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ATU SPECIAL OPEN ENROLLMENT Metropolitan Council Benefits.

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Presentation on theme: "ATU SPECIAL OPEN ENROLLMENT Metropolitan Council Benefits."— Presentation transcript:


2 ATU SPECIAL OPEN ENROLLMENT Metropolitan Council Benefits

3 Special Open Enrollment During this Special Open enrollment, you may: Change from one medical plan to another Add dependents If you currently waive medical coverage, you may enroll in a medical plan

4 Special Open Enrollment You may NOT: Drop medical coverage Drop coverage for any dependents Change any other coverage (such as dental, vision, or flex)

5 Medical Plans HealthPartners Plans  Open Access  Distinctions III  Empower HRA

6 Medical Plans Common Terms Lifetime Maximum  Total dollar amount payable under the plan Deductible  Amount you pay of a medical charge before the health plan pays Copays  Specific dollar amount that you pay for a specified service

7 Medical Plans Common Terms Coinsurance  The percentage of the charge that you are responsible for Out of Pocket Maximum  The dollar maximum that you could potentially pay in a calendar year for covered medical expenses (includes deductible, copays and coinsurance)

8 Medical Plans Common Terms Network Providers  Doctors and hospitals that contract with HealthPartners Network Discounts  Discounted amounts that HealthPartners negotiates with their network Doctors Formulary  A list of prescription drugs that are covered by HealthPartners health plans.

9 Medical Plans Common Traits Common Traits Between Plans All plans cover preventive services at 100% Same large network of doctors/facilities No referrals CIGNA network gives in-network benefits when out of area All in-network coverage provides an unlimited lifetime maximum

10 Medical Plans Open Access Plan

11 Medical Plans Open Access Plan Richest Benefits=Highest Cost No Calendar Year Deductible (in-network) $10 Office Visit Copay $40 Urgent Care Copay $50 Emergency Room Copay Prescription Drug Copay: $12 (generic or brand name) Mail order available

12 Medical Plans Distinctions III Plan

13 Medical Plans Distinctions III Three Tiers (Levels) of In Network Providers Tiers assigned by HealthPartners based on many factors, some of which are:  Patient outcomes  Overall cost of treatment  Use of technology  Patient Satisfaction

14 Medical Plans Distinctions III Who is Tiered?  Primary Care  Cardiology  Ear, Nose and Throat (ENT)  Orthopedics  Ob/Gyn  Hospital Specialties not tiered default to level 2

15 Medical Plans Distinctions III Providers re-evaluated every calendar year Lowest out of pocket costs when you use highest level of provider (level 1) You have coverage for all providers Look up providers levels on or call HealthPartners customer service at (952) 883-5000

16 Medical Plans Distinctions III Tiering is done individually Same clinic does not mean same tier or level  Primary Care may be level 2  Cardiologist in same clinic may be level 1, 2, or 3

17 Medical Plans Distinctions III- Office visits: $15 copay (level 1), $25 copay (level 2), $35 copay (level 3); no deductible Inpatient Hospital: $100 copay (level 1), $250 copay (level 2), $500 copay (level 3); deductible applies Outpatient Care: $30 copay (level 1), $40 copay (level 2), $70 copay (level 3); deductible applies Urgent Care: $25 copay; no deductible

18 Medical Plans Distinctions III- Behavioral Health and Convenience Care visits: $15 copay all levels; no deductible Emergency Room: $75 copay; no deductible Prescription Drugs: $8 copay for generic, $18 copay for brand name; mail order available

19 Medical Plans Distinctions III- $200 per person/$400 per family calendar year deductible (does not apply to every benefit) $1,000 per person/ $2,000 per family out of pocket maximum per calendar year See benefits chart for more information

20 Medical Plans Empower HRA Plan

21 Medical Plans Empower HRA High Deductible Health Plan combined with a Health Reimbursement Account (HRA) Employer contribution to HRA account Contribution fully funds deductible Contribution not pro-rated, regardless of entry date into plan HRA account reimburses out of pocket expenses

22 Medical Plans Empower HRA Health Reimbursement Account Employer contribution is tax-free Balance carries over year after year Balance is yours even if you switch plans, terminate employment or retire Interest bearing Metropolitan Council pays admin fee as long as you are enrolled in Empower HRA plan

23 Medical Plans Empower HRA Health Reimbursement Account Only Metropolitan Council can contribute to HRA account Eligible expenses for reimbursement from HRA account:  Deductible  Copays  Coinsurance  IRS 213D list (Flexible Spending Account List)

24 Medical Plans Empower HRA- Health Plan Benefits Unlimited Lifetime Maximum Preventive services covered at 100% All other services 80% after deductible $1,000 individual/$2,000 family calendar year deductible $2,500 individual/$5,000 family out of pocket maximum per calendar year

25 Medical Plans Empower HRA- Prescriptions Prescription drugs paid at 80% after deductible Debit card for prescription drugs only Compare drug costs with the drug cost calculator at

26 Medical Plans Empower HRA Medical Claims Processing

27 Medical Plans Empower HRA Prescription Claims Processing

28 Reimbursement from HRA account sent to you (check or direct deposit) Benefits from the health plan sent directly to provider of services Automatic reimbursement is called Crossover  MUST turn off crossover if there is other insurance coverage  MAY turn off crossover if you have an FSA

29 Medical Plans Scenario #1- single coverage  $1,000 contribution- 2011  1 office visit -$100 (discounted amount)= $900 balance  $1,000 contribution- 2012 (new balance $1,900)  2 office visits -$200 (discounted amount) = $1,700 balance  $1,000 contribution- 2013 (new balance $2,700)

30 Medical Plans Scenario #1- continued HRA account balance $2,700  $200,000 hospital bill (discounted amount)  $2,500 calendar year out of pocket maximum  HealthPartners pays $197,500  $2,500 is reimbursed to you from your HRA account- you pay hospital  $200 balance in account, all claims for the rest of the calendar year paid at 100%

31 Medical Plans Scenario #2- family coverage  $2,000 contribution- 2011  Several office visits and prescriptions  $2,200 in total expenses (discounted amount)  $2,000 deductible reimbursed from HRA account (balance is now $0)  Remaining $200 is paid under the health plan at 80%. You pay $40.  Total paid out of your pocket- $40

32 How To Choose Look at past medical history Current health Include premiums in your cost calculations Worst case scenario- combine annual premiums with out of pocket maximum Premiums are inevitable; deductibles, copays and coinsurance only apply if you have claims

33 WRAP-UP Metropolitan Council Benefits

34 Forms Due Special Open Enrollment forms must received in Benefits no later June 10, 2011 (fax, email, interoffice mail, regular mail) You must submit proof of eligibility for dependents you are enrolling - see the back of the form

35 Forms Due Submitting forms earlier is better If you do not submit your forms in time, you will not be able to enroll in a plan or change dependents until the next open enrollment, unless you have a qualified “family status change”.

36 Questions Any Questions? Benefits Contact Information: Email: Benefits-One Line (651) 602-1601

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