0. 2015 Medical Plan Options, Health Savings Accounts & Flexible Spending
Presented to:
Presented By:
Greg Biese
Vice President,
Senior Benefits Consultant
Associated Financial Group
Employee Benefits. Insurance. HR Solutions.

1. HealthCare Reform: Yesterday, Today & Tomorrow
● Individual Mandate
● Private Exchanges
● Medicaid Expansion
● Play or Pay (Employer Mandate)
● Wellness Incentives
● Government Reporting
● Medical Access
Cadillac Tax
Rules
Plan Design
Fees
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

2. 2015 Medical Eligibility & Rates
* St. Norbert College reserves the right to change the eligibility requirements at any time.
Effective January 1, 2015, St. Norbert College’s medical will implement a Spouse Medical Insurance Coverage Statement, requiring that an employee’s spouse enroll in at least single medical coverage through his/her employer to serve as their primary insurance coverage, or pay an additional surcharge to enroll or maintain enrollment in St. Norbert College’s medical plan as primary coverage. This additional surcharge is $37.50 twice a month ($900 annually)
All employees electing coverage for his/her spouse must complete the Spouse Medical Insurance Coverage Statement. If your spouse is covered under the College’s medical plan currently and you do not return this coverage statement, you will be assessed the additional surcharge until St. Norbert College receives the proper notification from you.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

3. 2015 Benefit highlights
(1) IMPORTANT HSA PLAN NOTICE: No individual family member's deductible or out-of-pocket is considered satisfied until the Full-Family deductible and out-of-pocket has been met.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

4. 2015 Benefit highlights (cont.)
What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood pressure, blood thinner, and beta blockers.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

5. PPO plan effective January 1, 2015
Preventive Services Unchanged
All medical and Rx copays (1) apply to maximum out-of-pocket
Increase to Deductible and Out-of-Pocket Maximums
Costs
New generics drugs
Prescription Drug Plan Design Unchanged
UMR & Optum Rx
Contraceptive Coverage Outside of Plan
(1) Due to Health Care Reform changes, beginning in 2015, all copays, including pharmacy copays, will apply to the out-of-pocket maximum.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

6. HDHP plan (HSA) effective January 1, 2015
100% Coverage (In-Network)
Preventive Services
No individual family member’s deductible or out-of-pocket is considered satisfied until the ‘Full Family’ deductible and out-of-pocket has been met.
Deductible and Out-of-Pocket Maximums (Non-Embedded)
Retail & Mail Order – Subject to Deductible & 90% Coinsurance
Generic Preventive Drugs covered at 100% when filled through Mail Order.
Prescription Drugs
UMR & Optum Rx
Contraceptive Coverage Outside of Plan
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

7. Certain services can be done for preventive or diagnostic reasons.
Preventive Services
Certain services can be done for preventive or diagnostic reasons.
Covered preventive services performed specifically for preventive screening with no known symptoms, illnesses or history are generally covered as preventive care, subject to age and gender guidelines and health status.
Associated Bank is the designated HSA custodian for employer sponsored medical plans. Associated Bank will provide a bank account for contributions to be deposited. Along with the account you will receive information about how the account will be managed along with online and telephonic banking.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

8. Diagnostic Services
Diagnostic services are generally not covered under the preventive care benefit but may be covered under another portion of your medical benefit plan.
Services are considered diagnostic when a person:
Has abnormalities found on previous preventive or diagnostic services that require further diagnostic services; or
Had abnormalities found on previous preventive or diagnostic services that would recommend a repeat of the same service within a shortened time period from the recommended preventive screening time period based on age and gender; or
Had a symptom(s) that required further diagnosis
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

