qhdhp/hsa educational seminar. open enrollment –medical & dental remaining with same carriers,...

QHDHP/HSA Educational Seminar

OPEN ENROLLMENT– Medical & Dental remaining with same carriers, Altius and EMI

– Adding a QHDHP/HSA- Education Meetings set up

– Vision, Life & Disability Staying the same

– All benefits effective August 1, 2013

– Change plan elections

– Add or delete dependents

– All enrollment MUST be completed no later than June 30th

– Once the enrollment period has ended, you may NOT change your

elections

SOME “LIFE EVENTS” ALLOW YOU TO MAKE CHANGES DURING THE YEAR:When you have a qualifying event or change in employment status, you have 30 days to complete and return a new enrollment/change formSUBMIT THE CHANGE TO HR WITHIN 30 DAYS

– Marriage– Divorce– Birth/Adoption – Loss of Coverage

HEALTH CARE REFORM UPDATES Dependents covered up to age 26 (in place, no change)

Certain preventive services covered at 100% (in place, no change)

Women’s Preventive Care Expanded – effective 8/1/12

No lifetime or annual dollar limits (in place, no change)

Emergency room same benefit in and out of network (in place, no change)

OTC medications not covered on FSA unless prescribed (in place, no change)

W-2 Reporting of Health Benefits in 2013 for 2012 tax year

2013 – Medical Flexible Saving Account - FSA maximum $2,500

Individuals taxed if not on coverage, in effect in 2014

Altius Peak Plus- QHDP

Participating Providers Non-Participating

Deductible – Plan Year *Applies to OOP

$1,500*/ $3,000* $3,000 */ $6,000 *

Out of Pocket Maximum $3,000 /$6,000 $6,000 / 12,000

Hospital Services

Inpatient 20% AD 40% AD

Outpatient 20% AD 40% AD

Maternity 20% AD 40% AD

Office Visits 20% AD 40% AD

Preventive 100% 40% AD

Specialist 20% AD 40% AD

Urgent Care 20% AD40% After Participating

Deductible

Emergency Room 20% AD 20% AD

Prescriptions30 Day

90 Day

After Medical Deductible$10AD$25AD $50AD

$30 / $75 / $150 AD

Participating Providers Only

CONSUMERISM

“Nobody spends someone else’s money as carefully as they spend their own.”

Milton Friedman

Consumer-Driven Health Plans

Cigna Choice Fund Experience Study

When compared to customers in traditional plans, CDHP customers:

Spend less on overall medical services

Receive equal or better

quality care

Are more engaged in their health and health spending

Are more satisfied with their health

care experience

Over five years, CDHP could save up to $9,700 more per employee when compared to traditional plans.



Substantially lower trend in pharmacy the first yearo 14% lower overall pharmacy trend in first yearo 72% of Cigna Choice Fund customers used generic equivalents over

brand-name medications

No sacrifice in quality of care

o Equal or higher use of over 400 evidence-based measureso Higher use of preventive care

Better health risk profiles on full-replacement caseso Improved health risk by 10% in the first year compared with those who

remained in traditional plans o Sustainable in subsequent years



Customers are just as satisfied

Choice Fund Traditional

89% 88%

Customers in Cigna Choice Fund were equally or more satisfied than customers in traditional plans

HRA / HSA Members Spend 7% Less On Overall Health Care Costs

Tota

l Pha

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y Cos

ts

Inpa

tient

Fac

ility

Ambu

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ry Fac

ility

Emer

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y Roo

m

Spec

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t Phy

sician

Prim

ary Ph

ysici

an

Radiology La

b

Home

Health

Med

ical P

harm

acy

$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,800

$2,000

Control GroupStudy Group

Over a 12-month period compared to matched traditional population

8th Annual Aetna Healthfund Study

-16%

-7%

-2%

-2%

-6%

-9% -3%

-2%

-11%

-11%

PCP

PCP

Routin

e

PCP

Non-R

outin

e

Spec

ialis

t

Spec

ialis

t Rou

tine

Spec

ilist

Non

-Rou

tine

Control Group Study Group

-2%

-12%

-5%

-9%

-11% -11%

HRA / HSA Members Are Getting More Routine Care and Less Non-Routine Care

And, most importantly, these patterns are seen in lower income households


Mam

mog

ram

Scr

eening

Cervica

l Can

cer S

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ning

Imm

uniza

tion

Color

ecta

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cree

ning

Pros

tate

Can

cer S

cree

ning

0%

10%20%30%40%50%60%

Control Group Study Group

1.3

3.4

2.4

0.7

3.5

HRA / HSA Members Have Higher Rates of Chronic and Preventive Care

Including breast, cervical, colorectal, and prostate cancer screening


• Savings account that you own to pay for your medical expenses

You and/or EmployerDeposit

Qualified Medical Expense

Employee’s HSA

WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)?

QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP)

Individual Coverage $1,500 Deductible$3,000 Out of Pocket

Max.

Two Party or Family Coverage $3,000 Deductible$6,000 Out of Pocket

Max.

QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) cont.

