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HDHP/HSA with discounted domestic benefit


Guest benefitsmstuart
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Guest benefitsmstuart

I work for a pediatric hospital and we are planning to introduce a HDHP with HSA next plan year. We wanted to have all domestic benefits (non-preventative services rendered at our facility) covered at 100% but it appears that is not possible.

Would it be possible to use a low co-pay that applies towards the deductible? The low co-pay is intended to incent members to use our facility. Or would this plan design make members ineligible for an HSA since the plan is covering services prior to the deductible being met?

Any guidance would be appreciated.

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  • 2 months later...

In the proposed arrangement, you state that "the plan is covering services prior to the deductible being met". I don't see that as being accurate. Actually, the plan is providing services prior to the deductible being billed.. In other words, the employee makes a low down payment, such as $50-$100 (you call it a co-pay), and then the facility bills the employee for the balance, maybe even provides an employee "loan", or allows low monthly payments. As long as the employee has to, sooner or later, meet the deductible of the HSA compatible HDHP, and receives no first dollar coverage, then the law has not been averted.

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You can offer a discount on the cost of services to your employees. Your hospital/company would need to develop a list of services that would be eligible for the reduced cost, calculate some type of discount, and then communicate it to employees. ( I am not familiar with the term "domestic benefits" that you are using ).

This is not unusual or new. Medical providers have been doing this for years under all other types of funding arrangements. By the way, depending on how your health benefits are being rated/funded, this strategy could help reduce the premium/funding levels needed for the health plan. You cost of claims is reduced by the amount of cost the hospital is discounting to the employees.

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