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USF PHYSICIANS GROUP Department of Human Resources

USF PHYSICIANS GROUP Department of Human Resources. Consumer Driven Health Plans with United Healthcare (UHC) OPEN ENROLLMENT July 2009 PRESENTED BY THE USFPG DEPARTMENT OF HUMAN RESOURCES. Changes to our Healthcare. Replacing United POS and POS Plus with United HRA and HRA Plus.

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USF PHYSICIANS GROUP Department of Human Resources

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  1. USF PHYSICIANS GROUPDepartment of Human Resources Consumer Driven Health Plans with United Healthcare (UHC) OPEN ENROLLMENT July 2009 PRESENTED BY THE USFPG DEPARTMENT OF HUMAN RESOURCES

  2. Changes to our Healthcare • Replacing United POS and POS Plus with United HRA and HRA Plus. • HRA is short for Health Reimbursement Account plan. Also called a “consumer driven health plan” or an “account-based health plan”. • Benefit value of the HRA plans is equivalent to the current POS plans • Deductible now on the Plan Year (July-June), not a Calendar Year • Payroll deductions will be for all 26 pay periods

  3. But first… No change to: • Short term and long term disability Insurance • Life insurance • Dental insurance • Dependent Care Flexible Spending Account maximums Change to: • Biweekly premiums for all benefits changing for deduction from 24 paychecks to 26 • Increase in the Health Care Flexible Spending Account maximum from $2,400 to $4,000 for the Plan Year • The Flexible Spending Account reimbursements will be administered by UHC. Details will be forthcoming.

  4. Plan Yr Deductible July 2009-June 2010 Preventive Care CONSUMER DRIVEN HEALTH PLANS (CDHP)HRA Plans – An Overview • Preventive care covered 100% • Employer provided HRA • Member Responsibility is Plan Year Deductible less HRA • Health coverage is coinsurance with an out-of-pocket maximum Health Coverage MemberResponsibility Health Reimbursement Account (HRA)

  5. Family Deductible How does the family deductible work for Family Coverage? Works just like the POS plans today. No one person will be out of pocket more than an individual (i.e. $1,000 Individual/$2,000 Family)

  6. HealthCoverage Health Coverage Health Coverage 20% In Network40% Out of Network 20% In Network40% Out of Network 20% In Network40% Out of Network Member Responsibility $1000/$2000 (In Network) Member Responsibility $700/$1400 (In Network) Member Responsibility $1000/$2000 (In Network) Plan Yr Deductible July 2009-June 2010 HRA $500/$1,000 HRA $500/$1,000 HRA $500/$1,000 Preventive Care 100% Preventive Care 100% Preventive Care 100% HRA and HRA Plus HRA HRA Plus Plan YrDeductible July 2009-June 2010

  7. Prescriptions The pharmacy benefit is part of the basic medical coverage. It is subject to deductible and coinsurance, as any other covered service or treatment. There are no co-pays in the CDHPs. Mail order program for convenience of home delivery is available continued

  8. More RX information… • The full cost of a prescription will be paid first from the HRA account, and if funds are exhausted, the cost will be part of the Member Responsibility. • Once the deductible is met, the plan will pay 80% and the member will pay the 20% coinsurance up to the Out of Pocket Maximum.

  9. RX Example #1: For a 30-day supply at Pharmacy A CholesterolRetail Cost BRAND: Lipitor 10 mg tabs $102.40 GENERIC: Not available Half-tablet Program: 15 tablets (20 mg) $73.03 Discuss alternatives with your physician BRAND: Mevacor 40 mg tablets $155.32 GENERIC: Lovastatin 40 mg tablets OR $49.99 Lovastatin 20 mg tablets X2 $4.00 {Pharmacy A “Savings Plan”}

  10. RX Example #2: High Blood Pressure Retail Cost • BRAND: Norvasc 10 mg tablets $57.48 (Pharmacy B, $97.99) • GENERIC: Amlodipine Besylate 10 mg tabs$53.99 (at Pharmacy B) OR $4.00 {Pharmacy A, “Savings Plan”}

  11. HOW DOES THE PROCESS WORK? The Provider submits a claim to United Healthcare, then: If HRA funds are available, UHC pays the claim If HRA funds have been utilized, you will receive a bill and you will pay any Member Responsibility amount If HRA funds and Member Responsibility have been met, UHC will pay the insured amount, and you will receive a bill for the coinsurance When you have claim activity, you will receive a Health Statement, or you may view the information online

  12. Health Care Flexible Spending Account • Contributions to FSA are pre-tax • Reimbursements are tax-free • Use to cover out-of-pocket expenses • “Use it or Lose it” • FSA works well with HRA plan • Option to enroll in medical automatic claim forwarding • Medical and pharmacy payments can be sent to the Provider • Reimbursements can be sent to you or deposited directly to your account • Balances and activity on www.myuhc.com

