1. UNA MEJOR OPtion PARA SU SALUD TOTAL [Employer group name]
City and County of Denver
High Deductible Health Plan (HDHP)

2. City and County of Denver – HDHP Agenda
Welcome and Introduction(s)
Video: How does a HDHP work?
Terminology and Definitions
Plan Benefits / Services Covered
What is a Health Savings Account (HSA)
Jump starting your HSA
Introduce ourselves, Cindy Kunkel, Account Executive; Candice Morrissey, Associate Account Manager; Anthony Robles, Enrollment Specialist. Let’s review a quick agenda for our presentation. This meeting is one of many education meetings that your insurance carriers will be conducting before open enrollment. We want to give you all the information you need to make the correct plan selection and in this meeting, we will be discussing the High Deductible Health Plan which is the new offering in As you may already know, the traditional HMO will no longer be offered.
We’d like to share with you a short video on the HDHP before we go into the presentation. The video is about 3 minutes long and explains how the HDHP works. We will then continue with the presentation and leave a period for questions at the end.

3. Integrated Care in Denver/Boulder
22 fully-staffed Medical Offices from Boulder and Longmont to Castle Rock
Over 1,000 Primary and Specialty care physicians to choose from
No referral needed for most specialists including Orthopedic and OB/Gyn
Primary Care, Laboratory, Radiology, and Pharmacy available in most offices
Additional approved providers available in Southern and Northern Colorado
Here’s an overview of services; no changes to services you are currently receiving. You keep the same doctor, same treatments.
22 fully-staffed Medical Offices from Boulder and Longmont to Castle Rock
Over 1,000 Primary and Specialty care physicians to choose from
No referral needed for most specialists including Orthopedic and OB/Gyn
Primary Care, Laboratory, Radiology, and Pharmacy available in most offices.

4. 2016 City and County of Denver High Deductible Health Plan
Before going into the specifics of your City and County of Denver HDHP, let’s take a look at how this type of plan works.

5. City and County of Denver - HDHP
Terminology and Definitions
Deductible
The amount you or your family must pay (“satisfy”) before the health plan shares in the expense of services received
Coinsurance
The percentage of the cost of services received for which you are responsible. You are charged coinsurance for services after satisfying your deductible
Out-of-pocket maximum (OPM)
The maximum limit you pay each year in coinsurance and deductible for covered services received
Explanation of Benefit (EOB)
A tracking document for each date of service outlining deductible status and out-of- pocket tracking
Patient Billing Statement
Statement outlining member’s financial responsibility after claim has processed through claims system
Talk about the terminology they will hear in the HDHP
Most important to hold onto is the Explanation of Benefits for all services received so you can track and have on hand should you believe there is discrepancy
Patient billing should coincide with the EOB. In addition the billing statement will reflect what you the member owes

6. City and County of Denver – HDHP – 2016
Annual deductible – per plan year
$1,350 subscriber only / $2,700 family
Annual out-of-pocket maximum (OPM) -
per plan year
$2,700 subscriber only / $5,400 family
You must meet the family Deductible before plan moves to coinsurance. Deductible is included in the OPM.
Covered service
You pay
Preventive care
No cost for most services
Doctor’s office visit
20% coinsurance*
Diagnostic lab tests
Imaging (x-ray, MRI, CT/PET scan)
Outpatient surgery
Hospitalization
Emergency care
Prescription drugs (in pharmacy)
Lets review of some key points.
Preventive care covered at 100% - keeping it preventive vs. diagnostic
There are no copays in this plan
You must meet your deductible before you move to coinsurance.
Your plan accumulators (deductible/OPM, etc.) are on calendar year basis, January 1 – December 31.
For this plan, if you cover any family members on the plan with you, you will need to satisfy the Family deductible and out-of-pocket maximum (OPM). So, for example, if you have a spouse on the plan with you, together, you need to satisfy a $2,700 deductible before either of you moves to coinsurance. Then, together, you need to satisfy a $5,400 OPM before the plan pays 100% for either of you.
Remember, if you join this plan, you are required to open a Health Savings Account (HSA) to help you pay for qualified medical expenses.
The City and County of Denver will provide seed money for the HAS at $600 for Individual and $1,200 for Family
*Coinsurance applies after the Deductible is met.
This is only a summary of some benefits and their copays and coinsurance. This chart does not describe the benefits. Refer to your Evidence of Coverage for information about coverage, limitations and exclusions of all benefits, including those not listed in this summary.

