2015 HSA Survey–Part I

Welcome to our annual HSA Survey. We asked the top companies in the state essential questions about coverage and services that affect you, the broker. Read on to find out which plans will work best for you and your clients. Look For Part II of Our Annual HSA Survey in the February 2015 Edition.

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.

Blue Shield: Blue Shield offers an integrated eligibility and claims experience for clients that choose an Account Based Health Plan (i.e., Health Plans wrapped with an HSA, HRA or FSA account).

Cigna: Cigna Choice Fund health savings account (HSA) is an integrated HSA, combining the plan’s entire healthcare and financial management features into one easy-to-use healthcare product. It includes several features, such as health coaching, medical and HSA claim capabilities, a diverse range of mutual fund choices, employee education, and medical and pharmacy cost transparency tools, hospital quality comparison tools, and online gamified health risk assessments.

HSA Bank: As part of our HSA product, HSA Bank offers access to myHealth Portfolio – an online dashboard with bill-pay and expense tracking features – through our Member Website and a mobile app for account management on the go. Members can also invest HSA funds with self-directed investment options through the Member Website. HSA Bank’s Business Relation team offers education, implementation, communication, and enrollment support to brokers and their employer groups.

Kaiser Permanente’s HSA product offers high-quality care through our integrated delivery system supported by a suite of resources and support tools that allow members to estimate costs and calculate HSA savings. Members can schedule appointments, view immunization status, receive lab results and communicate with their physician online, saving time and money.

The HSA administered through Kaiser Permanente provides account holders with a number of convenient services including: a Kaiser Permanente Health Payment (debit) card to access funds at the point of care; online account and health plan management via kp.org; a mobile application, and a dedicated customer service line. Mutual fund investment options and a waived monthly administrative fee also are available with a minimum account balance.

Sterling: Sterling Health Services Administration offers education, implementation and account management services through personal sales and service teams, as well as online for brokers, employers and accountholders. Among our primary services are HSA education, enrollment assistance, a review of the EOB, bill paying, record keeping, scanning and archiving of bills, receipts, and other critical information in case of an IRS audit. We are the only administrator to negotiate payment plans on behalf of our clients. We also offer options for self-directing investments and flagging expenses submitted as qualified and non-qualified for HSA distribution. Our online services include online enrollment, banking, account transaction information, and the ability to make changes to the HSA account. Sterling mobile web users can also check account status, make contributions and disbursements and submit photo receipts to substantiate a debit card purchase or for pending claim documentation. Among the Sterling services valued most by our HSA accountholders, online services are at the top of the list.

We offer educational materials and services in English and Spanish. Our trans-created Spanish website includes HSA online enrollment for individuals and employer groups. Our forms and collateral have also been trans-created for clients who prefer Spanish and we have many Spanish bi-lingual customer service representatives to help them.

UnitedHealth Group: United is the largest provider of consumer-driven health plans in the country with 6.3 million members enrolled in consumer-driven health plans that incorporate a health savings account or health reimbursement.

Additionally, UnitedHealth Group uses its own financial institution, Optum Bank, for its HSA program administration. Optum Bank, an FDIC-insured financial institution focused solely on health care banking, is the nation’s largest HSA administrator. 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 qualifying account balance, they also can invest in a range of highly regarded no-fee, non-proprietary investment options.

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

Aetna: Yes.

Blue Shield: Yes, Blue Shield offers predictable qualified high deductible health plans that can be wrapped with a health savings account. However, all plans offered on the Individual and family plan (IFP) and small group markerts are standardized according to the essential health benefits and tiered metallic levels outlined in the Affordable Care Act and Covered California.

Cigna: Yes, Cigna offers a full suite of account-based medical plan designs that meet the definition of a qualified high deductible plan.

HSA Bank: As an independent bank, HSA Bank can administer health savings accounts for any qualified high deductible health insurance plan with any carrier.

