ready. set. grow healthy. your 2012-2013 unitedhealthcare plan benefits chandler unified school...

READY. SET. GROW HEALTHY.

Your 2012-2013 UnitedHealthcare Plan BenefitsChandler Unified School District

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

2

What We Will Cover Today

Medical Plan Options

• Choice Plus PPO Plan

• HDHP 1500 Plan

• HDHP 2700 Plan

UHC Tools and Resources


3

Changes to the Choice Plus PPO

Specialist copay increases from $35 to $50

ER copay increases from $100 to $500

Wellness Incentive -$200.00 (Paid on paycheck end of school year) Complete Health Risk Assessment 05/01/2012 – 06/30/2013 Wellness Exams 05/01/2012 – 06/30/2013

United Health Care – Choice Plus PPO

Employee Only Employee+Spouse Employee+Child(ren) Employee+Family

$201.73/pay $703.09/pay $670.36/pay $974.18/pay


4

Changes to the HDHP 1500 Previously HSA1400 Plan Plan deductible increases from $1,400 to $1,500 Individual Out of Pocket maximum will increase from $3,800

to $3,900 Out-of-Network coinsurance reduced from 60% to 50% HSA contribution for will be $514 Wellness Incentive - $200.00 (HSA Deposit)

Health Risk Assessment 05/01/2012 – 06/30/2012 Wellness Exams 05/01/2012 – 06/30/2012

United Health Care – HDHP1500Employee Only Employee+Spouse Employee+Child(ren) Employee+Family

$0.00 $208.36/pay $193.64/pay $322.91/pay


5

Changes to the HDHP 2700 Previously HSA2600 Plan Plan deductible increases from $2,600 to $2,700 Individual Out of Pocket maximum will increase from

$4,550 to $4,650 Out-of-Network coinsurance reduced from 60% to 50% HSA contribution for will be $1,824 Wellness Incentive $200.00 (HSA Deposit)

Health Risk Assessment 05/01/2012 – 06/30/2013 Wellness Exams 05/01/2012 – 06/30/2013

United Health Care – HDHP2700Employee Only Employee+Spouse Employee+Child(ren) Employee+Family

$0.00 $156.00/pay $145.64/pay $237.82/pay

6Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Your Medical Benefits at a Glance Choice Plus PPO Plan

Type of coverage Network benefit Non-network benefit

Physician’s office services$25 co-payment 50% after deductible

Specialist office visit $50 co-payment 50% after deductible

Urgent care center services $50 co-payment50% after deductible

Emergency room services $500 co-payment $500 co-payment

Inpatient hospital stay20% after $1,000 individual deductible, $2000 family deductible

50% after $2,000 individual deductible, $4000 family deductible

Out of Pocket Maximum

$2,000 per individual, $4,000 family per Plan Year. (Deductibles and copays do not apply)

$6,000 per individual, $12,000 family per Plan Year

(Deductibles and copays do not apply)


Choice Plus PPO Plan Pharmacy Costs

Retail Mail order

Tier 1$10 Member Cost

1-Month Supply

$25 Member Cost

3-Month Supply


1-Month Supply

$87.50 Member Cost

3-Month Supply


1-Month Supply

$125 Member Cost

3-Month Supply

Members are subject to $100 individual pharmacy deductible before copayment’s apply.

Lowest Cost

Highest Cost

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UnitedHealthcare High Deductible Health Plan (HDHP)



Consumer-driven healthWe need to encourage more informed healthcare decisions

• Health care costs are skyrocketing

• People are currently removed from the true cost of health care

• There’s a need to save for future health care costs


Your Medical Benefits at a Glance HDHP 1500 – Non-Embedded Plan*


Physician’s office services20% after deductible 50% after deductible

Specialist office visit 20% after deductible 50% after deductible

Urgent care center services 20% after deductible50% after deductible

Emergency room services 20% after deductible 20% after deductible

Inpatient hospital stay

20% after $1,500 single deductible, $3,000 family deductible* (single deductible does not apply for families)

20% after $1,250 single deductible, $2, 500 family deductible* (single deductible does not apply for families)

Out of Pocket Maximum (single max does not apply to families)

$3,900 single, $7,800 for family coverage per Plan Year

(Deductibles and copays apply)

$7,800 single, $15,600 for family coverage per Plan Year

(Deductibles and copays apply)


Your Medical Benefits at a Glance HDHP 2700 – Embedded Plan*


Physician’s office services20% after deductible 50% after deductible

Specialist office visit 20% after deductible 50% after deductible

Urgent care center services 20% after deductible50% after deductible

Emergency room services 20% after deductible 20% after deductible

Inpatient hospital stay

20% after $2,700 individual, $5,400 family deductible per Plan Year (Individual deductible applies for each family member)

