READY. SET. GROW HEALTHY. Tolleson Union High School District July 1, 2012

Transcription

1 READY. SET. GROW HEALTHY. Tolleson Union High School District July 1, 2012

2 What We Will Cover Today Medical Plan Options Bronze Plan Silver HDHP 1250 Plan Gold HDHP 2500 Plan UHC Tools and Resources 2

3 Changes for 2012 The Buy Up Medical Plan has been eliminated Current Buy-Up enrollees will have the choice between the Bronze Base Plan, Silver HDHP 1250 Plan and Gold HDHP 2500 Plans. All new hires will only have the option of the two HDHP s 3

4 Your Medical Benefits at a Glance Bronze Plan Type of coverage Network benefit Non-network benefit Physician s office services $30 copayment No benefit Specialist office visit $45 copayment No benefit Urgent care center services $50 copayment No benefit Emergency room services $150 copayment $150 copayment Inpatient hospital stay 20% after $750 deductible per person per policy year not to exceed $2,250 per family No benefit Out of Pocket Maximum $2,000 per Covered Person per policy year, not to exceed $6,000 for all Covered Persons in a family. (Includes the Annual Deductible) 4

5 Bronze Plan Pharmacy Costs Lowest Cost Retail Mail order Tier 1 $10 Member Cost 1-Month Supply $25 Member Cost 3-Month Supply Tier 2 $30 Member Cost 1-Month Supply $75 Member Cost 3-Month Supply Tier 3 $50 Member Cost 1-Month Supply $125 Member Cost 3-Month Supply 5 Highest Cost

6 6 UnitedHealthcare High Deductible Health Plan (HDHP)

7 Consumer-driven health Factors affecting rising health care costs 50% of health care costs driven by behaviors Access 10% Genetic 20% Environment 20% Behavior 50% For every 100 employees: 64 are overweight or obese: average health costs 10-12% higher 23 smoke: average health costs 30-33% higher and annual productivity costs 60% higher 19 experience stress: average health costs 46% higher 7 Source: Adapted from Department of Health and Human Services, Centers for Disease Control and Prevention

8 Consumer-driven health We need to encourage more informed healthcare decisions Introduce a high-deductible which may result in more thoughtful use of health care services Provide a special spending account to help pay qualified expenses and related costs Cover preventive care at 100% in network of eligible expense for network services Provide education and support tools to make informed choices 8

9 Your Medical Benefits at a Glance HDHP Plan 1250 Non-Embedded Plan* Type of coverage Network benefit Non-network benefit Physician s office services 20% after deductible 50% after deductible Specialist office visit 20% after deductible 50% after deductible Urgent care center services 20% after deductible 50% after deductible Emergency room services 20% after deductible 50% after deductible Inpatient hospital stay 20% after $1,250 individual deductible, $2, 500 family deductible* (Individual deductible does not apply) 20% after $1,250 individual deductible, $2, 500 family deductible (Individual deductible does not apply) Out of Pocket Maximum 9 $3,750 per Covered Person per plan year. $7,500 for family coverage.* (Deductibles and copays apply) $7,500 per Covered Person per plan year. $15,000 for family coverage.* (Deductibles and copays apply)

10 Your Medical Benefits at a Glance HDHP Plan 2500 Embedded Plan* Physician s office services 20% after deductible 50% after deductible Specialist office visit 20% after deductible 50% after deductible Urgent care center services 20% after deductible 50% after deductible Emergency room services 20% after deductible 50% after deductible Inpatient hospital stay 20% after $2,500 individual deductible, $5,000 Family deductible* (Individual deductible does apply for each family member) 20% after $5,00 individual deductible, $10,000 Family deductible (Individual deductible does apply for each family member) Out of Pocket Maximum 10 $4,500 per Covered Person per plan year. $9,000 for family coverage. (Deductibles and copays apply) $9,000 per Covered Person per plan year. $18,000 for family coverage. (Deductibles and copays apply)

