Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 USF PHYSICIANS GROUP Department of Human Resources Consumer Driven Health Plans with United Healthcare (UHC) OPEN ENROLLMENT July 2009 PRESENTED BY THE.

Similar presentations


Presentation on theme: "1 USF PHYSICIANS GROUP Department of Human Resources Consumer Driven Health Plans with United Healthcare (UHC) OPEN ENROLLMENT July 2009 PRESENTED BY THE."— Presentation transcript:

1 1 USF PHYSICIANS GROUP Department of Human Resources Consumer Driven Health Plans with United Healthcare (UHC) OPEN ENROLLMENT July 2009 PRESENTED BY THE USFPG DEPARTMENT OF HUMAN RESOURCES

2 2 Changes to our Healthcare Replacing United POS and POS Plus with United HRA and HRA Plus. –HRA is short for Health Reimbursement Account plan. Also called a “consumer driven health plan” or an “account-based health plan”. Benefit value of the HRA plans is equivalent to the current POS plans Deductible now on the Plan Year (July-June), not a Calendar Year Payroll deductions will be for all 26 pay periods

3 3 But first… No change to:  Short term and long term disability Insurance  Life insurance  Dental insurance  Dependent Care Flexible Spending Account maximums Change to:  Biweekly premiums for all benefits changing for deduction from 24 paychecks to 26  Increase in the Health Care Flexible Spending Account maximum from $2,400 to $4,000 for the Plan Year  The Flexible Spending Account reimbursements will be administered by UHC. Details will be forthcoming.

4 4 CONSUMER DRIVEN HEALTH PLANS (CDHP) HRA Plans – An Overview Health Coverage Member Responsibility Health Reimbursement Account (HRA) Preventive Care Plan Yr DeductibleJuly 2009-June 2010 Preventive care covered 100% Employer provided HRA Member Responsibility is Plan Year Deductible less HRA Health coverage is coinsurance with an out-of-pocket maximum

5 5 PLAN COMPARISONS HRAHRA Plus In-NetworkOut-of-Network In-NetworkOut-of-Network PLAN YEAR DEDUCTIBLE (Combine HRA and Member Responsibility) EMPLOYEE $1,500$3,000 $1,200$2,400 EMPLOYEE & FAMILY $3,000$6,000 $2,400$4,800 HRA (MSSC and UMSA Annual contribution) EMPLOYEE $500 EMPLOYEE & FAMILY $1,000 Member Responsibility (Deductible less HRA) EMPLOYEE $1,000$2,500 $700$1,900 EMPLOYEE & FAMILY $2,000$5,000 $1,400$3,800 Preventive Care $0, (no Deductible)Deductible & 40% $0, (no Deductible)Deductible & 40% Physician ServicesDeductible & 20%Deductible & 40% Deductible &20%Deductible & 40% Inpatient Hospital/Outpatient SurgeryDeductible & 20%Deductible & 40% Deductible &20%Deductible & 40% PrescriptionsDeductible & 20%Deductible & 40% Deductible &20%Deductible & 40% Vision - One routine exam every 2 yrsDeductible & 20%Deductible & 40% Deductible &20%Deductible & 40% Behavioral HealthDeductible & 20%Deductible & 40% Deductible &20%Deductible & 40% Out-of-Pocket Maximum (Combine deductible and coinsurance) EMPLOYEE $4,000$6,000 $3,500$5,500 EMPLOYEE & FAMILY $8,000$12,000 $7,000$11,000

6 6 Family Deductible How does the family deductible work for Family Coverage? Works just like the POS plans today. No one person will be out of pocket more than an individual (i.e. $1,000 Individual/$2,000 Family)

7 7 Member Responsibility $1000/$2000 (In Network) HRA $500/$1,000 Preventive Care 100% Health Coverage 20% In Network 40% Out of Network HRA and HRA Plus Plan YrDeductibleJuly 2009-June 2010 HRA Member Responsibility $1000/$2000 (In Network) HRA $500/$1,000 Preventive Care 100% Health Coverage 20% In Network 40% Out of Network Member Responsibility $700/$1400 (In Network) HRA $500/$1,000 Preventive Care 100% Health Coverage 20% In Network 40% Out of Network Plan YrDeductibleJuly 2009-June2010 HRA Plus

8 8 Prescriptions The pharmacy benefit is part of the basic medical coverage. It is subject to deductible and coinsurance, as any other covered service or treatment. There are no co-pays in the CDHPs. Mail order program for convenience of home delivery is available continued

9 9 More RX information… The full cost of a prescription will be paid first from the HRA account, and if funds are exhausted, the cost will be part of the Member Responsibility. Once the deductible is met, the plan will pay 80% and the member will pay the 20% coinsurance up to the Out of Pocket Maximum.

10 10 RX Example #1: For a 30-day supply at Pharmacy A CholesterolRetail Cost BRAND: Lipitor 10 mg tabs$ GENERIC: Not available Half-tablet Program: 15 tablets (20 mg)$73.03 Discuss alternatives with your physician BRAND: Mevacor 40 mg tablets$ GENERIC: Lovastatin 40 mg tablets OR $49.99 Lovastatin 20 mg tablets X2$4.00 {Pharmacy A “Savings Plan”}

11 11 RX Example #2: High Blood PressureRetail Cost BRAND: Norvasc 10 mg tablets$57.48 (Pharmacy B, $97.99) GENERIC: Amlodipine Besylate 10 mg tabs$53.99 (at Pharmacy B) OR $4.00 {Pharmacy A, “Savings Plan”}

