Adobe 2014 Aetna Medical Plans

Transcription

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Adobe 2014 Aetna Medical Plans 2012

2 Aetna 2014 Medical Plan Options Aetna HealthSave (HSA) new for 2014 Aetna HealthFund (HRA) Aetna 90/70 Aetna OOA new plan design for 2014 ***Aetna 80/60 - discontinued for 2014 Common Features across Aetna Plans: Network is Open Access Choice POS II No Primary Care Physician election required No referrals required for Specialists or Procedures Lifetime Maximum is unlimited Teladoc phone and online visits new for 2014 Mental Health & Substance Abuse coverage is through Aetna Behavioral Health and is integrated with the medical plans Pharmacy coverage provided by Aetna new for 2014: all pharmacy costs apply to the out of pocket maximum 2

3 Aetna HealthSave (HSA) Deductible In and Out of Network Coinsurance In Network Coinsurance Out of Network Out of Pocket Maximum In Network Out of Pocket Maximum Out of Network Preventive Care Office Visits Behavioral Health Pharmacy* $1,250 individual / $2,500 family 90% after deductible 70% after deductible $ 2,800 individual / $5,600 family $4,800 individual / $9,600 family 100% in-network / out-of-network Subject to deductible and coinsurance Subject to deductible and coinsurance Subject to deductible, then base pharmacy plan design (copays are subject to the out of pocket maximum) * Medications on the preventive list bypass deductible 3

4 Aetna HealthSave (HSA) Key Features Preventive Care paid at 100% Plan provides comprehensive coverage after deductible is met Adobe helps you meet your deductible by contributing to your Health Savings Account through HealthEquity (after your HSA account is activated) Behavioral Health Services are integrated into the plan You save on employee contributions Pharmacy expenses apply to the deductible until deductible is met, then are subject to the underlying pharmacy plan design (Note: copays are subject to the out of pocket maximum as well). 4

5 Aetna HealthSave As Easy as All expenses are subject to the deductible: Medical, Rx (non-preventive), Behavioral Health 2. Once deductible is satisfied, medical and behavioral health claims pay at coinsurance level, Rx pays are copay level all coinsurance and Rx copays apply to the out of pocket maximum 3. You choose when you use you Health Savings Account to cover qualified expenses Adobe provides a contribution to your Health Savings Account ($750 employee, $1,500 employee + 1 or more) You may contribute additional funds to your Health Savings Account, up to the annual maximum ($3,300 employee, $6,550 employee + 1 or more). Catch-up contributions for individuals who are 55 or older is $1,000. (Limits inclusive of the Adobe contribution.) 1. The Deductible All expenses covered under the plan apply to the deductible* as required by law *Preventive List medications bypass the deductible 2. Base Medical/Rx Plan After the deductible is met, you pay a percentage of any additional Medical/BH services you receive (coinsurance), up to your annual out-of-pocket maximum pharmacy copays apply to the out of pocket maximum as well. 3. Health Savings Account Adobe provides dollars to pay for medical/pharmacy expenses. You may also contribute you own dollars to the account on a pre-tax basis Bonus: Unused amounts in your bank account stay with you, rollover to the next plan year. Should you leave Adobe, you take them with you! No limit to the rollover amount! 5

6 Aetna HealthFund (HRA) HealthFund Deposit $750 / $1,125 / $1,500 Deductible In and Out of Network $1,800 / $2,700 / $3,600 Coinsurance In Network 90% Coinsurance Out of Network 70% Out of Pocket Maximum In Network (does not include ded) Out of Pocket maximum Out of Network (does not include deductible) Preventive Care In and Out of Network Office Visits Behavioral Health Pharmacy $1,000 / $1,500 / $2,000 $3,000 / $4,500 / $6, % / 100% after deductible Subject to deductible and coinsurance Subject to deductible and coinsurance Copays are subject to the out of pocket maximum Unused Funds rollover to the next year, subject to plan limits: Employee Only - $2,800, Employee $4,200, Employee + 2 or more - $5,600 6

7 Aetna 90/70 Deductible In Network Deductible Out of Network Coinsurance In Network Coinsurance Out of Network Out of Pocket Maximum In Network Out of Pocket maximum Out of Network Preventive Care In and Out of Network Office Visits In Network Office Visits Out of Network Behavioral Health Pharmacy $1,500 individual / $3,000 family $3,000 individual / $6,000 family 90% after deductible 70% after deductible $2,800 individual / $5,600 family $4,800 individual / $9,600 family 100% / 70% after deductible $15 (PCP) / $30 (Specialist) 70% after deductible Subject to deductible and coinsurance Copays are subject to the out of pocket maximum 7