11 HDHP Plan Pharmacy Costs Lowest Cost Retail Mail order Tier 1 $10 Member Cost 1-Month Supply $25 Member Cost 3-Month Supply Tier 2 $30 Member Cost 1-Month Supply $75 Member Cost 3-Month Supply Tier 3 $50 Member Cost 1-Month Supply $125 Member Cost 3-Month Supply Highest Cost Members are subject to their Medical/Pharmacy deductible before copay s apply. Medications listed on Preventative Drug List are subject to copays. 11

12 Introducing the HDHP Plan Combines a high-deductible health plan that allows you the option to open a health savings account (HSA) High-deductible health Plan 100% network preventive care Optional health Annual savings deductible account (HSA) Annual outof-pocket protection Personal support and messages, health coaches 12

13 What is a health savings account (HSA)? You can open and fund the HSA to pay the plan deductible and other qualified health care costs or you can let your account grow. HSA It s yours even if you switch jobs or plans Triple tax savings Pay for today s $$ or save for tomorrow s Use for qualified expenses not covered by the plan Use it for retirement, investing* HSAs are designed to help you save and pay for your health care 13

14 What you should know about the HSA An HSA is not health insurance Used to pay/reimburse qualified expenses Each covered individual can open an HSA No use it or lose it requirement HSA is owned by you 14

15 HSA eligibility requirements You may be eligible to open an HSA if: You are not covered by any other non-high deductible health plan, such as a spouse s plan You are not enrolled in Medicare You do not receive health benefits under TRICARE You have not received Veterans Administration (VA) benefits within the past three months You cannot be claimed as a dependent on another person s tax return You cannot be covered by a health care FSA or HRA 15

16 Annual HSA contribution limits Annual contribution limits are set by the IRS Annual Contribution Rules 2012: $3,100 for individuals & $6,250 for families Additional Funding Those 55 years of age or higher, but not entitled to Medicare benefits, can fund an additional $1,000/year catch-up contribution! Amount of Funding Contributions above the annual limit are subject to income taxes and a 20% penalty. 16

17 How you can use the HSA Medical plan deductibles and coinsurance Pharmacy, dental, vision care services Use HSA dollars to pay for medical expenses for your spouse or dependents Any money you take out of your HSA for eligible medical expenses is federal income-tax free 17

18 How you can use the HSA Other qualified expenses 1 Coverage while receiving unemployment benefits 4 Medicare premiums and out-of-pocket expenses 2 COBRA continuation coverage 3 Eligible longterm care 18

19 How the HSA Plan Works HSA Payment Process Present ID card to network doctor Doctor sends claim to UnitedHealthcare UnitedHealthcare applies network discount and notifies doctor of amount you may owe. Doctor bills you for payment 1. You can use your HSA to pay 2. Or you can choose to pay another way (cash, credit card) and reimburse yourself later When you have claim activity, you will receive a Health Statement. TIP: Use your HSA to help you pay qualified expenses 19

20 Explanation of Benefits (EOBs) You may notice some changes on your EOBs beginning late You will see more information on: Appeal rights Consumer assistance programs What s more the EOB has been designed for easier readability. We encourage you to access your EOBs online at myuhc.com. 20

21 How the HSA Helps You Save The money Steve puts into his HSA is federal income tax-deductible. Any money Steve withdraws from his HSA to pay for qualified medical expenses is withdrawn federal income tax-free. Steve may earn interest on his account, and it is not taxable. The amount not spent during this year carries over for use in future years. 21

22 How Much Did Steve Save? In 2012, Steve will deposit $6,250 into his HSA, the maximum contribution for family coverage. Steve will withdraw $3,000 to pay for qualified health care expenses for him and his family. Steve earns interest on his account. Steve s federal and state income tax savings and FICA on his contributions for the year are $2,478. Steve will not have to pay income taxes on the $3,000 as long as he uses it to pay for qualified expenses. Steve does not have to pay federal income taxes on his interest. 4 Steve will carry over $3,250 HSA dollars (contributions expenses + account earnings) into. With a traditional plan, Steve wouldn t have this carryover option, which helps him save for the future. 22

