Butler County 2018 Insurance Open Enrollment

TABLE OF CONTENTS

1. Discuss open enrollment rights

2. 2018 Medical Plan Options

3. Benefit Definitions

4. Your HDHP and HSA

5. Pharmacy Tips

6. Where to Receive Care

7. Meritain Tools and Resources

8. Questions

What is open enrollment?

Open enrollment is the time of year that we receive new pricing from the current insurance carriers and request competitive quotes from the market.

During this time, you can join the plan, cancel your coverage or modify your current elections.

January 1 – Insurance Open Enrollment

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Can I make changes to my coverage during the year?

If you would like to make a change to your enrollment during the year,

you must experience a qualifying event.

If you are declining enrollment for yourself, your spouse or your dependents because of other health insurance coverage, you may in the future be able to enroll provided you request enrollment within 30 days after your coverage ends or the qualifying event date. In addition, if you have a new dependent as the result of a marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependent, provided you request enrollment within 30 days after the marriage, birth or adoption.

January 1 – Insurance Open Enrollment

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2018 Medical Plan Options

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Medical Benefits PPO: In-Network New HDHP: In-Network

Deductible $1,000 per person | $2,000 per family $2,700 per person | $5,400 per family

Coinsurance 80/20 90/10

Out-of-Pocket Maximum $3,250 per person | $6,500 per family $4,000 per person | $8,000 per family

Office Visit (PCP/SPC) $35 copay PCP| $45 copay SPC Deductible, then 10%

Preventive Care visit Covered in full Covered in full

Inpatient Hospital Deductible, then 20% Deductible, then 10%

Outpatient Hospital Deductible, then 20% Deductible, then 10%

Imaging (CT/PET/MRI) Deductible, then 20% Deductible, then 10%

Emergency Room $150 copay per visit Deductible, then 10%

Urgent Care $45 copay per visit Deductible, then 10%

Prescription Drugs $15 | $30 | $50 Deductible, then 10%

Prescription Tiers: Tier 1 – Generic | Tier 2 – Preferred Brands | Tier 3 – Non- Preferred Brands

*Out of Network Benefits available, see your Summary of Benefits and Coverage for more details.

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Important Terms and Definitions

• Copays – set amount to pay for specific medical service or supply

• Deductible – specific dollar amount you are required to pay out-of-pocket each year before your insurance begins to make payment for claims

• Coinsurance – specific amount you are obligated to pay for covered medical services after you’ve satisfied your annual deductible, generally a percentage of the charge

• Out-of-Pocket Maximum – total dollar amount member

will pay in a calendar year

• Preventive Care – Covered services that are intended to prevent disease or identify disease and are required to be covered without deductibles, copays or coinsurance

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Important Terms and Definitions

• Contracted Rate - the amounts that health insurance companies will pay to healthcare providers in their networks for services. These rates are negotiated and established in the insurers’ contracts with in-network providers.

– By going to an in-network provider for medical and dental, you will receive a contracted or lower rate than if you go out of network.

• Balance Billing (out of network)– Meritain will pay claims based on your out of network benefits, but because these providers don’t have a contracted rate with Meritain, these providers can bill you for the additional amount not covered by insurance.

Health Savings Account and your High Deductible

Health Plan

Consumer Directed Health Plans

Consumer Directed Health Plan (CDHP)

with

Health Savings Account (HSA)

Health Savings Account

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1. Receive Medical Services - Show ID Card (not debit card!) - Do not pay at time of service - Provider may ask for small “down

payment”

2.Provider Sends a Bill -Save bill until you receive your Explanation of Benefits from Meritain. This confirms what you owe. -Provider bill should match your EOB.

3.Meritain Sends Your EOB -Provider bill should match your EOB. -Reflects the provider discount. -Will show amount applied toward deductible (i.e. your responsibility).

MEDICAL PLAN

MEDICAL PLAN

4.Pay Your Provider -You do not pay the insurance company. -You can use your HSA to pay OR you can use any other form of payment. -You can also set up a payment plan with your Dr.

BANK ACCOUNT

What is an HSA?

• An HSA is a bank account created exclusively for you (the employee) and designed to help you pay for qualified health care expenses for you, your spouse and your children on a tax-free basis.

• You can access the funds using a debit card or checks.

