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1099-SA
Standard tax reporting form for HSAs (disbursements) sent yearly (paper distribution).
5498-SA
Standard tax reporting form for HSAs (contributions) sent yearly (paper distribution).
Account Opening Reminders
Reminders that are mailed to account holders if a signed confirmation and signature request form has not been received 30 days and 60 days after the initial enrollment information has been sent.
Adjudication
The process of settling a claim through an objective procedure.
Affirmation
Affirmation is the acceptance of the following: An employee who wants to open an HSA with OptumHealth Bank has reviewed the account's Terms & Condition documents, outlined in three (3) disclosure documents: Custodial & Deposit Agreement, Privacy Notice and Schedule of Fees. The affirmation will come to OptumHealth Bank when the employer uses the Batch with Affirmation for enrollment or if the employee uses the online enrollment method. The employer must take responsibility for all of these actions taking place.
Beneficiary Designation Request Form
Used by account holders to designate one or more beneficiaries to the HSA account.
Benefit Level
The limit or degree of services a person is entitled to receive based on the contract with a health plan or insurer.
Benefit Package
Coverage/reimbursement for health care services an insurer, government agency or health plan offers to a group or individual under the terms of a contract.
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Cafeteria Plan
An employee benefit plan where employees use pretax salary or wages to create their own customized benefits package. Employees may be able to take cash (which becomes taxable) for unused credits or convert more pretax dollars to pay for more benefits. This is also known as a flexible benefits plan.
Claim
Information submitted by a provider or a covered person that establishes the specific health services provided to a patient and requests reimbursement to the requestor.
Coinsurance
The portion of covered health care costs the covered person is financially responsible for, usually according to a fixed percentage. Coinsurance often is applied after a deductible requirement is met.
Consumer Driven Health Plan (CDHP)
Health care funding arrangements that typically involve a health savings account or other type of spending account funded at least in part by the employer to pay for member claims up to an annual dollar amount, combined with a health insurance policy providing coverage for services once the account is exhausted. The purpose of such plans is to involve the member more directly in the selection and purchasing of health care services.
Consumerism
The trend toward consumer-centric health care, direct-to-consumer health care advertising and increased consumer health care cost sharing.
Contribution
Funds that are placed into account holder's (employee's) health savings accounts. The funds can be either from the employer or made by the employee through the employer or made directly by the employee. Frequency is based on employer group selection — weekly, biweekly, monthly or as requested
Copayment
A cost sharing arrangement in which a covered person pays a specified charge for a specified service, such as $10 for an office visit. The covered person usually is responsible for payment at the time of the visit. Typical copayments are fixed or variable flat amounts for physician office visits, prescriptions and hospital services. Some companies use the term copayment to refer generically to both a flat dollar copayment and coinsurance.
Cost Sharing
A general set of financing arrangements, including deductibles, copayments and coinsurance, that specify how much the covered person must pay for health care services. See also copayment, coinsurance, deductible and out-of-pocket limit.
Covered Person
An individual who meets eligibility requirements and for whom premium payments for specified benefits of the contractual agreement are paid. Also may be referred to as plan participant or member.
Custodial & Deposit Agreement
Describes the terms and conditions between the HSA account holder and the account custodian, OptumHealth Bank.
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Debit Card
A health care debit card can be issued to members with a qualified plan. The card can be presented to medical or pharmacy providers to transfer funds from the applicable account for payment of health care services. In order for such accounts to properly qualify for tax-advantaged treatment, the administration of the debit card payments must meet IRS provisions.
Deductible
The amount of eligible expense the covered person must pay each year out-of-pocket before the plan will make payment for eligible benefits.
Dependent
An individual who relies on an enrollee for financial support and/or obtains health coverage through a spouse, parent or grandparent who is the enrollee.
Disbursement
When funds are withdrawn or requested from an HSA by the account holder.
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Effective Date
The date a contract becomes active.
