HSA Survey Part II
Constricting Healthcre Costs with HSAs
Find Out Which HSAs Will Work Best For You
With Our Annual Survey

16. What service guarantees do you offer?
Aetna: We do not offer HSA service guarantees.
Anthem Blue Cross: We do not offer performance guarantees in the Small Group market or Individual market.
Blue Shield of California: Our relationship with Wells Fargo provides for a number of service level agreements. One example of a typical service guarantee would be telephone average speed of response.
CIGNA: The standard performance guarantees apply.
First Horizon Msaver: Service-level guarantees vary based on the scope of the relationship with the customer, but generally include commitments around the delivery of debit cards and Welcome Kits as well as Customer Call Center metrics.
HSA California: HSA California guarantees outstanding service. Our customer service team has expert knowledge of the insurance industry and is available between 8:00 a.m. and 5:00 p.m. Monday-Friday for personal assistance.
Kaiser Permanente: We do not offer service guarantees to the Individual, Family or Small group markets.
Sterling HSA: Sterling HSA offers a full money back guarantee for up to 12 months of paid monthly maintenance fees if our accountholders are unhappy with our service for any reason. Sterling was the first HSA administrator to offer such a guarantee and made this commitment when the company was founded in 2004.
UnitedHealth Group: Service guarantees will vary based on the scope of the relationship with the customer, but are typically available with respect to administrative service delivered under the plan.

17. What kinds of depositories are desired?
Aetna: Not applicable.
Anthem Blue Cross: There is no minimum balance requirement.
Blue Shield of California: Guidelines will vary by financial institution.
Our relationship with Wells Fargo provides for the following:
• For IFP members, the minimum HSA deposit is $100
• For employer groups, there is no minimum deposit
• Any deposits after the initial $100 may be directed into investment accounts dictated by the member.
CIGNA: There are no minimum deposit or balance requirements. Contributions to the HSA can be funded through employer facilitated pre-tax payroll contributions (EFT/ACH transactions) or through unscheduled deposits in which participants arrange from an EFT from their personal bank account or send a check and deposit slip to a lockbox for contribution to their HSA.
First Horizon Msaver: No minimum balance requirement and no minimum initial deposit requirement for employer groups.
HSA California provides the following: No minimum balance requirement to open an HSA and no minimum deposit requirement for employer groups
Kaiser Permanente: Our preferred financial administrator for HSAs, Wells Fargo, does not require minimum deposits for employer groups with payroll deduction. The minimum deposit of $100 is required for individual and family plan members not enrolling through an employer group.
Sterling HSA: Sterling accepts cash checks, and electronic fund trans-
fers through www.sterlinghsa.com in a secure, password protected environment. We recommend an initial deposit of $100 and require a minimum balance of $20.

18. Where is your company headquartered?
Aetna: Hartford, Conn.
Anthem Blue Cross: The headquarters building for Anthem Blue
Cross is located at 21555 Oxnard Street, Woodland Hills, CA.
Blue Shield of California: Blue Shield is headquartered in San Francisco, Calif. CIGNA: CIGNA HealthCare is headquartered in Bloomfield, Conn. and CIGNA Corp., the parent company, is headquartered in Philadelphia, Penn.
First Horizon Msaver: Overland Park, KS, with an office in Fresno, CA.
HSA California HSA California is based in Orange, Calif., and does business throughout the state.
Kaiser Permanente: Oakland, California.
Sterling HSA: We are a locally owned company and are headquartered in Oakland, Calif.
UnitedHealth Group: Minnetonka, Minn.

19. Please provide the phone number and e-mail that brokers can use to find out more about your plan.
Aetna: 877-249-2472, prompt 6
Anthem Blue Cross: Please reference our online resources or contact their regional sales manager for individual and small group assistance. Large Group representatives should likewise call their group sales manager at the company.
CIGNA: Please contact your local CIGNA HealthCare sales representative at 888-802-4462.
Blue Shield of California: Brokers can call their Blue Shield sales representative or call Blue Shield Producer Services at (800) 559-5905 or visit Producer Connection at www.blueshieldca.com.
First Horizon Msaver: 1-866-889-8583, Option 3
msaverbroker@firsthorizon.com
HSA California: Brokers can call us at 866.251.4625 between 8 a.m. and 5 p.m. Monday-Friday, or e-mail us anytime at sales@hsacalifornia.com. Brokers can also visit us online at www.hsacalifornia.com, where they will find free sales training and collateral materials, and brochures and forms they can print and share with clients.
Kaiser Permanente: For questions or information about Kaiser Permanente: BrokerNet Website Address: brokernet.kp.org
Individual and Family Broker Sales: 1-800-789-4661, option 6 or 1-800-207-5084 (8:30 a.m. to 5 p.m. PST)
Small Business Broker Sales: 1-800-789-4661
(8:30 a.m. to 5 p.m.PST)
Client Services Unit: 866-752-4737 (8 a.m. to 5 p.m. PST)
For questions about Wells Fargo: 1-866-890-8309 (5 a.m. to 6 p.m.PST)
Wells Fargo Broker Support Line: 866-449-9929
(6:30 a.m. to 4 p.m.PST)
Sterling HSA: Our customer service and broker service number is 800-617-4729 or customer.service@sterlinghsa.com and broker.support@SterlingHSA.com. We have account executives and managers who support our broker and consultant channel as well. Their individual names and contact information is available at www.sterlinghsa.com.
UnitedHealth Group: For more information, please visit www.unitedhealthcare.com.

