Open Employee Forum - Medical Plans Strategies for 2012

Open Employee Forum - Medical PlansStrategies for 2012August 8, 2011

\EB\STLUN\2011\Employee Open Forum 7-7-11.pptx

Current State of Affairs• Health care costs continue to rise—current inflation is 10%

• Reasons for double-digit increases include:▫ Aging population▫ Increased utilization▫ New technologies▫ Government mandates▫ Lifestyle choices (approximately 2/3 of claims), particularly…

Tobacco usage Obesity

High blood pressure High cholesterol Heart disease Diabetes COPD


2012 Objectives•Maintain competitive medical/prescription

drug benefits

•Provide a plan at an affordable cost to both employees and SLU


Projected Medical/Rx Costs2011

Current

Primary/Plus

2012Renewal

Primary/Plus

2012 Proposed

HSA/Primary

2012 Proposed

HSA/PlusTotal Projected Medical/Rx Costs

Projected Employee Contribution

$8.3 Million $9.2 Million $8.9 Million $9.4 Million

Projected Employer Contribution

$25.9 Million $28.7 Million $27.0 Million $28.6 Million

• Maintains 75% University contribution


2012 Medical/Prescription Drug Benefits•SLU will continue to offer two programs:

Plus PPO Plan (with a modified Rx component)

Health Savings Account (HSA) Qualified Plan


What is a Health Savings Account (HSA)? An HSA is:• A consumer-owned, tax-advantaged savings account, created to pay

health care expenses• It is always combined with a qualified high deductible health plan • Provides the consumer an incentive (it’s your money!) to better plan

your utilization of health care resources

To be eligible to contribute to an HSA, you:• Must be enrolled in a qualified High Deductible Health Plan (HDHP)• Do not have benefits from another non-qualified health plan• Are not enrolled in Medicare/Medicaid benefits• Are not claimed on another’s tax return


Health Savings Account—How does it work?• Each calendar year, you can contribute money to your HSA,

subject to maximum annual contributions

• An eligible employee and his or her eligible covered dependents can use the money in the HSA to pay for qualified health care expenses, tax-advantaged

• Any money remaining in the account at the end of the calendar year rolls over into the next year; there is NO ‘use it or lose it’ penalty

• You keep it if you leave the University


Things to know about an HSA• Flexible use – consumers choose whether or when to use the account

for health HSA allowable charges

• Tax-free contributions

• Tax-free growth of interest or investment earnings with your choice of investment funds/portfolios

• Tax-free disbursements to pay for qualified expenses, now or later

• Withdraw funds at any time, as long as they are for qualified expenses

• Withdraw funds with an HSA debit card or by writing a check

• Funds must be in your account before disbursements can be made


Health Savings AccountQualified Reimbursements• Expenses not covered by the health plan, such as deductibles,

coinsurance, copayments, etc.

• Premiums for COBRA coverage• Retiree health insurance premiums (not Medicare supplements)• Premiums for qualified long term care insurance


2012 Proposed Medical Plan Options

Plus Plan HSA Plan

SLUCare In-Network Out-of-Network SLUCare In-Network Out-of-NetworkDeductible Non-Embedded: (One member can satisfy entire family

deductible)Individual $0 $250 $750 $1,500 $1,500 $3,000Family $0 $500 $1,500 $3,000 $3,000 $6,000Coinsurance 0% 10% 40% 0% 10% 40%Out-of-Pocket Maximum (includes deductibles) Non-Embedded: (One member can satisfy entire family

OOP Max)Individual $0 $1,250 $4,750 $3.000 $3,000 $6,000Family $0 $2,500 $9,500 $6,000 $6,000 $12,000Physician Office Visits

Primary Care $10 copay10% after ded. 40% after ded. 0% after ded. 10% after ded. 40% after ded.Specialist Care $20 copay

Inpatient Hospital

10% after ded. 40% after ded. 10% after ded. 40% after ded.Emergency Room

$100 copay $100 copay 10% after ded. 40% after ded.Urgent Care Center

$50 copay $50 copay 10% after ded. 40% after ded.


2012 Proposed Pharmacy Plan Options

Plus Plan HSA Plan

Express ScriptsRetail

(34-day supply)

Express ScriptsMail Order

(90-day supply)

Express ScriptsRetail

(34-day supply)

Express ScriptsMail Order

(90-day supply)Tier 1 $8 $16 Medical Deductible and Coinsurance

Tier 2 $30 $60 Medical Deductible and Coinsurance

Tier 3 $50 $100 Medical Deductible and Coinsurance

Tier 4 20% to $150 Medical Deductible and Coinsurance

Preventive Medications

Priced according to the tier in which they fall

Covered at 100%, no copay or deductible

NEW! Under the proposed HSA plan, certain preventive, or “maintenance,” medications would be covered at 100%...

