2014 USNH Employee Health Plan Options

Transcription

1 2014 USNH Employee Health Plan Options

2 Session Agenda Introductions Medical Plan Options & Rates Choice Plan Review Summary of Benefits; Mary Gore, Harvard Pilgrim Healthcare Choice Plan Health Savings Account; Jeff Venuti, Health Equity Online Plan Cost Estimator Tool; Mary Gore Questions & Answers Online Tools & Resources FSA vs. HSA Medical Services, Cost & Quality Tandem HPHConnect 2

3 2014 Health Plan Options Medical Plan Options HMO POS New Choice Plan* *Available to active benefits-eligible staff and faculty not covered by a collective bargaining agreement. 3

4 2014 Health Plan Options Health Maintenance Organization (HMO) Healthcare is provided or arranged through a network of primary care physicians, specialists, and other providers Plan members select a Primary Care Physician (PCP) in the network Co-payment for office visits Co-payment for prescription drugs Co-payment for inpatient and outpatient services Annual deductible and out-of-pocket maximum may apply Wellness Connection Program 4

5 2014 Health Plan Options Point of Service (POS) The POS plan has been designed to offer the coordinated care and cost advantages of an HMO as well as the choice of obtaining covered benefits outside the HMO Network Plan members select a Primary Care Physician (PCP) in the network PCP can refer you to a Specialist Specialist can be in-network or out-of network (subject to plan coverages) Co-payment for office visits Co-payment for prescription drugs Co-payment for inpatient and outpatient services In-Network annual deductible and out-of pocket maximum may apply out-of-network benefits with annual deductible, coinsurance, and outof pocket maximum Wellness Connection Program 5

6 2014 Health Plan Options Choice Plan - High Deductible Health Plan, Preferred Provider Organization (PPO) Medical Plan The PPO plan offers the availability of obtaining covered benefits through a network of participating providers or nonparticipating providers Annual deductible and out-of-pocket maximum apply High deductible health plan After deductible, coinsurance and prescription copayments until out-of-pocket maximum is met Wellness Connection Program 6

7 Choice Plan Presentation Mary Gore Harvard Pilgrim

8 Choice Plan Components of the Choice Plan Two components:» A qualified High Deductible Health Plan» A Health Savings Account (HSA) 8

9 Choice Plan Choice Plan PPO Design No need to designate a primary care physician (PCP) No referral for specialist care Full access to our local network, plus a national network of more than 450,000 providers 9

10 Choice Plan Choice Plan Puts You in Control Access care from providers outside the network (with employee higher costsharing) Access emergency care anywhere in the world at the in-network benefit level 10

11 Choice Plan Preventive Services Select in-network routine preventive services are not subject to deductible and coinsurance Covered in full: physicals, annual gyn visits, mammograms, pap smears, immunizations, blood work and urinalysis, and certain disease screenings

12 Choice Plan Choice Plan All diagnostics and treatments are subject to deductible and coinsurance Visits for illness or injury Imaging and outpatient services Inpatient services Prescription drugs 12

13 Choice Plan Choice Plan Prescription Drugs Benefit Subject to in-network deductible Payment is due at the time of purchase Once you reach the deductible, a copay applies ($5 / $25 / $40)

14 Choice Plan 14 Choice Plan Summary Annual Deductible Plan Provision In-Network Benefits Out-of-Network Benefits Annual Out-of-Pocket Maximum Preventive care including: Adult annual visit Well child visit Annual gynecological visit Immunization, including flu shot Emergency Room Other Services Office visit for illness or injury Lab test, diagnostic procedures In and out patient hospital services Treatment and procedures, such as surgeries, chemotherapy, allergy treatments, dialysis Prescription drug retail Prescription drug mail order $1,500 Individual $3,000 Family $3,000 Individual $6,000 Family 100% No deductible applies 90% after deductible $3,000 Individual $6,000 Family $ 6,000 Individual $12,000 Family 70% 90% after deductible 70% after deductible $5/$25/$40 after in-network deductible $10/$50/$80 after in-network deductible

