murray school district

M Murray School DistrictMedical Insurance Plan & Health Savings Account Information

September 1, 2013 through August 31, 2014

Choice in Provider Networks

34 Participating hospitals; 3,700+ Participating providers

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School District 9/2013 - 8/2014

NOTICE:The network of providers will no longer be offered as of September 1, 2013.

10 Participating hospitals; 1,200+ Participating providers

How To Find A Participating Provider

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• Visit www.selecthealth.org/provider

• Call Member Advocates at (801) 442-4993

• Refer to the printed provider and facility directory found within your SelectHealth materials

NEW! Med+ HealthSave Plan Traditional Med+ Traditional Value

Single Couple Family Single Couple Family Single Couple Family

Premiums(per month)

Savings Account

Contribution (annually)

$43.98

$1,067

$100.08

$2,400

$140.28

$3,398

$132.84

$0

$300.08

$0

$423.48

$0

$92.24

$0

$208.88

$0

$294.18

$0

Monthly Premiums & HSA Contributions

ADMINISTRATORSMurray


M


Participating Non-Participating Participating Non-Participating Participating Only

Deductible*(Per Plan Year)

Out-of-Pocket Maximum

(Per Plan Year)

$2,000/$4,000Individual / Family 2+

IRS Regulation


IRS Regulation


IRS Regulation


IRS Regulation

$500/$1,500Individual / Family

$2,500/$5,000Individual / Family



$500/$1,500Individual / Family

$2,500/$5000Individual / Family

Deductible & Out-of-Pocket Maximum

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In accordance with IRS regulations, the HealthSave plan has an individual deductible or a family (2 or more covered) deductible and out-of-pocket maximum. Unlike the traditional plans, when an employee selects a family plan (2 or more covered), the entire family deductible must be met BEFORE the copayment/coinsurance schedule goes into effect, even if all of the claims are accrued by just one individual in the family.

* The deductible is included in the out-of-pocket maximum on all plans.



Preventive Care

Primary Care Physician

Secondary Care Physician

Chiropractic Care

Rehab Therapy(Outpatient: Physical/Speech/Occupational

20 visits per therapy type)

100%

$15 after deductible


Not covered


Not covered

40% after deductible


Not covered


100%

$30

$40

Not covered


Not covered



Not covered


100%

$30

$40

Not covered


Office VisitsMMurray




Urgent Care

Emergency Room

Inpatient Services

Outpatient

$35/$15 after

deductibleInstaCare / KidsCare








$45 / $30InstaCare / KidsCare








$45 / $30InstaCare / KidsCare




Urgent Care, ER, Inpatient and Outpatient

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Separate

Rx Deductible

Up to a

30 Day Supply

Up to a mail order or Retail 90

90 Day SupplyAvailable for maintenance

medications only

Not ApplicableRx combined with medical deductible

Tier 1: $7 after medical deductible






*$100 Per person

*Tier 1: $15 *Tier 2: $30 after Rx deductible

*Tier 3: $50 after Rx deductible

*Tier 1: $15*Tier 2: $60 after Rx deductible


*$100 Per person

*Tier 1: $15 *Tier 2: $30 after Rx deductible


*Tier 1: $15*Tier 2: $60 after Rx deductible


Rx SelectPrescription Drugs

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Tier 1: Generic medication Generic substitution is required when a generic is available.Tier 2: Name brand preferred formulary medicationTier 3: Name brand non-preferred medication

* Not applied toward medical out-of-pocket maximum.

Procedure Total Cost SelectHealth Allowable Amount

NEW! Med+ HealthSave Plan

$2,000/$4,000 DeductibleTraditional Med+

$500/$1,500 DeductibleTraditional Value

$500/$1,500 Deductible

Annual Exam(Preventive)

Colonoscopy (Preventive)

Pharmacy Deductible

5 Prescriptions

Urgent Care Visit

Out-of-Pocket Medical Expense:

$120

$1,500

n/a

$350

$200

$2,170

$80

$1,000

n/a

$280

$150

$1,510

$0

$0

n/a

$280

$150

$430

$0

$0

$100

$90 copayments(4 - $15, 1 - $30)

$45 copay

$235

$0

$0

$100

$90 copayments(4 - $15, 1 - $30)

$45 copay

$235

How Do the Plans Work?MMurray


Scenario 1: Linda is enrolled with family coverage. During the year, she has an annual exam, a colonoscopy, fills 5 prescriptions for family members (4 generic / 1 name brand) and has a visit to an urgent care clinic. How will each plan cover her expenses?

