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HOW DOES THE HRA WORK? SHBP Health Reimbursement Account.

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Presentation on theme: "HOW DOES THE HRA WORK? SHBP Health Reimbursement Account."— Presentation transcript:

1 HOW DOES THE HRA WORK? SHBP Health Reimbursement Account

2 Features of the HRA Plan Lower employee premiums SHBP credits dollars each year that pay for covered initial charges, whether medical or pharmacy expenses. These dollars also reduce your deductible and maximum out-of-pocket expenses You do not pay co-pays under this plan but co-insurance whether it is for your prescription drugs, office visits or surgery Any dollars not used at the end of the year roll over to the next year 100 percent coverage for preventive care and the cost of these services do not come out of your HRA dollars

3 Features of the HRA Plan No primary care physician designation or specialist referrals required  Suggest that you designate a PCP Cost for certain asthma, diabetes and cardiac drugs may be waived  Must be enrolled and compliant with disease management program The employee and spouse can also each earn $125 (total of $250)  Must complete a health assessment and get an annual physical

4 The Yellow box on the side of the house shows preventive care benefits. There is no cost to you when you receive your annual physical from a participating provider AND you don’t use your HRA dollars to pay for this benefit! The Green section of the house reflects the dollars in your HRA account (provided by the State.) These dollars will be used for your medical expenses i.e. prescriptions or Dr. visits. Once these dollars have been exhausted YOU must satisfy the rest of your deductive before more benefits are paid. This is the blue box. The true deductible is $1,000, but because SHBP provides $500, your out-of-pocket costs or “Member Responsibility” is only $600. How an HRA Works—Single Coverage Wellness Plan Health Coverage SHBP pays 85/60% up to $3,000 Out-of-pocket maximum (reduced by $500 Contribution) $800 Member Responsibility $500 Health Reimbursement Account – funded by SHBP Preventive Care ---1,300 Deductible--- *Standard Plan HRA credits, deductibles and out-of-pocket maximums are higher, please refer to the decision guide for those limits.

5 This member has unused HRA account dollars that have rolled over to the next year, which is added to the new deposit of HRA dollars for the next plan year. This reduces the amount of out-of-pocket dollars the member pays for non-preventive expenses until they reach their deductible. ---1,300 Deductible--- Health Coverage SHBP pays 85/60% up to $3,000 Out-of-pocket maximum ( $500 Member Responsibility $800 Health Reimbursement Account $500 funded by SHBP in Year 2+$300 rolled over from Year 1 Preventive Care Member only had $200 of non-preventive care Medical expenses in Year 1 $300 of non-used HRA dollars rolls over to Year 2 SHBP credits another $500 to HRA HRA balance at beginning of Year 2 is $800 Member responsibility to meet deductible is now only $500

6 Prescription Drug Changes 2012 Prescription Drug Coverage The Pharmacy benefit will be the same under the Wellness and Standard HRA Plans Pharmacy costs will no longer apply to the deductible or out-of-pocket limit (Starting day one member will always pay coinsurance amounts) HRA dollar credits may be used for prescription drug, but will no longer help to offset your deductible or out-of-pocket limit The benefit will change to a 3 Tier structure with a minimum and maximum out-of-pocket Please note: UnitedHealthcare (UHC) members will need to provide a separate Health Care Spending Card to access HRA dollar credits for their pharmacy expenses. Additionally, UHC members will still need to present their UnitedHealthcare ID cards with any prescriptions at the pharmacy. No separate card is required for CIGNA members at the pharmacy.

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