2. 1940-1970 Virtually no cost control 1970-1980 Introduction of UC limits, deductibles and coinsurance 1980-1990 Hospital Pre-admission authorization, surgical authorizations, utilization review 1990’s Managed care History of Cost Controls Present Consumer Driven Health Care – CDHC

3. Health Care Costs % of change

4. Drivers of Health Care Costs Prescription Drugs Hospital Costs Lifestyle choices Third party payer system

5. Drivers of Health Care Costs Prescription Drugs Increased Utilization Price Inflation Higher Cost Drugs Rx costs are projected to increased over 12% each year until 2010. Marketing directly to consumer. Patients are asking for name-brand drugs

6. Drivers of Health Care Costs Rising cost of hospital visits Outpatient costs are the fasting growing component of healthcare costs. Inpatient costs are being driven primarily by increasing hospital expenses per inpatient stay Rising costs per admission are driven in part by: Greater use of expensive technology Higher labor costs Hospital consolidations

7. Drivers of Health Care Costs Lifestyle choices Centers for Disease Control (CDC) estimates that U.S. obesity-attributable medical expenditures reached $75 billion in 2003

8. Drivers of Health Care Costs People are not price sensitive in the market for health care as they are in the market for other goods and services because some third-party (Medicare or a private insurer) pays most of the cost of health services. Consumers do not know the true cost of health care. Third Party Payer

9. How Employees View Health Care Costs 63% underestimate health insurance costs 69% overestimate how much they contribute to health insurance 57% are unsatisfied with their coverage A recent Hewitt Study shows employees don’t understand health care costs.

10. Consumer Driven Health Care (CDHC) refers to health plans in which employees have a personal health accounts such as a Health Savings Account or a Health Reimbursement Arrangement from which they pay medical expenses directly Consumer Driven Health Care

11. Types of Consumer Driven Health Care HRA Health Reimbursement Account HSA Health Savings Account FSA Flexible Spending Account Who is eligibleEmployees and Retirees Employees Max Annual Contribution (2007) No maximum$2,850 Individual $5,650 Family No maximum Who ownsEmployerEmployeeEmployer Who contributesEmployer OnlyEmployer or Employee Employee Only Can employee earn interest on money NoYesNo Can money roll over Yes No Is an HDHP required NoYesNo Is it portable NoYesNo Eligible for Cafeteria NoYes

12. Health Savings Accounts (HSA) What is an HSA? An HSA is a savings account where consumers invest money and then withdraw it, tax free, for eligible medical expenses. HSAs combine with high-deductible health insurance plans to give consumers more control -- and more responsibility -- over their health spending.

13. Health Savings Accounts (HSA) Who is Eligible To be eligible, an individual must be covered by an HSA-qualified High Deductible Health Plan (HDHP) and must not be covered by other insurance that is not HDHP. An individual may not be claimed as a dependent on another person’s tax return. In other words, dependent children cannot establish their own HSAs.

14. Other Insurance Health Savings Accounts (HSA) Certain types of insurance are permitted with an HSA Specific disease or illness Accident Disability Dental Vision Long Term Care Employee Assistance Programs Wellness Programs

15. Can employees have both an HSA and FSA? Health Savings Accounts (HSA) You can have both types of accounts, but only under certain circumstances. If you offer a “limited purpose” (limited to dental, vision or preventive care) FSA, then your employees can still be eligible for an HSA.

16. Health Savings Accounts (HSA) What's a High Deductible Health Plan Sometimes called "catastrophic" coverage, high-deductible insurance plans offer low premiums in exchange for a high deductible. For 2007, the minimum deductible is $1,100 for individuals and $2,200 for families.

17. Health Savings Accounts (HSA) What's a High Deductible Health Plan: With the exception of preventive care, you must meet the annual deductible before the plan pays benefits.

