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READY. SET. GROW HEALTHY.
Your 2012 UnitedHealthcare Plan Benefits Glendale Elementary School District
What We Will Cover Today
Medical Plan Options
• • •
Medical Plan 104 HSA 1500 Plan HSA 2500 Plan UHC Tools and Resources
2 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
What We Will Cover Today
Open enrollment April 30 to May 11th
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Changes effective July 1st
• • •
Buy-Up Medical Plan 03 has been eliminated Medical Plan 104 has increased prescription copays from $10/$20/$40 to $10/$25/$50 HSA 2500 Plan has decreased prescription copays from $10/$30/$50 to $10/$25/$50 HSA 2500 Plan deductible and OOP max has been enhanced from a two tier to a three tier program making the program more attractive to those with dependent coverage. New HSA 1500 Plan offering 4 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Take Advantage Of Your Preventive Care Coverage
Certain preventive services are covered without charging a deductible, copayment or coinsurance when these services are provided by a network provider.
It’s important to review your plan documents for the preventive services included in your specific benefit plan.
Regular preventive care may help • Reduce risk of disease • Detect health problems early • Protect you from higher costs down the road
www.uhcpreventativecare.com
for age and gender specific guidelines
5 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your Medical Benefits at a Glance Medical Plan 104
Non-network benefit Type of coverage Network benefit
Physician’s office services Specialist office visit Urgent care center services Emergency room services Inpatient hospital stay $20 co-payment $40 co-payment $50 co-payment $100 co-payment 20% after $500 individual deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after $750 individual deductible Out of Pocket Maximum $1,750 per individual per calendar year. ( Deductibles and copays do not apply) $3,750 per individual per calendar year (Deductibles and copays do not apply) 6 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Medical Plan 104 Pharmacy Costs
Lowest Cost Retail Mail order
Tier 1 $10 Member Cost 1-Month Supply $25 Member Cost 3-Month Supply Tier 2 $25 Member Cost 1-Month Supply Tier 3
Highest Cost
$50 Member Cost 1-Month Supply $62.50 Member Cost 3-Month Supply $125 Member Cost 3-Month Supply 7 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
8
UnitedHealthcare Health Savings Account Plans (HSA’s)
Consumer-driven health
Factors affecting rising health care costs 50% of health care costs driven by behaviors Genetic 20% Access 10% Environment 20% Behavior 50% For every 100 employees :
• 64 are overweight or obese: average health costs 10-12% higher • 23 smoke: average health costs 30-33% higher and annual productivity costs 60% higher • 19 experience stress: average health costs 46% higher
Source: Adapted from Department of Health and Human Services, Centers for Disease Control and Prevention
Consumer-driven health
We need to encourage more informed healthcare decisions
•
People are currently removed from the true cost of health care
•
Health care costs are skyrocketing
•
There’s a need to save for future health care costs
Your Medical Benefits at a Glance HSA 1500 – Non-Embedded Plan*
Type of coverage
Physician’s office services
Network benefit Non-network benefit
20% after deductible 50% after deductible Specialist office visit Urgent care center services Emergency room services Inpatient hospital stay 20% after deductible 20% after deductible 20% after deductible 20% after $1,500 single deductible, $3,000 family deductible*
(single deductible does not apply for families)
50% after deductible 50% after deductible 50% after deductible 20% after $1,250 single deductible, $6,000 family deductible*
(single deductible does not apply for families)
Out of Pocket Maximum
(single max does not apply to families)
( $3,000 single, $5,000 for family coverage per Plan Year Deductibles and copays apply) 11 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
$6,000 single, $10,000 for family coverage per Plan Year ( Deductibles and copays apply)
Your Medical Benefits at a Glance HSA 2500 – Embedded Plan*
Physician’s office services Specialist office visit Urgent care center services Emergency room services Inpatient hospital stay 20% after deductible 20% after deductible 50% after deductible 50% after deductible 50% after deductible 20% after deductible 20% after deductible 50% after deductible 20% after $2,500 individual, $3,500 Individual +1, $4,000 family deductible per Calendar Year (Individual deductible applies for each family member) 20% after $5,000 individual, $7,000 Individual +1, $8,000 family deductible per Calendar Year (Individual deductible applies for each family member) Out of Pocket Maximum $4,500 per individual, $7,500 individual +1, $9,000 for family coverage per Calendar Year ( Deductibles and copays apply) 12 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
$9,000 per individual, $15,000 individual +1, $18,00 for family coverage per Calendar Year.
