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Frequently Asked Questions & Answers

 

HSA QUESTIONS


What is a Health Savings Account ("HSA")?

A Health Savings Account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their health care. HSA’s enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

You own and control the money in your HSA. Decisions on how to spend the money are made by you without relying on a third party or a health insurer. You can also decide what types of investments to make with the excess money (over $1,000) in the account in order to help it grow.

I don't have health insurance. Can I get an HSA?

You cannot establish and contribute to an HSA unless you have coverage under a High Deductible Montgomery County Health Plan (i.e., the County Plan or the Advantage Plan).

I'm on Medicare. Can I have an HSA?

You are not eligible for an HSA after you have enrolled in Medicare. If you had an HSA before you enrolled in Medicare, you can keep it. However, you cannot continue to make contributions to an HSA after you enroll in Medicare.

I am a Veteran, can I have an HSA?

Generally, if you have received any health benefits from the Veterans Administration or one of their facilities, including prescription drugs, in the last three months, you are not eligible for an HSA.

I'm active-duty military and have Tricare coverage. Can I have an HSA?

At this time, Tricare does not offer an HDHP options so you are not eligible for an HSA.

My spouse has an FSA or HRA through their employer, can I have HSA?

You cannot have an HSA if your spouse's FSA or HRA can pay for any of your medical expenses before your HDHP deductible is met.

Does my income affect whether I can have an HSA?

There are no income limits that affect HSA eligibility. However, if you do not file a federal income tax return, you may not receive all the tax benefits HSAs offer.

Can I start an HSA for my child?

No, you cannot establish separate accounts for your dependent children, including children who can legally be claimed as a dependent on your tax return.

I'm a single parent with HDHP coverage but have child/relative that can be claimed as a dependent for tax purposes, and this dependent also has non-HDHP coverage. Am I still eligible for an HSA?

Yes, you are still eligible for an HSA. Your dependent's non-HDHP coverage does not affect your eligibility, even if they are covered by your HDHP.

I'm over 55 and would like to make catch-up contributions to my HSA, like I've done with my IRA. Is that possible?

Yes, individuals 55 and older who are covered by an HDHP can make additional catch-up contributions of $1,000 each year until they enroll in Medicare.

If each spouse has self-only HDHP coverage (neither spouse has family coverage), how much can we contribute?

For 2017, each spouse is eligible to contribute to an HSA in their own name, up to the individual statutory limit.

Does tax filing status (joint vs. separate) affect my contribution?

Tax filing status does not affect your contribution.

Who decides whether the money I'm spending from my HSA is for a "qualified medical expense?"

You are responsible for that decision.  Therefore, you should familiarize yourself with what qualified medical expenses are (as partially defined in IRS Publication 502) and always keep your receipts in case you need to defend your expenditures or decisions during an audit.

What happens if I don't use the money in the HSA for medical expenses?

If the money is used for other than qualified medical expenses, the expenditure will be taxed and, for individuals who are not disabled or over age 65, subject to a 20% tax penalty.

Are dental and vision care qualified medical expenses under a Health Savings Account?

Yes, as long as these are deductible under the current rules. For example, cosmetic procedures, like cosmetic dentistry, would not be considered qualified medical expenses.

Can I use the money in my HSA to pay for medical care for a family member?

Yes, you may withdraw funds to pay for the qualified medical expenses of yourself, your spouse or a dependent without tax penalty. This is one of the great advantages of HSAs.

Can I use my HSA to pay for medical services provided in other countries?

Yes.

Can I pay my health insurance premiums with an HSA?

You can only use your HSA to pay health insurance premiums if you are collecting Federal or State unemployment benefits, or you have COBRA continuation coverage through a former employer.

Can I purchase long-term care insurance with money from my HSA?

Yes, if you have tax-qualified, long-term care insurance. However, the amount considered a qualified medical expense depends on your age. See IRS Publication 502 for the amounts deductible by age.

I have an HSA but no longer have HDHP coverage. Can I still use the money that is already in the HSA for medical expenses tax-free?

