Purdue Benefits
www.purdue.edu/benefits
IS A HIGH
-
DEDUCTIBLE MEDICAL
PLAN YOUR BEST CHOICE?
TAKING THE MYSTERY OUT OF HIGH
-
DEDUCTIBLE HEALTH
PLANS AND HEALTH SAVINGS ACCOUNTS
Agenda
o
High
-
Deductible Health Plan With HSA
High
-
Deductible Health Plan Basics
Health Savings Account (HSA) Basics
IRS Says
How It Works
Scenarios
Plan Tips (How To Make It Work For You)
Purdue Benefits
www.purdue.edu/benefits
High Deductible Health Plan Basics
HIGH DEDUCTIBLE
HEALTH PLAN BASICS
High
-
Deductible Health Plan Plus HSA
Plan Basics
Health
Plan
(HDHP)
Health
Savings
Account
(HSA)
Purdue
Health
Plans Plus
HSA
o
Created as a way to help with rising
health care costs
Offer tax advantages for medical
expenses
Provide HSA owners with control of
where dollars are being spent
o
HSA owners are generally more
interested in how funds are being
spent when they own the account
Health care providers have
incentive to lower rates due to a
more competitive environment
Background
o
Intent of high
-
deductible health plans and HSA
Improved version of FSA with retirement savings feature
Allows unspent funds to roll over every year
Employers are not required, but are able to contribute
Account earns interest and offers investment options
Account goes with you if you leave Purdue
Able to save funds for retirement medical expenses, including
premiums
Remember that funds used for
non
-
medical expenses
are fully taxable
Prevalence of plans
According to Mercer’s National Survey of Employer
-
Sponsored
Health Plans 2012:
o
36% of 2,809 employers surveyed offer an HDHP
o
Up from 20% in 2008
Background
Plan Basics
Deductible
Premium
Coinsurance
Out
-
of
-
Pocket
Maximum
Preventive Care
Contributions
Account
Management
High
-
Deductible
Health Plan (HDHP)
Health Savings
Account (HSA)
Withdrawals
o
High
-
Deductible Health Plan
Lowest premiums
compared to more
traditional health plans
Higher deductible and maximum limit on out
-
of
-
pocket covered expenses in a calendar year
Includes both medical and prescription
costs
100% coverage with in
-
network providers for
preventive
care and preventive generic
medications
for certain
conditions
(i.e
. asthma, diabetes, heart disease and stroke,
prenatal vitamins, smoking cessation
)
Plan Basics
High Deductible
Health Plan
(HDHP)
Deductible
Coinsurance
Out
-
of
-
Pocket
Maximum
Preventive
Care
Plan Basics
High Deductible
Health Plan
(HDHP)
Deductible
Coinsurance
Out
-
of
-
Pocket
Maximum
Preventive
Care
o
Preventive
care
100% covered with in
-
network
providers,
i
ncludes
but not limited to:
Annual
exams, routine prenatal and well
-
child
care, and child and adult
immunizations
Preventive (non
-
diagnostic) screening services
e.g.,
cancer, diseases (heart and vascular, infectious)
Conditions: metabolic, nutritional, endocrine, mental
health, obstetric and gynecological, and pediatric
Disorders
(musculoskeletal, vision and hearing
)
Eligible preventive medications
F
or certain conditions such as: asthma,
heart disease
and
stroke
P
renatal
vitamins, generic contraceptives approved by
the FDA, smoking cessation
Plan Basics
2014 Deductible
In
-
Network
Out
-
of
-
Network
Purdue Health Plan
Plus HSA 1
$1,750 employee only
$3,500 family
$3,500 employee only
$7,000 family
Purdue Health Plan
Plus HSA 2
$ 2,500 employee only
$ 5,000 family
$5,000 employee only
$10,000 family
o
Deductible Phase:
You
pay 100%
of
all eligible expenses up to
the plan's annual deductible. Includes:
Non
-
preventive medical visits and services
o
Doctor visits, labs
, diagnostics, hospitalizations
Non
-
preventive
prescriptions
High Deductible
Health Plan
(HDHP)
Deductible
Coinsurance
Out
-
of
-
Pocket
Maximum
Preventive
Care
Plan Basics
2014 Prescription Coinsurance
Purdue
Health Plan
Plus HSA 1
&
HSA 2
Prescription
Type
Home Delivery
(90 day
supply)
Retail
(30 day
supply)
Preventive
Generic
0%
0%
Generic
Ded
. then
$25 max
Ded
. then
$
10 max
Preferred
Ded
. then
25%
Ded
. then
35%
Non
-
Preferred
Ded
. then
45%
Ded
. then
55%
2014 Medical Coinsurance
In
-
Network
Out
-
of
-
Network
Purdue Health Plan Plus HSA 1
20%
40%
Purdue Health Plan Plus HSA 2
25%
45%
*Member Pays the Difference program is still in effect.
