© 2008 UnitedHealthcare Simple Health plan benefits you can understand. Glendale Elementary School...
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Transcript of © 2008 UnitedHealthcare Simple Health plan benefits you can understand. Glendale Elementary School...
© 2008 UnitedHealthcare
Simple Health plan benefits you can understand.
Glendale Elementary School District #40July 1, 2011
© 2008 UnitedHealthcare
What We Will Cover Today
Medical Plan Options • Choice Plus Plan 104• HSA 2500 • Choice Plus Plan 003 (membership is frozen effective 7/1/11)
UHC Tools and Resources
3
Changes effective July 1st• UHC Vision is no longer bundled with medical coverage (a separate election for
voluntary vision will need to be made)
• Plan 003 membership is frozen. Employees currently enrolled are grandfathered and can continue to be enrolled in the plan)
• In-Network Preventative Care covered at 100% on all plans
• No lifetime limits on benefits
• No coverage difference between network and non-network facilities in an emergency
• Dependents are eligible up to age 26 whether married or unmarried (May not be eligible if they are able to enroll in their own employer sponsored plan )
4
Out-of Network Benefits
• Non-network care now covered at 50% on all plan offerings with a separate higher deductible and coinsurance
• Non-network providers are free to set their prices
• In addition to your non-network deductible and coinsurance you are required to pay the total amount over the allowed charges (Allowed charges are 110% of Medicare’s fee schedule)
• You may receive a check from UHC for the covered portion and you will need to forward this payment to the provider
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
5
Your Medical Benefits at a Glance Choice Plus 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-payment 50% After deductible
Emergency room services $ 100 co-payment $ 100 co-payment
Inpatient hospital stay
20% after $500 deductible, out-of-pocket max $1,750
per person/Cal. Year
(Deductible does not apply to OOP max)
50% after $750 deductible, out-of-pocket max $3750
per person/Cal. Year
(Deductible does not apply to OOP max)
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
6
Your Medical Benefits at a Glance Choice Plus Plan 003
Type of coverage Network benefit Non-network benefitPhysician’s office services $ 20 co-payment 50% After deductible
Specialist office visit $ 20 co-payment 50% After deductible
Urgent Care center services $ 50 co-payment 50% After deductible
Emergency room services $ 100 co-payment $ 100 co-payment
Inpatient hospital stay
$250 copay per hospital stay
Out-of-pocket max $2,000 per person/Cal. Year
(Outpatient services subject to $250 deductible and 10%
coinsurance)
(Deductible does not apply to OOP max)
50% after $1,000 deductible, out-of-pocket
max $3,000 per person/Cal. Year
(Deductible does not apply to OOP max)
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
7
Retail Mail order
Tier 1 $10 Co-pay31-Day Supply
$25 Co-pay90-Day Supply
Tier 2 $ 20 Co-pay31-Day Supply
$50 Co-pay90-Day Supply
Tier 3 $40 Co-pay31-Day Supply
$100 Co-pay90-Day Supply
Traditional Plan Pharmacy Benefit
© 2008 UnitedHealthcare
Three key issues experts agree on
1. People are removed from the true cost of health care
2. Health care costs are skyrocketing
3. There’s a need to save for future health care costs
Solution…
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
9
A High Deductible Health Plan with a Health Savings Account provides you:
• More choices • More control • Dedicated support to help you
Lower your costs Improve your health Save for the future
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.10
Health Savings Account (HSA) Plan
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
11
HSA Plan Components
Medical Plan Health Savings Account
• Network and non-network coverage• Annual deductible• Protection from high out-of-pocket costs•100 percent preventive care• No copayments
