HealthPartners Empower Individual Health Plan

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SMHealthPartnersEmpower Individual Health Plan Summary of BenefitsYour health plan forchoice, control and flexibility

Access your healthy discounts and resourcesGet affordable, comprehensive healthcarecoverage with a HealthPartners Empowerindividual planEnjoy healthcare savings and resources availableexclusively to HealthPartners members: Fitness club discounts Savings on exercise classes and sporting equipment Eyewear discounts Health coaching by phone Online health information library and cost calculators After-hours nurse advice phone linesManage your healthcare onlineWith HealthPartners, you and your family have coveragefor the care you need: Preventive care Well child exams and immunizations Office visits Prescription medications Emergency care Hospital visits X-rays and lab work And much moreCreate a personal account at healthpartners.com andget secure access to: Check your plan benefits View claims and Explanation of Benefits (EOB)details Get test results Track immunization records Create a directory of favorite providers Schedule appointmentsPair your Empower plan with a Health SavingsAccount (HSA) for financial control, savings andtax advantagesWhen you’re ready to apply for a HealthPartnersEmpower plan, visit healthpartners.com/individualto apply online or talk to your broker. You can alsocomplete an application and submit via mail or fax.Contribute to an HSA and use the tax-free funds to pay foryour family’s qualified healthcare expenses. With an HSA,you get to decide how and when your healthcare dollarsare spent.See the doctors you preferAs a HealthPartners member, you have the freedom andconvenience to seeing the doctors you choose with noneed for referrals!Receive the most benefit from your plan when you seea network provider. Select from more than 565,000providers and more than 5,000 hospitals nationwide.Finding a network provider is easy. Visithealthpartners.com/individual and use the onlineprovider search or contact us for a CD directory.Apply for a HealthPartners plan todayYou must reside in Minnesota to apply for this plan.Learn about other HealthPartners individualplansWe realize your healthcare needs change over time, andwe have other plans to help to meet those needs:Traditional – comprehensive coverage with a range ofdeductibles to help you manage your budgetThree for Free – balanced coverage with three freeoffice visits before the deductibleShort Term – affordable, temporary coverage whenyou need immediate protectionDental – customizable and budget-friendly plan optionsFind help with your questions and decisionWe understand that choosing a health plan for you and your family may be confusing. It’s important to us that you get the helpyou need, so we have resources you can use to help make your decision:Contact our friendly sales consultants Monday – Friday 8 a.m. to 6 p.m.Call at 952-883-5599 or 1-877-838-4949 or e-mail individualsales@healthpartners.com.Visit healthpartners.com/individual and try our interactive plan selection tool. We’ll ask you a few simple questionsand, based on your responses, provide a quick recommendation for a plan we think best meets your needs.

A winning combination: HealthPartners Empowerhealth plan and Health Savings AccountsThe HealthPartners Empower plan provides affordablecoverage for the healthcare you need. Because it’s a highdeductible plan, monthly premiums are generally lowerthan those of traditional plans.If you choose to enroll in a tax-deferred Health SavingsAccount (HSA), you can use it to save money for currentor future medical expenses. Every dollar you deposit intoyour HSA reduces your taxable salary by one dollar. Thatmeans you pay less in taxes!Paired together, this is a smart option that gives you controlover your healthcare dollars. However, youmay decide to usethe Empower planwithout openingan HSA.The advantages of an HSA ax savings – Reduce your taxable income by contributingTto your HSA. Your savings grow tax-free and withdrawalsfor qualified medical expenses are also tax-free.I nvestment – Like an IRA, contributions to your HSA earntax-free interest and you have a variety of investmentoptions.Control – You decide how much to contribute and howto spend it.Flexibility – Use your funds to pay current medicalexpenses or save for future needs.Family friendly – Pay expenses for your spouse anddependent children, even if they’re not covered by ourEmpower plan.Funds are never lost – Carry over unused funds year toyear and build savings over time.Take it with you – The money you save in an HSAis yours. You can take your unused balance with youwherever you go.How does the HealthPartners Empower planwork with a Health Savings Account?Once you’re approved for a HealthPartners Empowerindividual plan, contact your preferred financial institution(such as a bank or credit union) to open your HSA andbegin contributing funds.How much can you contribute?Federal law limits how much you can contribute to yourHSA each year. Call HealthPartners or check with yourbroker or financial advisor to learn more.How do I use an HSA?Whenever you need medical care, visit any doctor,specialist, clinic or hospital in our large nationwidenetwork – no referrals required!You pay providers for the care you receive; then use yourHSA funds to get reimbursed for the qualified healthcareexpenses. HSA dollars are perfect for paying yourEmpower plan’s deductible or coinsurance.Use your HSA to pay forhealthcare expensesUse your HSA to pay for these expenses: Routine healthcare: doctor’s office visits,X-rays, lab work, prescriptions Hospital expenses: room and board,surgery, supplies Dental care: cleaning, fillings, crowns, X-rays Vision care: eye exams, eyeglasses, contacts Copays and coinsurance (the portions of medical billspaid by you, not the health plan)HSA funds can also be used for alternative or preventivetreatments not normally covered by health plans: LASIK surgery Braces Hearing aids Over-the-counter drugs Tobacco cessation programs Chiropractic services Long term care insuranceFor a detailed list of medical expenses that qualify for HSAcoverage, visit irs.gov.

