2018 HSA GUIDE. ...Your Benefits

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1 ...Your Benefits 2018 HSA GUIDE The HSA Plan consists of two parts that work together to give you more control over how you receive and pay for medical care and services, both now and in the future: the Health Savings Account and the HSA Medical Plan. This guide provides you with details on both parts of the plan to assist you in making this plan work for you and your family. The HSA Plan enables you to: Set up and contribute pre-tax dollars to a Health Savings Account (HSA), and receive a contribution from Emory, to pay for eligible medical, dental and vision services. Participate in an Emory-sponsored medical plan with the lowest employee contributions. Seek and receive preventive care at no cost to you (EHN and In-Network). Receive incentives for your participation in healthy activities. Support your efforts to stay healthy with access to information, programs and health topics affecting you and your family. Have the flexibility to choose how you pay and from whom you receive medical care and services. Read more inside! 1

2 The HSA Plan provides a more non-traditional approach to managing your health care than Emory s POS Plan. The HSA Plan gives you more choice and flexibility while emphasizing and supporting you and your family s efforts to stay healthy. Like the POS Plan, you have financial protection for medical costs through a deductible, co-insurance and an out-of-pocket maximum. But unlike the POS Plan, this plan provides you with an account, funded in part by Emory, that gives you the flexibility to choose how to spend your health care dollars. The Health Savings Account Enrolling in the HSA Plan allows you to take advantage of the tax savings features of a Health Savings Account. Emory contributes tax-free funds to your HSA upon your enrollment. You and your covered spouse can complete incentive activities and receive an additional Emory contribution. You can also contribute on a pre-tax basis through payroll deduction. Withdrawals to pay for eligible expenses are not taxable. The IRS does impose penalties if you use the funds for ineligible expenses. Save your receipts and your Explanation of Benefits (EOB). What you do not spend stays in your account for you to use in the future. HSA contributions are owned by you and are portable in the event that you leave Emory. In order to qualify for Health Savings Account: 1. You must be enrolled in the HSA Plan. 2. You cannot be claimed as a dependent on someone else s tax return. 3. You cannot be covered by a spouse s Flexible Spending Account (FSA). 4. You cannot be covered by any other medical Compare plan, including Medicare A and/or B. It is important to note that employee contributions for the HSA Plan are significantly lower than employee contributions for the POS Plan. To see how the HSA Plan compares with the POS Plan, use the Plan Selection & Cost Estimator Tool located online at ourehc.org/enrollment. POLICY CHANGE REMINDER Effective January 1, 2018, currently covered Same Sex Domestic Partners (SSDPs) must be legally married in order to continue their Emory benefits programs. If you have recently married, you need to provide the Benefits Department with a copy of your marriage license. If you are a new hire, a copy of your marriage license is required if your spouse has a different last name than yours and you wish to enroll them in benefits. 2

3 Opening your Account When you elect to establish a Health Savings Account, the Customer Identification Process (CIP) begins in order to open your account. Aetna/PayFlex, the administrator for the Health Savings Account, may contact you directly via or letter to request any additional information needed. Your timely response will facilitate the process. Until the account is open, no contributions will be applied to the account. Once the account is open, you will be mailed a welcome letter and debit card (PayFlex Card). Register your HSA following the directions in your welcome letter. Designate a beneficiary: If your spouse is the designated beneficiary, the HSA will be treated as your spouse s HSA after your death. If the designated beneficiary is not your spouse, the account stops being an HSA and the value of the HSA becomes taxable to the beneficiary. Emory s Annual Contribution If you are enrolled in the HSA Plan with individual coverage on January 1, Emory will make a $300 contribution to your Health Savings Account. If you cover any dependents (spouse or children), you will receive an additional $300 for a total annual maximum contribution of $600. For employees who enter the plan at any time after January 1, Emory s contribution to the HSA will be prorated based on your enrollment date. Emory s contributions are made on the first biweekly payroll of the month following enrollment. Emory s Incentive Contribution You can earn incentives that are added to your HSA by participating in and completing various healthy activities (see the Incentives section on page 7 to learn more). The maximum incentive amount that can be earned and contributed to an HSA during the plan year is $500 (with a covered spouse). To ensure that incentive funds are available to pay for your medical expenses, participate in and complete your incentives early in the year. Emory processes all incentives completed by the 15th of the month for incentive payment in the next pay period for biweekly paid employees. Activities must be completed January 1, 2018 through November 15, 2018 to be eligible for 2018 incentives. 3

