Health Savings Account (HSA) BSC Member Self Service 1
Agenda Blue Shield member self-service HSA: The basics Benefits of an HSA Contributions Integrated claims processing Qualified expenses Investment options HealthEquity website: What s new Mobile app SSL microsite Find a Provider Mobile capabilities Blue Shield member portal Treatment cost estimator Pharmacy tools Teladoc Understanding your EOB BSC system conversion 2
HSA: Control + savings Your HSA is an interest-bearing financial account that you own. It is used to pay for qualified medical expenses. Funds can be used for pre- and post-deductible medical charges or left alone to earn tax-free interest. High Deductible Health Plan with HSA Qualified PPO Savings Plan Lower-premium*, high-deductible health plan Health Savings Account Account used to fund qualified medical expenses with multiple-tax savings advantages Blue Shield of California Insurance Provider HealthEquity (HQY) Financial Administrator *When compared to traditional PPO plans. 3
Benefits of an HSA As an HSA user, you save in several ways: Lower monthly health insurance premiums HSA contributions are not taxed* You earn tax-free interest on HSA balances* HSA funds used for qualified medical expenses are not taxed* Saving for the future: HSA funds roll over from year to year With an HSA, you own the account and all contributions. Unlike flexible spending accounts (FSAs), your entire HSA balance rolls over and remains available for qualified expenses even if you change health plans, retire or leave the company. Once you reach a determined account balance, you can invest your HSA funds for increased earning potential. * HSAs are never taxed at a federal income tax level when used appropriately for qualified medical expenses. Also, most states recognize HSA funds as tax-free with very few exceptions. Please consult a tax advisor regarding your state s s specific rules. 1 4
HSA Contributions For the 2015 calendar year, SSL will contribute the following amounts to your HSA: $500 credited to your HSA when you get an annual physical (plus your exam is free when you see a participating physician). $250 credited to your HSA when your enrolled spouse/domestic partner or eldest dependent child (when no spouse or domestic partner is enrolled) gets an annual physical. You can also contribute pre-tax dollars from your paycheck. All contributions, including those provided by SSL, cannot exceed IRS guidelines. 5
HSA Contributions You may also contribute additional amounts up to the IRS limits through payroll deductions. Between SSL and you, the maximum annual contribution for 2015 is: SSL You Total Employee Only $500 $2,850 $3,350 Employee + Dependents $750 $5,900 $6,650 Employees age 55 and older can also make additional catch up contributions* up to $1,000 in 2015. New hires will receive a prorated portion of the annual fund. *Additional catch up contributions can be made directly with Health Equity, not through Payroll deductions. 6
Integrated medical and pharmacy Provider Process: HSA Member visits provider Provider submits claim to Blue Shield Claim is displayed on HealthEquity member portal Member presents Blue Shield applies Member settles claim medical ID card discounts and sends claim to HealthEquity member portal with HSA or personal funds. If personal, member can later self- reimburse with HSA. 7 7
Integrated medical and pharmacy Pharmacy Process: HSA Member visits pharmacy Pharmacy applies network discounts Card transaction and claim is displayed on HealthEquity member portal Member presents Member pays using Blue shield processes medical ID card HealthEquity HSA card (or pays out-of-pocket and reimburses self with and sends claim to HealthEquity member portal after pharmacy HSA dollars on member portal). has settled and submitted charge. 8
How do pharmacy claims work? Pick up a prescription at an in-network pharmacy The Pharmacy System will apply the contracted network discount and will calculate payment due. All prescriptions are subject to the deductible unless they are a Value-Based Tier Preventive medication. Value-Based Tier or Preventive Drugs for the treatment of hypertension, cholesterol, diabetes and asthma received in-network will not be subject to the calendar-year deductible or co-pays. Pay at the point-of-sale as you prefer: cash, credit card, HealthEquity HSA debit card, etc. If your deductible has been met, you will only pay the required coinsurance amount if applicable. Otherwise, you will pay the full amount (minus the network discount). 9
Health Equity debit card You can use your card with providers and pharmacies. Use your health debit card, schedule payment installments, reimburse yourself for qualified out-of-pocket expenses, and/or complete a telephone transaction by calling member services. 10
What is a qualified expense? You may spend your funds on qualified health care expenses for eligible dependents The qualified expenses include all those currently eligible under a health FSA Other permissible uses are: Medicare premiums and out-of-pocket expenses once you turn 65 COBRA premiums Qualified Long-term Care insurance 11
