2013 Medical Plans for CA employees

Views:
 
     
 

Presentation Description

Medical plan options for 2013

Comments

Presentation Transcript

2013 Medical Plan Options - California:

2013 Medical Plan Options - California

2013 Medical Plan Options:

Two HMO Options BlueShield Access+ HMO Providence OptionPLUS HMO Two PPO Options Health Reimbursement Medical Plan Health Savings Medical Plan 2013 Medical Plan Options

2013 HMO Options:

Two Options BlueShield Access+ HMO Providence OptionPLUS HMO This option is only available to those that live in LA County in most zip codes Coverage is the same – two key differences Network: OptionPLUS network is smaller and uses Providence facilities and affiliated medical groups only. Premiums: The cost for the OptionPLUS HMO is lower blueshieldca.com/providence 2013 HMO Options

2013 HMO Options:

Providence OptionPLUS HMO All Providence facilities are included in the OptionPLUS HMO as well as physicians from our Providence-affiliated medical groups, including: Providence Medical Institute Facey Medical Group Axminster Medical Group Affiliates in Medical Specialties Providence Care Network Providence Advanced Care Network Selected HealthCare Partners physicians and sites within Los Angeles County These medical groups were selected based on quality performance measures and their alignment with Providence and our Mission and core values 2013 HMO Options

2013 HMO Options:

2013 HMO Options Plan Feature BlueShield Access+ HMO and Providence OptionPLUS HMO Deductible None Out-of-Pocket Maximum $1,500 individual/$4,500 family Total Out-of-Pocket Limit $1,500 individual/$4,500 family Preventive Care 100% Office Visits $15 copay PCP/$30 Specialist Hospitalization 100% PHS/80% Other Outpatient 100% PHS/80% Other Emergency Room $150 copay Urgent Care $15 copay/$50 out-of-network Pharmacy PH&S Other Retail Generic $5 $10 Formulary $100/person deductible applies for non-PH&S scripts $20 25% ($30 min/$50 max) Non-Formulary $100/person deductible applies for non-PH&S scripts $50 40% ($70 min/$100 max) Mail Order RX 3 x retail copay

PPO Plans:

New PPO Account Based Plans Health Reimbursement Medical Plan Replaces PPO 600 Health Savings Medical Plan Replaces PPO 1000 Providence Health Plan (PHP) as administrator Network still Blue Shield of California PPO Plans

Account Based Options for 2013:

Account Based Options for 2013 Health Reimbursement Medical Plan Health Savings Medical Plan Health Reimbursement Account (HRA) Health Savings Account (HSA) 2 account based PPO plans

Account-Based PPO Plans:

Account-Based PPO Plans Out-of-pocket maximum Coinsurance Deductible Copays Your cost Shared cost Providence cost

Account-Based PPO Plans:

Account-Based PPO Plans Out-of-pocket maximum Coinsurance Deductible Copays Account

Account-Based PPO Plans:

Account-Based PPO Plans HRA or HSA account funds to pay health care costs tax-free Account Preventive care and preventive drugs covered at 100% Out-of-pocket maximum Coinsurance Deductible Copays

Preventive Services:

US Preventive Services Task Force Annual Physicals Nutritional Counseling Well child exams Cholesterol and diabetes screening Cancer screenings Immunizations Preventive Services

Preventive Drugs:

Specific Classes of Drugs Asthma (including brand inhalers) Diabetic drugs Diabetic supplies Cardiovascular (e.g. Lipitor) Prenatal Vitamins benefits.providence.org Preventive Drugs

Funding the Account:

Funding the Account Health Reimbursement Account (HRA) Health Savings Account (HSA) Providence puts money in the account when you earn your health incentive Providence puts money in the account when you earn your health incentive AND You can put money in your account on a pre-tax basis

Funding the Account:

Funding the Account Health Reimbursement Account (HRA) Health Savings Account (HSA) Providence puts money in the account when you earn your health incentive Providence puts money in the account when you earn your health incentive AND You can put money in your account on a pre-tax basis

2013 Health Incentives:

2013 Health Incentives You and your spouse or your adult benefit recipient (ABR) Who Earn a $700 health incentive ($1,400 total) Complete a biometric screening AND Attest that you have a primary care provider (PCP ) What Record actions between August 1 and January 31 ( HealthyRoads ) Incentive will be deposited into the account associated with your medical plan as a lump sum When

Flexible Spending Accounts:

Flexible Spending Accounts Dependent care FSA Health care FSA Dependent Care FSA for child and elder day care expenses ($5,000 maximum) Health Care FSA for out of pocket health care expenses ($2,500 maximum) You must re-enroll each year if you want to participate You enroll in FSAs in ProvConnect Any money you don’t use is forfeited by federal law so careful planning is required

