Medical Plan Comparison - Central Michigan University...Compare prices, find drug discount...
Transcript of Medical Plan Comparison - Central Michigan University...Compare prices, find drug discount...
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MedicalPlanComparisonCentralCarePlan
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2017-18BenefitsOpenEnrollment
• MANDATORY!Allbenefit-eligibleemployeeswillberequiredtoacCvelyelectbenefitsonlineviaCMUChoicesfor:– Medical/prescripCon– Dental– Vision– Health&dependentcareflexiblespendingaccount(FSA)
MANDATORYOpenEnrollment
for2017-18BenefitYear
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BenefitsPlanChanges
• NewAmwellOnlineHealthCareVisit– Whenyourregulardoctorisn’tavailable,youmayseeaU.S.board-
cerCfieddoctoranyCme.Noappointmentneeded– YoucaneitheruseyourmobiledevicetologintotheAmwellapporusea
computertologintobcbsm.amwell.com– Youmaywanttouse24/7onlinehealthcarevisitwhen:
• Yourprimarycaredoctorisnotavailable• Youcan’tleaveyourhomeorworkplace• You’reonvacaConortravelingforwork• You’recaringforchildrenorafamilymemberwhocan’tleavehome• You’relookingforaffordablea]er-hourscare
– SpecificaccountregistraConisfoundonthecmich.edu/benefitswebsite.– PlantoregisterfortheAmwellservicebeforeyouactuallyneedtomake
theonlineappointment
NEW
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BenefitsPlanChanges
• PPO1&PPO2MedicalPlans–BlueCrossBlueShield– EmergencyRoomVisitCopay:$75to$100– IncreasetoAnnualMedicalDeducCble– IncreasetoTotal(Medical&PrescripCon)AnnualOut-of-pocketMaximum
• HealthSavingsAccount–HealthEquity– UniversityHSAcontribuConswillconCnue– HSAindividualcontribuConlimitincreasedfrom$3,350to$3,400(effecCve1/1/2017)
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Medical/PrescripConMonthly&AnnualCostsComparing Medical / Prescription Plan Options
Medical/PrescriptionPlanOptions HDHPw/HSA PPO2 PPO1
EmployeeMonthlyCostShare
Single2-PersonFamily
$25.34$52.45$64.11
$3.02$6.25$7.64
$81.65$169.02$206.58
UniversityMonthlyHSAContribution
Single2-PersonFamily
$65.00$134.54$164.43
NotAvailable
NotAvailable
BenefitSummary(In-networkbenefits)MedicalNetworkPrescriptionNetwork
BCBSBCBS
BCBSCVSCaremark
BCBSCVSCaremark
Preventivecare $0(planpays100%) $0(planpays100%) $0(planpays100%)
Annualdeductible(7/1-6/30) $1,300member$2,600family*
$400member$800family
$200member$400family
Coinsurance None 20%afterdeductible NoneOfficevisit(primary,specialist,chiropractic) $0afterdeductible $20copay $20copay
Urgentcarevisit $0afterdeductible $20copay $20copayEmergencyroomvisit $0afterdeductible $100copay $100copay
Prescription 10%/20%/30%afterdeductible 10%/20%/30% 10%/20%/30%
Annualout-of-pocketmaximum(medical&prescriptioncombined)
$3,300member$6,600family
$3,600member$7,200family
$2,800member$5,600family
*Thefullfamilydeductiblemustbemetunderatwo-personorfamilycontractbeforebenefitsarepaidforanypersononthecontract.
Onlinehealthcarevisit
$49.00chargeuntildeductibleismet $5copay $5copay
Thisbenefitsummaryisintendedforuseonlyasasourceofreference.Officialbenefits,condiAons,exclusions,andlimitaAonsaredocumentedinthecerAficateandamendments.
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BenefitsPlanChanges
• Dental–MeritainHealth– Nochangetothevendororplanbenefits– Dentalpremiumwillincreaseby11.4%forCore100-50-50and8%forBuyUp100-75-50-50plan
• VSPvision,TheHarfordlifeinsurance/AD&Danddisabilitywillremainwithourcurrentvendorswithnochangestotheplanbenefitsorpremiums
Full-@meEmployeeMONTHLYPremiumCostShareCoverageTier Core100/50/50 Buy-up100/75/50/50Single $4.09 $28.312-Person $8.54 $57.48Family $10.22 $74.65
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BenefitsPlanChanges
• FlexibleSpendingAccount–GeneralAgency– NewcontribuConlimitforHealthCareFSA-$2,600(from$2,550)
• NochangetoDependentDayCareFSAlimit– UpgradetoemployeeFSAportal(SuperAdmintoAlegeus)
• Mid-June–NewFSAdebitcardsfor2017-18FSAparCcipants• July1–FSAclaimsprocessedunderbothplaformsduring2016-17run-outperiod(7/1–9/30/17)
– 2016-17claimprocessing:UsemyCareCarddebitcardorsubmitreimbursementrequestsonlineviaSuperAdminormail/faxtoGeneralAgency
– 2017-18claimprocessing:UsenewFSAdebitMasterCard®orsubmitreimbursementrequestsonlineviaAlegeusormail/faxtoGeneralAgency
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TotalMustPayandMightPaySide-By-SideComparison–EmployeeOnly(Annual)
Exhibitassumesin-networkusageandisprovidedforillustraAvepurposesonly.
