Introducing:

Plan C & the Health Savings Account (HSA)

Plan Design for 2013

Plan C - At a GlanceNetwork Medical and Pharmacy Benefit

Single Family

Deductible $2,500 $5,000

Coinsurance 0% 0%

Total Member Pays $2,500 $5,000

HSA Account Single Family

State HSA Contribution $1,500 $2,250

Minimum $25 Employee Contribution $600 $600

Total Annual HSA Contribution $2,100 $2,850

• All are Preferred Provider Organizations (PPO)• Use the same provider network as A & B• Standardize coverage for A, B & C• Claims paid based on the network status• Network Providers accept the plan

allowance as payment in full• Non Network Providers can balance bill

Plan C VendorsBlue Cross and Blue Shield of Kansas

Coventry/PHS

UnitedHealthcare Company

Plan C • Network Medical and Pharmacy Coverage

• $2,500/$5,000 Deductible• 0% Coinsurance• $2,500/$5,000 Total Deductible & Coinsurance• Preventive Care Services paid at 100%

• Non Network Medical Coverage• $2,500/$5,000 Deductible • 20% Coinsurance• $4,000/$8,000 Total Deductible & Coinsurance• Preventive Care is not covered

Preventive Care Covered in FullServices Services

Well Baby Exams - includes newborn screenings & age-appropriate office visits.

Contraceptive Coverage – Designated prescription drugs and sterilization procedures.

Well Woman, Man & Child Exams - includes an office visit & age-appropriate screenings, contraception services & counseling.

Ultrasonography for Aortic Aneurysm - Limited to one for men ages 65-75 with tobacco use history

Prenatal Screening & Counseling - Limited screening services.

Mammography – not limited to one.

Age-Appropriate Bone Density Screening

Vision Exam – one covered per person per year

Immunizations Routine Hearing Exam Colonoscopy – not limited to one.

 

Plan C Drug Plan

• Same Preferred Drug List as Plans A & B

• Covered drugs are subject to the Plan C deductible

• After the Member meets the deductible, the plan pays covered prescription drugs at 100% for the remainder of the plan year

• Discount Tier drugs are not covered drugs• Only eligible for Caremark’s negotiated discount

Plan C - At a GlancePlan C Network Medical & Pharmacy Benefits

Single Family

Deductible $2,500 $5,000

Coinsurance 0% 0%

Total Member Pays $2,500 $5,000

HSA Account Single Family

ER HSA Contribution $1,500 $2,250

Minimum $25 EE Contribution $600 $600

Total Annual HSA Contribution $2,100 $2,850

What is a Health Saving Account?• An employee owned bank account for saving

money to pay for current or future medical expenses for members enrolled in a qualified high deductible health plan

• Unspent HSA funds roll over and accumulate year to year and can be invested

• Portable - The account and the money belong to you

To Be Eligible for an HSA• You can….

• Not be enrolled in Medicare• Have other coverage that isn’t a High Deductible

Health Plan • includes your spouse’s if you are covered by it

• Not be covered by Tricare, or Tricare for Life• Not have VA benefits • Not have used a VA health center within 3 months

of enrolling in Plan C• Not have a Health Care Flexible Spending Account

(HCFSA)• Includes your spouse’s• Only a Limited FSA is allowed

State Increases HSA Funding• State will make a lump sum HSA contribution

• HSA funding depends on HCFSA:• Account funded in January if no HCFSA in 2012

or if all money has been used by 12/31/12• Account funded after March 15, 2013 if enrolled

in HCFSA in 2012 and you have funds during the grace period• Under IRS, you can’t contribute to HSA while

using an HCFSA• HSA contribution will be pro-rated

HSA Contributions Full Time Employee - (24 semi monthly deductions)

Single Family

Employer (ER) Contribution $1,500 $2,250

Employee (EE) Contribution $25 to $72.91 $25 to $175

Maximum Annual HSA Contribution (ER+EE)

$3,250 $6,450

Over age 55 “Catch up” amount $1,000 $1,000

•HSA Contributions are governed by the Internal Revenue Service (IRS).•Eligibility criteria for HSA Account is on Page 12 of the Open Enrollment Book•Minimum contribution of $25 semi-monthly by the employee is required•Contributions may be made with pre or post tax funds. •Members over age 55 can contribute additional funds to “catch up”

• All Plan C options will have the same HSA vendor:

• US Bank• A file with the members who enroll in Plan C

will be sent by SEHP to US Bank• Employees receive “welcome” notification via

email •Letter will be sent if no email address

• Employee Completes Online enrollment process•Must accept the Terms and Conditions•Order additional cards for dependents•Select account beneficiaries

HSA Enrollment is Easy

Using Your HSA Funds • Use your HSA Bank Card at a Pharmacy:

• Fill a prescription

• Swipe your HSA Bank Card for payment

• Save a copy of receipt for your records

• Use your HSA Bank Card for Medical Services:

• Health plan adjudicates claim & sends you an Explanation of Benefits (EOB)

