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Health Plan Options
Informational Sessions
November 2012
Agenda
• Overview of Health Plans
• Prescription Drug Coverage
• 2013 Health Premiums
• Health Care Flex Spending Account
• Health Savings Account (HSA)
• Out-of-Pocket Cost Comparisons
Health Plans
United HealthCare (UHC) Choice HMO United HealthCare Choice Plus POS Anthem Blue Cross Excel PPO Anthem Blue Cross Basic PPO UHC High Deductible Health Plan
(HDHP)
All Health Plans
• No pre-existing condition limitations
• No lifetime maximum benefit
• No requirement for referral from a primary care physician to see a specialist
• Coverage under health plan automatically includes coverage under the prescription drug, dental, and basic vision plans
United HealthCare Choice HMO
In Network Out of Network
Annual Deductible None N/A
Office Visit Co-Pay Preventive Primary Care Physician Specialist Physician
$0 $25$40
N/AN/AN/A
Hospital Co-Pays Emergency Room (waived if admitted) In-Patient (semi-private room)
$150$300
$150N/A
Outpatient Surgery Co-Pay $150 N/A
Urgent Care Co-Pay $35 N/A
Lab/X-Ray Preventive Non-Preventive Major Radiologic Diagnostic Test
$010% co-
insurance20% co-
insurance
N/AN/AN/A
Annual Co-Insurance Maximum Individual Family
$1,500$3,000
N/AN/A
United HealthCare Choice Plus POSIn Network Out of
Network
Annual Deductible Individual Family
NoneNone
$300$900
Office Visit Co-Pay Preventive Primary Care Physician Specialist Physician
$0$25$40
30%30%30%
Hospital Co-Pays Emergency Room (waived if admitted) In-Patient (semi-private room)
$150$300
$15030%
Outpatient Surgery Co-Pay $150 30%
Urgent Care Co-Pay $35 30%
Lab/X-Ray Preventive Non-Preventive Major Radiologic Diagnostic Test
$010% co-insurance20% co-insurance
30%30%30%
Annual Co-Insurance Maximum Individual Family
$1,500$3,000
$3,000$6,000
Anthem Blue Cross Excel PPO
In Network Out of Network
Annual Deductible Individual Family
$500$1,500
$500$1,500
Co-Insurance 20% 40%
Preventive Care 0% (no deductible)
40%
Hospital Emergency Care In-Patient (semi-private room) Outpatient Surgery
20%20%20%
20%40%40%
Urgent Care 20% 40%
Lab/X-Ray Preventive Non-Preventive
0%20%
40%40%
Annual Co-Insurance Maximum Individual Family
$1,500$4,500
$3,000$9,000
Anthem Blue Cross Basic PPO
In Network Out of Network
Annual Deductible Individual Family
$750$2,250
$750$2,250
Co-Insurance 20% 40%
Preventive Care 0% (no deductible)
40%
Hospital Emergency Care In-Patient (semi-private room) Outpatient Surgery
20%20%20%
20%40%40%
Urgent Care 20% 40%
Lab/X-Ray Preventive Non-Preventive
0%20%
40%40%
Annual Co-Insurance Maximum Individual Family
$2,500$7,500
$5,000$15,000
United HealthCare HDHP
In-Network Out of Network
Annual DeductibleIndividual (Employee Only)Family (Employee +1 or more dependents)
$1,500$3,000
$1,500$3,000
Co-Insurance 20% 40%
Preventive Care 0% (no deductible)
40%
Annual Co-insurance MaximumIndividualFamily
$1,250$2,500
$2,500$5,000
Annual Out-of-pocket Maximum (Including Deductible and Co-insurance)IndividualFamily
$2,750$5,500
$4,000$8,000
United HealthCare HDHP
• Separate In-Network and Out-of-Network deductibles
• Family deductible applies if you cover one or more family members
• Family deductible must be fully met even if only one family member utilizes the plan
• Deductible and co-insurance apply to prescription drugs (no co-pays)
Prescription Drug Benefits
Express Scripts
All Health Plans except UHC HDHP
UHC HDHP
Tier 1 Co-pay(generi
c)
Tier 2Co-pay
(preferred)
Tier 3Co-pay(non-
preferred)
30-Day Supply Retail Pharmacy
$10 $40 $65 Deductible, then 20% co-
insurance