Kaiser Permanente: Yes, we offer several HSA-qualified deductible plans for individuals, families and groups. Members enrolled in these plans have access to the same network of providers as with all our plans through our integrated health care delivery system.

Sterling: As an independent HSA administrator, Sterling can work with all HSA compatible plans — fully insured and self-insured

UnitedHealthcare: Yes. UnitedHealthcare offers several HSA qualified HDHPs.  In addition to administering the medical plan, UnitedHealthcare offers a wide variety of Health care services, tools and tips for its Health customers.

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

Aetna: Yes.

Blue Shield: Our clients and members can choose to have an integrated HSA model or a stand-alone HSA bank account. Both options promote pre-tax deposits and after-tax deposits; when the member reaches a certain dollar amount, he/she can choose to invest the savings in mutual funds

Cigna: Cigna has an extensive offering of consumer products that include an HSA, HRA, healthcare flexible spending account, dependent care flexible spending account, and incentive health reimbursement accounts (Healthy Awards).

HSA Bank: For spenders, the health savings account is an easy and tax-advantaged way to save and pay for healthcare costs before and after the deductible is met. For savers, an HSA is a great way to build savings for retirement.

Kaiser Permanente offers several options to employers and their employees who are interested in managing and controlling their health care costs and spending with our Health Payment Accounts. Options include a health savings account (HSA), a medical or dependent care flexible spending account (FSA), and several health reimbursement arrangements (HRA).

All account types offer employees:

• Convenient access to their health plan and Health Payment Account via kp.org

• Convenient payment or reimbursement options

• On the go account access via our mobile apps

• Dedicated customer support

Employers get the benefits of an easy transition onto the Kaiser Permanente health plan and associated Health Payment Account of their choice as well a library of communication tools to help with employee education before and after enrollment. Employers also have access to an online portal and a dedicated support team to help manage their account.

Sterling: Yes. In addition to HSAs, Sterling also provides administration services for HRAs, FSAs, POPs and COBRA. All of our product offerings include the appropriate compliance services, such as ERISA Wrap, Form 5500 filing, and non-discrimination testing to ensure that clients are in compliance with regulations. We offer many compliance services required under PPACA as well. Members of our dedicated Compliance Department are credentialed through the Certified in Flexible Compensation Program sponsored by the Employer’s Council on Flexible Compensation. Our entire sales team completed the NAHU Healthcare Reform Certification Course and all members are Certified Professionals ready to help with compliance issues under PPACA.

UnitedHealthcare: Both UnitedHealthcare offers both HSA and HRA plans.  We also have a new product feature that takes an HRA from a spending arrangement to a savings vehicle by attaching a Retiree Reimbursement Account to the employer’s plan.

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

Aetna: All sizes of groups.

Blue Shield: We offer qualified HDHP to be used with an HSA for all markets, including individual and family, small groups, midsize groups, and large groups (300+ employees). All plans on the IFP and small group market comply with ACA requirements.

Cigna: Our HSA product is available for employers with 50 or more eligible employees.

HSA Bank: We work with employee groups of all sizes with no minimum or maximum number of participants. Our HSA is also available to individuals not connected to an employer group.

Kaiser Permanente: Our HSA-qualified deductible plans are available to all group sizes. We also offer these plans to individuals and families.

Sterling: We work with groups of all sizes, including large, medium and small companies, nonprofits and unions. We also work with individuals, many of whom sign up for our HSA online.

UnitedHealthcare: We offer HSAs to employers with two or more employees.  We also have an individual policy with an HSA.

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

Aetna: Health insurance.

Blue Shield: Blue Shield’s management team is experienced in healthcare services, but works closely with our preferred vendors—Health Equity, which provides the integrated model; and Wells Fargo, for stand-alone accounts.

Cigna: Both, including through highly skilled sales managers.

HSA Bank: Both. HSA Bank’s management team and national sales force is highly experienced in health insurance and financial services as well as consumer directed healthcare. David Drzymkowski, the Regional Vice President — California & Hawaii, has held his insurance license since 1988.

