Transcript Slide 1

Health Plan Options
Informational Sessions
November 2012
Agenda
• Overview of Health Plans
• Prescription Drug Coverage
• 2013 Health Premiums
• Health Care Flex Spending Account
• Health Savings Account (HSA)
• Out-of-Pocket Cost Comparisons
Health Plans
 United HealthCare (UHC) Choice HMO
 United HealthCare Choice Plus POS
 Anthem Blue Cross Excel PPO
 Anthem Blue Cross Basic PPO
 UHC High Deductible Health Plan
(HDHP)
All Health Plans
• No pre-existing condition limitations
• No lifetime maximum benefit
• No requirement for referral from a
primary care physician to see a specialist
• Coverage under health plan automatically
includes coverage under the prescription
drug, dental, and basic vision plans
United HealthCare Choice HMO
In Network
Annual Deductible
Out of Network
None
N/A
$0
$25
$40
N/A
N/A
N/A
Hospital Co-Pays
Emergency Room (waived if admitted)
In-Patient (semi-private room)
$150
$300
$150
N/A
Outpatient Surgery Co-Pay
$150
N/A
$35
N/A
$0
10% co-insurance
20% co-insurance
N/A
N/A
N/A
$1,500
$3,000
N/A
N/A
Office Visit Co-Pay
Preventive
Primary Care Physician
Specialist Physician
Urgent Care Co-Pay
Lab/X-Ray
Preventive
Non-Preventive
Major Radiologic Diagnostic Test
Annual Co-Insurance Maximum
Individual
Family
United HealthCare Choice Plus POS
In Network
Out of Network
Annual Deductible
Individual
Family
None
None
$300
$900
$0
$25
$40
30%
30%
30%
$150
$300
$150
30%
$150
30%
$35
30%
$0
10% co-insurance
20% co-insurance
30%
30%
30%
$1,500
$3,000
$3,000
$6,000
Office Visit Co-Pay
Preventive
Primary Care Physician
Specialist Physician
Hospital Co-Pays
Emergency Room (waived if admitted)
In-Patient (semi-private room)
Outpatient Surgery Co-Pay
Urgent Care Co-Pay
Lab/X-Ray
Preventive
Non-Preventive
Major Radiologic Diagnostic Test
Annual Co-Insurance Maximum
Individual
Family
Anthem Blue Cross Excel PPO
In Network
Annual Deductible
Individual
Family
Out of Network
$500
$1,500
$500
$1,500
20%
40%
0% (no deductible)
40%
Hospital
Emergency Care
In-Patient (semi-private room)
Outpatient Surgery
20%
20%
20%
20%
40%
40%
Urgent Care
20%
40%
Lab/X-Ray
Preventive
Non-Preventive
0%
20%
40%
40%
$1,500
$4,500
$3,000
$9,000
Co-Insurance
Preventive Care
Annual Co-Insurance Maximum
Individual
Family
Anthem Blue Cross Basic PPO
In Network
Annual Deductible
Individual
Family
Out of Network
$750
$2,250
$750
$2,250
20%
40%
0% (no deductible)
40%
Hospital
Emergency Care
In-Patient (semi-private room)
Outpatient Surgery
20%
20%
20%
20%
40%
40%
Urgent Care
20%
40%
Lab/X-Ray
Preventive
Non-Preventive
0%
20%
40%
40%
$2,500
$7,500
$5,000
$15,000
Co-Insurance
Preventive Care
Annual Co-Insurance Maximum
Individual
Family
United HealthCare HDHP
In-Network
Annual Deductible
Individual (Employee Only)
Family (Employee +1 or more dependents)
Out of Network
$1,500
$3,000
$1,500
$3,000
20%
40%
0% (no deductible)
40%
Annual Co-insurance Maximum
Individual
Family
$1,250
$2,500
$2,500
$5,000
Annual Out-of-pocket Maximum
(Including Deductible and Co-insurance)
Individual
Family
$2,750
$5,500
$4,000
$8,000
Co-Insurance
Preventive Care
United HealthCare HDHP
• Separate In-Network and Out-of-Network
deductibles
• Family deductible applies if you cover
one or more family members
• Family deductible must be fully met even
if only one family member utilizes the
plan
• Deductible and co-insurance apply to
prescription drugs (no co-pays)
Prescription Drug Benefits
Express Scripts
All Health Plans except UHC HDHP
Tier 1
Co-pay
(generic)
UHC HDHP
Tier 2
Tier 3
Co-pay
Co-pay
(preferred) (non-preferred)
30-Day Supply
Retail Pharmacy
$10
$40
$65
Deductible, then
20% co-insurance
