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The Benefits Center For Inova Health System

A summary of benefits for the Aetna Health Savings Account HDHP is available here.


The Aetna Health Savings Account HDHP

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HSA Tax Advantages
How the Aetna Health Savings Account HDHP Works
    The Health Savings Account (HSA)
    The Medical and Prescription Drug Benefits Plan
    Online Resources to Help You Use Your Plan
See How the Aetna Health Savings Account HDHP Can Work for You
"Qualified Expenses" Under Your HSA
What's Covered/Not Covered by the Medical Plan?
Is the Aetna Health Savings Account HDHP Right for You?
The Aetna Health Savings Account HDHP (Aetna HealthFund HSA) Course

The Aetna Health Savings Account HDHP is a high deductible health plan (HDHP) with a health savings account (HSA) feature.

A Different Way to Manage Your Health and Your Health Care Expenses

The Aetna Health Savings Account HDHP is a benefits plan that gives you more control over how you spend, or save, your health care dollars.

With the Aetna Health Savings Account HDHP, you get the protection of a medical benefits plan, PLUS a tax-free health savings account that you can use to help pay for qualified medical expenses. Plus, the Aetna Health Savings Account HDHP offers you powerful resources and information to help you take care of your health and make the most of your benefits dollars.

You begin by contributing to your HSA through regular payroll deductions or in a lump sum amount, up to the maximum allowed.

You can then use your Aetna HSA debit card or checks to get instant access to your HSA dollars to pay for qualified out-of-pocket expenses (including your deductible) quickly and easily. Use your HSA debit card or checks, not your cash. Or, you can let your HSA grow and earn interest - for future or retiree health expenses.*

Best of all, you own your HSA, so you keep it, even if you change health plans or jobs. And, at the end of the year, money left in the account rolls over to the next year. From job to job ... plan to plan ... your HSA goes with you.

HSA Tax Advantages

  • Your HSA contributions are tax-free.
  • Your HSA funds are invested in a fixed-interest account that earns interest tax free.
  • You may pay for qualified health care expenses with tax-free dollars from your HSA.

*NOTE: Non-qualified withdrawals are taxed as income and subject to an additional 10 percent penalty.

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How the Aetna Health Savings Account HDHP Works

To understand how the Aetna Health Savings Account HDHP works, consider the plan's three components...

1. The Health Savings Account (HSA)

  • Each year, you choose the amount you wish to contribute to your HSA. You may contribute in one of two ways:
    • Choose a regular payroll deduction. Deductions are made before taxes and are taken from your paycheck.
    • Make a lump sum contribution - any time, in any amount, up to the maximum allowed. Then, claim your total contributions as a deduction when you file your taxes.
  • Enrolling in this high deductible health plan (HDHP) allows you the opportunity to also invest in a health savings account up to the statutory amount – a flat dollar amount determined by the IRS, adjusted each year for inflation. For 2009, the maximum annual HSA contribution for an eligible individual with self-only coverage is $3,000. For family coverage, the maximum annual HSA contribution is $5,900. "Catch-up" contributions for individuals who are 55 or older is $1,000 for 2009.
  • Individuals age 55 to 64 may make an additional "catch-up" contribution of $1,000 for 2009.
  • You may use your Aetna HSA debit card or checks to instantly access your account funds to pay for your qualified expenses (including your deductible and coinsurance payments). Using the debit card or checks means no waiting for reimbursement. Or, you can choose to pay out of pocket and save your HSA for future qualified expenses.
  • Your HSA can grow over time! Your funds will be invested in a fixed-interest account. (The interest rate is guaranteed for six months and can be re-evaluated each January 1 and July 1.)
  • At the end of the year, any remaining dollars roll over.
  • Be sure to contribute to your HSA account each year to make the most of your savings opportunity!

