A f lexible health fund that you control

Transcription

1 A f lexible health fund that you control Aetna HealthFund for Small Businesses A cost-effective health benefits solution your employees will value C (9/09)

2 A great solution in your fight against rising health care costs Health benefits and Health Insurance plans are offered, underwritten or administered by Aetna Health Inc., Aetna Health of the Carolinas Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products.

3 Did you know? In 2008, enrollment in CDHPs reached seven percent of all covered employees, up from five percent the previous year. 2 You re well aware of rising health care costs. You re looking for new ways to manage your company s health benefits dollars. And you re looking for cost-effective, quality health benefits and health insurance plans to offer your employees and their families. We have a solution. It s the Aetna HealthFund Health Reimbursement Arrangement ().* It includes a fund your employees can use to help pay for eligible health care expenses, such as out-of-pocket medical costs deductibles, coinsurance and more. The fund gives employees more control in how they spend their health care dollars. And research shows that total health spending is reduced when consumers bear more responsibility for their health care expenses. 1 Consumer-directed health plans (CDHPs) are built on the belief that as employees become more informed and selective, they ll seek the most appropriate care and become a valuable part of the battle against rising health care costs. That s where the Aetna HealthFund can help. *s are currently not available to HMO members in Illinois. 1 Goldfarb B. Care cost hikes are significantly lower for companies with high enrollment in consumer-directed health plans. AIS Consumer-Directed Care. April 22, Available at: html. Accessed January 28, Mercer survey finds $1,000 health plan deductible was the norm in November 19, Available at: Accessed February 9,

4 Designed for your business Help protect your bottom line while helping your employees pay for health care. Sign up for the Aetna HealthFund. It s one of a full suite of consumer-directed health plans we offer. Here s how it works: n Each year, you establish a fund for single or family enrollment. The fund is used by your employees to help them pay for eligible health care expenses.* n The fund can work with your employees health benefits plans to help them pay their out-of-pocket costs deductibles, coinsurance and more. n When a claim is paid under your Aetna medical plan, the out-ofpocket claim amount is submitted by our medical claim system to the employee s for reimbursement. The employee is then reimbursed from the without filing any paperwork. Reimbursements are typically paid through direct deposits into employee bank accounts.** n If you re offering a medical plan that covers preventive care without a deductible for eligible routine physicals, health screenings and immunizations, that s great news.*** It means there will be more remaining in the fund to cover less predictable employee medical costs. n Aetna health plan members with an out-of-network option have lower out-of-pocket costs when they get care within the network. That s because network providers have agreed to offer their services at a discounted rate. That means fewer dollars are used from the fund, leaving a greater balance to use for other eligible health expenses. You ll welcome the advantages There are many reasons to consider the Aetna HealthFund : n It s tax deductible. The amount you pay out in reimbursements is 100 percent tax deductible and the fund benefits your employees receive are tax free. n It s cost-effective. There s no need to fund claims until they are actually submitted. This can help improve your cash flow. n It s flexible. Want the fund to reimburse for deductibles only? Want employees to meet their deductibles before the fund pays? It s your choice. n It s seamless. If you re sponsoring both an Aetna HealthFund and an Aetna Flexible Spending Account (FSA), we ll manage the payments so your employees will be reimbursed by each fund when eligible. + * Eligible expenses include those generally defined in section 213(d) of the Internal Revenue Code. ** Direct deposit is our default option. For additional options please contact your Aetna representative. *** Depending on your medical plan, employees may be responsible for a copay or coinsurance amount for eligible services. + The Aetna Flexible Spending Account (FSA) lets employees direct some of their pretax salary into an account they can draw from to pay eligible expenses throughout the year. Employers can also contribute. 3

5 You ll get great flexibility with an design a plan that s right for you Choose the plan option that s right for you Aetna HealthFund First Dollar Access Plan INSURANCE Deductible First Plan INSURANCE With this option, the fund pays first and typically reduces the employee s deductible, giving the employee first-dollar coverage. Once the fund is exhausted, the employee pays the remainder of the deductible before the health plan pays a portion of the eligible expenses. With this three-part plan, the employee pays a portion of his or her deductible before the fund can be used. Once the deductible is met and the fund is exhausted, the health plan begins to pay a portion of the eligible expenses. Sandwich Deductible Plan With this option, there are two funds with an INSURANCE employee deductible in the middle. Once the two funds are exhausted and the employee deductible is met, the health plan begins to pay for a portion of eligible expenses. Reverse Sandwich Deductible Plan This option has two employee deductibles with INSURANCE a fund in the middle. Once the two employee deductibles are met and the fund is exhausted, the health plan begins to pay for a portion of eligible expenses. You ll get personalized service and more n Designated service representatives Looking for a service team who understands your specific business needs? Look no further. We are here. n Ongoing plan management As your workforce moves beyond their first plan year, your needs may change. Perhaps you just want to explore a different plan design. We ll help you find options just right for your business. n website Log in to It s updated daily. There you can check your fund balance, access a link to an Internal Revenue Service website, find useful forms and more. Your employees can log in to check their fund balance, get forms and more, too. n Customized reports* We can run reports specific to date ranges, individual employees and individual benefit amounts. You can also visit our website to generate your own custom reports. You can also create a standalone fund to help reimburse three types of eligible expenses: vision, dental and preventive care. You decide which expenses you want the fund to help cover. It s your choice. Pick one, two or all three if you like. * Customized reports are available for group sizes with five or more employees. 4

