Healthcare Q&A

Please see the below Q&A information to help you better understand certain parts of our health insurance plan.  If you have a question that is not answered below, please direct your inquiry to Lacy Clark, Benefits & Wellness Coordinator for the Bozeman School District.

Q:  Does our plan offer Vision coverage?

A:  As long as you are enrolled in the health insurance plan, you have vision reimbursement coverage.  Click here for additional information regarding the vision plan, and to find out how the reimbursement process works.

Q:  What does the Dental reimbursement plan cover?

A:  The dental reimbursement plan covers anything performed under a licensed dentists care.  This includes orthodontia coverage.  Click here for additional information regarding the dental plan, and to find out how the reimbursement process works. 

The dental plan is separate from the health plan: employees can choose to enroll in one without enrolling in the other.

Q:  What does it mean to be self-funded?

A:  At a high-level, a Self-Funded Group Health Plan (or Self-Funded Insurance Plan) is where an employer is financially responsible for healthcare claims incurred by employees and is responsible for providing employee health care benefits.  By contrast, a “fully-insured” plan means the insurance company designs the plan and assumes all financial risk for paying claims that arise under it.

The Bozeman School District has a self-funded health insurance plan.  The District collects employee and employer paid premiums and uses those premiums to pay our employees’ health claims.  The plan pays a monthly Administrative Fee to Blue Cross Blue Shield (BCBS) to process our health insurance claims and to obtain discounts they have negotiated with doctors and other providers.  Although BCBS pays our claims, the District has the ability to control costs by managing the benefit plan design. 

For Example (all dollar amounts used are purely for example and do not reflect actual plan costs):

Under a Fully-Funded Insurance Plan:

  • The School District and its employees would pay a combined total premium of $2,000,000 to an Insurance Carrier for a health insurance plan that is designed by that Carrier.
  • If, at the end of the plan year, Bozeman School District’s employees only incurred $1,500,000 in claims and expenses then the District and its employees would “lose” $500,000.
  • If at the end of the plan year Bozeman School District’s employees incurred $2,500,000 in claims and expenses, then the District and its employees would have received $500,000 in claims paid by the carrier.  However, then the Carrier would set a rate increase for the upcoming plan year to offset the costs they paid for the group’s health insurance claims.

Under a Self-Funded Insurance Plan:

  • The School District determines that the cost estimate for the upcoming plan year is $2,000,000 and both the School District and employees then contribute a combined total premium to ensure it covers the projected costs for the year.
  • The District limits its risk by obtaining outside insurance (Stop Loss Insurance).  This insurance will kick in if a particular member on the health plan exceeds a predetermined set claim limit.  This eliminates a large amount of risk from the plan.  The District pays $400,000 for the Stop Loss premiums and other administrative costs.
  • At the end of the year, the District incurred $1,500,000 in claims.
  • The plan estimated $2,000,000 in plan costs at the beginning of the year.  $1,500,000 went to paying claims, and $400,000 went to paying Stop Loss premiums.  This leaves $100,000 in savings that the plan then adds to the plan reserves.
  • The plan reserves are excess funds that are used to fund health benefits for those covered under the medical plan for future years.  If the plan has a year where revenue exceeds expenses, the reserve balance grows.  If the plan has a year where expenses exceed revenue, then the reserves are used to offset those costs.

Q:  What is the health insurance plan year dates?

A:  The District’s medical & dental plan year runs from September 1st of each year to August 31st.

Q:  How do I access my 3 free “mental health” visits each year?

A:  The EAP (Employee Assistance Program) offered through the District is available to all employee’s and family members.  Each family member may receive up to 3 free sessions from any of the counselors in the Magellan network.  Book an appointment, find a provider, and ask for help on a chat line by clicking here. 

The EAP is not a part of the District’s health care plan.  Rather, it is contracted through a private provider.  The EAP is designed to help employees and their families get direction and advice on issues they may be experiencing.  It is NOT intended to provide long-term support or replace ongoing services.

Q:  Why doesn't BSD7 offer a co-pay for doctor visits?

