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If you have additional questions, please email HR@co.whatcom.wa.us

 

SELF-INSURED MEDICAL PLAN 2014
Frequently Asked Questions & Answers
* as of 10/30/13 *

This Q&A is a general informational tool only and does not speak for IRS regulations, collective bargaining agreements, County policy or official medical plan documents.

What are plan options for 2014?

1. Qualified High Deductible Health Plan and, if eligible, a Health Savings Account (HSA). 

This plan promotes using preventive care features and a higher deductible.  Preventive care and preventive therapy drugs are covered in full (deductible waived).  The deductible for this plan is $1,500 for employee only coverage or $3,000 for employee plus dependent coverage.  With a QHDHP, you pay the full cost for medical care including, but not limited to, doctor visits, prescriptions, and/or inpatient and outpatient hospitalizations until you reach the deductible limits. Once the deductible is met, the Schedule of Benefits and provider network is the same as the other two plans.

*One-time County HSA seed money will be available only for new participants in 2014*

2. Contributory Cap Plan ($100.44 Employee monthly payroll deduction)

The County offers a Contributory Cap Plan where employees can elect a lower deductible level ($500 for individual coverage, $1,500 for family coverage). Employees pay $100.44 per month through pre-tax payroll deductions for this option.

Under the Contributory Cap Plan, you can access many services and have benefits kick in as soon as you pay the $20 office visit co-pay or 20% of prescription costs without paying a deductible.  After you meet your deductible the plan would cover the percent listed in the Schedule of Benefits.

3. Cap 2000 Plan

Some employees may not qualify for a QHDHP or HSA, or may not wish to make monthly payroll deductions toward medical coverage.  For these situations, the County offers a Cap 2000 Plan with a $2,000 deductible for individual coverage and $6,000 family deductible.

Under the Cap 2000 Plan, you can access many services and have benefits kick in as soon as you pay the $20 office visit co-pay or 20% of prescription costs without paying a deductible.  After you meet your deductible the plan would cover the percent listed in the Schedule of Benefits.

How are the plans changing in 2014?

  • Medical deductible, office copays & coinsurance accrue toward the out-of-pocket maximum
  • All annual and lifetime limits removed for essential benefits
  • Urgent care covered at 100% after $20 copay for Contributory CAP and CAP 2000 plans; covered at 100% after copay and deductible on CAP QHDHP plan
  • No lifetime maximum
  • No pre-existing conditions
  • No transplant waiting period or transplant transportation maximum
  • No annual or lifetime TMJ maximum

What does “qualified” mean?
A “qualified” high deductible health plan meets Internal Revenue Service (IRS) guidelines and allows, if eligible, participation in tax-advantaged, employee-owned health savings accounts (HSAs).

 
Why are QHDHPs becoming more common?
As costs rise, QHDHPs help employers maintain quality benefits for employees and provide a savings mechanism employees can use as more involved consumers of medical services.
 
Do prescriptions count toward the deductible under the QHDHP?
Yes, this may be the biggest change for QHDHP participants who take medications and must pay the full cost of prescriptions until the deductible is met. Remember, medications considered “preventive” are covered at 100% and are NOT subject to the deductible, see Preventive Therapy Drug List for more details.
 

Who is eligible for an HSA?
A person who is:

• Covered under a qualified high-deductible health plan (QHDHP).
• Not enrolled in other medical coverage (unless it’s another QHDHP plan)
• Not enrolled in Medicare
• Not claimed as a dependent on another person’s tax return

If you choose the Contributory Cap Plan or Cap 2000 Plan, you are NOT eligible for an HSA, however you may want to consider a Flexible Spending Account (FSA) to set aside funds for the 2014 tax year (use it or lose it) on a pre-tax basis.
 

Who funds the Health Savings Accounts (HSA)?
For employees enrolled in a QHDHP, the employer AND the employee can contribute funds up to limits set by the IRS.  The County’s one-time contribution, called “seed money,” is outlined in the collective bargaining agreement or in the Unrepresented Resolution as applicable.

