Colby College Welcome to Open Enrollment Plan year: 1/1/2012-12/31/2012.

Colby CollegeWelcome to Open EnrollmentPlan year: 1/1/2012-12/31/2012

Review of Important Benefits

• Cigna’s Network

• 2012 Medical & Pharmacy Plan Options -Open Access In-Network -Open Access Plus -Choice Fund – Health Savings Account

• Understanding a Health Savings Account• Vision Benefits

• Health and Wellness Resources and Tools

• Customer Service Support

• Questions and Answers

We are easy to work with.

We protect you from the unexpected.

We help you be well and live well.

What does the Open Access Network mean to you?

• You will have access to in-network providers in all 50 States

• You and your dependents can live anywhere in the US

• No need to worry when you travel across the US

• No referrals required for Specialist visits

• Primary Care Physician (PCP) not requiredbut highly suggested – Quarterback for yourhealth care

Same National Network for All Plan Options!

Review of OAPIN – In-Network plan

OAPIN - KEY COMPONENTS

• Deductibles = $250 Individual $500 Family

• Coinsurance after deductible = 10% (Plan pays 90%)

• Out-of-pocket maximum = $1,250 Individual $2,500 Family

• Sick office co-pay = $20 PCP $25 Specialist

• Prescriptions for 30 days = $10 Generic; $30 Cigna preferred; $50 Non-preferred brand 90 day = $20 Generic; $60 Cigna preferred; $100 Non-preferred brand

• Vision = $20 co-pay for routine annual in-network exam every 24 months Out of network vision exam = $45 allowance

IN NETWORK SERVICES ONLY


Review of OAP – In/Out-of-Network Copay Plan

OAP - KEY COMPONENTS

• Deductibles = $500 Individual $1,000 Family

• In-Network Coinsurance after deductible = 20% (Plan pays 80%)

• Out-of-Network Coinsurance after deductible = 40% (Plan pays 60%)

• Out-of-pocket maximum = $1,500 Individual $3,000 Family

• In-Network Sick office co-pay = $20 PCP/Specialist

• Out-Of Network Office Visit = 40% Plan pays (60% after the plan deductible is met)

• Prescriptions for 30 days = $10 Generic; $25 Cigna preferred; $40 Non-preferred brand90 day = $20 Generic; $50 Cigna preferred; $80 Non-preferred brand


6Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

HSA/OAP Coinsurance Plan- KEY COMPONENTS

•In/Out-of-Network Deductibles = $1,500/$3,000 Individual $3,000/$6,000 Family

•In-Network Coinsurance after deductible = 20% (Plan pays 80%)

•Out-of-Network Coinsurance after deductible = 40% (Plan pays 60%)

•In/Out-of-Network Out-of-pocket maximum = $3,000/$6,000 Individual $6,000/$12,000 Family

•In-Network Sick Office Visit Coinsurance after deductible = 20% (Plan pays 80%)

•Out-of-Network Sick Office Visit Coinsurance after deductible = 40% (Plan pays 60%)

•Prescriptions (after deductible) for 30days = 10% Generic; 20% Cigna preferred; 30% Non-preferred brand

90days = 10% Generic; 20% Cigna preferred; 30% Non-preferred brand

•Applicable Preventive Generic and Brand RX covered at 100%, not subject to plan deductible.

Choice Fund Health Savings Account Plan Underlying Medical Plan Open Access Plus



Open AccessPlus – In-Network Copay

Plan

Open AccessPlus –Copay Plan

Cigna Choice Fund with HSA

In-Network Only In-Network Out-of-Network In-Network Out-of-Network

Deductible$250 Individual

$500 Family

$500 Individual

$1,000 Family

$500 Individual

$1,000 Family$1,500 Individual$3,000 Family*

$3,000 Individual$6,000 Family*

Coinsurance after Deductible

Plan pays 90%

after deductiblePlan pays 80% after deductible

Plan pays 60% after deductible



Out-of-pocket maximum

$1,250 Individual

$2,500 Family

$1,500 Individual

$3,000 Family

$1,500 Individual

$3,000 Family

$3,000 Individual

$6,000 Family**

$6,000 Individual

$12,000 Family**

Lifetime maximum Unlimited Unlimited Unlimited

Preventive Care Office Visit

Office Visit

100%

$20 Primary Care Physician Copay /$25 Specialist Copay

100%

$20 Primary Care Physician/$20

Specialist Copay

In-network coverage only


100%


In-network coverage only


HSA contribution by employer

n/a n/a $1,000 Employee Only

$2,000 Employee + Family

How do you help me plan for my medical expenses?Medical plan highlights

Choice Fund with HSA (Cross Accumulation):