A:  The District offers four deductible options for health insurance.  Three of these options are HDHP (High Deductible Health Plans).  On these three options, IRS regulations prohibit the plan from covering any benefits (except preventive treatment) prior to meeting the deductible.  That means that HDHPs cannot have copay's for office visits.  The District does offer one Basic plan ($1,500 deductible) that could potentially have co-payments.  However, because the District pays for all medical claims incurred, premiums would have to increase to cover the cost of this additional benefit. 

Q:  Why is there a difference for insurance coverage between BSD7 and MSU?

A:  Comparing health insurance plans between Bozeman School District and MSU is like comparing oranges and apples.  The largest difference between our plan and MSU is the number of people enrolled in the health insurance.  The bigger the group size, the more premiums the plan generates – and the more participants there are to share in the plan’s risk.  With more premiums comes the ability to make different plan design changes and offer additional enhancements and benefits to the plan.  As MSU is part of the State University system pool (this includes all Universities within the State) it has a much larger funding level, giving them the ability to have different plan structure.  MSU offers three identical plans through three different carriers.  Their plans are based on a cafeteria system, in which MSU gives the employee a chunk of money and allows them to make their plan selection by first using the money provided, and any expenses beyond what is provided is then the employee’s responsibility.  although total premium costs are comparable between Bozeman School District & MSU plans, MSU has the ability to contribute a higher portion toward the premium.  The plans themselves, vary by deductible amounts, total of out pocket maximums, and co-insurance amounts.  Below is a chart that shows information on the MSU plan as compared to the Bozeman School District’s coverage. 

BSD7

 

Q:  Are Naturopaths covered by the plan?

A:  Naturopathic Care is covered under the Bozeman School District plan as long as the service being provided is for a medical condition or treatment that is allowed through the Insurance plan.   Therefore, Naturopaths who are in the BCBS network and submit claims for covered services (being medical or preventive) will process like any other contracted provider.  If the services are preventive, they are paid at 100% of the allowed amount.  Naturopaths are still not covered for “extensive” services, such as vitamin treatment, acupuncture, etc. 

 

Q:  How do I setup a Health Savings Account (HSA)?  Does this have to be done during the open enrollment period?

A:  An HSA account may be set up at any point in time at Big Sky Western Bank.  Monthly deductions from payroll cannot be made until the account is established.  To print and complete the paperwork prior to going to Big Sky Western Bank, click here.  Once the account has been opened, it is necessary to notify the Benefits desk of the account number so that funds can be deposited during payroll. 

Q:  What is a Co-op, and why is the District not part of one?

A:  An Insurance Co-op is a large group formed by multiple smaller groups.  A Co-op then self-funds the group’s health insurance.

In order for a Co-op to successfully run, it must first have groups that are similar size, demographics, and health risks.  Often, Co-ops will fail if a larger population of the group is subsidizing high claims incurred by the smaller populations of the group.  This will in turn increase costs for all members of the Co-op.  It is often difficult to find groups that will team together to create one large group, and all groups merging into a Co-op must be able to benefit from each other.  Within a Co-op there is no flexibility for the individual group to make plan design changes without the entire Co-ops consent.  This eliminates the ability to add or enhance the plan design by employer.

Q:  What is a less expensive option than going to the Emergency Room, or Urgent Care?

A:  The District recently started offering a Virtual Visit service through MD Live to provide you and your dependents with easy access to medical care 24/7.  MD Life allows you to visit with a doctor, receive a diagnosis, and have a prescription sent electronically to a pharmacy of your choice for a low cost of $44. 

To use MD Live, you must first sign up.  Please take a moment to watch this video with instructions for completing the registration process.  Then, take the time to enroll by clicking here.

Another option that is now offered in Bozeman (through Bozeman Health), is b2 MicroCare.  B2 MicroCare is fast and convenient care for minor ailments.  For a cost of $65, you can book the same-day for a no-wait appointment.  Visit their website by clicking here.  They are located in the Smith’s parking lot at 19th & Oak Street.

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