Grant County HRA 2012 - Final Online

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2012 HRA Health Insurance Presentation Grant County

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Agenda Introduce HRA Timing and Deadlines Post Employment Benefits 1 2 3 4 5 6 7 Rollover Accounts Flex Accounts How the Plan Works Claims Process These are summaries of coverage. The master contact and policyholder certificate should be used for the determination of actual benefits.

Factors of Health Care Costs: 

Demographics – Gender and age Medical Trend - Expense plus Federal and State Mandated coverage. Medical and RX usage – Only factor you can control . To have long-term positive effect on utilization – there is a need to change medical behavior; a part of this may be accomplished with plan design and incentives. Factors of Health Care Costs

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Same Carriers\Same Providers Dean and Medical Associates Same Medical Services If the service was covered before its covered now. Same Prescription (RX) Medicines If the RX was covered before its covered now. Its the same underlying plan. What stays the same?

What Does Change?: 

Implementation of a Health Reimbursement Arrangement (HRA) Addition of Employee Deductible Elimination of Office Visit Copay Increase in Prescription Drug Copays ($10\$30) Health Care Reform – Added Preventive Services. What Does Change?

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Deductible Example Definition A deductible is the amount you pay out of your own pocket before your insurance begins picking up any of the costs of health care. You have a $500 deductible per person. That means you’ll pay the first $ 500 this year, regardless of whether the first office visit costs that much or you make ten visits at $50 per visit .

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What is Included in Deductible? What is not? Ambulance Services Durable Medical Goods Chiropractic Visits Also Included 1 Included Services performed by Out of Network Providers without referral. Non Covered Services (Dental, Ortho, cosmetic surgery, etc) Prescription Drugs Preventive Care NOT Included Office Visits Inpatient and Outpatient Services Same Day Surgery Lab and X-Rays Urgent Care\ER Maternity 3 2

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Affordable Care Act (Health Care Reform) Preventive Care 1 Preventive services must be covered without you having to pay a copayment or meet your deductible. How does if effect me? www.healthcare.gov How do I find what is covered? 3 It is the consumers responsibility to understand what services are covered. Consumer Responsibility A partial list of covered services: Baby Wellness Adult Physical Exam Routine Mammogram Routine Eye Exam Covered Services for Pregnant Women Recommended Immunizations Colorectal Cancer screening for adults over 50 2

Preventive Care: 

If you are sick, bleeding, hurt and\or have symptoms and visit the doctor…it is not preventive. If you are receiving treatment and go for a scheduled appointment or schedule an appointment …it is not preventive. CDL license ….it is not preventative. If you do a routine eye exam and need refraction to get corrective lenses\contacts…the refraction is not preventive. If you have a Colonoscopy and they find an issue and do a surgical procedure….this is no longer preventive. (Dean) Services are provided based on age and various factors!! Preventive Care What is not covered!

How does the HRA plan work- Active Employees?: 

How does the HRA plan work- Active Employees?

How does the HRA plan work?: 

How does the HRA plan work?

Single Person Example: 

Joe , a single employee has $8,500 in medical claims in a plan year. Joe is responsible for the first $500. Grant County would pay the next $1,500 and the insurance pays the remaining $6,500. Single Person Example

Family Unit HRA Example: 

Deb , is married with 2 children, and has medical claims as follows: Deb : $1300 Tom : $ 250 Child 1: $3500 Child 2: $0 Total Family Claims - $5,050 Deb would be responsible for a maximum deductible of $500 per person, and a family maximum of $1,000. Therefore, Deb pays $1000, Grant County pays $3,000, and the insurance pays the remaining $1,050. Family Unit HRA Example Includes Employee\Spouse and Employee\Child( ren )

Family Unit HRA Example: 

Deb , is married with 2 children, and has medical claims as follows: Deb : $1300 Tom : $ 250 Child 1: $ 3500 $0 Child 2: $0 Total Family Claims - $1,550 Deb would be responsible for a maximum deductible of $500 per person, and a family maximum of $1,000. Therefore, Deb pays $?????, Grant County pays $?????, and the insurance pays the remaining $?????. Family Unit HRA Example Includes Employee\Spouse and Employee\Child( ren )

Family Unit HRA Example: 

Deb , is married with 2 children, and has medical claims as follows: Deb : $1300 Tom : $ 250 Child 1: $ 3500 $0 Child 2: $0 $ 500 + $250 = $750 Total Family Claims - $1,550 Deb would be responsible for a maximum deductible of $500 per person, and a family maximum of $1,000. Therefore, Deb pays $750, Grant County pays $800, and the insurance pays the remaining $0. Family Unit HRA Example Includes Employee\Spouse and Employee\Child( ren )

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Third Party Administrator (TPA) Example Definition is an organization that processes insurance claims for a separate entity. TPAs handle many aspects of other employee benefit plans such as the processing of retirement plans and flexible spending accounts .

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Explanation of Benefits (EOB) Includes Definition is a statement sent by a health insurance company or TPA to covered individuals (members) explaining what medical treatment and/or services were paid for on their behalf. The service performed, the date of the service, the description and/or insurer's code for the service, the name of the person or place that provided the service, and the name of the patient, etc. THIS IS NOT A BILL!

