Frequently Asked Questions

Medical Plans
Health Spending Accounts
Flexible Spending Accounts
Accident and Critical Illness


Medical Plans

What is a true family deductible?

The Anthem PPO Plan and Anthem HDHP HRA Plan both have two separate deductibles and out of pocket maximums. One for an individual and one for a family. Even if you are in a family plan, one member can never have a deductible higher than the individual deductible and can never pay more than the individual out of pocket maximum. It would take at least 2 family members to hit the family deductible and out of pocket maximum, at which point, these limits have been hit for the whole family. In the Anthem HSA Plan, if you are in the family plan, the only limits that exist are the family deductible and family out of pocket maximum, meaning that one member can fulfill this whole amount.

How much are prescription drugs in the Anthem HSA plan?

Unlike the other plans which have flat copays for drugs, members in the HSA will pay the full cost of the drug while in their deductible phase. Many generic drugs will still have low costs while in the HSA, but some prescription drugs carry a large price and can add up quickly in cost. Once the member has met their deductible they will pay the same copays as the other plans.

How much does it cost to use the Notre Dame Wellness Center if I am in the Anthem HSA Plan?

Members in the Anthem HSA Plan will be assessed a fair market value access fee of $30 to utilize the ND Wellness Center. While more than the other plans, this is significantly less than the charges for seeing another provider while in the deductible phase of their plan year. Once the member has hit their out of pocket maximum, there will be no charge to use the Wellness Center.

Does the $30 access fee count toward deductible?

Yes, the $30 access fee for services performed at the Notre Dame Wellness Center will go toward your deductible.

Is Individual Accident and Critical Illness Insurance included with the Anthem HSA Plan?

Yes, like the Anthem HDHP HRA Plan, enrollees in an HSA plan will receive individual coverage in both Accident and Critical Illness insurance. Anthem HSA Plan members can purchase additional coverage for family members if they so choose.

Why did you remove the Anthem HMO Plan as an option?

The costs for the Anthem HMO Plan have continued to rise significantly year over year. We have decided to discontinue the Anthem HMO Plan because of its significantly higher costs and its more restrictive options for selecting providers.

Why is this the last year for the Anthem HDHP HRA Plan?

The medical plan backing the HRA is not qualified for HSA accounts. By moving to an HSA plan, members will be able to contribute to the HSA tax free, and will be able to keep their accounts even if they leave the University or switch plans in the future. Removing the HRA will create less confusion and will ensure that members do not lose account balances in the future.

What happens if I still have an HRA balance at the end of 2020?

For employees that elect the HDHP/HRA plan for 2020, the HRA will be funded by the University and continue to be available for eligible expenses throughout the year. However, any HRA balances left at the end of 2020 will be forfeited. There is no mechanism made available by the government to transfer these funds to a different account.

Are there any changes to my prescription drug coverage?

No, OptumRx will continue to be the Prescription Benefit Manager for all medical plans. There are no changes to copays for the Anthem PPO or Anthem HDHP HRA plan. The Anthem HSA Plan does have different Prescription drug pricing and members in this plan will pay the full cost of the drugs until they have met their deductible. Once met, they will pay the same copay as the other plans. One area of note is that Briova, the specialty wing of OptumRx is changing its name to Optum Specialty Pharmacy effective 1/1/2020.

Health Savings Account (HSA)

Basics

What is an HSA?

HSA stands for Health Savings Account, and is a powerful way to save for medical expenses and reduce your taxable income. You must be enrolled in a qualified high-deductible health plan to contribute to this type of account. The exact rules of this plan design are set by the government. The most important of these rules is that you must pay the full cost of medical care while you are still in the deductible phase of your plan year. That means that everything from office visits and drugs up to a surgery will require you to meet your deductible before the plan will begin paying at 85%. Like the other plans, once you have hit the maximum out of pocket, you will have no medical responsibility for the remainder of the year. The funds in your HSA can help pay for care. The University will contribute $500 a year for an individual or $1,000 a year for a plus one or family enrollment. You are also able to contribute money, pre-tax, from your paycheck to increase your HSA balance. This account is yours and stays with you even if you leave the university or choose a different plan in the future, but it is important to know that if you choose a non qualifying plan in the future, you will not be able to contribute additional dollars to the account.

What makes a health plan qualified for an HSA?

The minimum deductible must be no less than $1,350 for individual plans and $2,700 for families.
Maximum out-of-pocket cost for the annual deductible and expenses, such as copays, can’t exceed $6,650 for individuals and $13,300 for families.
There are benefit exclusions until the deductible is met. You can only receive free preventive care, such as getting a physical, cancer screenings or immunizations, before meeting the annual deductible. In other words, if a health plan pays for other services, such as doctor visits or prescription drugs, before you meet the deductible, it’s not HSA-qualified.
The member cannot be covered by other health insurance that is not qualified for an HSA, including Medicare and Tricare.
You can’t be claimed as a dependent on someone else’s tax return to qualify for an HSA.
Notre Dame’s PPO and HRA plans are not qualified for an HSA.