Electronic Data Interchange (EDI)
The computer-to-computer exchange of business or other information between two organizations (trading partners). The data may be either in a standardized or proprietary format. Also known as electronic commerce.
Eligibility Date
The defined date a covered person becomes eligible for benefits under an existing contract.
Eligible Employee/Person
One who meets the requirements specified in the contract to qualify for coverage.
Eligible Medical Expenses
Expenses that would generally qualify for the medical and dental expenses deduction, which are the medical services listed under the IRS Section 213(d), the same governing FSA coverage. These are also explained in IRS Publication 502, Medical and Dental Expenses. Examples include amounts paid for doctors' fees, prescription and nonprescription medicines and necessary hospital services not paid for by insurance. Qualified medical expenses are those incurred by you, your spouse and your dependents.
Employee
An individual whose employment within a particular group is the basis of coverage in a health care delivery system. Also known as enrollee or subscriber.
Employer Contribution
The amount an employer contributes toward the health plan premiums. This amount varies widely among employers and is a critical variable in any risk analysis. Employer contributions can be based on dollar amounts, percentages, employment status, length of service, single or family status and other variables or combinations of variables.
Enrollee
An individual who is enrolled for coverage under a health plan contract and who is eligible on his or her own behalf (not by virtue of being a spouse or eligible dependent) to receive the health services provided under the contract. Also known as subscriber.
Enrollment
The total number of enrollees or covered persons in a health plan. The term also refers to the health plan process of signing up groups and individuals for membership.
Explanation of Benefits (EOB)
The coverage statement sent to covered persons listing services rendered, amount billed and payment made.
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Flexible Benefit Plan
A type of benefit program offered by some employers that annually offers employees a number of benefit options, allowing employees to tailor benefits to their specific needs. This is also known as a cafeteria plan.
Flexible Spending Account (FSA)
An account that reimburses the participant for qualified health costs, dependent care expenses and/or commuter costs through one pretax savings account. Employees or employers or both fund the account. At the end of each year, unused dollars are forfeited by the account holder.
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Group
A collection of individuals treated as a single entity; usually, an employer purchasing medical coverage on behalf of its full-time employees. Also called an enrolling group.
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Health Benefits Package
The services and coverage a health plan offers a group or individual.
Health Coverage
The payment of benefits for covered sickness or injury. This may include dental, medical and vision care, as well as other benefits.
Health Insurance Portability and Accountability Act (HIPAA)
A federal law intended to improve the availability and continuity of health insurance coverage that, among other things, places limits on exclusions for pre-existing medical conditions, permits certain individuals to enroll for available group health care coverage when they lose other health coverage or have a new dependent, prohibits discrimination in group enrollment based on health status, guarantees the availability of health coverage to small employers and the renewability of health insurance coverage in the small and large group markets, and requires availability of non-group coverage for certain individuals whose group coverage is terminated.
Health Reimbursement Arrangement (HRA)
An HRA can be offered in conjunction with a high-deductible health plan, and is funded by the employer for each participating employee. It pays for eligible health care expenses typically covered under the medical plan. Employers can choose whether unused funds may be carried over to the next year to cover future health care expenses, an incentive to employees to use their personal HRA wisely. If funds are exhausted, the employee is responsible for satisfying the remaining deductible before the plan begins to pay. If the employee changes jobs, the money stays with the employer.
Health Savings Account (HSA)
An account with a custodian or trustee (with or without OptumHealth Financial Services) that can be used to pay qualified medical expenses tax-free and save for future medical expenses on a tax-deferred basis. While individuals can use an HSA for items not considered qualified medical expenses, there are tax consequences associated with such use. An individual is eligible for an HSA if the account holder is enrolled in a qualified high deductible health plan, is not covered by other non-qualified health insurance, is not enrolled in Medicare and is not claimed as a dependent on someone else's tax return.
