Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA)

Transcription

1 Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) Michigan State University 2014 Open Enrollment Blue Care Network is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

2 Insurance Terms Deductible = Deductible is a specified amount that you are required to pay for covered services during each benefit period before benefits are paid by your plan. Coinsurance = Coinsurance is the percentage of the approved amount you must pay for eligible services once you have met your deductible requirements. Out of Pocket Maximum = The maximum out of pocket you have to pay for medical/prescriptions services during the Calendar Year. The Out of Pocket maximum includes your medical/prescription deductible, any copay and coinsurance. Approved Amount = The BCN maximum payment level or the provider's billed charge for the covered service, whichever is lower. Deductibles, copayments and coinsurance are deducted from the approved amount. 2

3 What is a Consumer Driven Health Plan (CDHP)? A Consumer Driven Health Plan is a health plan that allows you to combine a high deductible health care plan with a taxadvantaged Health Saving Account (HSA) to give you lower premiums. CDHPs have a deductible that you must pay out of pocket (with the exception of preventive care) before your plan begins covering your care. Your coverage starts once you meet your deductible. This means that your out-of-pocket costs will typically be higher than with a traditional plan. The annual deductible and maximum out of pocket are defined annually by the federal government. 3

4 MSU Health Plans Benefit Comparison Benefit Level Deductible - Single/Family (In-Network) Out of Pocket- Single/Family (In-Network) Coinsurance (After Deductible) Community Blue Blue Care Network CDHP with HSA $100/$200 $100/$200 $2,000/$4,000 $2,000/$4,000 $3,000/$6,000 $4,000/$8, % 100% 80% Office Visit $20 Copay $20 Copay 80% after deductible Labs/X-rays/MRI Inpatient and Outpatient Hospitalization 100% after deductible 100% after deductible 100% after deductible 100% after deductible 80% after deductible 80% after deductible Emergency Room $250 Copay $250 Copay 80% after deductible Preventive Services* 100% 100% 100% 4 *No deductible, coinsurance or copay applies to preventive services when services are rendered at in network physician s.

5 Examples of how MSU Health Plans Work At the doctor's office on Community Blue and BCN plans: Benefit Level Community Blue Blue Care Network Office Visit $20 Copay $20 Copay Preventive Services 100% 100% Community Blue Office Visit would be applied at time of service. - $20 Flat dollar Copay. - Flexible Spending Account (FSA) may be used if member has elected FSA coverage via MSU. BCN Office Visit would be applied at time of service. - $20 Flat dollar Copay. - Flexible Spending Account (FSA) may be used if member has elected FSA coverage via MSU. 5

6 Examples of how MSU Health Plans Work At the doctor's office (CDHP): At your appointment present your BCN ID card to the receptionist. The doctor submits the health care claim to BCN. Be sure to remind your doctor s office staff that certain preventative care check ups, screenings and immunizations are covered at 100 percent If you have not met your deductible, the provider will bill you for any balance owed, up to the amount of your deductible, for expenses that are not considered preventive care. You can use your HSA debit card, online bill pay to pay for the amount you owe or pay with other resources. If your deductible has been met but you have not met your out of pocket maximum, the provider will bill you a coinsurance amount. You can use your HSA debit card, online bill pay to pay for the amount you owe, or pay with other resources Note: The provider may require payment at the time of service. You can use the HSA debit card if the provider requires payment at the point of service (for example, a co-insurance). 6

7 Examples of how MSU Health Plans Work At the Hospital for Inpatient admission or Emergency Room Benefit Level Inpatient and Outpatient Hospitalization Emergency Room Community Blue 100% after deductible Blue Care Network 100% after deductible CDHP with HSA 80% after deductible $250 Copay $250 Copay 80% after deductible Deductible $100/$200 $100/$200 $2,000/$4,000 If you have not met your deductible, the provider will bill you for any balance owed, up to the amount of your deductible, for expenses that are not considered preventive care. You can use your HSA debit card, online bill pay to pay for the amount you owe or pay with other resources. If your deductible has been met but you have not met your out of pocket maximum, the provider will bill you a coinsurance amount. You can use your HSA debit card, online bill pay to pay for the amount you owe, or pay with other resources Note: The provider may require payment at the time of service. You can use the HSA debit card if the provider requires payment at the point of service (for example, a co-insurance). 7

8 Examples of how MSU Health Plans Work At the pharmacy in Community Blue and BCN plans: CVS/Caremark Prescription Plan Co-Pays for BCN and Community Blue Drug Tier 34-Day Supply Co-Pays 90 Day Supply Co-Pays* Generic $10 $20 Formulary Brand $20 $40 Non Formulary Brand $40 $80 Formulary Brand or Non Formulary Brand when generic is available, but not selected by member $10 plus 100% of the difference in cost between brand drug and direct generic equivalent. $10 plus 100% of the difference in cost between brand drug and direct generic equivalent. Formulary Brand or Non Formulary with generic available in same drug class $10 plus 100% of the difference in cost between brand drug and the average cost of all the generics available in the same class of drugs. $10 plus 100% of the difference in cost between brand drug and the average cost of all the generics available in the same class of drugs. Bio-Tech Drugs/Specialty Drugs $50 * 90-day supplies of biotech/specialty drugs are not covered. 8