7. City and County of Denver Health Savings Account (HSA)
You are responsible in opening your Health Savings Account (HSA).
An HSA is a savings account that works with an HSA-Qualified Deductible HMO (HDHP) plan.
You contribute money to your HSA each year and use those funds to pay for qualified medical expenses, now or in the future.
You own the money in this account, which you can grow and take with you, even if you change jobs or retire.
You are responsible for opening your Health Savings Account. If you have questions on how to do so, please work with your benefits administrators. You don’t want to loose out on the HSA seed money
To meet the requirements for an HSA, you must be enrolled in an HSA-qualified deductible health plan and meet other HSA eligibility rules. For further information, refer to IRS Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans, at irs.gov/publications. HSAs may also experience investment losses.

8. City and County of Denver – HSA and Tax Benefit
The IRS has provided tax benefits for your HSA funds.
The funds in your HSA are not considered part of your wages, so they’re not subject to federal income taxes
HSA funds used to pay for qualified medical expenses are not subject to taxes.
Any interest earnings in an HSA is tax-free as long as they’re used for qualified medical expenses
Maximum annual amount for Individual is $3,350 and Family is $6,750
Here you have some tax benefits when opening your HSA.
Funds you contribute are not considered part of your wages so not subject to federal income taxes
The HSA can only be used for qualified medical expenses
Any interest earnings are also non-taxable
Maximum annual contributions for individual is $3,350 and family is $6,750
Tax references in this document are related only to federal income tax. Consult your financial or tax advisor about state income tax law. Refer to the list of medical costs that meet the requirements, as defined under Internal Revenue Code Article 213(d); refer to IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications.

9. Contributing to your Health Savings Account
City and County of Denver providing tax-free seed money
Individual - $600
Family - $1200
Annual maximum contribution for Individual - $3,350
$3,350 - $600 = $2,750
Annual maximum contribution for Family - $6,750
$6,750 - $1,200 = $5,550
Amount rolls over from year to year without penalty
Keep in mind that any premium you are currently paying can be contributed to the HSA and eligible for the tax free benefits as identified earlier.

10. City and County of Denver – Qualified Medical Expenses
Examples of Qualified Medical Expenses
You can use the funds in your HSA to pay for qualified medical expenses, which will include deductible and coinsurance amounts for:
Non-preventive office visits with your PCP or Specialist
Prescription drugs
X-rays, MRIs, CT scans, PET scans and lab tests
Emergency visits
Hospital visits
Examples of qualified medical expenses:
Primary care, specialty care, medications/prescription drugs, x-rays, MRI’s, lab test, inpatient, outpatient. Following are some scenarios
Refer to the list of medical costs that meet the requirements, as defined under Internal Revenue Code Article 213(d); refer to IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications.

