Consumer Driven Health Plans - PowerPoint PPT Presentation

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Consumer Driven Health Plans

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  1. Consumer Driven Health Plans (CDHP)

  2. CDHPConsumerDrivenHealthPlans.us Consumer Driven Health Plans (CDHPs) are health benefits plans that engage covered individuals in choosing their own health care providers, managing their own health expenses, and improving their own health with respect to factors that they can control.

  3. 2009 medical plan options • Blue Care HMO • Preferred Care Blue PPO • Blue Saver QHDHP

  4. CDHP • 2 Components • Qualified High Deductible Health Plan (QHDHP) • PPO type plan with a high deductible and maximum out-of-pocket limit • Health Savings Account (HSA) • Type of medical savings account that allows you to save money to pay for current and future medical expenses on a tax-free basis.

  5. Things to Consider • Anticipated level of medical expenses for the year • Likelihood expenses will be covered • Level of resources available to pay for expenses before deductible is met • Other Insurance • HSA non-eligible • Can not be covered by a non-HDHP plan • Can not be eligible for medical FSA through spouse

  6. Qualified High Deductible Health PlanJohnson County plan • Deductible • $1500 individual • $3000 family • Entire deductible must be met before benefits are payable • $2300 embedded deductible • Out of Pocket annual maximum • $3000 individual • $6000 family • Coinsurance • In-Network providers 90/10 • Out-of-Network providers 60/40 • Preventive care • No deductible • 100% paid by plan

  7. QHDHPExample of Single Coverage

  8. QHDHPExample of Family Coverage

  9. Health Savings AccountHSA • What is an HSA? • Account funded by tax deferred dollars • Accumulates tax-free • Contributions held by third party • Base Account • Money Market account • Investment account • Unused dollars roll over from year to year • No maximum limit • No “use it or lose it”

  10. HSA • What is an HSA? • Flexible • Individual retains control of how money is spent • Save • Invest • Reimburse eligible expenses • Portable • Account goes with you • Term QHDHP coverage • Term employment

  11. Health Savings AccountHSA • Annual County contribution • $250 individual • $500 family • 2009 Maximum annual contributions • $3000 individual coverage • Includes County contribution • $5950 family coverage • Includes County contribution • $1000 catch-up contribution • Age 55 and older

  12. HSA • How does an HSA work? • Employee & Employer contribute funds into HSA account • Employee &/or family member seeks medical services • Employee pays cost of services • HSA debit card • Pay out-of-pocket • File claim for reimbursement from HSA • Must have funds in HSA account to receive reimbursement

  13. HSAIRS Code Section 213 • Qualified medical expenses • Insurance deductibles • Doctors visits, lab, x-ray • Prescription drugs • OTC medications • Vision expenses • Dental expenses • Hospital charges • Qualified Long Term Care insurance premium

  14. HSAPost-employment+ reimbursements • All of the previous screen • COBRA premiums • Any health plan retained while receiving unemployment • Retiree health premiums • Medicare part A and B premiums • No Medicare supplemental plans

  15. HSA • What is not eligible? • Expenses covered by another insurance plan • Non-HDHP • Non-eligible expenses may be reimbursed • Taxable income • 10% penalty

  16. HSA • Opt-out from QHDHP • HSA accounts remains with employee • Funds may be used for qualified medical expenses tax-free • Funds used for non-medical expenses • Under 65 • Taxable income • Additional 10% tax • Over 65 • Taxable income

  17. What Do I Do Now • Review your past health expenses • BCBSKC annual EOB • Out-of-pocket expenses • Review qualified medical expenses • Review calculator • OFM-Benefits web site • BCBSKC web site • Review personal financial obligations • Review personal financial resources