Frequently Asked Questions

Transcription

1 Frequently Asked Questions Health Savings Account Questions Q: What is a Health Savings Account? A: A Health Savings Account is a tax exempt account you set up with a qualified High Deductible Health Plan (HDHP). Both you and your employer have the option to contribute to the savings account. The savings account can be used to cover expenses such as your plan deductible, copayments and coinsurance. It can also be used for dental, vision and qualified non-covered medical treatment such as acupuncture though these types of expenses will not apply to your out-of-pocket maximum. Q: Who can contribute to a Health Savings Account? A: You and your employer can make tax-free deposits into your Health Savings Account as long as you are enrolled in a High Deductible Health Plan and you are not also enrolled in other healthcare coverage that will disqualify you (example Medicare Part A & B). Q: What happens to the money at the end of the year? A: The contributions remain in your account until you use them. It is NOT a use it or lose it account. The balance rolls over year to year, unlike a Flexible Spending Account. Q: Are there rules governing a Health Savings Account? A: Yes the IRS governs the rules regarding a High Deductible Health Plan that includes a Health Savings Account. For example, the IRS sets certain contribution limits each year. Refer to IRS publication 969 posted on the Employee Benefits Department web page for more information. Q: Can I have a Medical Flexible Spending Account and Health Savings Account? A: No. Health Savings Account participants cannot have another source such as a Medical Flexible Spending Account that pays for eligible expenses. Those participants that choose the OAP Buy Up plan can still participate in the Flexible Spending Account if they so choose. Q: Can I use my Health Savings Account funds for a dependent that is not on my medical plan? A: Yes, as long as the dependent is claimed on your tax return. For more details please refer to IRS Publication 969. Under IRS law, HSA distributions are tax-free if used for qualified medical expenses for: You and your spouse Any dependents you claim on your tax return Any person you could have claimed as a dependent Q: I am 65, still working and on the group medical plan. Can I participate in a Health Savings Account? A: Yes, however you will need to waive Medicare Part A & B while working. 1

2 Q: What happens to the money in my Health Savings Account when I leave the School District either by termination of employment or retirement? A: The Health Savings Account is yours, in your name and the money stays with you to use for qualified expenses. You can contribute to the Health Savings Account on a pre-tax basis only when enrolled in a qualified High Deductible Health Plan. Q: How do I access my health savings funds? A: You will have a card much like a credit card that is linked to your account. Q: I currently participate in a medical flexible spending account. Can I merge my flex dollars into my Health Savings Account? A: Flexible spending account funds need to be expended by December 31, The funds do not roll over therefore there wouldn t be a balance to merge into a health savings account. Q: Can I still add my son, who is disabled and on Medicaid, to my HDHP and have an HSA? And will I be able to utilize the funds in my HSA for him also? A: Check with your tax professional for your children if they are permanently and totally disabled. Q: If my spouse has insurance with an HSA with his employer (I am not covered), and I am covered on the HDHP with SCPS and meet all three requirements, will my HSA also be able to cover his expenses? A: Yes, you can both have individual HSA accounts. You cannot have a joint HSA account and will need to adhere to the family HSA contribution limits. Please refer to IRS Publication 969. Q: I am 65, still actively at work and have Medicare. Since I am not eligible for the Health Savings Account if I enroll in the High Deductible Health Plan, would I still be eligible to participate in a Flexible Spending Account? A: If you are enrolled in High-Deductible Health Plan (HDHP), IRS rules do not allow contributions to an HSA if you are covered by any disqualifying health coverage, including a general purpose health care FSA. Q: What is the age limit of the dependents that you are able to use the HSA on? A: PPACA requires that health plans offer coverage for adult children up to age 26 under a parent s family health plan. While they may qualify as a dependent for insurance purposes, adult children might not qualify as tax dependents on the parent s tax return. If that is the case, their medical expenses cannot be covered by a parent s HSA (IRS sec. 152,223(d) (2); PHS sec.2714). Q: I am an Active employee covering my spouse who is over 65 with Medicare. How will this affect my Incentive Award from SCPS if I elect the HDHP? A: It will not affect your incentive award. If you met the three requirements you will still receive your incentive award of the $750 into your Health Savings Account. Q: Will SCPS continue to contribute $750 annually as an incentive award for employees completing the wellness requirements in future years? 2

