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2008 BENEFITS 2008 BENEFITS OVERVIEWOVERVIEW
Employee PresentationEmployee Presentation
AETNA Benefits Offering OverviewAETNA Benefits Offering Overview
Multiple Medical Plans: HSA, HRA, HMO, PPOMultiple Medical Plans: HSA, HRA, HMO, PPO
Choice of Two Dental Plans: Dental PPO or DentalChoice of Two Dental Plans: Dental PPO or Dental Maintenance Organization – DMO (available in Maintenance Organization – DMO (available in somesome areas)areas)
Supplemental Life Insurance for Employee, SpouseSupplemental Life Insurance for Employee, Spouse & Children& Children
New 01/01/08New 01/01/08 – During the 90 day benefit waiting – During the 90 day benefit waiting periodperiod staff & contractor core benefit eligible employeesstaff & contractor core benefit eligible employees will be eligible for a limited medical (mini-med)will be eligible for a limited medical (mini-med) plan (SRC)plan (SRC)
What’s the Difference Between What’s the Difference Between Coinsurance and Copay?Coinsurance and Copay?Coinsurance is the percentage of covered expenses paid
by the health insurance plan after the deductible is met. This percentage varies depending on the plan design
In this example, a health insurance plan covers 80% (in-network) of medical expenses after the deductible is met
The member pays the remaining 20%
A copayment is a fixed-dollar amount paid for covered medical expenses
HRA 5, 12/06
Doctor Bills$100
Member Pays $20(or 20%
coinsurance)
Health Ins. Planpays $80 (or
80% coinsurance)
]
What is a Consumer-Directed Health What is a Consumer-Directed Health Plan?Plan?
HRA 5, 12/06 ]
Why does PDS advocate consumer driven Why does PDS advocate consumer driven healthcare?healthcare?
Informed consumers make better decisions. Lower spending leads to lower premium increases.
Consumer-directed health plans, or CDHPs, are made up of three elements:
An underlying deductible-based health insurance plan
A fund or account that you can use to help pay for qualified, out-of-pocket medical expenses
Interactive tools and information to help you make informed health care decisions
How Do Consumer-Directed Health Plans How Do Consumer-Directed Health Plans Work?Work?
Preventive Care Covered at 100%
All Other Care
Health care FUND for out-of-pocket
medical expenses
1 2
You pay medical expenses until you meet DEDUCTIBLE
3Underlying
insurance plan provides coverage
with COINSURANCE or COPAY
Out of Pocket Maximum
Information and Decision Support Tools
HSA – Health Savings AccountHSA – Health Savings Account The plan includes two components, the underlying The plan includes two components, the underlying medicalmedical plan, and a Health Savings Accountplan, and a Health Savings Account The underlying medical plan is deductible based, The underlying medical plan is deductible based, thereforetherefore the deductible must be satisfied before any expenses arethe deductible must be satisfied before any expenses are payable, with the exception of preventative payable, with the exception of preventative Once the deductible is satisfied a percentage of expenses Once the deductible is satisfied a percentage of expenses areare paid by the planpaid by the plan
$2,500 ee/$5,000 family – In Network$2,500 ee/$5,000 family – In Network $3,000 ee/$6,000 family – Out-of-Network$3,000 ee/$6,000 family – Out-of-Network
The provider network for the HSA is the same as the PPO The provider network for the HSA is the same as the PPO planplan The second component of the plan, is an account that youThe second component of the plan, is an account that you can use to help pay for qualified out-of-pocket expensescan use to help pay for qualified out-of-pocket expenses Long-term investment optionsLong-term investment options Unused account balances roll over year-to-yearUnused account balances roll over year-to-year The account is yours to keep even if you change The account is yours to keep even if you change employersemployers or medical plansor medical plans You determine how & when your Health Savings AccountYou determine how & when your Health Savings Account dollars are useddollars are used
How does a Health Savings Account How does a Health Savings Account (HSA) Work? (HSA) Work?
Health Savings Account
Contribute tax free
Reimburse qualified expenses tax free
Save for future expenses
Grow the account with interest and/or choose the HSA investment services offered
Medical and Prescription Drug
Plan Benefits
Preventive care covered at 100%
Meet the plan deductible), then
Pay coinsurance
Out-of-pocket maximum limits amount you pay annually
Manage Your Health Care
Secure, personalized online services
Track HSA activity, monitor savings
Find a doctor, estimate cost of care, compare hospitals
Research health topics and medications
How Much May I Contribute to my HSA?How Much May I Contribute to my HSA?