9. HSA What Exactly is an HSA?
PART 1:
HIGH DEDUCTIBLE
HEALTH PLAN
(HDHP)
Intended to cover serious illness or injury once the deductible is met.
HSA
PART 2:
HEALTH SAVINGS
ACCOUNT
(HSA)
Used to cover expenses until the deductible is met.
TWO PARTS TO AN HSA
To simplify that definition, let’s look at in through this flow chart.
An HSA is actually made up of two parts:
The first part is the health plan itself. In order to have an HSA, you must be covered by a qualified high deductible health plan (often called an HDHP) which is intended to cover serious illnesses or injuries once you have paid the high deductible. An HDHP generally costs less than what traditional health care coverage costs, so the money that you save on insurance can therefore be put into the Health Savings Account.
The second is the Health Savings Account itself. Money in the HSA is used to cover small routine expenses until the deductible is met.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

10. Important Information Regarding Your HSa / High Deductible Health Plan (HDHP)
There are NO office visit, emergency room, or prescription drug copays.
All out-of-pocket expenses count towards the deductible & out-of-pocket maximum.
The preventive healthcare benefit is still covered at 100% (all participants); includes services under the Women’s Care Act. Does not include contraceptive services.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

11. Important Information Regarding Your HSa / High Deductible Health Plan (HDHP)
The deductible and coinsurance out-of-pocket maximum for family is a true family deductible and out-of-pocket maximum.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

12. Who is Eligible for HSA’s?
Any employee that:
Is covered by an HDHP
Is not covered by another non-HDHP health plan
Is not enrolled in Medicare
Cannot be claimed as a dependent on someone else’s tax return
Simply defined, a health savings account (HSA), is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a High Deductible Health Plan (HDHP).
Think of it like an IRA for your healthcare. You set aside money in a HSA to pay for eligible out-of-pocket healthcare expenses. You pay all your medical costs until you reach your deductible, but you can use your HSA to reimburse yourself for these costs.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

13. Advantages of an HSA Ownership - you own the funds in your HSA
Tax-free
Portable
No “use it or lose it”
You may change your employee contribution amount throughout the year.
You can choose to invest your savings in an investment account.
One of the most significant advantages of owning a HSA is any contributions made to the account and funds accumulated are owned by the individual (not the employer). With that, the individual decides:
Whether he or she should contribute
How much to use for medical expenses
Which medical expenses to pay from the account
Whether to pay for medical expenses from the account or save the account for future us
Contributions are not subject to withholding for federal income tax. However, as previously mentioned, taxation varies by state. Account distributions are tax free when used for qualified medical expenses.
The HSA is portable. This means you take the account with you. For example, if an employee leaves and goes to another employer that offers a High Deductible Health Plan, they can have their employer start contributing to their account. When the employee is not covered by a HDHP but still has a HSA, they can use the funds for medical expenses.
Unlike Health Care Flexible Spending Accounts, there are no use it or lose it rules. This feature allows the account holder to rollover the account balance year after year.
The HSA is interest bearing both within the account and via the long term investment options.
Finally, as you look across the plan options offered by your employer, you will notice the High Deductible Health Plan has the lowest premium. While this is an advantage, you will want to make sure you understand how the plan works, because if you need to use Health Care you will have a higher deductible to satisfy before any benefits are paid by the plan.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

14. HSA Annual Contributions – 2015
Annual contributions to the HSA are limited to $3,350 single / $6,650 family (Employer & Employee Contributions Combined)
St. Norbert College - Annual HSA Contribution
$500 - Single Coverage; $750 - Family Coverage
Employer contributions will be deposited twice per year
Single: $333 (1st Payroll in January); $167 (1st payroll in September)
Family: $500 (1st payroll in January); $250 (1st payroll in September)
Benefits are subject to federal regulations. Minimum deductibles, maximum out-of-pocket limits and contribution maximums are determined annually
Account holders age 55 and up may make additional contributions of $1,000 in 2015.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

15. Contributing to Your HSA
You can elect how much money you want to put into your HSA.
It is your responsibility to ensure that you do not exceed the maximum HSA contribution limit.
Your employer will deduct this amount on the date of each payroll on a pre-tax basis and the money will be direct-deposited to your HSA account.
You may also deposit funds directly into your bank account with post-tax dollars and claim the amount on your tax return.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

