UnitedHealthcare Choice Plus Health Savings Account (HSA) Plans User Guide

Transcription

1 UnitedHealthcare Choice Plus Health Savings Account (HSA) Plans User Guide Tips for Healthy Saving and Spending

2 CHOOSE HEALTH. SPEND WISELY. We are committed to offering you a comprehensive benefits program that supports your total well-being physically, financially and emotionally. To help you make the most of your healthcare benefits, we ve developed this step-by-step guide to using the UnitedHealthcare (UHC) Choice Plus Health Savings Account (HSA) plans. DID YOU KNOW? A recent study showed that people who switched from a traditional insurance plan (like a PPO or an HMO) to a CDHP reduced their annual medical costs by an average of 12% in the first year along with nearly 4% lower pharmacy costs. (8th Annual Cigna Choice Fund Experience Study, 2014) What makes the UHC Choice Plus HSA plans different? The plans are considered consumer-driven health plans (CDHP) because they give you more control over your spending decisions. A CDHP is a health plan that allows participants to use an HSA to pay healthcare expenses directly, while a high-deductible health plan provides free preventive care services and protects the participant from catastrophic medical expenses. CDHPs encourage covered individuals to be informed and thoughtful consumers of healthcare services, much like they would be when purchasing other goods and services. There are some key differences that reward you for making consumer-minded healthcare decisions based on quality and cost. The UHC Choice Plus HSA plans have lower premiums with higher annual deductibles, which means: You keep more of your money each paycheck. You decide when and where to spend your money on eligible healthcare expenses, because you own your HSA. The money in your HSA that you don t spend is yours to keep. You can plan and save for future expenses with a tax-free HSA.

3 INSIDE THIS GUIDE This guide will help you make the most of the UHC medical plans. You ll learn: How the UHC Choice Plus HSA plans work 2 What to do before you need healthcare services 6 What to do when you need healthcare services 7 What to do after you receive healthcare services 9 Resources 11 b 1

4 HOW THE UHC CHOICE PLUS HSA PLANS WORK The plans have two parts low-premium, high-deductible healthcare coverage and a tax-free Health Savings Account (HSA). Part 1: Low-premium, high-deductible healthcare coverage For preventive care: Your costs will be covered at 100% with no deductible when you see an in-network provider. This includes annual physicals, well-child checkups, immunizations and more. For non-preventive care: 1. Non-preventive services include medical services that are provided in order to diagnose, treat or monitor disease, provide relief and/or improve the state of your health. 2. You pay the full cost for non-preventive care until you meet the annual deductible. 3. You can use your HSA dollars the amount provided by the company each year and your own contributions, if you choose to make them to help pay these expenses. 4. Once you meet your deductible, you and the plan share any further costs through coinsurance until you meet your out-of-pocket maximum To protect you financially, the plan limits the amount you have to pay each year for medical care. Once you meet the out-of-pocket maximum, the plan pays 100% of your eligible in-network expenses for the remainder of the year.

5 Part 2: Tax-free HSA Setting up your account: When you enroll in a UHC medical plan online, you ll be prompted to complete two steps to open an HSA that will work alongside your medical plan. PayFlex is the HSA administrator and will manage your account. First, there is a series of questions that you must answer to determine if you are eligible to open an HSA. Next, you will need to complete a banking disclosure to authorize CSAA IG to open an HSA on your behalf. Details of the enrollment process can be found on the Open Enrollment website at (Username: CSAAIG, Password: Ben2016). For new hires, you will receive an telling you how to enroll. It s a good idea to confirm that your HSA has been properly established by contacting PayFlex directly at or You will receive a debit card to use for payments to providers, etc. Company contributions: The company will contribute to your HSA when you enroll in one of the UHC medical plans. You (and your covered spouse/domestic partner) need to complete your biometric screenings to get the maximum contribution. The annual amounts below assume you take this important step toward good health. KEY TERMS Premiums The amount you pay for coverage out of your paycheck. Deductible The amount you pay for covered services before the plan starts sharing the cost through coinsurance. Coinsurance The percentage of costs you and the plan each pay for services after your deductible is met. Out-of-Pocket Maximum The total you will pay per year out of your pocket. UHC Choice Plus HSA 1500 Plan Up to $500 for employee-only coverage Up to $1,000 for family coverage UHC Choice Plus HSA 2500 Plan Up to $750 for employee-only coverage Up to $1,500 for family coverage First-time plan participants may also be eligible for a one-time lump-sum contribution of $500 (if your annual pay is below $50,000) or $300 (if your annual pay is between $50,000 and $99,999). DON T MISS OUT! You ll get the highest company contribution if you (and your covered spouse/domestic partner) complete your biometric screenings (Vitality Check). If you don t complete your biometric screenings, you ll miss out on $250 of your total HSA company contribution ($500 if neither you nor your covered spouse/domestic partner takes action). 3

