2014 HSA Survey

DoctorPiggyBankWelcome 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 2014 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 health risk assessments.

HSA Bank: HSA Bank provides HSA administration. Complimentary business support is offered to employers and brokers including implementation planning, enrollment meeting support, remote Webinars, and communication planning. Through free online banking, accountholders can view and download real-time transactions and year-to-date account information, transfer HSA funds to an investment account or other accounts, and more. HSA Bank also funds each new HSA with a penny to meet IRS establishment, enabling accountholders to be reimbursed for qualified medical expenses on day one.

SeeChange Health: SeeChange Health Insurance offers high-deductible health plans compatible with HSAs that financially reward members for taking actions to manage their health.

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: UnitedHealthcare is the largest provider of consumer-driven health plans in the country with nearly 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 corporation, OptumHealthBank, for its HSA program administration. OptumHealthBank, 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.

UnitedHealthcare: United is the largest provider of consumer-driven health plans in the country with 5.7 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: No, HSA Bank offers direct health savings administration. HSA Bank is an independent bank and can administer HSAs for any qualified high deductible health plan offered by any regional or national carrier. If the employer decides to switch carriers, they can keep their HSA with HSA Bank. There’s no need to transfer accounts.

SeeChange Health: Yes. To the best of our knowledge we offered the nation’s first value-based benefit HSA-compatible plans in the country.

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.

SeeChange Health: No. Members have the flexibility to use the HSA administrator, which delivers the most value.

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 (from 2 to 50 employees), midsize groups (51 to 299 employees), 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: An HSA at HSA Bank is available to 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.

SeeChange Health: Our fully insured plans are available to groups of 2-to-200 or more employees. We offer value-based benefit ASO services, as well.

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.

HSA Bank: HSA Bank’s leadership and national sales force is highly experienced and trained in both health insurance and financial services. David Drzymkowski, the regional vice president – California & Hawaii, has held his insurance license since 1988.

SeeChange Health: Our leadership has extensive experience in health in­surance and financial services as well as with value-based benefit plan designs.

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


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 serves as a valuable resource for HSA-related questions by phone and email. Our team is also pleased to schedule training Webinars for brokers. Plus, your regional vice president David Drzymkowski is happy to visit your office and host a Lunch and Learn on a variety of HSA topics.

SeeChange Health: Yes. We provide extensive training on our products, including HSA-compatible plans. We also work with the state’s major general agencies to help educate brokers.

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. For more info, visit hsabank.com/hsabank/AgentsBrokers.

SeeChange Health: We pay our regular commissions on HSA-compatible plans.

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.

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. Blue Shield will pass employee eligibility information to HealthEquity, which will automatically set up bank accounts. The client will be able to fund its employees’ HSA through payroll deduction. Employees enrolling in a Wells Fargo health savings account (HSA) through their employer are able to conveniently enroll online directly with Wells Fargo.

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.

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. Blue Shield will pass employee eligibility information to HealthEquity, which will automatically set up bank accounts. The client will be able to fund its employees’ HSA through payroll deduction on the HealthEquity Employer Portal. Training Webinars occur every Wednesday; to sign up, clients go to: http://www.healthequity.net/BSCsales, and click the link under LAUNCH AND BEYOND titled HSA Employer Portal Webinars.

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. 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.

 SeeChange Health: We expect to add this functionality in 2014.

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 comparison tools for researching quality and costs of care, decision support tools  and ready access to HSA funds. 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 57,000 pharmacies nationwide.  Cigna’s quality and cost comparison tools were recognized in 2012 by InformationWeek as being among the top ten technology innovations of the year.

SeeChange Health: We help our members understand their share of medical treatment and how they can offset those costs by completing health actions designed to help them manage their health. Expenditures from their HSA are handled directly between the member and their account administrator.

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 and 24/7/365 toll-free telephone service from specially-trained customer service representatives who respond to questions about the customer’s health insurance and the HSA.

