High Deductible Health Plan (HDHP) FAQs

Deductibles

Q1: I went to an out-of-network provider and had to pay for the services at the time of treatment. How do I get this added to my deductible?

A: You should file a CIGNA PPO medical claim form and include a copy of your receipt and mail it to CIGNA. Be sure the receipt includes date of service, procedure code, cost, and provider. Claim forms are available in the HR Forms Library.

Q2: How can I find what expenses have been applied toward my deductible?

A: You can look at your Explanation of Benefits that CIGNA sends when a claim has been received. Also, a personal medical claim history can be found by accessing www.mycigna.com. Pharmacy purchases are included in the medical history. Tel-Drug purchases are located under the Pharmacy section of www.mycigna.com.

Q3: Under the HDHP, does each member of the family using in-network services have to spend $3,100 in-network, before their deductible/out-of-pocket is met, or does the entire family have to spend $6,250 before the plan begins paying for everything?

A: Let’s assume the husband in a covered couple reaches the $3,100 deductible. His costs for the rest of the year would be covered in-network at 90%. His wife would have to reach her deductible, before the plan started paying for her eligible costs. If the couple also covered children, a combination of all family members must reach $6,250 before the plan started paying 90% in-network for the entire family. Individuals in the family can meet the individual deductible at any time and have the plan begin paying 90% for their qualified care. Once the deductible has been met, CIGNA will begin paying 90% of the claim up to an out-of-pocket maximum of $3,500 individual and $7,000 for family.

Q4: What happens after the deductible is met?

A: All other services, including office visits and procedures, will be covered at 90% in-network once you have met your annual deductible. You will be responsible for 10% of all costs for services, up to the out-of-pocket maximum.

The annual deductible is $3,100 for Employee, $6,200 for Employee + One and $6,250 for Family coverage.

The out-of-pocket maximum is $3,500 for Employee in-network and $6,000 for out-of-network.

The out-of-pocket maximum is $7,000 for Employee + One or Family in-network and $12,000 for Employee + One or Family out-of-network

Q5: Which network do we use?

A: The HDHP network uses the Open Access Plus network including pharmacies.

Q6: I do not understand the out-of-pocket limit under the HDHP/HSA which is $3,500/$7,000. What does it mean? Is it on top of the deductible limit?

A: An example may help explain:

An individual who has $10,000 in medical expenses and all are in the network, would pay the deductible or $3,100 and then 10% of the claim. If the expenses were out-of-network, then the employee pays the $3,100 deductible, plus 30% of the amount over the deductible, but only up to the out-of-pocket maximum, which covers the deductible and the co-insurance combined. The employee would pay $3,100 plus $400 in co-insurance, for a total of $3,500 in-network; and the plan would pay $6,500 if in-network; $3,000 if out-of-network.

Doctor’s Office Visits:

Q7: What change will I encounter when I go to the doctor’s office?

A: Inform the office that you have a the HDHP insurance plan. Give the office your medical ID card which indicates that payment should not be required at the time of service. The claim will be sent to CIGNA for processing. CIGNA will send the doctor and you an explanation of benefits (EOB) showing the discounted rate the doctor should charge. You will then receive a bill from your doctor.

Q8: Do I still pay the $10 co-pay for office visits under the HDHP? Do I still have a three-tier prescription plan?

A: There are no co-payments under the HDHP for office visits or prescriptions. Instead, participants pay a discounted rate for services which apply towards the deductible. There are co-insurance payments in the HDHP of 10% in-network and 30% for out-of-network charges above the deductible up to the out-of-pocket maximum.

Domestic Partners

Q9: Can I elect Employee + One coverage under the HDHP and HSA option for me and my domestic partner?

A: The HDHP insurance plan can cover domestic partners. However, the HSA is governed by IRS rules which do not allow domestic partners to be covered under them.

FSA vs. HSA

Q10: I’m on the HDHP and participate in the Health Savings Account (HSA). Can I also participate in the Health Care Flexible Spending Account (FSA) through WageWorks?

