Presentation on theme: "QHDHP/HSA Educational Seminar. OPEN ENROLLMENT –Medical & Dental remaining with same carriers, Altius and EMI –Adding a QHDHP/HSA- Education Meetings."— Presentation transcript:
OPEN ENROLLMENT –Medical & Dental remaining with same carriers, Altius and EMI –Adding a QHDHP/HSA- Education Meetings set up – Vision, Life & Disability Staying the same –All b enefits e ffective August 1, 2013 – Change plan elections – Add or delete dependents –All enrollment MUST be completed no later than June 30th – Once the enrollment period has ended, you may NOT change your elections
SOME “LIFE EVENTS” ALLOW YOU TO MAKE CHANGES DURING THE YEAR: When you have a qualifying event or change in employment status, you have 30 days to complete and return a new enrollment/change form SUBMIT THE CHANGE TO HR WITHIN 30 DAYS – Marriage – Divorce – Birth/Adoption – Loss of Coverage
HEALTH CARE REFORM UPDATES Dependents covered up to age 26 (in place, no change) Certain preventive services covered at 100% (in place, no change) Women’s Preventive Care Expanded – effective 8/1/12 No lifetime or annual dollar limits (in place, no change) Emergency room sam e benefit in and out of network (in place, no change) OTC medications not covered on FSA unless prescribed (in place, no change) W-2 Reporting of Health Benefits in 2013 for 2012 tax year 2013 – Medical Flexible Saving Account - FSA maximum $2,500 Individuals taxed if not on coverage, in effect in 2014
Altius Peak Plus- QHDP Participating ProvidersNon-Participating Deductible – Plan Year *Applies to OOP $1,500*/ $3,000*$3,000 */ $6,000 * Out of Pocket Maximum$3,000 /$6,000$6,000 / 12,000 Hospital Services Inpatient20% AD40% AD Outpatient20% AD40% AD Maternity20% AD40% AD Office Visits20% AD40% AD Preventive100%40% AD Specialist20% AD40% AD Urgent Care20% AD 40% After Participating Deductible Emergency Room20% AD Prescriptions 30 Day 90 Day After Medical Deductible $10AD $25AD $50AD $30 / $75 / $150 AD Participating Providers Only
CONSUMERISM “Nobody spends someone else’s money as carefully as they spend their own.” Milton Friedman
Consumer-Driven Health Plans Cigna Choice Fund Experience Study When compared to customers in traditional plans, CDHP customers: Spend less on overall medical services Receive equal or better quality care Are more engaged in their health and health spending Are more satisfied with their health care experience Over five years, CDHP could save up to $9,700 more per employee when compared to traditional plans.
Consumer-Driven Health Plans Cigna Choice Fund Experience Study Substantially lower trend in pharmacy the first year o 14% lower overall pharmacy trend in first year o 72% of Cigna Choice Fund customers used generic equivalents over brand-name medications No sacrifice in quality of care o Equal or higher use of over 400 evidence-based measures o Higher use of preventive care Better health risk profiles on full-replacement cases o Improved health risk by 10% in the first year compared with those who remained in traditional plans o Sustainable in subsequent years
Consumer-Driven Health Plans Cigna Choice Fund Experience Study Customers are just as satisfied Customers in Cigna Choice Fund were equally or more satisfied than customers in traditional plans
HRA / HSA Members Spend 7% Less On Overall Health Care Costs Over a 12-month period compared to matched traditional population 8 th Annual Aetna Healthfund Study -16%-7%-2% -6%-9%-3%-2%-11%
-12% -5% -9% -11% HRA / HSA Members Are Getting More Routine Care and Less Non-Routine Care And, most importantly, these patterns are seen in lower income households 8 th Annual Aetna Healthfund Study
3.4 2.4 0.7 3.5 HRA / HSA Members Have Higher Rates of Chronic and Preventive Care Including breast, cervical, colorectal, and prostate cancer screening 8 th Annual Aetna Healthfund Study
Savings account that you own to pay for your medical expenses You and/or Employer Deposit Qualified Medical Expense Employee’s HSA WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)?
QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) Individual Coverage$1,500 Deductible $3,000 Out of Pocket Max. Two Party or Family Coverage$3,000 Deductible $6,000 Out of Pocket Max.
QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) cont. Until Deductible is Met: You pay entire cost of medical expenses (doctor visits, prescriptions, diagnostic tests, hospitalization, surgeries, etc.) The amount you are billed is the discounted rate which has been negotiated by the insurance carrier Most preventative services are covered at 100% and are notsubject to the deductible.
QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) cont. After Deductible is Met: Co-payments and co-insurance apply After Out-of-Pocket Maximum is Met: All eligible claims are paid at 100%
WELCOME WASHINGTON COUNTY SCHOOL DISTRICT To Your Health Savings Account (HSA)
ELIGIBLE EXPENSES Qualified medical expenses: –Doctor and hospital visits –Medical equipment –Chiropractic Care –Dental care, braces, dentures, implants –Vision care, glasses, contacts, lasik –Medications, including some over-the-counter A complete list is found in the IRS Publication 502 (same list as FSA) The penalty for using HSA funds for non-qualified expenses is 20% +taxes. Keep all itemized receipts in the event of an IRS audit.
