Tips for Choosing Medical Coverage

Transcription

1 Tips for Choosing Medical Coverage Selecting the right medical plan can be difficult. There are so many factors to consider and terms you may not understand. This presentation will define some of the terms you need to know review the options you have for medical coverage identify the important factors to consider look at the advantages of enrolling in each option Provide you with additional resources to review before making your choice.

2 Network Terms You Need to Know Specific group of providers doctors, hospitals, laboratories, and pharmacies that have agreed to provide their services to plan members at a specific price. There are two types of networks Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO) The type of network determines the benefit you will receive when you use providers in the network verses when use providers outside of the network. 2

3 Types of networks: Terms You Need to Know Preferred Provider Organization (PPO) In a PPO, you receive the highest benefit when you use providers included in the plan's 'Preferred' network (In-Network). You may use providers not in the plan's 'Preferred' network (Out-of-Network), but your out of pocket expenses will be greater. Exclusive Provider Organization (EPO) To receive any benefit under an EPO, you need to use providers included in the plan's 'Exclusive' network (In-Network). Services received from providers not in the plan's Exclusive network (Out-of-Network) are not covered. 3

4 High Deductible Health Plan Terms You Need to Know A plan with a large deductions. The plan offered to NAU employees has a $1,300 individual and a $2,600 Family deductible. Health Savings Account This account is paired with a High Deductible Health Plan. Both you and NAU make pre-tax contributions each pay period to this account. The funds in this account can be used to pay for out-of- pocket medical expenses. Unused funds in the account roll over from to year and are yours if you leave NAU. 4

5 Out-of-Pocket Expenses Terms You Need to Know Are what you pay when you receive medical care. There are several types of Out-of-Pocket Expenses. Deductible Coinsurance Copay Out-of-Pocket Maximum Out-of-Pocket Maximum The most cost-sharing you will ever have to pay in a year. The items that count toward the maximum can vary based on the plan. Your premiums are not included. 5

6 Terms You Need to Know Types of Out-of-Pocket Expenses. Deductible This is the amount you pay every year before the insurance company starts paying its share of the costs. If the deductible is $500, then you would pay for the first $500 in health care you receive each year, after which the plan would start paying its share. Coinsurance The percentage of the cost of a service the plan pays. Copay A fixed dollar amount you pay for certain types of care. For example, You might pay $30 for a doctor visit and the plan will pick up the rest after you have met your annual deductible. 6

7 Coverage Terms You Need to Know Which services are covered by the plan and which services not covered the plan. Benefits How much of the coverage service is paid by the plan. 7

8 What Are Your Options? NAU offers eligible employees four different medical plan: NAU PPO through BCBSAZ State PPO through Aetna, BCBSAZ or United Health Care State EPO through Aetna, BCBSAZ, CIGNA or United Health Care High Deductible Health Plan (HDHP) through Aetna and Health Savings Account (HSA) administered by PayFlex

9 Other Medical Plans You can also choose any other medical plan for which you are eligible such as. your spouse s medical coverage your parent s medical coverage public programs such as Medicaid (AHCCCS in AZ), Medicare or Children s Health Insurance Program 9

10 What to Consider When comparing your options you need to consider: The Network The Benefits and Coverage Your Overall Cost* Premium Out-of-Pocket Expenses How easy the plan is to use *You should also consider your ability to cover large out-of-pocket expenses as deductibles 10

11 Benefits and Coverage All the plans offered to NAU employees provide coverage for common services such as preventive care, hospitalization, outpatient care and prescription drugs, but the benefits provided under each plan differs. Review the Summary Benefits and Coverage and the Voluntary Benefit Summary for more information on the coverage and benefits for each plan. 11

12 Paying for Medical Coverage You pay for medical coverage in two ways: your premium plus your out of pocket expenses. Review the Guide to Your Northern Arizona Benefits for cost information on the medical plans offered by NAU. 12

13 Which Medical Plan is Right for You? Everyone has different health and financial situation so you need to evaluate these difference carefully to find the plan that is best for you and your family. Lets go over some of the advantages and disadvantages of enrolling in each plan.

14 NAU BCBSAZ PPO Flexibility to go to providers not in the network and still receive a benefit. The premium is higher than some plans but this plan has lower out-ofpocket expenses Has the lowest deductible for a PPO plan Effective January 1, 2018 there is $ 0 copay and no deductible for Campus Health Services and Mental Health office visits Through the mail order program, you can get 90 days of some prescriptions for one copay Disadvantage Higher employee premium than EPO, HDHP/HSA and some of the coverage levels of the PPO 14

15 State Preferred Provider Organization (PPO) Flexibility to go to providers not in the network and still receive a benefit. There are several networks to choose from: Aetna, BCBSAZ and United Health Care. This plan has a higher premium than some plans but lower out-ofpocket expenses than the HDHP/HSA Disadvantages Higher employee premium than EPO and HDHP/HSA and some levels for the NAU BCBSAZ PPO. Higher deductible than the NAU BCBSAZ PPO 15

16 State Exclusive Provider Organization (EPO) Low out-of-pocket expenses NO DEDUCTIBLE There are several networks to choose from: Aetna, BCBSAZ, CIGNA and United Health Care. Lower premium that the PPO. Disadvantages You can only use the providers in the plan s exclusive network. There are NO benefits for services received from providers not in the network. Highest Maximum Out-of-Pocket 16

17 High Deductible Health Plan (HDHP) and Health Savings Account (HSA) Lowest premiums but the highest deductible ($1,3000 individual/$2,600 family) Each pay period NAU will contribute $27.70 for employee only coverage and $55.39 for all other levels of coverage to a Health Savings Accounts. You get to take unused contributions with you when you leave Disadvantages Large deductible must be met before benefits for most services will be paid. You may not have enough funds in your Health Savings Account to cover the large deductible or other out-of-pocket expense, particularly when you first join the plan. 17

18 Your Spouse s or Parent s Medical Plan The best option may be coverage under your spouse or parent s plan There may not be an additional cost for you to be covered Benefits and coverage could be better than any of the plans offered by NAU The overall cost could be better than any of the plans offered by NAU If you lose coverage you may be able to add medical coverage under one of NAU s medical plan as a Qualified Life Event(QLE). Learn more about QLEs 18

19 Public Medical Plans If you meet the eligible requirements for these plans your overall cost could be less than any of the plans offered by NAU. If you lose coverage under public plan you may be able to add medical coverage under one of NAU s medical plan as a Qualified Life Event(QLE). Learn more about QLEs 19

20 More Information For more information on medical coverage you should review Medical web page Summary of Benefits and Coverage Voluntary Benefit Summary Contact Human Resources at or if you have any questions about the benefits offered by NAU.