4 Your HSA Contributions The IRS establishes limits for the amount that can be contributed each year to an HSA by you and Emory: For 2018, the limits are $3,450 for individual coverage and $6,900 if you cover dependents. If you are age 55 or older, an additional $1,000 "catch-up" is allowed. You can make pre-tax contributions through payroll deduction. The amount of your contribution can be changed by contacting the Benefits Department. THE HSA: A TRIPLE TAX ADVANTAGE tax-free money in Emory contributes $300 (or $600). You can earn up to $400 (or $500) in incentives. You can contribute additional pre-tax money too! After-tax contributions can be made to your account by transferring funds from your bank account. HSA contribution limit includes Emory s contribution, your contribution, and any incentives you and your spouse earn. If your total HSA contributions exceed annual maximums, you will be taxed on the excess. HSA Debit Card tax-free money out Use your HSA to pay for medical expenses or pay for them yourself and save your HSA funds for later. You can make changes to your method of contribution, as well as your contribution amount at any time during the year; payroll deduction changes are processed for the next available payroll. Contributions are allowed until you begin participating in Medicare or you no longer qualify for a Health Savings Account. tax-free savings Unused funds remain in your account and grow with tax-free interest. They roll over year-to-year. There is no use-it or lose-it rule. The HSA is All About Choice! If you have funds available in your HSA, you can use them to pay your eligible medical expenses. Or, you can choose to save your HSA dollars and pay eligible expenses yourself. HSA funds are not forfeited at the end of the plan year; your HSA dollars will continue to be available for you to use. Investment options are available if your HSA balance is typically $1,000 or more. Contact PayFlex at for more information. 4

5 Managing your Account Register and log on to Aetna Navigator at Your HSA will be listed under See Coverage & Costs. You can see the account activity including contributions and distributions. PayFlex Mobile allows you to receive notifications, submit claims and more. Complete incentive activities to receive additional contributions to your account. Use your PayFlex card to pay your medical, dental or vision expenses, or pay out of pocket to save HSA funds for future use. Balances over $1,000 can be invested in BNY Mellon options. Investment earnings are tax-free. IRS Publication 969 provides information on Health Savings Accounts. Accessing Your HSA Funds Aetna/PayFlex MasterCard Debit Card You will receive a PayFlex MasterCard debit card in your welcome kit from Aetna. Once activated, you may use the debit card just as you would a debit card tied to a savings or checking account, as long as you use it to pay eligible expenses. You may make payments by phone, online or in person with the debit card. Make a Payment When you make a payment online using PayFlex, you can choose to have a check sent directly to your provider. Reimbursement When you pay eligible expenses, you may reimburse yourself from your HSA by transferring funds to your bank account. The linking process will require a one-time verification of your checking account. Details on this process are included in your welcome letter (Quick Reference Guide Aetna Reimbursement Accounts). Funds must be available in your account on the day you make payment or initiate reimbursement. HSA funds may not be used to pay or reimburse expenses for a child who is no longer a tax dependent, even if covered on your medical insurance plan. Be sure to keep your receipts and Explanation of Benefits (EOBs). 5