ADVANTAGES OF AN HSA Funds roll over from year to year –No use it or lose it Tax benefits on: –Contributions –Earnings –Distributions Portability –Funds follow you –Tax-free even if qualifying coverage ends
ADVANTAGES OF AN HSA cont. Flexibility in funding –Make increases/decreases at anytime of the year –You can do a lump sum contribution –One time roll-in from an IRA No Claim Substantiation –Save receipts in case of an IRS audit –Report on annual tax filing Long Term Investment Opportunities with Health Equity Provides Control over your Healthcare Dollars
Individual HDHP Coverage$3,250 Two Party or Family HDHP Coverage$6,450 (If you are age 55 or over, you may make an additional “catch-up” contribution of $1,000 per year.) Your own contributions, combined with any contributions from your employer, may not exceed these amounts. Excess contributions above these amounts are subject to IRS penalty. HSA CONTRIBUTION LIMITS FOR 2013
If you choose to enroll in a “High Deductible Health Plan” for 2013, the District will contribute to your “Health Savings Account” once established as follows: -Individual Coverage$1,150 -Two Party Coverage$1,150 -Family Coverage$1,150 Additionally, you could choose to contribute the following amounts on your own during the year: -Individual Coverage$2,100 (bringing you to the IRS maximum of $3,250) -Two Party Coverage$5,300 (bringing you to the IRS maximum of $6,450) -Family Coverage$5,300 (bringing you to the IRS maximum of $6,450) If you are over age 55 you can add $1,000 to these amounts FUNDING FOR 2013 HEALTH SAVINGS ACCOUNTS
HOW DOES THE HSA WORK AT THE DOCTORS OFFICE? Go to the doctor Doctor sends bill to your Insurance Carrier Insurance Carrier sends claim to HealthEquity and the Provider will send out bill to employee Do not pay at point of service, since you may not know the exact charge of the claim. Insurance Carrier adjusts price based on network discounts Go to the Health Equity web site to pay claim directly to the provider electronically or pay with your Health Equity Visa card. Show your ID card, not your HSA Card Health Plan ID Card Member Name: ID Number: Rx Bin Number:
DISADVANTAGES OF A “HIGH DEDUCTIBLE HEALTH PLAN” AND “HEALTH SAVINGS ACCOUNT” No first dollar coverage except for Preventive Care If enrolling as a two-party or family you must satisfy the family deductible You can only use what is in your account year-to-date –No advance funding unless you do a lump sum deposit Not compatible with other traditional insurance –Must have a HDHP to have an HSA
THINGS TO CONSIDER WHEN CHOOSING YOUR HEALTH PLAN Look at your family expenses for the past year Price out your on-going prescriptions If you are two-party or family – you will need to satisfy the family deductible Calculate your premium cost savings and add in the District contribution Consider funding your HSA with your previous Flexible Spending Account (FSA) amounts FSA will be limited to $2,500
THINGS TO CONSIDER WHEN CHOOSING YOUR HEALTH PLAN cont. If you choose HDHP coverage, you will not be eligible for a regular Flexible Spending Account (FSA). If you currently have a health FSA and select QHDHP coverage for 2013, you will need to make sure that you have a zero balance in your FSA BEFORE, you can open the HSA and be eligible to receive the District contribution. (even if you want to choose to use run-out period).
WHAT CAN YOU DO TO KEEP YOUR HEALTH CARE COSTS DOWN? Maintain a healthy lifestyle Explore your options
March 2013 GBS Rx Prescription Drug Pricing Tool
GBS Rx - Consumer Initiatives CDHP’s have introduced plan members to the actual retail costs of prescription drugs (…. and it’s more than the copay in most cases) Drug pricing can vary by pharmacy, by product, and by insurance plan/network The key to obtaining better retail prescription drug pricing – SHOP AROUND – After all, drugs are a commodity and prices vary, so why pay more than you have to? GBS Rx is a prescription drug pricing tool that enables consumers to easily compare drug prices at multiple pharmacies at the same time How to save at the pharmacy: – Always shop for better pricing; know your options (knowledge is power) – Ask for the lowest price – it is okay to negotiate – Compare your insurance card pricing vs. the coupon or cash price – Use generics whenever possible Walmart, Smith’s, Target all have $4 generic programs on hundreds of drugs
GBS Rx Drug Price Comparisons – Ogden, UT PharmacyPrice* Total Generic Actos, 30mg (pioglitazone) Generic Lexapro, 20mg (escitalopram) Generic Lipitor, 20mg (atorvastatin) Generic Plavix, 75mg (clopidogrel) Generic Singulair, 10mg (montelukast) Costco$101$7$16$11$27$163 Smith's$114$17$16$11$31$190 Walmart$114$18$17$14$28$190 Walgreen's$117$20$19$16$35$208 Medicine Shoppe$114$17$16$11$31$190 Shopko$231$98$17$11$43$399 Independents$113$99$16$11$43$282 Fresh Market$231$99$16$11$43$399 *Includes 'lesser of' cash price or 'coupon' pricing