<p>^ I think you are right, each school has their own rules.</p>
<p>Just checked Stonehill: Key phrase, It is your decision to enroll or waive.</p>
<p>"We have found that many students arrive on campus with insurance that is inadequate due to restrictive provider networks, high deductibles, or limited coverage for services received outside of a health plan’s service area.</p>
<p>It is your decision to enroll or waive the Student Accident and Sickness Insurance Plan, but here are some questions to think about and to ask your current health plan:"</p>
<p>I just want to say thank you to everyone discussing this subject on CC. Because of this discussion, I have put a few questions regarding specifics in DH’s CDO/HSA plan to the HR department head (this is a large multinational corp) and it appears she doesnt have the answers either. Just proves how overly complicated this healthcare mess has become. They are now scrambling to find the answers and get the info out to all employees. Enrollment period ends next Friday - talk about cutting it close.</p>
<p>We are going to try the CDO plan with an HSA for one year to see how things compare. Luckily, we are a healthy family and have the ability to try this route. I sympathize with those who aren’t in the same position.</p>
<p>1) If you can front load an HSA if the company is also contributing to the plan. DH’s co. has never contributed before, so they are not clear on the legalities of this. DD2 will be having oral surgery in Jan and I’d like to front load for that but also have the payroll deduction taken out for routine healthcare during the year. We would be contributing to the maximum under the combination of options.</p>
<p>2)Our CDO has co-pay for prescriptions. So I asked if the co-pays go against the family limit or if there is a separate drug co-pay limit. Having a drug co-pay seems to be unusual for a CDO plan.</p>
<p>@SteveMA, I’m also thinking of switching from the PPO plan to the HDHP/HSA option. I need to ask HR a question too next week. Maybe, you can help me out based on your experience.</p>
<p>The company’s health plan guide says to use your HSA Visa debit card whenever you are purchasing a prescription. If I switch to HDHP/HSA from PPO, how do I know that the amount I’m paying for is the “prescription cost to member?” </p>
<p>For example, for my 2012 PPO, if I look at the pharmacy claim details for a particular prescription drug, the amount submitted by CVS to Aetna is $523.31. However, the prescription cost to member is actually only $441.06. So the plan paid $396.95 (90%) while my co-pay is 44.11 (10%). If I switched to HDHP/HSA how do I know I’m paying for the RX cost to member and not the regular cost since I’m supposed to pay at the time of purchase?</p>
<p>I don’t think I will have this problem with medical claims because the plan guide says that I will use my HSA to pay for care after Aetna has processed the claims that the in-network provider has submitted.</p>
<p>MereMom–yes, you can front load the HSA. If you end up contributing too much to the plan, just get the excess funds out (via check or atm withdrawal) before the end of the year. You can’t deduct more than the $6450 ($7450 if you are 55 or older). You can put $6450 into your HSA on Jan 1st if you want, just make sure you have the accepting bank account open before Jan 1st. You can NOT make deductions from the HSA for medical expenses occurred before the bank account is open. You can also reimburse yourself later if you don’t want to front load the account, without penalty, as long as it’s a qualified medical expense. You don’t have to take payroll deductions either. You can just add the money as needed down the road. It just creates more bookkeeping for you as you have to fill out an extra form on your taxes but you will have to do that anyway with the Jan contribution. Most people take the payroll deduction because it is just easier and comes off on your W-2 for taxes at the end of the year.</p>
<p>It’s very unusual to have co-pays with a tax qualified high deductible plan. Part of the litmus test to be a tax qualified plan, however, is that there must be a common deductible, meaning all medical expenses must go toward the deductible except preventative care (covered at 100%). One person in your family can meet all of your deductible where as in a PPO type plan there is usually a limit per person. Is there something in the wording for the pharmacy that says “after deductible is met”?</p>
<p>Krlilies–the pharmacy computers should be “talking” to Aetna computers about how much the negotiated rate is for that medication. If you find a difference between what you paid and what the insurance company says you should pay, go back to the pharmacy and get a refund. I am also guessing you will have access to an online price check where you can plug in your medication and it will show how much you should be paying. Keep in mind that different pharmacies negotiate different rates so use that if you have it to keep your costs down. DS just got a refill on some acne meds and the one the dr wanted to prescribe wasn’t in our formulary and ranged in price from $90 to $180. I looked it up on my smart phone while he was examining DS :D. We stuck with the one that cost us $12. </p>
<p>I agree to not pay for medical care in advance because of the negotiated rates. You can still use your debit card when the dr bill comes if they take them, just write the number in on the bill and mail. I do suggest you run all payments through your HSA–you can transfer money into that account from your checking account when you get the bill and then send the bill off once those funds show up in your HSA. Reason being is bookkeeping for taxes. You will have one statement to use for your taxes. Just don’t spend more then what you have in your HSA or you will get hit with overdraft fees, etc. They are a regular bank account and subject to the same fees for “misuse” :D.</p>
<p>Looks like we are going to have Rx copays next year with our HSA (major automaker, salary PPO plan). That’s a first for us … we had to pay the full cost until we hit our deductible, then 10% to OOP max in past years. Now, we will be paying full cost until we hit our deductible, then a copay based on Rx tier until we hit the OOP max. For our drugs, this will be more expensive … not too pleased, since we aren’t likely to hit the OOP max. Oh, well. We will pay more for the plan each month, too, but we are still better off than so many others.</p>