50% after $5,400 individual, $10,800 family deductible per Plan Year (Individual deductible applies for each family member)

Out of Pocket Maximum

$4,650 per individual, $9,300 for family per Plan Year. (Deductibles and copays apply)

$9,300 per individual, $18,600 for family per Plan Year. (Deductibles and copays apply)


HDHP Plan Pharmacy CostsRetail Mail order


1-Month Supply

$25 Member Cost

3-Month Supply


1-Month Supply

$75 Member Cost

3-Month Supply


1-Month Supply

$125 Member Cost

3-Month Supply

Members are subject to their Medical/Pharmacy deductible before copay’s apply.

Medications listed on Preventative Drug List are subject to copays.

Lowest Cost

Highest Cost


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Introducing the HDHP

Optionalhealth

savings account(HSA)

High-deductible health Plan

100% network

preventive care

Annual deductible

Annual out-of-pocket protection

Personal support and messages,

health coaches

Combines a high-deductible health plan that allows you the option to open a health savings account (HSA)


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HSA

What is a health savings account (HSA)?

It’s yours even if you

switch jobs or plans

Triple tax savings

Pay for today’s $$ or

save for tomorrow’s

Use for qualified

expenses not covered by

the plan

Use it for retirement, investing*

The District opens and funds a HSA on behalf of eligible employees. Employees can also contribute into the account on a pre-tax basis to help pay the plan deductible and other qualified health care costs or let your account grow.

HSAs are designed to help you save and pay for your health care


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What you should know about the HSA

An HSA is not health insurance

Used to pay/reimburse qualified expenses

No “use it or lose it” requirement

HSA is owned by you

Each covered individual can open an HSA


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You are eligible to open an HSA if: • You are not covered by any other non-high deductible health plan,

such as a spouse’s plan

• You are not enrolled in Medicare

• You do not receive health benefits under TRICARE

• You have not received Veterans Administration (VA) benefits within the past three months

• You cannot be claimed as a dependent on another person’s tax return

• You cannot be covered by a health care FSA or HRA

HSA eligibility requirements


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Annual HSA contribution limits

Amount of Funding

Contributions above the annual limit are subject to income taxes and a 20% penalty.

Annual Contribution

Rules

2012: $3,100 for individuals & $6,250 for families

Additional Funding

Those 55 years of age or higher, but not entitled to Medicare benefits, can fund an additional $1,000/year “catch-up” contribution!

Annual contribution limits are set by the IRS


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How you can use the HSA

Use HSA dollars to pay for qualified medical expenses for your spouse or dependents

Pharmacy, dental, vision care services

Medical plan deductibles and coinsurance

Any money you take out of your HSA for eligible medical expenses is federal income-tax free


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How you can use the HSA

1Coverage while

receiving unemployment

benefits

2

COBRA continuation

coverage

3

Eligible long-term care

4Medicare

premiums and out-of-pocket

expenses

Other qualified expenses


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How the HSA Helps You Save

The money Steve puts into his HSA is federal income tax-deductible.

1

Any money Steve withdraws from his HSA to pay for qualified medical expenses is withdrawn federal income tax-free.

2

Steve may earn interest on his account, and it is not taxable.

3

The amount not spent during this year carries over for use in future years.

4


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How Much Did Steve Save?

Steve does not have to pay federal income taxes on his interest.

Steve’s federal and state income tax savings and FICA on his contributions for the year are $2,478.

Steve will not have to pay income taxes on the $3,000 as long as he uses it to pay for qualified expenses.

With a traditional plan, Steve wouldn’t have this carryover option, which helps him save for the future.

In 2012, Steve will deposit $6,250 into his HSA, the maximum contribution for family coverage.

1

Steve will withdraw $3,000 to pay for qualified health care expenses for him and his family.

2

Steve earns interest on his account.

3

Steve will carry over $3,250 HSA dollars.

4


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TIP: Use your HSA to help you pay qualified expenses

Present ID card to

network doctor

Doctor sends

claim to

UnitedHealthcare

UnitedHealthcare

applies network

discount and notifies

doctor of amount you

may owe.

When you have

claim activity, you

will receive a EOB.

Doctor bills you for

payment

1. You can use your HSA to pay

2. Or you can choose to pay another way (cash, credit card) and reimburse yourself

later

How the HSA Plan WorksHSA Payment Process


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Explanation of Benefits (EOBs)

You may have noticed some changes on your EOBs. You will see more information on:– Appeal rights– Consumer assistance

programs

The EOB has been designed for easier readability.

