Upload
karin-ford
View
217
Download
2
Tags:
Embed Size (px)
Citation preview
School District of Slinger
Health Insurance Coverage Effective September 1, 2013
July 22, July 29 and August 5th
What will be covered in today’s meeting…• Introductions
• Why is a change taking place?
• 2013 Plan options and premiums
• Fundamentals of a Health Savings Account
• Banking arrangement – First National Bank
• Group Vision
• Section 125
• Next Steps
• Questions
Introductions
Ryan Barbieri – Senior Vice President
Sharon Schulteis-Senior Client Manager
Karen Becker-Account Executive
Clara Scheckel-Field Account Manager
Tammy Tongusi-Personal Banking Manager
First National Bank is the District sponsored bank for H S A contributions starting September 1 st.
Why the health insurance is changing•The members of the school board/teacher handbook committee agreed that it was in everyone’s interest to explore some of the innovative and consumer driven health options
•Change will offer an opportunity with reduced premium share for employees
•Puts District in a better position to maximize future savings
•Southeastern Wisconsin healthcare is trending at 12%
What has been done leading up to this point?• Employees will have the opportunity to participate in a
Consumer Driven Health Plan that will qualify them for an additional benefit…H S A contributions made to a First National account
• Those electing H S A plan will have an option for Limited Purpose FSA as of 1/1/2014
• Those electing not to participate in the health plan will continue to have the Full Purpose FSA option as of 1/1/2014
• Employees will be provided with a Group Vision Plan effective 9/1/2013
Benefit Plan Eff. 9/1/2013
In-Network Out-of-Network
$2,500 $5,000
$5,000 $10,000
90% 70%
$4,000 $10,000
$8,000 $20,000
90% after ded 70% after ded
100% 70% after ded
90% aft. ded. 70% aft. ded.
90% aft. ded. 70% aft. ded.
$10/$30/$50(after deductible is met)
Includes Deductible
90% after ded.
H S A Option
Choice Plus
Policy or Calendar Year Deductible
Provider Network
Deductible Single
Family
Coinsurance
Out-of-Pocket Max(Includes Deductible)
Office Visits (PCP / SCP)
Preventive Care
Single
Family
Prescription Drugs
Retail
Hospital Services
Urgent Care
Emergency Room
7Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Preventive care services examples
Covered preventive care services include many types of exams subject to age and gender guidelines, which typically include:
Physician office services:Age- and gender-appropriate preventive
examinations
Well baby and well child preventive examinations
Immunizations
Health screening tests:Mammography screening
Colorectal cancer screening
Cervical cancer screening
Osteoporosis screening
8
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Expanded women’s preventive care services
Preventive ServiceExpanded Women’s
Preventive9/23 Provision
• Gestational Diabetes Screening
• All pregnant women (24-28 weeks); high risk screened twice
• Pregnant women at risk
• HPV DNA testing for women 30 years and older
• All women age 30+ every 3 years
• Women at risk; not mandated as preventive
• Counseling for sexually transmitted infections
• All sexually active women • Women at risk (teens, pregnant women, lifestyle)
• Screening and counseling for HIV
• All sexually active women • Women at risk (pregnant women, lifestyle)
• Screening and counseling for domestic violence
• All women • Women at risk
• FDA-approved contraception methods and counseling
• All methods, all women • Not specifically addressed; not mandated as preventive
• Counseling for breast-feeding and rental equipment and supplies
• Part of pre/post-natal counseling for pregnant women, coverage for rental of breastfeeding equipment
• Coverage for counseling only
• Well-woman exams • As many as necessary to obtain specified preventive services
• Yearly
myHealthcare Cost Estimator
The ultimate resource for life’s challenges
10
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Call Care24 services about:
•Routine illness•Minor injuries•Stress and anxiety•Relationship worries•Coping with grief and loss•Questions to ask your doctor•Personal legal concerns*•Men’s, women’s and children’s health•Prevention•Self-care information•Help Finding a doctor•Information on medications•General Health Information
11Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
UnitedHealthcare Health4Me™ makes it simpler for your employees to manage their health by providing:
• Easy access to their health plan information
• A mobile resource to find doctors and facilities anytime, anywhere
• Experienced Health Advisors to answer any questions they may have
• An interface that allows each plan member to be viewed independently
• Can be personalized with member photos
Health Insurance Full Premium
UHC H.S.A. Plan
$2,500 / $5,000 Deductible Plan September 1st, 2013
Coverage Amount per Month Employee Share per Month
Single $682.70 24 pays=$ 86 20 pays=$103.20
Family $1,547.61 24 pays=$195 20 pays=$234
Single Medicare $429.55 / $132.70*
Family Medicare $859.09 / $265.39*
Medicare Special $1,188.17
*Premium for medical only coverage where Medicare D is in place for drug coverage
What Is A H S A Plan
What Is A HSA?
