Health Plan Options Informational Sessions November 2012

Health Plan Options

Informational Sessions

November 2012

Agenda

• Overview of Health Plans

• Prescription Drug Coverage

• 2013 Health Premiums

• Health Care Flex Spending Account

• Health Savings Account (HSA)

• Out-of-Pocket Cost Comparisons

Health Plans

United HealthCare (UHC) Choice HMO United HealthCare Choice Plus POS Anthem Blue Cross Excel PPO Anthem Blue Cross Basic PPO UHC High Deductible Health Plan

(HDHP)

All Health Plans

• No pre-existing condition limitations

• No lifetime maximum benefit

• No requirement for referral from a primary care physician to see a specialist

• Coverage under health plan automatically includes coverage under the prescription drug, dental, and basic vision plans

United HealthCare Choice HMO

In Network Out of Network

Annual Deductible None N/A

Office Visit Co-Pay Preventive Primary Care Physician Specialist Physician

$0 $25$40

N/AN/AN/A

Hospital Co-Pays Emergency Room (waived if admitted) In-Patient (semi-private room)

$150$300

$150N/A

Outpatient Surgery Co-Pay $150 N/A

Urgent Care Co-Pay $35 N/A

Lab/X-Ray Preventive Non-Preventive Major Radiologic Diagnostic Test

$010% co-

insurance20% co-

insurance

N/AN/AN/A

Annual Co-Insurance Maximum Individual Family

$1,500$3,000

N/AN/A

United HealthCare Choice Plus POSIn Network Out of

Network

Annual Deductible Individual Family

NoneNone

$300$900

Office Visit Co-Pay Preventive Primary Care Physician Specialist Physician

$0$25$40

30%30%30%

Hospital Co-Pays Emergency Room (waived if admitted) In-Patient (semi-private room)

$150$300

$15030%

Outpatient Surgery Co-Pay $150 30%

Urgent Care Co-Pay $35 30%

Lab/X-Ray Preventive Non-Preventive Major Radiologic Diagnostic Test

$010% co-insurance20% co-insurance

30%30%30%


$1,500$3,000

$3,000$6,000

Anthem Blue Cross Excel PPO



$500$1,500

$500$1,500

Co-Insurance 20% 40%

Preventive Care 0% (no deductible)

40%

Hospital Emergency Care In-Patient (semi-private room) Outpatient Surgery

20%20%20%

20%40%40%

Urgent Care 20% 40%

Lab/X-Ray Preventive Non-Preventive

0%20%

40%40%


$1,500$4,500

$3,000$9,000

Anthem Blue Cross Basic PPO



$750$2,250

$750$2,250



40%

Hospital Emergency Care In-Patient (semi-private room) Outpatient Surgery

20%20%20%

20%40%40%

Urgent Care 20% 40%

Lab/X-Ray Preventive Non-Preventive

0%20%

40%40%


$2,500$7,500

$5,000$15,000

United HealthCare HDHP

In-Network Out of Network

Annual DeductibleIndividual (Employee Only)Family (Employee +1 or more dependents)

$1,500$3,000

$1,500$3,000



40%

Annual Co-insurance MaximumIndividualFamily

$1,250$2,500

$2,500$5,000

Annual Out-of-pocket Maximum (Including Deductible and Co-insurance)IndividualFamily

$2,750$5,500

$4,000$8,000

United HealthCare HDHP

• Separate In-Network and Out-of-Network deductibles

• Family deductible applies if you cover one or more family members

• Family deductible must be fully met even if only one family member utilizes the plan

• Deductible and co-insurance apply to prescription drugs (no co-pays)

Prescription Drug Benefits

Express Scripts

All Health Plans except UHC HDHP

UHC HDHP

Tier 1 Co-pay(generi

c)

Tier 2Co-pay

(preferred)

Tier 3Co-pay(non-

preferred)

30-Day Supply Retail Pharmacy

$10 $40 $65 Deductible, then 20% co-

insurance

90-Day SupplyMail Order

$25 $100 $162.50 Deductible, then 20% co-

insurance

2013 Employee Monthly Premiums

Full Time Faculty & Staff Earning less than $35,000

HEALTH PLANEMPLOYEE

ONLY

EMPLOYEE + ONE

DEPENDENT

EMPLOYEE + TWO OR MORE

DEPENDENTS

UHC Choice HMO $35.77 $193.80 $273.67

UHC Choice Plus POS 55.33 270.16 406.38

UHC High Deductible PPO

7.71 26.53 51.57

Anthem BC Excel PPO 73.92 298.90 445.46

Anthem BC Basic PPO 19.41 61.63 120.65

Dental Only 2.39 5.32 8.06

Vision Buy-Up Option 6.56 13.09 21.10


Full Time Faculty & Staff Earning $35,000 or more

HEALTH PLANEMPLOYEE

ONLY

EMPLOYEE + ONE

DEPENDENT


DEPENDENTS

UHC Choice HMO $43.55 $231.40 $328.77



10.46 35.09 67.20



Dental Only 2.39 5.32 8.06



Part-Time Faculty & Staff

HEALTH PLANEMPLOYEE

ONLY

EMPLOYEE + ONE

DEPENDENT


DEPENDENTS

UHC Choice HMO $231.06 $569.20 $794.04



141.15 290.05 428.90



Dental Only 4.78 10.64 16.12


Health Care Flex Spending Account (FSA)