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TotalMustPayandMightPaySide-By-SideComparison–TwoPerson(Annual)
Exhibitassumesin-networkusageandisprovidedforillustraAvepurposesonly.
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TotalMustPayandMightPaySide-By-SideComparison–Family(Annual)
Exhibitassumesin-networkusageandisprovidedforillustraAvepurposesonly.
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HealthSavingsAccount(HSA)• HSAsareindividually-ownedbankaccounts
– Theaccountbelongstoyousoonlyyoucandecidehowtospendit
– Bothyouandyouremployercancontributefunds
– Moneyle]inyouraccountcarriesoverfromyeartoyear
– ItremainsyoursevenifyouleavetheuniversityorreCre
• HSAsareusedtohelppayforbothcurrentand/orfuturehealthcareexpenses
– Youcanwithdrawmoneytax-freeforqualifiedhealthexpenses(non-qualifiedexpensesaresubjecttotaxes
andpenalCes)
– Oryoucansavefundstopayforfutureexpenses
• AHSAistripletax-advantaged
– Contributesaremadepre-taxandfundscangrowtaxfreeandwithdrawalsforqualifiedhealthexpensestax-free
• WhoiseligibleforanHSA?Anyonewhois:
– CoveredbyaqualifiedhighdeducCblehealthplan(HDHP)
– NotenrolledinMedicare
– Notcoveredunderotherhealthinsurancecoverage,includingaspouse’splan(unlessaqualifiedHDHP)
– Notanotherperson’staxdependent
MoreinformaCon,visitwww.treas.govandclickonHealthSavingsAccount(HSA)
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TripleTaxSavings
MoneyGoesInTaxFree
MoneyGrowsTax
Free
MoneyCanBeUsedTax
FreeMoneyIsYoursToKeep!
CoverageLevel
AnnualEmployerHSAContribu@on
AnnualEmployeeHSAContribu@on
TotalAnnualHSA
Contribu@onMaximum
Age55+Contribu@on“Catch-Up”–PerPerson
Single $779.98 $2,620.02 $3,400 $1,000
TwoPerson $1,614.42 $5,135.58 $6,750 $1,000
Family $1,973.18 $4,776.82 $6,750 $1,000
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HowtouseyourHSAattheDoctor’sOfficeGo 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-of-
pocket maximum
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
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HowtouseyourHSAatthePharmacy
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 maximum
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HSAEligibleExpenses• AcneTreatments• Acupuncture• AlcoholanddrugrehabilitaCon• AllergyMedicines(withRx)• Ambulance• AnestheCst• ArCficiallimbsandteeth• Blooddonorexpenses• Breastpumpsandsupplies• Chiropodist• Chiropractor• CertaincorrecCvesurgery• Copaysforofficevisitsand
prescripCons• Dentalcareanddentures• ExaminaCons• Eyeexam,glasses,contactsand
contactlenssoluCon• Gynecologist
• Hearingaidsandbaneries• Homehealthcareandnursesfee• Hospitalandskillednursing
facility• InsulinanddiabeCcsupplies• Laboratoryfees• NicoCnepatchesandgum• Obstetricalexpense,midwife• Oculist• Optometrist• OperaConsandrelated
treatments• OrthodonCst• OrthoCcs• Osteopath• OutpaCentclinic• Oxygenandoxygenequipment• Podiatrist• PrescripCondrugs
• Psychiatrist• Psychologist• Rentalorpurchaseofmedical
equipmentincludingspecialequipmentforusebyhandicappedpersons
• Sanitarium• SmokingcessaConprograms• SupportforcorrecCveservices,
includingsupporthose,legandkneebracesandcrutches
• Surgery• Therapy• Veinproceduresthatare
medicallynecessary• Visioncare• Certainweightlossprograms• X-rays
ItemsinBLUEareeligibleunderaLimitedPurposeFSA,medicalitemsarenoteligibleexpenseswithaLimitedPurposeFSA
Fordetailedlistofeligibleexpenses,seePublicaCon502onlineatwww.irs.gov
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Sandy:Employeeonlywith$1,000inmedicalcosts*
BCBSAdvantage(HDHP)Plan BCBSPPO2Plan BCBSPPO1Plan
AnnualDeducCble=$1,300
AnnualDeducCble=$400
AnnualDeducCble=$200
Sandypays: Sandypays: Sandypays:
AnnualEmployeePremiumCostShare(PayrollDeducCon) $304 $36 $980
DeducCble +$1,000 +$400 +$200
Coinsurance N/A +$120 N/A
ClaimspaidusingCMU’sHSAcontribuCons -$780 N/A N/A
Sandypaysmedicalexpenses+annualpayrolldeduc@ons
$524 $556 $1,180
Scenario assumes in-network providers are used in all cases
Scenarios
*.
