Benefits 101: Choosing the right plan for you

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Benefits 101Choosing the right plan for you
Federal Employee Plans

Disclaimer - This presentation is brought to you
by Aetna Life Insurance Company and/or its
affiliates to educate you on the Aetna plan
options available to you through the Federal
Employees Health Benefits Program (FEHBP) or
Federal Employees Dental and Vision Insurance
Program (FEDVIP). The Aetna HealthFund
(HDHP/CDHP), the Aetna Open Access HMO Plan, the
Aetna Dental PPO Plan are not endorsed by the
U.S. government and/or its federal agencies.
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Federal Employee Plans
FEHBP Features

• Choice of Plans and Coverage
• No waiting period
• No pre-existing condition limitations
• Salary deduction
• Government contributes 72
• Annual enrollment opportunity

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Federal Employee Plans
Common Healthcare Terms

• Provider/PCP
• Referral
• In-Network vs. Out-of-Network
• Co-pay
• Coinsurance
• Deductible

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Federal Employee Plans
Making Sense of the Acronyms!

• Plans and Coverage
• PPO
• FFS
• HDHP with an HSA
• CDHP w/ HRA
• HMO
• And theres more
• High, Basic, Standard
• FSA
• FEDVIP

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Federal Employee Plans
Making Sense of the Acronyms!

• Plans and Coverage
• PPO (Preferred Provider Organization)
• FFS (Fee For Service)
• HDHP with an HSA (High Deductible Health Plan
  with a Health Savings Account)
• CDHP w/ HRA (Consumer Driven Health Plan with
  Health Reimbursement Arrangement/Account)
• HMO (Health Maintenance Organization)
• And theres more
• High, Basic, Standard (Same Insurance Company
  might offer different plan options with different
  costs)
• FSA (Flexible Spending Account)
• FEDVIP (Federal Employee Dental Vision Insurance
  Plans)

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Federal Employee Plans
Comparing the types of plans PPO vs. HMO

• HMO
• Must live or work in the geographic area to
  enroll
• You must use network providers, except in
  emergencies
• Most have no deductibles or coinsurance, just pay
  co-pays

• PPO
• Nationwide network of preferred providers
• Allows you to choose providers in and
  out-of-network
• No referrals
• Deductible Coinsurance

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What do you get for your healthplan dollars?
Federal Employee Plans

• Plans with no referrals
• Plans with no deductibles
• Tax Savings
• National networks
• Out of Pocket Maximums
• Dental benefits included
• Vision benefits included
• Discounts on
• Weight loss programs
• Massage, Chiropractic and Acupuncture
• Gym Memberships
• Referrals required for California HMO.

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Federal Employee Plans
Compare. Theres more to it than just the premium
these days
Self Example Only Common PPO Plans PPO Network Plans (CDHP) Your Plan
Employee Premium Contribution(Bi-weekly premium x 26) 1,825 1,052
Carrier deposit to your fund (amount if any) 0 1,250
Deductible HospitalCo-payment 300 Annual 200/Admission 750
In-Network Coinsurance Level 90 90
Catastrophic OOP Maximum (In Network) 5,000 3,000
Are there tax saving? Can you carry over unused
funds? Is preventive care free?
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Federal Employee Plans
Example of CDHP Plan with PPO Network
1) Medical Dental Funds Medical Single-
1,250 / Family-2,500 Dental Single- 300 /
Family-600
100 Preventive Care In-Network
2) Deductible Medical Single- 750 /
Family-1,500

• 3) Coinsurance
• Plan pays for covered services
• In-network 90
• Out-of-network 60
• Rx 10/25/40 (your copay)

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Federal Employee Plans
Example of HDHP Plan with PPO Network
Monthly Deposits Single- 62.50/monthFamily-
125/month
Member Contributions(optional) Single- up to
2,250/year Family- up to 4,450/year
100 Preventive Care In-Network
2) Deductible In-network Single- 1,500 /
Family-3,000 Out-of-Network Single- 2,500 /
Family- 5,000

• 3) Coinsurance
• In-network 90/ 10
• Out-of-network 70/ 30
• Rx 10/25/40

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Federal Employee Plans
FFS PPO Network Plans
In-network Benefits Using participating
facilities and Providers -ARicher benefit
level -Mostly co-insurance -Negotiated Fees/Rates
Out-of-Network Benefits Non-Participating
Providers -more cost sharing
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Federal Employee Plans
HMO Network Plans
In-network Benefits Must use participating
facilities and Providers -Mostly
co-payments -Possible Referrals -MUCH less
paperwork!
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Federal Employee Plans
What about Perks?

• Common Special Discounts

• Eyewear Vision services
• Weight loss programs
• Fitness programs
• Chiropractic Acupuncture services
• Massage Therapy
• Vitamins
• Mail Order Rx

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Federal Employee Plans
Do you need a separateDental or Vision plan?

• What dental and vision benefits are in your
  Medical Plan
• Screenings?
• Cleanings?
• Fillings?
• Reimbursement for eyewear?

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Federal Employee Plans
How can you choose the right plan?

• Compare Plans and Plan features, like
• Premiums, Coinsurance, Copays and Network
• Tax Savings, Rollover feature
• Prescription drug coverage Generic drugs and
  Mail Order benefit
• Understand Vision and Dental benefits included
  with Medical Plans
• Discounts Access to discounts that could save
  money on services and items you use already!

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Federal Employee Plans
Now what?

• Research now before Open Season
• www.OPM.gov/Insure
• www.benefeds.com
• Do the math now Budget your expected medical
  expenses
• Do you now how to enroll?

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Federal Employee Plans
Questions?

• Thanks for coming!

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