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Health Plan Options Informational Sessions November 2012.

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Presentation on theme: "Health Plan Options Informational Sessions November 2012."— Presentation transcript:

1 Health Plan Options Informational Sessions November 2012

2 Agenda Overview of Health Plans Prescription Drug Coverage 2013 Health Premiums Health Care Flex Spending Account Health Savings Account (HSA) Out-of-Pocket Cost Comparisons

3 Health Plans  United HealthCare (UHC) Choice HMO  United HealthCare Choice Plus POS  Anthem Blue Cross Excel PPO  Anthem Blue Cross Basic PPO  UHC High Deductible Health Plan (HDHP)

4 All Health Plans No pre-existing condition limitations No lifetime maximum benefit No requirement for referral from a primary care physician to see a specialist Coverage under health plan automatically includes coverage under the prescription drug, dental, and basic vision plans

5 United HealthCare Choice HMO In NetworkOut of Network Annual DeductibleNoneN/A Office Visit Co-Pay Preventive Primary Care Physician Specialist Physician $0 $25 $40 N/A Hospital Co-Pays Emergency Room (waived if admitted) In-Patient (semi-private room) $150 $300 $150 N/A Outpatient Surgery Co-Pay$150N/A Urgent Care Co-Pay$35N/A Lab/X-Ray Preventive Non-Preventive Major Radiologic Diagnostic Test $0 10% co-insurance 20% co-insurance N/A Annual Co-Insurance Maximum Individual Family $1,500 $3,000 N/A

6 United HealthCare Choice Plus POS In NetworkOut of Network Annual Deductible Individual Family None $300 $900 Office Visit Co-Pay Preventive Primary Care Physician Specialist Physician $0 $25 $40 30% Hospital Co-Pays Emergency Room (waived if admitted) In-Patient (semi-private room) $150 $300 $150 30% Outpatient Surgery Co-Pay $15030% Urgent Care Co-Pay $3530% Lab/X-Ray Preventive Non-Preventive Major Radiologic Diagnostic Test $0 10% co-insurance 20% co-insurance 30% Annual Co-Insurance Maximum Individual Family $1,500 $3,000 $6,000

7 Anthem Blue Cross Excel PPO In NetworkOut of Network Annual Deductible Individual Family $500 $1,500 $500 $1,500 Co-Insurance20%40% Preventive Care0% (no deductible)40% Hospital Emergency Care In-Patient (semi-private room) Outpatient Surgery 20% 40% Urgent Care20%40% Lab/X-Ray Preventive Non-Preventive 0% 20% 40% Annual Co-Insurance Maximum Individual Family $1,500 $4,500 $3,000 $9,000

8 Anthem Blue Cross Basic PPO In NetworkOut of Network Annual Deductible Individual Family $750 $2,250 $750 $2,250 Co-Insurance20%40% Preventive Care0% (no deductible)40% Hospital Emergency Care In-Patient (semi-private room) Outpatient Surgery 20% 40% Urgent Care20%40% Lab/X-Ray Preventive Non-Preventive 0% 20% 40% Annual Co-Insurance Maximum Individual Family $2,500 $7,500 $5,000 $15,000

9 United HealthCare HDHP In-NetworkOut of Network Annual Deductible Individual (Employee Only) Family (Employee +1 or more dependents) $1,500 $3,000 $1,500 $3,000 Co-Insurance20%40% Preventive Care0% (no deductible)40% Annual Co-insurance Maximum Individual Family $1,250 $2,500 $5,000 Annual Out-of-pocket Maximum (Including Deductible and Co-insurance) Individual Family $2,750 $5,500 $4,000 $8,000

10 United HealthCare HDHP Separate In-Network and Out-of-Network deductibles Family deductible applies if you cover one or more family members Family deductible must be fully met even if only one family member utilizes the plan Deductible and co-insurance apply to prescription drugs (no co-pays)

