High Deductible Health
Plans & Health Savings
Account
Today’s Agenda
Review of High Deductible Health Plan (HDHP)
What is an HSA & Who is eligible
Advantages of an HSA
How it works
Tools to help you with your decision making
Be an educated consumer
High Deductible Health Plan
(HDHP)
Your Benefits - HDHP
In-Network
$3,500 Individual
$7,000 Family
Deductible
Payment Level
Out-of-Network
90% after deductible
80% after deductible
Out-of-Pocket Limit
$1,400 Individual
$2,800 Family
$2,800 Individual
$5,600 Family
Lifetime Maximum
Unlimited
Unlimited
Primary Care Physician
90% after deductible
80% after deductible
Specialist
90% after deductible
80% after deductible
Emergency
Room/Urgent Care
90% after deductible
90% after deductible
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Preventive Care Benefit Highlights
Benefit
In-Network
(
Preventive Visits (adult & pediatric)
100%
Deductible does not apply
Pediatric Immunizations
100%
Deductible does not apply
Routine Gynecological Exam
100%
Deductible does not apply
Routine Mammograms
100%
Deductible does not apply
Preventive Diagnostic Screening
100%
Deductible does not apply
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Prescription Drug Program
Retail (31/60/90) day supply
Plan pays 100% after deductible
Mail Order (90-day supply)
Plan pays 100% after deductible
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Qualified High Deductible Health Plans
Plan Highlights
• 100% coverage on in-network preventive office visits; not subject to the
deductible.
• Deductible applies to ALL non-preventive medical services AND prescriptions.
• Deductibles are aggregate. This applies to only those in a Family plan. One
person or a combination of family members must meet the family deductible
before benefits begin to pay.
• Same access to doctors and hospitals that you have today
• The Blue Cross network-negotiated discounted rate for all in-network medical
services and prescription drugs is the member’s responsibility until the
deductible is satisfied.
• Reimbursement may be made from your Highmark HSA
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What is an HSA?
 A Health Savings Account, or HSA, is a tax-advantaged
savings account that's available to people whose only
health care coverage is provided through a qualified
high-deductible health plan.
 Since the deductible — or amount you must pay out of pocket
before these plans begin to cover benefits — is high,
establishing an HSA to self-fund your out-of-pocket care
expenses may help you save money.
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Who Is Eligible?
Individuals covered under the High Deductible Health Plan:
Can NOT be covered by any other health plan that is not a
qualified high- deductible plan
Can NOT be enrolled in Medicare
Can NOT be claimed as a dependent on another person’s tax
return
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THE BASICS ON HEALTH SAVINGS ACCOUNTS
• It’s your money. You choose how to pay for
care services.
• It’s portable. It goes where you go, even if you
change jobs.
• Account funds roll over from year to year.
• You can pay for an exceptional range of health
care services and products. That includes
services – such as dental and vision care –
that may not be covered under your health
plan.
• You get “triple-tax savings.” HSA contributions
• It’s convenient. You access and track all
and earnings are tax exempt as long as they
are used for qualified medical services.
of your health care spending online at
your Highmark member website.
• Once you reach a $500 account balance, you
can invest in a wide range of mutual funds for
short- or long-term growth potential.
• Your account is offered through a
trusted industry leader, Bank of
America, who serves as the custodian.
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Preferred Custodian Review
Let’s talk about the HSA Custodian…
Bank of America
 Highmark’s preferred Custodian
 Advantages of choosing Bank of America:
• Authorization of pre-tax payroll deductions into your account
• Integration of CDHP and HSA
• Investment opportunity for over 20 Mutual Fund options
 Must reach a $500 balance in your account prior to purchasing funds
 When an employee invests, the responsibility is solely on them. Whether there are gains
from the market or losses, it’s no different than someone investing on their own. As the
taxpayer, the HSA account holder is solely responsible for the money in their account and
how it is used
 Maintenance fee of $3.50 per month covers all transactions and debit card
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Contributions & Distributions
Regulations determined & enforced by the Internal Revenue Service
Contributions
For 2013 contributions from all sources are limited to
• $3,250 Single Coverage
• $6,450 Family Coverage
Catch-up contributions of $1,000 allowed for members over age 55 in 2013
Distributions
Intended use is for “qualified medical expenses” as defined by section 213(d) of the
Internal Revenue Code
Same ‘Qualified Medical Expenses’ List for a Flexible Spending Account
If money from the HSA is used for qualified medical expenses, then the money is spent
tax-free
Unqualified distributions are subject to income tax and 20% penalty
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Highmark HSA
How does it work?
www.highmarkbcbs.com
Health Savings Account Options
 Your Health Savings Account will be established automatically upon enrollment in
the HDHP
• Can be managed online through the Highmark Blue Cross Blue Shield website
• Must go to website and accept terms and conditions
 Different Methods of Contribution
• Payroll Contribution
• Personal Check
• ACH Debit
 Different Methods of Claims Submission
• Debit Card
– All HSA participants will receive a debit card tied to account
– Additional cards can be requested for family members
• Claim-by-Claim Authorization
 Different Methods of Reimbursement
•
•
•
•
Debit Card
Direct Payment to Provider
Direct Deposit
Check to Member
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Website Login and Registration
 Enter User ID & Password in
the Log In box, or
 For new registrants click
“Register Now”
 New Registrants will receive
a PIN to allow complete
access
 Getting started is easy!
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To Open an HSA
Click on the link “Start
a Health Savings
Account and Save”
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Please wait 7-10 business days for your HSA to be open
Once your HSA is open you will automatically receive:
1) A Welcome Kit
2) A Debit Card
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Tools & Resources
ONLINE TOOLS
ENCOURAGING SMART CARE DECISIONS
• Provider Search: Simplifies
choosing the right provider
• Patient Experience Review:
Lets you rate your provider and
review other opinions
• Care Cost Estimator: Estimates the
portion you may have to pay for
services
• Hospital Advisor: Helps you choose
the right hospital based on national
quality ratings
• Mobile Site: Helps you find
providers, view new claims, and can
pull up your ID card
Confidential and Proprietary
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Provider Directory: Patient Experience Review
See overall patient ratings
based on five criteria:
• Experience: Was it good or bad?
• Recommendation: Would you recommend the
doctor to family and friends?
• Communication: Did you understand what the
doctor said?
• Availability: Was it hard to get an appointment?
• Environment: What was the office like?
Confidential and Proprietary
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Care Cost Estimator
Estimate the portion you
could have to pay based on
your cost sharing.
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Confidential and Proprietary
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Online HSA Savings Calculator
Calculate how much you can save over time on a pre-tax basis
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Additional Consumerism Tools & Resources

