What s new for 2018? IRS rules mandate HSA $2600 be updated to a $2700 deductible. Increase in premiums high claims - loss ratio at 93%

Size: px

Start display at page:

Download "What s new for 2018? IRS rules mandate HSA $2600 be updated to a $2700 deductible. Increase in premiums high claims - loss ratio at 93%"

Martha Shepherd
5 years ago
Views:

dollars and want a plan that has a lower premium Traditional PPO

2 What s new for 2018? IRS rules mandate HSA $2600 be updated to a $2700 deductible Increase in premiums high claims - loss ratio at 93% Adding a new HSA $ great for people that have accumulated some HSA dollars and want a plan that has a lower premium Traditional PPO plan - adding a $250 plan year RX deductible on Tier 2 and 3 and 4 New Wellness program One Community Details to follow 2

3 One Community Health and Wellness Tracking Portal Partner with St. Luke s Healthcare System

4 Traditional PPO With Deductible & Copays HSA 2000 Non-embedded HSA 2700 Embedded HSA 4000 Embedded NETWORK Blue Preferred Select Blue Preferred Select Blue Preferred Select Blue Preferred Select HSA NO YES YES YES PLAN YEAR July 1 June 30 In Network Single/Family In Network Single/Family In Network Single/Family In Network Single/Family Deductible $1000 / $2000 $2000 / $4000 (family coverage requires fam ded to be met) $2700 / $5000 (single ded applies to each family member) $4000 / $8000 (single ded applies to each family member) Coinsurance 20% 20% (was 0%) 20% (was 0%) 0% Out of Pocket $5000 / $10,000 $4000 / $7150 $4000 / $7150 $5500 / $11,000 Office Copays (PCP/SPC) $30 / $50 n/a n/a n/a Other Copays (IP/ER/UC) $0 / $300 / $75 n/a n/a n/a RX NETWORK Pharmacy (Copays apply to Out of Pocket NOT deductible) ANTHEM ESSENTIAL RX NETWORK AFTER DEDUCTIBLE AFTER DEDUCTIBLE AFTER DEDUCTIBLE Tier One $10 $10 $10 $10 $250 plan year deductible applies to tiers 2, 3,and 4 Tier Two $40 $40 $40 $40 Tier Three $75 $75 $75 $75 Tier Four 25% to a $200 copay per RX 25% to a$200 copay per RX 25% to a $200 copay per RX 25% to a $200 copay per RX

5 Traditional PPO With Deductible & Copays HSA 2000 Non-embedded HSA 2700 Embedded HSA 4000 Embedded Rates Full Rate Employee Cost Full Rate Employee Cost Full Rate Employee Cost Full Rate Employee Cost Employee $ $54.00 $ $0 $ $0 $ $0 * Employee + Spouse $ $ $ $ $ $ $ $ Employee + Child(ren) $ $ $ $ $ $ $ $ Employee + Family $ $ $ $ $ $ $ $ *The District will contribute $33.00 pre month to an eligible employee s HSA for employees that choose HSA $4000. ($396/yr)

6 Essential Pharmacy The Essential RX formulary is the current drug list for all our plans and can be found at this link: Essential Drug List 4-Tier (Searchable) All 3 HDHP / HSA options also have the Preventive RX list with several hundred options for FREE preventive medications. If you have the Essential formulary/drug list, this PreventiveRx drug list may apply to you: PreventiveRx Plus Drug List (Essential) These lists are kept up to date on the link above and may change quarterly. 6

7 All three plans include standard preventive care for adults and children at 100% coverage. (no cost share to you) This includes allowed services that are billed and coded by your provider as preventive such as: Mammogram 2D and 3D Colonoscopy one every 7-10 yrs Wellness office visits and labs Well Woman / PAP Immunizations Birth Control (some types) Preventive versus diagnostic care What s the difference? Preventive care helps protect you from getting sick. Diagnostic care is used to find the cause of existing illnesses. For example, say your doctor suggests you have a colonoscopy because of your age. That s preventive care. On the other hand, say your doctor suggests a colonoscopy to see what s causing your symptoms. That s diagnostic care and you may need to pay part of the cost. All HSA Plans include Preventive RX list covered at 100% (retail or mail order)

8 The benefits of registering at anthem.com co-branding logo here When you register online, you have great personalized tools to help you: Search for doctors. Check your claims. Estimate your costs. Review your medical benefits. View your ID card. Refill a prescription. 8

9 Looking for a doctor? co-branding logo here Finding one online is fast and easy. Look up a doctor, pharmacy or urgent care center. View doctor profiles and read patient reviews. Get directions to health care facilities. 9

10 co-branding logo here LiveHealth Online See a doctor or therapist at home Have a private video visit with a doctor or therapist on your smartphone, tablet or computer with a webcam. Choose from board-certified doctors and licensed therapists. You can be at home or even on vacation. Sign up at livehealthonline.com or download the app

However using he emergency room when it is NOT an emergency may result in you being responsible for the costs.

