Transcript Deductible then 20% - Odessa R-VII

JULY 1
Odessa R-VII School District
Your 2013 Medical Plan Options
•
Traditional Health Plans
Blue-Care – HMO (Health Maintenance Organization)
• Select a Primary Care Physician (PCP)
• In-Network Coverage Only
Preferred-Care Blue -- PPO (Preferred Provider Organization)
• No selection of a PCP (Primary Care Physician)
• In and Out of Network Coverage
•
Consumer Driven Health Plan
– Blue Saver – QHDHP (Qualified High Deductible Health Plan)
• Similar features to the Traditional PPO Plan
• Preferred-Care Blue PPO Network
• In and Out of Network Coverage
• Health Savings Account (HSA)
• Employee-Owned Health Savings Account
• Tax-Favored way to pay for Medical, Prescription Drug, Vision, Dental Expenses
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Hospital Locator
www.bluekc.com
HMO
Blue Care Network
PPO Preferred Care Blue
Network
Center Point Medical Center
X
X
Children’s Mercy Hospitals
X
X
KU Medical Center
X
X
Lee’s Summit Hospital
X
X
Liberty Hospital
X
NO
Menorah Medical Center
X
X
North Kansas City Hospital
X
X
NO
X
Olathe Medical Center
X
X
Overland Park Regional
X
X
Providence Medical Center
X
X
Research Medical Center
X
X
Shawnee Mission Medical Center
X
X
St. Joseph Medical Center
X
NO
St. Mary’s Medical Center
X
NO
Truman Medical Center (Hospital Hill and Lee’s
Summit)
X
NO
Hospital Name
St. Luke’s (All Locations)
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www.bluekc.com
View Your Claims, Print a Temporary ID card & Find Rx Info
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BlueCard PPO Network
Worldwide Network of PPO Healthcare Providers
National Network
Access through
BlueCard®
 1,177,194 Physicians
 6,776 Hospitals
 Access in ALL 50 States
Welcomed
in over 200
countries
Worldwide
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Traditional Plans
HMO and PPO
Blue-Care HMO
Office Visits
PCP: $25 copay (IM, FP, GP, PED)
Specialists: $50 copay (ENT, Derm, OB/GYN)
Inpatient Hospital
Services/Outpatient Surgery
MRI, MRA, CT and PET Scans
Physician’s Office, Imaging Center,
Outpatient Setting
Urgent Care
(Minute Clinics, Take-Care
Centers)
Emergency Care
$400 copay per day up to $2,000 per calendar year
(applies to inpatient services at a hospital and
outpatient surgeries at a hospital or an outpatient
facility)
$100 copay
Only one copay will apply for each provider on a
specified date of service even if multiple scans are
performed
$50 copay
(office visit/lab only)
$100 copay if treated and released
(copay waived if admitted to hospital)
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Traditional PPO
Office Visit
In-Network
Out-of-Network
$30*
Deductible & 40%
Deductible: Individual
$1,000
Deductible: Family
$2,000
Coinsurance (your share):
20%
40%
Out-of-Pocket Maximum:
Individual
$2,500
$5,000
Out-of-Pocket Maximum:
Family
$5,000
$10,000
Deductible & 20%
Deductible & 40%
Hospital: Inpatient or
Outpatient
Emergency Room
$100 copay + Deductible then 20%
(Copay waived if admitted)
Urgent Care
$30* copay
Deductible & 40%
(includes Minute Clinics and Take Care
Centers)
*Copay includes Office Charge & Lab services in Physician’s office or Independent Lab
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Prescription Drug Coverage
HMO and PPO Plans
Certain drugs may require prior authorization, have quantity limitations or require use of
Generics First Program. Refer to the Prescription Drug List in your packet for additional
details.
34 day supply
In-Network Pharmacy
Tier 1: $12
Tier 2: $35
Tier 3: $60
102 day supply
Mail-Order
Tier 1: $36
Tier 2: $105
Tier 3: $180
visit www.bluekc.com for a complete list of pharmacies in your area.
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BlueSaver
High Deductible Health Plan + Health Savings Account
Consumer Driven Health Plan
PPO + HSA (Health Savings Account)
Medical Plan
Health Savings
Account (HSA)
Owned by you
Lower monthly premiums
Used for eligible expenses
No copayments at doctor’s office you pay
entire discounted cost until deductible is
met; then 100%
Helps pay for deductible and Rx
You pay the entire discounted cost for
prescriptions until deductible is met; then
100%
No “use it or lose it” rule
Tax savings
Wells Fargo will administer your HSA
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QHDHP Claim Flow Example

Full cost of a doctor visit is $140

BCBSKC has negotiated a fee of $65 using
Preferred Care Blue Doctors

You pay nothing at the visit

Your doctor sends a bill for $140 to your home,
but you don’t pay it

You receive the Explanation of Benefits (EOB)
from BCBSKC indicating that you owe $65

You pay your doctor $65 (this amount goes towards
your deductible)
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QHDHP Claim Flow Example

Allergy Testing $900

BCBSKC has negotiated a fee of $500 using
Preferred Care Blue Doctors

You pay nothing at the visit

Your doctor sends a bill for $900 to your home,
but you don’t pay it

You receive the Explanation of Benefits (EOB)
from BCBSKC indicating that you owe $500