Qualified Health Expenses Acupuncture Alcoholism (rehab, transportation for medically advised attendance at AA) Ambulance Amounts covered under another health plan Annual physical examination Artificial limbs/teeth Birth control pills/prescription contraceptives Body scans Breast reconstruction surgery Chiropractor Contact lenses Crutches Therapy Dental treatments Transplants Eyeglasses/eye surgery Weight-loss program (if Hearing aids prescribed by a physician for a specific disease) Home care Wheelchairs Long-term care expenses Wigs (if prescribed) Medicines (prescribed, not imported from other countries) Nursing home Nursing services Optometrist Oxygen Stop-smoking programs Surgery Telephone equipment and repair for hearing-impaired See IRS publication 502 for more information Qualified medical expenses for a limited-purpose FSA are restricted to qualified out-of-pocket costs for dental and vision care. Other expenses normally eligible under a standard FSA aren t eligible under a limited-purpose FSA. HealthEquity does not provide medical or tax advice. Content should not in any case replace professional medical or tax advice. Please consult your tax advisor. If you have questions regarding a medical condition, please consult a qualified health care professional. 12
Non-Qualified Expenses Babysitting, child care, and nursing services for a normal, healthy baby (may qualify under a dependent care FSA) Dancing lessons Diaper service Elective cosmetic surgery Electrolysis or hair removal Funeral expenses Future medical care Hair transplants Health club dues Insurance premiums other than those explicitly included d Non-prescription drugs, medicines, and supplements (unless prescribed) Nutritional supplements, unless recommended by a medical practitioner as treatment for a specific medical condition diagnosed by a physician Teeth whitening See IRS publication 502 for more information Medicines and drugs from other countries Qualified medical expenses for a limited-purpose FSA are restricted to qualified out-of-pocket costs for dental and vision care. Other expenses normally eligible under a standard FSA aren t eligible under a limited-purpose FSA. HealthEquity does not provide medical or tax advice. Content should not in any case replace professional medical or tax advice. Please consult your tax advisor. If you have questions regarding a medical condition, please consult a qualified health care professional. 13
Penalties for Non-Qualified Distributions If you use the funds in your HSA for purposes other than qualified medical expenses: Distributions are taxable A 20% penalty is applied unless you are age 65 or older You should keep records of your expenses as you the taxpayer must validate that expenses are qualified if audited by the IRS. 14
HealthEquity HSA Investment Options You have the option to invest your HealthEquity HSA money into various investment vehicles such as mutual funds. Interest and earnings on these investments is also not taxable, provided it is used for qualified medical expenses. Investments are administered by Charles Schwab You are not charged commissions or fees to buy or sell investments Your HSA balance must meet a minimum threshold of $2,000 in order to be eligible for pre-selected mutual funds. Investments rise and fall so plan carefully. Should your investment balance fall below $2,000, you can continue to invest. Investment balances and HSA cash balances are treated as separate accounts Tip: Always keep enough cash in the cash account to cover your plan deductible For more information, contact HealthEquity member services at 866.346.5800 15
What happens if I leave the SSL PPO HSA plan? You are the HSA account owner HSA dollars: Are portable they remain yours to keep The HSA becomes an individual account which you may keep or transfer to another HSA custodian of your choice SSL stops contributing towards your HSA at separation You may have different/additional account fees You can no longer contribute to the HSA (unless you are covered through a qualified High Deductible Health Plan through COBRA or a new employer and remain eligible) You can continue using the available HSA funds for qualified expenses for yourself and qualified dependents 16
HealthEquity Member Portal: Simplicity defined 17
Customized claims page Enjoy multiple claim resolution options inside the member portal: 18
Reimbursement/payments 1 Choose Account 3 Pay the claim with scheduled dates 2 Verify Payee, pay entire claim or schedule payments 19
HealthEquity website: What s new? Dashboard widgets Bringing the most important account information to the home page dashboard allows for a more efficient user experience. Your widgets are individually customized based on your specific account configuration. Intuitive navigation While basic functionality of the member portal remains the same, the navigation menu has been simplified to improve the user experience with easy-to-use tabs: My Account Claims & Payments Docs & Forms Resources Responsive display design Customized to all viewing devices, the HealthEquity member portal is optimized for desktop, laptop, tablet, and mobile access. Including an ever-present navigation bar, your tabs and other helpful features remain visible as you scroll. Your HealthEquity account goes wherever you go. 20
HealthEquity website: What s new? New dashboard features 21
