1. Using your High Deductible Health Plan & HSA
St. Croix Central School District
November 2017
Thank you for investing your time in a brief review of how your HSA works as a participant in the St. Croix Central School District medical plan.
The objective of this presentation is to help you understand how the HSA is utilized to help you meet your medical plan deductible. The objective is also to show you some resources available to you to help control costs for yourself and the district.
Because the majority of claims incurred on the District Medical Plan are incurred through in-network providers I am going to talk through only your in-network benefits today. If any of you have questions on out of network benefits I am happy to spend time with you after this presentation to discuss.

2. Today we will Cover: The Medical Plan Deductible Amounts
What is an HSA and how is it used
How does the HSA work in conjunction with my medical plan
How can I reduce medical expenses and save money
Today we will review the medical plan deductible, how that deductible is met and how the HSA is used to fund that deductible. We will also talk about how you receive funds from your HSA and what to expect moving forward.

3. Medical Plan Design Summary
As we discussed during the 2015 Open Enrollment meetings, you have two HSA plan options to choose from in A Core Plan which offers a $2,000 in-network deductible for those enrolled with individual coverage and a $4,000 in-network deductible for those of you covering dependents. Or a Buy Down Plan which offers an embedded deductible of $3,500 per person not to exceed $7,000 per family.
The deductible is the amount of claims that need to be incurred before the Medica medical plan begins paying claims on your behalf. Until the deductible is met, you are responsible for paying your providers directly for any claims and prescriptions you incur.
There are two HSA medical plans and the deductible and out of pockets work differently on each.
Core Plan:
If you are enrolled in this health plan with single or individual coverage……once you have incurred $2,000 in claims which are subject to the health plan deductible, your deductible is satisfied for the plan year and the health plan (Medica) begins paying 100% of your eligible expenses for the remainder of the plan year.
If you cover dependents on your plan…….once your family has incurred $4,000 in claims which are subject to the health plan deductible, your family deductible is satisfied for the plan year and the health plan (Medica) begins paying 100% of your family’s eligible expenses for the remainder of the plan year. Remember, one person in your family could incur the full $4,000 in expenses or all of your family members combined may incur expenses to meet the family deductible.
Although the Medica Medical plan has a $2,000 individual deductible or $4,000 deductible for families, the amount of deductible you pay is $350 if enrolled in an individual contract or $700 if enrolled in a family contract!
This is because the St. Croix Central School District has committed to making a deposit of $1,650 or $3,300 into your HSA account during the 2016 calendar year which you can use to pay the medical plan deductible if needed.
Buy-Down Plan:
If you are enrolled in this health plan….once one individual on the plan has incurred $3,500 in claims, which are subject to the health plan deductible, that individual’s deductible is satisfied for the plan year and the health plan (Medica) begins paying 100% of that member’s eligible expenses for the remainder of the plan year. Or once all members covered on your plan have cumulatively incurred $7,000 in claims which are subject to the health plan deductible, the family deductible has been satisfied for the plan year and the health plan (Medica) begins paying 100% of eligible expenses for all family members for the remainder of the year.
Although the Medica Medical plan has a $3,500 per person or $7,000 per family deductible, the amount of deductible you pay is $1,494 if you have an individual or single policy or $2,894 if you are enrolled in a family plan.
This is because the St. Croix Central School District has committed to making a deposit of $2, or $4,104.4 into your HSA account during the 2016calendar year which you can use to pay the medical plan deductible if needed. It is important to understand that if you have a family Buy-Down policy you are eligible for $4, in HSA dollars per year, which would cover 100% of one person’s individual deductible.