8 Teladoc TEL-ADOC An individual has flu-like symptoms but doesn't have the time to sit in an urgent care waiting room. Instead they call Teladoc: Step 1. Medical history Individual is required to complete their medical history online, by phone, or by faxing a paper form prior to requesting a consultation. Step 2. Request consult They simply log on to their account or call Teladoc, 24/7/365, to request either a telephone or video consultation. Step 3. Talk with a physician A board-certified physician licensed in their state reviews their medical history and provides a consultation over the phone or through video, just like an inperson visit. Step 4. Resolve the issue The physician recommends the right treatment for their medical issue. If a prescription is necessary, it is electronically sent to the individual s pharmacy of choice. Step 5. Continuity of care The physician documents the results of the consultation in the individual s medical history. Consultation information can be sent to the individual s primary care physician upon request. Step 6. Reconcile Account Teladoc collects the appropriate copay from the individual and sends a claim to Aetna. 8

9 2014 Rx Plan Design 2014 Rx Co-payments Retail generic: $15 Mail Order: $30 Brand (preferred list): $45 Mail Order: $90 Brand (non-preferred): $65 Mail Order: $130 Specialty Medications are required to be filled through Aetna Specialty Pharmacy: Medications include injectable, infused, select oral therapies. Patient support programs staffed by clinical team of patient care coordinators, pharmacists and registered nurses 24/7 For more information visit Aetna Navigator or Remember for the Aetna HealthSave (HSA) plan, Rx is subject to the deductible, then you pay copays up to the maximum out of pocket. 9

10 HealthSave (HSA) Year 1: Putting it all together Chart indicates amounts that apply when network providers are used Year 1 Scenario With HSA rollovers, many employees out-ofpocket costs will be lower Annual Amounts Adobe Contribution Amount You only You + Spouse $750 $1,500 $1,500 Deductible $1,250 $2,500 $2,500 Your Share of Deductible Your coinsurance maximum $500 $1,000 $1,000 $1,550 $3,100 $3,100 Your maximum risk $2,050 $4,100 $4,100 You + Spouse (2 Children) This example assumes a full (12-month) Plan Year if you enroll in the HSA as a new hire or add dependents due to a change in status, the Adobe contribution amount will be prorated according to a schedule. Special rules apply to COBRA participants. 10

11 Consider your per-pay period premium contribution savings Annual You Only amounts Your premium contribution HealthSave (HSA) Plan HealthFund (HRA) Plan 90/70 Plan $0 $504 $2,028 Your premium savings $2,028 $1,524 NA Your share of deductible Your coinsurance maximum Your total potential cost worst-case scenario $500 $1,050 $1,500 $1,550 $1,000 $1,300 $2,050 $2,554 $4,828 Chart assumes network providers are used and a full year (12-months) of payroll contributions. 11

12 Consider your per-pay period savings Annual You, Spouse + 3 or more amounts Your premium contribution HealthSave (HSA) Plan HealthFund (HRA) Plan 90/70 Plan $2,244 $3,324 $8,724 Your premium savings $6,480 $5,400 NA Your share of deductible Your coinsurance maximum Your total potential cost worst-case scenario $1,000 $2,100 $3,000 $3,100 $2,000 $2,600 $6,344 $7,424 $14,324 Chart assumes network providers are used and a full year (12-months) of payroll contributions. 12

13 We re here to help! Health Concierge Explain in detail how your benefits work Walk you through how all the member tools work Help solve claim issues Helps explain all programs available to you Webchat available through Aetna navigator Care Managers Single nurse serves as your point person Assistance for acute (short-term) or chronic (ongoing) health care needs One nurse for your whole family (if needed) Helps coordinate care Completely free and voluntary, however please take the call As a note: If you make plan changes, you will get a new ID Card 13

14 Decision Support- ALEX Use this online tool to help you choose your benefits. Easy to use A virtual advisor, ALEX," leads you through. He explains your plan options simply and quickly. Focused on you ALEX asks questions and you answer. Your answers help ALEX present information based on your needs. Like having your own personal advisor ALEX helps you sort through a lot of information in stages that make sense, at your pace. Private The answers you enter are used only to help you choose a plan. They are not stored or used for anything else. Sound too good to be true? 99% of recently surveyed members said ALEX made it easier to choose a plan. Try ALEX today! 14

