2017 LVHN Health Plan (Choice Plus)

Transcription

1 2017 LVHN Health Plan (Choice Plus) CARE LVHN.org

2 Table of Contents Health Care Terms You Should Know... 2 Your Guide to the LVHN Health Plan... 3 Three-Tier Network Save Money Use LVHN Hospitals/Facilities and LVHN Health Plan Physicians Your 2017 Medical Plan Options at a Glance... 5 A Closer Look at the LVHN HSA Plan... 6 HSA Features HSA Contributions Other Important Information About HSAs Prescription Drug Coverage... 8 Emergent Prescription Drug Benefit Step Therapy for Prescription Medications Comparing the LVHN PPO Plan and LVHN HSA Plan We ve Got You Covered Choosing Your Medical Plan Option Making Your Medical Plan Decision for Health Care Terms You Should Know ALLOWABLE CHARGE: The amount on which both medical options base benefit payments. For Tier 2 out-of-area and Tier 3 outof-network services, you may need to pay any amounts greater than the allowable charge, in addition to your co-insurance. CO-INSURANCE: How you and the LVHN HSA Plan and the LVHN PPO Plan share costs after you meet the annual deductible. You and the plan each pay a percentage of the cost of covered health care expenses, with the plan usually paying the majority of the cost. CO-PAY: How you and the LVHN PPO Plan share costs. You pay a fixed dollar amount for certain covered expenses. This amount does not vary with the cost of services and is typically due at the time of service. The co-pay for Tier 1 providers is lower than for Tier 2 providers. DEDUCTIBLE: The amount you pay out of your pocket for most covered expenses each calendar year before the plan shares in the cost. The LVHN HSA Plan and the LVHN PPO Plan have different deductible amounts. All preventive covered expenses have the same deductible whether you choose a Tier 1, Tier 2 or Tier 3 provider. OUT-OF-POCKET MAXIMUM: The most you pay in a calendar year for covered expenses. Your deductible, co-pays and co-insurance count toward your out-of-pocket maximum. Once you meet it, both options pay 100 percent of eligible covered expenses for the rest of the year. The out-of-pocket maximum excludes premiums and out-of-network co-payments, penalties, member co-insurance greater than 20 percent, balance-billed charges and health care the plan doesn t cover. 2

3 Your Guide to the LVHN Health Plan You have two medical options to choose from the LVHN HSA Plan and the LVHN PPO Plan. Both options provide comprehensive coverage and feature the same covered services and provider network. The difference is the amount you contribute per pay period, the deductible, your co-insurance, out-of-pocket maximum, and how you pay for services. The LVHN HSA Plan has an additional feature a Health Savings Account (HSA) see page 6 for more information. Three-Tier Network The LVHN PPO Plan and the LVHN HSA Plan both feature a three-tier network, which is designed to promote use of LVHN providers and facilities. The amount you pay for medical care depends on the provider you use. Here are the network choices: Tier 1: LVHN hospitals/facilities and LVHN Health Plan (Choice Plus) Physicians Tier 2: All other LVHN Health Plan (Choice Plus) network hospitals/facilities and out-of-area hospitals/facilities and physicians Tier 3: Out-of-network When you receive care from LVHN hospitals/facilities and LVHN Health Plan (Choice Plus) Physicians, you will receive the highest level of coverage. When you receive care from any non-lvhn hospital/facility that participates in the LVHN Health Plan (Choice Plus) network, you will pay slightly more. This is also the level of benefits for colleagues and dependents who reside outof-area and use out-of-area providers. When you receive care outside of the LVHN Health Plan (Choice Plus) network, you will receive the lowest level of coverage. If a Tier 1 or Tier 2 provider performs services at an out-of-network facility, the provider s claims will be considered at the Tier 3 out-of-network benefit level. IMPORTANT: There are differences in deductible and out-of-pocket maximum amounts, as well as co-pays and co-insurance. The amount you pay for care depends on the provider you use. For both the LVHN PPO Plan and HSA Plan, you will pay the least out-of-pocket when you use Tier 1 providers. You will pay the most out-of-pocket when you visit Tier 3 out-of-network providers. Regardless of which option you choose, you can be assured that you re covered for most health care services. Geographic Area If you live in a zip code that is not listed in this table and you utilize a provider outside of the LVHN Health Plan (Choice Plus) network, these claims will be paid at the Tier 2 benefit level. The Tier 2 benefit option does not entitle you to go to nonparticipating facilities or physicians in the zip codes listed in the chart; doing this will be considered Tier 3 out-ofnetwork reimbursement. Tier 2 reimburses according to usual and customary charges. If you use an out-of-network provider, that provider may balance bill you for charges in excess of the option s reimbursement. You have the option to utilize a Tier 1 LVHN hospital/facility or LVHN Health Plan physician. If a Tier 1 or Tier 2 provider performs services at an out-ofnetwork facility, the provider s claims will be considered at the Tier 3 benefit level. In-Area Zip Codes Employees who live in these zip codes will be subject to Tier 1, 2 and 3 benefit levels