3 A: Future contributions have not been determined at this point in time. Q: What bank administers the HSA? A: HSA Bank. They are the nation s largest administrator of HSA accounts and are fully integrated with Cigna. Q: Does interest accrue on unused funds in my HSA account? A: Investment options are available through HSA Bank as you hit account balance objectives. Q: Are HSA funds in my account taxable when I leave SCPS? A: If you choose to withdraw the remaining balance rather than use it for qualified expenses, the withdrawn funds are subject to taxes and a penalty. Q: If I am an Active employee over 65 with Medicare and do not cancel my Medicare, will SCPS put the $750 Incentive Award into an FSA for me? A: No Q: If I am covered on both the SCPS medical and my spouse s non-hsa medical coverage, can I elect the HDHP? A: Yes, you can elect the HDHP, however you will not be eligible for an HSA. Incentive Requirements Questions Q: What is the deadline for meeting the incentive requirements? A: All three requirements must be met from September 1, 2014 through August 31, Q: What happens if I don t complete the three requirements by the deadline? A: You will not be eligible for the District contribution to the Health Savings Account if you enroll in the High Deductible Health Plan or you will not be eligible for the premium credit if you enroll in the Open Access Buy Up Plan. Q: How can I verify I have met the three requirements? A: You will need to register on Once you have registered, then go to the Manage My Health tab, and click on the Incentive Awards Program. If you have single coverage and have 3 points, you have met the requirements. If you cover your spouse and have 6 points, both of you have met the requirements. Each requirement met is listed further down the screen to make it easy to find out which points you are missing. Q: Can I earn more than 3 points on my Incentive Awards? A: No, each category has a maximum cap of one point: 1. Preventive physical and/or OB/GYN visit = 1 point 2. Lab work at physician s office or lab and/or participated at onsite biometrics 1 point 3. Health Assessment = 1 point 3

4 Q: When will incentive points show on MyCigna.com? A: Typically 18 business days from the date the claim was paid. Q: When will biometric information show on MyCigna.com? A: Typically 30 days from the date the lab results were sent to Cigna and approximately 3 weeks for onsite event values to populate MyCigna.com. Q: I am currently insured through another plan and would like to participate in the District s plan in How do I meet the requirements for the incentives? A: You would need to have your physician complete the special circumstances form and you need to complete the health risk assessment (through a special link provided to you). Please ask your on-site Benefit Advocate to contact the Employee Benefits Specialist to get the form and link. Q: Is there a penalty if I do not meet the normal range for my biometric values? A: No. The incentive awards are not outcome based for Q: I currently have military medical coverage. Can I participate in the High Deductible Health Plan and keep my military coverage? A: You can participate in the HDHP, however you will not be eligible to have an HSA. Q: My physician s office won t schedule my annual preventive exam. They say it has to be after 365 calendar days. How often can I have an annual preventive exam? A: You can have one annual preventive exam per calendar year. Our plan is not designed for the 365 day rule. Please have your physician s office verify with Cigna by calling Q: Can I verify if I have qualified for the incentives on the ESS this year? A: No, you will have to go to MyCigna.com, Manage My Health tab, and click on Incentive Awards Program. Q: Can Retirees earn the SCPS incentives? A: No, the Incentive Awards are only for Active Employees. Q: Will SCPS offer more onsite biometric clinics? A: The 2015 biometric clinics ended 04/10/2015. SCPS will continue to offer these clinics annually. General Questions Q: What are the preventive codes my physician should use? A: The preventive codes are listed on the Employee Self Service/Benefits/Benefits Summary Resources. Q: How often are the negotiated rates reviewed for procedures and medications? 4

