Aetna HDHP with a PPO Network FAQs
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An HSA is a tax-advantaged account - money goes in tax free, earns interest tax free and is not taxed when it's withdrawn to pay for qualified expenses.
- The Plan makes contributions to your HSA each month
- You may also make voluntary contributions to your HSA.
- Your HSA dollars earn interest, tax free.
- At the end of the year, any money remaining in your HSA rolls over to the next year.
- You own your HSA, so you keep the money even if you change jobs or health plans.
- You can withdraw money directly from your HSA using your PayFlex® Aetna HSA Mastercard® or checks to cover qualified expenses. Or, allow the account to grow over time and use it to help pay for future health-related expenses — like long-term care insurance premiums, TCC/COBRA premiums and certain retiree expenses.
A HDHP is a health plan that, when combined with an HSA, provides insurance coverage and a tax-advantaged way to help save for future medical expenses. The Aetna HealthFund HDHP with HSA gives you greater flexibility and discretion over how you use your health care dollars.
HDHPs have a higher annual deductible than traditional health plans.
To be eligible to fund an HSA, you must be covered by an HDHP; you cannot have other health insurance coverage (including a spouse's plan) that is NOT a high-deductible health plan; and you may not contribute any money to an HSA once you are enrolled in Medicare. See the "Who is eligible to fund an HSA?" question below for more information.
To fund an HSA, you must be covered by a HDHP. You can have no other health insurance coverage (including a health care flexible spending account (HCFSA)) that is NOT a high-deductible health plan and you may not be claimed on someone else's tax return.
Some examples of other coverage that would cause ineligibility are a health care flexible spending account (HCFSA), a spouse's HCFSA, a spouse's family enrollment in an HMO, other non-high deductible health insurance coverage, TRICARE, Medicare, or receipt of Indian Health Services or VA medical benefits within the previous three months. You are responsible for notifying us if you are ineligible and of any changes that cause you to become ineligible.
No, you may no longer contribute to your HSA, but you may continue to use the funds in your account. If you no longer qualify for an HSA, you are responsible for notifying us and we will enroll you in our HDHP with a Health Reimbursement Arrangement (HRA).
The HDHP with HSA is a health plan that provides traditional health care coverage and a tax-advantaged way to help you build savings for future medical needs. An HDHP with an HSA is designed to give greater flexibility and discretion over how you use your health care benefits because you decide how to spend the dollars in your HSA.
To understand how the Plan works, let's review its components.
The Health Savings Account
- The Plan will automatically deposit $62.50 per month/Self Only or $125 per month/Self Plus One or Family into your HSA. (That is $750/Self Only or $1,500/Self Plus One or Family annually.)
- You can earn additional $75 for Self Only or $200 for Self Plus One or Family (enrollee and spouse only) by completing the online Health Risk Assessment, one online wellness program and post-program survey, and your biometric screening. The money goes directly into your HSA!
- You can make voluntary contributions to your HSA. The annual statutory maximum (plan contributions plus voluntary contributions) for 2018 is $3,450/Self Only or $6,900/Self Plus One or Family so you may voluntarily deposit up to $2,700/Self Only or $5,400 Self Plus One or Family. If you receive the incentive credit for completing your Health Risk Assessment and Biometric Screening the amount you can contribute will be reduced. If you or your spouse are age 55 or older, you may each make a catch-up contribution of up to $1,000 for 2018.
- When you have a qualified expense (e.g. doctor visit, prescription refill, dental procedures), you may withdraw money from your HSA, tax free, to be reimbursed for this out-of-pocket expense. Or, you can choose to pay out of pocket and allow your HSA to grow over time and use it for future health related expenses. Expenses covered by the Plan will apply to your deductible, expenses not covered by the Plan will not.
- Any unused dollars roll over year after year.
- You own your HSA, so you keep it even if you change health plans or jobs.
- You may want to make voluntary contributions to your HSA every year. This will lower your taxes and help you build a larger savings for future health care expenses.
In addition to the HSA, your Aetna HealthFund HDHP Plan provides traditional health benefits after you have met your deductible. You can visit doctors or hospitals in our PPO network or go out-of network and use any licensed health care professional or hospital for covered services - without a referral. Precertification is required for hospitalization and certain procedures.