15 Choice Plan Reimbursement for Medical Claims You pay provider (you can use HSA funds) You visit provider Provider bills you Provider submits claim Harvard Pilgrim processes claim

16 Health Savings Account Jeff Venuti HealthEquity

17 What s an HSA? A tax-free savings account that belongs to you, and: Can be used to pay for qualified medical expenses Earns interest Can be invested once a certain threshold is met You and/or Employer Contribute Your HSA Qualified Medical Expense

18 HSA requires a qualified plan HSA COMPONENTS Qualified Medical Plan Low-Premium, High-Deductible Health Plan THE INSURANCE PIECE HSA Health Savings Account THE ACCOUNT USED TO FUND THE DEDUCTIBLE TAX-FREE Insurance Company Financial Custodian HealthEquity

19 Maximize your money Save and keep your money Lower premiums, tax-free, long-term savings You own the account and the money stays with you Grow your money Money rolls over year to year Triple tax-savings Contributions aren t taxed and reduce your annual taxable income Withdrawals are never taxed or penalized when used for qualified medical expenses; including Rx, dental, vision Earnings aren t taxed

20 Who qualifies for an HSA? To own an HSA, employees should: Be covered ONLY by an HSA-qualified health plan Other health coverage (including Medicare, a traditional health plan, or even an FSA) may disqualify them from the HSA Not be claimed as a dependent on someone else s tax return 20

21 Maximize your savings 2014 max contributions allowed by IRS: Individual = $3,300 Family = $6,550 Catch-up contribution, age 55+: $1,000 How to fund your HSA: Make pretax contributions through payroll deduction, online, or directly to HealthEquity Fully fund your HSA on day one Make contributions anytime after your HSA is open 21

22 Powerful tools Members can use their portal to Check their balance Review transactions Review claims Submit new claims or documents Send payments and reimbursements Access tax documents Convenient access Online Using our free mobile app By telephone 22

23 MEMBER PORTAL: Log On at

24 Mobile app On-the-go access for all account types Take a photo of documentation with phone and link to claims and payments Send payments and reimbursements from HSA Manage debit card transactions View claims status 24

25 Investment offerings Self-driven GPS Auto-pilot 39 funds/ 11 asset classes Maximize tax-free gains Invest HSA deposits into best-in-class funds Robust, easy-to-use 25

26 HSA HOW TO: Doctors Visits 1 Go to the doctor No co-pays 2 3 Doctor sends insurance carrier the bill Optional: Enter claim in member portal Insurance carrier adjusts price based on discounts Pay doctor from HSA funds, if funds are available. Pay out of pocket if funds aren t available and reimburse yourself later. *This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.

27 HSA HOW TO: Pharmacy Prescriptions 1 Go to pharmacy Show your pharmacy card 2 Pharmacy applies discount Pay with your HSA card 3 Pharmacy sends claim to insurance carrier Insurance carrier applies amount to your deductible no paperwork needed *This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.

28 Helpful member support Always available Our member services are taking calls 24 hours a day, every day of the year Every step along the way We are here to answer any questions you have and help you maximize your savings Call today Let us conduct a personal assessment of your plan options

29 Monthly member webinars Three-part series: 1. HSA Basics 2. Tips to Maximize Your HSA Savings 3. Member Portal Overview Each session taught twice each month by a trained and certified HSA expert. 29

30 Health Savings Account Resources: HealthEquity IRS Publications 969 and 502 Government websites Campus Human Resources

31 Choice Plan Cost Estimator Mary Gore Harvard Pilgrim

32 Selecting the Right Plan Option Just Got Easier & Smarter

33 Personalizing the Decision-Making Process

34 PCE: Helps with Answering the Tough Questions 34

35 PCE: Understanding How it Works How Does the Plan Cost Estimator Work? You start by indicating the services you expect each family member to use For each family member, you specify whether that individual is expected to be a low, medium or high utilizer of health care services. The tool uses pre-set services you just delete those that do not apply. You can add additional procedures, specific chronic conditions, multiple prescriptions and medical supplies each family member is likely to use. Note: New PCE V4 design shown

