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Health Plan Open Enrollment Presentation Handout
 

Health Plan Open Enrollment Presentation Handout

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    Health Plan Open Enrollment Presentation Handout Health Plan Open Enrollment Presentation Handout Presentation Transcript

    • Washington College Benefits Overview See Annual Health Plan Open Enrollment Letter and Benefit Summaries at http://hr.washcoll.edu for additional information. May 2009
    • Agenda
      • Eligibility for Health Plan Participation
      • Health Plan Options
      • Dental Insurance
      • Vision Plan
      • Enrollment Deadline – May 15
      • Questions at Any Time
    • Eligibility
      • Regular Full-Time Faculty & Staff
      • Full-Time, Full-Year Visiting Faculty
      • Part-Time Employees Hired Before 1-1-2004
        • Less than 15 years of service, prorated benefit
        • 15 or more years of service, full benefit
      • Temporary, Part-time Employees hired after
      • 1-1-2004, and Visiting Faculty hired on a semester-by-semester basis are Not Eligible
    • Who is UnitedHealthcare?
      • UnitedHealth Group Incorporated, is an innovative leader in the health and well-being industry, serving more than 50 million Americans.
      • Member Services is available Monday – Friday, 8am to 11pm EST.
      • National network provides access to 560,000 physicians, 4,800 hospitals and 60,000 pharmacies.
      • Providing resources such as myuhc.com and Care24 to empower members to make better healthcare decisions.
      • Extensive health and wellness information/support available to identify current health status, learn areas of improvement, online health coaching, wellness programs, manage chronic disease and provide discounts on products and services not covered by the medical plan.
    • Health Plan Options Available
      • UnitedHealthcare
        • MD Choice – Open Access HMO
        • MD Choice Plus - Low Option
          • Lower Premiums / Higher Out of Pocket
        • MD Choice Plus - High Option
          • Higher Premiums / Lower Out of Pocket
      • All three plans have identical medical coverage.
      • All three plans have the same physician network.
      • The only plan differences are:
        • Premium Cost
        • Copay Amounts
        • Deductible Amounts
        • Co-Insurance Rates
        • Choice of Out-of-Network Physicians
      Medical Plans – UnitedHealthcare
      • Open Choice HMO – Does not Require a Primary Care Physician
      • No Referral required for Specialists.
      • You may choose any UHC Network Provider for both Primary Care and Specialist Care
      • There is NO out of network coverage, except emergencies.
      • To check for participating physicians go to www.myuhc.com
      How the Choice HMO Works:
      • Do not Require a Primary Care Physician
      • No Referral required for Specialists.
      • May choose any UHC Network Provider for lowest cost health care coverage for both Primary Care and Specialist Care.
      • May choose Out of Network Providers, but at significantly higher cost.
