ready. set. grow healthy. your 2012-2013 unitedhealthcare plan benefits chandler unified school...
TRANSCRIPT
READY. SET. GROW HEALTHY.
Your 2012-2013 UnitedHealthcare Plan BenefitsChandler Unified School District
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
2
What We Will Cover Today
Medical Plan Options
• Choice Plus PPO Plan
• HDHP 1500 Plan
• HDHP 2700 Plan
UHC Tools and Resources
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3
Changes to the Choice Plus PPO
Specialist copay increases from $35 to $50
ER copay increases from $100 to $500
Wellness Incentive -$200.00 (Paid on paycheck end of school year) Complete Health Risk Assessment 05/01/2012 – 06/30/2013 Wellness Exams 05/01/2012 – 06/30/2013
United Health Care – Choice Plus PPO
Employee Only Employee+Spouse Employee+Child(ren) Employee+Family
$201.73/pay $703.09/pay $670.36/pay $974.18/pay
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4
Changes to the HDHP 1500 Previously HSA1400 Plan Plan deductible increases from $1,400 to $1,500 Individual Out of Pocket maximum will increase from $3,800
to $3,900 Out-of-Network coinsurance reduced from 60% to 50% HSA contribution for will be $514 Wellness Incentive - $200.00 (HSA Deposit)
Health Risk Assessment 05/01/2012 – 06/30/2012 Wellness Exams 05/01/2012 – 06/30/2012
United Health Care – HDHP1500Employee Only Employee+Spouse Employee+Child(ren) Employee+Family
$0.00 $208.36/pay $193.64/pay $322.91/pay
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5
Changes to the HDHP 2700 Previously HSA2600 Plan Plan deductible increases from $2,600 to $2,700 Individual Out of Pocket maximum will increase from
$4,550 to $4,650 Out-of-Network coinsurance reduced from 60% to 50% HSA contribution for will be $1,824 Wellness Incentive $200.00 (HSA Deposit)
Health Risk Assessment 05/01/2012 – 06/30/2013 Wellness Exams 05/01/2012 – 06/30/2013
United Health Care – HDHP2700Employee Only Employee+Spouse Employee+Child(ren) Employee+Family
$0.00 $156.00/pay $145.64/pay $237.82/pay
6Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your Medical Benefits at a Glance Choice Plus PPO Plan
Type of coverage Network benefit Non-network benefit
Physician’s office services$25 co-payment 50% after deductible
Specialist office visit $50 co-payment 50% after deductible
Urgent care center services $50 co-payment50% after deductible
Emergency room services $500 co-payment $500 co-payment
Inpatient hospital stay20% after $1,000 individual deductible, $2000 family deductible
50% after $2,000 individual deductible, $4000 family deductible
Out of Pocket Maximum
$2,000 per individual, $4,000 family per Plan Year. (Deductibles and copays do not apply)
$6,000 per individual, $12,000 family per Plan Year
(Deductibles and copays do not apply)
7Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Choice Plus PPO Plan Pharmacy Costs
Retail Mail order
Tier 1$10 Member Cost
1-Month Supply
$25 Member Cost
3-Month Supply
Tier 2$35 Member Cost
1-Month Supply
$87.50 Member Cost
3-Month Supply
Tier 3$50 Member Cost
1-Month Supply
$125 Member Cost
3-Month Supply
Members are subject to $100 individual pharmacy deductible before copayment’s apply.
Lowest Cost
Highest Cost
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UnitedHealthcare High Deductible Health Plan (HDHP)
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99Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Consumer-driven healthWe need to encourage more informed healthcare decisions
• Health care costs are skyrocketing
• People are currently removed from the true cost of health care
• There’s a need to save for future health care costs
10Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your Medical Benefits at a Glance HDHP 1500 – Non-Embedded Plan*
Type of coverage Network benefit Non-network benefit
Physician’s office services20% after deductible 50% after deductible
Specialist office visit 20% after deductible 50% after deductible
Urgent care center services 20% after deductible50% after deductible
Emergency room services 20% after deductible 20% after deductible
Inpatient hospital stay
20% after $1,500 single deductible, $3,000 family deductible* (single deductible does not apply for families)
20% after $1,250 single deductible, $2, 500 family deductible* (single deductible does not apply for families)
Out of Pocket Maximum (single max does not apply to families)
$3,900 single, $7,800 for family coverage per Plan Year
(Deductibles and copays apply)
$7,800 single, $15,600 for family coverage per Plan Year
(Deductibles and copays apply)
11Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your Medical Benefits at a Glance HDHP 2700 – Embedded Plan*
Type of coverage Network benefit Non-network benefit
Physician’s office services20% after deductible 50% after deductible
Specialist office visit 20% after deductible 50% after deductible
Urgent care center services 20% after deductible50% after deductible
Emergency room services 20% after deductible 20% after deductible
Inpatient hospital stay
20% after $2,700 individual, $5,400 family deductible per Plan Year (Individual deductible applies for each family member)
50% after $5,400 individual, $10,800 family deductible per Plan Year (Individual deductible applies for each family member)
Out of Pocket Maximum
$4,650 per individual, $9,300 for family per Plan Year. (Deductibles and copays apply)
$9,300 per individual, $18,600 for family per Plan Year. (Deductibles and copays apply)
12Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
HDHP Plan Pharmacy CostsRetail Mail order
Tier 1$10 Member Cost
1-Month Supply
$25 Member Cost
3-Month Supply
Tier 2$30 Member Cost
1-Month Supply
$75 Member Cost
3-Month Supply
Tier 3$50 Member Cost
1-Month Supply
$125 Member Cost
3-Month Supply
Members are subject to their Medical/Pharmacy deductible before copay’s apply.
