Heritage Centers Open Enrollment. With offices in Buffalo, Rochester & Medina. With offices in Buffalo,

Transcription

1 Heritage Centers 2017 Open Enrollment offices in offices in Rochester & Medina Hamburg & Medina.

2 Agenda Marketplace Plans Employee Cost How the plans work Additional Information offices in Hamburg & Medina. 2

3 Marketplace Premium Rate increases 9% - 14% Heritage Loss Ratio 94% (vs. 85% benchmark) Heritage Contribution to idirect plan 84% (vs. 78% benchmark) offices in Hamburg & Medina. 3

4 Cost of Health Insurance Benefits offices in Hamburg & Medina.

5 Heritage Claims Distribution offices in Hamburg & Medina. 5

6 Heritage Utilization Emergency Room and Urgent Care were both significantly higher than benchmark. All other Places of Service were below benchmark. offices offices in in Rochester Hamburg & Medina. Medina 6

7 2016 Recap Formed HWIC 1/1/15 with 5 local non-profit organizations Wellness Initiatives -Received a 2% reduction to the rate increase THANK YOU! offices offices in in Rochester Hamburg & Medina. Medina

8 2017 Plan Options offices in offices in Rochester & Medina Hamburg Medina.

9 2017 Plan Designs Encompass Essential Plus idirect Series 2 with Limited Use HRA In-Network Benefits: Deductible N/A $2,500/$5,000 Coinsurance N/A 20% Out-of-pocket Max $6,350/$12,700 $5,000/$10,000 Preventative Services Covered in Full Covered in Full Office Visit Copay - PCP $25 ($0 children) Ded then $25 Office Visit - Specialist $40 ($0 children) Ded then $25 Inpatient Copay $500 Ded then 20% Outpatient Surgery $250 Ded then 20% Emergency Room $250 Ded then 20% Ambulance $50 Ded then 20% Urgent Care $75 Ded then $75 Lab Testing $0 Ded then $0 Radiology $40 / $100 ($0 children) $40 / $100 Rx Copay $5/$35/$70 w/ $250/$750 Ded on Tiers 2 & 3 $10/$50/$100 Unique Benefits Limited Use HRA (funded by Heritage Centers) $250 Healthy Extras Card $250 Healthy Extras Card N/A $1,000 Single/$2,000 Family offices offices in in Rochester Hamburg & Medina. Medina 9

10 Date of Service IHA Explanation of Benefits (EOB) EXPLANATION OF BENEFITS THIS IS NOT A BILL Member Name: Group Name: Group #: Member ID # Provider: Claim # Dates of Service Service Description Rate Deduct Copay/Coins Not Covered Please retain this copy for your records and tax purposes Other Ins Paid Provider Liability 1/29/09 1/29/09 Medical Service Claim Totals Rem ark Code Plan Pays Interest 0.00 Total Member Responsibility 65.00* Total Plan Payment 0.00 Summary information for 01/01/09 2/31/09 Your individual annual deductible is $ $65 Amount applied to your individual annual deductible is ** Amount remaining until you meet your individual annual deductible is Your annual out of pocket maximum is $ Amount applied to your individual annual out of pocket maximum is $ Amount remaining until you meet your individual annual out of pocket is***... Deductible Initial out-of-pocket amount that the member is responsible for when receiving covered services. Applicable member liability applies once the deductible is satisfied. (ie, copay, coinsurance - varies by plan) The Deductible is determined as of the date(s) claims are processed by us, not the date that services were rendered. Out of pocket maximum The maximum dollar limit for deductibles, co-payment and co-insurance amounts that a member is responsible for in a given time period. * Member s responsibility payable to provider for services rendered ** The amount the individual has accumulated toward the family deductible. *** The amount remaining until your deductible is satisfied For Medical Claims $ $ Amount you owe, does not include any payment you gave provider Deductible Out of Pocket Maximum

11 idirect Limited Use HRA Funding Heritage Centers funds the limited use HRA for use with the idirect plan The Annual Funding Amount is: Single - $1,000; Family - $2,000 Employees who initially enroll July end of the year will only receive half of the Annual Funding Amount 50% of your year-end HRA balance is carried forward to a maximum of $5,000 in your HRA reserve fund offices offices in in Rochester Hamburg & Medina. Medina 11

12 Your HRA Reserve Amount Prior Plan year 2016 (Jan Dec 2016) Current Plan year 2017 (Jan Dec 2017) Runout period for prior plan year (2016) period after the plan year, in which you can still submit claims with dates of service for the prior plan year (2016) for plan year 2016 the runout period is Jan Feb 2017 Plan year 2016 will be settled on March 1, As of March 1, 2017, ½ of your remaining HRA for plan year 2016 will be put into your HRA Reserve Fund You will also have available your current plan year, 2017 HRA fund offices in Hamburg & Medina. 12

13 Independent Health ID Card (use at doctors, hospitals, and pharmacies) I am smart enough to use the idirect HRA funds before your FSA funds HRA / FSA Card Health Extras Card offices offices in in Rochester Hamburg & Medina. Medina 13

14 idirect with Limited Use HRA Scenarios offices in offices in Rochester & Medina Hamburg Medina.