11 Prescription Drug Benefits Express Scripts All Health Plans except UHC HDHPUHC HDHP Tier 1 Co-pay (generic) Tier 2 Co-pay (preferred) Tier 3 Co-pay (non-preferred) 30-Day Supply Retail Pharmacy $10$40$65Deductible, then 20% co-insurance 90-Day Supply Mail Order $25$100$162.50Deductible, then 20% co-insurance

12 2013 Employee Monthly Premiums Full Time Faculty & Staff Earning less than $35,000 HEALTH PLAN EMPLOYEE ONLY EMPLOYEE + ONE DEPENDENT EMPLOYEE + TWO OR MORE DEPENDENTS UHC Choice HMO $35.77$193.80$273.67 UHC Choice Plus POS 55.33270.16406.38 UHC High Deductible PPO 7.7126.5351.57 Anthem BC Excel PPO 73.92298.90445.46 Anthem BC Basic PPO 19.4161.63120.65 Dental Only 2.395.328.06 Vision Buy-Up Option 6.5613.0921.10

13 2013 Employee Monthly Premiums Full Time Faculty & Staff Earning $35,000 or more HEALTH PLAN EMPLOYEE ONLY EMPLOYEE + ONE DEPENDENT EMPLOYEE + TWO OR MORE DEPENDENTS UHC Choice HMO $43.55$231.40$328.77 UHC Choice Plus POS 69.08334.00503.71 UHC High Deductible PPO 10.4635.0967.20 Anthem BC Excel PPO 95.96386.33577.09 Anthem BC Basic PPO 24.8678.58152.81 Dental Only 2.395.328.06 Vision Buy-Up Option 6.5613.0921.10

14 2013 Employee Monthly Premiums Part-Time Faculty & Staff HEALTH PLAN EMPLOYEE ONLY EMPLOYEE + ONE DEPENDENT EMPLOYEE + TWO OR MORE DEPENDENTS UHC Choice HMO $231.06$569.20$794.04 UHC Choice Plus POS 302.02743.101048.46 UHC High Deductible PPO 141.15290.05428.90 Anthem BC Excel PPO 411.65891.851301.45 Anthem BC Basic PPO 183.20380.26568.93 Dental Only 4.7810.6416.12 Vision Buy-Up Option 6.5613.0921.10

15 Health Care Flex Spending Account (FSA) Qualified ExpensesOut-of-pocket Medical, Dental, Rx, and Vision Annual Maximum Contribution $2,500 Per Employee Payment MethodsDebit card / Pay Me Back / Pay My Provider Payment AmountUp to Annual Contribution Amount Debit Card RequirementsSettle Unverified Transactions Benefit to EmployeeFederal, State, & FICA Tax Savings Grace PeriodJanuary 1 through March 15 after Plan Year Claims Filing DeadlineApril 30 after Plan Year Limitations of PlanForfeiture of Unclaimed Balance WAGE WORKS

16 Health Savings Account (HSA) Eligibility RequirementsMust be Enrolled in WUSTL UHC High Deductible Health Plan (HDHP) Minimum Employee Contributions to receive university contribution $200 (Under $115,000 salary) $400 ($115,000 and greater salary) Maximum Employee Contributions$3,250 (Employee) - $2,850 w/ university contribution $6,450 (Family) - $6,050 w/ university contribution $1000 catch-up contribution – Age 55 & older University Contribution$400 Benefit to EmployeeIncome Tax Advantages Funds to be UtilizedActive or Retiree Health Costs Limitations of PlanCannot be enrolled in Health FSA or Medicare US BANK

17 Health Care FSA and HSA Comparison Health Care FSAHSA Health Plan Requirement NoMust be enrolled in HDHP Maximum Annual Contribution $2500 $3250 – Individual Coverage $6450 – Family Coverage University Contribution No $400 annual contribution if employee contributes required minimum Access to Annual Election Throughout year Yes No. Can access only up to YTD contributions Contribution Forfeiture Yes No. Unused contributions roll over from year-to-year