11. Total Cost – Individual Deductible = $5,344 $5,344*20% = $1,068.80
Scenario 1: Employee Only Coverage
Dave, with Department of Natural Resources, only covers himself on the plan. He is generally healthy, but has developed knee problems. He visits a specialist – orthopedic surgeon ($215). The specialist orders and MRI ($1,467), and based on the results, recommends outpatient surgery ($5,000). Dave also needs pain medication after the surgery (1 generic prescription).
IND Deductible $1,350
IND OPM $2,700
Total Cost of Services $6,694
Total Cost – Individual Deductible = $5,344 $5,344*20% = $1,068.80
Difference $2,700-$2,418 = $282
Generic Prescription $ 12
$1,350 + $1068 = $2,418
Out Patient Surgery $5,000
IND Deductible $1,350
MRI Procedure $1,467
Here is scenario 1
In this scenario, we’ll follow Dave, and employee with the City and County of Denver, who is on the medical plan by himself. Let’s walk through how the High Deductible Health Plan works in Dave’s situation:
Dave is generally healthy, but has developed an issue with his knee. Under the HDHP, Dave pays the full cost of the visit, or $215, towards his annual deductible.
To keep this illustration simple, we’ve totaled the cost of all services which amounts to $6,694, subtracted the individual deductible of $1,350 which he has met through the various services. Dave now has a balance of $5,344 of which Dave will pay 20% or $1,068.80
Remember, the deductible met is now part of meeting the OPM still leaving a balance of $282 to be met at 20%. David may not meet the OPM for this year; however, if he ends up having a major surgery, he pays 20% of the total surgery not to exceed the $282 and then Kaiser Permanente pays 100%
20% of $5, $1,068
Specialty Office Visit $ 215
Note: These are estimated costs only. Figures based on 2015 Sample Fee List.

12. Scenario 2: Family Coverage
Allison, Department of Public Safety, currently covers her husband and a daughter on the plan. She will deliver their second child, a son, in 4 months. The family has 4 preventive visits (including well baby visit), an inpatient stay for delivery ($9,000), 4 generic prescriptions after the baby is born and 1 specialist visit to the pulmonologist for their daughter’s allergies ($154 + $58 for a breathing test).
Family Deductible $3,000
Family OPM $5,400
Total Cost of Services $9,260
Difference $5,400-$4,252 = $1,148
Total Cost –
Family Deductible = $6,260
$6,260*20% = $1,252
Breathing Test $ 58
Prescriptions
$1,252 + $3,000 = $4,252
Specialty Office Visit $ 154
4 Generic Prescription $ 48
Family Deductible $3,000
In this example, we’ll follow Allison, Department of Public Safety. She currently covers her husband and a daughter on the plan. She will deliver their second child, a son, in 4 months. The family has 4 preventive visits (including one well baby visit), an inpatient stay for delivery ($9,000), 4 generic prescriptions after the baby is born and 1 specialist visit to the pulmonologist for their daughter’s allergies ($154 + $58 for a breathing test).
(Preventive at $0!)
On the HDHP, there is one family deductible, $2,700. When that is reached in this case, Allison then has the coinsurance on the remaining balance.
On the HDHP, because the family deductible was met, Allison now pays coinsurance for prescriptions.
On the HDHP, because Allison met the entire family deductible, she will be billed coinsurance for the visit cost, and coinsurance on the breathing test.
Inpatient Stay $9,000
20% of $6, $1,252
Note: These are estimated costs only. Figures based on 2015 Sample Fee List.
Ded=deductible Coin=coinsurance Copay=Copayment OPM=Out of Pocket Maximum

13. City and County of Denver – Wrapping it Up
Important Points to Remember
Evaluate Your Health Needs to determine best plan
Select your Kaiser Permanente plan, DHMO or HDHP
If you don’t select you will fall into the default plan
Open your Health Savings Account when electing the HDHP
If you don’t open your Health Savings Account the City and County of Denver cannot release your seed money into a non existent account

14. Additional Resources
Financial Counselors or TTY for the hearing/speech impaired.
Clinical Pharmacy Call Center – or TTY for the hearing/speech impaired
Both departments can be reached Monday through Friday between 8am and 6pm
Financial counselors are there to help you set up a payment plan
Clinical pharmacy can answer questions about cost of medications

15. Thank You! Questions?
So, to wrap up- Kaiser Permanente has provided some key components of the High Deductible Health Plan.
Open it up for Q&A