Once funds are deposited into the HSA, the account can be used to pay for qualified medical expenses tax-free, even if you no longer have HDHP coverage. The funds in your account roll over automatically each year and remain indefinitely until used. There is no time limit on using the funds.

What happens to the money in my HSA if I lose my HDHP coverage?

Funds deposited into your HSA remain in your account and automatically roll over from one year to the next. You may continue to use the HSA funds for qualified medical expenses. You are no longer eligible to contribute to an HSA for months that you are not an eligible individual because you are not covered by an HDHP. If you have coverage by an HDHP for less than a year, the annual maximum contribution is reduced; if you made a contribution to your HSA for the year based on a full year's coverage by the HDHP, you will need to withdraw some of the contribution to avoid the tax on excess HSA contributions. If you regain HDHP coverage at a later date, you can begin making contributions to your HSA again.

Do unused funds in a Health Savings Account roll over year after year?

Yes, the unused balance in a Health Savings Account automatically rolls over year after year. You won't lose your money if you don't spend it within the year.

What happens to the money in a Health Savings Account after you turn age 65?

You can continue to use your account tax-free for out-of-pocket, qualified health expenses. When you enroll in Medicare, you can use your account to pay Medicare premiums, deductibles, copays, and coinsurance under any part of Medicare. If you have retiree health benefits through your former employer, you can also use your account to pay for your share of retiree medical insurance premiums. The one expense you cannot use your account for is to purchase Medicare supplemental insurance or a "Medigap" policy.

Once you turn age 65, you can also use your account to pay for things other than medical expenses. If used for other expenses, the amount withdrawn will be taxable as income but will not be subject to any other penalties. Individuals under age 65 who use their accounts for non-medical expenses must pay income tax and a 20% penalty on the amount withdrawn.

Can I use my HSA to pay for medical expenses incurred before I set up my account?

No. You cannot reimburse qualified medical expenses incurred before your account is established. We recommend you establish your account as soon as possible.

Who will be the "bookkeeper" for my HSA?

It is your responsibility to keep track of your deposits and expenditures.  Be sure to keep all of your receipts as you will need them if you are ever audited by the IRS.

How do I use my HSA to pay my physician when I'm at the physician's office?

If you are still covered by your HDHP and have not met your deductible, you will be responsible for 100% of the amount agreed to be paid by your insurance policy to the physician. Your physician may ask you to pay for the services provided before you leave the office. Use your HSA checkbook or debit card to pay your physician directly from the account.

If your physician does not ask for payment at the time of service, the physician will probably submit a claim to your insurance company, and the insurance company will apply any discounts based on their contract with the physician. You will then receive an "Explanation of Benefits" from your insurance plan stating how much the negotiated payment amount is, and that you are responsible for 100% of this negotiated amount. If you have not already made any payment to the physician for the services provided, the physician may then send you a bill for payment.

Can the funds in an HSA be invested?

Yes, you can invest the funds in your HSA. The same types of investments permitted for IRA’s are allowed for HSA’s, including stocks, bonds, mutual funds, and certificates of deposit.

The HSA product offers an integrated investment platform which provides the HSA account holder a way to invest and grow their HSA dollars. Once the HSA balance reaches $1,000, an account holder can establish an investment account and begin to diversify accumulated HSA assets into a selection of 25 highly rated funds from a variety of fund families.

Who has control over the money invested in a Health Savings Account?

The account holder controls all decisions over how the money is invested. You can also choose not to invest your funds.

Will my bank notify me if I've exceeded my allowable contribution amount?

No, it is your sole responsibility to keep track of the amounts deposited and spent from your account, just like a normal savings or checking account.  You will also need to count any employer contributions to your HSA toward your annual maximum.

Can I borrow against the money in my HSA?

No. You may not borrow against it or pledge the funds in it. For more information on prohibited activities, see Section 4975 of the Internal Revenue Code.

Can I roll the money in a Health Savings Account over into an IRA?