12 12 HOW DOES THE PROCESS WORK? The Provider submits a claim to United Healthcare, then: If HRA funds are available, UHC pays the claim If HRA funds have been utilized, you will receive a bill and you will pay any Member Responsibility amount If HRA funds and Member Responsibility have been met, UHC will pay the insured amount, and you will receive a bill for the coinsurance When you have claim activity, you will receive a Health Statement, or you may view the information online

13 13 Health Care Flexible Spending Account Contributions to FSA are pre-tax Reimbursements are tax-free Use to cover out-of-pocket expenses “Use it or Lose it” FSA works well with HRA plan Option to enroll in medical automatic claim forwarding –Medical and pharmacy payments can be sent to the Provider –Reimbursements can be sent to you or deposited directly to your account Balances and activity on

14 14 Member Responsibility $0 HRA $1,000 Preventive Care 100% Health Coverage 20% $150 Rollover $850 Expenses HRA Pays How it Works - Phil and Nancy – FIRST YEAR Out-of-Pocket Expense None$0 Rollover To Year Two$150 * Example is based on in-network services; HRA plan Preventive Care Expenses 3 annual exams $800 Immunizations100 Total$900 3 Non-Preventive Expenses 3 prescriptions filled$300 Urgent Care visit150 5 physician visits400 Total$850 $900 paid 100% Plan Yr DeductibleJuly 2009-June 2010

15 15 How it Works – Phil and Nancy Beginning of 2ND YEAR PLAN MEMBER RESPONSIBILITY Reduced from $2,000 to $1,850 HRA Balance New $1,000 contribution plus $150 rollover from 1 st year Member Responsibility $1,850 HRA Beginning Balance in 2nd Year $1,150 Preventive Care 100% Health Coverage 20% Plan Yr DeductibleJuly 2009-June 2010

16 16 How it Works – Phil and Nancy Usage in 2 nd year Out-of-Pocket Expense $500 Rollover To Year Three$0 *Example is based on in-network services; HRA Plan Non-Preventive Expenses 8 prescriptions filled$750 Lab work150 ER visit450 4 physician visits300 Total$1,650 Preventive Care Expenses 3 annual exams $800 Immunizations100 Total$900 Member Pays $500 $1,150 Expenses HRA Pays Preventive Care 100% Health Coverage 20% $900 paid 100% Plan Yr DeductibleJuly 2009-June 2010

17 17 PREVENTIVE HEALTH BENEFITS  Regular preventive care helps  Reduce risk of disease  Detect health problems early  Save your life  Preventive care is covered 100% in both plans; no co-pay and your HRA is not affected  Yearly physical  Immunizations  Preventive mammograms  Well woman check ups  Preventive colonoscopy (age 50 and up)  Prostate cancer screening (age 50 and up)

18 18 HRA Plan Advantages 100% coverage for preventive benefits 100% coverage for non-preventive services up to the HRA amount Ability to rollover unused HRA dollars to the next year –Incentive for you to save your HRA dollars continued

19 19 HRA Plan Advantages A true out-of-pocket maximum…once deductible and coinsurance hit the maximum you have 100% coverage for the rest of the plan year No reduction in benefits No increase in employee contributions for Preferred rate

20 Biweekly Employee Contributions HRA PreferredStandard* Employee Only$14.30$21.24 Employee + Spouse$54.00$67.84 Employee+ Child(ren)$45.70$59.54 Family$80.30$ HRA Plus PreferredStandard * Employee Only$27.24$34.16 Employee + Spouse$84.46$98.30 Employee + Child(ren)$69.70$83.54 Family$105.22$ *Slight increase to Standard employee contributions

21 21 SAVINGS! In addition to 100% preventive benefits, you can save up to $540 per year if you are eligible for the Preferred Rate through the Healthy Pledge Program Savings: –$180 savings (single coverage) –$360 savings (employee plus spouse or child(ren) coverage) –$540 savings (family coverage)

22 22 HEALTHY PLEDGE PROGRAM Complete and submit the Healthy Pledge Form confirming that you and any covered dependents age 18 and older have not used a tobacco product in the past 12 months Complete online UHC Health Assessment and submit confirmation to the USFPG Department of Human Resources by 6/30/09 (required for all covered individuals 18 and older) Agree to participate in a UHC disease management program if invited to do so by UHC (i.e., asthma, diabetes, coronary artery disease) Your confidentiality is protected! Your confidential health information is not shared with MSSC OR UMSA

23 23 Network doctors / hospitals Estimate costs Track claims status Health improvement program Personal Health Record Health product discounts Review plan details Check account status UTILIZE THE WEB

24 24 CDHP Items of Importance Our group number will remain the same The network providers will remain the same An additional discount for utilizing USFPG physicians is being developed New ID cards will be issued by UHC You may log on to to print temporary cards after 6/30/09

25 25 Remember All enrollment paperwork is due by Friday, May 29 th (must include a completed United Healthcare enrollment form) To receive the lower Preferred rate: Complete the Healthy Pledge Form AND You and any covered dependents 18 and older register and complete an online Health Assessment and submit confirmation of completion for each individual to the USFPG Department of Human Resources by Tuesday, June 30, 2009

26 26 Question and answer sessions  The week of 5/11/09-5/15/09  We will be at 4 locations for informal sessions  Please refer to your Open Enrollment Packet for times and locations  You may also turn in your enrollment forms at one of these sessions

27 27


Download ppt "1 USF PHYSICIANS GROUP Department of Human Resources Consumer Driven Health Plans with United Healthcare (UHC) OPEN ENROLLMENT July 2009 PRESENTED BY THE."

Similar presentations


Ads by Google