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An independent licensee of the Blue Cross and Blue Shield Association Meredith College 2013 Renewal & Enhancements Andrea Rossbach 10/11/2012.

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Presentation on theme: "An independent licensee of the Blue Cross and Blue Shield Association Meredith College 2013 Renewal & Enhancements Andrea Rossbach 10/11/2012."— Presentation transcript:

1 An independent licensee of the Blue Cross and Blue Shield Association Meredith College 2013 Renewal & Enhancements Andrea Rossbach 10/11/2012

2 What has changed for 2013? BenefitHSAPPO 123 In-networkOut-of-networkIn-networkOut-of-network Deductible Individual Family $2,500 $5,000 $10,000 $500 $1000 $1,000 $3,000 Coinsurance80%50%90% level 2 70% level 3 60% level 2 60% level 3 Coinsurance Max Individual Family $4,000 $7,500 $8,000 $15,000 $2,000 $4000 $4,000 $12,000 Office Visit CopaysIn-network: Deductible applies to sick 100% preventative benefit In-network: $20 Primary Care Deductible applies to specialist 100% preventative Prescription Drugs (Note: The coverage level for tier 4 specialty drugs will not change in 2013 However, for in-network coverage, please use a participating specialty pharmacy.) In-network: Deductible Applies In-network: Tier 1: $4 Tier 2: $30 Tier 3: $45

3 Your 2013 Medical Plans: How They Compare Medical Plan Option HSA (In-network) PPO (In-network) Copayments None. You pay 100% for services until you meet your deductible. $20 for non-preventive Level 1 services Also pay $250 copay on inpatient hospital. Preventive Care Services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%. For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.www.bcbsnc.com/preventive Covered at 100% (before deductible) Covered at 100% (before deductible) Plan Year Deductible $2,500 Individual $5,000 Family $500 Individual $1000 Family Family Aggregate Deductible YesNo

4 Your 2012 Medical Plans: How They Compare Medical Plan Option HSA (In-network)PPO (In-network) Coinsurance (after you meet your deductible) Services covered at 80% (you pay 20%) after deductible Level 2 services covered at 90% (you pay10%) after deductible (and if applicable, $250 copay per admission) Level 3 services covered at 70% (you pay 30%) after deductible Out-of-Pocket Maximum (includes deductibles) $4000 Individual $7500 Family (Once met, covered services paid at 100% for rest of plan year.) Not applicable Coinsurance Maximum (does not include deductibles) Not applicable $2,000 Individual $4,000 Family (Once met, still pay copays for primary care doctor visits and prescription drugs) Health Savings Account (HSA) YesNo

5 What is Blue Options HSA SM ? High Deductible PPO Health Plan –Similar to a traditional PPO, except: High deductible (required by the federal government) 1 No co-payments High Deductible PPO Plan You pay 100% Until you meet your deductible Then you pay a 20% of the cost: coinsurance 1 Blue Options HSA plans, deductible and out-of-pocket maximum amounts are subject to change year to year in order to comply with IRS requirements. For the most up-to-date requirement information, see www.irs.gov.www.irs.gov

6 What is Blue Options HSA SM ? Health Savings Account (HSA) –Tax-free savings account for qualified medical expenses –Administered by BNY Mellon 1 Health Savings Account (HSA) * (for medical expenses) Contribute money tax-free Use money to pay for medical expenses tax-free 2 Earn interest over time tax-free 1 BCBSNC does not administer your HSA and is not affiliated with your HSA custodian or administrator. Your HSA custodian is The Bank of New York Mellon. 2 Withdrawals are tax-free only if used for qualified medical expenses. See irs.gov for specific regulations.

7 Similar to Traditional PPO Plans: + Choice of doctors + Large Blue Options SM network of providers + Out-of-network benefits option 1 + Access to specialists with no referrals 2 + Provider discounts = big savings + Nationwide, worldwide coverage 3 + Preventive 4 services at no charge 1 When you see an out-of-network provider, you may pay more out of pocket. 2 Referrals may be needed for mental health and substance abuse services. 3 Blue Cross and Blue Shield Association Internal Data, 2007: www.bcbs.com/news/press/facts/bluecard.html (Accessed September 2008)www.bcbs.com/news/press/facts/bluecard.html 4 Preventive care services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%. For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.www.bcbsnc.com/preventive  For a list of covered preventive care services: www.bcbsnc.com/preventive. www.bcbsnc.com/preventive

