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2014-2015 BENEFIT NEWS
We are pleased to announce that UnitedHealthcare will remain as our medical insurance carrier.
We will continue to offer UHC Choice Plus POS and Choice Plus HSA plans. There will be plan and
contribution changes for the new plan year. Please see page 2 for an overview of the plan and a
highlight of the changes.
Affordable Care Act (ACA) Mandated Medical Plan Changes
Risk-reducing prescription medications (such as tamoxifen or raloxifene) for certain women at
increased risk for breast cancer, are now covered when prescribed by clinicians. Coverage is without
cost-sharing for these medications.
Prescription drug copays accumulate towards the medical out-of-pocket maximum.
If you are not making any changes to your elections, you do not have to take any action. Your
current elections will automatically roll over to the new plan year.
If you are enrolling for the rst time or wish to make changes to your elections, please complete
the attached enrollment form and return to HR as soon as possible. If you would like to elect
an additional pre-tax deduction to go in your Health Savings Account (H.S.A.) please be sure
to indicate this on the enrollment form. To apply for an HSA please also complete the Optum
Bank application and submit to HR along with your enrollment form.
New ID cards will be distributed for the medical plan. If you do not receive your new UHC ID card by
November 1st and you need to access care you may print out a temporary ID card on
Open enrollment is underway and will end October 27, 2014. You must make your
benet elections by October 27. Benet elections will be effective November 1, 2014.
This is your one opportunity during the year to select your healthcare benet coverage for the
2014-2015 plan year. Outside of the annual open enrollment period, you are only allowed to change
your enrollment when a qualifying event has occurred. Qualifying mid-year/life event changes as
dened by the IRS include:
Marriage or divorce
Birth, adoption or legal guardianship
of your child
Death of a spouse or dependent
Change in your employment status
Change in your spouses coverage or job
Class 1
The table below is an overview of our medical plan options. It also shows how annual deductibles, out-of-
pocket maximums, in-network ofce visits and prescription copays have been afected. Changes to the plans
are in Bold. Enhancements are in Blue.
UnitedHealthcare Plan
Choice Plus POS Choice Plus HSA
In-Network Out-of-Network In-Network Out-of-Network
Annual Deductible Single/
$1,000 / $3,000 $1,500 / $4,500 $2,000 / $4,000 $4,000 / $8,000
Coinsurance 80% 60% 80% 60%
Out-of-pocket Maximum
incl. ded.) Single/Family
$3,000 / $6,000 $6,000 / $12,000 $5,000 / $10,000 $8,000 / $16,000
Lifetime Maximum Unlimited Unlimited
Primary Care / Specialist
Ofce Visit Copay
$30 / $60 Ded. + Coins. Ded. + Coins. Ded. + Coins.
Hospital Inpatient: Ded. + Coins. Ded. + Coins.
Outpatient Treatment: Ded. + Coins. Ded. + Coins.
Emergency Room Copay $150 Copay Ded. + Coins. Ded. + Coins.
Rx Deductible
None N/A
Medical Ded.
Retail Prescription Drugs:
30-day supply (Generic/
$10 / $35 / $60 Not Covered $10 / $30 / $50 Not Covered
Mail Order Co-pay:
90-day supply (Tier 1/Tier
2/Tier 3)
2.5x Retail Not Covered 2.5x Retail Not Covered
Out-of-Network UCR Level N/A 110% of Medicare N/A 110% of Medicare
Dependent Age Denition Age 26 Age 26
United HealthCare
OptumHealth Bank
(26 Pay Periods)
Choice Plus
Choice Plus
Employee Only $57.93 $0.00
Employee + Spouse $448.14 $279.82
Employee + Child(ren) $313.34 $175.48
Family $774.50 $532.44
(24 Pay Periods)
Choice Plus
Choice Plus
Employee Only $62.76 $0.00
Employee + Spouse $485.49 $303.14
Employee + Child(ren) $339.45 $190.10
Family $839.04 $576.81
Any inconsistency between terms of this document and any plan document or insurance contract will be governed
by the plan document or insurance contract. Although the Company expects to continue these benet plans
indenitely, the Company necessarily reserves the right to amend, modify or discontinue the plans at any time.
