City of Montgomery Health Care Plans – Your Options

Two Healthcare Options OPTION ONE – Traditional Plan with increased premiums, deductibles, and co- pays OPTION TWO – HMP Plan with premiums remaining the same

Premiums Comparisons PPOHMPANNUAL DIFFERENCE (PPO VS HMP) SINGLE$83 per pay period ($20 per pay period increase) $43 per pay period (no increase) $960 FAMILY$183 per pay period ($30 per pay period increase) $123 per pay period (no increase) $1440

OPTION ONE - PPO Features Doctor’s Visit Co-pay – Primary Care $50 (Currently $40) Specialist $60 (currently $50) Inpatient Hospital Admission - $300 per admission and $60 dollar co-pay days 2-5. (Currently $250 and $50) Emergency Room facility co-pay for Medical Emergency - $150 (currently ($125) Outpatient Surgery Facility co-pay - $175 (currently $150) Maximum Out of Pocket Limit Single $750/Family $2,250

OPTION TWO – HMP FEATURES Annual Calendar Year Deductible: Single - $1500/Family - $3000 Threshold Amount: Single $250/Family $500 Health Reimbursement Account: Single - $750/Family - $1500 Maximum Out of Pocket Limit Single-$3,000/Family-$6,000

Health Management Program The big question at this point should be how does the deductible get paid?

Health Management Program The answer is – 1/2 by the City and 1/2 by the employee.

Health Management Program SINGLE PLAN ILLUSTRATION

Health Management Program FAMILY PLAN ILLUSTRATION

Health Management Plan Once the calendar year deductible is met the insurance pays 80% and the employee pays 20% with two exceptions:

Health Management Plan There are certain preventive benefits covered by the Affordable Health Care Act that must be covered at 100% with no deductible. (I.E. HIV Counseling, Tobacco Cessation Counseling. ) Hospital per diem charge is covered at 100% once the calendar year deductible is met.

Health Management Program The Health Reimbursement Account has a rollover feature

Health Management Program Any funds left in your HRA at the end of the calendar year will roll over into the next year up to a maximum of the annual contribution.

COMPARISONS The following comparisons are not to be used as a cost estimator but as a general guideline on costs. Your expenses might be more or less based on how much you have in your HRA, where you are at with your deductible, or whether you are seeing an in or out of network provider.

HAVING A BABY (NORMAL DELIVERY) PPO vs HMP Total owed provider = $7,540 PATIENT PAYS Deductibles (RX and Meds) = $1750 Co-pays = $ 0 Co-insurance = $ 450 Limits or exclusions = $170 Total = $2,370 Yearly Single HMP Premium = $1,032 Yearly Family HMP Premium =$2,952 Total owed provider = $7,540 PATIENT PAYS Deductibles (RX & Meds) = $550 Co-pays = $350 Co-insurance = $ 0 Limits and Exclusions = $170 Total $1,070 Yearly Single PPO Premium = $1,992 Yearly Family PPO Premium = $4,392

Managing Type 2 Diabetes PPO vs HMP Total owed provider = $5,400 PATIENT PAYS Deductibles (RX & Meds) = $ 270 Co-pays = $ 320 Co-insurance = $ 0 Limits and Exclusions =$4,290 Total $4,630 Yearly Single PPO Premium = $1,992 Yearly Family PPO Premium = $4,392 Total owed provider = $5,400 PATIENT PAYS Deductibles (RX and Meds) = $ 1,000 Co-pays = $ 0 Co-insurance = $ 450 Limits or exclusions = $4,290 Total = $5,740 Yearly Single HMP Premium = $1,032 Yearly Family HMP Premium =$2,952

A THOUGHT If you use the CareHere Primary Care and Wellness Centers to manage your diabetes your cost would be about $30 per year. This cost is assuming all you need to buy are the lancets and you are on generic medications (not shots).

Primary Care and Wellness Center Features No Co-pays Can dispense 180+ generic medications (free) No crowded waiting room 5 minute average wait time Minimum 20 minute appointment with provider Free Health Coaching – in person, phone, & online Schedule online or by phone 24/7 nurse hotline No cost for Lab work CONFIDENTIALITY

Wellness Services Registered Dietician Registered Nurse Exercise Physiologist Behavioral Health Coach Tobacco Cessation Coach

Wellness Center Locations 310 Hull Street (There are actually three Primary Care and Wellness Clinics at these locations) 3845 Interstate Court (also known as the Perry Hill Clinic)

How to Get the Most out of Your CareHere Benefit and Consider Us Your 1 st Stop for any Health Care Need Enroll today… online or by phone Follow the Appointment Guidelines Complete a CareHere Health Risk Assessment Explore CareHere Connect Ask the provider to be referred to one of our Health Coaches Take a copy of any existing prescriptions with you to your clinic appointment. Schedule a “Get to Know Me” Appointment

Information To Remember Register or schedule appointments with CareHere by visiting or calling Insured Employees: 1 St time access code: CMTG6 CareHere 24/7 Nurse Line:

COVERING OUT OF POCKET COSTS No matter which Option you select. The next question you have should be - What can I do to set money aside to cover out of pocket expenses?

