Board of Regents University System of Georgia

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Board of RegentsUniversity System of Georgia
Indemnity/PPO/HMO/HDHP Plan Year 2009
Fall 2008, 2nd Open Enrollment , Revised
12-4-2008
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• INDEMNITY PLAN OVERVIEW

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INDEMNITY HEALTH PLAN

• Maximum Lifetime Benefits - 2 Million
• Annual Deductible
• Individual - 300
• Family (3 or more covered members) - 900
• Maximum Annual Out-of-Pocket Limit
• Individual - 2000
• Family (3 or more covered members) - 4000

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INDEMNITY Cont.

• Physician Services/Laboratory Services 80 of
  UCR for non-surgical services, subject to
  deductible.
• Wellness Care/Preventive Healthcare - 750 per
  person per plan year paid at 100 for UCR not
  subject to deductible.
• Physical Exams
• Mammogram
• Pap Smear
• Prostate Exam/PSA
• Well-baby Care and Immunizations
• Adult Immunizations
• Routine Eye Exams
• Routine Hearing Exams

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INDEMNITY Cont.

• Hospitalization
• 90 of UCR charges for surgeon, subject to
  deductible.
• 80 of UCR charges for anesthesiologist,
  pathologist, or radiologist services/consultations
  subject to deductible.
• Some surgeons and/or some hospital-based
  physicians providing services may not be part of
  the BCBSGA Participating Physician Program/BCBS
  National Participating Provider Network.

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Questions
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• PPO PLAN
• OVERVIEW

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PPO HEALTH PLAN

• Maximum Lifetime Benefits - 2 Million
• Annual Deductible
• In-Network (Georgia)
• Individual - 300
• Family - 900
• In-Network (National)
• Individual - 400
• Family - 1200

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PPO Cont.

• Maximum Annual Out-of-Pocket Limit
• In-Network (Georgia)
• Individual - 1000
• Family - 2000
• In-Network (National)
• Individual - 2000
• Family - 4000

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PPO Cont.

• Physician Services
• 20 copay per office visit, not subject to
  deductible
• Procedures/Laboratory services
• 90 In-Network (Georgia)
• 80 In-Network (BlueCard National Network)
• 60 Out-of-Network, subject to deductible and
  balance billing.

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PPO Cont.

• The network of provider is changing to Blue
  Cross Blue Shield GA/National Network.
  (BlueChoice Preferred Provider Network)
• Increase the number of participating providers in
  the PPO Plan.
• Access network providers at www.bcbsga.com under
  BlueChoice Preferred Provider Organization(PPO).
• LabCorp as a provider effective 1/1/2009. (no
  longer allowed to use Quest Diagnostics Labs.

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PPO Cont.

• Wellness Care/Preventive Healthcare - 750 per
  person per plan year paid at 100 of network
  rate not subject to deductible.
• Physical Exam
• Mammogram
• Prostate Exam/PSA
• Well-baby Care and Immunizations
• Adult Immunizations
• Routine Eye Exams
• Routine Hearing Exams

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Pharmacy Benefit

• Indemnity and PPO Pharmacy Benefit will be
  provided by Medco effective 1/1/2009. New
  pharmacy cards will be issued.
• 3-Tier Co-payment Structure for up to a 30-day
  supply.
• Generic, 10 copay
• Preferred Brand Name, 25 copay
• Non-Preferred Brand Name, 20 co-payment for
  non-preferred name brand drug cost, with minimum
  co-pay of 40, maximum co-pay of 100.

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Questions
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• BLUECHOICE HMO PLAN
• OVERVIEW

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BLUECHOICE HMO PLAN

• Maximum Lifetime Benefits - 2 Million
• Must select a Primary Care Provider (PCP)
• PCP can be changed once a month, by the 25th of
  the month, by calling 1-800-424-8950
• Office Visits/Preventive Care
• 15 copay
• Well-child care
• Immunization
• Physical Examinations
• Annual Pap Smear(no PCP referral)

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BLUECHOICE HMO Cont.

• Additional coverage with 15 copay
• Specialty care physician office visit (PCP
  referral required
• Second surgical opinion (PCP referral)
• Maternity services
• Vision care services provided by network
  ophthalmologist or optometrist for the treatment
  of acute conditions (no PCP referral required)
• Emergency Room Services
• 75 copay for Life-threatening illness, serious
  accidents or with PCP referral

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BLUECHOICE HMO Cont.