• Combines a Qualifying High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)
• Funded by the District and / or you
• Pre-tax basis by salary deferral and direct deposit for participants
• Pay for qualified expenses or save for the future
• Annual limit that can be contributed to account
• Catch-up contributions (Age 55 and up) up to $1,000
• Funds accumulate and earn non-taxable interest
• The dollars in the HSA are yours!
• It remains your money even if you leave the District or retire
What is the HSA Concept?
Part 1:
Qualifying High
Deductible Health
Insurance PlanPart 2:
Health Savings Account
HSA Concep
t Pays expenses until the
deductible is met.
Intended to cover serious
illness or injury after the
deductible has been met.
Two Basic Parts:
HSA Tax-Advantages
HSA
Name of account Health Savings Account
Who owns the account? Individual/employee
Who may fund the account? Employer or employee, can be both in the same yearEmployee can contribute pre-tax dollars through Section 125 plan
What plans may be offered with the tax-advantaged account?
An HDHP as follows:Min. Deductible$1,250 I $2,500 F**OPM$6,250 I $12,500 F**
Is there a limit on the amount that can be contributed per year?
$3,250 I $6,450 F**Catch-up contributions:$1,000 p/yr – age 55 by end of tax yearReduced by MSA contributions in same year
Does the uniform coverage rule apply? No
*Self-employed individuals, including partners, and more than 2% shareholders in a subchapter S-corporation cannot contribute.**For calendar year 2014.
HSA Tax AdvantagesHSA
Can unused funds be rolled over from year to year?
Yes
What expenses are eligible for reimbursement?
Section 213(d) medical expensesEffective 12/31/10, OTC medicine or drug expenses cannot be reimbursed unless they are prescribed or are insulin.-COBRA premiums-QLTC premiums-Health premiums while receiving unemployment benefits-If Medicare eligible due to age, health insurance premiums except medical supplement policies
Must claims submitted for reimbursement be substantiated?
No
(keeping in mind that receipts will be needed for IRS audits)
May account reimburse non-medical expenses?
Yes, but taxed as income and 20% penalty (no penalty if distributed after death, disability or eligible for Medicare)
Is interest earned on the tax-advantaged account?
Yes, accrues tax-free
This Chart is provided to you for informational purposes only. Please seek qualified and appropriate counsel for adviceon how to apply the topics discussed herein to your employee benefits plan. (3/04, JS 5/09; 8/10; KP 9/10) © 2004-2010 Zywave, Inc.
How to Obtain Further InformationYou May Contact your Tax Advisor
You may reference the IRS website at: www.IRS.gov
Who is eligible for a HSA?
An “eligible individual” is any individual who,
for a given month…
• is covered under a qualified high-deductible health plan (HDHP)
• Is not also covered by any other health plan unless it is also an HDHP
• may not be claimed as a dependent on another person’s tax return.
• is not covered by Medicare and receiving benefits
Expense
Deductible$2,500
Coinsurance 90% / 10%
For HSAReimbursement
Preventive Care - 1 Physical Exam
Covered at 100%
4 Office Visits (Non-Preventive)
$400 $400 — $400 (Deductible)
Emergency Room $800 $800 — $800(Deductible)
Diagnostics $2,000 $1300 Plan pays $630 Tom pays $70
$70
Totals $3,200 $2,500 Tom Pays $70 $1,270
Health Savings Account
Total Contribution
$2,000
Less - $1,270
Balance $730
Example of HSA Usage – TomEmployee Coverage
$2,000 District Contribution
Expense Deductible
$5,000Coinsurance
90% / 10%For HSA
Reimbursement
Preventive Care - 3 Physical Exams
Covered at 100%
6 Office Visits(Non-Preventive)
$600 $600 — $600
Out Patient Surgery for Dependent Child
$3,500 $2,500 Plan Pays $900Sarah Pays $2,500 +
$100=$2,600
$2600
3 Office Visits for Dependent Child
$1,000 $0.00* Child has met Single Deductible
Plan pays $900Sarah pays $100
$100
OutpatientSurgery
$10,500 $1,900 Plan Pays-$7,740Sarah pays $1900+
$860=$2,760
$700
3 Specialist Visits $3,600 $0 Plan pays $3,240Sarah pays $360
Totals $19,200 $5,000 Sarah pays $5,820 $4,000
Health Savings Account
Total Contribution $4,000
Less - $4,000
Balance $0
Sarah’s Responsibility $1,820
Example of HSA Usage – SarahEmployee + Family Coverage-with embedded deductible
$4,000 District Contribution
What form can contributions be made?