Until Deductible is Met: You pay entire cost of medical expenses (doctor

visits, prescriptions, diagnostic tests, hospitalization, surgeries, etc.)

The amount you are billed is the discounted rate which has been negotiated by the insurance carrier

Most preventative services are covered at 100% and are not subject to the deductible.

QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) cont.

After Deductible is Met:Co-payments and co-insurance apply

After Out-of-Pocket Maximum is Met:All eligible claims are paid at 100%

WELCOMEWASHINGTON COUNTY SCHOOL DISTRICT

To Your Health Savings Account (HSA)

HSA: THE BASICS

Building Health Savings

Copyright © 2011 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc.Confidential and proprietary. Reproduction without express written consent is prohibited.

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.


HSA COMPONENTS

Insurance Company

AltiusFinancial Custodian

HealthEquity

HSA REQUIRES QUALIFIED PLAN

HDHPLow-Premium, High-Deductible Health Plan

THE INSURANCE PIECE

HSAHealth Savings Account

THE ACCOUNT USED TO FUND THE DEDUCTIBLE—TAX-FREE


WHAT’S AN HSA?

A tax-free savings account that belongs to you, and:

• Can be used to pay for qualified medical expenses• Earns interest • Can be invested once a certain threshold is met

Qualified Medical ExpenseYour HSA

You and/orEmployer Contribute


WHO’S ELIGIBLE?

To qualify for an HSA, you must:• Be covered under a qualified health

plan on the first day of any month for which eligibility is claimed

• Not be enrolled in Medicare

• Not be claimed as a dependent on someone else’s tax return

• Have no other insurance except what’s permitted by the IRS (see IRS Publication 969)


HOW TO CONTRIBUTE

2013 maximum contributions allowed by the IRS:

Single-coverage $3,250

Family-coverage $6,450

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

• Fully fund your HSA on day one (subject to the annual maximum)

• Make contributions anytime after your HSA is open

• Make pretax contributions through payroll deduction, online, or directly to HealthEquity

WHY CHOOSE AN HSA?


Save and keep your money• Lower premiums, tax-free, long-term savings

• You own the account and the money stays with you

Grow your money• Money rolls over year to year

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

MAXIMIZE YOUR MONEY


Keep your doctor• Even if your doctor isn’t a network provider, you may use

your HSA to pay your bill

Protect your account and pocket book• Change jobs or retire and keep your account and balance

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

• Cover spouse/dependent expenses, even if on another health plan- Your spouse and dependents don’t need to be covered by your HDHP

to use your HSA funds to pay their out-of-pocket medical expenses

MAXIMIZE YOUR OPTIONS

WHY CHOOSE A HEALTHEQUITY® HSA?


BENEFITS OF A HEALTHEQUITY® HSA

1. Easy-to-use online access

2. Live service any day, anytime

3. Remarkable education and support

4. Plus:• FDIC-insured cash deposits

• Competitive interest rates

• Free investment options with no transaction fees—something most banks don’t offer

YOUR HEALTHEQUITY EXPERIENCE


YOUR EXPERIENCE

HealthEquity Receives Electronic

Enrollment

Welcome Kit and Debit Card

First Login to Web Portal

Account Screeningand Set Up

Open Enrollment Meetings and Communications

Ongoing Education

Ongoing60–90 days prior 40 days prior 15–20 days prior Plan Yr. Begins

01001010010110


MEMBER PORTAL: Log On at www.myhealthequity.com


PREPOPULATED WITH YOUR CLAIMS


VIEW AND PAY CLAIMS ONLINE

USING AN HSA


HSA HOW TO:Doctors’ Visits

*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.

No co-pays

Insurance carrier adjusts price based on discounts

Pay doctor from HSA funds, if funds are available. Pay out of pocket if funds aren’t available and reimburse yourself later.

Go to the doctor

Doctor sends insurance carrier the bill

Claim integratedinto member portal

3

2

1


HSA HOW TO:Pharmacy Prescriptions

Show your pharmacy card

Pay with yourHSA card

Insurance carrier applies amount to your deductible—no paperwork needed

*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.

Go to pharmacy

Pharmacy applies discount

Pharmacy sends claim to insurance carrier

3

2

1

ELIGIBLE EXPENSES

• Qualified medical expenses:– Doctor and hospital visits– Medical equipment– Chiropractic Care– Dental care, braces, dentures, implants– Vision care, glasses, contacts, lasik– Medications, including some over-the-counter

• A complete list is found in the IRS Publication 502 (same list as FSA)

The penalty for using HSA funds for non-qualified expenses is 20% +taxes. Keep all itemized receipts in the event of an IRS audit.

ADVANTAGES OF AN HSA

Funds roll over from year to year– No use it or lose it

Tax benefits on:– Contributions– Earnings– Distributions

Portability– Funds follow you– Tax-free even if qualifying coverage ends

ADVANTAGES OF AN HSA cont.