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

SeeChange Health: Questions related to plan coverage are handled by SeeChange Health.  With select administrators we have warm transfers between our Member Services area.

 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.

SeeChange Health: No, as members are free to select any HSA administrator they choose

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 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.

SeeChange Health: That will vary based on the HSA administrator chosen by the member.

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, HSA Bank offers several enrollment options including electronic file format, online enrollment and paper application. Each enrollment option provides unique capabilities and is designed to work best for different types of groups.

Kaiser Permanente: We require our standard application and enrollment process plus necessary forms to set up the Wells Fargo HSA. Wells Fargo: A broker must complete the “HSA Broker Supplement – Application for Services” form and an “HSA Employer Application.” You can find copies of the applications at wellsfargo.com/hsa

SeeChange Health: No special forms are required when applying for an HSA-compatible plan.

 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.

Kaiser Permanente: We consider our entire portfolio of health plans for our own employees.

SeeChange Health: 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 has been the trustee for our Cigna Choice Fund HSA product since January 1, 2005.

HSA Bank: Webster Bank, N.A. provides trust services and serves in a capacity as the custodain, HSA bank has been a division of Webster Bank, N.S. since 2005.

SeeChange Health: Members are free to choose their own HSA administrators and, consequently, their own trustees.

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.


16. What service guarantees do you offer?

Aetna: We do not offer HSA service guarantees.

Blue Shield: In order to ensure our members consistently receive excellent customer service, we have a number of service level agreements in place as part of our relationships with Wells Fargo and Health Equity (e.g., performance agreements for average speed of telephone response).

CIGNA: The standard performance guarantees apply. Kaiser Permanente: We do not offer service guarantees to the Individual, Family or Small group markets.

SeeChange Health: We strive to provide excellent service on all of our health plans.

UnitedHealthcare: 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. Blue Shield: As members may open their HSAs with the financial institution of their choice, depository guidelines will vary by financial institution.

Cigna: There are no minimum deposit or balance requirements. Contributions to the HSA can be funded through employer facilitated pretax payroll contributions (EFT/ACH transactions) or through unscheduled deposits in which participants arrange for an EFT.

Kaiser Permanente: The HSA administered through Kaiser Permanente does not require a minimum deposit for account holders.

SeeChange Health: This will vary based on the HSA administrator chosen by the member.

Sterling: Sterling accepts cash, checks, and electronic fund transfers through www.sterlinghsa.com in a secure, password protected environment. We recommend an initial deposit of $100 and require a minimum balance of $20 to keep the account open and active.

UnitedHealthcare: No, front-end employer deposits are required for the HRA or HSA.

18. Where is your company headquartered?

Aetna: Hartford, Conn.

Blue Shield: Blue Shield is headquartered in San Francisco, Calif.

CIGNA: CIGNA HealthCare is headquartered in Bloomfield, Conn.

HSA Bank: HSA Bank is a division of Webster Bank, N.A. headquartered in Waterbury, Connecticut. HSA Bank is based in Wisconsin.

Kaiser Permanente: Oakland, Calif.

SeeChange Health: Calabasas, Calif.

Sterling: We are a California-based company and are headquartered in Oakland, Calif. We serve clients nationwide with personal sales representatives and account managers covering all states, including Hawaii.

UnitedHealthcare: 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

CIGNA: Please contact your local CIGNA HealthCare sales representative at 888-802-4462. Blue Shield: 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.

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)

SeeChange Health: Brokers can call SeeChange Health’s sales support team at 888-237-6650 or email them at Sales@SeeChange- Health.com. Brokers can also contact their preferred General Agency to learn more about our HSA and other offerings.