<p>SteveMA, re-reading the disparate sections of the plan description, it looks like the drug co-pays (which match the PPO plan copays) go against the “medical” co-pay under the CDO plan (in our case $6000 for family coverage). I will wait to see what the company says on Monday, but I am going ahead and planning under the facts as I understand them. </p>
<p>kelsmom–Aetna seems to use PPO a little differently-they use that more of “in-network” plan while many plans use PPO for non-CDHP type policies. It mainly refers to using an approved network of doctors. Most company’s PPO plans are co-pay/co-insurance plans, where a tax qualified high deductible plan can no have co-pays before the deductible is met. The federal designation of the tax qualified high deductible plan states that the deductible is common so say one person is in the hospital and has a lot of medical costs and your deductible is $3000. That person will use up all of the deductible. Under co-pay type plans, one person typically would use up 1/2, say $1500 of that and then other family members would have to meet the rest to meet your deductible.</p>
<p>MereMom–something is missing in translation here-from your company documents–I just double checked because I wanted to make sure I was correct but you can NOT have a copay for medical or Rx before your deductible is met under a tax qualified high deductible plan with an HSA. The cost for the Rx’s have to go against the deductibles to qualify for an HSA.</p>
<p>We have had a CDHP with HSA for about 7-8 years. DH company funds HSA at $2000 per year for families and our deductable is $3600. Anything we don’t use rolls over. This year (2012) has been the first year I have paid 1 cent out of pocket. 4 years ago both DH and DS had out patient surgeries in the same year but we had enough in the HSA to cover everything even after hitting the deductable. The best thing is having no copays for visits or medicines.</p>
<p>SteveMA, DH’s HR dept finally sent out clarification information. The drug co-pay relates to Special Drugs (Tier 4 and 5 of their formulary). There is a Rx co-pay that kicks in once the deductible is met. This sounds more consistent with what I have been reading about HSA’s and from your posts. I can front load the HSA account (even though HR seems unhappy about this), so will be doing both payroll deductions and a front load check to the trustee.</p>
<p>MereMom–why would HR be unhappy about it? Why would they care? Are you having that front loaded part taken out of your paycheck and then have to change that after the fact again? You can just mail the check to the bank or depending on your bank and/or the HSA bank, transfer funds on-line. We can transfer funds from our regular bank account to the HSA as needed.</p>
<p>Thanks SteveMa for the info. HR did say that as long as we go to an in-network pharmacy, the amount deducted from our HSA debit card at the point of sale is the discounted prescription cost.</p>
<p>For our 2013 HDHP/HSA option, cost of certain medications on the preventive medicine list for chronic conditions does not count towards the deductible. These drugs are paid at 100% after the co-pay for a generic or co-insurance for a non-generic. However, the costs count toward the out-of-pocket maximum.</p>
<p>Krlilies–that drug list is a federal drug list part of the health reform and many of those will cost nothing, which is why it doesn’t count against your deductible–just like your annual physicals won’t.</p>
Yes, you’re right. The generic form of lipitor will cost us only $20 co-pay for a 90-day supply via mail order. </p>
<p>Aside from the max contribution amt difference b/w an FSA and HSA and the use-it-or-lose-it drawback by the FSA, I observed a few things.</p>
<p>With the FSA I can use it even if there arent sufficient funds yet at the beginning of the year as long as my costs dont max out my FSA annual elected amount.</p>
<p>With an HSA: (1) I have to make sure there is enough funds in my HSA to avoid being charged with an insufficient funds fee, (2) I can open an HSA investment account but I have to make sure the balance doesnt go below $2k otherwise I will be charged a monthly fee.<br>
(1) is not an issue provided a person has sufficient funds to front-load the HSA at the beginning of the year and/or the employee is comfortable with deducting a huge amount from his first paycheck next year.</p>
<p>If I paid cash or credit card for medical or pharmacy expenses …
With an FSA, as long as I havent maxed out my FSA annual elected amount, I will be automatically reimbursed via my personal bank account.</p>
<p>With an HSA, I have to withdraw via ATM from the bank handling our HSA. Otherwise, I will be charged an ATM fee. Transferring monies from HSA account to personal bank acct is currently not possible. So your best bet is to use an HSA debit card or use the online bill payment feature.</p>
<p>SteveMA, I just think this HR department is worried that someone might abuse their system. They don’t seem very well versed on the subtleties and real world applications of thier healthcare plans. The IRS ist he final arbiter of compliance with pre-tax contributions allowed. </p>
<p>Not a big deal, just a vibe I get when speaking to them. I had the same problem when establishing the tax withholding percentage for an option exercise. Had to remind them that they do not know my tax situation and don’t have the final say when it comes to making the decision.</p>
<p>MereMom–sounds like HR needs some lessons :D. I just did a presentation at a company and the HR person there was using his HSA funds wrong—and as a result, so were many people in the company. YIKES!!! Set them straight on that one quickly and hope none of them get audited (new account for us so not my fault)!!</p>
<p>SteveMA, our PPO is Blue Cross/Blue Shield — and it is a CDHP. </p>
<p>Color me ignorant, but I am having a difficult time understanding why one would front-load the plan to pay for an early-in-the-year procedure. You don’t have to use HSA money to pay for your deductible. If you are doing pre-tax HSA funding, you can’t take an above-the-line deduction on your taxes. So I am not sure what the reasoning would be to put non-payroll deduction (pre-tax) money into the HSA to front-load it. Just skip that step & pay the money directly.</p>
<p>Many observations about fees for your HSA account are particular to terms of your HSA. Mine does not have the fees you described and overwithdawal is handled differently. I have no problems transferring money into my bank account. In short, YMMV.</p>