20. Which market segment (small/mid/large) do you anticipate these plans will best accommodate?
Aetna: All segments.
Anthem Blue Cross: We are seeing interest and adoption in all market segments.
Blue Shield of California: HSA-eligible plans are generating interest from all market segments, including individual and group markets. To date, Blue Shield’s membership in HSA-eligible plans encompasses all lines of business, from the individual group market to large, major employers.
CIGNA: We believe that HSAs and consumer directed health plans would be appropriate for all markets.
First Horizon Msaver: We successfully service individuals to groups of thousands of employees. Our Implementation and Account Management teams can develop enrollment, funding, and communication programs to fit any size group.
HSA California: We believe HSAs are appealing to all market segments; however, HSA California is designed for employers with 2-50 employees.
Kaiser Permanente: Our HSA-Qualified deductible HMO, PPO and EPO plans appeal to all market segments, including Individual and Family, Small, Mid and Large.
Sterling HSA: HDHP/HSAs accommodate all market segments.
UnitedHealth Group: All segments.

21. What channels have been most effective in selling HSAs?
Aetna: Brokers and general agents, consultants, Aetna sales force.
Anthem Blue Cross: Agents and brokers remain our most effective channel for HSA marketing and sales.
Blue Shield of California: Blue Shield is a broker-driven organization. Our HSA-eligible high-deductible health plans are sold via the broker channel. To assist brokers in selling our HSA-eligible plans, we’ve provided them with educational and marketing collateral to help them sell HSAs during the plan purchase.
CIGNA: We have found that the broker/consultant channel has been the most effective.
First Horizon Msaver: We believe that the most effective channel for selling HSAs is through an informed and empowered broker network.
HSA California: All HSA California sales are through licensed independent insurance brokers and authorized general agencies. To make sure brokers understand the unique selling opportunity behind HSA California – that we’re the only small group, fully integrated HSA program with multiple carriers in California – we produce timely communications and brochures that walk them through the program.
Kaiser Permanente: All channels have been successful in selling HSA programs.
Sterling HSA: We are committed to the broker, agent and consultant channel.
UnitedHealth Group: UnitedHealthcare’s HSA-qualified plans are sold primarily through brokers and consultants, or directly to individuals purchasing insurance policies on their own.

22. Which customer segments have been most receptive to HSAs?
Aetna: All customer segments.
Anthem Blue Cross: All customer segments continue to express interest in and adoption of HSAs.
Blue Shield of California: HSA-eligible plans appeal to all customer segments, from the individual market to small, midsize, and large groups.
CIGNA: Brokers have been very supportive of these plans.
First Horizon Msaver: All segments.
Kaiser Permanente: We have seen strong growth in all customer segments including the Individual and Family, Small, Mid and Large Group segments.
Sterling HSA: Customers who want to contain their healthcare costs and reduce increases are rapidly moving to the HSA market. Areas with high PPO penetration move quickly as well.
UnitedHealth Group: All segments have been receptive to the HSA product.

