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Healthcare Plan 2011

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    Healthcare Plan 2011 Healthcare Plan 2011 Presentation Transcript

    • 1
      Saint Michael’s College
      Plan year: 1/1/2011-12/31/2011
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 2
      We are easy to work with.
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • Statement of Principles
      Saint Michael’s College is committed to providing competitive and comprehensive healthcare benefits to its faculty and staff
      The healthcare design should promote healthy choices and encourage informed use of plan features
      The College will continually investigate new and contemporary plan designs and market changes
      The College and employees will share in the cost of the plan
    • What will we cover today?
      Review the new Choice Fund HRA plan effective 1/1/2011
      What portion of expenses do you pay under the new Health Plan?
      How does the Health Reimbursement Account (HRA) work with the new Health Plan?
      The Healthy Award Account; Additional ways you can earn $ to help with your medical expenses
      Resources available to help you with your questions and your health
      Pre-enrollment
      After the effective date (1/1/2011)
      What will it cost you to enroll in the new Choice Fund HRA plan?
      Next steps and future communication topics
      Most importantly! Answer your questions
    • Highlights of the new plan
      100% coverage for Preventive Care
      100 % coverage for routine eye exam when you use a CIGNA participating provider
      Employer funded Health Reimbursement Account to help you with some of your out of pocket medical costs
      Opportunities to earn additional dollars by voluntarily participating in Healthy activities
      Unused funds may rollover for use in later years
      Access to Customer Service 24/7/365
      Access to CIGNA’s National Provider Network
      Out of Network coverage
      Transition/Continuation of care
      Primary Care Physician recommended but not required
      Extensive resources to help you improve your physical and financial health
      5
    • New Terms to Familiarize Yourself With
      Calendar Year Medical Plan Deductible: Amount you pay before the plan reimburses you for your medical expenses you incur
      Medical Plan Coinsurance: % of expenses paid by the plan after you satisfy the deductible
      Calendar Year Medical Plan Out of Pocket Maximum (OOP): A Cap on the $ amount you pay in deductibles + coinsurance. Once you meet the OOP maximum, the plan reimburses you for 100% of eligible expenses.
      Health Reimbursement Account (HRA): $ made available to you by Saint Michael’s to help you offset your medical out of pocket (deductible/coinsurance) expenses
      Healthy Awards Account (HAA): Additional $ you can earn to help you offset your medical out of pocket expenses.
      6
    • Coverage begins after you meet your deductible for most services
      After you pay your deductible you pay the following coinsurance for services until you meet your Out of Pocket Maximum (OOP):
      ServiceIn-Network Coinsurance
      PCP Office Visit you pay 20%, plan pays 80%
      Specialist Office Visit you pay 20%, plan pays 80%
      Inpatient Hospital Care you pay 20%, plan pays 80%
      Outpatient Hospital Care you pay 20%, plan pays 80%
      Emergency Room Visit you pay 20%, plan pays 80%
      Lab and X-Ray you pay 20%, plan pays 80%
      The Deductible does not apply to Certain Services!
      Preventive Care covered at 100% (including preventive lab work)
      Prescription Drug coverage (more on that later)
      Annual Eye Exam (more on that later)
    • Components of your Out of Pocket Maximum (OOP)
      * Note: under 2-person and family coverage each individual has theirown deductible, coinsurance and OOP maximum. Amounts above shown to illustrate your financial responsibility if multiple family members meet their per person maximum. Under family coverage this could mean that a family of five could meet their $1500 maximum deductible without any one person meeting the $500 per person deductible (5 x $300 = $1500 = family maximum deductible met.)
      8
      +
      =
    • How your HRA and HAA help you with your deductible or OOP Maximum
      9
      -
      -
      =
      After a person meets their deductible the member pays 20%, plan 80% until you meet your maximum out of pocket.
      -
      -
      =
      * This really assumes a worst case scenario. Remember each family member has their own
      deductible, coinsurance, OOP Max! However any family members deductible coinsurance
      expenses can be reimbursed from the families HRA or HAA – we will show an example later.