4 Save Money Use LVHN Hospitals/Facilities and LVHN Health Plan Physicians Consider receiving care from a Tier 1 LVHN hospital/facility or LVHN Health Plan physician and save money when you do. Both options also reimburse at a slightly higher level of benefits when you visit a Tier 2 LVHN Health Plan hospital or facility instead of a Tier 3 hospital or facility. Tier 1: LVHN Hospitals/Facilities and LVHN Health Plan (Choice Plus) Physicians Lehigh Valley Hospital Cedar Crest Lehigh Valley Hospital Muhlenberg Lehigh Valley Hospital 17 th Street Lehigh Valley Hospital Hazleton Lehigh Valley Health Network Tilghman All LVHN Imaging Services locations Health Network Laboratories (HNL) Health Spectrum Pharmacy All LVHN ExpressCARE locations All LVHN Health Plan (Choice Plus) participating physicians For a complete list of the LVHN Health Plan (formerly Choice Plus) network hospitals, facilities and physicians, refer to the LVHN Health Plan (Choice Plus) Provider Directory available at MyPopulytics.com and the HR intranet. The provider directory will identify each provider as Tier 1 or Tier 2. Services at Cancer Treatment Centers of America and Coordinated Health are excluded from coverage under all LVHN Health Plan Tiers. Tier 2: All Other LVHN Health Plan (Choice Plus) Hospitals/Facilities and Out-of-Area Hospitals/Facilities and Physicians* Good Shepherd Rehabilitation Hospital Gnaden Huetten Memorial Hospital Lehighton Campus The Children s Hospital of Philadelphia Milton S. Hershey Medical Center Tier 2 facilities are reflected in the LVHN Health Plan (Choice Plus) Provider Directory on MyPopulytics.com and the HR intranet (hr.content.lvh.com). * Out-of-area hospitals/facilities and physicians benefit option applies if you live in a zip code that is not considered in-area. Out-of-area providers are not listed in the LVHN Health Plan (Choice Plus) Provider Directory. In order to receive benefits at the highest level for services not available at a Tier 1 hospital/facility or physician, you must obtain a Certificate of Non-Availability (CNA) through care management before services are rendered. See your Summary Plan Description for details. You are not required to use an LVHN provider. However, we encourage you to use LVHN facilities when appropriate. You may always choose the physicians and hospitals that best meet your needs. You pay the most out-of-pocket when you visit an out-of-network provider. 4