We encourage you to access your EOBs online at myuhc.com.


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Comparing an HSA with an FSA

• Owned by employer

• Funded by the employee

• All funds must be used by the end of the plan year or grace period

• Only vision & dental care are reimbursable

• Must enroll each year enrollment

Limited-Purpose FSA

• Owned by employee

• Funded by the employee and employer

• Funds automatically rollover to next plan year

• Qualified expenses determined by IRS and employer

• Automatic enrollment

HSA


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Common HSA Questions

• Enroll during your Open Enrollment period

• Check your employer benefit information for details

How do I enroll?

1

Can I take the funds in my HSA with me if I leave the company?

2

Can others contribute to my HSA?

3

How do I access the funds in my account?

4

Yes. Funds belong to you even if you leave your job, change health plans or retire.

Yes. Anyone can contribute to your HSA. Keep in mind that annual contribution limits above what is allowed are subject to income taxes and a penalty.

• Use your HSA debit card

• Pay by check, cash or credit card and reimburse yourself later from your HSA


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OptumHealthSM Bank, Member FDICUnitedHealthcare’s health care bank of choice

• FDIC-insured so you know your money is safe

• Dedicated to helping people save for health care

• One of the nation’s leading HSA custodians

• Offers a Health Savings Account Debit MasterCard®

• Account holders will receive Health Savings News e-newsletter

Only OptumHealth Bank offers the convenience of HSA banking

through myuhc.com

Pay bills

Make deposits

Reimburse yourself

Track spending

See your tax savings

And more

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Choose the Right Mix of Fees and Interest

Understand the rates, fees and features for each account type:

Investments are not FDIC-Insured, are not guaranteed, and may lose value.

Health eAccess Health eSaver Health eInvestor

Monthly Maintenance Fee

Balance Required to Obtain APY

Investment Threshold

Monthly Investment Fee

$0-$499.99

$500-$999.99

$1,000-1,999.99

$2,000-$4,999.99

$15,000+

$5,000-$14,999.99

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

Annual Percentage Yield (APY) Annual Percentage Yield (APY) Annual Percentage Yield (APY)

$2,000 $2,000 $500

$3 $0 $2.50

$0 if balance exceeds $500$1 if balance is $1-$499.99

$0 if balance exceeds $5,000$3 if balance is $1-$4,999.99

$0 if balance exceeds $5,000$3 if balance is $1-$4,999.99

Variable based on balanceVariable based on balance Variable based on balance

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How the High Deductible Plan Works


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*From www.healthcarelane.com

How the HDHP Works


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$2,700Annual

deductible

$4,650Out-of-pocket

maximum

80%/20%network

coinsurance

100%network coverage

Employer deposits $1,824 in HSAChris deposits $1,000 in HSA


How the HDHP 2700 Plan Works

Chris chooses the HSA Plan for himself because:• No cost monthly premiums• His employer is contributing $1,824 • Chance to use HSA to save for future expenses

Here is what Chris’s plan looks like:

Chris is a fictitious person used to illustrate UnitedHealthcare products.


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$2,700Annual

deductible

$4,650Out-of-pocket

maximum

$2,424$2,824 in HSA


How the HDHP Plan Works

Chris uses HSA to pay

HSA paid total $400

Chris paid $400

1 preventive exam per member $400

1 visit to urgent care $200

1 doctor visits $100

2 prescriptions $100

Non-preventive total $400

And Chris still has $2,424 in his HSA!

Paid 100% by plan


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$2,700Annual

deductible

$4,650Out-of-pocket

maximum

District funds $1,824 in HSA


How the HDHP 2700 Works

80%/20%network

coinsurance

100%network coverage

Jane chooses the single HSA Plan because:• No monthly premiums• Typically has few health expenses• Ability to open and save with an HSA• Tax savings

Here is what Jane’s plan looks like:

Jane is a fictitious person used to illustrate UnitedHealthcare products.


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$2,700Annual

deductible

$4,650Out-of-pocket

maximum

Reaches deductible 80%/20% 100%


How the HDHP Works

Emergency surgery $100,000

6 Doctor visits $824

11 Prescriptions $1,000

Total actual cost $101,824

Jane uses HSA to meet a portion of her deductibleRemaining bill $100,000

Insurance pays (80%)Jane to pay (20%)

But she pays only $2,826 to get to her $4,650 maximum.