    • Prescription Benefits
      Medical Plan Deductible does not apply to Pharmacy costs
      Retail Pharmacy
      Generic …20% up to a maximum of $10
      Preferred …25% up to a maximum of $30
      Non-preferred …30% up to a maximum of $50
      CIGNA Home Delivery Prescriptions
      Generic …20% up to a maximum of $25
      Preferred …25% up to a maximum of $75
      Non-preferred …30% up to a maximum of $125
      Prescription out of pocket maximums are:
      $1,500 per person (new financial protection feature)
      *You cannot use your Health Reimbursement Funds for
      Prescription drug costs
    • 11
      Vision Plan Highlights
      For In-Network coverage you need to use a CIGNA Vision Participating Provider. Find Providers at Mycigna.com
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 12
      Healthy Awards
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2009 CIGNA
    • 13
      Earn Additional dollars with Healthy Awards
      Voluntarily Participate in
      activities to improve health
      Earn $ in a Healthy Awards Account
      Use $ to help pay for eligible claim expenses
      What’s eligible?
      Expenses related to:
      • Medical Deductible and Coinsurance you pay
      Unused money “rolls over” to next year – you don’t lose it.
    • 14
      Healthy Awards: Eligible Activities and Awards
      Funds will be made available in your account once activities have been completed.
      Within 10 business days for:
      Health Assessment
      Within 5 business days for:
      Employer activities reported via myCIGNA.com
      Within 2-3 weeks for:
      Employer activities reported via paper form
      This enables the following potential for the year
      • Employee $275
      • Employee & Spouse $400
      • Employee & Child $400
      • Employee & Children or Employee & Spouse & Child(ren) $525
      Unused money “rolls over” to next year – you don’t lose it.
      * More information will be provided about the Healthy Incentives during November and December!
    • Health Reimbursement Account vs. Healthy Awards AccountWhat is the difference??
      Health Reimbursement Account
      Automatically funded each year by Saint Michael’s
      Only a portion of unused funds roll over year to year
      $125 for Employee
      $300 for Employee + 1
      $550 for Family
      These dollars are utilized toward services covered on the medical plan that are subject to the deductible or coinsurance.
      Healthy Awards Account
      You earn dollars by participating in health and wellness programs
      All of your unused funds roll over year after year
      These dollars are utilized toward services covered on the medical plan that are subject to the deductible or coinsurance.
      Both are components of a Health Reimbursement Arrangement
    • 16
      I’ve heard that I don’t have to pay at the time of service. How are my medical claims paid?
      Sick visit to an in-network doctor/hospital/facility.
      Doctor standard fee: $250
      Medical Claim Payment Process
      CIGNA updates quarterly Health Statement; sends email alert or mails to your home, based on preference setting
      Doctor bills CIGNA $200.
      CIGNA determines your payment responsibility: You owe $200
      CIGNA subtracts payment owed from your HRA -HAA balance and pays doctor.
      $200 deducted from HRA-HAA and sent to doctor and Updates claim and account information on myCIGNA.com.
      Show CIGNA Choice Fund ID card. Pay nothing at visit. Doctor discounted CIGNA fee: $200
      CIGNA provides an Explanation of Benefits (your receipt) showing:
      • Doctor fee, CIGNA discount, amount billed, amount deducted from HRA-HAA, amount paid to doctor, remaining HRA-HAA balance.
      Preventive visits are covered at 100%
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 17
      My life is busy. How does CIGNA help me understand and track my health care expenses?
