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Your Guide to Health Care Benefits
Our Benefits Philosophy
• Deliver competitive benefits
• Offer value to you and your family
• Encourage you to make informed health care choices
• Help keep costs sustainable – for the company and you
2
[Adjust as needed]
Health Care Reform Update
• Starting January 1, 2014, nearly everyone in the U.S. must have medical coverage or pay a penalty
• Your options for coverage:– Full time/part time employees (30+ hours/week) –[client name]’s
medical plan meets government affordability requirements • Not eligible for a government subsidy
– Part time employees (<30 hours/week) not eligible for coverage at [client name] – may need to look to the public marketplace
– Spouse’s medical plan– Your state’s Health Insurance Marketplace or “Exchange”– Private insurance companies– Medicaid, TEFRA and the Children’s Health Insurance Program
(if eligible)
Health Care Reform
What’s Coming Up• August 2013 – December 2013
– You may hear more about your Exchange options or get information from individual medical plan companies
• [October 1 – November 15, 2013]– [Client name] 2014 Open Enrollment
• October 2013 – March 2014– Exchange enrollment period for 2014 coverage
• January 1, 2014– Nearly everyone must be enrolled for health care coverage or
pay a penalty
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Your Medical Options
PPO
Health Savings Account (HSA)
Company Contributions
Your Contributions
CDHP + HSA
Medical Options:
Compare and Contrast PPO CDHP
Routine and preventive care?
100% covered in-network 100% covered in-network
Are there copays?
Only for doctor’s visits, specialists’ visits and ER
No copays
Pay the deductible first?
Yes, except for prescription drugs
Yes, but the HSA helps
Coinsurance? 75% in-network50% out-of-network
80% in-network60% out-of-network
Out-of-pocket maximums
Only for medical care;your prescription drug costs are
separate
Only for medical care;most of your prescription drug
costs are separate
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[update as needed]
Medical Options:
Compare and Contrast
PPO CDHPNetworks Cigna Healthcare Cigna Healthcare
What are the payroll deductions?
Lower deductibles; higher premiums
Higher deductibles; lower premiums
The most you’ll pay out-of-pocket in a year if you stay in the network?
For medical care onlyEmployee Only: $4,000Family: $12,000
You continue to pay your share of prescription drug costs
For medical care onlyEmployee Only: $4,000Family: $8,000
You continue to pay your share of prescription drug costs
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[update as needed]
Deductibles, Coinsurance and Out-of-Pocket Maximums
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PPO (in-network)
CDHP(in-network)
Deductible• Individual• Family
$750$2,250
$2,000$4,000
Your coinsurance (what you pay) 25% 20%
Out-of-pocket maximum• Individual• Family
$4,000$12,000
$4,000$8,000
After you reach out-of-pocket max, your coinsurance (what you pay)
0% 0%
[update as needed]
Deductible and Out-of-Pocket Maximum Work Differently:
If You Enroll Dependent(s)
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Two ways to meet the deductible (CDHP example) …Combined covered expenses
for entire family.
$4,000
Covered expenses for one family member, or …
• You must meet the family deductible before the plan begins to pay benefits for anything except preventive care
• You must meet the family out-of-pocket maximum before the plan pays 100%
$4,000
[update as needed]
CDHP with HSA: Working Together
Preventive care
Plan pays 100%
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Health Savings Account
Together, contributions from you and the Company can cover you deductible and coinsurance.
CDHP with HSA: Working Together
Preventive care
Plan pays 100%
Deductible
You pay 100%. Once
the deductible is met,
coinsurance kicks in
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CDHP with HSA: Working Together
Preventive care
Plan pays 100%
Coinsurance
You and the Company share a percentage of the costs until you meet the out-of-pocket maximum.
Deductible
You pay 100%. Once
the deductible is met,
coinsurance kicks in
Health Savings Account
Together, contributions from you and the Company can cover you deductible and coinsurance.
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Health Savings Account
Together, contributions from you and the Company can cover you deductible and coinsurance.
CDHP with HSA: Working Together
Preventive care
Plan pays 100%
Out-of-pocket maximum
Once you reach this, the plan pays 100% of
in-network costs.
Deductible
You pay 100%. Once
the deductible is met,
coinsurance kicks in
Coinsurance
You and the Company share a percentage of the costs until you meet the out-of-pocket maximum.
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Health Savings Account (HSA)
Available with the CDHP if you have no other medical coverage
Money goes in tax-free
Money comes out tax-free when you use it for qualified health care expenses
Unused HSA balance stays with you
Health Savings Account (HSA)
Company Contributions
Your Contributions
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Health Savings Accounts (HSAs):
We Get You Started
Based on your medical coverage level
CompanyContribution
Individual $500
Family $1,000
*The company does not make HSA contributions for highly-compensated employees.