Kaiser Permanente: Our management team is experienced in both health insurance and consumer-directed health care financial accounts such as the health reimbursement arrangement (HRA), health savings account (HSA) and flexible spending account (FSA).

Sterling: Yes. Our executive, sales, benefits and compliance teams have extensive experience in health insurance, healthcare financing and consumer directed account management to support our clients during benefit design, enrollment and long-term management of their accounts with us.

UnitedHealthcare: Both, UnitedHealth Group is unique in that we own our own bank, Optum Bank, so we have a very experienced management team in both health insurance and financial services

6. Do you provide training for brokers about HSAs?

Aetna: Our sales teams are knowledgeable on HSAs and can answer any questions that brokers/members may have.

Blue Shield: Yes, Blue Shield provides a continuing education seminar on HSAs to our IFP brokers periodically. Brokers also have access to educational programs and tutorials through Health Equity and Wells Fargo Websites: http://www.healthequity.com/BSCemployeeEd https://www.wellsfargo.com/com/retirement-employee-benefits/hsa/broker-sales-support.

Cigna: Cigna provides consumerism education on products including the HSA to brokers via forums and through highly skilled sales managers.

HSA Bank: Yes. Our Business Relations department is ready to answer your questions at (866) 357-5232 or businessrelations@hsabank.com<mailto:businessrelations@hsabank.com>. Ask us for Webinars, Lunch & Learns, CE Courses or Brainshark on demand presentations on a variety of HSA topics.

Kaiser Permanente provides a variety of support and training for our brokers. Through brokernet.kp.org, brokers can find tools and information to help them sell our plans and support their clients. Kaiser Permanente also has dedicated teams to help brokers with questions on the HSA, commissions, membership, billing, and other services.

Sterling: Yes, Sterling offers a variety of training options, including CE courses, webinars, “lunch and learn” meetings for large regional brokerage groups, and individual sessions pairing Sterling account representatives with brokers and consultants

UnitedHealthcare: Yes, we have an online broker portal that provides educational information about all of our products and services.  Optum Bank’s training materials are regarded throughout the industry as best in class.

7. What commissions are paid to brokers and when?

Aetna: Standard commission levels, monthly.

Blue Shield: Blue Shield does not pay commissions for HSAs because we administer the HDHP.

Cigna: Cigna pays its standard commissions for HSA sales.

HSA Bank: We recognize the important role you play in our success. To show our appreciation, we created a producer recognition program that rewards brokers on three levels beginning at 10 HSAs. For more info, visit hsabank.com.

Sterling: We pay commissions quarterly for our HSA business for all new and renewing groups. The commissions are based on our fees. We also pay commissions on many other product lines offered by Sterling.

Kaiser Permanente: Brokers are paid the standard medical commissions for all of our HSA-qualified deductible plans within 60 days after the sale.

Sterling HSA: Yes, we provide online enrollment for individuals who are part of employer groups, individuals seeking a HSA administrator on their own, and for employer groups to manage the HSA enrollment of employees. Sterling account enrollment and management forms are also available on our Website at www.sterlinghsa.com in a fill-able PDF format to download, complete, and email or mail to Sterling. Our online enrollment and paper forms are available in English and Spanish.

UnitedHealthcare: United Healthcare’s standard commission schedules and payment processes apply to the CDH products.

8. Are electronic enrollment forms accessible through your Website?

Aetna: Yes.

Blue Shield: Enrolling online eliminates the need to complete and mail in paper enrollment forms, provides an efficient enrollment process that is accurate and secure, and delivers immediate enrollment confirmation to employees. During the Blue Shield group installation for our integrated program, the client will be seamlessly set up with HealthEquity.

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.