6 Making your own HSA contributions: You can contribute to your account with before-tax money from your paycheck, which lowers your taxable income and saves on your annual federal (and some states ) income taxes. You can change your contribution amount at any time during the year either increasing or reducing it by going to My Life at AAA and selecting My Benefits (if you are on the company network) or from your personal home computer by going to and logging in using your g ID and password. Once logged in, you ll need to go to the MyHealth section and select Life Status Change. You may also call the AAA Employee Service Center at Note that you do not need to make contributions yourself in order to receive the company contribution. Using your account: Only expenses incurred after your HSA account is open are allowed. Any expenses incurred prior to your HSA account being opened are not allowed per IRS regulations. You can only spend HSA money that is already in your account. Check your account balance at or contact PayFlex at If you incur expenses that exceed the balance in your HSA, you can pay out-of-pocket and reimburse yourself later when your HSA has accumulated more funds. This is a great time to increase your contributions. You can pay your provider directly from your account using your PayFlex debit card or the online system. Or you can pay out-of-pocket using a credit card, personal check or cash and later reimburse yourself for eligible expenses by submitting the receipts to PayFlex. Be sure to keep all receipts in case of an IRS audit. You are responsible for proving that you used your HSA only for qualified healthcare expenses. If you use your HSA funds for other expenses, you will owe taxes on the withdrawal, as well as a 20% penalty tax. Your unspent HSA dollars carry over year after year you will never lose them, even if you change medical plans or leave the company. Consider investing your HSA money. Your HSA balance will earn interest, and any amount above a balance of $1,000 can be invested through PayFlex. Any interest and investment gains you earn are tax-free, as long as the money is used to pay for eligible healthcare expenses. For more information, contact PayFlex at LIMITED PURPOSE REIMBURSEMENT ACCOUNT (LPRA) When you enroll in a UHC medical plan, you have the opportunity to also enroll in a Limited Purpose Reimbursement Account (LPRA). You can use this account to pay for eligible dental and vision expenses and save your HSA for medical and prescription drug expenses. To pay for your expenses, use your PayFlex debit card (PayFlex is the administrator for the HSA and for reimbursement accounts such as the LPRA). Or you can pay out-of-pocket and submit your receipts to PayFlex for reimbursement. Unlike the HSA, the LPRA has a use it or lose it limitation, although due to recent legislation, you can carry over up to $500 of unused funds into the next year. 4 For more information about the LPRA and all of our reimbursement accounts, visit the Open Enrollment website at After Open Enrollment has ended, this information will be available on our benefits site by going to My Life at AAA and clicking on My Benefits, then Resources and Plan Information.

