Transcript UNA MEJOR OPtion PARA SU SALUD TOTAL City and County of Denver [Employer group name] High Deductible Health Plan (HDHP)

UNA MEJOR OPtion PARA SU SALUD TOTAL
City and County of Denver
[Employer group name]
High Deductible Health Plan (HDHP)
City and County of Denver – HDHP Agenda
 Welcome and Introduction(s)
 Video: How does a HDHP work?
 Terminology and Definitions
 Plan Benefits / Services Covered
 What is a Health Savings Account (HSA)
 Jump starting your HSA
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Integrated Care in Denver/Boulder
• 22 fully-staffed Medical Offices from Boulder and Longmont
to Castle Rock
• Over 1,000 Primary and Specialty care physicians to
choose from
• No referral needed for most specialists including
Orthopedic and OB/Gyn
• Primary Care, Laboratory, Radiology, and Pharmacy
available in most offices
• Additional approved providers available in Southern and
Northern Colorado
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2016
City and County of Denver
High Deductible Health Plan
City and County of Denver - HDHP
Terminology and Definitions
Deductible
Coinsurance
The amount you or your family must pay (“satisfy”) before the health plan
shares in the expense of services received
The percentage of the cost of services received for which you are responsible.
You are charged coinsurance for services after satisfying your deductible
Out-of-pocket The maximum limit you pay each year in coinsurance and deductible for
maximum (OPM) covered services received
Explanation
A tracking document for each date of service outlining deductible status and
of Benefit (EOB) out-of- pocket tracking
Patient Billing
Statement
Statement outlining member’s financial responsibility after claim has
processed through claims system
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City and County of Denver – HDHP – 2016
Annual deductible – per plan year
$1,350 subscriber only / $2,700 family
Annual out-of-pocket maximum (OPM) per plan year
$2,700 subscriber only / $5,400 family
You must meet the family Deductible before plan moves to
coinsurance. Deductible is included in the OPM.
Covered service
You pay
Preventive care
No cost for most services
Doctor’s office visit
20% coinsurance*
Diagnostic lab tests
20% coinsurance*
Imaging (x-ray, MRI, CT/PET scan)
20% coinsurance*
Outpatient surgery
20% coinsurance*
Hospitalization
20% coinsurance*
Emergency care
20% coinsurance*
Prescription drugs (in pharmacy)
20% coinsurance*
*Coinsurance applies after the Deductible is met.
This is only a summary of some benefits and their copays and coinsurance. This chart does not describe the benefits. Refer to your Evidence of Coverage for
information about coverage, limitations and exclusions of all benefits, including those not listed in this summary.
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City and County of Denver
Health Savings Account (HSA)
You are responsible in opening your Health Savings Account (HSA).
An HSA is a savings account that works with an HSA-Qualified Deductible HMO (HDHP)
plan.
You contribute money to your HSA each year and use those funds to pay for qualified
medical expenses, now or in the future.
You own the money in this account, which you can grow and take with you, even if you
change jobs or retire.
To meet the requirements for an HSA, you must be enrolled in an HSA-qualified deductible health plan and meet other HSA eligibility rules. For further information, refer
to IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans, at irs.gov/publications. HSAs may also experience investment losses.
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City and County of Denver – HSA and Tax Benefit
The IRS has provided tax benefits for your HSA funds.
• The funds in your HSA are not considered part of your wages, so they’re not
subject to federal income taxes
• HSA funds used to pay for qualified medical expenses are not subject to taxes.
• Any interest earnings in an HSA is tax-free as long as they’re used for qualified
medical expenses
• Maximum annual amount for Individual is $3,350 and Family is $6,750
Tax references in this document are related only to federal income tax. Consult your financial or tax advisor about state income tax law. Refer to the list of medical costs
that meet the requirements, as defined under Internal Revenue Code Article 213(d); refer to IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications.
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Contributing to your Health Savings Account
City and County of Denver providing tax-free seed money
• Individual - $600
• Family - $1200
Annual maximum contribution for Individual - $3,350
• $3,350 - $600 = $2,750
Annual maximum contribution for Family - $6,750
• $6,750 - $1,200 = $5,550
Amount rolls over from year to year without penalty
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City and County of Denver – Qualified Medical Expenses
Examples of Qualified Medical Expenses
You can use the funds in your HSA to pay for qualified medical expenses,
which will include deductible and coinsurance amounts for:
• Non-preventive office visits with your PCP or Specialist
• Prescription drugs
• X-rays, MRIs, CT scans, PET scans and lab tests
• Emergency visits
• Hospital visits
Refer to the list of medical costs that meet the requirements, as defined under Internal Revenue Code Article 213(d); refer to IRS Publication 502, Medical and Dental
Expenses, at irs.gov/publications.
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Scenario 1: Employee Only Coverage
Dave, with Department of Natural Resources, only covers himself on the plan. He
is generally healthy, but has developed knee problems. He visits a specialist –
orthopedic surgeon ($215). The specialist orders and MRI ($1,467), and based on
the results, recommends outpatient surgery ($5,000). Dave also needs pain
medication after the surgery (1 generic prescription).
IND Deductible
IND OPM
$1,350
$2,700
Total Cost of Services $6,694
Generic Prescription $ 12
Out Patient Surgery $5,000
MRI Procedure
$1,467
Total Cost –
Individual Deductible
= $5,344
$5,344*20% =
$1,068.80
Specialty Office Visit $ 215
Note: These are estimated costs only. Figures based on 2015 Sample Fee List.
Difference $2,700-$2,418 = $282
$1,350 + $1068 =
$2,418
IND Deductible
$1,350
20% of $5,344
$1,068
Scenario 2: Family Coverage
Allison, Department of Public Safety, currently covers her husband and a daughter on the plan. She
will deliver their second child, a son, in 4 months. The family has 4 preventive visits (including well
baby visit), an inpatient stay for delivery ($9,000), 4 generic prescriptions after the baby is born and 1
specialist visit to the pulmonologist for their daughter’s allergies
($154 + $58 for a breathing test).
Family Deductible
$3,000
Total Cost of Services
$9,260
Breathing
Test
Prescriptions
$ 58
Specialty Office Visit
$ 154
4 Generic Prescription
Inpatient Stay
Family OPM
Total Cost –
Family Deductible =
$6,260
$6,260*20% =
$1,252
$5,400
Difference $5,400-$4,252 = $1,148
$1,252 + $3,000 =
$4,252
$ 48
Family Deductible
$3,000
$9,000
20% of $6,260
$1,252
Note: These are estimated costs only. Figures based on 2015 Sample Fee List.
Ded=deductible
Coin=coinsurance
Copay=Copayment
OPM=Out of Pocket Maximum
City and County of Denver – Wrapping it Up
Important Points to Remember
• Evaluate Your Health Needs to determine best plan
• Select your Kaiser Permanente plan, DHMO or HDHP
• If you don’t select you will fall into the default plan
• Open your Health Savings Account when electing the
HDHP
• If you don’t open your Health Savings Account the City
and County of Denver cannot release your seed
money into a non existent account
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Additional Resources
Financial Counselors - 303-338-3025 or 1-800-6592656 TTY for the hearing/speech impaired.
Clinical Pharmacy Call Center – 303.338.4503 or
303.338.4228 TTY for the hearing/speech impaired
Both departments can be reached Monday through
Friday between 8am and 6pm
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Thank You!
Questions?