Transcript Presentation Title

Simple
Health plan benefits you can understand.
Glendale Elementary School District #40
July 1, 2011
© 2008 UnitedHealthcare
What We Will Cover Today
Medical Plan Options
• Choice Plus Plan 104
• HSA 2500
• Choice Plus Plan 003 (membership is frozen effective 7/1/11)
UHC Tools and Resources
© 2008 UnitedHealthcare
Changes effective July 1st
• UHC Vision is no longer bundled with medical coverage (a separate election for
voluntary vision will need to be made)
• Plan 003 membership is frozen. Employees currently enrolled are grandfathered and
can continue to be enrolled in the plan)
• In-Network Preventative Care covered at 100% on all plans
• No lifetime limits on benefits
• No coverage difference between network and non-network facilities in an emergency
• Dependents are eligible up to age 26 whether married or unmarried (May not be
eligible if they are able to enroll in their own employer sponsored plan )
3
Out-of Network Benefits
• Non-network care now covered at 50% on all plan offerings with a
separate higher deductible and coinsurance
• Non-network providers are free to set their prices
• In addition to your non-network deductible and coinsurance you are
required to pay the total amount over the allowed charges (Allowed
charges are 110% of Medicare’s fee schedule)
• You may receive a check from UHC for the covered portion and you
will need to forward this payment to the provider
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Your Medical Benefits at a Glance
Choice Plus Plan 104
Type of coverage
Network benefit
Non-network benefit
Physician’s office services
$ 20 co-payment
50% After deductible
Specialist office visit
$ 40 co-payment
50% After deductible
Urgent Care center services
$ 50 co-payment
50% After deductible
Emergency room services
$ 100 co-payment
$ 100 co-payment
20% after $500 deductible,
out-of-pocket max $1,750
per person/Cal. Year
50% after $750 deductible,
out-of-pocket max $3750
per person/Cal. Year
(Deductible does not apply
to OOP max)
(Deductible does not apply
to OOP max)
Inpatient hospital stay
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
5
Your Medical Benefits at a Glance
Choice Plus Plan 003
Type of coverage
Network benefit
Non-network benefit
Physician’s office services
$ 20 co-payment
50% After deductible
Specialist office visit
$ 20 co-payment
50% After deductible
Urgent Care center services
$ 50 co-payment
50% After deductible
Emergency room services
$ 100 co-payment
$ 100 co-payment
$250 copay per hospital
stay
Out-of-pocket max $2,000
per person/Cal. Year
Inpatient hospital stay
(Outpatient services subject
to $250 deductible and 10%
coinsurance)
50% after $1,000
deductible, out-of-pocket
max $3,000 per person/Cal.
Year
(Deductible does not apply
to OOP max)
(Deductible does not apply
to OOP max)
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
6
Traditional Plan Pharmacy Benefit
Retail
Mail order
Tier 1
$10 Co-pay
31-Day Supply
$25 Co-pay
90-Day Supply
Tier 2
$ 20 Co-pay
31-Day Supply
$50 Co-pay
90-Day Supply
Tier 3
$40 Co-pay
31-Day Supply
$100 Co-pay
90-Day Supply
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Three key issues experts agree on
1. People are removed from the true cost of
health care
2. Health care costs are skyrocketing
3. There’s a need to save for future health
care costs
Solution…
© 2008 UnitedHealthcare
A High Deductible Health Plan with
a Health Savings Account provides
you:
• More choices
• More control
• Dedicated support to help you
 Lower your costs
 Improve your health
 Save for the future
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
9
Health Savings Account (HSA)
Plan
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
10
HSA Plan Components
Medical Plan
• Network and non-network coverage
• Annual deductible
• Protection from high out-of-pocket costs
•100 percent preventive care
• No copayments
Health Savings
Account
• Your personal bank account
• Take it with you if you leave your job
• Triple-tax benefits
• Use it for medical & pharmacy bills
• No “use it or lose it” rule
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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About the HSA Plans
Out-of-pocket maximum
• Protects you from
high costs
• Gives you peace of mind
Tools and resources
• Available via telephone or Web
• Health coaches
• Cost/Quality comparisons
Medical plan pays
(coinsurance)
HSA
With an HSA you can:
• Deposit dollars
• Grow your savings
• Save on taxes
• Pay for health care
now or later
Annual
Deductible
Preventive Care
Health
Coverage
• Must be satisfied before
health coverage begins
• Preventive care not subject
to deductible
•Preventive care
covered 100 percent
by your employer
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
12
About the HDHP $2500/HSA Plan
Employee + 1
or more
Employee Only
Health Coverage
Plan pays 80%
$4,500 Out-of-Pocket
maximum
Health Coverage
Plan pays 80%
$9,000 Out-of-Pocket
family maximum
(Individual OOP max
$4,500)
$3,050
District
Contribution
$2,000
Annual
Deductible
$2,500
$6,150
Family Annual
Deductible
$5,000
District
Contribution
$2,000
(Individual
deductible
$2,500)
Preventive Care: 100%
Max HSA
contribution
Preventive Care: 100%
Max HSA
Contribution:
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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HSA Pharmacy Benefits –
Members are subject to
their Medical/Pharmacy deductible before copay’s apply.