- Preventive Care - The Plan includes in-network preventive care coverage (e.g. routine physicals, immunizations, screenings and cleanings at the dentist) — covered at 100% — to encourage you to receive these important services.
- Deductible - The Plan includes an annual deductible — the amount you pay out of pocket before the medical coverage begins payment for covered expenses — of $1,500/Self Only or $3,000/Self Plus One or Family for in-network service and $2,500/Self Only or $5,000 Self Plus One or Family for out of network service per year. Remember, you may use money from your HSA to pay for covered health care expenses which helps satisfy your deductible.
- Medical Coverage - When the deductible is met, the medical coverage (90% in network, 70% out of network) begins for covered expenses. The medical plan also includes an annual out-of-pocket maximum to limit the amount you pay out-of-pocket in a given year — meaning once you reach that maximum, the Plan pays 100% of your covered medical expenses for the remainder of the year. The 2018 out-of-pocket maximum is $4,000 for Self Only and $6,850 for Self Plus One or Family enrollment in-network.
- Prescription Drug Coverage - When you fill a prescription, you will pay the cost of the prescription, until the deductible has been met. Once the deductible has been met, you pay a copayment/coinsurance for each covered prescription. Refer to your Federal Plan brochure for additional details.
The HDHP with HSA is an innovative health plan that gives you more control over how you spend your health care dollars, or save for future health care expenses with a tax-advantaged HSA.
Key Plan features are:
- Affordable, low premiums with automatic monthly deposits into your HSA of $62.50 for Self Only enrollments and $125 for Self Plus One or Family enrollments
- 100% coverage for in-network preventive care (medical, dental and vision) that are not subject to the deductible
- You can use your PayFlex® Aetna HSA Mastercard® to pay claims quickly
- Your voluntary HSA contributions are tax deductible
- Interest earned on your account is tax free
- Investment options for HSA balances of $1,000 or more*
- Tax-free withdrawals may be made for qualified expenses
- Unused funds and interest are carried over, without limit, from year to year
- You own the HSA and it is yours to keep – even when you change health plans, jobs or retire
- A $100 allowance for eyeglasses or contact lenses every 24 months
- Nationwide coverage with the freedom to choose your providers
- Traditional medical plan coverage of 90% in network and 70% out of network once the Plan deductible has been met
- A cap that limits the amount you will have to pay out of pocket in a plan year
If you are looking for a plan with 100% coverage for in-network preventive care, nationwide coverage in and out of network, and where part of the premium you pay is deposited into an HSA that is yours, then the HDHP with HSA could be right for you. Consider the following:
- Review your past year's medical services use and expenses. Be sure to include the cost of your prescription medications in your review.
- Estimate any expected changes in your medical expenses for the coming year.
- Compare the out-of-pocket costs (employee contributions, deductibles, coinsurance, etc.) for the HDHP with HSA and other health insurance plans available to you.
- Compare dental and vision benefits available with the HDHP with HSA and other health benefits plans available to you.
- Consider whether you are ready to participate in an HDHP, knowing that you may save through tax-free payments on health expenses.
Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available at Enroll Now on the website. Enrollment procedures vary by agency. You will need to know the enrollment code for the Aetna HDHP with HSA which is 224 for Self Only coverage, 226 for Self Plus One and 225 for Self and Family coverage.
You have several options:
- Review the Federal Plan brochure and other information on this website
- Visit Aetna Navigator® to see the resources and information available to you when you enroll. Click on Site Tour and enter the following user name and password:
User name: federal3
- Visit the Office of Personnel Management's HSA website. This website has extensive information about HSAs including FAQs, worksheets, comparison charts, etc.
- Call Aetna at 888-238-6240
- Chat live with a health plan specialist or schedule an appointment for a one-on one phone consultation
All members will have access to Teladoc, a convenient, lower cost alternative to urgent care or the emergency room. Teladoc® lets you speak to a licensed doctor by web, phone or mobile app in under 10 minutes.. It's perfect for when you're traveling or when your doctor isn't available. Members simply visit teladoc.com/aetna or call 855-Teladoc to get started.
