Medical Plan Comparison Central Care Plan Medical / Prescription - - PowerPoint PPT Presentation

Medical Plan Comparison

Central Care Plan

Medical / Prescription Benefit Summary

In‐Network In‐Network In‐Network

MEDICAL PLAN BCBS BCBS BCBS Annual Deductible (7/1 ‐ 6/30) $1,300 Single* $2,600 Family* $250 Single $500 Family $100 Single $200 Family Coinsurance (After Deductible) 100% Plan / 0% Member 80% Plan / 20% Member 100% Plan / 0% Member Office Visit Copay $0 after deductible $20 Copay $20 Copay Urgent Care Copay $0 after deductible $20 Copay $20 Copay ER Copay $0 after deductible $75 Copay $75 Copay Preventive Care $0 (Plan pays 100%, no deductible/copay) $0 (Plan pays 100%, no deductible/copay) $0 (Plan pays 100%, no deductible/copay) Coinsurance / Copay Maximum $0 Single $0 Family $1,000 Single $2,000 Family $500 Single $1,000 Family $1,300 Single $2,600 Family $1,250 Single $2,500 Family $600 Single $1,200 Family PRESCRIPTION PLAN Deductible N/A Generic 10% Copay 10% Copay 10% Copay Formulary 20% Copay 20% Copay 20% Copay Non‐Formulary 30% Copay 30% Copay 30% Copay Prescription Out‐of‐Pocket Maximum TOTAL MEDICAL + Rx OUT‐OF‐POCKET MAXIMUM (7/1‐6/30) $3,300 Single $6,600 Family $3,250 Single $6,500 Family $2,600 Single $5,200 Family $2,000 Single $4,000 Family N/A PLAN OPTIONS

PPO 1 Plan Advantage HDHP/HSA Plan

Copay applies after deductible $2,000 Single (after deductible) $4,000 Family (after deductible)

PPO 2 Plan

HDHP Deductible includes medical and Rx costs

Medical Out‐of‐Pocket Maximum (7/1 ‐ 6/30) BCBS CVS Caremark

*The full family deductible must be met under a 2 person or family contract before benefits are paid for any person on the contract.

CVS Caremark $2,000 Single $4,000 Family This benefit summary is intended for use only as a source of reference. Official benefits, conditions, exclusions, and limitations are documented in the certificate and amendments.

Medical / Prescription Monthly & Annual Costs

In‐Network In‐Network In‐Network

Single $23.88 $0.00 $78.29 2‐Person $49.42 $0.00 $162.05 Family $60.41 $0.00 $198.07 Single $286.56 $0.00 $939.48 2‐Person $593.04 $0.00 $1,944.60 Family $724.92 $0.00 $2,376.84 Monthly HSA Contribution Single: $70.29 Two Person: $145.48 Family: $177.80 Annual HSA Contribution Single: $843.48 Two Person: $1,745.76 Family: $2,133.60

University contributions are depostied into employee's HSA each pay period.

PLAN OPTIONS

Advantage HDHP/HSA Plan PPO 2 Plan PPO 1 Plan

FULL‐TIME EMPLOYEE PREMIUM COST SHARE 2016‐2017 Plan Year CMU HSA Contribution Monthly Cost Share Amount Annual Cost Share Amount

Total Must Pay and Might Pay Side‐By‐Side Comparison – Employee Only (Annual)

$0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 HDHP w/HSA CMU PPO 2 CMU PPO 1 Prescription Might Pay (coinsurance maximum for prescription plan) Medical Might Pay (meeting deductibles and coinsurance maximum for medical plan) Must Pay (full‐time employee annual contribution)

$939 employee payroll contribution

*Net of CMU HSA Contribution

Total Maximum Annual EE Cost of HDHP w/HSA, including CMU HSA Contribution of $843, EE Only Option = *$2,744 Total Maximum Annual EE Cost of PPO 2, EE Only Option = $3,250 Total Maximum Annual EE Cost of PPO 1, EE Only Option = $3,539 $287 employee payroll contribution $2,000 in prescription copay maximum $2,000 in prescription copay maximum $2,000 in prescription copay maximum

*$2,744

$600 in medical deductible & copay maximum $1,250 in medical deductible, coinsurance & copay maximum $1,300 in medical + prescription deductible

Exhibit assumes in‐network usage and is provided for illustrative purposes only.

