NationalONE $2700-100%
The High Deductible Health Plan
(HDHP)
and Health Savings Account (HSA)
July 1, 2019
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District 622 Health Plan Offerings
In-Network BenefitsNationalOne
$200-$25
NationalOne
$2700-100% HSA
Available to: All groups
Clerical, Education
Assistants, Local 70,
Non Units,
Paraprofessionals,
Principals
Deductible$200 individual
$600 family
$2,700 individual
$5,400 family
Medical Out-of-pocket
Maximum
$500 individual
$1,000 family
$2,700 individual
$5,400 family
Prescription Out-of-
pocket Maximum
$500 per person
$750 per family
Combined with Medical
Out-of-Pocket Maximum
Lifetime maximum Unlimited Unlimited
Preventive health care 100% coverage 100% coverage
Office Visits
Urgent Care$25 copay
100% coverage after
deductible
Convenience Clinics
(Retail Clinics)$0 copay
100% coverage after
deductible
Preferred Benefits based on completion of Wellness incentive
Provider network and drug formulary the same for all plans
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In-Network BenefitsNationalOne
$200-$25
NationalOne
$2700-100% HSA
Inpatient,
Outpatient hospital,
Ambulance
100% after
deductible100% after deductible
Emergency Room $75 copay 100% after deductible
Durable medical
equipment
100% after
deductible100% after deductible
Home health care 80% after
deductible100% after deductible
Retail pharmacy:
-- Generic preferred
-- Brand preferred
-- Non-preferred
34 day supply/100
units
$8 copay
$16 copay
$32 copay
31 day supply
100% after deductible
Mail order pharmacy 2 copays for a 90
day supply100% after deductible
District 622 Health Plan Offerings
Preferred Benefits based on completion of Wellness incentive
Provider network and drug formulary the same for all plans
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How does it work?
High Deductible Plan with a
Reimbursement Account (HSA)
2. HealthPartners
processes the
claim, applies
their discount and
sends Explanation
of Benefits to
provider and you.1. You seek
medical care,
your provider
submits the
charges to
HealthPartners.
3. Provider
sends you bill
for amount
you owe.
4. You pay the
doctor using
provided checks
or Further debit
card.
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HSA OverviewClerical, Education Assistants, Non-Unit, Paraprofessionals,
Principals
What is a Health Savings Account (HSA)?Financial account that is owned by an individual
Associated with a High Deductible Health Plan
(HDHP)
Contributions to the account are to pay for
current and future medical expenses
No “use it or lose it”, unused funds rollover
Interest earned is tax free
Investment opportunities
Portable
Beneficiary can be named to account
Post age 65 non-medical distributions without
penalty
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HSA Employee Advantages
Control over the account
Ability to contribute tax free $ to HSA account
2019: single $3,500, family $7,000
Catch up (age 55+) $1,000
Rollover provides opportunity to save for future health
care expenses
Tax-exempt withdrawals for qualified medical
expenses not covered by the health plan
Interest and earnings grow tax free w/ investment
opportunities
Portability
Post 65 non-medical withdraws
This is the employee’s account and the entire
balance belongs to the employee, regardless of your
present or future employment and/or who deposited
the funds.
Using your account
We make it easy to access your funds
Debit Card
Direct
deposit
File a
claim
online, fax
or mail
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Smart Card
Accepted everywhere Visa is accepted
No ATM access
No Fees for Debit Card
Spouse or additional cards for no cost
Some substantiation required (VEBA)
SAVE RECEIPTS AND EXPLAINATION OF BENEFITS
(EOB)!
Debit Card – Gives you choices
Online Member Service Center
Register with the site to:
View your account 24/7 via PC, Tablet or mobile
phone
Request reimbursement for out of pocket expenses
Check balance
View account activity
Request additional debit cards, add/change
beneficiaries, manage investment funds
Managing your account is easy with
hellofurther.com
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View your account 24/7 via PC, Tablet or
mobile phone
Request reimbursement for out of pocket
expenses
Check balance
View account activity
Request additional debit cards
Manage investment funds
Member MobileMore than an App, full website enabled experience
from any mobile device
We’re here to helpOur expert, friendly service team is here to answer
your questions
1.800.859.2144651.662.5065
Monday thru Friday
7 a.m. to 8 p.m. CST
hellofurther.comYour Online Member
Service Center
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Who is Eligible for an HSA?
Anyone who is:
• Covered by the High Deductible Health Plan,
NationalONE $2700-100%
• Not enrolled in Medicare
• Not covered under other health insurance*
Cannot be covered by any other health insurance
that reimburses you for health expenses you incur,
unless it is another HSA-qualified HDHP.