15 How Does idirect Work If I go to a Pharmacy? $1,000 Member Picks up prescription at pharmacy and there is a $50 tier 2 copay You have $1,000 in your HRA account you access through your PowerPay debit card Use your PowerPay Card to pay the pharmacy. Member Pays $0 out of their pocket!

16 How Does idirect Work If I go to the Doctor for a sick visit $1,000 Member Has Service Doctor Bills $112 IHA receives invoice from Doctor. Member hasn t met deductible. Member is charged the negotiated cost of $84 as per EOB. You have $1,000 in your HRA account. Use HRA PowerPay Card to pay the doctor $84 from your HRA money. *Use your PowerPay Card like a debit card. You can give the provider the card number to pay your bill. Member Pays $0 out of their pocket Reminder: Annual Physical is covered in full as a preventive service (no cost to you)

17 How Does idirect Work If I go to the Hospital for outpatient surgery? $1,000 Member Has Service, Hospital Bills $2,600 There is a deductible ($2,500) and coinsurance due (20% x $100 = $20). Member owes $2,520. IHA pays the hospital the remaining $80. Total $2,600 -$80 from IHA -$1,000 Heritage Reimbursement Program -$1,000 HRA -$520 Employee out of pocket Owe $2,520 Heritage Center s Reimbursement Program to be reimbursed up to $1,000. Balance of $1,520. You have $1,000 in your HRA account. Your final out of pocket cost is $520.

18 How Does HRA Reserve Fund Work 2016 $1, $1,000 Reserve Bucket 2016 $ HRA funds used 1 st then Reserve Bucket

19 Additional Information offices offices in in Rochester Hamburg && Medina. Medina

20 Why elect a Flexible Spending What is it? Account (FSA)? Employee funded account with pre-tax dollars to be used toward eligible medical, dental, and vision expenses How much can you put in? $2,550 annually How much can you roll-over? $500 maximum What happens if you leave Heritage? You can no longer use the FSA funds for claims after your termination date offices offices in in Rochester Hamburg & Medina. Medina 20

21 idirect Funding Coordination Heritage Center s Reimbursement Program, Limited Use HRA, and FSA Heritage Center s Reimbursement Program will be used first, *when applicable (funded by Heritage Centers) Limited Use HRA money will always be used next (funded by Heritage Centers) FSA money will be used last (funded by employee) **reimbursement program: is only for inpatient hospitalizations and outpatient surgeries, is a program run outside of the medical insurance, and is only available for active employees offices offices in in Rochester Hamburg & Medina. Medina 21

22 $0 Preventive Services Annual Physical exam Basic metabolism test (general health panel) Immunizations Cholesterol test (lipid panel) Pap smear HPV screening Mammogram Prenatal and one postpartum visit Rh screen Colonoscopy and sigmoidoscopy Prostate test (Prostate Specific Antigen PSA ) Hemoglobin and hematocrit testing HIV screening Chlamydia screening Fecal blood testing Bone mineral density measurements or tests Lead screen in childhood and/or pregnancy Rubella screening Abdominal aortic aneurysm screen Well child visit

23 23 What have I earned credit for?

24 You feel sick Emergency Room Most Expense Option Longest Wait Hospitals do not have your medical records Urgent Care Center Better Option, but still they still do not have your medical records Normally will see you within an hour Physicians Office/Physician After Hours Best Option Cost effective They have your medical records Telemedicine Most Cost effective, $40 negotiated rate or $10 copay Telephonic, FaceTime, Skype Doctor can prescribe Rx IHA Nurse Helpline Rochester, Avon, Medina www.

25 Telemedicine Benefit Telemedicine benefit provided through Teladoc When you can t reach your doctor, you can talk to a physician anytime, anywhere from home or at work Provides 24/7 access to medical care for adults and children via phone or secure online video Connects you with a board-certified, state-licensed physician in an average of minutes 25

26 How Telemedicine Works Request consult for common/routine illnesses, such as: Allergies Ear Infection Pink Eye Bronchitis Sinus Problems Nasal Congestion Cough and Urinary Tract Infection Flu Symptoms Receive prescriptions for short-term antihistamines, antibiotics, cough suppressants or anti-bacterial agents Generic drugs are substituted automatically Controlled substances are not prescribed A Clinical Consult Record (CCR) can be sent to your physician, upon request You may be referred to your doctor for clinical follow-up 26

27 Questions? offices in offices in Rochester & Medina Hamburg & Medina.