Medications listed on Preventative Drug List are subject to copays.
Lowest Cost
Highest Cost
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13
Introducing the HDHP
Optionalhealth
savings account(HSA)
High-deductible health Plan
100% network
preventive care
Annual deductible
Annual out-of-pocket protection
Personal support and messages,
health coaches
Combines a high-deductible health plan that allows you the option to open a health savings account (HSA)
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HSA
What is a health savings account (HSA)?
It’s yours even if you
switch jobs or plans
Triple tax savings
Pay for today’s $$ or
save for tomorrow’s
Use for qualified
expenses not covered by
the plan
Use it for retirement, investing*
The District opens and funds a HSA on behalf of eligible employees. Employees can also contribute into the account on a pre-tax basis to help pay the plan deductible and other qualified health care costs or let your account grow.
HSAs are designed to help you save and pay for your health care
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What you should know about the HSA
An HSA is not health insurance
Used to pay/reimburse qualified expenses
No “use it or lose it” requirement
HSA is owned by you
Each covered individual can open an HSA
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You are eligible to open an HSA if: • You are not covered by any other non-high deductible health plan,
such as a spouse’s plan
• You are not enrolled in Medicare
• You do not receive health benefits under TRICARE
• You have not received Veterans Administration (VA) benefits within the past three months
• You cannot be claimed as a dependent on another person’s tax return
• You cannot be covered by a health care FSA or HRA
HSA eligibility requirements
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Annual HSA contribution limits
Amount of Funding
Contributions above the annual limit are subject to income taxes and a 20% penalty.
Annual Contribution
Rules
2012: $3,100 for individuals & $6,250 for families
Additional Funding
Those 55 years of age or higher, but not entitled to Medicare benefits, can fund an additional $1,000/year “catch-up” contribution!
Annual contribution limits are set by the IRS
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How you can use the HSA
Use HSA dollars to pay for qualified medical expenses for your spouse or dependents
Pharmacy, dental, vision care services
Medical plan deductibles and coinsurance
Any money you take out of your HSA for eligible medical expenses is federal income-tax free
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How you can use the HSA
1Coverage while
receiving unemployment
benefits
2
COBRA continuation
coverage
3
Eligible long-term care
4Medicare
premiums and out-of-pocket
expenses
Other qualified expenses
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20
How the HSA Helps You Save
The money Steve puts into his HSA is federal income tax-deductible.
1
Any money Steve withdraws from his HSA to pay for qualified medical expenses is withdrawn federal income tax-free.
2
Steve may earn interest on his account, and it is not taxable.
3
The amount not spent during this year carries over for use in future years.
4
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21
How Much Did Steve Save?
Steve does not have to pay federal income taxes on his interest.
Steve’s federal and state income tax savings and FICA on his contributions for the year are $2,478.
Steve will not have to pay income taxes on the $3,000 as long as he uses it to pay for qualified expenses.
With a traditional plan, Steve wouldn’t have this carryover option, which helps him save for the future.
In 2012, Steve will deposit $6,250 into his HSA, the maximum contribution for family coverage.
1
Steve will withdraw $3,000 to pay for qualified health care expenses for him and his family.
2
Steve earns interest on his account.
3
Steve will carry over $3,250 HSA dollars.
4
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22
TIP: Use your HSA to help you pay qualified expenses
Present ID card to
network doctor
Doctor sends
claim to
UnitedHealthcare
UnitedHealthcare
applies network
discount and notifies
doctor of amount you
may owe.
