Presentation on theme: "What is a High Deductible Health Plan? City and County of Denver"— Presentation transcript:
1 What is a High Deductible Health Plan? City and County of Denver 1/1/2016
2 OpeningA high deductible health plan and an HSA may sound confusing, but we are here today to help you better understand your new plan option.
3 High Deductible Health Plan New in 2016 for all City and County of Denver employees
4 High Deductible Health Plan (HDHP) A high deductible health plan (HDHP) is a type of health insurance plan that meets the deductible limits set by the Internal Revenue Service (IRS). The plan lets you open a health savings account and save money, tax-free.Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,350, you are responsible for all expenses at the discounted UHC rate until you’ve met the $1,350 deductible.Preventive Care: Preventive care is covered at 100% on your HDHP. For a detailed list of services covered, go to Preventive care services are determined by US Preventive Task Force Alliance per health reform guidelines.
5 The Benefits of a HDHP Low Up Front Premium! Member is responsible for all costs up to $1,350 deductible for Employee only coverage and $2,700 deductible for Employee + 1 or more.Member pays 20% coinsurance for medical services after deductible is met, and copays for prescription medications.All expenses, including deductible, and pharmacy copays apply to the out-of-pocket maximum of $2,700 for individual and $5,400 for family.Paired with a Health Savings Account (HSA) which is a bank account that you own to help pay for your qualified expensesBest of all – The City and County is making an initial contribution of $600 (individual) and $1,200 (family) into your HSA account.
7 High Deductible Health Plan You have the freedom to use any doctor or hospital you want. The UHC Network will remain the same. The Network is Nationwide and you do not need to change your doctors.You save money when you use health care providers in the Choice Plus network because they’ve agreed to charge lower prices.You will have coverage if you receive care outside the network. However, you will likely pay more.You save more when you stay in network.
8 High Deductible Health Plan You do not need to choose a primary care provider (PCP).The covered services remain the same, it is just how the services are paid which is changing. If you are currently in treatment (i.e. pregnancy, chiropractic, or diabetic) your treatment will not be impacted.A PCP can be helpful in managing your care.See any doctor, including specialists, without referrals.
9 HDHP with HSA How the plan works: Your deductible – You pay until you reach the deductible.Your co-insurance – You and your plan share the cost of services.Your out-of-pocket limit – You are done paying for the year.123Your DeductibleYour co-insurance (After you reach the deductible)Your out-of-pocket limitPay with your HSA or another wayIndividual $1,350 / Family $2,700You are done payingIndividual: $2,700 / Family $5,400 (When you reach the limit, the plan pays 100%.)Your plan pays 80 %You pay 20%+(You can pay your share using your HSA.)Use $1350 Individual Deductible, $2,700 Family Deductible, 80% Coinsurance, and $2,700, $5,400 OOP. Preventive care is covered 100% when you use a network doctor.
10 Pay with your HSA or another way Member Scenarios – MariaMaria is a healthy 26 year old with no chronic conditions. She has employee only coverage and would like a health plan with low monthly payments, but still have coverage in the event of any unexpected health incidents.Type of CostUHC HDHP with Health Savings AccountYearly Premium$360.24HSA Contribution received from City and County of Denver-$600.00Sick visit to PCP$68.00Preventive Care Visit$0Tier 1 Medication$8.00Total Cost in 2016-$163.76Money saved in 2016 by enrolling in HDHP over the Deductible HMO plan.$1,025.12Your DeductiblePay with your HSA or another wayIndividual $1,350 / Family $2,750In $1350 Individual Deductible, $2,700 Family Deductible, 80% Coinsurance, and $2,700, $5,400 OOP. Preventive care is covered 100% when you use a network doctor.
11 Pay with your HSA or another way Member Scenarios – TomTom is a father of 2 young children and a spouse who is expecting their third child in He has family coverage and needs a plan that makes the most financial sense.Type of CostUHC HDHP with Health Savings AccountYearly Premium$3,458.04HSA Contribution received from City and County of Denver-$1,200.004 Sick visits to PCP$272.004 Preventive Care Visits$0Urgent Care Visit$110.00Emergency Room Visit$1,800.004 Day Hospital IP Admit$3,210.00Tier 1 Medication$8.00Total Cost in 2016$7,658.04Money saved in 2016 by enrolling in HDHP over the Deductible HMO plan.$1,468.04Pay with your HSA or another wayIndividual $1,350 / Family $2,750In 2016, $1350 Individual Deductible, $2,700 Family Deductible, 80% Coinsurance, and $2,700, $5,400 OOP. Preventive care is covered 100% when you use a network doctor.