HealthEquity website: What s new? 22
HealthEquity mobile app The HealthEquity mobile app provides easy, on-the-go access to your account. The free app provides comprehensive tools to help you manage transactions and maximize your health savings. Access all account types wherever you go Photo documentation: Simply take a photo with your device to initiate claims and payments Send payments & reimbursements from HAS Manage debit card transactions View claims status 23
Sample member profile: Meet Gavin Gavin is 30 and single. Medical plan: Blue Shield High Deductible PPO/HSA $1300/$2600 annual deductible; $4000/8000 out-of-pocket of (OOP) maximum HSA Balance: $3000 (including employer contribution) 2015 Medical/Rx Costs (negotiated rates) Payments Using Gavin s HSA Deductible/OOP Balance Preventive Exam $0 $0 $1300/$4000 $3000 Allergy medication (90 day supply) Ski accident, ER visit $100 $100 $1200/$3900 $2900 $3400 $1200 (meets deductible) + $220 ($2200 x10%) Total Out of Pocket = $1420 ($1420 from HSA) Deductible satisfied /$2480 HSA Balance $1480 Allergy medication (90 day supply) $100 $20 (20% of $100) Deductible satisfied /$2460 24 $1460
Blue Shield/HealthEquity website This microsite provides a wide range of collateral, video and tools to learn more about your HSA plan http://healthequity.com/ed/bsc/ 25
Health Equity Customer service: Always on for you 26
Self-service 27
SSL microsite blueshieldca.com/ssl Search for network doctors, hospitals and other facilities Get information about medical and pharmacy benefits Print copies of your Blue Shield ID card (once logged in to member portal) Learn about your Blue Shield programs and services Get secure access to medical and pharmacy benefits, claims, etc. Log in to the BSC member portal 28
Find a network provider It s easy Add FAP page imagery Just go to blueshieldca.com, click on Members Go to Find a Provider Search What are you looking for? Pharmacies 29
Mobile capabilities nauthenticate ed/guest U Guest Member View ID Card Download a copy of ID card X View Plan Access to medical plan overview, X Summary copayment and benefits information View Claims View all finalized claims and sort by date X Find an Urgent Care Access turn-by-turn directions to the nearest urgent care center X X Authenticate ed/member Find a Provider/Facility Search for a doctor, hospital, dentist, vision, pharmacy & durable medical equipment Contact Us Options include phone, mail and email X X Login & Registration Reset username/password or register to create an account X X X 30
BSC member portal: Deductibles, copayment maximums, and HSA balances Link to HealthEquity Website Deductible HSA Balance Copayment Maximum 31
Treatment cost estimator Estimates for more than 400 of the most common treatments and services by in-network providers. Total treatment and service cost estimates, include estimated costs for the facility and doctors from admission to discharge Member s estimated in-network out-of-pocket cost Total treatment and service cost estimates, which include estimated costs for the facility and doctors from admission to discharge 32
Pharmacy tools Members have access to: Up to 24 months member specific Pharmacy Claim History information Drug Pricing specific to the member's Pharmacy plan benefits Drug Condition/Interaction information Pharmacy Locator to find pharmacies that accept the member s plan benefits Drug Coverage Limits and Payment Details Guest s have access to: Drug Condition/Interaction information Pharmacy Locator 33
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Understanding your explanation of benefits (EOB) 1. Patient responsibility The amount you are responsible for paying to the provider. It consists of deductible, copayment/ coinsurance, and non-covered amounts. 2. Amount Blue Shield paid The amount Blue Shield paid to your provider for you. 3. Amount billed The amount your provider billed for the services you received. 4. Date(s) () of service The date(s) you received services. 5. Amount allowed The amount we used to calculate your benefits for the services provided. 6. Non-covered The portion of the amount billed not covered by your plan. You are responsible for this amount. 7. Deductible The dollar amount that you must pay for covered services each year before we start paying benefits under your plan. You are responsible for this amount. 8. Copayment/coinsurance Copayment is the predetermined amount for which you are responsible, based on your plan benefits. Coinsurance is the amount remaining after your plan pays its share of covered medical services, usually expressed as a percentage of charges. You are responsible for this amount. 35
BSC System Conversion Effective 9/1/2015 Upgraded Eligibility and Claims systems New ID cards issued for Medical Cards to be received 1 st week of September Old cards will work until new ones received Be sure SSL has your current address Be sure to present your new ID card to your providers If you do not receive a new ID card by September 15, please contact Member Services @ 1-888-331-3210 3210 36
We re here to help Blue Shield Member Services Representative 7 a.m. to 7 p.m., Monday through Friday Spanish speaking representatives available (855) 331-3210 3210 37
thank you! 38