Monday, October 29, 2012

Health Insurance 202: Advanced Health Insurance Terms

In terms of health insurance, do you know what EOB stands for?
“Elephant obesity?”

 How about PDL?
“Public display of love?”

And do you know what an HSA is?
“Home shopping association?”

When UHC-TV cameramen asked sidewalk volunteers to define some health care acronyms, people got pretty creative with their answers.

You may recall that when I blogged a few weeks ago about some of the basic health insurance terms we asked people about on UHC-TV, our volunteers were able to give pretty good answers for terms like “premiums” and “copays.”  But when we started asking people to explain some frequently used but less known terms, most people couldn’t quite come up with the right answer, although they did show off their sense of humor.

So whether you’re sitting down to choose your health plan for the upcoming year, are trying to better understand your current plan, or just want to brush up your knowledge of the health care options available to you, here are some terms you should know:
  • Explanation of Benefits (EOB): The EOB is a statement that can be sent to you electronically or in the mail.  It breaks down the exact benefits provided, the reimbursement amounts allowed, deductibles, coinsurance or other adjustments taken as well as the net amount paid.
  • Prescription Drug List (PDL):  Your EOB should include a list of prescription drugs covered under your plan and how much you pay for them.  Because generic drugs work just as well as prescription drugs but usually cost less, the PDL may assign different payment amounts to generic and brand-name medications.
  • Health Reimbursement Account (HRA): An HRA is an account that may be set up by your employer to which your employer contributes to help you cover medical expenses you would normally cover yourself.  Employers decide whether to let the remaining balance carry over to the next year.
  • Health Savings Account (HSA): HSAs are typically paired with a high-deductible health plan and allow you or your employer to contribute pre-tax dollars from your paycheck into an account to pay for qualified medical expenses.  The funds are owned by you, so you can decide to roll them over from year to year and keep the account even if you change employers or benefits. If your employer does not offer an HSA, you can set one up on your own.
  • Flexible Savings Account (FSA): Employers may set up flexible savings accounts to allow employees to contribute pre-tax dollars from their paychecks each year to pay for medical expenses not covered by their plan, such as deductibles, copays, and coinsurance.  Unused funds do not carry over from year to year, so it’s important to plan carefully.
Data from a UnitedHealthcare study revealed that when reviewing their health options, 50 percent of people spend only an hour or less reviewing their choices.  But in many cases, consumers who spend quality time reviewing their health plan options can find ways to save money – whether it's through selecting a plan that better fits their expected health costs in the coming year, making sure their doctors are in their insurer's care provider network or evaluating prescription drug coverage.

So check out to learn more about health care terms, watch videos with tips on healthy lifestyles, see answers to common questions on Medicare, hear advice from medical experts, and even have a few laughs.

Monday, October 22, 2012

Leadership Matters

How do we know that we’re headed in the right direction?

It’s a question on the minds of a lot of us in the health care industry who are working to iron out the details of implementing health care reform.  And although none of us has a crystal ball into the future, I believe that our best guide to navigate what comes our way will always be to follow our values.

Last week, I had the opportunity to join CEOs from hospitals and health insurance companies in New Jersey to talk about “How Leadership Matters to your Organization in a Time of Reform."  The panel discussion was a part of the 36th annual Institute of the New Jersey chapter of the Healthcare Financial Management Association.  This year’s institute was held in cooperation with the Metropolitan Philadelphia Chapter.  Joining me on the panel were the CEOs from MagnaCare, Engelwood Hospital Medical Center, Children’s Specialized Hospital, Amerihealth and University Medical Center of Princeton.     

I heard a lot from my fellow panel members about what they are doing to address the changes of the healthcare system and what they are doing to encourage positive leadership.  And yes, the financials drive a lot of what we have to do.  But real leadership in healthcare is about more than just building the largest physician network, establishing the most technologically advanced data processing system or simplifying the health insurance experience for the consumer, all of which UnitedHealthcare has done.  It’s about more than just what we’re doing – it’s about how we’re doing it.

And that takes me back to our core values.  I strongly believe the best leaders will be measured not only by their innovation but by their ability to inspire their colleagues and employees at every level to incorporate the company’s core values in the decisions they make each and every day.