Sterling: Brokers can contact any of our sales representatives. Their names, email addresses, phone numbers and territories are available at www.sterlinghsa.com on the Contact Us page. Brokers can also email broker.support@sterlinghsa.com or customer.service@sterlinghsa. com. Our phone number is 800-617-4729 and we’re available Monday – Friday from 8 am – 6 pm Pacific. Personal service and account support is a hallmark of Sterling Health Services Administration.

UnitedHealthcare: For more information, please visit www.uhc.com.

20. Which market segment (small/ mid/large) do you anticipate these plans will best accommodate? Aetna: All segments.

Blue Shield: HSA-eligible plans continue to generate interest from all market segments, including individual and group markets. Therefore, Blue Shield members enrolled in HSA-eligible plans span across all lines of business, from the individual and small group markets to large employers.

Kaiser Permanente: Our HSA-Qualified deductible HMO plans appeal to all market segments, including Individual and family, small, mid and large.

SeeChange Health: HSA-compatible plans have matured greatly in the past several years, becoming popular with all market segments.

Sterling: HDHP/HSAs accommodate all market segments and we serve them all today.

UnitedHealthcare: All segments. 21. What channels have been most effective in selling HSAs? Aetna: Brokers and general agents, consultants, Aetna sales force.

Blue Shield: Our HSA-eligible high-deductible health plans are primarily sold via soliciting brokers. To assist brokers in selling our HSAeligible plans, we’ve provided educational and marketing collateral as valuable resources to ease the plan purchase process.

CIGNA: We have found that the broker/consultant channel has been the most effective. Kaiser Permanente: All channels have been successful in selling HSA programs.

SeeChange Health: As with all health insurance products, brokers are the most effective channel when it comes to helping consumers and employers find the medical plans that best fit their needs. Given that our HSA-compatible plans provide value-based benefits that reward members for taking specified health actions, brokers play an extremely valuable role in assuring that our members receive the maximum benefit from their SeeChange Health Insurance plans.

Sterling: We are committed to the broker, agent and consultant channel.

UnitedHealthcare: 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.

Blue Shield: HSA-eligible plans appeal to all customer segments, from the individual market to small, midsize, and large groups.

Cigna: We have seen receptivity in all customer segments from the smaller group segment through large national accounts.

Kaiser Permanente: We have seen strong growth in all customer segments including the individual and family, small, mid and large group segments.

SeeChange Health: HSAs have evolved beyond being a niche product and have been embraced by all customer segments.

Sterling: Customers who want to contain their healthcare costs and reduce increases continue moving to the HSA market. Areas with high PPO penetration move quickly as well. We believe this trend will continue due to rising health plan premium costs and taxes, as well as the advent of the Cadillac tax in 2018.

UnitedHealthcare: All segments have been receptive to the HS 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.

Blue Shield: We have received positive broker feedback on our HSA eligible HDHPs, as these plans have proven to be an important option for brokers looking to provide plan benefit designs at more affordable price points for their IFP and group clients. In addition, HSA-eligible HDHPs are also attractive because of the possible tax and personal saving advantages.

CIGNA: Brokers have been very supportive of these plans. Kaiser Permanente: Brokers are very supportive of these programs when they meet their customers’ business needs.

SeeChange Health: Professional brokers focus on meeting the needs of their clients. We’ve seen no reluctance to sell our value-based, HSAcompatible plans.

Sterling: Brokers who think this is the right thing to do for their clients place them in a HDHP/HSA. Many brokers use the HSA concept as a marketing advantage to grow their book of business and sell multiple lines of coverage.

UnitedHealthcare: 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 studies in HSA and HRA results.

Blue Shield: While preventive care is covered on all our HSA-eligible HDHPs with low or no co-payment and all Blue Shield members can take advantage of our core wellness programs, it is yet to be determined if HSA-eligible HDHPs reduce utilization.

Cigna: During the past several 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, substantially reduce the overall employer medical trend. Moreover, Cigna’s multi-year experience studies of CDHP plans provide evidence demonstrating that our consumerdriven health plans both improve costs and health care quality.

