SHBP 2011 HRA Questions

Hello,

It is time to make a insurance decisions for 2011 and I have to make sure that I pick HRA plan that will cover WLS.  I looked at some information today off web that confused me about HRA.
1.  It said SHBP contribute dollar credits.  Does that mean that they give you some money or is this the money I choose to put in monthly that will be on account at beginning of year.
2.  Then you pay rest of deductable. 
3. Then it says after that you only pay coinsurance.  What is co insurance.  

I also want someone from both Cigna and UHC to tell me about how their plan is working out for his or her family and also how much you contribute to HRA plan monthly. 

Ok Do you pay full amt each time yhou go to doctor or do the doctor already know what you need to pay.

Any information provided will be appreciated because I am trying to be prepared.

Ok here is how it works...


1. You have an out of pocket max of $2500 with the HRA.

2. SHBP contributes $500  ..... so your out of pocket max is truly only  $2000

3. Complete the online Health Assesment and earn $125 ... so your out of pocket max is  down to $1875 Out of pocket max.

                      OK, GOT THAT SO FAR...


Now, you have a deductible of  $1100.  That means you will need to spend $1100 out of pocket before Cigna contributes.   

So, for the deductible, subtract the $500 state contribution and the $125 for the health assesment leaving you $475 out of pocket deductible.

They will use your $500 and the $125 before they charge you 100% for anything... 


After you pay the $475, your co-pay will be about 15% of whatever prescription or physician co-pay.   I had a Dr. visit  the other day that was $60, my co-pay was $9.    The $9 went toward my out of pocket max...


Once you have reached the deductible, you will continue to pay the co-pay 15% until you get to the $1875.  Then everything is FREE!!!


EXAMPLES:
So if you have your DS 1-1--2011 hypothetically and have not had any other medical bills...

DS is $35,000
you haven't met the deductible, but amount is larger than $1100, so it doesn't relaly matter
you pay $1875 (out of pocket max) Cigna pays rest


You have DS 3-1-2011
DS is $35,000
15% is $5250
You've spent $775 on pre-op testing, medicine, etc.
You pay $1100 ( out of pocket max) Cigna pays rest


You have DS 9-1-2011
DS is $35,000
15% is $5250
You've spent $1870 on pre-op testing, co pays, etc
You pay $5 for (out of pocket max) Cigna pays rest



I know it's confusing, but think of it this way... You know you are gonna have to spend $1875 out of pocket.  

So, if you are having your surgery early in the year, either have that $1875 set aside "or" open a flex spending account  and have $156.25 per month deducted each month (156.25x12=$1875).  This will be pre-tax, so it does not hurt as much as you think it will.

The cool thing, is with the flex account ALL the $1875 will be loaded onto your flex card 1/1/2011, so you will have it to use right away, it will kinda be like you're paying on it every month, but they give you ALL of it up front.

Also you can use the flex card for vision, dental, pre-op testing, co-pays,  travel expenses for medical care including lodging and mileage, vitamins(with Dr. note), etc. So, even if for whatever reason you didn't us it on the surgery, there are other things you will use it for.


Since you are getting your DS early next year, you should hit your out of pocket max right away. Then, the rest of the year you will have $0 co-pays for everything!!! That will be great.

This is the breakdown for a single person.  I'm not sure how it works for a family plan???

I also am clueless about how the High deductible option works, since everyone on here has the HRA?

If we do not use all of our money in spending account will we loose it.

Yes, that is correct.  Use it or lose it. 

LaShelle covered it beautifully!  She is Cigna (I think)  and I am UHC.  UHC workes exactly like Cigna. 

One thing, do not get the HRA account and a flex spending account confused.  Many of my coworkers are confused about it. 

The flex spending account is the money you contribute each month pre tax.  It is what you want to put away to cover your out-of-pocket expenses.  Regardless of what they take each month, the full amount is available on January 1, 2011. 

