High Deductible Health Plan/ Health Savings Account Presentation

Transcription

1 High Deductible Health Plan/ Health Savings Accunt Presentatin

2 WHY CHANGE? Future plan structured s emplyees will think and act differently Prmte preventin and getting healthier Prmtes cnsumerism Current plan cannt be sustained inflatin and disease states cmpunding effect n cst fr emplyees and Bard

3 NEW MEDICAL PLAN EFFECTIVE JANUARY 1, 2015 HIGH DEDUCTIBLE HEALTH PLAN / HEALTH SAVINGS ACCOUNT +

4 Hw des the High Deductible Health Plan and Health Savings Accunt wrk? HDHP Pre-Tax Premiums All services and prescriptins apply t the deductible, except preventive care which is cvered at 100%. Once the deductible has been met, cpays fr sme services will apply until yu reach yur utf-pcket maximum. Once the ut-f-pcket maximum has been met all services and prescriptin drugs are cvered at 100%. In-netwrk services and prescriptin drugs are paid based n the carrier negtiated rates N c-insurance as lng as yu stay in-netwrk Remember, preventive care is cvered at 100% Insurance Cverage + HSA Pre-Tax Cntributins Mney rlls ver year-t-year Earns interest Yu wn this accunt nt a use it r lse it accunt Accunt is prtable Banking Institutin

5 In-Netwrk Out-f-Netwrk Deductible Nn-Embedded $1,500/$3,000 $4,000/$8,000 C-Insurance 100% 70%/30% Maximum Out-f-Pcket $3,500/$7,000 $5,000/$10,000 Lifetime Maximum Unlimited Unlimited Preventive Care Cvered in Full Subject t Deductible Hspital Inpatient/Outpatient Subject t Deductible Subject t Deductible Prfessinal Services Subject t Deductible Subject t Deductible Physician Office Visit Cpay After deductible has been met Emergency Rm Cpay After deductible has been met High Deductible Health Plan $20 PCP/$40 Specialist Subject t Deductible $150 $150 Urgent Care Cpay After deductible has been met $50 Subject t Deductible Prescriptin Drug Cpay $10 / $30 / $50 Subject t Deductible Mail Order $30 / $90 / $150 Nt Applicable All ther medical benefits are subject t the deductible and c-insurance. Cpays listed abve apply t the ut-f-pcket maximum.

6 Advantages f a High Deductible Health Plan Because it is imprtant t get yur rutine preventive screenings, Preventive Care is cvered at 100%. These services include, but are nt limited t the fllwing services: Rutine Physicals Well Child Exams and Immunizatins Preventive Gyneclgical Exams Preventive Mammgrams Wmen s Preventive Care and Screenings Preventive PSA Testing Preventive Clnscpy

7 What is a Health Savings Accunt A Health Savings Accunt (HSA) is a tax-favred accunt wned by the emplyee used t pay fr current and future qualified health care expenses. A Health Savings Accunt must be established in cnjunctin with a High Deductible Health Plan (HDHP). Cntributins int the accunt can be made by yu and/r yur emplyer. Daytn Public Schls will be cntributing $750 int yur accunt fr Single cverage and $1,500 int yur accunt fr Family cverage.

8 Advantages f a Health Savings Accunt YOU wn the accunt. If yu change jbs, mve t anther state, retire the mney stays with yu. Health Savings Accunt (HSA) mney accumulates tax- free and can be used fr current and future health care expenses (medical, dental and visin). Yu t determine hw much mney t depsit int yur accunt (up t the IRS annual maximum). Funds can be used t pay fr expenses incurred by yur spuse and dependents, even if they are nt cvered under yur plan. N use it r lse it rules. HSA funds accumulate frm year t year. It is an interest bearing accunt. Once yu reach certain accunt balances investment pprtunities are available.