8 Different from Traditional PPO Plans High Deductible –Required by federal government Family aggregate deductible –Single deductible for all covered family members No co-payments for services –You pay 100% until you meet your deductible Pay for care with HSA –Pre-taxed funds For guidance, visit www.irs.gov, publication 502www.irs.gov 1 When you see an out-of-network provider, you may pay more out of pocket. 2 Referrals may be needed for mental health and substance abuse services. 3 Blue Cross and Blue Shield Association Internal Data, 2007: www.bcbs.com/news/press/facts/bluecard.html (Accessed September 2008)www.bcbs.com/news/press/facts/bluecard.html 4 Preventive care services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%. For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.www.bcbsnc.com/preventive

9 How does Blue Options HSA SM work? You pay 100% of your health care & prescription drug expenses Exception: In-network preventive care 2 is covered at 100%, without paying your deductible first + You pay 20% of your health care expenses, including prescriptions Before you reach your deductible 1 After you reach your out-of-pocket maximum 1 Of $4000 employee/$7500 family + BCBSNC pays 100% of all covered expenses for the rest of the plan year 1 Blue Options HSA plans, deductible and out-of-pocket maximum amounts are subject to change year to year in order to comply with IRS requirements. For the most up-to-date requirement information, see www.irs.gov.www.irs.gov 2 Preventive care services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%. For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.www.bcbsnc.com/preventive After you reach your deductible 1 Deductible: $2,500 employee/ $5,000 family

10 How the HSA Works You, your employer, or anyone can contribute to the HSA – tax-free! When you use your HSA to pay for qualified medical expenses, the money comes out tax-free 1 ! HSA checkbook and debit card from Mellon Use for medical expenses at doctor’s office, pharmacy, etc. If you don’t use your HSA money, you don’t lose it! The fund grows - tax-free! 1 Withdrawals are tax free only if used for qualified medical expenses. Specific regulations and a list of qualified medical expenses can be found in IRS publication 502, available at www.irs.gov.www.irs.gov 2013 Annual Contribution Limits:  $3,250 individual  $6,450 family  $1,000 per year catch-up contribution (55 or older by 12/31/13)

11 Pharmacy Benefits * For a 30-day supply ** There is a $50 minimum and $100 maximum per 30-day supply. PharmacyHSAPPO Tier 1: GenericDeductible$4 Copay Tier 2: Preferred Brand Deductible$30 Copay Tier 3: BrandDeductible$45 Copay Tier 4: Specialty BrandDeductible25% Coinsurance

12 Health Care Cost Estimator Tool Look at costs on 56 procedures Find Blue Distinction Centers and make informed decisions on health care costs. https://www.brainshark.com/bcbsnc/costtransparency

13 A friendly reminder Blue Points will discontinue 12/31/2012 for Meredith Employees. Please cash in your points by 12/30/2012

14 New Wellness Program: Healthy Outcomes

15 Achiever A Credit Tracking – 6 months 15 Healthy Outcomes groups will be defaulted to this plan option. Groups that are not Healthy Outcomes groups may choose this plan as well if they wish. Program ActivityCredit ValueAnnual Max Award Credits Process Health Assessment (required)40 Auto Healthy Living Programs2040Auto Healthy Living Conversations1030Auto Online Monthly Seminars530Auto 1 on 1 Health Coaching Interaction 40 Various Preventive Care Adherence with 4 services within USPSTF Guidelines 50 Claims / Form Custom Activity25 Form / File Health Challenges25100Auto Total Opportunity355 Program 5 Goal: 125 Credits

16 Employee portal Personalized messaging Dashboard incentive status and activity tracking Top three program recommendations prominently displayed Tools and media  Weight, nutrition, exercise, pain Multiple health programs and trackers  Calculators  Planners and guides 16 Welcome screen

17 Employee portal Wellness overview Displays program overview Informs member how to achieve their goals Describes each program activity Shows credit value of each activity 17

18 Private and confidential Health Assessment responses are confidential Results are not used to determine insurance rates or eligibility for coverage Get a personal health report you can print Access programs to improve your specific risk conditions

19 Why should you participate? Helps you get healthier Meredith college is giving $20 per month to the HSA fund or $20 towards premium to members on the PPO beginning 1/1/2014 Helps your company control health care costs, which is good for everyone, last year there was a savings but we need to increase participation

20 Questions???


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