• Your personal bank account• Take it with you if you leave your job• Triple-tax benefits• Use it for medical & pharmacy bills• No “use it or lose it” rule
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
12
About the HSA Plans
Health Coverage
HSA AnnualDeductible
Pre
ven
tive
Ca
re
•Preventive care covered 100 percent by your employer
With an HSA you can:• Deposit dollars• Grow your savings• Save on taxes• Pay for health care now or later
Medical plan pays (coinsurance)
Tools and resources • Available via telephone or Web• Health coaches• Cost/Quality comparisons
• Must be satisfied before health coverage begins• Preventive care not subject to deductible
Out-of-pocket maximum• Protects you from
high costs• Gives you peace of mind
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
13
About the HDHP $2500/HSA Plan
AnnualDeductible
$2,500
Max HSA contribution$3,050
Pre
ve
nti
ve
Ca
re:
100%
Employee Only Employee + 1 or more
DistrictContribution
$2,000
Family AnnualDeductible
$5,000
(Individual deductible
$2,500)
Max HSA Contribution:
$6,150
Pre
ve
nti
ve
Ca
re:
100%
DistrictContribution
$2,000
Health CoveragePlan pays 80% $4,500 Out-of-
Pocket maximum
Health CoveragePlan pays 80%$9,000 Out-of-Pocket family
maximum
(Individual OOP max $4,500)
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
14
Retail Mail order
Tier 1 $10 Copayment31-Day Supply
$25 Copayment90-Day Supply
Tier 2$30 Copayment31-Day Supply $75 Copayment
90-Day Supply
Tier 3 $50 Copayment31-Day Supply
$125 Copayment90-Day Supply
HSA Pharmacy Benefits – Members are subject to their Medical/Pharmacy deductible before copay’s apply. Medications listed on Preventative Drug List are subject to copays.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
15
To open and contribute to an HSA you must:
• Be covered by high-deductible health plan (HDHP) • Not covered by other non-HDHP health insurance • Not enrolled in Medicare or TRICARE
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
16
Contributing to the HSA
• For 2011, you can contribute up to the IRS maximum of: – $3,050 (single) – $6,150 (family)
• Age 55 and older, “catch-up” contributions of $1,000• Contributions may be made via:
– Payroll deduction (pre-taxed)– Direct to OptumHealth Bank by check or on
myuhc.com
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
17
How it works – ChristopherHis reasons for selecting the HDHP $2500 with HSA Plan were:
• Opportunity to save on taxes and save for future health care expenses
• Preventive care and preventive medications covered 100 percent
Annual deductible: $2,500District funds HSA: $2,000Maximum HSA contribution: $3,050
Health coverage (network):20 percentOut-of-pocket maximum: $4,500
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
18
Christopher – Year One $2,500 Deductible Plan
Preventive care $ 250
Non-preventive
1 Urgent Care visit $ 200
2 Prescriptions 75
$ 275
HSA pays $ 275
Remains in HSAfor Year Two $ 2,225
Chris funds his HSA $ 500
District funds HSA $ 2,000
Member pays $ 0
Health Coverage20% coinsurance
$4,500 out-of-pocket max
AnnualDeductible
$2,500
Pre
ven
tive
Ca
re:
100%
HSAHSA
$2,500
$275$275 $25
0
Note: Assumes all network care – different coinsurance levels on non-network care apply.
HSA pays $275
Remains in HSA$2,225
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
19
Christopher – Year Two$2,500 Deductible Plan
Preventive care $ 275
Non-preventive
3 Physician Visits $ 350
4 Prescriptions 225
$ 575
HSA pays $ 575
Remains in HSAfor Year Three $ 4,150
HSA funds from year 1 $ 2,225
Chris Funds his HSA $ 500
District Funds HSA $ 2,000
Total $ 4,725
Member pays $ 0
Health Coverage80% coinsurance
$4,500 out-of-pocket max
AnnualDeductible
$2,500
Pre
ven
tive
Ca
re:
100%
HSA
HSA$4,725
$575$575 $27
5
Note: Assumes all network care – different coinsurance levels on non-network care apply.