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Sandy:Employeeonlywith$5,000inmedicalcosts*
BCBSAdvantage(HDHP)Plan BCBSPPO2Plan BCBSPPO1Plan
AnnualDeducCble=$1,300
AnnualDeducCble=$400
AnnualDeducCble=$200
Sandypays: Sandypays: Sandypays:
AnnualEmployeePremiumCostShare(PayrollDeducCon) $304 $36 $980
DeducCble +$1,300 +$400 +$200
Coinsurance N/A +$920 N/A
ClaimspaidusingCMU’sHSAcontribuCons -$780 N/A N/A
Sandypaysmedicalexpenses+annualpayrolldeduc@ons
$824 $1,356 $1,180
Scenario assumes in-network providers are used in all cases
Scenarios
*.
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PlanCostEsCmatorPlanInforma@on AdvantageHDHP/HSA PPO2Plan PPO1Plan
AnnualCostofPlan(whatyoupayoutofyourpaycheck)
$ $0 $
Employer’sHSAAnnualContribuCon- $779.98single- $1,614.42twoperson- $1,973.18family
-$0 -$0
TOTALMUSTPAYCOST(regardlessofuClizaConofplan)
Es@matedExpenses(Annual)
#ofofficevisitsCmescopayoraveragecost(HDHP) ____x$80=$____ ____x$20=$____ ____x$20=$____#ofgenericdrugCmesaveragecopayoraveragecost(HDHP) ____x$17=$____ ____x$1.70=$____ ____x$1.70=$____#ofbrandnamedrugCmesaveragecopayoraveragecost(HDHP) ____x$225=$____ ____x$67.50=$____ ____x$67.50=$____#ofemergencyroomvisitsoraveragecost(HDHP) ____x$550=$____ ____x$75=$____ ____x$75=$____
Hospital,surgical,other(deducCble/coinsurance) $ $ $TOTALMIGHTPAYCOST(basedonplanuClizaCon)
Mightpaycostscan’texceedamountstotheright(annualoutofpocketmaximum)forapplicableplan.Ifhigher,capcostsatthisamount.
$3,300Single$6,600Family
$3,250Single$6,500Family
$2,600Single$5,200Family
TOTALMUSTPAYandMIGHTPAYCost1+2
2
1
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DecisionSupportTools
• BCBSMCostEsCmateTool
Loginatbcbsm.comandusethe“FindaDoctor”featuretoevaluatequalityandget
costesCmatesformorethan400healthcareservicesnaConally
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www.goodrx.comCompareprices,findpharmacycoupons,manufacturerdiscounts,generics,comparabledrugchoicesandsavingsCps
www.michigandrugprices.comCompareprices,finddrugdiscountprograms,findassistanceprograms,comparepharmacies
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 ManypharmaciesofferfreeordiscountedmedicaCons.Askyourpharmacisttoday!
Compare drug prices, use coupons, shop around. Thereareanumberofpricingtoolsavailablethatyoucanaccessonyourphonethroughanapporonline.
www.medCpster.comCompareprices,findpharmacycoupons,manufacturerdiscounts,generics,comparabledrugchoicesandsavingsCps
www.onerx.comCompareprices,findpharmacycoupons,manufacturerdiscounts,generics,comparabledrugchoicesandsavingsCps
ShopforHighQuality,LowCostPrescripCon
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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.
EASYAS1,2,31.GoTowww.healthcarebluebook.com
2.SelectorSearchforcommonprocedures.
3.ComparepricesamongphysiciansandfaciliCesinyourarea.
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DecisionSupportTool
• ALEXisHereToHelpYou– ALEXisourneweasytouseon-linedecisionsupporttool!
• FunandinteracCve• Showsyoumostlikelyandworstcasecostscenarios• Accessiblefromanyinternetconnectdevice• Includesmedical/prescripCon,dental,vision,life/AD&D,disabilityandFSA/HSA
• CheckoutALEXonlineathdps://www.myalex.com/cmu
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QuesCons?– Call989-774-3661– [email protected]– Website:www.cmich.edu/openenrollment
ENROLLBYFRIDAY,MAY5th,5P.M.(ET)
Nochangescanbemadea]er5p.m.onMay5th
REMEMBER
YouMUSTenrollbetweenApril24andMay5,2017
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Thankyouforanending.