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An independent licensee of the Blue Cross and Blue Shield Association Meredith College 2013 Renewal...
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Transcript of An independent licensee of the Blue Cross and Blue Shield Association Meredith College 2013 Renewal...
An independent licensee of the Blue Cross and Blue Shield Association
Meredith College2013 Renewal & Enhancements
Andrea Rossbach 10/11/2012
What has changed for 2013?Benefit HSA PPO 123
In-network Out-of-network In-network Out-of-network
Deductible IndividualFamily
$2,500$5,000
$5,000$10,000
$500$1000
$1,000$3,000
Coinsurance 80% 50% 90% level 270% level 3
60% level 260% level 3
Coinsurance MaxIndividualFamily
$4,000$7,500
$8,000$15,000
$2,000$4000
$4,000$12,000
Office Visit Copays In-network:Deductible applies to sick100% preventative benefit
In-network:$20 Primary CareDeductible applies to specialist100% preventative
Prescription Drugs
(Note: The coverage level for tier 4 specialty drugs will not change in 2013 However, for in-network coverage, please use a participating specialty pharmacy.)
In-network:Deductible Applies
In-network: Tier 1: $4Tier 2: $30Tier 3: $45
Your 2013 Medical Plans: How They Compare
Medical Plan OptionHSA
(In-network)PPO
(In-network)
CopaymentsNone. You pay
100% for services until you meet your
deductible.
$20 for non-preventive Level 1 services
Also pay $250 copay on inpatient hospital.
Preventive CareServices received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%. For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.
Covered at 100% (before deductible)
Covered at 100% (before deductible)
Plan Year Deductible$2,500 Individual
$5,000 Family$500 Individual$1000 Family
Family Aggregate Deductible
Yes No
Your 2012 Medical Plans: How They Compare Medical Plan
OptionHSA (In-network) PPO (In-network)
Coinsurance(after you meet your deductible)
Services covered at 80% (you pay 20%) after deductible
Level 2 services covered at 90% (you pay10%) after deductible (and if
applicable, $250 copay per admission)
Level 3 services covered at 70% (you pay 30%) after deductible
Out-of-Pocket Maximum(includes deductibles)
$4000 Individual$7500 Family
(Once met, covered services paid at 100% for rest of plan year.)
Not applicable
Coinsurance Maximum (does not include deductibles)
Not applicable
$2,000 Individual$4,000 Family
(Once met, still pay copays for primary care doctor visits and prescription drugs)
Health Savings Account (HSA)
Yes No
What is Blue Options HSASM? • High Deductible PPO Health Plan
– Similar to a traditional PPO, except:• High deductible (required by the
federal government)1
• No co-payments
High Deductible PPO Plan
You pay 100%
Until you meet your deductible
Then you pay a 20% of the cost: coinsurance
1 Blue Options HSA plans, deductible and out-of-pocket maximum amounts are subject to change year to year in order to comply with IRS requirements. For the most up-to-date requirement information, see www.irs.gov.
What is Blue Options HSASM? • Health Savings Account (HSA)
– Tax-free savings account for qualified medical expenses
– Administered by BNY Mellon1
Health Savings Account (HSA)*
(for medical expenses)
Contribute money tax-
free
Use money to pay for medical expenses tax-
free2
Earn interest over time tax-free
1 BCBSNC does not administer your HSA and is not affiliated with your HSA custodian or administrator. Your HSA custodian is The Bank of New York Mellon.2 Withdrawals are tax-free only if used for qualified medical expenses. See irs.gov for specific regulations.
Similar to Traditional PPO Plans:+ Choice of doctors
+ Large Blue OptionsSM
network of providers
+ Out-of-network benefits option1
+ Access to specialists with no referrals2
+ Provider discounts = big savings
+ Nationwide, worldwide coverage3
+ Preventive4
services at no charge
1 When you see an out-of-network provider, you may pay more out of pocket. 2 Referrals may be needed for mental health and substance abuse services. 3 Blue Cross and Blue Shield Association Internal Data, 2007: www.bcbs.com/news/press/facts/bluecard.html (Accessed September 2008)4 Preventive care services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%.
For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.
For a list of covered preventive care services: www.bcbsnc.com/preventive.
