Medical Plan Comparison. Central Care Plan

Transcription

1 Medical Plan Comparison Central Care Plan

2 Benefits Open Enrollment Elections Required IMPORTANT! All benefit-eligible employees will be required to actively elect benefits online via CMU Choices for: Dental default to 100/50/50 plan Vision default to no coverage MANDATORY Open Enrollment for Benefit Year Flexible Spending Account (FSA) election required each plan year Health Savings Account (HSA) election required each plan year

3 Benefits Plan Changes Blue Cross Blue Shield Medical Plans PPO1 Plan: Enrollment frozen to current participants High Deductible Health Plan (HDHP): Due to IRS regulations, the deductibles and out-of-pocket s will increase: In-network Deductible: $1,350 for individuals and $2,700 for 2 person/families In-network Out-of-Pocket Maximum: $3,350 for individuals and $6,700 for 2 person/families CVS Caremark Prescription Plan (PPO1/PPO2) Adopt Transforming Diabetes Care (TDC) Program Introduce Specialty Drug Copay Card Program No coverage option CMU will no longer contribute benefit dollars towards waiver of medical and dental coverage

4 Benefits Plan Changes Increase annual health flexible spending account (FSA) contribution limit from $2,600 to $2,650 Health Savings Account (BCBS High Deductible Health Plan) University HSA contributions will continue for benefit year Single: $386 annual contribution Two Person: $799 annual contribution Family: $977 annual contribution For Only: ½ of annual university HSA contribution will be deposited into HDHP participants HSA account beginning of plan year Remaining 50% will be equally deposited each pay period during the benefit year

5 Benefits Plan Changes The Hartford: One Time Special Opportunity to enroll without completing evidence of insurability (completing a health questionnaire) Employee Life & AD&D Insurance: Employees may elect up to 3 times base salary, up to $575,000 Spouse/OEI Life & AD&D Insurance: Employees may elect up to $50,000 Short Term Disability Insurance: No evidence of insurability required for new election (i.e. no coverage (current) to 50% benefit level) or increase in STD election (i.e. 50% (current) to 67% benefit level) VSP vision will remain with our current vision provider with no changes to the plan benefits or premiums

6 Medical / Prescription Monthly & Annual Costs Comparing Medical / Prescription Plan Options Medical / Prescription Plan Options HDHP w/hsa PPO2 PPO1 Premium Cost Share 97.5% CMU 94.2% CMU 85.3% CMU 2.5% Employee 5.8% Employee 14.7% Employee Employee MONTHLY Cost Share Single 2-Person Family $13.18 $27.28 $33.35 $33.85 $70.08 $85.66 $ $ $ University ANNUAL* HSA Contribution Single 2-Person Family Benefit Summary (In-network benefits) Medical Network Prescription Network $ $ $ Not Available This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions, and limitations are documented in the certificate and amendments. Not Available 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) $1,350 member $400 member $200 member $2,700 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 (medical & prescription combined) $3,350 member $6,700 family $3,600 member $7,200 family $2,800 member $5,600 family *CMU will prefund 50% of annual HSA contribution the first pay period of benefit year. **The full family deductible must be met under a two-person or family contract before benefits are paid for any person on the contract.

7 Dental Monthly & Annual Costs Dental Plan Options Premium Cost Share Comparing Dental Plan Options (Staff, Fixed Term Faculty, Medical Faculty, Post Docs) Core Plan 100/50/50 85% CMU 15% Employee Buy-up Plan 100/75/50/ % CMU 50.5% Employee Employee Monthly Cost Share Single 2-Person Family $ 4.88 $10.06 $12.55 $28.30 $57.48 $74.64 Benefit Summary (No changes) Annual deductible (7/1-6/30) Single 2-Person Family $50 $100 $150 None Maximum annual benefit (7/1-6/30) $1,000 per person $1,500 per person Class 1: Preventive Services 100% (no deductible) 100% Class 2: Basic Services 50% after deductible 75% Class 3: Major Services 50% after deductible 50% 50% Class 4: Orthodontic Service None $2,000 lifetime (children 19 years or younger) per person This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions, and limitations are documented in the certificate and amendments.