• Outpatient Services
• Plan pays 100, facility/hospital charges
  (including diagnostic x-ray and lab services.
• Plan pays 100, after 50 copay.
• Inpatient Services
• 200 copay, plan pay 100 after copay, for daily
  room, board and general nursing care, ICU/CCU
  charges, diagnostic x-ray and lab services.

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BLUECHOICE HMO Cont.

• Prescription Benefit
• 10 copay for generic (up to 30-day supply)
• 25 copay for name brands (up to 30-day supply)
• No coverage, for prescription medication not on
  HMO pharmacy drug list

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KAISER PERMANENTE HMO OVERVIEW
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KAISER PERMANENTE HMO

• Maximum Lifetime Benefits - 2 Million
• Must select a Primary Care Provider (PCP)
• Office Visits/Preventive Care
• 15 copay
• well-child care
• Immunization
• Physical Examinations
• Annual Pap Smear
• Mammogram (100 covered)
• Routine Eye Exam
• Routine Hearing Exam

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KAISER PERMANENTE HMO Cont.

• Outpatient Services
• - 100 covered after 100 copay
• Inpatient Services
• - 100 covered after 200 copay
• Emergency Room Service
• - 75 copay per visit, waived if admitted
  within 24 hours.
• Urgent Care Services (location/place of treatment
  determines copay
• 15 copay at physician office
• 30 copay at Kaiser Premanente urgent center
  facility, other than emergency room

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KAISER PERMANENTE HMO Cont.

• Senior Advantage
• Not available for Medicare-eligible retirees
  who reside outside of the service area.
• (Available in Barrow, Bartow, Butts, Cherokee,
  Clayton, Cobb, Coweta, Dekalb, Douglas, Fayette,
  Forsyth, Fulton, Gwinnett, Hall, Henry, Newton,
  Paulding, Rockdale, Spalding, and Walton)

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Questions
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HSA/PPO (HIGH DEDUCTIBLE HEALTH PLAN)OVERVIEW

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HSA/PPO (HDHP)

• The High Deductible Healthcare Plan (HDHP) is
  Health Savings Account (HSA) qualified
• HSA Administered by U.S. Bank.
• 2009 fee to setup HSA will paid by BOR.
• Medicare Eligible Retirees (65 and older) can not
  contribute to an HSA
• Members may choose to either have an HSA or
  Flexible spending account. IRS guidelines will
  not permit both accounts.

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HSA/PPO (HDHP) Cont.

• The HDHP is fully-insured (BCBSGa pays the
  claims)
• Medical, Pharmacy, Mental Health are all provided
  by BCBSGa and the same phone numbers are used
  with this plan that are used with the BLUECHOICE
  HMO plan
• BlueCard PPO National Network will be utilized
  for this plan
• BCBS providers who accept the PPO plan nationwide
• No Referrals required

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HSA/PPO (HDHP) Cont.

• Overview of Benefit Structure
• 2 million Lifetime maximum
• Deductibles
• 1,500 Employee Only
• 3,000 Family (entire family deductible must be
  met before any family member moves to the
  co-insurance phase)
• Co-Insurance
• 90/10 In-Network
• 70/30 Out of Network
• Out-of-pocket Calendar Year maximum
• Individual 3,000 in-network 6,000 out of
  network
• Family 6,000 in-network 12,000 out of network
• Unlimited Wellness Benefit per family member per
  plan year

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HSA/PPO (HDHP) Cont.
How does a HDHP work? - A single deductible for
both prescription drugs and medical services.
- Coinsurance does not apply to prescription
drugs or medical services until the deductible
has been met. - Preventive care benefits begin
paying immediately, while other benefits are paid
once your deductible is met.
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HSA/PPO (HDHP)Disease Management Programs

• - Programs Available to HDHP Members
• Asthma (Adult Pediatric)
• CAD/COPD
• CHF
• Diabetes (Adult Pediatric)
• Nurse Information Line (BlueChoice On-Call)
• Future Moms
• Kidney Disease (New in 2007)

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About Health Savings Accounts (HSA)
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What is a Health Savings Account?