What is the difference between an HRA and HSA?

An HRA works similar to an HSA in that you have an account of money that you can use to pay for medical expenses. However, there are some key differences. First, the HSA can be used on any qualified medical expenses, while the HRA can only be used toward expenses that apply toward your deductible, Second, in addition to contributions from the University, employees have the option to contribute pre-tax dollars into their HSA, while the HRA is only funded by the University. It is also important to note that a member will forfeit their HRA if they choose a different plan or leave the University. The HSA is the member’s personal account and they cannot lose it.
What are the tax advantages of using an HSA?
There are significant tax advantages to contributing to an HSA. HSAs are the only triple tax incentivised plans the government allows. First, that means the money put in is tax-free. Second, if you choose to invest the balance and it grows in amount, the proceeds are tax free. Third, if you withdraw the money for a qualified medical expense, the withdrawal is tax free. Due to this unique design, many individuals do not reimburse themselves for small amounts, instead choosing to leave the money to grow for retirement or for larger expenses later in life. It is also a good strategy to invest as much of your own money as you can since it offers such unique tax incentives.

Will I lose HSA funding if I leave the University or choose a different plan in the future?

No, the HSA account is yours once created and belongs to you in full. That means you take the account with you if you leave or choose a different plan in the future. Members are unable to contribute from an HSA if they are not enrolled in a qualified plan, but they do not lose the balance.
What if I already have an HSA from a previous employer?
There is no rule about having more than one HSA account, but the University will only contribute to the account created through Fidelity when electing an HSA at the University. It may be advantageous to roll your previous account into your new Fidelity HSA account for ease of tracking balances and receiving withdraws.

Are there any unique HSA rules?

Yes, since there are so many tax advantages to an HSA, the IRS is strict in ensuring that they are not misused. You may only receive tax free reimbursement for qualified medical expenses. You are also unable to have a full flexible spending account (for medical, dependent care is still allowed) as this would allow double dipping of tax savings. HSA contributions are not allowed if you have any coverage that does not qualify for an HSA plan. That means that if you have double coverage through a spouse or parent that is not HSA-qualified, you will not be able to elect the HSA plan. Similarly, if you are participating in Medicare Part A or Tri-care for military veterans, you would not be eligible for contributions to your HSA.

Eligible Expenses

What types of expenses are eligible under an HSA?

An HSA can be used to pay for “qualified medical expenses” (QMEs). If used for these types of expenses, distributions from the HSA are tax free. The IRS issues a Publication 502 for the most complete and up-to-date information on what is considered a QME. Examples of QMEs include: medical costs towards your deductible, copayments, or coinsurance; dental a vision costs, and prescriptions.
Please see the attached list of Qualified Medical Expenses (QMEs). They are the same as FSA or HRA QMEs you might have experienced in the past.

Qualified Medical Expenses (PDF)

Can I use HSA funds for dental and vision expenses?

Yes, HSA funds may be used for payment of eligible medical expenses, which includes dental and vision.

Are medical expenses incurred before I set up my account eligible for reimbursement from the HSA?

No, you cannot reimburse qualified medical expenses incurred before your account is established.

Can you receive reimbursement for health clubs?

Gym and health club memberships are generally not considered qualified medical expenses that can be paid for or reimbursed from your HSA.

What if I use the HSA for something other than a qualified medical expense?

Distributions from your HSA are only tax-free for qualified medical expenses. If used for something else, the funds used for that expense will be taxed. In addition, if you are under the age of 65, you will also be subject to a 20% tax penalty.
You are responsible for deciding if your purchase or expense is qualified before using funds from your HSA. You must report the amount of qualified medical expenses paid for from your HSA when preparing your tax return each year. You should keep receipts of your medical expenses in case you need to defend your expenditures or decisions during an audit.
Are there any other special rules for HSA distributions?
If you are age 65 or older at the time of withdrawal, you are not subject to a 20% tax penalty if the distribution is used for something other than a qualified medical expense. However, the distribution will be considered taxable income and you will have to pay the applicable income tax.

Contributions and Investments

What is the maximum HSA contribution?

The IRS limits for HSA contributions in 2020 are $3,550 for an Individual and $7,100 for a family. These amounts include the $500/$1000 the University contributes on your behalf.

Can I make catch up contributions to my HSA?

Employees age 55 and older are eligible to make HSA catch-up contributions. The IRS catch-up contribution limit in 2020 is $1,000.

What is the timing of my HSA funding?

