Open Employee Forum Medical Plans for 2012
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Transcript of Open Employee Forum Medical Plans for 2012
Open Employee ForumMedical Plans for 2012September 14, 2011
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2012 Medical/Prescription Drug Benefits•SLU will continue to offer two programs:
Plus PPO Plan (with a modified Rx component)
Health Savings Account (HSA) Qualified Plan
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2012 Medical Plan Options
Plus Plan HSA Plan
SLUCare In-Network Out-of-Network SLUCare In-Network Out-of-Network
Deductible Non-Embedded: (One member can satisfy entire family deductible)
Individual $0 $250 $750 $1,500 $1,500 $3,000Family $0 $500 $1,500 $3,000 $3,000 $6,000Coinsurance 0% 10% 40% 0% 10% 40%
Out-of-Pocket Maximum (includes deductibles) Non-Embedded: (One member can satisfy entire family OOP Max)
Individual $0 $1,250 $4,750 $1,500 $3,000 $6,000Family $0 $2,500 $9,500 $3,000 $6,000 $12,000Physician Office Visits
Primary Care $10 copay10% after ded. 40% after ded. 0% after ded. 10% after ded. 40% after ded.
Specialist Care $20 copay
Preventive Care 100% 100% 100% 100% 100% 100%
Inpatient Hospital
10% after ded. 40% after ded. 10% after ded. 40% after ded.Emergency Room
$100 copay $100 copay 10% after ded. 40% after ded.Urgent Care Center
$50 copay $50 copay 10% after ded. 40% after ded.
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2012 Pharmacy Plan Options
Plus Plan HSA Plan
Express ScriptsRetail
(34-day supply)
Express ScriptsMail Order
(90-day supply)
Express ScriptsRetail
(34-day supply)
Express ScriptsMail Order
(90-day supply)Tier 1 $8 $16 Medical Deductible and Coinsurance
Tier 2 $30 $60 Medical Deductible and Coinsurance
Tier 3 $50 $100 Medical Deductible and Coinsurance
Tier 4 20% to $150 Medical Deductible and Coinsurance
Preventive Medications
Priced according to the tier in which they fall
Covered at 100%, no copay or deductible
NEW! Under the proposed HSA plan, certain preventive, or “maintenance,” medications would be covered at 100%...
NO copay or deductible would need to be satisfied by you or your family!
Information on which drugs qualify as preventive will be distributed during open enrollment.
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What is an HSA?Health Savings Accounts (HSAs) are designed to help you save and pay for your health care
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OptumHealth BankSM, Member FDIC
Focuses solely on health care banking
We administer over 600,000 individual Health Savings Accounts
Is one of the nation’s leading custodians of health savings accounts
We offer three HSA options to meet individual goals
UnitedHealthcare HSA Bank of Choice
Established in 2003
OptumHealth Bank serves thousands of employers, families and individuals
We have more than $1 billion in assets
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HSA Overview
Require a High Deductible Health Plan
Used to pay for qualified
health care expenses
immediately
Grows over time and can be invested
Funded by you, your employer
or others
Account funds belong to you
Investments are not FDIC insured, are not guaranteed by OptumHealth Bank and may lose value.
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HSA EligibilityYou are eligible to open and contribute to an HSA if you:
Are covered by an eligible high deductible health plan
Are not covered by a healthcare FSA
Are not claimed as a dependent on someone else’s tax return
Have not received VA benefits within the past 3 months
Are not enrolled in Medicare, Medicaid, or TRICARE
Are not covered by any other health plan that is not a high deductible plan
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Amount of Funding
The IRS determines how much you can fund.
Contribution Limits
Rules For 2012, individuals can contribute up to $3,100 and $6,250 for families.
Additional Funding
Those 55 years of age or higher, but not entitled to Medicare benefits, can fund an additional $1,000/year “catch-up” contribution!
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How an HSA Helps You Save
Steve
Steve puts his money into his HSA pre-tax
1
The amount not spent during this year carries over for use in future years.
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Any money Steve withdraws from his HSA to pay for qualified medical expenses is withdrawn income tax-free.
2
Steve may earn interest on his account, and it is not taxable.
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How Much Did Steve Save?
Steve does not have to pay income taxes on his interest.
Steve’s federal and state income tax savings on his contributions for the year are $2,291.
Steve will not have to pay income taxes on the $3,000 as long as he uses it to pay for qualified expenses.
With a traditional plan, Steve wouldn’t have this carryover option, which helps him save for the future.
In 2012, Steve will deposit $6,250 into his HSA, the maximum contribution for family coverage.
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Steve will withdraw $3,000 to pay for qualified health care expenses for him and his family.
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Steve earns interest on his account. 3
Steve will carry over $3,250 HSA dollars (contributions—expenses + account earnings) into the next year.
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How You Can Make the Most of Your Coverage
Health Care Consumerism
Make informed choices
Look for ways to lower health care costs
Own your health care decisions
Understand your medical coverage
Maintain a healthy lifestyle
Use your preventive care coverage to catch health
issues early
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HSA Qualified Medical Expenses
Any money you take out of your HSA for qualified medical expenses is income-tax free
Medical plan deductibles and
coinsuranceMedical, dental and
vision care and services
Use HSA dollars to pay for medical
expenses for your spouse or
dependents
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Other HSA-Qualified Medical Expenses
Health coverage while
receiving unemployment
benefits
COBRA continuation
coverage
Eligible long-term care
Medicare premiums and out-of-pocket
expenses
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Paying for Non-Qualified Expenses
Any funds used for purposes other than to pay for qualified medical
expenses are:
Taxable as income
Subject to a 20 percent tax penalty
The tax penalty increased from 10 to 20 percent in
2011. The penalty does not apply to account holders
age 65 and older, those who become disabled or enroll
in Medicare.
