Medical Plan Comparison. Central Care Plan

Transcription

1 Medical Plan Comparison Central Care Plan

2 Benefits Open Enrollment MANDATORY! All benefit-eligible employees will be required to accvely elect benefits online via CMU Choices for: Medical / prescripcon Dental Vision MANDATORY Open Enrollment for Benefit Year Health & dependent care flexible spending account (FSA)

3 Benefits Plan Changes NEW New Amwell Online Health Care Visit When your regular doctor isn t available, you may see a U.S. boardcercfied doctor anycme. No appointment needed You can either use your mobile device to log into the Amwell app or use a computer to log into bcbsm.amwell.com You may want to use 24/7 online health care visit when: Your primary care doctor is not available You can t leave your home or workplace You re on vacacon or traveling for work You re caring for children or a family member who can t leave home You re looking for affordable a]er-hours care Specific account registracon is found on the cmich.edu/benefits website. Plan to register for the Amwell service before you actually need to make the online appointment

4 Benefits Plan Changes PPO 1 & PPO2 Medical Plans Blue Cross Blue Shield Emergency Room Visit Copay: $75 to $100 Increase to Annual Medical DeducCble Increase to Total (Medical & PrescripCon) Annual Outof-pocket Maximum Health Savings Account Health Equity University HSA contribucons will concnue HSA individual contribucon limit increased from $3,350 to $3,400 (effeccve 1/1/2017)

5 Medical / PrescripCon Monthly & Annual Costs Comparing Medical / Prescription Plan Options Medical / Prescription Plan Options HDHP w/hsa PPO2 PPO1 Single $25.34 $3.02 $ Employee Monthly 2-Person $52.45 $6.25 $ Cost Share Family $64.11 $7.64 $ University Monthly HSA Contribution Single 2-Person Family $ $ $ Not Available Not Available Benefit Summary (In-network benefits) Medical Network Prescription Network BCBS BCBS BCBS CVS Caremark BCBS CVS Caremark Preventive care $0 (plan pays 100%) $0 (plan pays 100%) $0 (plan pays 100%) Annual deductible (7/1-6/30) $1,300 member $400 member $200 member $2,600 family* $800 family $400 family Coinsurance None 20% after deductible None Office visit (primary, specialist, chiropractic) $0 after deductible $20 copay $20 copay Urgent care visit $0 after deductible $20 copay $20 copay Emergency room visit $0 after deductible $100 copay $100 copay Prescription 10%/20%/30% after deductible 10%/20%/30% 10%/20%/30% Annual out-of-pocket maximum (medical & prescription combined) $3,300 member $6,600 family $3,600 member $7,200 family $2,800 member $5,600 family * The full family deductible must be met under a two-person or family contract before benefits are paid for any person on the contract. Online healthcare visit $49.00 charge until deductible is met $5 copay $5 copay This benefit summary is intended for use only as a source of reference. Official benefits, condiaons, exclusions, and limitaaons are documented in the ceraficate and amendments.

6 Benefits Plan Changes Dental Meritain Health No change to the vendor or plan benefits Dental premium will increase by 11.4% for Core and 8% for Buy Up plan Employee MONTHLY Premium Cost Share Coverage Tier Core 100/50/50 Buy-up 100/75/50/50 Single $4.09 $ Person $8.54 $57.48 Family $10.22 $74.65 VSP vision, The Harford life insurance/ad&d and disability will remain with our current vendors with no changes to the plan benefits or premiums

7 Benefits Plan Changes Flexible Spending Account General Agency New contribucon limit for Health Care FSA - $2,600 (from $2,550) No change to Dependent Day Care FSA limit Upgrade to employee FSA portal (SuperAdmin to Alegeus) Mid-June New FSA debit cards for FSA parccipants July 1 FSA claims processed under both plaforms during run-out period (7/1 9/30/17) claim processing: Use mycarecard debit card or submit reimbursement requests online via SuperAdmin or mail / fax to General Agency claim processing: Use new FSA debit MasterCard or submit reimbursement requests online via Alegeus or mail / fax to General Agency

8 Total Must Pay and Might Pay Side-By-Side Comparison Employee Only (Annual) Exhibit assumes in-network usage and is provided for illustraave purposes only.