o
Coinsurance Phase
:
After
meeting
your deductible, you pay a
smaller percentage of
expenses
High Deductible
Health Plan
(HDHP)
Deductible
Coinsurance
Out
-
of
-
Pocket
Maximum
Preventive
Care
Plan Basics
Annual Out
-
of
-
Pocket Maximum
In
-
Network
Out
-
of
-
Network
Purdue Health Plan
Plus HSA 1
$3,500 employee only
$7,000 family
$7,000 employee only
$14,000 family
Purdue Health Plan
Plus HSA 2
$ 5,000 employee only
$ 10,000 family
$10,000 employee only
$20,000 family
o
Out
-
of
-
Pocket Maximum Phase:
Plan pays 100% of eligible medical and
prescription drug costs once you meet the
annual maximum
This is the most you will pay for medical and
prescription drugs during 2014
High Deductible
Health Plan
(HDHP)
Deductible
Coinsurance
Out
-
of
-
Pocket
Maximum
Preventive
Care
Purdue Benefits
www.purdue.edu/benefits
High
-
Deductible Health Plan
HEALTH SAVINGS ACCOUNT
(HSA) BASICS
o
What Is An HSA
?
A bank account
–
called a health savings
account (HSA
)
Offers tax advantages and allows savings to
build over time
Available with high deductible health plans
only
Administered by
PayFlex
Debit card allows convenient access to funds
in the account
Account access via web and mobile
File claims, view account balance,
transfer funds, etc.
Plan Basics
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
2014 HSA
IRS
Contribution
Limit
Purdue
Contributions
Remaining
Employee
Contribution
Allowed
Employee
$3,300
$650
$2,650
Family
$6,550
$1,300
$5,250
o
HSA Contributions
Purdue contributes, and you have the
option to contribute to the same account
Plan Basics
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
o
HSA Contributions
Contributions are deposited pre
-
tax and
available for use on or after each pay date
Age
55 or
older any
time during
2014,
eligible
to contribute an additional $1,000
Update contributions any time during
year through EBenefits
Option to contribute after
-
tax
Plan Basics
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
Plan Basics
o
HSA
Funds
Remaining funds in
account
roll over
every
year, never lose
contributions
Even if you separate or retire
Funds earn interest and grow tax
-
free
with investment options available once
minimum balance is met
Potential for long
-
term, tax
-
free savings
No limit on account balance
Funds available to beneficiary in the
event of
death
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
o
HSA Withdrawals
Funds never taxed when used for eligible
expenses such as:
Medical (e.g. doctor visit, hospital stay)
Prescription and Over
-
the
-
counter drugs
(with doctor's prescription)
Vision (e.g. contacts, glasses)
Dental (e.g. fillings, braces)
Upon retirement , use funds tax
-
free for medical
premiums and eligible medical expenses
Including COBRA,
Medicare
premiums and supplement
plans, and
long
-
term care premiums
Age 65 or older able to pay tax and withdraw funds
with no tax
penalty for any reason
Plan Basics
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
o
HSA Withdrawals
P
ay eligible expenses of any family member
who qualifies as a dependent on your tax
return, even if you cover only yourself
D
ependent
must be covered
under plan
, for
expenses to apply
toward your plan’s deductible
Same
-
sex domestic partners
are eligible to be
covered under an employee’s
HDHP
o
Partner must be employee’s
qualified tax
dependent
for University’s HSA family
contribution to apply
o
Tax
-
free distributions can be made from the
HSA
for the qualified tax dependent’s health expenses
Plan Basics
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
Plan Basics
o
HSA Withdrawals
Flexibility to pay expenses from HSA or
pay out
-
of
-
pocket and reimburse yourself
Direct deposit option available
Use funds for you, your spouse, and your
tax dependents, even if you cover only
yourself
Keep your receipts for expenses
If not an eligible expense:
o
Pay tax on purchase(s)
o
20% tax penalty
Health Savings
Account (HSA)
Contributions