7 How Much Should You Contribute to Your HSA? Deciding how much to contribute to your HSA is a personal decision. Consider the following: The annual IRS limit. You can contribute a maximum of $3,350 for individual coverage or $6,750 for employee & spouse/partner or family coverage (including any amount contributed by the company). If you will be age 55 or older in 2016, you can make an additional contribution of $1,000. Your annual deductible. You may want to have at least enough money in your HSA to meet your annual deductible. Remember, the company will make contributions to your HSA to help you cover your initial outof-pocket expenses before reaching your deductible. Your premium savings. Costs are based on the plan you select, whom you decide to cover and your base pay. Also, if you complete certain wellness activities, you ll get a premium reduction on your paycheck. Here s how the 2016 paycheck contributions would look like for an employee enrolled in employee & family coverage whose annual salary is less than $50,000: Employee & Family Coverage/ Salary Under $50,000 Medical Premiums per Pay Period with NO Wellness Discount UHC Choice Plus HSA 1500 Plan $231 $201 UHC Choice Plus HSA 2500 Plan $185 $155 Medical Premiums per Pay Period with Wellness Discount* * Assumption: Employee and covered spouse/domestic partner completed wellness activities in order to obtain premium reduction. How much you expect to spend during the year. UHC s Cost Estimator tool provides information on the cost of medical services and treatment based on where you receive care. Before scheduling an appointment, determine the cost of services. For example, the cost of an MRI can vary from $500 to $5,000. Visit or call UHC at Your future healthcare expenses. The money in your HSA is always yours to keep even if you leave the company or retire. So think about saving for future healthcare expenses, while taking advantage of current income tax savings. Use the HSA calculator tools to estimate future expenses. Double savings advantages: Contributions to your HSA reduce your federal (and some states ) income tax liability (you pay less on taxes). HSA dollars used for eligible healthcare expenses are tax-free. 5

8 WHAT TO DO BEFORE YOU NEED HEALTHCARE SERVICES The UHC Choice Plus HSA plans help you focus on your physical and financial wellness by encouraging you to become a more informed healthcare consumer. To make the plan work the best for you, do a little homework before you go to the doctor or use other healthcare services. Check whether your doctors are in-network providers. Using innetwork providers and services saves you money through lower rates that UnitedHealthcare negotiates with providers. It s also more convenient because you don t have to file claims. If you use out-ofnetwork providers who do not have contracts with UHC, you will pay more, and you may be required to submit claim forms. UHC s provider directory is available at or by calling USE TELADOC Teladoc is a great alternative for non-emergency medical care for employees enrolled in a UHC medical plan. Through Teladoc, you have access to a national network of physicians who provide quality healthcare through convenient and confidential telephone and online video consultations. The fee for Teladoc services is $45 per consultation. Be informed about healthcare costs. Find out what typical charges are for the medical services you need before you visit your doctor. Information about the cost of medical services in your area is available by using UHC s Cost Estimator tool at or by calling UHC at You can also download the free UHC Health4Me app to your smartphone, available for iphones and Android. Practice preventive care. Remember, in-network preventive care procedures are covered at 100% and Tier 1 preventive drugs for specific conditions (high blood pressure, cardiovascular/heart disease, high cholesterol and diabetes) are also covered at 100%. It s important to get your annual screenings, such as mammograms and prostate exams. A list of recommended immunizations and screenings for women, men and children is available at or by calling Manage chronic illness. If you or a family member has a chronic condition, such as diabetes or asthma, then you know it s very important to follow through on the course of treatment. Through our partnership with UnitedHealthcare, we offer a variety of programs that can help you lead a healthier life, better manage any chronic conditions or assist you if you or a family member becomes seriously ill. You will have a personal nurse with specialized training to help you through the program. For 2016, we ll help UHC members facing chronic illness and are at high risk for certain conditions find high-quality, affordable treatment and ongoing care. You will receive a $200 incentive for engaging with a specialized nurse to manage your condition throughout the year. Participation in these health management programs is voluntary and confidential. Save money while improving your health today! Call UHC at to learn more. 6