• Pay the provider using your HSA Bank Card

• Save a copy of the bill or EOB for your records

Additional Ways to Pay with Your HSA

• Pay the Provider through online Bill Pay

• Go to US Bank online and use Bill Pay to issue payment to the provider of service

• Reimburse yourself for expenses paid out of your pocket

• With Bill Pay you can send a direct deposit reimbursement to your checking or savings account for health care services

U.S. Bank Online Tools

• WebMD® Coverage Advisor – evaluate health insurance options, determine OOP costs and model HSA and/or FSA contribution levels

• WebMD ® -WebMD is one of the leading sources for trustworthy and timely health and medical news, helping individuals take an active role in managing their own health and wellness

• MayoClinic.com – provides an array of health information, medical services and education & research

• Expense Tracker - Pitch the shoebox! Our Healthcare Expense Tracker enables you to consolidate and manage your healthcare bills. Simply enter your expenses online, track and categorize them, and securely upload a receipt.

Our Healthcare Toolbox provides smart, easy-to-use interactive tools to help manage healthcare spending and reduce costs.

Future Webinars

• Additional webinars are being planned this fall

• Next webinar will focus on the Health Savings Accounts

Questions

• Please submit your questions now and we will be preparing a Q&A document to post to the website.

• You may also submit questions after this webinar to: benefits@kdheks.gov

Thank you for attending!

QuestionsQ. When will the employer contribution be made to the employee’s Health

Savings Account?

A. State employees – The full employer contribution will be made

• during the 1st pay period in January 2013 for employees with a zero balance in their Health Care FSA by December 31, 2012.

• after March 15th on a prorated basis for employees that still have a balance in their Health Care FSA on December 31, 2012

Non State Employees – Employees will need to check with their employer to see when the Employer HSA contribution will be made.

These funds are available to use as soon as they are deposited.

Q. When does my enrollment become effective?  When does the annual coverage year start and end?

A. These changes take effect on January 1st. The annual coverage year is on a calendar year basis and runs from January 1st through December 31st.

Q. What are the amounts of employer contributions for PY2013?

A. For member only coverage the employer contribution is $1,500 and for members with dependent coverage the employer contribution is $2,250.

Q. Can the employee HSA contribution amount be changed at any time?

A. Yes, contribution amounts may be increased or decreased without a qualifying event. The effective date of the change will be the first of the month following the date that the change form is received by SEHP Membership Services. Example: if a change form is received on September 15th, the change will be reflected in the 1st pay check in October. For a change form received after a payroll cycle has completed, the agency payroll staff may have to make an adjustment to ensure that the contribution change appears on the first check of the next month. Also, contribution increase changes must stay within the minimum and maximum amounts, per pay check, listed in the Comparison Chart.

Q: How will the switch to US BANK work if we're currently with Select Account?

A: Members with existing accounts will have an opportunity to transfer their funds to the new account or they can leave them where they are now. It will be up to the member to decide whether or not to transfer the funds to US Bank.

 We are finalizing the transfer details but at this time, our understanding is a letter from the State with a transfer form will be sent to members enrolled in Plan C for 2013 and who have existing HSA accounts with the current HSA vendors. If the member elects to make a transfer, they complete the form and US Bank with work with the other bank to get the money transferred without additional cost to the member.

Q: If an employee is currently enrolled in Plan C program, are they grandfathered in to $1500 deductable for single?

A: No. The new plan takes effect January 1, 2013 for all Plan C members.

Q: If the spouse of an employee has only dental and vision coverage through their employer and is on the state plan, can the employee participate in an HSA?

A: To be enrolled in an HSA, you must be enrolled in a Qualified High Deductible Health Plan and not have other medical coverage like a major medical plan. A vision or dental plan are fine and wouldn’t prevent you from having Plan C with an HSA.

Q. If a married couple are both employed by the State, can they have separate HSA accounts, or share one?

A. Spouse’s who work for the State must be enrolled separately in the SEHP and have separate HSAs when enrolled in Plan C. Total contributions into both accounts cannot exceed the IRS HSA limits for a family.

Q. Can an employee be enrolled in both a Health Care Flexible Spending Account (FSA) and an HSA?

A. The IRS does not allow dual enrollment in a Health Care FSA and an HSA. There is a Limited Scope FSA available for members enrolled in Plan C with Health Savings Account. These funds can be used for eligible expenses related to dental and vision costs.

Q. Is the Members over age 55 “catch up” contribution of $1,000 a total, or semi-monthly amount?

A. $1,000 is the total contribution for the catch up.

Q. What are the plan year 2013 premiums for Plan C?

A. State employee premium rates are listed in the Comparison Chart included with your Open Enrollment 2013 booklet

Non State Employees can get premium rates from your employer.

Q. For PY 2013, the Plan C deductibles are $5,000 for family coverage and $2,500 per person. If one family member has $3,000 in medical costs, the plan will pay the last $500 but, if two family members have $1,500 each in medical costs, the plan pays nothing. Is this a correct example?

A. Yes. The plan will pay 100% of eligible expenses after a family member meets the single deductible of $2,500, but pays nothing if two family members have incurred any expenses under the $2,500 deductible - for example $1,500.