8 Total Must Pay and Might Pay Side-By-Side Comparison Employee Only (Annual) $5,000 $4,500 $4,000 $3,500 $3,000 Total Maximum Annual EE Cost of HDHP w/hsa, including CMU HSA Contribution of $386.11, EE Only Option = *$3,122 *$3,122 Total Maximum Annual EE Cost of PPO 2, EE Only Option = $4,406 Total Maximum Annual EE Cost of PPO 1, EE Only Option = $3,929 $2,000 in prescription copay $2,000 in prescription copay $2,500 $2,000 in prescription copay *Net of CMU HSA Contribution $2,000 $1,500 $1,000 $500 $0 $1,350 in medical + prescription deductible $158 employee payroll contribution $2,000 in medical deductible, coinsurance & copay $406 employee payroll contribution $800 in medical deductible & copay $1,129 employee payroll contribution HDHP w/hsa CMU PPO 2 CMU PPO 1 Prescription Might Pay (coinsurance for prescription plan) Medical Might Pay (meeting deductibles and coinsurance for medical plan) Must Pay (full-time employee annual contribution) Exhibit assumes in-network usage and is provided for illustrative purposes only.

9 Total Must Pay and Might Pay Side-By-Side Comparison Employee + 1 (Annual) $8,000 $7,000 Total Maximum Annual EE Cost of HDHP w/ HSA, including CMU HSA Contribution of $799.19, EE + 1 Option = *$6,228 Total Maximum Annual EE Cost of PPO 2, EE + 1 Option = $7,240 Total Maximum Annual EE Cost of PPO 1, EE + 1 Option = $7,537 $6,000 $5,000 $4,000 in prescription copay *$6,228 *Net of CMU HSA Contribution $4,000 in prescription copay $4,000 in prescription copay $4,000 $3,000 $2,000 $2,700 in medical + prescription deductible $2,400 in medical deductible, coinsurance & copay $1,200 in medical deductible & copay $1,000 $0 $328 employee payroll contribution $840 employee payroll contribution contribution HDHP w/hsa CMU PPO 2 CMU PPO 1 Prescription Might Pay (coinsurance for prescription plan) Medical Might Pay (meeting deductibles and coinsurance for medical plan) Must Pay (full-time employee annual contribution) Exhibit assumes in-network usage and is provided for illustrative purposes only.

10 Total Must Pay and Might Pay Side-By-Side Comparison Family (Annual) $9,000 $8,000 Total Maximum Annual EE Cost of HDHP w/ HSA, including CMU HSA Contribution of $977, Family Option =*$6,124 Total Maximum Annual EE Cost of PPO 2, Family Option = $7,427 Total Maximum Annual EE Cost of PPO 1, Family Option = $8,056 $7,000 $6,000 $5,000 $4,000 in prescription copay *$6,124 *Net of CMU HSA Contribution $4,000 in prescription copay $4,000 in prescription copay $4,000 $3,000 $2,000 $1,000 $0 $2,700 in medical + prescription deductible $400 employee payroll contribution $2,400 in medical deductible, coinsurance & copay $1,027 employee payroll contribution $1,200 in medical deductible & copay $2,856 employee payroll contribution HDHP w/hsa CMU PPO 2 CMU PPO 1 Prescription Might Pay (coinsurance for prescription plan) Medical Might Pay (meeting deductibles and coinsurance for medical plan) Must Pay (full-time employee annual contribution) Exhibit assumes in-network usage and is provided for illustrative 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 left in your account carries over from year to year It remains yours even if you leave the university or retire 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 penalties) 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 deductible 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 information, 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 Contribution Annual Employee HSA Contribution Total Annual HSA Contribution *Maximum Age 55+ Contribution Catch-Up Per Person Single $ $3, $3,450 $1,000 Two Person $ $6, $6,850 $1,000 Family $ $5, $6,850 $1,000 *Maximums listed are for the 2018 calendar year and are subject to change annually.