6 Using the fund is easy Pick from three reimbursement options... the choice is yours: 1. We can reimburse your employees through direct deposits into their bank accounts. 2. Or we can send you the reimbursement checks to distribute to your employees. 3. We can also send you a report so you can reimburse your employees directly. n Look for a detailed report from us bimonthly or visit our secure website at You ll find fund information that s updated daily. And remember: With Aetna s streamline feature, employees can enjoy payment processing without the need to file a paper claim form. Here s how the typically reimburses Medical or dental reimbursements 1. Employee visits a doctor for care. 2. Doctor submits a bill to Aetna. 3. We adjust pricing to reflect our network discount rate, and we mail the member s Explanation of Benefits (EOB) to the doctor and employee. 4. Our medical claim system provides out-of-pocket information to the. 5. If funds are available, the sends the out-of-pocket reimbursement to the employee. That means no claim form. Prescription reimbursements 1. Employee visits a pharmacist to fill a prescription. 2. Pharmacist electronically processes the claim and readjusts pricing to reflect negotiated rates or apply applicable copay (based on Rx plan in place). 3. Employee pays discounted prescription cost or applicable copay to the pharmacy. 4. Our pharmacy claim system provides out-of-pocket information to the. 5. If funds are available, the sends the out-of-pocket reimbursement to the employee. Again, there s no claim form. A survey by the Employee Benefit Research Institute found that consumer-directed health plan participants make better-informed health care decisions and are generally healthier. 3 3 CDHP and HDHP participants better informed, healther. MedBen News. November 26,

7 THE AETNA HEALTHFUND COMPARED TO OTHER TYPES OF FUND ACCOUNTS* Health Reimbursement Arrangement () Health Savings Account (HSA) Flexible Spending Account (FSA) Who s eligible? All employees, except those self-employed Any individual covered by a qualified high-deductible health plan All employees, except those self-employed Who can contribute? Employer only Employer, individual or anyone Employer or employee What are the funding options? Employer-funded, paid as incurred (No employee contributions permitted) Funded by employer, employee and others Self-funded, paid as incurred, up to employee s contribution election (health care FSA), paid as incurred up to employee s contribution (dependent care FSA) less any prior reimbursements Does the balance rollover? Yes One-time balance rollover into HSA** Yes No, although a grace period may apply One-time FSA balance rollover into HSA** Can rollover contributions from another account be made to this account? No Yes, rollover contributions from MSAs and HSAs are permitted One-time transfer from IRA or one-time rollover from FSA and/or permitted No Is the fund account portable? Are there interest or investment earnings? Are contributions taxable income to the employee? No Yes No No Yes No No No No In addition, contributions are not subject to FICA or FUTA taxes Are distributions/ reimbursements taxable income to the employee? No No, if made for qualified expenses; otherwise subject to income tax and 10% penalty No *Please check IRS guidelines at for additional criteria. **Subject to additional restrictions and at the direction of the employer only. 6

8 Helping employees become more engaged health care consumers Offer your workforce an affordable choice that s good for them and your business. Sign up for the Aetna HealthFund today! With Aetna, your workforce can take advantage of our online tools and other resources. They help your employees make decisions about their health and their health care benefits, while taking steps to get the care they need. Keeping employees engaged throughout the year Picking the right health plan n Member website n Plan Selection and Cost Estimator n Employee materials Making informed health care decisions n DocFind online directory n Cost and Quality of Care decision support tools n Health information tools Managing their health n Health History Report n Personal Health Record n Plan for Your Health SM Getting answers to their questions n Member website n Aetna Voice Advantage phone service n Member Services n Informed Health Line Please check with your Aetna representative for more information about these programs. Value-added services And your employees also get access to many value-added programs. These programs can help contain health costs and enhance workplace performance. These programs include: n Personal Health Record n Routine preventive care services n Beginning Right maternity program n Disease management programs n Discount programs This managed care plan may not cover all of your health care expenses. Read your contract carefully to determine which health care services are covered. To contact the plan if you are a member, call the number on your ID card; all others, call AETNA ( ). This material is for information only and is not an offer or invitation to contract. Not all health services are eligible. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health benefits and health insurance plans contain exclusions and limitations. Aetna s are subject to employer-defined use and forfeiture rules, and are unfunded liabilities of your employer. Fund balances are not vested benefits. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. The Aetna Personal Health Record ( PHR ) should not be used as the sole source of information about the member s medical history. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to Policy forms issued in Oklahoma include: HMO/OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23 and/or GR-29/GR-29N Aetna Inc C (9/09)