( Deductibles and copays apply)
HSA Plan Pharmacy Costs
Lowest
Tier 1
Cost Retail
$10 Member Cost 1-Month Supply
Mail order
$25 Member Cost 3-Month Supply Tier 2 $25 Member Cost 1-Month Supply $62.50 Member Cost 3-Month Supply $50 Member Cost $125 Member Cost Tier 3 1-Month Supply 3-Month Supply
Highest Cost
Members are subject to their Medical/Pharmacy deductible before copay’s apply. Medications listed on Preventative Drug List are subject to copays.
13 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Introducing the HSA
Combines a high-deductible health plan that allows you the option to open a health savings account (HSA)
100% network preventive care High-deductible health Plan Optional health Annual savings deductible account (HSA) Annual out of-pocket protection Personal support and messages, health coaches
14 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
What is a health savings account (HSA)?
You can open and fund the HSA to pay the plan deductible and other qualified health care costs – or you can let your account grow.
It’s yours even if you switch jobs or plans Triple tax savings HSA Pay for today’s $$ or save for tomorrow’s Use for qualified expenses not covered by the plan Use it for retirement, investing* HSAs are designed to help you save and pay for your health care
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What you should know about the HSA
An HSA is not health insurance Used to pay/reimburse qualified expenses Each covered individual can open an HSA No “use it or lose it” requirement HSA is owned by you 16 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
HSA eligibility requirements
• • • • • •
You may be eligible to open an HSA if:
You are not covered by any other non-high deductible health plan, such as a spouse’s plan You are not enrolled in Medicare You do not receive health benefits under TRICARE You have not received Veterans Administration (VA) benefits within the past three months You cannot be claimed as a dependent on another person’s tax return You cannot be covered by a health care FSA or HRA 17 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Annual HSA contribution limits
Annual contribution limits are set by the IRS
Annual Contribution Rules
2012:
$3,100
for individuals &
$6,250
families for
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!
Amount of Funding
Contributions above the annual limit are subject to income taxes and a 20% penalty.
18 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
How you can use the HSA
Medical plan deductibles and coinsurance Pharmacy, dental, vision care services Use HSA dollars to pay for qualified medical expenses for your spouse or dependents Any money you take out of your HSA for eligible medical expenses is federal
income-tax free
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How you can use the HSA
Other qualified expenses
1 Coverage while receiving unemployment benefits 4 Medicare premiums and out-of-pocket expenses 3 Eligible long term care 2 COBRA continuation coverage
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How the HSA Helps You Save 1
The money Steve puts into his HSA is federal income tax-deductible.
2
Any money Steve withdraws from his HSA to pay for qualified medical expenses is withdrawn federal income tax-free.
3
Steve may earn interest on his account, and it is not taxable.
4
The amount not spent during this year carries over for use in future years.
21 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
How Much Did Steve Save?
1
In 2012, Steve will deposit $6,250 into his HSA, the maximum contribution for family coverage.
Steve’s federal and state income tax savings and FICA on his contributions for the year are
$2,478
.
2
Steve will withdraw $3,000 to pay for qualified health care expenses for him and his family.
Steve will
not
have to pay income taxes on the
$3,000
as long as he uses it to pay for qualified expenses.
3
Steve earns interest on his account.
Steve does
not
have to pay federal income taxes on his interest.
4
Steve will carry over
$3,250
HSA dollars (contributions – expenses + account earnings) into.
With a traditional plan, Steve wouldn’t have this carryover option, which helps him save for the future.
22 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
How the HSA Plan Works
HSA Payment Process
Present ID card to network doctor Doctor sends claim to UnitedHealthcare UnitedHealthcare applies network discount and notifies doctor of amount you may owe. Doctor bills you for payment 1. You can use your HSA to pay 2. Or you can choose to pay another way (cash, credit card) and reimburse yourself later When you have claim activity, you will receive a Health Statement.