9 Total Must Pay and Might Pay Side-By-Side Comparison Two Person (Annual) Exhibit assumes in-network usage and is provided for illustraave purposes only.

10 Total Must Pay and Might Pay Side-By-Side Comparison Family (Annual) Exhibit assumes in-network usage and is provided for illustraave purposes only.

11 Health Savings Account (HSA) HSAs are individually-owned bank accounts The account belongs to you so only you can decide how to spend it Both you and your employer can contribute funds Money le] in your account carries over from year to year It remains yours even if you leave the university or recre HSAs are used to help pay for both current and/or future health care expenses You can withdraw money tax-free for qualified health expenses (non-qualified expenses are subject to taxes and penalces) Or you can save funds to pay for future expenses A HSA is triple tax-advantaged Contributes are made pre-tax and funds can grow tax free and withdrawals for qualified health expenses taxfree Who is eligible for an HSA? Anyone who is: Covered by a qualified high deduccble health plan (HDHP) Not enrolled in Medicare Not covered under other health insurance coverage, including a spouse s plan (unless a qualified HDHP) Not another person s tax dependent More informacon, visit and click on Health Savings Account (HSA)

12 Triple Tax Savings Money Grows Tax Free Money Can Be Used Tax Free Money Is Yours To Keep! Money Goes In Tax Free Coverage Level Annual Employer HSA Annual Employee HSA Total Annual HSA Maximum Age 55+ Catch-Up Per Person Single $ $2, $3,400 $1,000 Two Person $1, $5, $6,750 $1,000 Family $1, $4, $6,750 $1,000

13 How to use your HSA at the Doctor s Office Go to Doctor and present your Blue Cross Blue Shield Medical ID card and receive services. Note you should not pay anything at the time of service. Doctor submits claims to Blue Cross Blue Shield If services are billed as preventive, office visit will be covered at 100% If services are not billed as preventive, discounted charges will be applied to your deductible/out-ofpocket maximum You will receive an Explanation of Benefits (EOB) in the mail outlining the charges you are responsible for. Your doctor will bill you directly for any charges. You will use your HSA debit card, or other method of payment to pay your doctor the charges you are responsible for

14 How to use your HSA at the Pharmacy Obtain the Prescription / Rx from your Doctor Go to pharmacy of your choice and present your Blue Cross Blue Shield Medical ID card Use your HSA debit card or checkbook to pay for the discounted cost of the drug at the point of sale. Save your receipt for tax purposes. The pharmacy s system will submit your claim electronically to Blue Cross Blue Shield to apply the charges towards your deductible/ out-of-pocket maximum

15 HSA Eligible Expenses Acne Treatments Acupuncture Alcohol and drug rehabilitacon Allergy Medicines (with Rx) Ambulance AnestheCst ArCficial limbs and teeth Blood donor expenses Breast pumps and supplies Chiropodist Chiropractor Certain correccve surgery Copays for office visits and prescripcons Dental care and dentures ExaminaCons Eye exam, glasses, contacts and contact lens solucon Gynecologist Hearing aids and baneries Home health care and nurses fee Hospital and skilled nursing facility Insulin and diabecc supplies Laboratory fees NicoCne patches and gum Obstetrical expense, midwife Oculist Optometrist OperaCons and related treatments OrthodonCst OrthoCcs Osteopath OutpaCent clinic Oxygen and oxygen equipment Podiatrist PrescripCon drugs Psychiatrist Psychologist Rental or purchase of medical equipment including special equipment for use by handicapped persons Sanitarium Smoking cessacon programs Support for correccve services, including support hose, leg and knee braces and crutches Surgery Therapy Vein procedures that are medically necessary Vision care Certain weight loss programs X-rays Items in BLUE are eligible under a Limited Purpose FSA, medical items are not eligible expenses with a Limited Purpose FSA For detailed list of eligible expenses, see PublicaCon 502 online at

16 Scenarios Sandy: Employee only with $1,000 in medical costs* Annual Employee Premium Cost Share (Payroll DeducCon) BCBS Advantage (HDHP) Plan Annual DeducCble = $1,300 BCBS PPO 2 Plan Annual DeducCble = $400 BCBS PPO 1 Plan Annual DeducCble = $200 Sandy pays: Sandy pays: Sandy pays: $304 $36 $980 DeducCble + $1,000 + $400 + $200 Coinsurance N/A + $120 N/A Claims paid using CMU s HSA contribucons Sandy pays medical expenses + annual payroll deduc@ons - $780 N/A N/A $524 $556 $1,180 Scenario assumes in-network providers are used in all cases *.

