Transcript High Deductible Health Plan

Open Enrollment and
Medical Plan Overviews
What We’ll Cover Today
• Open Enrollment
– Changes and enhancements for 2016
• Medical Plans Overviews
– Traditional Plan
– High Deductible Health Plan
– Features of Health Accounts
• Key Dates
• Important Reminders
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Open Enrollment Overview
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2016 What’s New and Changing
• Cost and benefit enhancements effective April 1, 2016:
– 5% increase to premiums (excludes HDHP for full-time employees)
– Out-of-Network mental health coverage
• Currently Out-of-Network providers we not covered
– HDHP Out-of-pocket maximums for an individual cannot exceed $6,850,
family plans will include this embedded limit (ACA provision)
– Regence pharmacy:
• 90-day retail at participating pharmacies (Regence)
• Mail order services changing from Walgreens to OmedaRx
• Speciality drug services changing from Walgreens to BriovaRx
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2016 Summary
• High Deductible Health Plan:
– $0 premium for full-time employees
– County HSA contribution:
• $600/$1,200 with April 7 paycheck
• $250/$500 wellness incentive
• Health Savings Account (HSA) Annual Limits:
– Employee only: $3,350 (no change)
– Family: $6,750 (increase)
– Catch-up contribution for age 55+: $1,000 (no change)
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Healthcare Benefits Overview
Choosing a Medical Plan
• Choose a plan that fits your needs:
– Your current providers are in-network
– Location of hospitals and clinics
– Total annual cost
Choosing a Medical Plan
• Two networks to choose from:
– Regence – ValueCare Plan
– SelectHealth – SelectMed Plus
• Two types of plans
– High Deductible Health Plan
– Traditional PPO Plan
• Traditional and HDHP provide you with the
same comprehensive coverage
Evaluating Medical Plan Costs
1. What you pay in premiums
2. What you pay at the doctor and for
prescription medication
– All County plans have an out-of-pocket
maximum to protect you:
• Employee only: $3,500
• Family: $7,000
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Traditional: How It Works
• You pay premium out of your paycheck
• You pay the full cost of your medical care and
prescription drug expenses until you meet your
deductible
Your Deductible
• $500 employee only
• $1,000 Family coverage
You Pay
In-network preventive care is covered at 100%
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Traditional: How It Works
• After you meet the deductible you pay a portion of the
cost:
– Copay for doctor visits, labs, and prescriptions
– Coinsurance for other services
Your
Deductible
• $500 employee only
• $1,000 Family coverage
You Pay
Your
Coverage
You
Pay
20%
+
Plan
Pays
80%
Coinsurance
In-network preventive care is covered at 100%
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Traditional: How It Works
• You’re protected from major expenses with an out-of-pocket
maximum. This is the most you will pay for in-network medical
and prescription drug expenses.
• Your deductible and coinsurance/copays are applied to your
out-of-pocket maximum.
Your Deductible
• $500 employee only
• $1,000 Family coverage
You Pay
Your Coverage
You
Pay
20%
+
Plan
Pays
80%
Coinsurance
Your Out-of-Pocket
Maximum
•$3,500 for employee only
•$7,000 family coverage
Plan Pays 100%
once you reach the outof-pocket maximum
In-network preventive care is covered at 100%
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Medical Flex Spending Account
• Enroll in Medical FSA to pay for health
care expenses with pretax money
• You can use your Medical FSA for:
–
–
–
–
–
–
Medical
Dental
Vision
Prescription drugs
Deductible, coinsurance, copays
Services not covered by medical coverage
• Lasik, acupuncture, some elective surgery
Medical Flex Spending Account
• Administered AxisPlus
• Elect between $130 and $2,500 per plan
year
• Your account is front loaded
• Unused money up to $500 will roll over
• Visa debit card
• Keep your receipts
HDHP: How It Works
• $0 premium for full-time and 20% premium for part-time
• You pay the full cost of your doctor visits and prescription drug
expenses until you meet your deductible
• You can use your HSA funds to pay for your expenses
Your Deductible
• $2,000 Employee only
• $4,000 Family coverage
TIP! Use your county
HSA contribution to
help you pay for your
deductible.
