2015 BCBS Presentation

Report
BlueEdge HSA
SM
bcbsok.com
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Copyright © 2013. All rights reserved.
Discussion Items
BlueEdge HSASM
•
High Deductible Health Plan
Benefits – What are the benefits?
•
•
•
•
•
Examples
Difference between BlueEdge/BlueOptions
Premium Difference
Health Savings Account
•
•
•
•
•
•
Define the benefits
What is it?
Advantages
Eligibility
Contribution Rules
Benefit Wallet (Bank)
Member Experience
* America’s Health Insurance Plans (AHIP), Center for Policy and Research, 2013
Source: BlueEdge Value Story, 2012
2
What are the Benefit Differences
BENEFIT
BLUEOPTIONS
BLUEEDGE PPO
BluePreferred (BP) BlueChoice (BC)
BlueChoice
$30.00 Primary Care
$50.00 Specialist
No Office Visit Copayments
Deductible
$750.00 Individual BP/BC/$2,250 Family
Embedded*
$1,500 Deductible / $3,000 Family
Aggregate*
Coinsurance
80% In Network
80%
Out of Pocket
$4,250 Individual/$12,700 Family
Embedded*
$4,000 Individual/$8,000 Family
Aggregate*
Provider Network
Office Visit Copayments
Pharmacy Benefits
$4.00 Generic
Subject to Deductible and Out of Pocket
$50.00 Preferred
Maximum – Member must meet
$100.00 Non Preferred
deductible before insurance pays
Embedded - For services that are subject to the plan deductible, once the Individual Deductible is met, the member does
not have to wait for the entire Family Deductible to be satisfied before benefits are payable.
Savings Account with
No
Yes
Aggregate - For services that are subject to the plan deductible, the entire Family Deductible must be satisfied before
Investment Options
3
benefits are payable
Office Visit Claim In Network
OFFICE VISIT
Member has an office visit for Bronchitis and seeks services from their PCP
BlueEdge High Deductible
Total Charge:
$300.00
Allowable Charge:
$250.00
Deductible:
$250.00
Member Responsibility: $250.00
BlueOptions
Total Charge:
$300.00
Allowable Charge:
$250.00
Office Visit Copay:
$30.00
Deductible:
$0.00
Member Responsibility: $30.00
BlueEdge Plan - The members responsibility is $250.00 because there is no office visit
copayment on the plan. EVERYTHING, except preventative care will apply to the benefit
period deductible before health insurance is paid.
4
Preventative Claim In Network
OFFICE VISIT
Member has a routine physical
BlueOptions
BlueEdge High Deductible
Total Charge:
$200.00
Allowable Charge:
$175.00
Total Charge:
Allowable Charge:
Member Responsibility: $0.00
Member Responsibility: $0.00
$200.00
$175.00
Both plans cover preventative care at 100% of allowable charge.
***Preventative care is the ONLY type of services that will be covered at 100% of
allowable when deductible and out of pocket have not been satisfied.
5
Taking a look at the Hospitalization Claim – Total Benefit Perspective
BlueEdge Vs. BlueOptions
INPATIENT
Member is inpatient and has employee only coverage.
BlueEdge
Total Charge:
$30,000.00
Allowable Charge:
$20,000.00
Deductible:
$ 1,500.00
20% after Deductible: $ 2,500.00
BCBSOK Paid:
$16,000.00
Member Responsibility: $ 4,000.00
BlueOptions
Total Charge:
$30,000.00
Allowable Charge:
$20,000.00
Deductible:
$ 750.00
20% after Deductible: $3,500.00
BCBSOK Paid:
$16,000.00
Member Responsibility: $ 4,250.00
In this scenario, the member is out of pocket less money because the member out of
pocket is lower on the BlueOptions Plan for Employee Only Coverage.
6
Hospitalization In-Network
OFFICE VISIT
Member is inpatient and has Family Coverage. No other member has had any claims process for the
current year.
BlueEdge High Deductible
Total Charge:
$30,000.00
Allowable Charge:
$20,000.00
Deductible:
$ 3,000.00
20% after Deductible: $ 5,000.00
BCBSOK Paid:
$12,000.00
Member Responsibility: $ 8,000.00
BlueOptions
Total Charge:
$30,000.00
Allowable Charge:
$20,000.00
Deductible:
$ 750.00
20% after Deductible: $ 5,000.00
BCBSOK Paid:
$15,750.00
Member Responsibility: $ 4,250.00
BlueEdge Plan –
• The provider can bill the member $3,000 at the time of service when they verify benefit coverage during
the admissions process.
• Family deductible is aggregate which means the entire deductible must be met prior to any payment by
BCBSOK.