• Not another person’s tax dependent
*Other health insurance does not include: specific
disease or illness insurance, accident, disability,
dental care, vision care and long-term care
insurance
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Eligibility Scenarios -- Acceptable Situations:
Single employee enrolled
in HDHP
no medical flex
no HRA/VEBA
limited medical flex
limited HRA/VEBA
suspended HRA/VEBA
not on Medicare
Married employee enrolled in
HDHP
not enrolled in spouse’s medical
plan
spouse doesn’t have a traditional
medical flex
spouse doesn’t have an
HRA/VEBA
spouse has an HRA/VEBA that is
limited to spouse’s expenses
limited HRA/VEBA
suspended HRA/VEBA
not enrolled in Medicare
Spend Down Approach:
Employee elects HDHP and wishes to spend down their
HRA/VEBA balance. The first of the month following when the
VEBA balance is $0, the participant could establish an HSA
account, assuming they are not enrolled in the traditional flex
plan or have any other coverage that would make them
ineligible for an HSA account.
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Some scenarios Eligibility Scenarios -- Problem Situations:
Single employee enrolled in non HDHP, doesn’t suspend or
limit existing VEBA
Gets married, want to enroll in HDHP and HSA.
Can’t start HSA as long as HRA/VEBA has funds remaining or
until next plan year when the HRA/VEBA can be limited or
suspended
Single employee enrolled in non HDHP, doesn’t have
HRA/VEBA, but elects traditional medical flex
Gets married, want to enroll in HDHP and HSA.
Can’t start HSA until next flex plan as flex creates HSA
ineligibility
Married employee enrolled in non HDHP, doesn’t suspend or
limit existing HRA/VEBA
Wishes to enroll in HDHP and HSA due to spouse plan
change/cost.
Can’t start HSA as long as HRA/VEBA has funds remaining or
until next plan year when the HRA/VEBA can be limited or
suspended
Married employee enrolled in non HDHP, doesn’t have VEBA,
but elects traditional medical flex
Wishes to enroll in HDHP and HSA due to spouse plan
change/cost.
Can’t start HSA until next flex plan as flex creates HSA
ineligibility
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Distribution Rules
Distributions are tax-free if they are taken for “qualified medical expenses”
Accounts can only be used for expenses that are incurred on or after the date the account was established
Funds can be used for expenses from a prior year, as long as the expenses incurred on or after the date the account was established
Distributions can be taken for qualified medical expenses
for the following people:
The account holder (employee covered by the HDHP)
Spouse of account holder (even if not covered by the
HDHP)
Dependent Children
HSA: Tax Dependents of that individual
For individuals age 65 and older, HSA distributions can be
used for non-qualified medical expenses without facing
the 20 percent penalty
However, income taxes will apply for non-medical
distributions
This rule is regardless of whether the individual is
enrolled in Medicare
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Qualified Medical Expenses
The IRS defines expenses that are considered “qualified medical
expenses” for HSA distributions
Expenses must be primarily to treat or prevent a physical or
mental defect or illness
If you use HSA funds for expenses beyond what the IRS defines as
qualified, you will be subject to income tax on the distribution
and an additional 20 percent penalty
Examples of qualified medical expenses:
Most medical care that is subject to your deductible (copays,
coinsurance, doctor visits, inpatient or outpatient treatment, etc.)
Prescription drugs
Over-the-counter drugs, only if you obtain a prescription
Insulin (with or without a prescription)
Dental and vision care
Select insurance premiums
COBRA, qualified long-term care insurance, health insurance
premiums paid while receiving unemployment benefits,
health insurance after you turn 65 except for a Medicare
supplemental policy
Examples of not considered “qualified medical expenses”:
Insurance premiums (other than the exceptions listed above)
Over-the-counter drugs (unless a prescription is retained from a
physician – insulin is an exception)
Cosmetic procedures such as teeth whitening
A full list of qualified medical expenses is available at www.hellofurther.com or
from the Benefits office
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Which plan is a good fit for me?
For the high deductible examples, the assumption is
that average office visit costs $110
Remember:
Routine Preventative Physicals are covered 100%
under all plans
200-25 Plan has a prescription copay of $8 generic
preferred, $16 brand preferred and $32 non
preferred; an office visit copay of $25 and a $200
per person deductible (maximum of $400 per
family).
The HSA plan has a deductible of $2,600 per
person and a maximum of $5,200 per family.
Assuming Preferred Benefits resulting from
completed of the Wellness Incentive Program
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HSA ContributionClerical, Education Assistants, Non-Unit, Paraprofessionals,
Principals--HSA $2600-100%
Where applicable, effective July 1, 2018 District
Contributions to the HSA will be the surplus of the District
Contribution compared to the health plan premium.
Please note for full-time Clerical, Driver/Custodians, Non-
Units and Principals contributions are made each paycheck
July through June; 24 paychecks. For all other groups,
contributions are made each paycheck October through
May; 16 paychecks.
