Special section: SPEEA/Boeing open enrollment Nov. 7-28
Continued from page 5 Compare and choose a medical plan
What is a deductible?
The annual deductible is the amount you
pay for covered services and supplies before
your plan begins to pay benefits in any given
calendar year. The annual deductible applies
to most, but not all, services. For example,
preventative care with an A or B recommendation from the United States Preventative
Services Task Force (USPSTF) is not subject
to the calendar-year annual deductible. On the
Traditional Medical Plan, prescription drugs
are not subject to the deductible but on the
Advantage+ plan, non-preventative drugs are
subject to the deductible.
• Note: Instead of paying premiums, these
same costs could be contributed pre-tax into
your HSA, which, when combined with
Boeing’s HSA contribution, will more than
cover your entire 2018 Advantage+ individual or family deductible.
The SPEEA/Boeing Professional and Technical
contracts provide three dental plan options
for represented employees in the Puget Sound
region. All three are free from premium contributions.
Select Network Plan –
12% premium contribution
• The Select Network Plan has no network
outside Washington state and provides
no out-of-network benefits. The only
non-network claims covered are for
emergency room visits.
What is coinsurance?
On the Traditional Medical Plan and the
Advantage+ plan, coinsurance is the percentage you pay after you have satisfied the annual
deductible. For example, the in-network coinsurance for covered medical expenses on the
Traditional Medical Plan and the Advantage+
plan is 10%. For in-network services, the coinsurance is applied to the provider’s negotiated-discount reimbursement amount, also known
as the “allowed amount.”
• When comparing the Select Network
medical plan to the Advantage+ plan,
don’t forget the annual premiums
required for Select Network. For example, the annual premiums for a family
($2,903) plus the family HSA contribution ($2,025) is more than the entire
family deductible ($2,700) and 10% of
the next $22,000 of in-network medical
• Dental Delta of Washington (DDWA)
Preferred Dental - This is recommended for the vast majority of SPEEA-represented employees. For the highest
benefit, plan to use an in-network Delta
Dental of Washington (DDWA) PPO
dentist. Nationwide in-network coverage is available, using the National Delta
Dental PPO networks. Note: PPO
Network and Premier Network dentists
are prohibited from billing you the difference between the charged and the maximum
allowable rate, known as “balance billing.”
• Because of the high premiums, the lack
of non-network coverage and the service
area being limited to Washington state,
the Select Network plan does not make
sense for the vast majority of individuals.
• DDWA Scheduled Dental Plan - The
Boeing Scheduled Dental Plan is administered by DDWA. There is still no network of providers, and covered employees
can use any licensed dentist in the United
States, but the reimbursable fee schedule
has not changed for approximately 20
What is the Out-Of-Pocket maximum?
Kaiser (formerly Group Health) –
The Out-Of-Pocket maximum (OOP) is the
most you or your family must pay in a calendar year for covered services. Once the annual
maximum is reached, the plan will begin to pay
most covered services and supplies at 100% of
the allowed amount or maximum allowable cost
for the rest of that calendar year. Not all items
count towards the OOP max. For example,
amounts above the maximum allowable cost for
non-network providers do not count towards
the OOP max.
12% premium contribution
• Kaiser is an HMO with a very limited
network. Similar to Select Network,
Kaiser has no out-of-network benefits.
The only non-network claims covered by
Kaiser are for emergency room visits.
• DDWA Prepaid Dental - The Prepaid
Dental Plan is an HMO. This is a
‘buyer-beware’ plan, because SPEEA
receives more complaints on this plan
than the other two plans combined.
How do the deductible,
coinsurance and Out-Of-Pocket
maximum work together?
Beginning Jan. 1, 2018, the administration of
behavioral health benefits — also referred to as
mental health and substance use disorder benefits — transitions from Beacon Health Options
to Blue Cross and
Blue Shield of Illinois
(BCBSIL) for members
with BCBSIL medical
Below is an example of a $25,000 in-network hospitalization. This illustrates how the
deductible, coinsurance and OOP maximum
work together for an individual on the 2018
Traditional Medical Plan.
Once you choose a medical and dental plan for
2018, estimate the amount of out-of-pocket
expenses you had in
2017 and consider
enrolling in the FSA.
Your entire election is
generally available the
first day of the year, and
if you leave mid-year,
you do not have to repay
the amount you spent in
excess of the sum of your elections.
Send an email to firstname.lastname@example.org
if you have questions about open
enrollment, medical or
With this change, members and covered dependents access the BCBSIL
provider network for in-
2) Negotiated Discount
3) Allowed Amount (#1 - #2)
Up to $500 of your 2018 FSA election can roll
over to 2019 (but not beyond that); this provides
a small safety net for those who accidentally elect
more than they need for 2018.
network care, and BCBSIL will pay claims and
handle customer service inquiries. The current
negotiated benefits design remains in place.
5) Remaining Allowable (#3 - #4)
6) In-Network Coinsurance (#5 x 10%)
7) Plan Paid Provider (#5 - #6)
8) Member Paid Provider (#4 + #6)
Continued on page 7
If you sign up for the Advantage+ plan and are
eligible to make an HSA contribution, it may
be beneficial to contribute the maximum to
your HSA before considering putting money in
the FSA. Additionally, if you are enrolled in the
Advantage+ plan, the HSA and FSA work differently. Before satisfying your annual medical
Advantage+ deductible, the FSA cannot be used
for anything subject to the Advantage+ deductible.
Members and covered dependents currently
receiving or planning to receive behavioral health
benefits should talk with their provider about
whether he or she is part of the BCBSIL network,
which is larger than the Beacon Health Options
network. Members also can call BCBSIL for provider information at (888) 802-8776, or visit
6 SPEEA SPOTLITENOVEMBER 2017