What expenses can be paid using HSA dollars?

• Prescription Medication

• Exams and Tests

• Dental

• Vision

• COBRA Premiums

• Long Term Care Premiums

• Premiums while on Unemployment

• Retiree Health Insurance Premiums

• Over the Counter Medications (when accompanied by a prescription from your doctor)

Penalties for misuse of an HSA

• IRS audits and penalties

• 20% excise tax

• Income taxes applied

Do I need to submit receipts for reimbursement?

• No. You do not need to submit receipts to a Third Party for reimbursement

• When you use your HSA to pay for qualified medical expenses, SAVE YOUR RECEIPTS!

• If you are audited by the IRS, you must show your receipts to prove that you used the funds on qualified medical expenses.

Health Savings Account

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• Butler County contributes the following:

• Maximum Contributions for 2017 (includes employer and employee contributions):

$3,450 / Single $6,900 / Family

• If you are 55+ you may contribute an additional $1,000 ‘catch-up’ contribution to your account

HDHP

Single $600

Employee + Spouse $1,200

Employee + Child(ren) $1,200

Family $1,200

• Any employee enrolled in a NON-qualified medical plan through a spouse or other source (e.g., a PPO plan)

• Any employee ALSO enrolled in a Full Flexible Spending Account

• Any employee whose spouse is enrolled in a Full Flexible Spending Account

– Participating in Dependent-Care FSA or Limited FSA is allowable to pair with HSA.

• An employee who is enrolled in Medicare

• An employee who is receiving VA benefits

• Contributions cannot be made to an HSA if the individual can be claimed as a dependent on another person’s tax return.

Who is INELIGIBLE to participate in a HSA?

Prescription Savings Tips

PRESCRIPTION SAVINGS TIPS

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• Prescribed the lowest cost prescription in that class of medication

• Samples

• Coupons

• Visit the website

• Costco and Sam’s will often be the least expensive

PLEASE NOTE: often times when you use a discount or prescription assistance program, the amount you pay does not apply towards your deductible.

Prescription Savings Tips

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FREE and Low Cost Generics

Kroger

Meijer

Walmart

Target

Meritain Online

Cost compare online

www.goodrx.com

Shop area pharmacies

for best price

Discount cards and Coupons

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Where to receive care?

Where to receive care?

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What type of care would they provide?

Considerations

• Routine checkups • Immunizations • Preventive services • Manage your general health

• Normally requires an appointment • Little wait time with scheduled

appointments

You need routine care of treatment for a current health issue. Your primary doctor knows you and your health history, can access your medical records, provide preventive and routine care, manage your medications and refer you to a specialist, if necessary.

Doctors Office

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What type of care would they provide?

Considerations

• Common infections (strep throat) • Minor skin conditions • Flu Shots • Pregnancy tests • Minor cuts • Ear aches

• Walk in patients welcome with no

appointments necessary, but wait time can vary

Where to receive care?

You can’t get to your doctor’s office, but your condition is not urgent or an emergency. Convenience care clinics are often located in malls or retails stores offering services for minor health conditions. Staffed by nurse practitioners and physician assistants.

Convenience Care Clinic

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What type of care would they provide?

Considerations

• Sprains • Strains • Minor Broken bones • Minor infections • Minor burns

• Walk in patients welcome, but

waiting periods may be longer as patients with more urgent needs will be treated first

Where to receive care?

You may need care quickly, but it is not an emergency, and your primary physician may not be available. Urgent care centers offer treatment for non-life threatening injuries or illnesses. Staffed by physicians.

Urgent Care Center

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What type of care would they provide? Considerations

• Heavy Bleeding • Large open wounds • Sudden change in vision • Chest pain • Sudden weakness or trouble talking • Major burns • Spinal injuries • Sever head injury • Difficulty breathing

• Walk in patients welcome, but

waiting periods may be longer as patients with more urgent needs will be treated first

Where to receive care?

You need immediate treatment of a very serious or critical condition. The ER is for the treatment of life-threatening or very serious conditions that require immediate medical attention. Do not ignore an emergency. If a situation seems life threatening, take action. Call 911 right away.

Emergency Room

Meritain Tools and Resources

Connect to Your Benefits

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Healthcare Bluebook

Make the experience fit my life

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

QUESTIONS?