      Explanation of Benefits
      • Available by mail or online at myCIGNA.com
      • Based on your preference, either mailed to your home or you're alerted by email after each claim is processed and posted to myCIGNA.com
      • Clearly shows how and when claims were paid, and how the plan and account(s) paid toward claims
      Quarterly Health Statement
      • Available by mail or online at myCIGNA.com
      • Based on your preference, either mailed to your home or you're alerted by email after each statement is posted to myCIGNA.com
      • Shows year-to-date deductibles, all claim activity and out-of-pocket expenses for that quarter
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 18
      Carlos
      Single, 35 yrs. old
      Works hard, plays hard
      Healthy; occasional sport injury
      Year 2
      Year 1
      100% after $1,500
      (in-network)
      End of Year 1
      End of Year 2
      Health
      Plan80%
      100% after $1,500
      (in-network)
      $300 preventive care exam
      Covered 100% by Plan;
      No cost to Carlos
      +
      $ 70 urgent care doctor visit
      $150 sports medicine visit
      $220 total medical expenses
      $300 preventive exam
      Covered 100% by Plan;
      No cost to Carlos
      +
      $200 specialist visits (2)
      $ 25 prescription coinsurance expense (not eligible for HRA reimbursement)
      $225 total expenses
      How Expenses Are Paid
      $200 HRA
      ($300 covered by Plan)
      $500 paid by Plan
      $25 paid by Carlos
      Health
      Plan80%
      Carlos’ Share$220
      ($250 - $30)
      100% PreventiveCare(in-network)
      Out-of-Pocket Max
      Carlos’ Share$250
      100% PreventiveCare(in-network)
      HRA$280
      How Expenses Are Paid
      $220 paid from HRA
      ($300 Preventive Covered by Plan)
      $520 paid by Plan
      $0 paid by Carlos
      Deductible
      HRA$250
      $80 HRA Balance;
      Rolls over to
      next year’s HRA
      $30 HRA Balance;
      Rolls over to
      next year’s HRA
      Remember, Carlos could also earn extra dollars through the Healthy Awards Account
    • 19
      The Coopers
      Active family of 6
      Spouse has diabetes
      Year 1
      100% after $4,500
      (in-network)
      Health
      Plan80%
      $1,500 annual exams (5)
      Covered 100% by Plan;
      No cost to the Coopers
      +
      $1,600 Endocrinologist visits (10)
      $1,500 Doctor visits (12)
      $3,100 total medical expenses
      $1200 in Drug costs (her coinsurance averages 20%)
      $5,800 Total
      How Expenses Are Paid
      $ 500 for Mrs. Cooper’s deductible
      $ 520 Coopers’ coinsurance
      • $650 (Available HRA not counting HAA)
      $370- Net cost to the Coopers*
      $ 240 Cooper’s portion of drug cost
      $ $610 Cooper’s total responsibility*
      The total Medical Expense was $5800
      The Coopers paid $610 or about 10%
      The Plan paid $5,090 or about 90%
      *If the Coopers earned Healthy award $ they could offset an additional $370 of their Cost
      Cooper’s Share$850
      100% PreventiveCare(in-network)
      Out-of-Pocket Max
      Deductible
      HRA$650
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 20
      The Davidsons
      Late 50s, Empty nesters
      Husband in severe auto accident
      Year 1
      100% after $3,000
      (in-network)
      Health
      Plan80%
      How Expenses Are Paid
      $500 for Mr. Davidsons’ deductible
      $1,000 Mr. Davidsons’ Coinsurance (he has
      met his OOP Maximum)
      -$500 (available HRA not counting HAA)
      $1,000 (Net Cost to Davidsons*
      $ 300 Davidson’s portion of drug cost
      $1,300 Davidson’s Total Responsibility
      $600 annual exams (2)
      Covered 100% by Plan;
      No cost to the Davidsons
      +
      $25,000 Hospitalization
      $ 2,500 Radiology
      $ 2,500 Specialist visits (10)
      $ 2,500 Rehabilitation (10)
      Total = $32,500 medical expenses
      $1,500 in drug costs (their coinsurance averages 20%)
      Total with Preventive = $34,600
      Davidson’s Share$500
      100% PreventiveCare(in-network)
      Out-of-Pocket Max
      Deductible
      HRA$500
      The total Medical Expense was $34,600
      The Davidson’s paid $1,300 or about 4%
      The Plan paid $33,300 or about 96%
      *If the Davidson’s earned Healthy award $ they could offset an additional $400 of their Cost
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 21
      Helping you be well and live well.
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 22
      Help when you need it!
      Help with coordinating care if you’re admitted to the hospital
      Compare prescription drug costs – preferred brand vs. generic, retail vs. at-home delivery online drug-interaction checker helps you keep track of prescription medications and avoid interactions
      Easy-to-use, confidential health assessment gives you an overall health “score” and a personalized report
      Online coaching programs to help you maintain a healthy lifestyle
      Save money on health and wellness products and services like fitness clubs, eyewear, massage therapy and more
      A personal health advocate to help you prepare for office visits, improve your lifestyle and reduce your health risks, explore and choose treatment options, and answer health and coverage questions
      Healthy pregnancy education programs with March of Dimes helps every baby get a healthy start.
