Waco ISD 2013 Open Enrollment GHC24354 02/12. 1. 2013 Medical Benefits 2. Vision Plan 3. Humana...
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Transcript of Waco ISD 2013 Open Enrollment GHC24354 02/12. 1. 2013 Medical Benefits 2. Vision Plan 3. Humana...
Waco ISD 2013 Open Enrollment
GHC24354 02/12
1. 2013 Medical Benefits
2. Vision Plan
3. Humana Resources
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Agenda
2013 Medical Plans
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Humana NPOS HDHP with HSACoverage In-NetworkCo-insuranceOut of Pocket Max*Out of Pocket Max includes Deductibles
80%$5,950 Individual$11,900 Family
Deductibles $4,000 Individual$8,000 Family
Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screenings
100% No deductible
Physician ServicesPrimary Care PhysicianSpecialists
80% after deductible and $40 copay80% after deductible and $55 copay
Hospital ServicesInpatientOutpatient
80% after deductible80% after deductible
Emergency Room 80% after deductible and $250 Copay
Urgent Care 80% after deductible and $100 Copay
How the High Deductible Health Plan works
• The High Deductible Health Plan has two key components:– Integrated deductible: medical and prescription costs apply to the same
deductible– Coinsurance: once the deductible is met, the plan pays coinsurance – a
percentage of your health care costs• Other High Deductible Health Plan features:
– For family coverage, costs for all covered members apply to same aggregate deductible
– Includes coverage for preventive care services at no cost regardless of whether the deductible is met
• A Health Savings Account, or HSA, is a financial account used to pay for qualified medical expenses.
• HSAs combine the benefits of both traditional and Roth 401(k)s and IRAs for medical expenses.
• Taxpayers receive a 100% income tax deduction on annual contributions, they may withdraw HSA funds tax-free to reimburse themselves for qualified medical expenses, and they may defer taking such reimbursements indefinitely without penalties.
• HSAs are unique—“IRAs on Steroids”—with triple tax advantages:– Tax-deductible contributions– Tax-free accumulation of interest and dividends tax-free, and– Tax-free distributions for qualified medical expenses.
• 2013 Max Contribution: Individual $3250 / Family $6450
• Catch up Contribution (if age 55 or older) additional $1000 per year
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Background on Health Savings Accounts
Contributing money to an HSA
• It’s a fund you can use to cover your qualified healthcare costs• Humana oversees the administration of both your plan and the HSA, which is
managed by our partner bank, UMB• Receive a Humana Access card to use as payment for qualified expenses• You, your employer, and anyone else can contribute to your account• Once money goes into the account, it’s yours forever• Unused money carries over from year to year (unlike FSA - use it or lose it)• If you leave your current employer, HSA funds can stay in the same account or roll into
another HAS• HSA contributions are credited to account monthly, not lump sum at beginning of year
like an FSA• IRS Rule - You cannot contribute to an HSA unless you are enrolled in an HDHP* Please refer to IRS.gov or your Humana enrollment packet for detailed tax and HDHP/HSA information.
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Humana NPOS 70/50 Copay PlanCoverage In-NetworkCo-insuranceOut of Pocket Max*Out of Pocket Max calculates separately and does not include Copays/Deductibles
70%$5,000 Individual$10,000 Family
Deductibles $8,000 Individual$16,000 Family
Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits /MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screenings
100% No deductible
Physician ServicesPrimary Care PhysicianSpecialists
100% after $50 copay100% after $100 copay
Hospital ServicesInpatient / Outpatient 70% after deductible
Emergency Room 70% after deductible
Urgent Care 100% after $50 Copay at a Concentra Facility70% after deductible for non-Concentra Facility
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Humana NPOS Simplicity PlanCopays Only – No Deductibles or Coinsurance!
Coverage In-NetworkCopay / Out of Pocket Maximum $6000 Individual / $12,000 Family
Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screeningsPhysician Services for inpatient/outpatient hospital, emergency and surgical (Facility Charges subject to separate copay)
$0 Copay
Office Visits/Urgent CarePrimary Care PhysicianConvenient Care ClinicConcentra Urgent Care FacilitySpecialists/Other Specialist Office VisitsChiropractic care, physical, occupational, cognitive, speech and audiology therapy (visit limitations apply)Urgent Care at NON- Concentra Facility
$50 Copay per visit
$100 Copay per visit
$125 Copay per visit
Inpatient Hospital StaysOutpatient Surgical Services (Facility)Emergency Room
$1500 Copay per day for the first 3 days$1500 Copay per visit$600 Copay per visit
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Humana NPOS 80/50 Copay PlanCoverage In-NetworkCo-insuranceOut of Pocket Maximum*Out of Pocket Max calculates separately and does not include Copays/Deductibles
80%$5,000 Individual$10,000 Family
Deductibles $2,500 Individual$5,000 Family
Preventive CareAnnual Routine Physical Exams Well-Child Care / ImmunizationsRoutine Well-Woman Visits MammographyRoutine Lab and X-RayPreventive EndoscopyPreventive Prostate screenings
100% No deductible
Physician ServicesPrimary Care PhysicianSpecialists
100% after $30 copay100% after $45 copay
Hospital ServicesInpatient / Outpatient 80% after deductible
Emergency Room 100% after $150 copay
Urgent Care 100% after $30 Copay at a Concentra Facility100% after $75 non-Concentra Facility
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Pharmacy BenefitsPlan Coverage
NPOS 80/50 HDHP with HSA
NPOS 70/50 Copay PlanSimplicity PlanNPOS 80/50 Copay Plan
RX4 Copay After DeductibleLevel 1 - $10 Level 2 - $40Level 3 - $70Level 4 – 25%
RX4 Level 1 - $10 Level 2 - $40Level 3 - $70Level 4 – 25%
Right Source Mail Order RX 2.5 Copays for 3 Month Supply
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Women’s Preventive Care Updates for 2013
Coverage In-NetworkContraceptive methods and counseling includes :
All FDA approved contraceptive methods, sterilization including vasectomies, and patient education and counseling.
Prescription is required, includes over the counter contraceptives
*Brand name contraceptives are covered at 100% only when no generic alternative is available in that class/category
Breastfeeding support, supplies and counseling to include costs for renting breastfeeding equipment
Covered at 100% in network only
Vision Plan Automatically included to ALL Waco ISD Humana medical members at no additional cost!
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Pharmacy Tools
Access RightSource Rx registration and maintenance information
Compare drug costs and view alternative medications
View prior authorization requirements
Locate local pharmacies
Maximize your benefit
Physician Finder
• Go to www.humana.com
• Under Resources and & Support tab, click on “Find a Doctor”
• Under Type of Coverage, ensure Employer Group Plan is selected, input zip code
• For network, please select National Point of Service- Open Access
• Agree to terms, select parameters and go!
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Concentra in Waco Save Money on Urgent Care
Humana Vitality
Comprehensive wellness program
Integrates rewards with health and wellness
Provides the tools and support necessary to help Humana members live healthier lives.
Humana Vitality members rewarded for making healthier choices, i.e. attending preventive screenings, exercising regularly and quitting smoking.
Clinical Program available for Humana Members
Programs available:
Asthma
Diabetes
Heart Disease
Pregnancy
Renal Failure
Ask a Humana representative today about getting involved in these programs
Get Engaged: Member Communications
Humana will be reaching out to members using various communication methods:
Phone Calls directly to member’s homes Email communication regarding preventive reminders, clinical programs available, etc.Plan Professor NewslettersMember Welcome GuideMaximize your benefit Smart EOB
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Questions