When you have
claim activity, you
will receive a EOB.
Doctor bills you for
payment
1. You can use your HSA to pay
2. Or you can choose to pay another way (cash, credit card) and reimburse yourself
later
How the HSA Plan WorksHSA Payment Process
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23
Explanation of Benefits (EOBs)
You may have noticed some changes on your EOBs. You will see more information on:– Appeal rights– Consumer assistance
programs
The EOB has been designed for easier readability.
We encourage you to access your EOBs online at myuhc.com.
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Comparing an HSA with an FSA
• Owned by employer
• Funded by the employee
• All funds must be used by the end of the plan year or grace period
• Only vision & dental care are reimbursable
• Must enroll each year enrollment
Limited-Purpose FSA
• Owned by employee
• Funded by the employee and employer
• Funds automatically rollover to next plan year
• Qualified expenses determined by IRS and employer
• Automatic enrollment
HSA
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
25
Common HSA Questions
• Enroll during your Open Enrollment period
• Check your employer benefit information for details
How do I enroll?
1
Can I take the funds in my HSA with me if I leave the company?
2
Can others contribute to my HSA?
3
How do I access the funds in my account?
4
Yes. Funds belong to you even if you leave your job, change health plans or retire.
Yes. Anyone can contribute to your HSA. Keep in mind that annual contribution limits above what is allowed are subject to income taxes and a penalty.
• Use your HSA debit card
• Pay by check, cash or credit card and reimburse yourself later from your HSA
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
26
OptumHealthSM Bank, Member FDICUnitedHealthcare’s health care bank of choice
• FDIC-insured so you know your money is safe
• Dedicated to helping people save for health care
• One of the nation’s leading HSA custodians
• Offers a Health Savings Account Debit MasterCard®
• Account holders will receive Health Savings News e-newsletter
Only OptumHealth Bank offers the convenience of HSA banking
through myuhc.com
Pay bills
Make deposits
Reimburse yourself
Track spending
See your tax savings
And more
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Choose the Right Mix of Fees and Interest
Understand the rates, fees and features for each account type:
Investments are not FDIC-Insured, are not guaranteed, and may lose value.
Health eAccess Health eSaver Health eInvestor
Monthly Maintenance Fee
Balance Required to Obtain APY
Investment Threshold
Monthly Investment Fee
$0-$499.99
$500-$999.99
$1,000-1,999.99
$2,000-$4,999.99
$15,000+
$5,000-$14,999.99
0.00%
0.00%
0.00%
0.00%
0.00%
0.00%
Annual Percentage Yield (APY) Annual Percentage Yield (APY) Annual Percentage Yield (APY)
$2,000 $2,000 $500
$3 $0 $2.50
$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
$0 if balance exceeds $5,000$3 if balance is $1-$4,999.99
Variable based on balanceVariable based on balance Variable based on balance
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How the High Deductible Plan Works
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29
*From www.healthcarelane.com
How the HDHP Works
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$2,700Annual
deductible
$4,650Out-of-pocket
maximum
80%/20%network
coinsurance
100%network coverage
Employer deposits $1,824 in HSAChris deposits $1,000 in HSA
*From www.healthcarelane.com
How the HDHP 2700 Plan Works
Chris chooses the HSA Plan for himself because:• No cost monthly premiums• His employer is contributing $1,824 • Chance to use HSA to save for future expenses
Here is what Chris’s plan looks like:
Chris is a fictitious person used to illustrate UnitedHealthcare products.
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31
$2,700Annual
deductible
$4,650Out-of-pocket
maximum
$2,424$2,824 in HSA
*From www.healthcarelane.com
How the HDHP Plan Works
Chris uses HSA to pay
HSA paid total $400
Chris paid $400
1 preventive exam per member $400
1 visit to urgent care $200
1 doctor visits $100
2 prescriptions $100
Non-preventive total $400
And Chris still has $2,424 in his HSA!
Paid 100% by plan
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$2,700Annual
deductible
$4,650Out-of-pocket
maximum
District funds $1,824 in HSA
*From www.healthcarelane.com
How the HDHP 2700 Works
80%/20%network
coinsurance
100%network coverage
Jane chooses the single HSA Plan because:• No monthly premiums• Typically has few health expenses• Ability to open and save with an HSA• Tax savings
Here is what Jane’s plan looks like:
Jane is a fictitious person used to illustrate UnitedHealthcare products.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
33
$2,700Annual
deductible
$4,650Out-of-pocket
maximum
Reaches deductible 80%/20% 100%
*From www.healthcarelane.com
How the HDHP Works
Emergency surgery $100,000
6 Doctor visits $824
11 Prescriptions $1,000
Total actual cost $101,824
Jane uses HSA to meet a portion of her deductibleRemaining bill $100,000
Insurance pays (80%)Jane to pay (20%)
But she pays only $2,826 to get to her $4,650 maximum.