HSA Bank: Yes. Our dedicated implementation specialists will work closely with you through the implementation process to set up the enrollment and contribution process that fits best for your employees. Enrollment via our electronic file will allow the employer to send their enrollment via our standard file format that will be provided to the employer during the implementation process. This file will be PGP encrypted and sent securely to our FTP/SFTP server. HSA Bank offers a variety of online enrollment options for the employer. With our Auto Enrollment File process, employers can easily enroll all HSA-qualified employees in an HSA by uploading a Microsoft Excel file. With HSA Bank’s Group Online Enrollment system, the employer can easily facilitate the HSA-enrollment process by providing their employees with a custom enrollment link to an online application.

Kaiser Permanente: Because the HSA election is managed through medical plan eligibility, employees enroll in their medical plan and the HSA administered through Kaiser Permanente through their employer’s existing enrollment process. Employees then establish and manage their health savings account online via kp.org.

Sterling: Yes. We provide online enrollment for individuals who are part of employer groups, individuals seeking a HSA administrator on their own, and for employer groups to manage the HSA enrollment of employees. Sterling account enrollment and management forms are also available on our website at www.sterlinghsa.com in a fill-able PDF format to download, complete, and email, mail or fax to Sterling. Our online enrollment and paper forms are available in English and Spanish.

UnitedHealthcare: HSA enrollment is available through our website.

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

Aetna: We provide cost estimator and quality assessment tools.

Blue Shield: With our new account-based platform with Health Equity, there are just five simple steps from visit to reimbursement:

1. Member visit to healthcare provider

2. Claims sent to HealthEquity by Blue Shield

3. Automatic notification of responsibility

4. Claim and account information on the same screen

5. Provider paid directly or reimbursement from CDH account

When employees are notified of a claim with member responsibility, they just access the Website to process payment and reimbursement. After viewing the claim detail, members can choose the action to be taken: pay provider, reimburse themselves, or close expense. The medical expense payment process is easy and flexible. Members can directly pay a provider from their HSA pre-tax account or add an additional external bank account; both pre- and post-tax distributions are tracked and housed on the member portal for tax reporting purposes.

Cigna: Cigna helps account holders manage their healthcare expenses with information, online and mobile comparison tools for researching quality and costs of care, decision support tools, ready access to HSA funds, and 24/7 customer service availability. Cigna provides real-time cost and quality information specific to an individual’s own plan for more than 200 procedures performed by specialists, in hospitals and in outpatient facilities. The pharmacy price quote tool compares actual real time out-of-pocket costs for medications at pharmacies nationwide.  Cigna’s quality and cost comparison tools were recognized in 2012 by InformationWeek as being among the top 10 technology innovations of the year.

HSA Bank: We offer myHealth PortfolioSM, where members have a self-service, online dashboard that gives them the complete picture of their HSA contributions and payments to providers, as well healthcare expenses. It puts them in control and shows them the way to make informed, health finance decisions. The expense tracker is used to organize and store healthcare receipts, medical claims, premiums, and important documents in one place. Members can scan in bills and receipts from a laptop or take a picture from their mobile device. They can decide to pay from their account now, pay later, or store for their records – it’s like an electronic “shoebox”. The payment manager makes it easy for members to initiate payment from their HSA or a personal account for items stored in their Expense Tracker. They can pay medical providers through online bill pay or reimburse themselves for healthcare expenses.

Kaiser Permanente reaches out by phone to new HSA-qualified deductible plan members to let them know of the tools and information available to support them in health and health plan management. One of the key online tools available is called “Estimates.” This tool provides personalized medical services cost estimates to help members make cost effective and clinically appropriate decisions around their health care.

Members can use their HSA debit card to pay for services due at the point of care or online for additional payments that may be due later.

At any time, members can manage their HSA through kp.org. The ability to check available balances, request distributions, and manage investments supports overall financial management.

Sterling: Sterling reviews the EOB and medical bills for health plan discounts to insure that our accountholders 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.  A number of our clients come to us for help with payment plans in the event there are insufficient funds to pay a medical bill. This service is especially valuable when our clients are faced with unexpected large bills.

UnitedHealthcare: Depending on the type of consumer-driven health plan, i.e. HSA or HRA, the options are different.  The HSA offers free bill pay through our website.

