Listening to the Heartbeat of HSAs…Our Fourth Annual Survey

Welcome to part I of our HSA survey that covers the specifics of HSA plans that are on the market in California. In part II, which appears in February, companies will give their take on various aspects of the market and will offer some predictions.

1. What are the primary services you offer as part of your HSA product?

Aetna: Compatible high deductible medical plan, HSA administration,
HSA investment services
Ben-e-lect: Ben-e-lect HSA proposals give brokers a way to introduce,
explain, and implement HDHPs and HSAs properly. We offer a complete package including promotion, training, proposals, plan design, compliance, implementation, cus-tomer service, and payment advisories. Our system helps brokers with implementation up to the member receiving their debit card.
Blue Cross of California: Our new Lumenos HSA products from BC Life & Health Insurance Company include traditional healthcare coverage and a companion HSA through Mellon bank. The HSA includes debit card, banking and investment options, a streamlined enrollment process, integrated medical and HSA customer service unit, and online Web-access to account balances through our online member portal.
Blue Shield of California: Blue Shield of California has a relationship with Wells Fargo Bank to administer HSAs for Blue Shield members in HSA-eligible plans. Services include an HSA debit card, dedicated customer service for Blue Shield members with HSAs, online accoun t management for HSAs, and an array of institutional mutual funds for investment of HSA funds.
CIGNA: CIGNA Choice Fund HSA, powered by JPMorgan Chase, is integrated HSA, combining the plan’s entire healthcare and financial management features into one easy-to-use healthcare product.
• Comprehensive consumer package that includes market leading health coaching and consumerism member service specialists
• Integrated medical and HSA claim capabilities allow members to elect to have the HSA direct payment to the provider with a single EOB documentation of the medical and HSA processing.
• Single sign on to the web for access to the medical plan and the HSA account
• Single member and employer point of contact for questions the medical plan and the HSA
• FDIC insured HSA cash account administered by JPMorgan Chase with a competitive interest rate and low fees
• A diverse range of mutual fund choices in the HSA Investment Account
• Award winning HSA communications program to help educate employees about the HSA advantage.
• Specialized team to support the set up and administration of HSA bank accounts
Member education and information available including medical and pharmacy cost transparency tools, hospital quality comparison tool, and online health risk assessments.
Health Net of California: Health Net of California offers the
EZAccess HSA program, which pairs HSA-compatible PPO plans and an HSA and debit card through Bank of America. Health Net also offers several HSA-compatible health plans. A Visa debit card is offered, which enables members to access their HSA accounts funds. Health Net provides customer service, administration services related to the health plan, and the ability for members to be transferred directly to Bank of America to ask questions related to their HSA.
HSA Bank: HSA Bank’s product offering evolved over the years to
include the following: electronic and online enrollment options; electronic and online contribution options; investment options; a customized HSA Internet Banking platform; educational resources; multi-purse debit card options; and more. HSA Bank focuses on providing a comprehensive health savings account product, including the following: banking services, client education and training, customer service, and ancillary features for added convenience.
Kaiser Permanente: Kaiser Permanente has selected Wells Fargo as
the preferred administrator for our HSA products, which is available to our members who enroll in one of our HSA-eligible plans. Services offered through Wells Fargo include an HSA debit card, online account management, and dedicated customer service.
Sterling HSA: Sterling offers a comprehensive range of services,
including a review of the explanation of benefits, bill paying, record keeping, scanning and archiving of bills, receipts, and other critical information in case of IRS audit. It offers options for self-directing investments, flagging expenses submitted as qualified and non-qualified for HSA distribution, and online banking and online access to account information. Sterling also provides education and training for our broker partners, employer groups, and individual account holders.
UnitedHealth Group: UnitedHealthcare is the largest provider of
consumer-driven health plans in the country with more than 2.2 million members enrolled in consumer-driven health plans that incorporate a health savings account (HSA) or health reimbursement account (HRA). As of Sept. 30, 2007, nearly 1.1 million UnitedHealth Group members were enrolled in an HSA plan. Additionally, UnitedHealth Group uses its own financial corporation, Exante Bank, for its HSA program administration. Exante, an FDIC-insured financial institution focused solely on health care banking, is the nation’s largest HSA administrator, with more than 308,000 HSA accounts and $436 million in deposits (including investments). Exante’s HSA account holders receive market competitive interest rates on their deposits, online bill payment options, and direct debit card access to their accounts. Additionally, once they get a $2,000 account balance, they also have the option to invest in a range of highly regarded no-fee, non-proprietary investment options.
Veritas: Online access to funds, debit cards, money market rates, 15 investment fund alternatives, numerous consumer help tools, and IRS claim tracking software standard with Patent Pending Claims Vault Software.