Medications listed on Preventative Drug List are subject to
copays.
Tier 1
Tier 2
Tier 3
Retail
Mail order
$10 Copayment
31-Day Supply
$25 Copayment
90-Day Supply
$30 Copayment
31-Day Supply
$50 Copayment
31-Day Supply
$75 Copayment
90-Day Supply
$125 Copayment
90-Day Supply
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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To open and contribute to an
HSA you must:
• Be covered by high-deductible health plan (HDHP)
• Not covered by other non-HDHP health insurance
• Not enrolled in Medicare or TRICARE
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Contributing to the HSA
• For 2011, you can contribute up to the IRS maximum of:
– $3,050 (single)
– $6,150 (family)
• Age 55 and older, “catch-up” contributions of $1,000
• Contributions may be made via:
– Payroll deduction (pre-taxed)
– Direct to OptumHealth Bank by check or on
myuhc.com
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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How it works – Christopher
His reasons for selecting the HDHP $2500 with HSA
Plan were:
• Opportunity to save on taxes and save for future
health care expenses
• Preventive care and preventive medications covered
100 percent
Annual deductible:
District funds HSA:
Maximum HSA contribution:
$2,500
$2,000
$3,050
Health coverage (network):
Out-of-pocket maximum:
20 percent
$4,500
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Christopher – Year One
$2,500 Deductible Plan
HSA pays
$275
$2,500
$275
$250
HSA
Remains
$2,500
HSA
in HSA
$2,225
Annual
Deductible
Preventive Care: 100%
Health Coverage
20% coinsurance
$4,500 out-of-pocket max
Chris funds his HSA
$
500
District funds HSA
$
2,000
Preventive care
$
250
Non-preventive
1 Urgent Care visit
2 Prescriptions
$
$
200
75
275
HSA pays
$
275
Member pays
$
0
Remains in HSA
for Year Two
$
2,225
Note: Assumes all network care – different coinsurance levels on non-network care apply.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Christopher – Year Two
$2,500 Deductible Plan
HSA pays
$575
Annual
Deductible
$
2,225
Chris Funds his HSA
$
500
District Funds HSA
$
2,000
Total
$
4,725
Preventive care
$
275
Non-preventive
3 Physician Visits
4 Prescriptions
$
$
350
225
575
HSA pays
$
575
Member pays
$
0
Remains in HSA
for Year Three
$
4,150
$2,500
$575
$275
HSA
Remains
$4,725
inHSA
HSA
$4,150
Preventive Care: 100%
Health Coverage
80% coinsurance
$4,500 out-of-pocket max
HSA funds from year 1
Note: Assumes all network care – different coinsurance levels on non-network care apply.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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How it works – Jane
Her reasons for selecting the HDHP $2,500 with HSA
Plan were:
• No upfront cost for preventive care visits
• Free preventive medications, list of 2010 Core List of
Preventive Medications
Annual deductible:
District funds HSA:
Maximum HSA contribution:
$2,500
$2,000
$3,050
Health coverage (network):
Out-of-pocket maximum:
20 percent
$4,500
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Jane – Year One
$2500 Deductible Plan
$2,000
Coinsurance
$32,500
Preventive Care: 100%
$2,500
$1,500
deductible paid
by HSA
$250
Health Coverage
80% coinsurance
$4,500 out-of-pocket max
$28,000 paid by
Health Plan
Annual
Deductible
HSA
$0
$2,500
Note: Assumes all network care – different coinsurance levels on non-network care
apply.
