Transcript AICPA – Comparing PPO and HSA Plans

Meredith College – Comparing Blue
Options 1-2-3 and Blue Options HSA
Plans
Jessica Smith – Health Promotion Specialist
September 6, 2013
An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11
How are the Plans alike?
SM
Blue Options 1-2-3
+
+
+
+
+
+
+
Blue Options HSA
PPO: Preferred Provider Organization
Choice of providers: in-networkSMor out-of-network
Large network of Blue Options providers
Access to specialists with no referrals
Provider discounts = big savings
Nationwide, worldwide coverage
In-network preventive services at no charge
For a list of covered preventive care services:
www.bcbsnc.com/preventive.
SM
How are the Plans different?
SM
Blue Options 1-2-3
Blue Options HSA
SM
Co-pays* for :
• Prescription drugs
No co-pays* for any services.
You pay 100% until you meet your
deductible
Deductible*:
$500 individual,
$1,000 family
Deductible*:
$2,500 individual,
$5,000 family
(aggregate)
Once met, Plan pays 90% (level 2)
70% (level 3)* until:
$2,000 individual
$4,000 family
Once met, Plan pays 80%* until:
$1,500 individual
$2,500 family
Plan pays 100%* of covered services
except for co-pays
Plan pays 100%* of covered services
for the rest of the year
* In-network
In-Network Comparison: Office Visits, ER, etc.
SM
SM
Blue Options 1-2-3
Blue Options HSA
$20 co-pay
80%, after deductible
Specialist Office Visit
70%, after deductible
80%, after deductible
Preventive Care (In-Network)
100%, no deductible
100%, no deductible
70% after
deductible
80%, after
deductible
70%, after deductible
80%, after deductible
In-Network Benefits
Primary Care Physician
Office Visit
Emergency Room
Urgent Care
In-Network Comparison: Deductibles, Coinsurance
In-Network
Deductible
Employer Contribution to
HSA
Inpatient (level 2) /
Outpatient Facility (level 3)
Coinsurance Maximum
Total Out-of-Pocket
(deductible + coinsurance, not
including co-pays)
Lifetime Maximum
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Blue Options 1-2-3
Blue Options HSA
SM
$500 - Individual
$1,000 - Family
$2,500 - Individual
$5,000 – Family*
Not applicable
$102.43 monthly
($1,229.16 – year)
90% after deductible
(level 2)
70% after deductible
(level 3)
80% after deductible
$2000 - Individual
$4000 - Family
$1,500 - Individual
$2,500 – Family
(Excludes deductible)
(Excludes deductible)
$2,500 - Individual
$5,000 - Family
$4,000 - Individual
$7,500 - Family
Unlimited
Unlimited
In-Network Comparison: Prescription Drugs
SM
SM
In-Network Benefits
Blue Options 1-2-3
Blue Options HSA
Tier 1:
Generic
$4 co-pay*
80%, after deductible
Tier 2: Preferred Brand
$30 co-pay*
80%, after deductible
$45 co-pay*
80%, after deductible
You pay 25% **
80%, after deductible
Tier 3: Brand
Tier 4:
Specialty Brands
*For a 30-day supply
** There is a $50 minimum and $100 maximum
per 30-day supply.
2013 Medical Plan
Premium Contributions
Monthly Employee Contributions
Blue Options
BO 1-2-3
HSA
Employee Only
$68.29
$0
Employee + Spouse
$605.34
$330.09
Employee + Children
$395.16
$131.75
Family
$841.42
$496.53
The High Deductible Health Plan
+ Similar to a traditional PPO, except:
High
Deductible
PPO Plan
▪ High deductible (required by the federal
1
government)
▪ No co-payments
You pay 100%
1
Until you meet
your deductible
Then you pay a
% of the cost:
coinsurance
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.
The Health Savings Account (HSA)
+ Tax-free savings account for qualified
medical expenses
1
+ Administered by BNY Mellon
Contribute
money tax-free
Meredith College
will contribute
$102.43/month
1
2
Use money to pay
for medical
expenses tax-free
2
Health
Savings
Account
(HSA)*
(for medical
expenses)
Earn interest
over time
tax-free
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.
Withdrawals are tax-free only if used for qualified medical expenses. See irs.gov for specific regulations.
Using HSA Funds
+ Eligible medical expenses







Deductible and coinsurance amounts
Visits to your doctor
Medical procedures
Prescription drugs
Eyeglasses, contact lenses
Laser eye surgery
Hearing aids
For guidance, visit www.irs.gov, publication 502.
Over-the-Counter Medications
+ Over-the-counter medications are not reimbursable
from your HSA except for:
▪ Insulin
▪ Medical devices, supplies
– Include crutches, bandages, blood sugar test kits
▪ Prescribed by your doctor
– Must have a prescription from your doctor
– Responsible to keep a copy of your prescription
For guidance, visit www.irs.gov, publication 502.
