Independent Schools Association of Northern New England (ISANNE) Brewster Academy May 20, 2010.

Independent Schools Association of Northern New England (ISANNE)

Brewster AcademyMay 20, 2010

2 © 2009 Harvard Pilgrim Health Care

* “America’s Best Health Plans” is a trademark of U.S.News & World Report. The source for data contained in this publication is Quality Compass® 2009) and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2009 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

More reasons to trust us: #1 commercial health plan in America – five years in a row!

“America’s Best Health Plans” 2009-2010 List – Top-rated in Member Satisfaction and

Quality of Care – for an unprecedented fifth consecutive year!*

– Joint ranking of commercial plans by U.S.News & World Report/NCQA

– Determined by data in NCQA’s Quality Compass®

– Featured in December 1st edition of U.S.News & World Report

Benefit OverviewChanges Effective July 1, 2010


Harvard Pilgrim PPO:High Deductible Health Plan (HDHP)

EFFECTIVE: 7/1/2010 PPO HDHP (In-network)

Deductible (Combined In- and Out-of-Network / Medical and Pharmacy Claims)

$2,000 Individual / $4,000 Family

Coinsurance None

Out-of-Pocket Maximum (includes deductible) $4,000 Individual / $8,000 Family

Preventive Care Office Visits $0 Copay

Sick-Care Office Visits Deductible & then covered in full

Diagnostic Testing

Hi Tech Radiology – MRI/CT/PET Scans

Deductible & then covered in full Deductible & then covered in full

Inpatient and Outpatient Hospital Care Deductible & then covered in full

ER Services Deductible & then covered in full

Prescription DrugsDeductible, then: Retail: $10/$25//$40*

Mail Order Program: $20/$50/$120*

*For the 2010 Plan Year, Brewster Academy will reimburse members for the Prescription Drug Copayments applicable once the combined Medical/Pharmacy Deductible has been satisfied.



Federal Mental Health Parity Act:

Effective July 1, 2010, Behavioral and Substance Abuse services are covered as any other medical condition under the ISANNE plan. Specifically, this means:

– No Longer a 30 Day Maximum on Inpatient Claims– No Longer a 20 Visit Maximum on Outpatient Claims

Although unlimited, these services are still subject to medical necessity review and you must call the Toll-Free number on the back of your ID Card prior to receiving benefits.



Plan is considered a Federally-Qualified HDHP, meaning it can be used with either an HRA or a Health Savings Account (HSA),

Brewster Academy will offer the HSA Option to all benefit-eligible employees for the 2010 Plan Year,

Brewster Academy will make the following contributions to the HSA for the 2010 Plan Year:

Single Coverage: $ 750

Two Party/Family Coverage: $1,500 If Two Brewster Academy employees are covered under the same plan, they are eligible for a larger

HSA Contribution.


Prescription Drugs

Our open-formulary offers greater choice….not restrictions

Value-added mail service program

Large network of pharmacies

Prescription drugs are subject to the in-network deductible and then Pharmacy Copayments Apply, up to the Out-of-Pocket Maximum ($4,000/$8,000 inc. Deductible)– Retail Pharmacy (30 day supply): $10 / $25 / $40*

– Mail Order Pharmacy (90 day supply): $20 / $50 / $120*

*For the 2010 Plan Year, Brewster Academy will reimburse members for the Prescription Drug Copayments applicable once the combined Medical/Pharmacy Deductible has been satisfied.

The Health Savings Account throughMellon Bank


Health Savings Account Rules Review

Eligibility– You can’t be enrolled in any other health plan

• Not enrolled in a spouse’s non-High Deductible Health Plan

• Not enrolled in Medicare or Medicaid

• Not eligible for reimbursement through your or a spouse’s Health FSA

– You can’t be someone else’s tax dependent

Contributions– The School will be making contributions on your behalf

– You can make pre-tax payroll contributions• Reduce taxable income

• Put more money aside to grow tax-free to pay current or future eligible expenses


Health Savings Account Contributions

Your maximum contribution for 2010 from all sources (including the School’s contribution) is:– Individual contract, under age 55 $3,050

– Individual contract, age 55+ $4,050

– Family contract, under age 55 $6,150

– Family contract, one age 55+ $7,150

– Family contract, two age 55+ $8,150

(second individual must open an HSA)

The core figures ($3,050 and $6,150) are indexed annually for inflation– You’ll be able to contribute even more in future years



Since the IRS calculates contributions on a calendar year and you’re joining mid-year, you have two options