6 Eligible Expenses HSAs are to be used for eligible medical expenses, such as deductibles and co-insurance for doctor visits, hospitalization, and surgery for you and your eligible dependents. You may also use your HSA for prescription drugs, dental care and certain vision expenses. In general, you may not use your HSA to pay health care premiums while an active employee. However, there are exceptions for COBRA enrollees, and for those receiving unemployment benefits or who are age 65 and older. You may also use HSA funds for Medicare premiums and long-term care (LTC) premiums, if applicable. Any HSA funds used for ineligible expenses are subject to income tax and a 20% IRS tax penalty. IRS Publication 502 provides information on qualified medical expenses. While you may cover a child up to age 26 under the HSA Medical Plan, qualified medical expenses are those incurred by you, your spouse, and all dependents you claim on your tax return. Refer to IRS Publication 969 for more details. Coordinating HSA with a Flexible Spending Account If you elect a Healthcare Flexible Spending Account (FSA), it will be a Limited FSA administered by Aetna/PayFlex. You can receive reimbursement for dental and vision expenses. Once you have met the HSA annual deductible, medical expenses can be reimbursed from the FSA. You must submit a claim for reimbursement; the limited FSA will not be on your PayFlex card. Remember, FSA funds do not roll over from year to year. FSA Balances and IRS Restrictions on HSAs In accordance with IRS regulations, if you are a new enrollee in the HSA Plan for 2018 (i.e. switching from the POS Plan) and you have a balance in a 2017 Healthcare Flexible Spending Account (as of December 31, 2017), you are not eligible to contribute funds to an HSA or receive any funds in your HSA until April 1, This includes Emory s annual contribution, incentives earned from wellness activities, or contributions you make to your HSA. The April 1, 2018, date still applies even if your Healthcare FSA account balance reaches $0 at an earlier point during Additionally, if you have a balance in your FSA as of December 31, any medical expenses incurred prior to April 1, 2018, are not eligible for reimbursement with HSA funds. Expenses must be incurred after April 1, 2018, in order to use HSA funds. You will need to consider whether or not you will have an FSA balance on December 31 when making your decisions about enrolling in the HSA Plan including making any contributions to an HSA through payroll deduction. If you have a $0 balance in your 2017 Healthcare FSA as of December 31, 2017, you are HSA eligible on January 1, 2018, and you (and Emory) can make contributions to the account and eligible medical expenses can be paid with your HSA funds. 6

7 Managing your own personal well-being is going to get even easier in 2018 with the arrival of Healthy Emory Connect, our new online wellness platform. Among many other things, Healthy Emory Connect is what you will use to earn your 2018 medical plan incentives Incentives Managing your own personal well-being is going to get even easier in 2018 with the arrival of Healthy Emory Connect. Emory s new, personalized web platform and mobile app will be your one-stop-shop for participating in all of your wellness activities like earning your medical plan incentives, competing in challenges, and tracking your health goals. Healthy Emory Connect offers numerous resources and online education tools on topics like fitness, nutrition, sleep, stress and financial wellness. Earn your incentives. To earn your 2018 medical plan incentives, the first step is to register on the Healthy Emory Connect platform. Registration opens after January 1, You can then use the platform or mobile app for your other incentive activities such as completing your Health Risk Assessment and competing in the 2018 Move More Challenge. To participate in the challenge, you can use your Fitbit or another wearable device such as Garmin or Nike. The platform s online programs on stress and nutrition will provide incentives for you to earn as well. Build your network. One of the biggest advantages of Healthy Emory Connect is the ability to connect with Emory friends and co-workers who can help you achieve your personal health goals. You also have the option of inviting your friends and family members from outside of Emory to participate in healthy activities with you. Register on the Healthy Emory Connect platform, and you will be well on your way to building your healthy support network! 2018 INCENTIVES Registration Get started earning your incentives by registering on Healthy Emory Connect. Registration opens after January 1, Earn $25. Health Risk Assessment (HRA) Complete your HRA on Healthy Emory Connect. Earn $50. Move More Challenge Compete in the Move More Challenge in the spring of Stress & Nutrition Programs Participate in online stress management and/or nutrition programs. Colonoscopy/Cologuard Get a colonoscopy or Cologuard test. If you are 50 or older and haven t been screened, talk with your doctor. Your spouse can also earn this incentive. Earn $100. Activities must be completed January 1, 2018 through November 15, 2018 to be eligible for 2018 incentives. Note: Spouses are eligible for the Colonoscopy/ Cologuard incentive, but not the other 2018 incentives. 7