18 Scenario #1: Single Employee (Income >$35,000) – Generally Healthy Premium/ProcedureUHC Choice HMO UHC Choice Plus POS UHC HDHPBC ExcelBC Choice Annual Physical ($280) $0 Office Visit – Illness ($90) $25 $90 Antibiotic – Generic ($10) $10 Out-of-Pocket Cost ($380) $35 $100 Premium Contribution $522.60$828.96$125.52$1,151.52$298.32 HSA University Contribution ($400) $200 HSA Contribution Tax Savings* (28% Rate) ($56.00) Total Annual Cost $557.60$863.96($230.48)$1,251.52$398.32 * Tax savings will vary based on your current FSA contribution and medical plan election.

19 Scenario #2: Employee Plus Spouse (income >$35,000) – Having First Baby in June Premium/ProcedureUHC Choice HMO UHC Choice Plus POS UHC HDHPBC ExcelBC Choice Pre-Natal Care – 6 OB visits ($740) $0 Office Visit – Illness ($90) $25 $90 Normal Delivery ($6,000) $300 $3,528$1,528$1,728 Out-of-Pocket Cost ($6,830) $325 $3,618$1,618$1,818 Premium Contribution $3,361.02$5,026.26$613.74$5,780.52$1,388.34 HSA University Contribution ($400) $200 HSA Contribution with Tax Savings* (28% Rate) (56.00) Total Annual Cost $3,686.02$5,351.26$3,775.74$7,398.52$3,206.34 * Tax savings will vary based on your current FSA contribution and medical plan election.

20 Scenario #3: Employee Plus Spouse (income >$35,000) - Elective Surgery for Family Member Premium/ProcedureUHC Choice HMO UHC Choice Plus POS UHC HDHPBC ExcelBC Choice Annual Physical ($280) $0 Office Visits (1 PCP, 2 specialists) - ($330) $105 $330 MRI – Knee ($750) $150 $750$286$486 Elective Knee Surgery ($7,000 charge) $150 $2,936$1,384$1,400 Rehabilitation ($1,560 – 18 visits) $720 $312$0$312 Out-of-Pocket Cost ($9,920) $1,125 $4,328$2,000$2,528 Premium Contribution $2,776.80$4,008$421.08$4,635.96$942.96 HSA University Contribution ($400) $200 HSA Contribution with Tax Savings* (28% Rate) ($56.00) Total Annual Cost $3,901.80$5,133$4,293.08$6,635.96$3,470.96 * Tax savings will vary based on your current FSA contribution and medical plan election.

21 Scenario #4: Employee Plus Family with Two Children – One child has a sports injury, the other child has asthma Premium/ProcedureUHC Choice HMO UHC Choice Plus POS UHC HDHPBC ExcelBC Choice Child 1* - Emergency Room Visit, Treatment for Broken Leg, and Physical Therapy ($7,200) $630 $3,840$1,840$2,040 Child 2 - ER Visit, 1 Night in the Hospital, 4 office visits, and Asthma Medications (12 Tier 2 Retail) ($5,800/$1,700 Rx) $400 + $480 (Rx) $400 + $480 (Rx) $1,500 $1,560 + $480 (Rx) $1,760 + $480 (Rx) Employee – Annual Physical ($250) $0 Spouse – Well Woman Exam ($230) and 2 office visits for illness ($180) $50 $36 Out-of-Pocket Cost ($15,360) $1,560 $5,376$3,916$4,316 Premium Contribution $3,945.25$6,044.52$806.40$6925.08$1,833.72 HSA University Contribution ($400) $200 HSA Contribution with Tax Savings* (28% Rate) ($56.00) Total Annual Cost $5,505.24$7,604.53$5,726.40$10,841.08$6,149.72 * 4 specialist visits, 8 physical therapy sessions ** Tax savings will vary based on your current FSA contribution and medical plan election.


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