New Medical Plan - (CDHP)

Transcription

1 New Medical Plan - (CDHP) COMPANY LOGO HERE What is a CDHP? The BCBS/Anthem BC Consumer Directed Health Plan (CDHP) gives you more control over how you spend and save your health care dollars. The BCBS/Anthem BC CDHP is available to all eligible employees. It provides comprehensive coverage, has much lower per-paycheck contribu ons than the other Hoya PPO medical plans and puts health care decisions in your hands! The BCBS/Anthem BC CDHP makes purchasing health care similar to buying any other product or service. It puts the control of health care spending - and the responsibility for managing your money - en rely in your hands. This plan allows you to decide how health care is delivered to you and is focused on enhancing your experience as a member. It is a way to manage the costs of medical expenses and make health care work for you. The BCBS/Anthem BC CDHP: Two Parts, One Coverage Op on This coverage op on is made up of two unique components: High deduc ble health plan with PPO network and features Health Savings Account + (HSA) = BCBS/Anthem BC CDHP The CDHP Plan works just like the Anthem Blue Cross PPO plans, except that it has a few key differences: How it s the same How it s different Covers the same health care services Has lower per paycheck employee contribu ons Uses a larger na onal network of Has a higher single and family deduc ble that you must meet providers Allows you to establish a Health Savings Account (HSA) - a tax Provides comprehensive coverage advantaged savings account that can be used to pay for health care expenses now or in future years Prescrip on drug cost applies to the deduc ble unlike the PPO plans Family maximum amounts are aggregate and the en re family deduc ble must be met

2 Part One: Health Plan with PPO Network and Features The medical plan piece of the BCBS/Anthem BC CDHP works like a tradi onal PPO medical plan, but has some different features. The chart below outlines these CDHP features. Keep in mind that if you enroll in family coverage, the en re family deduc ble must be met before any benefits are paid. Prescrip on drugs are subject to the deduc ble as well. So, you will pay the full cost of your prescrip on medica on un l you meet your deduc ble, at which me you will only have to pay the applicable coinsurance. Anthem Blue Cross Consumer Directed Health Plan (CDHP) Deduc ble /Coinsurance In Network Out of Network Individual / Family $1,350 / $3,000 $2,500 / $6,000 Coinsurance 20% 50% Out of Pocket Maximum Individual / Family $3,500 / $6,850 $7,000 / $14,000 Coverage Highlights Office Visit 20% a er deduc ble 50% a er deduc ble Preven ve Care Covered 100% 50% a er deduc ble Rou ne Well-Child Exams Covered 100% 50% a er deduc ble Diagnos c Lab & X-ray (performed and billed by an independent facility) 20% a er deduc ble 50% a er deduc ble Outpa ent Surgery 20% a er deduc ble 50% a er deduc ble Walk-in Clinic 20% a er deduc ble 50% a er deduc ble Urgent Care No coverage for non-urgent care) 20% a er deduc ble 50% a er deduc ble Emergency Room (no coverage for non-emergency care) 20% a er deduc ble 50% a er deduc ble Inpa ent Hospital 20% a er deduc ble 50% a er deduc ble Mental Health (Inpa ent) 20% a er deduc ble 50% a er deduc ble Mental Health (Outpa ent) 20% a er deduc ble 50% a er deduc ble Substance Abuse (Inpa ent) 20% a er deduc ble 50% a er deduc ble Substance Abuse (Outpa ent) 20% a er deduc ble 50% a er deduc ble Durable Medical Equipment 20% a er deduc ble 50% a er deduc ble Outpa ent Short-Term Rehab (60 days/year) 20% a er deduc ble 50% a er deduc ble Prescrip on Coverage Provided through CVS Caremark Annual Deduc ble (excludes generic) $50 per individual $50 per individual Retail Prescrip on (30 day supply) Generic Preferred Brand Name Specialty 20% ($150 max) a er medical deduc ble 20% ($150 max) a er medical deduc ble $95 copay a er medical deduc ble 50% copay 50% copay N/A Mail Order Pharmacy (90 day supply) Generic Preferred Brand Name Specialty 20% ($300 max) a er medical deduc ble 20% ($300 max) a er medical deduc ble N/A Not Covered Not Covered Not Covered Important: While all employees are eligible to enroll in the BCBS/Anthem BC CDHP, certain individual are not eligible to open an HSA per IRS regula ons. You are not eligible to open an HSA if you fall into any of the following categories: You are enrolled in another medical plan (e.g., your spouse s plan), unless it is a qualified high deduc ble health plan You are enrolled in Medicare You are eligible to be claimed as a dependent on another individual s tax return You are not a U.S. resident, or are a resident of American Samoa You are a veteran and have received veterans benefits within the last three months You are ac vely in the military If you fall into one of the categories listed above, be aware that the BCBS/Anthem BC CDHP may not be a good fit for you since you are not eligible to open an HSA. You will not be eligible for the Hoya Employer contribu on to the HSA.