Different from Traditional PPO Plans • High Deductible
– Required by federal government
• Family aggregate deductible– Single deductible for all covered family members
• No co-payments for services– You pay 100% until you meet your deductible
• Pay for care with HSA– Pre-taxed funds
For guidance, visit www.irs.gov, publication 502
1 When you see an out-of-network provider, you may pay more out of pocket. 2 Referrals may be needed for mental health and substance abuse services. 3 Blue Cross and Blue Shield Association Internal Data, 2007: www.bcbs.com/news/press/facts/bluecard.html (Accessed September 2008)4 Preventive care services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%.
For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.
How does Blue Options HSASM work?
• You pay 100% of your health care & prescription drug expenses
• Exception: In-network preventive care2 is covered at 100%, without paying your deductible first
+ You pay 20% of your health care expenses, including prescriptions
Before you reach your deductible1
After you reach your out-of-pocket maximum1
Of $4000 employee/$7500 family+ BCBSNC pays 100% of all covered expenses for
the rest of the plan year
1 Blue Options HSA plans, deductible and out-of-pocket maximum amounts are subject to change year to year in order to comply with IRS requirements. For the most up-to-date requirement information, see www.irs.gov.
2 Preventive care services received from an in-network provider in an office-based, outpatient or ambulatory surgical setting or urgent care center are now covered at 100%. For a list of covered preventive care services refer to www.bcbsnc.com/preventive. Some restrictions may apply.
After you reach your deductible1
Deductible: $2,500 employee/ $5,000 family
How the HSA Works
You, your employer, or anyone can contribute to
the HSA – tax-free!
When you use your HSA to pay for qualified medical
expenses, the money comes out tax-free1!
HSA checkbook and debit card from
Mellon
Use for medical expenses at
doctor’s office, pharmacy, etc.
If you don’t use your HSA money, you don’t lose it!
The fund grows - tax-free!
1 Withdrawals are tax free only if used for qualified medical expenses. Specific regulations and a list of qualified medical expenses can be found in IRS publication 502, available at www.irs.gov.
2013 Annual Contribution Limits: $3,250 individual $6,450 family $1,000 per year catch-up contribution
(55 or older by 12/31/13)
Pharmacy Benefits
* For a 30-day supply** There is a $50 minimum and $100 maximum per 30-day supply.
Pharmacy HSA PPO
Tier 1: Generic Deductible $4 Copay
Tier 2: Preferred Brand
Deductible $30 Copay
Tier 3: Brand Deductible $45 Copay
Tier 4: Specialty Brand Deductible 25% Coinsurance
Health Care Cost Estimator Tool
Look at costs on 56 procedures
Find Blue Distinction Centers and make informed decisions on health care costs.
https://www.brainshark.com/bcbsnc/costtransparency
A friendly reminder Blue Points will discontinue 12/31/2012 for Meredith Employees. Please cash in your points by 12/30/2012
Achiever ACredit Tracking – 6 months
15
Healthy Outcomes groups will be defaulted to this plan option. Groups that are not Healthy Outcomes groups may choose this plan as well if they wish.
Program Activity Credit Value Annual Max
Award Credits Process
Health Assessment (required) 40 40 Auto
Healthy Living Programs 20 40 Auto Healthy Living Conversations 10 30 Auto Online Monthly Seminars 5 30 Auto 1 on 1 Health Coaching Interaction 40 40 Various
Preventive Care Adherence with 4 services within USPSTF Guidelines
50 50 Claims / Form
Custom Activity 25 25 Form / File Health Challenges 25 100 AutoTotal Opportunity 355
Program 5 Goal: 125 Credits
Employee portal
Personalized messaging
Dashboard incentive status and activity tracking
Top three program recommendations prominently displayed
Tools and media Weight, nutrition,
exercise, pain
Multiple health programs and trackers Calculators Planners and guides
16
Welcome screen
Employee portalWellness overview
Displays program overview
Informs member how to achieve their goals
Describes each program activity
Shows credit value of each activity
17
Private and confidential• Health Assessment responses are confidential• Results are not used to determine
insurance rates or eligibility for coverage• Get a personal health report you can print• Access programs to improve your specific risk conditions
Why should you participate?• Helps you get healthier• Meredith college is giving $20
per month to the HSA fund or $20 towards premium to members on the PPO beginning 1/1/2014
• Helps your company control health care costs, which is good for everyone, last year there was a savings but we need to increase participation