5 Your 2017 Medical Plan Options at a Glance This chart provides highlights of the LVHN PPO Plan and LVHN HSA Plan benefits. Additional benefit information is available on the human resources intranet at hr.content.lvh.com, in the Benefit Information Guide (available in early October) and the Summaries of Benefits and Coverage (SBCs). LVHN PPO Plan LVHN HSA Plan Tier 1 Tier 2* Tier 3** Tier 1 Tier 2* Tier 3** Deductible $250 individual $500 family $400 individual $800 family $1,000 individual $2,000 family $1,300 single $2,600 family $1,300 single $2,600 family $1,300 single $2,600 family Out-of-Pocket Maximum (includes eligible copays, co-insurance and amounts applied to the deductible) $2,500 individual $5,000 family $3,500 individual $7,000 family $5,000 individual $10,000 family $5,000 individual $10,000 family $5,000 individual $10,000 family $7,500 individual $15,000 family Primary Care Doctor Visits You pay a $15 co-pay/visit You pay a $20 co-pay/visit Plan pays 90% Plan pays 90% Specialist Visits You pay a $30 co-pay/visit You pay a $40 co-pay/visit Plan pays 90% Plan pays 90% Outpatient Physical Therapy You pay a $10 co-pay/visit Plan pays 80% afterdeductible Plan pays 90% Plan pays 80% Preventive Care (i.e., routine physicals, mammograms, etc.) Plan pays 100%, no deductible Plan pays 100%, no deductible Not covered Plan pays 100%, no deductible Plan pays 100%, no deductible Not covered Hospital Stays Plan pays 100% Plan pays 80% Plan pays 100% Plan pays 80% Emergency Room Visits for Emergency You pay a $100 co-pay/visit You pay a $100 co-pay/visit You pay a $100 co-pay/visit Plan pays 90% Plan pays 90% Plan pays 90% X-ray and Laboratory Plan pays 100% Plan pays 80% Plan pays 100% Plan pays 80% * Reimbursement for out-of-area services is based on the usual and customary charge, which is the fee charged by similar providers for similar services. For out-of-area services, you may need to pay any amounts that are greater than the usual and customary charge, in addition to your co-insurance. ** Reimbursement for out-of-network services is based on the allowable charge. The allowable charge is the amount on which the plan bases benefit payments. For out-of-area and out-of-network services, you may need to pay any amounts that are greater than the allowable charge, in addition to your co-insurance. For services requiring a co-pay outlined above, please note the deductible applies for the remaining balance after the co-pay. 5

6 A Closer Look at the LVHN HSA Plan The LVHN HSA Plan has lower premiums than the LVHN PPO Plan but does have a higher deductible. You pay co-insurance instead of co-pays; however, preventive care is still covered at 100 percent with no deductible when you use a Tier 1 or Tier 2 provider. The annual deductible applies to all non-preventive care services. If you cover any dependents, the family deductible must be met before the plan begins to pay benefits for any person. One person, or a combination of family members, can meet the family deductible. The plan has an out-of-pocket maximum. Once the out-of-pocket maximum is met, the plan pays 100 percent for covered eligible expenses if you use a Tier 1 provider. If you use a Tier 2 or Tier 3 provider, you may be responsible for any expenses above the allowable charge in addition to any co-insurance. If one person meets the individual out-of-pocket maximum, the plan begins to pay 100 percent of eligible expenses. The other covered individuals must meet the family out-of-pocket maximum. The LVHN HSA Plan has an additional feature a Health Savings Account (HSA). An HSA is a tax-advantaged account that lets you save money on a pre-tax basis that you can use for eligible expenses now and in the future. You may not have other nonhigh deductible health coverage and elect the LVHN HSA Plan. What if I Decide Not to Contribute to a Health Savings Account? If you enroll in the LVHN HSA Plan but decide not to contribute money to the Health Savings Account, LVHN will still make employer contributions to your HSA. You will need to pay for all of your health care expenses that are not covered through the medical plan with after-tax dollars once you use the money provided by LVHN. 6

7 HSA Features YOU NEVER PAY TAXES. You don t pay taxes on any money you and LVHN put into your HSA when it goes into your account or when you use it for eligible expenses. If you invest your HSA dollars and earn interest, those earnings are also tax-free. IT S ALL YOURS. You own the money in your account. It rolls over from year to year even if you change medical options or drop LVHN coverage. The account stays with you. IT HAS A LOT OF FEATURES. You can access your funds as easily as you would from a checking account with a debit card or with checks. Your account earns interest, like a savings account and, you can invest it in mutual funds when your balance is more than $2,500 (all of that is tax free). Any banking fees will be outlined in the welcome packet. YOU CAN USE IT NOW. You can use your HSA balance on an ongoing basis to pay for incurred eligible expenses, up to the amount in your account at any given time. Eligible expenses include the deductible, co-insurance, allowable expenses not covered by the plan and charges above the allowable charge for out-of-network care. YOU CAN USE IT IN THE FUTURE. Because your funds roll over and you own the account, you can use the HSA as your retirement health care savings account. After you leave employment or retire, you can continue to spend the accrued funds on eligible medical and prescription drug expenses without paying taxes; you can even cover COBRA, long-term care or Medicare premiums with your tax-free savings. HSA Contributions LVHN contributes to your HSA. LVHN s annual contribution is $650 for Employee Only coverage or $1,300 if you cover any family members. That s half of the annual deductible. This contribution will be deposited in your HSA throughout the year, in an equal amount each pay period ($25 per pay period for Employee Only coverage or $50 per pay period for family coverage). You can make pre-tax contributions. Your HSA can grow faster, and you can save on taxes when you make pre-tax contributions. The maximum annual amount that LVHN and you can contribute in total to your HSA is set by the IRS. For Employee Only coverage, the maximum amount for 2017 is $3,400, so you may contribute up to $2,750. For Employee + Spouse, Employee + Child(ren) or Employee + Family coverage, the maximum amount for 2017 is $6,750, so you may contribute up to $5,450. If you are age 55 or older in 2017, you may contribute an additional $1,000 to your HSA. This is known as a catchup contribution. HSA Flow HSA account deposits employee and LVHN Use HSA to pay for medical expenses Save for future qualified medical expenses Investment options Other Important Information About HSAs Funds are available as they are deposited in your account; you can only use the amount in your account at any time. You may not have other non-high deductible health coverage (i.e., from a parent, spouse or Medicare) while enrolled in the LVHN HSA Plan. You (and your spouse) cannot have a Health Care FSA and an HSA. You may change your HSA contributions once a month, including starting or ending contributions. You pay less when you use Tier 1 or Tier 2 providers. 7