All other expenses are covered 100% for the rest of the year
Jane pays $2,826District deposits $1,824 HSA
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Jane compares plans…
Choice Plus Plan HDHP 1500 HDHP 2700
Member costs
District Funded HSA Pays $0 $514 $1,824
Member Deductible $1,000 $1,500 $2,700
Out of Pocket Maximum $2,000 $3,900 $4,650
Copays $750 $0 $0
Premium $4,438 $0 $0
Total Member Pays $8,188 $3,386 $2,826
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Wellness Tools
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
36
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
37Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Large National Network
660,000 doctors
660,000 doctors
5,100hospitals5,100
hospitals
60,000 pharmacies60,000
pharmacies
And world-wideemergency care coverageAnd world-wideemergency care coverage
1,000convenience care clinics
1,000convenience care clinics
More than:More than:
38Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Our Large National Network
Your doctor is likely already in our network.
Available to
98%of Americans
Available to
98%of Americans
Includes
95,000Specialists designated for their quality and cost efficiency based on national standards
Includes
95,000Specialists designated for their quality and cost efficiency based on national standards
More than
1,000convenience
care clinics
More than
1,000convenience
care clinics
Includes
2out of3providers
Includes
2out of3providers
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39
The UnitedHealth Premium® program evaluates doctors for quality and cost efficiency to help you choose a doctor with confidence
Doctors who meet both quality and cost-efficiency guidelines receive two stars, and those who meet quality receive one star
Promoting Quality & Affordable Health Care
Quality Care UnitedHealthcare awards one star to physicians who meet national standards for quality care.
Cost-efficient Care UnitedHealthcare awards a second star to physicians who meet local area benchmarks for cost-efficient use of resources in delivering health care.
UnitedHealth Premium Two-Star Physicians Two-star physicians have been recognized for providing quality and cost-efficient care to their patients. They meet or exceed nationally recognized guidelines, and they’re likely to recommend the right tests and treatments for a variety of conditions.
+ =
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40
Take Advantage Of Your Preventive Care Coverage
Certain preventive services are covered without charging a deductible, copayment or coinsurance when these services are provided by a network provider.
It’s important to review your plan documents for the preventive services included in your specific benefit plan.
Regular preventive care may help• Reduce risk of disease • Detect health problems early• Protect you from higher costs down the road
www.uhcpreventivecare.comfor age and gender-specific guidelines
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Health Assessment
Take a free, online questionnaire about your health from the University of Michigan
Program includes interactive online health coaching
Feedback on progress toward living a healthier life
Recommendations for online health and wellness services
Information to help members have productive conversations with doctor
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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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
Care24 1-866-271-7340
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Healthy Pregnancy Program
Get support through every stage of pregnancy
Nurses available, toll-free, 24/7
Personalized pregnancy assessment
Educational materials and resources
No Additional Cost Gifts and Savings–Your Journey Through Pregnancy, a book
that will help you learn more about your
nine-month journey.
–A booklet from Johnson & Johnson:
What’s Next?: The magic unfolding
of the first days of life.
44
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Personalized information on-the-go supports better health care decisions
UnitedHealthcare Health4Me™ is designed to make it simpler for members to manage their health and:– View each plan member independently
– Personalize with member photos
– Find doctors and facilities anytime, anywhere
– Check claims, benefits, and account balances
– View and share health plan ID card in the doctor’s office or at the pharmacy
45Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
45
myHealthcare Cost Estimator
• Designed to calculate and compares cost differences for treatments between providers, locations and facility types, including both plan and member expenses for each treatment
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
46
Explore Health Care Lane Today!
A fun and interactive way to learn about health insurance
healthcarelane.com/VSEBT
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47
Mary Winters
Fred Winters, spouseAnn Winters, dependentSusan Winters, dependent
• Mailed to new members within 30 days of enrolling
• Includes your plan information
• Lets providers know how to bill
Health plan ID cards
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Voluntary Delta Dental Plan
•All employees who work 20 hours or more per week are eligible to enroll in dental benefits.