*Deductible - If enrolled in a family plan, all family members contribute to the family deductible which must be satisfied before the plan coinsurance applied to any family member’s claims.

**Out-of Pocket Maximum – If enrolled in a family plan, all family members contribute to the family out-of-pocket maximum which must

be satisfied before any family member’s claims are covered at 100%.


Open AccessPlus – In-Network Copay

Plan

Open AccessPlus –Copay Plan

Cigna Choice Fund with HSA

In-Network Only In-Network Out-of-Network In-Network Out-of-Network

Inpatient Hospital/Outpatient Facility Services

Plan pays 90% after plan deductible





Emergency Room/Urgent Care Plan pays 90% after plan

deductiblePlan pays 80% after plan deductible


Lab and radiology Services






Short-Term Rehab

(PT/OT/ST)$20 Primary Care Physician/$25 Specialist per office visit co-pay

$20 per office visit co-pay




Chiropractic Care$20 Primary Care Physician/$25 Specialist per office visit co-pay

$20 per office visit co-pay




How do you help me plan for my medical expenses?Medical plan highlights


Open Access Plus –

In-Network Copay PlanOpen Access Plus-Copay

PlanCigna Choice Fund

with HSA**

In-networkRetail

(30-day supply)

ME Retail/Home Delivery (90-day supply)

Retail(30-day supply)


Retail(30-day supply)


Generic You pay $10 You pay $20 You pay $10 You pay $20

You pay 10% coinsurance,

after plan deductible

You pay 10% coinsurance,

after plan deductible

Cigna-preferred brand

You pay $30 You pay $60 You pay $25 You pay $50

You pay 20% coinsurance, after plan deductible


Non-preferred brand

You pay $50 You pay $100 You pay $40 You pay $80



Out-of-network Not covered Not covered Not covered

**Preventive Drugs covered at 100%, no plan deductibleMedical Conditions include Hypertension, High Cholesterol, Diabetes, Asthma, Osteoporosis, Stroke, Prenatal Nutrient Deficiency.

How do you help me plan for my prescription expenses?Prescription plan highlights

This chart shows the amounts you’ll pay for covered services after your plan deductible has been met.

Make sure you get your preventive care- it’s covered at 100%!

• Some examples• Routine Check-Up• Immunizations• Mammograms• Screenings

• Talk to your primary care physician – what is right for you depends upon your age and whether you’re a male or female –


Karen’s Claim Example on Open Access In-Network Plan

Preventive Care $ 398

ER Visit $2,6004 PCP Visits $ 320Generic Rx (12) $ 288Brand Rx (3) $ 240Medical Expenses $3,448

How Expenses Are PaidPaid by Plan(coinsurance, balance on $2,673 office visits and Rx) Paid by Karen(ded., coins., copays) $ 775Karen’s Premium Contribution ($46x12) $ 552Total AnnualOut of Pocket $1,327

What Karen Paid

$0 copay

$250 deductible; $235 in coinsurance

$ 80 in copays

$120 in copays

$ 90 in copays

$ 775. Total Paid Out of Pocket


Karen’s Claim Example on Open Access Plan


ER Visit $2,600 4 PCP Visits $ 320 Generic Rx (12) $ 288 Brand Rx (3) $ 240Medical Expenses $3,448

How Expenses Are PaidPaid by Plan $2,253 (coinsurance, balance on office visits and Rx)Paid by Karen $1,195 (ded.,coinsurance and copays)Karen’s Premiumcontribution ($40x12) $ 480Total Annual Out of Pocket $1,675

What Karen Paid

$0 copay

$500 Deductible plus $420 coinsurance

$ 80 in copays

$120 in copays

$ 75 in copays

$1,195 Total Paid Out of Pocket


• A tax advantaged health plan that provides coverage for current medical/pharmacy expenses and allows the option to save for future health expenses.