8 Prescription Drug Coverage Going to a Health Spectrum Pharmacy when you need to fill a prescription saves you money. You also save money by using generic drugs when they are available. You pay the following amounts for your prescriptions, based on whether the medication is generic, preferred brand name or non-preferred brand name. Important for HSA Plan members: You pay 100 percent of the cost for your prescriptions until you meet your deductible. Prescription Coverage Change In an effort to continue to contain costs associated with escalating drug prices, beginning in 2017, there will be some brand drugs that have less expensive brand or generic name equivalents excluded from prescription coverage under the LVHN Health Plan. The list of excluded brand drugs is available at MyPopulytics.com and LVHN.org/pharmacy. Prescription Drugs and Health Spectrum Pharmacy Generic LVHN PPO Plan* You pay an $8 co-pay per month per prescription (some generic medications have only a $4 co-pay). LVHN HSA Plan You pay 10% of the allowable charge, up to a maximum of $24 per prescription, after you meet the deductible. Preferred Brand Name You pay a $20 co-pay per month per prescription. You pay 10% of the allowable charge, up to a maximum of $60 per prescription, after you meet the deductible. Non-preferred Brand Name You pay a $40 co-pay per month per prescription. You pay 10% of the allowable charge, up to a maximum of $120 per prescription, after you meet the plan deductible. Specialty Drugs You pay 20% co-insurance with a $150 maximum for a 30-day supply. You pay 10% of the allowable charge, up to a maximum of $450 per prescription, after you meet the plan deductible, up to a 90-day supply. * If the retail price of the medication is lower than the co-pay, you pay the lower price. Supplies for 30, 60 or 90 days are allowed if ordered by your physician for the co-pay total per month. Prescriptions for brand-name drugs will only be paid at the brand level if your doctor expressly notes that a brand-name drug is medically necessary or a generic equivalent is not available. Otherwise, both options will pay only the cost of the generic equivalent. The member is required to pay the difference, and this difference will not be applied to the out-of-pocket maximum. Prescription Drugs (Retail Pharmacy or Physician s Office) Out-of-Area Out-of-Network LVHN PPO Plan You pay a $40 co-pay and 20% of the allowable charge after you meet a separate prescription plan deductible of $250 per person, up to $500 per family. This deductible is separate from the health plan deductible. You pay a $40 co-pay and 20% of the allowable charge after you meet a separate prescription plan deductible of $250 per person, up to $500 per family. This deductible is separate from the health plan deductible. LVHN HSA Plan You pay 10% of the allowable charge, after you meet the deductible. You pay 50% of the allowable charge, after you meet the deductible. 8

