Author Topic: HSA and what qualifies as HDHP confusion  (Read 4811 times)

drumstache

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HSA and what qualifies as HDHP confusion
« on: March 31, 2021, 09:07:51 AM »
I set up an HSA based on meeting the deductible requirements.  I was under the impression that meeting that requirement was all that was needed.  Searching some threads here, that doesn't seem to be the case.

I called my insurance company for clarification.  After 10 minutes on hold, I was told that the plan did meet the requirements as HDHP.  But, he was basing this on a google search, and the deductible requirement from the same websites I had just looked at.  If my insurance company can't properly figure out if they're qualified, how am I supposed to?

But no, its not a qualified plan from what I've found.  It would be nice if the HSA sites would add this information in addition to the deductible requirements.

To be qualified as HPHP, the ins company doesn't pay for anything (Dr's visits, prescription until deductible is met). 
 
From IRS.gov
Prescription drug plans. You can have a prescription drug plan, either as part of your HDHP or a separate plan (or rider), and qualify as an eligible individual if the plan doesnít provide benefits until the minimum annual deductible of the HDHP has been met. If you can receive benefits before that deductible is met, you arenít an eligible individual

Tigerpine

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Re: HSA and what qualifies as HDHP confusion
« Reply #1 on: March 31, 2021, 09:19:11 AM »
Don't forget this part from the same IRS website.  It's not that you have to receive zero benefits of any kind before the deductible is met to qualify for an HSA.

Quote from: IRS
An HDHP may provide preventive care benefits without a deductible or with a deductible less than the minimum annual deductible. Preventive care includes, but isnít limited to, the following.

Periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals.
Routine prenatal and well-child care.
Child and adult immunizations.
Tobacco cessation programs.
Obesity weight-loss programs.
Screening services. This includes screening services for the following.
Cancer.
Heart and vascular diseases.
Infectious diseases.
Mental health conditions.
Substance abuse.
Metabolic, nutritional, and endocrine conditions.
Musculoskeletal disorders.
Obstetric and gynecological conditions.
Pediatric conditions.
Vision and hearing disorders.
For more information on screening services, see Notice 2004-23, 2004-15 I.R.B. 725, available at IRS.gov/irb/2004-15_IRB#NOT-2004-23.

For additional guidance on preventive care, see Notice 2004-50, 2004-2 C.B. 196, Q&A 26 and 27, available at IRS.gov/irb/2004-33_IRB#NOT-2004-50; and Notice 2013-57, 2013-40 I.R.B. 293, available at IRS.gov/pub/irs-drop/n-13-57.pdf. Preventive care can also include coverage for treatment of individuals with certain chronic conditions listed in the Appendix of Notice 2019-45, 2019-32 I.R.B. 593, if such services were received or items were incurred on or after July 17, 2019. For information on preventive care for chronic conditions, see Notice 2019-45, 2019-32 I.R.B. 593, available at IRS.gov/pub/irs-drop/n-19-45.pdf.

drumstache

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Re: HSA and what qualifies as HDHP confusion
« Reply #2 on: March 31, 2021, 09:39:45 AM »
Don't forget this part from the same IRS website.  It's not that you have to receive zero benefits of any kind before the deductible is met to qualify for an HSA.

Quote from: IRS
An HDHP may provide preventive care benefits without a deductible or with a deductible less than the minimum annual deductible. Preventive care includes, but isnít limited to, the following.

Periodic health evaluations, including tests and diagnostic procedures ordered in connection with routine examinations, such as annual physicals.
Routine prenatal and well-child care.
Child and adult immunizations.
Tobacco cessation programs.
Obesity weight-loss programs.
Screening services. This includes screening services for the following.
Cancer.
Heart and vascular diseases.
Infectious diseases.
Mental health conditions.
Substance abuse.
Metabolic, nutritional, and endocrine conditions.
Musculoskeletal disorders.
Obstetric and gynecological conditions.
Pediatric conditions.
Vision and hearing disorders.
For more information on screening services, see Notice 2004-23, 2004-15 I.R.B. 725, available at IRS.gov/irb/2004-15_IRB#NOT-2004-23.

For additional guidance on preventive care, see Notice 2004-50, 2004-2 C.B. 196, Q&A 26 and 27, available at IRS.gov/irb/2004-33_IRB#NOT-2004-50; and Notice 2013-57, 2013-40 I.R.B. 293, available at IRS.gov/pub/irs-drop/n-13-57.pdf. Preventive care can also include coverage for treatment of individuals with certain chronic conditions listed in the Appendix of Notice 2019-45, 2019-32 I.R.B. 593, if such services were received or items were incurred on or after July 17, 2019. For information on preventive care for chronic conditions, see Notice 2019-45, 2019-32 I.R.B. 593, available at IRS.gov/pub/irs-drop/n-19-45.pdf.

Thank you, I've about gone cross-eyed reading through this.

But from what I understand, my plan doesn't qualify due to having a prescription plan?

yachi

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Re: HSA and what qualifies as HDHP confusion
« Reply #3 on: March 31, 2021, 10:02:33 AM »
What I've seen is plans that are HDHP are marketed as such.  So the name of the health plan is something like "Highmark Pre-Tax High Deductible".  When you get one from your employer, they chose the HSA provider as well and offer that to you.

When it's not preventative (like annual checkups, maybe well-baby visits).  We pay 100% of the negotiated cost and the insurance pays nothing until we meet the deductible.  That means $1500 per lung specialist visit, $600 emergency room visits, $2,500 sleep studies.  We're not talking copays, it's 100% on us.  My former employer covered prescriptions under a HDHP with a copay, but only after the deductible was met.  So early in the year inhalers cost us $350, but at the end of the year they cost us $40.

But basically, its always been the insurance company that tells me if the plan is a HDHP or not.  Even looking on the ACA exchange they are listed as such.

Is your insurance paying before the deductible is met, or merely negotiating prices?

drumstache

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Re: HSA and what qualifies as HDHP confusion
« Reply #4 on: March 31, 2021, 10:11:31 AM »

Is your insurance paying before the deductible is met, or merely negotiating prices?

Yes.  Dr visit co-pays, prescription co-pays without having to meet a deductible first.

reeshau

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Re: HSA and what qualifies as HDHP confusion
« Reply #5 on: April 01, 2021, 06:42:21 AM »
Were you talking to the actual insurance company, or some broker or benefits manager?  As @yachi  says, these plans are designed to meet the rules, so It's in the name.  It's not by accident, nor should you have to decide.  If you want examples (and counter-examples) take a look at your state's ACA marketplace.

DaMa

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Re: HSA and what qualifies as HDHP confusion
« Reply #6 on: April 01, 2021, 09:56:02 AM »

Is your insurance paying before the deductible is met, or merely negotiating prices?

Yes.  Dr visit co-pays, prescription co-pays without having to meet a deductible first.

Definitely not an HDHP.

Remember the person in your company making these decisions (or giving the information to the decision maker) might not understand this.  Health insurance companies will price a non-qualified HDHP plan lower than a similar qualified HDHP plan.  So that person might choose lower cost plan thinking they are making a good choice. 

Just one more way the US system is ridiculous.

Check your Summary Plan Document for the insurance.  If it doesn't say "qualified HDHP", I would assume it's not.

drumstache

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Re: HSA and what qualifies as HDHP confusion
« Reply #7 on: April 01, 2021, 10:13:32 AM »
Thanks for the info all.  Just glad I caught it before I got too far down the line with it.  Could have been a big mess!