• Combines a Qualified Medical Plan (medical/pharmacy coverage) with a Health Savings Account.

• You, your employer or both can contribute to the Health Savings Account.

• Money deposited into the Health Savings Account is generally not taxable.

• You have the option to invest the money into interest-bearing investment vehicles. Interest on these investments is also not taxable.

What Is a Health Savings Account (HSA) plan?

+ =Qualified Medical Plan

Tax Advantaged HSA Plan


*In/Out-of-Network Coverage Level

How does an HSA work?Individual Family

Ou

t-of-

Pocket

Max

100% after $3000/$6000*

Deductible$1,500/$3000*

HealthCoverage80%/60%*

Pre

ven

tive C

are

10

0%

Ded

ucti

ble

Ou

t-of-

Pocket

Max

100% after $6000/12000*

Deductible$3,000/$6,000*

HealthCoverage80%/60%*

Pre

ven

tive C

are

10

0%

Ded

ucti

ble

Contributions can be used to pay for current year qualified health expenses or saved

to pay for future health expenses

Contribution$1,000 Colby + Employee $

Contribution$2,000 Colby + Employee $


Karen• Single, in her 50s• Heart disease; controlling health through medication• Looking to save money for future health expenses

HSA Deposits by Karen $1500by Employer $1000


ER Visit $2,6004 PCP Visits $ 320Generic Rx (12) $ 288Brand Rx (3) $ 240Medical Expenses $3,448

How Expenses Are PaidPreventive $ 398(100% by Plan)Applied to deductible $1,500 $1948Paid by Plan (80%) $1,558.40Paid by Karen (20%) $ 389.60

*In/Out-of-Network Coverage Level

Ou

t-of-

Pocket

Max

100% after $1,500/$3,000*

Deductible$1,500/3,000*

HealthCoverage80%/60%*P

reven

tive C

are

10

0%

Ded

ucti

ble

Contribution$1,000 Colby + Employee $1500

Total HSA Contribution $2,500.00

What Karen Paid from HSA $1,889.60

Remaining HSA Balance $ 610.40

Paid from Karen’s Fund

Deductible $1,500.00

20% Coinsurance $ 389.60

Karen’s Premium

Contribution ($23 x 12) $ 276.00

Total Annual OOP $2,165*

*Colby contributed $1,000 towards Deductible


Am I eligible to participate in an HSA plan?

Because HSA plans have special tax advantages, the IRS defines specific rules for participation. To be eligible, you:

• Must be enrolled in an IRS-qualified high-deductible medical plan (high-deductible medical plans sold with Cigna’s Choice Fund HSA meet IRS requirements)

• Cannot have any other health coverage • Not covered by spouse’s medical or pharmacy plan• Not covered through Medicare Part A or Part B• Not covered through a general-purpose Flexible Spending Account (FSA) plan

(either employer’s or spouse’s)

• Cannot be claimed as a dependent on another person’s tax return


What is the maximum I can contribute annually to the HSA?

The IRS has set the following limits:

• Under age 55 and not enrolled in Medicare (based on a 12-month period):

2011

• Up to $3,050 individual coverage*

• Up to $6,150 family coverage*

2012• Up to $3,100 individual coverage*• Up to $6,250 family coverage*

• Age 55 or older:

• Maximum contribution increases by $1,000 (considered a “catch-up” contribution)

• Up to $4,100* individual coverage in 2012

• Up to $7,250* family coverage in 2012

• To make the maximum contribution in a calendar year, you must:

• Meet all requirements to be eligible for HSA contributions on January 1

• Remain qualified through December 1

• If these criteria are not met, maximum contribution is prorated = if 1/12 maximum contribution for each month then individual is qualified

*Contributions to your HSA that you receive from your employer and incentives count toward your maximum.

18

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

We’re Here to Help!