A: You can have a FSA but it will be restricted. Under IRS regulations, people who have HSAs cannot have other medical insurance in addition to an HDHP.  Technically, FSAs are considered an insurance plan; that is why people can pre-spend (e.g., spend the money before it’s been removed from the paycheck) out of their FSAs during the year.  Therefore, the FSA is “restricted” to vision and dental expenses only for those employees that also have an HSA. It is an IRS requirement.

Q11: Do I have to enroll in each of these plans every year?

A: Yes, you must re-enroll in both the FSA and the HSA every year. The per pay period amount that you contributed during for the previous year does not roll over from year to year. People’s needs change from year to year so it’s necessary to re-evaluate and enroll in them each year.

Q12: Since I have both the HSA and the FSA, how much money should I place in each? Is there a “rule of thumb” to follow?

A: Here are some reminders about what you should consider when determing how much money to put in each account:

• Dollars contributed during a calendar year to a Health Care Flexible Spending Account MUST be used for services incurred within the calendar year – “use it or lose it.” You have until March 31, 2012 to submit claims to WageWorks that were incurred by December 31, 2011.
• The dollars contributed to the Health Savings Account are handled differently from the Flexible Spending Account. The account balance rolls over from year to year. There is no time limit in which you must pull money out of the account. For example, if you incurred a claim during 2005, you can reimburse yourself for that claim in 2012. You must have been participating in the HSA during 2005.
• If possible, put the maximum amount in the Health Savings Account since the money does roll over from year to year. You never have to “use it or lose it.” If you put in the full amount, you’ll have enough to cover the annual deductible.
• Limit the dollars that you put into the Health Care Flexible Spending Account to only vision and dental costs. Be sure it’s an amount you can use completely by December 31. To help determine how much to put into the FSA take a look at these costs from the previous year.
• You could elect to only contribute to the Health Savings Account and use it for all medical expenses, vision and dental. Keep in mind that if you use your HSA for vision and dental expenses, you will have dipped into the pre-tax dollars to pay for your medical deductible when you could have set up a FSA to use specifically for those expenses.

Q13. Are dental implants reportable for the Health Care Flexible Spending account?

A: If the implants are for cosmetic reasons, you cannot report them on your Flex Spending. If they are medically necessary, then they can be a reported expense. Check out IRS Publication 502 for additional allowable expenses.

Health Savings Account Investments

Q14: Are investment options available for dollars remaining in my HSA?

A: Yes, investment options are available.

Out-of-Pocket Maximums

Q15: Can you give me an example of how the out-of-pocket maximum works if I have HDHP Employee Only coverage and use in-network and non-network providers?

A: Only in-network costs can be used when determining if you have met your in-network out-of-pocket maximum ($3,500). If you have in-network and non-network costs, they can be combined to determine if you have met the non-network out-of-pocket maximum ($6,000).

Prescriptions

Q16: If I purchase my prescriptions from an out of network pharmacy, how do I make sure the expense is included in my deductible?

A. You should complete a prescription claim form located in the HR forms library and mail it to CIGNA along with your receipt. Your out of pocket maximum will increase to an additional $2,500 and the purchase will be included in your deductible.

Q17: Is the cost of prescriptions I purchase from a grocery store pharmacy (King Soopers) included in my deductible with CIGNA?

A: Yes, the pharmacy registers your prescription with CIGNA at the time of purchase. In-network pharmacies include: Albertsons, City Market, King Soopers, K-Mart, Rite Aid, Safeway, WalMart, Walgreens, Costco, Sam’s Club, Target, etc.

Q18: Am I receiving a discounted cost when purchasing my prescriptions?

A:Yes, you receive the CIGNA discounted rate if you purchase your prescriptions at a participating network pharmacy. If you purchase prescriptions through Tel-Drug (mail order), your discount is greater, generally about 30%.

Reimbursing Yourself from the Health Savings Account (HSA)

Q19: If I don’t have enough money in my HSA and I pay out of pocket for a medical claim, how do I reimburse myself?

A: You have two options. You can to go an ATM and use your MasterCard debit card to withdraw the cash. If you elected to receive a checkbook, you can write yourself a check to reimburse yourself. Be sure to keep receipts of your medical expense to prove the withdrawal was for a qualified expense.

If you use a Chase Bank ATM, there is no service charge. Any other non-Chase Bank ATM has a $1.25 service charge.

November 2011