Pennsylvania College of Technology. Health Benefits Q&A Spring 2017

Transcription

1 Pennsylvania College of Technology Health Benefits Q&A Spring 2017 May 2, 2017

2 Agenda 1. QHDHP Plan Basics 2. Highmark Resources 3. Health Savings Accounts 4. Health Advocate 5. Open Q&A Insurance Products offered are: Not FDIC-insured; not a deposit in, obligation of, nor insured by any federal government agency; not guaranteed or underwritten by the bank; not a condition to the provisions or terms of any banking service or activity. Insurance services, benefits consulting services and insurance products are offered through Key Insurance & Benefits Services, Inc. ( KIB ), which is a licensed insurance broker and agent. Insurance policies are obligations of the insurers that issue the policies. Insurance products may not be available in all states. KIB and KeyBank are separate entities, and when you purchase risk management services, business consulting services or insurance products you are doing business with KIB, and not KeyBank. 2

3 Qualified High Deductible Health Plan

4 QHDHP Benefit Summary Benefits Network QHDHP-1 Out-of-Network Individual Deductible $1,300 $2,500 Family Deductible $2,600 $5,000 Coinsurance (Medical) 10% Primary Care/Emergency PCP Visit 10% Specialist Visit 10% Emergency Care 10% Urgent Care 10% Radiology MRI, Advanced Imaging 10% Diagnostic (Lab, X-ray) 10% Preventive Services Annual Preventive Exam No charge Preventive Mammogram No charge Childhood Immunizations No charge Prescription Drug Deductible Subject to Medical Deductible Retail Mail Order Out-of-Network Generic $3 or $10 $6 or $20 Not Covered Brand Formulary $25 $50.00 Not Covered Brand Non-Formulary $50 $100 Not Covered Annual Out-of-Pocket Maximums Out-of-Pocket: Individual* $2,000 $4,000 Out-of-Pocket: Family* $4,000 $8,000 Medical and Prescription costs build the Plan accumulators, which satisfy the Deductible and Out-of-Pocket Maximums (OOP) Network and Out-of-Network accumulations for satisfying the Deductible and OOP Maximums are separate Coinsurance (10%) refers to the Member liability portion of the network allowable amount for medical services, after the deductible has been satisfied Preventive services continue to be covered at 100% in-network Mail Order offers significant savings (up to 33%) and convenience for maintenance medications 4

5 Highmark Resources

6 Highmark Resources is your gateway to information and resources to maximize your Health Plan experience, including: 1. Member Portal 2. Claims and electronic Explanation of Benefits (EOB) 3. Plan information 4. Provider Network Search 5. Pharmacy Network and current Formulary information Telemedicine for minor acute care Blues on Call 24-hour Nurse Hotline 888-BLUE-428 Mental Health/Substance Abuse Specialty Pharmacy (Walgreen s)

7 Highmark Member Portal Go to click on Register (for assistance call ) DURING REGISTRATION, YOU WILL BE ASKED TO PROVIDE: Your member ID number (enter numbers only; no spaces, no letters) Your first and last name, address and date of birth Your relationship to the policyholder Your address You will also need to choose a user login ID and password, and then re-enter that password. YOU ARE NOW REGISTERED TO USE YOUR MEMBER WEBSITE. HERE S WHAT YOU CAN DO: Check the status of a claim and view Explanation of Benefits (EOB) View current Deductible and Out-of-Pocket accumulations Request ID cards Locate providers Check Rx history Access health reference tools 7

8 Highmark Preventive Schedule Comprehensive schedule of recommended services aimed at detecting certain conditions early and keeping you well Subject to periodic revisions based on recommendations from the CDC and NIH Schedules provided for both Children and Adults, depending on age, gender and certain risk factors Consider taking a copy of the Preventive Schedule to your annual exam, to discuss options with your doctor and avoid any billing surprises 8

9 Highmark Preventive Schedule 9

10 Health Savings Accounts

11 HSA Funding Thresholds Based on 26 Pay Periods Amounts in red are the maximum Employee contributions to an HSA for Both Employer and Employee contributions count towards the annual maximums allowed by the IRS: Employee Only: $2,750 Family (emp + 1): $5,450 Amounts in gray are the levels needed to fully fund your HSA account to cover 2017 Out-of-Pocket expenses. Employee Only: $1,350 Family: $2,700 Annual Contribution Bi-Weekly Amount $5,450 $ $4,500 $ $3,500 $ $2,750 $ $2,700 $ $2,500 $96.15 $1,500 $57.69 $1,350 $51.92 $1,000 $38.46 $500 $19.23 $250 $9.62 If you turn age 55 during the benefit period, the IRS says you can catch-up on your contributions. They allow an additional $1,000 to be contributed annually. Remember your contributions are deposited tax-free! 11

12 HSA Compliance Rules IRS Publication 969 is the go-to resource for information related to compliance in the use of Health Savings Accounts (HSA), Health Reimbursement Arrangements (HRA), and Flexible Spending Accounts (FSA) Rules applying to contributions, distributions and ownership of multiple types of tax-favored accounts 12

13 HSA Compliance Rules-Dependents IRS Publication 969 provides language pertaining to children of separated/divorced parents with regard to treatment of distributions KIB recommends employees consult their Tax Advisor for clarification, particularly when there is a Court Order establishing Custody 13

14 HSA Compliance Rules-Distributions IRS Publication 502 provides the definition and examples of qualified medical expenses as well as a list of items that do not qualify KIB recommends employees consult their Tax Advisor for clarification if you are unclear about whether a specific product or service will qualify for HSA distribution 14

15 Health Advocate

16 Health Advocate Services 16

17 Questions? *Please refer to detailed footnote on slide 2. 17