employee, and the employee may choose to use HSA funds in the current plan year or roll the account balance forward to let it grow – even into retirement. And if an employee leaves Vanderbilt, the HSA goes with them.
- 100 percent of qualified expenses (including pharmacy prescriptions) are paid by the employee until the employee deductible is met. Once the deductible is met, the employee will pay 20 percent co-insurance until the employee out-of-pocket maximum is reached. At that point, the Choice CDHP plan pays 100 percent of qualified expenses for the remainder of the plan year.
- A child may be covered by a parent’s health care plan per Affordable Care Act (ACA) regulations through age 25, regardless of whether the child is a dependent for tax purposes; however, under separate IRS regulations, a parent’s HSA funds cannot be used to reimburse for a child’s health expenses unless the child is claimed as a dependent on the parent’s tax return.
- Note: If an employee is Medicare-eligible, still working, and enrolls in Social Security, they will be automatically enrolled in Medicare Part A. Neither Vanderbilt nor employee can contribute to the HSA after enrolling in any part of Medicare (Part A, B, C or D). For more information, visit the Social Security website.
- Employees who enroll in the Choice CDHP with the HSA cannot also enroll in the health care Flexible Spending Account (dual enrollment is prohibited by the IRS, since both are tax-advantaged accounts).
Making a decision
To help employees make the best and most informed decision for themselves and their families, Vanderbilt offers the following additional tools and resources:
- Use the My VU Benefits website to view benefit elections, update beneficiaries, or make a family status change.
- Visit the Open Enrollment website for:
- “PlanSelect,” an online Q&A guide that provides a personalized cost and value analysis and will be available later this month. By entering personal scenarios, the tool estimates what costs might look like under each of the two plans.
- A comparative plan design chart
- 2019 health care monthly premiums
- Additional information about Vanderbilt, mail-order and retail pharmacy options
- 2019 health care FAQs
- Visit the Open Enrollment Event Calendar for information on upcoming opportunities to learn more and ask questions about Vanderbilt benefit plans.
- Benefits Open House, Oct. 24 from 10 a.m. to 4 p.m., Baker Building, 10thfloor
- Schedule for Benefits Enrollment Labs, where employees can get assistance to help enroll
For questions or assistance, email: email@example.com or call: 615-343-4788.