9 Maximum Annual HSA Pre-tax Cntributins fr Allwable Pre-Tax Maximum Cntributin Single: $3,300 Family: $6,550 Remember, the mney in yur HSA accunt rlls ver frm year t year. Age 55 years and lder catch up prvisin $1,000.00

10 Expenses that can be paid using yur HSA Belw is a partial list f qualified medical expenses eligible fr reimbursement under yur HSA. Fr mre detailed infrmatin, yu can visit Childbirth classes COBRA premiums Cntact lenses/slutin Deductible expenses Dental treatment Eye exam/eyeglasses Health insurance premiums (Retiree r while drawing unemplyment) Hspital and Emergency Rm services Labratry fees Medicare premiums Lng Term Care premiums Orthdntia Adult and Child Over-the-cunter medicatins (yu must have a prescriptin frm yur physician) Physical therapy Radial kerattmy / Lasik surgery Smking treatment prgram Speech therapy Vaccines Weight lss prgrams (Prescribed fr illness) Please nte that althugh these expenses are allwed t be reimbursed under yur HSA, they may nt apply t yur medical deductible. Only thse services cvered under the medical plan will reduce the deductible.

11 HSA Participatin Eligibility Yu are nt eligible t pen the bank accunt if yu are: enrlled in a full purpse medical FSA (yu may cntinue FSA dependent care) Nte: a limited purpse flexible spending accunt will be made available t thse emplyees wh pen a Health Savings Accunt. The limited purpse FSA will cver dental and visin expenses nly and therefre can be used in cnjunctin with a Health Savings Accunt. enrlled in any Medicare benefits (Part A, Part B and/r Part D) enrlled in a nn-high deductible health plan claimed as a dependent n anther persn s tax return Yu can nt reimburse yurself fr expenses incurred PRIOR t pening yur HSA.

12 Keeping Receipts and Paying Bills N claims submissin is required fr an HSA YOU MUST keep yur wn receipts as prf that yur purchases were eligible expenses, in case f an IRS audit If yu use the mney in this accunt fr a nn-qualified health expense yu will pay a 20% penalty and tax. (At age 65, yu can use the mney in the accunt fr any purchase, hwever if it is used fr a nn-qualified health care expense, yu will pay tax n the purchase.) Yu may use yur HSA debit card r ptinal checks t pay medical bills r prviders directly Yu may save yur bills fr several years and pay yurself back in the future, nce yur accunt has grwn in value, prvided all receipts are dated since accunt pening date

13 Filing Yur Taxes Substantiatin that HSA expenditures were fr qualifying expenses is between yu and the IRS Every participant fills ut Frm 8889 Bank prvides Frm 1099-SA (Distributins) Emplyer prvides cntributins n W-2, Bx 12 Bank als prvides 5498 (Cntributins) Participant reprts any nn-allwable purchases and these increase taxable incme n the 1040

14 Hw d I use my HSA at the dctr s ffice? Shw yur insurance card s the claim is filed with the insurance carrier. The insurance carrier will prcess yur claim, apply the discunted rate and then credit yur deductible. Yur claims will be prcessed tward the deductible in the rder in which they are received, nt necessarily by the actual date-f-service. Yu will receive an Explanatin f Benefits (EOB) frm the insurance carrier explaining hw the claim was prcessed. Yur physician s ffice will receive this same infrmatin. Yu will als receive a bill frm yur physician shwing the discunted rate (negtiated by the insurance carrier) fr yur visit. Make sure yur EOB and bill match befre paying yur physician, using the mney in yur HSA (if yu chse).

15 Hw d I use my HSA at the pharmacy? Shw yur insurance card t the pharmacist s the prescriptin medicatin is credited tward yur deductible and yu receive the discunted rate. Yur card will shw c-pays are required after the deductible is met. The Pharmacist will enter yur insurance carrier infrmatin and the discunted carrier rate will autmatically be calculated at the time yu pick up yur prescriptin. Pay fr yur prescriptin with yur HSA Visa/MasterCard.