9 WHAT TO DO WHEN YOU NEED HEALTHCARE SERVICES When it s time to see the doctor, be a savvy shopper not just a patient. Get informed before receiving services. Follow these tips: Compare quality and costs. Since your plan won t start sharing the cost of your services until you meet your deductible, it s in your best interest to shop around before choosing a provider. Different medical practices, hospitals and pharmacies may charge different fees and offer different levels of service. Call ahead to ask questions before making your choice, and access UHC s Cost Estimator tool to see the estimated cost for medical care. You can also turn to Health Advocate for assistance comparing providers costs. Call or visit Seek less costly options. You can save money by requesting a generic equivalent for a brand-name prescription. Ask your doctor or pharmacist if there is a less expensive and appropriate generic available. You may want to fill maintenance (long-term) prescriptions by mail order instead of using a walk-in pharmacy. Also, be sure to get the right care for your needs. Go to the doctor s office or urgent care center instead of a hospital emergency room when you feel sick or have symptoms or injuries that are not life-threatening. For $45 per consultation, you can access Teladoc, our telephonic advice service, for guidance from a doctor or for a short-term prescription refill. Present your ID card. When you arrive at the doctor s office, present your ID card. When you see an in-network doctor, you won t pay anything at the time of your visit. Your doctor will submit the claim to UHC before a bill is sent to you. Your ID card ensures you ll be billed at the reduced in-network rates. (Note: The provider must submit the claim in order for the contracted discount to apply, so avoid paying for your office visit at the time of your appointment and wait for the actual cost to be billed to you.) Ask questions. Don t be afraid to ask your doctor to explain his or her recommendations, such as why a test is necessary or how a medication will help you. And be sure to tell your doctor everything that might be helpful in determining the best course of treatment, such as your health history and any medications you are currently taking. If you want a second opinion, reach out to Best Doctors, a company-paid program, which can answer your questions and conduct a review of your diagnosis. Call Best Doctors at or visit PREVENTIVE AND DIAGNOSTIC CARE KNOW THE DIFFERENCE! Preventive care focuses on evaluating your current health status to obtain early diagnosis and treatment. This care is covered at 100% with no cost to you when you use in-network providers. Diagnostic care is medical treatment for specific health issues or conditions, ongoing care, lab tests and health screenings necessary to manage or treat an already-identified medical issue or condition. 7

10 KNOW THE DIFFERENCE BETWEEN EMERGENCY AND URGENT CARE Avoid using emergency services for routine or urgent care. Emergency rooms have medical staff and equipment for life and death situations, such as heart attacks or car accidents. 8 Emergency Situation Urgent Care Situation Non-Urgent Care Situation Call 911 immediately. Call your doctor or UnitedHealthcare s 24-hour NurseLine; the phone number is located on your plan member ID card. Call Teladoc (800.TELADOC) to resolve many common medical issues, saving you time, money and perhaps an unnecessary trip to the ER or urgent care center. An accident or sudden illness that must be treated right away to avoid loss of life, serious medical complications or permanent disability. Examples include: A situation that requires prompt medical attention but is not considered an emergency. Examples include: A common medical issue that does not require immediate attention. Examples include: Severe sore throat Common cold or cough Ear infection Refilling a short-term prescription Uncontrollable bleeding Sprains and strains Seizure or loss of consciousness Ear or eye infection Shortness of breath Fever Chest pains Sudden paralysis Broken bones Severe pain

11 WHAT TO DO AFTER YOU RECEIVE HEALTHCARE SERVICES After receiving in-network healthcare services, here s how your charges are processed. FIRST: You Visit a UHC Provider You pay nothing at the time of service. Your doctor will send a bill to UHC (and you may receive a copy, but you don't need to do anything yet). THEN: UHC Will Send You an Explanation of Benefits (EOB) UHC will pay your provider any amounts it owes under the plan and send you an EOB. Your EOB will tell you how your claim was processed. Your EOB will tell you the amount you are responsible for paying. Review your EOB carefully for accuracy. If Your Care Was PREVENTIVE If Your Care Was NON-PREVENTIVE You will owe nothing. Contact UHC Customer Service if you are charged for any preventive care services. You can pay in any of the following ways: - Use your PayFlex debit card. - Use the PayFlex online system ( to pay provider claims or to reimburse yourself for eligible out-of-pocket expenses. - Pay out-of-pocket and submit a reimbursement request to PayFlex to have funds withdrawn from your HSA at a later date. You don t have to file for reimbursement during the same year the expense was incurred. - Pay out-of-pocket without requesting reimbursement and save your HSA balance for expenses you incur later this year or in future years. CHECK YOUR DEDUCTIBLE See how much of your annual deductible you ve met by logging on to and viewing your medical and prescription drug claims history. HEALTH ADVOCATE CAN HELP Don t forget that if you need help understanding your Explanation of Benefits (EOB), using your HSA or navigating the medical claims process, you can call Health Advocate at for assistance. 9