• Contributions to a HSA must be made in “cash”. For example, contributions may not be made in the form of stock or other property.
• Contributions to the HSA can be made through payroll deduction on a pre-tax basis.
• The District will contribute $2,000 for Employee coverage and $4,000 for Family coverage
District HSA Contributions 2013-2014
FAMILY
24 pays: $4,000/12 = $333.33/mo.
Sept. 10th : $333 x 4 = $1,332(Sept–Dec lump sum to get started)
Jan – Aug: $333/mo = $2,331
June: $337(to accommodate for rounding difference)
20 pays: $4,000/10 = $400.00/mo.
Sept 10th: $400 x 4 = $1,600
Jan - June: $400/mo = $2,400
SINGLE
24 pays: $2,000/12 = $166.67/mo.
Sept. 10th : $167 x 4 = $668(Sept–Dec lump sum to get started)
Jan – Aug: $167/mo = $1,169
June: $163(to accommodate for rounding difference)
20 pays: $2,000/10 = $200.00/mo.
Sept 10th: $200 x 4 = $800
Jan - June: $200/mo = $1,200
How are distributions treated for tax purposes?
• Tax Free
(Qualifying medical expense)
• Ordinary Tax
(Non-medical distribution after age 65)
• Ordinary Tax + 20% penalty
(Non-medical distribution prior to age 65)
When may I take distributions from my HSA?
• Your HSA dollars can be taken at any time to pay for qualifying medical expenses.
Note: If reimbursing expenses from previous years, you must maintain sufficient records to prove the expense was not previously reimbursed.
Qualified HSA Expenses• Medical, dental, vision deductibles and
coinsurance amounts
• Certain Long Term Care insurance premiums
• COBRA premiums
• Hearing aids
• Smoking cessation
• Wheelchairs
• Organ transplants
• Medicare premiums
What are qualifying Medical Expenses?
• A Qualifying Medical Expense (QME) is generally any expense incurred to maintain your health or your family’s health
• A partial list of expenses that can be reimbursed is included with the HSA information
• A complete listing provided in Section 213 of IRS Ruling.
Vision
A national network of over 54,000 access points
National reach, local providers
50% Private Practice Providers / 50% Retail Chain Providers
More than 100 national and local retail brands including 16 of the top 20*
* Vision Monday, May 18, 2009
Provider Network Access and Choice
Your Vision Program: In-Network Benefits
Eye Examination• Fully covered, after applicable copay
• Performed by a licensed optometrist or ophthalmologist
• Includes case history, examination for eye pathology and abnormalities, visual analysis (refraction), diagnosis, visual field testing, and prescription (if necessary)
Your Vision Program: In-Network Benefits
Lens Benefit• Standard single vision• Standard lined bifocal• Standard lined trifocal • Standard lenticular• Standard Scratch Resistant coating
Discounts on non-covered lens options including popular selections such as:• Polycarbonate lenses• Photo-chromatic lenses• Anti-reflective coating• Tints• Progressive lenses
Your Vision Program: In-Network Benefits
Frame Benefit• $130 allowance applied to the retail price of any frame of the
member’s choice. If members choose frames over $130 retail cost, they are only responsible for the difference between the allowance and the retail cost.
• Many providers offer a discount of 30% off of the difference between the retail cost and the $130 allowance. Providers offering this discount are indicated in the online provider directory.
Your Vision Program: In-Network Benefits
Industry-Leading Contact Lens Benefit
• Covered-in-full Contacts*
Fitting/evaluation fee, contacts (including up to 6 boxes of disposables, depending on prescription and frequency of disposable contact)
• Outside covered-in-full selection
$150 allowance for fitting/evaluation, purchase, and up to two follow-up visits
• Online ordering and discount on contact lenses
Online ordering with10% discount off already low prices from Vision Direct via www.myuhcvision.com
*Coverage for Covered Contact Lens Selection does not apply at Walmart, Sams Club and Costco. The allowance for non-selection contact lenses will be applied towards the fitting/eval fee and purchase of all contacts.
Your Vision Program: Out-of-Network Benefits
Standard Out-of-Network Benefits*
• Examination reimbursement up to $40
• LensesSingle Vision reimbursement up to $40Bifocal reimbursement up to $60Trifocal/Lenticular reimbursement up to $80
• Frames reimbursement up to $45
• Contacts Elective reimbursement up to $150Necessary reimbursement up to $210
*Out-of-network reimbursement not subject to plan copays.