  13. Health Coverage 20% Member Responsibility $0 Plan Yr Deductible July 2009-June 2010 HRA $1,000 Preventive Care 100% How it Works - Phil and Nancy – FIRST YEAR Preventive Care Expenses3 annual exams $ 800Immunizations 100Total $ 900 Non-Preventive Expenses3 prescriptions filled $ 300 Urgent Care visit 150 5 physician visits 400 Total $ 850 $900 paid 100% $150 Rollover Out-of-Pocket ExpenseNone $ 0 $850 Expenses HRA Pays RolloverTo Year Two $ 150 * Example is based on in-network services; HRA plan

  14. How it Works – Phil and Nancy Beginning of 2ND YEAR Health Coverage 20% Member Responsibility $1,850 Plan Yr Deductible July 2009-June 2010 HRA Beginning Balance in 2nd Year $1,150 Preventive Care 100% HRA Balance New $1,000 contribution plus $150 rollover from 1st year PLAN MEMBER RESPONSIBILITYReduced from $2,000 to $1,850

  15. Health Coverage 20% Member Pays $500 Plan Yr Deductible July 2009-June 2010 $1,150 Expenses HRA Pays Preventive Care 100% How it Works – Phil and Nancy Usage in 2nd year Preventive Care Expenses3 annual exams $ 800Immunizations 100Total $ 900 Non-Preventive Expenses8 prescriptions filled $ 750 Lab work 150 ER visit 450 4 physician visits 300 Total $ 1,650 $900 paid 100% Out-of-Pocket Expense $ 500 RolloverTo Year Three $ 0 *Example is based on in-network services; HRA Plan

  16. PREVENTIVE HEALTH BENEFITS • Regular preventive care helps • Reduce risk of disease • Detect health problems early • Save your life • Preventive care is covered 100% in both plans; no co-pay and your HRA is not affected • Yearly physical • Immunizations • Preventive mammograms • Well woman check ups • Preventive colonoscopy (age 50 and up) • Prostate cancer screening (age 50 and up)

  17. HRA Plan Advantages • 100% coverage for preventive benefits • 100% coverage for non-preventive services up to the HRA amount • Ability to rollover unused HRA dollars to the next year • Incentive for you to save your HRA dollars continued

  18. HRA Plan Advantages • A true out-of-pocket maximum…once deductible and coinsurance hit the maximum you have 100% coverage for the rest of the plan year • No reduction in benefits • No increase in employee contributions forPreferred rate

  19. 2009 Biweekly Employee Contributions HRAPreferredStandard* Employee Only $14.30 $21.24 Employee + Spouse $54.00 $67.84 Employee+ Child(ren) $45.70 $59.54 Family $80.30 $101.08 HRA PlusPreferredStandard * Employee Only $27.24 $34.16 Employee + Spouse $84.46 $98.30 Employee + Child(ren) $69.70 $83.54 Family $105.22 $126.00 *Slight increase to Standard employee contributions

  20. SAVINGS! In addition to 100% preventive benefits, you can save up to $540 per year if you are eligible for the Preferred Rate through the Healthy Pledge Program Savings: • $180 savings (single coverage) • $360 savings (employee plus spouse or child(ren) coverage) • $540 savings (family coverage)

  21. HEALTHY PLEDGE PROGRAM • Complete and submit the Healthy Pledge Form confirming that you and any covered dependents age 18 and older have not used a tobacco product in the past 12 months • Complete online UHC Health Assessment and submit confirmation to the USFPG Department of Human Resources by 6/30/09 (required for all covered individuals 18 and older) • Agree to participate in a UHC disease management program if invited to do so by UHC (i.e., asthma, diabetes, coronary artery disease) • Your confidentiality is protected! Your confidential health information is not shared with MSSC OR UMSA

  22. UTILIZE THE WEB www.myuhc.com Network doctors / hospitals Estimate costs Track claims status Health improvement program Personal Health Record Health product discounts Review plan details Check account status

  23. CDHP Items of Importance • Our group number will remain the same • The network providers will remain the same • An additional discount for utilizing USFPG physicians is being developed • New ID cards will be issued by UHC • You may log on towww.myuhc.comto print temporary cards after 6/30/09

  24. Remember All enrollment paperwork is due by Friday, May 29th (must include a completed United Healthcare enrollment form) To receive the lower Preferred rate: Complete the Healthy Pledge Form AND You and any covered dependents 18 and older register and complete an online Health Assessment and submit confirmation of completion for each individual to the USFPG Department of Human Resources by Tuesday, June 30, 2009

  25. Question and answer sessions • The week of 5/11/09-5/15/09 • We will be at 4 locations for informal sessions • Please refer to your Open Enrollment Packet for times and locations • You may also turn in your enrollment forms at one of these sessions

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