Health Management Program Set aside funds in your Medical Flexible Spending Accounts (FSA) to cover out of pocket expenses.

Medical FSA Account Features Employee can contribute up to $2,500 annually. Can be used for out of pocket medical expenses (your benefits booklet has a detailed listing of eligible expenses). Can be used for out of pocket dental and vision expenses. (your benefits booklet has a detailed listing of eligible expenses). Rollover feature of up to $500 maximum into next FSA Plan Year Employee does not have to be enrolled in the City’s health plan to participate.

FSA RULE OF THUMB For every $5 you contribute to your FSA account it will only cost you $4 due to the tax savings

FSA TAX SAVINGS EXAMPLE Without FSAWith FSA Annual Income$30,000 Pre tax Contribution$0($28,000) Taxable Income$30,000$28,000 Tax Rate 28%($8,400)($7,840) After Tax Expenses($2,000)$0 Net Income$19,600$20,160 ANNUAL TAX SAVINGS WITH FSA : $560

How the FSA and HRA work together Flexible Spending Account & Health Reimbursement Account Use the FSA funds to reach the Employee Threshold Deductible: – Single coverage: $250 – Family coverage: $500 Use the HRA funds to reach the Employee Remaining Deductible: - Single coverage: $500 - Family coverage: $1,000 Use any remaining FSA funds to continue to cover unreimbursed medical expenses (co-insurance)

How the FSA/HRA card works with the HMP Example One – Physician Visit – The threshold amount is not met by the employee. Pay with the FSA/HRA card and it will use any available FSA funds to pay for the visit or you will have to pay with Personal means ( Credit card, Debit card, Check or Cash) If you do not enroll in the Flexible Spending Account, YOU MUST pay for the expenses out-of-pocket until the threshold has been met!

How the FSA/HRA card works with the HMP Example Two – Physician Visit – The threshold amount has been met by the employee. Pay with the FSA/HRA card and it will use any available HRA funds to pay for the visit. If no HRA funds are available you will have to pay with Personal means (Credit card, Debit card, Check or Cash or FSA Card)

Health Management Program Consider Supplemental Insurance Plans such as that being offered by Colonial this year.

Colonial Life Coverage Closes the Gaps in your Health Insurance! The Advantage of Colonial Life: Convenience. You pay through payroll deduction—no checks to write, no premium deadlines to remember. Plans pay in addition to other benefits you may have with other insurance companies. Plans are offered with group rates and some with NO HEALTH QUESTIONS. Benefits are paid directly to you. You’re free to use the benefit any way you choose to pay your household bills. With most plans, your policy is yours to keep. Take your coverage with you if you change jobs or retire.

Health Foundation Coverage You may have Health Insurance, but are you really covered? Designed to supplement your major medical coverage. Hospital Confinement with Outpatient Surgery coverage- ($1,000 hospital, $2,500 outpatient) Guaranteed Issue - NO HEALTH QUESTIONS ASKED! Pays you to have the coverage with your Health Risk Checkup Wellness per year. Pays you directly to cover your out-of-pocket deductible and co-pays!

How Will You Pay for What Your Health Insurance Won’t? To cover your medical deductibles, out-of-pocket catastrophic costs and your part of the 20% co- insurance, consider Cancer and Critical Illness Coverage. Helps cover experimental treatments, travel & lodging, child care, lost wages, home health care needs. Cancer Assist (NEW) – Has a $10,000 initial diagnosis benefit not available anywhere else. Critical Illness – Has a Guaranteed Issue $15,000 lump sum benefit. Coverage up to $75,000 available. BOTH pay you to have the coverage with your Health Risk Checkup Wellness per year.

The Next Step Choose a Health Care Plan – PPO or HMP - If you’re sticking with the same plan you have now you don’t have to do anything.

The Next Step Choose a Health Care Plan – PPO or HMP - If you’re sticking with the same plan you have now – You don’t have don’t have to do anything. How much do I want in my flexible spending account. If you’re satisfied with the amount you have already declared during open enrollment you don’t have to do anything.

The Next Step Choose a Health Care Plan – PPO or HMP - If you’re sticking with the same plan you have now – You don’t have don’t have to do anything. How much do I want in my flexible spending account. If you’re satisfied with the amount you have already declared during open enrollment you don’t have to do anything. Make a decision on supplemental insurance – Do I need it?

Choosing a Health Care Plan You have until September 19, 2014 to choose a health care plan. You can call Erica Kirk at and make an appointment. If you are happy with the plan you have. You don’t have to do anything.

Flexible Spending Accounts You have until August 22, 2014 to make changes to your Flex Spending Accounts. If you have already sat down with an enroller and/or you are happy with the amount you have set aside for your Flexible Spending Accounts. You don’t have to do anything.

Changes to Colonial Products You also have until August 22 to make adjustments to your Colonial Products based on the health care option you select. If you have already sat down with an enroller and you are happy with your supplemental insurance - you don’t have to do anything.

Schedule for Colonial and Flex Enrollers Between July 29 and August 22, 2014 the enrollers will be in City Hall - Room 109: – Every Tuesday from 9AM-11AM – Every Thursday from 2PM-4PM No appointment necessary

QUESTIONS