If you enroll in the HSA during open enrollment, a University contribution will be made into your account during January ($500 for individual coverage, $1,000 for individual + 1 or family coverage). During open enrollment, you may also elect an annual amount of pre-tax dollars to contribute to the HSA via payroll deduction. This election may be changed at any time, and will be spread over the payroll periods throughout the calendar year. Unlike in the FSA, funds must first be contributed to the HSA before they can be withdrawn.

Can I change my HSA contribution at any time?

Yes, you can change the amount of money contributed from your paycheck, pre-tax, at any time. It is important to note that there are maximum limits set by the government.

What investment options will be available in the HSA?

Fidelity provides access to many investment options. One potential option is choosing funds from a 25 fund menu that Fidelity monitors closely. Fidelity can provide you advice about cash strategy, potential asset allocation strategies and particular funds that would fit your strategy. Should you want another investment, Fidelity provides many other investment choices. You can view those additional options at www.fidelity.com or contact Fidelity’s HSA Department at 800-544-3716.

Using the HSA

How can I access my funds as I have Qualified Medical Expenses?

At Fidelity, you can access your funds to pay for QMEs or reimburse yourself as follows:

  • Fidelity HSA® debit card
  • Fidelity BillPay®
  • Fidelity Checkwriting for your HSA
  • Pay out of pocket and reimburse yourself to another Fidelity account (or other account)

Contact Fidelity’s HSA Department at 800-544-3716 with any questions.
https://www.fidelity.com/go/hsa/how-to-spend

Flexible Spending Accounts (FSA)

Can I use the FSA and HSA?

No, the government does not allow for a member to both contribute to an HSA and an FSA at the same time. The University does offer a special FSA for HSA members called a “Limited Purpose FSA”. This FSA works similar to traditional FSAs in that it can be used to save for dental or vision expenses, but does not allow medical expenses.

What if I have rollover money in my FSA and elect the HSA?

The University and the member are unable to contribute to an HSA if there is an FSA balance that rolls over into the new year. That means that if a member has an FSA in 2019 and plans to elect the HSA plan in 2020, they should use the entirety of their FSA by the end of 2019 (both incur the claim and request reimbursement). No funds will rollover to 2020 and the member will lose them if they have not been reimbursed.

Can I use the Limited Purpose FSA with the PPO or HDHP/HRA Plans?

Only employees enrolled in the Anthem HSA Plan are eligible to enroll in the Limited Purpose FSA. Employees in the PPO or HDHP/HRA Plans may enroll in the traditional FSA.

What can I be reimbursed for with a Limited Purpose FSA?

Only dental and vision expenses can be reimbursed.

What is the contribution limit for the Limited Purpose FSA?

$2,700 in 2019

Accident/Critical Illness

What types of accidents/critical illnesses are covered in the insurance offered by Securian?

The program offered by Securian has very similar covered benefits to the program previously offered by MetLife. Please consult the 2020 Open Enrollment guidebook, as well as the plan summary prepared by Securian and available on the HR website.

Is Individual Accident and Critical Illness Insurance included with the HSA/HRA Plans?

Yes, enrollees in the HSA and HRA plans will receive INDIVIDUAL coverage in both the Accident and Critical Illness ($5,000 coverage) insurances. These members can also purchase voluntary coverage if they so choose.

Why is Notre Dame changing accident/critical illness vendors?

We have renegotiated our voluntary plans to offer you a significant cost reduction for 2020. The voluntary plans will now be offered through Securian Financial, the existing provider of our life insurance plans. The quality and level of coverage will remain the same, with the added option of choosing more coverage for critical illness.

Why don’t I get to keep my prior issue age for critical illness?

An issue age policy means that you have been paying rates on your policy based on your age at the time of initial enrollment. As part of the transition to Securian as the new critical illness provider, employees enrolling in the Critical Illness benefit will receive a new issue age at the time of enrollment in the plan through Securian. However, due to the significant cost decreases negotiated with this new provider, no employee will be paying a higher premium, even if they are now in a higher age band.

Is there any waiting period after my initial critical illness enrollment if I receive a diagnosis?

No, there is no waiting period and diagnoses made immediately after the insurance becomes effective will become eligible for the benefit.

What is the claim process like?

Claims can be submitted directly through Securian, either via phone (1-866-365-2374), online (securian.com), or fax. Securian will request that you complete a Claimant’s Statement and/or Attending Physician’s Statement. Once you submit these forms, a Securian examiner will review your claim and make a determination. If the claim is approved, you will receive payment. If for some reason your claim is denied, you will receive a letter with the reason for denial, policy language to support the claim decision, and instructions on how to appeal if necessary.

The status of the claim may be checked online at any time.

Can coverage be converted or ported after I’m not longer employed?

Yes, your voluntary coverage may be eligible for portability. Portability means continuation as a group policy which is still generally more expensive than your policy premiums while actively employed. Conversion means continuation as an individual policy and is generally the most costly. For more information, including rates and forms, you can call Securian directly at 1-866-365-2374.