BlueOptions –
• The provider can bill $750.00 at the time of service when they verify benefits coverage during the
admission process.
• Family deductible is embedded, unlike the BlueEdge High Deductible plan, the individual only has to meet
their individual deductible and out of pocket maximum amounts.
7
Pharmacy Claim
Member fills a brand name prescription at the pharmacy.
BlueEdge High Deductible
Total Charge:
$175.00
Allowable Charge:
$125.00
Deductible:
$125.00
Member Responsibility: $125.00
BlueOptions
Total Charge:
$175.00
Allowable Charge:
$125.00
Copayment:
$50.00
Member Responsibility: $50.00
BlueEdge Plan
•
The member will receive a discount at the time of purchase at the pharmacy. There is no
copayment for the BlueEdge plan so the member will be required to pay the entire
discounted amount at the time of purchase. The claim is transmitted to BCBSOK to apply to
the deductible.
•
When the deductible is satisfied, then the member would only be required to pay 20% at the
time of purchase.
8
What are the 2015 premium differences
BENEFIT
BLUEOPTIONS
BLUEEDGE PPO
Premium
Difference
Annualized
Employee
Only Coverage
$491.40
$390.94
$100.46
$1,205.52
Employee and
Spouse
$1230.50
$978.96
$251.54
$3,018.48
Employee and
Dependent
$890.70
$708.66
$182.04
$2,184.48
Family
$1618.86
$1287.62
$331.24
$3,974.88
9
What is an HSA?
A Health Savings Account (HSA)
is a tax-exempt account established
exclusively for the purpose of
paying qualified medical expenses.
An HSA must be used in combination with a
qualified high-deductible health plan (HDHP)
• A higher annual deductible
• Out-of-pocket maximum applies
only to covered expenses
• No First dollar coverage (100%)
except for preventive care
benefits without a deductible
10
FOR EMPLOYERS
HSA
ADVANTAGES
• Lower health insurance premiums
• Employees make better health care choices
FOR EMPLOYEES
• Protects against high / unexpected medical bills
• Members decide how much money to put into the
account and whether to use it to pay for current
qualified medical expenses or save the money for
future needs
•
Triple Tax Savings
•
Portability
•
No “use it or lose it” rules
11
TO BE ELIGIBLE YOU:
•
Must be enrolled in an HSA-compatible
High Deductible Health Plan (HDHP)
•
May not have other first dollar medical coverage
If an employee enrolls on the HDHP and uses the HSA option,
they could not also be covered under their spouses plan that is
NOT HDHP compatible meaning it could not have an office visit
copayment, or first dollar coverage under pharmacy.
•
May not be claimed as a dependent on another person's
tax return
•
May not be enrolled in Medicare
–
An individual can be Medicare eligible and have an HSA. However, once
enrolled in Medicare contributions to the HSA account must stop. The
individual can keep any funds in the account prior to enrolling in Medicare
and use those funds to pay for qualified medical expenses tax-free.
12
HSA
CONTRIBUTION RULES
• If made by the individual outside a cafeteria plan,
contributions are a tax-free deduction
• If made by the employer, contributions are not
taxable to the employee (excluded from income)
• Contributions can be made by others on behalf of
the individual and deducted by the individual
• If an individual has more than one HSA, the
aggregate annual contributions made to all the HSAs
are subject to the limit
13
U.S. TREASURY GUIDELINES FOR 2015
Annual Contributions
Self-Only
Family
HSA Contributions
$3,350
$6,650
Minimum Deductible Amounts
$1,300
$2,600
Annual Out-of-Pocket (In-network)
$6,450
$12,900
“Catch-up” Contributions
(Individuals age 55 and older)
$1,000*
Amounts are adjusted annually for inflation.
* No change from calendar year 2014
14
FLEXIBILITY OF THE BlueEdge HSA
SM
USERS
have multiple options
to leverage HSA $$$s
HSA
account balance
Health Care
Transaction
SAVERS
Excess Balance
Investment
Options
use personal funds to
cover expenses and
invest excess
15
BANKING PARTNER
16
BlueEdge HSASM
Custodian Integration Features
DIMENSIONS OF
INTEGRATION
INTEGRATION FEATURES
Automatic Debit
●
Online bill pay
●
Payment via debit card/checkbook
●
Enrollment & Eligibility
Integrated Enrollment File to Bank
●
Web Services
Access to balance & transactional
details on BAM via real-time web feed
●
Can access bank via single sign-on
●
BCBS handles all “tier 1” questions
●
Warm transfer to bank for detailed Q’s
●
BlueEdge Plan communications
●
Bank custodian communications
●
Payment Options
Customer Service
Integration
Communications
17
THE VALUE OF BlueEdge
Banking 2015 Financials*
Account Set Up Fees
$0
Monthly Maintenance Fees – Accountholder Paid
$2.25 waived for balances of $3,000+
Monthly Maintenance Fees – Employer Invoiced/Paid
$2.25 waived for balances of $3,000+
Investment Options
20+ highly rated mutual funds
Balance Threshold prior to investing
$1,000
Minimum Investment Amount
Varies by Fund
Investment Fees
$2.90 per month
Interest Rate
(subject to change at ANY time)
Flat, earned on first dollar
Miscellaneous
Other fees may apply
* All banks may have additional, miscellaneous fees. Refer to each bank’s fee schedule for additional information.
