QHDHP/HSA Educational Seminar
OPEN ENROLLMENT– Medical & Dental remaining with same carriers, Altius and EMI
– Adding a QHDHP/HSA- Education Meetings set up
– Vision, Life & Disability Staying the same
– All benefits effective August 1, 2013
– Change plan elections
– Add or delete dependents
– All enrollment MUST be completed no later than June 30th
– Once the enrollment period has ended, you may NOT change your
elections
SOME “LIFE EVENTS” ALLOW YOU TO MAKE CHANGES DURING THE YEAR:When you have a qualifying event or change in employment status, you have 30 days to complete and return a new enrollment/change formSUBMIT THE CHANGE TO HR WITHIN 30 DAYS
– Marriage– Divorce– Birth/Adoption – Loss of Coverage
HEALTH CARE REFORM UPDATES Dependents covered up to age 26 (in place, no change)
Certain preventive services covered at 100% (in place, no change)
Women’s Preventive Care Expanded – effective 8/1/12
No lifetime or annual dollar limits (in place, no change)
Emergency room same benefit in and out of network (in place, no change)
OTC medications not covered on FSA unless prescribed (in place, no change)
W-2 Reporting of Health Benefits in 2013 for 2012 tax year
2013 – Medical Flexible Saving Account - FSA maximum $2,500
Individuals taxed if not on coverage, in effect in 2014
Altius Peak Plus- QHDP
Participating Providers Non-Participating
Deductible – Plan Year *Applies to OOP
$1,500*/ $3,000* $3,000 */ $6,000 *
Out of Pocket Maximum $3,000 /$6,000 $6,000 / 12,000
Hospital Services
Inpatient 20% AD 40% AD
Outpatient 20% AD 40% AD
Maternity 20% AD 40% AD
Office Visits 20% AD 40% AD
Preventive 100% 40% AD
Specialist 20% AD 40% AD
Urgent Care 20% AD40% After Participating
Deductible
Emergency Room 20% AD 20% AD
Prescriptions30 Day
90 Day
After Medical Deductible$10AD$25AD $50AD
$30 / $75 / $150 AD
Participating Providers Only
CONSUMERISM
“Nobody spends someone else’s money as carefully as they spend their own.”
Milton Friedman
Consumer-Driven Health Plans
Cigna Choice Fund Experience Study
When compared to customers in traditional plans, CDHP customers:
Spend less on overall medical services
Receive equal or better
quality care
Are more engaged in their health and health spending
Are more satisfied with their health
care experience
Over five years, CDHP could save up to $9,700 more per employee when compared to traditional plans.
Consumer-Driven Health Plans
Cigna Choice Fund Experience Study
Substantially lower trend in pharmacy the first yearo 14% lower overall pharmacy trend in first yearo 72% of Cigna Choice Fund customers used generic equivalents over
brand-name medications
No sacrifice in quality of care
o Equal or higher use of over 400 evidence-based measureso Higher use of preventive care
Better health risk profiles on full-replacement caseso Improved health risk by 10% in the first year compared with those who
remained in traditional plans o Sustainable in subsequent years
Consumer-Driven Health Plans
Cigna Choice Fund Experience Study
Customers are just as satisfied
Choice Fund Traditional
89% 88%
Customers in Cigna Choice Fund were equally or more satisfied than customers in traditional plans
HRA / HSA Members Spend 7% Less On Overall Health Care Costs
Tota
l Pha
rmac
y Cos
ts
Inpa
tient
Fac
ility
Ambu
lato
ry Fac
ility
Emer
genc
y Roo
m
Spec
ialis
t Phy
sician
Prim
ary Ph
ysici
an
Radiology La
b
Home
Health
Med
ical P
harm
acy
$0
$200
$400
$600
$800
$1,000
$1,200
$1,400
$1,600
$1,800
$2,000
Control GroupStudy Group
Over a 12-month period compared to matched traditional population
8th Annual Aetna Healthfund Study
-16%
-7%
-2%
-2%
-6%
-9% -3%
-2%
-11%
-11%
PCP
PCP
Routin
e
PCP
Non-R
outin
e
Spec
ialis
t
Spec
ialis
t Rou
tine
Spec
ilist
Non
-Rou
tine
Control Group Study Group
-2%
-12%
-5%
-9%
-11% -11%
HRA / HSA Members Are Getting More Routine Care and Less Non-Routine Care
And, most importantly, these patterns are seen in lower income households
8th Annual Aetna Healthfund Study
Mam
mog
ram
Scr
eening
Cervica
l Can
cer S
cree
ning
Imm
uniza
tion
Color
ecta
l Can
cer S
cree
ning
Pros
tate
Can
cer S
cree
ning
0%
10%20%30%40%50%60%
Control Group Study Group
1.3
3.4
2.4
0.7
3.5
HRA / HSA Members Have Higher Rates of Chronic and Preventive Care
Including breast, cervical, colorectal, and prostate cancer screening
8th Annual Aetna Healthfund Study
• Savings account that you own to pay for your medical expenses
You and/or EmployerDeposit
Qualified Medical Expense
Employee’s HSA
WHAT IS A HEALTH SAVINGS ACCOUNT (HSA)?
QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP)
Individual Coverage $1,500 Deductible$3,000 Out of Pocket
Max.
Two Party or Family Coverage $3,000 Deductible$6,000 Out of Pocket
Max.
QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) cont.
Until Deductible is Met: You pay entire cost of medical expenses (doctor
visits, prescriptions, diagnostic tests, hospitalization, surgeries, etc.)
The amount you are billed is the discounted rate which has been negotiated by the insurance carrier
Most preventative services are covered at 100% and are not subject to the deductible.
QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN (QHDHP) cont.
After Deductible is Met:Co-payments and co-insurance apply
After Out-of-Pocket Maximum is Met:All eligible claims are paid at 100%
WELCOMEWASHINGTON COUNTY SCHOOL DISTRICT
To Your Health Savings Account (HSA)
HSA: THE BASICS
Building Health Savings
Copyright © 2011 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.
TRADITIONAL PLAN VS HSA PLAN
Traditional Plan HSA-Based Plan
Employee’s Spending Account
Insurance Premium
Insurance Premium
Monthly Payment
This is used for regular medical expenses and employees keep what they don’t spend.
Copyright © 2011 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.
HSA COMPONENTS
Insurance Company
AltiusFinancial Custodian
HealthEquity
HSA REQUIRES QUALIFIED PLAN
HDHPLow-Premium, High-Deductible Health Plan
THE INSURANCE PIECE
HSAHealth Savings Account
THE ACCOUNT USED TO FUND THE DEDUCTIBLE—TAX-FREE
Copyright © 2011 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.
WHAT’S AN HSA?
A tax-free savings account that belongs to you, and:
• Can be used to pay for qualified medical expenses• Earns interest • Can be invested once a certain threshold is met
Qualified Medical ExpenseYour HSA
You and/orEmployer Contribute
Copyright © 2011 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.
WHO’S ELIGIBLE?
To qualify for an HSA, you must:• Be covered under a qualified health
plan on the first day of any month for which eligibility is claimed
• Not be enrolled in Medicare
• Not be claimed as a dependent on someone else’s tax return
• Have no other insurance except what’s permitted by the IRS (see IRS Publication 969)
Copyright © 2011 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.
HOW TO CONTRIBUTE
2013 maximum contributions allowed by the IRS:
Single-coverage $3,250
Family-coverage $6,450
Catch-up contribution, age 55+ $1,000
• Fully fund your HSA on day one (subject to the annual maximum)
• Make contributions anytime after your HSA is open
• Make pretax contributions through payroll deduction, online, or directly to HealthEquity
WHY CHOOSE AN HSA?
Copyright © 2011 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.
Save and keep your money• Lower premiums, tax-free, long-term savings
• You own the account and the money stays with you
Grow your money• Money rolls over year to year
Triple tax-savings • Contributions aren’t taxed and reduce your annual
taxable income
• Withdrawals are never taxed or penalized when used for qualified medical expenses; including Rx, dental, vision
• Earnings aren’t taxed
MAXIMIZE YOUR MONEY
Copyright © 2011 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.
