250 likes | 339 Views
Shattuck - St. Mary’s School Open Enrollment 2012 - 2013. Medical Benefits by HealthPartners – No Changes !!!. Choice of 2 plans Open Access $500 - $25 Open Access $1700-75% HRA National Network CIGNA
E N D
Medical Benefits by HealthPartners – No Changes!!! • Choice of 2 plans • Open Access $500 - $25 • Open Access $1700-75% HRA • National Network • CIGNA Reminder: Deductibles and Out-of-Pocket Maximums accumulate on the Plan Year (July through June) for the HRA plan and the calendar year (January through December for the copay plan
HDHP Plan – 1700HRA Max. Out-of-Pocket: Single: $3,500 Family: $7,000 With HRA Contribution ‘True” OOP: Single: $2,750 Family: $5,500 The HRA is treated as member money as payments count towards both medical plan deductible and out-of-pocket maximum. 100% In Network Coverage 75% In Network Coverage to Max. Out-of-Pocket Deductible $1,700 single/$3,400 family (Plan Year Deductible and OOP) The HRA automatically pays for deductible claims. Member Responsibility Single $950 Family $1900 Prescription Drug Co-pays $12/$50/$75 100% Preventive Care Coverage 100% of unused HRA amounts carry forward year-to-year. HRA is Employer Funded HRA Single $750 HRA Family $1500 HRA Family $1,500 Rx claims are subject to co-pays with HRA plans. Reimbursed by HRA Account.
Health Reimbursement Arrangement (HRA) • Shattuck – St. Mary’s funds the HRA Account at $750 (single) and $1,500 (family) • Upon depletion of the HRA Account, employee pays expenses incurred until deductible level and out-of-pocket maximums have been reached • 100% of unused HRA Account dollars will roll into next plan year • HRA Account Maximum • Single: $1,500 • Family: $3,000
Provider claim Member $ $ $ $ Health Plan $ $ $ $ $ $ claim Account CDHC: How it Works… Step 1: Member seeks medical care. Step 2: After care is received; provider sends claim to HealthPartners. Step 3: HealthPartners processes the claim and sends the Explanation of Benefits to member and to the HRA account. *If there are funds available in the HRA account, a check will either be sent to the member or directly deposited into their checking / savings account. If there are no HRA funds available, the member can choose to remit the EOB to their FSA account. Step 5: The Provider bills member for services. Step 6: The member is responsible for paying the provider. *Prescription drug co pays are automatically rolled to the HRA account. Member Health Plan
2012-2013 Employee Contributions • $1700 HRA MonthlyAnnualSavings: HRA vs. Copay • Single $0.00 $ 0.00 • Single + Spouse $300.80 $ 3,609.7 0 $ 730.82 • Single + Child(ren) $248.13 $ 2,977.56 $ 657.00 • Family $505.59 $ 6,067.08 $ 1,020.84 • $500-$25 • Single $0.00 $ 0.00 • Single + Spouse $361.71 $ 4,340.52 • Single + Child(ren) $302.88 $ 3,634.56 • Family $590.66 $ 7,087.92
Which Option To Choose? • Things to Consider • Review previous claims history • Estimate (to the best of your ability) future claims • “Maximum” Exposure • Premium • Annual “True” Out-of-Pocket Maximum:
Additional HealthPartners Benefit – “VIRTUWELL”Their Online “House Call” First THREE visits FREE!!! (per member per year) www.virtuwell.com • Available 24/7 • Simple conditions • Sinus or ear pain • Pink eye • Bladder infections • Log on and complete 10-minute interview • Nurse Practitioners • Review information • Respond with diagnosis/treatment plan (about 30 minutes) • Can prescribe medications to your selected pharmacy • Copay Plan - $10 copay • HRA Plan - $40 charge subject to deductible and coinsurance
Resources… Help is just a phone call away • Member Services • 7:30 a.m. – 7:00 p.m. (CST) weekdays by phone, plus face-to-face visits available • CareLine • 24/7 nurse phone line staffed with Registered Nurses • Nurse Navigators • Answers to complex medical and benefit questions • BabyLine • For new moms and moms-to-be (dads, too!) staffed with specially trained OB/GYN Nurses
Resources…www.healthpartners.com • Personal Claims / Benefit Information • Register a personal user name/password for access • All Members must have own user name/password • Consumer Tools / Cost Calculator • Annual medical cost planner • Treatment and procedure costs • Drug cost calculator • Formulary • Search by drug name or category
What can I do on my phone? Search for urgent care, clinics or hospitals near you See your Member ID card Call the 24/7 CareLineSM nurse service Go to m.healthpartners.com from your smart phone
AchieveSM Programs • Frequent Fitness Program • Join up and work out 12 days per month at any of the participating health clubs and earn a $20 credit on your monthly club dues • Two adult members qualify for credit • For a current list of clubs, visit healthpartners.comor call Member Services at 952-883-5000 • Healthy Discounts • Weight Watchers, Nutrisystem, Foss Swim School, 2nd Wind Exercise, Jazzercise, Yoga North, Good Life Yoga
NEW!!! Dental Benefits – HealthPartners Dental • In-Network Highlights • $1,000 Calendar Year maximum per covered member • 100% preventive coverage • $50/$150 Deductible • 80% basic care coverage (deductible applies) • 50% major restorative coverage (deductible applies) • Out-of-Network • $750 Calendar Year maximum per covered member • 80% preventive coverage • $50/$150 Deductible • 60% basic care coverage (deductible applies) • 50% major restorative coverage (deductible applies) • Balance billing may apply 1/1 – 6/30 Data from MetLife will be provided to HP
Employee Dental MONTHLY Contributions Monthly Single $ 0.00 Employee + One $ 29.03 Family $ 72.40
Life and LTD – NEW!!! • Lincoln Financial Group • No changes to benefits • Basic Life / AD&D • One times annual salary to $50,000 • If enrolled at initial eligibility • Dependent Spouse $5,000 • Dependent Child $1,000 • LTD • 60% to $5,000/month • 90 day elimination
Voluntary Life • One-time open enrollment • Guarantee issue with no medical evidence • Employee $10,000 increments to $130,000 • Spouse $5,000 increments to $30,000 (50% of EE) • Child(ren) up to $10,000 • Employee must have coverage for dependent coverage
Value-Add with Lincoln - TravelConnect • Travel Assistance Services • MEDEX Assistance Corporation • Available to all employees enrolled with Basic Life • Traveling 100+ miles from home • Medical evacuation and transportation • Security and political evacuation • Lost/Stolen travel documents • Language translation • Emergency travel arrangements MEDEX ID: 322541 Group Name: Lincoln Financial Group
Employee Assistance Program (EAP) The number to call when you don’t know who to call! • HealthPartners EAP • Available to all employees • Confidential • 24 hours a day – 7 days a week • Telephonic Only 1-866-326-7194 • Lincoln with EmployeeConnect EAP • Available to employees with LTD coverage • Confidential • 24 hours a day – 7 days a week • 1-877-757-7587 • 4 Face-to-Face visits per issue per year www.eapadvantage.com Password: connect
Open Enrollment – What do you need to do? • Medical Enrollment/Change Form • Dental Enrollment • MUST complete enrollment form • Voluntary Enrollment Form • Life Beneficiaries All forms to Michelle Mahowald in Human Resources no later than June 13, 2012 JUNE 13