9 Examples of how MSU Health Plans Work At the pharmacy (CDHP): At the pharmacy present your CVS Caremark ID card to the pharmacist. Since participating pharmacies submit your claims at the time of service, you ll know immediately how much you owe and how much is covered by your Caremark prescription drug plan. If you have not met your deductible, you may need to pay the full price of the prescription drug cost. If your deductible has been met, but you have not met your out of pocket maximum, you may pay a 20% coinsurance of the prescription drug cost full price. Generic prescription drugs for Asthma, Cholesterol, Diabetes and High Blood Pressure are covered at 100% without a deductible. You can use your HSA debit card to pay for the amount you owe or pay with other resource. Claims will automatically be sent to HealthEquity 9

10 10 Ways to Save More with CDHP 1. Find an in-network BCN provider at 1. Select Find a Doctor 2. Select BCN/HMO 3. Select Blue Care Network 2. Tell Your Doctor About Your Plan 3. Research Costs First 4. Get An Estimate 5. Discuss Payment Options 6. Wait for Your EOB, Then Pay 7. Ask About Generic Drugs 8. Time Your Appointments Carefully 9. Keep the Conversation Focused 10. Use Your HSA as an Investment Account 10

11 CDHP Exclusions Unauthorized Services Facility Administration Prior to Effective Date Services that are not Medically Necessary Non-Covered Services Cosmetic Surgery Millitary Care Custodial care Comfort Items Experimental or Investigational Services Court Related Services Services Covered Through Other Programs All exclusions are listed in detail in your 2014 BCN Member Handbooks which will be available in early

12 What is an HSA? A Health Savings Account (HSA) is like a 403(b) for health care. It is a tax advantaged personal savings or investment account that individuals can use to save and pay for qualified health care expenses, now or in the future. Paired with a qualified Consumer Driven (high deductible) Health Plan (CDHP), an HSA is a powerful financial tool that empowers consumers to be more actively involved in their health care decisions. Compound interest accrued through HSAs may result in significant savings over time A debit card is standard 12

13 Who is eligible for an HSA? IRS regulations state you are eligible to enroll in a Health Savings Account if you meet the conditions below: 1. You must be covered by a HSA qualified high deductible health plan (like the MSU CDHP/HSA administered by Blue Care Network); 2. You cannot be covered by another non-high deductible medical plan (a major medical plan) or a high-deductible plan that is not compliant with IRS rules regarding HSA s; 3. You cannot be covered by a health care flexible spending account; 4. You cannot be covered by Medicare (Part A, B or D); and 5. You cannot be claimed as a dependent on another individual s tax return. Note: You cannot receive an employer contribution or contribute to your HSA plan as long as you have remaining funds in a health care flexible spending account until the end of the FSA grace period, currently April 30th. 13

14 Contribution Guidelines Contributions are not subject to income tax Contributions can be made by: - Account holders - Employers* - Any third party Contributions in excess of the allowable limits must be withdrawn or incur a 6% excise tax Individuals 55 or older may contribute catch-up contributions until they enroll in Medicare 2014 Maximum Contribution Limits Individual $3,300 Family $6,550 Annual Catch-up* $1,000 *For individuals 55 and older before they enroll in Medicare * MSU will contribute up to $750. Check with your Human Resource department for more information 14

15 Distribution Guidelines Money withdrawn from an HSA may be used to pay for eligible medical expenses for the account holder, spouse, or any dependents. Parents may only use HSA funds to pay for the health expenses of an adult child if the child is considered a dependent for tax purposes. Reimbursement can be taken from the HSA for expenses from prior years if the HSA was in place when the expenses occurred. Withdrawals for non-medical expenses are possible: Before retirement age = Distribution is taxed as income with 20% penalty After retirement age = Only taxed as income (may provide tax advantages) Save those receipts! Account holders are responsible for ensuring that HSA funds are used for qualified expenses and to maintain records. 15

16 Qualified Medical Expenses According to the Internal Revenue Service, HSA funds can be used to pay for: Most medical care and services, dental services and vision care Health insurance premiums under COBRA continuation coverage or while receiving unemployment compensation Medicare Part A or Part B premiums A qualified long-term care insurance contract NOTE: For a detailed list, visit irs.gov.* 16

17 HSA Member Experience Highlights Activation Welcome Kit, Including: Debit Card Web Personal Desktop Ability to direct payments and online bill pay from personal accounts Ability to decide whether to spend or save at the claim level Ability to perform self service including upload claims Customer Service 24x7 service live and self-service available Call the number on the back of BCN ID card or HSA card Education Resource Site Member Tutorials and FAQs Calculators that help members to calculate and plan their health care expenditures 17

18 How does it work? Step 1: Enroll in MSU s CDHP Step 2: Access your HSA Step 3: Contribute to your HSA Step 4: Use the money in your HSA Step 5: Invest your money Step 6: Enjoy your retirement 18

19 Customer Service CDHP members can call the BCN Customer Service Number at (800) HSA members can call Health Equity at Health Equity s expert team of specialists are standing by 24-hours a day, 365 days a year to answer your questions about anything and everything related to the HSA account. 19

20 Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) Q & A 20 Blue Care Network is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.