Teladoc doctors diagnose non-emergency medical problems, like cold & flu, pink eye, skin rash, stress/anxiety,, and recommend treatment. They can even call in a prescription to your pharmacy of choice, when necessary. All Teladoc doctors:
- Are U.S. board-certified in internal medicine, family practice, emergency medicine or pediatrics.
- Are U.S. residents and licensed in your state.
- Average 15 years of practice experience.
Please note: Teladoc is not available to all members and operates subject to state regulations. Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna or plans administered by Aetna. For complete descriptions of the limitations of Teladoc services, visit Teladoc.com/Aetna
Please note: Teladoc is not available if you are physically located in the states of AR, MO and ID when you place your call. But, if you have a plan from one of these state and are outside of these states when you call, Teladoc is available to you.
You must live or work in our service area to enroll in our plan. See our rate calculator to find plans available in your area. Once enrolled in the HDHP plan, covered medical services received overseas would be considered out-of-network. You may use money in your HSA to pay for covered medical and dental services prior to meeting your deductible. After your deductible has been met, we pay 70% out of network for covered medical services. See Section 7 of our federal brochure for more information on how to submit overseas claims.
Health Savings Account (HSA)
At the end of the year, any money remaining in your HSA remains in your HSA for the next year.
Yes, the money in your HSA earns interest. Interest earned on your HSA is not included in your income for federal tax purposes. There is no minimum balance required to earn interest.
We will credit interest on the balance in your FDIC insured interest bearing account above the required minimum balance for interest, if any, that applies to your account. We will calculate this interest on a nightly basis (reflecting the available cash balance in your FDIC insured interest bearing account and using the interest rate in effect that night), track this interest during the course of a month and credit interest earned to your FDIC insured interest bearing account no later than the second banking day of the next month. The interest rate for the month will be disclosed to you in your online account transaction history and, where applicable, in periodic account statements.
Participation in voluntary investment options is entirely optional. For HSA balances of $1,000 or more, you’ll be able to choose from a variety of mutual funds. You can view these funds in the Financial Center of your online account. A monthly investment fee of $2.00 will be taken out of your HSA cash account. See the Federal Plan brochure for more details.
You have three options.
Option 1: Keep your HSA at PayFlex
- You can use your remaining balance to pay for your eligible health care expenses.
- You have until the tax filing deadline to contribute for the months that you were eligible. You’ll need to divide the Internal Revenue Service (IRS) contribution limit by the number of months you were eligible. This will help you know how much you’re eligible to contribute.
- You’ll use the same PayFlex debit card.
- You’ll have to pay a monthly maintenance fee of $4. This fee will be paid from your HSA on the first of each month. You’ll need to log in to view the HSA Fee Schedule in the Financial Center.
- You’ll continue to use the PayFlex member website to manage your HSA.
You may move your HSA funds to your new HSA administrator. Just ask them for a Trustee Transfer form. Then, complete the form and send it to PayFlex.
Option 3: Return your HSA balance to yourself and rollover to a new HSA
- You may request to withdraw your balance from PayFlex and have the funds sent directly to you.
- To help avoid taxes and penalties on these funds, you'll need to rollover those funds into a new HSA. You must complete this process within 60 days of receiving the funds.
- You're only allowed one rollover into another HSA per calendar year. This is an IRS rule.
- The funds you roll over don't count towards the IRS maximum contribution amount.
First, your estate can use your HSA funds to pay any unpaid eligible medical expenses you may have at the time of your death. If you named a beneficiary, they’ll receive the remaining HSA funds. If that’s your spouse, the HSA will remain an HSA. However, it will be in your spouse’s name. Your spouse won’t have to pay any taxes on these funds.
If the beneficiary is not your spouse, then the funds won’t stay in an HSA. Your beneficiary will receive the funds as a withdrawal from your HSA. This means that the funds will be subject to income taxes. The funds won’t be subject to the 20% penalty tax. Note: If you have a spouse and the beneficiary is not your spouse, some states require your spouse’s consent for you to have that beneficiary. If you have additional questions, you should speak to an attorney or tax advisor.
You may be able to make pre-tax allotments to HSAs through The Federal Flexible Benefits Plan (FEDFLEX). The Office of Personnel Management has worked with payroll providers and employee self-service systems to provide this service. Please contact your payroll office to determine whether this feature is available for your agency.