      How the Choice Plus Plans Work:
    • Bi-Weekly Premiums - Medical Insurance $379.33 NA $319.27 $217.97 Employee + Family <$28,000 $389.33 NA $329.27 $227.97 Employee + Family $189.34 NA $147.61 $ 71.77 Employee + Children $238.87 NA $192.60 $112.94 Employee + Spouse/Partner $ 38.37 NA $ 10.47 $ 6.10 Employee Only Plan Options MD Choice Plus High Option No Middle Option Offered This Year MD Choice Plus Low Option MD Choice HMO
    • Choice HMO Out of Pocket Costs $75 (waived if admitted) Emergency Room $50 copay Urgent Care Center None Deductible $10/$30/$50 Tier I/II/III $25/$75/$125 Tier I/II/III (2.5 Times 31 Day) Prescription Drugs 31 Days Retail Prescription Drugs 90 Days by Mail $20 copay Physical, Speech, & Occ Therapy Covered in Full. Requires Preadmission Authorization Mental Health & Substance Abuse (inpatient)
      • 1-5 Visits: 20%
      • 6-30 Visits: 35%
      • 31+ Visits: 50%
      Mental Health & Substance Abuse (Outpatient) Covered in Full when Medically Necessary. Pre-Service notification is required for non-emergency. Ambulance (Ground or Air) Plan Pays 100% Member Pays 0% Requires Preadmission Authorization Co-insurance Rate Inpatient Hospital Surgical Services $15 PCP / $20 Specialist Physician Office Visits In-Network ONLY (Member Pays)  
    • Choice Plus (Low Option) Out of Pocket Costs $75 (waived if admitted) $75 (waived if admitted) Emergency Room 30% after deductible $50 Urgent Care Center $10/$30/$50 Tier I/II/III Mail Order Not Available $10/$30/$50 Tier I/II/III $25/$75/ $125 Tier I/II/III Prescription Drugs Retail – Up to 31 Days Mail Order – Up to 90 Days $400 / $800 $100 / $200 Deductible 30% after deductible – Pre-service Notification is required $20 copay Physical, Speech, & Occupational Therapy 10% - after deductible – Requires Prior Authorization
      • 1-5 Visits: 20%
      • 6-30 Visits: 35%
      • 31+ Visits: 50%
      10% after deductible – Pre-Service notification is required for non-emergency. Plan Pays 90% After Deductible Member Pays 10% $20 copay In-Network (Member Pays) Plan Pays 70% After Deductible Member Pays 30% Pre-service Notification is required Co-insurance Rate Inpatient Hospital Surgical Services 10% after deductible – Pre-Service notification is required for non-emergency Ambulance
      • 1-5 Visits: 25%
      • 6-30 Visits: 35%
      • 31+ Visits: 50%
      Mental Health & Substance Abuse (outpatient) 30% after deductible – Requires Prior Authorization Mental Health & Substance Abuse (inpatient) 30% after deductible Physician Office Visits Out of Network (Member Pays)  
    • Choice Plus (High Option) Out of Pocket Costs
      • 1-5 Visits: 25%
      • 6-30 Visits: 35%
      • 31+ Visits: 50%
      • 1-5 Visits: 20%
      • 6-30 Visits: 35%
      • 31+ Visits: 50%
      Mental Health & Substance Abuse (outpatient) $75 (waived if admitted) $75 (waived if admitted) Emergency Room 20% after deductible $50 copay Urgent Care Center $10/$25/$45 Tier I/II/III Mail Order Not Available $10/$25/$45 Tier I/II/III $25/$62.50/ $112.50 Tier I/II/III Prescription Drugs Retail – Up to 31 Days Mail Order – Up to 90 Days $250 / $500 None Deductible 20% after deductible $20 copay Physical, Speech, & Occupational Therapy Covered In Full - Prior Authorization is required Covered in Full - Pre-Service notification is required for non-emergency. Plan Pays 100% - No Deductible Member Pays 0% $20 copay In-Network (Member Pays) Plan Pays 80% After Deductible Member Pays 20% Pre-service Notification is required Co-insurance Rate Inpatient Hospital Surgical Services Covered in Full - Pre-Service notification is required for non-emergency ambulance Ambulance 20% after deductible - Prior Authorization is required Mental Health & Substance Abuse (inpatient) 20% after deductible Physician Office Visits Out of Network (Member Pays)  
