HDHP + HSA Design for SUU

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1 HDHP + HSA Design for SUU TRADITIONAL INSURANCE PLAN DEDUCTIBLE $500 individual $1,000 family CO-INSURANCE MAXIMUM $2,000 individual $4,000 family These figures are mutually exclusive which means the total out-of-pocket expenses for deductible-related items is either $2,500 or $5,000 HIGH DEDUCTIBLE HEALTH PLAN DEDUCTIBLE IRS Guideline $1,500 single $1,250 $2,500 family $2,500 OUT-OF-POCKET MAX IRS Guideline $3,000 single $6,050 $5,000 family $12,100 These figures are mutually inclusive which means the total out-of-pocket expenses for all items is either $3,000 or $5,000 SUU HDHP & HSA Presentation with Scenarios for Employee Reference 1

2 HDHP + HSA Design for SUU TRADITIONAL INSURANCE PLAN HIGH DEDUCTIBLE HEALTH PLAN CO-PAYMENTS (non-deductible) $40 Primary Care Physician $50 Secondary Care Physician $300 Emergency Room $10 Generic Prescription 30% Preferred-Brand Prescription (capped at $250 per script) 50% Non-Preferred-Brand Prescription (capped at $250 per script) CO-PAYMENTS (after deductible) $40 Primary Care Physician $50 Secondary Care Physician 80%/20% for other procedures $10 Generic Prescription 30% Preferred-Brand Prescription (capped at $250 per script) 50% Non-Preferred-Brand Prescription (capped at $250 per script) SUU HDHP & HSA Presentation with Scenarios for Employee Reference 2

3 What does this mean in terms of cost (FY14)? Under the traditional plan, individual coverage will have the following costs: Employee pays $43.13 per pay period ($1, annually) - 18% premium share collected by SUU to pay claims/admin costs to EMI Health Employer pays $ per pay period ($4, annually) - 82% premium share used to pay claims/admin costs to EMI Health Under the HDHP, single coverage will have the following costs: Employee pays $20.44 per pay period ($ annually) - 10% premium share goes into the employee s HSA Employer pays $ per pay period ($4, annually) - Pay period premium used to pay claims/admin costs to EMI Health Employees could still contribute up to $2,500 of their own funds to an FSA per plan fiscal year, but those funds must be used during the current plan year. HSA accounts allow maximum contributions of $3,250 in 2013 between employer and employee contributions for single coverage. SUU HDHP & HSA Presentation with Scenarios for Employee Reference 3

4 What does this mean in terms of cost (FY14)? Under the traditional plan, two party coverage: Employee pays $97.05 per pay period ($2, annually) - 18% premium share collected by SUU to pay claims/admin costs to EMI Health Employer pays $ per pay period ($10, annually) - 82% premium share used to pay claims/admin costs to EMI Health Under the traditional plan, family coverage: Employee pays $ per pay period ($3, annually) - 18% premium share collected by SUU to pay claims/admin costs to EMI Health Employer pays $ per pay period ($14, annually) - 82% premium share used to pay claims/admin costs to EMI Health Employees could still contribute up to $2,500 of their own funds to an FSA pear year, but it has to be used during the plan year. Under the HDHP, family coverage: Employee pays $59.33 per pay period ($1, annually) - 10% premium share goes into the employee s HSA Employer pays approx. $ per pay period ($13, annually) - Pay period premium collected by SUU to pay claims/admin costs to EMI Health HSA accounts allow maximum contributions of $6,450 in 2013 between employer and employee contributions for family coverage. SUU HDHP & HSA Presentation with Scenarios for Employee Reference 4

5 Scenarios of Utilization for FY2014 Scenario #1: Single Coverage (all in-network) Type of Service Actual Cost of Service Traditional HDHP Two (2) Primary Care Doctor s Office Visits ($84 each) $168 $80 $168 Secondary Care Doctor s Office Visit $175 $50 $175 Annual Preventative/Routine Exam $300 $0 $0 Five (5) prescriptions per month: 2 generic medications ($24 each) 2 preferred-brand medications ($131 each) 1 non-preferred-brand medication ($150 each) $576 $3,144 $1,800 $240 $944 $900 $576 $944 $900 Inpatient Hospitalization - Emergency Surgery (May) $15,000 $2,500 $237 Secondary Care Doctor s Office Visit (post-surgery) $100 $50 $0 Total Out-of-Pocket Expenses for Services based on plan design $4,764 $3,000 Premiums Paid to Insurance Company OR contribution to HSA $1,035 $490 HSA Funds Available for use $0 ($490) Remaining Balance in HSA that is rolled to next plan year $0 $0 Actual Out-of-Pocket Expenses (including Premiums) $5,799 $3,000 SUU HDHP & HSA Presentation with Scenarios for Employee Reference 5