TIP: Use your HSA to help you pay qualified expenses
23 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Explanation of Benefits (EOBs)
You may notice some changes on your EOBs beginning late 2011. You will see more information on: – Appeal rights – Consumer assistance programs What’s more the EOB has been designed for easier readability.
We encourage you to access your EOBs online at myuhc.com.
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Comparing an HSA with an FSA
HSA
• Owned by employee • Funded by the employee and employer • Funds automatically rollover to next plan year • Qualified expenses determined by IRS and employer • Automatic enrollment
Limited-Purpose FSA
• Owned by employer • Funded by the employee • All funds must be used by the end of the plan year or grace period • Only vision & dental care are reimbursable • Must enroll each year enrollment 25 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
1
Common HSA Questions
How do I enroll?
• Enroll during your Open Enrollment period • Check your employer benefit information for details 2 Can I take the funds in my HSA with me if I leave the company?
Yes. Funds belong to you even if you leave your job, change health plans or retire. 3 Can others contribute to my HSA?
Yes. Anyone can contribute to your HSA. Keep in mind that annual contribution limits above what is allowed are subject to income taxes and a penalty.
4 How do I access the funds in my account?
• Use your HSA debit card • Pay by check, cash or credit care and reimburse yourself later from your HSA 26 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
OptumHealth
SM
Bank, Member FDIC
UnitedHealthcare’s health care bank of choice • • • • FDIC-insured so you know your money is safe Dedicated to helping people save for health care One of the nation’s leading HSA custodians Offers a Health Savings Account Debit MasterCard ®
Only OptumHealth Bank offers the convenience of HSA banking through myuhc.com
Pay bills Make deposits • Account holders will receive
Health Savings News
e-newsletter Reimburse yourself Track spending See your tax savings And more 27 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Choose the Right Mix of Fees and Interest
Understand the rates, fees and features for each account type:
Monthly Maintenance Fee Balance Required to Obtain APY
$0-$499.99
$500-$999.99
$1,000-1,999.99
$2,000-$4,999.99
$5,000-$14,999.99
$15,000+
Investment Threshold Monthly Investment Fee
Health eAccess $0 if balance exceeds $500 $1 if balance is $1-$499.99
Annual Percentage Yield (APY) Annual Percentage Yield (APY) 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% $2,000 $2,000 Annual Percentage Yield (APY)
Variable based on balance
$500 $3 Health eSaver $0 if balance exceeds $5,000 $3 if balance is $1-$4,999.99
$0 Health eInvestor $0 if balance exceeds $5,000 $3 if balance is $1-$4,999.99
$2.50
Investments are not FDIC-Insured, are not guaranteed, and may lose value.
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How the HSA Plan Works
How the HAS Plan Works
*From www.healthcarelane.com
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How the HSA 2500 Plan Works
Chris chooses the HSA Plan for himself because: • No cost monthly premiums • His employer is contributing $2,000 • Chance to use HSA to save for future expenses Here is what Chris’s plan looks like:
Employer deposits $2,000 in HSA Chris deposits $1,000 in HSA 80%/20% network coinsurance 100% network coverage $2,500 Annual $4,500 Out-of-pocket deductible maximum
Cheryl is a fictitious person used to illustrate UnitedHealthcare products.
*From www.healthcarelane.com
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How the HSA Plan Works
1 preventive exam per member 1 visit to urgent care 1 doctor visits 2 prescriptions
Non-preventive total
$400 $200 $100 $100
$400
Paid 100% by plan
And Chris still has $2,600 in his HSA!
Chris uses HSA to pay HSA paid total $400 Chris paid $400 $2,500 Annual $4,500 Out-of-pocket deductible maximum
*From www.healthcarelane.com
32 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
How the HSA 2500 Works
Jane chooses the HSA Plan because: • No monthly premiums • Typically has few health expenses • Ability to open and save with an HSA • Tax savings Here is what Jane’s plan looks like:
District funds $2,000 in HSA 80%/20% network coinsurance 100% network coverage $2,5000 Annual $4,500 Out-of-pocket deductible maximum
*From www.healthcarelane.com
33 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Chris is a fictitious person used to illustrate UnitedHealthcare products.