You cannot roll the HSA funds over into an IRA. They will stay in the HSA or be rolled into another HSA.

What happens to the money in my HSA when I die?

What happens depends on how the HSA is designed. If your spouse is designated as the beneficiary by you, your spouse becomes the owner of the HSA when you die. If you provide that it goes to your estate or other entity, the value of the HSA at death is income to the estate or other entity.

If I am enrolled in the County Plan can I use my HSA money for dental and vision expenses? Are those expenses counted toward my deductible and out-of-pocket maximums?

You can use HSA money for dental and vision expenses.  However, since dental and vision are separate from the medical plan, they will not accumulate toward your deductible or out-of-pocket maximums for your HDHP.

 

LIFE INSURANCE QUESTIONS


Is the Life Insurance offered by the County considered Whole or Term?

The Basic and Supplmental Life options that the County offers are Term Insurance. There is a detailed document on the benefits website for additional reference.

A printable Life Insurance Certificate is available on the life insurance link.

 

GENERAL OPEN ENROLLMENT QUESTIONS


Are employees required to turn in dependent documentation for dependents that are already covered?

No, if you currently have your spouse and dependents covered under your insurance, you are not required to send dependent documentation. You will only have to submit dependent documentation if the dependent that was not previously covered under a plan.

How do the Annual Deductible and Out-of Pocket Maximum work for each of the Health plans for Montgomery County?

Advantage Plan: Single deductible is $2,000.00 in-network. Prescriptions and covered in-network medical/procedures are paid for by the employee at the discounted vendor rate until they have paid $2,000.00. Once the $2,000.00 deductible is met, the employee pays 30% for prescriptions and medical visits/procedures. When the employee has paid $5,000 out of pocket (in-network), the plan pays 100% for prescriptions and covered in-network medical/procedures through the end of the plan year. The $5,000.00 out-of-pocket maximum includes the $2,000.00 deductible.

Advantage Plan: Employee +1 or Family deductible is $4,000.00 in-network.  This must be met by either one person or the combined members of the plan before the plan begins paying a percentage. Prescriptions and covered in-network medical/procedures are paid for by the employee at the discounted vendor rate until the member(s) have paid $4,000.00. Once the $4,000.00 deductible is met, the employee pays 30% for prescriptions and medical visits/procedures. Once one person or the combined members of the plan have paid $10,000.00 out of pocket (in-network), the plan pays 100% for prescriptions and covered in-network medical/procedures through the end of the plan year. The $10,000.00 out of pocket max includes the $4,000.00 deductible.

County Plan: Single deductible is $1,600.00 in-network. Prescriptions and covered in-network medical/procedures are paid for by the employee at the discounted vendor rate until they have paid $1,600.00. Once the $1,600.00 deductible is met, the employee pays 30% for prescriptions and medical visits/procedures. When the employee has paid $3,700 out of pocket (in-network), the plan pays 100% for prescriptions and covered in-network medical/procedures through the end of the plan year. The $3,700.00 out of pocket max includes the $1,600.00 deductible.

County Plan: Employee +1 or Family deductible is $3,200.00 in-network.  This must be met by either one person or the combined members of the plan before the plan begins paying a percentage. Prescriptions and covered in-network medical/procedures are paid for by the employee at the discounted vendor rate until the member(s) have paid $3,200.00. Once the $3,200.00 deductible is met, the employee pays 30% for prescriptions and medical visits/procedures. Once one person or the combined members of the plan have paid $5,800.00 out of pocket (in-network), the plan pays 100% for prescriptions and covered in-network medical/procedures through the end of the plan year. The $5,800.00 out of pocket max includes the $3,200.00 deductible.