90-Day Supply
Mail Order
$25
$100
$162.50
Deductible, then
20% co-insurance
2013 Employee Monthly Premiums
Full Time Faculty & Staff Earning less than $35,000
EMPLOYEE
ONLY
EMPLOYEE +
ONE
DEPENDENT
EMPLOYEE +
TWO OR MORE
DEPENDENTS
UHC Choice HMO
$35.77
$193.80
$273.67
UHC Choice Plus POS
55.33
270.16
406.38
UHC High Deductible PPO
7.71
26.53
51.57
Anthem BC Excel PPO
73.92
298.90
445.46
Anthem BC Basic PPO
19.41
61.63
120.65
Dental Only
2.39
5.32
8.06
Vision Buy-Up Option
6.56
13.09
21.10
HEALTH PLAN
2013 Employee Monthly Premiums
Full Time Faculty & Staff Earning $35,000 or more
EMPLOYEE
ONLY
EMPLOYEE +
ONE
DEPENDENT
EMPLOYEE +
TWO OR MORE
DEPENDENTS
UHC Choice HMO
$43.55
$231.40
$328.77
UHC Choice Plus POS
69.08
334.00
503.71
UHC High Deductible PPO
10.46
35.09
67.20
Anthem BC Excel PPO
95.96
386.33
577.09
Anthem BC Basic PPO
24.86
78.58
152.81
Dental Only
2.39
5.32
8.06
Vision Buy-Up Option
6.56
13.09
21.10
HEALTH PLAN
2013 Employee Monthly Premiums
Part-Time Faculty & Staff
EMPLOYEE
ONLY
EMPLOYEE +
ONE
DEPENDENT
EMPLOYEE +
TWO OR MORE
DEPENDENTS
UHC Choice HMO
$231.06
$569.20
$794.04
UHC Choice Plus POS
302.02
743.10
1048.46
UHC High Deductible PPO
141.15
290.05
428.90
Anthem BC Excel PPO
411.65
891.85
1301.45
Anthem BC Basic PPO
183.20
380.26
568.93
Dental Only
4.78
10.64
16.12
Vision Buy-Up Option
6.56
13.09
21.10
HEALTH PLAN
Health Care Flex Spending Account (FSA)
WAGE WORKS
Qualified Expenses
Out-of-pocket Medical, Dental, Rx, and
Vision
Annual Maximum
Contribution
$2,500 Per Employee
Payment Methods
Debit card / Pay Me Back / Pay My Provider
Payment Amount
Up to Annual Contribution Amount
Debit Card Requirements
Settle Unverified Transactions
Benefit to Employee
Federal, State, & FICA Tax Savings
Grace Period
January 1 through March 15 after Plan Year
Claims Filing Deadline
April 30 after Plan Year
Limitations of Plan
Forfeiture of Unclaimed Balance
Health Savings Account (HSA)
US BANK
Eligibility Requirements
Must be Enrolled in WUSTL UHC High
Deductible Health Plan (HDHP)
Minimum Employee Contributions to
receive university contribution
$200 (Under $115,000 salary)
$400 ($115,000 and greater salary)
Maximum Employee Contributions
$3,250 (Employee) - $2,850 w/ university
contribution
$6,450 (Family) - $6,050 w/ university
contribution
$1000 catch-up contribution – Age 55 & older
University Contribution
$400
Benefit to Employee
Income Tax Advantages
Funds to be Utilized
Active or Retiree Health Costs
Limitations of Plan
Cannot be enrolled in Health FSA or Medicare
Health Care FSA and HSA Comparison
Health Care FSA
HSA
Health Plan Requirement
No
Must be enrolled in HDHP
Maximum Annual
Contribution
$2500
$3250 – Individual Coverage
$6450 – Family Coverage
University Contribution
No
$400 annual contribution if
employee contributes
required minimum
Access to Annual Election
Throughout year
Yes
No. Can access only up to
YTD contributions
Contribution Forfeiture
Yes
No. Unused contributions
roll over from year-to-year
Scenario #1: Single Employee (Income >$35,000) –
Generally Healthy
Premium/Procedure
UHC
Choice HMO
UHC
Choice Plus
POS
UHC HDHP
BC Excel
BC Choice
$0
$0
$0
$0
$0
Office Visit – Illness
($90)
$25
$25
$90
$90
$90
Antibiotic – Generic
($10)
$10
$10
$10
$10
$10
Out-of-Pocket Cost
($380)
$35
$35
$100
$100
$100
$522.60
$828.96
$125.52
$1,151.52
$298.32
$1,251.52
$398.32
Annual Physical ($280)
Premium Contribution
HSA University
Contribution
($400)
$200 HSA Contribution
Tax Savings* (28%
Rate)
Total Annual Cost
($56.00)
$557.60
$863.96
($230.48)
* Tax savings will vary based on your current FSA contribution and medical plan election.
Scenario #2: Employee Plus Spouse (income >$35,000) –
Having First Baby in June
Premium/Procedure
UHC
Choice
HMO
UHC
Choice Plus
POS
UHC HDHP
BC Excel
BC Choice
$0
$0
$0
$0
$0
$25
$25
$90
$90
$90
Normal Delivery
($6,000)
$300
$300
$3,528
$1,528
$1,728
Out-of-Pocket Cost
($6,830)
$325
$325
$3,618
$1,618
$1,818
$3,361.02
$5,026.26
$613.74
$5,780.52
$1,388.34
$7,398.52
$3,206.34
Pre-Natal Care – 6 OB
visits ($740)
Office Visit – Illness
($90)
Premium Contribution
HSA University
Contribution
($400)
$200 HSA Contribution
with Tax Savings* (28%
Rate)
(56.00)
Total Annual Cost
$3,686.02
$5,351.26
$3,775.74
* Tax savings will vary based on your current FSA contribution and medical plan election.
Scenario #3: Employee Plus Spouse (income >$35,000) Elective Surgery for Family Member
Premium/Procedure
UHC
Choice HMO
UHC
Choice
Plus POS
UHC HDHP
BC Excel
BC Choice
$0
$0
$0
$0
$0
Office Visits (1 PCP, 2
specialists) - ($330)
$105
$105
$330
$330
$330
MRI – Knee ($750)
$150
$150
$750
$286
$486
Elective Knee Surgery ($7,000
charge)
$150
$150
$2,936
$1,384
$1,400
Rehabilitation ($1,560 – 18
visits)
$720
$720
$312
$0
$312
$1,125
$1,125
$4,328
$2,000
$2,528
$2,776.80
$4,008
$421.08
$4,635.96
$942.96
$6,635.96
$3,470.96
Annual Physical
($280)
Out-of-Pocket Cost
($9,920)
Premium Contribution
HSA University Contribution
($400)
$200 HSA Contribution with
Tax Savings* (28% Rate)
($56.00)
Total Annual Cost
$3,901.80
$5,133
$4,293.08
* Tax savings will vary based on your current FSA contribution and medical plan election.
Scenario #4: Employee Plus Family with Two Children –
One child has a sports injury, the other child has asthma
Premium/Procedure
UHC
Choice HMO
UHC
Choice Plus
POS
UHC HDHP
BC Excel
BC Choice
$630
$630
$3,840
$1,840
$2,040
$400 +
$480 (Rx)
$400 +
$480 (Rx)
$1,500
$1,560
+ $480
(Rx)
$1,760 +
$480 (Rx)
Employee – Annual Physical ($250)
$0
$0
$0
$0
$0
Spouse – Well Woman Exam ($230)
and 2 office visits for illness ($180)
$50
$50
$36
$36
$36
$1,560
$1,560
$5,376
$3,916
$4,316
$3,945.25
$6,044.52
$806.40
$6925.08
$1,833.72
$10,841.08
$6,149.72
Child 1* - Emergency Room Visit,
Treatment for Broken Leg, and
Physical Therapy ($7,200)
Child 2 - ER Visit, 1 Night in the
Hospital, 4 office visits, and
Asthma Medications (12 Tier 2
Retail) ($5,800/$1,700 Rx)
Out-of-Pocket Cost ($15,360)
Premium Contribution
($400)
HSA University Contribution
$200 HSA Contribution with Tax
Savings* (28% Rate)
Total Annual Cost
($56.00)
$5,505.24
$7,604.53
$5,726.40
* 4 specialist visits, 8 physical therapy sessions
** Tax savings will vary based on your current FSA contribution and medical plan election.