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2. The Medical and Prescription Drug Benefits Plan

Your Medical Benefits

  • You may visit any licensed health care provider or hospital for covered services - no referrals are required.
  • Your plan provides 100% payment for covered preventive care services such as screenings, physical examinations and immunizations, with no deductible required (within Aetna preventive care guidelines).
  • Your plan includes a deductible - a set amount of covered expenses you pay out-of-pocket for your covered medical services (except preventive care services) and prescription drugs each year, before the benefits plan begins to make payments.
  • When the deductible is met, you pay a coinsurance (a percentage of the provider's charges) each time you seek care from a participating provider, and a higher coinsurance each time you seek care from a non-participating provider.
  • Your medical plan includes an out-of-pocket maximum - a cap that limits the amount you pay for covered services in a given year. When your costs reach this limit, remaining eligible expenses are covered by the benefits plan at 100%, up to the lifetime maximum benefit.

Your Prescription Drug Benefits

When you fill a prescription, you pay the cost of the prescription until the deductible has been met. Please note that beginning in 2009 prescription drug benefits will be provided by Medco.

Prescription Drug Copayment (once deductible is met)

Retail: $10 generic/$25 brand formulary/$40 brand nonformulary

Mail Order: $25 generic/$60 brand formulary/$100 brand nonformulary

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3. Online Resources to Help You Use Your Plan

The Aetna Health Savings Account HDHP gives you the information and resources you need to maximize the value of your benefits, take a more active role in your health care, and spend your health care dollars more effectively.

  • Log on to Aetna Navigator® for secure and personalized health and benefits information. Perform self-service functions like ordering ID cards or checking eligibility or claims status.
  • From Aetna Navigator, go to Aetna InteliHealth® for credible health and wellness information and helpful interactive features. Or go to Healthwise® Knowledgebase, where you can research clinical information on thousands of health topics and medications.
  • You can also use the Estimate the Cost of Care tools, a suite of interactive tools that provide cost information you can use to make more informed decisions. This resource compares costs using in-network and out-of-network providers for prescription drugs, medical procedures, office visits and medical tests, and shows you potential cost savings when you use network providers.
  • The Aetna Navigator Hospital Comparison Tool lets you compare area hospitals on measures that are important to your care.
  • Access the most up-to-date information on participating providers through the DocFind® online provider directory - including important credentials like education, board certification and languages spoken.
  • Online customer service allows you to request member ID cards, send secure messages to Member Services and more.

If you would like to preview a few of these valuable tools on Aetna Navigator, click here to take a site tour to learn more.

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See How the Aetna Health Savings Account HDHP Can Work for You

Here is an example of how a member, George, used his Aetna Health Savings Account HDHP to pay for medical expenses.

Plan Features

Individual Deductible Amount: $1,500
Total Individual HSA Contribution: $1,500

Individual Plus One Family Member Deductible Amount: $2,250
Total Individual Plus One Family Member HSA Contribution: $2,250

Family Deductible Amount: $3,000
Total Family HSA Contribution: $3,000

Coinsurance:

Hospital: Inova pays 80% at an Inova facility; 70% at another in-network facility and 60% at an out-of-network facility.

Other Services: Inova pays 80% for in-network services and 60% for out-of-network services.

Preventive Care (Physicals, Immunizations, etc. - subject to Aetna preventive care guidelines): In-network preventive care is covered at 100%. Out-of-network preventive care is not covered.

Prescription Drug Copayment (once deductible is met)

Retail: $10 generic/$25 brand formulary/$40 brand nonformulary

Mail Order: $25 generic/$60 brand formulary/$100 brand nonformulary

George

George has individual plan coverage. His medical and prescription drug expenses for the year totaled $2,850 - $2,500 for medical expenses in March, $150 for a physical examination in June and $200 for prescription drug expenses in November. George's individual HSA totaled $1,500 from payroll deductions.

George chose to withdraw money from his HSA to reimburse** $1,000 of the deductible - leaving $500 in the account to grow for future health-related expenses. George satisfies his deductible using $1,000 from his HSA and $500 from his checking account.

Since George's medical expenses were $2,500, after satisfying the $1,500 deductible, his remaining medical expenses totaled $1,000. He received care from preferred providers and was responsible for a 20% coinsurance ($200), because his deductible was met. The plan paid the remaining $800. (George had a physical examination totaling $150. The plan paid for these preventive care costs at 100% and they did not count as an expense to George.)