15 Decision Support - Plan Selection Tool Benefits.Adobe.com Annualized Paycheck Contribution Amounts EE EE + Child(ren) EE + SP/DP EE + SP/DP + up to 2 kids EE + SP/DP + 3 or more kids HealthSave (HSA) $0 $1,032 $1,572 $2,052 $2,244 HealthFund (HRA) $504 $1,488 $2,268 $2,964 $3,324 90/70 $2,028 $4,104 $5,436 $7,344 $8,724 15

16 Member Payment Estimator Real-time out-of-pocket estimates for the most common medical, non-emergency health care services Compare costs before you receive care including: Physician office visits such as routine exams and specialist visits (In- and out-ofnetwork) Surgical procedures including maternity services, ear tube insertion and cataract/lens surgeries (in-network only) Diagnostic tests and procedures including upper GI endoscopies and colonoscopies (in-network only) Estimates based on your actual benefits plan (including deductible, coinsurance, copayments, plan limits, HRA dollars) Allows you to: Compare up to ten in-network providers or facilities at one time and view estimates for certain out-ofnetwork physician services. Provides estimates for service bundles Multiple services typically performed together as one procedure or visit (for example, office visit, colonoscopy) with the option to view details 16

17 Aetna Apps/Mobile Functionality: Register Now Forgot user name and/or password Search Doctor or Facility Get turn-by-turn directions to the office with the built-in Global Positioning System (GPS) Call the doctor's office with the tap of a finger Transfer the doctor or facility contact information right to your address book View your member ID card information Look up Claims - see the status of your five most recent claims or conduct a search for more specific needs View your Personal Health Record including Alerts & Reminders, Emergency Information, Medications, and Tests & Procedures (as appropriate) Check Drug Prices - provides both Aetna Rx Home Delivery and local retail pharmacy costs based on coverage and benefits. View Coverage and Benefit Information High level summary of Medical Plan balances (as appropriate) Summary by family and for each individual on the plan Deductible and co-insurance data summary to include: plan limits, amounts applied to date, and remainders Claim details for amount applied to date, are also available Summary of claims, payments and account balances 17

18 Medical/Rx - Ways to Save Use the Member Payment Estimator before elective services Use Urgent Care Centers over Emergency Room whenever possible (Access current listing at anytime on Aetna Navigator or on the App) When needing lab services, utilize Quest Diagnostics whenever possible. For RX, ask if there is an Over-The-Counter (OTC) equivalent or generic available If you are on a non-preferred (3 rd tier) drug, ask if another drug in the same drug class is available on the preferred level (2 nd tier) Utilize Mail Order when possible for maintenance medications you will pay 2 copays* for a 3 month supply of medicine *unless on the preventive medication listing, you will pay full negotiated cost of the medication until your deductible is met on the HealthSave (HSA) plan for legal compliance reasons. Utilize Price-a-Drug before any new prescriptions and check those you use now for generic additions or lower cost tier options 18

19 Aetna Tools & Programs Aetna Navigator (24/7 member access) Personal Health Record w/ Member Health Engagement Plan Beginning Right (Maternity Management) Informed Healthline (24/7 Nurseline) Simple Steps (Health Assessment and online programs) Care Managers for clinical support whether its an acute condition or ongoing 19

20 Healthy Lifestyle Coaching! Make lasting health changes with the help of a wellness coach: Personal attention from a highly trained wellness coach who will help you improve the way you feel, every day Support for your individual needs such as losing weight, quitting tobacco, nutrition, stress management and more Coaching sessions that fit your schedule Convenient ways to talk with your coach (phone or ) Online programs you can do anytime to help you boost your progress Ongoing follow up Qualify for Incentives! 20

21 Personal Health Record Member Provides you with a personalized list of recommended actions to help improve your health and wellness. New kjdjdkjakdjkljasdkjsdkjasdkjkasjdkasdjkjsdakjasdkjas dkjasdkjkasdjew for 2013 Member Health Engagement Plan Health Engagement Plan Benefits diverse health statuses and provides action plans tailored to your needs. 21

22 Aetna Navigator Access DocFind for participating in-network doctors and facilities Monitor your claims Peruse Cost of Care tools to look up prices of Doctors, Rx Drugs, Medical Procedures and compare facilities and their actual costs Access Simple Steps, Personal Health Record, Maternity Management, Disease Management, and Healthwise Knowledgebase Access information on Healthy Lifestyle Coaching, Online Disease Management, and Member Health Engagement Plan (through the Personal Health Record) 22

23 Thank you