1. Provide Comprehensive & Superior Benefits at the Lowest Costs. 2. To improve the Benefit Administration Process
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- Priscilla Blair
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2 Pierce Group Benefits is a comprehensive benefit consulting firm created to design employee benefit solutions. Pierce Group currently provides benefits to 145 public sector clients and serves over 150,000 employees. 1. Provide Comprehensive & Superior Benefits at the Lowest Costs 2. To improve the Benefit Administration Process 3. Provide tools and resources to Save you Money 4. Offer Benefit Counseling so you can customize your benefits to fit your needs
3 Consumer-Driven Health Plans
4 Factors Driving Trends Skyrocketing prescription costs Rising hospital and physician costs Advances in technology Increase in chronic conditions Increased usage Aging population Hidden Costs ACA/Health care reform Health Care Cost Drivers
5 Traditional Key Advantage Plan Provider Network Contracted Rates (Discounts) 100% Preventive Care Copayments Deductible Coinsurance OOP Max High Premium High Deductible HDHP Provider Network Contracted Rates (Discounts) 100% Preventive Care Deductible Coinsurance OOP Max Lower Premium
6 HDHP + HSA = CDHP (Consumer Driven Health Plan) When structured correctly, they can provide: 1) Cost Savings 2) Control 3) Opportunity
7 What is a Qualified HDHP? A qualified High Deductible Health Plan is defined by IRS as a health plan with a minimum annual deductible and out of pocket maximum Type of Limit Health Plan Enrollment 2017 HDHP Minimum Deductible Employee Only $1,300 Family Coverage $2,600 HDHP Maximum OOP Employee Only $6,550 Family Coverage $13,100 These plan designs contain two types of potential liability: Deductibles and Coinsurance They do not contain Copayments ACA Plans cover Preventative Care at 100%
8 What is an HSA? Financial Account, similar to a checking account, that is owned by the employee Must be paired with a qualified high deductible health plan (HDHP) that contains specific plan design elements Contributions to the account are to pay for current qualified medical expenses or saved for future qualified medical expenses (health, dental, vision, RX) for you or family members
9 Who is Eligible for an HSA? Any Individual who: Is covered by a qualified HDHP Is not entitled to Medicare Is not covered by any other health insurance If you file Married Tax Status: can t have an HSA and FSA Can t be claimed as a dependent on anyone else s tax return
10 Why Should I Elect an HSA? 1)Cost Savings Triple Tax Benefit Health Plan Premium Savings Interest-bearing savings account Employer Contribution An HSA is a cost-effective option for many individuals and families, here s why you should consider it:
11 Triple tax advantages of an HSA Contributions HSA account growth Withdrawals Payroll deduction contributions are pretax After-tax contributions can be deducted when you file your tax return Interest earned on your cash account is generally not taxable Investment earnings on mutual funds are generally not taxable Withdrawals to pay qualified health care expenses are tax-free At age 65 and beyond: withdraw funds for any reason with no penalty (taxes do apply)
12 Power of Pre-tax Benefits Post Tax Expenses Gross Monthly Salary $2, Minus Pre-Tax Deductions $0.00 Wages subject to Tax $2, Minus Taxes $ Take Home Salary $1, Minus Medical Expenses $ SPENDABLE INCOME $1, Pre Tax Expenses $2, $ , $ $1, $0.00 $1, Annual Savings of $624
13 Why Should I Elect an HSA? 1)Cost Savings Triple Tax Benefit Health Plan Premium Savings Interest-bearing savings account Employer Contribution An HSA is a cost-effective option for many individuals and families, here s why you should consider it: 2) Long-Term Financial Benefits Save for future medical expenses Funds roll over year to year Investment Options This is your account; you take it with you 3) Choice You control and manage your health care expenses
14 2017 HSA Contribution Limits Employee Only Coverage: $3,400 Employee plus Dependents: $6,750 Over 55 Catch up Contributions: $1,000 additional
15 Anthem applies discount and applies service to deductible then sends Member an Explanation of Benefits (EOB) Member visits Doctor Member calls the Doctor s Office to settle the claim. If Funds are available in HSA, member pays with HSA Debit Card, if funds are not available another form of payment must be used CDHP Flowchart In-network sick visit Member Visits Doctor Member shows Anthem/TLC ID Card Member receives Balance Bill from Doctor s Office Doctor s Office submits Claim to Anthem/TLC
16 Member Visits Doctor and Receives a Prescription If Funds are available in HSA, member pays with HSA Debit Card, if funds are not available another form of payment must be used CDHP Flowchart- Prescriptions Member goes to Pharmacy and shows Anthem/TLC ID Card Pharmacy applies Negotiated Discount
17 Money Saving Mobile App Save money on your prescriptions right from your smartphone: OneRx Find the lowest price, with or without insurance Instantly redeem deals and discounts on your prescription Compare prices at nearby pharmacies
18 For More Information Log in feature on top right: Mecklenburg County Public Schools HSA Overview Video HSA Eligibility Video HSA Eligible Expenses Video
19 What s Next Open Enrollment - Middle of April Exciting New Benefits Group Meetings & Individual Benefit Counseling Sessions
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