You may also authorize to have funds deducted from your personal checking or savings account on a post-tax basis by completing an Electronic Funds Transfer form (EFT form) , or you may make a lump sum contribution at any time, in any amount up to the maximum limit. You can claim your total voluntary contribution for the year as a tax deduction when you file your income taxes. You have until April 15 of the following year to make HSA contributions for the current year. An EFT/direct deposit form is available on the www.aetnafeds.com website.
HSA contributions will be available for withdrawal when funds are deposited. Voluntary HSA contributions may be made from your designated bank account through electronic funds transfer (EFT) or on a lump sum basis at any time during the plan year. The availability of funds depends on how funds are contributed and varies by individual.
Once contributions have been made to your account, you can use your PayFlex® Aetna HSA Mastercard® to get instant access to your HSA dollars to pay for qualified out-of-pocket expenses quickly and easily. Use your PayFlex® Aetna HSA Mastercard® or checks, not your cash.
Connected claims is a fast and easy way to pay out-of-pocket health expenses from your HSA, without having to use your PayFlex® Aetna HSA Mastercard®. You can go on line, view your claims and choose how to pay them. You can pay the provider, pay yourself back or you can archive the claim for future use.
Your HSA can be used to pay for "qualified expenses," as defined by IRS Code 213(d). These expenses include, but are not limited to, medical plan deductibles, diagnostic services covered by your plan, health insurance premiums if you are receiving federal unemployment compensation, LASIK surgery and some nursing services. You can request a copy of IRS-allowable expenses (IRS Publication 502) by calling 800-829-3676, or visit the IRS website.
You can also use your HSA funds to pay premiums for TCC/COBRA continuation coverage. When you become age 65, you can use the account to purchase any health insurance other than a Medigap policy. You may not, however, continue to make contributions to your HSA once you are enrolled in Medicare.
Remember to keep receipts for your HSA purchases to show that you used your HSA funds for qualified expenses. If you are audited and your HSA expenses are questioned, your receipts provide the best proof. Under HSA regulations, you are responsible for determining which expenses are considered "qualified expenses." Please consult your tax advisor for guidance.
Yes. You may withdraw money from your HSA for items other than qualified expenses, please consult your tax advisor for guidance.
The administrative fee to maintain your HSA is included in your premium. If you are not enrolled in our High Deductible Health Plan (HDHP), we will deduct a monthly $5.00 administrative fee from your HSA.
No, there are no fees associated with using the PayFlex® Aetna HSA Mastercard®.
Deposits to the HSA by the Plan are made monthly. The monthly deposit is $62.50 per month for Self Only coverage and $125 per month for Self Plus One or Family coverage.
If you enroll during open season and remain covered during the year, the Plan will deposit the following to your HSA over the course of the year:
- $750 per year for a Self Only enrollment
- $1,500 per year for a Self Plus One or Family enrollment
The annual statutory maximum (Plan contributions plus voluntary contributions) for 2018 is $3,450/Self Only or $6,850/Self Plus One or Family per year.
You may contribute the following to your HSA assuming a January 1, 2018 effective date:
- Up to $2,700 per year for a Self Only enrollment
- Up to $5,400 per year for a Self Plus One or Family enrollment
If you receive the incentive credit for completing your Health Risk Assessment and Biometric Screening the amount you can contribute will be reduced.
Individuals age 55 and older may make an additional "catch-up" contribution of $1,000 per year in 2018.
For example, if you have Self Only coverage and you join during open season, the Plan will contribute $750 from premium on an annual basis (or $62.50 per month) and you may make up to a $2,700 voluntary contribution for a total of $3,450, if your HSA effective date is 1/1/18. If you have Self Plus One or Family coverage, the Plan will contribute $1,500 from premium on an annual basis (or $125 per month) and you may make up to a $5,400 voluntary contribution for a total of $6,900 if your HSA effective date is 1/1/18.
If the amount of your eligible medical expense exceeds the amount in your HSA you would be responsible for paying that expense out of pocket. You can reimburse yourself using your HSA debit card as additional funds become available.