1.800.401.4041 24/7 Customer Service

THANK YOU for your time!

Questions?

Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA

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Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA

Helping you be well and live well.

Delivering information that is easy, helpful and fast

• Learning how to set up your HSA• Deciding how and when to use HSA funds• Understanding how claims are paid• Tracking health care expense• Understanding HSA Investment options• Tracking health care expenses• Helpful tools and much more…….


I need help enrolling. How can you help?

• Before opening the account, JPMorgan Chase will: • Verify your identity (required by the Federal government)

using information provided in the HSA application and enrollment form

• Notify you if additional documentation is needed to verify your name, social security number or address

• JPMorgan Chase will send your HSA information and a debit card within 7–10 days of the start of the plan year or the verification of identity (whichever is later)

• ID cards are mailed from Cigna

• Debit cards are mailed separately from JPMorgan Chase

JPMorgan Chase cannot open an HSA until it is able to satisfy the requirements of the Federal government.


How Does Money in the HSA Get Used? Employee decides how and when to use the money.

Four ways to access money in the HSA to pay for qualified medical expenses:

Automatic Claim Forwarding (employee selects at enrollment). In this scenario, CIGNA will automatically pay eligible medical expenses from the employee’s Health Savings Account. This option is not available for behavioral or pharmacy claims.

Checkbook. Employees can use the Choice Fund checks to pay for out-of-pocket expenses (deductibles and coinsurance).

Debit Card. Employees can use the Mastercard® branded debit card to pay for out-of-pocket expenses.

•The card can also be used to get cash at ATMs to reimburse themselves for qualified expenses they paid with other personal funds (e.g., didn’t have debit card/checkbook with them at doctor visit so paid in cash).

Online Bill Pay. Can pay medical expenses directly from HSA. Enables employees to monitor, manage and schedule payments online, anytime. Payments can be scheduled on a one-time or repeating basis.

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Cigna updates quarterly Health Statement; sends email alert or mails to your home, based on preference setting.

Cigna provides an Explanation of Benefits or EOB (“receipt”) showing: Doctor’s fee, Cigna discount, amount billed, amount deducted from the HSA, amount paid to doctor, remaining HSA balance, and what you saved.

Sick visit to an in-network doctor/hospital/facility.

Show Cigna Choice Fund ID card to obtain Cigna discounted rates.

Doctor bills Cigna.

Cigna receives the claim and processes it based on the HSA- qualified plan deductible, covered expenses and Cigna-negotiated discounts.

If Auto Claim Forwarding was elected, Cigna automatically subtracts theamount owed to the doctor from your HSA and pays the doctor.

If no Auto Claim Forwarding in place, you have the option to pay the doctorbill using your HSA (debit card/checkbook) or pay out of pocket.

How are my medical claims paid?Medical claim payment process


Explanation of Benefits (EOB)• Available in print or online at

myCigna.com• Choose if you would like EOBs mailed to

your home, or go paperless and receive email alerts after each claim is processed and posted to myCigna.com

• Clearly shows how and when claims were paid, and by which plan and/or account(s)

Quarterly Health Statement• Available online at myCigna.com• You will be alerted by email after each

statement is posted to myCigna.com • Shows year-to-date deductibles, all

claim activity and out-of-pocket expenses for that quarter

Can you help me understand and track my health care expenses?


What Are My HSA Investment Options?

• $2,000 minimum in HSA to invest

• Once the investment account is open, no minimum balance applies

• Eight mutual funds from which to choose

• Investments can be allocated into one fund or multiple funds

• No minimum deposit for any fund

• Tax-free growth of interest or investment earnings

• Monthly fees apply

• Online trading – no fees apply

• Track your balance online or with convenient monthly statements


How can you save me time?