All other expenses are covered 100% for the rest of the year

Jane pays $2,826District deposits $1,824 HSA


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Jane compares plans…

Choice Plus Plan HDHP 1500 HDHP 2700

Member costs

District Funded HSA Pays $0 $514 $1,824

Member Deductible $1,000 $1,500 $2,700

Out of Pocket Maximum $2,000 $3,900 $4,650

Copays $750 $0 $0

Premium $4,438 $0 $0

Total Member Pays $8,188 $3,386 $2,826

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Wellness Tools


36

myuhc.com

Find network doctors/hospitals

Estimate costs

Track claims status

Build a health improvement program

Keep a Personal Health Record

Get health product discounts

Review plan details


Large National Network

660,000 doctors

660,000 doctors

5,100hospitals5,100

hospitals

60,000 pharmacies60,000

pharmacies

And world-wideemergency care coverageAnd world-wideemergency care coverage

1,000convenience care clinics

1,000convenience care clinics

More than:More than:


Our Large National Network

Your doctor is likely already in our network.

Available to

98%of Americans

Available to

98%of Americans

Includes

95,000Specialists designated for their quality and cost efficiency based on national standards

Includes

95,000Specialists designated for their quality and cost efficiency based on national standards

More than

1,000convenience

care clinics

More than

1,000convenience

care clinics

Includes

2out of3providers

Includes

2out of3providers


39

The UnitedHealth Premium® program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidence

Doctors who meet both quality and cost-efficiency guidelines receive two stars, and those who meet quality receive one star

Promoting Quality & Affordable Health Care

Quality Care UnitedHealthcare awards one star to physicians who meet national standards for quality care.

Cost-efficient Care UnitedHealthcare awards a second star to physicians who meet local area benchmarks for cost-efficient use of resources in delivering health care.

UnitedHealth Premium Two-Star Physicians Two-star physicians have been recognized for providing quality and cost-efficient care to their patients. They meet or exceed nationally recognized guidelines, and they’re likely to recommend the right tests and treatments for a variety of conditions.

+ =


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Take Advantage Of Your Preventive Care Coverage

Certain preventive services are covered without charging a deductible, copayment or coinsurance when these services are provided by a network provider.

It’s important to review your plan documents for the preventive services included in your specific benefit plan.

Regular preventive care may help• Reduce risk of disease • Detect health problems early• Protect you from higher costs down the road

www.uhcpreventivecare.comfor age and gender-specific guidelines

http://www.uhcpreventivecare.com/


41

Health Assessment

Take a free, online questionnaire about your health from the University of Michigan

Program includes interactive online health coaching

Feedback on progress toward living a healthier life

Recommendations for online health and wellness services

Information to help members have productive conversations with doctor


42

Care24 Nurseline and EAP

Connect with a registered nurse and highly experienced counselors

Get help with legal, financial and emotional needs

Prepare yourself before you seek a doctor’s care

Access recorded messages on health topics

Communicate in live, one-to-one Nurse Chats at myuhc.com

Care24 1-866-271-7340


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Healthy Pregnancy Program

Get support through every stage of pregnancy

Nurses available, toll-free, 24/7

Personalized pregnancy assessment

Educational materials and resources

No Additional Cost Gifts and Savings–Your Journey Through Pregnancy, a book

that will help you learn more about your

nine-month journey.

–A booklet from Johnson & Johnson:

What’s Next?: The magic unfolding

of the first days of life.

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Personalized information on-the-go supports better health care decisions

UnitedHealthcare Health4Me™ is designed to make it simpler for members to manage their health and:– View each plan member independently

– Personalize with member photos

– Find doctors and facilities anytime, anywhere

– Check claims, benefits, and account balances

– View and share health plan ID card in the doctor’s office or at the pharmacy


45

myHealthcare Cost Estimator

• Designed to calculate and compares cost differences for treatments between providers, locations and facility types, including both plan and member expenses for each treatment


46

Explore Health Care Lane Today!

A fun and interactive way to learn about health insurance

healthcarelane.com/VSEBT


47

Mary Winters

Fred Winters, spouseAnn Winters, dependentSusan Winters, dependent

• Mailed to new members within 30 days of enrolling

• Includes your plan information

• Lets providers know how to bill

Health plan ID cards

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Voluntary Delta Dental Plan

•All employees who work 20 hours or more per week are eligible to enroll in dental benefits.

Enhancements

•Deductible is waived for preventative services

•The cost of preventative services does not count toward your calendar year max

•Potential additional benefit of $300 per person per calendar year

Voluntary Dental

Core PlanNo Orthodontics

6 month waiting period

Preventative 100%

Basic Services - 70%

Excludes sealants

Major Services - 40%

Calendar Year Max - $1500

Dental Plan

Employee

Only

Employee + Spouse Employee+Child(ren) Employee+Family

Core $14.12 $27.23 $30.99 $50.47

Premier $20.03 $39.35 $44.87 $73.61

Premier Plan Orthodontics

Lifetime Max - $750Preventative - 100%

Basic Services - 80%

Includes sealantsMajor Services - 50%

Calendar Year Max - $1500

Vision - VSPCovers eye exams once every year.Covers eye exams once every year.