Qualified Expenses Out-of-pocket Medical, Dental, Rx, and Vision

Annual Maximum Contribution

$2,500 Per Employee

Payment Methods Debit card / Pay Me Back / Pay My Provider

Payment Amount Up to Annual Contribution Amount

Debit Card Requirements

Settle Unverified Transactions

Benefit to Employee Federal, State, & FICA Tax Savings

Grace Period January 1 through March 15 after Plan Year

Claims Filing Deadline

April 30 after Plan Year

Limitations of Plan Forfeiture of Unclaimed Balance

WAGE WORKS

Health Savings Account (HSA)

Eligibility Requirements Must be Enrolled in WUSTL UHC High Deductible Health Plan (HDHP)

Minimum Employee Contributions to receive university contribution

$200 (Under $115,000 salary) $400 ($115,000 and greater salary)

Maximum Employee Contributions

$3,250 (Employee) - $2,850 w/ university contribution$6,450 (Family) - $6,050 w/ university contribution$1000 catch-up contribution – Age 55 & older

University Contribution $400

Benefit to Employee Income Tax Advantages

Funds to be Utilized Active or Retiree Health Costs

Limitations of Plan Cannot be enrolled in Health FSA or Medicare

US BANK

Health Care FSA and HSA Comparison

Health Care FSA HSAHealth Plan Requirement No Must be enrolled in

HDHP

Maximum Annual Contribution $2500

$3250 – Individual Coverage

$6450 – Family Coverage

University Contribution No

$400 annual contribution if

employee contributes required minimum

Access to Annual Election Throughout

yearYes

No. Can access only up to YTD

contributions

Contribution Forfeiture YesNo. Unused

contributions roll over from year-to-year

Scenario #1: Single Employee (Income >$35,000) – Generally Healthy

Premium/Procedure UHC

Choice HMO

UHC

Choice Plus POS

UHC HDHP BC Excel BC Choice

Annual Physical ($280) $0 $0 $0 $0 $0

Office Visit – Illness

($90) $25 $25 $90 $90 $90

Antibiotic – Generic

($10) $10 $10 $10 $10 $10

Out-of-Pocket Cost

($380) $35 $35 $100 $100 $100

Premium Contribution $522.60 $828.96 $125.52 $1,151.52 $298.32

HSA University Contribution ($400)

$200 HSA Contribution Tax Savings* (28% Rate)

($56.00)

Total Annual Cost $557.60 $863.96 ($230.48) $1,251.52 $398.32

* Tax savings will vary based on your current FSA contribution and medical plan election.

Scenario #2: Employee Plus Spouse (income >$35,000) – Having First Baby in June

Premium/Procedure UHC Choice HMO

UHCChoice Plus

POS


Pre-Natal Care – 6 OB visits ($740) $0 $0 $0 $0 $0

Office Visit – Illness($90)

$25 $25 $90 $90 $90

Normal Delivery($6,000)

$300 $300 $3,528 $1,528 $1,728

Out-of-Pocket Cost($6,830)

$325 $325 $3,618 $1,618 $1,818

Premium Contribution $3,361.02 $5,026.26 $613.74 $5,780.52 $1,388.34


$200 HSA Contribution with Tax Savings* (28% Rate)

(56.00)

Total Annual Cost $3,686.02 $5,351.26 $3,775.74 $7,398.52 $3,206.34

* Tax savings will vary based on your current FSA contribution and medical plan election.

Scenario #3: Employee Plus Spouse (income >$35,000) - Elective Surgery for Family Member


UHCChoice

Plus POS


Annual Physical($280)

$0 $0 $0 $0 $0

Office Visits (1 PCP, 2 specialists) - ($330) $105 $105 $330 $330 $330

MRI – Knee ($750) $150 $150 $750 $286 $486

Elective Knee Surgery ($7,000 charge) $150 $150 $2,936 $1,384 $1,400

Rehabilitation ($1,560 – 18 visits) $720 $720 $312 $0 $312

Out-of-Pocket Cost($9,920)

$1,125 $1,125 $4,328 $2,000 $2,528

Premium Contribution $2,776.80 $4,008 $421.08 $4,635.96 $942.96


$200 HSA Contribution with Tax Savings* (28% Rate) ($56.00)

Total Annual Cost $3,901.80 $5,133 $4,293.08 $6,635.96 $3,470.96* Tax savings will vary based on your current FSA contribution and medical plan election.

Scenario #4: Employee Plus Family with Two Children – One child has a sports injury, the other child has asthma


UHCChoice Plus

POS


Child 1* - Emergency Room Visit, Treatment for Broken Leg, and Physical Therapy ($7,200)

$630 $630 $3,840 $1,840 $2,040

Child 2 - ER Visit, 1 Night in the Hospital, 4 office visits, and Asthma Medications (12 Tier 2 Retail) ($5,800/$1,700 Rx)

$400 + $480 (Rx)

$400 +$480 (Rx)

$1,500$1,560 + $480

(Rx)

$1,760 +$480 (Rx)

Employee – Annual Physical ($250) $0 $0 $0 $0 $0

Spouse – Well Woman Exam ($230) and 2 office visits for illness ($180) $50 $50 $36 $36 $36

Out-of-Pocket Cost ($15,360) $1,560 $1,560 $5,376 $3,916 $4,316

Premium Contribution $3,945.25 $6,044.52 $806.40 $6925.08 $1,833.72


$200 HSA Contribution with Tax Savings* (28% Rate) ($56.00)

Total Annual Cost $5,505.24 $7,604.53 $5,726.40 $10,841.08 $6,149.72

* 4 specialist visits, 8 physical therapy sessions** Tax savings will vary based on your current FSA contribution and medical plan election.

Documents

Health Plan Options Informational Sessions November 2012