5.1.A. ERMUSR 10-11-2011 - Laserfiche WebLink

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For family coverage there cannot be an embedded individual deductible of less than the minimum family deductible. This means the entire deductible under family coverage (under certain plan designs) could be incurred by one family member. Only preventive care can be covered 100% without being subject to the deductible. Other expenses must be subject to the deductible including pharmacy expenses. Maximum 2011 out of pockets for QHDHPS cannot exceed $5,950 individual / $11,900 family for network services. The maximum out of pocket limits for 2012 will be $6,050 individual/$12,100 family for network services. • Eligible individuals cannot be covered under another health plan that is not a QHDHP. For example, an employee cannot be covered by a QHDHP and a spouse's employer-provided traditional health plan. • Eligible individuals may not have received any health benefits from the Veteran's Administration or one of their facilities, including prescription drugs, in the last three months. • Specified disease coverage, vision, dental, accident, disability and auto insurance do not count as other coverage. These plans are considered "permitted coverage." • Eligible individuals must not be eligible to be claimed as a dependent on another person's tax return. • HSAs are not available to members entitled to benefits under Medicare. "Entitled" to benefits under Medicare means both eligibility and enrollment in Medicare. Therefore, individuals not actually enrolled in Medicare Part A or Part B may contribute to an HSA until the month that individual is enrolled in Medicare. (At age 65 employees automatically receive Part A. These employees must postpone coverage under Part A in order to remain eligible for HSA funding.) Q: How does HSA plan eligibility and flex plans work together? A: General-purpose health FSA coverage will prevent an individual from being eligible for HSA contributions for the individual's entire period of coverage under the health FSA-even after the individual has completely exhausted his or her health FSA account balance. However, there are alternative health FSA designs that will not prevent HSA eligibility. The IRS has confirmed that an individual with a $0 balance at plan year-end under a general purpose health FSA with a grace period can disregard that health FSA coverage and be HSA- eligibleduring the grace period. This rule requires that the $0 balance be determined on a cash basis, without considering pending claims, claims submitted or under review that have not been paid as of the date in question. A member cannot have both a medical FSA and an HSA unless the FSA is limited to expenses not covered underthe medical plan (usually dental and vision expenses). However, the limited medical FSA can cover medical expenses incurred after the statutory minimum annual health plan deductible is satisfied. For 2011, this is $1,200/single and $2,400/family and these amounts remain unchanged for 2012. CONFIDENTIAL. PAGE 4