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Sweetwater
County School
District # 1
Employee Benefit
Open Enrollment
Effective September 1, 2015
Agenda

New Medical Benefit Plans
• $1,000 PPO Plan
• $1,500 High Deductible Health Plan (HDHP)
Presenters
• $2,500 High Deductible Health Plan (HDHP)
New Dental Benefit Plan
New Vision Benefit Plan
 OptumBank

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What is an HSA?
Who is eligible for an HSA?
What are eligible HSA expenses?
How do I contribute and use the HSA funds?
Is the School District contributing to my HSA?
General information
© 2015 United HealthCare Services, Inc.
Glossary of Terms

Deductible


Coinsurance


A qualified High Deductible Health Plan, as defined by the IRS, allows members who
are enrolled in this type of Plan to contribute to a tax-free Health Savings Account
(HSA)
Reasonable & Customary

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Additional amount member pays for certain types of services (Emergency Room)
HDHP / HSA


Amounts the member pays for Covered Expenses, such as Deductible and any
Coinsurance amounts
Copay (surcharge)


Presenters
After the member satisfied the Deductible, this is the
percentage of the covered
expense each member pays until the out-of-pocket maximum is reached
Out-of-Pocket Maximum


An amount of money paid by a member before any Covered Expenses are paid by
the Plan. When a new Plan Year begins, a new Deductible must be satisfied
Amount charged by health care providers in the same geographical area for the
same services, treatment or materials
© 2015 United HealthCare Services, Inc.
Medical Benefit Plans
PPO & High Deductible Health Plans
Administered by UMR – PPO Plans
Network: UnitedHealthcare OptionsPPO
Current Plan
New $1,000 Plan
$400 / $800
(combined w/Dental)
$1,000 / $2,000
$2,400 / $4,800
$4,000 / $8,000
Hospital Inpatient
20% AD
20% AD
Hospital Outpatient
20% AD
20% AD
Maternity
20% AD
Routine Prenatal 100%
Delivery 20% AD
Office Visit
20% AD
20% AD
100% up to $500 then
20%
100%, no $ limit
20% AD
20% AD
$45 copay (surcharge)
+ 20% AD
$45 copay (surcharge)
+ 20% AD
Deductible
Out of Pocket Maximum
Preventive Care
Urgent Care
Emergency Room
Prescriptions
(Deductible waived)
$0 generic / 20% preferred /
30% + $15 non-preferred
Administered by UMR – HDHP’s
Network: UnitedHealthcare OptionsPPO
$1,500 / $3,000
$2,500 / $5,000
Deductible
$1,500 / $3,000
$2,500 / $5,000
Out of Pocket Maximum
$4,500 / $9,000
$6,000 / $12,000
Inpatient
20% AD
20% AD
Outpatient
20% AD
20% AD
Maternity
Routine Prenatal 100%
Delivery 20% AD
Routine Prenatal 100%
Delivery 20% AD
20% AD
20% AD
100% Covered
100% Covered
Urgent Care
20% AD
20% AD
Emergency Room
20% AD
20% AD
Hospital Services
Office Visit
Preventive Care
Prescriptions
After Medical Deductible
20%
Administered by UMR – Dental
Network: None
Current Plan
Stand-alone Plan
$400 / $800
(Combined w/Medical)
$50 / $100
$1,500
$1,500
$1,500 lifetime
$1,500 lifetime
Subject to Reasonable &
Customary Limits
Subject to Reasonable &
Customary Limits
100% Covered
(Deductible waived)
100% Covered
(Deductible waived)
Basic Services
20% AD
20% AD
Major Services
20% AD
20% AD
Orthodontic Services
20% AD
20% AD
Deductible
Annual Maximum
Orthodontic Maximum
Diagnostic and
Preventive Care
Administered by UMR – Vision
Network: None
Current Plan
Stand-alone Plan
None
None
100% Covered
1 per year
100% Covered
1 per year
Lenses – All
100% Covered
1 set /year up to $350
100% Covered
1 set /year up to $350
Frames
100% Covered
1 set /year up to $125
100% Covered
1 set /year up to $125
Elective Contacts
100% Covered
1 set /year up to $350
100% Covered
1 set /year up to $350
Deductible
Eye Exam / Refraction /
Contact Lens Fitting
myHealthcare Cost Estimator
Get cost
estimates
9
View quality
rating information
Helps manage
health care costs
© 2015 United HealthCare Services, Inc.
Premium® designation program
Evidence-based,
medical society &
national industry
