Intended to cover serious illness or injury once the - PowerPoint PPT Presentation

• • •

• • Intended to cover serious illness or injury once the deductible has been met Used to cover small and routine medical expenses until the deductible is met.

+ Health Savings Account High Deductible Health (HSA) Plan (HDHP) Funded by you and District Comprehensive medical and 155 Rx coverage Pays for healthcare expenses Preventive care at no cost Save on taxes three ways Same BCBS of IL PPO network of providers Account balance rolls over every year Lower monthly premiums Higher deductible

• • • • •

• • •

Based on In-Network Coverage HMO Regular PPO HDHP/HSA PPO Benefit Individual Deductible N / A $750 $2,700 Family Deductible N / A $1,500 $5,400 Individual Out-of-Pocket Max $1,500 $2,500 $5,400 Family Out-of-Pocket Max $3,000 $5,000 $10,800 Office Visit (PCP / Specialty) $40 copay / $60 copay $40 copay / $60 copay 90%* 100% 100% 100% Preventive Care $200 copay $200 copay + 20% coins. 90%* Emergency Room 100% 80% 90%* Inpatient Admission All Other Covered Services 100% after copays 80% 90%* Retail Rx – Generic / $9 / $50 / $75 $9 / $50 / $75 $10 / $25 / $50* Preferred / Non-Preferred / Specialty 90 days / Mail Rx – Generic / $18 / $100 / $150 $18 / $100 / $150 $20 / $50 / $100* Preferred / Non-Preferred / Specialty * = After deductible

• • • • •

 You decide to put $100 from your paycheck into your Health Savings Account and you are in a 22% tax bracket. You will not pay federal income tax or state income tax taxes on this $100. Without HSA With HSA $100 $100 Federal Income Tax - $22.00 N / A State Income Tax - $4.95 N / A Social Security Tax - $0.00 N / A Net $73.05 $100  To pay for a physician’s office visit that costs $100, you must earn $ 136.90 to have $100 left over after taxes.  If you pay for a physician’s office visit with tax -free funds from your HSA, you need only to earn $100 to pay for the $100 cost of the visit.

+ + = = - - = =

+ + = = - + =

HDHP/HSA PPO Regular PPO HMO Benefit Physician’s billed charges $675 $675 $675 BCBS discounted price $450 $450 N / A Member responsibility $0 $0 $0 In network preventive services covered at 100%; no deductible; no copays on all plans HDHP/HSA PPO Regular PPO HMO Benefit Physician’s billed charges $165 $165 $165 BCBS discounted price $95 $95 N / A Member responsibility $95 $40 copay $40 copay On HDHP plan, the $95 goes towards the member’s deductible and out -of-pocket expense. On PPO and HMO plans, the copay goes towards the member’s maximum out -of-pocket expense.

HDHP/HSA PPO Regular PPO HMO Benefit Total billed charges (hospital $35,000 $35,000 $35,000 and physicians) BCBS discounted price $18,500 $18,500 N / A Member responsibility $2,700 (deductible) $750 (deductible) N / A Remaining balance $15,800 $17,750 N / A Member responsibility $1,580 $1,750 N / A 10% of balance up to the out of 20% of balance up to the out of N / A pocket maximum pocket maximum Total member responsibility $4,280 $2,500 N / A District #155 HSA contribution $1,500 $0 $0 Final member responsibility $2,780 $2,500 $0 Other things to consider: • Annual cost of premium contributions • Provider availability

Benefit HDHP/HSA PPO Regular PPO HMO Generic Rx BCBS discounted price $12 $12 $12 Member responsibility $12 (applied to deductible) $9 copay $9 copay Brand name Rx; preferred BCBS discounted price $65 $65 $65 Member responsibility $65 (applied to deductible) $50 copay $50 copay Brand name Rx; non- preferred BCBS discounted price $175 $175 $175 Member responsibility $175 (applied to deductible) $75 copay $75 copay Discounted cost of drug; Specialty drug; $75 copay $75 copay member responsibility applied to deductible Other things to consider: • On the HSA, all prescription drug costs are applied to the plan deductible. After the deductible is met, member pays copays for prescription drugs until the overall out of pocket maximum is met. • On the Regular PPO, there is a separate Rx out of pocket maximum of $4,850 per individual or $9,700 per family. • On the HMO, there is a separate Rx out of pocket maximum of $1,000 per individual or $2,000 per family.

Show ID card to obtain BCBS processes claim Visit in-network doctor BCBS of Illinois Doctor bills BCBS and applies discounted discounted rates rates BCBS provides Explanation of Benefits Doctor bills you Compare bill to EOB to Pay provider from your (EOB) showing what (unless it was a make sure the amount HSA or personal was paid and what you preventive care visit) you owe matches finances owe Don’t pay that bill yet!

Pharmacy can see Show ID card at the your plan details and You pay pharmacy pharmacy to obtain determine the from HSA or personal BCBS of Illinois amount due at the finances discounted rates time of sale If using mail order pharmacy, you can set up automatic payment from your HSA

• • • • • • • • • • • • • • • • • • • • • • • • • • • •

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

• • • • • • • •