9 Emergent Prescription Drug Benefit LVHN Health Plan members who receive a prescription from an emergency room or urgent care setting outside of the regular business hours of Health Spectrum Pharmacy Services (HSPS), and have a need to fill the prescription immediately, will now be able to fill this at a non-hsps pharmacy and be reimbursed at the Tier 1 prescription benefit level. The member will be required to pay the providing pharmacy at the time of service, complete the Emergent Prescription claim form and submit to Populytics for reimbursement. The form is available on the LVHN human resources intranet under Quick Forms or on MyPopulytics.com under Pharmacy then Pharmacy Forms and Benefit Guides. Step Therapy for Prescription Medications New medications come on the market all the time. As a new drug is developed, it takes some time to make sure that it will work as expected. These new drugs can be costly. LVHN Health Plan is always looking for ways to keep costs down for members while still making sure you get the safest, most effective and reasonably priced drug available. One way we can do this is with a step therapy program. Step therapy is trying other medications in the same drug class first before stepping up to drugs that cost more. The Plan wants to know that less expensive options don t work before the drug will be covered. Here s an example of step therapy: STEP 1: You try a low-cost medication proven to be effective for acid reflux. You re still having symptoms. STEP 2: Because you have tried a lower-cost medication, if your physician prescribes a more expensive medication for acid reflux, it will be covered. The list of drugs requiring step therapy is available at MyPopulytics.com and LVHN.org/pharmacy. If your drug needs step therapy, either you or your pharmacist will need to let your doctor know. Your doctor might switch your therapy to another drug that doesn t require approval from the health plan. Or, your doctor will contact care management to start the approval process and tell us the information we need. Coverage for Contraceptives Generic prescription contraceptives are covered at 100 percent with no deductible at a Health Spectrum Pharmacy. Brand-name prescription contraceptives will only be paid without a co-pay or deductible if your physician expressly notes that a brand-name medication is medically necessary or a generic equivalent is not available. Otherwise, the plan will only pay the cost of the generic equivalent, and the balance is not applied to the out-of-pocket maximum. 9

10 Comparing the LVHN PPO Plan and LVHN HSA Plan At-a-glance, here s how the two options compare: Features LVHN PPO Plan LVHN HSA Plan Covered services Provider network Tier 1 network care Tier 2 network care Tier 3 out-ofnetwork care Same Same LVHN Health Plan (Choice Plus) network There is a discounted cost of care (the allowable charge) when you use an LVHN or LVHN Health Plan (Choice Plus) hospital/facility or physician. For out-of-area services, you may need to pay any amounts that are greater than the usual and customary charge, in addition to your co-insurance. Both options cover most out-of-network care, but you ll pay the most out-of-pocket. Reminder: All LVHN Health Plan tiers exclude coverage from Cancer Treatment Centers of America and Coordinated Health Your premiums Higher Lower Plan deductible Lower Higher Important if you cover any dependents: The family deductible must be met before the plan begins to pay benefits for any person. One person or a combination of family members can meet the family deductible. What you pay for care What you pay for prescription drugs Co-pay when you visit the doctor, fill a prescription, or visit the emergency room or an urgent care facility Co-insurance for most other services Generally co-pays Co-insurance after you meet the deductible (single or family) Co-insurance after you meet the deductible (single or family) What you pay for preventive care Out-of-pocket maximums (most you pay in one year for covered services) Lower Nothing when you use a Tier 1 or Tier 2 provider, up to the plan maximums Higher Health care account Health Care Flexible Spending Account (FSA) optional Health Savings Account (HSA) 10

11 We ve Got You Covered Regardless of which medical option you select, you ll have access to comprehensive coverage and quality provider networks at an affordable cost. Each time you need care, be sure to: UNDERSTAND THE NETWORK OF PROVIDERS. You can save the most on out-of-pocket costs if you use an LVHN hospital/facility or LVHN Health Plan (Choice Plus) physician. If an LVHN hospital/ facility isn t an option, then choosing a hospital/ facility that participates in the LVHN Health Plan (Choice Plus) network is your next best choice. CHOOSE AND FILL PRESCRIPTION DRUGS WISELY. Purchase your prescriptions from a Health Spectrum Pharmacy at any of the following locations: LVH Cedar Crest, LVH 17th Street and LVH Muhlenberg. Save money by finding out if there is a generic drug available. Generic drugs are virtually identical in makeup to their brand-name counterparts and cost much less. KNOW WHERE TO GO TO RECEIVE CARE. Do you need the emergency room or an LVHN ExpressCARE center? Physician s office or convenience care clinic? Making the right choice can save you time and money. Consider using one of the LVHN ExpressCARE locations as another option for a non-urgent issue other than the emergency room: Hazleton Shopping Center (Broad Street) Lehigh Valley Health Network Tilghman Health Center at Bangor LVPG Family Medicine Nazareth Health Center at Bethlehem Township LVPG Family Medicine Whitehall Health Center at Fogelsville ExpressCARE Muhlenberg Health Center at Macungie Nesquehoning Medical Center Health Center at Moselem Springs If you utilize the emergency room for a non-urgent issue, your co-pay will be higher. 11