Kaiser Permanente: We are frequently 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. Our care is built on a foundation of prevention to better motivate employees in engage in and improve their health. Additionally, our doctors are prompted to ask about behaviors such as exercise and smoking at every routine office visit. If members miss a screening, we follow up with phone calls and email to make sure they stay up-to-date with the care they need to get and stay healthy. By continuously screening members, we can catch conditions early, before treatment costs escalate.

SeeChange Health: Not only have studies shown that HSA-compatible plans positively impact utilization, but their relatively lower costs mean more consumers can afford coverage, reducing the number of uninsured Californians. Sterling: Our experience suggests that our clients are carefully evaluating cost/treatment alternatives, thereby reducing unnecessary medical utilization. Trends on a national level are below that of traditional health plans.

Unitedhealthcare: Results based on our UnitedHealthcare book of business show that members in a consumer-driven health plan seek more preventative care, more enroll in wellness coaching, and they 22 CALIFORNIA BROKER visit us at www.calbrokermag.com FEBRUARY 2014 have a higher rate of utilization of generic medications. All of these factors help reduce the cost of health care.

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.

Blue Shield: Blue Shield has relationships with HSA custodians to promote HSAs and offer consumer education to brokers and employer groups. For example, vendors can demonstrate for employers how moving from a traditional PPO or HMO product to an HSA-eligible HDHP offers more affordability, which also allows for greater employee coverage. Our website provides extensive information on this topic: http://www.healthequity.com/BSCemployeeEd.

Cigna: By providing information to help brokers understand the consumer advantages of the HSA product, providing products and processes that are easily understood by employers and supporting the customer education at enrollment and on an ongoing basis.

Kaiser Permanente: Vendors can make HSAs more effective and attractive by keeping the sales process simple, supporting great communications and education, supporting installations and bringing effective online tools to the employer and members. By creating an integrated HSA pairing that includes our integrated delivery-care model, we can offer an effective, attractive and competitive solution for our brokers.

SeeChange Health: Whether talking about HSA-compatible plans or more traditional policies, at SeeChange Health Insurance we’re extremely broker-centric, providing unique products that actually encourages members to see their doctor, strong training and education, and delivering outstanding service to them and their clients.

Sterling: We support the broker channel with sales representatives who handle their needs personally. We also offer HSA training and education, including CE classes and webinars, analysis tools, Power- Point 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 clients’ needs. We also consistently update clients on regulation changes, important new service benefits, etc. through targeted email campaigns, our blog, Facebook, Twitter and LinkedIn.

UnitedHealthcare: 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 shortterm 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. Blue Shield: Research indicates that consumers appreciate the lower cost of the actual HSA-eligible HDHP as well as the flexibility offered by HSAs, whether used to cover short-term medical expenses or for longer-term financial planning.

Kaiser Permanente: Consumers purchase Kaiser Permanente HSA – Qualified Deductible HMO plans and open HSAs to cover both immediate and long-term medical expenses, as well as to reduce tax liability.

SeeChange Health: California is a diverse state so it’s not surprising that employers are buying HSA-compatible plans for both reasons.

Sterling: 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.

UnitedHealthcare: Optum Bank’s analysis of saving vs. spending patterns of HSA consumers reveals diverse trends in spending vs. saving behavior on the HSA account. Data from Optum Bank released in September 2013, shows HSA account holders typically can be categorized into one of three basic patterns of account usage: spenders, savers and investors. Around 45% of Optum Bank’s 1,100,000 accountholders are spenders (typically spend more than 50% of their annual contributions). A sizable 16% of the population saves 100% of their HSA funds while the remaining 39% spend 1% to 50%. In addition, there is a growing population that is seeking mutual fund investing, as a way to help save for future medical needs. An average Optum Bank HSA account holder carries over $2,100 in their account. Investors tend to have significant higher balances, averaging over $11,000 in their investment portfolio.

