*** HDHP Info *** Want to go with UHC, but cant justify paying the astronomically high premiums set by the DCH? You may want to consider the HDHP option. This option can be confusing at first, and the DCH was SUPPOSED to offer members more information about this plan. However, the Board member who insisted on greater education efforts was dismissed from the board by Deal. So, here is my best shot at explaining the HDHP plan. (Keep in mind I am NOT a benefits manager!) The plan is High Deductible Health Plan. It is just what it says, a plan that offers low premiums in exchange for a high deductible. If you arent prepared, it can be worse than the HRA plans. There are several benefits to this plan, however. 1) The premiums are LOW. Family plan is 225.56 (58% lower than Gold HRA, 13% lower than Bronze HRA, and more than 60% lower than UHC HMO) 2) You can set up a Health Savings Account (HSA) to help cover your costs. You can put money into a HSA and use it to pay coinsurance costs when you need it. If you do not go to the doctor, your HSA account does not go away at the end of the year (like Flex Spending Accounts), and will roll over for when you need it. (Please note, this account can ONLY be used for health expenses!) So, if you look at Family Plan numbers, UHC HDHP is $359.24 less per month than UHC HMO. If you take that difference and put it into a HSA, you would have $4,310.88 after 12 months (if you didnt have to use it). It wont cover the $7,000 deductible, but it helps! You do have to cover the ENTIRE $7,000 deductible before ANY family member can receive benefits. (NOTE: the benefits guide says an HSA cannot be combined with an FSA, but CAN be combined with a general limited purpose FSA.) Now, look at Health Incentive Account (HIA) credits (previously Wellness credits). First, on a Family plan, you have to meet $2,600 of your deducible before you can use HIA credits. Once you meet that amount, you can use your HIA credits, up to $1,200 for a family, which will be reimbursed back to you. 3) Pharmacy costs count towards your deductible in the HDHP. In the HMO and HRA plans, pharmacy only count towards OOP max. In the HDHP, they will count towards meeting your deductible. This may help you reach your deductible faster than on the HRA plan - especially since you have to pay 100% of pharmacy costs until you hit your deductible! After you reach your deductible, you pay 30% until you reach your OOP max. (This is not spelled out clearly in the SHBP Decision Guide, but has been confirmed by UHC.) 4) Bottom line: Keep in mind theres more to insurance than premiums. Here are the yearly premium + deductible costs (since Kaiser is such a different model, I did not include it here.): Gold HRA - $9478 Silver HRA - $8548 Bronze HRA - $8124 BCBS HMO - $7918 UHC HMO - $9617 UHC HDHP- $9706 Now, lets look at OOP Max, which is the amount you will pay before insurance kicks in at 100% (in-network/out-of-network): Gold HRA - $14,478 / $22,478 Silver HRA - $14,548 / $24,548 Bronze HRA - $15,124 / $27,124 BCBS HMO - $14,318 / $14,318 (no coverage for out-of-network) UHC HMO - $16,017 / $16,017 (no coverage for out-of-network) UHC HDHP- $15,606 / $28,506 The UHC HMO option is certainly higher than the others in regards to in-network OOP max. I would look at the out-of-network OOP, however, especially with BCBS, since many services are being denied, and many doctors are leaving the network. I am not recommending anyone go with the HDHP, just trying to point out the advantages of the plan. Keep in mind, the DCH actuarial value for the HDHP is 60% (as reported in the October 2014 GSRA newsletter). That means that you could pay, on average, 40% of the expected medical expenses - compared with 12% for Kaiser, 26% for the HMOs, and 32% for HRA Bronze. This makes the HDHP a very risky plan, epsecially if you dont have the HSA funds available, or the cash to pay for 100% costs. However, I have spoken with several people in the healthcare field who have this type of plan. It takes some preparation and planning, but it may be worth it if you are disciplined in investing in the HSA, and if you are relatively health now, and have time to build up an HSA account.
Posted on: Mon, 03 Nov 2014 11:17:42 +0000
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