4. What is an HSA Plan?
High deductible health insurance policy that covers large medical or hospital claims
Investment or savings account from which you can withdraw money tax-free for qualified medical expenses
By choosing to participate in one of St. Croix School District’s HSA plans, each of you has made the decision to accept lower fixed monthly costs in exchange for a higher front end deductible.
The idea is that you purchase a medical plan with a higher deductible and go back to using insurance for what it was originally intended for……insuring the big stuff!
Because you chose the HSA plan, you have been given an investment vehicle which allows you to save money on a tax free basis which can be used for qualified medical expenses that you or your eligible dependents incur now or in the future.
Your HSA is a triple tax advantaged account. It is the only savings vehicle like this! Any funds deposited into your HSA are received tax free (whether the funds are contributed by the District or deposited by you through payroll deduction), the funds also grow tax deferred and as long as they are withdrawn to be used for qualified medical expenses the distribution is also tax free!
You are taking advantage of a great opportunity because the St. Croix Central School District has committed to giving you an HSA contribution which will cover the entire amount of your deductible this year. And the money that they give you is your money so if you don’t use it, it stays in your HSA to earn interest and grow.

5. Who Is Eligible for an HSA?
Medica Value Story
Who Is Eligible for an HSA?
Any individual that:
Is covered by a high deductible health plan (HDHP)
Is not covered by other health insurance, unless it is a HDHP (includes traditional Flexible Spending Accounts and Health Reimbursements Accounts)
Is not enrolled in Medicare or Tricare
Has not received VA non-preventive care benefits in the last 3 months
Is not claimed as a dependent on someone else’s tax return
Like any good tax advantage account the IRS has issued regulations that determine who is eligible to make and receive contributions to a health savings account.
First, you must be enrolled in one of the districts HSA medical plans.
You may not be covered by a non-high deductible health plan such as a traditional health plan, traditional Flexible Spending account, or an HRA Plan. For example, if your spouse covers you through their employer on a non HDHP or a traditional FSA, you would not be able to make and receive HSA contributions.
The IRS also says that you cannot be receiving medicare, tricare or VA non-preventive benefits and may not be claimed as a dependent on another persons tax return.

6. So How does this work When I see my Doctor?
You see a physician or receive other professional services
You present your Medica ID Card to the provider
Provider bills Medica for the service
Medica applies the in-network discounts and applies the allowed amount to your deductible
Medica sends you an Explanation of Benefits
Provider bills you for the service
You receive the EOB and bill for services
You confirm the “amount you owe” on the EOB matches the provider bill
You pay your provider using your HSA Card, HSA Checks or personal funds

7. So How does this work When I use a pharmacy?
You visit a pharmacy to pick-up a prescription drug
You present your Medica ID Card to the pharmacist
Pharmacist runs the prescription through Medica and applies the negotiated discounts to the price of your medication
Medica applies the cost of the prescription to your deductible
You pay for the prescription using your HSA Card, HSA Checks or personal funds

8. Explanation of Benefits
As I mentioned, it is critical that you show your Medica member ID card every time you visit your provider or pharmacy. This will allow the provider or pharmacy to submit a claim to Medica so the expense is applied to your medical plan deductible. Once Medica processes your claim, they will issue you an Explanation of benefits. Typically you will receive the EOB from Medica right around the time you receive the bill for services from your provider.
You are responsible for paying the providers for your services; however, I recommend waiting to pay the provider until you receive the EOB from Medica. This ensures that you are not paying the provider for claims that have not been submitted to Medica and applied toward you medical plan deductible.
Here is an example of what the Medica Explanation of Benefits looks like. Each EOB will list the name of the patient, the date of service, charges billed by your provider, Allowed Amount, provider Responsibility, Amount applied toward your deductible, the amount Medica paid of the claim, and the amount you owe.
As you review the EOB pay close attention to the amount charged as well as the provider responsibility. This is where you will begin to see the power of using in-network providers. Because Medica has negotiated contracts with the in-network providers you will see that significant discounts are applied to the in-network services. You will also want to pay close attention to the amount applied toward your deductible, the amount paid by Medica and finally the amount you owe to the provider of the service you received.