Health Savings Account Summary
Quarterly Summary Report sent to employer groups that includes:
- Current year-to-date employee and employer contributions, distributions, interest, service charges, service charge transactions, accounts opened (with and without hold), accounts closed, accounts pending and accounts funded (with and without hold)
- Current year-to-date total account balances and average account balance
- Prior year employee and employer contributions
High-Deductible Health Plan (HDHP)
This term generally refers to a health benefit plan with a large deductible.
HSA Comparison Chart
Details differences between HSAs, FSAs and HRAs.
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IRS Contribution/Deductible Guidelines
Provides guidelines on maximum allowable contributions based on deductible amount.
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Maximum Contribution Limit
The maximum dollar amount, determined by the IRS, that an account holder is allowed to contribute, per year, into their HSA.
Member
A person who has been enrolled in a health care delivery system during the reporting period. Members include all people directly enrolled (enrollees/subscribers) and their eligible dependents. Also known as covered person and plan participant.
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Network
A system of contracted physicians, hospitals and other health care providers that provides health care to members.
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Open Enrollment Period
A time during which subscribers in a health benefit program have an opportunity to re-enroll or select an alternate health plan being offered to them, usually without evidence of insurability or waiting periods.
Out-of-Pocket Costs/Expenses
The portion of payments for covered health services required to be paid by the enrollee, including copayments, coinsurance and deductibles.
Out-of-Pocket Maximum
The maximum dollar amount that you have to pay in a calendar year for services covered by a health plan. Only certain expenses you pay count toward meeting the out-of-pocket maximum and they generally include the deductible(s) and coinsurance payments.
Over-the-Counter (OTC) Drug
A drug product that does not require a prescription under federal or state law.
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Payer
An organization that pays for health care expense coverage.
Physician
Any doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who is duly licensed and qualified under the law of jurisdiction in which treatment is received.
PIN Mailer
Contains personal identification number for ATM access and point-of-sale PIN transactions using the HSA debit card. A separate (PIN) mailer is sent for each card issued.
Portability
Benefits that can be easily accessed throughout a national provider network. Relative to HIPAA, the ability to reduce or eliminate pre-existing condition limitations when an individual changes health plans by providing proof of previous continuous coverage under other recognized health plans.
Preventive Care
Comprehensive care emphasizing priorities for prevention, early detection and early treatment of conditions, generally including routine physical examination, immunization and well-person care.
Privacy Policy
Outlines OptumHealth Bank's privacy policy and gives an account holder the opportunity to limit disclosures of personal information through an opt-out reply form.
Provider
A physician, hospital, group practice, nursing home, pharmacy or any individual or group of individuals that provides a health care service.
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Renewal
Continuance of coverage under a policy beyond its original term by the acceptance of a premium for a new policy term.
Rollover Transfer Form
Used to transfer funds from an existing HSA or MSA account to an OptumHealth Bank HSA account.
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Section 125 Plan
A term referring to flexible benefit plans. The reference derives from the section of the IRS code that defines such plans and stipulates that employee contributions to such plans may be made with pretax dollars. Such plans commonly are used to permit employees’ share of premiums to be paid with pretax dollars. See also flexible spending account.
Standard Benefit Package
A set of specific health care benefits that would be offered by delivery systems. Benefit packages could include all or some of the following: preventive care, hospital and physician services, prescription drugs, mental health and substance abuse services.
Schedule of Fees and Charges
Listing of fees associated at the account holder level, for the administration of their health savings account.
Subscriber
See enrollee.
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Terms and Conditions
Mandated documents that OptumHealth Bank must provide to all account holders. The documents include: Privacy Notice, Schedule of Fees and Charges and Custodial and Deposit Agreement.
Third-Party Administrator (TPA)
An independent person or corporate entity (third party) that administers group benefits, claims and administration for a self-insured company/group. A TPA does not underwrite the risk.
Truth in Savings Document (TIS)
This is a regulatory disclosure (the document includes both the TIS and the Expedited Funds Availability EFA disclosure). The TIS discloses interest rate information, and the EFA discloses to the customer when funds will be available on their account.
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