Dual Capacity Disclosure and Advance Fee Agreement Form

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Dual Capacity Disclosure and Advance Fee Agreement Form Powered By Docstoc
					           Welcome to First HSA

At First HSA, we are dedicated to providing and
servicing Health Savings Accounts (HSA’s) for our

  Your First Choice in Health Savings Account

First HSA Services
     Accounts are FDIC insured
     Earn money market interest
     Unlimited check writing
     Free VISA Debit Card (if requested)
                                          Money Market Interest
     On-line account access              Earnings Rates:
     Monthly paper or e-statements
                                          $ 501 - 1,000: 1.40%
     IRS reporting
                                          $1001 – 5,000: 2.00%
     Investment options                  $5001 - 14,999: 3.25%
                                          $15,000 & up: 4.25%
     Health management tools
     Partnership to provide “Health Bridge” line-of-credit

   An account for deposit of tax-free funds that can be
     withdrawn to pay for qualified health expenses
      Must be linked to a qualified “high deductible”
                       health plan

                 Health Savings Account

Qualified High Deductible             Custodial/Trust
        Health Plan                  Savings Account

   Employees enrolled in a qualified high deductible health
    plan (HDHP), such as the Health & Wealth Builder plan

   Employees who are not:
     receiving Medicare
     receiving Medicaid
     covered by Tri-Care
     claimed as a dependent on some else’s taxes i.e. parents
     not dual covered by another medical plan, unless it is
      also a qualified HDHP

    Deposits are restricted for 90 days after receiving VA benefits

   Contributions made by you or your family are tax
     free to the beneficiary
   Contributions made by the University are tax free
   Interest and investment earnings are tax free
   Withdrawals for qualified health expenses are tax
   You do not have to itemize to save taxes on health
   Contributions to your HSA are not limited by your
     adjusted gross income

   Unused balance rolls forward year after year
   Account is individually owned and controlled

All funds remain with you when you:
    retire
    change employment
    change medical plans

   IRS regulates maximum annual contributions
   Tax Year 2008, plus interest
     Individuals - $2,900
     Individual, plus one or more dependent - $5,800
     Contributions must stop at Medicare (age 65)
     Over-contributions can be withdrawn before April
      15th, or a tax penalty applies

   Deposits from all sources are counted
     Your payroll and direct contributions
     Matching contributions
     Contributions made by others
     Loan advances

You can make extra contributions
 Catch up contributions are allowed
     - In the year of your 55th birthday to age 65 (Medicare)
     - Additional amount is up to $900 for 2008
     - Increases up to $1000 in 2009
   Post-tax (deductible) made directly to First HSA Bank
   Advances from your “Health Bridge” loan

The University of Idaho:

    allows changes quarterly
    allows changes when loan re-payment is
      established through payroll deduction
    matches your contribution $1 for every $2,
      up to $19.23/pay, to a maximum $500/year
    matches only contributions made through
      pre-tax payroll deductions
    transmits your deduction and match as a direct
      deposit to your account

   - $1000 to receive the University’s full $500 match
   - your current paycheck deduction amount
   - savings from your lower cost medical choice
   - funds otherwise directed to your flexible health
      care spending account (the HSA is also for spending)
  - funds otherwise paid out of pocket
  - your tax savings (about 25% - $250 / $1000)
Save your receipts for *smaller, manageable expenses:
  – reimburse yourself on a rainy day or let your
      balance grow
                  *Examples include prescription, dental and vision
                   deductibles, co-payment and
                   co- insurance, other routine care
How to Grow Your HSA Account

   Tax free withdrawals are made only for qualified
    health care expenses

   Funds do not have to be withdrawn in the year the
    expense was incurred

   Does not require the submission of receipts
     Save these with your IRS records

   Expenses otherwise allowed by your flexible
    health spending account, except OTC
   Any expense listed in IRS publication 502 for
    health savings accounts

These include:
     - medical, dental, vision plan deductibles,
       co-insurance and qualified expenses not
       covered by your benefits
     - prescriptions, over-the-counter
  treatments that are not preventive and
  supported by doctor instructions, and
  more…..                                           14
   Qualified long-term care services
   Long Term Care insurance premiums
   (limits apply)

   Cost of COBRA coverage
   Health care insurance while receiving
      unemployment benefits
   Medicare premiums (but not Medigap or
      University retiree health cost sharing)
   Expenses for your IRS dependents even if
      covered by another medical plan or Medicare
   Health expenses after retirement
    Use funds as additional income at retirement
      (age 65) and pay only regular income tax as
    Early withdrawals and non-qualified
      withdrawals, require tax, plus a 10% penalty
    Funds are transferred to your spouse upon
      death without tax or penalty
   Funds can be withdrawn without penalty if you
      become disabled

   If requested, receive a free VISA debit card
   Receive checks to draw from your account
   Pay and reimburse yourself this year or in another
   Reimburse yourself with a check or ATM
   Daily cash limits apply to the debit car
    call First HSA at the time of service to increase

