Aetna HSA Plan

About the HSA Plan

Features of the HSA plan include:

• The same covered services and network of providers as the POS Plan with a different way to pay for and save for health care expenses.
• A Health Savings Account (HSA) with tax advantages, funded in part by Emory. The HSA gives you the flexibility to choose how to spend your health care dollars.
• Like the POS Plan, the HSA Plan also has deductibles, co-insurance and an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year.

Networks

The HSA Plan has three network options:

• Tier 1: The Tier 1 Network includes the Emory Healthcare Network (EHN) along with Emory facilities: Emory Decatur, Emory Hillandale and Emory Long Term Acute Care facilities. Tier 1 also includes all EHN and DeKalb Physician Hospital Organization (DPHO) providers. This network’s facilities and providers offer the lowest copays, coinsurance and deductibles.
• Tier 2: The Tier 2 Network includes providers and facilities contracted through Aetna’s national network. Copays, coinsurance and deductibles are higher than Tier 1 providers.
• Tier 3: The Tier 3 Network includes providers and facilities not participating in Aetna and has the highest costs associated with it.

To locate a physician or facility in the Tier 1 or Tier 2 or Network, use Aetna's DocFind:

Deductible

All eligible expenses incurred by you or your covered dependents throughout the plan year apply towards meeting the annual deductible.

• The Tier 1 deductible is $1,650 (Employee Only) or $3,300 (Employee + Spouse, Employee + Children, or Family).
• The Tier 2 deductible is $1,900 (Employee Only) or $3,750 (Employee + Spouse, Employee + Children, or Family).
• The Tier 3 deductible is $2,850 (Employee Only) or $5,700 (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 coinsurance, 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 $3,300 (Tier 1), $3,750 (Tier 2), or $5,700 (Tier 3) before any expenses are covered under coinsurance.

Coinsurance

Once the annual deductible is satisfied, the HSA Plan works like a traditional plan by paying the majority of expenses through coinsurance.

• Tier 1 care is covered at 85% (you pay 15%)
• Tier 2 care is covered at 75% (you pay 25%) 
• Tier 3 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 $3,750 within the Tier 1 Network and $5,550 (Tier 2) will be applied to a covered family member who incurs medical expenses after the family deductible has been met ($3,100 within Tier 1 or $3,500 Tier 2). 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 (HSA)

The HSA is funded in three ways:

1 — Emory’s Annual Contribution

If you enroll in:

• Employee-Only coverage — Emory contributes $300 to your HSA.
• Employee + Spouse, Employee + Child(ren) or Family level coverage — Emory contributes $600 to your HSA.

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

2 — Incentives

In addition to Emory’s annual contribution to your HSA, you can earn incentives (additional contributions for completing various healthy activities). Your spouse may also be eligible for some of the incentives.

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

• You must be enrolled in the HSA Plan
• You cannot be claimed as a dependent on someone else’s tax return
• You cannot be covered by a spouse’s Flexible Spending Account (FSA)
• 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 health care 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 Purpose FSA for dental and vision, as well as health care 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

• Withdrawals from HSAs for qualified health care expenses are tax-free. If you withdraw money for any reason other than qualified health care expenses, you must pay income tax and a 20% IRS tax penalty.
• You must have a balance in your account to make a withdrawal.
• The maximum you can contribute to an HSA in one year is set by the IRS (in 2024, it is $4,150 for single coverage and $8,300 for family coverage). If you are age 55 or older, you can contribute an additional catch-up contribution of $1,000. It is your responsibility to make sure your HSA contributions, including any employer or incentive contributions, do not go over the IRS maximum.

Prescription Drugs

Prescription drug coverage is part of your medical plan and is administered through CVS Caremark.

Behavioral Mental Health

Behavioral Mental Health is covered as part of your Emory medical plan. Aetna provides a network of experienced psychiatrists, psychologists, clinical nurse specialists and licensed counselors with broad expertise in treating children, adolescents, adults and families.

To make it easier and more cost-effective to access behavioral mental health services, out-of-network behavioral health providers will now be covered at the in-network benefit level for the Aetna POS and HSA Plans. This includes psychiatry, psychology and other licensed behavioral health providers.

For a listing of providers, contact Aetna at 800-847-9026 or use Aetna DocFind: