A Guide to Using your Consumer-Directed Health Plan (CDHP)

Transcription

1 A Guide to Using your Consumer-Directed Health Plan (CDHP) and Health Savings Account (HSA)

2 A Guide to Using Your At The Hartford, we offer competitive benefits and programs to help you live well and coverage options that give you control over how you spend your health care dollars. The Consumer-Directed Health Plan (CDHP) options and the Health Savings Account (HSA) give you more power to manage your health care and encourage you to make informed health care decisions. It s important to understand how your medical coverage works before you need care, so when the time comes you know what to do. Click the tabs to the left to learn more about your CDHP, and how it works together with your HSA and how using your plan wisely can save you money on health care expenses today and in the future. This guide is intended to provide a general overview of certain benefits. Details about those benefits are provided in official plan documents, which govern eligibility for the benefits and the operation of the plans. Any differences between this guide and the plan documents are not intended, but if any differences are found to exist, the plan documents will govern. 2

3 A Consumer-Directed Health Plan (CDHP) is a little different than a traditional health plan that you may be used to, but taking time to get to know the plan could mean extra money in your pocket. CDHPs are designed to give you more control over how you spend your health care dollars. These plans cost less per pay period, but have higher deductibles than other plans. CDHPs allow you to contribute to a special tax-advantaged Health Savings Account (HSA) you can use to pay for qualified health care expenses like doctor s bills, hospital charges and pharmacy expenses. funds can also be used for dental and vision expenses. Any remaining funds in your HSA carry forward from year to year, so you can build your savings. You own your HSA, not The Hartford, so the money is yours to take with you wherever you go! 3

4 The CDHP Options at a Glance Here are some highlights of how the CDHP options work: In-network preventive care services are covered at 100%, so you pay nothing. You have access to both in-network and out-of-network providers you ll pay less when you stay in-network. You pay 100% of eligible medical and prescription drug expenses (except for preventive care expenses) until you satisfy the annual deductible. After you satisfy the deductible the Plan pays a portion of eligible expenses and you pay the rest (the coinsurance). If you cover dependents, you must satisfy the family deductible. An out-of-pocket maximum protects you from the high cost of a major illness or injury. In addition, the CDHP options offer you the unique ability to save tax-free money through an HSA to pay for health care expenses now or save for the future. A Note about How Deductibles Work under the CDHPs If you cover dependents, you must meet the family deductible, not the individual deductible, before the CDHP options begin paying benefits. One family member, or all family members combined, can satisfy the deductible. So, for example, if you elected family coverage under the CDHP Standard option and you have a $3,000 expense in February, you and your family must incur an additional $2,000 in expenses to satisfy the $5,000 family annual deductible (even though you personally have exceeded the $2,500 individual deductible). Let s suppose you incur an additional $2,000 of expenses in March. Then, the annual deductible has been satisfied for you and all of your covered family members for the remainder of the year. 4

5 CDHP Value CDHP Standard CDHP Basic* Out-of- Out-of- Out-of- In-Network Network In-Network Network In-Network Network Preventive care Plan pays 100%, Plan pays 60% Plan pays 100%, Plan pays 60% Plan pays 100%, Plan pays 60% no deductible after deductible no deductible after deductible no deductible after deductible Deductible $1,500 individual $3,000 individual $2,500 individual $5,000 individual $3,500 individual $7,000 individual $3,000 family $6,000 family $5,000 family $10,000 family $7,000 family $14,000 family Office visits Plan pays 90% Plan pays 60% Plan pays 80% Plan pays 60% Plan pays 80% Plan pays 60% (non-preventive care after deductible after deductible after deductible after deductible after deductible after deductible visits with primary care physician/specialist) Coinsurance (Your share 10% 40% 20% 40% 20% 40% after deductible for other covered services) Out-of-pocket $4,000 individual $8,000 individual $5,000 individual $10,000 individual $6,450 individual $12,900 individual maximum (includes $8,000 family $16,000 family $10,000 family $20,000 family $12,900 family $25,800 family deductible)** * This option does not provide creditable prescription drug coverage under Medicare Part D; if you or your spouse will be over age 65 any time during the plan year, at the time you apply for Medicare Part D coverage you may be subject to a premium penalty if enrolled in this plan. See the Notice of Creditable for more details. ** After a family member reaches the individual maximum, all eligible expenses for that family member are covered 100% by the plan even if the family maximum has not been met. Tip: Save Money by Using In-Network Providers Keep in mind that you will generally pay less when you use in-network providers, rather than providers who are out-of-network. The plan pays 100% of the cost of in-network preventive care for you and your covered family members, so be sure to take advantage of preventive care screenings and wellness visits. To find an in-network provider, check the online provider directory at anthem.com. 5

6 PAYING FOR IN-NETWORK CARE When considering cost, remember that you ll need to meet your deductible before the plan starts sharing any non-preventive care costs. Once you satisfy the deductible, you and the plan share in the cost of covered services (your coinsurance). If you reach the out-of-pocket maximum, the plan pays the full cost of covered services for the remainder of the year. Preventive care The Plan 100% Free to you! } Care for treatment of an illness or injury You 100% up to deductible deductible You The Plan Coinsurance Out-of-pocket Maximum Remember, you may use your HSA funds to help offset your out-of-pocket expenses or save them for future health care expenses. The Plan 100% 6

7 When you visit an in-network provider, you will generally pay nothing at the time of your visit. So, when and how do you pay for care? Just follow these steps: 1. Present your Anthem health plan ID card. Generally, you do not need to pay anything at the time of your visit. 2. After your visit, your provider will send a bill to Anthem. 3. You will receive your Explanation of Benefits (EOB) from Anthem the amount listed under Member Responsibility is the amount you owe your provider. 4. You will receive a separate bill from your provider. You have a choice to: Pay the bill using funds from your HSA Use your HSA debit card or check to pay your bill, if you have money in your account, or pay out-of-pocket and get reimbursed later. Learn more about how to use your HSA to pay for eligible expenses. OR Pay out-of-pocket and save your HSA funds for future use You may decide that you prefer to save your HSA funds for a future expense. For example, maybe you are saving your funds for a planned surgery next year or you prefer to use your HSA as a way to save for medical expenses after retirement. Always Check Your EOB Carefully for Accuracy It s important to check your EOB carefully to be sure your health services were billed correctly. For example, preventive care services are generally covered at 100%; if you think you were billed for what should have been a preventive care service, be sure to contact your provider. Sometimes health care services can be miscoded by providers resulting in billing errors. Checking your statements may save you from overpaying. Questions about coverage or bills? Call Anthem at for assistance. 7

8 The Choice Is Yours When you incur an eligible expense for example, a bill from your doctor before you ve met your deductible, or prescription drug costs at the pharmacy you can choose to use your HSA funds to pay the expense. Or, you can pay out-of-pocket and save your HSA funds for later. The choice is yours: Use Your Funds to Using th HSA to Pay for Care Cover Expenses This Year Before you satisfy the annual deductible to pay for: Provider visits and other health care services Prescription drugs at the pharmacy After you satisfy the annual deductible: To pay your share of the coinsurance 2015 Plan for The Future Do you have a chronic condition and aren t sure how much care you ll need each year? Are you thinking of retiring soon and want to set aside money for medical expenses? Do you expect to have a surgery in the next few years? Access to The Hartford s HSA Contribution Begins Right Away Remember, the company makes an annual contribution to your HSA if you enrolled in either the Value or Standard CDHP options ($400 for individual coverage/$800 for family coverage). You ll receive the full deposit as of the first pay period after you open your account, so you can begin using these funds immediately to help offset your deductible. Keep in mind, the annual company contribution is prorated if you enroll in the CDHP after January 1st. 8

9 Make the Most of Your Visit to the Doctor Your primary care physician plays a key role in diagnosing health problems, discussing options for care including screening and disease prevention strategies and health promotion, and making referrals as needed for quality care. Be Prepared for a Medical Appointment When you go to the doctor, there s usually a lot to consider in a short amount of time. It s easy to overlook a symptom you meant to bring up or a question you meant to ask. It helps to be well prepared for your appointment. Here s how. Know your medical history, including: allergies, family health history, drug, alcohol, and tobacco use, and current exercise program. Write down any current prescription medications, over-the-counter medications, vitamins, herbal or natural remedies, and supplements you re taking, including the dosage. Have there been any major life changes or stresses you re currently experiencing? Take a few minutes before your appointment to make a list of your questions, concerns, and symptoms, and refer to the list during your appointment. Feel Confident about Asking Questions Asking questions, lots of questions, is the number one best step you can take towards getting better health care, and having greater peace of mind about the care you get. Here are some tips to help you ask questions and get more answers: If possible print out or write down all of your questions and bring them to your appointment. Bring a family member or friend with you to take notes so that you can concentrate on what the doctor is saying. If you can t bring someone, write down or record the discussion, with your doctor s permission, so you can review it later. If you don t understand something, anything, ask the doctor or nurse to explain it again. It s their responsibility as medical professionals to make sure you are well informed about your care. 9