3 COMPANY LOGO HERE Part Two: Health Savings Account The most unique feature of the BCBS/Anthem BC CDHP is the Health Savings Account (HSA). With a Health Savings Account: You own the account Contribu ons can be used for current and future health care expenses - the funds rollover from year-to-year Contribu ons are tax free Investment earnings are tax free Withdrawals are tax free for qualified health care expenses Depending on the state where you live, you may save on state taxes, as well You are only reimbursed for expenses if the money is available in your account. (This differs from the Health Care FSA) The HSA is automa cally created for you and administered by HealthEquity, which is FDIC insured. If you elect the CDHP, you are authorizing HealthEquity to open a Health Savings Account (HSA) on your behalf. In compliance with the USA Patriot Act, HealthEquity must verify the iden ty of all customers seeking to open an HSA. As part of this iden ty verifica on process, you may be asked to provide addi onal informa on and/or documenta on before your account can be established. Contribu on Limits Contribu ons to your HSA come from two sources - you and Hoya. All the money in your account is yours to spend on health care or save. The 2018 HSA maximum that may be contributed for Employee Only coverage is $3,450, and the HSA maximum is $6,850 if you cover any of your dependents. These maximums include the Hoya contribu on to your account. Each year, the maximum amount you can contribute to your HSA may change, per IRS regula ons. Please note, you must remain enrolled in the BCBS/Anthem BC CDHP for the remainder of the year plus the next 12 consecu ve months or a por on of the HSA contribu ons may be subject to tax and penalty, per IRS regula ons. It is your responsibility to ensure contribu ons do not exceed the annual limit. Tax penal es may apply on excess contribu ons. You should consult your personal tax advisor with ques ons regarding your HSA and the filing of your tax returns. 55 or over? You can contribute an addi onal $1,000 above the IRS annual limit.

4 How the BCBS/Anthem BC CDHP Works How do your health care expenses get paid? Let s start at the bo om of your BCBS/Anthem BC CDHP house and work our way up... Founda on: Preven ve Care Preven ve care is the founda on of the BCBS/Anthem BC CDHP and is 100% covered in-network. All eligible preven ve services - such as annual physical exams, preven ve screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing, and vision), immuniza ons, and health educa on - are FREE to you when you visit BCBS/Anthem BC in-network providers and the doctor codes the visit as preven ve. This list is not exhaus ve. This benefit includes all Preven ve Care Services required by federal and state law. Regular preven ve care may help prevent and iden fy health issues before they become problems or chronic condi- ons, so be sure to get your free annual checkup and screenings such as mammograms and colonoscopies.