90-Day SupplyMail Order
$25 $100 $162.50 Deductible, then 20% co-
insurance
2013 Employee Monthly Premiums
Full Time Faculty & Staff Earning less than $35,000
HEALTH PLANEMPLOYEE
ONLY
EMPLOYEE + ONE
DEPENDENT
EMPLOYEE + TWO OR MORE
DEPENDENTS
UHC Choice HMO $35.77 $193.80 $273.67
UHC Choice Plus POS 55.33 270.16 406.38
UHC High Deductible PPO
7.71 26.53 51.57
Anthem BC Excel PPO 73.92 298.90 445.46
Anthem BC Basic PPO 19.41 61.63 120.65
Dental Only 2.39 5.32 8.06
Vision Buy-Up Option 6.56 13.09 21.10
2013 Employee Monthly Premiums
Full Time Faculty & Staff Earning $35,000 or more
HEALTH PLANEMPLOYEE
ONLY
EMPLOYEE + ONE
DEPENDENT
EMPLOYEE + TWO OR MORE
DEPENDENTS
UHC Choice HMO $43.55 $231.40 $328.77
UHC Choice Plus POS 69.08 334.00 503.71
UHC High Deductible PPO
10.46 35.09 67.20
Anthem BC Excel PPO 95.96 386.33 577.09
Anthem BC Basic PPO 24.86 78.58 152.81
Dental Only 2.39 5.32 8.06
Vision Buy-Up Option 6.56 13.09 21.10
2013 Employee Monthly Premiums
Part-Time Faculty & Staff
HEALTH PLANEMPLOYEE
ONLY
EMPLOYEE + ONE
DEPENDENT
EMPLOYEE + TWO OR MORE
DEPENDENTS
UHC Choice HMO $231.06 $569.20 $794.04
UHC Choice Plus POS 302.02 743.10 1048.46
UHC High Deductible PPO
141.15 290.05 428.90
Anthem BC Excel PPO 411.65 891.85 1301.45
Anthem BC Basic PPO 183.20 380.26 568.93
Dental Only 4.78 10.64 16.12
Vision Buy-Up Option 6.56 13.09 21.10
Health Care Flex Spending Account (FSA)
Qualified Expenses Out-of-pocket Medical, Dental, Rx, and Vision
Annual Maximum Contribution
$2,500 Per Employee
Payment Methods Debit card / Pay Me Back / Pay My Provider
Payment Amount Up to Annual Contribution Amount
Debit Card Requirements
Settle Unverified Transactions
Benefit to Employee Federal, State, & FICA Tax Savings
Grace Period January 1 through March 15 after Plan Year
Claims Filing Deadline
April 30 after Plan Year
Limitations of Plan Forfeiture of Unclaimed Balance
WAGE WORKS
Health Savings Account (HSA)
Eligibility Requirements Must be Enrolled in WUSTL UHC High Deductible Health Plan (HDHP)
Minimum Employee Contributions to receive university contribution
$200 (Under $115,000 salary) $400 ($115,000 and greater salary)
Maximum Employee Contributions
$3,250 (Employee) - $2,850 w/ university contribution$6,450 (Family) - $6,050 w/ university contribution$1000 catch-up contribution – Age 55 & older
University Contribution $400
Benefit to Employee Income Tax Advantages
Funds to be Utilized Active or Retiree Health Costs
Limitations of Plan Cannot be enrolled in Health FSA or Medicare
US BANK
Health Care FSA and HSA Comparison
Health Care FSA HSAHealth Plan Requirement No Must be enrolled in
HDHP
Maximum Annual Contribution $2500
$3250 – Individual Coverage
$6450 – Family Coverage
University Contribution No
$400 annual contribution if
employee contributes required minimum
Access to Annual Election Throughout
yearYes
No. Can access only up to YTD
contributions
Contribution Forfeiture YesNo. Unused
contributions roll over from year-to-year
Scenario #1: Single Employee (Income >$35,000) – Generally Healthy
Premium/Procedure UHC
Choice HMO
UHC
Choice Plus POS
UHC HDHP BC Excel BC Choice
Annual Physical ($280) $0 $0 $0 $0 $0
Office Visit – Illness
($90) $25 $25 $90 $90 $90
Antibiotic – Generic
($10) $10 $10 $10 $10 $10
Out-of-Pocket Cost
($380) $35 $35 $100 $100 $100
Premium Contribution $522.60 $828.96 $125.52 $1,151.52 $298.32
HSA University Contribution ($400)
$200 HSA Contribution Tax Savings* (28% Rate)
($56.00)
Total Annual Cost $557.60 $863.96 ($230.48) $1,251.52 $398.32
* Tax savings will vary based on your current FSA contribution and medical plan election.