Lenses are covered 100% after a $20 co-pay.Lenses are covered 100% after a $20 co-pay.

Frame allowance $130.Frame allowance $130.

Contacts in lieu of lenses and frames allowance $130.Contacts in lieu of lenses and frames allowance $130.

Premium based on 22 payroll deductions.Premium based on 22 payroll deductions.

Employee Only Employee+1 Employee+2 or more

$4.29 $6.21 $11.14

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Sun Life

Life Insurance• Basic life insurance provided to all benefit eligible employees in the Basic life insurance provided to all benefit eligible employees in the

amount of $50,000amount of $50,000

• Additional voluntary life insurance coverage available to purchase, Additional voluntary life insurance coverage available to purchase, premiums based on age and amount of coveragepremiums based on age and amount of coverage

• Spouse/child coverage availableSpouse/child coverage available

• If you are not currently enrolled in voluntary life insurance coverage If you are not currently enrolled in voluntary life insurance coverage but wish to enroll now, OR if you wish to increase your current but wish to enroll now, OR if you wish to increase your current coverage level during this year’s Open Enrollment, you must provide coverage level during this year’s Open Enrollment, you must provide Sun Life with evidence of your good health, by completing the Sun Sun Life with evidence of your good health, by completing the Sun Life Evidence of Insurability form.Life Evidence of Insurability form.

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Assurant Short Term Disability

• For new coverage, if coverage amount elected is less than $3,000, For new coverage, if coverage amount elected is less than $3,000, evidence of insurability is not required. Individuals currently covered can evidence of insurability is not required. Individuals currently covered can move up one step without EOI.move up one step without EOI.

• The policy does not pay for disabilities within 12 months of your initial The policy does not pay for disabilities within 12 months of your initial enrollment plan, if you received medical treatment, consultation, care or enrollment plan, if you received medical treatment, consultation, care or services (including diagnostic measures), or took prescribed drugs or services (including diagnostic measures), or took prescribed drugs or medicines for the disabling condition during the 12 months prior to your medicines for the disabling condition during the 12 months prior to your initial enrollment date. initial enrollment date.

• To be eligible during pregnancy, you cannot be pregnant prior to the To be eligible during pregnancy, you cannot be pregnant prior to the benefit effective date.benefit effective date.

• The plan provides monthly benefits ranging from $360 to $5,000, based The plan provides monthly benefits ranging from $360 to $5,000, based on your annual salary, not to exceed 66 2/3% of your salary.on your annual salary, not to exceed 66 2/3% of your salary.

53

BASIC Flexible Spending Accounts

• An election must be made every year if you wish to enroll in a Flex An election must be made every year if you wish to enroll in a Flex PlanPlan

• Medical Flexible Spending account limit for 2012-13 plan year is Medical Flexible Spending account limit for 2012-13 plan year is $2,500$2,500

• Dependent Care Flexible Spending account limit will remain at Dependent Care Flexible Spending account limit will remain at $5,000 maximum.$5,000 maximum.

• If you are enrolled in an HSA plan you are only able to use your If you are enrolled in an HSA plan you are only able to use your medical flex spending account for dental and vision expensesmedical flex spending account for dental and vision expenses

• When making flex account elections please keep in mind that if When making flex account elections please keep in mind that if you do not use the funds by June 30, 2012 you will forfeit all you do not use the funds by June 30, 2012 you will forfeit all remaining money in the accountremaining money in the account

Long Term Care•District provides to full-time employees working 30 hours or more a base plan free of charge to the employee

•Provides a monthly benefit to help offset the cost of personal and medical care for an individual who is unable to carry out the normal activities of daily living, such as dressing, bathing, eating, moving or when someone suffers a severe cognitive impairment.

•$2000/month for up to 2 years

•100% benefit for nursing home or assisted living facility

•50% licensed professional care

•Max benefit of $48,000

•Employees who work 20-29 hours may elect to purchase benefit at their own cost

•All employees electing to purchase additional coverage are required to submit proof of good health.

QUESTIONS

ready. set. grow healthy. your 2012-2013 unitedhealthcare plan benefits chandler unified school...

Documents

individual deductible

wellness exams

wellness incentive

united health care choice

family deductible50

plan year deductibles

glance choice

hsa contribution