HSA pays $575
Remains in HSA$4,150
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
20
How it works – Jane
Her reasons for selecting the HDHP $2,500 with HSA Plan were:• No upfront cost for preventive care visits• Free preventive medications, list of 2010 Core List of
Preventive Medications
Annual deductible: $2,500District funds HSA: $2,000Maximum HSA contribution: $3,050
Health coverage (network):20 percentOut-of-pocket maximum: $4,500
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
21
Jane – Year One$2500 Deductible Plan
Preventive Care $ 250
Non-Preventive1 ER Visit $ 2,250Hospitalization 28,0504 Physician’s visits 70011 Prescriptions 1,500
$ 32,500
HSA Pays Deductible $ 2,500
Remaining Amount: $ 30,000Coinsurance @ 20% $ 6,000But out of pocket is: $ 4,500
Jane Funds her HSA $ 500
District Funds HSA $ 2,000Health Coverage80% coinsurance
$4,500 out-of-pocket max
AnnualDeductible
$1,500
Pre
ven
tive
Ca
re:
100%
HSAHSA$2,500
$32,500
$2,500 deductible paid
by HSA $250
$2,000 Coinsurance
$28,000 paid by Health Plan
So Jane pays: $ 2,500Health Plan pays: 30,000
So only $2,500 comes out of Jane’s pocket on a $32,500 bill.
Note: Assumes all network care – different coinsurance levels on non-network careapply.
HSA$0
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
22
Jane compares plans…
Base Plan 104 Plan 003 HSA 2,500
Member costs
District Funded HSA Pays $0 $0 $2,000
Member Deductible $500 $0 $2,500
Out of Pocket Cost $1,750 $0 $4,500
Copays $830 $1,020 $0
Premium $0 $2,051 $0
Total Member Pays $3,080 $3,071 $2,500
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
23
The HSA payment process
1 43
Present ID card
to doctor.
1
Doctor sends
claim to
UnitedHealthcare
2
If you owe payment
as part of your
deductible, your
provider will bill
you the discounted
amounts for the
services provided.
3a
When you have
claim activity, you
will receive a Health
Statement.
4
If you have
satisfied your
deductible, Health
Coverage will pay
the provider. The
provider will bill
you for your
portion.
3b
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
24
OptumHealth BankSM
• A leader in health care banking and HSAs • Member FDIC • A UnitedHealth Group company
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
25
Easy access to funds• Use at the point of service
(doctor’s office, pharmacy)• Can withdraw cash at
ATM where MasterCardis accepted*
• Can ask for additional cards for covered family members
• Free online bill pay• Checks (optional, $10 for
25 checks)
OptumHealth BankSM
*Access fees may also be charged by ATM owner.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
26
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
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
27
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
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
28
Our large national network
Your doctor is likely already in our network.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
29
UnitedHealth Premium designation program• Doctors and cardiac
facilities that follow medical guidelines
• Compare quality and costs of health care facilities
• Look for the stars when you search for a physician
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
30
Pharmacy Resources on myuhc.com
• Find brand-name and generic medications• Compare costs of medications• Locate over 60,000 pharmacies nationwide• Order and refill prescriptions
– 30-day– 90-day mail order myuhc.com
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
31
Treatment Cost Estimator
• Provides cost estimates for specific treatments and procedures based on selected physician’s costs
• Helps you understand the cost of treatment
• Allows you to plan in advance of your health care need
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
32
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
myuhc.com
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
33
Healthy Pregnancy program
• Get support through every stage of pregnancy and delivery
• Nurses available, toll-free, 24/7• Personalized pregnancy assessment• Free pregnancy book and healthy baby bag• Discount on PJ’s Comfort
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
34
Get DocGPSTM today!Find network doctors with our new mobile phone app
• Uses GoogleTM Maps• Search based on your
location• Download for iPhone,
Blackberry and Droid phones
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
35
Learn more
• Talk with Jodi Finnesy in Human Resources (623) 237-7149 or [email protected]
• Open Enrollment is May 2 to May 31, 2011
© 2008 UnitedHealthcare
Simple Health plan benefits you can understand.
The plans and outcomes given as examples in this presentation may not represent the plans and outcomes available in every state. Talk to a UHC representative to find out benefit and limitation information applicable in your state.
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group. © 2009 United HealthCare Services, Inc.UHCEW439246-000