© 2008 UnitedHealthcare Simple Health plan benefits you can understand. Glendale Elementary School...

© 2008 UnitedHealthcare

Simple Health plan benefits you can understand.

Glendale Elementary School District #40July 1, 2011


What We Will Cover Today

Medical Plan Options • Choice Plus Plan 104• HSA 2500 • Choice Plus Plan 003 (membership is frozen effective 7/1/11)

UHC Tools and Resources

3

Changes effective July 1st• UHC Vision is no longer bundled with medical coverage (a separate election for

voluntary vision will need to be made)

• Plan 003 membership is frozen. Employees currently enrolled are grandfathered and can continue to be enrolled in the plan)

• In-Network Preventative Care covered at 100% on all plans

• No lifetime limits on benefits

• No coverage difference between network and non-network facilities in an emergency

• Dependents are eligible up to age 26 whether married or unmarried (May not be eligible if they are able to enroll in their own employer sponsored plan )

4

Out-of Network Benefits

• Non-network care now covered at 50% on all plan offerings with a separate higher deductible and coinsurance

• Non-network providers are free to set their prices

• In addition to your non-network deductible and coinsurance you are required to pay the total amount over the allowed charges (Allowed charges are 110% of Medicare’s fee schedule)

• You may receive a check from UHC for the covered portion and you will need to forward this payment to the provider

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.

5

Your Medical Benefits at a Glance Choice Plus Plan 104

Type of coverage Network benefit Non-network benefit

Physician’s office services $ 20 co-payment 50% After deductible

Specialist office visit $ 40 co-payment 50% After deductible

Urgent Care center services $ 50 co-payment 50% After deductible

Emergency room services $ 100 co-payment $ 100 co-payment

Inpatient hospital stay

20% after $500 deductible, out-of-pocket max $1,750

per person/Cal. Year

(Deductible does not apply to OOP max)

50% after $750 deductible, out-of-pocket max $3750

per person/Cal. Year



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Your Medical Benefits at a Glance Choice Plus Plan 003

Type of coverage Network benefit Non-network benefitPhysician’s office services $ 20 co-payment 50% After deductible

Specialist office visit $ 20 co-payment 50% After deductible

Urgent Care center services $ 50 co-payment 50% After deductible

Emergency room services $ 100 co-payment $ 100 co-payment

Inpatient hospital stay

$250 copay per hospital stay

Out-of-pocket max $2,000 per person/Cal. Year

(Outpatient services subject to $250 deductible and 10%

coinsurance)


50% after $1,000 deductible, out-of-pocket

max $3,000 per person/Cal. Year



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Retail Mail order

Tier 1 $10 Co-pay31-Day Supply

$25 Co-pay90-Day Supply

Tier 2 $ 20 Co-pay31-Day Supply


Tier 3 $40 Co-pay31-Day Supply


Traditional Plan Pharmacy Benefit


Three key issues experts agree on

1. People are removed from the true cost of health care

2. Health care costs are skyrocketing

3. There’s a need to save for future health care costs

Solution…


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A High Deductible Health Plan with a Health Savings Account provides you:

• More choices • More control • Dedicated support to help you

Lower your costs Improve your health Save for the future

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.10

Health Savings Account (HSA) Plan


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HSA Plan Components

Medical Plan Health Savings Account

• Network and non-network coverage• Annual deductible• Protection from high out-of-pocket costs•100 percent preventive care• No copayments

• Your personal bank account• Take it with you if you leave your job• Triple-tax benefits• Use it for medical & pharmacy bills• No “use it or lose it” rule


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About the HSA Plans

Health Coverage

HSA AnnualDeductible

Pre

ven

tive

Ca

re

•Preventive care covered 100 percent by your employer

With an HSA you can:• Deposit dollars• Grow your savings• Save on taxes• Pay for health care now or later

Medical plan pays (coinsurance)

Tools and resources • Available via telephone or Web• Health coaches• Cost/Quality comparisons

• Must be satisfied before health coverage begins• Preventive care not subject to deductible

Out-of-pocket maximum• Protects you from

high costs• Gives you peace of mind


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About the HDHP $2500/HSA Plan

AnnualDeductible

$2,500

Max HSA contribution$3,050

Pre

ve

nti

ve

Ca

re:

100%

Employee Only Employee + 1 or more

DistrictContribution

$2,000

Family AnnualDeductible

$5,000

(Individual deductible

$2,500)