12 Focus on Wellness and Prevention The best way to keep your healthcare costs down and enjoy a healthier life is to focus on wellness and prevention every day. Take advantage of no-cost preventive care. Yearly checkups are a great way to prevent serious health problems down the road. If you haven t already, schedule an annual wellness visit with your primary doctor it s free! In addition to annual checkups, all in-network preventive services and Tier 1 preventive medications for specific chronic conditions (diabetes, heart disease, high blood pressure and high cholesterol) are covered at no cost to you. Make your health a priority. Our Living Healthy at AAA wellness program (in partnership with Vitality) is the foundation of our commitment to a culture of health. From an online health assessment to health screenings and online courses and calculators, our wellness program offers many ways to help you adopt a healthier lifestyle. We strive to create an experience that s personal and meaningful to you, no matter where you are on your path to well-being. Learn more by visiting My Life at AAA and clicking on Vitality, or log on to Spouses/domestic partners can go directly to MAKE YOUR WELL-BEING A PRIORITY 10 There are so many ways to earn Vitality Points for healthy activities you may already be doing. For example, you can earn points for getting your teeth cleaned, visiting your doctor for your preventive screenings, getting a flu shot and going to the gym. Need help getting started? Contact your wellness coordinator today at wellness.coordinator@csaa.com.

13 RESOURCES For More Information About... UnitedHealthcare (UHC) UHC Choice Plus HSA 1500 Plan UHC Choice Plus HSA 2500 Plan Health Savings Account (HSA) and Limited Purpose Reimbursement Account Get help from a Benefits Advisor to do the following: Understand your health plan options Understand the HSA and other reimbursement accounts Resolve a claims/billing issue For questions and second opinions Consult with a doctor by phone or video about common health situations Your benefits service center Living Healthy at AAA wellness program UnitedHealthcare Group Number # PayFlex Health Advocate Best Doctors Teladoc AAA Employee Service Center My Life at AAA, click on My Benefits (when in the office) or (using your g ID and password when on your personal home computer) Vitality Call From work: Go to My Life at AAA and click on the Vitality link. From home: Go to (use your network credentials, e.g., g ID and password) Spouses/domestic partners: Go to or send an to wellness.coordinator@csaa.com 11

14 CDHP Reference Guide Facts to Know A CDHP is a health plan that allows you to use an HSA to pay healthcare expenses directly, while a high-deductible health plan provides free preventive care services and protects you from catastrophic medical expenses. The CDHP structure motivates you to take a more active role in selecting your healthcare providers, managing your healthcare expenses and improving your overall health through good nutrition, exercise and other factors that you can control. The company will make contributions to your HSA to help you cover your initial out-of-pocket expenses before reaching your deductible. The company HSA contributions depend on the plan you are enrolled in, your coverage level and if you have completed certain wellness activities. The HSA is similar to a traditional savings account, but is designated specifically for paying for eligible health-related expenses, such as deductibles, coinsurance, prescription medications and medical expenses that are not covered by your health plan. Like most health plans, the CDHP includes an annual deductible. A deductible is a fixed amount you must pay before the plan begins to share in expenses (coinsurance). Most preventive medical services such as routine physical exams and age-based screenings and immunizations are covered at 100% under the CDHP when you receive care from in-network providers, so you will not pay for these services. Preventive and wellness services are not subject to the annual deductible or coinsurance. You have the option to pay for healthcare expenses out-of-pocket (on your own), instead of using your available HSA funds. You can save now and spend later because your HSA balance rolls over from year to year. At the end of the plan year, unused HSA funds remain in your HSA for the next plan year. There is no maximum balance for accumulated HSA funds. However, there are annual limits on contributions that can be deposited into your HSA. The 2016 HSA contribution maximum limit is $3,350 for individual and $6,750 for family, and the amount includes both your contributions and the company s contributions. If you are over age 55, the limit increases by $1,000. The HSA accrues interest similar to a traditional savings account. Any interest and investment gains you earn are tax-free, as long as the money is spent on eligible healthcare expenses. 12 October 2015