Medical Plans - 2013

High Deductible Health Plan ~ HDHP

 

The High Deductible Health Plan gives you more control over how you spend and save your health care dollars. There are two parts to the HDHP:

  1. The high deductible health plan, administered by Aetna or United
  2. The health savings account (HSA), administered by PayFlex with funds held at UMB Bank
  3. United Healthcare is the HDHP carrier for employees living or working in Colorado, Florida, Iowa, Nebraska and New York. In all other states Aetna is the HDHP carrier.

Here's how the high deductible health plan works:

  • Preventive care, such as routine physicals, immunizations and screenings, is covered at 100% subject to age and frequency limits (for either in-network or out-of-network providers).
  • You must meet your deductible before the plan begins to pay benefits. The deductible is $1,500 for individual and the family deductible is $3,000. The family deductible applies to you and all eligible covered dependents. Each covered person pays toward his or her individual deductible until the family deductible is met.
  • You may pay your deductible with your HSA or you may pay out of pocket and save your HSA for future medical expenses.
  • Once you reach the deductible, you and First Data share the cost of your eligible expenses through coinsurance (a percentage of the covered expense).
  • If you reach your out-of-pocket maximum, First Data will pay 100% of the remaining eligible medical and prescription drug expenses for the rest of the year.

Here's how the HSA works:

An HSA is a tax-exempt account established exclusively for paying qualified medical expenses. You must be enrolled in a high deductible health plan to have an HSA. With an HSA, you can pay for current health care expenses and save money for future medical expenses, including in retirement.

  • 2013 maximum contribution amounts are $3250 for individuals and $6450 for family
  • This election will be deducted before taxes from your paycheck on a per pay period basis. You will make this election at the time you enroll in the High Deductible Health Plan. You may change this election if you experience a qualified status change during the year.
  • If you or your spouse is age 55 or older, you may make an additional "catch-up" contribution to your HSA, above the annual maximum. The catch-up contribution limit is $1,000. If your spouse is age 55 or older and would like to make catch-up contributions, those contributions must be made to his or her own individual HSA account.
  • You own your HSA and your before-tax contributions earn interest and are not taxed when you make withdrawals to pay for future qualified medical expenses.
  • You withdraw money using a special debit card, which is the same card that is used for the Health Care Flexible Spending Account. If you pay out of pocket at point of service, you can transfer those payment funds from your HSA account into your checking account by logging on to your HSA account through the PayFlex web site. You also may allow the account to accumulate over time and use it to help pay for future expenses. You decide when and how to use the money in your account which is held at UMB bank. If you have a PayFlex Mastercard, your amounts will be loaded directly onto your current card
  • Your HSA balance rolls over from year to year, and if you leave the plan, you take your account with you.
  • You can manage your HSA at the HealthHub.com.
  • When you are contributing to an HSA, you can enroll in a limited FSA that you can use for dental and vision expenses.

Your HSA account will begin earning interest right away at UMB Bank. When you have at least $1,000 in your account, you have two additional investment options—a Money Market Sweep Account and an HSA Brokerage Account. Both options allow for excess funds to be moved into, or swept into, a separate account, which may allow you to earn higher yields.

Once you enroll in the HSA, you will receive additional information from UMB Bank.

The HDHP at a Glance:

FeatureHigh Deductible Health Plan ~ HDHP
Deductible

In-Network

$1,500 individual

$3,000 family

Out-of-Network

$3,000 individual

$6,000 family

HSA contributions
  • $100 to $3,250 individual - 2013
  • $100 to $6,450 family - 2013
Coinsurance after you pay the deductible In-Network
Plan pays 80%
You pay 20%
Out-of-Network
Plan pays 60%
You pay 40%
Annual out-of-pocket maximum, including deductible (individual/family)

In-Network

$2,750 individual
$5,500 family

Out-of-Network

$5,500 individual
$11,000 family

Lifetime maximum Unlimited

Unlimited

Preventive Care In-Network
100% subject to age and frequency limits
Out-of-Network
100% up to reasonable and customary charges, subject to age and frequency limits
Office visit Subject to deductible and coinsurance
Emergency room / urgent care Subject to deductible and coinsurance

The HDHP prescription drug benefits are administered by Medco. See the Prescription Drug section for prescription drug copay and coinsurance amounts.

For complete plan details, refer to the 2013 SPD.

Group Number 719964

For More Information...

Aetna
800.475.8782
Web site for non-members
Personalized member Web site - Aetna Navigator

United
866.627.7800
Web site for non-members
Personalized member Web site - My UHC