1. Douglas County School District
2018 Medical Plan Review
Douglas County School District
January 1, 2018 – December 31, 2018
Today’s Agenda:
Open Enrollment Reminders
Review of Medical Plan options
Health Savings Account (HSA)
Questions and Answers

2. Open Enrollment What is open enrollment? Open enrollment window:
Thursday 11/16 – Tuesday 12/5
Employee benefits plan year:
January 1, 2018 – December 31, 2018
After open enrollment, no changes are allowed unless you have a “Qualifying Life Event” such as: marriage, birth or adoption of a child, gain/loss of other coverage, court-ordered coverage, etc.

3. Which plan should I choose?
2018 Medical Plan Offering
$500 PPO
Option 1
$1,500 HSA
Option 2
Which plan should I choose?

4. Important Terms to Know
Deductible
The amount of money you must pay in a calendar year before Insurance will pay a claim
Out-of-Pocket Maximum
The most money you will pay during the calendar year for services
Copays, co-insurance, and deductible costs all accumulate towards the out-of-pocket maximum
Copay
A fixed dollar amount you must pay at the time of service regardless of the total service cost
Co-Insurance
A percentage of the total allowable charges an insured is responsible for paying

5. Medical Option 1 - $500 Deductible PPO Plan
Benefit
PPO Plan
In-Network
Out-of-Network
Calendar Year Deductible
$500 Individual
$1,750 Family
$1,000 Individual
$3,500 Family
Calendar Year
Out-of-Pocket Maximum
$2,500 Individual – Medical
$4,100 Individual – Rx
$7,500 Family – Medical
$5,700 Family – Rx
$10,000 Individual – Medical/Rx Combined
$30,000 Family – Medical/Rx Combined
Primary Care Office Visit
$20 Copay
40% after deductible
Specialist Office Visit
$40 Copay
Preventive Care
No Charge
Routine Lab & X-Ray
20% after deductible
Inpatient Hospital &Surgery
Outpatient Surgery
Emergency Room
Urgent Care
$50 Copay
In Network Prescription Drugs
30 day supply
Generic
Greater of $15 copay or 20%
Preferred Brand Name
Greater of $35 copay or 20% 
Non-Preferred Brand Name
Greater of $50 copay or 20%
Specialty
Greater of $55 copay or 20%

6. Medical Option 2 – $1,500 Deductible PPO Plan w/ HSA
Benefit
PPO Plan with HSA
In-Network
Out-of-Network
Calendar Year Deductible
$1,500 Individual
$3,000 Family (Aggregate)
Calendar Year
Out-of-Pocket Maximum
$5,800 Individual – Medical/Rx Combined
$11,600 Individual – Medical/Rx Combined
Primary Care Office Visit
20% after deductible
40% after deductible
Specialist Office Visit
Preventive Care
No Charge
Routine Lab & X-Ray
Inpatient Hospital &Surgery
Outpatient Surgery
Emergency Room
Urgent Care
In Network Prescription Drugs
30 day supply
Generic
Preferred Brand Name
Non-Preferred Brand Name
Specialty

7. Everything You Need to Know
Health Savings Accounts (HSAs)
Everything You Need to Know

8. What is an HSA? Health Savings Accounts (HSAs)
A Health Savings Account (HSA) is an account that you can use to pay Medical/Rx, Dental, or Vision expenses.
Must be used in conjunction with a high deductible health plan (HDHP)
Can be used to pay for your dependents expenses even if they’re not on your DCSD plan.
You own the account, but both you and your employer can contribute funds
Tax-advantages: Contribute pretax money, funds accrue tax-free and withdraw funds tax-free (if used for eligible expenses)

9. Benefits of an HSA Health Savings Accounts (HSAs)
Tax advantage means you save money on your health care expenses
Funds rollover each year, so you can use your HSA to save tax- free money for retirement
You own the account, even if you leave the company
Lower monthly premiums than a traditional health plan

10. High-Deductible Health Plan
Health Savings Accounts (HSAs)
High-Deductible Health Plan
HSAs can only be offered with a Qualified High Deductible Health Plan (HDHP).
This is a plan that must provide coverage as follows:
Minimum deductible:
$1,300 single, $2,600 family (2017 limits, established by the IRS)
$1,350 single, $2,700 family (2018 limits, established by the IRS)
Maximum annual out-of-pocket:
$6,550 single, $13,100 family (2017)
$6,650 single, $13,300 family (2018)

11. How Does The HSA/HDHP Work?
Health Savings Accounts (HSAs)
How Does The HSA/HDHP Work?
You contribute money to the HSA (either a lump sum payment or monthly through payroll deductions).
You can use HSA dollars to pay your health insurance deductible, along with other qualified medical expenses such as dental or vision services.
Once you meet your deductible, your insurance pays additional covered expenses in accordance with our plan (mostly at 80%).
Preventive Services are covered at no charge to you