You Pay
In-network preventive care is covered at 100%
HDHP: How It Works
• After you meet the deductible you pay a portion of the
cost:
– Copay for doctor visits and prescription drugs
– Coinsurance for other services
Your
Deductible
• $2,000 employee only
• $4,000 Family coverage
You Pay
Your
Coverage
You
pay
10%
+
Plan
pays
90%
Coinsurance
In-network preventive care is covered at 100%
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HDHP: How It Works
• You’re protected from major expenses with an out-of-pocket
maximum. This is the most you will pay for in-network medical
and prescription drug expenses.
• Your deductible and coinsurance/copays apply to your out-ofpocket maximum.
Your Deductible
• $2,000 employee only
• $4,000 Family coverage
You Pay
Your Coverage
You
Pay
10%
+
Plan
Pays
90%
Coinsurance
Your Out-of-Pocket
Maximum
•$3,500 for employee only
•$7,000 family coverage
Plan Pays 100%
once you reach the outof-pocket maximum
In-network preventive care is covered at 100%
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Salt Lake County
Winning with an HSA
Nothing in this communication is intended as legal, tax, financial, medical or marital advice. Always consult
a professional when making life changing decisions. It is the members' responsibility to ensure eligibility
requirements as well as if they are eligible for the plan and expenses submitted.
No soliciting. No recording. No photography. No part of this presentation may be copied, recorded, or
rebroadcast in any form.
Copyright © 2013 HealthEquity, Inc. All rights reserved. HealthEquity and the HealthEquity logo are registered trademarks and service marks of HealthEquity, Inc.
Confidential and proprietary. Reproduction without express written consent is prohibited.
Winning with an HSA
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Health care costs in retirement
•
The average couple retiring this year will incur
$220,000* to cover medical expenses during
retirement
•
This is $325,000 gross withdrawal from
traditional 401(k) plan to achieve net $220,000
medical expense in retirement**
-or• Only $220,000 tax free withdrawal from HSA
* Fidelity Benefits Consulting https://www.fidelity.com/viewpoints/retirement/retirees-medical-expenses
** Assumes 33% tax rate
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Why choose an HSA?
Easy win in today’s complex health care
system:
– Save now:
• $0 premium for full-time employees
• HSA deposits aren’t taxed or are tax deductible
• Typically lowers income tax liability
– Save for the future:
• HSA funds roll over from year to year
• Tax-free interest earned
• You keep the money even if you change
jobs or insurance plans
• Comprehensive and easy investment options
– Same doctors, same network, same pricing
* Source: Fidelity http://www.fidelity.com/inside-fidelity/employer-services/fidelity-analysis-reveals-extra-health-care
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Two Parts: Health Plan + Savings Account
•
•
•
HSA-qualified plan through Regence or
Select Health insurance
Preventative services covered at 100%
Office Visits, Rx, Deductible, Copays, and
Coinsurance ALL count towards Out of
Pocket maximum
•
•
•
HSA through HealthEquity
Tax-free savings for medical
expenses
Works in conjunction with the
HSA powered plan with Regence
or Select Health
HSAs are never taxed at a federal income tax level when used appropriately for qualified medical expenses. Also, most states
recognize HSA funds as tax-free with very few exceptions. Please consult a tax advisor regarding your state's specific rules.
How an HSA works
You and/or your employer
$
$
Qualified medical expenses:
Exams, prescriptions, procedures, vision, dental and more
For illustrative purposes only. Visit the IRS website for a complete list of qualified medical expenses.
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Maximize your savings
Maximize your HSA contributions in 2016:
• Single-coverage: $3,350 Save up to $1005 in Taxes!*
• Family-coverage: $6,750 Save up to $2025 in Taxes!*
• Catch-up contribution, age 55+: $1,000
*Estimated savings are based on an assumed combined federal and state income tax bracket of 30%. Actual saving will depend on
your taxable income and tax status. HealthEquity does not provide tax advice.
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How to contribute to your HSA
• Salt Lake County contributes into your HSA! (April 7 paycheck)
• Individual=$600, Family=$1200
• Wellness activities ($250 employee only or $500 if you cover a
spouse):
• Annual preventive exam - $125
• Online Assessment (Healthy Lifestyles) - $100
• Annual flu vaccination - $25
• Make pre-tax contributions through payroll deductions
• Change your payroll contributions at any time
• Make post-tax contributions directly to HealthEquity online or
by sending a check
• Fully fund your HSA on day one
• Make contributions anytime after your HSA is open
• Keep your receipts
It is the member’s responsibility to ensure eligibility requirements as well as if they are eligible for the plan and expenses submitted.