Note: Your contributions are made through automatic pre-tax
payroll deductions. Contributing with pre-tax dollars means
that your contributions are deducted from your salary before
federal and state taxes are taken. This results in the lowering
of your taxable income, which in turn, reduces your taxes.
The Choice Plus HSA plan is part of a category of health coverage called Consumer-Driven Health Plans
(CDHP). This category is one of the fastest growing types of coverage in the country. The CDHP Health
Plan has two parts: the medical plan and the saving account.
How the Medical Plan Works
The CDHP covers in-network preventive screenings and routine annual physical at 100% (the deductible
does not apply for preventive services). The plan will pay 100% as long as the exam does not turn into
a diagnostic appointment.
You pay all eligible expenses until you reach the ded uctible (in-network: $2,000 for an individual, $4,000 for
family) and then the plan takes over at 80% coverage in-network until you reach the annual in-network out-
of-pocket maximum ($5,000 individual, $10,000 family).
You do not pay anything at the time of the visit. There are no copays in this plan except for prescriptions.
Prescription copays begin after the deductible is met. Your Explanation of Benets (EOB) from UHC
will give you the amount you owe.
You pay the negotiated contract rate for services until you reach your deductible (the same rate that
UHC would pay the provider). Coinsurance charges would apply after the deductible is met until you
reach your in-network out-of-pocket maximum for the year.
How the HSA Works
When you participate in the HSA Plan, you will have the opportunity to open a health savings account
at Optum Bank.
Here are a few HSA features:
The HSA enables you to set aside tax-free dollars to pay for eligible out-of-pocket expenses.
You can roll-over unused amounts to build savings to cover future medical expenses.
The money in this bank account is yours and is portable if you leave Saratoga Medical Center.
You get triple tax savings: The money you put in to your HSA is tax deductible; your savings grow
tax-free; any money you take out to pay for eligible medical expenses is income-tax free.*
NOTE: Health Savings Accounts must be used in conjunction with a medical plan like the CDHP. You cant
open one if you are participating in our POS plan, or are covered on a spouses plan that is not a CDHP.
You are permitted to contribute on a pre-tax basis an annual amount up to the IRS limit for 2014 of
$3,300 for Single coverage and $6,550 for Family coverage. IRS announced the 2015 limits to be $3,350/
$6,650 respectively.
If you are age 55 or older (but less than age 65, you may make an additional pre-tax catch up contribu-
tion of up to $1,000 per year per enrolled family member who is over the age of 55. Employees age 65
and above cannot contribute to a Health Savings Account due to Federal regulations.
Healthcare Plan
Pre-Tax Savings
1 2
The cost of the CDHP plan is typically 50% less
than traditional plans.
* Tax savings are an important consideration in under standing the value of an HSA versus a traditional plan. If you fund the
savings account through pay roll deduction, the dollars you spend will be pre-tax, representing another 25-30% tax savings
depend ing on your tax bracket. (This applies to federal taxes. Please note that state tax provisions apply to res i dents of Alabama,
California, New Jersey, and Pennsylvania.)
4 A Health Savings Account (HSA) is easy to contribute to and easy to use. Here are some important facts:
Q. What is a Consumer Driven Health Plan (CDHP)?
A A CDHP is a health insurance plan designed to involve participants more closely in making cost-
effective care decisions. The plan begins to pay for health care after your deductible is met. In return,
employee contributions are lower. Of course, your HSA is available to help you pay for the expenses
your plan does not cover.
Q. How does my HSA account work?
A If you elect to enroll in the HSA, you may make con tributions to the account up to the maximum
allowed by the IRS. A savings account in your name will be opened at Optum Bank. Direct contributions
that you make are deductible on your federal income tax return. You can then use the monies in that
account to pay for qualied medical expenses.
The 2014 HSA annual contributions maximums are: Individual HDHP coverage $3,300, Family HDHP
coverage $6,550, Catch Up contributions (age 55 or older) $1,000.
The 2015 HSA annual contributions maximums: Individual HDHP coverage $3,350, Family HDHP
coverage $6,650, Catch Up contributions (age 55 or older) $1,000.
