HealthSolutions

Putnam County School Board

Open Enrollment – November 2 – 30Effective 1/1/12

Blue Cross and Blue Shield of Florida is an independent licensee of the Blue Cross and Blue Shield Association

ect e / /

Welcome to Open Enrollment!Welcome to Open Enrollment!

• Elections made during enrollment will become• Elections made during enrollment will become effective January 1, 2012.

The following family members are eligible:The following family members are eligible:

‐Spouse

d 26‐Dependents up to age 26

Future ChangesFuture Changes• After January 1, 2012, you cannot make changes to the benefits you elect 

until the next open enrollment period unless you have a qualified change in status.   A qualified change in status includes any of the following:

• Marriage• Divorce• Legal separation• Domestic partnership• Birth or adoption of a child• Change in child’s dependent status• Death of a spouse, child or other qualifying dependent

h d d l f f d• Change in residence due to an employment transfer for you, your spouse or domestic partner

• Commencement or termination of adoption proceedings• Change in spouse’s or domestic partner’s benefits or employment status• Change in spouse s or domestic partner s benefits or employment status

328‐1100328 1100

• Bates Hewett & Floyd is here to:Bates Hewett & Floyd is here to:– Provide assistance with claims and service items– Assist members with understanding their ginsurance plan and how to best utilize services

– Educate members about additional programs and services such as online resources

• We want you to consider our office as a local i t th t i il bl t i tservice center that is available to assist you 

with your health insurance program.

Health SavingsHealth Savings AccountsAccounts

Offered with High Deductible Health Plans D03160/03161

In the pursuit of health

HSA OverviewHSA Overview

• A Health Savings Account (HSA) is a special accountA Health Savings Account (HSA) is a special account owned by an individual that can be used to pay for current and future medical expenses.

• HSA’s are used in conjunction with a High‐Deductible j gHealth Plan (HDHP).– Insurance that does not cover first dollar medical expenses ( f )(except for preventive care)

HSA DetailsHSA Details• Build funds with tax breaks

Si il t I di id l R ti t A t (IRA)• Peace of Mind

A l t d f h lth– Similar to Individual Retirement Account (IRA) – Money contributed used to build savings for 

future medical costs– Account deposits and interest earnings receive 

tax‐favored treatment

– Accumulated money for health expenses – Pay insurance premiums (i.e., long‐term care, 

COBRA, or health premiums while unemployed)

• Retirement at age 65– Pay for Medicare or 

– Money contributed to HSA can be withdrawn tax‐free to pay for qualified medical expenses (QME)

• Move it, keep it!– Completely portable, even if employees move  – Funds rollover from year to year

yemployees’ share of any medical insurance premiums

Funds rollover from year to year

• Simple start– Establish accounts easily through ??????

• 2012 annual contributions– Individual limit ‐ $3,100$ ,– Families ‐ $6,250

HSA Key Account Features

• Best HSA value

Get triple tax savingswith an HSA

– Debit Cards provided –

– Internet and telephone support• Accounts funded by individual, employer 

or both (up to IRS max)

Contributions to the account Interest/investment savings Withdrawals for QMEs

( p )• Individual responsible for managing HSA, 

filing HSA tax form and validating IRS qualified medical expenses (QMEs)

All are tax‐free!

Who is eligible?• Open to everyone enrolled in a qualified high‐deductible health plan 

• Individuals must not be enrolled in Medicare

I di id l t t b li ibl t b l i d d d t th ’ t• Individuals must not be eligible to be claimed as a dependent on another person’s tax return

• Individuals are not eligible with health care FSA medical vehicle

I di id l t b d d th h lth l th t i t lifi d hi h• Individuals cannot be covered under another health plan that is not a qualified high‐deductible plan; VA, Tricare, Medicare

• Plans listed below are not considered other health coverage

Specific disease coverage (cancer plan) visionFixed payments for hospitalization dentalAuto insurance accident  & disability

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HSAHSA • Once you elect coverage under HDHP and open an HSA, complete the information and return the signature card from your enrollment kit or activate your account on line and return the signature cardy g

• Receive a debit card and checks to access your HSA fundsfunds

• Claim forms are not needed to file for reimbursement 

• Save your receipts to help prepare your tax form

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Contributions to an HSA• Contributions must be made in dollars

• Employee/Account holder must be enrolled in a qualifiedEmployee/Account holder must be enrolled in a qualified HDHP to contribute

• Employer and employee can contributeEmployer and employee can contribute

• Employee/Account holder may no longer contribute once they enroll with Medicarey