36 PCE: Understanding How it Works How Does the Plan Cost Estimator Work? View and compare your costs from plan to plan Compare your annual premium contributions, cost of services and USNH s contributions and your own HSA or FSA contributions. Calculate your potential tax savings if you elect to enroll in an HSA or an FSA. Compare your annual plan costs and per paycheck deductions. Display plan summaries, add your own plan, and print estimates.

37 PCE Demo 37

38 Questions?

39 Closing and Resources Susan Strogen USNH HR

40 2014 Health Plan Options: Contribution Rates HMO Employee Rates* 1Person $ Person $ Family $ Flexible Spending Account (FSA) election available, employee funded only POS Employee Rates* 1Person $ Person $ Family $ Flexible Spending Account election available, employee funded only CHOICE PLAN Employee Rates* 1 Person $ Person $49.95 Family $ Health Savings Account (if eligible), employer funded at: 1 Person $500 2 P/Family $1,000 *Assumes 100% time and 26 pay periods

41 2014 Health Plan Options: What s Best for me? HMO/POS NEW: CHOICE PLAN I feel more comfortable limiting my health spending to the premiums deducted from my paycheck I am comfortable managing my own health care expenses & using the online tools HPHC and USNH provide I like having my PCP guide my medical care and decisions and I don t mind needing referrals for specialty care Accessing out of network providers may not be important to me I know I can find high-quality, low cost providers through the Tandem Care Incentive Program as well as other cost saving programs I elect an Flexible Spending Account and I m comfortable managing my election so I don t forfeit any money I want to be in charge of my medical care: my PCP might recommend someone but I like to choose my own specialists I like that there are no network constraints if I am willing to pay I know I can find high-quality, low cost providers through the Tandem Care Incentive Program as well as other cost saving programs I like the idea of having an employercontribution, if eligible, to an HSA to help fund first dollar medical expenses 41

42 Tools to be a savvy and informed consumer 1. Health care is a business: shop around! 2. Ask if a generic prescription is right for you 3. Participate in the Tandem Care Incentive Program 4. Take advantage of USNH/HPHC Wellness Programs 5. Utilize the USNH Employee Assistance Program 6. When you are in need of medical care, know where to go: try the UNH Employee Clinic 7. Ask questions

43 Additional Resources

44 Resources Choice Plan Resources available online via the USNH Human Resources webpage Employee Communications Online Tutorial for the Choice Plan Online Tutorial for the Health Savings Account Harvard Pilgrim Cost Estimator Tool Tandem FAQs Campus Human Resources links 44

45 2014 Health Plan Options: FSA vs. HSA Flexible Spending Account (FSA) Health Savings Account (HSA) Employer owned: used balances are forfeited at the end of the grace period (March 30 of the following year) Contributions are tax free Cannot change election amount without a qualifying event Full election amount available January 1 st Employee owned: the money is yours and rolls over year to year Contributions are tax free Election changes will be effective the first of the following month Access only to current account balance IRS contribution limit: $2,500 Available with traditional health plans IRS contribution limit: $3,000 (individual) $6,550 (family) Available*with USNH Choice Plan *if eligible

46 How much do medical services cost, anyway?

47 Where can I find about the cost of procedures?

48 What about quality?

49 Tandem Be a savvy health care shopper

50 Tandem 50

51 Tandem Savings Examples

52 Tandem Savings Examples Tandem Savings Examples (UNH) Service Provider Price A Provider Price B Provider Price C Normal delivery $12,565 (WDH) $16,313 (Portsmouth) $17,525 (Exeter) Office visit (age 50-65) $86 (Portsmouth Family Practice) $116 (Mill Pond Family Practice) $167 (Dover Internal Medicine) Emergency room visit, minor $204 (Exeter) $552 (WDH) $772 (Frisbie) Shoulder x-ray $402 (Access Sports Medicine) $524 (Portsmouth) $636 (WDH) Hernia repair, OP $10,545 (Exeter) $15,537 (WDH) $17,784 (Portsmouth) MRI, knee, OP $1,916 (Exeter) $3,600 (WDH) $3,808 (Portsmouth)