10 After Your Appointment Stay In Touch with Your Doctor Be sure to check in with your doctor when planned even if you are feeling better. Call your doctor immediately if you experience an unexpected side effect from the treatment or prescription. Make sure you go to your follow-up appointments If you don t hear back on any laboratory results, make sure to follow up with your doctor s office Contact ConsumerMedical TM if you have any medical claims questions or problems Whether you have a newly-diagnosed condition or have been living with a chronic illness for many years, important treatment decisions will need to be made. Knowing the benefits, risks and any possible complications will help you make the best choices for you and your loved ones. Here are some things to do when faced with a treatment decision: Think about what s important to YOU in terms of quality. Know where to find the information that you need. Visit websites, make phone calls, ask questions, and BE INFORMED. Be an active participant in your care! ConsumerMedical If you need care, be sure you are receiving the right care, from the right provider, at the right cost. ConsumerMedical, a benefit available to all employees and dependents at no cost, helps you obtain reliable, current and personalized information and support with any health-related concern or issue. Helpful tools from ConsumerMedical Questions to Ask Your Physician Questions developed by ConsumerMedical physicians and research teams to help you become an informed consumer. Questions can be used as a guide when speaking to your own doctor. Best Websites for a Condition ConsumerMedical physicians and research teams have carefully reviewed and identified credible websites on a variety of medical diagnoses. These websites can get you started on accessing high quality online resources. Visit the ConsumerMedical website or call for more information. 10

11 under the CDHP Options When you participate in The Hartford s health plan, you automatically receive prescription drug coverage through Express Scripts. With the CDHP options, you must satisfy the combined medical/prescription drug annual deductible before prescription drug coverage begins. Your out-of-pocket prescription drug expenses count toward the combined medical/prescription drug out-of-pocket maximum. Keep in mind, however, that preventive drugs (as mandated by the Affordable Care Act) are covered at 100% with no deductible. All of The Hartford s health plan options include a formulary feature, which is a list of commonly prescribed medications that have been shown to be clinically effective and cost effective, and includes four drug types: Generic Preferred brand Non-preferred brand Patient Choice You can purchase these medications through a participating retail pharmacy or by mail through the home delivery program. How s Are Covered retail Pharmacy (up to a 30-day supply) mail Order (up to a 90-day supply) After meeting the combined medical/prescription drug deductible, you pay Generic 20% up to a maximum of 20% up to a maximum of $200 per prescription $400 per prescription Preferred Brand 20% up to a maximum of 20% up to a maximum of $200 per prescription $400 per prescription Non-Preferred Brand 40% up to a maximum of 40% up to a maximum of $200 per prescription $400 per prescription mail Patient Choice Drugs* 50% up to a maximum of 50% up to a maximum of $200 per prescription $400 per prescription Annual Included in combined medical/prescription drug out-of-pocket maximum Out-of-Pocket Maximum * Patient choice drugs include non-sedating antihistamines, weight loss drugs and drugs used to treat infertility and erectile dysfunction. 11

12 When You Need to Fill a Prescription? You have two ways to fill a prescription: Retail Pharmacy (up to a 30-day supply) When you need a prescription right away, you can get your prescription filled at one of the thousands of Express Scripts participating pharmacies around the country. Visit express-scripts.com to locate a participating pharmacy. Mail Order (up to a 90-day supply) You can have prescriptions you take regularly (maintenance drugs) delivered to your home through the mail order program. You can conveniently manage your prescriptions online while saving time and money. Enroll online at express-scripts.com. Note: For maintenance medications, the Plan requires that you use the mail order program beginning after the third fill. Otherwise, even after you have met your deductible, you will have to pay 100% of the discounted cost of the drug. Whether You Are Using A Retail Pharmacy or Mail Order, Remember: 1. You will need to present your Express Scripts ID card when you pick up your prescription at a retail pharmacy. Remember, your prescription drug card is separate from your Anthem health plan ID card. 2. The health plan annual deductible applies to all prescriptions, so you ll need to meet the deductible before the Plan begins to share the cost. 3. Once you ve met the deductible, you ll pay your share of the discounted cost of the drug (based on the type of prescription drug: Generic/Preferred, Non-Preferred or Patient Choice). 4. Use your HSA to pay your pharmacist by debit card or with your HSA checkbook, or pay out-ofpocket and get reimbursed later. Learn more about using your HSA to pay for eligible expenses. 12