16. Who Determines Whether HSA Distributions are Used Exclusively for Qualified Medical Expenses?
YOU!
Your bank will submit information to the IRS each year to report contributions and withdrawals.
You will need to report withdrawals on your federal income tax forms.
Individuals who establish HSAs should maintain records of their medical expenses to show that the distributions have been made exclusively for qualified medical expenses.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

17. HSA Withdrawals / Distributions
Federal tax treatment of funds used:
HSA Withdrawals are always Federal tax free for qualified medical expenses, and are so at any age. After age 65, you can use the funds for non-qualified medical expenses without a penalty, but you the money will be taxed.
If you use your HSA funds for non-qualified medical expenses before age 65, not only will the funds be taxed, but you will also pay a 10% penalty.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

18. Eligible Medical Expenses for Tax-Free Distributions
Qualifying medical expenses - IRS Publication 502
Dental and vision care expenses
Long-term care insurance
Premiums for coverage while receiving unemployment compensation
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

19. Bank Information
At the end of the year, the bank will send each account beneficiary a statement with the fair market value of the HSA and forms with the total contributions and distributions:
Form 1099-SA (distributions)
Form 5498-SA (contributions, rollover deposits and fair market value for each calendar year)
This information is reported to the IRS.
You will need to complete form 8889 and file with your personal income tax return.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

20. Ways to Be a More Cost Conscious Consumer of Health Care
Get Healthy and Stay Healthy!
Use Appropriate ‘Levels of Care’ – Fast Care/Urgent Care/Emergency Room
Use In-Network Providers
Consider Generic or Mail Order prescriptions
Consider $4 Generic Programs at Target & Wal-Mart Stores
Ask doctors and pharmacists questions
Most effective treatment
Cost of treatment
Alternatives to treatment
Support and participate in company sponsored wellness and disease management initiatives
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

21. Convenience – Walk-In Care Clinic
Levels of Care Sample
COST
$500+
$200+
$125+
$49-$69 $0
Emergency Room
Complex chest pain, trauma
Available extended hours & weekends
Urgent Care Clinic
Sprains, strains, sutures; typically hospital-based
Available extended hours & weekends
Primary Care Provider
Wellness/preventive/screening services, comprehensive management of acute and chronic conditions
Available extended hours & weekends in some cases
Convenience – Walk-In Care Clinic
Colds, flu, quick service
Available extended hours & weekends
Nurse Line
Health and first aid questions, premium provider search, guidance on appropriate facility and location to meet care needs
No Cost
Available 24/7
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

22. Prescription Cost and Savings Opportunities - $4 Prescriptions
WHAT IS IT?
Many retail pharmacies have recently created new and innovative programs to help control prescription drug costs for consumers. One of the most popular is the $4 prescription drug program, which has allowed consumers to take advantage of tremendous savings for their everyday prescriptions needs. This program is offered at many national and regional pharmacies, including those shown above, and typically includes hundreds of medications in a variety of therapeutic classifications.
Other programs that may be available in your area may include free antibiotics and various 90-day supply discounts for maintenance medications. Many pharmacies also have low-cost membership programs that allow you to access significant savings. It is likely that there will be new programs and enhancements to existing programs in the future as pharmacies continue to compete for the right to fill your prescriptions.
Interaction with insurance - continue to provide your insurance information to ensure you receive the deepest discount and that your coinsurance is applied to your deductible and/or out-of-pocket maximum. If your insurance company has negotiated a deeper discount than $4 (or the pharmacy’s discount rate) for the prescribed medication, you will be charged the lesser of the two prices.
KEEP MONEY
IN YOUR BANK! 22
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