You pay your doctor $500 (this amount goes towards
your deductible)
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BlueSaver
QHDHP + HSA (Health Savings Account)
In-Network
Out-of-Network
Cal. Yr. Deductible:
Individual
$2,500
Cal. Yr. Deductible: Family
$5,000
0%
20%
Out of Pocket Maximum: Individual
$2,500
$5,000
Out of Pocket Maximum: Family
$5,000
$10,000
Office Visit
Deductible then 0%
Deductible then 20%
Hospital: Inpatient or Outpatient
Deductible then 0%
Deductible then 20%
Coinsurance (your share):
Emergency Room
Deductible then 20%
Urgent Care (Minute Clinics and Take
Care )
Deductible then 0%
Deductible then 20%
Retail Prescriptions (34 day supply)
Deductible then 0%
Deductible & 50% after
$12/$35/$60
Mail Order Prescriptions (102 day
supply)
Deductible then 0%
N/A
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Prescription Drugs on the QHDHP
Important Points/Reminders…
Member pays Entire Rx Cost (less BCBSKC discount) of the prescription
1.
Discounted cost of the prescription applies to deductible.
2.
After the deductible is met – Prescription Drugs are covered at 100%
Always show your BCBSKC I.D. card at the pharmacy
Prescription Drugs are credited to your Deductible at the time of your purchase
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What is an HSA?
A Health Savings Account (HSA) that can help you manage your expenses today
and in the future.
It’s yours to:

Own . The HSA is always yours, even if you change jobs, become unemployed
or retire.

Grow. Your unused balance rolls over from year to year.

Save. HSA’s provide tax-free earnings and tax-free withdrawals.

Choose. Use for current expenses, save for the future or explore investment
options.
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Eligibility to Open an HSA
•
You must elect the BlueSaver QHDHP $2,500 High Deductible plan
AND
•
•
You may NOT be covered by any of the following:
–
A Traditional health plan
–
Medicare, Medicaid, or Tricare Coverage
–
Health Flexible Spending Account (FSA) (except a limited account for Dental and Vision)
–
Spouse’s general purpose health FSA
–
Veteran’s Administration (VA) benefits within the last 3 months
You cannot be claimed as a dependent on someone else’s tax return.
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Saving and Spending – Contributions to your HSA
o
Money may be contributed to your HSA by you, or anyone else, as long as the
total doesn’t exceed the IRS annual maximum:
2013
o
Catch up of an additional $1,000 if 55 years of age
o
Withdrawals can be made only after the money is deposited to your account.
o
No expenses may be reimbursed for services incurred before the HSA is set up, regardless
of when the QHDHP was effective.
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How to use your HSA Funds

Use the HSA funds to pay for IRS “qualified medical expenses” permitted under
Federal Tax law including:

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Medical out-of-pocket expenses (i.e. deductibles and coinsurance)
Dental treatment (i.e. fillings, braces, extractions)
Prescription drugs and over-the-counter drugs
Eye exams, eyeglasses, and contact lens

Pay for expenses for yourself and your spouse or other tax-code dependents,
even if they are not covered by your health plan.

Domestic partners are not tax code dependents.

See IRS Publication 502 website for a full listing of IRS eligible expenses.
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HSA Eligible Expenses
Complete list: IRS Publication 502

Acupuncture

Alcoholism Treatment

Medicines or Drugs

Ambulance Services

Nursing Home

Artificial Limb or Prosthesis

Nursing Services

Artificial Teeth

Operations or Surgery

Birth Control Pills

Psychiatric Care

Chiropractors

Psychologist

Crutches


Dental Care
Telephone Equipment (for vision/hearing
impaired)

Diagnostic Devices (such as a blood sugar test
kit)

Television Equipment (for hearing-impaired)

Therapy or Counseling

Doctor’s Fees

Transplants

Drug Addiction Treatment

Transportation for medical care

Fertility Enhancement (including in-vitro
fertilization)

Vasectomy

Hearing Aids and Hearing Aid Batteries

Vision (exams, eyeglasses, contacts, corrective
surgery)

Hospital Services (including meals and lodging)

Wheelchair

Laboratory Fees

X-Rays
Eligible Expenses also include: Medicare premiums (Part A through D), COBRA premium, certain Long Term Care
insurance premium and health insurance premium if receiving unemployment.
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What If…
I use my funds for a non-qualified expenses, such as a new TV?
• 20% penalty for non-qualified expenses plus taxes
• Keep your receipts in case of an audit!
I turn age 65?
• Spend on non-qualified expenses with no penalty
• Pay normal income tax
I change to one of the Traditional plans next year? What happens to the funds in the
account?
• Continue to spend on qualified medical expenses, you just can’t contribute
I don’t have enough funds in my HSA to cover my service or prescription?
• Pay out of pocket, you can reimburse yourself once your funds are available
• Use on-line Services to transfer funds
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General Information
Preventive Care: What to Know!
All of your BCBSKC plans will cover Preventive Care
Services at 100%, according to established government
guidelines:
•
•
•
•
Annual Physicals
Childhood Immunizations
Well Women Exams
PSA Tests
Services MUST be Preventive and received by In-network
providers
Effective July 1, 2013:
•
•
•

Generic Oral Contraceptive drugs at 100%
Certain Contraceptive implants, injectables & devices at
100%
Breastfeeding support, supplies (pumps) and counseling
at 100%
Refer to the Routine Preventive Services flier for a
complete list of covered services.
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24-Hour Nurse Line
877-852-5422
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Access to Care Advisors to help you with symptoms or answer
health-related questions
How Can They Help?
◦ Gain convenient access to quality care
◦ Become better informed about healthcare
◦ Gain confidence when speaking to providers
◦ Become educated on self-care for non-urgent situations
◦ Improve knowledge of drugs and medications
24 hours a day…365 days a year!
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▪
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Blue365 online resources include:

Tools to help employees make the best choices about their health

Select discounts and savings on products and services they can use to improve and
maintain health
Select companies include:
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Questions?
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