One should consult a tax advisor as individual factors and situations vary.
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Who is eligible for an HSA?
To contribute to an HSA, you need to:
• Be covered ONLY by an HSAqualified health plan
– Other health coverage will disqualify
you:
• Traditional Plan (through a spouse)
• TriCare, CHAMPUS or other military
insurance
• Medicare, including Part A
• No full purpose FSA (including through a
spouse)
• Claimed as a dependent on someone
else’s tax return
It is the member’s responsibility to ensure eligibility requirements as well as if they are eligible for the plan and expenses submitted.
One should consult a tax advisor as individual factors and situations vary.
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Learn and Compare
Learn more about the High Deductible Health Plan at:
www.benefits.slco.org, click HDHP
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Plan comparison tool
Let us do the math! Use the side-by-side comparison on the website.
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Once You Are Enrolled
• Convenient access
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Debit card
Online
Free mobile app
By telephone
• Use your HealthEquity account to
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Check your balance
Review transactions
Review claims
Submit new claims or documents
Send payments and reimbursements
Access tax documents
Debit card is issued by Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.
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HealthEquity mobile app
Convenient, powerful tools:
• On-the-go access for all account types
• Take a photo of documentation with
phone and link to claims and payments
• Send payments and reimbursements
from HSA
• Manage debit card transactions
• View claims status
Available FREE for iOS and Android
Must activate account via HealthEquity website in order to utilize mobile app.
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Account Mentors
Always available
Our member services agents are taking
calls 24 hours a day, every day of the year
Call today
Let us conduct a personal assessment of
your plan options
866.346.5800
www.healthequity.com
HealthEquity, Inc. does not provide legal, tax, financial or medical advice. Always consult a professional when making life changing
decisions.
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Limited Flex Spending Account
• Enroll in Limited FSA to pay for health
care expenses with pretax money
• You can use your Limited FSA for:
– Dental
– Vision
– Lasik
Limited Flex Spending Account
• Administered by AxisPlus
• Elect between $130 and $2,500 per plan
year
• Your account is front loaded
• Unused money up to $500 will roll over
• Visa debit card
• Keep your receipts
Cost Comparisons
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Best Case Scenario
HDHP vs. Traditional PPO Plan
You only coverage
Best Case
HDHP
Traditional
Annual premium
$0
$1,188
You only receive preventive care (annual
exam) and have no prescriptions during the
year
$0
$0
County HSA contribution (Annual contribution
$600 + wellness activity $250)
$850
N/A
Total cost to you:
+$850
-$1,188
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Worst Case Scenario
HDHP vs. Traditional PPO Plan
You + 3 dependents
Best Case
HDHP
Traditional
$0
$3,468
You and your family have ER visits,
hospitalizations, several expensive
medications, or surgery and you reach the
out-of-pocket maximum
$7,000
$7,000
County HSA contribution (annual contribution
$1,200+ wellness activity $500)
$1,700
N/A
Total cost to you:
-$5,300
-$10,468
Annual premium
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Your Case Scenario
HDHP vs. Traditional PPO Plan
You + Spouse
Best Case
HDHP
Traditional
$0
$2,592
You break your ankle and it requires a cast
and physical therapy, and your spouse takes
a maintenance medication.
$2,580
$1,650
County HSA contribution (Annual contribution
$1,200+ wellness activity $500)
$1,700
N/A
Total cost to you:
-$880
-$4,242
Annual premium
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Create Your Own Scenario
• Using the side-by-side comparison on the HDHP
website www.benefits.slco.org
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Key Dates
• Must complete enrollment
by February 26
– Self Service via PeopleSoft
• April 1: New benefit plan
year begins
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Important Reminders
• Open Enrollment is your opportunity to:
– Review your health plan options.
– Add, change, or drop coverage for your dependents.
– Enroll or re-enroll in
• Health Savings Account (for HDHP only)
Note: If you are electing $0; enter $0 to avoid delay of County
contribution
• Flexible Spending Accounts (medical/limited)
• Dependent Care Flexible Spending Accounts
– Only time you can enroll or drop:
• U.S. Legal Plan
• Short-Term Disability
– Review and/or update your Life Insurance Plans at
www.pehp.org
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1095-C
• IRS tax document
• Available by March 31, 2016
• Opt-in to receive an electronic copy
– PeopleSoft: Main Menu > Self Service >
Benefits > 1095-C Consent
Questions?
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