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

Aetna: Customer service representatives are available by phone and through our Website.

Cigna: Cigna offers integrated customer service via our myCigna.com website, my Cigna mobile app  and 24/7/365 toll-free telephone service from specially trained customer service representatives who respond to questions about the customers’ health insurance and the HSA.

Blue Shield: All HDHP-related questions are referred back to Blue Shield.

Kaiser Permanente: has specialized customer service units that respond to insurance and financial account questions. In addition, the integrated customer service centers provide a comprehensive website that helps account holders understand both their medical plan and financial accounts.

HSA Bank: Insurance-related questions should be directed to the carrier.

Sterling: Our multi-lingual customer service representatives are available Monday – Friday from 8 am to 6 pm Pacific. Clients and brokers can reach us at 800-617-4729 and via e-mail at customer.service@sterlinghsa.com.

UnitedHealthcare: UnitedHealthcare’s Customer Care Professionals are available by phone to respond to all insurance and account-related questions; a number of resources, including calculators and FAQs, are also available online at www.myuhc.com.

11. Is the administrator integrated with the health plan?

Aetna: Yes

Blue Shield: Blue Shield offers a fully integrated experience through our partnership with Health Equity. Our new Account Based platform offers a completely integrated healthcare experience for both members and clients. All accounts are on one platform with integrated enrollment and claims information, and flexible contribution models. We will also provide clients with an Employer Portal with access in real time to eligibility information, contributions, fee payments, and more. Clients will also be able to run reports for easy reconciliation.

Cigna: Yes, the HSA is fully integrated with the high deductible health plan.

HSA Bank is an independent bank that provides the health savings account working with all HSA-compatible health plans.

Kaiser Permanente’s integrated care delivery system brings the health plan, physicians, state-of-the-art medical centers and pharmacies together to improve care, engage members, and manage costs. Our HSA solution integrates health plan and HSA enrollment, eligibility, and online services to allow for innovative online tools, simplified access to account management and comprehensive support for employees in managing their health and health care. The HSA administered through Kaiser Permanente provides the right care at the right time to promote employee health, and it helps members make a personal investment in their health and become more accountable for financial health care decisions.

Sterling: Yes. With Health Expense from Sterling, HSA accountholders can connect their health plan explanation of benefits (EOBs) with their HSA, HRA or FSA account for an online, carrier-integrated view of medical claims and to make payments or reimburse themselves using funds available in their Sterling account. This service is available for HSAs, HRAs and FSAs.

It’s also important to note that Sterling is an independent administrator available to work with all health plans across the nation.

UnitedHealthcare: Yes, in 2002, UnitedHealth Group chartered OptumHealthBank to help advance the growing convergence of healthcare and financial services and to give consumers a more integrated experience.

12. Are investment choices limited by the administrator?

Aetna: The administrator provides a diverse fund selection by asset classes supporting a range of investment objectives.

Blue Shield: Under the Health Equity program, employees can invest their HSA dollars directly from the Website after reaching the $2,000 minimum balance; investments are on the same, single platform. There are no fees to invest and members can access up to 12 different mutual funds and each fund prospectus. Tax statements are also available on the Website. Wells Fargo has 13 mutual fund options available for investment options.

Cigna: Cigna offers a customized slate of diversified HSA investment options currently and HSA Bank beginning in 2015 through JP Morgan Chase as part of our Cigna Choice Fund HSA.

HSA Bank: Accountholders can select from two self-directed investment platforms based on their unique approach to investing. The Mutual Fund selection offers a professionally, pre-selected group of no-load mutual funds covering a range of fund families and asset classes. The Direct Brokerage option offers stocks, bonds and thousands of mutual funds. There’s no minimum HSA balance to begin investing. And, there’s no default or proprietary investment based on account balance.

Kaiser Permanente: The HSA administered through Kaiser Permanente offers a choice of professionally selected no-load mutual funds and a no-fee interest bearing account that employees can invest in when their cash account reaches a qualifying minimum balance. Online investing is simplified by single sign-on through kp.org where employees can manage their investments, elect automatic fund sweep, and access fund prospectuses, tax statements, and other information.

