Our medical plans are "self-insured," so the Company and all covered associates share the costs. Sharing responsibility means:
Being a good healthcare consumer means:
An approach to healthcare where associates meet specific health targets; for example, blood pressure and BMI, or make progress toward a goal. Maintain or improve your numbers within the healthy ranges, and you'll be eligible for StayWell Point$ to earn cash incentives.
It's the amount you are responsible for paying out of your own pocket before the plan starts paying for most services. For in-network coverage, you're responsible for paying:
You pay the full cost of all expenses, including prescription drugs, until you meet the deductible. However, preventive care is covered at 100% in-network, and preventive maintenance prescriptions are covered at 85% with no deductible for the Consumer Choice Plan and Max Consumer Choice Plan, and 70% for the Basic Consumer Choice Plan. All expenses you pay count toward the out-of-pocket maximum.
It's the cost-sharing between you and the plan for healthcare services after you meet the annual deductible. Once you meet the deductible (if required), the plan pays a percentage of your covered expenses. For in-network services under the Consumer Choice Plan and Max Consumer Choice Plan, the plan pays 85% and you pay 15%; for out-of-network service, the plan pays 50% and you pay 50%. For in-network services under the Basic Consumer Choice Plan, the plan pays 70% and you pay 30%; for out-of-network service, the plan pays 50% and you pay 50%.
As part of our consumerism and shared responsibility strategy, H&R Block shares the cost of the premium with associates.
Doctors and facilities that participate in the Anthem BCBS network provide services at a discounted rate. So when you use in-network providers, you and H&R Block can save money. For services received in-network in 2016 under the Consumer Choice Plan and Max Consumer Choice Plan, the plan pays 85% of expenses and you pay 15%, after you meet your deductible. For in-network services under the Basic Consumer Choice Plan, the plan pays 70% and you pay 30%. Your out-of-pocket maximum is also lower when you visit in-network providers.
Out-of-network providers do not participate in the Anthem BCBS network. If you use out-of-network providers, your costs are higher and the plan pays less of the expenses (50%).
It's the most you'll have to pay out of your pocket in a plan (calendar) year for covered services. If you reach your out-of-pocket maximum, the play pays 100% of eligible expenses.
Affordable Care Act Changes
To bring all plans into compliance with the Affordable Care Act (ACA), there are changes to how the out-of-pocket maximum works for each of the plans.
Max CCP and Basic CCP
Once a family member meets the single (individual) out-of-pocket maximum, the plan pays 100% of costs for that individual for the rest of the year.
How does it work? If you have family coverage in the Max CCP or Basic CCP plan, and one of your covered members reaches the single out-of-pocket maximum, the care for the rest of the year for that individual will be paid by the plan in full. The feature works for every covered member in your family until the family out-of-pocket maximum is met, then the plan pays 100% of care for the entire covered family.
How does it benefit me? This provides additonal protection if one individual in your family has high expenses in a calendar year.
CCP
The family out-of-pocket maximum has been reduced to $6,850.
How is it different than the Max CCP and Basic CCP? The covered family (from one person or combination of family members) must meet the entire $6,850 family out-of-pocket maximum before the plan pays 100% of costs for the rest of the year.
Preventive care is covered at 100% when you visit an in-network provider. Preventive maintenance drugs are covered at 85% under the Consumer Choice Plan and Max Consumer Choice Plan, and 70% under the Basic Consumer Choice Plan and certain prescription contraceptives for women are covered at 100%. You do not pay a deductible when you receive preventive care services in-network.
The Affordable Care Act, also known as ACA or healthcare reform, is the 2010 law that focused on improving the availability of medical coverage and providing more protection to covered people. This law requires individuals to have medical coverage and for employers to offer coverage to associates that meet the eligibility requirements.
In 2016, associates will receive a 1095-C form as part of the latest ACA requirements. You will need this form to complete your 2015 tax return.
Online public shopping sites where people and small businesses can buy health insurance that meets ACA requirements.
ACA's requirement that virtually all Americans have medical coverage or pay a penalty. Associates enrolled in the medical plan offered by H&R Block will have met the Individual Mandate.
What you'll pay when you file your federal taxes if you don't buy medical coverage when the ACA requires it. The federal 2016 medical coverage penalties are:
Penalties will increase each year.
Dollar amount that helps eligible people buy health insurance coverage through the marketplace. Eligibility depends on household income and available employer medical plans.