2. Do you offer an HSA-qualifying high deductible health insurance plan?

Aetna: Yes.
Ben-e-lect: We offer a turnkey package including the qualified HDHP 
offered by every carrier in the market, but more importantly, we can offer the HSA with alternative plan choices for members not wishing to enroll in an HSA.
Blue Cross of California: There are many standard plan designs in our Lumenos HSA portfolio. All plan designs are HSA-qualified, cover preventive care at 100%, and are integrated with the Mellon HSA account. Deductibles, coinsurance, and out-of-pocket maximums vary.
Blue Shield of California: Yes, Blue Shield offers HSA-eligible high
deductible health plans in the individual and family plans and employer group markets.
CIGNA: Yes. CIGNA offers a variety of medical plan designs that
meet the definition of a qualified high deductible plan.
Health Net of California: Health Net of California offers HSA-compatible PPO plans in all of its commercial segments, including the individual and family plans, small-group and large-group business segments.
HSA Bank: HSA Bank is an HSA administrator and does not provide the high deductible health insurance plan. However, HSA Bank has many relationships with insurance carriers, third-party administrators and agents that can help you in getting a high deductible health plan. A list of insurance providers and agents that offer HSAs is available at www.hsabank.com/products/find_hdhp.aspx.
Kaiser Permanente: Yes, Kaiser Permanente offers a wide array of HSA-eligible plans for the individual and family plan and employer group markets.
Sterling HSA: As an independent HSA administrator, Sterling can work
with all HSA compatible plans -- fully insured and self-insured.
UnitedHealth Group: Yes, UnitedHealth Group offers several HSA
qualified HDHPs. In addition to administering the medical plan, UnitedHealth Group offers a wide variety of health care services, tools, and tips for its HSA customers.
Veritas: No, We can work with HDHP carrier the broker chooses.

3. Are you providing a health spending arrangement or a savings vehicle?

Aetna: Yes.
Ben-e-lect: Both, so that employers can address the need of every employee. This gives employees an easy way to choose the right plan for themselves and their family.
Blue Cross of California: Our banking partner, Mellon, administer the health savings account.
Blue Shield of California:Yers, Blue Shield offers a health spending arrangement via a consumer directed health product (CDHP). The health spending arrangement is an HRA sponsored by the employer group. This product with an HRA is available for the self-funded market. All of Blue Shield’s health plans are compatible with HRAs. Blue Shield offers HSA-eligible high-deductible health plans to individual and family plans and employer group markets. Members in HSA-eligible high-deductible health plans may open an HSA with any HSA qualified trustee or custodian.
CIGNA: CIGNA has an extensive offering of consumer funds that in-
clude Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), Health Care Flexible Spending Account, Dependent Care Flexible Spending Account and Incentive Health Reimbursement Account (Healthy Awards)
Health Net of California: In addition to HSA-compatible plans, Health
Net of California also offers the Optimizer HMO, which provides members with a health reimbursement arrangement. All our plans use a Bank of America Visa debit card. B of A is the financial custodian and handles the financial portion of the HRA funding account, including issuance of the debit card.
HSA Bank: HSA Bank is solely focused on providing health savings
accounts administration and services. HSA Bank offers multiple account options. Accountholders have access to an interest-bearing, FDIC-insured bank account. Accountholders also have the option to open a non-FDIC insured investment account through TD Ameritrade Corporate Services or HSA Bank’s Mutual Fund Selection platform.
Kaiser Permanente: Members who are enrolled in one of our HSA-
eliigible plans can open a health savings account through our preferred administrator, Wells Fargo. However, members are free to open a health savings account with the financial institution of their choice. Our HSA-eligible health plans are designed to work with all HSA financial providers.
Sterling HSA: 
Sterling HSA does not offer FSA administration.
UnitedHealth Group: Yes, UnitedHealth Group has partnered with
Exante Bank for HSA administration, savings, and investment opportunities.
Veritas: Both