    • Health Coverage – High Level Comparison $0 / 20% 10% / 30% $0 Inpatient Hospital (In/Out) 0% / 20% 10% / 30% None Coinsurance (In/Outrk) $75 $75 $75 Emergency Room $50 / 20% $50 / 30% $50 Urgent Care (In/Out) $20 / $20 20% After Deductible $20 / $20 30% After Deductible $15 / $20 N/A PCP/Specialist In Network PCP/Specialist Out of Network $1,300 / $2,600 $1,400 / $2,800 N/A Out of Pocket Max - In Network (Includes Deductible) $250 / $500 $400 / $800 N/A Deductible - Out of Network None $100 / $200 None Deductible - In Network $10 / $25 / $45 $10 / $30 / $50 $10 / $30 / 50 Rx Co-Pays (Tier I / II / III) $2,250 / $4,500 $2,400 / $4,800 N/A Out of Pocket Max - Out of Network (Includes Deductible) Member Pays Member Pays Member Pays Summary of Benefits MD Choice Plus – High Option Higher Premiums Lower Out of Pkt MD Choice Plus – Low Option Lower Premiums Higher Out of Pkt MD Choice HMO
    • Health Coverage – High Level Cost Comparison $120.00 $120.00 $ 90.00 Six Primary Care Visits $ 0.00 $100.00 $ 0.00 Deductible – In Network $997.62 $272.22 $158.60 Annual Premiums 0% 10% of UCR Cost 0% Additional Costs – Coinsurance $1,477.62 $902.22 + 10% UCR $658.60 Total Routine Estimated Cost $250.00 $300.00 $300.00 One Tier II Prescription (Maint) $20.00 $ 20.00 $ 20.00 Two Tier I Prescriptions (1x) 0% 10% of UCR Cost 0% Coinsurance > Copay + Ded $ 50.00 $ 50.00 $ 50.00 One Urgent Care Visit $ 40.00 $ 40.00 $ 40.00 Two Specialist Visits Member Pays Member Pays Member Pays Employee Only Example MD Choice Plus – High Option Higher Premiums Lower Out of Pkt MD Choice Plus – Low Option Lower Premiums Higher Out of Pkt MD Choice HMO Comparison of Plans based on Total Estimated Health Care Cost & Tolerance for Health Care Risk
    • Health Coverage – Out of Network Example $120.00 $100.00 Amt Submitted to Insurance $ 0.00 $ 20.00 Office CoPay $120.00 $120.00 Actual Billing $ 78.00 $ 26.00 Total Cost to Employee $ 42.00 (No UCR) $ 0.00 Billed to Employee Out of Network $ 0.00 No Write-Off $ 40.00 Write-Off Physician Write-Off In Network $ 78.00 $ 80.00 Total Payments to Physician $ 36.00 (No UCR) $ 6.00 10% In/30% Out Employee Coinsurance (% UCR) $ 42.00 (% of UCR) $ 54.00 90% In/70% Out Insurance Payments (% UCR) $ 60.00 $ 60.00 Insurance UCR Primary Care Physician Office Out of Network Payments & Benefits + Net Billing In-Network Payments & Benefits Comparison of In Network / Out of Network Costs for MD Choice Plus (Low Opt)
      • Reasons To Use myuhc.com
      • Get Information About Hospitals and Physicians
      • Organize Your Medical Claims Online
      • Learn More About Your Coverage
      • Request a Medical ID Card
      • Compare Costs for Treatments
      • Learn About Health Conditions, Treatments & Procedures
      • Order and Renew Prescriptions Online
      • Identify cost savings for comparable medications
      • Health Risk Assessments
      myuhc.com
    • MD Children’s Health Program Comparable Coverage – Lower Rates $64,475 $77,370 $64,475 $51,580 5 $55,125 $66,150 $55,125 $44,100 4 $45,775 $54,930 $45,775 $36,620 3 $36,425 $43,710 $36,425 $29,140 2 $ 0.00 $ 27.69 $ 22.15 $ 0.00 Biweekly Premium [Paid Monthly to MD DoH] $ 9,350 $11,220 $ 9,350 $ 7,480 For Ea Add’l Person, Add NA $32,490 $27,075 $21,660 1 Children’s Health Max Income Children’s Health Max Income Children’s Health Max Income Children’s Health Max Income MD Children’s Health Plan Family Size & Family Income [* Included Unborn Child]
    • To Find a Participating Dentist, go to: http://www.deltadental.com
      • Delta Dental PPO plus Premier
      • Maintains freedom of choice
      • Combination of Delta Dental PPO and Delta Dental Premier networks
      • Features cost-saving, two-tier network that expands your access to Delta Dental participating dentists who can save you money