– You can pro-rate your 2010 contribution by accepting no more than 7/12 of the 2010 maximum contribution• You’ll be “safe” and face no potential repercussions

– You can make the full calendar 2010 contribution as long as you remain HSA-eligible continuously through the end of the “testing period” (Dec. 31, 2011)• If you lose eligibility during the testing period, then any excess

contribution is subject to income tax and a 10% penalty



You can make a one-time rollover from an IRA to an HSA

Once per lifetime, to be completed by Jan. 1, 2012

The rollover counts against the annual contribution limit

You must remain HSA-eligible through the “testing period” (12 full months after the month of the rollover)

Advantages– Quick seeding of the HSA– Traditional IRA distributions are taxed, while HSA contributions

are tax-free if used for eligible expenses

Concerns– If you spend the rollover funds, you reduce your financial assets


HSA Keys to Success

Open your HSA promptly and fund it immediately– The IRS won’t let you reimburse any eligible expenses tax-free

unless the date of service is on or after the date that you open and fund [even nominally] your HSA

Make regular, steady contributions to your HSA, as you do to your retirement program

Understand the program, as the IRS makes you responsible for managing your HSA to the rules– A great resource: www.hsainsider.com, then follow the links to

download “HSA Road Rules”

– Another resource: http://www.treas.gov/offices/public-affairs/hsa/

http://www.hsainsider.com/

http://www.treas.gov/offices/public-affairs/hsa/

http://www.treas.gov/offices/public-affairs/hsa/

Member Savings Programs


Your Member Savings: more discounts for Faculty and Staff

• $150 Fitness reimbursement

• Eyewear savings – including discounts at many popular locations like LensCrafters, Sears Optical and Target Optical

• Online drugstore for over-the-counter health products

• Support Plus — foot, leg and comfort care products

• CareScout Eldercare Program

• Childproofing and home safety items

• Maine Running Company (ME), Runner’s Alley (NH) and Marathon Sports and Northampton Running Company (MA)

• Weight Watchers• Diet.com• Appalachian Mountain Club

membership• And more!

There are many ways our members can save:

Interacting with Harvard Pilgrim


www.harvardpilgrim.org: exclusive online services at your fingertips

Find a doctor and access their contact information and profile

Find up-to-date and credible health information on topics that interest you– Health Topics A – Z (extensive database from Healthwise®

Knowledgebase)– Symptom Checker

Get information about your medications, find a pharmacy and order prescriptions by mail

Map your way to Wellness with the My Way to Better interactive tool


Programs that make a positive difference in the lives of members

We support members dealing with issues such as:

– Diabetes

– Asthma

– Cancer

– Congestive heart failure

– Cholesterol management in cardiac disease

– Depression

– End stage renal disease

– High-risk pregnancy

– Anticoagulation management(for members taking blood-thinner medications)

– Conditions like seizure disorders, rheumatoid arthritis, multiple sclerosis and others

– Personal Coaching


Member Services: more ways to serve you better

Access by phone - 1-888-333-4742– Timely and accurate responses to your questions

– Extended hours on Mondays and Wednesdays

– Interactive Voice Response (IVR) offers 24-hour access to general information

Access via www.harvardpilgrim.org - 24/7 – Self-service with HPHConnect

– E-mail Member Services and get responses quickly

National Health Reform


National Health Reform

While there has been much discussion of the impact of the National Health Reform Legislation signed into law by President Obama on 3/23/2010, you should be aware that:

– The earliest that any changes can go into effect is 6 months after the bill is signed (9/23/2010),

– Most provisions are effective on the first group anniversary date following 9/23/2010 (ISANNE = 7/1/2011)

– Since HPHC does not have any Pre-Existing Conditions, and NH legislation provides coverage for unmarried dependents to age 26, the immediate impact to ISANNE will be minimal.


National Health Reform (Continued)

The provisions with the most immediate impact to the ISANNE Plan are:– Provision which no longer allows use of FSA/HSA funds for

over-the-counter medicines (1/1/2011)

– Prohibition on lifetime and annual benefit spending limits (7/1/2011)

– Provision requiring plans to cover most preventive care services at no charge (7/1/2011)

– Provision allowing dependents to stay on parents’ policies to age 26, regardless of marital status (7/1/2011)

The entire industry is in a “holding pattern”, waiting for the appropriate governmental departments to issue guidance on this and other provisions of the law.

QUESTIONS?

Independent Schools Association of Northern New England (ISANNE) Brewster Academy May 20, 2010.

Documents

Transcript of Independent Schools Association of Northern New England (ISANNE) Brewster Academy May 20, 2010.