Frequently Asked Questions
about the HSA Plan
This is a consumer-driven health plan that works with a spending account option – a Health Savings Account (HSA) – that you fund. This plan gives you control over how you spend your health care dollars and includes four major components:
- HSA funds from you are used to pay for covered health care expenses. Money spent from this account, for covered services, counts toward your deductible.
- PPO benefits begin after you meet the deductible. You have the freedom to see any doctor without a referral.
- Preventive care and wellness visits are covered – nothing is deducted from the spending account and you don't need to meet the deductible to enjoy these benefits.
- Online decision resources help increase your awareness and knowledge of health issues and help you keep track of your HSA and health care expenses.
Most traditional plans pay a percentage of the charges for covered medical expenses only after you satisfy a plan deductible or copayment. With the New Mexico Health Investment Plan (NMHIP) HSA Plan, your preventive care and wellness services are covered without first meeting the deductible. You may also set aside a specific amount of money for you each benefit year in an HSA. The HSA funds pay for other covered health care expenses that are also applied to your deductible. You pay the remaining deductible amount and then PPO benefits begin. Any funds in a HSA are yours to keep, even if you change jobs or stop working.
An HSA is a tax-favored savings account that you use with a high-deductible health insurance plan. The HSA is established with funds from you. The money in an HSA helps pay the deductible, as well as any other eligible medical expenses (including coinsurance), that may not be covered by your health plan after you meet your deductible.
An HSA is similar to an individual retirement account (IRA) because it can be invested in a variety of investment vehicles while accumulating tax-free interest. However, your HSA funds are not taxed when withdrawn to pay for qualified medical expenses. You can make withdrawals from your HSA for nonmedical expenses, but it will be taxed as normal income and subject to a 10% penalty (if withdrawn before age 65).
At the end of each year, any unused funds in your HSA remain in the account and continue to earn interest tax-free.
HSA funds are portable, which means you own the account. Even if you switch jobs, the funds stay with you.
For more information about HSAs, visit www.irs.gov
* HSAs have tax and legal ramifications. The information provided herein is for informational purposes only and is not intended as tax or legal advice. Consult a tax or legal professional for advice regarding HSAs.
Using funds in your HSA is easy. HSA Bank (your HSA administrator) will provide you with a debit card and a checkbook. For example: When you need to visit your doctor and pay for a qualified medical expense, use the debit card or check to make the payment. You will receive more information from HSA Bank.
HSAs can be used to pay for many types of medical expenses, even some which are often excluded on health insurance plans. These include:
- Health insurance plan deductibles, copayments, and coinsurance
- Prescription and over-the-counter drugs
- Dental services, including braces, bridges, and crowns
- Vision care, including glasses and lasik eye surgery
- Psychiatric and certain psychological treatments
- Long-term care services
- Medically related transportation and lodging
View a list of eligible medical expenses that can be reimbursed from your health savings account. This is simply a quick reference and is not an all-inclusive list. Check with your tax advisor or go to www.irs.gov to obtain a current list of qualified medical expenses as determined by the IRS.
You may withdraw money from your HSA for items other than qualified health expenses; however, that money may be subject to additional taxes or penalties. Contact HSA Bank for more information.
A deductible is a fixed amount you are required to pay before health care benefits begin. The HSA pays a portion of the deductible and you are responsible for paying the remaining part. Please note that certain expenses can be paid from your HSA, but may not qualify toward your deductible.
If I have family coverage, does my entire family have to meet the deductible before the plan will pay a portion or all of the charges for covered services?
No, if you have family coverage and one individual meets the individual deductible, that person's plan benefits will begin even though the rest of the family has not met the family deductible. The family deductible is not an aggregate deductible, which means that the entire family does not have to satisfy the family deductible amount before benefits begin for any family member. If one individual in the family satisfies the individual deductible, the benefits will begin for that person only.
No. Most preventive medical services (e.g., routine physical exams, age-based testing and vaccinations) are covered at 100 percent under the Plan when you receive care from in-network doctors. Check your group plan documents for specific coverage details.
There are two circumstances when you will have out-of-pocket expenses:
- You've used all your HSA funds, but have not yet met your deductible. You are responsible for paying for health care services until you satisfy the deductible.
- Non-covered services, additional coinsurance (until you meet the higher out-of-pocket limit) and charges in excess of our allowed amount when you receive services out of network.
Yes. Your funds will accumulate without a maximum limit.
You own your HSA. You can take it from one job to the next. You can even use it when you retire.
Your health plan includes BCBSNM prescription drug benefits that are administered by Prime Therapeutics, our pharmacy benefits manager (PBM). Log in to Blue Access for MembersSM to access the Prime Therapeutics site and learn more about your prescription drug plan.
BCBSNM's customer service representatives are available to answer your questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas Day). If you call after hours, you can leave a message and we will return your call by the next business day. Call the SONM Designated Service Unit toll-free at 877-994-2583; the number is printed on the back of your member ID card. Please have your ID card available when you call. You can also contact Customer Service with a secure message through Blue Access for Members.