h.b. fuller company 2009 open enrollment: helping you buy well, use well, be well october, 2008
Post on 21-Dec-2015
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An overview of your plan options for 2009 Market 400
Value 750
High Deductible Health Plan (HDHP)with a Health Savings Account (HSA)
Key differences between plan options
Tools and resources to find the information you need
How and when to enroll
Today’s Discussion
PURPOSE OF TODAY’S MEETING:To help you understand your new choices in medical plan options
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Market 400 Value 750 HDHP w/ HSA
Deductible $400 Single
$800 Family
$750 Single
$1,500 Family
$2,000 Single
$4,000 Family
Fuller contribution to HSA
N/A N/A $500 Single
$1,000 Family (active employees only)
Out of pocket maximum
$1,500 Single
$3,000 Family
$3,000 Single
$6,000 Family
Same as your deductible
Preventive care (in-network only)
100% 100% 100%
Office visit copay
$30 $30 N/A
Medical Plan Options Summary
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Market 400 Value 750 HDHP w/ HSA
Pharmacy
Generic
Brand
Non-formulary
Specialty
You pay 20% with:
Minimum Maximum
$10 $20
$20 $40
$40 $80
$80 $160
You pay 20% with:
Minimum Maximum
$10 $20
$20 $40
$40 $80
$80 $160
100% after deductible
Coinsurance 80% after deductible 80% after deductible 100% after deductible
Out-of-network coverage
60% (deductible and OOP max doubled)
60% (deductible and OOP max doubled)
100% - no network restrictions
Premium (Month)
Employee
Employee + 1
Family
$79.80
$159.60
$239.40
$57.80
$115.60
$173.40
$54.80
$109.40
$164.40
Medical Plan Options Summary (cont.)
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This option is the most similar to what you have today, with the deductible and out–of- pocket maximum adjusted to be at the mid-point of the market. As this option has the lowest deductible and out-of-pocket limit, it carries the highest premium contribution.
Pharmacy: 20% member copay with a min/max of:
Key Features of Market 400
Deductible – $400 single $800 familyOut of Pocket - $1,500 single $3,000 family
Office visit copay -- $30
Preventive care 100% in-network only
Deductible and coinsurance applies to X-ray and imaging, inpatient and outpatient hospital, emergency room (+$75 copay) and durable medical equipment
Office visit, pharmacy and emergency room copays do not apply to deductible or out-of-pocket maximum.
Generic – $10/$20 Brand – $20/$40 Non-Formulary Brand – $40/$80 Specialty Pharmacy – $80/$160
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The other plan features are identical to the Market 400. Eligible expenses are paid in the same manner in both options. Office visit copay -- $30 Preventive care – 100% in-network only Pharmacy: 20% member copay with a min/max of: Generic – $10/$20 Brand – $20/$40
Non-Formulary Brand – $40/$80 Specialty Pharmacy – $80/$160 Deductible and coinsurance applies to X-ray and imaging, inpatient and outpatient
hospital, emergency room (+$75 copay) and durable medical equipment Office visit, pharmacy and emergency room copays do not apply to deductible or
out-of-pocket maximum.
Key Features of Value 750Choosing a higher
deductible is similar to the decision you make when you buy car insurance.
You balance what you can afford to fix yourself vs.
what you want your insurance to cover. It is always more expensive when you have a low
deductible.
This option lets you pay less in monthly premium. In exchange, you may need to pay a higher deductible before the plan begins to pay.
Deductible -- $750, $1,500 Out of pocket limit -- $3,000, $6,000 Premium: 40% less than Market 400
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Key Features of HBF’s HDHP with HSA
This means: High Deductible Health Plan with a Health Savings Account
High Deductible Health Plan
$2,000/$4,000 deductible (total family deductible must be met)
The out-of-pocket maximum matches the deductible. The plan pays 100% after the deductible is met for eligible expenses.
Same definition of eligible expenses as in Market 400 and Value 750
Prescription drugs must apply toward the deductible
Preventive care is covered at 100% in-network
Health Savings Account
Employees have the option to use pre-tax dollars to fund their account up to the IRS limits. For 2009, the limits are $3,000 single/ $5,950 family.
For 2009, HBF will contribute $500/ single
and $1,000/ family
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Tax-free contributions to pay for current and/or future medical expenses
No “use it or lose it”
Interest earned tax free
Investment opportunity with tax-free growth
Flexible – you choose when or whether to use the account for health care expenses
Portable – you own the account
Banking services provided by JPMorgan Chase Bank. Some fees required.
Easy access to funds through debit card
Key Features of an HSA
What is an HSA?It is a savings account that is owned by you
and is associated with a High Deductible Health Plan
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Includes expenses such as: Deductibles Coinsurance Not covered but eligible
IRS expenses Prescription drugs
It also includes expenses for: COBRA-continuation coverage Health plan coverage while receiving unemployment compensation Medicare premiums and out-of-pocket expenses Qualified long-term care insurance
Employees are responsible for keeping all receipts and records, demonstrating that HSA dollars were used for qualified health
care expenses.