• Maximum yearly contributions in 2012– $3,100 for individual or $6,250 for family$3,100 for individual or $6,250 for family

• Individuals age 55 and older can make an additional “catch‐up” contribution of $1000 in 2012

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p $

Distributions from an HSA• Only funds available (deposited) in the account may be used

• Funds the HSA can still be used for qualified medical expenses, even if a person is no longer enrolled in a qualified high‐deductible health plan

• Amounts distributed, which are not used to pay for qualified medical expenses, are subject to income taxes and an additional 10% excise taxare subject to income taxes and an additional 10% excise tax

• Employee/Account holder is responsible for ensuring that expenses paid from the account are qualified medical expenses —Banks, your employer or the Health Plan does not verify paid expenses are qualified under the IRS guidelines

• Balances remaining in an HSA at the end of a year roll to the next year

• Beneficiary rules apply upon death

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HSA Qualified Medical ExpensesHSA Qualified Medical ExpensesHSA Qualified Medical Expenses

To qualify, an expense cannot be reimbursable to you through any other source, such as group health insurance, a lf f d d h l h l h i b i d b li iblself-funded group health plan or another reimbursement program. Expenses incurred by you, your eligible spouse

or legal dependents are reimbursable. Attached are examples of qualified medical expenses (QMEs) that typically qualify for reimbursement utilizing your Health Savings Account (HSA) Additional guidance may be found in section 213d of the IRS tax code. For more information visit www.irs.gov and see Publications 502 and 969

In addition to the qualified medical expenses provided on the attachment, HSA accounts can be used to pay for health related premiums such as:

•Medicare Part A&B (individuals age 65+)•Medicare HMO premi ms (indi id als age 65+)•Medicare HMO premiums (individuals age 65+) •COBRA continuation coverage premiums•Premiums for Long Term Care Coverage•Premiums for Health Care Coverage (while receiving unemployment benefits)•Premiums for employer-sponsored retiree health insurance (individuals age 65+)

Note: Medicare Supplement coverage premiums are NOT an eligible IRS medical expense.

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Ways to manage health care costWays to manage health care costTake advantage of your preventative care benefit

Use generic prescription drugs

Stay in‐network NetworkBlue provider network

Use an Urgent Care Center for non‐emergency care

Use Quest Diagnostics for lab servicesUse Quest Diagnostics for lab services

Use on line health and cost information

Take advantage of Blue365 discounts, discounts on orthodontic services & discounts on dental cosmetic services

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Quick Comparison GuideQuick Comparison GuideHSA FSA

Contributor • Employee and/or employer, family and friends of eligible account holders

• Employee and/or Employer• Tax-deductible by employer, pre-tax to

• Contributions and investment earnings are tax-free

y p y , pemployee

Balances carried over the next year

Yes Employer can choose to carry over balance 2 months and 15 days past end of plan yearof plan year

Portability Yes, funded individual account. Employee retains access to unused account balance even when they change employers

• No. Must be used during periods of employment, and/or continuation under COBRA

• Cash-outs not permittedp

BCBSF health plans that BlueOptions® • BlueOptionsC S ea t p a s t atwork with financial programs

ueOpt o s ueOpt o s• BlueChoice• BlueCare®

Those with FSAThose with FSA

• Current FSA Account must be Zero byCurrent FSA Account must be Zero by 12/31/11

• Limited FSA available in conjunction with HSA

• Example Child Care or Dentalp

Comparing Four Health PlansComparing Four Health PlansCOST SHARING Maximums shown are Per Benefit Period (BPM) unless noted

Predictable Cost 03559Plan A

Predictable Cost 03359 Plan B

Lower Cost 05360Plan C

HSA Compatible 03160Plan D

HSA Compatible 03161Plan D

(Single Coverage) (Family Coverage)

Deductible (DED) (Per Person/Family Aggregate)

In-Network $300 / $900 $500 / $1,500 $750 / $2,250 $1,500 / Not Applicable

$3,000 / $3,000Applicable

Out-of-Network Combined with In-netwk

Combined with In-netwk

Combined with In-netwk

$2,500 / Not Applicable

$5,000 / $5,000

Coinsurance (Member Responsibility)

In-Network 20% 20% 20% 20% 20%

O t f N t k 40% 40% 40% 40% 40%Out-of-Network 40% 40% 40% 40% 40%

Out of Pocket Maximum (Per Person/Family Aggregate)

Includes DED, Coins, Copays;

Excludes Rx

Includes DED, Coins, Copays;

