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HSA Process Review 1 HDHP + HSA Health Savings Account You must have an IRS Qualified High Deductible Health Plan (HDHP) to open an HSA. The two pieces work together to help you cover your medical expenses. 2 Medical and prescription drug Deductible HDHP Plan Prescription Drugs © 2015 M3 Insurance – CONFIDENTIAL – DO NOT REPRODUCE OR DISTRIBUTE expenses accumulate to the same combined deductible The HDHP (processed by SAS) covers medical expenses after the deductible has been met Prescription drugs have copayments that apply after the deductible has been met, and are then covered after copayments. Funds in the HSA can be used to pay for any eligible expenses as defined by Section 213(d) including deductible and copayment charges HSA Process Flow Chart – Deductible not yet met Member goes to the doctor’s office for service and gives NEW insurance card information only Provider submits claim to insurance Insurance determines if deductible is met Claim is processed and applied to deductible Insurance mails Explanation of Benefits (EOB) to member, statement of remittance to provider Provider bills member for outstanding liability amount Option 1: Member pays provider with available HSA funds Option 2: Member pays provider with own out of pocket(OOP) funds, then reimburses themselves with HSA funds Option 3: Member chooses to pay OOP and saves HSA funds for future use NO 3 © 2015 M3 Insurance – CONFIDENTIAL – DO NOT REPRODUCE OR DISTRIBUTE HSA Process Flow Chart – Deductible previously met Member goes to the doctor’s office for service and gives insurance card information only Provider submits claim to insurance YES Insurance processes claim 4 Insurance mails check to provider and Explanation of Benefits (EOB) to member © 2015 M3 Insurance – CONFIDENTIAL – DO NOT REPRODUCE OR DISTRIBUTE Insurance determines if deductible is met No HSA funds needed. Any HSA funds left in account at the end of the year will roll over to the following year. How the plan works Single Plan with $1,300 HDHP HSA – YEAR ONE WSD contribution Your contribution (Optional) You see your doctor for an annual physical (Preventive) $1,000 $300 HSA account balance $1,300 -$0 $1,300 A minor hiking accident sends you to the emergency room -$638 $662 Monthly prescription filled at $25/month -$300 $362 HSA balance at the end of year one 5 © 2015 M3 Insurance – CONFIDENTIAL – DO NOT REPRODUCE OR DISTRIBUTE $362 will roll over to following year Plan, Save and Pay for Health Care We’re here to help 6