23. Health Savings Accounts (HSA) and Flex Spending Accounts (FSA)
One of the qualifications to have an HSA is that you are not covered by any other low deductible insurance – this includes an FSA.
Therefore, if you enroll in the HDHP Plan and open an HSA Account, you may not participate in a Standard FSA Plan. However, you may enroll in a Limited FSA which can be used to reimburse Dental & Vision expenses ONLY.
You may still participate in the dependent care account.
One of the most significant advantages of owning a HSA is any contributions made to the account and funds accumulated are owned by the individual (not the employer). With that, the individual decides:
Whether he or she should contribute
How much to use for medical expenses
Which medical expenses to pay from the account
Whether to pay for medical expenses from the account or save the account for future us
Contributions are not subject to withholding for federal income tax. However, as previously mentioned, taxation varies by state. Account distributions are tax free when used for qualified medical expenses.
The HSA is portable. This means you take the account with you. For example, if an employee leaves and goes to another employer that offers a High Deductible Health Plan, they can have their employer start contributing to their account. When the employee is not covered by a HDHP but still has a HSA, they can use the funds for medical expenses.
Unlike Health Care Flexible Spending Accounts, there are no use it or lose it rules. This feature allows the account holder to rollover the account balance year after year.
The HSA is interest bearing both within the account and via the long term investment options.
Finally, as you look across the plan options offered by your employer, you will notice the High Deductible Health Plan has the lowest premium. While this is an advantage, you will want to make sure you understand how the plan works, because if you need to use Health Care you will have a higher deductible to satisfy before any benefits are paid by the plan.
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

24. Flexible Spending Account (FSA)
Healthcare FSA
Annual limit of $2,500 (capped per IRS regulations)
Pre-tax dollars used to pay for qualified medical, dental & vision expenses
New: Limited Flex (reimbursement for dental & vision expenses only) for those enrolled in the HDHP Plan (HSA)
New: $500 Roll-Over Feature. Allows Health Care FSA participants to roll-over up to $500 of their previous year’s funds and add them to the new year plan. Rollover funds can only be used after the dollars from the new year’s plan have been used up. (Unused FSA funds in will roll-over into 2016)
Dependent Care FSA
Annual limit of $5,000 (pre-tax dollars used to pay for daycare expenses)
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

25. EBC Features: Submitting claims is EASY
My Mobile Account Assistant
For Android and iPhone
Camera scans documentation
Upload with claim information
Receive notification when a claim is processed
Use the app to review FSA account information
Submit claims online or using paper
My Account Assistant
Your secure web portal lets you review all aspects of your account online at
Submit claims and documentation
Claim Form
Mail or fax a paper form with attached documentation
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

26. 1/1/2015 CHECKLIST New ID cards issued – new member and group number
Other Insurance Questionnaire
Re-Register on UMR.com
Same Network – Choice Plus
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

27. Better information, better decisions, better health on UMR.com
In two clicks
UMR.com gives members access to:
Health cost estimator tools MyHCE (My Healthcare Cost Estimator)
Provider search capability to identify quality and cost efficient providers classified as Tier 1.
Health Education Library
Resources on healthy living
Access to OptumRx
Last modified: 2/26/14
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

28. SECURE Mobile Web Access (No Download Necessary)
Simplified navigation
What’s new
Find out about new tools and information to help you live a healthier life.
Need help?
Click the question mark any time you are confused about a term or benefit and get an explanation.
Home: Return to the main menu. Menu: Display the menu.
Gear: Log out or learn more.
Log in
Enter your username and password for instant access to all our mobile inquiry tools.
Look up claims
Look up a claim for yourself or an authorized dependent.
Check your benefits
View medical and/or
dental benefits, as well as
persons covered.
Find a provider
Need to find a doctor fast? Access an alphabetical listing of network providers.
View, scan or fax your ID card
View your ID card, allow your provider to scan the on-screen bar code for instant access to your benefit information, and/or fax it to a provider. .
Last modified: 5/6/13
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

29. PPO Plan vs. HDHP/HSA Plan (OptumRx)
HDHP Plan (HSA)
Deductible
No Deductible on Rx
$2,000 Single
$4,000 Family
Maximum Out-of- Pocket (Includes Medical & Rx)
$1,500 Single
$3,000 EE+1
$4,500 Family
$4,000 Single
$8,000 Family
Copayment / Coinsurance
Retail: 25% ($10 Min / $50 Max)
Mail Order: $30 Copay (Generic) $90 Copay (Brand)
Deductible, 90% coinsurance
Generic Preventive HSA Medication
n/a
100% coverage if filled at mail order
What are examples of preventive drugs: medications used for diabetes, heart disease, cholesterol, blood pressure, blood thinner and beta blockers.