23. How prone are brokers to support this with reduced commissions on the high deductible health plan side of the equation?
Aetna: We have seen widespread broker support of HSA plans as a viable option for their clients.
Anthem Blue Cross: There is high interest in supporting this product from brokers to date. We continue to believe brokers will promote the appropriate health plans based on their client’s needs, regardless of commission rate.
Blue Shield of California: Blue Shield has been selling high-deductible health plans for many years even prior to the passage of the Medicare legislation that enabled HSAs. High-deductible plans have been an important option for brokers in providing their IFP and group clients plan benefit designs at more affordable price points. HSA-eligible high-deductible health plans are even more attractive because of the possible tax and personal saving advantages. We have received positive broker feedback on our HSA-eligible high-deductible health plans.
CIGNA: Brokers have been very supportive of these plans.
First Horizon Msaver: Brokers most prone to support high-deductible health plans are those who have received education, support, and the tools that allow them to recommend these plans with confidence.
HSA California: In today’s economy, the owners of small businesses are looking to reduce premiums yet still provide quality benefits to employees. HSA California takes HDHPs and HSAs to a new level by not only offering affordable benefits, but packaging three top California health plans in one program – each employee can choose a different health plan – a choice no other program in the state offers. As the market continues to change, we believe brokers will continue to adopt HSAs as an applicable solution for many clients.
Kaiser Permanente: Brokers are very supportive of these programs when they meet their customers’ business needs.
Sterling HSA: Brokers who think this is the right thing to do for their clients place them in an HDHP/HSA. Many brokers use the HSA concept as a marketing advantage to grow business in their book.
UnitedHealth Group: Brokers realize that the CDH plans are experiencing rapid adoption and they are doing their best to offer their customers the product that is right for them.

24. Will high-deductible health plans actually reduce utilization?
Aetna: We see continued positive signs of cost control and consumer engagement in Aetna’s studies of HRA and HSA results.
UnitedHealth Group: A series of studies from UnitedHealthcare in 2006 and 2007 create a solid body of evidence illustrating that CDH plans are delivering positive changes in health care behaviors and costs for both employers and consumers:
• A December 2007 study found that CDH plans constrain costs and utilization over time;
• A September 2008 study found that Health Savings Accounts encourage saving among all consumer segments, including low-income populations as well as white-collar professionals;
• An April 2007 study of preventive and chronic-care services confirms that the above gains do not come at the expense of vulnerable populations or discourage individuals from seeking needed care.
Anthem Blue Cross: When members engage in healthy choices and become active in their medical decisions, utilization is affected.
Blue Shield of California: It is to be determined if HSA-eligible high-deductible health plans reduce utilization. Satisfaction is increased when HSA-eligible plans are offered in tandem with wellness programs and an emphasis on preventive care.
CIGNA: During the past four years, CIGNA has compiled empirical data on literally millions of individuals enrolled in our CDHP, HMO and PPO plans based on claims experience that demonstrates that our consumerism products (HRA and HSA) offered as part of a comprehensive package of communication, member education and access to reliable and actionable information will substantially reduce the overall employer medical trend. Moreover, CIGNA’s multi-year experience studies of CDHP plans provide evidence demonstrate that our consumer-driven health plans both improve costs and health care quality.
First Horizon Msaver: High deductible health plans are designed to engage plan members in health care decisions by making the true cost of health care more transparent. First Horizon Msaver assists in this process by providing its HSA account holders with an online prescription drug cost comparison tool, a free consumer guide to help them determine fair prices for health care services in their area, and a medical bill evaluation and negotiation service.
HSA California: The goal of an HDHP is to allow employees and their families to control what they spend on healthcare. It’s still too early to tell whether utilization will actually be reduced by offering plans with higher deductibles.
Kaiser Permanente: We are evaluating the impact on utilization. Based on some small samples assessed, we have seen a drop in utilization with our members in HSA-qualified health plans. The lower risk factor behind this population segment may be a contributing factor. Additionally, there are also some small studies that indicate a change in behavior from these members as they become more financially engaged and responsible for their health expense. Preliminary information shows that some members have pursued alternative options – e.g., emailing their physician.
Sterling HSA: Our experience suggests that our clients are carefully
evaluating cost/treatment alternatives, thereby reducing unnecessary medical utilization.

25. How can vendors make HSAs more effective and attractive for brokers?
Aetna: Make the sales process as simple as possible and give brokers tools that allow them to present these options to employers and employees effectively.
Anthem Blue Cross: Vendors can make HSAs more effective by streamlining and simplifying the enrollment and communication processes.
Blue Shield of California: From a broker perspective, they would like higher referral fees from the HSA administrator and ease of enrolling their client into an HSA.
CIGNA: Provide information to help brokers understand the consumer advantages of the HSA product, provide products and processes that are easily understood by employers and support the member education at enrollment on an ongoing basis.
First Horizon Msaver: We make HSAs more effective and convenient for brokers by providing education and training as well as local and telephonic broker/employer support to simplify the enrollment and funding processes.
HSA California: Education is the key. It’s important that brokers are comfortable explaining the concept of an HSA and how it can work to completely satisfy the needs of clients, employees and families. HSA California and The Bancorp Bank provide a number of educational resources for brokers to help them better explain HSAs to clients. For more information on these materials, brokers can call us anytime at 866.251.4625.
Kaiser Permanente: Vendors can make HSAs more effective and attractive by keeping the sales process simple, supporting good communications, supporting installations and bringing effective online tools to the employer and members.
Sterling HSA: We support the broker channel with sales directors and account managers who handle their needs personally. We also offer HSA training and education. We have online toolkits for brokers and consultants who have registered with Sterling. These include spreadsheets, PowerPoint presentations, and other sales material. In addition, we support the broker’s employer clients in a similar fashion. This helps our broker partners better satisfy their client’s needs.
UnitedHealth Group: Make quoting, set up, and enrollment as simple as possible for the broker. Provide as much broker training as possible. Provide simple communication materials for HR staff and the enrollees. Leverage the experience and materials of your health plan partner, who can offer communications materials and other tools to provide assistance.