11 ER for Emergencies! Be sure to use the LOWEST POSSIBLE COST SETTING for services like xrays, MRI s, lab work, etc! Save the ER for Emergencies! Going to the emergency room or calling 911 is always the way to go when it is an emergency. However using he emergency room when it is NOT an emergency may result in you being responsible for the costs. Be sure to use the LOWEST POSSIBLE COST SETTING for services like xrays, MRI s, lab work, etc! This is not a change in your benefits. If you need care, but it s not an emergency try these options: Urgent Care 24/7 Nurse Line Live Health Online Your Physician is on call 24/

12 It s Open Enrollment - - JULY 1 - Make changes now for Open Enrollment or anytime during the year within 30 days of a Qualifying Event (birth, death, divorce, marriage, involuntary loss of coverage). Plan year: Medical - July - June / Dental - January December Blue Preferred Network NO CHANGE A regional network for Mid Missouri and the east side of the state. Boone Hospital is in network, all other BJC facilities are out of network. Please make sure your providers are IN- NETWORK for Anthem discounted pricing and to avoid balance billing. Dependents - Medical - covered to age 26 end of calendar year; Dental - age 26 End of Year - matches medical ; Vision - age 26 - End of Year matches medical Voluntary Life - 15 days to 26 end of year to match medical. Paperwork - All benefit eligible employees will complete the Compliance form. If you are making changes to medical coverage you will also need a form for that. New ID cards only if making changes Mail order RX thru Express Scripts - Also - $4/$12 at Walmart, Grocery chains, etc. or Canada Pharmacy. Try Good Rx to get the retail cost of meds at local pharmacies, discount coupons and other savings!

13 THERE ARE TWO PARTS TO AN HSA.. 1) the health plan (follows Anthem rules ) and 2) the bank account. (follows IRS rules.) All benefit eligible employees can enroll in any of the health plans offered by the District. The IRS rules about other coverage say that if you are enrolled in a Qualified High Deductible Health Plan (QHDHP) and also in a traditional (first dollar) PPO plan then the member is NOT allowed to open the HSA bank account. So the banking part is the only part in question. If you have other traditional coverage or are on a spouse s FSA and choose the HDHP option.you would not have the HSA bank account.so no HSA contributions. You could still take medical tax deductions at the end of the year if you itemize. Am I eligible for the HSA BANK ACCOUNT? You must be covered under a qualifying high-deductible health insurance plan (HDHP). You cannot be covered by another health plan that is not an HDHP. (like a spouse s traditional plan) You cannot be enrolled in Medicare or Medicaid. You cannot be claimed as a dependent on someone else s tax return. You are not covered on Tri-Care You have not used Veteran s Benefits in the last three months Your spouse can not be enrolled in an employer s flex plan. The IRS views this as double dipping since both of you are eligible for both programs. *QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN / Health Savings Account

14 There are two hurdles for people considering a HDHP / HSA: EXAMPLE A: 1) cash flow (especially at the pharmacy) 2) management (becoming an informed consumer and keeping some records of what you spend the HSA dollars on) I m a low utilizer of my health plan. I see one doc a year and might have one RX a year. I get that at Wal-Mart on their $10 plan (for 3 months quantity) EXAMPLE B: I m on 4 or more meds, I see the doctor numerous times a year and I may have a procedure or a baby. The HDHP / HSA is the perfect plan for Example A or B. Build up your HSA bank account and utilize the Preventive Care that is covered at 100%.

I m saving money for healthcare expenses for my future (works like a medical IRA) Tax savings save it, spend it on eligible expenses and earn a little interest on it - - all tax free Make 2017

15 I m saving money for healthcare expenses for my future (works like a medical IRA) Tax savings save it, spend it on eligible expenses and earn a little interest on it - - all tax free Make 2017 contributions up to tax day 2018 I m a better consumer so I have more control over what I spend I can use the funds for other expenses like OTC, Dental and Vision. I can use the money for family members - even if they are not on the plan No use it or lose it like on a Flex plan (FSA) 2018 Contribution limits Self Only $3450 / Family $6850 Catch up Contribution age 55+ is $1000 per person per year

Anthem BCBS Life, Voluntary Life, Dental and Vision Board paid benefits: Employer Paid Basic Life - includes Resource Advisor - Resources available to members at no additional charge, counseling,

16 Anthem BCBS Life, Voluntary Life, Dental and Vision Board paid benefits: Employer Paid Basic Life - includes Resource Advisor - Resources available to members at no additional charge, counseling, legal, financial planning, Identity theft protection, online tools, beneficiary support. Free LIVEHEALTHONLINE counseling visits Travel Assist Travel assistance to members full details attached Employer Paid Accidental Death & Dismemberment You can also enroll in these Voluntary plans with payroll deductions: Voluntary Life see ancillary packet for enrollment options Dental rates increased slightly. Offering 2 plans. Always ask your dentist to do a Pre-Determination of benefits on services over $300 Vision Blue View Vision Network

Financial 573-443-1000 ext 211 Cell 573-881-0723

17 Any Questions??? Julie Koirtyohann Account Executive, Sundvold Financial ext 211 Cell Fax W Nifong Bldg 4 Suite 104 Columbia, Mo juliek@sundvold.com

How Does a CDHP Work with an HSA

How Does a CDHP Work with an HSA 1 What is an HSA? A Health Savings Account (HSA) is a tax-advantaged checking account that works in conjunction with your Consumer Driven Health Plan (CDHP). Allows you