9. Explanation of Benefits
The Explanation of benefits will also let you know your year to date out of pocket and deductible expenses. Each time a claim is submitted to Medica, they will apply the allowed amount to your deductible and out of pocket maximum. And report back to you, on the EOB, how much as accumulated towards each.
Core Plan
Remember, for those enrolled in individual coverage through the district, your medical plan deductible is $2,000. Once your Explanation of Benefits shows that you have Accumulated $2,000 for the plan year: January 1 – December 31, the Medica medical plan will pay the providers directly for your eligible incurred claims.
And for those of you who are enrolled in family coverage through the district, your medical plan deductible is $4,000, therefore once your Explanation of Benefits shows that you have accumulated $4,000 for the plan year: January 1 – December 31, the Medica medical plan will pay the providers directly for your eligible incurred claims.
Buy-Down Plan
Remember, the per person deductible on this plan is $3,500 so once any individual member on your plan receives an Explanation of Benefits showing that they have accumulated $3,500 for the plan year: January 1 – December 31, the Medica medical plan will pay the providers directly for that member’s eligible incurred claims. And once your Explanation of Benefits indicates the family deductible of $7,000 has been met cumultiverly by two or more members covered on your plan for the plan year: January 1 – December 31, the Medica medical plan will pay the providers directly for all of family member’s eligible incurred expenses.

10. Who can I contact for help? 1-800-952-3455 www.medica.com
Call if you have questions about:
Medical Plan Coverage or Claim
Deductible or Out-of-Pocket balances
Finding a Doctor, Dentist or Specialist
Health Plan Services
If you have questions on: your medical plan benefits, deductible or out of pocket balances, or how to find a provider, contact Medica Customer Service or visit their website.
Agents are available Monday through Friday 8am – 6pm
This number and web address can also be found on the back of your member id card

11. Who can I contact for help? Associated Bank or Westconsin CU
Call if you have questions about:
Contributions to your HSA
Reimbursements from your HSA
Requesting a HSA Bank Cards or checks
Questions on your Health Savings Account should be directed to either Associated Bank or Westconsin CU.

12. Managing Health Plan Costs Requires Teamwork
Your claims create the premiums you pay
Utilize tools available to be a good health care consumer
Take advantage of wellness
opportunities available
(including the fitness club discounts!!)
Before we end I want to take a few minutes to remind each of you that you have access to several tools on the Medica website that can help you to become a better consumer of health care services.
Remember, the claims incurred on the St. Croix Central School District plan create the premiums that you pay. So even after your health plan deductible is met and Medica begins paying 100% of eligible expenses, it is still important that you seek to receive the highest quality most cost effective care.

14. mymedica.com
Pharmacy Resources Price a Medication

15. Main Street Medica Helps you compare: Prescription costs
Costs for a variety of procedures and conditions
Hospital quality ratings
Prescription costs
Chiropractic services
Equipment & supplies

16. Main Street Medica
Cost estimates are based on Medica’s actual contracted rates

17. 24 Hour Nurse Line Your nurse is one call away
Health & Wellness
24 Hour Nurse Line
Your nurse is one call away
Immediate support for your health concerns
Help in making decisions about your health
Available 24/7
Call
to access a registered nurse
Chat live with a nurse online at mymedica.com

18. Employee Assistance Program (EAP)
Health & Wellness
Employee Assistance Program (EAP)
Jump over life’s hurdles.
Start with one easy call to the Medica EAP – 24/7
Whatever your concern:
Find a new day care for your child
Manage credit card debt
Research addiction support options
Look for a family counselor
Deal with grief
Call
Tailored support when you need it – free & easy

19. Health Club Reimbursement Program
Health & Wellness
Health Club Reimbursement Program
240
Reasons to get fit with Fit ChoicesSM by Medica 12
Visits per month
$20
Credit toward monthly dues 8K
Health clubs to choose from (national and regional)

20. Health Club Reimbursement Program
Health & Wellness
Health Club Reimbursement Program
National facilities Regional facilities

21. Thank You for teaming up with JA Counter and Medica!
Thank you for investing your time to learning more about your medical plan benefits through the District.
I am happy to address any questions at this time.