Health Plan Isn't Specifically Called a HDHP/HSA Eligible Plan, but is it?

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Okay folks, this might be a silly question, but I recently changed jobs and am now working at a very small startup. The boss provides a health insurance plan (Florida Blue -- i.e. BCBS -- plan 05190, single coverage PPO) that had a deductible of $1250 in 2016. That alone made it clear that I didn't qualify to contribute to an HSA plan since the deductible limit for qualifying for an HSA was $1300 in 2016. We just received our new policy documents and the deductible for 2017 is $1500, which is now over the unchanged $1300 HSA qualification limit.

So, my question is: Although our policy makes no mention of being a HDHP or HSA eligible plan, does the high deductible alone make me eligible to contribute to an HSA? Or is there some other qualification that the plan has to meet in order to be eligible?

 

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Do you have co-pays for office visits, or those only kick in after meeting the deductible?

Depends. Can you see doctors with a copay before you hit your deductible? If so, you're out of luck.

There are a few rules. Your best bet would be to call your plan customer service and ask, they should be able to tell you whether or not it qualifies and, if not, exactly why not. In summary, to qualify for an HSA:

  • Your health plan must have a deductible over $1,300
  • Your health plan must have a maximum out of pocket under $6,550 (which is less than the ACA max OOP for reasons I cannot figure)
  • Your health plan must not cover any services prior to meeting the deductible with certain exceptions for routine preventive visits (checkup and immunization), disease screening, weight management, smoking cessation, dental, and vision
  • Your health plan must not cover prescriptions prior to meeting the deductible with certain exceptions for preventive drugs
  • You must not be covered by any other, non-HDHP health plans, including general-purpose FSA and HRAs

Full details: https://www.irs.gov/publications/p969/ar02.html#en_US_2015_publi...

Usually PPO health plans are not HDHP plans so the way the insurer named the plan would tend to indicate it's not eligible for HSA. But better ask the insurer directly.

It's likely not HSA-compliant if it doesn't say so pretty obviously. The HSA being attached is a large selling point for people looking for those. While it's presumably possibly to get a low-ish deductible HSA plan, most of them are automatically quite high deductibles (3k-6k individual). Your plan probably has co-pays, which would make it non HSA eligible.



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