18. Health Savings Accounts (HSA) How much can you contribute to an HSA?

19. HSA Contribution Limits - 2007 HDHP Deductible Maximum HSA Contribution Single Coverage Minimum: $1,110$2,850 $1,500$2,850 $2,000$2,850 $2,500$2,850 $3,000$2,850 Family Coverage Minimum : $2,200$5,650 $3,000$5,650 $4,000$5,650 $5,000$5,650 $6,000$5,650

20. HSA Out of Pocket Limits - 2007 Maximum out-of-pocket limits for HDHP Single Coverage $5,500 Family Coverage $11,000

21. Health Savings Accounts (HSA) Eligible Expenses In general, funds from an HSA can be used for a wider range of expenses than covered by comprehensive insurance plans. HSAs cover routine doctors' appointments and prescriptions, and cash can be withdrawn to cover over- the-counter medicines, such as aspirin and antihistamines. A partial list of eligible expenses is available in IRS publication 502.

22. Health insurance premiums (Exceptions: LTC, COBRA, and for individuals over age 65 certain Medicare premiums) Expenses incurred BEFORE the HSA coverage is established. Expenses that are covered by your health care plan. Health Savings Accounts (HSA) These are not considered eligible expenses

23. Individuals typically receive a checkbook or debit card Individuals are responsible for paying providers as they are billed There is no “gatekeeper” to insure the charges are for qualified expenses During an IRS audit, it is the individual’s responsibility to prove that deductions for the account were for qualified medical expenses How are claims processed?

24. Reduced Premiums Provide Incentives to employees to get Involved with healthcare decisions Encourage healthier staff Advantage to the School District Health Savings Accounts (HSA)

25. Money (including any employer contributions) belongs exclusively to the employee. Money can be invested and income earned grows tax-deferred. Unused balances carry over each year without limitations. Portable – Employees can take with them when they change jobs or retire. Advantages to the employee Health Savings Accounts (HSA)

26. Review plan design specifics and determine level of employer involvement Limit medical offerings to one vendor to avoid adverse selection Outline eligibility Select a vendor and or HSA administrator Draw a clear line between the HSA and the health coverage to make it clear that there are two components How to add an HSA

27. Communicate clearly to staff – before, during and after implementation Share the savings from switching to a high deductible plan with the employees Make a one time contribution to the account. Ongoing contributions can be paid by the employee When you educate the employees, talk about the savings account first; the deductible second. During the first year, only a small percentage of employees will participate even if it is designed correctly. The second year – through word of mouth – generates greater participation. How to add an HSA

28. The two most predictive aspects of an employer’s success in offering an HSA are: 1. Whether or not they fund the account 2. How much the employer funds it. How to add an HSA

29. A recent Pricewaterhouse Coopers survey of large employers who implemented an HSA: Reductions in prescriptions by 5-25% Reductions in office visits by 5-20% First year rate increases in the range of –5% to +8% as opposed to +14% to +16% nationally In the first year alone, over 60% of CDHP enrollees had average HSA balances of $400 to roll over to the next year. According to Forrester projections, the number of HSAs will grow to more than 6 million in 2008. That number could triple to more than 18 million by 2012. Results and forecast

32. Call Bill Baker 417-882-2992 Or e-mail: moeducators@ftj.com moeducators@ftj.com Interested in a quote for your district? Forrest T. Jones & Company has worked with Missouri School Districts since 1953. We’d be happy to work with your School District to see how much you can save by introducing an HSA.

33. Resources: U.S Treasury Department for HSAs http://www.ustreas.gov/offices/public-affairs/hsa/pdf/HSA-Tri-fold-english-07.pdf FSAFEDS www.fsafeds.com; 1-877-FSAFEDS(372-3337) or TTY 1-800-952-0450 www.fsafeds.com OPM Web address for HSAs www.opm.gov/hsa www.opm.gov/hsa U.S Treasury Department for HSAs www.ustreas.gov/offices/public-affairs/hsa For a list of qualified medical expenses that can be reimbursed through an HSA or HRA: www.irs.gov/pub/irs-pdf/p502.pdf HSA Insider http://www.hsainsider.com www.ustreas.gov/offices/public-affairs/hsawww.irs.gov/pub/irs-pdf/p502.pdf