23 Comparing an HSA with an FSA HSA Owned by employee Funded by the employee and employer Funds automatically rollover to next plan year Qualified expenses determined by IRS and employer Automatic enrollment Limited-Purpose FSA Owned by employer Funded by the employee All funds must be used by the end of the plan year or grace period Only & dental are reimbursable Must enroll each year enrollment 23

24 Common HSA Questions 1 How do I enroll? Enroll during your Open Enrollment period Check your employer benefit information for details 2 Can I take the funds in my HSA with me if I leave the company? Yes. Funds belong to you even if you leave your job, change health plans or retire. 3 4 Can others contribute to my HSA? How do I access the funds in my account? Yes. Anyone can contribute to your HSA. Keep in mind that annual contribution limits above what is allowed are subject to income taxes and a penalty. Use your HSA debit card Pay by check, cash or credit care and reimburse yourself later from your HSA 24

25 OptumHealth SM Bank, Member FDIC UnitedHealthcare s health care bank of choice FDIC-insured so you know your money is safe Dedicated to helping people save for health care One of the nation s leading HSA custodians Offers a Health Savings Account Debit MasterCard Only OptumHealth Bank offers the convenience of HSA banking through myuhc.com Pay bills Make deposits Reimburse yourself Track spending Account holders will receive Health Savings News e-newsletter See your tax savings And more 25

26 Choose the Right Mix of Fees and Interest Understand the rates, fees and features for each account type: Health eaccess Health esaver Health einvestor Monthly Maintenance Fee $0 if balance exceeds $500 $1 if balance is $1-$ $0 if balance exceeds $5,000 $3 if balance is $1-$4, $0 if balance exceeds $5,000 $3 if balance is $1-$4, Balance Required to Obtain APY Annual Percentage Yield (APY) Annual Percentage Yield (APY) Annual Percentage Yield (APY) $0-$ % $500-$ $1,000-1, % 0.00% Variable based on balance Variable based on balance $2,000-$4, % $5,000-$14, % $15, % Investment Threshold Monthly Investment Fee $2,000 $2,000 $500 $3 $0 $2.50 Investments are not FDIC-Insured, are not guaranteed, and may lose value. 26

27 27 How the High Deductible Health Plan Works

28 How the HDHP Plan Works *From 28

29 How the HDHP 2500 Plan Works Chris chooses the HDHP Plan for himself because: No cost monthly premiums His employer is contributing $700 He can keep his doctor Chance to use HSA to save for future expenses Here is what Chris s plan looks like: Employer deposits $700 in HSA Chris deposits $1,000 in HSA 80%/20% network coinsurance 100% network coverage *From $2,500 Annual deductible $4,500 Out-of-pocket maximum 29 Cheryl is a fictitious person used to illustrate UnitedHealthcare products.

30 How the HDHP Plan Works 1 preventive exam per member $400 1 visit to urgent care $200 1 doctor visits $100 2 prescriptions $100 Non-preventive total $400 Paid 100% by plan And Chris still has $1,300 in his HSA! Chris uses HSA to pay HSA paid total $400 Chris paid $400 $1,300 *From $2,500 Annual deductible $4,500 Out-of-pocket maximum 30

31 How the HDHP 2500 Plan Works Jane chooses the HDHP Plan because: No monthly premiums Has few health expenses Ability to open and save with an HSA Tax savings Here is what Jane s plan looks like: District funds $700 in HSA 80%/20% network coinsurance 100% network coverage *From $2,5000 Annual deductible $4,500 Out-of-pocket maximum 31 Chris is a fictitious person used to illustrate UnitedHealthcare products.