      Well Aware disease management program to help you with chronic conditions
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 11 conditions addressed in 5 Well Aware programs
      • Claims
      • Medical ,Pharmacy
      • Health Assessment
      • Referral from other programs
      • Case Management
      • Lifestyle Improvement
      • Health Advisor
      • Self-Referral
      • Health Care Professional
      Identify
      Low Back Pain
      Participation in these programs is voluntary
      Activate
      Support
      23
    • Communications
      Ongoing nurse outreach by phone
      24/7 access to registered nurses
      Routine preventive care reminders
      Education Materials including:
      • Program Workbook
      • Quarterly Newsletters
      Online tools and resources
      • Goal Tracker
      • Program Alerts
      • Symptom Checker
      mywellaware.com
      24
    • 25
      What is CIGNA doing to make sure I’m getting quality care?
      Features
      • Quickly compare cost and quality using 1-3 star rating system
      • Ratings for 29 conditions
      • Ratings based on Healthshare plus CIGNA data
      • Quality rankings let you compare doctors and hospitals
      • Online resources let you check for dangerous drug interactions
      • Alerts sent to you and your doctor if we see or anticipate possible gaps or errors in care
      • Support from our care coordinators if you are hospitalized with a serious illness
      Find CIGNA Centers of Excellence
      3 Stars = Center of
      Excellence
      1 – 3 star rating system
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 26
      How can I reach CIGNA when I need help?
      • Call us anytime day or night – live, 24/7 customer service
      • Find information when you need it at myCIGNA.com
      • We speak many languages
      For J.D. Power and Associates Certified Call Center ProgramSM information, visit www.jdpower.com.
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 27
      My life is busy. How can CIGNA save me time?
      • 24/7 online and phone assistance to find doctors, specialists, hospitals, labs and pharmacies close to home or when you are traveling
      • Talk to a trained nurse with questions when you can’t reach your doctor – day or night
      • Self-service through myCIGNA.com lets you:
      • Print forms or print/order ID cards
      • Check your coverage
      • Track claims, payments and deductibles
      • View, print and download your explanation of benefits and health statements
      • Access articles and health education resources, and sign up for online coaching programs
      • Keep track of your health history and records with a secure online database
      • Award-winning decision support tools
      • Learn about common health problems and options for treatment
      • Find doctors, hospitals, specialist and labs
      • Compare treatment and procedure costs
      • Switch a prescription to CIGNA Home Delivery Pharmacy with one easy phone call and have your medications delivered to your door at no extra cost
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • 28
      Everyone says they are the best. Why should I trust CIGNA?
      • Voted 2009 Best Employee Assistance Program as ranked by readers of Business Insurance
      • Winner of “Innovation in Multicultural Health Care” Award from independent National Committee for Quality Assurance (NCQA)
      • Top industry rankings for Effectiveness of Care by NCQA
      • Our customer call centers are certified by J.D. Power and Associates* for providing “an outstanding customer service experience”
      • Doctors and hospitals ranked us #1 and #2 respectively on our payment, accuracy and efficiency in the annual survey by AthenaHealth
      • CIGNA’s Explanation of Benefits is one of only three to earn “Excellent” designation for clarity, content and design from Dalbar
      • Earned #1 ranking for Best Innovation in customer intimacy across all industries for cost and quality tools on myCIGNA.com from Information Week 500
      • Gold medal for “exemplary customer strategy and excellence in customer experience.”
      *For J.D. Power and Associates Certified Call Center ProgramSM information, visit www.jdpower.com.
      Confidential, unpublished property of CIGNA. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2010 CIGNA
    • Important Dates
      • Enrollment packets to home addresses week of October 18, 2010.
      • Forms due to Human Resources by November 17, 2010.
      Questions about the new plan?
      • Call the toll-free hotline 24/7/365 – 1.800.401.4041
    • 30
      "CIGNA", “CIGNA HealthCare”, "myCIGNA.com" and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries and not by CIGNA Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company (CGLIC), CIGNA Health and Life Insurance Company (CHLIC), Tel-Drug, Inc. and its affiliates, CIGNA Behavioral Health, Inc., Intracorp, and HMO or service company subsidiaries of CIGNA Health Corporation and CIGNA Dental Health, Inc. In Arizona, HMO plans are offered by CIGNA HealthCare of Arizona, Inc. In California, HMO plans are offered by CIGNA HealthCare of California, Inc. In Connecticut, HMO plans are offered by CIGNA HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by CIGNA HealthCare of North Carolina, Inc. All other medical plans in these states are insured or administered by CGLIC or CHLIC. All models are used for illustrative purposes only. 838558 08/10 © 2010 CIGNA Some content provided under license.