4. 
What size employee group is the HSA available for?

Aetna: All sizes of groups.
Ben-e-lect: Ben-e-lect markets to groups from two to 500 employees. However, the two to 50 market is our focus and better opportunity for brokers.
Blue Cross of California: All.
Blue Shield of California: Our HSA-eligible high-deductible health plans are available for individual and family plans, small, midsize, and large employer groups. Small groups are defined as having fewer than 50 eligible employees; midsize groups have 51 to 299, and large groups have 300 or more.
CIGNA: Our HSA product is available for employers with 200 or more eligible employees. We also offer qualified High Deductible Health Plans to groups with 50 or more eligible employees.
Health Net: Health Net of California’s HSA-compatible PPO plans are 
offered to employer groups of all sizes and to people.
HSA Bank: HSA Bank makes HSAs available to all sizes of employee groups and individual policyholders. HSA Bank has relationships with several Taft-Hartley and Fortune 500 companies.
Kaiser Permanente: All.
Sterling HSA: Sterling HSA is available for people, small group, mid-market as well as large group and national clients.
UnitedHealth Group: Our consumer-driven health plans are available to people and groups of all sizes.
Veritas: Two to 5,000

5. 
Is your management team -experienced in health insurance, financial services, or both?

Aetna: Health insurance.
Ben-e-lect: Both, we offer combined insurance and financial experience.
Blue Cross California: The Blue Cross of California management is experienced in health insurance and all of the requirements related to financial services. However, our partner at Mellon is equally as experienced in financial services.
Blue Shield of California: Blue Shield is experienced in offering and managing HSA eligible high deductible health plans and other health insurance products.
CIGNA: CIGNA HealthCare is experienced in health insurance. J Morgan Chase, CIGNA HealthCare’s partner in offering an -integrated HSA product is experienced in financial services.
Health Net of California: Health Net of California’s executive man-
agement team has extensive experience in health insurance and - financial services.
HSA Bank: HSA Bank’s management team combines expertise in banking and insurance industries. In addition to our banking professionals, HSA Bank has hired professionals from the insurance and third-party administrator industries. The combined perspectives provide us with insight into the many facets of the HSA industry and differentiates us from our competitors. We recognize the need for flexibility and differentiation with each relationship.
Kaiser Permanente: Both.
Sterling HSA: Sterling HSA’s executive team has extensive experience, over 50 years combines, in healthcare/insurance management. We have complemented those skills with staff and advisory board members (who have experience in financial services) to optimize support of our clients during enrollment and to manage their accounts.
UnitedHealth Group: UnitedHealth Group’s primary business focus is in the health insurance industry. Exante Financial Services, a division of UnitedHealth Group, is the only integrated financial services organization dedicated solely to the health care industry.
Veritas: Yes, our management team has over 27 years of combined experience in Group Health.

6. 
Do you provide training for brokers about HSAs?

Ben-e-lect: Yes, in fact, training is the biggest priority in delivering our products and services. Our training and support allows brokers to use the HDHPs efficiently.
Blue Cross of California: We provide on-going broker communications, newsletters, and product demos as new products are introduced.
Blue Shield of California: Blue Shield provides a continuing education seminar on HSAs to our individual and family plans brokers periodically. Through our relationship with Wells Fargo, we can coordinate HSA education sponsored by Wells Fargo for all brokers.
CIGNA: CIGNA provides consumerism education on products including the HSA to brokers via forums and through highly skilled sales managers.
Health Net of California: Yes, as part of Health Net of California’s broker education and communication program, training for high-deductible medical insurance products, including health savings accounts (HSAs) and health reimbursement arrangements (HRAs) is offered.
HSA Bank: HSA Bank provides a comprehensive training program by combining in-person training sessions, webinars, Adobe Flash animation presentations, and customized PowerPoint presentations. The in-person training is conducted by HSA Bank’s regional vice presidents, assistant vice presidents, and business relations coordinators. Additionally, HSA Bank offers a comprehensive communication kit to brokers, which can help them in guiding employers through each phase of the HSA program: implementation, pre-enrollment, enrollment, and ongoing education.
Kaiser Permanente: Yes.
Sterling HSA: Yes, Sterling offers a variety of training options, includ- 
ing CE courses across the nation, lunch and learn meetings for large regional brokerage groups, and individual sessions pairing Sterling account executives with brokers and consultants.
UnitedHealth Group: Yes, we routinely provide training to brokers on 
all of our products and services.
Veritas: Yes.