Total Must Pay and Might Pay Side‐By‐Side Comparison – Two Person (Annual)

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 HDHP w/HSA CMU PPO 2 CMU PPO 1 Prescription Might Pay (coinsurance maximum for prescription plan) Medical Might Pay (meeting deductibles and coinsurance maximum for medical plan) Must Pay (full‐time employee annual contribution)

$1,945 employee payroll contribution

*Net of CMU HSA Contribution

Total Maximum Annual EE Cost of HDHP w/HSA, including CMU HSA Contribution of $1,746, EE+1 Option = *$5,447 Total Maximum Annual EE Cost of PPO 2, EE+1 Option = $6,500 Total Maximum Annual EE Cost of PPO 1, EE+1 Option = $7,145 $593 employee payroll contribution $4,000 in prescription copay maximum $4,000 in prescription copay maximum $4,000 in prescription copay maximum

*$5,447

$1,200 in medical deductible & copay maximum $2,500 in medical deductible, coinsurance & copay maximum $2,600 in medical + prescription deductible

Exhibit assumes in‐network usage and is provided for illustrative purposes only.

Total Must Pay and Might Pay Side‐By‐Side Comparison – Family (Annual)

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 HDHP w/HSA CMU PPO 2 CMU PPO 1 Prescription Might Pay (coinsurance maximum for prescription plan) Medical Might Pay (meeting deductibles and coinsurance maximum for medical plan) Must Pay (full‐time employee annual contribution)

$2,377 employee payroll contribution

*Net of CMU HSA Contribution

Total Maximum Annual EE Cost of HDHP w/HSA, including CMU HSA Contribution of $2,134, Family Option= *$5,191 Total Maximum Annual EE Cost of PPO 2, Family Option = $6,500 Total Maximum Annual EE Cost of PPO 1, Family Option = $7,577 $725 employee payroll contribution $4,000 in prescription copay maximum $4,000 in prescription copay maximum $4,000 in prescription copay maximum

*$5,191

$1,200 in medical deductible & copay maximum $2,500 in medical deductible, coinsurance & copay maximum $2,600 in medical + prescription deductible

Exhibit assumes in‐network usage and is provided for illustrative purposes only.

Health Savings Account (HSA)

• HSAs are individually‐owned bank accounts

– The account belongs to you so only you can decide how to spend it – Both you and your employer can contribute funds – Money left in your account carries over from year to year – It remains yours even if you leave the university or retire

• HSAs are used to help pay for both current and/or future health care expenses

– You can withdraw money tax‐free for qualified health expenses (non‐qualified expenses are subject to taxes and penalties) – Or you can save funds to pay for future expenses

• A HSA is triple tax‐advantaged

– Contributes are made pre‐tax and funds can grow tax free and withdrawals for qualified health expenses tax‐free

• Who is eligible for an HSA? Anyone who is:

– Covered by a qualified high deductible health plan (HDHP) – Not enrolled in Medicare – Not covered under other health insurance coverage, including a spouse’s plan (unless a qualified HDHP) – Not another person’s tax dependent

More information, visit www.treas.gov and click on Health Savings Account (HSA)

Triple Tax Savings

Money Goes In Tax Free Money Grows Tax Free Money Can Be Used Tax Free

Money Is Yours To Keep! Coverage Level Annual Employer HSA Contribution Annual Employee HSA Contribution Total Annual HSA Contribution Maximum Age 55+ Contribution “Catch‐Up” – Per Person Single $843.48 $2,506.52 $3,350 $1,000 Two Person $1,745.76 $5,004.24 $6,750 $1,000 Family $2,133.60 $4,616.40 $6,750 $1,000