Bridge2Health UnitedHealthcare Medical and Vision – Better Together
Taking care of your eyes benefits your overall health Because UnitedHealthcare provides both your medical and vision benefits, we
understand how the health of one part of your body affects the health of the rest of your body. We’re not just focusing on your eye health. We’re connecting the dots to help you understand and improve your overall health.
Get the most from your benefits Members have access to a wide variety of online health and wellness
information, easy-to-use tools and reminder programs.
• myuhc.com – find important information about your medical and vision plans, locate a provider, and access health and wellness education materials.
• myuhcvision.com – access your vision plan information, print and ID card, search for a provider, fine eye health and wellness information.
• Reminder call program: It’s important to have an annual eye exam, especially if you have a chronic condition such as diabetes, hypertension, high cholesterol and vascular disease. If you missed your annual exam, our program is here to remind you.
35Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Health Savings Account1st National Bank of Hartford
Your Independent Local Community Bank since 1907
Three Convenient LocationsThree Convenient Locations
Hartford Location
116 W. Sumner Street
Hartford, WI 53027
262-673-5800
Richfield Location
1297 State Hwy 175
Hubertus, WI 53033
262-628-5500
Slinger Location
439 E. Washington Street
Slinger, WI 53086
262-644-7606
MEMBER FDIC
How does your bank account work?How does your bank account work?
$500.00 Minimum Daily Balance is required to earn interest $500.00 Minimum Daily Balance is required to earn interest
(If the balance falls below $500.00 a $2.50 monthly maintenance will be assessed)(If the balance falls below $500.00 a $2.50 monthly maintenance will be assessed)
Free debit card Free debit card (10 business days to receive)(10 business days to receive)
Free 24-hour internet banking Free 24-hour internet banking (Setup online or at the branch)(Setup online or at the branch)
Free bill pay Free bill pay (Setup online or at the branch)(Setup online or at the branch)
Free telephone banking Free telephone banking (Setup at the branch by calling or stopping in)(Setup at the branch by calling or stopping in)
Interest paid monthlyInterest paid monthly$500.00 or greater and less than $2,499.99$500.00 or greater and less than $2,499.99 .50% .50%APY .50% .50%APY
$2,500.00 or greater and less than $9,999.99$2,500.00 or greater and less than $9,999.991.00%1.00% 1.00%APY1.00%APY
$10,000.00 or more$10,000.00 or more 1.49%1.49% 1.50%APY1.50%APY
MEMBER FDIC
Rate of interest is subject to change at any timeRate of interest is subject to change at any time
Things to know:Things to know: Please fill out the application that was mailed to Please fill out the application that was mailed to
you completely. Authorized Agent and Beneficiary you completely. Authorized Agent and Beneficiary section is very important.section is very important.
Retain your receipts. You need to be able to show Retain your receipts. You need to be able to show for every dollar spent.for every dollar spent.
Limits per year. Your contribution limits will Limits per year. Your contribution limits will depend on the tax year and whether it is self-only depend on the tax year and whether it is self-only or family plan.or family plan.
You have until April 15You have until April 15thth of every year to make a of every year to make a previous year contribution.previous year contribution.
Debit cards. You will receive these before the Debit cards. You will receive these before the initial deposit. Beware they will not work until initial deposit. Beware they will not work until funded.funded.
Who do we contact?Who do we contact? Beverly Schatz at our Slinger LocationBeverly Schatz at our Slinger Location
262-644-7606262-644-7606 Tammy Tongusi at our Hartford LocationTammy Tongusi at our Hartford Location
262-673-5800262-673-5800 Kathy Schliepp at our Richfield LocationKathy Schliepp at our Richfield Location
262-628-5500262-628-5500
or any New Account Representative!or any New Account Representative!
We are here for you!We are here for you!MEMBER FDIC
What’s Next?•On track to have Health ID cards to members by September 1st
•Deductibles accumulate on a calendar year basis – they will reset and start over January 1st - for this year, September through December incurred deductibles will carryover into 2014
•You must complete a separate health and vision enrollment form to designate your level of coverage
•Information regarding the FSA benefit options will be provided by the district this fall - IF you intend to participate in the FSA benefit, you MUST re-enroll
What’s Next?•Your benefit election is an Annual Irrevocable Election unless there is a Qualifying Event
Qualifying Event, such as:
New Child – Adoption or Newborn
Change of Child Custody or Support Order
Marriage/Divorce
Spouse Loses/Quits their Job
Death of Spouse
NOTE:
Changes must be received within 31 days after the qualifying event
Questions…