Waco ISD 2013
Open Enrollment
GHC24354 02/12
Agenda
1.
2013 Medical Benefits
2.
Vision Plan
3.
Humana Resources
2
2013 Medical Plans
3
Humana NPOS HDHP with HSA
Coverage
In-Network
Co-insurance
Out of Pocket Max
80%
$5,950 Individual
$11,900 Family
*Out of Pocket Max includes Deductibles
Deductibles
$4,000 Individual
$8,000 Family
Preventive Care
Annual Routine Physical Exams
Well-Child Care / Immunizations
Routine Well-Woman Visits Mammography
Routine Lab and X-Ray
Preventive Endoscopy
Preventive Prostate screenings
100% No deductible
Physician Services
Primary Care Physician
Specialists
80% after deductible and $40 copay
80% after deductible and $55 copay
Hospital Services
Inpatient
Outpatient
80% after deductible
80% after deductible
Emergency Room
80% after deductible and $250 Copay
Urgent Care
80% after deductible and $100 Copay
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How the High Deductible Health Plan works
•
•
The High Deductible Health Plan has two key components:
–
Integrated deductible: medical and prescription costs apply to the same
deductible
–
Coinsurance: once the deductible is met, the plan pays coinsurance – a
percentage of your health care costs
Other High Deductible Health Plan features:
–
For family coverage, costs for all covered members apply to same
aggregate deductible
–
Includes coverage for preventive care services at no cost regardless of
whether the deductible is met
Background on Health Savings Accounts
•
A Health Savings Account, or HSA, is a financial account used to pay for qualified
medical expenses.
•
HSAs combine the benefits of both traditional and Roth 401(k)s and IRAs for
medical expenses.
•
Taxpayers receive a 100% income tax deduction on annual contributions, they
may withdraw HSA funds tax-free to reimburse themselves for qualified medical
expenses, and they may defer taking such reimbursements indefinitely without
penalties.
•
HSAs are unique—“IRAs on Steroids”—with triple tax advantages:
– Tax-deductible contributions
– Tax-free accumulation of interest and dividends tax-free, and
– Tax-free distributions for qualified medical expenses.
•
2013 Max Contribution: Individual $3250 / Family $6450
•
Catch up Contribution (if age 55 or older) additional $1000 per year
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Contributing money to an HSA
•
It’s a fund you can use to cover your qualified healthcare costs
•
Humana oversees the administration of both your plan and the HSA, which is
managed by our partner bank, UMB
•
Receive a Humana Access card to use as payment for qualified expenses
•
You, your employer, and anyone else can contribute to your account
•
Once money goes into the account, it’s yours forever
•
Unused money carries over from year to year (unlike FSA - use it or lose it)
•
If you leave your current employer, HSA funds can stay in the same account or roll
into another HAS
•
HSA contributions are credited to account monthly, not lump sum at beginning of year
like an FSA
•
IRS Rule - You cannot contribute to an HSA unless you are enrolled in an HDHP
* Please refer to IRS.gov or your Humana enrollment packet for detailed tax and HDHP/HSA information.
Humana NPOS 70/50 Copay Plan
Coverage
In-Network
Co-insurance
Out of Pocket Max
70%
$5,000 Individual
$10,000 Family
*Out of Pocket Max calculates separately and does not include Copays/Deductibles
Deductibles
$8,000 Individual
$16,000 Family
Preventive Care
Annual Routine Physical Exams
Well-Child Care / Immunizations
Routine Well-Woman Visits /Mammography
Routine Lab and X-Ray
Preventive Endoscopy
Preventive Prostate screenings
100% No deductible
Physician Services
Primary Care Physician
Specialists
100% after $50 copay
100% after $100 copay
Hospital Services
Inpatient / Outpatient
70% after deductible
Emergency Room
70% after deductible
Urgent Care
100% after $50 Copay at a Concentra Facility
70% after deductible for non-Concentra Facility
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Humana NPOS Simplicity Plan
Copays Only – No Deductibles or Coinsurance!
