ready. set. grow healthy. your 2012 unitedhealthcare plan benefits glendale elementary school...

READY. SET. GROW HEALTHY.

Your 2012 UnitedHealthcare Plan BenefitsGlendale Elementary 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

• Medical Plan 104

• HSA 1500 Plan

• HSA 2500 Plan

UHC Tools and Resources


3

What We Will Cover Today

Open enrollment

April 30 to May 11th


4

Changes effective July 1st

Buy-Up Medical Plan 03 has been eliminated Medical Plan 104 has increased prescription copays from

$10/$20/$40 to $10/$25/$50

• HSA 2500 Plan has decreased prescription copays from $10/$30/$50 to $10/$25/$50

• HSA 2500 Plan deductible and OOP max has been enhanced from a two tier to a three tier program making the program more attractive to those with dependent coverage.

• New HSA 1500 Plan offering


5

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.uhcpreventativecare.com for age and gender-specific guidelines

http://www.uhcpreventativecare.com/

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

Your Medical Benefits at a Glance Medical Plan 104

Type of coverage Network benefit Non-network benefit

Physician’s office services$20 co-payment 50% after deductible

Specialist office visit $40 co-payment 50% after deductible

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

Emergency room services $100 co-payment 50% after deductible

Inpatient hospital stay20% after $500

individual deductible50% after $750

individual deductible

Out of Pocket Maximum

$1,750 per individual per calendar year.

(Deductibles and copays do not apply)

$3,750 per individual per calendar year

(Deductibles and copays do not apply)


Medical Plan 104 Pharmacy Costs

Retail Mail order

Tier 1$10 Member Cost

1-Month Supply

$25 Member Cost

3-Month Supply


1-Month Supply

$62.50 Member Cost

3-Month Supply


1-Month Supply

$125 Member Cost

3-Month Supply

Lowest Cost

Highest Cost

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UnitedHealthcare Health Savings Account Plans (HSA’s)



50% of health care costs driven by behaviors

Consumer-driven health

Source: Adapted from Department of Health and Human Services, Centers for Disease Control and Prevention

Behavior50%

Environment20%

Genetic20%

Access10%

Factors affecting rising health care costs

For every 100 employees:• 64 are overweight or

obese: average health costs 10-12% higher

• 23 smoke: average health costs 30-33% higher and annual productivity costs 60% higher

• 19 experience stress: average health costs46% higher



Consumer-driven healthWe need to encourage more informed healthcare decisions

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

• Health care costs are skyrocketing

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


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

Type of coverage Network benefit Non-network benefit

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 50% 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,

$6,000 family deductible* (single deductible does not apply for families)

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

$3,000 single, $5,000 for family coverage per Plan Year

(Deductibles and copays apply)

$6,000 single, $10,000 for family coverage per Plan Year



Your Medical Benefits at a Glance HSA 2500 – 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 50% after deductible

Inpatient hospital stay

20% after $2,500 individual, $3,500 Individual +1, $4,000 family deductible per Calendar Year

(Individual deductible applies for each family member)

20% after $5,000 individual, $7,000 Individual +1, $8,000 family deductible per Calendar Year

(Individual deductible applies for each family member)

Out of Pocket Maximum

$4,500 per individual, $7,500 individual +1, $9,000 for family coverage per Calendar Year


$9,000 per individual, $15,000 individual +1, $18,00 for family coverage per Calendar Year.



HSA Plan Pharmacy CostsRetail Mail order


1-Month Supply

$25 Member Cost

3-Month Supply


1-Month Supply

$62.50 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 HSA

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)


15

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*

You can open and fund the HSA to pay the plan deductible and other qualified health care costs – or you can let your account grow.

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


16

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


17

You may be 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


18

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


19

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


21

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 (contributions – expenses + account earnings) into.

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 Health

Statement.

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 notice some changes on your EOBs beginning late 2011. You will see more information on:– Appeal rights– Consumer assistance

programs

What’s more 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 care 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 HSA Plan Works


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*From www.healthcarelane.com

How the HAS Plan Works


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$2,500Annual

deductible

$4,500Out-of-pocket

maximum

80%/20%network

coinsurance

100%network coverage

Employer deposits $2,000 in HSAChris deposits $1,000 in HSA


How the HSA 2500 Plan Works

Chris chooses the HSA Plan for himself because:• No cost monthly premiums• His employer is contributing $2,000 • Chance to use HSA to save for future expenses

Here is what Chris’s plan looks like:

Cheryl is a fictitious person used to illustrate UnitedHealthcare products.


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$2,500Annual

deductible

$4,500Out-of-pocket

maximum

$2,600$3,000 in HSA


How the HSA 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 $2,600 in his HSA!

Paid 100% by plan


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$2,5000Annual

deductible

$4,500Out-of-pocket

maximum

District funds $2,000 in HSA


How the HSA 2500 Works

80%/20%network

coinsurance

100%network coverage

Jane chooses the 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:

Chris is a fictitious person used to illustrate UnitedHealthcare products.


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$2,500Annual

deductible

$4,500Out-of-pocket

maximum

Reaches deductible 80%/20% 100%


How the HSA Works

Emergency surgery $100,000

6 Doctor visits $1,000

11 Prescriptions $1,000

Total actual cost $102,000

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

Insurance pays (80%) $80,000Jane to pay (20%) $20,000

But she pays only $2,500 to get to her $4,500 maximum.

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

Jane pays $2,500District deposits $2,000 in HSA


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Jane compares plans…

Medical Plan 104 HSA 1500 HSA $2500

Member costs

District Funded HSA Pays $0 $1,200 $2,000

Member Deductible $500 $1,500 $2,500

Out of Pocket Maximum $1,750 $3,000 $4,500

Copays $900 $0 $0

Premium $0 $0 $0

Total Member Pays $3,150 $1,800 $2,500

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Wellness Tools


37

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


40

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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Treatment Cost Estimator

SOURCE: UnitedHealthcare service data, April 2010

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

Includes treatment costs for: ~ 116 diseases/conditions ~ 90 surgeries/procedures~ 500+ individual services ~ 3,000+ medications


42

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


43

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.


45

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


Get Health4Me and DocGPS® App Today!

• Uses Google® Maps

• Search based on your location

• Download for iPhone®, BlackBerry® and Droid phones®

Find network doctors with our new mobile phone app

Google Android is a trademark of Google, Inc.iPhone is a registered trademark of Apple, Inc.BlackBerry is a registered trademark of Research in Motion LimitedDroid is a registered trademark of Lucasfilms Ltd.


47

Explore Health Care Lane Today!

A fun and interactive way to learn about health insurance

healthcarelane.com/VSEBT

QUESTIONS?

ready. set. grow healthy. your 2012 unitedhealthcare plan benefits glendale elementary school...

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