Enhancements
•Deductible is waived for preventative services
•The cost of preventative services does not count toward your calendar year max
•Potential additional benefit of $300 per person per calendar year
Voluntary Dental
Core PlanNo Orthodontics
6 month waiting period
Preventative 100%
Basic Services - 70%
Excludes sealants
Major Services - 40%
Calendar Year Max - $1500
Dental Plan
Employee
Only
Employee + Spouse Employee+Child(ren) Employee+Family
Core $14.12 $27.23 $30.99 $50.47
Premier $20.03 $39.35 $44.87 $73.61
Premier Plan Orthodontics
Lifetime Max - $750Preventative - 100%
Basic Services - 80%
Includes sealantsMajor Services - 50%
Calendar Year Max - $1500
Vision - VSPCovers eye exams once every year.Covers eye exams once every year.
Lenses are covered 100% after a $20 co-pay.Lenses are covered 100% after a $20 co-pay.
Frame allowance $130.Frame allowance $130.
Contacts in lieu of lenses and frames allowance $130.Contacts in lieu of lenses and frames allowance $130.
Premium based on 22 payroll deductions.Premium based on 22 payroll deductions.
Employee Only Employee+1 Employee+2 or more
$4.29 $6.21 $11.14
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Sun Life
Life Insurance• Basic life insurance provided to all benefit eligible employees in the Basic life insurance provided to all benefit eligible employees in the
amount of $50,000amount of $50,000
• Additional voluntary life insurance coverage available to purchase, Additional voluntary life insurance coverage available to purchase, premiums based on age and amount of coveragepremiums based on age and amount of coverage
• Spouse/child coverage availableSpouse/child coverage available
• If you are not currently enrolled in voluntary life insurance coverage If you are not currently enrolled in voluntary life insurance coverage but wish to enroll now, OR if you wish to increase your current but wish to enroll now, OR if you wish to increase your current coverage level during this year’s Open Enrollment, you must provide coverage level during this year’s Open Enrollment, you must provide Sun Life with evidence of your good health, by completing the Sun Sun Life with evidence of your good health, by completing the Sun Life Evidence of Insurability form.Life Evidence of Insurability form.
52
Assurant Short Term Disability
• For new coverage, if coverage amount elected is less than $3,000, For new coverage, if coverage amount elected is less than $3,000, evidence of insurability is not required. Individuals currently covered can evidence of insurability is not required. Individuals currently covered can move up one step without EOI.move up one step without EOI.
• The policy does not pay for disabilities within 12 months of your initial The policy does not pay for disabilities within 12 months of your initial enrollment plan, if you received medical treatment, consultation, care or enrollment plan, if you received medical treatment, consultation, care or services (including diagnostic measures), or took prescribed drugs or services (including diagnostic measures), or took prescribed drugs or medicines for the disabling condition during the 12 months prior to your medicines for the disabling condition during the 12 months prior to your initial enrollment date. initial enrollment date.
• To be eligible during pregnancy, you cannot be pregnant prior to the To be eligible during pregnancy, you cannot be pregnant prior to the benefit effective date.benefit effective date.
• The plan provides monthly benefits ranging from $360 to $5,000, based The plan provides monthly benefits ranging from $360 to $5,000, based on your annual salary, not to exceed 66 2/3% of your salary.on your annual salary, not to exceed 66 2/3% of your salary.
53
BASIC Flexible Spending Accounts
• An election must be made every year if you wish to enroll in a Flex An election must be made every year if you wish to enroll in a Flex PlanPlan
• Medical Flexible Spending account limit for 2012-13 plan year is Medical Flexible Spending account limit for 2012-13 plan year is $2,500$2,500
• Dependent Care Flexible Spending account limit will remain at Dependent Care Flexible Spending account limit will remain at $5,000 maximum.$5,000 maximum.
• If you are enrolled in an HSA plan you are only able to use your If you are enrolled in an HSA plan you are only able to use your medical flex spending account for dental and vision expensesmedical flex spending account for dental and vision expenses
• When making flex account elections please keep in mind that if When making flex account elections please keep in mind that if you do not use the funds by June 30, 2012 you will forfeit all you do not use the funds by June 30, 2012 you will forfeit all remaining money in the accountremaining money in the account
Long Term Care•District provides to full-time employees working 30 hours or more a base plan free of charge to the employee
•Provides a monthly benefit to help offset the cost of personal and medical care for an individual who is unable to carry out the normal activities of daily living, such as dressing, bathing, eating, moving or when someone suffers a severe cognitive impairment.
•$2000/month for up to 2 years
•100% benefit for nursing home or assisted living facility
•50% licensed professional care
•Max benefit of $48,000
•Employees who work 20-29 hours may elect to purchase benefit at their own cost
•All employees electing to purchase additional coverage are required to submit proof of good health.
QUESTIONS