Max HSA Contribution:

$6,150

Pre

ve

nti

ve

Ca

re:

100%

DistrictContribution

$2,000

Health CoveragePlan pays 80% $4,500 Out-of-

Pocket maximum

Health CoveragePlan pays 80%$9,000 Out-of-Pocket family

maximum

(Individual OOP max $4,500)


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Retail Mail order

Tier 1 $10 Copayment31-Day Supply

$25 Copayment90-Day Supply

Tier 2$30 Copayment31-Day Supply $75 Copayment

90-Day Supply

Tier 3 $50 Copayment31-Day Supply

$125 Copayment90-Day Supply

HSA Pharmacy Benefits – Members are subject to their Medical/Pharmacy deductible before copay’s apply. Medications listed on Preventative Drug List are subject to copays.


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To open and contribute to an HSA you must:

• Be covered by high-deductible health plan (HDHP) • Not covered by other non-HDHP health insurance • Not enrolled in Medicare or TRICARE


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Contributing to the HSA

• For 2011, you can contribute up to the IRS maximum of: – $3,050 (single) – $6,150 (family)

• Age 55 and older, “catch-up” contributions of $1,000• Contributions may be made via:

– Payroll deduction (pre-taxed)– Direct to OptumHealth Bank by check or on

myuhc.com


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How it works – ChristopherHis reasons for selecting the HDHP $2500 with HSA Plan were:

• Opportunity to save on taxes and save for future health care expenses

• Preventive care and preventive medications covered 100 percent

Annual deductible: $2,500District funds HSA: $2,000Maximum HSA contribution: $3,050

Health coverage (network):20 percentOut-of-pocket maximum: $4,500


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Christopher – Year One $2,500 Deductible Plan

Preventive care $ 250

Non-preventive

1 Urgent Care visit $ 200

2 Prescriptions 75

$ 275

HSA pays $ 275

Remains in HSAfor Year Two $ 2,225

Chris funds his HSA $ 500

District funds HSA $ 2,000

Member pays $ 0

Health Coverage20% coinsurance

$4,500 out-of-pocket max

AnnualDeductible

$2,500

Pre

ven

tive

Ca

re:

100%

HSAHSA

$2,500

$275$275 $25

0

Note: Assumes all network care – different coinsurance levels on non-network care apply.

HSA pays $275

Remains in HSA$2,225


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Christopher – Year Two$2,500 Deductible Plan

Preventive care $ 275

Non-preventive

3 Physician Visits $ 350

4 Prescriptions 225

$ 575

HSA pays $ 575

Remains in HSAfor Year Three $ 4,150

HSA funds from year 1 $ 2,225

Chris Funds his HSA $ 500

District Funds HSA $ 2,000

Total $ 4,725

Member pays $ 0

Health Coverage80% coinsurance


AnnualDeductible

$2,500

Pre

ven

tive

Ca

re:

100%

HSA

HSA$4,725

$575$575 $27

5

Note: Assumes all network care – different coinsurance levels on non-network care apply.

HSA pays $575

Remains in HSA$4,150


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How it works – Jane

Her reasons for selecting the HDHP $2,500 with HSA Plan were:• No upfront cost for preventive care visits• Free preventive medications, list of 2010 Core List of

Preventive Medications

Annual deductible: $2,500District funds HSA: $2,000Maximum HSA contribution: $3,050

Health coverage (network):20 percentOut-of-pocket maximum: $4,500


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Jane – Year One$2500 Deductible Plan

Preventive Care $ 250

Non-Preventive1 ER Visit $ 2,250Hospitalization 28,0504 Physician’s visits 70011 Prescriptions 1,500

$ 32,500

HSA Pays Deductible $ 2,500

Remaining Amount: $ 30,000Coinsurance @ 20% $ 6,000But out of pocket is: $ 4,500

Jane Funds her HSA $ 500

District Funds HSA $ 2,000Health Coverage80% coinsurance


AnnualDeductible

$1,500

Pre

ven

tive

Ca

re:

100%

HSAHSA$2,500

$32,500

$2,500 deductible paid

by HSA $250

$2,000 Coinsurance

$28,000 paid by Health Plan

So Jane pays: $ 2,500Health Plan pays: 30,000

So only $2,500 comes out of Jane’s pocket on a $32,500 bill.

Note: Assumes all network care – different coinsurance levels on non-network careapply.

