Waco ISD 2013 Open Enrollment

GHC24354 02/12

1. 2013 Medical Benefits

2. Vision Plan

3. Humana Resources

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Agenda

2013 Medical Plans

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Humana NPOS HDHP with HSACoverage In-NetworkCo-insuranceOut of Pocket Max*Out of Pocket Max includes Deductibles

80%$5,950 Individual$11,900 Family

Deductibles $4,000 Individual$8,000 Family

Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screenings

100% No deductible

Physician ServicesPrimary Care PhysicianSpecialists

80% after deductible and $40 copay80% after deductible and $55 copay

Hospital ServicesInpatientOutpatient

80% after deductible80% after deductible

Emergency Room 80% after deductible and $250 Copay

Urgent Care 80% after deductible and $100 Copay

How the High Deductible Health Plan works

• The High Deductible Health Plan has two key components:– Integrated deductible: medical and prescription costs apply to the same

deductible– Coinsurance: once the deductible is met, the plan pays coinsurance – a

percentage of your health care costs• Other High Deductible Health Plan features:

– For family coverage, costs for all covered members apply to same aggregate deductible

– Includes coverage for preventive care services at no cost regardless of whether the deductible is met

• A Health Savings Account, or HSA, is a financial account used to pay for qualified medical expenses.

• HSAs combine the benefits of both traditional and Roth 401(k)s and IRAs for medical expenses.

• Taxpayers receive a 100% income tax deduction on annual contributions, they may withdraw HSA funds tax-free to reimburse themselves for qualified medical expenses, and they may defer taking such reimbursements indefinitely without penalties.

• HSAs are unique—“IRAs on Steroids”—with triple tax advantages:– Tax-deductible contributions– Tax-free accumulation of interest and dividends tax-free, and– Tax-free distributions for qualified medical expenses.

• 2013 Max Contribution: Individual $3250 / Family $6450

• Catch up Contribution (if age 55 or older) additional $1000 per year

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Background on Health Savings Accounts

Contributing money to an HSA

• It’s a fund you can use to cover your qualified healthcare costs• Humana oversees the administration of both your plan and the HSA, which is

managed by our partner bank, UMB• Receive a Humana Access card to use as payment for qualified expenses• You, your employer, and anyone else can contribute to your account• Once money goes into the account, it’s yours forever• Unused money carries over from year to year (unlike FSA - use it or lose it)• If you leave your current employer, HSA funds can stay in the same account or roll into

another HAS• HSA contributions are credited to account monthly, not lump sum at beginning of year

like an FSA• IRS Rule - You cannot contribute to an HSA unless you are enrolled in an HDHP* Please refer to IRS.gov or your Humana enrollment packet for detailed tax and HDHP/HSA information.

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Humana NPOS 70/50 Copay PlanCoverage In-NetworkCo-insuranceOut of Pocket Max*Out of Pocket Max calculates separately and does not include Copays/Deductibles

70%$5,000 Individual$10,000 Family

Deductibles $8,000 Individual$16,000 Family

Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits /MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screenings

100% No deductible

Physician ServicesPrimary Care PhysicianSpecialists

100% after $50 copay100% after $100 copay

Hospital ServicesInpatient / Outpatient 70% after deductible

Emergency Room 70% after deductible

Urgent Care 100% after $50 Copay at a Concentra Facility70% after deductible for non-Concentra Facility

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Humana NPOS Simplicity PlanCopays Only – No Deductibles or Coinsurance!

Coverage In-NetworkCopay / Out of Pocket Maximum $6000 Individual / $12,000 Family

Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screeningsPhysician Services for inpatient/outpatient hospital, emergency and surgical (Facility Charges subject to separate copay)

$0 Copay

Office Visits/Urgent CarePrimary Care PhysicianConvenient Care ClinicConcentra Urgent Care FacilitySpecialists/Other Specialist Office VisitsChiropractic care, physical, occupational, cognitive, speech and audiology therapy (visit limitations apply)Urgent Care at NON- Concentra Facility

$50 Copay per visit

$100 Copay per visit

$125 Copay per visit

Inpatient Hospital StaysOutpatient Surgical Services (Facility)Emergency Room

$1500 Copay per day for the first 3 days$1500 Copay per visit$600 Copay per visit

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Humana NPOS 80/50 Copay PlanCoverage In-NetworkCo-insuranceOut of Pocket Maximum*Out of Pocket Max calculates separately and does not include Copays/Deductibles

80%$5,000 Individual$10,000 Family

Deductibles $2,500 Individual$5,000 Family

Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screenings

100% No deductible

Physician ServicesPrimary Care PhysicianSpecialists

100% after $30 copay100% after $45 copay

Hospital ServicesInpatient / Outpatient 80% after deductible

Emergency Room 100% after $150 copay

Urgent Care 100% after $30 Copay at a Concentra Facility100% after $75 non-Concentra Facility

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Pharmacy BenefitsPlan Coverage

NPOS 80/50 HDHP with HSA

NPOS 70/50 Copay PlanSimplicity PlanNPOS 80/50 Copay Plan

RX4 Copay After DeductibleLevel 1 - $10 Level 2 - $40Level 3 - $70Level 4 – 25%

RX4 Level 1 - $10 Level 2 - $40Level 3 - $70Level 4 – 25%

Right Source Mail Order RX 2.5 Copays for 3 Month Supply

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Women’s Preventive Care Updates for 2013

Coverage In-NetworkContraceptive methods and counseling includes :

All FDA approved contraceptive methods, sterilization including vasectomies, and patient education and counseling.

Prescription is required, includes over the counter contraceptives

*Brand name contraceptives are covered at 100% only when no generic alternative is available in that class/category

Breastfeeding support, supplies and counseling to include costs for renting breastfeeding equipment

Covered at 100% in network only

Vision Plan Automatically included to ALL Waco ISD Humana medical members at no additional cost!

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Pharmacy Tools

Access RightSource Rx registration and maintenance information

Compare drug costs and view alternative medications

View prior authorization requirements

Locate local pharmacies

Maximize your benefit

Physician Finder

• Go to www.humana.com

• Under Resources and & Support tab, click on “Find a Doctor”

• Under Type of Coverage, ensure Employer Group Plan is selected, input zip code

• For network, please select National Point of Service- Open Access

• Agree to terms, select parameters and go!

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Concentra in Waco Save Money on Urgent Care

Humana Vitality

Comprehensive wellness program

Integrates rewards with health and wellness

Provides the tools and support necessary to help Humana members live healthier lives.

Humana Vitality members rewarded for making healthier choices, i.e. attending preventive screenings, exercising regularly and quitting smoking.

Clinical Program available for Humana Members

Programs available:

Asthma

Diabetes

Heart Disease

Pregnancy

Renal Failure

Ask a Humana representative today about getting involved in these programs

Get Engaged: Member Communications

Humana will be reaching out to members using various communication methods:

Phone Calls directly to member’s homes Email communication regarding preventive reminders, clinical programs available, etc.Plan Professor NewslettersMember Welcome GuideMaximize your benefit Smart EOB

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Questions