Scenario #2: Employee Plus Spouse (income >$35,000) – Having First Baby in June
Premium/Procedure UHC Choice HMO
UHCChoice Plus
POS
UHC HDHP BC Excel BC Choice
Pre-Natal Care – 6 OB visits ($740) $0 $0 $0 $0 $0
Office Visit – Illness($90)
$25 $25 $90 $90 $90
Normal Delivery($6,000)
$300 $300 $3,528 $1,528 $1,728
Out-of-Pocket Cost($6,830)
$325 $325 $3,618 $1,618 $1,818
Premium Contribution $3,361.02 $5,026.26 $613.74 $5,780.52 $1,388.34
HSA University Contribution ($400)
$200 HSA Contribution with Tax Savings* (28% Rate)
(56.00)
Total Annual Cost $3,686.02 $5,351.26 $3,775.74 $7,398.52 $3,206.34
* Tax savings will vary based on your current FSA contribution and medical plan election.
Scenario #3: Employee Plus Spouse (income >$35,000) - Elective Surgery for Family Member
Premium/Procedure UHC Choice HMO
UHCChoice
Plus POS
UHC HDHP BC Excel BC Choice
Annual Physical($280)
$0 $0 $0 $0 $0
Office Visits (1 PCP, 2 specialists) - ($330) $105 $105 $330 $330 $330
MRI – Knee ($750) $150 $150 $750 $286 $486
Elective Knee Surgery ($7,000 charge) $150 $150 $2,936 $1,384 $1,400
Rehabilitation ($1,560 – 18 visits) $720 $720 $312 $0 $312
Out-of-Pocket Cost($9,920)
$1,125 $1,125 $4,328 $2,000 $2,528
Premium Contribution $2,776.80 $4,008 $421.08 $4,635.96 $942.96
HSA University Contribution ($400)
$200 HSA Contribution with Tax Savings* (28% Rate) ($56.00)
Total Annual Cost $3,901.80 $5,133 $4,293.08 $6,635.96 $3,470.96* Tax savings will vary based on your current FSA contribution and medical plan election.
Scenario #4: Employee Plus Family with Two Children – One child has a sports injury, the other child has asthma
Premium/Procedure UHC Choice HMO
UHCChoice Plus
POS
UHC HDHP BC Excel BC Choice
Child 1* - Emergency Room Visit, Treatment for Broken Leg, and Physical Therapy ($7,200)
$630 $630 $3,840 $1,840 $2,040
Child 2 - ER Visit, 1 Night in the Hospital, 4 office visits, and Asthma Medications (12 Tier 2 Retail) ($5,800/$1,700 Rx)
$400 + $480 (Rx)
$400 +$480 (Rx)
$1,500$1,560 + $480
(Rx)
$1,760 +$480 (Rx)
Employee – Annual Physical ($250) $0 $0 $0 $0 $0
Spouse – Well Woman Exam ($230) and 2 office visits for illness ($180) $50 $50 $36 $36 $36
Out-of-Pocket Cost ($15,360) $1,560 $1,560 $5,376 $3,916 $4,316
Premium Contribution $3,945.25 $6,044.52 $806.40 $6925.08 $1,833.72
HSA University Contribution ($400)
$200 HSA Contribution with Tax Savings* (28% Rate) ($56.00)
Total Annual Cost $5,505.24 $7,604.53 $5,726.40 $10,841.08 $6,149.72
* 4 specialist visits, 8 physical therapy sessions** Tax savings will vary based on your current FSA contribution and medical plan election.