12 Choosing Your Medical Plan Option Choosing your medical plan option is about comparing costs your premiums, co-pays, deductibles and co-insurance and what medical services you expect to need during the year. (Please refer to your EOBs on MyPopulytics.com from the past year to get an estimate of your health charges and allowable expenses for the year.) Much of this decision depends on your health, your risk tolerance and if you have disposable funds during the year to pay for health care expenses. Take a look at these examples to see how costs compare for low, medium and high health care users. Remember, the medical costs shown here are estimates and may be different from what you could ultimately pay for the same or similar services. Premiums are based on the salaries in these examples. Meet Matthew Matthew is enrolled in the LVHN PPO Plan and lives within the LVHN Health Plan (Choice Plus) network area. When he needs to go to his primary care doctor, he has a choice of using a Tier 1 doctor part of the LVHN Health Plan (Choice Plus) network or a Tier 3 doctor. Assuming he has met the deductible, using a Tier 1 provider is the most cost-effective. Cost of Service Matthew s Cost Tier 1 $125 $15 Tier 2 (applicable if out-of-area) $125 $20 Tier 3 $250 $125 Meet Audra Audra is enrolled in the LVHN PPO Plan. She is generally healthy but gets a bad cold and develops a chronic, serious cough and a fever. Audra is enrolled in the LVHN PPO Plan and has met her annual deductible. She has a choice of going to an LVHN ExpressCARE facility or a hospital emergency room. Because her condition is not considered a medical emergency, she would pay less at an LVHN ExpressCARE facility (assuming she has met the deductible) than at the ER, regardless of the tier. Cost of Service Audra s Cost Emergency Room Tier 1 $1,500 $300 Tier 2 $1,500 $300 Tier 3 $3,000 $1,500 LVHN ExpressCARE Facility Tier 1 $150 $15 Tier 2 N/A N/A Tier 3 N/A N/A 12

13 Meet Stephen Stephen is enrolled in the LVHN PPO Plan. He has some unexpected health care expenses during the year and needs a knee replacement and to be hospitalized for surgery. He has not met his deductible, but if he uses a Tier 1 LVHN hospital/facility, his out-of-pocket expenses for his hospital stay will be lower than with a Tier 2 hospital/facility or Tier 3 out-of-network hospital/facility. Cost of Service Stephen s Cost Tier 1 $13,000 $250 (Tier 1 deductible, then no charge) Tier 2 $13,000 Tier 3 $25,000 $2,920 ($400 Tier 2 deductible, then 20% of $12,600) $13,000 ($1,000 Tier 3 deductible, then 50% of $24,000) Meet Lissette Lissette is a full-time colleague making $35,000. She enrolls her husband, who is self-employed and does not have access to other medical coverage, and her daughter in Employee + Family coverage. The family uses only Tier 1 providers. During the year, Lissette becomes pregnant and delivers. Her husband is fairly healthy, going to the doctor for his preventive exam each year. Her daughter also is generally healthy, but like all children, she gets colds and ear infections and goes to the doctor three times during the year, in addition to her preventive exams. Because of the baby, Lissette s medical costs are high, and it looks like the LVHN PPO Plan is more cost-effective for her. But with the LVHN HSA Plan, if she uses her LVHN HSA contributions to pay for expenses, her out-of-pocket costs would be $1,716, making the LVHN HSA Plan more cost-effective. LVHN PPO Plan LVHN HSA Plan Tier 1 Providers Only Cost of Service Lissette s Cost Lissette s Cost Annual deductible $500 family $2,600 Annual physicals (no cost under either plan) Lissette s pregnancy office visit $1,400 $0 $0 $2,100 $30 co-pay $2,100 (deductible) Lissette s delivery $12,000 $250 (deductible) $164 (deductible) Doctor office visits (three visits) $336 $45 co-pays ($250 deductible) $336 (deductible) Lissette s health care costs (co-pays, co-insurance and deductible) $575 $2,600 Total cost of services $15,836 $575 $2,600 Annual premium (Employee + Family) $2, $416 Lissette s total cost $ 2, $3,016 Lissette s total cost with HSA $2, $1,716 13

