M Murray School DistrictMedical Insurance Plan & Health Savings Account Information
September 1, 2013 through August 31, 2014
Choice in Provider Networks
34 Participating hospitals; 3,700+ Participating providers
MMurray
School District 9/2013 - 8/2014
NOTICE:The network of providers will no longer be offered as of September 1, 2013.
10 Participating hospitals; 1,200+ Participating providers
How To Find A Participating Provider
MMurray
School District 9/2013 - 8/2014
• Visit www.selecthealth.org/provider
• Call Member Advocates at (801) 442-4993
• Refer to the printed provider and facility directory found within your SelectHealth materials
NEW! Med+ HealthSave Plan Traditional Med+ Traditional Value
Single Couple Family Single Couple Family Single Couple Family
Premiums(per month)
Savings Account
Contribution (annually)
$43.98
$1,067
$100.08
$2,400
$140.28
$3,398
$132.84
$0
$300.08
$0
$423.48
$0
$92.24
$0
$208.88
$0
$294.18
$0
Monthly Premiums & HSA Contributions
ADMINISTRATORSMurray
School District 9/2013 - 8/2014
M
NEW! Med+ HealthSave Plan Traditional Med+ Traditional Value
Participating Non-Participating Participating Non-Participating Participating Only
Deductible*(Per Plan Year)
Out-of-Pocket Maximum
(Per Plan Year)
$2,000/$4,000Individual / Family 2+
IRS Regulation
$4,000/$8,000Individual / Family 2+
IRS Regulation
$2,250/$4,500Individual / Family 2+
IRS Regulation
$5,500/$11,000Individual / Family 2+
IRS Regulation
$500/$1,500Individual / Family
$2,500/$5,000Individual / Family
$1,000/$3,000Individual / Family
$5,000/$10,000Individual / Family
$500/$1,500Individual / Family
$2,500/$5000Individual / Family
Deductible & Out-of-Pocket Maximum
MMurray
School District 9/2013 - 8/2014
In accordance with IRS regulations, the HealthSave plan has an individual deductible or a family (2 or more covered) deductible and out-of-pocket maximum. Unlike the traditional plans, when an employee selects a family plan (2 or more covered), the entire family deductible must be met BEFORE the copayment/coinsurance schedule goes into effect, even if all of the claims are accrued by just one individual in the family.
* The deductible is included in the out-of-pocket maximum on all plans.
NEW! Med+ HealthSave Plan Traditional Med+ Traditional Value
Participating Non-Participating Participating Non-Participating Participating Only
Preventive Care
Primary Care Physician
Secondary Care Physician
Chiropractic Care
Rehab Therapy(Outpatient: Physical/Speech/Occupational
20 visits per therapy type)
100%
$15 after deductible
$25 after deductible
Not covered
$25 after deductible
Not covered
40% after deductible
40% after deductible
Not covered
40% after deductible
100%
$30
$40
Not covered
$40 after deductible
Not covered
40% after deductible
40% after deductible
Not covered
40% after deductible
100%
$30
$40
Not covered
$40 after deductible
Office VisitsMMurray
School District 9/2013 - 8/2014
NEW! Med+ HealthSave Plan Traditional Med+ Traditional Value
Participating Non-Participating Participating Non-Participating Participating Only
Urgent Care
Emergency Room
Inpatient Services
Outpatient
$35/$15 after
deductibleInstaCare / KidsCare
$75 after deductible
20% after deductible
20% after deductible
40% after deductible
$75 after deductible
40% after deductible
40% after deductible
$45 / $30InstaCare / KidsCare
$250 after deductible
20% after deductible
20% after deductible
40% after deductible
$250 after deductible
40% after deductible
40% after deductible
$45 / $30InstaCare / KidsCare
$250 after deductible
20% after deductible
20% after deductible
Urgent Care, ER, Inpatient and Outpatient
MMurray
School District 9/2013 - 8/2014
NEW! Med+ HealthSave Plan Traditional Med+ Traditional Value
Separate
Rx Deductible
Up to a
30 Day Supply
Up to a mail order or Retail 90
90 Day SupplyAvailable for maintenance
medications only
Not ApplicableRx combined with medical deductible
Tier 1: $7 after medical deductible
Tier 2: $21 after medical deductible
Tier 3: $42 after medical deductible
Tier 1: $7 after medical deductible
Tier 2: $42 after medical deductible
Tier 3: $126 after medical deductible
*$100 Per person
*Tier 1: $15 *Tier 2: $30 after Rx deductible
*Tier 3: $50 after Rx deductible
*Tier 1: $15*Tier 2: $60 after Rx deductible
*Tier 3: $150 after Rx deductible
*$100 Per person
*Tier 1: $15 *Tier 2: $30 after Rx deductible
*Tier 3: $50 after Rx deductible
*Tier 1: $15*Tier 2: $60 after Rx deductible
*Tier 3: $150 after Rx deductible
Rx SelectPrescription Drugs
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School District 9/2013 - 8/2014
Tier 1: Generic medication Generic substitution is required when a generic is available.Tier 2: Name brand preferred formulary medicationTier 3: Name brand non-preferred medication
* Not applied toward medical out-of-pocket maximum.