   Plan H, is a PPO Plan
       However, benefits are the same in and out-of-
      Provider contracts require in-network discount
       to be applied before you pay
      Unless the provider knows this amount, do
        not pay at time of service
      Do not negotiate your own “cash price”
      You should be billed later
   Out-of-network, you may be asked to pay at the
    time of service and you can ask for a discount

   Prescriptions are:

       paid by you before the deductible, you pay the full cost
       subject to and accumulate towards your plan deductible and
        out-of-pocket maximum
       paid at 70% after your deductible, and at 100% after the out-
        of-pocket maximum
       managed by Wellpoint (apply expenses to your deductible
        and benefits) – process charges to Blue Cross
       pay the full cost (before deductible) or your share at the
        pharmacy as you do currently
   Buy generics or brands, all covered drugs are all
    paid at 70% after the deductible (but generics cost less)

   Only the balance in your account can be accessed
    – the annual election is not advanced
   If there are not enough funds:
     your account will advance up to the balance
     you can pay the remainder out-of-pocket
     you can make payment arrangement with the
       provider, and make payments as funds are
     your “Health Bridge” line-of-credit will
       automatically advance to cover a shortfall

   Employer sponsored line of credit
   Advances automatically, like an overdraft protection
   Available to all employees
       regardless of credit history
       does not affect other borrowing capacity
       same interest rate for all employees
   Funds available up to deductible limit
     $1500 employee only, $3000 employee plus 1 or more
   Repayment through payroll deduction
       1% of unpaid balance ($25 minimum)
       1% advance fee, 1% of monthly balance
       no fees until used
       no penalties for pre-payment
   Advances are tax deductible contributions
     review contributions to avoid over-contributions
     change contributions when you establish
   Health Bridge advances after HSA funds
   If funds are invested, Health Bridge will advance if
    expenses exceed Money Market balance
       invested funds can be returned to your money
        market within 5-7 days
   Access Health Bridge with only checks
     daily limits:
         checks – up to your available credit

   Review monthly statements to ensure there are no
    over-contributions (withdraw before April 15th)
   Use form 8889 Health Savings Account to report
    contributions and distributions
   At the end of the year, First HSA will send:
       1099-SA to report distributions
       5498-SA to report contributions

   Risk assessment for investment strategy
   Asset allocation models
   Wide choice of low-cost mutual funds
   Transfer of funds via internet
   Minimum balance of $3,000 to invest
   $1,000 balance must remain in money market
       at time of investment transfer
   $35 annual fee
   No transaction fees
     moving the funds to invest
     between mutual funds
     or back to the traditional HSA account

   Elect your contributions with your benefits
   Complete First HSA application and Health
    Bridge agreement/truth in lending disclosure
   Request your free debit card
   Ask for e-statements or paper
       image copy of checks provided
   E-statement requires valid email and
   Must reply to confirmation email to activate
              Default is paper if no election or no response

   Mailed January 2, 2008 – contains account
    information and starter checks
   Kits includes debit card activation information
   Free VISA debit card – 14 days later
   PIN information is sent before the debit card
   Debit card can be processed as a debit or credit
    transaction – no charge for access
   Daily limit as credit $1000, debit $400
   Can use ATM’s for reimbursement (terminal
    fees are allowed expenses - $2 or $0)
   20 more free checks – 4 weeks later
       Reorder from First HSA- $4.75 for 20 or $9.50 for 40
On-line account access
 Via the Reconciler* platform
 www.1hsa.com
   View HSA deposit account
   View investment portfolio (if applicable)
   Transfer balances to make investments
   Enter your deductible and track applicable
   Input qualified healthcare expenses
     Reimbursed through self payments
     Receipts you wish to save for later
      reimbursement                              28
Download manufacturer coupons from First HSA site:

     Choose your prescription
     Enter prescription details with alternatives
     Compare coupons
     Print coupons

Valid at most retail pharmacies. Valid at mail order only when
   the coupon functions as a check.

Medical procedure pricing tool:
 search costs for in and out –patient services and office
 fees are based on Medicare fee schedule
 CPT (diagnosis) codes that physicians uses nationally
 Rx pricing tool
 find the costs of all major prescriptions,
      compare, find alternatives, research side effects
Personal health advocate:
  access to 24 hour nursing hotline
  find specialists and schedule appointment
  assist with health plan questions or treatment options
  perform dispute resolution on your behalf

   Customer service representatives
       highly qualified, trained individuals
       phones answered by live person
   Hours of customer service
       5:30 AM to 3 PM Pacific Time
       toll-free customer
         service numbers
       24-hour automated
         telephone banking

   First HSA
      1044 MacArthur Road
      Reading, PA 19605
   Phone:
       610-678-6000 or
       toll free at 888-769-8696
   Fax:
       (610) 678-6818
   Web: www.1hsa.com


Description: Dual Capacity Disclosure and Advance Fee Agreement Form document sample