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Save Your Receipts!
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• Save your receipts for all qualified health expenses.
• OptumHealth Bank does not track or validate your expenses or verify eligibility.
Important Tips:
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How Molly Uses Her HSA
Molly
Molly goes to the doctor
with her HSA
Molly presents her UnitedHealthcare health plan ID card at the doctor’s office
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Molly receives and pays her doctor’s bill
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Molly fills her prescription3
Molly keeps her receipts5
The doctor submits a claim to the health care plan
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Managing Your HSA with myuhc.com
• Check monthly statements and interest rates
• Pay bills to health care providers• Download forms needed to manage
your account• Update personal information• Arrange deposits from another
banking account• Manage investment activities for
your HSA • Learn about HDHPs and HSAs• Use HSA calculators
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Investments are not FDIC insured, are not guaranteed by OptumHealth Bank and may lose value.
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Common Questions
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Yes. You can open an HSA at any time, as long as you are covered by an HSA-eligible health care plan
Can I open a Health Savings Account at any time during the year?
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Can I take the funds in my HSA with me if I leave the company?
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Am I required to contribute a specific amount each year?
3
Do I need to use all of the funds in my HSA during the year?
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Yes. Funds in your HSA belong to you, including any contributions that your employer or anyone else has made.
No. You can contribute as much as you’d like up to the IRS maximums. Most people base contributions on the annual deductible required by their HDHP.
No. HSA plans are not subject to IRS “Use It or Lose It” regulations. This means that funds in the account continue to accumulate over time.
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To Learn More Online
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A series of short, online training sessions on HSAs are available at any time
You can access all Health Accounts Self-Guided Tours at the site below.
Access all Self-Guided Tours at: www.hsaenroll123.com/self-guided-tours/
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2012 Cost Sharing
• If you enroll in the HSA Qualified Plan for 2012, SLU will contribute funds to help you build your balance: $250 for Single Enrollees $500 for Enrollees with Family Members
• Wellness Incentive increased from $20 to $30 for 2012
Plus PlanMonthly Payroll Deductions With Wellness Incentive Without Wellness IncentiveSingle $94.34 $124.34Employee and Spouse $313.79 $343.79 Employee and Child(ren) $283.90 $313.90Family $448.26 $478.26
HSA Qualified PlanMonthly Payroll Deductions With Wellness Incentive Without Wellness IncentiveSingle $29.81 $59.81Employee and Spouse $178.28 $208.28 Employee and Child(ren) $161.30 $191.30Family $254.68 $284.68
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2012 Cost SharingAnnual Contribution Difference vs. 2011 Plus Plan
Plus PlanAnnual Difference in Payroll Deductions With Wellness IncentiveSingle $304.44Employee and Spouse $181.92Employee and Child(ren) $164.52Family $259.80
HSA Qualified PlanAnnual Difference in Payroll Deductions With Wellness IncentiveSingle ($469.92)Employee and Spouse ($1,444.20)Employee and Child(ren) ($1,306.68)Family ($2,063.16)
• If you enroll in the HSA Qualified Plan for 2012, SLU will contribute funds to help you build your balance:▫ $250 for Single Enrollees▫ $500 for Enrollees with Family Members
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Eligible DependentsDefinition of an Eligible Dependent
Legal spouse or dependent child under 26 years of age of the employee or the employee's spouse. The term child includes any of the following:
• A natural child• A stepchild• A legally adopted child• A child placed for adoption• A child for whom legal guardianship has been awarded to the
employee or the employee's spouse• Handicapped children over the age of 26 with certification from a
physician
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Dependent Eligibility Audit• SLU has a responsibility to:
Administer the plan as stated in the plan document Administer the plan consistently for all employees Monitor the costs of the plan
• SLU will complete a Dependent Eligibility Audit in early 2012 Employees will be asked to provide verification for enrolled
dependents Ineligible dependent will be removed from the plan Claims paid for ineligible dependents may be recovered and
the expenses would become the responsibility of the employee
• Additional information will be provided
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Vitality Program• Activity Distribution
▫ Members completing 2-5 activities April: 60% of total population May: 55% of total population June: 52% of total population
▫ Members completing over 10 activities April: 5% of total population May: 10% of total population June: 12% of total population
• Vitality Status Earned (YTD)▫ April/May/June
Blue: 1,874/1,897/1,868 Bronze: 740/722/757 Silver: 1,694/1,733/1,752 Gold: 16/20/28 Platinum: 1/4/6
• Verified Workouts ▫ April: 46▫ May: 334 Added Simon Rec Center
▫ June: 427• Education Activities
▫ April: 306▫ May: 342▫ June: 365
• Healthy Living Activities ▫ April: 40▫ May: 63▫ June: 70
• Prevention Activities ▫ April: 79▫ May: 118▫ June: 142
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Contact Information•Please email questions or comments to:
[email protected] [email protected]
•Your feedback is important!!!