Procedure Total Cost SelectHealth Allowable Amount
NEW! Med+ HealthSave Plan
$2,000/$4,000 DeductibleTraditional Med+
$500/$1,500 DeductibleTraditional Value
$500/$1,500 Deductible
Annual Exam(Preventive)
Colonoscopy (Preventive)
Pharmacy Deductible
5 Prescriptions
Urgent Care Visit
Out-of-Pocket Medical Expense:
$120
$1,500
n/a
$350
$200
$2,170
$80
$1,000
n/a
$280
$150
$1,510
$0
$0
n/a
$280
$150
$430
$0
$0
$100
$90 copayments(4 - $15, 1 - $30)
$45 copay
$235
$0
$0
$100
$90 copayments(4 - $15, 1 - $30)
$45 copay
$235
How Do the Plans Work?MMurray
School District 9/2013 - 8/2014
Scenario 1: Linda is enrolled with family coverage. During the year, she has an annual exam, a colonoscopy, fills 5 prescriptions for family members (4 generic / 1 name brand) and has a visit to an urgent care clinic. How will each plan cover her expenses?
Procedure NEW! Med+ HealthSave Plan
$2,000/$4,000 DeductibleTraditional Med+
$500/$1,500 DeductibleTraditional Value
$500/$1,500 Deductible
Annual Family Premium To Have Coverage
+ Out-of-Pocket Medical Expense Total (see previous slide)
PREMIUM & OUT-OF-POCKET EXPENSES
- HSA Contribution from MSD for Health Expenses
FINAL OUT OF POCKET COSTS
HSA Contribution Balance Available to Roll Over to Be Used Toward Next Year’s Medical Expenses
Employee’s HSA Contribution/Roll Over
$1,683
$430
$2,113
- $3,398
$1,683
$2,968
TBD
$5,081
$235
$5,316
n/a
$5,316
n/a
TBD
$3,530
$235
$3,765
n/a
$3,765
n/a
TBD
How Do the Plans Work?MMurray
School District 9/2013 - 8/2014
CONTINUED - Scenario 1 : Linda is enrolled with family coverage. During the year, she has an annual exam, a colonoscopy, fills 5 prescriptions for family members (4 generic / 1 name brand) and has a visit to an urgent care clinic. How will each plan cover her expenses?
Procedure Total Cost SelectHealth Allowable Amount
NEW! Med+ HealthSave Plan
$2,000/$4,000 DeductibleTraditional Med+
$500/$1,500 DeductibleTraditional Value
$500/$1,500 Deductible
Birth Deductible Coinsurance
5 Office Visits
Pharmacy Deductible
Prescriptions
Out-of-Pocket Medical Expense:
$10,000
$600
n/a
$11,700
$22,300
$7,500
$400
n/a
$8,200
$16,100
$4,000 deductible (MET!)100%
$75 copayments
n/a
$588 copayments(1 -$7 x 12, 1 - $42 x 12)
$4,663
$1,000 deductible (20%) $1,300 coinsurance
$150 copayments
$100
$780 copayments(1 - $15 x 12, 1 - $50 x 12)
$3,330
$1,000 deductible(20%) $1,300 coinsurance
$150 copayments
$100
$780 copayments(1 - $15 x 12, 1 - $30 x 12)
$3,330
How Do the Plans Work?MMurray
School District 9/2013 - 8/2014
Scenario 2: John is enrolled with family coverage. During the year, his wife has a baby. He later has five office visits and takes two prescriptions on a monthly basis (1 generic / 1 non-preferred name brand). How will each plan cover his expenses?