Employee Group Family Single
CLERICAL-10 mo, Full-time (Hired before 8/7/92) $9.44 $60.67CLERICAL-10 mo, Full-time (Hired after 8/7/92) $0.00 $60.67CLERICAL-11 mo, Full-time (Hired before 8/7/92) $9.44 $60.67CLERICAL-11 mo, Full-time (Hired after 8/7/92) $0.00 $60.67CLERICAL-12 mo, Full-time $9.44 $60.67DRIVER/CUSTODIAN-12 mo, Full-time $9.44 $60.67DRIVER-STUDENT CONTACT DAY $0.00 $60.67EDUCATION ASSISTANT $0.00 $0.00NON-UNITS-FAMILY CAP $9.44 $60.67NON-UNITS-NURSES $0.00 $60.67NON-UNITS-SINGLE CAP $0.00 $60.67PARAPROFESSIONALS $0.00 $35.65PRINCPALS $9.44
$60.67
District Contribution to the
HSA (monthly)
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HSA Contribution
Each year, the IRS sets contribution limits
These limits are for the total funds contributed,
including company contributions, your contributions
and any other contributions
You are allowed to contribute the entire year’s limit
whenever you first become eligible for the HSA (even if
that is in December)
However, you must remain eligible for at least 12
months after that date, or you will be subject to taxes
and penalties on the amount you contributed
For individuals ages 55 and older, the IRS allows
additional “catch-up contributions”
Eligible individuals may contribute an extra $1,000 for
the calendar year (for 2019)
2018
Individual $3,500
Family $7,000
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200-25
Plan
2700/5400 HSA
Plan
($728 District
Contribution to HSA)
*Annual premiums $1,410 $0^
Office visits $50 $220
Rx drugs $32 $240
Total estimated
maximum costs$1,492 $460
Reimbursable
expenses in HSAn/a $460
Cost after HSA
reimbursement$1,492 $0
HSA Balance n/a $268 ($728-$460)
Scenario 1: Low Healthcare User-SingleHDHP HSA (Clerical, EA, Local 70, Non Units,
Paraprofessionals, Principals)
*Annual premiums
based on groups with
highest District
contribution.
^The HSA premiums
will vary based on
individual
contribution to the
HSA account (the
higher contribution
the higher health
premium)
Maggie is a single, healthy female who takes advantage of
preventive care visits. In a typical year, she usually sees the
doctor twice. She has a preferred brand prescription for
Singulair that costs $120 (retail) and is filled twice per year.
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200-25
Plan
2600/5200 HSA Plan
($115 District
Contribution to HSA,
assumes $0 by employee)
*Annual premiums $5,590 $0^
Office visits $375 $1,650
Rx drugs $288 $1,500
Total estimated
maximum costs $6,253 $3,150
Reimbursable
expenses in HSAn/a
$3,150
($3,150 is reimbursable,
but $115 annual trust
amount)
Cost after HSA
reimbursement$6,253 $3,035 ($3,150-$115)
HSA Balance n/a $0
*Annual premiums
based on groups
with highest
District
contribution.
^The HSA
premiums will vary
based on
individual
contribution to
the HSA account
(the higher
contribution the
higher health
premium)
Carol’s family includes two children under the age of 6 and her
husband. During the year there are a total of 15 visits to the
doctor and 2 prescriptions per month between all the family
members. The prescriptions filled included 12 preferred
generic and 12 preferred brand ($1,500 total retail cost).
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Recordkeeping Whenever you use HSA funds to pay for a medical
expense, you should keep your receipt
You are responsible for demonstrating to the IRS that HSA
distributions were for qualified medical expenses
If the IRS requests receipts for verification purposes,
failure to provide those receipts could result in having to
pay a penalty
IRS Forms sent by Further IRS Form 1099-SA
Provides the total amount distributed from your HSA in prior
year. This form will be mailed to you by January 31, and
reported to the IRS by February 28.
Do not attach Form 1099-SA to your income tax return.
Instead, keep it for your records.
IRS Form 5498-SA
Provides the total amount of contributions credited to your
HSA for prior year. Rollover amounts and year-end fair
market values also are reported on this form. This form will
be mailed to you after April 15, to allow you time to apply
additional contributions to your HSA for prior year. It will be
mailed by May 31, and a copy will be sent to the IRS on your
behalf.
Do not attach Form 5498-SA to your income tax return.
Instead, keep it for your records.
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IRS Forms sent by Further
IRS Form 1099-SA
– Provides the total amount distributed from your HSA
in prior year. This form will be mailed to you by
January 31, and reported to the IRS by February 28.
– Do not attach Form 1099-SA to your income tax
return. Instead, keep it for your records.
IRS Form 5498-SA
◦ Provides the total amount of contributions credited to
your HSA for prior year. Rollover amounts and year-
end fair market values also are reported on this form.
This form will be mailed to you after April 15, to allow
you time to apply additional contributions to your HSA
for prior year. It will be mailed by May 31, and a copy
will be sent to the IRS on your behalf.
◦ Do not attach Form 5498-SA to your income tax
return. Instead, keep it for your records.
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