8 The HSA Medical Plan The HSA Medical Plan features a deductible, coinsurance and an annual out-of-pocket maximum to provide financial security. Annual Deductible: You are financially responsible for meeting the deductible before the plan pays for any eligible expenses. You can use the funds that accumulate in your HSA to pay eligible medical, dental and vision expenses incurred by you, your spouse, and dependents you claim on your tax return. The deductible depends on the coverage level you have elected. Employee Only Coverage: Annual Deductible - $1,350 (EHN). You pay the first $1,350 in eligible expenses. You can fund these expenses by utilizing your HSA. The In-Network deductible is $1,500 and the Out-of-Network deductible is $2,500. Employee + Spouse, Employee + Child(ren) and Family level Coverage: Annual Deductible -$2,700 (EHN). You pay the first $2,700 in eligible expenses. You can fund these expenses by utilizing your HSA. The In-Network deductible is $ $3,000 and the Out-of-Network deductible is $5,000. Coinsurance Once the deductible has been satisfied, the plan provides coverage for eligible expenses through coinsu rance. The highest levels of coverage under the plan are by utilizing the Emory Healthcare Network (EHN) or by obtaining services from In-Network providers (Aetna National Network). EHN Plan pays 85% of eligible medical expense, you pay 15% In-Network Plan pays 75% of eligible medical expense, you pay 25% Out-of-Network Plan pays 50% of eligible medical expense, you pay 50% Annual Out-of-Pocket Maximum The HSA Plan also provides financial protection for you and your family in the event of a catastrophic illness or injury through the annual out-of-pocket maximum. Like a traditional plan, there is a maximum amount that you are financially responsible for under the plan each year. The individual out-of-pocket maximum of $3,500 within the EHN and $4,750 In-Network will be applied to a covered family member who incurs medical expenses after the family deductible has been met ($2,700 within the EHN or $3,000 In-Network). This eliminates the need for the full family out-of-pocket maximum to be satisfied if only one family member needs medical care. However, the combined medical charges incurred by additional family members will satisfy the full family out-of-pocket maximum. When the family out-ofpocket maximum is satisfied, eligible expenses for all family members will be covered at 100% for the remainder of the plan year. 8

9 Prescription Drug Coverage The pharmacy benefit manager for the HSA Plan is CVS/ caremark. You may fill prescriptions either at a retail pharmacy (30 day supply) or by using mail order service (90 day supply). You may also fill a 90-day supply of your maintenance medication at a retail CVS location. The table below shows what your responsibility is once your deductible is satisfied. For example, if the table shows co-insurance is 20%, the plan will pay 80% of the cost of the prescription drug and you are responsible for the other 20%. However, there is financial protection built into the prescription drug benefit in that you will never pay more than the 30-day Retail Maximum, outlined in the table below: You must pay all out-of-pocket costs for prescription drugs until you meet your annual deductible. After you meet the deductible, you will pay the applicable co-insurance amount under the HSA Plan, up to the 30-day Retail Maximum. Mail order is 2 1/2 x the retail maximum. You can use your HSA to pay for prescription drugs. Preventive medications are covered under Tier Zero and the deductible and co-insurance do not apply. If you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your prescriptions in one of three ways: through CVS/caremark s mail order service, at a CVS retail pharmacy location, or at an Emory pharmacy. Please be aware that if you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost. Check up on Medications It s a good idea to occasionally check up on your medications coverage tiers. Sometimes drugs change tiers. To be certain which tier your medications are on, call CVS/caremark at TIER COINSURANCE 30-DAY RETAIL MAXIMUM Zero 0% $0 1 10% $ % $ % $ % $ day supply is 2½ x the retail amount 9