53 Cost of Medical Services What do things cost, anyway? (UNH) Service Ordering Provider Lower Cost Provider Difference Tandem Reward Physical Therapy Dover: $1,400 Dover, free-standing facility: $800 Colonoscopy Exeter: $2,339 Stratham, free standing facility: $705 Colonoscopy & Upper Rochester: $4,000 Stratham, free GI Endoscopy standing facility: $2,300 MRI Dover: $3,553 Portsmouth NH free standing facility: $632 Lab test Dover: $388 UNH Employee Clinic: $94 Lab test Rochester: $652 UNH Employee Clinic: $119 X-ray Dover: $297 UNH Employee Clinic: $43 $600 $100 $1,634 $200 $1,700 $200 $2,921 $200 $294 $75 $534 $100 $254 $75 53

54 Tandem Savings Examples Tandem Savings Examples (UNH-M) Service Ordering Provider Lower Cost Provider Difference Tandem Reward Cataract Removal Manchester, freestanding facility: $3,700 Nashua, free-standing facility: $2,800 Colonoscopy Manchester: $3,129 Bedford, free standing facility: $1,985 Colonoscopy & Upper GI Endoscopy Rochester: $4,000 Stratham, free standing facility: $2,300 MRI Exeter: $1,965 North Andover, free standing facility: $941 Lab test Manchester, $239 Free-standing facility: $85 Lab test Rochester: $652 UNH Employee Clinic: $119 X-ray Dover: $297 UNH Employee Clinic: $43 $1,100 $200 $1,144 $200 $1,700 $200 $1,024 $200 $174 $40 $534 $100 $254 $75

55 Cost of Medical Services What do things cost, anyway? (UNH-M) Service Provider Price A Provider Price B Provider Price C Normal delivery $11,580 (Elliot Hospital) $15,964 (St. Joseph s) $17,525 (Exeter Hospital) Office visit (age 50-65) $80 (Apple Tree Family Physicians, Londonderry) $91 (Southern NH Internal Medical Associates, Derry) $132 (Webster Street Internal Medicine, Emergency room visit, minor Manchester) $380 (St. Joseph s) $424 (Elliot Hospital) $790 (Catholic Medical Center) Shoulder x-ray Hernia repair, OP MRI, knee, OP $236 (Catholic Medical Center) $5,373 (Elliot One Day Surgery Center) $1,450 (Derry Imaging Center) $505 (Elliot Hospital) $587 (St. Joseph s) $9,892 (Elliot Hospital) $13,303 (St. Joseph s) $2,920 (St. Joseph s) $3,010 (Elliot Hospital)

56 Tandem Savings Examples Tandem Savings Examples (KSC) Service Ordering Provider Lower Cost Provider Difference Tandem Reward Cataract Removal Manchester, freestanding facility: $3,700 Nashua, free-standing facility: $2,800 Colonoscopy Keene: $2,550 Manchester, free standing facility: $2,035 Colonoscopy Lebanon: $2,500 Concord, free standing facility: $941 Physical Therapy Keene: $1,400 Free-standing facility: $800 Mammogram Concord: $454 Concord, free standing facility: $307 $1,100 $200 $515 $100 $1,040 $200 $600 $100 $147 $40 Ultra Sound Brattleboro: $539 Keene: $283 $256 $75 56