Procedure NEW! Med+ HealthSave Plan
$2000/$4000 DeductibleTraditional Med+
$500/$1,500 DeductibleTraditional Value
$500/$1,500 Deductible
Annual Family Premium To Have Coverage
+ Out-of-Pocket Medical Expense Total (see previous slide)
PREMIUM & OUT-OF-POCKET EXPENESES
- HSA Contribution from MSD for Health Expenses
FINAL ANNUAL OUT-OF-POCKET COST
Employee’s HSA Contribution/Roll Over
$1,683
$4,663
$6,346
-$3,398
$1,265
TBD
$5,081
$3,330
$8,411
n/a
$8,411
TBD
$3,530
$3,330
$6,860
n/a
$6,860
TBD
How Do the Plans Work?MMurray
School District 9/2013 - 8/2014
CONTINUED - Scenario 2: John is enrolled with family coverage. During the year, his wife has a baby. He later has five office visits and takes two prescriptions on a monthly basis (1 generic / 1 non-preferred name brand). How will each plan cover his expenses?
Procedure Total Cost SelectHealth Allowable Amount
NEW! Med+ HealthSave Plan
$2,000/$4,000 DeductibleTraditional Med+
$500/$1,500 DeductibleTraditional Value
$500/$1,500 Deductible
Broken Leg Deductible Coinsurance
Pharmacy Deductible
Prescriptions
Out-of-Pocket Medical Expense:
$6,000
n/a
$1,000
$7,000
$3,800
n/a
$600
$4,400
$2,000 deductible(20%) $360 coinsurance
n/a
$600
$2,960
$500 deductible (20%) $660 coinsurance
$100
$360 copayments(1 - $30 x 12)
$1,620
$500 deductible(20%) $660 coinsurance
$100
$360 copayments(1 - $30 x 12)
$1,620
How Do the Plans Work?MMurray
School District 9/2013 - 8/2014
Scenario 3: Susan is enrolled with single coverage. During the year, she goes in for outpatient services from a skiing accident and takes a prescription monthly for pain. How will each plan cover her expenses?
Procedure NEW! Med+ HealthSave Plan
$2000/$4000 DeductibleTraditional Med+
$500/$1,500 DeductibleTraditional Value
$500/$1,500 Deductible
Annual Single Premium To Have Coverage
+ Out-of-Pocket Medical Expense Total (see previous slide)
PREMIUM & OUT-OF-POCKET EXPENESES
- HSA Contribution from MSD for Health Expenses
FINAL ANNUAL OUT-OF-POCKET COST
Employee’s HSA Contribution/Roll Over
$527
$2,960
$3,487
-$1,067
$2,420
TBD
$1,594
$1,620
$3,214
n/a
$3,214
TBD
$1,106
$1,620
$2,793
n/a
$2,793
TBD
How Do the Plans Work?MMurray
School District 9/2013 - 8/2014
CONTINUED - Scenario 3: Susan is enrolled with single coverage. During the year, she goes in for outpatient services from a skiing accident and takes a prescription monthly for pain. How will each plan cover her expenses?
WHY CHOOSE AN HSA Account?
TRADITIONAL PLAN VS. HSA PLAN
Traditional Plan HSA-Based Plan
Employee’s Spending Account
Insurance Premium
Insurance Premium
Monthly Payment
This is used for regular medical expenses and employees keep what they don’t spend.
Save and keep your money year-over-year with an Health Savings Account!
• Lower medical plan premiums, tax-free contributions and long-term saving
• Contributions roll over from year-to-year with the potential to invest at a certain balance level
HSA COMPONENTS
TO HAVE A HEALTH SAVINGS ACCOUNT, YOU MUST HAVE A QUALIFIED HIGH DEDUCTIBLE HEALTH PLAN
HDHPLow-Premium, High-Deductible Health Plan
THE INSURANCE PLAN PIECE FROM SELECTHEALTH
HSAHealth Savings Account
THE SAVINGS ACCOUNT USED TO FUND EXPENSES, TAX-FREE
WHO’S ELIGIBLE TO HAVE A HEALTH SAVINGS ACCOUNT?