2008 annual maximum2008 annual maximum $2,900 per individual$2,900 per individual $5,800 per family$5,800 per family
Catch Up ContributionsCatch Up Contributions Individuals age 55 to 64Individuals age 55 to 64 $900 for 2008$900 for 2008 Amount increases $100 per year until Amount increases $100 per year until
20092009
If age 65+ and enrolled inIf age 65+ and enrolled in Medicare Part A Medicare Part A or Bor B HSA may remain openHSA may remain open No additional contributions can be madeNo additional contributions can be made
The Value of Tax-Advantaged HSA The Value of Tax-Advantaged HSA Savings* Over TimeSavings* Over Time
Annual Contribution Annual Contribution AmountsAmounts
Tom, Age 39Tom, Age 39 $1,000$1,000 $2,000$2,000 $3,000$3,000
Total Savings for Future Total Savings for Future Medical Expenses** (at Medical Expenses** (at age 65)age 65)
$34,34$34,3433
$68,68$68,6877
$103,03$103,0322
Annual Tax SavingsAnnual Tax Savings $330$330 $660$660 $990$990
Accumulated Tax Accumulated Tax Savings (at age 65)Savings (at age 65) $8,580$8,580 $17,16$17,16
00$25,740$25,740
*Employers and employees should consult with a tax advisor to determine eligibility requirements and tax advantages associated with participating in the Aetna HealthFund HSA plan.**Based on an estimated 2 percent investment rate of return each year. Assumes member is in the HSA for an entire year and contributing up until the age selected (65) and that the contribution rate and interest rate selected remain constant until the age that the member stops contributing.
HRA – Health Reimbursement AccountHRA – Health Reimbursement Account
The plan pays the first $500 (ee only) or $1,000 (family)The plan pays the first $500 (ee only) or $1,000 (family)
covered expenses at 100%covered expenses at 100% Any remaining fund amounts ($500/$1,000) can be Any remaining fund amounts ($500/$1,000) can be
rolled over to the next plan yearrolled over to the next plan year Once the health fund is exhausted, you will need toOnce the health fund is exhausted, you will need to
satisfy a deductiblesatisfy a deductible $3,000 ee/$6,000 family – In Network$3,000 ee/$6,000 family – In Network $6,000 ee/$12,000 family – Out of Network$6,000 ee/$12,000 family – Out of Network
Expenses paid by your health fund also reduce theExpenses paid by your health fund also reduce the
deductibledeductible Preventative services payable at 100%. The health fund Preventative services payable at 100%. The health fund andand
and deductible is waived.and deductible is waived. Plan uses the same provider network as the PPO planPlan uses the same provider network as the PPO plan You determine how & when your health fund dollars are You determine how & when your health fund dollars are used.used. Unused health fund balance is forfeited when you move toUnused health fund balance is forfeited when you move to
another plan or terminate employmentanother plan or terminate employment
How Does a Health Reimbursement How Does a Health Reimbursement Account (HRA) Work?Account (HRA) Work?
HRA 5, 12/06 ]
The Fund
Use your employer-provided fund to pay for eligible medical expenses.
Rollover: Unused fund balance rollsover to next year’s fund balance.
The Deductible
If the fund is exhausted, you pay for the remaining or future expenses until your deductible is met.
The Base Insurance Plan
If the fund is exhausted and the deductible met, your base insurance plan begins to pay toward covered expenses. You pay a coinsurance amount for eligible expenses.
HMO – Health Maintenance OrganizationHMO – Health Maintenance Organization(Not available in all locations)(Not available in all locations)
Selection of a Primary Care Provider (PCP) Selection of a Primary Care Provider (PCP) is required. Your PCP will manage your is required. Your PCP will manage your overall care.overall care.