 

What does “seed money” mean?
The County’s one-time contribution toward employees’ HSA account is intended to give employees a head start on building savings to cover medical costs.  New, first-time QHDHP enrollees in 2014 are eligible for County “seed money.” Continuing QHDHP enrollees can build their HSA account by electing payroll deductions. Deduction amounts may be changed on a quarterly basis.

 
Who administers the HSA?
Flex-Plan Services, Inc. administers the HSA program and provides useful web tools for accessing and managing HSA accounts.
 
Are funds in the HSA “use it or lose it?”
No, any unspent funds in your HSA are yours and will remain in the account from year to year and follow you when you leave County employment. You can spend your HSA funds on current year qualified medical expenses or leave them for future qualified medical expenses during and after employment with Whatcom County.
 
How much can be contributed to my HSA?
The total 2014 contribution limit is $3,300 for an individual or $6,550 for a family which is inclusive of any Whatcom County contribution. For those age 55 and over, there is an additional annual $1,000 per participant catch-up contribution.
 
How do you make withdrawals from the HSA?
It works just like a bank account. You use a debit card at the point of service or use on-line bill pay services from funds in your account.
 
Who keeps records to substantiate HSA reimbursements?
You do in order to respond to IRS inquiries.
 
What happens to my HSA account when I die?
In the event of the account holder’s death, any money in the HSA would go to the beneficiary the account holder designated during account set up.
 

Can I make a different plan choice for the 2015 plan year?
Yes, open enrollment will occur during the month of November 2014 for 2015 benefits.

 

How are the three Cap plan options the same?
All three plans use the same “Preferred Provider” (PPO) networks and use Preferred and Participating providers.  All three plans are administered by Healthcare Management Administrators (HMA). There is no need to designate a Primary Care Physician or seek referrals to see a specialist under any of these plans. The main difference is the deductible level. Once met, the plans provide the same protection for medical coverage.

 
Where can I find detailed information about the Plans?
Summary Plan Descriptions for the 2013 plans are posted on the Benefits page of InsideWhatcom, on the County’s website under Human Resources, and also on HMA’s website. Official plan documents for 2014 will be posted on InsideWhatcom by December 1st.
 

What about “coordination of benefits?”
Coordination of Benefits (C.O.B.) occurs when a person has coverage under more than one insurance plan (for example, if covered on your County plan as well as a spouse's plan, or you and your spouse both cover your dependents.) If you are covered by a QHDHP, you cannot be covered by any other “health insurance plan” that reimburses you for medical expenses unless it is another qualified high deductible health plan. Your spouse and dependents CAN be double-covered.

 
What about domestic partners?
Employees can cover domestic partners on the Cap (QHDHP) and receive the County’s one-time “seed money” contribution at the employee plus dependents amount. Due to IRS regulations, at this time, funds from that account cannot be used for the domestic partner’s medical costs unless he or she is a dependent for tax purposes. The Plan covers same sex and opposite sex spouses.
 
Can I have an HSA and a Flexible Spending Account (FSA) at the same time?
If you will have a 2014 Health Savings Account (HSA), IRS regulations do not permit you to also contribute to a 2014 Flexible Spending Account for medical expenses.  However, you are able to have a “Limited Purpose” Flexible Spending Account for dependent care, dental, orthodontics, and vision expenses in 2014.
 

When will I receive information about my 2014 Flexible Spending Account (FSA)?
Whatcom County will send information out by November 4th on how to enroll in this benefit.

 

When will I receive information about my 2014 Health Savings Account (HSA)?
If you are enrolled in the qualified high deductible health plan for 2014, Flex Plan Services will reach out to you in December regarding your next steps for your HSA.

 
Which groups are covered by the self-insured medical plan?
ALL county employees EXCEPT Teamsters Master and the Lummi ferry MMP group.

COVERED GROUP
Approximate # of Employees
Unrepresented Employees
174
Deputy Sheriff's Guild
74
Teamsters Corrections
66
Local 17 (Env. Health)
22
Washington State Nurses Association
15
Inlandboatman's Union (Ferry)
8
District Employees
93
 
If you have additional questions, please email them to HR@co.whatcom.wa.us
 
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