independent schools association of northern new england (isanne) brewster academy may 20, 2010
TRANSCRIPT
Independent Schools Association of Northern New England (ISANNE)
Brewster AcademyMay 20, 2010
2 © 2009 Harvard Pilgrim Health Care
* “America’s Best Health Plans” is a trademark of U.S.News & World Report. The source for data contained in this publication is Quality Compass® 2009) and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2009 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
More reasons to trust us: #1 commercial health plan in America – five years in a row!
“America’s Best Health Plans” 2009-2010 List – Top-rated in Member Satisfaction and
Quality of Care – for an unprecedented fifth consecutive year!*
– Joint ranking of commercial plans by U.S.News & World Report/NCQA
– Determined by data in NCQA’s Quality Compass®
– Featured in December 1st edition of U.S.News & World Report
Benefit OverviewChanges Effective July 1, 2010
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Harvard Pilgrim PPO:High Deductible Health Plan (HDHP)
EFFECTIVE: 7/1/2010 PPO HDHP (In-network)
Deductible (Combined In- and Out-of-Network / Medical and Pharmacy Claims)
$2,000 Individual / $4,000 Family
Coinsurance None
Out-of-Pocket Maximum (includes deductible) $4,000 Individual / $8,000 Family
Preventive Care Office Visits $0 Copay
Sick-Care Office Visits Deductible & then covered in full
Diagnostic Testing
Hi Tech Radiology – MRI/CT/PET Scans
Deductible & then covered in full Deductible & then covered in full
Inpatient and Outpatient Hospital Care Deductible & then covered in full
ER Services Deductible & then covered in full
Prescription DrugsDeductible, then: Retail: $10/$25//$40*
Mail Order Program: $20/$50/$120*
*For the 2010 Plan Year, Brewster Academy will reimburse members for the Prescription Drug Copayments applicable once the combined Medical/Pharmacy Deductible has been satisfied.
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Harvard Pilgrim PPO:High Deductible Health Plan (HDHP)
Federal Mental Health Parity Act:
Effective July 1, 2010, Behavioral and Substance Abuse services are covered as any other medical condition under the ISANNE plan. Specifically, this means:
– No Longer a 30 Day Maximum on Inpatient Claims– No Longer a 20 Visit Maximum on Outpatient Claims
Although unlimited, these services are still subject to medical necessity review and you must call the Toll-Free number on the back of your ID Card prior to receiving benefits.
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Harvard Pilgrim PPO:High Deductible Health Plan (HDHP)
Plan is considered a Federally-Qualified HDHP, meaning it can be used with either an HRA or a Health Savings Account (HSA),
Brewster Academy will offer the HSA Option to all benefit-eligible employees for the 2010 Plan Year,
Brewster Academy will make the following contributions to the HSA for the 2010 Plan Year:
Single Coverage: $ 750
Two Party/Family Coverage: $1,500 If Two Brewster Academy employees are covered under the same plan, they are eligible for a larger
HSA Contribution.
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Prescription Drugs
Our open-formulary offers greater choice….not restrictions
Value-added mail service program
Large network of pharmacies
Prescription drugs are subject to the in-network deductible and then Pharmacy Copayments Apply, up to the Out-of-Pocket Maximum ($4,000/$8,000 inc. Deductible)– Retail Pharmacy (30 day supply): $10 / $25 / $40*
– Mail Order Pharmacy (90 day supply): $20 / $50 / $120*
*For the 2010 Plan Year, Brewster Academy will reimburse members for the Prescription Drug Copayments applicable once the combined Medical/Pharmacy Deductible has been satisfied.