Your HRA account is the money the state is crediting you with for signing up with a higher deductible policy.  In LaShelle's examples, it is the $500 and the $125 for the health assessment and physical examination (which could also be a well woman checkup).  Those monies are spent first before you are charged for anything. 

My example for my policy with my son:

My deductible for Employee + Child(ren) is $1900.

My HRA credit for the year is $1000.  I received a $100 credit for having a well woman exam and a $25 credit for the health assessment.  My total credit is $1125. 

My Out of Pocket Maximum is $4100. 

If I had surgery in 2010, I would need $2975 ($4100-1125) in my flex spending account.   This would come out monthly at $248 pre tax. 

It can be a shocker switching to HRA.  Any medications and doctor visits before meeting the deductible will be charged at a full but negotiated rate. 

Also, with UHC (it may be the same with Cigna) most places will file the insurance and bill you what balance is owed.  The only place I ever had to pay at the time of visit was my first  cardiologist visit.  The second time I went in, I whipped out a little card UHC sent me to show any health care personel about billing first, they made a copy of it, and billed me that visit.  I was getting way to close to my out of pocket maximum to play with having credits at offices I would never go to again.  Oh yeah, I also had to pay $150 at the ER earlier that same year for my son, but the ER may fall under different rules.  

I hope this helps!  Good luck!

Ok now am so it is 2 diffrent cards one is HRA that I do not contribute to and the other is Flex where I can have my money upfront the first of the year and have it taken out of check monthly.  OK with that being said I would have to have $350 month taken out of check for flex because I have family coverage to assure I have all the money needed for the year.  How much did your  pay check change or did it even out with the money not being taxed.  Also how much did the HRA plans cost.  Because I know it has to be lest than what we are paying now I currently pay $305 just for health.  Did most of you keep vision and other insurance or did you drop other insurances.  Thanks in advance for assistance. 

I want to be able to have surgery and not have money or have poor preperation be the cause of my surgery not being successful.

Thanks

My medical insurance cost this year $185.30.  That is employee + children.  Employee + Spouse + Children is more.  We have already received notice that all cost will go up 10-16%.  I did not drop any other insurance. 

As for the flex spending money, it averages out to be $60 on the $100.  So if you take out $350, you would see a decrease in pay of only about $200 - $250. 

The HRA account is not an actual card.  It is an account that UHC/Cigna will keep up with.  

Thans ladies do anyone know if they have posted the new rates also do the flex spending account roll over or do you loose it if you do not use it.

They e-mailed the new rates to us.  Will e-mail them to you.  The flex spending card scared me a little too, but I really did not miss the money that much believe it or not. Plus it was available for me to spend Jan 1.  It was really a blessing because I wouldn't  have always had the money for co-pays and testing, etc.

Think of it as interest free pre-tax financing repaid with an automatic payroll deduction. I actually love it.  I even renewed it this year. it comes in handy for unexpected stuff and dental visits, getting my contacts, prescriptions, etc.

Also if you are travelling for your surgery, you can get reimbursed for your hotel and mileage, etc.

Do be prepared for the rates and the co-pays to increase!!!  I believe 10% And this while they continue the damned furloughs!  Girl, I need a new job YESTERDAY!


One thing to mention too is the doctors are always supposed to bill you for your co-pays because it has to go through claims before the doctor knows exactly what you owe thrm. You sometimes have to insist on this. For a while at the begening of the plan year your co-pays will be $0 until you spend all the shbp $500...

Thanks ladies  for your assistance and Lashelle for information provided.  OK stupid but serious question my maximum out of pocket for family is $5,700 after subtracting $1,625 for HRA and that leave $4,075  of maximum out of pocket to pay.  My deductible is $2, 750 does that mean I have to have $4, 075 in my spending account.  Or would I have deductible and 15% of what is left after after deductible is met which is $2,950 15% of that is $44.50.  Which would mean I would have to have $1, 542.50 in flex spending account.  I want to have all the money that I need for the year put away and covered so I have nothing to worry about and no surprises.  And yes this insurance is killing everyone especially with no raises.