To qualify for an HSA, you must:
• Participate in a qualified high-deductible health plan (HDHP)
• Must be 18 years or older• Have no other coverage except what is
permitted by the IRS as other health coverage (i.e., Tricare. See IRS Publication 969)
• Not be enrolled in Medicare• Not be claimed as a dependent on
someone else’s tax return
What is a Health Savings Account (HSA)?
It is a savings account that you own to pay for your qualified medical expenses.
Employee’s HSA
Qualified Medical Expense
Qualified Medical Expense
IRS ALLOWABLE CONTRIBUTIONS
2013 maximum contributions allowed by the IRS:
Single-coverage $3,250
Family-coverage (2 or more family members) $6,450
Catch-up contribution, age 55+ $1,000
• Employees can fully fund the HSA on day one (subject to the annual maximum)
• You can make contributions anytime after your HSA is open
• You can make pre-tax contributions through payroll deduction, online, or directly to HealthEquity
• Money rolls over from year-to-year. You don’t lose the money left in your HSA or the interest it’s earned. It’s your money.
Murray School District’s annual contribution to your account:
Single Coverage: $1,066.80 per yearCouple Coverage: $2,400.00 per yearFamily Coverage: $3.398.40 per year
You too, can contribute pre-tax dollars!
HOW DO I GET STARTED BUILDING AN HSA?
Triple tax-savings • Contributions aren’t taxed and reduce your annual taxable income• Withdrawals are never taxed or penalized when used for qualified medical expenses; including
Rx, dental, vision• Earnings aren’t taxed
An HSA is your account • You own the account and the money stays with you, even if you change jobs or retire
• Most HSA-qualified plans have maximum out-of-pocket limits- Before you reach your out-of-pocket limit, use your HSA balance to pay expenses- Reach your out-of-pocket limit, and expenses are fully covered
• Cover spouse/dependent expenses, even if on another health plan- The money in your HSA can be used to pay for qualified medical expenses of any family
member who qualifies as a dependent on your tax return. However, if the dependent isn’t covered under your medical plan, their expenses will not be applied toward meeting your deductible and out-of-pocket maximum
MAXIMIZE YOUR MONEY
How the HSA Plan Works: Going to the Doctor
Go to the doctor
Doctor sends SelectHealth the bill
Claim integrated from SelectHealth to HealthEquity website
Try not to pay at point of service, since you may not know the exact charge of the claim and want SelectHealth discounts applied to the service.
Health Plan adjusts price based on network discounts.
Go to HealthEquity website to pay the claim directly to the provider. If funds aren’t available, pay out of pocket and reimburse yourself later.
SelectHealth Medical Plan ID Card
Member Name:ID Number:Rx Bin Number:
How the HSA Plan Works: Going to the Pharmacy
Go to the pharmacy
Pharmacy automatically applies discounts
Pharmacy sends claim to SelectHealth
Show your SelectHealth ID card. Pharmacy discounts are automatically applied at point of service.
Pay with your HealthEquity HSA Card.
SelectHealth applies the amount toward your deductible.
• Order additional ID cards and update your personal information including address
• View your medical plan benefits as an employee of Murray School District
• View your claims and EOBs, including year-to-date totals toward meeting your deductible and out-of-pocket maximum
• Access your pharmacy benefit information, review your pharmacy claims, your prescription drug history, and lower-cost drug alternatives
• Go green! Switch to paperless explanation of benefits (EOB) when your claims are processed
• View your Intermountain medical records including lab results and imaging reports
• Securely message with SelectHealth’s Member Services team
HealthEquity website prepopulated with your claims information
View and pay your claims online from HealthEquity website
Helping you manage the financial side of health care
Together, HealthEquity and SelectHealth look forward to another year serving you!
MMurray
School District 9/2013 - 8/2014
• Visit www.healthequity.com • Questions? (866) 346-5800
• Visit www.selecthealth.org • Questions? (801) 442-5038