How to use your HSA at the Doctor’s Office

Go to Doctor and present your Blue Cross Blue Shield Medical ID card and receive services. Note – you should not pay anything at the time of service. Doctor submits claims to Blue Cross Blue Shield If services are billed as preventive, office visit will be covered at 100% If services are not billed as preventive, discounted charges will be applied to your deductible/out-of- pocket maximum You will receive an Explanation of Benefits (EOB) in the mail outlining the charges you are responsible for. Your doctor will bill you directly for any charges. You will use your HSA debit card, or other method of payment to pay your doctor the charges you are responsible for

How to use your HSA at the Pharmacy

Obtain the Prescription / Rx from your Doctor Go to pharmacy of your choice and present your Blue Cross Blue Shield Medical ID card Use your HSA debit card or checkbook to pay for the discounted cost of the drug at the point of sale. Save your receipt for tax purposes. The pharmacy’s system will submit your claim electronically to Blue Cross Blue Shield to apply the charges towards your deductible/ out-of-pocket maximum

HSA Eligible Expenses

• Acne Treatments
• Acupuncture
• Alcohol and drug rehabilitation
• Allergy Medicines (with Rx)
• Ambulance
• Anesthetist
• Artificial limbs and teeth
• Blood donor expenses
• Breast pumps and supplies
• Chiropodist
• Chiropractor
• Certain corrective surgery
• Copays for office visits and

prescriptions

• Dental care and dentures
• Examinations
• Eye exam, glasses, contacts and

contact lens solution

• Gynecologist
• Hearing aids and batteries
• Home health care and nurses fee
• Hospital and skilled nursing

facility

• Insulin and diabetic supplies
• Laboratory fees
• Nicotine patches and gum
• Obstetrical expense, midwife
• Oculist
• Optometrist
• Operations and related

treatments

• Orthodontist
• Orthotics
• Osteopath
• Outpatient clinic
• Oxygen and oxygen equipment
• Podiatrist
• Prescription drugs
• Psychiatrist
• Psychologist
• Rental or purchase of medical

equipment including special equipment for use by handicapped persons

• Sanitarium
• Smoking cessation programs
• Support for corrective services,

including support hose, leg and knee braces and crutches

• Surgery
• Therapy
• Vein procedures that are

medically necessary

• Vision care
• Certain weight loss programs
• X‐rays

Items in BLUE are eligible under a Limited Purpose FSA, medical items are not eligible expenses with a Limited Purpose FSA

For detailed list of eligible expenses, see Publication 502 online at www.irs.gov

Sandy: Employee only with $1,000 in medical costs* BCBS Advantage (HDHP) Plan BCBS PPO 2 Plan BCBS PPO 1 Plan

Annual Deductible = $1,300 Annual Deductible = $250 Annual Deductible = $100 Sandy pays: Sandy pays: Sandy pays:

Annual Employee Premium Cost Share (Payroll Deduction) $285 $0 $940 Deductible + $1,000 + $250 + $100 Coinsurance N/A + $150 N/A Claims paid using CMU’s HSA contributions ‐ $840 N/A N/A

Sandy pays medical expenses + annual payroll deductions $445 $400 $1,040

Scenario assumes in-network providers are used in all cases

Scenarios

*.

Sandy: Employee only with $5,000 in medical costs* BCBS Advantage (HDHP) Plan BCBS PPO 2 Plan BCBS PPO 1 Plan

Annual Deductible = $1,300 Annual Deductible = $250 Annual Deductible = $100 Sandy pays: Sandy pays: Sandy pays:

Annual Employee Premium Cost Share (Payroll Deduction) $285 $0 $940 Deductible + $1,300 + $250 + $100 Coinsurance N/A + $950 N/A Claims paid using CMU’s HSA contributions ‐ $840 N/A N/A

Sandy pays medical expenses + annual payroll deductions $745 $1,200 $1,040

Scenario assumes in-network providers are used in all cases

Scenarios

*.