16 Example Healthy Emplyee Only Cverage HDHP Deductible DPS will cntribute $750 fr Single cverage int yur Health Savings Accunt $1,500 Out-f-Pcket Maximum $3,500 C-Insurance (After Deductible) 100% Preventive Care 1. Office Visits 1 Visits (1 visits t PCP OB/GYN annual) 2. Prescriptin Drugs (4 prescriptins generic birth cntrl) Cvered in Full Amunt yu may we: $0 Preventive Visit Amunt yu may we: $0 Preventive medicatins Ttal Out-f-Pcket Expense $0 (and yu have $750 accumulated in yur Health Savings Accunt) 2014 HSA Maximum Cntributin: $3,300 Single / $6,550 Family

17 Example - Emplyee Only Cverage HDHP Deductible DPS will cntribute $750 fr Single cverage int yur Health Savings Accunt $1,500 Out-f-Pcket Maximum $3,500 C-Insurance (After Deductible) 100% Preventive Care 1. Office Visits 3 Visits (2 visits t PCP / 1 visit t Specialist) 2. Prescriptin Drugs (3 prescriptins at $100 each) Cvered in Full Amunt yu may we: $450 (PCP: $125 each / SPC: $200) Amunt yu may we: $300 Ttal Out-f-Pcket Expense $750 (Because DPS is depsiting $750 int yur health savings accunt, yur ttal ut-fpcket expense wuld be $0) 2014 HSA Maximum Cntributin: $3,300 Single / $6,550 Family

18 Example Family Cverage Deductible - DPS will cntribute $1,500 fr Family cverage int yur Health Savings Accunt HDHP $3,000 Out-f-Pcket Maximum $7,000 C-Insurance 100% Preventive Care Cvered in Full 1. Outpatient Surgery ($10,000 utpatient surgery first claim f the year) 2. Office Visits (4 Visits after utpatient surgery) 3. Prescriptin Drugs (3 Tier 1 Prescriptins) Amunt yu may we: $3,000 (applies t the deductible) Amunt yu may we: $80 ($20 PCP applies t ut-f-pcket maximum) Amunt yu may we: $30 (applies t the ut-f-pcket maximum) Ttal Out-f-Pcket Expense $3,110 (Because DPS is depsiting $1,500 int yur health savings accunt, yur ttal ut-f-pcket expense wuld be $1,610) 2014 HSA Maximum Cntributin: $3,300 Single / $6,550 Family

19 H:client/DBOE/2014Renewal/HSApresentatin

20 Example - Emplyee Only Cverage Deductible DPS will cntribute $750 fr Single cverage int yur Health Savings Accunt HDHP $1,500 Out-f-Pcket Maximum $3,500 C-Insurance (After Deductible) 100% Preventive Care 1. Emergency Rm (1 Visit - $850 ea.) 2. Urgent Care (1 Visit - $75) 3. Prescriptin Drugs (1 prescriptin) Cvered in Full Amunt yu may we: $850 (applies t deductible) Amunt yu may we: $75 (applies t deductible) Amunt yu may we: $500 (applies t deductible) Ttal Out-f-Pcket Expense $1,425 (Because DPS is depsiting $750 int yur health savings accunt, yur ttal ut-f-pcket expense wuld be $675) 2014 HSA Maximum Cntributin: $3,300 Single / $6,550 Family

21 Example Family Cverage Deductible - DPS will cntribute $1,500 fr Family Cverage int yur Health Savings Accunt HSA $3,000 Out-f-Pcket Maximum $7,000 C-Insurance After Deductible 100% Preventive Care 1. Office Visits (2 $125 each) 2. In-Patient Hspital Stay ($20,000) 3. ER (2 Visits) ($850 each ER Cpay is $150 after deductible has been met) 4. Prescriptin Drugs (1 prescriptin Tier 3) Cvered in Full Amunt yu may we: $250 (applies t deductible) Amunt yu may we: $2,750 (applies t deductible) Amunt yu may we: $300 (applies t ut-f-pcket maximum) Amunt yu may we: $50 (applies t ut-f-pcket maximum) Ttal Out-f-Pcket Expense $3,350 (Because DPS is depsiting $1,500 int yur health savings accunt, yur ttal ut-fpcket expense wuld be $1,850) 2014 HSA Maximum Cntributin: $3,300 Single / $6,550 Family