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Town of Wayland West Suburban Health Group HSA Qualified Plans


Academic year: 2021

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Town of Wayland


Today’s Agenda

Consumer Driven Health – A new way to receive your

health benefits

- HSA Qualified Plan Design Features - Health Savings Accounts


Components of an HDHP with HSA

HSA Qualified Health Plan (Fallon, HPHC, Tufts, BCBS) Health Savings Account Health Plan administers the QHD plan and will cover medical services after the deductible is met

Health Equity

administers the personal savings account


HSA Qualified Plan

The same provider network you are accustomed to

HMO members must access services within the provider network

HMO plan requires PCP’s and referrals for specialty care

- Referrals not needed for OB/GYN, Chiro, Routine Eye, Emergency Room

Lower Premiums and higher deductible

All Services (except preventive care and certain preventive

drugs) are subject to the deductible

Rx also subject to deductible (except for some preventive meds)

Plan is compatible and paired with a Health Savings Account


Your In-Network Deductible

Your plan deductible:

- Self-only contract: $2,000 - Family contract: $4,000

- There is no individual deductible on the family contract

Once you meet the deductible*, you incur the following


- Prescription Drugs: $10/$30/$65


Subject to Deductible

(Rx copayments apply after deductible)

Advantages of QHDP with HSA

Covered in Full

Select routine office visits

• Routine physicals for adults and children

• Annual GYN


Select disease screenings and tests

• Routine blood work and urinalysis

• Mammogram and pap • PSA

• Colorectal cancer screening


• Non-preventive office visits • Imaging (x-ray, MRI, CT scan) • Non-preventive laboratory


• Inpatient services and day surgeries • Emergency services

• Outpatient therapies such as chemo and radiation

• Behavioral and substance abuse counseling


Preventive Drug Benefit

Certain medications to help prevent chronic conditions and

illnesses are not subject to the deductible:

 Anticoagulants & Platelet Aggregation Inhibitors for STROKE PREVENTION

 Antineoplastics for BREAST CANCER  Blood Glucose Regulators for DIABETES

 Cardiovascular Agents for HEART DISEASE/HYPERTENSION  Dyslipidemics for HIGH CHOLESTEROL

 Hormonal (Parathyroid/Metabolic Bone Disease) for OSTEOPOROSIS


 PRENATAL VITAMINS (excludes over-the-counter products)  Respiratory Agents for ASTHMA/COPD



Deductible Notes

You typically don’t pay for medical services at the time of


You never pay more than the carrier’s negotiated rate for

services subject to deductible

- Providers cannot “balance bill” you the difference between their retail price and a carrier’s contracted rate

You receive EOBs which identify the amount applied

toward the deductible


Example #1 – Diagnostic Services

You injure your shoulder

 Doctor visit to diagnose is subject to deductible  MRI is subject to deductible

 Day surgery is subject to deductible 





Example # 2 – Preventive care that

could become diagnostic

Annual physical with your PCP and you address other

health conditions:

 Routine annual physical is covered in full

 Routine blood work, flu shot and urinalysis are covered in full

 EKG and lab tests to check thyroid function are subject to deductible


Tips to Accessing Cost-Effective Care

Consider site of service when medically appropriate

- Urgent care facility vs. emergency room

- Free-standing imaging center vs. hospital - Independent lab vs. hospital

Talk to your doctor about generic drugs and alternatives

to prescriptions




What is a Health Savings Account?

A tax-advantaged savings account where money can be

set aside to pay for qualified medical expenses, now and

in the future

- Tax free Contributions

- Tax free earnings on dollars accumulating in the HSA - Tax free withdrawals for qualified medical expenses 

Employee owned and managed account

- Funds can be used for you, your spouse and your tax


- Unused funds rollover from year to year - Availability to Invest funds


Health Savings Account Contributions

2020 IRS HSA Contribution Limits (Employee + Employer contributions)

Employee Only $3,550

Employee +1 or Family $7,100

Age 55 and older – Additional $1,000 "catch-up“ contribution is allowed

IRS Contribution Limits

Funding Your HSA

Employer will fund 50% of the deductible into an employee’s HSA account; frontloaded at the beginning of the plan year or staggered throughout the plan year.

Employee Only $1,000

Employee +1 or Family $2,000


Health Savings Account Eligibility


In order to contribute to an HSA, you must meet the

following criteria:

• You must be enrolled in a HSA Qualified plan

• You cannot have other health coverage (see IRS Publication 969) • You cannot be enrolled in Medicare (Part A, B, or D) or Medicaid • You cannot be claimed as a dependent on someone else’s tax


• You cannot be active in the military*

• You cannot be enrolled in a Full Scope Health FSA (including

through a spouse’s plan) or have an FSA balance during the grace period


HSA Qualified Expenses

Qualified medical expenses as outlined in IRS

publication 502, and IRC Section 213 (d)


- Deductibles - Co-pays

- Co-insurance

- Eyeglasses/contact lenses - Dental care

HSA funds can only be used as they are in the account

Withdrawals not used for qualified medical expenses are


Go to the doctor

Doctor sends health insurance carrier the bill

Health insurance carrier sends you a Claim Summary & Provider sends you their bill

Present your Medical ID card

Health insurance carrier adjusts price based on discounts

Employee pays provider with HealthEquity®

Visa® Health Account Card or via the online


HSA HOW TO: Doctor Visits

Spending Your HSA: Medical Care


HSA Multiple Ways To Pay Or Get Reimbursed

Reimbursement options include:

 Debit Card* - for immediate payment at pharmacies and doctors’ offices

 Online distributions - use Health Equity Online Portal to

make online one-time transfers into any bank account or pay your provider directly


Investment Options To Grow HSA Funds

Deposit Account

 Insured by the Federal Deposit Insurance Corporation (FDIC)

Investment Opportunity

 $2,000 minimum deposit account balance must be reached and maintained to invest future contributions

 Health Equity mutual funds available for investment from conservative to aggressive

 A brief overview of each HSA mutual fund option is available on the HealthEquity website


Health Equity HSA Tools

Comparison Tool: CompareMyHSA.com

 Compare your health plan options side-by-side

Account Mentors – 24 hour access

 866-346-5800

Member Portal: www.myhealthequity.com

 Check your balance

 Review claims & transactions  Submit claims or documents  Pay your providers



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