Transcript What is a High Deductible Health Plan? City and County of Denver 1/1/2016
What is a High Deductible Health Plan?
City and County of Denver
1/1/2016
Opening
A high deductible health plan and an HSA may sound confusing, but we are here today to help you better understand your new plan option.
High Deductible Health Plan
New in 2016 for all City and County of Denver employees
High Deductible Health Plan (HDHP)
A
high deductible health plan (HDHP)
is a type of health insurance plan that meets the deductible limits set by the Internal Revenue Service (IRS). The plan lets you open a health savings account and save money, tax-free.
Deductible:
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,350, you are responsible for all expenses at the discounted UHC rate until you’ve met the $1,350 deductible.
Preventive Care:
Preventive care is covered at 100% on your HDHP. For a detailed list of services covered, go to www.uhcpreventivecare.com
. Preventive care services are determined by US Preventive Task Force Alliance per health reform guidelines.
The Benefits of a HDHP
Low Up Front Premium!
Member is responsible for all costs up to $1,350 deductible for Employee only coverage and $2,700 deductible for Employee + 1 or more. Member pays 20% coinsurance for medical services after deductible is met, and copays for prescription medications. All expenses, including deductible, and pharmacy copays apply to the out-of-pocket maximum of $2,700 for individual and $5,400 for family. Paired with a Health Savings Account (HSA) which is a bank account that you own to help pay for your qualified expenses Best of all – The City and County is making an initial contribution of
$600 (individual)
and
$1,200 (family)
into your HSA account.
HOW DOES A HIGH DEDUCTIBLE HEALTH PLAN WORK?
High Deductible Health Plan
You have the freedom to use any doctor or hospital you want. The UHC Network will remain the same. The Network is Nationwide and you do not need to change your doctors.
You save more when you stay in network.
You save money when you use health care providers in the Choice Plus network because they’ve agreed to charge lower prices.
You will have coverage if you receive care outside the network.
However, you will likely pay more.
High Deductible Health Plan
You do not need to choose a primary care provider (PCP). The covered services remain the same, it is just
how the services are paid
which is changing. If you are currently in treatment (i.e. pregnancy, chiropractic, or diabetic) your treatment will not be impacted. See any doctor, including specialists, without referrals.
A PCP can be helpful in managing your care.
HDHP with HSA
How the plan works: 1
Your deductible –
You pay until you reach the deductible.
2
Your co-insurance –
You and your plan share the cost of services.
3
Your out-of-pocket limit –
You are done paying for the year.
Your Deductible Pay with your HSA or another way Individual $1,350 / Family $2,700 Your co-insurance (After you reach the deductible) Your plan pays 80 % + You pay 20% (You can pay your share using your HSA.) Your out-of-pocket limit You are done paying Individual: $2,700 / Family $5,400 (When you reach the limit, the plan pays 100%.)
Use $1350 Individual Deductible, $2,700 Family Deductible, 80% Coinsurance, and $2,700, $5,400 OOP.
Preventive care is covered 100% when you use a network doctor.
Member Scenarios – Maria
Maria is a healthy 26 year old with no chronic conditions. She has employee only coverage and would like a health plan with low monthly payments, but still have coverage in the event of any unexpected health incidents .
Your Deductible Pay with your HSA or another way Individual $1,350 / Family $2,750
Type of Cost
Yearly Premium HSA Contribution received from City and County of Denver Sick visit to PCP Preventive Care Visit Tier 1 Medication Total Cost in 2016 Money saved in 2016 by enrolling in HDHP over the Deductible HMO plan.
UHC HDHP with Health Savings Account
$360.24
-$600.00
$68.00
$0 $8.00
-$163.76
$1,025.12
In 2016 - $1350 Individual Deductible, $2,700 Family Deductible, 80% Coinsurance, and $2,700, $5,400 OOP.
Preventive care is covered 100% when you use a network doctor.
Member Scenarios – Tom
Tom is a father of 2 young children and a spouse who is expecting their third child in 2016. He has family coverage and needs a plan that makes the most financial sense.