HSA Tax-Qualified Expenses
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HSA Eligibility Requirements to Contribute
Member is not eligible to be claimed on another’s tax return1
Member does not have benefits from another qualified health plan2
Member is not currently enrolled in Medicare benefits3
Eligibility
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Health Coverage
Deductible
HSA Pre
ven
tive
Ca
re• Financial stake• Employer and /or employee dollars• Potential rollover and / or savings / investment incentives
100% coverage for preventive care services based on age and gender as recommended under U.S. guidelines
• Peace of mind• Out-of-pocket maximums
• Clearly defined out-of-pocket potential
• Option to reimburse from account
• Financial stake
How the HDHP with HSA Works
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Len -- Year One –
Note: Assumes all in-network care.
Preventive Care $ 750
HSA funded $ 2,000
Non-Preventive3 Physician’s visits $36012 Prescriptions 840
$ 1,200
Health CoverageEmployee Pays $ 0Health Plan Pays $ 750
Remains in HSA for 2nd year $ 800
HSA Pays $ 1,200
Pre
ven
tive C
are
: 1
00
%$
75
0
Health Coverage100% CoinsuranceMax OOP $2,000
Health Coverage
$800 Remaining
$1,200HSA Paid
$1,200
$2,000 HSA
$2,000 Deductible
Example with Moderate Utilization
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Len – Year Two –
Moderate Utilization
Health Coverage100% Coins.
Max OOP $2,000
Pre
ven
tive C
are
: 1
00
%$
30
0$900
$1900 Remaining
$900
$2,000 Deductible $2,800
HSA
HSA Rollover fromyear one $ 800HSA funded $ 2,000
New HSA balance $ 2,800
Immunizations $ 300Non-Preventive
5 Prescriptions $ 350Lab work 2503 Physician’s visits300
$ 900HSA Pays $ 900
Employee Pays $ 0
Health Plan Pays $ 300Remains in HSAfor year three $ 1,900
Note: Assumes all in-network care.
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How Claims Get Filed
Aetna processes the claim, applies the
discounted rate and sends an Explanation of Benefits based on High Deductible Health Plan
Benefits
You visit the doctor
Doctor sendsbill to Aetna
You receive a bill from the provider
You decide whether or not to use HSA funds
You paythe doctor
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Market 400/Value 750
Member copay is 20%
($20min/$40 Max) You pay $25 The plan pays $100
HDHP and HSA
$125 applies to the deductible You pay $125 at the pharmacy You decide when or if you get
reimbursed for the $125
Participating Pharmacy Brand Rx- $125
Claim Payment Comparison
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Claim Payment Comparison
In-Network Preventive Care Office Visit-
$150 Contracted Rate
Market 400/Value 750
Plan pays 100% You pay nothing
HDHP and HSA
Plan pays 100% You pay nothing
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Claim Payment Comparison
In-network Hospital Stay- $4,000 Contracted RateMarket 400 Option
You pay $400 deductible plus
20% of the $3,600= $720 Total member responsibility is
$1,120 Plan pays $2,880
Value750 Plan You pay $750 deductible plus
20% of the $3,250= $650 Total member responsibility is
$1,400 Plan pays $2,600
HDHP with HSA Individual Coverage You pay $2,000* deductible Plan pays $2,000
Family Coverage (2 or more people on the plan)
Plan applies $4,000 toward deductible You pay $4,000* Next claim will be paid at 100%.
*You decide when and if to get reimbursed for any portion available in the HSA
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Important things to consider when making your choice:
Understand how the deductible works Individual vs. family What counts, what doesn’t
Annual premium difference – do the math!
If you are considering the HSA, here are additional considerations:
Prescription coverage – You pay 100% up to the deductible
Tax advantaged, portable savings. Great for retiree medical!
Key Differences
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For help in choosing the right medical plan option
Read newsletters and Enrollment Guide Visit the Aetna website and sign up for Aetna Navigator Try the Plan Selection and Cost Estimator Tool Use Aetna’s Cost Estimator to determine cost of care For “in-person” help, call
the HBF Benefits Connection (formerly FlexPlus) Aetna
Tools for Choosing a Medical Plan
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To enroll online or by phone, you will need:
your 6-digit employee ID (on your pay stub)
Your PIN (Unless changed, PIN is last four digits of SSN)
Either elect or waive coverage for each available category
Print and review confirmation at end of session
Confirmation also sent to you by mail. Confirm elections, send in any additional information required and correct errors within 10 days by calling 800-798-5446 (no corrections online after Nov 11)
How and When to Enroll
Enroll October 29 to November 11
There are no extra “grace days” this year! You MUST enroll in Medical to have coverage 1/1/09
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Why Changes Are Being Made
Assure benefits program is competitive at mid-point to the market
Provide choice to employees Consolidate vendors in order to:
Offer same benefits to all employees Better maximize value Reduce administrative cost and complexity
Adjust contribution and rate setting processes to: Better manage high cost of program More fairly share costs between employees and retirees Involve employees in data-driven decisions Build a Culture of Health