12 Consumerism and the HDHP How do I know how much my healthcare costs?
13 The cost of care – how will you know? We have many tools available to make you a wiseconsumer of healthcare.Utilize UHC’s Treatment Cost Estimator available onUse Tier 1 Medications when appropriate, the UHC Pharmacy Drug list is available onSeek care at appropriate place of service (i.e. utilize urgent care rather than emergency room)Ask Questions!
14 Where will you go for care? Average out-of-pocket costs while meeting your deductible$80 PCP Visit$180 Specialist$50 Convenience Care$120 Urgent Care$1,800Emergency Room
16 How the plan works with an HSA Think of an HSA as a savings plan for health care you’ll need today, tomorrow and into the future.It’s a real bank account, but you don’t pay federal income tax on the money you deposit into it and the money you use for qualified medical expenses. Your savings also grows tax free.You can even build your savings into a nest egg for retirement. Your savings grow from year to year. There’s no “use it or lose it” rule.The money is there when you need it. And it’s yours to keep.
18 Health Savings Account You own it.It has triple tax benefits.Anyone can contribute.It’s not just for doctor visits.You can invest it.You can save it for the future.Your employer is making an up-front contribution of $600 (employee only) and $1,200 (family) your HSA. There is no match required!
20 EligibilityTo deposit money into an HSA, you must be enrolled in an HSA-eligible health plan.You are eligible if:You are covered under an eligible high-deductible health plan (HDHP).You are covered by no other health coverage, unless it is permissible coverage like vision or dental.You are not enrolled in Medicare.You cannot be claimed as a dependent on someone else’s tax return.Some other restrictions apply. Please consult your tax, benefits or financial advisor.
21 2016 HSA GUIDELINES – AS ESTABLISHED BY THE IRS
22 2016 Contribution LimitsThe IRS limits how much you can put into your HSA each year.The 2016 limits are:Family CoverageIndividualCoverage$3,350$6,750Source: National Data as Reported by HHS through March 10, 2015Are you 55 or older?You can put in an extra $1,000 this year.
24 OptumBankUnitedHealthcare’s preferred health care bank is dedicated to helping people save for health care.The national leader in HSA banking with more than a million account holders.Offers the convenience of banking through myuhc.com.
26 Health Savings Account (HSA) A health savings account (HSA) is a bank account that lets people put money aside, tax-free, to save and pay for health care expenses.The Internal Revenue Service (IRS) limits who can open and put money into an HSA.
28 How to open your HSA with OptumBank – Member FDICOptumBank is focused only on health care and helping you save.Three different account types.Each has different monthly maintenance fees which are waived once a specified dollar amount is reached.Some earn interest on account balances.You can invest the money in mutual funds after a certain dollar amount is reached (level of money needed for investments differs by account type).Yes, they are a real bank and the largest HSA bank in the country.Will be linked to your insurance plan to make things easy.The City and County of Denver will provide you a URL link to open your bank account with OptumBank during Open Enrollment.
29 Benefits of the HSA Debit Card You will receive a UnitedHealthcare HSA Debit CardEasy access to HSA dollarsProvided by OptumHealth BankUse at doctor’s office or pharmacyWithdraw cash at ATM*Get additional cards for family membersFree online bill payChecks (optional, $10 for $25)*Access fees may also be charged by ATM owner.
31 Payment for Services Payment is simple: You can use your HSA to pay for qualified medical, dental and vision expenses, such asdoctor visits, prescriptions and hospital visits, to name only a few.There’s no “use it or lose it” rule. You decide whether to spend your money on health carenow or to build your savings for expenses later.Payment is simple:Use your Optum Bank HSA Debit MasterCard® at a pharmacy, doctor’s office or other health care provider. Payment at time of service is only required for pharmacy charges.Reimburse yourself for qualified health care expenses from your HSA.Pay bills online at no charge, or pay with checks linked to your HSA, if you choose to purchase them.
32 Payment for Services The HSA payment process: 3 Doctor then bills you for payment. After deductible, doctor bills you for your share of co-insurance.1Present ID card to doctor2Doctor sends claim to UnitedHealthcare. UnitedHealthcare applies network discount, sends back to doctor.4When you have claim activity, you will receive a Health Statement.
34 Recap of HDHP with HSA Here’s a recap of how your plan works: Remember, you’ll begin your HSA with your employer contribution:1You have a health event.You pay the full cost of your health care expenses until you meet your deductible. You can choose to pay your deductible with money from your HSA or you can pay another way and let your HSA grow.Once your deductible is paid, the plan coverage begins and you and the plan pay co-insurance. You’re protected with an out-of-pocket limit. After you reach this limit, the plan pays 100% of covered expenses.$600$1,20023FamilySingleDeposited into your OptumBank HSA account 1/1/2016Where to go for more information:welcometouhc.com/denver