Withdrawals
Account
Management
o
Limited Purpose Flexible Spending
Account (LPFSA)
In addition to the HSA,
you
have
the
option to contribute
pre
-
tax to a Limited Purpose
FSA (LPFSA)
M
ay
only be used for eligible
dental and vision expenses
Funds are available for use
immediately
Must use funds by end of
year
(use it or lose it rule)
2014
contribution limit of
$2,500
per employee
Plan Basics
o
Limited Purpose Flexible Spending
Account (LPFSA)
If you choose the
LPFSA
with
your HSA, you will receive one
card
PayFlex’s
technology will
understand which purchases
should be applied to your
Limited Purpose FSA before
your HSA
Claim forms and direct deposit
available if you choose to pay
out of pocket and reimburse
yourself
Plan Basics
Purdue Benefits
www.purdue.edu/benefits
IRS SAYS
High
-
Deductible Health Plan Plus HSA
o
To offer an HSA with a high
-
deductible health plan,
certain IRS rules apply
Higher deductible and out
-
of
-
pocket maximum with
lower premiums than traditional plans
Must combine medical and prescription expenses to
one deductible and out
-
of
-
pocket maximum
Offer preventive care and certain preventive
medications at no cost
Charge fair market value for services
(i.e., No “low or no” cost services)
IRS Says
o
To participate in an HSA, certain IRS rules
apply
You
must
be covered under a
high
-
deductible health
plan (HDHP)
You
cannot
be covered under any non
-
HDHP plan in addition to your Purdue
HDHP plan
If your spouse has non
-
HDHP coverage,
you
cannot
be covered by that plan
If you elect an HSA, your spouse
cannot
have a health
c
are FSA
You
cannot
be claimed as a dependent on
someone else's tax
return
IRS Says
Insurance
or
accounts
n
ot
a
llowed
with an HSA
:
Non
-
HDHP medical
coverage
Health
c
are
f
lexible
s
pending account
(HCFSA)
or a Spouse's
HCFSA
Part A and/or Part B
Medicare
TRICARE or TRICARE For
Life
Any VA benefits used
within previous 3 months
IRS Says
You
can
have additional
insurance that provides
benefits for the following
items:
Accident
Disability
Dental care
Vision care
Long term
care
Specified disease or illness
Insurance that pays a fixed
amount per day for
hospitalization
o
To participate in an HSA, certain IRS rules apply
o
To participate in an HSA, certain IRS
rules apply
You
must
keep records to show:
Funds were used exclusively to pay or
reimburse qualified medical expenses,
qualified medical expenses had not
been previously paid or reimbursed
from another source, and
medical expenses had not been taken
as an itemized deduction in any year
Expenses incurred before you
establish
your HSA are
not
qualified medical
expenses
IRS Says
o
To participate in an HSA, certain
IRS rules apply
If funds are withdrawn for
anything other than a
qualified medical expense
prior to retirement, you are
subject to taxes plus a 20%
tax penalty
IRS Says
o
Special Limitation
Groups
Long Term Disability
Not eligible for HSA
COBRA
Not eligible for HSA
Over 65 Active Employees
Eligible for HSA, if
not
covered
under Medicare (including Part A
)
Under
65
Retirees
Not eligible for HSA
Over 65
Retirees
Not eligible for HSA
Purdue’s Special Rules
Purdue Benefits
www.purdue.edu/benefits
HOW IT WORKS
High
-
Deductible Health Plan Plus HSA
o
Pharmacy
Show your
Anthem ID
card
Pharmacy processes
through Express
Scripts
Payment due at time of purchase
Choose to use your HSA card or another form of
payment
Amount
owed will count toward your medical/
prescription deductible and out
-
of
-
pocket
maximum
unless
you choose a brand name prescription over
generic (Member Pays The
Difference)
How It Works
Purdue Benefits
www.purdue.edu/benefits
SCENARIOS
High
-
Deductible Health Plan Plus HSA
Purdue Benefits
www.purdue.edu/benefits
PLAN TIPS
High
-
Deductible Health Plan Plus HSA
Tips
o
Take advantage of
your 100% covered preventive
benefits,
including preventive
medications
o
Talk with your doctor or pharmacist
Be open and honest, keep the line of communication open
