Transcript: CHOOSING UNIVERSITY MEDICAL INSURANCE VIDEO
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- Damian Dennis
- 8 years ago
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1 [Intro music and then music fades.] The University of Missouri System offers different options for medical insurance. We want to help you choose which plan is right for you. There are three plans to examine: the Healthy Savings Plan, the Custom Network Plan, and the PPO Plan. The Custom Network Plan is only available to employees who live or work in the nine counties surrounding Columbia. There are many things to consider when comparing the plans. First, let s talk about one type of cost that you will pay throughout the year: your premiums. Premiums are the monthly fees you pay for insurance. They re lowest for the Healthy Savings Plan. The Custom Network Plan has mid-range premiums. And you ll pay the most per month for the PPO Plan. Second, let s consider another type of cost: your deductible. The deductible is the amount you pay each calendar year before your insurance will begin to make payments. I ll compare the university s three plans in a moment, but first let s look at an example to give you an idea of what a deductible is. A chart provided to you each year will tell you your deductible for that year. What you see on the screen right now is a sample chart. The amounts may be different from year to year than what you see on the screen. If we look in the far right columns for the PPO Plan, you ll see that some of the out-of-network services have a deductible-based payment structure. In this example, let s look at out-of-network Lab & X-ray for the PPO Plan, which has a 20% expense to you after your deductible is met. In this example, let s say your annual deductible is $100. Remember: You pay 20% of Labs & X-rays after you meet your deductible. Now, imagine you need an X-ray, the full cost of which is $90. The first time you get this X-ray, you haven t paid anything toward your deductible. Therefore, you owe the full $90 for the X-ray. Page 1 of 5
2 But later in that same year, you need the same X-ray. Let s say this time, you ve already met your annual deductible. That means you only owe $18, or 20% of the X-ray s $90 cost. Now we know what a deductible is. But how do the university s three insurance plans compare? The Custom Network has the lowest deductible of $0 for in-network providers and services. But remember, it is currently available only for those employees who live or work in the nine counties surrounding Columbia. The PPO Plan has the mid-range deductible of the three plans. And the Healthy Savings Plan has the highest deductible. In fact, it is categorized as an IRS-approved high-deductible health care plan. That s what allows the university to offer a Health Savings Account or HSA with the Healthy Savings Plan. I ll explain more about the HSA later in this video. Third, let s consider another type of cost: a copay which is a shortened form of the word copayment. A copay is a predetermined, flat fee that you pay for health care. Let s look at that sample chart again, and this time we ll choose the PPO Plan s In-Network Urgent Care for our example. Because a copay is a flat fee, it s what you pay every time. It never changes. For our example, remember the in-network urgent care visit copay is $50. It doesn t matter if the full cost of an urgent care visit is $100, $500, or even $1,000, you ll always pay $50 for the visit. However, it is important to understand that additional costs associated with an urgent care visit would not fall under the umbrella of the $50 copay for the visit itself. For example, a fee for a strep throat test would be an additional charge above and beyond the copay for the visit. Generally speaking, it s not possible to say that one of the university s insurance plans has higher or lower copays than the others, because of the different structures of the plans. But one thing to note is that the Custom Network Plan and the PPO Plan have copays, and the Healthy Savings Plan is structured around deductible-based expenses only, meaning that once you ve met the Healthy Savings Plan deductible, you ll pay a coinsurance amount. Page 2 of 5
3 Coinsurance means you pay a portion of the covered costs until you ve reached your out-of-pocket maximum. As an example, let s assume you need an X-ray performed after you ve already met your deductible. It results in a bill of $100. You ll pay 10% of the cost, and the plan will pay the remaining 90%. This means you re responsible for paying $10 for the x-ray. It s best to consult the chart made available to you each year such as this sample on your screen to see what you ll owe for a particular health care service. So far, we ve discussed premiums, deductibles, copays, and coinsurance. The final type of cost to consider is your out-of-pocket limit. This is the maximum limit you re required to pay for your health care costs in a given year. If you reach this maximum, you no longer pay deductibles, copays, or coinsurance for the rest of the year. Instead, the insurance plan covers 100% of the cost of eligible health care services. For the Healthy Savings Plan, there s one combined limit for both medical expenses and prescription expenses. What your limit is depends on your coverage level. Since Self Only covers the medical needs of just one person, the limit is lower than Self & Spouse (or Sponsored Adult Dependent), Self & Child(ren), or Self & Family coverage, which all share the same limit. The other two plans are the Custom Network and PPO plans. And there are two separate out-of-pocket limits under these plans. One limit is for medical expenses. The other is for prescription expenses. As you would expect, the medical and prescription out-of-pocket limits for Self Only coverage are lower than all other levels of coverage. Remember that chart we ve been referring to throughout this video? It also explains the out-of-pocket limit for each plan. When you re thinking about which medical insurance is right for you, the last two differences to consider are: 1. The network of providers under each plan, and 2. The health care accounts you can use to help pay for expenses. Let s start with the provider network, which defines those doctors and other health care providers you may visit at lower, in-network costs. The Custom Network Plan offers a network of providers that s tailored around a Page 3 of 5
4 partnership with the MU Health System. That means you have a more focused list of doctors and other health care providers you can visit for the lower, in-network rates. The Healthy Savings Plan and the PPO Plan both provide a broad nationwide network. But regardless of the plan you choose, if you stay in network, your costs will be much lower. All plans cover the same medical services, including emergency and urgent care, no matter where you are. The final consideration when weighing your medical plan options is the health care account available to you. With the Healthy Savings Plan, you re able to have a Health Savings Account to which the university will contribute money each year. Also, you may contribute your own pre-tax money, up to the IRS limits, which allows you to reduce the taxable money in your paycheck. But you aren t required to contribute anything for the university to add money to your account. With the Custom Network Plan and the PPO Plan, you can t have an HSA, but you can have a Flexible Spending Account, or FSA. Note that HSA stands for Health Savings Account and FSA stands for Flexible Spending Account. The S stands for spending because you must spend the entirety of your FSA every year. You cannot save and invest it, like you can with an HSA. Also, only you contribute to an FSA. The university does not. The FSA allows you to contribute pre-tax dollars just like an HSA so you pay less in taxes with each paycheck. A separate video about HSAs and FSAs explains the positives of each type of account and how they might work for your needs. The video is available on the Total Rewards website, if you d like more details. In this video, we ve examined the three insurance plans offered to employees of the University of Missouri System. When selecting a plan that s right for you consider premiums, deductibles, copays, coinsurance, and out-of-pocket limits. Also, consider the provider network and health care accounts available to you. Page 4 of 5
5 [Music returns, playing under voiceover.] Transcript: CHOOSING UNIVERSITY MEDICAL INSURANCE VIDEO We ve been talking a lot about types of costs, but it s important to remember that regular, annual check-ups and other eligible preventive services are available at no cost to you, as long as you use an in-network health care provider. The university cares about your long-term health and preventing illness before it starts. So preventive services are free. [Music fades out; the following on-screen text appears.] University of Missouri System Columbia Kansas City Rolla St. Louis Total Rewards (573) (800) HRServiceCenter@umsystem.edu Research you plan options at This is a transcript of the Choosing university medical insurance video, created and published by the University of Missouri System s Total Rewards Department. Available at Doc# 0083-HR-TRBEN Page 5 of 5
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