Procedure NEW! Med+ HealthSave Plan




Annual Family Premium To Have Coverage

+ Out-of-Pocket Medical Expense Total (see previous slide)

PREMIUM & OUT-OF-POCKET EXPENSES

- HSA Contribution from MSD for Health Expenses

FINAL OUT OF POCKET COSTS

HSA Contribution Balance Available to Roll Over to Be Used Toward Next Year’s Medical Expenses

Employee’s HSA Contribution/Roll Over

$1,683

$430

$2,113

- $3,398

$1,683

$2,968

TBD

$5,081

$235

$5,316

n/a

$5,316

n/a

TBD

$3,530

$235

$3,765

n/a

$3,765

n/a

TBD



CONTINUED - Scenario 1 : Linda is enrolled with family coverage. During the year, she has an annual exam, a colonoscopy, fills 5 prescriptions for family members (4 generic / 1 name brand) and has a visit to an urgent care clinic. How will each plan cover her expenses?






Birth Deductible Coinsurance

5 Office Visits

Pharmacy Deductible

Prescriptions


$10,000

$600

n/a

$11,700

$22,300

$7,500

$400

n/a

$8,200

$16,100

$4,000 deductible (MET!)100%

$75 copayments

n/a

$588 copayments(1 -$7 x 12, 1 - $42 x 12)

$4,663

$1,000 deductible (20%) $1,300 coinsurance

$150 copayments

$100

$780 copayments(1 - $15 x 12, 1 - $50 x 12)

$3,330

$1,000 deductible(20%) $1,300 coinsurance

$150 copayments

$100

$780 copayments(1 - $15 x 12, 1 - $30 x 12)

$3,330



Scenario 2: John is enrolled with family coverage. During the year, his wife has a baby. He later has five office visits and takes two prescriptions on a monthly basis (1 generic / 1 non-preferred name brand). How will each plan cover his expenses?


$2000/$4000 DeductibleTraditional Med+



Annual Family Premium To Have Coverage


PREMIUM & OUT-OF-POCKET EXPENESES


FINAL ANNUAL OUT-OF-POCKET COST


$1,683

$4,663

$6,346

-$3,398

$1,265

TBD

$5,081

$3,330

$8,411

n/a

$8,411

TBD

$3,530

$3,330

$6,860

n/a

$6,860

TBD



CONTINUED - Scenario 2: John is enrolled with family coverage. During the year, his wife has a baby. He later has five office visits and takes two prescriptions on a monthly basis (1 generic / 1 non-preferred name brand). How will each plan cover his expenses?






Broken Leg Deductible Coinsurance

Pharmacy Deductible

Prescriptions


$6,000

n/a

$1,000

$7,000

$3,800

n/a

$600

$4,400

$2,000 deductible(20%) $360 coinsurance

n/a

$600

$2,960

$500 deductible (20%) $660 coinsurance

$100

$360 copayments(1 - $30 x 12)

$1,620

$500 deductible(20%) $660 coinsurance

$100

$360 copayments(1 - $30 x 12)

$1,620



Scenario 3: Susan is enrolled with single coverage. During the year, she goes in for outpatient services from a skiing accident and takes a prescription monthly for pain. How will each plan cover her expenses?


$2000/$4000 DeductibleTraditional Med+



Annual Single Premium To Have Coverage


PREMIUM & OUT-OF-POCKET EXPENESES


FINAL ANNUAL OUT-OF-POCKET COST


$527

$2,960

$3,487

-$1,067

$2,420

TBD

$1,594

$1,620

$3,214

n/a

$3,214

TBD

$1,106

$1,620

$2,793

n/a

$2,793

TBD



CONTINUED - Scenario 3: Susan is enrolled with single coverage. During the year, she goes in for outpatient services from a skiing accident and takes a prescription monthly for pain. How will each plan cover her expenses?

WHY CHOOSE AN HSA Account?

TRADITIONAL PLAN VS. HSA PLAN

Traditional Plan HSA-Based Plan

Employee’s Spending Account

Insurance Premium

Insurance Premium

Monthly Payment

This is used for regular medical expenses and employees keep what they don’t spend.

Save and keep your money year-over-year with an Health Savings Account!

