Presentation on theme: "1 CIGNA Consumer-Driven Health Care HSA-qualified HDHP Program Overview For employers with 50 or fewer employees."— Presentation transcript:
1 CIGNA Consumer-Driven Health Care HSA-qualified HDHP Program Overview For employers with 50 or fewer employees
2 Today’s Discussion Growth of Consumer-Driven Health Plans The CIGNA Approach To Consumer-Driven Health Care HSA Overview Engagement and Advocacy Service Experience and Employee Education
3 Currently Offer*Offer by 2007 All employers (>1,000)16%38% Large employers20 - 25%50% Mid-size employers5 – 8%33% Small employersUnder 3%33% * end of 2004 Forrester Research. Employers Sound Off on CDHPs, May 2005. Consumer-Driven Health Momentum Has Reached All Segments Optional Slide
5 Improve health. It’s our single focus. It means we stand for care that is effective and personal choices that matter. It means we connect the health of your employees to the health of your business. What We Stand For Optional Slide
6 Our Approach Improve Health – Control Costs Consumerism: personal choices that matter Enabling informed healthcare decisions Health Advocacy: care that’s effective Delivering integrated care for superior clinical outcomes Actionable Information: connecting employee health to the health of your business Providing consumers with the tools they need to make informed decisions about their health
8 Definitions Health Savings Account A tax-exempt trust or custodial account created exclusively to pay for the qualified medical expenses of the account holder and his or her spouse or dependents. Covers all medical expenses listed in IRC section 213(d) Can be used only in conjunction with a qualified high-deductible health plan Funded with actual dollars Remains the property of the account holder; no “use it or lose it” rules High-Deductible Health Plan A medical plan that meets certain criteria set by the federal government Minimum Deductible*$1,100 single / $2,200 family Out-of-Pocket Maximum*$5,500 single / $11,000 family * These are 2007 limits. Limits for future years will be set by the IRS.
9 Working Together A high deductible health plan (HDHP) is required for an HSA 100% Preventive Care The Health Plan 100% Coverage High- Deductible Health Plan (coinsurance) Deductible $ Health Savings Account Minimum Deductible*: $1,100 Single / $2,200 Family Maximum Out of Pocket*: $5,500 Single / $11,000 Family Deductible and covered expenses apply to out-of-pocket maximum 100% Preventive coverage recommended One deductible amount for Medical and Pharmacy *2007 Federal Limits
10 Funding Employer and/or Employee Maximum: Lesser of in-network deductible or annual limit set by IRS (For 2007, $2,850 for individuals/$5,650 for families) Tax Advantages Account balances & Investment earnings grow tax-free Withdrawals for qualified expenses are tax-free Account Ownership Employee Flexibility Employee chooses to use or save $ Portability Yes. Employee owns the fund Annual Rollover Yes Qualifying Expenses 213(d) medical expenses not covered by HDHP, long- term care, COBRA HSA Overview CIGNA Advantages HSA banking option powered by JPMorgan Chase Industry-leading consumer decision support tools, including WebMD ® suite of tools Leading clinical resources …Helping create more engaged consumers and lower medical costs.
12 Tax Advantages of an HSA* Tax-Free Contributions Employee contributions: income tax-free Employer contributions (optional): Deductible for employer; not taxable for employee Tax-Free Interest and Investment Gains Interest and gains accrue tax free while they remain in the HSA Tax-Free Withdrawals Withdrawals for a qualified medical expense are not taxed Other withdrawals incur income taxes plus 10% penalty (<65) *In Alabama, California, New Jersey, and Wisconsin, contributions are prior to federal taxes but after state income taxes. Employer contributions, earned interest and investment income are taxable as gross income for state income tax purposes.