Pay with your HSA or another way Individual $1,350 / Family $2,750 Type of Cost
Yearly Premium HSA Contribution received from City and County of Denver 4 Sick visits to PCP 4 Preventive Care Visits Urgent Care Visit Emergency Room Visit 4 Day Hospital IP Admit Tier 1 Medication Total Cost in 2016 Money saved in 2016 by enrolling in HDHP over the Deductible HMO plan.
UHC HDHP with Health Savings Account
$3,458.04
-$1,200.00
$272.00
$0 $110.00
$1,800.00
$3,210.00
$8.00
$7,658.04
$1,468.04
In 2016, $1350 Individual Deductible, $2,700 Family Deductible, 80% Coinsurance, and $2,700, $5,400 OOP.
Preventive care is covered 100% when you use a network doctor.
Consumerism and the HDHP How do I know how much my healthcare costs?
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The cost of care – how will you know?
We have many tools available to make you a wise consumer of healthcare.
Utilize UHC’s Treatment Cost Estimator available on www.myuhc.com
. Use Tier 1 Medications when appropriate, the UHC Pharmacy Drug list is available on www.myuhc.com
. Seek care at appropriate place of service (i.e. utilize urgent care rather than emergency room) Ask Questions!
Where will you go for care?
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Care center Doctor’s Office Why would I use this care center What type of care would they provide*
You need routine care or treatment for a current health issue. Your primary doctor knows you and your health history, can access your medical records, provide preventive and routine care, manage your medications and refer you to a specialist, if necessary. } Routine checkups } Immunizations } Preventive services } Manage your general health
Convenience Care Clinic
You can’t get to your doctor’s office, but your condition is not urgent or an emergency. Convenience care clinics are often located in malls or retail stores offering services for minor health conditions. Staffed by nurse practitioners and physician assistants. } Common infections (e.g.: strep throat) } Minor skin conditions (e.g.: poison ivy) } Flu shots } Pregnancy tests } Minor cuts } Ear aches
What are the cost** and time considerations?**
} Often requires a copayment and/or coinsurance } Normally requires an appointment } Little wait time with scheduled appointment } Often requires a copayment and/or coinsurance similar to office visit } Walk in patients welcome with no appointments necessary, but wait times can vary
Urgent Care Center
You may need care quickly, but it is not an emergency, and your primary physician may not be available. Urgent care centers offer treatment for non-life threatening injuries or illnesses. Staffed by qualified physicians. } Sprains } Strains } Minor broken bones (e.g.: finger) } Minor infections } Minor burns } Often requires a copayment and/or coinsurance usually higher than an office visit } Walk in patients welcome, but waiting periods may be longer as patients with more urgent needs will be treated first
Emergency Room
You need immediate treatment of a very serious or critical condition. The ER is for the treatment of life-threatening or very serious conditions that require immediate medical attention.
Do not ignore an emergency. If a situation seems life threatening, take action. Call 911 or your local emergency number right away.
} Heavy bleeding } Large open wounds } Sudden change in vision } Chest pain } Sudden weakness or trouble talking } Major burns } Spinal injuries } Severe head injury } Difficulty breathing } Major broken bones } Often requires a much higher copayment and/or coinsurance than an office visit or urgent care visit } Open 24/7, but waiting periods may be longer because patients with life-threatening emergencies will be treated first Average out-of-pocket costs while meeting your deductible $80 PCP Visit $180 Specialist $50 Convenience Care $120 Urgent Care $1,800 Emergency Room
HOW DOES THE PLAN WORK WITH AN HSA?
How the plan works with an HSA
Think of an HSA as a savings plan for health care you’ll need today, tomorrow and into the future. It’s a real bank account, but you don’t pay federal income tax on the money you deposit into it and the money you use for qualified medical expenses. Your savings also grows tax free.
You can even build your savings into a nest egg for retirement. Your savings grow from year to year. There’s no “use it or lose it” rule. The money is there when you need it. And it’s yours to keep.
WHY HAVE A HEALTH SAVINGS ACCOUNT?
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Health Savings Account
You own it. It has triple tax benefits. Anyone can contribute.
