2021 CDHP CDHP / HSA 101

CDHP / HSA 101 2022

2021 CDHP 101

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2022 & Beyond

• Our long-term strategy is to encourage

consumerism among plan participants and

eventually eliminate the PPO in favor of Consumer Driven Health Plans (CDHP).

• Keeping that strategy in mind, we wanted to give you options for your health coverage.

– We provide two CDHP options and a PPO option.

– Both the CDHP and the PPO are offered in the United Healthcare and Blue Cross Blue Shield networks.

– If you are in the St. Louis, Springfield or Joplin markets you will also have the Mercy network option offering In-Network benefits only.

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2021 & Beyond

Health Plan Choices:

Why the CDHP/HSA?

• Promote better consumerism

• Tax planning tool: Pre-tax contributions to a Health Savings Account (HSA)

• HSA dollars are yours

• Retirement health planning

• Preventive Care coverage at 100%

• More flexibility – how you pay for services

• Lower premiums

Why

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Health Plan Choices:

What’s the Difference?

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Health Savings Account (HSA)

Pay full cost of services up to Plan Deductible then Coinsurance until out of

pocket max

Preventive care covered at 100%

Plan Deductible &

Coinsurance (Includes all eligible medical and prescription

drug expenses)

Wellness Care

Health Care Expenses

Office Visit Copays RX Copays ER Copays

Preventive care covered at 100%

Plan Deductible &

Coinsurance

Differences

CDHP/HSA vs. POS/PPO

Common Health Care Expenses and

Minor

Emergencies

How the POS/PPO Plan Works

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Plan pays 100% after member reaches

$4,000 / $8,000* Out of Pocket Maximum

Assumes in-network providers

Deductible $750 / $1,500*

Assumes in-network providers

Health Plan pays 80%,

Assumes in-network providers

You can contribute pre-tax dollars to a Health Care ‘Flexible Spending Account’

to help pay for current year qualified health expenses

Copays: PCP - $25 Specialist - $45 Emergency - $150 Rx - $10/$30/$50/$100

*These do not count toward your deductible, but do count toward the out of pocket maximum*

*Single coverage / Family coverage

De duc tibl e

O ut o f P oc ket M axi m um 10 0% pr ev en tiv e c are co ve rag e (in -ne tw ork pr ov ide rs)

Member pays 20%

Assumes in-network providers What Commerce pays

What you pay

POS/PPO

How the CDHP/HSA 1500 Plan Works

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Plan pays 100% after member reaches

$3,500 / $7,000* Out of Pocket Maximum Health Plan pays 80%,

After Deductible

Member Pays 100% of allowable medical and prescription drug costs

until you reach your deductible Deductible $1,500/3,000*

*Single coverage / Family coverage

Members can use their HSA monies to cover medical costs up to

& including their deductible and all other out of pocket expenses.

10 0% pr ev en tiv e c are co ve rag e (in -ne tw ork pr ov ide rs)

Member pays 20%

Up to out of pocket max What Commerce pays

What you pay

De duc tibl e Af ter R ea ch D ed uc tib le

Your Contributions to HSA

Commerce HSA contributions ($250 / $500)

Health Savings Account

CDHP/HSA

1500

How the CDHP/HSA 2500 Plan Works

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Plan pays 100% after member reaches

$4,500 / $7,350* Out of Pocket Maximum Health Plan pays 80%,

After Deductible

Member Pays 100% of allowable medical and prescription drug costs

until you reach your deductible Deductible $2,500/5,000*

*Single coverage / Family coverage

Members can use their HSA monies to cover medical costs up to

& including their deductible and all other out of pocket expenses.