14 Meet Edward Edward is a full-time colleague making $45,000 a year. He enrolls his two children in Employee + Child(ren) coverage. During the year, they have a variety of health care needs annual physicals, two primary care doctor visits, four specialist visits, two generic prescriptions and a medically necessary trip to an emergency room that resulted in ambulatory surgery. They generally use Tier 1 providers, but one of the specialist visits is to a Tier 3 provider. The LVHN PPO Plan is more cost-effective for Edward because he is a heavy health care user. LVHN PPO Plan LVHN HSA Plan Cost of Service Edward s Cost Edward s Cost Tier 1 Tier 3 Tier 1 Tier 3 Annual deductible $500 family $2,000 family $2,600 family $2,600 family Annual physicals (no cost under either plan) $1,500 $0 N/A $0 N/A Two primary care doctor visits (Tier 1) $200 $30 co-pays N/A $200 (deductible) N/A Three specialist visits (Tier 1) $450 $90 co-pays N/A $450 (deductible) N/A One specialist visit (Tier 3) $250 N/A $250 (deductible) N/A $250 (deductible) Two generic prescriptions $75 $16 co-pays N/A $75 (deductible) N/A Medically necessary emergency room visit $1,500 $100 co-pay N/A $1,500 (deductible) N/A Ambulatory surgery (Tier 1) $12,000 $0 N/A $1, ($125 deductible then 10% of $11,875) N/A Edward s health care costs (co-pays, co-insurance and deductible) $486 $3, Total cost of services $15,975 $486 $3, Annual premium (Employee + Child(ren)) $1, $312 Edward s total cost (includes Tier 1 family deductible) $2, $4, If Edward uses his LVHN HSA contributions to pay for expenses, his out-of-pocket cost would be $2,

15 Meet Cynthia Cynthia is a full-time colleague making $110,000 a year who lives in a zip code that is considered out-of-area, but Tier 1 providers are convenient for her. She enrolls herself and her husband, who doesn t have access to health care coverage, in Employee + Spouse coverage. During the year, their only health care needs are their annual physicals. The LVHN HSA Plan is more cost-effective for them because they are low health care users. LVHN PPO Plan LVHN HSA Plan Cost of Service Cynthia s Cost Cynthia s Cost Tier 1 Tier 1 Annual deductible $500 $2,600 Annual physicals (no cost under either plan) $1,500 $0 $0 Cynthia s health care costs (co-pays, co-insurance and deductible) $0 $0 Total cost of services $1,500 $0 $0 Annual premium (Employee + Spouse) $3, $988 Cynthia s total cost $3, $988 Making Your Medical Plan Decision for 2017 Your best buy in medical coverage is the option that: Provides you with the level of comfort and security you need. (Which is better for you? LVHN PPO Plan? LVHN HSA Plan?) Is financially efficient for you based on your annual premiums, anticipated expenses, co-pays, co-insurance, deductibles, HSA amount, out-of-pocket costs, etc. 15 Covers expenses you expect to incur. Is easy to use. Here are some questions to ask yourself as you consider your medical coverage for 2017: Do I want to pay less up front in lower premiums and more when (and if) I receive care? Or would I prefer to pay higher premiums each paycheck, so that I pay fixed co-pays for services like doctor visits? How often do I or my dependents need health care services? Or am I and any dependents I cover generally healthy and only receive preventive care services each year? Did I spend enough in medical and prescription drug claims in 2016 to meet the LVHN HSA Plan deductible? Since prescription costs count toward the LVHN HSA Plan deductible, it s actually easier to reach the deductible when the plan begins paying benefits. How comfortable am I being involved in and spending time to ensure I m receiving the best possible care at the most costeffective price? Do I have other medical coverage available to me through my spouse s employer plan? If so, how does that coverage and its cost compare to the options available to me through LVHN? Do I want to consider waiving LVHN medical coverage? Whom do I currently cover for medical coverage? And which dependents should I cover going forward? Remember, you will pay more in an LVHN medical plan if you enroll a working spouse who has access to other medical coverage through his or her employer Open Enrollment is from Friday, Oct. 7 to Friday, Oct. 28, Make the time to review your two medical plan options, understand how they re changing for 2017, and decide which medical option is right for you and your family for 2017.

16 / CARE LVHN.org