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How HDHPs and HSAs Work
Transcript of How HDHPs and HSAs Work
high deductible health plan
healthcare coverage for medical services and RX
used in conjunction with health savings account (HSA)
you pay 100% for services, except preventive care,until deductible is met, then you share only a portion of the cost
you pay NOTHING once the out-of-pocket max is met
must meet strict guidelines
reduces your out-of-pocket-costs
check your medical carrier's website
calendar year deductible
...for family coverage, the full family deductible must be met before the employee or covered dependents can receive benefits for covered services
calendar year out-of-pocket max
in-network: $3,000 individual or $6,000 family
out-of-network: $6,000 individual or $12,000 family
includes plan deductible
...for family coverage, the full family out of pocket max must be met before the employee or covered dependents can receive 100% benefits for covered services.
after the deductible is met the plan pays 80% (in-network providers)
employee "share" (after deductible) is 20%
see benefits summaries on myCoram for specifics
any tips to maximize my $?
utilize free preventive services
ER visit vs. urgent care facilities
generic RX $19 vs Brand $140
save taxes with Health Savings Account
generic retail: $10
preferred retail: 30%, up to a max of $50
non-preferred brand retail: 50%, up to a max of $100
subject to deductible
features & benefits
Tax-advantaged personal savings accounts that work with HSA-eligible health plans*
Pay for qualified medical expenses with tax-free dollars
You own it — no “use-it-or-lose-it” requirement
Your balance, earned interest, and investment earnings carry over from year to year — tax free
* Tax references are at the federal level. State taxes vary. Please consult a tax advisor.
Most out-of-pocket healthcare expenses can be paid with an HSA
Enrolled in health insurance other than an HSA-eligible health plan
Enrolled in Medicare or Tri-care
Claimed as a dependent on someone else’s tax return
HSA advantage: Tax savings* and Long-term savings
Contributions made through payroll deductions are on a pre-tax basis
Earnings are tax-free for as long as the money stays in your HSA
Withdrawals for qualified medical expenses are tax free
Save for future medical needs
Unused balances roll over tax-free from year to year
*Tax references are for federal taxes only. State taxes vary. Consult your tax advisor.
You will receive instructions from your medical carrier and their HSA financial institution on how to set up your account.
Account must be set up account for deposits, including Coram contribution, to be made to your account.
Required to sign a Master Signature Agreement for account to be set up.
How much can I contribute?
HSA Annual Contribution Limits
HSA Catch Up Contribution
1,000 per individual age 55 & over
Things to remember...
Pre-tax payroll deductions
Transfer/rollover from another HSA
To make things easy:
HSA debit card swipe at doctor’s office or pharmacy
Debit card number written on a bill
You can also get Cash disbursement/reimbursement:
HSA customer service
Managing your HSA
Contribute as much as you can, up to the annual limit. The more you contribute, the more you save in taxes!*
Keep track of and save receipts
Review monthly statements
File all appropriate tax forms
Know your account balance before using your debit card
* Tax references are at the federal level. State taxes may vary. Please consult a tax advisor.
Why Offer an HDHP?
encourages employees to become educated consumers with a “think first” before spending advantage
employees become active participants in health care
allows an opportunity for employees to build investment savings through HSA
Employer HSA Funding
Coram will fund a matching contribution to your account.
$200 for employee only coverage
$400 for family coverage
generic mail order: $25
preferred brand name mail order: 30%, up to a max of $125
non-preferred brand mail order: 50%, up to a max of $300
Contact lenses including saline solution and cleaner
x-rays, fillings, extractions, etc.
Medicines or drugs (does not include OTC items)
HDHPs and HSAs
preventive care is covered at 100% prior to meeting the deductible. examples of preventive care:
annual wellness exams (adult and child)
immunizations and vaccinations
how your prescription plan works
approved preventive medications are covered prior to meeting the deductible. you pay the co-pay or coinsurance amount under the plan.
once you have reached your deductible, you pay only the co-payments or coinsurance under the plan.
Example 1: Your medication is a generic preventive medication and costs $50. You will pay $10 at retail, or $25 at mail order.
Example 2: Your medication is a brand name non-preventive medication and costs $100. You will need to meet your deductible first, and then pay 30% up to a max of $50 at retain, or $125 at mail order.
*includes Coram contribution and your contributions
Check out the the resources on myCoram (click the Annual Enrollment link on the Home page)
Still have questions?
Email us at CoramBenefits@coramhc.com