10 How the HSA Plan Works The HSA Plan encourages healthy living by providing 100% coverage for preventive care when you use Emory Healthcare providers (EHN) or In-Network providers (Aetna National Network). The plan also gives you more control over how you receive and pay for health care services. Like a traditional plan, the HSA Plan has a deductible, coinsurance and an out-of-pocket maximum to provide financial protection in the event of a serious illness or injury. A distinct advantage when enrolling in the HSA Plan is the ability to set up a health savings account and contribute pretax to it each year. Emory Contributes $300 1 or $600 1 You Earn Incentives Up To $400 (or $500) You Contribute Any Amount Up To Plan Maximum Money in the HSA will be invested in a money market fund. Maximum Contributions All Sources (Emory Contributions, Incentives, and Your Contributions): $3,450 2 or $6,900 2 Preventive Care Covered at 100% (EHN or In-Network) Health Savings Account (HSA) Emory Contribution + Your Earned Incentives + Your Contributions Deductible Co-Insurance Out-of-Pocket Maximum Remaining HSA Balance Use your HSA funds to pay for eligible medical expenses. Total Possible HSA Contributions 2 : $3,450 (Employee Only) $6,900 (Employee + Spouse, Employee + Child(ren) or Family) You pay all eligible expenses until the deductible is satisfied. You may use funds in your HSA to meet your deductible. $1,350 (Employee Only EHN); $1,500 (In-Network); $2,500 (Out-of-Network) $2,700 (Employee + Spouse, Employee + Child(ren) or Family EHN); $3,000 (In-Network); $5,000 (Out-of-Network) Once the deductible is satisfied, for services you pay: 15% in the Emory Healthcare Network (EHN) 25% in the Aetna National Network (In-Network) 50% Out-of-Network If your expenses paid annually exceed: $3,500 (Employee Only EHN & $4,750 In-Network); $10,000 (Out-of-Network) $7,000 (Employee + Spouse, Employee + Child(ren or Family EHN) & $9,500 In-Network; $20,000 (Out-of-Network). Then the plan pays 100% 3 Unused HSA funds will continue to be available for future use on eligible medical, dental and vision expenses Emory contributes $300 if you are enrolled in employee only coverage; $600 if you cover any dependents (spouse or children). Employees 55 years of age and over can add up to an additional $1,000 contribution to the HSA maximums for catch-up contributions. Once the annual out-of-pocket maximum is satisfied, the plan pays 100% of all remaining eligible expenses during the plan year, including Emergency Room visits and prescription drugs. 10

11 HSA Plan Examples Donna Single Coverage Employee Only Meet Donna! Her health expenses throughout the year are usually low. Other than getting her annual check-up, she typically has few medical expenses. Since she does not usually spend much on health care, Donna likes the idea of receiving funding from Emory to meet her other health care needs during the year. Donna takes advantage of 100% In-Network covered preventive care by getting her well-woman check-up. Because Donna has registered for Healthy Emory Connect and completed her online Health Risk Assessment, she receives $75. Additionally, she has one other office visit and fills one prescription every 90 days from Tier 2 at a retail pharmacy. YEAR ONE Donna s HSA Contributions Emory s contribution....$ 300 Received incentives (Healthy Emory Connect & online HRA).... $ 75 Donna s Contribution ($100 per month x 12 months)... $1,200 Total HSA funds available...$1,575 Donna s Medical Expenses Tier 2 prescription....$ 750 In-Network office visit..... $125 Annual check-up (preventive care is paid by the plan at 100%).... $0 YEAR TWO Donna s HSA Contributions HSA balance carried over from previous year... $700 Emory s contribution.... $300 Received incentive... $75 Total HSA funds available in year two...$1,075 Donna s Medical Expenses Tier 2 prescription... $750 In-Network office visit.... $125 Annual check-up (preventive care).... $0 Total Expenses in year $ 875 Donna s Totals HSA funds available...$1,075 Annual deductible satisfied... $875 Annual out-of-pocket maximum satisfied... $875 With the HSA Plan, Donna again used her HSA to cover her $875 of medical expenses during the plan year. The $200 remaining in her HSA at the end of year two will be available for future use. YEAR THREE Donna s HSA Contributions HSA balance from previous year...$200 Emory s contribution...$300 Received incentive...$75 Total HSA funds available in year three...$575 For year three, Donna can increase the funds in her HSA by completing additional incentives. Total expenses $ 875 Donna s Totals HSA funds available....$1,575 Annual deductible satisfied... $875 Annual out-of-pocket maximum satisfied... $875 With the HSA Plan, Donna can pay for her $875 in expenses by using her HSA. The $700 remaining in her HSA will be available for future eligible medical expenses. 11