Excludes Rx

Includes DED, Coins, & Copays;

excludes Rx

Includes DED, Coins, Copays

Includes DED, Coins, Copays

In-Network $2,500 / $7,500 $3,000 / $9,000 $3,000 / $9,000 $3,500 / Not Applicable

$7,000 / $7,000Applicable

Out-of-Network Combined with In-netwk

Combined with In-netwk

Combined with In-netwk

$10,000 / Not Applicable

$10,000 / $10,000

Lifetime Maximum No Maximum No Maximum No Maximum No Maximum No Maximum

Comparing Four Health Plans – contd.Comparing Four Health Plans  contd.BlueOptions BlueOptions BlueOptions BlueOptions BlueOptions

COST SHARING Maximums shown are Per Benefit Period (BPM) unless noted

Predictable Cost 03559Plan A

Predictable Cost 03359 Plan B

Lower Cost 05360Plan C

HSA Compatible 03160Plan D

(Single Coverage)

HSA Compatible 03161Plan D

(Family Coverage)(Single Coverage) (Family Coverage)

Office Services

In-Network Family Physician $20 $20 $20 DED + 20% DED + 20%

In-Network Specialist DED + 20% DED + 20% DED + 20% DED + 20% DED + 20%In Network Specialist DED + 20% DED + 20% DED + 20% DED + 20% DED + 20%

Out-of-Network DED + 40% DED + 40% DED + 40% DED + 40% DED + 40%

PREVENTIVE CARE

Adult Wellness Office Services

In-Network Family Physician $0 $0 $0 $0 $0

In-Network Specialist $0 $0 $0 $0 $0

Out-of-Network 40% (No DED) 40% (No DED) 40% (No DED) 40% (No DED) 40% (No DED)

Urgent Care Centers (UCC)

In-Network DED + 20% DED + 20% DED + 20% DED + 20% DED + 20%

Out-of-Network DED + 40% DED + 40% DED + 40% DED + 40% DED + 40%

PRESCRIPTION DRUGSDeductible $100 RX Brand $100 RX Brand $100 RX Brand only DED DEDDeductible $100 RX Brand

only$100 RX Brand

only$100 RX Brand only DED DED

In-NetworkRetail (30 days)

Generic/Preferred Brand/Non-Preferred

$15 / $30 / $50 $15 / $30 / $50 $15 / $30 / $50 $15 / $50 / $80 $15 / $50 / $80

WellnessWellness

• Health Fair “Jump into Fitness”Health Fair Jump into Fitness– Wednesday January 11, 2012Palatka High School Gym– Palatka High School Gym

– 10:30‐4:30 – Early Release DayH lth A t– Health Assessment 

Ad l W ll C d 100%– Adult Wellness Covered at 100%• In‐network visit

Case Study Emergency Room VisitCase Study Emergency Room VisitEmergency Room Visit

Plan C: $100 + 20%Plan C:      $100 + 20%Average Paid per Visit $1,129.00         *BCBS PCSB 2010 Data

Member Responsible for $100 + 20% of 1,029.00 = 205.8T l $305 80Total $305.80

Plan D: Deductible + CoinsuranceAverage Paid per Visit $1,129.00         *BCBS PCSB 2010 Datag p $ ,

Member Responsible for $1,129.00

Case Study Hospital AdmitCase Study Hospital Admit

Hospital Admit – In‐NetworkpAverage Hospital Inpatient Payment per Admit $10,424.72Average Length of Stay 4 Days     *BCBS PCSB 2010 Data

Plan CPlan C‐Deductible + CoinsuranceAverage Bill $10,424.72 ‐ $750 Deductible $9,674.72 x 20% Coinsurance = $1,934.94  Member Responsibility $750 Deductible + $1,934.94 = $2,684.94

Plan D

‐$1500  Deductible Average Bill $10,424.72 ‐ $1500 Deductible $8,924.72 x 20% Coinsurance = $1,784.94

Member Responsibility $1500 Deductible + $1,784.94 = $3,284.94  

RatesRatesA B C D

Plan Blue Options Blue Options Blue Options HDHP/HSA

Pd 1 x month Pd1x month Pd1x month Pd1x monthPd 1 x month Pd1x month Pd1x month Pd1x month

Employee $333.71 $284.47 $101.67 $7.75

Emp/Child(ren) $935.39 $842.79 $587.16 $410.57

Emp/Spouse $1,065.25 $963.38 $691.99 $497.54

Family $1,820.74 $1,664.45 $1,301.57 $1,003.37

• One time $500 HSA Contribution 

• Those choosing Plan D will have 1 time opt‐out next year.y

HSA Conclusion

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