The plan does not have a deductibleThe plan does not have a deductible
You pay a fixed dollar co-pay for office You pay a fixed dollar co-pay for office visits & preventative carevisits & preventative care
A referral from your PCP is required for A referral from your PCP is required for services not provided by the PCPservices not provided by the PCP
There is no out-of-network coverageThere is no out-of-network coverage
You will pay a higher premium to have a You will pay a higher premium to have a flat dollar co-pay for office visitsflat dollar co-pay for office visits
PPO – Preferred Provider PPO – Preferred Provider OrganizationOrganization
You pay a fixed dollar co-pay for You pay a fixed dollar co-pay for office visits & preventative careoffice visits & preventative care
You must satisfy the deductible You must satisfy the deductible before any expenses, other than before any expenses, other than office visits are payableoffice visits are payable
Plan includes out of network Plan includes out of network coverage, at reduced reimbursementcoverage, at reduced reimbursement
The most expensive premium for the The most expensive premium for the least amount of benefitsleast amount of benefits
Open Enrollment Tools and Open Enrollment Tools and SupportSupport
Aetna Navigator, Your Secure Aetna Navigator, Your Secure Personal Website…Personal Website…www.aetnanavigator.comwww.aetnanavigator.com Take a tour of the website’s key features Take a tour of the website’s key features Estimate the Cost of Care Suite of ToolsEstimate the Cost of Care Suite of Tools Health Information on conditions & alternative Health Information on conditions & alternative optionsoptions Quality of participating providersQuality of participating providers 24 x 7 availability24 x 7 availability
Online TutorialsOnline Tutorials HSA and HRA plansHSA and HRA plans
HSA Savings CalculatorHSA Savings CalculatorExplore the savings potential of an HSAExplore the savings potential of an HSA
NEW FOR 01/01/08 NEW FOR 01/01/08 SRC – LIMITED MEDICAL PLANSSRC – LIMITED MEDICAL PLANS
Staff & core benefit eligible employees will be Staff & core benefit eligible employees will be eligible for eligible for SRC during the 90-day probationary periodSRC during the 90-day probationary period
There are two plan options available, $5,000 orThere are two plan options available, $5,000 or $10,000 plan maximum$10,000 plan maximum
The plan provides limited coverage for office visits, The plan provides limited coverage for office visits, pharmacy expenses, hospital servicespharmacy expenses, hospital services
Access to Aetna’s negotiated provider discounts Access to Aetna’s negotiated provider discounts usually usually discounts average 40% - 60%)discounts average 40% - 60%)
Provides employee’s a low cost alternative other Provides employee’s a low cost alternative other than than continuing COBRA coverage during benefit waiting continuing COBRA coverage during benefit waiting periodperiod
2008 Plan Design Changes2008 Plan Design Changes
HSA – No changesHSA – No changesHRA – No changesHRA – No changesHMO HMO
PCP - $40, Specialist $50 Co-paysPCP - $40, Specialist $50 Co-pays Rx - $15/$20/50%Rx - $15/$20/50% Inpatient & Outpatient Co-insurance – Inpatient & Outpatient Co-insurance –
70%/30%70%/30%PPO PPO
Inpatient Co-insurance – 70%/30%Inpatient Co-insurance – 70%/30% Outpatient Co-insurance – 50%/50%Outpatient Co-insurance – 50%/50%
2008 Open Enrollment2008 Open Enrollment
October 22 – November 4October 22 – November 4www.pdstech.com/benefits2008.comwww.pdstech.com/benefits2008.com
No password requiredNo password required Plan DesignsPlan Designs Tutorials – Aetna Navigator, HSA and HRA Plans, Tutorials – Aetna Navigator, HSA and HRA Plans,
Printing ID Cards, etc.Printing ID Cards, etc.
www.pdstech.essbenefits.comwww.pdstech.essbenefits.com Requires social security # and passwordRequires social security # and password
SSN entered as numerals onlySSN entered as numerals onlyPassword is reset to MMYY of date of birthPassword is reset to MMYY of date of birth
Print confirmation statements onlinePrint confirmation statements onlineNo mailing of confirmation statementsNo mailing of confirmation statements
Open Enrollment QuestionsOpen Enrollment Questions
PDS Benefits WebsitePDS Benefits WebsiteJulie Barton – ext 10135Julie Barton – ext 10135Lorri Bloom – ext 10132Lorri Bloom – ext 10132Jathan Van Winkle ext 10145Jathan Van Winkle ext 10145
Benefits WebsitesBenefits Websites
Aetna – Aetna – www.aetna.comwww.aetna.comVSP – Vision Service Plan - VSP – Vision Service Plan -
www.vsp.comwww.vsp.comHyatt Legal – Hyatt Legal – www.legalplans.comwww.legalplans.comPersonal Care – Personal Care –
www.personalcare.orgwww.personalcare.org