Flexibility in funding– Make increases/decreases at anytime of the year– You can do a lump sum contribution– One time roll-in from an IRA

No Claim Substantiation– Save receipts in case of an IRS audit– Report on annual tax filing

Long Term Investment Opportunities with Health Equity

Provides Control over your Healthcare Dollars

Individual HDHP Coverage $3,250

Two Party or Family HDHP Coverage $6,450

(If you are age 55 or over, you may make an additional “catch-up” contribution of $1,000 per year.)

Your own contributions, combined with any contributions from your employer, may not exceed these amounts. Excess contributions above these amounts are subject to IRS penalty.

HSA CONTRIBUTION LIMITS FOR 2013

If you choose to enroll in a “High Deductible Health Plan” for 2013, the District will contribute to your “Health Savings Account” once established as follows:

- Individual Coverage $1,150

- Two Party Coverage $1,150

- Family Coverage $1,150

Additionally, you could choose to contribute the following amounts on your own during the year:

- Individual Coverage $2,100 (bringing you to the IRS maximum of $3,250)

- Two Party Coverage $5,300 (bringing you to the IRS maximum of $6,450)

- Family Coverage $5,300 (bringing you to the IRS maximum of $6,450)

If you are over age 55 you can add $1,000 to these amounts

FUNDING FOR 2013 HEALTH SAVINGS ACCOUNTS

HOW DOES THE HSA WORK AT THE DOCTORS OFFICE?

Go to the doctor

Doctor sends bill to your Insurance Carrier

Insurance Carrier sends claim to HealthEquity and the Provider will send out bill to employee

Do not pay at point of service, since you may not know the exact charge of the claim.

Insurance Carrier adjusts price based on network discounts

Go to the Health Equity web site to pay claim directly to the provider electronically or pay with your Health Equity Visa card.

Show your ID card, not your HSA Card

Health Plan ID Card

Member Name: ID Number:Rx Bin Number:

DISADVANTAGES OF A “HIGH DEDUCTIBLE HEALTH PLAN” AND “HEALTH SAVINGS

ACCOUNT” No first dollar coverage except for Preventive

Care

If enrolling as a two-party or family you must satisfy the family deductible

You can only use what is in your account year-to-date– No advance funding unless you do a lump sum deposit

Not compatible with other traditional insurance– Must have a HDHP to have an HSA

THINGS TO CONSIDER WHEN CHOOSING YOUR HEALTH PLAN

Look at your family expenses for the past year Price out your on-going prescriptions If you are two-party or family – you will need to satisfy the

family deductible Calculate your premium cost savings and add in the District

contribution Consider funding your HSA with your previous Flexible

Spending Account (FSA) amounts FSA will be limited to $2,500

THINGS TO CONSIDER WHEN CHOOSING YOUR HEALTH PLAN

cont.

If you choose HDHP coverage, you will not be eligible for a regular Flexible Spending Account (FSA).

If you currently have a health FSA and select QHDHP coverage for 2013, you will need to make sure that you have a zero balance in your FSA BEFORE, you can open the HSA and be eligible to receive the District contribution. (even if you want to choose to use run-out period).

WHAT CAN YOU DO TO KEEP YOUR HEALTH CARE COSTS DOWN?

Maintain a healthy lifestyle

Explore your options

M a r c h 2 0 1 3

GBS RxPrescription Drug

Pricing Tool

GBS Rx - Consumer Initiatives

• CDHP’s have introduced plan members to the actual retail costs of prescription drugs (…. and it’s more than the copay in most cases)

• Drug pricing can vary by pharmacy, by product, and by insurance plan/network

• The key to obtaining better retail prescription drug pricing – SHOP AROUND

– After all, drugs are a commodity and prices vary, so why pay more than you have to?

• GBS Rx is a prescription drug pricing tool that enables consumers to easily compare drug prices at multiple pharmacies at the same time

• How to save at the pharmacy:– Always shop for better pricing; know your options (knowledge is power)– Ask for the lowest price – it is okay to negotiate– Compare your insurance card pricing vs. the coupon or cash price– Use generics whenever possible

• Walmart, Smith’s, Target all have $4 generic programs on hundreds of drugs

GBS Rx Drug Price Comparisons – Ogden, UT

Pharmacy Price* TotalGeneric Actos,

30mg (pioglitazone)

Generic Lexapro, 20mg

(escitalopram)

Generic Lipitor, 20mg

(atorvastatin)

Generic Plavix, 75mg

(clopidogrel)

Generic Singulair, 10mg

(montelukast)

Costco $101 $7 $16 $11 $27 $163

Smith's $114 $17 $16 $11 $31 $190

Walmart $114 $18 $17 $14 $28 $190

Walgreen's $117 $20 $19 $16 $35 $208

Medicine Shoppe $114 $17 $16 $11 $31 $190

Shopko $231 $98 $17 $11 $43 $399

Independents $113 $99 $16 $11 $43 $282

Fresh Market $231 $99 $16 $11 $43 $399

*Includes 'lesser of' cash price or 'coupon' pricing

GBS Rx Consumer Initiatives

Questions?

qhdhp/hsa educational seminar. open enrollment –medical & dental remaining with same carriers,...

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