7. What commissions are paid to brokers and when?

Aetna: Standard commission levels, monthly.
Ben-e-lect: Brokers get the full commission paid by carriers and administrative fees are added into services. Compensation for brokers does not need to be lower just because premiums are reduced.
Blue Cross of California: Brokers will continue to be paid commissions based on the HSA-qualifying high deductible health plan.
Blue Shield of California: Blue Shield of California pays commissions to brokers on health plans. Referral fees for HSAs vary by financial institution.
CIGNA: 
CIGNA pays its standard commissions for HSA sales.
Health Net of California: Standard commission schedules and agreements apply.
HSA Bank: HSA Bank offers revenue sharing to brokers at the time the HSA is opened based on application type and on a monthly basis. To receive revenue sharing, HSA Bank requires brokers to have a minimum of five active account referrals.
Kaiser Permanente: Kaiser Permanente allocates commission to brokers for health plan enrollment only. Wells Fargo handles and pays any commissions for the health savings account. By offering your clients an HSA through our preferred administrator, they don’t have to search for a provider, thus facilitating the health plan sale.
Sterling HSA: Commissions are 10% of all fees, paid quarterly on all new and renewing business.
UnitedHealth Group: UnitedHealth Group’s standard commission schedules and payment processes apply to the CDH products.
Veritas: The broker sets their own compensation. Paid monthly.

8. 
Are electronic enrollment forms -accessible through your Website?

Aetna: Yes.
Ben-e-lect: Yes, but we have not implemented it yet since most small groups have preferred paper enrollment to get started. We think 2007 should be a big year for our electronic enrollment systems.
Blue Cross of California: PDF enrollment forms are available for download. Mellon also allows for an online e-signature process to activate the employee’s account. In addition, employers can enroll and maintain their employees’ membership information through our employer portal.
Blue Shield of California: Employers can enroll members into our HDHPs via our online enrollment vendor. Members enrolling in health savings accounts must enroll directly with the HSA trustee or custodian. Many HSA trustees offer electronic enrollment for group set-up and individual enrollments, but it varies by institution.
CIGNA: CIGNA provides an online and paper version of the HSA bank enrollment application. Employers can provide online or paper enrollment options for their employees.
Health Net of California: Health Net of California offers Internet based services to employer groups and people. Typically, smaller employer groups and third-party administrators use www.healthnet.com to update information, and larger groups use the eServices site due to the large volume of information. Information processed through Health Net’s direct website is real-time. Updates from large employer groups that use eServices are downloaded twice a day. Also, during an open-enrollment period, Health Net provides trained staff members who visit employer groups to answer employees’ questions about health insurance issues and the enrollment process.
HSA Bank: HSA Bank’s website provides accountholders with access to individual and group online enrollment systems. The paper enrollment form is also available as a PDF format. Beyond the enrollment forms, accountholders may access the necessary forms online to manage their HSA. HSA Bank provides employers with the Employer Administration Area, which allows the employer to setup and administer its employees’ HSA enrollment, view its employee list, contribute to its employees’ HSAs online, upload contribution data, and sign up for employer updates. Also, HSA Bank’s Employer Communication Kit is available for download from the Employer Administration Area.
Kaiser Permanente: HSA enrollment can be downloaded at www.wfhbs.com/kaiserpermanente.
Sterling HSA: Sterling HSA has on-line enrollment for people who are interested in a self-service HSA program, called the eSavings Plan. Sterling account enrollment and management forms are also available on our Website in PDF format to download, print, and send. A form version, which can be filled out, will be available soon.
UnitedHealth Group: Yes, electronic enrollment forms are available through our Website.
Veritas: Yes