• No claim forms needed when you receive care from in-network participating health care professionals and facilities

• 24/7 online and phone assistance to find doctors, specialists, hospitals, labs and pharmacies close to home or when you are traveling

• Talk to a trained nurse for information when you can’t reach your doctor – day or night

• Self-service through myCigna.com lets you:

• Print forms or print/order ID cards

• Check your coverage

• Track claims, payments and deductibles

• View, print and download your Explanation of Benefits and health statements

• Access articles and health education resources, and sign up for online coaching programs

• Keep track of your health history and records with a secure online database

• Award-winning decision support tools

• Learn about common health problems and options for treatment

• Find doctors, hospitals, specialists and labs

• Compare treatment and procedure costs

• Switch a prescription to Cigna Home Delivery Pharmacy with one easy phone call and have your medications delivered to your door

My life is busy. How do you help me understand and track my health care expenses?

24/7 Online Health Account Management

• Personalized and secure online account tool

• Review plan coverage levels

• Track claims and payments

• Pay providers online via Quicken Health Expense Tracker

• Order an ID Card

• Research Prescription Alternatives

• Review personalized plan coverage

• Check available balances• Track claims and

payments• Get HSA bank account

information• Manage investment

accounts via link to JPMorgan Chase

At-A-Glance

Account Summary

My life is busy. How do you help me understand and track my health care expenses?

24/7 Online Health Account Management

29

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

Compare Pharmacy Pricing on myCIGNA.com

Pharmacy Plan – Prescription Drug Price Quotes

Features• Learn actual

prices you’ll pay

• Compare costbetween retail pharmacies and CIGNA Tel-Drug home delivery

• See cost for generic equivalent, if available


Health Care Reform Impacts on HSAs

Dependent Coverage – 9/23/2010• With the extension of dependent coverage to age 26, you can add your dependents to the

medical plan; however, the change in legislation did not extend to the use of the HSA. If you list a dependent on your Federal income tax return, money in your HSA may be used for eligible expenses for that dependent.

Over-the-Counter Drugs – 1/1/2011• Purchases of most over-the-counter drugs and medicines on or after January 1, 2011 cannot be

reimbursed without a doctor’s prescription and store receipt • Some eligible items, such as insulin, and diabetic and first-aid supplies, will not require a

prescription • You should keep a copy of the prescription and receipt for tax purposes • You may use the same prescription to buy a specific medicine for up to 12 months (this rule may

change if government regulations change)

IRS Penalty increase on HSAs – 1/1/2011• The tax penalties on HSA distributions that are not used for qualified expenses will increase from

10% to 20% of the amount used• HSA funds can only be used for eligible expenses of tax dependents – even if an adult

dependent is covered by the health plan, if that dependent is not claimed as a tax dependent, any expenses paid by the HSA will be subject to tax penalties


2012 Open Access Plus – In Network

Vision Plan Highlights

In Network Coverage

Out of Network Reimbursement Frequency Calendar Year

Exam Copay $20 N/A

Exam allowance Covered in Full $45 allowance 24 months

In-Network Coverage Includes

One preventive vision and eye health evaluation including but not limited to eye health examination, dilation, refraction, and prescription for glasses.

Vision Network Savings Program

Minimum 20% savings on additional purchases of frames and/or lenses, including lens options, with a valid prescription; offered savings does not apply to contact lens materials. Check with your CIGNA Vision Network eye care professional for details.


Open Access In-Network Plan Claim Examples

Outpatient Day Surgery – Inland Hospital

Submitted charges $4,500.

CIGNA Network Discount $1,100.

$3,400.

Deductible Not Met, applied $ 250. Member paid

$3,150.

90% coinsurance applied $2,835. CIGNA paid

10% coinsurance applied $ 315. Member paid

Total member responsibility $ 565 `

Member has met $565. of their out of pocket maximum for the calendar year, with a remaining

balance of $685. Once the $685 has been met, all future Inpatient/Outpatient services will be

covered at 100%.

Outpatient Xray – EMMC

Submitted charges $ 675.

CIGNA Network Discount $ 105.

$ 570.

Deductible not met $ 250. Member Paid

$ 320.

90% coinsurance applied $ 288. CIGNA paid

10% coinsurance $ 32. Member paid

Total member responsibility $ 282.

Questions

Colby College Welcome to Open Enrollment Plan year: 1/1/2012-12/31/2012.

Documents

Transcript of Colby College Welcome to Open Enrollment Plan year: 1/1/2012-12/31/2012.