13 Your Health Savings Account (HSA) One of the best things about the CDHP is that it gives you access to a Health Savings Account (HSA). How Is Funded You contribute to an HSA with pre-tax dollars. Depending on the CDHP option you elected, The Hartford may contribute to your account, too: Contributions from You. You can contribute to your HSA on a pre-tax basis, up to the annual IRS maximum. If you are age 55 or older, you can make an additional annual catch-up contribution. Contributions from The Hartford. If you enrolled in either the Value or Standard option, The Hartford will contribute either $400 if you have individual coverage or $800 if you cover family members each year (prorated if you enroll after January 1) provided you have opened your account. Be sure to visit NetBenefits to open your account, if you have not already done so. HSAs Offer a Triple Tax Advantage You can contribute on a pre-tax basis. The withdrawals you make to pay for qualified health care expenses are tax-free. And, any investment earnings are tax-free! 13

14 Building Balance See below for the maximum amount you can contribute on a pre-tax basis for 2015 based on the CDHP option you elected. Remember, you can change the amount of your HSA contributions any time during the year as your needs change, so you may want to keep the IRS maximums in mind. To change your contributions, visit NetBenefits. CDHP Basic CDHP Standard CDHP Value The Hartford s Contribution None $400 individual $400 individual $800 family $800 family Your Maximum HSA Contribution for 2015 $3,350 individual $2,950 individual $2,950 individual $6,650 family $5,850 family $5,850 family IRS Maximum HSA Contribution for 2015 $3,350 individual $3,350 individual $3,350 individual (Your contributions + The Hartford s $6,650 family $6,650 family $6,650 family contributions) Additional Catch-Up Contribution $1,000 $1,000 $1,000 (If you are age 55 or older) Using HSA funds for family members Funds from your HSA can be used to pay for expenses incurred by your tax dependents, including your spouse and children. However, generally you cannot use your HSA funds to pay for expenses of family members whom you cannot claim as tax dependents on your tax return for example, a domestic partner or your adult child who is covered under your health plan but is not considered a tax dependent according to IRS regulations. 14

15 Use for Future Health Care Expenses The money in your HSA is yours to use now and in the future it s your choice. So, if you don t use all of the money in your HSA during the year, it will carry over to the next year and you will build savings to use for future health care expenses. You own your HSA, not The Hartford, so the money is yours to take with you. The CDHP offered in conjunction with an HSA gives you greater control of your health care spending. You can take your HSA balance with you wherever you go! If you switch to another high deductible health plan such as your spouse s plan or if you leave The Hartford, you can continue to use your HSA balance to pay for qualified expenses. Investment options. Once your HSA balance reaches $2,500, you can choose to invest your balance among a broad range of investment options managed by Fidelity. You will be notified by Fidelity once your account reaches the $2,500 minimum. Checking your HSA balance is easy Log on to NetBenefits, Click on Health & Insurance, then click on your Health Savings Account benefit. 15

16 How Much Should You Set Aside in? Using How Much Should You Set Aside in? If you are enrolled in a, it s very important to understand the cost for care and how the plan works so you can accurately budget for your health care expenses. Knowing the general cost of your medical care can help you ensure that you set aside enough money to cover any upcoming expenses. You ll need to cover your plan s deductible with out-of-pocket funds or the money in your HSA. So you ll want to make sure to budget and plan ahead. A good place to start is by reviewing your past expenses. You can access this information on your claims administrators websites. Remember, you can change your HSA contributions during the year if your health care or financial needs change by visiting NetBenefits. Have You Opened Yet? If you elected a CDHP option, visit NetBenefits to open your HSA, if you have not already done so. You can access HSA information by clicking on Health Savings Account under Featured Resources on the NetBenefits home page. Remember, you must establish an account online to be eligible to contribute your own money and receive The Hartford s contribution so don t wait! 16

17 How Much Should You Set Aside in? Using Using your HSA You have four options to choose from when paying for qualified medical expenses from your HSA: use the Fidelity HSA debit card The HSA debit card is a signature-based card and does not require a personal identification number (PIN). Funds come directly from the cash available in your HSA and payment details show up on your account statement so you can track the expenses paid from your account. If you request an HSA debit card when you open your HSA, you will automatically receive it within approximately two weeks. To request one at a later time, visit NetBenefits to complete the Debit Card Application for yourself or the Supplemental Debit Card Application to obtain an HSA debit card for your spouse or dependent. 33. Write a Fidelity HSA check Like the debit card, a Fidelity HSA check pays directly from the cash available in your HSA and records the transaction on your monthly account statement. Additional fees may apply. To request an HSA checkbook please complete the Checkwriting Form available on NetBenefits. 2. Pay online with Fidelity BillPay for HSAs This convenient service enables you to make online payments for qualified medical expenses to health care providers, companies and individuals. Additionally, you can set up an automatic schedule for recurring payments, keep track of all bill payments and reimburse yourself for out-of-pocket qualified medical expenses. You can also choose to go paperless by signing up to receive an ebill with providers who offer electronic billing. You ll receive an notification when your online bill is available and posted to your HSA BillPay account. This free online service lets you pay bills electronically as long as you have Internet access. Visit NetBenefits to enroll. 44. Pay out of pocket and request a reimbursement If you pay out of pocket for a qualified medical expense, you can get reimbursed from your HSA in one of four ways: Transfer money from your HSA into an existing Fidelity account or an outside bank account. Request a check for yourself electronically through Fidelity BillPay for HSAs. Write yourself a check using your HSA checkbook. Contact Fidelity to request that a withdrawal check be mailed to you or to transfer money from your HSA to another account. Remember, money left in your HSA is yours money will carry over from year to year allowing you to build savings for future eligible expenses. 17