12. Who is Eligible for an HSA?
Health Savings Accounts (HSAs)
Who is Eligible for an HSA?
Anyone who is:
Covered by an QHDHP
Not enrolled in Medicare
Not covered under other health insurance*
Not another person’s dependent
* Other health insurance does not include: specific disease or illness insurance, accident, disability, dental care, vision care and long-term care insurance

13. Health Savings Accounts (HSAs)
HSA CONTRIBUTIONS

14. HSA Contribution Limits
Health Savings Accounts (HSAs)
HSA Contribution Limits
Each year, the IRS sets contribution limits
These limits are for the total funds contributed, including company contributions, your contributions and any other contributions.
2018 limits:
$3,450 for individual coverage
$6,900 for family coverage
Individual age 55+ are allowed an additional $1,000 “catch-up” contribution amount.

15. HSA Contributions Health Savings Accounts (HSAs)
You are allowed to contribute the entire year’s limit when you first become eligible for the HSA, as long as you are still eligible on the first day of the last month of your tax year (December 1 for most taxpayers).
However, if you join mid-year and contribute the maximum amount to your HSA, you must remain eligible for at least 12 months after the last day of the last month of that tax year (December 31 for most taxpayers), or you will be subject to taxes and penalties on the amount you contributed.

16. HSA DISTRIBUTION RULES
Health Savings Accounts (HSAs)
HSA DISTRIBUTION RULES

17. HSA Distribution Rules
Health Savings Accounts (HSAs)
HSA Distribution Rules
Distributions from your HSA are tax-free if they are taken for “qualified medical expenses”.
Your HSA can only be used for expenses that are incurred on or after the date the HSA was established.
However, HSA funds can be used for expenses from a prior year, as long as the expenses incurred on or after the date the HSA was established.
There is no “advance funding” as with an FSA.

18. HSA Distribution Rules
Health Savings Accounts (HSAs)
HSA Distribution Rules
HSA distributions can be taken for qualified medical expenses for the following people:
The account holder (person covered by the HDHP)
Spouse of that individual (even if not covered by the HDHP)
Dependents of that individual (even if not covered by the HDHP)

19. Distributions – Age 65-plus
Health Savings Accounts (HSAs)
Distributions – Age 65-plus
For individuals age 65 and older, HSA distributions can be used for non-qualified medical expenses without facing the 20 percent penalty.
However, income taxes will apply for non-medical distributions.
This rule is regardless of whether the individual is enrolled in Medicare.

20. QUALIFIED MEDICAL EXPENSES
Health Savings Accounts (HSAs)
QUALIFIED MEDICAL EXPENSES

21. Qualified Medical Expenses
Health Savings Accounts (HSAs)
Qualified Medical Expenses
The IRS defines expenses that are considered “qualified medical expenses” for HSA distributions.
Expenses must be primarily to treat or prevent a physical or mental defect or illness.
If you use HSA funds for expenses beyond what the IRS defines as qualified, you will be subject to income tax on the distribution and an additional 20 percent penalty.

22. Qualified Medical Expenses
Health Savings Accounts (HSAs)
Qualified Medical Expenses
Examples of qualified medical expenses include:
Most medical care that is subject to your deductible (copays, coinsurance, doctor visits, inpatient or outpatient treatment, etc.)
Prescription drugs
Over-the-counter drugs, only if you obtain a prescription
Insulin (with or without a prescription)
Dental and vision care
Select insurance premiums
COBRA, qualified long-term care insurance, health insurance premiums paid while receiving unemployment benefits, health insurance after you turn 65 except for a Medicare supplemental policy

23. Ineligible Medical Expenses
Health Savings Accounts (HSAs)
Ineligible Medical Expenses
Expenses that are not considered “qualified medical expenses” include:
Insurance premiums (other than the exceptions listed on the previous slide)
Over-the-counter drugs (unless a prescription is retained from a physician–insulin is an exception)
Surgery purely for cosmetic reasons
General health items such as tissues, toiletries and hand sanitizer

24. Recordkeeping Health Savings Accounts (HSAs)
Whenever you use HSA funds to pay for a medical expense, you should keep your receipt.
You may need to demonstrate to the IRS that HSA distributions were for qualified medical expenses.
If the IRS requests receipts for verification purposes, failure to provide those receipts could result in having to pay a penalty.

25. Considerations when choosing a plan
Things to Consider
Considerations when choosing a plan
Cost
Employer HSA funding = $81.22/mo. ($975/yr.)
How do I use my insurance?
Copays
Upcoming Procedure
Prescriptions
PPO
HSA
Employee Only
$0.00
Employee + Spouse
$371.32
$331.98
Employee + Child
$410.08
$364.72
Employee + 2 or more
$694.86
$604.45

26. Questions?