It’s open enrollment season again and the Group Insurance Trust has taken the opportunity to strengthen its offerings with two new medical plans that give members even more flexibility in fine tuning their coverage through different levels of deductibles, co-pays, and premiums. Protect 40, a new co-pay plan, features a higher deductible and a higher $40 co-pay than the popular Protect 35 plan but lower than the Protect 45 copay plan. Protect HSA 3,500, a new HSA-eligible plan, features higher deductibles and lower member-paid coinsurance than the Protect 1500, 2500 and 2850 HSA plans with premiums approximating those of the Protect 45 copay plan.

As in previous years, the annual open enrollment period—continuing this year from November 1 through December 16—allows CalCPA-member firms a variety of options. Firms can offer employees the Trust medical, dental, and vision plans as a new benefit, while employees who had previously declined coverage can also enroll at this time. Current subscribers can take advantage of this opportunity to review their insurance needs, consider the new plans, and/or make any changes they have contemplated during the year. Finally, keep in mind that while most employers offer a single plan, your firm may elect to offer a combination of ProtectPlus co-pay, ProtectPlus HSA and Anthem Blue Cross HMO plans.

Choosing the Right Plan

While reviewing all the available choices might seem a daunting task, a new set of video presentations featured on the ProtectPlus website has just made it easier—even a little entertaining. Using the Video Toolbox feature on the homepage, you can get a video summary for each plan. The videos are segmented into topics such as coinsurance and deductibles so you don’t need to watch the whole presentation to get the information you are looking for. New videos are being added weekly, so be sure to check back frequently. Of course, you can still access plan information in written form. The 2012 EZ Guide is available online as an easy-to-read Summary Plan Benefits Comparison Chart. Once you’ve selected the plan or plans you’re interested in, you can get quotes based on the demographics of your firm using the Get a Quote Tool. If you have questions click on Ask the Expert and submit your query to the Trust staff. While they promise to get back to you within two days, you often receive an answer within the hour.

New Pharmacy Benefit Manager

Beginning January 1, 2012 ProtectPlus co-pay and HSA plan pharmacy benefits will be serviced by Medco rather than Express Scripts. (Please note that this change does not affect HMO participants.) Current subscribers who aren’t making any changes in their coverage should receive a welcome packet in the mail from Medco in the middle of December. Included in the mailing will be a welcome letter describing Medco services as well as your new pharmacy benefits ID card, which you will need to obtain your prescription drugs.

Between now and January 1, 2012 you can access the Medco open enrollment website to look up the cost of your prescription drugs pre- and post-deductible under the Medco pharmacy plan. After January 1, use your new Medco ID number to register at Medco.com to access the Medco mail order pharmacy and your personal prescription drug records. Although copays and coinsurance levels are not changing, differences between the old and new prescription drug formularies may result in an increase or decrease in your out-of-pocket costs.

Members who currently use specialty prescription medications for complex conditions will receive a letter introducing them to Accredo, Medco’s provider of specialty drugs. The letter will include information on contacting Accredo’s specialty pharmacists and nurses toll-free, 24 hours per day, 7 days a week. There is also an explanation of procedures for transitioning your specialty prescriptions and for scheduling regular deliveries.

Responding to the growing popularity of Health Savings Account eligible medical insurance plans (commonly referred to as HSAs), the Group Insurance Trust (CPA ProtectPlus) has expanded its current offerings with a third such plan, Protect HSA $2,500.

With premiums approaching the lower end of ProtectPlus co-pay plans, the new plan offers significantly greater benefits than the two already established Protect HSA plans.

As with all HSA-eligible plans, Protect HSA$2,500 features a high annual deductible that must be satisfied before benefits are paid by the plan. For the new plan the deductible is $2,500 per individual and $5,000 per family.

Though not greatly different from HSA $2,850 in respect to the deductible, the difference in benefits is large indeed.

After the deductible is met HSA $2,500 provides 100 percent coverage for all in-network office visits, professional services, emergency and in-patient hospitalization, hospital and outpatient surgery, lab costs and more.

It also pays 70 percent of the negotiated fee for all these services when provided out-of-network. In contrast, HSA $1,500 and $2,850 pay 70 percent of negotiated fees for in-network services and 50 percent of negotiated fees out-of-network.

Those considering an HSA eligible plan should keep in mind some important facts about how these plans work. First, annual deductibles and out-of-pocket maximums are applied somewhat differently in most HSA eligible plans than they are in traditional copay plans. Most copay plans “embed” the individual deductible within the family deductible.

This allows one family member to meet his/her deductible or out-of-pocket maximum before the entire family deductible or out-of-pocket maximum is met. However, most HSAs do not embed individual deductibles or out-of-pocket maximums within the family deductible and out-of-pocket maximum amounts. This is done in part because of the regulations governing HSAs and in part to reduce premium costs. As a result, for HSA subscribers covering family members, the entire family deductible and out-of-pocket maximum must be met before any family member’s deductible or out-of-pocket maximum is considered met.

It’s important to be clear about the two elements involved in HSAs that are commonly confused. This confusion stems in large part from the misleading, generic use of the term HSA.

The principle to keep in mind is that the law granting HSA tax benefits intends for subscribers to combine a high-deductible health plan (HDHP, but also called an HSA eligible plan) with a tax-exempt trust or custodial account through a financial institution. The latter is the “health savings account” that gives the entire program its name.

There are now many institutions that have HSA trustee account programs, and ProtectPlus HSA subscribers are free to use the financial institution of their choice. However, as a convenience, the Trust provides access to Health Savings Accounts through Bank of New York Mellon, US Bank, and, most recently, Alliant Credit Union. For more information regarding ProtectPlus HSA plans and Health Savings Account program visit CPA ProtectPlus, or simply compare HSA Plans here.

Also See “HSA Factors To Consider (Part 1 & 2)” for more information.