Account Based Plan HRA:

Account Based Plan HRA Health Reimbursement Medical Plan Health Savings Medical Plan Deductible $1,150 Single $2,300 Family $1,500 employee only $3,000 all other levels Total Out of Pocket Maximum $3,300 Single $6,600 Family $3,000 employee only $6,000 all other levels Preventive Care 100% in network 50% out of network 100% in network 50% out of network Office Visits $20 copay in-network Primary Care Provider Subject to deductible 80% Specialist 50% out-of-network No copays Subject to deductible 90% Primary Care Provider 80% Specialist 50% out-of-network Emergency Room 100% after $250 copay Subject to deductible 80%

Account Based Plan HRA:

Account Based Plan HRA Health Reimbursement Medical Plan Health Savings Medical Plan All Services Subject to deductible Outpatient Hospital Surgery Facility Fees 90% Providence facility 75% in-network facilities 50% out-of-network 90% Providence facility 75% in-network facilities 50% out-of-network Hospital Facility Fees 90% Providence facility 75% in-network facilities 50% out-of-network 90% Providence facility 75% in-network facilities 50% out-of-network Hospital Physician Fees 80% in-network 50% out of network 80% in-network 50% out of network Lab and X-ray 80% in-network 50% out of network 80% in-network 50% out of network

Account Based Plan HRA - Rx:

Account Based Plan HRA - Rx Health Reimbursement Medical Plan Health Savings Medical Plan Preventive Drugs 100% 100% Providence Pharmacies (30-day supply) Generic: $10 copay Subject to deductible Formulary Brand: 80% Non-formulary brand: 60% Maximum you pay is $150 Subject to deductible 90% for Generic Formulary Brand: 80% Non-formulary brand: 60% Maximum you pay is $150 Other retail (30-day supply) and Mail Order (90-day supply) Generic: $10 copay Subject to deductible Formulary Brand: 70% Non-formulary brand: 50% Maximum you pay is $150 per 30 day supply Subject to deductible 90% for Generic Formulary Brand: 70% Non-formulary brand: 50% Maximum you pay is $150 per 30 day supply

Health Reimbursement Account (HRA):

Account goes with the Health Reimbursement Medical Plan Funded by Providence through the health incentive The health incentive money is tax-free Employees cannot contribute to the HRA, only Providence Use HRA to pay for out-of-pocket medical expenses Unused HRA money rolls over each year for future use You vest in the funds after five years of service Health Reimbursement Account (HRA)

Using an HRA with an FSA:

Using an HRA with an FSA Use your HRA only to pay out-of-pocket medical costs Vision Dental Medical Use FSA to pay your out-of-pocket dental and vision costs Use FSA to pay for medical costs only after your HRA is empty

Account Based Plan HSA:

Account Based Plan HSA Health Reimbursement Medical Plan Health Savings Medical Plan Deductible $1,150 Single $2,300 Family $1,500 employee only $3,000 all other levels Total Out of Pocket Maximum $3,300 Single $6,600 Family $3,000 employee only $6,000 all other levels Preventive Care 100% in network 50% out of network 100% in network 50% out of network Office Visits $20 copay in-network Primary Care Provider Subject to deductible 80% Specialist 50% out-of-network No copays Subject to deductible 90% Primary Care Provider 80% Specialist 50% out-of-network Emergency Room 100% after $250 copay Subject to deductible 80%

Account Based Plan HSA:

Account Based Plan HSA Health Reimbursement Medical Plan Health Savings Medical Plan All Services Subject to deductible Outpatient Hospital Surgery Facility Fees 90% Providence facility 75% in-network facilities 50% out-of-network 90% Providence facility 75% in-network facilities 50% out-of-network Hospital Facility Fees 90% Providence facility 75% in-network facilities 50% out-of-network 90% Providence facility 75% in-network facilities 50% out-of-network Hospital Physician Fees 80% in-network 50% out of network 80% in-network 50% out of network Lab and X-ray 80% in-network 50% out of network 80% in-network 50% out of network

Account Based Plan HSA - Rx:

Account Based Plan HSA - Rx Health Reimbursement Medical Plan Health Savings Medical Plan Preventive Drugs 100% 100% Providence Pharmacies (30-day supply) Generic: $10 copay Subject to deductible Formulary Brand: 80% Non-formulary brand: 60% Maximum you pay is $150 Subject to deductible 90% for Generic Formulary Brand: 80% Non-formulary brand: 60% Maximum you pay is $150 Other retail (30-day supply) and Mail Order (90-day supply) Generic: $10 copay Subject to deductible Formulary Brand: 70% Non-formulary brand: 50% Maximum you pay is $150 per 30 day supply Subject to deductible 90% for Generic Formulary Brand: 70% Non-formulary brand: 50% Maximum you pay is $150 per 30 day supply

