Aetna HDHP with HSA
The High Deductible Health Plan (HDHP) with Health Savings Account (HSA) is a high deductible plan. In-network preventive care is paid at 100%, with no coinsurance, no deductible and no copayment. All other services are subject to the deductible, coinsurance, and/or copays. It is important to note that the deductible applies to prescription drugs as well.
The tax-advantaged HSA is what really sets the HDHP apart from other traditional medical plans. The HSA allows you to contribute money from your paycheck, tax-free, into your HSA to help cover your deductible and other qualified healthcare expenses. Segal also makes contributions to your HSA. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options.
Provider Network. The Aetna HDHP with HSA uses the Aetna Choice® POS II (Open Access) provider network.
The Aetna HDHP includes a variety of transition assistance transgender services*, such as:
- Behavioral health services. Your mental well-being is important and talking to a behavioral health provider before your gender affirmation surgery is a requirement for your transition planning.
- Hormone therapy and medications (covered under OptumRx). Used to make you more masculine or more feminine.
- Gender affirmation surgery and gender support services. Aetna Concierge Services can help you find an appropriate surgeon and work with your surgeon to get all the precertifications needed.
- Reproductive services. You may be covered for in vitro fertilization services (note that ART reproductive services are only covered under the Aetna HDHP, not under the Aetna PPO).
- Staying healthy after your surgery. You’re covered for preventive health services based on your birth anatomy, including certain cancer screenings.
*Coverage for gender transition services depends on certain federal laws.
The Aetna HDHP Transform Oncology program includes resources and support you may need to manage your cancer care, understand your benefits and locate the right providers.
- Personal Navigator. Your dedicated advocate who will provide you and your caretaker with personalized support.
- Guided Genetic Health® program. Genetic counseling and testing can help guide your treatment and assess your risk of developing other forms of cancer.
- Aetna Cancer Support Center. Providing resources to your fingertips, serving as your trusted source for information and guidance on what to expect while managing cancer treatment and care.
You have access to the Aetna Back and Joint Care Services Partnership with Hinge Health.
- Manage chronic back and joint pain with digital exercise therapy.
- Engage with a physical therapist virtually for more recent musculoskeletal issues.
- Avoid common musculoskeletal conditions through the wellness program.
- The Aetna Back and Joint Care program is included on your member website, with a direct connection to the Hinge Health online screener.
The Aetna HDHP with HSA is covering 3 lifetime attempts of Advanced Reproductive Technology (ART) infertility treatment as long as the definition of infertility is met and prior required steps are taken. Please see the Summary of Benefits, Booklet Certificate and Schedule of Benefits for full details and limitations. Note: The Aetna PPO does not include ART coverage.
View the Aetna HDHP Summary of Benefits and Coverage (SBC) and the Aetna HDHP Summary of Benefits.
Learn more about how the HSA works.
View the Aetna HDHP Booklet Certificate and the Aetna HDHP Schedule of Benefits for the details of your healthcare benefits, your share of the costs and which services are covered. The 2024 editions are coming soon.
Your HSA consists of Segal's contributions and your own tax-free payroll contributions (if you elect to contribute).
- Segal will contribute $700 per Employee or $1,400 per Employee Plus One or More Dependents to your HSA. This amount will be deposited each pay period throughout the year (pro-rated for new hires/elections).
- HSA funds are yours to use as soon as they are deposited.
- You make pretax payroll contributions to your HSA of up to $4,150 per Employee and $8,300 per Employee Plus One or More Dependents for 2024. If you are age 55 and over, you can contribute an additional $1,000.
- Note: these maximums include Segal's contribution of $700 per Employee or $1,400 per Employee Plus One or More Dependents, deposited each pay period throughout the year and pro-rated for new hires/elections.
- During Annual Enrollment, you decide the dollar amount you want to contribute each pay period.
- You can change your HSA pre-tax payroll contribution amount during the year in HRConnect. This allows you to adjust your contributions based on your situation. In order to avoid tax penalties, make sure you do not contribute more to your account than the IRS annual limit.
- You can also make contributions directly to your account. Contributions can come from other sources, such as gifts from family members.
- Your account earns "money-market" interest. You can also invest your account once the balance is at least $1000, in any of the investment options offered through WEX.
2024 IRS contribution limits for HSAs are:
- $4,150 per Employee
- $8,300 per Employee Plus One/Family
Maximums include Segal's contribution ($700 per Employee or $1,400 per Employee Plus One or More Dependents, deposited each pay period throughout the year and pro-rated for new hires/elections). When determining your HSA annual election, please be sure to consider Segal's contribution.
Employees age 55 and over can contribute an additional $1,000 catch-up.
As you incur covered medical expenses, you pay for them directly out of your own pocket until you meet your annual deductible.
- Annual deductible for Employee: $1,750 in-network/$4,500 out-of-network.
- Annual deductible for Employee Plus One/Family: $3,500 in-network/$9,000 out-of-network. For Employee Plus One or More Dependents, benefits for any family member are payable once any covered member of your family (including yourself) satisfies the deductible.
- In-network providers submit claims to Aetna.
- You can use your HSA funds to pay your provider directly, if you choose. Learn about "Accessing Your HSA Funds"
- Once you meet the deductible, you pay coinsurance. Coinsurance is lower for in-network providers.
- Once you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for remainder of the calendar year.
Prescription drug coverage is provided through OptumRx, the prescription drug plan administrator for the Aetna medical plans (except the EPO).
Under the Aetna HDHP with HSA, prescription drugs are grouped into preventive and non-preventive medications.
- Preventive prescription medications are used to prevent conditions such as asthma.
- The Affordable Care Act (ACA) lists preventive drugs that are covered at 100% and are not subject to the deductible.
- OptumRx lists preventive drugs that require a copay (for generic drugs) or coinsurance (for brand-name and specialty drugs). The copay and coinsurance are not subject to the deductible.
- For non-preventive medications, you pay the full cost of the drug (after OptumRx discounts are applied) at the time of purchase. Non-preventive medication expenses do apply to the deductible. Go to OptumRx to search for all covered drugs under the Plan and see how much they cost.
- Once you meet your annual deductible, you pay the applicable copay or coinsurance.
There is no separate out-of-pocket maximum for prescription drugs under the HDHP.
Learn more about the HDHP with HSA.