Transcript Health Care Reform Changes for 2014

Medical Plan Review 2014
THA Group, Inc.
Agenda
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THA Healthcare: Year In Review
Health Insurance Offerings
Health Care Reform Changes for 2014
Additional Plan Changes
THA Group Health Savings Account
Prescription Updates
Plan Reminders
2013 Premium Rebate Update
PPC/Healthgram
Other Benefits
Questions
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THA Group Healthcare: 2013 Review
 Our year-end projections indicate that health care costs will increase by
about 13% in 2013 compared to 2012.
 The average number of members covered by the plan increased from 68
to 79.
 Network coverage was expanded for employees in South Carolina
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2013 Estimated Health Expenses Per
Member
THA portion
EE only GOLD premium
$449
$8531
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Health Insurance Plan Changes
 You will continue to have 2 Consumer-Driven Plans from which to
choose – The Healthy Return$ and Healthy Return$ GOLD Plans
 In order to be eligible for the Healthy Return$ GOLD Plan, you must
be tobacco free
 Both plans will be partnered with a Health Savings Account (HSA) to
offset deductible expenses
 Premiums will increase, but the increase is well below the national
average
- Premiums will increase between 5% and 9% depending on your
coverage category
- THA Group will pay 95% of the premium costs for Employee only
coverage
 Deductibles and out of pocket maximums will also increase slightly
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Your Premium Cost in 2014
Healthy Returns $1,600/$3,000
Deductible
Employee monthly contribution
EE Only
EE Spouse
EE Children
EE Family
$60.39
$457.89
$365.90
$603.36
THA Group per pay period contribution $27.87
$211.33
$168.88
$278.47
IHC/IH per pay period contribution
$30.20
$228.95
$182.95
$301.68
ILAH per pay period contribution
$13.94
$105.67
$84.44
$139.24
Healthy Returns Gold $3,000/$5,950
Deductible
Employee monthly contribution
EE Only
EE Spouse
EE Children
EE Family
$40.77
$349.82
$320.93
$519.75
THA Services per pay period
contribution
IHC/IH per pay period contribution
$18.82
$161.46
$148.12
$239.88
$20.39
$174.91
$160.47
$259.88
ILAH per pay period contribution
$9.41
$80.73
$74.06
$119.94
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Plan Comparison – Employee Only Coverage
Employee only coverage
Healthy Return$
Healthy Return$ GOLD
Embedded deductible
N/A
N/A
Preventive care covered at
100%
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$1,600
$3,000
Employer payment to open
HSA acct (one time only)
$100
$400
Employer Match (annual)
$100
$400
20% until $3,000 out of
pocket is met (incl. deduc.)
None. Plan pays at 100%
after deductible.
Deductible
Co-insurance after
deductible
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Plan Comparison – Family Coverage
Family coverage
Healthy Return$
Healthy Return$ GOLD
Embedded deductible
NO
YES
Preventive care covered at
100%
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$3,000
$5,950
($3,000 individual)
Employer payment to open
HSA acct (one time only)
$100
$400
Employer Match (annual)
$100
$400
20% until $5,500 out of
pocket is met (incl. deduc.)
None. Plan pays at 100%
after deductible.
Deductible
Co-insurance after
deductible
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Health Care Reform Changes for 2014
Due to Health Care Reform, the following changes will
be implemented to the THA Group plan effective
January 1st, 2014:
 Pre-existing condition limitations will no longer be
imposed.
 Coverage for approved clinical trials is now
included.
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Additional Plan Changes
 Endovenous Ablation Therapy – vein stripping is a
cosmetic procedure that will now be limited to
$2500 per year.
 Cochlear Implants will now be covered under the
medical plan.
 Therapy visits will be capped at 30 per year.
 East Georgia Regional Hospital will no longer be
considered in network.
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Health Care Reform & The Individual
Mandate
 In 2014, most individuals will be required to have health
insurance.