Health Saving Account (HSA):

Health Saving Account (HSA) Eligibility Enrolled in a qualified medical plan You cannot be enrolled in another plan unless it is qualified You cannot be enrolled in Medicare or Medicaid The only way to use an FSA is to use a limited purpose FSA

Health Savings Account (HSA):

Account goes with the Health Savings Medical Plan Funded by Providence through the health incentive You can also contribute via pre-tax payroll contributions Maximum contribution is $3,250 single / $6,450 family Contributions are tax-free except for CA state income tax Unused HSA money rolls over each year for future use Health Savings Account (HSA) Use account for medical, dental and vision expenses Unused funds always belong to the employee

Using and HSA with a Limited Purpose FSA:

Using and HSA with a Limited Purpose FSA Use your HSA to pay out-of-pocket medical, dental and vision costs Medical Vision Up to deductible- $1,500 employee only/ $3,000 family After deductible is met Use a limited purpose FSA to pay your out-of-pocket dental and vision costs Use a limited purpose FSA to pay only post-deductible medical costs Dental

HRA vs. HSA – Account Comparison:

HRA vs. HSA – Account Comparison Feature Health Reimbursement Account (HRA) Health Savings Account ( HSA) Employee contributions No Yes, you can make pre-tax paycheck contributions Eligible expenses Medical plan deductible, copays and coinsurance for covered services for you and your covered dependents. Medical , dental and vision out-of-pocket expenses for you and your tax dependents. Eligible dependents Any family member you cover under the health reimbursement medical plan. You r tax dependents. Portable if you leave Providence Your unused balance is forfeited unless you have 5 years of service, or elect COBRA . Yes. Your HSA is owned by you and is always yours to keep. Eligibility Must be enrolled in the Health Reimbursement Medical Plan. Must be enrolled in the Health Savings Medical Plan and not have any other health coverage (covered family members can have other coverage).

HRA vs. HSA – Account Comparison (continued):

HRA vs. HSA – Account Comparison (continued) Feature Health Reimbursement Account (HRA) Health Savings Account ( HSA) Compatible with a Health Care Flexible Spending Account (FSA) Yes, but must use HRA funds before Health Care FSA funds can be spent (however, you can use your FSA for dental and vision expenses without restriction). No, can only use the Limited Purpose Health Care FSA for dental, vision and post-deductible medical expenses. Investments available No, you cannot invest the funds in an HRA. Yes. Once the account has a minimum balance of $1,000, you can invest the funds. Any earnings are tax-free. Maximum contributions allowed The maximum is the health incentive contributed by Providence. The IRS sets a 2013 maximum of $3,250 for individual coverage and $6,450 if you cover dependents (plus an additional $1,000 if you’re 55 or older). This is the combined maximum for health incentives and your payroll contributions

What to consider:

What to consider Health Reimbursement Medical Plan Health Savings Medical Plan Your Cost for Coverage Higher for employee only coverage Lowest for family coverage No cost for full-time employee only coverage Higher for family coverage Coverage Considerations Lower deductible Highest out-of-pocket maximum Copays for certain services Highest deductible Lower out-of-pocket maximum No copays Account Providence-funded Health Reimbursement Account (HRA) through earned health incentive Providence-funded Health Savings Account (HSA) through earned health incentive and you can make additional pre-tax contributions

PowerPoint Presentation:

Sustainable, affordable benefits

Working Spouse Surcharge:

Working Spouse Surcharge In 2013, employees who cover a spouse on the medical plan will pay a $150 per month surcharge IF their spouse is working, has employer coverage, but chooses not to enroll in the plan The surcharge does not apply if The spouse elects coverage and the Providence medical plan is secondary The spouse is on Medicare, Medicaid, TriCare , Tribal health coverage The spouse’s employer plan has an annual out-of-pocket maximum that is greater than $6,250 (single) / $12,500 (all other coverage levels) Employees covering a spouse can self-declare this in ESS during OE, otherwise all others will receive an attestation from ConSova . The attestation will require a signature, and no response by deadline will result in surcharge being applied.

Medical Premium Assistance Program:

Medical Premium Assistance Program Employees who have difficulty making their premium payments may qualify for the Medical Premium Assistance Program Eligibility: employees whose family income is less than 200% of the Federal Poverty Level (FPL) Application process: administered by APS Healthcare (Employee Assistance Program vendor) Applicants approved for payment will have their medical premium reduced by 80%, so they would pay just 20% of the premium

Tools and Resources:

Benefits.providence.org – Benefits website Medical Cost Calculator – available in ProvConnect Health Fairs Employee Forums HR Service Center – 888-687-3753 HRServiceCenter@providence.org Tools and Resources

authorStream Live Help