standards across 25
specialties
Quality and
cost-efficiency
ratings by provider
UnitedHealth Premium® Tier 1
physicians have received the Premium
designation for:
• Quality & Cost Efficiency OR
• Cost Efficiency & Not Enough
Data to Assess Quality
Shared patient &
physician
Supports cost
transparency
engagement
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© 2015 United HealthCare Services, Inc.
The OptumRx Application
CONSUMERS CAN EASILY:
The OptumRx App makes the online pharmacy experience as
simple as possible.
REFILL A HOME
DELIVERY
MEDICATION
TRANSFER A
PRESCRIPTION TO
HOME DELIVERY
RENEW A HOME
DELIVERY
MEDICATION
FIND DRUG PRICES AND
LOWER COST OPTIONS
VIEW CLAIM
HISTORY
LOCATE A
PHARMACY
OptumBank
Health Savings Account (HSA)
www.OpenEnrollment123.com
http://financialservicesdemo.optum.com/
What is an HSA?
• Savings account that you own to pay for your healthcare
expenses
Employee’s
HSA
You
and
SWCSD#1
make deposits
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Qualified
medical expense
© 2011 United HealthCare Services, Inc.
Who is eligible for an HSA?
You must meet the following requirements:
– You must be covered under a “qualified” HDHP
– You must not have any other health coverage, including funds in
a Flexible Spending Account
– You must not be enrolled in Medicare
– You cannot be claimed as a dependent on someone else’s tax
return
If you enroll in one of the HDHP but do not meet the
other requirements mentioned above, you cannot
contribute towards an HSA, nor can the School District
contribute on your behalf.
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© 2011 United HealthCare Services, Inc.
What are eligible HSA expenses?
– Doctor and hospital visits
– Medical equipment
– Chiropractic Care
– Dental care, braces, dentures, implants
– Vision care, glasses, contacts, Lasik
– Medications, including some over-the-counter
A complete list is found in the IRS Publication 502 (same
list as FSA)
The penalty for using HSA funds for non-qualified expenses is 20% +taxes. Keep all
itemized receipts in the event of an IRS audit.
What are the account types & fees?
2The
bank account balance must remain at or exceed the investment minimum each time a new investment is made.
Fee (when applicable) is only assessed after the establishment of an investment.
3Investment
Investments are not FDIC-Insured, are not guaranteed, and may lose value.
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© 2012 United HealthCare Services, Inc.
How do I contribute and use the HSA?
• Contributions / Deposits
– Contribution limits for 2015
• Single $3,350
• Non-Single $6,650
– Making contributions
• Payroll / Quarterly changes
– Availability of funds
• Withdrawals / Payments
– Pay your provider / debit card
– Reimburse yourself
– Save your receipts!
• Investing in your HSA
http://cdn.optum.com/optum/hsa-investment-portal-video/index.html
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© 2012 United HealthCare Services, Inc.
Is the School District contributing to
my HSA?
Contributions by Sweetwater County School District # 1:
Incentive
Front Load
Match Limit
Total
Enroll by 7/01/2015
Deposit 9/01/2015
Employee Only
$100
$200
$300
$600
EE + Spouse
$100
$200
$300
$600
EE + Child(ren)
$200
$400
$600
$1,200
EE + Family
$200
$400
$600
$1,200
– Only available to those who enroll in the either the
$1,500 / $3,000 HDHP or the $2,500 / $5,000 HDHP
– OptumBank account must be open and active by 9/01/2015
– Overall contribution maximums*
• Single $3,350
• Family $6,650
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*additional $1,000 if age 55 or older
© 2011 United HealthCare Services, Inc.
General Tax Information
Save your receipts!
IRS Publication 969:
http://www.irs.gov/publications/p969/in
dex.html
IRS Publication 502:
http://www.irs.gov/publications/p502/
Tax forms:
•5498 – SA
•1099 – SA
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© 2015 United HealthCare Services, Inc.
Questions?