At UnitedHealthcare, that means that we’ll always keep the following values top of mind in whatever we do:
  • Integrity.  We will make honest commitments and work to honor them, without compromising ethics.  When we make mistakes, we will have the courage to acknowledge them and do whatever is needed to address them.
  • Compassion.  We will strive to listen with empathy, and try to walk in the shoes of the people we serve and the people we work with throughout the healthcare community.  We celebrate our role in serving people in an area as vitally human as their health.
  • Relationships.  We will build trust by cultivating relationships with truthfulness, integrity and active collaboration.  We encourage the variety of thoughts and perspectives that reflect the diversity of our markets, customers and workforce.
  • Innovation.  We will pursue continuous, positive and practical innovation, using our deep experience in health care to be advocates of change and to use the insights we gain to invent a better future that will make the health care environment work and serve everyone more fairly, productively and consistently.
  • Performance.  We are committed to delivering excellence in everything we do and challenge ourselves to strive for even better outcomes each day.
These are tough times for the health insurance industry.  We must work together to figure out a way to make profound changes to a system that has been in place for decades.  We must do a lot of things and we must do them all well.  At UnitedHealthcare our work is shaped by our core values and they will inform everything we do as a company and as employees as we address the health care challenges of today and the future.

For more information about UnitedHealthcare’s mission and values, click here.

Tuesday, October 16, 2012

Giving 7th Graders a Head Start

When you hear “head start” I’m pretty certain most people think of toddlers getting a jump on kindergarten by learning, through play, in a pre-school environment.  But at the Westfield YMCA in New Jersey, they had a different kind of head start in mind when they launched their 7th Grade Initiative program five years ago.

As kids grow into teens and begin making more of their own choices including how to spend their time, many parents only cross their fingers and hope that their teens will make healthy decisions.

That’s why UnitedHealthcare stepped in to support the Westfield Y in the development of a 7th Grade Initiative program that helps pre-teens learn to make healthy choices as they begin to make their own decisions about nutrition and exercise.

The 7th Grade Initiative gives students a free Pre-Teen Plus membership to the YMCA, allowing them access to the YMCA’s exercise equipment, pool and gym.  The program also includes fitness testing, Friday night teen nights, nutrition education, exercise classes, and family activities.

Last Wednesday, we kicked off the 2012 – 2013 7th Grade Initiative at the Y with a high-energy party, complete with fitness testing, health experts, a climbing wall and healthy snacks.  We were thrilled to see more than 100 seventh grade kids and their families come out and sign up for the program.

Research indicates that seventh grade is a critical junction in a child’s development of attitudes and behaviors regarding body image, nutrition and self esteem.  The goal of the 7th Grade Initiative is to help kids pass through this critical time of development with a healthy self-image and a thorough understanding of the importance of exercise and healthy nutrition that will last students throughout their teen years and into adulthood.

The signature culminating event of the 7th Grade Initiative is the UnitedHealthcare Health Bee that takes place in the spring.  The Health Bee is a quiz show-style competition that tests students’ health and fitness knowledge.  Students from eight middle schools in New Jersey compete.

Last year, 330 students took part in the program, and we are hoping for even more this year.  The program is an important step toward curbing childhood obesity in New Jersey and helping our youth learn healthy habits.

For more information about childhood obesity and what can be done to prevent it, check out UnitedHealthcare’s Generations of Wellness website.

I joined more than 100 7th grade students as we kicked off the 7th Grade Initiative at the Westfield YMCA in New Jersey

Tuesday, October 9, 2012

Health Insurance Terms 101

If someone with a microphone stopped you and asked you to define “HRA” do you think you could?  If you answered “not likely”, you’re not alone.

When UnitedHealthcare interviewers took our cameras to the streets to talk to people about health care terms it was clear that lots of people aren’t really sure what many of the terms mean and how they impact their wallets. 