Keep your doctor• Even if your doctor isn’t a network provider, you may use
your HSA to pay your bill
Protect your account and pocket book• Change jobs or retire and keep your account and balance
• Most HSA-qualified plans have maximum out-of-pocket limits- Reach your limit, and expenses are fully covered- Before you reach your limit, use your HSA balance to pay costs
• Cover spouse/dependent expenses, even if on another health plan- Your spouse and dependents don’t need to be covered by your HDHP
to use your HSA funds to pay their out-of-pocket medical expenses
MAXIMIZE YOUR OPTIONS
WHY CHOOSE A HEALTHEQUITY® HSA?
Copyright © 2011 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.
BENEFITS OF A HEALTHEQUITY® HSA
1. Easy-to-use online access
2. Live service any day, anytime
3. Remarkable education and support
4. Plus:• FDIC-insured cash deposits
• Competitive interest rates
• Free investment options with no transaction fees—something most banks don’t offer
YOUR HEALTHEQUITY EXPERIENCE
Copyright © 2011 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.
YOUR EXPERIENCE
HealthEquity Receives Electronic
Enrollment
Welcome Kit and Debit Card
First Login to Web Portal
Account Screeningand Set Up
Open Enrollment Meetings and Communications
Ongoing Education
Ongoing60–90 days prior 40 days prior 15–20 days prior Plan Yr. Begins
01001010010110
Copyright © 2011 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.
MEMBER PORTAL: Log On at www.myhealthequity.com
Copyright © 2011 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.
PREPOPULATED WITH YOUR CLAIMS
Copyright © 2011 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.
VIEW AND PAY CLAIMS ONLINE
USING AN HSA
Copyright © 2011 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.
HSA HOW TO:Doctors’ Visits
*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.
No co-pays
Insurance carrier adjusts price based on discounts
Pay doctor from HSA funds, if funds are available. Pay out of pocket if funds aren’t available and reimburse yourself later.
Go to the doctor
Doctor sends insurance carrier the bill
Claim integratedinto member portal
3
2
1
Copyright © 2011 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.
HSA HOW TO:Pharmacy Prescriptions
Show your pharmacy card
Pay with yourHSA card
Insurance carrier applies amount to your deductible—no paperwork needed
*This card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC.
Go to pharmacy
Pharmacy applies discount
Pharmacy sends claim to insurance carrier
3
2
1
ELIGIBLE EXPENSES
• Qualified medical expenses:– Doctor and hospital visits– Medical equipment– Chiropractic Care– Dental care, braces, dentures, implants– Vision care, glasses, contacts, lasik– Medications, including some over-the-counter
• A complete list is found in the IRS Publication 502 (same list as FSA)
The penalty for using HSA funds for non-qualified expenses is 20% +taxes. Keep all itemized receipts in the event of an IRS audit.
ADVANTAGES OF AN HSA
Funds roll over from year to year– No use it or lose it
Tax benefits on:– Contributions– Earnings– Distributions
Portability– Funds follow you– Tax-free even if qualifying coverage ends
ADVANTAGES OF AN HSA cont.
Flexibility in funding– Make increases/decreases at anytime of the year– You can do a lump sum contribution– One time roll-in from an IRA
No Claim Substantiation– Save receipts in case of an IRS audit– Report on annual tax filing
Long Term Investment Opportunities with Health Equity
Provides Control over your Healthcare Dollars
Individual HDHP Coverage $3,250
Two Party or Family HDHP Coverage $6,450
(If you are age 55 or over, you may make an additional “catch-up” contribution of $1,000 per year.)
Your own contributions, combined with any contributions from your employer, may not exceed these amounts. Excess contributions above these amounts are subject to IRS penalty.