Q. Who is eligible for an HSA?
A You must be covered by a Consumer Driven Health Plan (CDHP) to be able to take advantage of an
HSA. You cannot have other disqualifying health insurance cov erage (including a spouses plan) that
is NOT a CDHP. If you or your spouse participates in a regular Section 125 Health FSA (aside from
a limited use FSA), you are not eligible to participate in an HSA. You may not contribute to an HSA
once you are enrolled in Medicare.
Q. Can I cover my dependent who is over the age of 19 (24, if full-time student) on the High
Deductible Health Plan? Can they use the HSA funds?
A Health Care Reform legislation requires health plans of all types to cover adult children to age 26;
however, this coverage does not extend to permitting your HSA funds to be used for expenses incurred
by the covered child. If your child is not a tax dependent, he or she cannot use your HSA funds but
can open their own health savings account.
Q. What if I have paid for expenses for a dependent out of the HSA mistakenly and they were
not a taxable dependent?
A You can complete a Withdrawal Correction Form. The primary account holder can use the Withdrawal
Correction Form to pay back their HSAs for any eligible out-of-pocket medical expenses for their adult
Q. What expenses can I pay for with my HSA?
A Your HSA can be used to pay for most qualied expenses, as dened by IRS Code 213(d). These
expenses include, but are not limited to, medical plan deductibles, diagnostic services covered by
your plan, health insurance premiums (if you are receiving federal unemployment compensation),
LASIK surgery and some nursing services.
Help Desk
Contact the Benefts Help Desk
if you have questions about
your beneft plans, claims
assistance and more.
You can reach the Benefts
Help Desk toll-free at
(877) 373-6535 or email
8 am - 8 pm
Monday through Friday EST.
representatives are available.
Your HSA funds can also be used to pay for retiree medical expenses, COBRA premiums, Long Term
Care, as well as dental and vision expenses.
For the complete list of IRS allowable expenses, you can request a copy of IRS Publication 502 by
calling 800-829-3676, or visit the IRS Web site at and click on Forms and Publications.
Q. What happens to any remaining money in my HSA at the end of the year?
A Unlike other health spending accounts (for example, Flexible Spending Accounts), there is no use-
it-or-lose-it rule with HSAs. The money remains in your account to earn interest and is available for
use in subsequent years.
Q. Do I have to fund my HSA every year?
A No, you can opt to use any available rollover monies toward covered expenses. However, it is a good
idea to contribute to your HSA every year. This will lower your taxes and help you build a larger savings
for future health care expenses.
Q. What happens if I change my health plan?
A You own your account, so you keep your HSA, even if you change health plans. If you become enrolled
in a non-CDHP, you can no longer contribute to your HSA but can use the funds for qualied expenses.
Q: If I am enrolled in my spouses Medical Flexible Spending Account (FSA), can I enroll in
the HSA?
A. No. You cannot be enrolled in a FSA while enrolled in an HSA (unless the FSA is a Limited FSA ).
Saratoga Medical Center is not offering a Limited FSA plan.
Q. Are there survivor benets associated with my HSA?
A Your HSA may transfer to your spouse tax free, if you name them as your beneciary. If you do not name
a beneciary, or if you name someone other than your spouse, then the distribution will be taxable.
Q. Do I have to pay income tax on money in my HSA?
A Only if you use it for non-qualified purposes or make contributions in excess of your maximum
annual limit.
Q. How are HSA contributions treated from a federal tax standpoint?
A. Direct contributions that you make are deductible on your federal income tax return. Contributions
made by your employer are pretax and are not included in your taxable income.
Q. How does the state tax treatment of HSAs differ from federal tax treatment?
A HSAs (and the legislation that created them) are federal. As a federal program, each state can decide
whether to comply with the federal guidelines regarding the tax treatment of HSAs, or establish their
own rules. As a result, some income that may be tax-free at the federal level may not be tax free at
the state level.
Nearly all states now conform to the Federal Internal Revenue Code for HSA purposes. However,
there are still a small number of states that do not accept or follow the federal tax treatment for HSAs.
Consult your personal tax advisor for information on your specic situation.
Note: The above information is designed only to give general information on this topic, and is not
intended to be a comprehensive summary of the subject covered or provide tax or legal advice.
HSA F.A.Q. Continued
Call the Benets Help Desk toll-free
at (877) 373-6535 or email