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. 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