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 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

15 HSA Eligible Expenses Acne Treatments Acupuncture Alcohol and drug rehabilitation Allergy Medicines (with Rx) Ambulance Anesthetist Artificial limbs and teeth Blood donor expenses Breast pumps and supplies Chiropodist Chiropractor Certain corrective surgery Copays for office visits and prescriptions Dental care and dentures Examinations Eye exam, glasses, contacts and contact lens solution Gynecologist Hearing aids and batteries Home health care and nurses fee Hospital and skilled nursing facility Insulin and diabetic supplies Laboratory fees Nicotine patches and gum Obstetrical expense, midwife Oculist Optometrist Operations and related treatments Orthodontist Orthotics Osteopath Outpatient clinic Oxygen and oxygen equipment Podiatrist Prescription drugs Psychiatrist Psychologist Rental or purchase of medical equipment including special equipment for use by handicapped persons Sanitarium Smoking cessation programs Support for corrective 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 Publication 502 online at

16 Sandy: Employee only with $1,000 in medical costs* Annual Employee Premium Cost Share (Payroll Deduction) BCBS Advantage (HDHP) Plan Annual Deductible = $1,350 Sandy pays: BCBS PPO 2 Plan Annual Deductible = $400 Sandy pays: $ $ Deductible + $1,000 + $400 Coinsurance N/A + $120 Claims paid using CMU s HSA contributions Scenarios - $ N/A Sandy pays medical expenses + annual payroll deductions $ $ Scenario assumes in-network providers are used in all cases *.

17 Sandy: Employee only with $5,000 in medical costs* Annual Employee Premium Cost Share (Payroll Deduction) BCBS Advantage (HDHP) Plan Annual Deductible = $1,350 Sandy pays: BCBS PPO 2 Plan Annual Deductible = $400 Sandy pays: $ $ Deductible + $1,350 + $400 Coinsurance N/A + $920 Claims paid using CMU s HSA contributions Scenarios - $780 N/A Sandy pays medical expenses + annual payroll deductions $1, $1, Scenario assumes in-network providers are used in all cases *.

18 1 Annual Cost of Plan (what you pay out of your paycheck) Plan Cost Estimator Plan Information Advantage HDHP/HSA PPO 2 Plan Employer s HSA Annual Contribution TOTAL MUST PAY COST (regardless of utilization of plan) Estimated Expenses (Annual) $ $ - $ single - $ two person - $ family # of office visits times copay or average cost (HDHP) x $80 = $ x $20 = $ # of generic drug times average copay or average cost (HDHP) x $17 = $ x $1.70 = $ # of brand name drug times average copay or average cost (HDHP) x $225 = $ x $67.50 = $ # of emergency room visits or average cost (HDHP) x $550 = $ x $75 = $ Hospital, surgical, other (deductible/coinsurance) $ $ - $0 TOTAL MIGHT PAY COST (based on plan utilization) Might pay costs can t exceed amounts to the right (annual out of pocket ) for applicable plan. If higher, cap costs at this amount. TOTAL MUST PAY and MIGHT PAY Cost $3,350 Single $6,700 Family $3,600 Single $7,200 Family

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

20 Shop for High Quality, Low Cost Prescription 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 medications. 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 tips Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips

21 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. EASY AS 1, 2, 3 1. Go To 2. Select or Search for common procedures. 3. Compare prices among physicians and facilities in your area.

22 Decision Support Tool Once again we are using ALEX ALEX is an easy to use, on-line, decision support tool! Fun and interactive Shows you most likely and worst case cost scenarios Accessible from any internet connect device Includes medical/prescription, dental, vision, life/ad&d, disability and FSA/HSA Check out ALEX online at

23 Questions? Call REMEMBER You MUST enroll between April 23 and May 4, 2018 Website: ENROLL BY FRIDAY, MAY 4th, 5 P.M. (ET) No changes can be made after 5 p.m. on May 4th

24 Thank you for attending.