Intended to cover serious illness or injury once the - - PowerPoint PPT Presentation

• Intended to cover

serious illness or injury

• nce the deductible

has been met Used to cover small and routine medical expenses until the deductible is met.

Health Savings Account (HSA)

Funded by you and District 155 Pays for healthcare expenses Save on taxes three ways Account balance rolls over every year

High Deductible Health Plan (HDHP)

Comprehensive medical and Rx coverage Preventive care at no cost Same BCBS of IL PPO network of providers Lower monthly premiums Higher deductible

+

Benefit

HMO

Individual Deductible N / A Family Deductible N / A Individual Out-of-Pocket Max $1,500 Family Out-of-Pocket Max $3,000 Office Visit (PCP / Specialty) $40 copay / $60 copay Preventive Care 100% Emergency Room $200 copay Inpatient Admission 100% All Other Covered Services 100% after copays Retail Rx – Generic /

Preferred / Non-Preferred / Specialty

$9 / $50 / $75 90 days / Mail Rx – Generic /

Preferred / Non-Preferred / Specialty

$18 / $100 / $150

Based on In-Network Coverage

HDHP/HSA PPO

$2,700 $5,400 $5,400 $10,800 90%* 100% 90%* 90%* 90%* $10 / $25 / $50* $20 / $50 / $100*

* = After deductible

Regular PPO

$750 $1,500 $2,500 $5,000 $40 copay / $60 copay 100% $200 copay + 20% coins. 80% 80% $9 / $50 / $75 $18 / $100 / $150

• You decide to put $100 from your paycheck into your Health Savings

Account and you are in a 22% tax bracket. You will not pay federal income tax or state income tax taxes on this $100.

• To pay for a physician’s office visit that costs $100, you must earn $136.90

to have $100 left over after taxes.

• If you pay for a physician’s office visit with tax-free funds from your HSA,

you need only to earn $100 to pay for the $100 cost of the visit. Without HSA With HSA $100 $100 Federal Income Tax

• $22.00

N / A State Income Tax

• $4.95

N / A Social Security Tax

• $0.00

N / A Net $73.05 $100

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Benefit

HDHP/HSA PPO Regular PPO HMO

Physician’s billed charges $675 $675 $675 BCBS discounted price $450 $450 N / A Member responsibility $0 $0 $0 In network preventive services covered at 100%; no deductible; no copays on all plans

Benefit

HDHP/HSA PPO Regular PPO HMO

Physician’s billed charges $165 $165 $165 BCBS discounted price $95 $95 N / A Member responsibility $95 $40 copay $40 copay On HDHP plan, the $95 goes towards the member’s deductible and out-of-pocket expense. On PPO and HMO plans, the copay goes towards the member’s maximum out-of-pocket expense.

Benefit

HDHP/HSA PPO Regular PPO HMO

Total billed charges (hospital and physicians) $35,000 $35,000 $35,000 BCBS discounted price $18,500 $18,500 N / A Member responsibility $2,700 (deductible) $750 (deductible) N / A Remaining balance $15,800 $17,750 N / A Member responsibility $1,580 $1,750 N / A

10% of balance up to the out of pocket maximum 20% of balance up to the out of pocket maximum N / A

Total member responsibility $4,280 $2,500 N / A District #155 HSA contribution $1,500 $0 $0 Final member responsibility $2,780 $2,500 $0

Other things to consider:

• Annual cost of premium contributions
• Provider availability

Benefit

HDHP/HSA PPO Regular PPO HMO

Generic Rx BCBS discounted price $12 $12 $12 Member responsibility $12 (applied to deductible) $9 copay $9 copay Brand name Rx; preferred BCBS discounted price $65 $65 $65 Member responsibility $65 (applied to deductible) $50 copay $50 copay Brand name Rx; non- preferred BCBS discounted price $175 $175 $175 Member responsibility $175 (applied to deductible) $75 copay $75 copay Specialty drug; member responsibility Discounted cost of drug; applied to deductible $75 copay $75 copay

Other things to consider:

• On the HSA, all prescription drug costs are applied to the plan deductible. After the deductible is met, member

pays copays for prescription drugs until the overall out of pocket maximum is met.

• On the Regular PPO, there is a separate Rx out of pocket maximum of $4,850 per individual or $9,700 per family.
• On the HMO, there is a separate Rx out of pocket maximum of $1,000 per individual or $2,000 per family.

Visit in-network doctor Show ID card to obtain BCBS of Illinois discounted rates Doctor bills BCBS BCBS processes claim and applies discounted rates BCBS provides Explanation of Benefits (EOB) showing what was paid and what you

• we

Doctor bills you (unless it was a preventive care visit) Compare bill to EOB to make sure the amount you owe matches Pay provider from your HSA or personal finances Don’t pay that bill yet!

Show ID card at the pharmacy to obtain BCBS of Illinois discounted rates Pharmacy can see your plan details and determine the amount due at the time of sale You pay pharmacy from HSA or personal finances

If using mail order pharmacy, you can set up automatic payment from your HSA