Buy Up Plan: Single deductible is $850.00 in-network. Office Visits, Emergency Room Visits (less than 24 hours), Urgent Care Visits, and Prescriptions are subject to a co-pay which does not accumulate toward the deductible or out-of-pocket maximum. Covered in-network medical procedures, lab work, x-rays, etc. are paid for by the employee at the discounted vendor rate until they have met the $850.00 deductible. Once the $850.00 deductible is met, the employee pays 20% for medical procedures, lab work, x-rays, etc. Once the employee has paid $3,300.00 out of pocket (in-network), the plan pays 100% for covered in-network medical procedures, lab work, prescriptions, x-rays, etc. through the end of the plan year. The $3,300.00 out-of-pocket maximum includes the $850.00 deductible. The employee will is responsible for co-pays in the Buy-Up Plan regardless of amounts spent toward the deductible or out-of-pocket maximum.

Buy Up Plan: Employee+1 or Family deductible is $1,700.00 in-network. Office Visits, Emergency Room Visits (less than 24 hours), Urgent Care Visits, and Prescriptions are subject to a co-pay which does not accumulate toward the deductible or out-of-pocket maximum. Covered in-network medical procedures, lab work, x-rays, etc. are paid for by the employee at the discounted vendor rate until one member has met the $1700 deductible. Once the $1,700.00 deductible is met by one member, the member pays 20% for medical procedures, lab work, x-rays, etc. Once the member has paid $6,600 out of pocket (in-network), the plan pays 100% for covered in-network medical procedures, lab work, x-rays, etc. through the end of the plan year for that specific member. The $6,600.00 out-of-pocket maximum does include the $1,700.00 deductible. The remaining members in the plan will then have to meet an $850.00 deductible to satisfy the $1,700.00 Employee + 1/Family deductible. Once that has been met, the remaining members pay 20% for medical procedures, lab work, x-rays, etc. and when the overall total of $6,600 out of pocket (in-network) has been met, the plan pays 100% for covered in-network medical procedures, lab work, x-rays, etc. through the end of the plan year for the covered members on the plan. The $6,600.00 out-of-pocket maximum does include the $1,700.00 deductible. The employee is responsible for co-pays in the Buy Up Plan regardless of amounts spent toward the deductible or out-of-pocket maximum.

What is the procedure if I visit an in-network doctor, but I am billed more than the agreed pricing amount?

You must contact Anthem to investigate why the doctor charged over the agreed pricing amount. You can request that that the Anthem representative work with the provider to determine the details of the billing and if you are being billed appropriately.

If my doctor recommends that I come in several times a year for follow up exams and bloodwork, is that covered under wellness at 100%?

No, your annual physical and any standard age/gender appropriate testing is covered at 100% under the wellness benefit. Diagnostic follow-up is subject to deductible and co-insurance.

How do we obtain a list of preventive medicines covered 100% by the health care plans?

In order to receive additional information on how services or medications are covered, you should contact Anthem or Express Scripts with your specific questions.

If the out-of-pocket mamimum amount is reached, is a patient forced to use "preferred" medication to be covered at 100%? Or can the employee use the "alternative" medications?

It depends on the drug. Montgomery County participates in a Preferred Drug Step Therapy program for certain drug categories. If the drug is targeted by this program, you would be required to use the preferred drug or be previously authorized via a coverage review to receive the non-preferred product. In order to receive additional information on how services or medications are covered, you should contact Anthem or Express Scripts with your specific questions. For other covered drugs, both preferred and non-preferred brands would be covered at 100% once the out-of-pocket maximum has been met.

For other covered drugs, both preferred and non-preferred brands would be covered at 100% once the out-of-pocket maximum has been met in the County and Advantage Plan. In the Buy-Up plan, you will still be responsible for your prescription co-pay, regardless of your out-of-pocket maximum status.

Do we have to submit proof of other insurance?

Yes. You will need to submit the Verification of Employer-Sponsored Health Coverage form along with proof of current coverage for yourself and any other covered dependents. The completed verification form and proof of current coverage should be sent to the Benefits Department via email at hr@mcohio.org or by fax at (937) 496-7407. This information must be provided each year.

Can I sign up for Dependent Care FSA and not take the medical plan?

Yes. You can participate in Flexible Spending Accounts without being enrolled in a medical plan through Montgomery County.