So before you sit down to select your health insurance plan, take a minute to to review let me take you thorugh my Health Insurance Terms 101 crash course.  The following terms are sure to pop up frequently as you review your health insurance plan options or seek medical care.  Understanding these terms can help you better understand your financial responsibilities and benefits under each plan offered by your employer or if you’re a small business owner, your broker:
  • Premium: the amount you pay each month to have health insurance coverage.  This amount is usually taken out of your paycheck.
  • Deductible: your portion of the costs before insurance kicks in.  Preventive care, such as annual screenings and physicals, do not apply to the deductible.
  • Copay: a fixed amount that you pay each time you see a doctor or fill a prescription.  The amount of your copay may vary depending on whether you are seeing a primary care physician, a specialist, or seeking emergency care.
  • Coinsurance: a predetermined percentage of the total cost you pay for medical services, such as office visits, lab work and emergency room care.  Coinsurance will apply up until you hit your out-of-pocket maximum.
  • Out-of-pocket Maximum: the maximum amount you have to pay for health services every year.  Once you have paid this amount, your insurance company usually pays 100% of your health care costs, subject to any policy limitations.
Here is an example of how you may encounter these terms in the course of the year: Suppose you enroll in a traditional health plan for which a monthly premium is taken out of your paycheck.  The plan has a $500 deductible, a 20% coinsurance rate, and an out-of-pocket maximum of $2,000.

Imagine that you go to your doctor for an annual physical and she finds a suspicious mole on your back, and refers you to a dermatologist.  The physical is free because it is preventive care, but you have a $25 copay at the dermatologist’s office, which counts toward your deductible.  The dermatologist removes the mole, a procedure that costs $1,475.

You pay the remaining $475 of your deductible first.  After that, your insurance kicks in to apply to the remaining $1,000 balance.  Because your coinsurance rate is 20%, the insurer will pay $800 and you will be responsible for $200 of that portion.

Your total cost would be the $25 copay to see the dermatologist, plus the remaining $475 deductible, plus the $200 coinsurance rate, for a total of $700.

Then suppose that later in the year, you end up in the hospital for 4 days with an illness.  Your total bill from the hospital is $20,000.  Your coinsurance rate means that you are responsible for $4,000, but your maximum out-of-pocket for the year is $2,000.  You’ve already paid $700 earlier in the year, so you would only have to pay the remaining $1,300. 

Once you hit the $2,000 maximum out-of-pocket, all of your eligible medical expenses for the rest of the year will be covered 100% by your insurance.

For more explanations about various aspects of health insurance, check out for videos like the one below.

Monday, October 1, 2012

It's open enrollment season: Tips for choosing a health plan

Open enrollment season is about to begin and there are a lot of reasons why everyone should pay close attention.  Open enrollment is the period of time each year when many Americans, particularly those under the age of 65, who rely on health insurance offered through their workplace, get the option to re-evaluate their health benefits and make different selections if necessary.  It usually takes place in the fall and lasts a few weeks.

This open enrollment season, I’d like to pass on the following tips to help you figure out exactly which plan is the best fit for you and your family. 

1.      Decide what you need.  Think carefully about your family’s health.  Are you all generally in good health?  Or do you have medical conditions such as diabetes or a chronic disease that require special care or medication?  If you do have a medical condition, check the details of the plans being offered by your employer to make sure they provide coverage for those areas.

2.      Do your research.  Talk to your human resources manager, attend a company seminar or go online to get more information on each of the health plans you get to choose from.  If you buy health insurance on your own, take a look at the glossary of terms on any health insurer’s website to make sure you understand the lingo.

3.      Know how much your plan costs.  Your costs are more than just your monthly premium.  In addition to what you will pay monthly through a payroll deduction, make sure you know your maximum out-of-pocket, co-pay and prescription drug costs. 

4.      Find out how you can save.  Many employers offer health savings accounts or flexible savings accounts, which allow employees to contribute pre-tax dollars for out-of-pocket medical expenses, such as prescriptions, deductibles or co-pays.  Your insurer can also help you find out ways to save, such as using in-network doctors or switching to the generic form of a prescription drug.

5.      Make wellness a priority. You can often earn financial rewards by achieving wellness goals, such as maintaining a healthy weight, participating in a smoking cessation program and completing preventive health screenings.  Many employers offer wellness programs to employees, so get the details and take advantage if your employer offers one.  Remember that better overall health for you and your family means lower health costs.

Even if you decide to stick with the health benefits plan you currently have, open enrollment is an excellent time to review your existing health benefits to make sure that you are managing your health in a way that is cost-effective and using the preventive care and wellness benefits offered. 

One more thing: There’s a new twist for employees of small businesses this year, as the health insurance industry has begun to offer private health insurance exchanges. The exchange is simple for employer and employee. The employer pays a certain set amount per month for the employee’s healthcare benefits and the employee picks from a number of plans, up to 30 in some cases.  Several insurers have these private exchanges in planning or operation; we call ours “Multi-Choice.”