NO copay or deductible would need to be satisfied by you or your family!

Information on which drugs qualify as preventive will be distributed during open enrollment.


2012 Proposed Cost Sharing

• If you enroll in the HSA Qualified Plan for 2012, SLU will contribute funds to help you build your balance: $250 for Single Enrollees $500 for Enrollees with Family Members

• Wellness Incentive increased from $20 to $30 for 2012

Plus PlanMonthly Payroll Deductions With Wellness Incentive Without Wellness IncentiveSingle $94.34 $124.34Employee and Spouse $313.79 $343.79 Employee and Child(ren) $283.90 $313.90Family $448.26 $478.26

HSA Qualified PlanMonthly Payroll Deductions With Wellness Incentive Without Wellness IncentiveSingle $29.81 $59.81Employee and Spouse $178.28 $208.28 Employee and Child(ren) $161.30 $191.30Family $254.68 $284.68


2012 Proposed Cost SharingAnnual Contribution Difference vs. 2011 Plus Plan

Plus PlanAnnual Difference in Payroll Deductions With Wellness IncentiveSingle $304.44Employee and Spouse $181.92Employee and Child(ren) $164.52Family $259.80

HSA Qualified PlanAnnual Difference in Payroll Deductions With Wellness IncentiveSingle ($469.92)Employee and Spouse ($1,444.20)Employee and Child(ren) ($1,306.68)Family ($2,063.16)

• If you enroll in the HSA Qualified Plan for 2012, SLU will contribute funds to help you build your balance:▫ $250 for Single Enrollees▫ $500 for Enrollees with Family Members


Eligible DependentsDefinition of an Eligible Dependent

Legal spouse or dependent child under 26 years of age of the employee or the employee's spouse. The term child includes any of the following:

• A natural child• A stepchild• A legally adopted child• A child placed for adoption• A child for whom legal guardianship has been awarded to the

employee or the employee's spouse


Dependent Eligibility Audit• SLU has a responsibility to:

Administer the plan as stated in the plan document Administer the plan consistently for all employees Monitor the costs of the plan

• SLU will complete a Dependent Eligibility Audit in early 2012 Employees will be asked to provide verification for enrolled

dependents Ineligible dependent will be removed from the plan Claims paid for ineligible dependents may be recovered and

the expenses would become the responsibility of the employee

• Additional information will be provided


Vitality Program• Activity Distribution

▫ Members completing 2-5 activities April: 60% of total population May: 55% of total population June: 52% of total population

▫ Members completing over 10 activities April: 5% of total population May: 10% of total population June: 12% of total population

• Vitality Status Earned (YTD)▫ April/May/June

Blue: 1,874/1,897/1,868 Bronze: 740/722/757 Silver: 1,694/1,733/1,752 Gold: 16/20/28 Platinum: 1/4/6

• Verified Workouts ▫ April: 46▫ May: 334 Added Simon Rec Center

▫ June: 427• Education Activities

▫ April: 306▫ May: 342▫ June: 365

• Healthy Living Activities ▫ April: 40▫ May: 63▫ June: 70

• Prevention Activities ▫ April: 79▫ May: 118▫ June: 142


Vitality Communication

Toni Sullivant (25 years of service) has been one of the most active Vitality members at the University since it started last fall. She tells SLULife how she used the program to conquer life-long weight issues: “I always wanted to do something about my weight but never had the incentive or the money to join a gym.

“After joining Vitality, I used the website daily to take advantage of the fitness and weight- loss programs. When I learned about the fitness subsidy, I was ecstatic! I joined Curves in January and have since lost over 30 pounds and 28 inches (at 4’10” tall!), and because my Vitality Status is Platinum, the membership fee is fully covered!”

“People at the University definitely noticed me slimming down. I want to motivate—I’m a ‘Walk to Madrid’ leader, and I’ve got coworkers joining gyms and getting Fitbugs."

“I’ve been asked if Vitality pays me! But really, I’m saving money, feeling better, and couldn't be happier. “I feel blessed and hope my story inspires those with weight issues to make the most of Vitality and share my success!”

Do you have a success story you would like to share? Please contact [email protected]!


Contact Information•Please email questions or comments to:

[email protected] [email protected]

•Your feedback is important!!!

mailto:[email protected]

mailto:[email protected]

Documents

Open Employee Forum - Medical Plans Strategies for 2012