 If you choose not to enroll in some form of health insurance,
you will be subject to a penalty on your taxes of $95 ($285
family max) or 1% of your family income.
 Please note: As a THA employee, you will not be eligible
for a subsidy because you have access to coverage
through your employer.
 Please see more details on the individual mandate in your
enrollment packet.
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What is a Health Savings Account?
 A Health Savings Account (HSA) is a special account
owned by an individual and used to pay for current and
future medical expenses
 Employee HSA contributions are made on a pre-tax basis,
which provides savings by reducing your taxable income
 HSAs are used in conjunction with insurance that does not
cover first dollar medical expenses (except for preventive)
 HSA plan rules are dictated by the IRS
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HSA Contribution Rules
 Contributions to the HSA can be made by the employer or
the individual, or both
 If made by the employer, it is not taxable to the employee
(excluded from income and wages)
 Maximum amount that can be contributed in 2014
 $3,300 (employee-only coverage)
 $6,550 (family coverage)
 Individuals age 55 and older can make additional "catchup" contributions to their HSA
 For 2014 - $1,000
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THA Group HSA Contributions
 Healthy Return$ Plan - THA Group will provide a one-time
contribution of $100 to open an HSA account (new
participants only). THA will also match HSA contributions
up to $100 annually
 Healthy Return$ GOLD Plan - THA will provide $400 to
start an HSA account (one-time contribution for new
participants). THA will also match HSA contributions up to
$400 annually
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Prescription Updates
 Step Therapy
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Step Therapy will now be required for the following classes of
medications: Insomnia Agents, SSRIs, SNRIs, and Specialty
Medications
If you are prescribed one of these classes of drugs, you will be
required to try the more cost effective alternative before filling the
brand name drug
 Quantity Limits
THA will adopt Envision Rx’s standard quantity limits on all
medications
If you are affected by any of these prescription drug changes, Envision
will provide a member notification to your home.
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Prescription Updates
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DON’T FORGET!
90 day fills are required on maintenance medications. Make sure you
ask your provider for a 90 day prescription.
Publix offers 7 antibiotics for free! Next time you need an antibiotic,
please request one of the free Publix antibiotics to save money.
Publix also now offers lisinopril & metformin at no cost.
Many other pharmacies offer discounted generic medications as well.
Shop around for your medications to see where you can get the best
deal.
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Plan Reminders
Pre-certification is required for the following procedures:
 non-emergency hospital admissions (including observation)
 ambulatory surgery (outpatient surgery)
 dialysis
 inpatient care
 inpatient rehabilitation services
 chemotherapy/radiation therapy
 durable medical equipment (rental or purchase)
 prosthetics
 pain therapy (outpatient)
Precertification is required 7 days in advance of a non-emergent procedure. Please note
that often the provider will certify for you but it is ultimately your responsibility to make
sure it is done. Please contact Healthgram to make sure the pre-cert has been done.
Failure to comply with these requirements will result in a 50% reduction in benefits.
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Plan Reminders
Urgent Care vs. Emergency Room
 Did you know that an Emergency Room
visit costs an average of $2,019
 If you visit an Urgent Care, you will only
pay a fraction of the cost ($796 on avg.)
 Save time and money by visiting an Urgent
Care facility instead of the Emergency
Room
 If you are experiencing a true emergency,
please go to the nearest facility.
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Plan Reminders
The Care Network
 The Care Network utilizes St. Joseph’s/Candler facilities and physicians.
 To find an in-network provider or facility, please visit
http://www.sjchs.org/body.cfm?id=30
 This website can also be found on your ID card.
 Memorial Hospital facilities and physicians are NOT in-network.
 Staying in-network will provide
you with the best benefits for
the money.
