HSA Plan

The HSA Plan, a consumer-driven medical plan with a Health Savings Account, puts you in charge of how your health care dollars are spent. For a more detailed overview of the HSA Plan, read the HSA Plan Quick Guide.

Features of this plan include:

The HSA Plan has deductibles, coinsurance and an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year.

arrow  View the 2018 Medical Plan Rates

arrow  View the 2018 Medical Plan Comparison Quick Guide


DEDUCTIBLE

All eligible expenses incurred by you or your covered dependents throughout the plan year apply towards meeting the annual deductible. The EHN deductible is $1,350 (Employee Only) or $2,700 (Employee + Spouse, Employee + Children, or Family). The In-Network deductible is $1,500 (Employee Only) or $3,000 (Employee + Spouse, Employee + Children, or Family).

As expenses are incurred, including ER visits and prescription drugs, you can use funds that have accumulated in your HSA to cover these costs. Once your HSA balance is exhausted, any remaining portion of your deductible that needs to be met for the year will be an out-of-pocket expense and your financial responsibility. The annual deductible must be satisfied before any plan expenses are paid by co-insurance, with the exception of preventive care and Tier Zero prescriptions which are covered at 100%. If you enroll and elect employee and dependent coverage, any covered expenses incurred will apply towards meeting the family deductible of $2,700 (EHN) or $3,000 (In-Network) before any expenses are covered under co-insurance.


CO-INSURANCE

Once the annual deductible is satisfied, the HSA Plan works like a traditional plan by paying the majority of expenses through co-insurance. Emory Healthcare Network (EHN) care is covered at 85% (you pay 15%); In-Network care is covered at 75% (you pay 25%) and Out-of-Network care is covered at 50% (you pay 50%).



OUT-OF-POCKET MAXIMUM

Like a traditional plan, there is a maximum amount that you are financially responsible for under the plan each year. The individual out-of-pocket maximum of $3,500 within the EHN and $4,750 In-Network will be applied to a covered family member who incurs medical expenses after the family deductible has been met ($2,700 within the EHN or $3,000 In-Network). This eliminates the need for the full family out-of-pocket maximum to be satisfied if only one family member needs medical care. However, the combined medical charges incurred by additional family members will satisfy the full family out-of-pocket maximum. When the family out-of-pocket maximum is satisfied, eligible expenses for all family members will be covered at 100% for the remainder of the plan year.


HEALTH SAVINGS ACCOUNT

The HSA is funded in three ways:

1.  Emory's Annual Contribution:

Note: Emory's contribution is prorated based on your enrollment date if after January 1.

2.  Incentives: You can earn up to $400 in incentives towards your HSA balance.

3.  Your Contributions:  If you want a way to save tax-free for current or future eligible medical expenses, you can also contribute to your HSA. Contributions to your HSA have no expiration date — they remain in the account until you decide to access them or reimburse yourself for an eligible expense you already paid out-of-pocket. You decide when and how to pay.


To Qualify for a Health Savings Account:

1. You must be enrolled in the HSA Plan.

2. You cannot be claimed as a dependent on someone else’s tax return.

3. You cannot be covered by a spouse’s Flexible Spending Account (FSA).

4. You cannot be covered by any other medical plan, including Medicare A and/or B.


What’s Different About a Health Savings Account?

The Health Savings Account (HSA) is only available if you participate in the HSA Plan. The money is yours, is held in an investment account and is portable; it goes with you to be used for qualified medical expenses if you leave Emory or when you retire.

If you are enrolled in the HSA Plan, you may not participate in a general Healthcare Flexible Spending Account (FSA). However, you can participate in the limited Healthcare FSA for dental and vision, as well as medical expenses once you have met your deductible. If you are enrolled in the HSA Plan, you may still participate in the Dependent Day Care Flexible Spending Account.


Additional HSA features

IMPORTANT NOTE: In accordance with IRS regulations, if you are a new enrollee in the HSA Plan for 2018 (i.e. switching from the POS Plan) and you have a balance in a 2017 Healthcare Flexible Spending Account (as of December 31, 2017), you are not eligible to contribute funds to an HSA or receive any funds in your HSA until April 1, 2018. Make sure your FSA balance is $0 by December 31, 2017.


PRESCRIPTION DRUGS

If you are enrolled in the HSA Plan, you must pay all out-of-pocket costs for prescription drugs until you meet your annual deductible (with the exception of Tier Zero drugs, Emory pays 100% and plan participants will pay $0 for drugs that are listed as Tier Zero). For non-Tier Zero drugs, you can use your HSA to pay for your prescription drug costs. After you meet the deductible, you will pay the applicable co-insurance amount under the HSA Plan, up to the "30-day Retail Maximum." The table below shows what your responsibility is once your deductible is satisfied. For example, if the table shows co-insurance is 20%, the plan will pay 80% of the cost of the prescription drug and you are responsible for the other 20%. However, there is financial protection built into the prescription drug benefit in that you will never pay more than the "30-day Retail Maximum," outlined in the table below:

prescription drug chart 2018

Prescription drug coverage is administered through CVS/caremark. To determine your coverage tier or cost, call 866-601-6935.

Maintenance Drugs: A maintenance drug is one that is commonly used to treat a chronic or long-term condition and requires regular, daily use. Examples include drugs used to treat high blood pressure, heart disease, asthma and diabetes. Birth control is also considered a maintenance drug. If you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your 90-day prescriptions in one of three ways:

If you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost.