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Weber State University. STAR Plan 2014. The STAR Plan. S elf-Directed T ax A dvantaged R esource. The STAR Plan Intent. How does it benefit you…. The STAR PLAN. PEHP. Star Plan Health Benefits (A qualified HDHP) Medical and Pharmacy. Health Savings Account (HSA)
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Weber State University STAR Plan 2014
The STAR Plan Self-Directed Tax Advantaged Resource
The STAR Plan Intent How does it benefit you…
The STAR PLAN PEHP Star Plan Health Benefits (A qualified HDHP) Medical and Pharmacy Health Savings Account (HSA) Interest-bearing account Two Components HealthEquity Financial Institution
HSA ELIGIBILITY To qualify for an HSA, an individual: Must be covered by PEHP’s STAR Plan (a HDHP) • Must be 18 years or older • Can’t be enrolled in Medicare A, B, C, D • Can’t be claimed as a dependent on someone else's tax return • Can’t have other health coverage, unless permitted by the IRS. (TRICARE) • Cannot participate or be covered by a FSA or HRA, or the balance will be $0 by June 30th
HEALTHCARE REFORM Preventive Health Benefits Routine Services Contracted Provider Some are age specific Deductible does not apply Women’s Health Removal of waiting periods for adults
ADVANTAGE/SUMMIT STAR When Using Contracted Providers Deductible You pay for all pharmacy, doctor and hospital visits before PEHP begins paying for coverage. Payment based on PEHP’s Allowed Amount (AA) • Individual: $1,500 • Two- Party, Family: $3,000 After Deductible is met you pay: 20% coinsurance for inpatient and out patient services 20% coinsurance for physician office visits Applicable pharmacy copays
Advantage and Summit STAR When Using Non - Contracted Providers You pay for all pharmacy, doctor and hospital visits before PEHP begins paying for coverage. Payment based on PEHP’s Allowed Amount Deductible Combined with Contracted Provider • Individual: $1,500 • Two- Party, Family: $3,000 After Deductible is met you pay: 40% coinsurance for inpatient and out patient services 40% coinsurance for physician office visits Applicable pharmacy copays. Excess fees above AA NO out-of-Pocket Maximum
Star vs. Traditional Deductibles and Plan Maximums
Star vs. Traditional Out-of-pocket Maximum Comparison
STAR Plan Key Concepts PEHP pays eligible Medical/Pharmacy benefits after Deductible is met Payment is based on Allowed Amount One Deductible - Includes pharmacy/medical One out-of-pocket maximum - Includes pharmacy/medical Medical Benefits – July 1 to June 30th each year
Health Savings Account Administered by HealthEquity Savings account combined with qualified health plans to offset cost of higher deductibles Can be used to offset retiree coverage costs Both the employer and employee can contribute • Like a Flex Plan …… But Better!
HSA Facts Interest-bearing account Account money rolls over to the next plan year Account is portable Employee & Employer contributions are made tax-free Money grows tax-free Money used on eligible expenses is tax-free
Who can use HSA Funds? Based on IRS guidelines. Yourself Spouse and dependents you claim on your tax return or could be claimed on your tax return.
LIMITED PURPOSE FLEX This option is only available on the STAR plans You may elect a Limited Purpose Flex Account • Dental and Vision expenses • Medical Expenses after the deductible is met • Up to $2,500 • This is in addition to your H.S.A contributions FLEX RULES APPLY…USE OR LOSE
STAR PLAN WSU will help you fund the account with Semi-monthly contributions. • $33.09 for Individual coverage • $66.18 for Double Family coverage • Employer and employee contributions made through payroll will be in deposited in your account. • Change your contribution each pay period WSU Contribution
HSA – Contributions Must be enrolled in the STAR plan (HDHP) Contribution limits are based on a Calendar year! Catch-up contribution 55 years and above Includes Employer and Employee contributions
How Can HSA Funds be Used? Deductibles Copayments Dental Vision Prescription Costs * Eligible services not covered by the medical plan. *1/1/11 OTC medications require a prescription.
HSA Common Uses Reminders Just because you can use your HSA money for a service does not guarantee that the service will accrue towards your deductible or out-of-pocket maximum
STAR Plan Key Concepts It is your account, you never lose funds Employer and Employee contributions are made tax free. Must be enrolled in a qualified HDHP to make contributions Contributions based on calendar year Allows you to save for future costs. You can’t have a Flex account You can have Dependent Day Care account HSA
HSA How To: Doctors Visit Show ID card No payment at time of service PEHP adjusts price based on discounts (see your EOB). Pay provider from your HSA funds, if they are available. Pay out of pocket if funds aren’t available and reimburse yourself later. 1 2 3
HSA How To: Pharmacy Prescriptions 1 Show your pharmacy card Pay with your HSA Card PEHP applies amount to your deductible, no paperwork necessary. 2 3
Questions for Medical HealthEquity 24/7 • 866-346-5800 PEHP Customer Service • 801.366.7555 • 800.765.7347