The Health Savings Account throughMellon Bank
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Health Savings Account Rules Review
Eligibility– You can’t be enrolled in any other health plan
• Not enrolled in a spouse’s non-High Deductible Health Plan
• Not enrolled in Medicare or Medicaid
• Not eligible for reimbursement through your or a spouse’s Health FSA
– You can’t be someone else’s tax dependent
Contributions– The School will be making contributions on your behalf
– You can make pre-tax payroll contributions• Reduce taxable income
• Put more money aside to grow tax-free to pay current or future eligible expenses
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Health Savings Account Contributions
Your maximum contribution for 2010 from all sources (including the School’s contribution) is:– Individual contract, under age 55 $3,050
– Individual contract, age 55+ $4,050
– Family contract, under age 55 $6,150
– Family contract, one age 55+ $7,150
– Family contract, two age 55+ $8,150
(second individual must open an HSA)
The core figures ($3,050 and $6,150) are indexed annually for inflation– You’ll be able to contribute even more in future years
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Health Savings Account Contributions
Since the IRS calculates contributions on a calendar year and you’re joining mid-year, you have two options
– You can pro-rate your 2010 contribution by accepting no more than 7/12 of the 2010 maximum contribution• You’ll be “safe” and face no potential repercussions
– You can make the full calendar 2010 contribution as long as you remain HSA-eligible continuously through the end of the “testing period” (Dec. 31, 2011)• If you lose eligibility during the testing period, then any excess
contribution is subject to income tax and a 10% penalty
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Health Savings Account Contributions
You can make a one-time rollover from an IRA to an HSA
Once per lifetime, to be completed by Jan. 1, 2012
The rollover counts against the annual contribution limit
You must remain HSA-eligible through the “testing period” (12 full months after the month of the rollover)
Advantages– Quick seeding of the HSA– Traditional IRA distributions are taxed, while HSA contributions
are tax-free if used for eligible expenses
Concerns– If you spend the rollover funds, you reduce your financial assets
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HSA Keys to Success
Open your HSA promptly and fund it immediately– The IRS won’t let you reimburse any eligible expenses tax-free
unless the date of service is on or after the date that you open and fund [even nominally] your HSA
Make regular, steady contributions to your HSA, as you do to your retirement program
Understand the program, as the IRS makes you responsible for managing your HSA to the rules– A great resource: www.hsainsider.com, then follow the links to
download “HSA Road Rules”
– Another resource: http://www.treas.gov/offices/public-affairs/hsa/
Member Savings Programs
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Your Member Savings: more discounts for Faculty and Staff
• $150 Fitness reimbursement
• Eyewear savings – including discounts at many popular locations like LensCrafters, Sears Optical and Target Optical
• Online drugstore for over-the-counter health products
• Support Plus — foot, leg and comfort care products
• CareScout Eldercare Program
• Childproofing and home safety items
• Maine Running Company (ME), Runner’s Alley (NH) and Marathon Sports and Northampton Running Company (MA)
• Weight Watchers• Diet.com• Appalachian Mountain Club
membership• And more!
There are many ways our members can save:
Interacting with Harvard Pilgrim
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www.harvardpilgrim.org: exclusive online services at your fingertips
Find a doctor and access their contact information and profile
Find up-to-date and credible health information on topics that interest you– Health Topics A – Z (extensive database from Healthwise®
Knowledgebase)– Symptom Checker
Get information about your medications, find a pharmacy and order prescriptions by mail
Map your way to Wellness with the My Way to Better interactive tool
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Programs that make a positive difference in the lives of members
We support members dealing with issues such as:
– Diabetes
– Asthma
– Cancer
– Congestive heart failure
– Cholesterol management in cardiac disease
– Depression
– End stage renal disease
– High-risk pregnancy
– Anticoagulation management(for members taking blood-thinner medications)
– Conditions like seizure disorders, rheumatoid arthritis, multiple sclerosis and others
– Personal Coaching
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Member Services: more ways to serve you better
Access by phone - 1-888-333-4742– Timely and accurate responses to your questions
– Extended hours on Mondays and Wednesdays
– Interactive Voice Response (IVR) offers 24-hour access to general information
Access via www.harvardpilgrim.org - 24/7 – Self-service with HPHConnect
– E-mail Member Services and get responses quickly
National Health Reform
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National Health Reform
While there has been much discussion of the impact of the National Health Reform Legislation signed into law by President Obama on 3/23/2010, you should be aware that:
– The earliest that any changes can go into effect is 6 months after the bill is signed (9/23/2010),
– Most provisions are effective on the first group anniversary date following 9/23/2010 (ISANNE = 7/1/2011)
– Since HPHC does not have any Pre-Existing Conditions, and NH legislation provides coverage for unmarried dependents to age 26, the immediate impact to ISANNE will be minimal.
22 © 2009 Harvard Pilgrim Health Care
National Health Reform (Continued)
The provisions with the most immediate impact to the ISANNE Plan are:– Provision which no longer allows use of FSA/HSA funds for
over-the-counter medicines (1/1/2011)
– Prohibition on lifetime and annual benefit spending limits (7/1/2011)
– Provision requiring plans to cover most preventive care services at no charge (7/1/2011)
– Provision allowing dependents to stay on parents’ policies to age 26, regardless of marital status (7/1/2011)
The entire industry is in a “holding pattern”, waiting for the appropriate governmental departments to issue guidance on this and other provisions of the law.
QUESTIONS?