ready. set. grow healthy. your 2012 unitedhealthcare plan benefits glendale elementary school...
TRANSCRIPT
READY. SET. GROW HEALTHY.
Your 2012 UnitedHealthcare Plan BenefitsGlendale Elementary School District
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2
What We Will Cover Today
Medical Plan Options
• Medical Plan 104
• HSA 1500 Plan
• HSA 2500 Plan
UHC Tools and Resources
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3
What We Will Cover Today
Open enrollment
April 30 to May 11th
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4
Changes effective July 1st
Buy-Up Medical Plan 03 has been eliminated Medical Plan 104 has increased prescription copays from
$10/$20/$40 to $10/$25/$50
• HSA 2500 Plan has decreased prescription copays from $10/$30/$50 to $10/$25/$50
• HSA 2500 Plan deductible and OOP max has been enhanced from a two tier to a three tier program making the program more attractive to those with dependent coverage.
• New HSA 1500 Plan offering
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5
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.uhcpreventativecare.com for age and gender-specific guidelines
6Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your Medical Benefits at a Glance Medical Plan 104
Type of coverage Network benefit Non-network benefit
Physician’s office services$20 co-payment 50% after deductible
Specialist office visit $40 co-payment 50% after deductible
Urgent care center services $50 co-payment50% after deductible
Emergency room services $100 co-payment 50% after deductible
Inpatient hospital stay20% after $500
individual deductible50% after $750
individual deductible
Out of Pocket Maximum
$1,750 per individual per calendar year.
(Deductibles and copays do not apply)
$3,750 per individual per calendar year
(Deductibles and copays do not apply)
7Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Medical Plan 104 Pharmacy Costs
Retail Mail order
Tier 1$10 Member Cost
1-Month Supply
$25 Member Cost
3-Month Supply
Tier 2$25 Member Cost
1-Month Supply
$62.50 Member Cost
3-Month Supply
Tier 3$50 Member Cost
1-Month Supply
$125 Member Cost
3-Month Supply
Lowest Cost
Highest Cost
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UnitedHealthcare Health Savings Account Plans (HSA’s)
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99Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
50% of health care costs driven by behaviors
Consumer-driven health
Source: Adapted from Department of Health and Human Services, Centers for Disease Control and Prevention
Behavior50%
Environment20%
Genetic20%
Access10%
Factors affecting rising health care costs
For every 100 employees:• 64 are overweight or
obese: average health costs 10-12% higher
• 23 smoke: average health costs 30-33% higher and annual productivity costs 60% higher
• 19 experience stress: average health costs46% higher
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1010Proprietary 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
• People are currently removed from the true cost of health care
• Health care costs are skyrocketing
• There’s a need to save for future health care costs
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Your Medical Benefits at a Glance HSA 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 50% 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,
$6,000 family deductible* (single deductible does not apply for families)
Out of Pocket Maximum (single max does not apply to families)
$3,000 single, $5,000 for family coverage per Plan Year
(Deductibles and copays apply)
$6,000 single, $10,000 for family coverage per Plan Year
(Deductibles and copays apply)
12Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your Medical Benefits at a Glance HSA 2500 – Embedded Plan*
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 50% after deductible
Inpatient hospital stay
20% after $2,500 individual, $3,500 Individual +1, $4,000 family deductible per Calendar Year
(Individual deductible applies for each family member)
20% after $5,000 individual, $7,000 Individual +1, $8,000 family deductible per Calendar Year
(Individual deductible applies for each family member)
Out of Pocket Maximum
$4,500 per individual, $7,500 individual +1, $9,000 for family coverage per Calendar Year
(Deductibles and copays apply)
$9,000 per individual, $15,000 individual +1, $18,00 for family coverage per Calendar Year.
(Deductibles and copays apply)
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HSA Plan Pharmacy CostsRetail Mail order
Tier 1$10 Member Cost
1-Month Supply
$25 Member Cost
3-Month Supply
Tier 2$25 Member Cost
1-Month Supply
$62.50 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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14
Introducing the HSA
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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15
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*
You can open and fund the HSA to pay the plan deductible and other qualified health care costs – or you can 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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17
You may be 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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21
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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22
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 (contributions – expenses + account earnings) into.
4
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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 Health
Statement.
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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24
Explanation of Benefits (EOBs)
You may notice some changes on your EOBs beginning late 2011. You will see more information on:– Appeal rights– Consumer assistance
programs
What’s more 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
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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 care and reimburse yourself later from your HSA
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
27
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 HSA Plan Works
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30
*From www.healthcarelane.com
How the HAS Plan Works
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31
$2,500Annual
deductible
$4,500Out-of-pocket
maximum
80%/20%network
coinsurance
100%network coverage
Employer deposits $2,000 in HSAChris deposits $1,000 in HSA
*From www.healthcarelane.com
How the HSA 2500 Plan Works
Chris chooses the HSA Plan for himself because:• No cost monthly premiums• His employer is contributing $2,000 • Chance to use HSA to save for future expenses
Here is what Chris’s plan looks like:
Cheryl is a fictitious person used to illustrate UnitedHealthcare products.
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32
$2,500Annual
deductible
$4,500Out-of-pocket
maximum
$2,600$3,000 in HSA
*From www.healthcarelane.com
How the HSA 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 $2,600 in his HSA!
Paid 100% by plan
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$2,5000Annual
deductible
$4,500Out-of-pocket
maximum
District funds $2,000 in HSA
*From www.healthcarelane.com
How the HSA 2500 Works
80%/20%network
coinsurance
100%network coverage
Jane chooses the 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:
Chris is a fictitious person used to illustrate UnitedHealthcare products.
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34
$2,500Annual
deductible
$4,500Out-of-pocket
maximum
Reaches deductible 80%/20% 100%
*From www.healthcarelane.com
How the HSA Works
Emergency surgery $100,000
6 Doctor visits $1,000
11 Prescriptions $1,000
Total actual cost $102,000
Jane uses HSA to meet a portion of her deductibleRemaining bill $100,000
Insurance pays (80%) $80,000Jane to pay (20%) $20,000
But she pays only $2,500 to get to her $4,500 maximum.
All other expenses are covered 100% for the rest of the year
Jane pays $2,500District deposits $2,000 in HSA
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35
Jane compares plans…
Medical Plan 104 HSA 1500 HSA $2500
Member costs
District Funded HSA Pays $0 $1,200 $2,000
Member Deductible $500 $1,500 $2,500
Out of Pocket Maximum $1,750 $3,000 $4,500
Copays $900 $0 $0
Premium $0 $0 $0
Total Member Pays $3,150 $1,800 $2,500
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Wellness Tools
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37
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
38Proprietary 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:
39Proprietary 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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40
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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41
Treatment Cost Estimator
SOURCE: UnitedHealthcare service data, April 2010
• Designed to calculate and compares cost differences for treatments between providers, locations and facility types, including both plan and member expenses for each treatment
Includes treatment costs for: ~ 116 diseases/conditions ~ 90 surgeries/procedures~ 500+ individual services ~ 3,000+ medications
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
42
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
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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.
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45
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
46Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Get Health4Me and DocGPS® App Today!
• Uses Google® Maps
• Search based on your location
• Download for iPhone®, BlackBerry® and Droid phones®
Find network doctors with our new mobile phone app
Google Android is a trademark of Google, Inc.iPhone is a registered trademark of Apple, Inc.BlackBerry is a registered trademark of Research in Motion LimitedDroid is a registered trademark of Lucasfilms Ltd.
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47
Explore Health Care Lane Today!
A fun and interactive way to learn about health insurance
healthcarelane.com/VSEBT
QUESTIONS?