5 COMPANY LOGO HERE Example Here is an example that shows you haw the BCBS/Anthem BC CDHP works. Also, remember, the employee premiums deducted out of your paycheck are significantly less than the Base and Buy-Up PPO plans! Meet Carol Carol is healthy and ac ve. So when a cycling accident led to a knee injury and unexpected surgery, Carol had some out-of-pocket expenses in the first year of her plan. However, the following year was more typical - only preven ve services, office visits and prescrip ons - so Carol was able to build savings in her HSA. This is an example. Your actual experience will vary. All expenses assume the use of innetwork providers, and no changes to IRS regula ons. Line Hoya s contribu on to Carol s HSA $ Carol s contribu on to her HSA $ Total dollars available in HSA (lines 1+2) $ 1,100 4 Preven ve care services $ Arthroscopic knee surgery $ 4,100 6 Office visits $ Prescrip on drugs $ Total expenses (lines ) $ 4,650 9 Plan pays for preven ve care services (line 4) $ Total expenses remaining $4,400 (lines 8 9) $ 4, Amount paid from HSA (Carol s choice) toward annual deduc ble (line 3) $ 1, Total expenses a er Carol uses HSA to pay for part of her deduc ble (lines 10 11) $ 3, Carol must first meet her $1,350 annual deduc ble. She s paid $1,100 toward her deduc ble; she must pay an addi onal $250 before coinsurance begins $ Total expenses a er deduc ble has been sa sfied (line 10 minus $1,300) $ 3,050 Coinsurance Begins 15 Plan pays (80% of $3,050) (amount from line 14 x 80%) $ 2, Carol pays coinsurance (20% of $3,050) (amount from line 14 x 20%) $ 610 Summary of total expenses for Total amount plan pays (lines 9+15) $ 2, Total amount Carol pays (lines ) $ 1, HSA rollover to 2019 $ Rollover from 2018 (line 19) $ 0 21 Hoya s contribu on to Carol s HSA $ Carol s contribu on to her HSA $ 0 23 Total dollars available in HSA (lines ) $ Preven ve care services $ Office visits $ Prescrip on drugs $ Total expenses (lines ) $ Plan pay for preven ve care services $ Total expenses remaining (lines 27 28) $ Amount paid from HSA (Carol s choice) toward annual deduc ble (line 23) $ HSA rollover to 2020 (lines 23-30) $ 300

6 How will the BCBS/Anthem BC CDHP and HSA plan benefit you? Fill in this worksheet with your own details to find out how the BCBS/Anthem BC CDHP can help you take control of your health care decisions, and save money too. When es ma ng your medical needs in 2018, consider your use of health care benefits in 2017, and use this to es mate how o en you will need care in This can also help you predict what kinds of medical costs you will have. If you plan to become pregnant, have a surgery or undergo significant medical treatment during 2018, this will likely impact the amount of health care you use. Tip: Look at your EOBs (Evidence of Benefits) for 2017 that Aetna provided you to help you es mate your health care expenses. Keep in mind you will want to es mate the actual cost for services, not your copays or coinsurance CDHP PPO (Base or Buy-up) Annual deduc ble (varies, depending on level of coverage). See the comparison chart this Benefits Guide $ $ Es mated annual medical expenses for 2018 (for you and your covered dependents) Preven ve care (if received by out-of-network provider; innetwork preven ve care is covered at 100%) $ $ 2 Office visits (both general prac oners and specialists) $ $ 3 Prescrip on drugs $ $ 4 Physical therapy $ $ 5 Other $ $ 6 Total es mated annual medical expenses (add lines 1-5) $ $ 7 Annual contribu ons (what you pay for coverage) $ $ 8 Subtotal Out-of-Pocket Costs (add lines 6 + 7) $ $ 9 Hoya s contribu on to your HSA $600 / $1,000 / $1,500 None 10 Total Out-of-Pocket Costs (subtract line 9 from line 8) $ $

7 Paying for Expenses with the HSA When you enroll in the BCBS/Anthem BC HSA plan, you will receive a debit card to pay for qualified medical expenses. Here is an example of how you pay for expenses: Cost-Saving Tips You get the most value out of the BCBS/Anthem BC CDHP by making smart decisions about your health and your health care. Since the money in your HSA is yours to keep, you will want to make sure you are spending your health care dollars wisely. To help you calculate your savings, BCBS/Anthem BC has an HSA calculator tool. Go to and select ESTIMATE YOUR COST. COMPANY LOGO HERE