32 How the HDHP Plan Works All other expenses are covered 100% for the rest of the plan year Emergency surgery $100,000 6 Doctor visits $1, Prescriptions $1,000 Non-preventive total $102,000 Total actual cost $102,000 District deposits $700 in HSA Jane uses HSA to meet a portion of her deductible Remaining bill $101,300 Insurance pays (80%) Jane to pay (20%) But she pays only $3,800 to get her $4,500 maximum. Jane pays $3,800 $2,500 $4,500 Reaches deductible 80%/20% 100% Annual deductible Out-of-pocket maximum *From 32

33 Jane compares plans Bronze Plan HDHP 1,250 HDHP $2,500 District Funded HSA Pays $0 $0 $700 Out of Pocket Maximum $2,000 $3,750 $4,500 Copays $955 $0 $0 Premium $2,400 $0 $0 Total Member Pays $5,355 $3,750 $3,800 33

34 34 Wellness Tools

35 Take Advantage Of Your Preventive Care Coverage Certain preventive services are covered without charging a deductible, copayment or coinsurance when these services are provided by a network provider. It s important to review your plan documents for the preventive services included in your specific benefit plan. Regular preventive care may help Reduce risk of disease Detect health problems early Protect you from higher costs down the road for age and genderspecific guidelines 35

36 myuhc.com Find network doctors/hospitals Estimate costs Track claims status Build a health improvement program Keep a Personal Health Record Get health product discounts Review plan details 36

37 Large National Network More than: 660,000 doctors 1,000 convenience care clinics 5,100 hospitals 60,000 pharmacies And world-wide emergency care coverage 37

38 Our Large National Network Your doctor is likely already in our network. Available to 98% of Americans More than 1,000 convenience care clinics Includes 2 out of3 providers Includes 95,000 Specialists designated for their quality and cost efficiency based on national standards 38

39 Promoting Quality & Affordable Health Care The UnitedHealth Premium program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidence Doctors who meet both quality and cost-efficiency guidelines receive two stars, and those who meet quality receive one star Quality Care UnitedHealthcare awards one star to physicians who meet national standards for quality care. + = Cost-efficient Care UnitedHealthcare awards a second star to physicians who meet local area benchmarks for cost-efficient use of resources in delivering health care. UnitedHealth Premium Two-Star Physicians Two-star physicians have been recognized for providing quality and cost-efficient care to their patients. They meet or exceed nationally recognized guidelines, and they re likely to recommend the right tests and treatments for a variety of conditions. 39

40 Treatment Cost Estimator Designed to calculate and compares cost differences for treatments between providers, locations and facility types, including both plan and member expenses for each treatment SOURCE: UnitedHealthcare service data, April 2010 Includes treatment costs for: ~ 116 diseases/conditions ~ 90 surgeries/procedures ~ 500+ individual services ~ 3,000+ medications 40 40

41 Health Assessment Take a free, online questionnaire about your health from the University of Michigan Program includes interactive online health coaching Feedback on progress toward living a healthier life Recommendations for online health and wellness services Information to help members have productive conversations with doctor 41

42 Care24 Nurseline and EAP Connect with a registered nurse and highly experienced counselors Get help with legal, financial and emotional needs Prepare yourself before you seek a doctor s care Access recorded messages on health topics Communicate in live, one-to-one Nurse Chats at myuhc.com Care

43 Healthy Pregnancy Program Get support through every stage of pregnancy Nurses available, toll-free, 24/7 Personalized pregnancy assessment Educational materials and resources No Additional Cost Gifts and Savings Your Journey Through Pregnancy, a book that will help you learn more about your nine-month journey.. A booklet from Johnson & Johnson: What s Next?: The magic unfolding of the first days of life. 43

44 Health plan ID cards Mailed to new members within 30 days of enrolling Includes your plan information Lets providers know how to bill Mary Winters Fred Winters, spouse Ann Winters, dependent Susan Winters, dependent 44

45 Get Health4Me and DocGPS App Today! Find network doctors with our new mobile phone app Uses Google Maps Search based on your location Download for iphone, BlackBerry and Droid phones Google Android is a trademark of Google, Inc. iphone is a registered trademark of Apple, Inc. BlackBerry is a registered trademark of Research in Motion Limited Droid is a registered trademark of Lucasfilms Ltd. 45

46 Explore Health Care Lane Today! A fun and interactive way to learn about health insurance healthcarelane.com/vsebt 46

47 QUESTIONS