Page 11 - Open Enrollment Guide Sample
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When you participate in an HSA (and are not covered by another health plan) you are eligible to contribute to a
healthcare bank account. This type of savings account allows team members to pay for out-of-pocket expenses,
such as ofice visits or prescriptions with pre-tax dollars.
Example #1 (Team member only coverage)Example #2 (Family coverage)
Joe visits his doctor. Jane Takes Her Son to the Doctor
Joe visits his in-network physician in early January. It is Jane has satisied her family deductible of $2,600.
early in the year and he has not met his deductible of She takes her son to the physician. Jane provides her
$1,300. Joe presents his Anthem member ID card to Anthem member ID card to the physician’s ofice.
the physician’s ofice. Joe is in need of a prescription. Jane’s son needs a prescription. Jane remembers she
Joe remembers he is responsible for all pharmacy is responsible for her pharmacy charges and asks the
charges until he meets his deductible. He asks his doctor to chose a generic version for her child, if
doctor to provide a generic version of the drug, if appropriate and available. This will help to keep Janes’s
appropriate and available. This will help to keep Joe’s out-of-pocket expenses down.
cost down.
Jane Fills Her Prescription
Joe Fills His Prescription Jane visits the pharmacy and shows her Anthem
Joe visits the pharmacy and shows his Anthem member ID card so that this claim will count toward
member ID card so that this claim will count toward her out-of-pocket maximum. Since Jane has already
his deductible. Joe pays for his prescription in full, at met the family deductible of $2,600, she is only
the in-network discounted rate. responsible for the 20% coinsurance.
The Doctor Files a Claim with Anthem The Doctor Files a Claim with Anthem
Since it is early in the year and Joe has not met his Jane has satisied her family deductible of $2,600,
deductible of $1,300, Anthem notiies the doctor but has not reached the out-of-pocket maximum of
that Joe is responsible for paying for the visit. The $5,100. Anthem notiies the doctor that it will pay
doctor sends Joe a bill for the visit at the in-network 80% of the allowed charges. The doctor sends Jane a
discounted rate. bill for the remaining 20% of charges at the in-network
discounted rate.
Joe Pays His Doctor Bill
Joe receives a bill from his doctor. After he checks his Jane Pays Her Doctor Bill
Explanation of Beneits (EOB) on www.anthem.com Jane receives a bill from her son’s doctor. After
and conirms it agrees with his bill, he pays for his she checks the Explanation of Beneits (EOB) on
doctor visit. www.anthem.com and conirms it agrees with her bill,
she pays the 20% share of her son’s doctor visit.
2016 Open Enrollment
When you participate in an HSA (and are not covered by another health plan) you are eligible to contribute to a
healthcare bank account. This type of savings account allows team members to pay for out-of-pocket expenses,
such as ofice visits or prescriptions with pre-tax dollars.
Example #1 (Team member only coverage)Example #2 (Family coverage)
Joe visits his doctor. Jane Takes Her Son to the Doctor
Joe visits his in-network physician in early January. It is Jane has satisied her family deductible of $2,600.
early in the year and he has not met his deductible of She takes her son to the physician. Jane provides her
$1,300. Joe presents his Anthem member ID card to Anthem member ID card to the physician’s ofice.
the physician’s ofice. Joe is in need of a prescription. Jane’s son needs a prescription. Jane remembers she
Joe remembers he is responsible for all pharmacy is responsible for her pharmacy charges and asks the
charges until he meets his deductible. He asks his doctor to chose a generic version for her child, if
doctor to provide a generic version of the drug, if appropriate and available. This will help to keep Janes’s
appropriate and available. This will help to keep Joe’s out-of-pocket expenses down.
cost down.
Jane Fills Her Prescription
Joe Fills His Prescription Jane visits the pharmacy and shows her Anthem
Joe visits the pharmacy and shows his Anthem member ID card so that this claim will count toward
member ID card so that this claim will count toward her out-of-pocket maximum. Since Jane has already
his deductible. Joe pays for his prescription in full, at met the family deductible of $2,600, she is only
the in-network discounted rate. responsible for the 20% coinsurance.
The Doctor Files a Claim with Anthem The Doctor Files a Claim with Anthem
Since it is early in the year and Joe has not met his Jane has satisied her family deductible of $2,600,
deductible of $1,300, Anthem notiies the doctor but has not reached the out-of-pocket maximum of
that Joe is responsible for paying for the visit. The $5,100. Anthem notiies the doctor that it will pay
doctor sends Joe a bill for the visit at the in-network 80% of the allowed charges. The doctor sends Jane a
discounted rate. bill for the remaining 20% of charges at the in-network
discounted rate.
Joe Pays His Doctor Bill
Joe receives a bill from his doctor. After he checks his Jane Pays Her Doctor Bill
Explanation of Beneits (EOB) on www.anthem.com Jane receives a bill from her son’s doctor. After
and conirms it agrees with his bill, he pays for his she checks the Explanation of Beneits (EOB) on
doctor visit. www.anthem.com and conirms it agrees with her bill,
she pays the 20% share of her son’s doctor visit.
2016 Open Enrollment