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Provider sends claim to Dean and they mail an Explanation of Benefit ( EOB) to your home – this is not a bill! Dean will automatically (No paperwork for employee) forward this claim to their Third Party Administrator – Employee Benefits Corporation (EBC), who will “direct deposit” any monies due in your bank account. You are responsible to pay the entire bill. Single - $500 of your money and $1500 max of county money. Double for family . Process of Claims Dean Health Employee receives a provider bill and pays it in full. Claim is sent to TPA and Check is deposited Claim is sent to Dean - You will Receive a Dean EOB Visit the Doctor and present ID Card

Dean EOB: 

Dean EOB

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Provider sends claim to Medical Associates and they mail a Explanation of Benefit ( EOB) to your home – This is not a bill! MA will automatically (No paperwork for employee) forward this claim to their Third Party Administrator – Health Choices which will pay the provider directly (minus your deductible) and send you an additional Health Choices EOB. The provider will deduct the HRA money received from your employer and you are responsible to pay the entire bill you receive. On occasion , these will pass in the mail. No worries…wait and you will receive a corrected bill from the provider OR call Medical Associates member services. Process of Claims Medical Associates (MA) Employee receives a provider bill and pays it in full. Claim is sent to TPA and EOB is sent Claim is sent to MA - You will Receive a MA EOB Visit the Doctor and present ID Card

Medical Associates EOB: 

Medical Associates EOB

Health Choices EOB: 

Health Choices EOB

Company Websites : 

Company Websites

Rollover Account: 

Rollover Account Grant County wants to reward employees who make wise health related decisions and who focus on fitness\wellness. Singles – The County will rollover to the employee any unused county HRA money from $501-$1000 that they do not utilize. Families - The County will rollover to the employee any unused county HRA money from $1001-$2000 that it does not utilize.

How does the HRA plan work?: 

How does the HRA plan work?

Rollover Example – Single Person: 

Rollover Example – Single Person Jill , a single person, has only $400 of medical claims for the year. Jill pays the first $400 and Grant County pays no money from the HRA funds . Jill would get $500 rolled over into her account for future expenses. This $500 rollover is available the next plan year to pay for any deductible incurred. No maximum on how big your account can grow.

Rollover Example – Family Unit: 

Rollover Example – Family Unit Dan , a married employee has $ 1,900 of medical claims for the year. Dan pays the first $1,000 and Grant County pays $900 from the HRA funds. The county would rollover $100 ($1,000 – $900 ) for Dan. Includes Employee\Spouse and Employee\Child( ren )

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Determine Rollover Status - Single or Family (Employee Spouse and Employee child are considered Family) If you are not on the county offered health insurance as of September 1 st – You are not eligible for rollover that year. You need to be an employee of the county as of January 1 st . Rollover calculation will take place after April 1 st to allow for run out of claims. County Criteria for elgibility Determination of Rollover April 1, 2013 Rollover Calculations after runout Jan 1st, 2013 Status of Employement Sept 1, 2012 Status of Health Care Election Visit the Doctor and present ID Card

EBC Flex Plan: 

EBC Flex Plan Grant County will now pay for all of the annual and monthly administration fees. Annually, employee elects money to be taken out of each payroll check on a pretax basis. Money can be used to pay for health deductibles, RX copays, dental and vision expenses, etc. as defined by the IRS. Entire election is available January 1 st . IRS RULE - USE IT OR LOSE IT = Employee must use elected money by end of calendar year or they lose it. May also elect up to $5000 per year for dependent coverage. Can only use money as it is withdrawn from paychecks ($100 a month election = $100 a month for claims). Unlike HRA – employee must complete paperwork and present receipts. Online website (EBC) to show status of claims, balances, etc.

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EBC Flex Accounts This is a “Use it or Lose it” contract. You must use your elected money during the plan year or you “lose it”. Get reimbursed with Pretax dollars. Submit paperwork and receipts to TPA Pay medical, dental, vision, RX, etc. bills. Make an Annual Pretax Election.

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Employee knows they will have to following: $ 500 in medical expenses Two generic prescriptions ($ 4 each per month ($4x2)x12) One brand name prescription ($30 x 12) Total annual planned expenses = $956 . At an assumed 23% tax savings = $219 Saving using flex. Flex Example of Savings

Post Employment\Retirement Benefits: 

Post Employment\Retirement Benefits COBRA – If you elect COBRA you will continue to utilize the HRA. Your deductible does not change and you are eligible for the HRA funds but not for the Rollover. Retirees\Board Members – Retirees and board members will be on the current HRA plan but will be responsible for the full deductible ($2000\$4000). Post Retirement Rollover Benefits - (2013 and beyond) Eligible when an employee terminates employment for any reason OR is an active employee no longer on the County offered health insurance and has a balance above $100 in their rollover account. Rollover money may be used for all IRS qualified expenses (same as Flex), as well as, Medicare supplements until the balance reaches $100. In the event of an employees death, the rollover money may be used by the spouse or dependent for qualified expenses or will be turned over to the estate.

Meeting in a Minute: 

Meeting in a Minute Health Plans – Underlying health plans are identical to current plans - same carriers, doctors, services and prescription drugs. YOUR Deductible – Active Employee - $500 for a single & $1000 for a family unit for the year. That is the most you will pay for medical bills per year. Retirees\Board members $2000\$4000. Preventive Care – It is your responsibility to understand what is and what is not included. HRA Claims – Active Employee - $1500 for a single & $3000 for a family unit – The County provides funding for these claims. Dean subscribers need to pay the bills up to the $2000\$4000 deductible. RX – Same underlying plan. Increase in copays. ($10 Generic\$30 Brand) Flex – County paying ALL administrative fees - consider using this program to reduce out of pocket expenses by using pre-tax dollars. Save 15-28%. This is a once a year election. Use it or Lose it. Rollover – Eligible in 2013 and beyond.

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Timelines and Deadlines 3 By November 30 th , 2011 at 4:30! All Paperwork must be to Grant County Human Resources Makes changes to the Health insurance carrier (Dean, Medical Associates or waive.), add dependents, add or modify dental coverage and make EBC Flex elections. Month of November is Open Enrollment 1 Must complete a EBC direct deposit slip for HRA reimbursements! ALL Dean Health Insurance Member 2

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Questions, Contact Human Resources! THANK YOU!