George's prescription drug expenses totaled $200 for three prescriptions. Two prescriptions were filled using brand formulary drugs, so his copay equaled $25 each ($50). The other prescription was filled using a generic drug, so he paid $10. George paid a total of $60 for his prescription drugs, and the plan paid the remaining $140.

Summary for George

Medical Expenses

$2,500

Physical Examination

$ 150
Prescription Drugs

$ 200

Total Medical and Drug Expense

$2,850

   
Amount Paid by George to Meet Deductible:

$1,500

HSA Reimbursement:

$1,000

HSA Remaining at Year-End:

$500

   (rolls over and is added to next year's account balance)

Remaining Amount Paid by George:

$260

   ($200 medical coinsurance, $60 prescription drug copayments)

Amount Paid by the Plan:

$1,090

   ($800 medical expenses, $150 preventive care, $140 prescription drugs)

Total Paid by George and by the Plan

$2,850

*Prescription drugs filled prior to meeting the deductible will be payable by the member at the pharmacy at the plan-negotiated rate. Copayments/Coinsurance apply only after the deductible has been met.

**Reimbursement from HSA funds is limited to the amount of money available in the account at any given time.

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"Qualified Expenses" Under Your HSA

You may use your HSA for qualified health-related expenses as allowed by the IRS. Some expenses may not be covered by your benefits plan, but are considered "qualified expenses" for payment with HSA dollars. The following list provides some typical examples. For a complete list of IRS-allowable expenses, you can request a copy of IRS Publication 502 by calling 1-800-829-3676. Or visit the IRS website at www.irs.gov and click on "Forms and Publications."

  • Medical deductibles
  • Diagnostic services not covered by your plan
  • Long-term care premiums
  • LASIK surgery
  • COBRA premiums
  • Dental care
  • Contact lenses
  • Some nursing services
  • Birth control pills
  • Hearing aids
  • Wheelchairs
  • Organ transplants
  • Certain classes of over-the-counter drugs
  • Premiums while receiving federal unemployment compensation
  • Medicare and Medicare+Choice premiums

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What's Covered by the Medical Plan?

With the Aetna Health Savings Account HDHP, your medical plan covers a wide array of medical services, including:

  • Routine office visits and preventive care
  • Specialty care
  • Hospitalization and surgery
  • Emergency care - anytime, anywhere
  • Diagnostic testing
  • Maternity and newborn care
  • Mental health and substance abuse treatment
  • Durable medical equipment

What's Not Covered by the Medical Plan?

This plan does not cover all health care expenses and includes exclusions and limitations. Members should refer to their plan documents to determine which health care services are covered and to what extent. The following is a partial list of services and supplies that are generally not covered; however, your plan documents may contain exceptions to this list.

  • All medical and hospital services not specifically covered in, or which are limited or excluded by, your plan documents
  • Charges related to any eye surgery mainly to correct refractive errors
  • Cosmetic surgery, including breast reduction
  • Custodial care
  • Dental care and dental X-rays
  • Donor egg retrieval
  • Experimental and investigational procedures
  • Hearing aids
  • Immunizations for travel or work
  • Infertility services, including artificial insemination and advanced reproductive technologies, such as IVF, ZIFT, GIFT, ICSI and other related services, unless specifically listed as covered in your plan documents
  • Non-medically necessary services or supplies
  • Orthotics
  • Over-the-counter medications and supplies
  • Reversal of sterilization
  • Services for the treatment of sexual dysfunction or inadequacies, including therapy, supplies or counseling
  • Special-duty nursing

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Is the Aetna Health Savings Account HDHP Right for You?

Consider the following:

  1. Review your past year's medical services use and expenses.
  2. Estimate any expected changes in your medical expenses for the coming year.
  3. Compare the employee contributions for the Aetna Health Savings Account and other health insurance plans available to you. Remember, you can fund your HSA with some or all of that difference.
  4. Utilize the HSA Savings Calculation Tool to estimate potential tax savings and the future value of a health savings account – before you enroll in the HSA plan.
Please note, if you enroll in the Aetna Health Savings Account HDHP, you may not submit medical expenses to the Health Care FSA.

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