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. Blue Shield: We are reviewing the HMO/HSA market trends and will be introducing new HDHPs that answer the markets needs.

CIGNA: We have not seen significant interest at this time.

Kaiser Permanente: Absolutely, since 2005 Kaiser Permanente HSAQualified Deductible HMO plans have appealed to all market segments, including Individual and family, small, mid and large groups.

SeeChange Health: We offer only PPO plans, but HSA-eligible HMOs will likely find an audience, although we don’t think it will be nearly as large as HSA-compatible high deductible plans. Sterling: Several carriers already offer an HMO/HDHP plan or EPO/ HDHP plan design. Sterling administers the HSA account component of these plans.

UnitedHealthcare: Yes, as long as the plan is a qualified HDHP.

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.

Blue Shield: Blue Shield experience indicates that the broker interest in HSAs is statewide.

Cigna: We offer an array of individual and family plans in California, some of which are HSAs. Cigna is price competitive in this market.Kaiser Permanente: We are seeing demand across all geographic areas and demographics.

SeeChange Health: We sell exclusively to groups of two to 200 employees or more.

Sterling: 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. We also see strong interest in certain geographic areas where Sterling has recently expanded, including key markets in the Southwest. UnitedHealthcare: All.

29. What problems, if any, have you encountered with HSA eligible plans?

Aetna: None

Blue Shield: We have not encountered any issues specifically pertaining 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 customer on the value of the plan and the tools to become actively engaged in the management and maintenance of their own health care.

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 has developed extensive training materials and marketing collateral for brokers, employers, employees and individuals for both our medical plans as well as the HSA administered through Kaiser Permanente.

SeeChange Health: None. Sterling: Pricing is imperative in an HSA plan. If the rates are not competitive, then the HDHP plan does not sell well. However, we have recently seen a differential in the traditional PPO and HDHP/HSA compatible plan that is supporting considerable sales of this product.

UnitedHealthcare: No problems, but it is important to educate consumer on how 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?

Blue Shield: Blue Shield is pleased to now offer our clients an unsurpassed Account Based Health Plan (ABHP) in conjunction with our new partner, HealthEquity. We researched the market extensively before selecting a strategic Account Based Custodial vendor that can service all lines of business. This is a platform and not a banking system and was designed and developed by HealthEquity. HealthEquity’s leading technology supports releases and platform enhancements and updates twice a month and has a speed to market, which is unheard of with our competition. 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 our 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 for easy reconciliation.

Cigna: We continue to enhance our online cost and quality comparison tools, to help people make informed choices about where they seek care. One such tool is our health risk assessment. Cigna has a longterm 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. We are also introducing new digital engagement capabilities including gamification that make the health assessment fun and even easier to complete. We also offer online coaching capability that invites immediate, active participation in online behavior change modules, pushing targeted follow-up based on health assessment responses.

Kaiser Permanente: Aside from compliance with federal health care reform, We have no significant changes planned for 2011/2012, 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.

SeeChange Health: We introduced what we believe to be the nation’s first value-based benefit HSA-compatible plans in 2010 at the request of our brokers. Our 2014 HSA plans are PPACA compliant. We offer Silver-level and Bronze-level HSA-compatible plans.

Sterling HSA: We continue to invest in our HSA offering with mobile applications and improved website functionality to enhance the client experience. We offer discounted set-up fees for groups adopting multiple products from Sterling (HSA with HRA, HSA with FSA, COBRA). We do not charge set up fees for HSA rollover business. We continue to offer two HSA plans — Standard and Value. Finally, we have been complimented for our outreach to the Latino community with our website, collateral and customer service representatives.

UnitedHealthcare: UnitedHealthcare continues to modify the product portfolio to meet employers’ needs. Incentive programs continue to grow where funds are made available to the HRA or HSA. Also, we are seeing more employers contributing to HSAs and matching employee contributions up to a certain dollar amount.