HSA CONTRIBUTION LIMITS FOR 2013
If you choose to enroll in a “High Deductible Health Plan” for 2013, the District will contribute to your “Health Savings Account” once established as follows:
- Individual Coverage $1,150
- Two Party Coverage $1,150
- Family Coverage $1,150
Additionally, you could choose to contribute the following amounts on your own during the year:
- Individual Coverage $2,100 (bringing you to the IRS maximum of $3,250)
- Two Party Coverage $5,300 (bringing you to the IRS maximum of $6,450)
- Family Coverage $5,300 (bringing you to the IRS maximum of $6,450)
If you are over age 55 you can add $1,000 to these amounts
FUNDING FOR 2013 HEALTH SAVINGS ACCOUNTS
HOW DOES THE HSA WORK AT THE DOCTORS OFFICE?
Go to the doctor
Doctor sends bill to your Insurance Carrier
Insurance Carrier sends claim to HealthEquity and the Provider will send out bill to employee
Do not pay at point of service, since you may not know the exact charge of the claim.
Insurance Carrier adjusts price based on network discounts
Go to the Health Equity web site to pay claim directly to the provider electronically or pay with your Health Equity Visa card.
Show your ID card, not your HSA Card
Health Plan ID Card
Member Name: ID Number:Rx Bin Number:
DISADVANTAGES OF A “HIGH DEDUCTIBLE HEALTH PLAN” AND “HEALTH SAVINGS
ACCOUNT” No first dollar coverage except for Preventive
Care
If enrolling as a two-party or family you must satisfy the family deductible
You can only use what is in your account year-to-date– No advance funding unless you do a lump sum deposit
Not compatible with other traditional insurance– Must have a HDHP to have an HSA
THINGS TO CONSIDER WHEN CHOOSING YOUR HEALTH PLAN
Look at your family expenses for the past year Price out your on-going prescriptions If you are two-party or family – you will need to satisfy the
family deductible Calculate your premium cost savings and add in the District
contribution Consider funding your HSA with your previous Flexible
Spending Account (FSA) amounts FSA will be limited to $2,500
THINGS TO CONSIDER WHEN CHOOSING YOUR HEALTH PLAN
cont.
If you choose HDHP coverage, you will not be eligible for a regular Flexible Spending Account (FSA).
If you currently have a health FSA and select QHDHP coverage for 2013, you will need to make sure that you have a zero balance in your FSA BEFORE, you can open the HSA and be eligible to receive the District contribution. (even if you want to choose to use run-out period).
WHAT CAN YOU DO TO KEEP YOUR HEALTH CARE COSTS DOWN?
Maintain a healthy lifestyle
Explore your options
M a r c h 2 0 1 3
GBS RxPrescription Drug
Pricing Tool
GBS Rx - Consumer Initiatives
• CDHP’s have introduced plan members to the actual retail costs of prescription drugs (…. and it’s more than the copay in most cases)
• Drug pricing can vary by pharmacy, by product, and by insurance plan/network
• The key to obtaining better retail prescription drug pricing – SHOP AROUND
– After all, drugs are a commodity and prices vary, so why pay more than you have to?
• GBS Rx is a prescription drug pricing tool that enables consumers to easily compare drug prices at multiple pharmacies at the same time
• How to save at the pharmacy:– Always shop for better pricing; know your options (knowledge is power)– Ask for the lowest price – it is okay to negotiate– Compare your insurance card pricing vs. the coupon or cash price– Use generics whenever possible
• Walmart, Smith’s, Target all have $4 generic programs on hundreds of drugs
GBS Rx Drug Price Comparisons – Ogden, UT
Pharmacy Price* TotalGeneric Actos,
30mg (pioglitazone)
Generic Lexapro, 20mg
(escitalopram)
Generic Lipitor, 20mg
(atorvastatin)
Generic Plavix, 75mg
(clopidogrel)
Generic Singulair, 10mg
(montelukast)
Costco $101 $7 $16 $11 $27 $163
Smith's $114 $17 $16 $11 $31 $190
Walmart $114 $18 $17 $14 $28 $190
Walgreen's $117 $20 $19 $16 $35 $208
Medicine Shoppe $114 $17 $16 $11 $31 $190
Shopko $231 $98 $17 $11 $43 $399
Independents $113 $99 $16 $11 $43 $282
Fresh Market $231 $99 $16 $11 $43 $399
*Includes 'lesser of' cash price or 'coupon' pricing
GBS Rx Consumer Initiatives
Questions?