Employee Benefits Blog

Let’s face it, healthcare has become a major expense for everyone in this country. To help offset a portion of this costly burden for employees, employers typically offer two very popular tax-advantaged savings accounts: HRAs and HSAs. But what’s the difference between these two healthcare savings plans, what are the legal distinctions, and which is better for your employees and your company?

Making an informed decision about these tax-advantaged reimbursement plans can help you maximize the benefits for both your employees and your company.

(For a side-by-side comparison of these plans, including comparisons to FSAs and QSEHRA tax-advantaged accounts, click here to download our four page guide.)

Defining HRAs and HSAs

Not to be confused with a flexible spending account (FSA), an HSA, or health savings account, is a savings account specifically linked to a qualified high deductible health plan (HDHP); it’s meant to help offset the higher out-of-pocket expenses that potentially come with plans of this design.

Health savings accounts (HSAs) have grown in popularity in recent years for a variety of reasons. Many employers are looking to cut employee benefit costs due to the rapid and seemingly never ending increasing cost of healthcare, while others are looking to avoid the ACA’s hefty Cadillac Tax (an ACA-related 40% tax, set to go into effect in 2020 which impacts “rich” health coverage that exceeds predetermined threshold amounts).

High deductible health plans (HDHPs) allow both employers and employees to save on premiums and are a simple way to accomplish both goals. They also fit with a growing trend towards consumer-driven healthcare. Most importantly, as HDHPs become more prevalent, so do HSAs as they go hand-in-hand.

Enrollment in HSAs has exploded in the past decade, growing from 3.2 million people in 2006 to 20.2 million in 2016 and once the data is in for 2017, this number is expected to be even higher. Even with all their pros and cons, it appears that HDHPs with HSAs are here to stay as more and more companies make the transition to less expensive health insurance options.

HSAs may be a good deal for businesses and workers alike, but it’s important for employers to be informed of HSA regulations so they can ensure the HSA they offer is compliant with federal law. Here are four common mistakes employers make when offering an HSA.

4 Common HSA Mistakes to Avoid

Mistake #1: Setting Up An HSA with a Non-Qualified High Deductible Health Plan

Employers are only allowed to offer an HSA when it’s set up in conjunction with a qualified high deductible health plan. Note that this doesn’t simply mean a health insurance plan with a high deductible — many comprehensive plans are now being built to have higher deductibles so they can boast lower premiums, which is another common money saving strategy among employers these days. Rather, the term “High Deductible Health Plan” is specific to health insurance plans that not only have high deductibles, but also conform to other established federal guidelines.

As the cost of traditional group health insurance has gone up, high deductible health plans (HDHPs) with tax-advantaged health savings accounts (HSAs) have become increasingly popular among employers of all sizes. But offering a HDHP is only helpful if employees, assuming they’re given a choice, then choose to adopt them. And employees who are most satisfied with HDHPs are the ones who make the most of a HDHP’s best feature, the HSA.

HSAs (which are only available with a qualifying HDHP) are primarily designed to help employees offset the high out-of-pocket costs which come along with HDHPs by allowing both employers and employees to contribute dollars into a special savings account. (Employee contributions are made on a pretax basis.) Because HSA funds roll-over and can eventually be converted into retirement savings, savvy employees have quickly learned how to take advantage of these accounts and those who can afford it are maximizing this benefit to the full extent of the contribution limits, which currently stand at $3,400 for an individual and $6,750 for a family.

That said, the average HSA participant can’t afford to max out this benefit. In fact, most HSA participants barely contribute enough to the HSA to cover their anticipated out-of-pocket medical costs for the year. The average individual contribution is just $833, far less than any deductible on a HDHP, thereby causing enrollees to suffer under the weight of this type of plan design. Some of this behavior is simply due to limited incomes, but some can be attributed to other factors, such as a lack of education on how an HSA works.

To ensure that your workforce fully embraces HDHPs with HSA plans, it behooves every employer to explore ways to motivate employees to participate in their HSA. Afterall, according to the Employee Benefit Research Institute, between 20 and 22 million people in the U.S. are currently enrolled in an HDHP with an HSA.

Here are just a few ideas for improving HSA participation:

For any employer hoping to contain employee benefit costs, workforce adoption of high deductible health plans (HDHPs) is almost always a critical component these days. Yet this flight to what’s become known as “consumer driven healthcare” comes with a duty to help the workforce become savvy shoppers of healthcare. As the traditional decision makers in this area, employers must keep in mind that many employees will feel overwhelmed with this new responsibility.  If fact, many experts already feel as if we are failing as a nation when it comes to this concept of healthcare consumerism.

Never before have employees had to care much about whether a prescription was brand name or generic; they just had a copay. Maybe that copay was more expensive for the brand name drug, but it was manageable in comparison with paying the full retail price. They also never had to pay more than a copay for a doctor visit, but now they’re on the hook for the whole bill (at least until they reach their deductible). It’s understandable that many people feel confused and frustrated by this change in benefits.

This is not, however, an impossible transition. With more and more companies shifting to HDHPs every year, the education challenge is widespread. Engaging employees in the decision making process will empower them to feel as if they can make good decisions on their own — instead of expecting their employer to do it for them. With some education and a little assistance from your employee benefits broker and internal communications team, employees can gain the confidence they need to control their healthcare spending. Here are a few things employers can do to engage their employees in consumer driven healthcare.