The law states that the HSA is effective on the first day of the month following the effective date of the health plan coverage; unless the effective date of the health plan coverage is the first day of the month. For most federal employees who enroll during Open Season, the effective date of the health plan is the first day of the first pay period, which in 2017 is January 8, 2017 for many people. Postal workers' first pay period in may differ slightly. With a health plan effective date of January 8, 2017, the HSA is effective February 1, 2017. The first Plan contribution would be made in February. However, we do make 12 deposits for members joining the plan at open season.
Yes. The first Plan deposit would be made in February and monthly thereafter. There will be two deposits made in December 2018 to bring you up the full $750.
You may be able to make pre-tax allotments to HSAs through The Federal Flexible Benefits Plan (FEDFLEX). The Office of Personnel Management has worked with payroll providers and employee self-service systems to provide this service. Please contact your payroll office to determine when this feature will be available for your agency.
You may also have funds direct deposited to your HSA on a post-tax basis from your personal checking or savings account by completing an EFT form, which can be found at www.aetnafeds.com
You can use funds from your HSA to pay for LTC insurance premiums. The amount you withdraw from your HSA to pay LTC premiums would NOT count toward your catastrophic limit nor toward your deductible because it is not a covered expense under the HDHP Plan.
The Plan deposit to your HSA is made and reflected on Aetna Navigator®? each month. The timing regarding posting of withdrawals (or debits) and voluntary deposits to your HSA will vary depending upon the method used (Electronic Funds Transfer (EFT), debit card, check, etc.).
Your voluntary contributions to your HSA made with post tax dollars (money that has already been subject to income tax) are tax deductible.
PayFlex® will send a Form 5498-SA that will list your contributions to your HSA and a Form 1099-SA that will list the distributions from your HSA. You will need to complete a Form 8889 to report HSA contributions. See the IRS website or your tax advisor for more information.
HDHP Plan Details
You can check your HSA balance online using the Aetna Navigator® self-service member website; request to receive a monthly paper statement; or you can call Aetna Customer Service as directed on your PayFlex® Aetna HSA Mastercard®.
You may check the status of your deductible by using Aetna Navigator®.
The deductible is per all persons covered and can be satisfied by one or more covered members.
In most instances you will not make a payment at the time you receive services at a participating provider. Instead, you should wait for the medical claim to be processed through our claim system. We will process the claim and apply the applicable amount towards your deductible. The doctor's office will send you a bill requesting payment. If you decide to use your HSA, you should write your PayFlex® Aetna HSA Mastercard® debit card number on the doctor's bill and submit for payment or use an HSA check (if purchased). If you have already met your deductible, you will be billed for the difference between the billed charges and the amount covered by the medical plan.
Generally, when you visit a participating provider for covered preventive care, you pay nothing because eligible in-network preventive care (medical, dental, vision) is covered at 100%.
While many nonparticipating providers will submit claims for covered care to Aetna on your behalf, some may not. In that case you may have to pay the full cost of the visit up front and then submit a claim.
Participating providers should bill Aetna members the Aetna-negotiated fee, so it is important for you to identify yourself as an Aetna member and show your Aetna ID card. You may use the online Cost of Care tools on our Aetna Navigator® website to estimate the cost of service at the negotiated fee. Your Explanation of Benefits, which can be viewed on Aetna Navigator®, will also show the "submitted charges" and the "negotiated or allowable amount" so that you can be sure you are being billed the Aetna-negotiated fee.
Yes. You may use your available HSA funds to reimburse yourself for any qualified expenses (per IRS). If you satisfy the Plan deductible and access care overseas using the traditional coverage of the Plan you would be using out-of-network providers and Aetna pays 70% of the plan allowance for covered benefits. See Section 7 of our federal brochure for more information on how to submit overseas claims.
The Plan covers preventive care at 100% when you visit participating providers. Some preventive services included are routine physicals, routine immunizations, routine screenings, prophylaxis (cleaning of teeth), fluoride treatment, routine eye exam, etc. Please see your Federal Plan brochure for frequency limitations and other details.
Aetna Navigator® - Your personalized, secure self-service website packed with health and benefits information. When you register, you can order ID cards, check eligibility or claim status, check HSA balance and much more. Here are just a few highlights:
- Estimate the Cost of Care – compare in-network and out-of-network provider fees, the cost of brand-name drugs versus their generic equivalents, and the costs for services such as routine physicals, emergency room visits, lab tests, X-rays, MRIs, etc.