Plan Cost Estimator

Plan Information Advantage HDHP/HSA PPO 2 Plan PPO 1 Plan

Annual Cost of Plan

(what you pay out of your paycheck)

$ $0 $ Employer’s HSA Annual Contribution

‐ $843.48 single ‐ $1,745.76 two person ‐ $2,133.60 family

‐ $0 ‐ $0

TOTAL MUST PAY COST

(regardless of utilization of plan)

Estimated Expenses (Annual) # of office visits times copay or average cost (HDHP)

____x $80 = $____ ____x $20 = $____ ____x $20 = $____

# of generic drug times average copay or average cost (HDHP)

____x $17 = $____ ____x $1.70 = $____ ____x $1.70 = $____

# of brand name drug times average copay or average cost (HDHP)

____x $225 = $____ ____x $67.50 = $____ ____x $67.50 = $____

# of emergency room visits or average cost (HDHP)

____x $550 = $____ ____x $75 = $____ ____x $75 = $____

Hospital, surgical, other (deductible/coinsurance)

$ $ $

TOTAL MIGHT PAY COST (based on plan utilization)

Might pay costs can’t exceed amounts to the right (annual

• ut of pocket maximum) for applicable plan. If higher, cap

costs at this amount.

$3,300 Single $6,600 Family $3,250 Single $6,500 Family $2,600 Single $5,200 Family

TOTAL MUST PAY and MIGHT PAY Cost

1+2 2 1

Decision Support Tools

• BCBSM Cost Estimate Tool

Log in at bcbsm.com and use the “Find a Doctor” feature to evaluate quality and get cost estimates for more than 400 health care services nationally

www.goodrx.com Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips www.michigandrugprices.com Compare prices, find drug discount programs, find assistance programs, compare pharmacies

There are many ways to shop and save for your prescription drugs. Many pharmacies offer discounted generic drugs. You can also compare pharmacies using pricing tools available.

FREE or Discounted Generic Drugs

Many pharmacies offer free or discounted medications. Ask your pharmacist today!

Compare drug prices, use coupons, shop around.

There are a number of pricing tools available that you can access on your phone through an app or online.

www.medtipster.com Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips www.onerx.com Compare prices, find pharmacy coupons, manufacturer discounts, generics, comparable drug choices and savings tips

Shop for High Quality, Low Cost Prescription

The Healthcare Blue Book is a free consumer guide to help you determine fair prices in your area for healthcare services. If you pay for your own healthcare, have a high deductible or need a service your insurance does not fully cover, Healthcare Blue Book can help. The Blue Book will help you find fair prices for surgery, hospital stays, doctor visits, medical tests and much more.

EASY AS 1, 2, 3

• 1. Go To www.healthcarebluebook.com
• 2. Select or Search for common procedures.
• 3. Compare prices among physicians and facilities in your area.

Decision Support Tool

• ALEX is Here To Help You

– ALEX is our new easy to use on‐line decision support tool!

• Fun and interactive
• Shows you most likely and worst case cost scenarios
• Accessible from any internet connect device
• Includes medical/prescription, dental, vision,

life/AD&D, disability and FSA/HSA

• Check out ALEX online at

https://www.myalex.com/cmu/2016

2016‐17 Benefits Open Enrollment

• MANDATORY! All benefit‐eligible

employees will be required to actively elect benefits online via CMU Choices for:

– Medical / prescription – Dental – Vision – Health & dependent care flexible spending account (FSA)

Benefit Year MANDATORY Open Enrollment for 2016‐17 Benefit Year

Plan Tips and Resources

Questions?

–Call 989‐774‐3661 –Email benefits@cmich.edu –Website: www.cmich.edu/openenrollment ENROLL BY FRIDAY, MAY 13th, 5 P.M. (ET) No changes can be made after 5 p.m. on May 13th

REMEMBER You MUST enroll between April 25 and May 13, 2016

Any Questions?