High Deductible Health Plans

Preventive Care Covered at 100% regardless of the deductible!

Children Recommended services for children at each preventive care visit will vary based on age, but will include some of the following when provided in a primary care setting:  Age-appropriate well child examination  Measurement of your child’s head size  Measurement of length/height and weight  Metabolic screening panel for newborns - age 0-90 days old  Screening blood tests, if appropriate  Age-appropriate immunizations  Vision screening for children less than age 5  Oral health risk assessment  Fluoride application for ages 0-6 years, under certain circumstances  Hearing screening  Autism screening at 18 months and 24 months. May be done earlier or more frequently for young children at defined risk  Counseling on the harmful effects of smoking and illicit use of drugs (for older children and adolescents)  Counseling for children and their parents on promoting a healthy diet and exercise  Screening certain children at high risk for high cholesterol, sexually transmitted diseases, lead poisoning, tuberculosis and more  Screening for depression  Evaluate the need for iron supplements Not all children require all of the services identified above. Following your child’s preventive visit the doctor should also provide you with information about your child’s growth, development and general health, and answer any questions you may have about your child.

Adults Recommended services for children at each preventive care visit will vary based on age, but will include some of the following when provided in a primary care setting:

In-NetworkOut-of-Network Deductible – Non-Embedded (deductibles work on a calendar year basis)$1,500/$3,000$4,000/$8,000 Co-Insurance100%70%/30% Maximum Out-of-Pocket$3,500/$6,850$5,000/$10,000 Lifetime MaximumUnlimited Preventive CareCovered in FullSubject to Deductible Hospital – Inpatient/OutpatientSubject to Deductible Professional ServicesSubject to Deductible Physician Office Visit Copay – After deductible has been met$20 PCP/$40 SpecialistSubject to Deductible Emergency Room Copay – After deductible has been met$150 Urgent Care Copay – After deductible has been met$50Subject to Deductible Prescription Drug Copay$10 / $30 / $50Subject to Deductible Mail Order$30 / $90 / $150Not Applicable All other medical benefits are subject to the deductible and co-insurance. Copays listed above apply to the out-of-pocket maximum. High Deductible Health Plan

Each participant must meet their respective deductible. After the deductible is met, hospital related expenses (in-patient, out-patient, x-ray, MRI,…) will be paid at Single Deductible Family Deductible 100%. $1,500 if “single” covered $3,000 if “family” covered

How do I pay for medical services… Doctor’s Office

1) The doctor/hospital will send the bill to the insurance company… 2) …the insurance company will discount the rate and send you an EOB… = EXACTLY matching the discounted rate on the EOB. 3) …the doctor/hospital will then send you a bill

How do I pay for medical services… Pharmacy

1) You will go to the pharmacy to pick up your script… 2) …the pharmacist will put your information into the system, and will automatically get the reduced cost from the insurance company… 3) …you will then pay the pharmacy the appropriate negotiated rate for the prescription.

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If…Then… If you are on a qualified HDHP (high deductible health plan) Then the government will permit you to open an HSA (health savings account)

HSA Accounts Tax Free 1.Deposit pre-taxed 2.Write off at the end of the year 2016 Contribution Limits: (Employer and Individual contributions combined) –Single - $3,350 –Family - $6,750 –Over age 55 - $1,000

Increase in annual HSA contribution. Previously, the maximum HSA contribution was the lesser of the deductible of the individual's HSA-eligible plan or a statutory maximum. The new rules make the limit the statutory maximum contribution, regardless of the individual's deductible. For 2016, the maximum contribution for an eligible individual with self-only coverage is $3,350, and the maximum contribution for an eligible individual with family coverage is $6,750. These limits are indexed for inflation. The catch up contribution for individuals who are 55 or older is increased by statute to $1,000 for Full HSA contribution regardless of month individual becomes eligible. Normally, the HSA contribution is pro rated based on the number of months that an individual during the year a person was an eligible individual. The new provisions provide an exception to this rule that will allow individuals who become covered under an HSA-eligible plan in a month other than January to make the maximum HSA contribution for the year based on their coverage in the last month of the year. This eliminates a common barrier to switching to HSA- eligible coverage. If an individual does not stay in the HSA-eligible plan 12 months following the last month of the year of the first year of eligibility, the amount which could not have been contributed except for this provision will be included in income and subject t o a 20 percent additional tax.

HSA Accounts Use it and keep on using it… Can deposit the Government stipulated amount every year (over 55 higher contributions) Grow until the age of 65 Medicare Supplements LTC Take out at regular tax for retirement

HSA Accounts Grow interest TAX FREE Use on Qualified Medical Expenses TAX FREE…

HSA Accounts Qualified Medical Expenses Tax Free Cobra Premiums –Tax Free

Who can I use the money on? Anyone who is a tax qualified dependent on the plan Tax qualified dependents who are not on the plan **You cannot open an HSA if you are also covered under a traditional plan or have a general FSA plan.

For Your Information… If you withdraw money out of your HSA for reasons other than qualified medical, you will be subject to regular taxes + a 20% tax penalty. If you leave the District, you can no longer contribute to your account (if you are not on the HDHP) but you are permitted to continue to use the money tax free for “Qualified Medical Expenses”.

You are permitted to reimburse yourself for “Qualified Medical Expenses”. For Your Information… You may make tax free contributions up until tax time. If you name your spouse as a beneficiary, your spouse is permitted to continue use the account as HSA. If you name anyone other than your spouse as the beneficiary, they will be subject to regular taxes.

Thank You!