17 Scenarios Sandy: Employee only with $5,000 in medical costs* Annual Employee Premium Cost Share (Payroll DeducCon) BCBS Advantage (HDHP) Plan Annual DeducCble = $1,300 BCBS PPO 2 Plan Annual DeducCble = $400 BCBS PPO 1 Plan Annual DeducCble = $200 Sandy pays: Sandy pays: Sandy pays: $304 $36 $980 DeducCble + $1,300 + $400 + $200 Coinsurance N/A + $920 N/A Claims paid using CMU s HSA contribucons Sandy pays medical expenses + annual payroll deduc@ons - $780 N/A N/A $824 $1,356 $1,180 Scenario assumes in-network providers are used in all cases *.

18 1 2 Plan Cost EsCmator Plan Informa@on Advantage HDHP/HSA PPO 2 Plan PPO 1 Plan Annual Cost of Plan (what you pay out of your paycheck) Employer s HSA Annual ContribuCon TOTAL MUST PAY COST (regardless of uclizacon of plan) Es@mated Expenses (Annual) $ $0 $ - $ single - $1, two person - $1, family - $0 - $0 # of office visits Cmes copay or average cost (HDHP) x $80 = $ x $20 = $ x $20 = $ # of generic drug Cmes average copay or average cost (HDHP) x $17 = $ x $1.70 = $ x $1.70 = $ # of brand name drug Cmes average copay or average cost (HDHP) x $225 = $ x $67.50 = $ x $67.50 = $ # of emergency room visits or average cost (HDHP) x $550 = $ x $75 = $ x $75 = $ Hospital, surgical, other (deduccble/coinsurance) $ $ $ TOTAL MIGHT PAY COST (based on plan uclizacon) Might pay costs can t exceed amounts to the right (annual out of pocket maximum) for applicable plan. If higher, cap costs at this amount. 1+2 TOTAL MUST PAY and MIGHT PAY Cost $3,300 Single $6,600 Family $3,250 Single $6,500 Family $2,600 Single $5,200 Family

19 Decision Support Tools BCBSM Cost EsCmate Tool Log in at bcbsm.com and use the Find a Doctor feature to evaluate quality and get cost escmates for more than 400 health care services naconally

20 Shop for High Quality, Low Cost PrescripCon There are many ways to shop and save for your prescription drugs. Many pharmacies offer discounted generic drugs. You can also compare pharmacies using pricing tools available. FREE or Discounted Generic Drugs Many pharmacies offer free or discounted medicacons. Ask your pharmacist today! Compare drug prices, use coupons, shop around. There are a number of pricing tools available that you can access on your phone through an app or online. Compare prices, find drug discount programs, find assistance programs, compare pharmacies Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings Cps Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings Cps Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings Cps

21 EASY AS 1, 2, 3 1. Go To 2. Select or Search for common procedures. 3. Compare prices among physicians and facilices in your area. The Healthcare Blue Book is a free consumer guide to help you determine fair prices in your area for healthcare services. If you pay for your own healthcare, have a high deductible or need a service your insurance does not fully cover, Healthcare Blue Book can help. The Blue Book will help you find fair prices for surgery, hospital stays, doctor visits, medical tests and much more.

22 Decision Support Tool ALEX is Here To Help You ALEX is our new easy to use on-line decision support tool! Fun and interaccve Shows you most likely and worst case cost scenarios Accessible from any internet connect device Includes medical/prescripcon, dental, vision, life/ AD&D, disability and FSA/HSA Check out ALEX online at hdps://

23 QuesCons? Call REMEMBER You MUST enroll between April 24 and May 5, 2017 Website: ENROLL BY FRIDAY, MAY 5th, 5 P.M. (ET) No changes can be made a]er 5 p.m. on May 5th

24 Thank you for anending.