• Employee-owned savings account with tax
  advantages similar to an IRA or 401(k)
• Triple tax advantage
• Contributions
• Accumulations (interest earnings or investment
  growth)
• Withdrawals for qualified medical expenses
• Make pre-tax contributions via payroll deduction
• Spend funds on Qualified Medical Expenses (QME)
  or on general expenses in retirement
• Funds spent on QME are not taxed
• Funds spent for non-QME in retirement are subject
  to regular income tax

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Health Savings Account (HSA) Eligibility

• You are eligible if
• You are covered by a qualified high deductible
  health plan
• You are not eligible if you are
• enrolled in Medicare or receiving Social Security
  benefits
• claimed as a dependent on anyone elses tax
  return
• covered by other health coverage that is not a
  qualified high deductible plan
• received health benefits from the Department of
  Veterans Affairs in the past three months

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What is the U.S. Bank Health Savings Solution?

• Interest bearing FDIC-insured checking account
• Visa Debit Card(s) and HSA checks
• Real-time transaction processing
• Investment Options (20 Mutual Funds)
• Mutual fund options from First American Funds and
  Fidelity Advisor Funds
• Account balance over 2,500 may be invested
  (automatic sweep available)

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HSA Investment Options

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How do I enroll?

• Enroll in a High Deductible Health Plan (HDHP)
• Complete a Payroll Deduction Form and submit to
  HR
• After we receive your enrollment information,
  your Health Savings Solution Welcome Kit will be
  mailed to you in 7-10 business days.
• The Welcome Kit includes
• Personalized Welcome Letter
• Simple Account Activation Instructions
• Deposit Coupons
• Account Activation and Maintenance form to
• Request 2nd debit card for spouse or
  eligible dependent
• Beneficiary designation election
• Request HSA checkbook

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How do I make contributions to my HSA?

• Contribute on a Pre-Tax basis
• Contributions through your employer via payroll
  deduction (maximizes your tax deductibility)
• Contribute on an After-Tax basis
• Use the on-line eContributeSM tool to
  electronically debit your personal checking or
  savings account
• Use U.S. Bank HSA deposit coupons (provided in
  your Welcome Kit) and mail with a check
• Deduct after-tax contributions from taxable
  income when filing your personal tax return as an
  above-the-line deduction

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HSA Contributions

• How much can I contribute to my HSA each year?
• - For 2009 and forward, your maximum annual
  HSA contribution is based on the statutory limit
  for your type of coverage. For 2009, if you have
  self-only HDHP coverage, your contribution is
  3,000 5,950 if family HDHP, no matter what
  your HDHP deductible is. Before 2006, the
  contribution could not exceed the deductible of
  your HDHP.

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How do I access my HSA Funds?

• Pharmacy Visit
• Fill a prescription or purchase qualified
  over-the-counter medication
• Swipe your HSA Visa debit card
• Save a copy of receipt for your records
• Doctor/ Healthcare Provider Visit
• Doctor submits claim to insurance carrier
• Health plan adjudicates claim and sends out
  Explanation of Benefits (EOB)
• Doctor sends you a final bill
• Provide your method of payment
• Write an HSA check
• Provide HSA debit card information

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Qualified Medical Expenses

• IRS Publication 502 contains a list of all
  approved qualified medical expenses, including
• Doctors office visits
• Prescriptions
• Some over-the-counter medicine
• Hospital visits
• Acupuncture
• Chiropractor
• Eyeglasses and contact lenses
• Dental treatment
• Eye surgery
• Smoking cessation programs
• Therapy
• Weight loss programs
• IRS Publication 502 can be found online at
  www.irs.gov .

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Open EnrollmentDates

• 2nd Open Enrollment Dates
• December 4 thru December 15
• All changes to benefits must be submitted to
  Human Resources, Benefits no later than December
  15, 2008 _at_ 500 P.M.
• Effective Date
• All changes to medical benefits made during open
  enrollment will be effective January 1, 2009,
  with exception of benefits requiring proof of
  insurability.

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Thank You
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GSU Human Resources, Benefits Staff

• Vicki Hodges, Assistant Director/ Benefits
• [phone]
• Cynthia Hendrix, Benefits Manager
• [phone]
• Samantha Melton, Personnel Specialist II
• [phone]
• Sara Jo Britt, Personnel Specialist I
• [phone]