18 How Much Should You Set Aside in? Using Using HSA funds for other kinds of expenses You can withdraw money from your HSA for any reason. But keep in mind that there are tax implications if you use the funds for non-eligible expenses. If you withdraw money before you reach age 65 and don t use it for eligible health expenses, you will pay a 20% penalty. Also, the money will be treated as ordinary income and subject to taxes (regardless of your age). To avoid paying unnecessary taxes, be sure to think carefully at the time of purchase. For example, if you grab a pack of gum at the pharmacy while picking up your prescription, use your HSA for the prescription only and pay for the gum with other money. After the calendar year ends, your W-2 will show any contributions made by you or The Hartford to your HSA. In addition, you will receive a 1099-SA, which shows the withdrawals from your HSA. It s important to keep all of your Explanation of Benefits forms and receipts throughout the year in case you re audited. You ll also receive a Form 5498-SA from Fidelity. This form is used to report distributions made from a health savings account (HSA). Keep this form with your tax return copies in case you re audited. Do Your Part to Manage Costs One of the best ways to manage your costs is by preventing serious and costly conditions in the future. Be sure to have preventive exams and screenings, and take advantage of The Hartford s wellness programs to help you stay healthy, reduce your risks and, if applicable, manage a chronic condition. Learn more by viewing the Wellness ebook. 18

19 Managing Contact Information Important Terms For information about the CDHP, visit NetBenefits to review the Summary Plan Description (SPD) or watch the short descriptive videos on the Benefits Resource Site. Managing Visit NetBenefits to: View your account balance. Access investment information and make investment transactions. Find forms and applications (debit card application, check writing form, automated BillPay, etc.). Access tools and information. Maintain beneficiary information. Change your address. 19

20 Managing Contact Information Important Terms Contact Information For Contact at General benefit questions HR Service Center HR-AT-WORK ( ) or and help using your HSA Health plan coverage Anthem questions or online at Prescription drug coverage Express Scripts questions or online at HSA information HR Service Center HR-AT-WORK ( ) or Health-related information ConsumerMedical , Monday through Friday, 8:30 a.m. to 5 p.m. ET or online at Wellness program information My Wellness at Work or online at 20

21 Managing Contact Information Important Terms Important Terms Annual Deductible The amount you pay for covered services each calendar year before the plan begins to pay benefits. The amount paid toward the deductible also applies toward the out-of-pocket maximum. Coinsurance The percentage you pay for most covered expenses after you ve met the annual deductible. Generic Drug A drug product that is comparable to a brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use yet, is available at a lower cost than brand equivalents. In-Network Refers to doctors or healthcare facilities that are part of your medical plan s network. Your deductible, coinsurance, and out-of-pocket maximums are generally lower for in-network care compared to out-ofnetwork care. Out-of-Pocket Maximum The most you pay each calendar year for covered services. Your deductible and coinsurance count toward your out-of-pocket maximum. Once you meet the out-of-pocket maximum, the plan pays 100% for covered expenses for the rest of the year (excluding expenses above the Maximum Allowed Amount, if out-of-network or penalties). Patient Choice Drugs Express Scripts classifies patient choice drugs as drugs taken by choice, rather than medical necessity, such as non-sedating antihistamines, weight loss drugs and drugs used to treat infertility and erectile dysfunction. Preventive Care Routine physical exams and health screenings (like routine blood tests, immunizations, Pap smears, prostate screenings, and other age-appropriate health screenings), as defined by Health Care Reform. Such Preventive Care services are generally covered at 100% when received through an in-network provider. Tax Dependent All dependents you can claim on your tax form. Please see IRS regulations at for specific examples. 21