health plan open enrollment presentation handout
TRANSCRIPT
Washington CollegeBenefits Overview
See Annual Health Plan Open Enrollment Letter and Benefit Summaries at http://hr.washcoll.edu for
additional information.
May 2009
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Agenda
• Eligibility for Health Plan Participation
• Health Plan Options
• Dental Insurance
• Vision Plan
• Enrollment Deadline – May 15
• Questions at Any Time
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Eligibility
Regular Full-Time Faculty & Staff
Full-Time, Full-Year Visiting Faculty
Part-Time Employees Hired Before 1-1-2004 Less than 15 years of service, prorated
benefit 15 or more years of service, full benefit
Temporary, Part-time Employees hired after 1-1-2004, and Visiting Faculty hired on a semester-by-semester basis are Not Eligible
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Who is UnitedHealthcare?
UnitedHealth Group Incorporated, is an innovative leader in the health and well-being industry, serving more than 50 million Americans.
Member Services is available Monday – Friday, 8am to 11pm EST.
National network provides access to 560,000 physicians, 4,800 hospitals and 60,000 pharmacies.
Providing resources such as myuhc.com and Care24 to empower members to make better healthcare decisions.
Extensive health and wellness information/support available to identify current health status, learn areas of improvement, online health coaching, wellness programs, manage chronic disease and provide discounts on products and services not covered by the medical plan.
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Health Plan Options Available
UnitedHealthcare
1. MD Choice – Open Access HMO
2. MD Choice Plus - Low Option
• Lower Premiums / Higher Out of Pocket
3. MD Choice Plus - High Option
• Higher Premiums / Lower Out of Pocket
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Medical Plans – UnitedHealthcare
1. All three plans have identical medical coverage.
2. All three plans have the same physician network.
3. The only plan differences are: 1. Premium Cost
2. Copay Amounts
3. Deductible Amounts
4. Co-Insurance Rates
5. Choice of Out-of-Network Physicians
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• Open Choice HMO – Does not Require a Primary Care Physician
• No Referral required for Specialists.
• You may choose any UHC Network Provider for both Primary Care and Specialist Care
• There is NO out of network coverage, except emergencies.
• To check for participating physicians go to www.myuhc.com
How the Choice HMO Works:
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• Do not Require a Primary Care Physician
• No Referral required for Specialists.
• May choose any UHC Network Provider for lowest cost health care coverage for both Primary Care and Specialist Care.
• May choose Out of Network Providers, but at significantly higher cost.
How the Choice Plus Plans Work:
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Bi-Weekly Premiums - Medical Insurance
MD ChoiceHMO
MD
Choice Plus
Low Option
No Middle Option Offered
This Year
MD
Choice Plus
High Option
Plan Options
Employee Only $ 6.10 $ 10.47 NA $ 38.37
Employee + Spouse/Partner $112.94 $192.60 NA $238.87
Employee + Children $ 71.77 $147.61 NA $189.34
Employee + Family $227.97 $329.27 NA $389.33
Employee + Family <$28,000 $217.97 $319.27 NA $379.33
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Choice HMO Out of Pocket Costs In-Network ONLY (Member Pays)
Deductible None
Physician Office Visits $15 PCP / $20 Specialist
Urgent Care Center $50 copay
Emergency Room $75 (waived if admitted)
Co-insurance Rate Inpatient HospitalSurgical Services
Plan Pays 100%Member Pays 0%Requires Preadmission Authorization
Ambulance (Ground or Air)Covered in Full when Medically Necessary.Pre-Service notification is required for non-emergency.
Mental Health & Substance Abuse (Outpatient)
•1-5 Visits: 20% •6-30 Visits: 35%•31+ Visits: 50%
Mental Health & Substance Abuse (inpatient)
Covered in Full. Requires Preadmission Authorization
Physical, Speech, & Occ Therapy $20 copay
Prescription Drugs 31 Days RetailPrescription Drugs 90 Days by Mail
$10/$30/$50 Tier I/II/III$25/$75/$125 Tier I/II/III (2.5 Times 31 Day)
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Choice Plus (Low Option) Out of Pocket Costs
In-Network (Member Pays) Out of Network (Member Pays)
Deductible $100 / $200 $400 / $800
Physician Office Visits $20 copay 30% after deductible
Urgent Care Center $50 30% after deductible
Emergency Room $75 (waived if admitted) $75 (waived if admitted)
Co-insurance Rate Inpatient HospitalSurgical Services
Plan Pays 90% After DeductibleMember Pays 10%
Plan Pays 70% After DeductibleMember Pays 30% Pre-service Notification is required
Ambulance10% after deductible – Pre-Service notification is required for non-emergency.