HSA$0


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Jane compares plans…

Base Plan 104 Plan 003 HSA 2,500

Member costs

District Funded HSA Pays $0 $0 $2,000

Member Deductible $500 $0 $2,500

Out of Pocket Cost $1,750 $0 $4,500

Copays $830 $1,020 $0

Premium $0 $2,051 $0

Total Member Pays $3,080 $3,071 $2,500


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The HSA payment process

1 43

Present ID card

to doctor.

1

Doctor sends

claim to

UnitedHealthcare

2

If you owe payment

as part of your

deductible, your

provider will bill

you the discounted

amounts for the

services provided.

3a

When you have

claim activity, you

will receive a Health

Statement.

4

If you have

satisfied your

deductible, Health

Coverage will pay

the provider. The

provider will bill

you for your

portion.

3b


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OptumHealth BankSM

• A leader in health care banking and HSAs • Member FDIC • A UnitedHealth Group company


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Easy access to funds• Use at the point of service

(doctor’s office, pharmacy)• Can withdraw cash at

ATM where MasterCardis accepted*

• Can ask for additional cards for covered family members

• Free online bill pay• Checks (optional, $10 for

25 checks)

OptumHealth BankSM

*Access fees may also be charged by ATM owner.


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Choose the Right Mix of Fees and Interest

Understand the rates, fees and features for each account type:

Investments are not FDIC-Insured, are not guaranteed, and may lose value.

Health eAccess Health eSaver Health eInvestor

Monthly Maintenance Fee

Balance Required to Obtain APY

Investment Threshold

Monthly Investment Fee

$0-$499.99

$500-$999.99

$1,000-1,999.99

$2,000-$4,999.99

$15,000+

$5,000-$14,999.99

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

Annual Percentage Yield (APY) Annual Percentage Yield (APY) Annual Percentage Yield (APY)

$2,000 $2,000 $500

$3 $0 $2.50

$0 if balance exceeds $500$1 if balance is $1-$499.99

$0 if balance exceeds $5,000$3 if balance is $1-$4,999.99

$0 if balance exceeds $5,000$3 if balance is $1-$4,999.99

Variable based on balanceVariable based on balance Variable based on balance


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myuhc.com• Find network

doctors/hospitals• Estimate costs• Track claims status• Build a health

improvement program• Keep a Personal

Health Record• Get health

product discounts• Review plan details


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Our large national network

Your doctor is likely already in our network.


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UnitedHealth Premium designation program• Doctors and cardiac

facilities that follow medical guidelines

• Compare quality and costs of health care facilities

• Look for the stars when you search for a physician


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Pharmacy Resources on myuhc.com

• Find brand-name and generic medications• Compare costs of medications• Locate over 60,000 pharmacies nationwide• Order and refill prescriptions

– 30-day– 90-day mail order myuhc.com


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Treatment Cost Estimator

• Provides cost estimates for specific treatments and procedures based on selected physician’s costs

• Helps you understand the cost of treatment

• Allows you to plan in advance of your health care need


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Care24 Nurseline and EAP

• Connect with a registered nurse and highly experienced counselors

• Get help with legal, financial and emotional needs• Prepare yourself before you seek a doctor’s care• Access recorded messages on health topics• Communicate in live, one-to-one Nurse Chats

at myuhc.com

myuhc.com


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Healthy Pregnancy program

• Get support through every stage of pregnancy and delivery

• Nurses available, toll-free, 24/7• Personalized pregnancy assessment• Free pregnancy book and healthy baby bag• Discount on PJ’s Comfort


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Get DocGPSTM today!Find network doctors with our new mobile phone app

• Uses GoogleTM Maps• Search based on your

location• Download for iPhone,

Blackberry and Droid phones


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Learn more

• Talk with Jodi Finnesy in Human Resources (623) 237-7149 or [email protected]

• Open Enrollment is May 2 to May 31, 2011


Simple Health plan benefits you can understand.

The plans and outcomes given as examples in this presentation may not represent the plans and outcomes available in every state. Talk to a UHC representative to find out benefit and limitation information applicable in your state.

Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. © 2009 United HealthCare Services, Inc.UHCEW439246-000

© 2008 UnitedHealthcare Simple Health plan benefits you can understand. Glendale Elementary School...

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Transcript of © 2008 UnitedHealthcare Simple Health plan benefits you can understand. Glendale Elementary School...