- Member Payment Estimator- provides real-time, out-of-pocket estimates for medical expenses based on your Aetna health plan. You can compare the cost of doctors and facilities before you make an appointment, helping you budget for and manage health care expenses.
- Hospital Comparison Tool – see how hospitals in your area rank by factors important to you.
- Simple Steps To A Healthier Life® Program – assess your potential health risks, develop a personalized action plan for better health, track your progress and much more.
- Personal Health Record - captures important health information in one place, helping you stay healthy with personalized alerts and reminders and allowing you to print and share your health history with your doctors.
- DocFind® online provider directory – lists participating physicians, hospitals and other health care providers. It also includes important provider credentials like education, board certification and languages spoken.
- Aetna Mobile - Puts Aetna's online features at your fingertips, it allows you to view your member ID card, find a doctor, look up claims, and access your Personal Health Record (PHR). It's available for Android™ and iPhone® mobile devices. If you have a smart phone we have apps you can use. Just type Aetna.com into your mobile web browser.
Dental, Vision and Pharmacy
Prophylaxis (cleaning of teeth) two times per calendar year is covered at 100% when you use a participating provider. Find participating PPO providers by using the DocFind® online provider directory. Please see your Federal Plan brochure for more information about covered dental preventive care.
The Plan only covers in-network preventive dental care at 100%. Find participating providers by using the DocFind® online provider directory.
There is no coverage for out-of-network dental care. You may choose to use your HSA to pay for non-covered dental care; however non-covered services would not apply to the deductible. As long as the services are considered IRS-qualified expenses, your HSA withdrawal would not be taxed. For the complete list of IRS-allowable expenses, you can request a copy of IRS Publication 502 by calling 800-829-3676, or visit the IRS website.
Until you meet your deductible, you will pay the entire cost of the prescription (Aetna's negotiated rate at a participating pharmacy). It is important for you to identify yourself as an Aetna member and show your Aetna ID card to get the negotiated rate. If you have funds available in your HSA, you may use your PayFlex® Aetna HSA Mastercard® debit card to purchase the prescription. Once you meet your deductible, you will be subject to a prescription copayment ($10/$35/$75). Specialty drugs are also covered at 50% up to a $250 maximum for preferred or up to $500 maximum for non-preferred per prescription.
No. Beginning in 2011, you are not eligible to use your HSA to pay for over the counter (OTC) drugs, unless you have a prescription from your doctor. OTC medications are no longer considered a qualified expense by the IRS. For the list of IRS-allowable expenses, you can request a copy of IRS Publication 502 by calling 888-238-6240, or visit the IRS website.
The plan covers one routine eye refraction every 12-month period is covered at 100% when you visit a participating provider. Your provider would submit the claim to Aetna and you would pay nothing. Members are also eligible for a $100 eyewear reimbursement every 24 months and discounts on frames, lenses, LASIK procedure, etc., through the Aetna VisionSM Discount program. If you use a participating location, they will take the $100 eyewear reimbursement off at the point of sale. If you use another eyewear provider, simply mail the receipt along with your member ID number to:
PO Box 14089
Lexington, KY 40512-4089
You can find participating locations by using the DocFind® online provider directory.
For other covered vision services, your provider will generally submit the claim to Aetna on your behalf. If you use a nonparticipating provider you may have to submit a claim. Claim forms are available on Aetna Navigator® our member website.
Just call us at 888-238-6240. Tell the customer service representative that you enrolled in the Aetna HealthFund HSA Plan and have not received your ID card and Welcome Kit. The representative will tell you whether your enrollment information has been received from your benefit office.
There may be fees associated with a Health Savings Account (“HSA"). These are the same types of fees you may pay for checking account transactions. Please see the HSA fee schedule in your HSA enrollment materials for more information. This material is for informational purposes only and is not an offer of coverage. It does not contain legal or tax advice. You should contact your legal counsel if you have any questions or if you need additional information. Information is believed to be accurate as of the production date; however, it is subject to change. PayFlex cannot and shall not provide any payment or service in violation of any United States (US) economic or trade sanctions. For more information about PayFlex, visit payflex.com.
Trademarks included in this material are the intellectual property of their respective owners.