10 0% pr ev en tiv e c are co ve rag e (in -ne tw ork pr ov ide rs)

Member pays 20%

Up to out of pocket max What Commerce pays

What you pay

De duc tibl e Af ter R ea ch D ed uc tib le

Your Contributions to HSA

Commerce HSA contributions ($500 / $1,000)

Health Savings Account

CDHP/HSA

2500

2022 Pricing Comparisons

costs PPO more than 2X as much

The Dollars – Per Paycheck

The Sense -

Key Difference with the CDHP = Less upfront cost + proactive planning on usage

Coverage

Per Month Savings 1500

Plan Annual Difference

Per Month Savings 2500

Plan Annual

Difference Employee $ 125.84 $1,635.92 $ 142.64 $1,854.32 Employee +

Spouse $ 329.56 $4,284.28 $ 372.72 $4,845.36

Employee +

Children $ 222.90 $2,897.70 $ 251.68 $3,271.84

Family $ 482.98 $6,278.74 $ 545.32 $7,089.16

* Based on 2021 monthly premiums for UHC plans

Coverage CDHP 1500 CDHP 2500 PPO

Employee $ 45.55 $ 37.15 $ 108.47

Employee +

Spouse $ 119.85 $ 98.27 $ 284.63

Employee +

Children $ 80.30 $ 65.91 $ 191.75

Family $1 74.38 $ 143.21 $ 415.87

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2021 Pricing

2022 Plan Design Comparison

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Plan Design

Plan Details – Including Deductibles & Coinsurance

CDHP + HSA Options

PPO Plan

Plan 1500 Plan 2500

Network In Out-of-

Network In

Network Out-of-

Network In

Network Out-of- Network Company Contribution to HSA

(Individual/Family) $250/$500 $500/$1,000 N/A

Annual Deductible (Individual/Family) $1,500/$3,000 $2,500/$5,000 $750/$1,500 $2,000/$4,000

Out-of-Pocket Maximum

(Includes Deductible) $3,500/

$7,000 $5,500/

$11,000 $4,500/

$7,350 $9,000/

$18,000 $4,000/

$8,000 $7,000/

$14,000

Coinsurance (you pay) 20% 50% 20% 50% 20% 40%

Lifetime Maximum Unlimited Unlimited

In Network vs. Out of Network Benefit Coverage

Plan Benefits

In Network

both CDHP Plans Out of Network both CDHP

Plans In Network _Network ^Out-of-

UHC/BCBS/Mercy UHC/BCBS UHC/BCBS

Mercy UHC/BCBS

Preventive Care Covered at 100%

No Deductible Not Covered Covered at 100%

No Deductible Not

Covered Primary Physician Office Visit Deductible & Coinsurance Deductible & Coinsurance $25 Copay Deductible &

Coinsurance Specialist Office Visit Deductible & Coinsurance Deductible & Coinsurance $45 Copay Deductible &

Coinsurance Inpatient Hospital Services Deductible & Coinsurance Deductible & Coinsurance $200 Copay then

Coinsurance Deductible &

Coinsurance Outpatient Hospital Services Deductible & Coinsurance Deductible & Coinsurance Deductible & Coinsurance Urgent Care Deductible & Coinsurance Deductible & Coinsurance $50 Copay Deductible &

Coinsurance

Emergency Room Care Deductible & Coinsurance Deductible & Coinsurance $150 Copay

Retail Prescriptions (30-day supply)



Tier 1/Generic



Tier 2/Brand Preferred



Tier 3/Brand Non-preferred



Tier 4/Specialty

Deductible & Coinsurance Not Covered

$10 Copay

$30 Copay

$50 Copay

$100 Copay

Covered Not

Mail Order Prescriptions (90-day supply)



Tier 1/Generic



Tier 2/Brand Preferred



Tier 3/Brand Non-preferred

Deductible & Coinsurance Not

Covered $25 Copay

$75 Copay

$125 Copay

Covered Not

Single Family

HSA Maximum Contribution 2021 $3,650 $7,300

HSA Catch Up (Age 55+ Eligible) $1,000 $1,000

HSA Basics

• Contribution limits are combined employee and employer

• Single deposit account for employee and employer

• Employee contributions are pre-tax.

