9. 200000001275 - Schedule N - Health Savings Account (HSA) Questionnaire (Optional).docx

Schedule N – Health Savings Account (HSA) Questionnaire

An HSA is currently out of scope for this bid proposal, therefore responses to the below questions are voluntary and for information gathering purposes only.

HSA General

1. Do you administer health savings accounts (HSA) directly or through a banking partner? If you administer directly, is the HSA account FDIC insured? If you use a partner, please provide the following:

Response

Legal name and address

Type of contractual relationship

Number of years using this partner

Duration of existing contract

2. If you use a banking partner to administer the HSA, please confirm that your responses to this section reflect your joint administrative capabilities.

Indicate YES or NO.

3. Provide responses to the following questions below:

Your Organization

Your Organization

If not confirmed, explain.

Your Banking Partner

Your Banking Partner

If not confirmed, explain.

Enter YES or NO

Enter YES or NO

Enter YES or NO

Enter YES or NO

Enter YES or NO

f. What is your standard turnaround time for adjudication and claims processing.

4. Confirm that your organization can administer HSAs in conjunction with a High Deductible Health Plan (HDHP).

Indicate YES or NO

5. List the number of clients and employee lives for which your organization administers accounts for:

Response

a. 2019 HSA clients

b. 2019 HSA employee accounts

c. 2019 HSA funds managed

d. 2020 projected number of HSA clients

e. 2020 HSA projected number of employee accounts

f. 2020 Projected number of HSA funds managed

HSA Administration In this section, "you" or "your" refers to both your organization and to your banking partner's organization.

6. Please describe in detail the processes/flows used to synchronize data between systems, including HSA administration, trust, debit cards, and claim adjudication.

7. Please describe the data elements you require on an eligibility file feed. For example, in addition to employee demographic detail, do you collect single/family plan election status?

8. Do you have experience administering HSA benefits for other employers who also use SOM's current administrators? (check all that apply) 1: Yes, BCBSM. Name:

2: Yes, OptumRx. Name:

3: None

9. How long have you offered administration services for HSAs?

1: < 1 year, 2: 1 to 5 years, 3: 5 to 10 years, 4: greater than 10 years

10. Can you administer automatic claim submission from the HDHP to the HSA?

1: Yes, explain:

2: No

11. Confirm that your organization is responsible for all adjustments and reconciliations for the account if an overpayment or underpayment is made.

Indicate YES or NO

12. Confirm that your organization is responsible for identifying and reporting (to the employee) non-qualified withdrawals from the HSA.

13. Will you and your banking partner accept employer contributions for accounts which are "unopened" (e.g., employee enrolls in HDHP but does not complete account enrollment before employer contributions are sent), in order to establish the account?

14. What is the process for reconciling “unopened” accounts?

15. Indicate the methods available for members to direct access to the HSA funds.

1: Debit card, 2: ATM, 3: Online banking, 4: Checks, 5: Auto-payment to provider, 6: Other, explain:

HSA Debit Cards

16. Do you provide real-time substantiation and authorization at the point of sale for eligible flat dollar plan provisions (i.e., office visit copays)?

17. Is the available balance on the debit card real-time adjusted?

HSA Enrollment

18. Confirm that you can receive eligibility and funding information from the vendor types listed below.

1: Employer, 2: Medical plan administrator, 3: Other, explain:

19. Describe the election process required at initial and annual enrollment. Please be specific as to data elements required and who is responsible for collecting the information including the information required to open the HSA.

20. If you controlled enrollment in the HSA, will you contact the participant to determine if s/he wants to enroll in the HSA or would you expect the participant to be instructed to contact you?

21. What information and in what format would you require the employer to pass to you when a participant terminates enrollment in the HDHP and is no longer eligible for HSA deposits?

Proposed HSA Pricing Contractor's price should be listed as per participant per month (PPPM). For bidding purposes assume the following participants counts:

Participation Assumption Estimated HSA participants (number)

Monthly HSA Admin Fees

HSA Account Administration Fee (PPPM)

Debit Card (PPPM)

Other (specify)

Other (specify)

Other HSA Admin Fees

One Time Set-up fee

Check transaction

Non-sufficient funds

ATM withdrawal

Bank teller withdrawals

Monthly investment

Paper statements

Check copy

Check replacement

Check stop payment

Debit card replacement

Account closing

Member decision support tools (e.g., plan modeler, treatment cost estimator)

Other (specify)