5 A: Cigna works, throughout the year on both medical and pharmacy. The whole provider network/pharmacy pricing doesn t renew on one day. Some are annual, some are every three-five years (big systems) with annual adjustments. Pharmacy changes with medication developments, changes in generic manufacturers, etc., as often as daily, weekly or monthly. Q: Does everyone under the HDHP have to meet the out of pocket max to be covered at 100%? A: The out of pocket max on the HDHP will be non-collective, so two members of the dependent or family will meet the out of pocket maximum. Q: Which plan should I enroll in? A: It will depend on your personal situation and how you utilize a plan. Each team member will have the opportunity to sit with an enroller in the fall to assist in the enrollment process. Q: What expenses track toward my out of pocket maximum (OOP max)? A: Your deductible, coinsurance, medical copays and prescription copays apply to your OOP max. Please note copays do not count towards your deductible, they count towards your OOP max. Q: Which plan will cost more? A: It will depend on your personal situation and how you utilize a plan. Enrollers will be available at annual enrollment to assist employees with education on how the two plans work. Q: Are both plans free for the employee only coverage? A: Of the two proposed plans for 2016, the High Deductible Health Plan will be free for employee only and the Buy Up Plan will have a premium for all levels of coverage including employee only. Q: How will I know the cost for physicians, medications, procedures, etc? A: Cigna has cost estimators for both medical and prescription costs to help you determine costs prior to your treatment. If you look at your current Explanation of Benefits (EOBs), please refer to the covered amount column to find out what the cost will be if you have not yet met your deductible. Q: Will we continue to have options for other coverage such as dental, vision, disability, etc? A: Yes, the current products that are offered will continue to be offered at annual enrollment. Q: How do I research if my physician is on the Local Plus Network? A: You can either go to Cigna.com, Find a Doctor, Dentist or Facility and search or you can call the number on the back of your Cigna ID card. Q: My physician s office charged me to complete the wellness form. Can they do that? A: Some physician s offices do charge for completion of forms. That is at their discretion. The District & Cigna have no control over the physician s billing procedures. Q: Will we get the incentives to use for Medical insurance elsewhere? A: No 5

6 Q: When is annual enrollment this year? A: Annual enrollment will be in the fall, typically around October. This year team members will have the opportunity to make an appointment to sit down one-on-one with an enroller to discuss their benefit options and ask questions. Q: What if I want to waive coverage in the new plan year? A: During annual enrollment you will waive the medical and provide proof of other coverage to the Employee Benefits Department. You can elect, in lieu of a medical plan, the Board paid Mutual of Omaha disability coverage with a $300 weekly benefit for up to 104 weeks in the event you become disabled. Q: I do not participate on the District s group plan, however would like to in What do I need to do? A: You will need a special circumstances form completed by your physician indicating you had a preventive exam and bloodwork. You will need to reach out to your onsite Benefit Advocate to get the form and the link to complete the Health Assessment in order to receive credit for meeting the three incentive requirements. Q: I would like to purchase an individual policy and drop the District s plan. What do I need to do? A: During annual enrollment you will be able to drop your coverage with the District. An individual policy is not a qualifying event to come off our group plan during the year. Q: I don t see a premium stated on the Health Plan Options page. How will I know what I would be paying in premium? A: Premiums will be determined at a later time in advance of the annual enrollment period. Q: What is the premium for employees and dependents on each plan? A: Premiums will be determined at a later time in advance of the annual enrollment period. Q: Will we still have the Healthy Pregnancy Healthy Baby Program available? A: Yes, the Healthy Pregnancy Healthy Baby Program will still be available. By participating, after the baby is born the employee will receive $150 if they enrolled during their 1 st trimester and $75 if they enroll during their 2 nd trimester. Q: How can I get additional questions answered? A: Each site has a Benefit Advocate. Your Benefit Advocate is your first point of contact. The Employee Benefits Department is always here to assist: or Benefits@scps.k12.fl.us. Q: I went to to find the cost of a preventive colonoscopy and am unable to find it. A: All preventive care is covered 100%. Because there is no cost to you, preventive care is not included in the cost estimator. 6

7 Q: If I get pregnant in 2015 and deliver my baby in 2016, are my benefits paid according to my current coverage? A: Claims are paid when they occur, which is the birth of the baby in Your claim will be paid according to the plan you elect for Q: Will my routine blood work be covered on both plans? A: Yes, both plans cover preventive care, including mammograms, at 100% Q: What is the cost for Durable Medical Equipment (DME) in 2016? A: Durable Medical Equipment (DME) is covered and your deductible and coinsurance will apply according to the plan you select. 7