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How to shop for HSA Health Plans

HSA Health Insurance > How to shop for HSA Health Plans

What is an HSA Qualified health plan?

An HSA qualified health plan is called a High Deductible Health Plan (HDHP). You must have coverage under a HDHP in order to open and contribute to a Health Savings Account (HSA). Federal law requires that for 2013 the health insurance deductible be at least:

$1,250 - Self-only coverage
$2,500 - Family coverage

In addition, annual out of pocket expenses under the plan (including deductibles, co-pays, and co-insurance) cannot exceed:

$6,250 - Self-only coverage
$12,500 - Family coverage

In general, the deductible will apply to all medical expenses (including prescriptions) covered by the HDHP. However, HSA health plans do pay for "preventive care" services without any cost sharing such as deductibles or copayments. Preventive care includes routine annual physical exams, well-child care, prostate screening, mammograms, pap smears, etc.

Limited Benefit HDHP's

While all insurance carriers offer a "comprehensive major medical" HDHP, some carriers offer a discounted "limited benefit" HDHP that excludes coverage for certain medical services. These plans can be a more affordable option, as long as you are aware of the policy limitations and are willing to assume the extra financial risk.

Limited Benefit HDHP's
Carrier Plan Name Limitations
Humana One HSA 100% Prescriptions, mental health and chiropractic services are not covered by this plan, Humana does provide a discount RX card and you can still use your "tax free" HSA dollars to pay for these services.

If your trying to keep your health insurance premiums low and also limit your exposure, you can also consider a comprehensive health plan with the highest deductible available - usually $5,000 for single coverage or $10,000 for family coverage. Humana also offers the Enhanced HSA 100 that includes coverage for prescriptions and mental health and costs roughly 20% more than the HSA 100. Remember - you can still use your tax free HSA savings to pay for these excluded services, it's just that they won't be applied towards your health plan deductible.

Aggregate or Embedded Family Deductibles

Family deductibles on most HSA qualified HDHP's are aggregate deductibles. A family deductible would apply whenever you insure two or more family members on a HDHP. An aggregate deductible means that there is "one" deductible for all insured family members. An embedded deductible means that each family member has their own individual deductible. Currently Aetna and Coventry are the only carriers who's plans includes embedded per member deductibles on family policies.

Example 1 - John, Joan and their two children apply for the $10,000 deductible family HDHP with Cigna. Cigna's HDHP has the one aggregate family deductible. John has a $20,000 surgery, so all of his medical expenses are applied to the family $10,000 deductible, then Cigna pays the balance. John and his family have now met their $10,000 aggregate family deductible so any further medical expenses from any family member is paid by Cigna at 100%. The cost for John's $20,000 surgery - $10,000.

Example 2 - Mark, Mary and their two children apply for the $5,000 per member/$10,0000 family HDHP with Coventry. Coventry's HDHP features the embedded per member deductible, with a family maximum deductible equal to two times the per member deductible. Mark has a $20,000 surgery, so all of his medical expenses are applied to his per member $5,000 deductible, then Coventry pays the balance. Mark has now met his per member deductible and Coventry will pay 100% of his covered medical expenses for the remainder of the calendar year. Any additional medical expenses from Mary or the two children are now applied towards the remaining $5,000 balance of the family maximum $10,000 deductible. The cost for Mark's $20,000 surgery - $5,000.

Preventive Care Benefits

With the passing of healthcare reform on March 23, 2010, federal law now requires all non grandfathered plans and any new individual policy issued after September 23, 2010 to cover preventive care services without any cost sharing (e.g., deductibles, copayments or coinsurance). This applies to any HSA qualified High Deductible Health Plan.

What services are considered preventive care? The Patient Protection and Affordable Care Act (PPACA) defines preventive care services as follows:

  • Items or services recommended with an A or B rating by the U.S. Preventive Services Task Force. For a complete listing A or B rated preventive care services visit Healthcare.gov
  • Immunizations recommended by the Advisory Committee on Immunization Practices of the CDC.
    Georgia also has state mandates covering child wellness services from birth thru age five.
  • Preventive Care and screenings for women supported by the Health Resources and Services Administration. Preventive annual mammography and Pap tests are covered preventive care services.

Do the preventive care requirements apply to both in-network and out of network services?
No, plans are not required to provide coverage for recommended services delivered by out of network providers. Refer to our Doctor Lists page to make certain your services are provided by an in network provider.

Georgia HSA Plans recommends that you schedule your preventive care services separate from any other accident or illness services. If the primary purpose of your office visit is other than the delivery of a preventive care service then some form of cost sharing (copayment or deductible) may be applied.

Maternity Benefits

Maternity benefits on individual and family HDHP's are not always a covered expense. Aetna, Assurant, Cigna, Coventry, Humana, Kaiser Permanente and United Healthcare do NOT offer coverage for normal maternity benefits on their HSA qualified HDHP's. While normal maternity benefits are not covered with these carriers, you can still use your tax free HSA dollars to pay for maternity expenses. Georgia HSA plans recommend that you ask your physician and hospital providers to provide you a "discounted cash rate" for maternity services not covered under your HDHP. All carriers are required to cover complications of maternity. Blue Cross does offer normal maternity benefits as optional addition to the policy.

Carrier Plan Name Maternity Benefits
Blue Cross FowardFocus HSA Maternity coverage is an optional benefit on plan deductibles of $2,500 or higher. Normal maternity benefits are covered after you have been insured with the maternity rider for a period of twelve months. Maternity benefits are covered subject to the plan deductible and coinsurance selected. Current maternity rider rates add $230 to the 80% coinsurance plans and $287 for the 100% coinsurance plans.

Health Insurance Underwriting

Each carrier has different underwriting guidelines concerning preexisting health conditions. Carriers can modify their offer for coverage in one of three ways:

  1. Rating - This method will increase the monthly premium for your policy, but with most policies the preexisting condition will then be a covered expense.

  2. Exclusion Rider - This method will exclude coverage under the policy for the preexisting condition. Your monthly premium is not increased since the preexisting condition is not covered. With an HSA plan this may be an acceptable solution since you would still be able to use your tax free HSA dollars to pay for these expenses.

  3. Decline - Some health conditions, such as a recent heart attack will result in a denial.

We recommend that you Contact Us concerning pre existing health conditions so that we may recommend the best carrier.

Rate Guarantees and Renewals

Most carriers will guarantee their rates for the first twelve months. Most carriers are now renewing their policies at their current market rates, which helps to keep your policy affordable for the long term. The health insurance market tends to be cyclical, where certain companies are competitive for a few years, or prices tend to be attractive when a carrier updates their product offerings. We recommend that you Contact Us when you receive your renewal so we can compare your renewal rates with current market rates.