It’s not just for doctor visits. You can invest it. You can save it for the future. Your employer is making an up-front contribution of $600 (employee only) and $1,200 (family) your HSA. There is no match required!
WHO IS ELIGIBLE TO OPEN AN HSA?
Eligibility
To deposit money into an HSA, you must be enrolled in an HSA-eligible health plan.
You are eligible if:
You are covered under an eligible high-deductible health plan (HDHP).
You are covered by no other health coverage, unless it is permissible coverage like vision or dental.
You are not enrolled in Medicare.
You cannot be claimed as a dependent on someone else’s tax return.
Some other restrictions apply. Please consult your tax, benefits or financial advisor.
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2016 HSA GUIDELINES – AS ESTABLISHED BY THE IRS
2016 Contribution Limits
The IRS limits how much you can put into your HSA each year. Source: National Data as Reported by HHS through March 10, 2015
The 2016 limits are:
$6,750 $3,350 Individual Coverage Family Coverage
Are you 55 or older?
You can put in an extra $1,000 this year.
WHO IS OPTUMBANK?
OptumBank
UnitedHealthcare’s preferred health care bank is dedicated to helping people save for health care.
The national leader in HSA banking with more than a million account holders.
Offers the convenience of banking through myuhc.com.
WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)?
Health Savings Account (HSA)
A
health savings account (HSA)
is a bank account that lets people put money aside, tax-free, to save and pay for health care expenses.
The Internal Revenue Service (IRS) limits who can open and put money into an HSA.
Video
http://bcove.me/36evndji
How to open your HSA with OptumBank
– Member FDIC
Yes, they are a real bank and the largest HSA bank in the country
.
Will be linked to your insurance plan to make things easy.
The City and County of Denver will provide you a URL link to open your bank account with OptumBank during Open Enrollment. OptumBank is focused only on health care and helping you save.
Three different account types.
Each has different monthly maintenance fees which are waived once a specified dollar amount is reached.
Some earn interest on account balances.
You can invest the money in mutual funds after a certain dollar amount is reached (level of money needed for investments differs by account type).
Benefits of the HSA Debit Card
You will receive a UnitedHealthcare HSA Debit Card Easy access to HSA dollars Provided by OptumHealth Bank Use at doctor’s office or pharmacy Withdraw cash at ATM* Get additional cards for family members Free online bill pay Checks (optional, $10 for $25) *Access fees may also be charged by ATM owner.
PAYING FOR SERVICES RECEIVED
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Payment for Services
You can use your HSA to pay for qualified medical, dental and vision expenses, such as doctor visits, prescriptions and hospital visits, to name only a few.
There’s no “use it or lose it” rule. You decide whether to spend your money on health care now or to build your savings for expenses later.
Payment is simple:
Use your Optum Bank HSA Debit MasterCard ® at a pharmacy, doctor’s office or other health care provider. Payment at time of service is only required for pharmacy charges. Reimburse yourself for qualified health care expenses from your HSA. Pay bills online at no charge, or pay with checks linked to your HSA, if you choose to purchase them.
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Payment for Services
The HSA payment process:
1 Present ID card to doctor 3 Doctor then bills you for payment. After deductible, doctor bills you for your share of co-insurance.
2 Doctor sends claim to UnitedHealthcare.
UnitedHealthcare applies network discount, sends back to doctor.
4 When you have claim activity, you will receive a Health Statement.
RECAP OF HDHP WITH HSA
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Recap of HDHP with HSA
Here’s a recap of how your plan works:
1 You have a health event.
2 You pay the full cost of your health care expenses until you meet your deductible. You can choose to pay your deductible with money from your HSA or you can pay another way and let your HSA grow.
3 Once your deductible is paid, the plan coverage begins and you and the plan pay co insurance. You’re protected with an out of-pocket limit. After you reach this limit, the plan pays 100% of covered expenses.
Where to go for more information:
welcometouhc.com/denver
Remember, you’ll begin your HSA with your employer contribution:
$1,200 $600 Family Single Deposited into your OptumBank HSA account 1/1/2016
Sidewalk Talk - Video
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