• Lower medical plan premiums, tax-free contributions and long-term saving

• Contributions roll over from year-to-year with the potential to invest at a certain balance level

HSA COMPONENTS

TO HAVE A HEALTH SAVINGS ACCOUNT, YOU MUST HAVE A QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN

HDHPLow-Premium, High-Deductible Health Plan

THE INSURANCE PLAN PIECE FROM SELECTHEALTH

HSAHealth Savings Account

THE SAVINGS ACCOUNT USED TO FUND EXPENSES, TAX-FREE

WHO’S ELIGIBLE TO HAVE A HEALTH SAVINGS ACCOUNT?

To qualify for an HSA, you must:

• Participate in a qualified high-deductible health plan (HDHP)

• Must be 18 years or older• Have no other coverage except what is

permitted by the IRS as other health coverage (i.e., Tricare. See IRS Publication 969)

• Not be enrolled in Medicare• Not be claimed as a dependent on

someone else’s tax return

What is a Health Savings Account (HSA)?

It is a savings account that you own to pay for your qualified medical expenses.

Employee’s HSA

Qualified Medical Expense

Qualified Medical Expense

IRS ALLOWABLE CONTRIBUTIONS

2013 maximum contributions allowed by the IRS:

Single-coverage $3,250

Family-coverage (2 or more family members) $6,450

Catch-up contribution, age 55+ $1,000

• Employees can fully fund the HSA on day one (subject to the annual maximum)

• You can make contributions anytime after your HSA is open

• You can make pre-tax contributions through payroll deduction, online, or directly to HealthEquity

• Money rolls over from year-to-year. You don’t lose the money left in your HSA or the interest it’s earned. It’s your money.

Murray School District’s annual contribution to your account:

Single Coverage: $1,066.80 per yearCouple Coverage: $2,400.00 per yearFamily Coverage: $3.398.40 per year

You too, can contribute pre-tax dollars!

HOW DO I GET STARTED BUILDING AN HSA?

Triple tax-savings • Contributions aren’t taxed and reduce your annual taxable income• Withdrawals are never taxed or penalized when used for qualified medical expenses; including

Rx, dental, vision• Earnings aren’t taxed

An HSA is your account • You own the account and the money stays with you, even if you change jobs or retire

• Most HSA-qualified plans have maximum out-of-pocket limits- Before you reach your out-of-pocket limit, use your HSA balance to pay expenses- Reach your out-of-pocket limit, and expenses are fully covered

• Cover spouse/dependent expenses, even if on another health plan- The money in your HSA can be used to pay for qualified medical expenses of any family

member who qualifies as a dependent on your tax return. However, if the dependent isn’t covered under your medical plan, their expenses will not be applied toward meeting your deductible and out-of-pocket maximum

MAXIMIZE YOUR MONEY

How the HSA Plan Works: Going to the Doctor

Go to the doctor

Doctor sends SelectHealth the bill

Claim integrated from SelectHealth to HealthEquity website

Try not to pay at point of service, since you may not know the exact charge of the claim and want SelectHealth discounts applied to the service.

Health Plan adjusts price based on network discounts.

Go to HealthEquity website to pay the claim directly to the provider. If funds aren’t available, pay out of pocket and reimburse yourself later.

SelectHealth Medical Plan ID Card

Member Name:ID Number:Rx Bin Number:

How the HSA Plan Works: Going to the Pharmacy

Go to the pharmacy

Pharmacy automatically applies discounts

Pharmacy sends claim to SelectHealth

Show your SelectHealth ID card. Pharmacy discounts are automatically applied at point of service.

Pay with your HealthEquity HSA Card.

SelectHealth applies the amount toward your deductible.

• Order additional ID cards and update your personal information including address

• View your medical plan benefits as an employee of Murray School District

• View your claims and EOBs, including year-to-date totals toward meeting your deductible and out-of-pocket maximum

• Access your pharmacy benefit information, review your pharmacy claims, your prescription drug history, and lower-cost drug alternatives

• Go green! Switch to paperless explanation of benefits (EOB) when your claims are processed

• View your Intermountain medical records including lab results and imaging reports

• Securely message with SelectHealth’s Member Services team

HealthEquity website prepopulated with your claims information

View and pay your claims online from HealthEquity website

Helping you manage the financial side of health care

Together, HealthEquity and SelectHealth look forward to another year serving you!

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• Visit www.healthequity.com • Questions? (866) 346-5800

• Visit www.selecthealth.org • Questions? (801) 442-5038

http://www.healthequity.com/

http://www.selecthealth.org/

murray school district

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entire family deductible

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participating hospitals

traditional plans

participating providershow

irs regulations

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