Anthem s Lumenos with HSA Plan

Transcription

1 Anthem s Lumenos with HSA Plan

2 Who can open an HSA? The IRS and the U.S. Department of the Treasury have specific rules on who can open an HSA. You can open an HSA if you: Are enrolled in the Lumenos HSA plan, because it includes an HSA-compatible health plan Are a U.S. resident and not a resident of American Samoa Are not enrolled in Medicare Are not claimed as a dependent on another individual s tax return Are not active military Others refer to online health site Note: You cannot open an HSA if you have coverage under any other health plan that is not an HSA-compatible health plan. 2 2

3 Lumenos Plan Overview

4 Anthem s Lumenos Plan Stay healthy with Preventive Care coverage You and the Plainville BOE make contributions to your account to use toward your deductible and/or co-insurance to pay for medical care and prescription drugs Once you have satisfied your annual deductible, Traditional Health Coverage then covers additional expenses (similar to a PPO) An annual out-of-pocket maximum protects you from large medical expenses Plus earn Healthy Rewards dollars Preventive Care 100% In-Network HSA Funded by you and employer to help satisfy annual deductible and save for future medical expenses Annual Deductible Traditional Health Coverage Healthy Rewards 4 4

5 Your Lumenos Plan Details At-a-Glance Anthem s Lumenos with HSA Plan Single Coverage Family Coverage Preventive Nationally recommended services No cost, no deduction from HSA <with innetwork providers> HSA Annual HSA contribution maximum for 2015 $3,350 $6,650 Traditional Health Coverage Annual Deductible You can use the funds from your Health Savings Account to help satisfy your annual deductible Then, you pay coinsurance for covered services $2000 $ % for In-Network Services 80% for Non-Network Services Anthem s Lumenos Plan pays 100% after annual out-of-pocket maximum (includes annual deductible and coinsurance) In-Network $2000 Non-Network $4,000 In-Network $4000 Non-Network $8,

6 How Your Plan Works When you visit an in-network doctor: Show your ID card at the time of service Typically you pay nothing at the time of service. Your provider will file a claim You will receive a Claim Recap showing the total cost and the allowed cost. Your provider will then bill you for the allowed cost of the service(s) If you have funds in your HSA you can pay your provider using your HSA checkbook or debit card When you visit a doctor that is not in the network: Show your ID card at the time of service You may be asked to pay at the time of services. Use your HSA checkbook or debit card to pay your provider for services (provided you have the funds available) If your provider does not file a claim on your behalf, you will need to file a claim with Anthem BCBS to ensure expenses get applied towards your out-ofpocket. You can download a claim form at anthem.com 6 6

7 Using Your HSA Plan to Get Care When you visit a pharmacy: Show your ID card at the pharmacy Until you have satisfied your annual deductible you will pay the full discounted cost of your prescription drug You can pay for your prescription at the pharmacy using your HSA debit card or checkbook as long as there are funds available in your HSA account. Once you satisfy your deductible and the Traditional Health Coverage begins To get the lowest cost, visit our online health site to learn about generics or other low-cost alternatives Or order your prescriptions by mail: Order a 90-day prescription drug supply Take advantage of our ability to buy in volume and potentially save money Download a mail order form from anthem.com and obtain refills by phone 7 7

8 Using your HSA for Qualified Medical Expenses (QMEs)

9 HSA s and Non-Qualified Medical Expenses Any amount you spend will be considered taxable income (you will have to pay taxes on the amount used), and you will have to pay a 20% penalty on the amount Non-qualified expenses will not count toward your out-of-pocket responsibility under the Traditional Health Coverage Once you are 65, you can withdraw the money without penalty, but it will be considered taxable income 9 9

10 Covered and Qualified Medical Expenses Covered Medical Expenses Medical expenses are the costs of diagnosis, cure, mitigation, treatment, or prevention of disease. Expenses covered by the medical plan described in the Summary Plan Description. Some examples are: Dr. Office/Specialist/Chiropractic Visits Hospital Stays, Radiology, Lab Work Speech/Occupational/Physical therapies Prescription Drugs Qualified Medical Expenses Qualified medical expenses are those expenses that would generally qualify for the medical and dental expenses deduction under tax advantaged accounts (FSA s & HSA s). These are defined by the IRS under Publication 502. Some of these medical expenses are not covered by your Medical Plan and don t count towards your deductible, but you may still use HSA funds for payment. Some examples are: Copays, coinsurance Vision checkups, glasses Dental care, etc. For a complete listing of qualified medical expenses, visit and search Publication

11 Funding Your HSA

12 Making Contributions to Your HSA There are several ways you can contribute to your account: Tax-free through payroll deductions Post-tax by personal check When you file your taxes, you can make an adjustment to your gross income to receive the tax benefit You ll receive deposit slips for your HSA in the mail Anyone may contribute to your HSA, provided the total contributions to your HSA do not exceed your maximum allowable annual limit $3,250 for individual coverage $6,450 for family coverage You can make catch-up contributions if you are 55 years of age or older ($1,000 for 2012) 12 12

13 Our Health Approach in Action

14 360 Health Programs 360 Health is our approach to surrounding you with the resources, tools, guidance and support to help you manage your health MyHealth Coach Future Moms Healthy Lifestyles ConditionCare Programs ComplexCare 24/7 NurseLine 14 14

15 Anthem.com Engaging, intuitive, and easy Easy, more secure access to personalized member services Quick access to the most common member tasks Tone is friendly, helpful, simple language without insurance jargon Seamless transition from public to private site for secure content 15 15

16 Appendix Post Enrollment Communications

17 Quarterly Health Statement 17 17

18 Claim Recap 18 18

19 Legal Disclaimer Anthem Blue Cross and Blue Shield is the trade name for the following: In Colorado, Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. In Missouri: RightCHOICE Managed Care, Inc. (RIT) and Healthy Alliance Life Insurance Company (HALIC). RIT and certain affiliates administer non-hmo benefits underwritten by HALIC. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi") underwrites or administers the PPO and indemnity policies; Compcare and BCBSWi collectively underwrite or administer the POS policies. Serving residents and business in Indiana, Kentucky, Ohio, Colorado, Nevada, Connecticut, Main, New Hampshire, Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123), Missouri (exclluding 30 counties in the Kansas City area) and Wisconsin. Independent licensees of the Blue Cross and Blue Shield Association. Anthem, Lumenos and 360 Health are registered trademarks. Blue Cross and Blue Shield names and symbols are registered trademarks of the Blue Cross and Blue Shield Association