What happens to your HSA down the road?
+ Once your account reaches a balance of
$1,000, you can begin investing amounts
as low as $1* beyond the $1,000
+ Your HSA is portable - it’s yours!
+ At retirement, continue to use HSA funds
for qualified medical expenses, tax-free
*
Availability of the ACS|BNY Mellon HSA Solution investment alternative is subject to HSA account balance minimums. BCBSNC is not affiliated with your investment
fund. Please see your HSA handbook for details.
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Why will I like Blue Options HSA
?
1. Tax savings
▪
▪
▪
Contribute tax-free
Save funds in your HSA tax-free
Pay for medical expenses tax-free
2. Aggregate deductible
▪
All family expenses count toward a single
deductible
3. 100% coverage after out-of-pocket max
▪
If you reach your out-of-pocket maximum,
BCBSNC pays all covered expenses for the
rest of the plan year
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Why will I like Blue Options HSA
?
4. Employer Contribution
▪
EMPLOYER contributes $102.43/month
5. Portability
▪
▪
Take your HSA funds with you
Use them now or in the future, even in
retirement
6. Convenience
▪
Use debit card or checkbook for medical
expenses
What Else Should I Consider When Comparing
Plans?
 How much money do I and/or my family spend each year for
qualified expenses?
 What is my out-of-pocket maximum (including premium) that I will
have to spend?
 How much is my employer contributing to my HSA account?
 How much can I contribute to my HSA account?
An independent licensee of the Blue Cross and Blue Shield Association.
®, SM Marks of the Blue Cross and Blue Shield Association.
SM1 Mark of Blue Cross and Blue Shield of North Carolina.
©
2013 BCBSNC. All rights reserved.
Ethan
Coverage Tier:
Employee Only
Deductible
Out-of-Pocket Maximum
Premiums per paycheck
PPO
$500
$2,500
$68.29
HSA
$2,500
$4,000
$0
$0
$40
$48
No
$0
N/A
No ($0)
$88
N/A
$819
$0
$214
$48
No
$262
N/A
No ($262)
$262
($1,229)
$0
$907
($967)
Services
2013 Medical Story
 Very Healthy
 Flu: Office Visit
Prescription – generic
Annual Physical & Preventative Care
Office Visits & Procedures
Prescriptions
Deductible Met?
Medical Expenses to Deductible
Coinsurance (20% after Deductible)
Out-of-Pocket Max Met?
Total Medical Exp Paid by Employee
HSA Funding by Meredith College
Annual Premiums
Net Medical Cost
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*Estimates based on BCBS Cost Estimator In-Network Fees in NC, personal experience may vary
Joel
Coverage Tier:
Family
Deductible
Out of Pocket Maximum
Premiums per paycheck
PPO
$1,000
$5,000
$841.42
HSA
$5,000
$7,500
$496.53
Services
2013 Medical Story
 Hernia surgery, cold
turned into pneumonia.
Whole family caught the
cold.
 Wife: Allergies
2 Teenage Sons:
 Kyle: Appendectomy
 Nathan: Broke leg
playing hockey
Annual Physical & Preventative Care
$0
$0
Office Visits & Procedures
$34,717
$34,717
Prescriptions
$700
$3,815
Deductible Met?
Yes
Yes
Medical Expenses to Deductible
$1,000
$5,000
Coinsurance (20% after Deductible)
$6,743
$6,706
Out-of-Pocket Max Met?
YES ($7,743) Yes ($11,706)
Total Medical Expenses
$5,700
$7,500
HSA Funding by Meredith College
N/A
($1,229)
Annual Premiums
$10,097
$5,958
Net Medical Cost
$15,797
*Estimates based on BCBS Cost Estimator In-Network Fees in NC, personal experience may vary
$12,229
17
Patricia
Coverage Tier:
Family
Deductible
Out-of-Pocket Maximum
Premiums per paycheck
PPO
$1,000
$5,000
$841.42
HSA
$5,000
$7,500
$496.53
Services
2013 Medical Story
 High Cholesterol – Dr.
Visits + Lipitor monthly, Precancerous mole removed +
Dermatologist visits
 Husband: Arthritis – Dr.
visits + Enbrel monthly
 Son – 12 years old: Strep
throat
Annual Physical & Preventative Care
$0
Office Visits & Procedures
$875
Prescriptions
$970
Deductible Met?
No
Medical Expenses to Deductible
$875
Coinsurance (20% after Deductible)
N/A
Out-of-Pocket Max Met?
No ($875)
Total Medical Exp Paid by Employee
$1,845
HSA Funding by Meredith College
N/A
Annual Premiums
$10,097
Net Medical Cost
$11,942
*Estimates based on BCBS Cost Estimator In-Network Fees in NC, personal experience may vary
$0
$2,053
$23,450
Yes
$5,000
$4,100
Yes ($9,100)
$7,500
($1,229)
$5,958
$12,229
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