Navigating the alphabet soup of types of health insurance can make anyone’s eyes glaze over, but it doesn’t have to be so intimidating — or boring. HMOs, PPOs, EPOs, POSs, and HDHPs share similarities, but they all provide health benefits in slightly different ways — and some of those can be deal-breakers for employees. Here’s a go-to guide for differentiating the types of health insurance plans available on the market today.

HMOs (Health Maintenance Organization)

Created by the Health Maintenance Organization Act of 1973, HMOs are designed to be a less expensive type of health insurance plan than some of the alternatives — in fact, they are usually among the least expensive options, but with that perk generally comes narrow networks and less freedom of choice when it comes to doctors and hospital systems.

With HMOs, you must see a primary care physician (PCP) prior to seeing any kind of specialist, otherwise the visit and any treatment provided may not be covered. In addition, the insurance policy does not cover any portion of a bill accumulated from an out-of-network provider. However, if an enrollee is transported to an out-of-network hospital in the case of an emergency (such as in an ambulance or life flight), services must be covered at the in-network price. The exception to this rule may be doctors within that hospital because they can bill separately (such as an anesthesiologist).

This type of health insurance generally boasts the least amount of paperwork, which is appealing for many people in an age where insurance paperwork seems to be as endless as it is pointless. Policyholders are subject to monthly premiums, in addition to their deductible, copays at the doctor’s office and pharmacy, and coinsurance.

While employers across the country are battling the rising cost of health care, Arizona employers are facing unique challenges of their own. Arizona’s border with Mexico presents unique circumstances many states don’t encounter, and certain state laws have created a challenging environment for employers to cultivate meaningful employee benefits packages. Here are four issues Arizona employers are facing in 2017 when it comes to employee benefits:

Arizona Employee Benefits Issue #1: Lack of Exchange Options

For small businesses with fewer than 50 full-time equivalents (FTEs), offering a SBHRA (Small Business Healthcare Reimbursement Arrangement) can be a challenge. Taking advantage of newly passed legislation regarding SBHRAs should generally help small businesses with recruitment and retention — however, the lack of Exchange options in Arizona is likely to frustrate employees, rather than appeal to them.  

This lack of Exchange options means competition is virtually non-existent, which generally leads to higher healthcare prices. Of course, this means employees are having difficulty finding affordable healthcare that fits within their budget, leading some employers to feel obligated to increase the amount they offer via SBHRAs.

Many employers are making the move from traditional healthcare plans such as HMOs, POSs, EPOs, or PPOs, to high deductible health plans, commonly referred to as HDHPs. Employers find that HDHPs allow them to save on premium costs while at the same time encouraging workers to become more active and educated consumers of healthcare. Some companies might offer HDHPs as one of two or more medical plan options, although this strategy does them little good in terms of saving money if the majority of employees fail to adopt an HDHP plan.

Regardless of the options employers choose to offer, consumer-driven healthcare is on the rise and high deductible health plans aren’t going away anytime soon. As they continue to become more and more prevalent, it’s important for HR to step up their communication efforts. Employees will be (understandably) concerned and confused by the differences in HDHPs, but it’s nothing education, patience and a bit of behavioral economics knowledge can’t solve to ward off buyer's remorse. Here are some ways to help employees embrace high deductible health plans.

1. Communication is Key

As with any other change in your company, you must be very explicit and intentional in your communication. Remember that people like to have explanations for what is happening (and why), rather than have changes dictated to them without any kind of supporting information. Just remember Benjamin Franklin's oft-cited adage "Tell me and I forget, teach me and I may remember, involve me and I learn."

When introducing a HDHP, it's critical to hold an active (vs. passive) enrollment. It's also smart to hold an open enrollment meeting so your employees can ask you questions - just make sure they’re prepared for it by sending out the benefits information a few days prior to presentation. In this way, they'll have time to review the information and come prepared with any questions they might have. Be as candid as possible so they feel as though you’re understanding their concerns - and do your best to be as patient as you can to assuage their fears. This course of action will go a long way toward a smooth transition.

2. Educate Employees about How High Deductible Health Plans Work

If your employees have never been enrolled in a high deductible health plan before, they’ll have plenty of questions about how they work. Why aren’t there copays? How much does an office visit cost at the doctor? What if one of the members on the plan is seriously injured? For what type of person are HDHPs most appropriate? Although HDHPs are growing in popularity among employers, employees tend to know very little about them and therefore, shy away from them.

Everyone - employers and employees alike - know all too well that the world of healthcare coverage is confusing. As they say in the movies, “It’s complicated.” Yet despite the confusion, there's simply no stopping the trend towards consumer-driven healthcare coverage.

That’s why it's time to unpack the facts about workplace health spending accounts, otherwise known as Health Reimbursement Accounts (HRAs) and Health Savings Accounts (HSAs) - with a focus on how to view their costs and benefits.

Before we dive into the benefits of each one, let’s start with clarifying what they are.

HRAs

HRAs come in many flavors, including Retiree HRAs, Stand-Alone HRAs, One-Person Stand-Alone HRAs, and Integrated HRAs, which are also known as Group HRAs, Linked HRAs, or Deductible-Only HRAs.  For purposes of this discusion, we are talking about Integrated HRAs - those linked with a High Deductible Health Plan (HDHP). 

This type of HRA is designed to help offset the cost of higher deductibles and is only offered to employees and their dependents who enroll in the group health insurance plan. Only the employer contributes to the HRA, and only the employer owns the account. An employer will typically set aside a dollar amount per employee per year that can cover some portion of group plan premiums, co-pays, and deductible expenses. This does not mean, however, that funds accumulate in a separate account; employers only pay after employees incur healthcare expenses.