9. How do you help account holders with paying medical bills?

Aetna: We provide cost estimator and quality assessment tools to encourage members to become educated consumers.
Ben-e-lect: We educate providers regularly; help explain the plans; and simplify the process for patients. We instruct members not to pay bills until they get our explanation of benefits. This eliminates over payments and refunds from providers.
Blue Cross of California: Account status and explanation-of-benefits are available through our member self-services Website Members can use their debit card or Mellon checks to pay for their out of pocket responsibility. The customer service advocates are available to help members understand their financial responsibility.
HSA Bank: HSA Bank offers several methods for accountholders to access their HSA funds.
1. Debit card: an HSA Visa debit card. This card provides access to the HSA funds at point-of-sale and ATM cash withdrawals.
2. Checks: Accountholders can write a check to a provider to pay for qualified medical expenses or reimburse themselves for expenses already incurred.
3. Withdrawal requests: Accountholders can submit a withdrawal request to HSA Bank. HSA Bank will then send the accountholder a check for the disbursement.
Kaiser Permanente: Kaiser Permanente has a specialized customer service team to address all deductible billing and medical cost questions and provide members with sample fees of our most common medical services and pharmaceuticals.
Sterling HSA: Sterling reviews the explanation of benefits and medical bills for discounts (retail versus wholesale) to ensure that our account holders do not spend more for a healthcare service or product than the insurance company would pay. We also alert accountholders when we spot disbursements that do not appear to comply with IRS rules.
UnitedHealth Group: Participants can use checks or a debit card to access funds in their HSA to pay providers directly for outstanding expenses or reimburse themselves for out-of-pocket expenses paid to a provider. UnitedHealth Group then gives members monthly health statements that provide personalized cost-saving and health improvement tips, as well as simple charts showing people’ claims experience and health care account balances – all in a an easy, concise, plain-English sort of way.
Veritas: We will substantiate and certify qualified expenses and hold those receipts in the member’s private claims vault for future reference.

10. How does the administrator help the accountholder with -insurance-related questions?

Blue Cross of California: Our customer service advocates are experts in HSAs and HSA-compatible health plans. They respond to consumer questions on benefits, claims, account use, and qualified medical expenses. Questions about investments, reports of lost or stolen debit cards or other banking related questions are transferred directly to Mellon.
Blue Shield of California: As a health plan, Blue Shield determines plan eligibility and payment for services incurred. This includes 
determining plan and member responsibility based on plan agreements. In terms of paying for medical bills from the HSA, the member is responsible for determining what qualified medical expenses they can choose to pay out of the HSA. Any HSA financial transactions are managed by the HSA trustee or custodian. (This involves movement of money in and out of the HSA regardless of qualified medical expenses status).
CIGNA: CIGNA helps account holders with managing their healthcare expenses with information decision support tools and ready access to HSA funds, including:
• Hospital, Radiation, and Outpatient Treatment Cost Transparency Tools that provide the out-of-pocket costs to members according to their plan.
• Pharmacy Price Quote Tool provides and compares real time out-of-pocket costs for brand name, generic and over the counter medications at 57,000 pharmacies nationwide.
Health Net of California: Health Net of California helps by:
1. Educating members to not pay medical bills until an Explanation of Benefits is received indicating the member’s financial responsibility. This eliminates over payments the need to request refunds from providers.
2. Offering members a treatment cost calculator, drug cost estimator and other assessment tools through Health Net’s web-based Decision Power program, which helps consumers make better-informed decisions and increase their understanding of health care and treatment options. The assessment tools are online information database comparison tools.
3. Making our Member Services department available to help members with claims-related issues.
Ben-e-lect: We offer complete customer service interface with the HDHP. In fact, we instruct members to call us before contacting the HDHP. This is a critical component of making the members comfortable with HSAs.
Blue Shield of California: All insurance-related questions are referred back to Blue Shield.
CIGNA: CIGNA offers integrated customer service via our www.mycigna.com Website and a toll-free telephone number to respond to questions about the member’s health insurance and the HSA.
Health Net of California: Bank of America offers HSA account admin- 
istration expertise, investment options, Treasury Department guidance questions, and information about issues related to its health savings account administrative operations. B of A also handles the financial portion of the HRA funding account, including the issuance of the HRA debit card.
HSA Bank: HSA Bank does not answer insurance-related questions. However, HSA Bank will help the accountholder, whenever possible, in contacting the correct health plan provider and helping with questions regarding HSA qualification.
Sterling HSA: Our customer services representatives are available toll-free at 800-617-4729, and via e-mail, at customer.service@sterlinghsa.com from 8:00 a.m. to 6:00 p.m. PST Monday-Friday.
UnitedHealth Group: UnitedHealth Group’s Customer Care Professionals are available to respond to all insurance-related questions
Veritas: Customer service representatives are all fully trained on all plan aspects of the employer’s HDHP benefits, PPO network, etc. The Veritas website has links to important and useful items of the member’s health plan.

Look For Part II in Our February Issue