How the HSA Works
All other expenses are covered 100% for the rest of the year
Emergency surgery 6 Doctor visits 11 Prescriptions $100,000 $1,000 $1,000
Jane uses HSA to meet a portion of her deductible Remaining bill $100,000 Insurance pays (80%) $80,000 Jane to pay (20%) $20,000 But she pays only $2,500 to get to her $4,500 maximum.
Total actual cost District deposits $2,000 in HSA $102,000 Jane pays $2,500 Reaches deductible $2,500 Annual 80%/20% $4,500 Out-of-pocket deductible maximum
*From www.healthcarelane.com
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100%
Jane compares plans…
Medical Plan 104 HSA 1500 Member costs
District Funded HSA Pays Member Deductible Out of Pocket Maximum Copays Premium
Total Member Pays
$0 $500 $1,750 $900 $0
$3,150
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$1,200 $1,500 $3,000 $0 $0
$1,800 HSA $2500
$2,000 $2,500 $4,500 $0 $0
$2,500
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Wellness Tools
myuhc.com
Find network doctors/hospitals Estimate costs Track claims status Build a health improvement program Keep a Personal Health Record Get health product discounts Review plan details 37 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Large National Network
More than:
660,000 doctors 5,100 hospitals 1,000 convenience care clinics 60,000 pharmacies
And world-wide
emergency care coverage
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Our Large National Network
Your doctor is likely already in our network.
Available to
98%
of Americans More than
1,000
convenience care clinics Includes
2
out of
3
providers Includes
95,000
Specialists designated for their quality and cost efficiency based on national standards
39 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Promoting Quality & Affordable Health Care
The UnitedHealth Premium
®
program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidence Doctors who meet both quality and cost-efficiency guidelines receive two stars, and those who meet quality receive one star
Quality Care
UnitedHealthcare awards one star to physicians who meet national standards for quality care.
+ Cost-efficient Care
UnitedHealthcare awards a second star to physicians who meet local area benchmarks for cost-efficient use of resources in delivering health care.
= UnitedHealth Premium Two-Star Physicians
Two-star physicians have been recognized for providing quality and cost-efficient care to their patients. They meet or exceed nationally recognized guidelines, and they’re likely to recommend the right tests and treatments for a variety of conditions. 40 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Treatment Cost Estimator
• Designed to calculate and compares cost differences for treatments between providers, locations and facility types, including both plan and member expenses for each treatment
Includes treatment costs for:
~ 116 diseases/conditions ~ 90 surgeries/procedures ~ 500+ individual services ~ 3,000+ medications SOURCE: UnitedHealthcare service data, April 2010 41 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
41
Health Assessment
Take a free, online questionnaire about your health from the University of Michigan Program includes interactive online health coaching Feedback on progress toward living a healthier life Recommendations for online health and wellness services Information to help members have productive conversations with doctor 42 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Care24 Nurseline and EAP
Connect with a registered nurse and highly experienced counselors Get help with legal, financial and emotional needs Prepare yourself before you seek a doctor’s care Access recorded messages on health topics Communicate in live, one-to-one Nurse Chats at myuhc.com
Care24 1-866-271-7340
43 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Healthy Pregnancy Program
Get support through every stage of pregnancy Nurses available, toll-free, 24/7 Personalized pregnancy assessment Educational materials and resources No Additional Cost Gifts and Savings –
Your Journey Through Pregnancy, a book that will help you learn more about your nine-month journey..
–
A booklet from Johnson & Johnson: What’s Next?: The magic unfolding of the first days of life.
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Health plan ID cards
• • Mailed to new members within 30 days of enrolling • Includes your plan information Lets providers know how to bill
Mary Winters Fred Winters, spouse Ann Winters, dependent Susan Winters, dependent
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Get Health4Me and DocGPS
®
App Today!
Find network doctors with our new mobile phone app
• • Uses Google
®
Maps Search based on your location • Download for iPhone
®
, BlackBerry
®
and Droid phones
®
Google Android is a trademark of Google, Inc.
iPhone is a registered trademark of Apple, Inc.
BlackBerry is a registered trademark of Research in Motion Limited Droid is a registered trademark of Lucasfilms Ltd.
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Explore Health Care Lane Today!
A fun and interactive way to learn about health insurance healthcarelane.com/VSEBT
47 Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.