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Plan Reminders
In-Network Benefits
 It is your responsibility to check that your providers are in-network
 This includes any referrals that your provider may make
 For example, if you visit Optim Health (formerly Southeastern Orthopedic)
providers and they refer you to their surgery center - the surgery center is
not in your network and you will be responsible for 100% of the charges for
those services
 Common out of network facilities – labs, x-rays, scans, surgery centers
Important Tip: Be sure to ask your provider about the cost of
additional procedures he or she may recommend during your
visit – be a good consumer!
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Plan Reminders
Spousal Coverage
A covered Employee’s spouse, who is employed and eligible for
coverage under his/her employer plan, must accept coverage under
his/her employer plan in order to be eligible for coverage under the THA
plan. If the spouse is not employed or their Employer does not provide
coverage, the spouse will be considered an eligible dependent.
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Plan Reminders
Advantages of being a part of the Savannah Business Group
& The Care Network include:
 Free Car Seats for newborns at Candler Hospital
 Meal Tickets for family members
 Bearly Sick – child day care service
 (912) 819-7382
 Discounts at Lord’s Eye Center
 Nurse Call Center – 24 hours a day
 Available 7 days a week
 (912) 813-3360
 For those patients who are unable to keep their scheduled
appointments due to transportation difficulties, the network will assist
by arranging a taxi to transport the patient to their scheduled
appointment. (Call Managed Care – 912 819 3332)
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2013 Health Premium Rebate Program
Last Year’s Promise:
 During the year, we tracked actual health plan cost against actuarial
cost.
 If actual cost for 2012 was less than actuarial cost, employees
would receive a premium rebate of up to 5% (based on percentage
savings realized)
The Results:
 Costs through the first 3 quarters of 2012 were significantly lower
than previous years
 Unfortunately, as employees satisfied their deductibles, 4th quarter
expenses brought the total plan costs to a level that negated any
rebate opportunities
 Costs have continued to rise through 2013
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Health Care Cost Control:
What You Can Do
 Practice healthy habits
- Get your preventive screenings
- Maintain a healthy diet and exercise
- Abstain from smoking; use alcohol in moderation, if at all
 Use The Care Network whenever possible
 Avoid costly alternatives like ER visits
 Get prior authorization; when costs are high, work with
Healthgram to identify alternatives
 Be an advocate with your coworkers. We are all in this
together!
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PPC is now
 Primary PhysicianCare changed their name to Healthgram on
September 1, 2013.
 They have not changed ownership, staff, or location, and your
customer service contact information remains the same.
 Please do not discard your current insurance card until you receive
your new insurance card for 2014.
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View your medical claims online
www.healthgram.com
 As part of their updated look and feel, Healthgram has
launched a redesigned website as well as new Member
Portals. You’ll notice a more user-friendly system that will
save you valuable time.
 For initial log-in, follow the prompts using your member ID
number found on your ID card
 View claims for you and your family
 You have access to your personal health
information, including screening results.
 Access your deductible and out-of-pocket
amounts to determine what you’ve met
and how much you have left.
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SECURE & Password-Protected
www.healthgram.com
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Online Member Portal
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Mobile Website
 Access important health plan information and your personal
health record, all from your
web-capable mobile phone.
 View claims, rx history,
deductibles, ID card info, test
results, blood pressure,
medications, and search for
providers.
 Go to www.healthgram.com
using your mobile phone.
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What about my other benefits?
 All other benefits will renew as is for 2014 – Dental,
Vision, Disability, Life and AD&D
 Dental premiums will increase by 14.2% (part of
increase is due to additional Healthcare Reform
taxes); all others are unchanged for 2014
 Flexible Spending Accounts (FSAs) are still
available for child care and medical costs (for those
who do not participate in THA Group’s health plan)
- You must enroll every year to participate
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How do I complete my benefits enrollment?
 Change forms are available for any adjustments
you need to make to your current coverage
 If you do not wish to add, drop, or change
coverage, simply check the “No Change” box on
the change form and return to Talent Management
 All completed forms are due in Talent Management
no later than December 13, 2013.
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Questions?
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