Snapshot – How one family uses their HealthPartners Empower plan and HSABob and Sara Anderson are married and have onedaughter, Emma.Year 1The Andersons’ Empower plan has a family deductibleof 2,800. Bob and Sara contribute 2,000 into theirHSA every year – about 170 per month.Anderson contributionYear 1Year 2The Andersons spend about 1,000 in healthcare. Theyuse their HSA funds to pay for the qualified expenses.Because their medical expenses are less than their HSAbalance, the extra funds are carried over to the next year.Year 2Emma has her tonsils removed, which is a 3,000 expense. In addition, they incur 1,500 inother healthcare spending. This totals 4,500 inannual expenses.The Andersons use their HSA to cover their 2,800deductible. Then, HealthPartners pays 80 percent of theremaining 1,700 ( 1,360) and Bob and Sara pay their20% coinsurance ( 340) using their HSA.Year 3The Andersons have 860 left in HSA funds that carryover from the previous year.Healthcare expensespaid from HSAExpenseActivityHSABalance 2,000 1,000Year-end 1,000ExpenseActivityHSABalanceRoll over from Year 1 1,000Anderson contribution 2,000 3,000Emma’s tonsils 3,000Other healthcareexpenses 1,500Family deductible paidfrom HSA 2,800HSA balance afterdeductible 1,200Remaining expenses tobe paid 1,700HealthPartners 80%coverage 1,360Andersons 20% 340coinsurance paid from HSAHSA balance aftercoinsuranceYear 3Roll over from Year 2 860ExpenseActivityHSABalance 860Note: This is an example. Your actual plan benefit detailsand HSA contribution may vary.

Summary of BenefitsThe following is a brief summary of the HealthPartners Empower individual coverage. For a detailed description ofterms and conditions, refer to a HealthPartners Insurance Certificate or call 952-883-5599 or 1-877-838-4949.80% Plan OptionsDeductibleIndividualCalendar year deductibleOut-of-pocket maximumFamilyCalendar year deductibleOut-of-pocket maximumPreventive care-R outine physicals and tmaximum 1,200 2,400 2,600 2,600 1,400 2,800 3,100 3,100 1,600 3,200 5,000 5,000 2,000 4,000 5,600 5,600 2,300 4,600 2,400 4,800 5,200 5,200 2,800 5,600 6,200 6,200 3,200 6,400 10,000 10,000 4,000 8,000 11,200 11,200 4,600 9,200100% up to 200 maximum per year (no deductible), then 80%Office visits- Illness or injury- Chiropractic care- Mental healthcare- Chemical healthcareEmergency and urgent careInpatient and outpatienthospital careOutpatient MRI and CTLaboratory servicesPrescription medicationsPhysical, occupational andspeech therapyBehavioral healthcareDurable medical equipmentHome healthcareMaternity- Labor and delivery- Postnatal care100% after deductible80% after deductible, maximum of 120 visits per year100% after deductible, maximum of 120 visits per year100% (no deductible)100% (no deductible)No coverage for the first 18 months. Beginning with the19th month of coverage: 80% after deductible.No coverage for the first 18 months. Beginning with the19th month of coverage: 100% after dar year deductibleOut-of-pocket maximum 2,400 2,800 3,200 4,000 4,600FamilyOut-of-networkCalendar year deductibleOut-of-pocket maximum 4,800 5,600 6,400 8,000 9,200100% up to 200 maximum per year (no deductible), then 100%80% after deductibleuntil out-of-pocket maximum is reached,then 100%Well child services to age 6;immunizations to age 18Prenatal careOut of Network coverage100% Plan OptionsOut-of-pocketmaximumNo maximumNo maximumDeductible 5,200 6,200 10,000 11,200 10,400 12,400 20,000 22,40040% after deductible is metLifetime maximum per personIn and out-of-networkThe HealthPartners family of health plans are underwritten and administered by HealthPartners, Inc.,Group Health, Inc., HealthPartners Insurance Company or HealthPartners Administrators, Inc.Out-of-pocketmaximumNo maximumNo maximum50% after deductible is met 5 million

Three simple steps to apply for aHealthPartners individual health plan1. Choose a deductible that fits your needsand budget.A deductible is the amount that you pay upfronteach year. If you choose coverage for your family,a family deductible applies. Once you have paid thedeductible amount in medical expenses each year,HealthPartners pays 80 percent to 100 percent ofexpenses. Generally, higher deductible plans havelower monthly premiums.If you’re not sure which deductible is right for youand your family, contact HealthPartners. We’re hereto help you understand your options.2. Complete an application online, via mail orfax or talk to your broker.Visit healthpartners.com/individual for details.It’s helpful to have the following information handywhile you complete your application: Current and previous health insurance information Doctor’s contact information Information about your health history andmedications Payment information (payment for your firstmonth’s premium is due with your application)3. Learn about the review process.Applications for the HealthPartners Empowerindividual plan are reviewed by our underwriters,and you will be notified of a decision in one to twoweeks. A decision on your application may takelonger if additional medical information is needed.For full details on the application process, visithealthpartners.com/individual.SM8170 33rd Avenue SouthP.O. Box 1309Bloomington, MN 55425healthpartners.com 2008 HealthPartners420330 (7/08 benefits)

The Andersons' Empower plan has a family deductible of 2,800. Bob and Sara contribute 2,000 into their HSA every year - about 170 per month. Year 1 The Andersons spend about 1,000 in healthcare. They use their HSA funds to pay for the qualified expenses. Because their medical expenses are less than their HSA

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