26. Will consumers purchase plans for their traditional health plan features and view the HSA account as a perk to cover short-term medical expenses or will the primary purchase decision focus more on long-term financial planning to cover immediate and long term medical expenses and to reduce tax liability?
Aetna: We see both with the latter being more common.
Anthem Blue Cross: The HSA plans offer choices for all members. The member can choose to save the tax-deferred monies or choose to spend the monies to cover their individual or family medical and pharmacy claims.
Blue Shield of California: Statistics are showing that consumers are using their HSAs for both purposes, though the investment dollars in HSA accounts are growing at a rapid pace
First Horizon Msaver: We recognize that the HSA appeals to both segments and we have designed our HSA offering to benefit both “spenders” and “savers.” For example, our low monthly administration fee and no transaction fees approach appeals to “spenders,” whereas our tiered interest rates and trio of investment options address the needs of those planning for the longer term.
HSA California: It depends on the individual consumer. Having funds available in an HSA for short-term medical expenses is a great feature. However, the long-term advantages are equally important. The ability to save HSA funds and earn interest tax-free year-after-year, provides the unique value inherent in HSAs. An HSA is a perfect savings vehicle to add to a long-term savings portfolio next to a 401(k), IRA or any retirement medium.
Kaiser Permanente: Consumers purchase our HSA-qualified deductible HMO plans and open HSAs to cover both immediate and long-term medical expenses, as well as to reduce tax liability.
Sterling HSA: The latter appears to be the case. This is truly a new way to finance the costs related to healthcare. In today’s economic climate, the HSA is a great way to budget for medical, dental and vision expenses as well.
UnitedHealth Group: Based on research from OptumHealthBank released in April 2007, HSA accountholders typically can be categorized into one of three basic patterns of account usage: Spenders, savers and investors. Roughly half of OptumHealthBank 400,000 accountholders are spenders and most of the remaining are Savers. While less than 5 percent of today’s HSA population are Investors, this may someday be the largest group based on early, accelerating balance trajectories. OptumHealthBank Spenders carry balances that hover between $400 and $600, spend 80 percent of contributions on current medical expenses and contribute an average of $133 per month. OptumHealthBank Savers hold a balance of nearly $1,500 on average and spend less than 10 percent of contributions to their account. OptumHealthBank Investors are the most active contributors with the highest total balances and highest expected tax savings, holding over $2,000 in bank balances and, on average, investing another $3,000 in any combination of OptumHealthBank eight highly regarded non-proprietary mutual funds.

27. Do you envision interest in an HSA eligible HMO (low-cost) plan?
Aetna: Yes, since January 2006, Aetna has offered an HMO HSA in some markets.
Anthem Blue Cross: Anthem is reviewing market interest and feasibility of offering an HSA HMO.
Blue Shield of California: Statistics are showing that consumers are using their HSAs for both purposes, though the investment dollars in HSA accounts are growing at a rapid pace
CIGNA: We have not seen significant interest at this time.
First Horizon Msaver: Yes, and since our HSA may be paired with any carrier’s eligible plan, the HSA becomes portable making it easy for a member to move between eligible plans without disrupting the saving portion of the program.
HSA California: Yes, we envision interest in an HSA-eligible HMO plan.
Kaiser Permanente: Absolutely. Since 2005, our HSA-Qualified Deductible HMO plans have appealed to all market segments, including Individual and Family, Small, Mid and Large Groups.
Sterling HSA: There has been widespread interest in HMO plans that are HSA compatible. Both Kaiser and Western Health Advantage provide these products.
UnitedHealth Group: Yes.