Jane Funds her HSA
$
500
District Funds HSA
$
2,000
Preventive Care
$
250
$
$
2,250
28,050
700
1,500
32,500
HSA Pays Deductible
$
2,500
Remaining Amount:
Coinsurance @ 20%
But out of pocket is:
$
$
$
30,000
6,000
4,500
So Jane pays:
Health Plan pays:
$
2,500
30,000
Non-Preventive
1 ER Visit
Hospitalization
4 Physician’s visits
11 Prescriptions
So only $2,500 comes out of Jane’s
pocket on a $32,500 bill.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Jane compares plans…
Base Plan 104
Plan 003
HSA 2,500
$0
$0
$2,000
Member Deductible
$500
$0
$2,500
Out of Pocket Cost
$1,750
$0
$4,500
$830
$1,020
$0
$0
$2,051
$0
$3,080
$3,071
$2,500
Member costs
District Funded HSA Pays
Copays
Premium
Total Member Pays
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
22
The HSA payment process
11
Present ID card
to doctor.
2
Doctor sends
claim to
UnitedHealthcare
33a
If you owe
payment as part
of your
deductible, your
provider will bill
3b
you the
discounted
If you have
amounts
for the
satisfied your
services
deductible,
provided.
Health Coverage
will pay the
provider. The
provider will bill
you for your
portion.
4
When you have
claim activity,
you will receive a
Health
Statement.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
23
OptumHealth BankSM
• A leader in health care banking and HSAs
• Member FDIC
• A UnitedHealth Group company
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
24
OptumHealth BankSM
Easy access to funds
• Use at the point of service
(doctor’s office, pharmacy)
• Can withdraw cash at
ATM where MasterCard
is accepted*
• Can ask for additional cards
for covered family members
• Free online bill pay
• Checks (optional, $10 for
25 checks)
*Access fees may also be charged by ATM owner.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Choose the Right Mix of Fees and
Interest
Understand the rates, fees and features for each account type:
Health eAccess
Health eSaver
Monthly
Maintenance Fee
$0 if balance exceeds $500
$1 if balance is $1-$499.99
$0 if balance exceeds $5,000
$3 if balance is $1-$4,999.99
Balance Required
to Obtain APY
Annual Percentage Yield (APY)
Annual Percentage Yield (APY)
Health eInvestor
$0 if balance exceeds $5,000
$3 if balance is $1-$4,999.99
Annual Percentage Yield (APY)
$0-$499.99
0.00%
$500-$999.99
0.00%
$1,000-1,999.99
0.00%
$2,000-$4,999.99
0.00%
$5,000-$14,999.99
0.00%
$15,000+
0.00%
Investment
Threshold
$2,000
$2,000
$500
Monthly Investment
Fee
$3
$0
$2.50
Variable based on balance
Variable based on balance
Investments are not FDIC-Insured, are not guaranteed, and may
lose value.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
26
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
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27
Our large national network
Your doctor is likely already in our network.
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28
UnitedHealth Premium
designation program
• Doctors and cardiac
facilities that follow
medical guidelines
• Compare quality and costs
of health care facilities
• Look for the stars when you
search for a physician
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29
Pharmacy Resources on
myuhc.com
•
•
•
•
Find brand-name and generic medications
Compare costs of medications
Locate over 60,000 pharmacies nationwide
Order and refill prescriptions
– 30-day
myuhc.com
– 90-day mail order
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30
Treatment Cost Estimator
• Provides cost estimates
for specific treatments
and procedures based
on selected physician’s
costs
• Helps you understand
the cost of treatment
• Allows you to plan in
advance of your health
care need
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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myuhc.com
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
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32
Healthy Pregnancy program
• Get support through every stage of pregnancy
and delivery
• Nurses available, toll-free, 24/7
• Personalized pregnancy assessment
• Free pregnancy book and healthy baby bag
• Discount on PJ’s Comfort
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
33
Get DocGPSTM today!
Find network doctors with our new mobile phone app
• Uses GoogleTM Maps
• Search based on your
location
• Download for iPhone,
Blackberry and Droid
phones
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34
Learn more
• Talk with Jodi Finnesy in Human Resources
(623) 237-7149 or [email protected]
• Open Enrollment is May 2 to May 31, 2011
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35
Simple
Health plan benefits you can understand.
The plans and outcomes given as examples in this presentation may not represent
the plans and outcomes available in every state. Talk to a UHC representative to find
out benefit and limitation information applicable in your state.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
© 2008 UnitedHealthcare
© 2009 United HealthCare Services, Inc.
UHCEW439246-000