18
Member Experience
19
AUTOMATIC HSA DEBIT FOR MEDICAL
(BenefitWallet)
Member goes to doctor for broken arm
AUTO DEBIT ON*
•
•
•
•
BCBSOK requests HSA balance
information
If balance available, BCBSOK pays
provider directly
BCBSOK creates consolidated
EOB with HSA dollars used
If any remaining patient share,
member pays doctor after EOB
generated
AUTO DEBIT OFF*
•
•
Doctor submits claim to BCBSOK
BCBSOK processes claim, determines
out-of-pocket liability for member (copay,
coinsurance, deductible)
BCBSOK creates EOB that
includes patient share
Member receives EOB and pays
doctor patient share using bank
debit card, bank checkbook, or
personal funds
20
*Assumes PPO network provider. This feature is only available with BenefitWallet.
AUTOMATIC HSA DEBIT FOR RX
(BenefitWallet/Prime)
Member goes to a pharmacy to fill a prescription
AUTO DEBIT ON*
•
•
•
PBM requests HSA balance
information
If balance available, PBM pulls HSA
dollars to pay pharmacy for claim
The pharmacist can see amount due
from member (zero if HSA covered
RX cost, or partial balance if funds
covered only part of Rx cost)
AUTO DEBIT OFF*
•
Pharmacy sends claims to PBM
Member pays for the RX at
the point of sale with bank
debit card, bank checkbook,
or his/her own personal funds
PBM processes claim and
determines the out of pocket liability
for member (copay, coinsurance,
deductible) at the point of sale
21
*Assumes PPO network provider. This feature is only available with BenefitWallet and Prime.
22
23
Other Resources
24
MyPrime.com and MyPrimeMail.com
Link from Blue Access for Members to:
•
•
•
•
•
Locate a pharmacy
Find drugs / formulary
View prescription claim history
Create personal drug list
Learn about specific drugs
– Rx Cost Calculator
– Health information
• PrimeMail
– Refill a mail order prescription
– Check the status of an order
– Streamlined order refills
– Manage payment options
– Add alternative mailing address
24/7Nurseline
Advice anytime.
Advice isn’t just needed
from 9 to 5.
Round-the-clock health and the wellness advice from licensed professionals
More than 1,200 AudioHealth
Library topics
800-581-0407
Available in
English and
Spanish
26
Blue Access Mobile
BCBSOK App
Features:
• Member resources
• Find Doctors or Hospitals near you
• Shop for Plans
Text BCBSOK APP to 33633 to download*
*msg and data rates may apply
Or visit store links below:
27
Online Tools and
Resources
Benefits and Claims
ID Card Management
Monthly Health Topics
Health Assessment
Blue Access
for MembersSM
Provider Finder®
Cost Estimator tool
Member Care Profile
Member Discounts
Health Care School
Member Wellness Portal
Be Smart. Be Well.®
Wellness Points
eCards for HealthSM
Special Beginnings®´
28
Interactive Video Tutorials
Easy to use, technology-powered
video coaching modules that enable
the most informed treatment decisions
Some of the 180 videos:
•
•
•
•
•
Coronary Artery Disease
Bariatric Surgery
Chronic Low Back Pain
Depression
Diabetes
– Blood Sugar
– Insulin Injections
– Type 2 Diabetes
• Metabolic Syndrome
Expectant mothers and babies
get off to a healthy start with prenatal and
postnatal education and support
Enroll in the program to receive guidance from
pregnancy to six weeks after delivery
• Pregnancy risk assessment
• Frequent, personal contact based on risk
• Educational materials
• Coordinated care with your physician
• Screening for depression
web
text
Lifestyle Management
Weight Management &
Tobacco Cessation:
Support for a Healthier You
Personalized Coaching
• Counseling and coaching with
licensed Wellness Coaches
• 24/7 Nurseline
• Referrals when appropriate
Self-Paced Approach
• Online programs
• Secure email outreach keeps
members on track
Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Health Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association. © 012 Health Care Service Corporation. All rights reserved.

similar documents