Call the Utilization Management Organization before receiving services for the following:

• Inpatient stays in Hospitals, Extended Care Facilities, or residential treatment facilities.
• Partial hospitalizations.
• Organ and tissue transplants.
• Home Health Care.
• Durable Medical Equipment, excluding braces or orthotics, over $1,500 or Durable Medical Equipment rentals over $500 per month.
• Prosthetics over $1,000.
• Qualifying Clinical Trials.
• Inpatient stays in Hospitals or Birthing Centers that are longer than 48 hours following normalvaginal deliveries or 96 hours following Cesarean sections.
• Bariatric surgery.
• Cochlear Implants.

Note:  If a Covered Person receives Prior Authorization for one facility, but then is transferred to another facility, Prior Authorization is also needed before going to the new facility, except in the case of an Emergency.

The phone number to call for Prior Authorization is listed on the back of the Plan identification card.

Yes.  A non-Prior Authorization penalty is the amount that must be paid by a Covered Person who does not call for Prior Authorization prior to receiving certain services. A penalty of 50% up to $300 may be applied per confinement if a Covered Person receives services but does not obtain the required Prior Authorization.

You can make changes to a benefit plan during the open enrollment period.  The open enrollment period is usually in November of each year and will be announced by the employer.

You can also make changes to your benefit plan when you or your spouse experience a qualifying life event.  A qualifying life event may include a loss of benefits due to a job change or termination, the birth of death of a dependent, the adoption of a child, a divorce or marriage, becoming a US citizen, and moving to a new state that doesn’t offer your current plan. Check with the benefit administrator in the Commissioners’ Office for more information.

Benefit enrollment changes must be submitted to the Office of the Board of Commissioners.  UMR Enrollment Change Forms are available on this web site.

No. You own the Account, and Health Savings Accounts are individually owned. Your financial institution may allow you to have an authorized signer on the account. HSA’s cannot have joint ownership.

Contact your bank for a “Mistaken HSA Distribution Form”.  Complete the form and replace the amount spent in error by the tax deadline.  If you fail to do so, then the amount spent in error is subject to income tax plus a 20% penalty.

Yes, you may use your HSA to pay for the qualified, medical expenses of your children so long as you can claim the child as a tax dependent.

No, the catch-up rule applies only to the Account Holder per IRS regulations.

No. Only claims incurred after the account was effective can be paid or reimbursed from the account.

If you cannot have an HSA and enroll in the FSA for 2017, your FSA will be a general purpose FSA. It will cover Medical, Rx, Dental & Vision.

An employer, an employee, or someone on behalf of an employee may contribute to an HSA. Employer contributions to an employee’s HSA are not included in the employee’s gross income, and employers may deduct those HSA contributions as business expenses.

If you are over age 65 and enrolled in Medicare you can no longer contribute to your HSA. If you turn 65 in March, you can contribute in January and February only.

No. Employers must make pro-rata contributions for employees who are eligible for less than the full year. For example, if the employer contributes $500 for the full year, the employer must contribute $250 to an employee who is HSA eligible for 6 months.

An individual may have excess contributions based on an employer contribution (e.g., an employee loses HSA eligibility during the year where the employer pre-funds HSAs) or based on her own contribution.

The individual must remove the excess contributions, plus earnings by the tax filing date (generally April 15) or pay a 6% excise tax on the excess contributions (including earnings on the excess amount).

Excess employer contributions removed by the tax filing date will be taxable as income, but will not be subject to the 6% excise tax.

An employer is only required to verify whether: (1) the individual is enrolled in your organization’s HDHP; (2) whether the individual is enrolled in disqualifying coverage through your organization such as a health FSA or an HRA that is not HSA-compatible; and (3) the individual’s age (to determine if the individual is eligible for catch-up contributions).

The employer may rely on information the employee provides about his/her age. The employer is not responsible for verifying that an individual may not be claimed as another taxpayer’s dependent, that an
individual is not enrolled in Medicare, or that the employee does not have disqualifying coverage from another source such as the spouse’s employer.

Each spouse can have their own HSA and contribute between them up to the Family maximum ($6,750). The assumed IRS split is 50% or $3,375 each.

Individuals who are HSA eligible for the full year, but change from single to family (or family to single status) will need to pro-rate the contribution amount. For example:

Tom is covered under a single HDHP. Tom gets married at the end of March and changes his coverage to family HDHP on April 1. Cindy drops her old coverage when she becomes covered under Tom’s plan. Tom’s maximum contribution (based on statutory maximums of $3,400 and $6,750) would be:
$3,400/12 x 3 (3 months of single coverage) $850
$6,750/12 x 9 (9 months of family coverage) $5,062.50
Total $5,912.50

Situation: The employee selects family coverage under the employer’s HDHP/HSA and elects to contribute $300 per month to the HSA under the employer’s cafeteria plan. His wife waives medical coverage under her employer’s health plan, but enrolls in her employer’s general purpose FSA.

Problem: Mid-year, after the employee has contributed $1,800 to his HSA account, he finds out that he is not HSA eligible because his wife enrolled in a general purpose FSA. Since the employee has not been HSA eligible at any time during the year, he can’t contribute any amount to an HSA.

Solution: The employee will need withdraw all of the funds and close the HSA. He will also need to cancel his $300 HSA election under the cafeteria plan. (Note: No other cafeteria plan changes may be made.) The employer will need to include the $1,800 already deducted on the employee’s Form W-2 as taxable income. The employee will need to report any interest earned on the $1,800 while in the account since it will be taxable.

Most likely you can and you should check with your banking institutions. There will be a HSA rollover/transfer form and you may only have a limited window of time to do this.

Distributions from an HSA can be made for medical expenses of children whom the individual claims as dependents on his or her income tax return (or whom the individual could claim, if the children’s own incomes were disregarded). This means that for a child’s expenses to be qualified medical expenses, the child must: (1) be under age 19 at the end of the year (or under age 24 if a student), (2) provide no more than half of his or her own support for the year, and (3) have the same principal place of abode as the individual for more than one-half of such taxable year. The child (adopted or natural) may be the
individual’s daughter, son, stepdaughter, stepson, or foster child, or a descendant of such a child (e.g., employee’s grandchild); or the individual’s brother, sister, stepbrother, stepsister, or a descendant of any such relative. In other words, HSA distribution rules do not use the “child under age 26” approach. The changes PPACA made to the tax  treatment of adult children for health coverage such as major medical, dental, vision, and even FSAs do not apply to HSA distributions.

The HSA account holder dies. The HSA ceases to be an HSA and becomes taxable as income to the beneficiary (separate rules apply to a surviving spouse).  If the account holder dies and the surviving spouse was the designated beneficiary, the surviving spouse inherits the HSA (Federal tax-free) and may continue to withdraw funds for qualified expenses on a tax-free basis.