• Employer contributions are not taxable to the employee

• HSA Balance is always yours-rolls from year to year

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The Basics

HSA Eligibility

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• Must be covered under a Consumer Driven Health Plan to contribute to an Health Savings Account

• Can not be covered by another health insurance plan (Spouse, Medicare)

• If you are age 65 or older and have not enrolled in any

portion of Medicare, you are eligible to open a health savings account and contribute on a pre-tax basis

• You or your spouse are not enrolled in a health flexible spending account at any time you are participating in an HSA (unless it is/was a limited use spending account

designed to work with an HSA.)

• Can have separate coverage for Dental, Vision, Voluntary Benefits, Life, Disability, and Long Term Care

Eligibility

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Limited Use Flexible Spending Account/ FSA

• Can Be Used for Dental and Vision Claims Only

• $2750 Annual Limit on Medical FSA

• Same Process and Rules as Traditional Medical FSA

• No Impact on Dependent Care Accounts

Limited Use

Fidelity – Health Savings Account Vendor

• When paired with your Commerce CDHP, the Fidelity HSA can help you meet the rising cost of health care.

– Online access, account management and BillPay through Fidelity’s website (NetBenefits).

– Full spectrum of investment options available.

– Integration with claims information (medical, dental, vision, pharmacy) allowing for management & payment via desktop or mobile app.

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Fidelity

HSA

Advantages of a Health Savings Account

• Multiple tax advantages.

– Contributions are tax deductible – Interest accrued is tax-free – Monies can be used tax-free

• Accounts are portable – meaning they stay with you even if you change jobs or leave the workforce.

• Unspent funds can remain in your account year after year, there is no “Use It or Lose It” rule.

• HSA’s convert to typical individual retirement accounts once you reach age 65.

– Withdrawals made for qualified medical expenses remain tax-free withdrawals.

– Withdrawals made for non-qualified expenses are subject to taxes.

• Even though Medicare Part B premiums are deducted from your Social Security benefits, you can reimburse yourself from your HSA.

– You can also use HSA money to pay Medicare Part D premiums as well as premiums for Medicare Advantage plans (but not Medigap).

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Advantages HSA

Frequently Asked Questions and Answers

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Eligibility and Claims Submissions:

• Can a Spouse and Employee both have an HSA at their employers?

– Yes, both can contribute up to the single maximum if there are no dependents

– If one covers their dependents, combined contributions for both cannot exceed the annual family maximum.

• Can funds be used to cover out-of-pocket medical expenses not covered by the health plan?

– Yes, the HSA covers expenses similar to the Medical FSA.

• Do I receive a debit card?

– Yes, the debit card will be issued by Commerce Bank.

• Can the monies be used to pay Medicare A,B,C, and D premiums?

– Yes.

• Are submitted claims reviewed?

– No, you are responsible for ensuring expenses are qualified and that you maintain documentation on the expense.

• What if I don’t have enough in my account to cover a claim?

– Different from Flex Accounts, the funds must be in your HSA account in order to use them.

FAQS

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What can I expect my costs to look like:

• Is Preventive Care covered at 100%? What falls under preventive care?

– Yes. Covers all preventive benefits under the Patient Protection and Affordable Care Act (PPACA). Refer to www.healthcare.gov for

guidelines.

• What costs go toward meeting my deductible?

– All expenses paid by you for covered medical and prescription services will count towards meeting your annual deductible.

Frequently Asked Questions and Answers

FAQS

Frequently Asked Questions and Answers

• How will I know the cost of the services or prescriptions I have to pay for?

– For prescriptions you can contact CVS Caremark and question the cost of your prescription.

– For medical services, you can obtain a determination of benefits from the carrier so that you will know up-front your costs.

• I have heard that I will spend more money in the CDHP? Is that true?

– It depends. You need to look at your individual situation and costs to compare.

• Are tax information / documents provided for tax filing?

– Yes, information will be provided for your filing.

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FAQS