57 Cost of Medical Services What do things cost, anyway? (KSC) Service Provider Price A Provider Price B Provider Price C Normal delivery $ 8,547 (Littleton) $14,031 (Cheshire) $18,939 (Mary Hitchcock) Office visit (age 50-65) Emergency room visit, minor Shoulder x-ray $86 (North Meadow Family Health Peterborough) $315 (Cheshire Medical Center) $571 (Cheshire Medical Center) $116 (Dartmouth Hitchcock Keene) $396 (Cheshire Medical Center) $820 (Mary Hitchcock) $918 (Concord) $592 (Concord) $759 (Monadnock) Hernia repair, OP $8,219 (Monadnock) $9,992 (Cheshire) $14,189 (Concord) MRI, knee, OP $1,881 (Cheshire Medical Center) $1,969 (Concord) $4,414 (Mary Hitchcock)

58 Tandem Savings Examples Tandem Savings Examples (PSU) Service Ordering Provider Lower Cost Provider Difference Tandem Reward Cataract Removal Manchester, freestanding facility: $3,700 Nashua, free-standing facility: $2,800 MRI Boston: $1,447 Portsmouth, free standing facility: $985 Colonoscopy Lebanon: $2,500 Concord, free standing facility: $941 Mammogram Concord: $454 Concord, free standing facility: $307 Lab test Plymouth: $255 Plymouth, free-standing facility: $56 $1,100 $200 $462 $100 $1,040 $200 $147 $40 $201 $40 Lab test Plymouth: $439 Franklin: $110 $329 $75 58

59 Cost of Medical Services What do things cost, anyway? (PSU) Service Provider Price A Provider Price B Provider Price C Normal delivery $8,547 (Littleton) $11,057 (Speare) $18,859 (Concord) Office visit (age 50-65) $68 (Mid-State) $100 (Concord Family Medicine) $335 (Linwood Medical Associates, Lincoln) Emergency room visit, minor $888 (Lakes Region) $918 (Concord) $999 (Speare) Shoulder x-ray $255 (New London) $452 (Littleton) $592 (Concord) Hernia repair, OP $6,914 (Speare) $12,424 (Lakes Region) $14,189 (Concord) MRI, knee, OP $1,969 (Concord) $2,940 (Speare) $3,325 (Littleton)

60 Tandem Savings Examples Tandem Savings Examples (GSC) Service Ordering Provider Lower Cost Provider Difference Tandem Reward Cataract Removal Manchester, freestanding facility: $3,700 Nashua, free-standing facility: $2,800 Colonoscopy Concord: $2,550 Manchester, free standing facility: $2,035 Colonoscopy Lebanon: $2,500 Concord, free standing facility: $941 Mammogram Concord: $454 Concord, free standing facility: $307 MRI Exeter: $1,965 North Andover, free standing facility: $941 Lab test Rochester: $652 UNH Employee Clinic: $119 $1,100 $200 $515 $100 $1,040 $200 $147 $40 $1,024 $200 $534 $100 60

61 Cost of Medical Services What do things cost, anyway? (GSC) Service Provider Price A Provider Price B Provider Price C Normal delivery $18,051 (Frisbie Memorial) $11,580 (Elliot Hospital) $18,859 (Concord) Office visit (age 50-65) Emergency room visit, minor $91 (Southern NH Internal Medical Associates, Derry) $100 (Concord Family Medicine) $132 (Webster Street Internal Medicine, Manchester) $380 (St. Joseph s) $918 (Concord) $790 (Catholic Medical Center) Shoulder x-ray Hernia repair, OP MRI, knee, OP $236 (Catholic Medical Center) $5,373 (Elliot One Day Surgery Center) $1,450 (Derry Imaging Center) $587 (St. Joseph s) $592 (Concord) $13,929 (St. Joseph s) $14,189 (Concord) $3,010 (Elliot) $4,414 (Mary Hitchcock)

62 HPHConnect View all claims, authorizations, prescription drug history and monthly Activity Summaries Compare provider cost and quality Create a personal medical record Research a condition Review your plan documents Schedule of Benefits and Benefit Handbook Pharmacy program Much more