Coverage
In-Network
Copay / Out of Pocket Maximum
$6000 Individual / $12,000 Family
Preventive Care
$0 Copay
Annual Routine Physical Exams
Well-Child Care / Immunizations
Routine Well-Woman Visits Mammography
Routine Lab and X-Ray
Preventive Endoscopy
Preventive Prostate screenings
Physician Services for inpatient/outpatient hospital, emergency
and surgical (Facility Charges subject to separate copay)
Office Visits/Urgent Care
Primary Care Physician
$50 Copay per visit
Convenient Care Clinic
Concentra Urgent Care Facility
Specialists/Other
Specialist Office Visits
Chiropractic care, physical, occupational, cognitive, speech and
audiology therapy (visit limitations apply)
Urgent Care at NON- Concentra Facility
Inpatient Hospital Stays
Outpatient Surgical Services (Facility)
Emergency Room
$100 Copay per visit
$125 Copay per visit
$1500 Copay per day for the first 3 days
$1500 Copay per visit
$600 Copay per visit
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Humana NPOS 80/50 Copay Plan
Coverage
In-Network
Co-insurance
Out of Pocket Maximum
80%
$5,000 Individual
$10,000 Family
*Out of Pocket Max calculates separately and does not include Copays/Deductibles
Deductibles
$2,500 Individual
$5,000 Family
Preventive Care
Annual Routine Physical Exams
Well-Child Care / Immunizations
Routine Well-Woman Visits Mammography
Routine Lab and X-Ray
Preventive Endoscopy
Preventive Prostate screenings
100% No deductible
Physician Services
Primary Care Physician
Specialists
100% after $30 copay
100% after $45 copay
Hospital Services
Inpatient / Outpatient
80% after deductible
Emergency Room
100% after $150 copay
Urgent Care
100% after $30 Copay at a Concentra Facility
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100% after $75 non-Concentra Facility
Pharmacy Benefits
Plan
Coverage
NPOS 80/50 HDHP with HSA
RX4 Copay After Deductible
Level 1 - $10
Level 2 - $40
Level 3 - $70
Level 4 – 25%
NPOS 70/50 Copay Plan
Simplicity Plan
NPOS 80/50 Copay Plan
RX4
Level 1 - $10
Level 2 - $40
Level 3 - $70
Level 4 – 25%
Right Source Mail Order RX
2.5 Copays for 3 Month Supply
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Women’s Preventive Care Updates for 2013
Coverage
In-Network
Contraceptive methods and counseling includes :
Covered at 100% in network only
All FDA approved contraceptive methods, sterilization
including vasectomies, and patient education and
counseling.
Prescription is required, includes over the counter
contraceptives
*Brand name contraceptives are covered at 100% only
when no generic alternative is available in that
class/category
Breastfeeding support, supplies and counseling to
include costs for renting breastfeeding equipment
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Vision Plan
Automatically included to
ALL Waco ISD Humana
medical members at no
additional cost!
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Pharmacy Tools
Access RightSource Rx
registration and
maintenance information
Compare drug costs and
view alternative medications
View prior authorization
requirements
Locate local pharmacies
Maximize your benefit
Physician Finder
•
Go to www.humana.com
•
Under Resources and &
Support tab, click on “Find a
Doctor”
•
Under Type of Coverage,
ensure Employer Group
Plan is selected, input zip
code
•
For network, please select
National Point of ServiceOpen Access
•
Agree to terms, select
parameters and go!
Concentra in Waco
Save Money on Urgent Care
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Humana Vitality
Comprehensive wellness
program
Integrates rewards with health
and wellness
Provides the tools and support
necessary to help Humana
members live healthier lives.
Humana Vitality members
rewarded for making healthier
choices, i.e. attending
preventive screenings,
exercising regularly and quitting
smoking.
Clinical Program available for Humana Members
Programs available:
Asthma
Diabetes
Heart Disease
Pregnancy
Renal Failure
Ask a Humana representative today
about getting involved in these
programs
Get Engaged: Member Communications
Humana will be reaching out to members
using various communication methods:
Phone Calls directly to member’s homes
Email communication regarding
preventive reminders, clinical programs
available, etc.
Plan Professor Newsletters
Member Welcome Guide
Maximize your benefit
Smart EOB
Questions
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