Sterling: Sterling accountholders have significant latitude in managing funds in their HSA account. Our accountholders can choose any IRS qualified investment for their HSA funds, including stocks, bonds, mutual funds, and CDs. They can work with the financial planner or brokerage firm of their choice as long as HSA funds are accepted. Sterling has also made arrangements with TD Ameritrade to offer investment services at a discounted fee for Sterling accountholders. Through TD Ameritrade, Sterling accountholders have access to a wide range of investment options. In addition, Sterling accountholders are paid interest on the funds in their accounts at prevailing bank savings rates.

UnitedHealthcare: Yes, Optum Bank offers several investment options for employees that have qualifying bank balances.

13. What forms are needed to submit an HSA case?

Aetna: Aetna’s standard enrollment processes are used. There are separate medical and HSA elections. Eligibility/enrollment options are electronic batch enrollment, paper enrollment, and Web enrollment.

Blue Shield: There are no extra forms needed; all questions are included in your Blue Shield group installation paperwork.

Cigna: Cigna’s standard processes and forms are used for all Cigna products including the HSA.

HSA Bank: To make enrolling in an HSA convenient for employers and their employees, our dedicated implementation specialists will work closely with you through the implementation process to set up the enrollment process that fits best for employers. Enrollment via our electronic file will allow the employer to send its enrollment via our standard file format that will be provided to the employer during the implementation process. This file will be PGP encrypted and sent securely to our FTP/SFTP server.

Kaiser Permanente: Clients continue to use our standard application and enrollment process for the medical plan selection. If an HSA administered through Kaiser Permanente is selected, additional forms are completed by Kaiser Permanente on behalf of the customer, including those that outline the set-up of the HSA required by the client.

Sterling: It’s very simple. Just a completed employer group application (for groups) and an individual accountholder application for each accountholder, along with a list bill and employer preferred form of contribution. Online enrollment and forms are available at www.sterlinghsa.com, a very robust employer and employee portal.

UnitedHealthcare: Employers contributing to the HSA account are required to complete an employer discovery document.

14. Do you plan to offer an HSA-eligible plan to your own employees?

Aetna: Aetna Inc. offers HSA plans to our employees.

Blue Shield: Blue Shield employees have been offered a High Deductible Health Plan and HSA since January 1, 2007.

Cigna: Yes, Cigna has offered employees HRA and HSA plan options since January 2005.

HSA Bank: Absolutely. We offer an HOHP with HSA.

Kaiser Permanente: Yes.

Sterling: We have offered our employees an HSA plan since Sterling was founded in 2004.

UnitedHealthcare: All UnitedHealth Group employees have the option of enrolling in an HSA. Each year we see more and more of our employees electing the HSA eligible plan.

15. Are you using a trustee? If so, how long have you been with the trustee?

Aetna: Yes, since May 2004

Blue Shield: Blue Shield has vendor relationships in place today with Wells Fargo (since 2004) and, for our integrated model, Health Equity (new for 2011). Both vendors are qualified trustee and custodians that administer health savings accounts.

Cigna: JP Morgan Chase, which has been the trustee for our Cigna Choice Fund since 2005, is in the process of transitioning its HSA administration to HSA Bank. As the major carrier involved in this transaction, Cigna is closely managing the transition with JP Morgan and HSA Bank.

Kaiser Permanente: Yes. HealthcareBank, a division of Bell State Bank and Trust in Fargo, North Dakota, has provided custodial services for HSAs administered through Kaiser Permanente since 2012.

UnitedHealthcare: Yes, UnitedHealthcare partners with Optum Bank for HSA administrative services. UnitedHealthcare’s parent company, UnitedHealth Group, chartered Optum Bank in 2002 to help advance the growing convergence of health care and financial services.

Look for Part II of the HSA Survey in our February 2015 Issue!