10% after deductible – Pre-Service notification is required for non-emergency
Mental Health & Substance Abuse (outpatient)
•1-5 Visits: 20% •6-30 Visits: 35%•31+ Visits: 50%
•1-5 Visits: 25% •6-30 Visits: 35%•31+ Visits: 50%
Mental Health & Substance Abuse (inpatient)
10% - after deductible – Requires Prior Authorization
30% after deductible – Requires Prior Authorization
Physical, Speech, & Occupational Therapy $20 copay
30% after deductible – Pre-service Notification is required
Prescription Drugs Retail – Up to 31 DaysMail Order – Up to 90 Days
$10/$30/$50 Tier I/II/III$25/$75/ $125 Tier I/II/III
$10/$30/$50 Tier I/II/IIIMail Order Not Available
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Choice Plus (High Option) Out of Pocket Costs
In-Network (Member Pays) Out of Network (Member Pays)
Deductible None $250 / $500
Physician Office Visits $20 copay 20% after deductible
Urgent Care Center $50 copay 20% after deductible
Emergency Room $75 (waived if admitted) $75 (waived if admitted)
Co-insurance Rate Inpatient HospitalSurgical Services
Plan Pays 100% - No DeductibleMember Pays 0%
Plan Pays 80% After DeductibleMember Pays 20%Pre-service Notification is required
AmbulanceCovered in Full - Pre-Service notification is required for non-emergency.
Covered in Full - Pre-Service notification is required for non-emergency ambulance
Mental Health & Substance Abuse (outpatient)
•1-5 Visits: 20% •6-30 Visits: 35%•31+ Visits: 50%
•1-5 Visits: 25% •6-30 Visits: 35%•31+ Visits: 50%
Mental Health & Substance Abuse (inpatient)
Covered In Full - Prior Authorization is required
20% after deductible - Prior Authorization is required
Physical, Speech, & Occupational Therapy $20 copay 20% after deductible
Prescription Drugs Retail – Up to 31 DaysMail Order – Up to 90 Days
$10/$25/$45 Tier I/II/III$25/$62.50/ $112.50 Tier I/II/III
$10/$25/$45 Tier I/II/IIIMail Order Not Available
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Health Coverage – High Level Comparison
MD Choice HMO MD Choice Plus – Low Option
Lower Premiums
Higher Out of Pkt
MD Choice Plus – High Option
Higher Premiums
Lower Out of Pkt
Summary of Benefits Member Pays Member Pays Member Pays
PCP/Specialist In Network PCP/Specialist Out of Network
$15 / $20N/A
$20 / $2030% After Deductible
$20 / $2020% After Deductible
Urgent Care (In/Out) $50 $50 / 30% $50 / 20%
Emergency Room $75 $75 $75
Deductible - In Network None $100 / $200 None
Deductible - Out of Network N/A $400 / $800 $250 / $500
Coinsurance (In/Outrk) None 10% / 30% 0% / 20%
Inpatient Hospital (In/Out) $0 10% / 30% $0 / 20%
Out of Pocket Max - In Network (Includes Deductible) N/A $1,400 / $2,800 $1,300 / $2,600
Out of Pocket Max - Out of Network (Includes Deductible) N/A $2,400 / $4,800 $2,250 / $4,500
Rx Co-Pays (Tier I / II / III) $10 / $30 / 50 $10 / $30 / $50 $10 / $25 / $45
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Health Coverage – High Level Cost Comparison
Comparison of Plans based on Total Estimated Health Care Cost & Tolerance for Health Care Risk
MD Choice HMO MD Choice Plus – Low Option
Lower Premiums
Higher Out of Pkt
MD Choice Plus – High Option
Higher Premiums
Lower Out of Pkt
Employee Only Example Member Pays Member Pays Member Pays
Annual Premiums $158.60 $272.22 $997.62
Deductible – In Network $ 0.00 $100.00 $ 0.00
Six Primary Care Visits $ 90.00 $120.00 $120.00
Two Specialist Visits $ 40.00 $ 40.00 $ 40.00
One Urgent Care Visit $ 50.00 $ 50.00 $ 50.00
Coinsurance > Copay + Ded 0% 10% of UCR Cost 0%
Two Tier I Prescriptions (1x) $ 20.00 $ 20.00 $20.00
One Tier II Prescription (Maint) $300.00 $300.00 $250.00
Total Routine Estimated Cost $658.60 $902.22 + 10% UCR $1,477.62
Additional Costs – Coinsurance 0% 10% of UCR Cost 0%
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Health Coverage – Out of Network Example
Comparison of In Network / Out of Network Costs for
MD Choice Plus (Low Opt)
In-Network Payments & Benefits
Out of Network Payments& Benefits+ Net Billing
Primary Care Physician Office
Actual Billing $120.00 $120.00
Office CoPay $ 20.00 $ 0.00
Amt Submitted to Insurance $100.00 $120.00
Insurance UCR $ 60.00 $ 60.00
Insurance Payments (% UCR) 90% In/70% Out $ 54.00 $ 42.00 (% of UCR)
Employee Coinsurance (% UCR) 10% In/30% Out $ 6.00 $ 36.00 (No UCR)
Total Payments to Physician $ 80.00 $ 78.00
Physician Write-Off In Network $ 40.00 Write-Off $ 0.00 No Write-Off
Billed to Employee Out of Network $ 0.00 $ 42.00 (No UCR)
Total Cost to Employee $ 26.00 $ 78.00
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Reasons To Use myuhc.com
• Get Information About Hospitals and Physicians
• Organize Your Medical Claims Online
• Learn More About Your Coverage
• Request a Medical ID Card
• Compare Costs for Treatments
• Learn About Health Conditions, Treatments & Procedures
• Order and Renew Prescriptions Online
• Identify cost savings for comparable medications
• Health Risk Assessments
myuhc.com