Expense Summary & View Your Claims

Plan Activity Statement

Wellness and Research Tools Through Partnership with WebMD®

Blues on Call

My Care Navigator
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5 Money Saving Actions
1)
Choose generic drugs over brand name drugs.
•
2)
You can save up to 6 times the cost of brand name drugs and get the same results
Go to Urgent Care Centers rather than the ER for common, non life threatening health
concerns.
•
3)
ER visits for common conditions like the flu, colds, rashes, or ankle sprains can be 2 to 3
times more expensive than urgent care centers.
Have typical blood tests performed at Independent Labs rather than hospitals
•
4)
It possible to save up to 50% and most labs are quick and efficient and offer convenient
hours, too.
Get X-rays and other imaging tests performed at an X-ray or Imaging Center rather than
a hospital
•
5)
On average, X-Rays, CT Scans and MRIs performed at most hospitals are up to 30 percent
more expensive than those done at an imaging center.
When you have any medical tests performed, give the lab the contact information of
your provider
•
You’ll be less likely to have tests repeated unnecessarily. On average, you can save
between $83 to $105 on common lab tests and $ 1,100 and $1,800 on imaging tests.
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Should You Choose the High Deductible
Health Plan?


Determine the difference in your premium contribution for each health plan option



Calculate potential earnings from accumulated funds in your HSA
Review your out-of-pocket expenses and compare to the premium cost of each plan
Compute potential tax savings from your HSA contributions
Use the tools on the Highmark website to estimate your costs
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Questions??