As the
patient,
you have the right to know
Ask the tough
questions
Make sure to get copies of medical records and
imaging
to reduce
duplicate services
o
Use Tier 1 labs for the best savings
www.purdue.edu/hr/Benefits/Medical/purdueChoiceFund.html#Tier1labs
o
Check
out the Center for Healthy Living
for a
high quality, low cost option
$45
flat fee for center
visits
No
-
cost
health coach services
Tobacco cessation
Medication therapy management
Nutritional counseling
Employee assistance
counseling
Convenient online scheduling
option
Tier 1 lab location
o
Lower
your costs for prescriptions
Use generics
Try home delivery
Check with retailers for low cost
prescription
programs
Tips
Tips
o
Always show your insurance
information, even when you have
to meet your deductible
Medical
and
prescription
expenses
In
-
network provider discounts
o
Keep your receipts and
explanations of benefits (EOBs)
o
Consider a Limited
Purpose
Flexible Spending
Account
Vision/dental expenses
o
Check in to additional
coverage
with
accident
/
critical
i
llness
insurance options
Tips
o
Benefit from the
triple tax
advantages
Contributions you make are pre
-
tax
Consider contributing what you
would have paid
for 2013 premiums
Add what you would typically
contribute to your FSA
Funds in HSA grow with interest
tax
-
free
You have option to allow HSA to build
now, save funds for
later
Funds are tax
-
free when used for
eligible
expenses
Continue to use HSA funds tax
-
free
on eligible expenses after
retirement,
including Medicare
premiums
o
Use
available technology
Center for Healthy Living
Schedule appointments online
Castlight
Shop around for
care
Express Scripts
Price medications and
order home delivery refills
PayFlex
(
Healthhub
)
Track your
expenses
EBenefits
Update HSA contributions anytime
Tips
Center for Healthy Living
1.
Schedule an
appointment
2.
View lab
results
from
your visits
with the
center
Castlight
1.
Search
personalized cost
and quality
information for in
-
network providers
and services
2.
Track how close
you are to meeting
your
deductible
3.
Connect seamlessly
to Express Scripts
for
prescription
pricing,
ordering
and
more
4.
See tips to help
manage you health
care
Castlight
Castlight Mobile
Available for iPhone, Android and
other smartphones
View
personalized cost and quality
information
View
provider
details
Check
your deductible and out
-
of
-
pocket maximum status
Castlight Guides By
Phone
Full
access over the telephone
Call toll
-
free 888
-
272
-
9572, Monday
-
Friday, 8 a.m.
-
9 p.m.
Castlight
www.purdue.edu/castlight
Express Scripts
1.
Order home
delivery
prescriptions
2.
Make the
switch from
retail to home
delivery
3.
Track your
prescription
expenses and
view history
Express Scripts
1.
Price
medications
and compare
costs:
Retail vs.
home
delivery
Brand name
vs. generic
equivalent
PayFlex
1.
View
account
details and
history
2.
File claims, view
eligible
expenses, and
order additional
debit
cards
3.
Update settings
to receive
email/text
notifications
4.
Enroll in direct
deposit, submit
documents
online
PayFlex
1.
Link your bank
account to
transfer funds
to and from
your HSA with
ease and view
investment
options
2.
Set up
recurring
transactions,
print claim
forms, and use
planning tools
PayFlex
Mobile
Access real
-
time account information
Account balances
Claims
status
Transaction details
Account alerts
Submit claims
Take pictures of
receipts and
submit
from your
phone
PayFlex
EBenefits
1.
Increase and
decrease HSA
contributions
at any time
during the year
Resources
Purdue
Benefits
www.purdue.edu/benefits
hr@purdue.edu
www.purdue.edu/hrhelp
Try
HR’s new
secure message
tool!
765
-
494
-
2222
Anthem
www.anthem
.com
Check out Anthem’s tools
and resources today!
Castlight
www.purdue.edu/castlight
Mobile app available!
888
-
272
-
9572
Center for
Healthy
Living
www.purdue.edu/healthyliving
Now schedule appointments online!
765
-
494
-
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