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MD Children’s Health ProgramComparable Coverage – Lower Rates
MD Children’s Health Plan
Family Size & Family Income
[* Included Unborn Child]
Children’s Health
Max Income
Children’s Health
Max Income
Children’s Health
Max Income
Children’s Health
Max Income
1 $21,660 $27,075 $32,490 NA
2 $29,140 $36,425 $43,710 $36,425
3 $36,620 $45,775 $54,930 $45,775
4 $44,100 $55,125 $66,150 $55,125
5 $51,580 $64,475 $77,370 $64,475
For Ea Add’l Person, Add $ 7,480 $ 9,350 $11,220 $ 9,350
Biweekly Premium [Paid Monthly to MD DoH]
$ 0.00 $ 22.15 $ 27.69 $ 0.00
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To Find a Participating Dentist, go to:http://www.deltadental.com
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Delta Dental PPO plus Premier
• Maintains freedom of choice
• Combination of Delta Dental PPO and Delta Dental Premier networks
• Features cost-saving, two-tier network that expands your access to Delta Dental participating dentists who can save you money
• PPO dentists and Premier dentists are paid their respective allowances
Delta Dental Benefits Programs
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Bi-Weekly Premiums –Dental Insurance
Delta Dental Dental Bi-Weekly Premiums
Employee Only $ 9.90
Employee + Spouse/Partner $21.79
Employee + Children $15.19
Employee + Family $28.28
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Dental Plan Design Details for Washington College (PPO plus Premier)
Note: Percentages are based on applicable Delta Dental allowances.
Covered BenefitDelta Dental PPO Dentists Delta Dental Premier and
Non-Participating Dentists
Paid by Delta Dental
Paid by Patient
Paid by Delta Dental
Paid by Patient
Diagnostic* (Exams and x-rays) 100% 0% 100% 0%
Preventive* (Cleanings, sealants, fluoride treatment, emergency treatment, consultations, space maintainers)
100% 0% 100% 0%
Basic Restorative (Fillings) 80% 20% 80% 20%
Oral Surgery (Extractions) 80% 20% 80% 20%
Endodontics (Root canal therapy) 50% 50% 50% 50%
Periodontics ( non-surgical treatment of gum disorders – PERIO MAINTENANCE)
80% 20% 80% 20%
Periodontics (Surgical and non-surgical treatment of gum disorders)
50% 50% 50% 50%
Major Restorative (Crowns, inlays, onlays) 50% 50% 50% 50%
Prosthodontics (Dentures, bridgework, implants) 50% 50% 50% 50%
Implants 50% 50%% 50% 50%%
Deductible$25 per person, not to exceed $75 per family.
*Diagnostic and Preventive services are exempt from the deductible.
Annual Maximum $1,000 per person based on a contract year
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Dental Plan FeaturesLimitations:
• Exams, bitewings, prophylaxes and fluoride:
Two in any contract period
• Fluoride to age 19
• Sealants to age 19
• Space maintainers to age 14.
Enhanced benefits:
• Periodontal enhancement for pregnant enrollees Coverage for additional oral exam and one of the following:
Additional prophylaxis
Periodontal scaling / root planing
Additional periodontal maintenance procedure
• Coverage for dental implants, implant-supported prosthetics and other implant services
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Online Services from Delta Dental’s Web Site
Easy-to-use participating dentist directories for all networks with maps and driving directions
Secure login for benefits and eligibility lookup
• Access information on program benefits, eligibility, status of deductibles, maximum usage, and claim status
Fee Finder for common procedures Printable Claim Forms Printable ID cards SmileKids – an interactive site for children Extensive dental health section E-mail inquiries to customer service Enrollee section in Spanish
www.deltadentalins.comwww.deltadentalins.com
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To Find a Participating Provider, go to:http://www.avesis.com/
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Vision
• Offered through Avesis
• Employee Paid Benefit
• Benefits from a Participating Provider: Routine Vision Exams are covered every 12 months for a
$10 Copay Lenses are covered every 12 months for a $10 Copay for
Standard Single, Bifocals, & Trifocals (one $10 co-pay for lenses and frames together)
Contact Lenses are covered every 12 months for a $110 allowance in lieu of frames & spectacle lenses
Frames are covered every 24 months for a $35 Wholesale Allowance (approximate retail of $75-$100)
• Reimbursable Benefits Vary for Non-Participating Providers – please refer to benefit summary
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Bi-Weekly Premiums –Vision Insurance
Avesis Vision Bi-Weekly Premiums
Employee Only $ 2.74
Employee + Spouse/Partner $ 4.79
Employee + Children $ 5.06
Employee + Family $ 7.11
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Enrollment Deadlines
May 15, 2009
• No automatic rollover for health insurance.
• You must enroll in health to continue coverage!
• Dental & Vision will roll with no changes.
Sam Connally Truee Dorsey
778-7706 778-7799