6 Scenarios of Utilization for FY2014 Scenario #2: Two-Party Coverage (all in-network) parent + one dependent Type of Service Actual Cost of Service Traditional HDHP Five (5) Pediatrician Office Visits ($100 each) $500 $200 $500 Primary Care Doctor s Office Visit ($84 each) $84 $40 $84 Annual Preventative/Routine Exam $300 $0 $0 Well-Child Visit $125 $0 $0 Instacare Facility Visit $127 $50 $127 Four (4) generic prescriptions during the year for Amoxicillin ($4 each on pharmacy s list) $16 $16 $16 Total Out-of-Pocket Expenses for Services based on plan design $306 $727 Premiums Paid to Insurance Company OR contribution to HSA $2,329 $1,424 HSA Funds available for use $0 ($727) Remaining Balance in HSA that is rolled to next plan year $0 $697 Actual Out-of-Pocket Expenses (including Premiums) $2,635 SUU HDHP & HSA Presentation with Scenarios for Employee Reference 6

7 Scenarios of Utilization for FY2014 Scenario #3: Family Coverage (all in-network) Type of Service Actual Cost of Service Traditional Primary Care Doctor s Office Visit $84 $40 $84 Two (2) Annual Preventative Exams ($300 each) $600 $0 $0 Two (2) Well-Child Visits ($125 each) $250 $0 $0 Four (4) generic prescriptions during the year for antibiotics and child supplements ($4 each) HDHP $16 $16 $16 Total Out-of-Pocket Expenses for Services based on plan design $56 $100 Premiums Paid to Insurance Company OR contribution to HSA $3,346 $1,424 HSA Funds available for use $0 ($100) Remaining Balance in HSA that is rolled to next plan year $0 $1,324 Actual Out-of-Pocket Expenses (including Premiums) $3,402 SUU HDHP & HSA Presentation with Scenarios for Employee Reference 7

8 Scenarios of Utilization for FY2014 Scenario #4: Family Coverage (all in-network) Type of Service Annual Cost of Service Traditional HDHP Eight (8) Pediatrician Office Visits ($100 each) $800 $320 $800 Four (4) Primary Care Dr s Office Visits ($84 each) $336 $160 $336 Three (3) Annual Preventative Exams ($300 each) $900 $0 $0 Three (3) prescriptions per month: 2 generic medications ($24 each) 1 preferred-brand medications ($131 each) $576 $1,572 $240 $472 $576 $1,028 Two (2) Instacare Facility Visits ($127 each) $254 $100 $100 Two (2) Emergency Room Visits ($1,440 each) $2,880 $600 $576 Total Out-of-Pocket Expenses for Services based on plan design $1,892 $3,416 Premiums Paid to Insurance Company OR contribution to HSA $3,346 $1,424 HSA Funds used during the current plan year $0 ($1,424) Remaining Balance in HSA that is rolled to next plan year $0 $0 Actual Out-of-Pocket Expenses (including Premiums) $5,238 $3,416 SUU HDHP & HSA Presentation with Scenarios for Employee Reference 8

9 Scenarios of Utilization for FY2014 Scenario #5: Family Coverage (all in-network) Type of Service Annual Cost of Service Traditional Two (2) Annual Preventative Exams ($300 each) $600 $0 $0 HDHP Inpatient Hospitalization (Maternity) - November $3,500 $1,100 $2,700 Dr s services in conjunction with Maternity $2,500 $500 $500 Inpatient Hospitalization (Newborn) $1,500 $700 $300 Monthly Generic Medication ($16 each) $192 $120 $144 Four (4) Well-Baby Preventative Visits ($125 each) $500 $0 $0 Two (2) Primary Care Dr s Office Visits ($84 each) $168 $80 $80 Total Out-of-Pocket Expenses for Services based on plan design $2,500 $3,724 Premiums Paid to Insurance Company OR contribution to HSA $3,346 $1,424 HSA Funds used during the current plan year $0 ($1,424) Remaining Balance in HSA that is rolled to next plan year $0 $0 Actual Out-of-Pocket Expenses (including Premiums) $5,846 $3,724 SUU HDHP & HSA Presentation with Scenarios for Employee Reference 9

10 Questions? A link is available with FAQs and a place to ask any additional SUU HDHP & HSA Presentation with Scenarios for Employee Reference 9