30. Contraceptive Services Only (CSO) coverage for Eligible Organizations
Coverage for contraceptives services only (both medical and/or Rx, as provided by insurer/TPA) as required by PPACA.
Provides 100% coverage for standard, eligible preventive contraceptive services
Separate from the customer’s medical policy
No cost to employer – not passed on through ASO administrative fees
Must be prescribed (even OTC contraceptives) and filled at a network pharmacy
Cover certain female birth control drugs and services only
All female members, no matter their age, will have birth control available to them
Age limits not applied because:
The age that a woman is no longer able to have children is different for everyone.
It is up to the family, not the health insurance company, to decide if or at what age a young woman might get birth control.
Health insurance companies are required by the health reform law to provide this benefit to ALL females.
Contraceptive Services Only (CSO) coverage
Eligible Organization
Medical/Rx (non CSO) coverage

31. www.optumrx.com Review benefit highlights and coverage
Access to Mail Service Pharmacy prescriptions
My Prescription Dashboard to refill, renew and manage prescriptions
My Medicine Cabinet to manage and price prescription and OTC medications
Locate a retail pharmacy
Explore lower-cost alternatives and options
Download order forms
Access general health information
Web Health Awards:
Now in its 16th year, the goal of the Web Health Awards is to recognize high-quality digital health resources for consumers and health professionals. The awards program is organized by the Health Information Resource Center (HIRC), an 20-year old clearinghouse for professionals who work in consumer health fields.
e-healthcare leadership award: “Best Healthcare Site” and “Best eBusiness Site” among health care companies This leading awards program exclusively recognizes the very best websites and digital communications of healthcare organizations (both large and small), online health companies, pharmaceutical/medical equipment firms, suppliers, and business improvement initiatives. These awards highlight the Internet's role in achieving an organization's business objectives and recognize the hard work that has gone into creating outstanding health websites and digital initiatives.

32. www.optumrx.com Personalized Rx Dashboard Visual Image of All Drugs
Quickly identify Refills
View drugs for renewal
Check Order Status
At-a-Glance Calendar for expiration and refill dates
Quick drop down box to change account for Household/Caregiver view
Simple tab design and quick links to improve navigation and user experience.
My Prescriptions Dashboard
When members login, they will see their personalized Rx Dashboard
Makes it easy for members to view and access their account and prescription information from a single page
Single sign-on
Go on Compass Rose website and they can go over to the consumer portal
Link directly to the PS page
From CR page,
This lead the UHC and Link to Find a Dr.
UHC search application – by UMR
During the presentation – show how to log-in, we can build to so that there is a customized member experience, based on their benefit.
Offer a recommendation- go to the website, and demo and give them the recommendation—show how it works. 32

33. Mobile Website

34. Required Forms to Be Completed
Deadline for enrollment forms is November 26, Return completed forms to your Human Resources Department.
UMR Enrollment Form (New Enrollees, Adding/Removing Dependents, Enrolling in the HDHP/HSA Plan, Dropping Coverage)
Not required if you are keeping your current coverage
Spouse Medical Insurance Coverage Statement.
Required if you have a spouse covered under the SNC plan.
Associated Bank Health Savings Account (for those enrolling in the HDHP/HSA Plan)
Complete application and applicable forms to open your HSA bank account and start contributing!
Delta Dental Enrollment Form (New Enrollees, Adding/Removing Dependents Only, Dropping Coverage)
EBC - FSA Enrollment Form
Enrollment does not carry over - employees who wish to participate must enroll again for 2015
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx

35. Questions?
St. Norbert College/15/Ren/2015 OE Meeting - Plan Options & HSA Education.pptx