28. Which geographic areas and consumer demographics are brokers seeing a demand for competitive individual and family plan HSAs?
Aetna: We are not in that market segment, so we cannot respond.
Anthem Blue Cross: Being our HSA plans are consumer centric and come with strong preventive benefits, we are seeing strong demand across all territories and demographics.
Blue Shield of California: Blue Shield experience indicates that the broker interest in IFP HSAs is statewide.
CIGNA: At this time, we do not offer an individual/family plan in California so we do not have information on this market.
First Horizon Msaver: We have seen growing interest throughout the state.
HSA California: We’re seeing growing interest throughout the state.
Kaiser Permanente: We are seeing demand across all geographic areas and demographics.
Sterling HSA: We know that the early baby boomer is very interested in choosing a HDHP/HSA product. Areas with high PPO concentration and lower pricing are high sales areas. The individual market has been a PPO market for some time and was the first to migrate to the HSA. Some individuals already have a HDHP and now have a tax-advantaged way to pay for medical expenses or save for retirement
UnitedHealth Group: All.

29. What problems, if any, have you encountered with HSA eligible plans?
Aetna: None
Anthem Blue Cross: Many health plans in the California market have had challenges pricing the 100% HSA plans. Anthem made pricing adjustment in 2008 and a pharmacy benefit adjustment in 2009 to reflect the actual utilization we were seeing in these 100% plans. Anthem small group also introduced new 80% plans in 2009 and the market continues to show an interest in HSA plans in all market sizes
Blue Shield of California: We have not encountered any specific issues relative to HSA-eligible plans.
CIGNA: We have not encountered problems with the administration of the HSA eligible plans. One of the challenges of introducing these plans is to educate the member on the value of the plan and the tools to become actively engaged in the management and maintenance of their own health care.
First Horizon Msaver: A common problem is the insufficient orientation of employees as to how both parts of the program (HDHP and HSA) work together. To help brokers and employers with this education process, First Horizon Msaver has added to fristhorizonmsaver.com a number of short video clips of real people telling of their first hand experiences with the program. We have also added an interactive HSA tutorial that provides a self-guided tour of HSA basics. These new features compliment existing HSA education located at firsthorizonmsaver.com.
HSA California: We haven’t encountered any problems with our benefit plan designs.
Kaiser Permanente: When there is excellent communication to the employer and employees we do not encounter problems. It is important to provide education on how the deductible plans and the HSA work together. Kaiser Permanente and our preferred financial administrator for HSAs, Wells Fargo, have developed extensive training materials and marketing collateral for brokers, employers, employees and individuals.
Sterling HSA: Some of the carriers have not priced them competitively enough and the prices were dramatically increased in 2009. Employers want to see enough of a differential in cost and deductible limits. Carriers that have priced the products most competitively are finding the greatest opportunity to sell. The carriers that get creative on the first dollar coverage will also be very attractive to people.
UnitedHealth Group: The main challenge with the HSA product is educating the consumer to take financial responsibility when receiving health services. Most consumers are used to dealing with a health insurance company or their bank. The HSA product is more than the sum of its parts; it involves educating the members and encouraging them to ask financial questions when seeking and receiving health services.

30. How has your plan changed from last year?
Anthem Blue Cross: We have enhanced our online support of resources with our banking partners BNY/Mellon (ACS/Mellon), added Rx Copay vs. Coinsurance and a variety of enhanced deductibles for our HSAs.
CIGNA: We have added enhanced decision support tools including the Health Risk Assessment CIGNA HealthCare has entered into a long-term agreement with the University of Michigan providing access to the use of analytics that help consumers and CIGNA identify and address health risks and help employers develop worksite health and wellness programs. New online coaching capability invites immediate, active participation in online behavior change modules, pushing targeted follow-up based on HRA responses.
First Horizon Msaver: Our program has
changed over the last year with the addition of:
• Broker/Employer Support Team
• Healthy Lifestyles Portal: Prescription drug discounts, prescription drug cost comparison tool, a free consumer guide to help them determine fair prices for health care services in their area, and a medical bill evaluation and negotiation service.
• Video Vault
• Interactive HSA education
• Online calculators
HSA California: There have been no changes to our plan this year. Our health plan portfolio still includes Health Net, Kaiser Permanente and Western Health Advantage,
Kaiser Permanente: We have no significant changes planned for 2010, but we are always exploring ways to make improvements to meet our customers’ needs. We have expanded member support activities including proactive outreach activities to assist with employee understanding of these programs.
Sterling HSA: Sterling HSA has seen steady growth despite the economic environment. We anticipate healthcare reform legislation may modify HSAs to some degree, but expect industry growth to continue in 2010 and beyond. Brokers have become much more knowledgeable about HSAs and are presenting it across the board to their clients. We have also seen many clients move from a multiple option program to a total replacement of their program either initially or at renewal.