      • PPO dentists and Premier dentists are paid their respective allowances
      Delta Dental Benefits Programs
    • Bi-Weekly Premiums – Dental Insurance $28.28 Employee + Family $15.19 Employee + Children $21.79 Employee + Spouse/Partner $ 9.90 Employee Only Bi-Weekly Premiums Delta Dental Dental
    • Dental Plan Design Details for Washington College (PPO plus Premier) Note: Percentages are based on applicable Delta Dental allowances. 20% 80% 20% 80% Periodontics ( non-surgical treatment of gum disorders – PERIO MAINTENANCE) 50% 50% 50% 50% 50% 50% 50%% 50% 50%% 50% Implants $1,000 per person based on a contract year Annual Maximum 50% 50% Prosthodontics (Dentures, bridgework, implants) 50% 50% Major Restorative (Crowns, inlays, onlays) 20% 80% 20% 80% Basic Restorative (Fillings) $25 per person, not to exceed $75 per family. *Diagnostic and Preventive services are exempt from the deductible. Deductible 50% 50% Periodontics (Surgical and non-surgical treatment of gum disorders) 50% 50% 50% 50% Endodontics (Root canal therapy) 20% 80% 20% 80% Oral Surgery (Extractions) 0% 100% 0% 100% Preventive* (Cleanings, sealants, fluoride treatment, emergency treatment, consultations, space maintainers) 0% 100% 0% 100% Diagnostic* (Exams and x-rays) Paid by Patient Paid by Delta Dental Paid by Patient Paid by Delta Dental Delta Dental Premier and Non-Participating Dentists Delta Dental PPO Dentists Covered Benefit
    • Dental Plan Features
      • Limitations:
      • Exams, bitewings, prophylaxes and fluoride:
        • Two in any contract period
      • Fluoride to age 19
      • Sealants to age 19
      • Space maintainers to age 14.
      • Enhanced benefits:
      • Periodontal enhancement for pregnant enrollees
        • Coverage for additional oral exam and one of the following:
          • Additional prophylaxis
          • Periodontal scaling / root planing
          • Additional periodontal maintenance procedure
      • Coverage for dental implants, implant-supported prosthetics and other implant services
    • Online Services from Delta Dental’s Web Site
      • Easy-to-use participating dentist directories for all networks with maps and driving directions
      • Secure login for benefits and eligibility lookup
        • Access information on program benefits, eligibility, status of deductibles, maximum usage, and claim status
      • Fee Finder for common procedures
      • Printable Claim Forms
      • Printable ID cards
      • SmileKids – an interactive site for children
      • Extensive dental health section
      • E-mail inquiries to customer service
      • Enrollee section in Spanish
      www.deltadentalins.com
    • To Find a Participating Provider, go to: http://www.avesis.com/
    • Vision
      • Offered through Avesis
      • Employee Paid Benefit
      • Benefits from a Participating Provider:
        • Routine Vision Exams are covered every 12 months for a $10 Copay
        • Lenses are covered every 12 months for a $10 Copay for Standard Single, Bifocals, & Trifocals (one $10 co-pay for lenses and frames together)
        • Contact Lenses are covered every 12 months for a $110 allowance in lieu of frames & spectacle lenses
        • Frames are covered every 24 months for a $35 Wholesale Allowance (approximate retail of $75-$100)
      • Reimbursable Benefits Vary for Non-Participating Providers – please refer to benefit summary
    • Bi-Weekly Premiums – Vision Insurance $ 7.11 Employee + Family $ 5.06 Employee + Children $ 4.79 Employee + Spouse/Partner $ 2.74 Employee Only Bi-Weekly Premiums Avesis Vision
    • Enrollment Deadlines
      • May 15, 2009
      • No automatic rollover for health insurance.
      • You must enroll in health to continue coverage!
      • Dental & Vision will roll with no changes.
      • Sam Connally Truee Dorsey
      • 778-7706 778-7799