HSA
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Health Savings Accounts (HSAs):
IRS Contributions Limitsfor Your HSA
HSA
When you … You and the Company can contribute up to a combined …
Enroll for Individual coverage
$3,300 per year
Enroll for Family coverage
$6,550 per year
Are age 55 or older
An extra $1,000 per year
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Health Savings Account: An Example
How Money Goes Into Your HSA
HSA$1,000
Provided for enrolling$500
You add$500
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Health Savings Account: An Example
How Money Comes Out
- $138 visit to your primary doctor- $30 for two prescriptions- $148 specialist visit
$316
$684 left
HSA$1,000
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Health Savings Account: An Example
Unused HSA Dollars Roll Over
2014: $684 remaining
2015:Start off with $684
Health Savings Account:
Consider Saving Enough to Cover Deductible
20
In-Network Deductible
Company contribution
What you need to save
Individual Coverage $2,000 $500 $1,500 or $125/month
Family Coverage $4,000 $1,000 $3,000 or $250/month
[update as needed]
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Examples to Help You Choose
Example 1Single,
Generally healthy
Example 2Family
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CDHP
PPO
Care + Rx
PCP: $200
Prescription Drugs: $180
Total: $380
Teresa’s Out-of-Pocket
Health Care Costs
= $380
HSA Dollars
Company: $500
+
Teresa: $500
Total in HSA: $1,000
Out-of-Pocket(minus HSA dollars): $0
Carries forward$620 in HSA
Premium + HSA contributions: $X,XXX
Care + Rx
PCP: $50
Prescription Drugs: $180
Total: $230
Teresa’s Out-of-Pocket
Health Care Costs
= $230
Teresa – Generally healthy, single, in her late 20s
Here’s what Teresa anticipates her expenses to be in 2014, based on her care in 2013:
• 3 doctor visits – one preventive – and 12 prescriptions (at $15 each)
Premium: $X,XXX
23
Tami and Sam – Family coverage
Here’s what Tami anticipates her expenses to be in 2014, based on her care in 2013:
• 8 doctor visits – 5 preventive – and 1 specialist, with 12 generic prescriptions (at $15 each) and 3 brand-name (at $35 each)
• 2 follow up specialist visits
Care + Rx
3 Doctor visits = $3001 Specialist visit = $200
Prescriptions drugs = $180Preferred brand prescriptions = $105
2 Follow-up specialist visits = $400
Total: $1,185
Tami’s Out-of-Pocket
Health Care Costs
= $1,185
HSA Dollars
Company: $1,000+
Tami: $400
Total in HSA: $1,400
Out-of-Pocket(minus HSA dollars): $0
Carries forward$215 in HAS
Premium + HSA contributions: $X,XXX
Tami’s Out-of-Pocket
Health Care Costs
= $5,10 Premium: $X,XXX
Care + Rx
3 Doctor visits = $751 Specialist visit = $50
Prescriptions drugs = $180Preferred brand prescriptions = $105
2 Follow-up specialist visits = $100
Total: $510
CDHP
PPO
Prescription Drug Coverage
• You receive prescription drug coverage when you enroll in either medical plan
• Generic: $15 copay
• Brand-name formulary: $35 copay
• Brand-name non-formulary: $50 copay– For 30-day supplies when you visit retail pharmacy
• 90-day supplies available through mail-order
• CDHP offers preventive prescription drugs covered at 100%
24
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Dental OverviewIn-network
Plan year deductible• Individual• Family
$50$150
Plan year maximum• Individual $1,500
Preventive• Exam• Cleanings• X-rays
100 %
Basic• Fillings• Endodontics • Periodontics
80% after deductible
Major• Crowns/Bridges 50% after deductible
Orthodontia (Children under 19)
Up to $1,250 lifetime maximum benefit
Vision Overview In-network
Deductible $25
Eye exam (every 12 months)
Covered at 100% up to $125 after deductible
Frames(every 12 months)
Covered at 100% up to $125 after deductible
Contact lenses One pair every 12 months in lieu of
eyeglasses
NO changes to Dental benefits
NO changes to Vision benefits
[update or delete]
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Consider Your Choices
Enroll for medical
coverage?
Consider your likely health care
needs, other available
coverage, cost
Which medical
plan?
Consider your estimated total cost
If you enroll in the CDHP - how much to
additionally contribute to your HSA?
Consider what it would take to meet the deductible
Factor in employer contributions and your own
1 2 3
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Three Simple Steps to Enroll
Verify your dependents
Submit the
needed documents within
31 days of enrolling a new
dependent
Complete your screenings and
health assessment
Online health assessment available
starting October 1
1 2 3
Enroll for 2014 benefits
Everyone must make an election – visit the
Employee Portal to enroll from
Oct. 1 – Nov. 15