12 HSA Plan Examples The Smith Family Family Coverage 2 Adults, 1 Child Meet the Smiths! Andrew and Cindy and their three-yearold son, Joe, have a variety of planned and unplanned health expenses throughout the year. Each year, they all normally get an annual physical exam. The family estimates at least five office visits per year two well-child and two well-adult visits, plus an office visit for Cindy s chronic asthma condition. Cindy and Andrew both get $100 each in incentive money for completing their colonoscopy. Cindy also completed in the 2018 Move More Challenge and completed two online programs to earn $200 in additional incentives. YEAR ONE Smith Family HSA Contributions Emory s contribution...$600 Cindy completed an incentive (colonoscopy)...$100 Andrew completed an incentive (colonoscopy)...$100 Cindy completed two additional incentives...$100 Smith Family Payroll Contribution.... $1,800 Total HSA funds available...$2,700 Smith Family Medical Expenses Smiths Paid Plan Paid HSA Funds Used Joe has an emergency room visit that results in eligible charges totaling $750. One $750 $0 $0 office visit for Cindy s Asthma Condition. $150 $0 $0 Asthma Prescriptions $1,200 $0 $0 Two In-Network Well-Adult and two Well-Child visits at $125 each totaling $500. The Smiths responsibility is $0 because preventive care is covered at 100%. $0 $500 $0 Total Expenses $2,100 $500 $0 The Smiths have HSA available funds totaling $2,700. They have decided to save their HSA funds for future eligible medical expenses. Alternatively, the Smiths could have decided to pay all of their expenses incurred using their HSA, and paid $0 out of their own pocket. Then, they would start year two with an HSA balance of $600 ($2,700 - $2,100 = $600) from year one s balance rolling forward. 12

13 Frequently Asked Questions How do I deposit funds into my HSA? Funds to your HSA can come from (1) Emory s annual contribution, (2) incentives you and/or your spouse earn and (3) contributions you and/or your spouse make. Your contributions to the HSA, including contributions from your spouse, can be made through pre-tax payroll deductions, or may be made after-tax by transferring funds from your bank account. NOTE: If you enroll in the HSA Plan for 2018 and have a balance in a 2017 Healthcare Flexible Spending Account (as of December 31, 2017), you are not eligible to contribute funds to an HSA or receive any funds in your HSA until April 1, This includes Emory s annual contribution, incentives earned from wellness activities, or contributions you make to your HSA. The April 1, 2018 date still applies even if your Healthcare FSA account balance reaches $0 at an earlier point during How do I get a new or additional debit card for myself or my dependents? If you need a replacement card or an additional card for yourself or your dependent, you should request one through Aetna/PayFlex by calling I am a new employee and want to enroll in the HSA Plan. Will I receive the entire annual Emory contribution? No. The contributions you receive from Emory to your HSA will be prorated based on when you activated your HSA. For example, if you are hired on February 10 and enroll in employee-only coverage, you receive the annual contribution for the March December timeframe that s 10 out of 12 months or 83% of the year ($300 x.83 = $249). I am 55 years of age. Can I contribute more to my HSA? Yes, if you are an Emory employee and are age 55 or older, you can make an additional $1,000 in catch-up contributions to your HSA. When including catch-up contributions, the annual contribution maximums are increased to $4,450 for individual coverage and $7,900 for family coverage. How do I access the beneficiary form for the HSA? Beneficiary designation forms are available on the Aetna Navigator website ( After you log in to your account, click the Forms tab at the top of the page. on the next page, under the PayFlex Reimbursement Accounts, click the link for all PayFlex forms. Can I use funds in my HSA to pay medical expenses for my 25-year-old child? Yes. If your 25-year-old child is covered on your medical plan and you can claim the child on your tax return, you may use your HSA funds to pay for their medical expenses. Can I still have an FSA if I am enrolled in the HSA Plan? Yes. You can enroll in a limited Healthcare Flexible Spending Account (FSA) even if you are enrolled in the HSA Plan. You may use the limited FSA to pay for dental and vision expenses and for medical expenses once your deductible has been met. Remember: with an FSA, the funds must be used by the end of the grace period (March 15 of the following year) or they are forfeited. For more information, contact: Employee Resource Center ehc.hr/benefits@emoryhealthcare.org Aetna