14 CIGNA Resources Address the Continuum of Consumer Health Needs Health advocacy services to engage, navigate and facilitate services across the continuum of care Help Assess Target Acute Cost of medical care per memberNumber of members impacted Care ManagementDisease ManagementLifestyle ManagementHealth Promotion 7% of cost; 43% of members 48% of cost; 17% of members 35% of cost; 18% of members 10% of cost; 22% of members Chronic Healthy At Risk Goal: Keep everyone well Goal: Prevent from migrating to more chronic/acute condition Goal: Minimize impact of illness Goal: Resolve acute illness impact as quickly and effectively as possible CIGNA Programs Cancer High Risk Maternity Neonatal Intensive Care Transplant Extended care Cardiac Depression Diabetes Obesity Tobacco Cessation Weight Loss Stress Management Substance Abuse Health Risk Assessment Physician report card and member reminder mailings Prenatal/Maternal Care Work/Life Balance Preventative Care Programs Discounts on Health & Wellness services Asthma Low Back Pain COPD 10 Secondary “targeted conditions” Musculoskeletal Inpatient Management Intensive Behavioral
15 CriteriaDiagnostic LabDrug Outpatient Surgery Opportunity to plan MRIProzac Arthroscopic Joint surgery Price variation Hospital vs. Stand-alone imaging centers Brand vs. Generic Retail vs. Mail Hospital vs. Stand-alone surgery center Consumers, Armed With The Right Information, Can Take Action
16 The Key: myCIGNA.com 16 Review benefit coverage levels Track account balance, claims and payments Support important health decisions Cost and quality information Read personalized messages
17 15-minute questionnaire helps determine accurate personal health status Employs 5,000+ calculations that screen for over 21 clinical risk factors Results are integrated with CIGNA’s Disease Management Programs Health Risk Assessment 17
18 Procedure Pricing Tool Saint Hospital Community Hospital
19 Members select pharmacy and drug Receive actual price they’ll pay Prescription Pricing Tool LOCAL PHARMACY 123 MAIN STREET HOMETOWN, ST 00000 (555) 123-4567
20 Hospital Quality Information Saint Hospital Community Central Hospital 123 Main Street Hometown, ST 00000 (123) 555-1234 123 Center Street Hometown, ST 00000 (123) 555-5678
21 Hospital information tool allows members to compare hospitals based on data for 164 surgical and medical procedures Personalized with In/Out of Network indicators to help members understand financial implications of decisions Physician Surgical Volume results will be included in limited areas Hospital Quality Information
23 CIGNA ■ HDHP claim adjudication ■ JD Power certified customer service ■ Large National Network ■ Medical management ■ Decision support tools ■ Enrollment and communication support JPMorgan Chase ■ Debit card/checkbook processing ■ Financial service specialists ■ Interest crediting ■ Scheduled and unscheduled deposits ■ Investment options CIGNA HSA-qualified HDHP when powered by JPMorgan Chase CIGNA Advantages We have capitalized on the strengths of both organizations to deliver an empowered HSA Employer An affordable alternative to health care Provides employees with savings opportunity Potential for reduced claim costs Consumer One toll-free member services number Combined web experience via myCIGNA.com and link to JPMC Online bank application and signature 100% Preventive Care coverage
24 Two Ways to Access HSA Dollars if account is established through JPMorgan Chase… HSA Debit Card Visa ® branded, issued by Chase Can be used at ATM as well Checkbook Two Ways to Track Utilization if account is established through JPMorgan Chase… myCIGNA.com Access to claim transactions and history Link to JPMC member website JPMorgan Chase Member Website Access to Health Savings Account transaction and balance information General Information (including investment options) available
25 Improve Health – The CIGNA Advantage CIGNA Health Advocacy & Clinical Resources Outreach triggers: Health risk assessment Predictive model Integrated data Referrals myCIGNA.com, WebMD, 800.CIGNA24 Education A more aware health care consumer Member Education Personalized Media Open Enrollment Provider Outreach CIGNA activities Member activities Clinical Programs: Health promotion Disease Management Care Management 24-Hour Nurse Line Clinical guidance and care support Behavior Change Lifestyle Management
26 Simplifying Your Communication Needs Access to communication materials Newsletters Business activities
27 Using Communications To Build Active, Engaged Members POST-ENROLLMENTENROLLMENT
28 “CIGNA has catapulted itself into the top ranks” - Consumer Driven Market Report, September 2004 #1 in Health Sector IT - 2006 InformationWeek 500 Best Technology & Communications Introduced by a Health Plan Organization for Employee/Consumer Choice – 2005 Consumer Directed Health Care Conference & Expo 2005 Health Plan/ Managed Care Organization Disease Management Leadership Award – Disease Management Association of America America’s Best Health Plans NCQA – 2005 CIGNA Plans Recognized Awards And Recognition Demonstrate CIGNA’s Commitment To The Consumer Top 100 IT Innovators 2005 for technology NCQA Highest Effectiveness of Care Measures 5 years in a row (2001 – 2005) Optional Slide