How Are the Value HSA and Super Value HSA Unique?
The Value HSA and Super Value HSA have higher annual deductibles than the EPO, but lower employee payroll deductions. They allow you the opportunity to participate in an HSA, administered by Fidelity.
Here’s how it works:
Your HSA:
- MAPFRE contributes to your HSA:
- Value HSA – $500 individual / $1,000 family
- Super Value HSA – $1,000 individual / $2,000 family
- You may also make pre-tax contributions to your HSA
- MAPFRE’s contribution plus your contributions cannot exceed IRS annual limits (2022: $3,650 individual / $7,300 family)
Note for New Employees: MAPFRE’s contribution will be made on the first day of the month following your hire date. The annual employer contribution listed above will be divided by 12 and then multiplied by the number of months remaining in the calendar year. The amount deposited will be reduced for the number of months not employed with MAPFRE.
Medical plan coverage:
- Preventive care (like your annual physical) are covered at 100% throughout the year, with no deductible
- For other services, you must meet your deductible before the plan begins to pay
- After your deductible, you pay a 10% coinsurance for covered services for the rest of the year
- In the Value HSA, if you enroll one or more family members, you must meet the full FAMILY deductible before the plan starts to pay expenses for any one individual.
- In the Super Value HSA, each family member needs to only meet the individual deductible and the plan will pay for that member.
- You can use HSA funds to help pay your deductible and coinsurance, if desired
- If you reach the out-of-pocket maximum, the plan will pay 100% of eligible expenses for the rest of the year
- In the Value HSA, if you enroll one or more family members, you must meet the full FAMILY out-of-pocket maximum before the plan starts to pay covered services at 100% for any one individual.
- In the Super Value HSA, each family member needs to only meet the individual out-of-pocket maximum and the plan will start paying 100% of eligible expenses for that member.
If you have any funds left in your HSA at the end of the year, they will roll over into the next year and can help cover future covered expenses.
About the HSA
An HSA is a tax-advantaged savings account available to you only if you enroll in the Value HSA or Super Value HSA. It allows you to set aside pretax dollars to cover certain qualified out-of-pocket health care expenses. The HSA offers a triple-tax advantage and the ability to plan for health costs over the long term—not just year-to-year. You can use your HSA funds to help offset your qualified health care expenses now, or save them for the future.
Triple Tax Savings*
- The money you put in is tax-free
- Your savings grow tax-free
- Any money you take out to pay for qualified health care expenses is tax-free
* Refers to federal taxes. State tax rules vary. Consult with your tax advisor for more details.
Who Contributes to the HSA?
If you are a new hire, MAPFRE’s HSA contribution is deposited in one lump sum on the first business day of the month after you enroll. If you elect at Open Enrollment, MAPFRE’s contribution is deposited just after the first of the following year. There’s no vesting schedule for MAPFRE’s contribution. Once the account is funded, the money is available for your use.
If you were hired mid-year, the employer contribution will be prorated for the number of months remaining in the calendar year.
If you choose, you can also contribute to your HSA. You can start, stop or change contributions at any time during the year.
| Coverage Tier |
MAPFRE Contribution |
Your Max. Contribution |
2022 IRS Annual Limit |
|---|---|---|---|
| Value HSA (Individual / Family) | $500 / $1,000 | $3,150 / $6,300 | $3,650 / $7,300 |
| Super Value HSA (Individual / Family) | $1,000 / $2,000 | $2,650 / $5,300 | $3,650 / $7,300 |
If you are age 55 or older, you may make an additional $1,000 pre-tax catch-up contribution to your HSA each calendar year.
There is no lifetime maximum balance for an HSA and there is no limit to how much you can roll over from one year to the next.
Eligible Expenses
Qualified Expenses
Doctor’s visits, dental care, orthodontic treatments, vision care, eye glasses, counseling, prescription drugs, insulin, crutches, wheelchairs and more. Review the entire list at www.irs.gov/pub/irs-pdf/p502.pdf.
Who is Eligible
Your dependent must be a tax dependent to reimburse their expenses through your HSA. These include:
- Your spouse
- Your domestic partner, only if they are a dependent under federal tax law
- Children who derive over half of their support for the calendar year from you, including stepchild(ren), foster child(ren), legally adopted child(ren) or grandchild(ren) who are under age 19 or under age 24 if a full-time student and who are not the qualifying dependent of another tax payer for the tax year.
Managing Your HSA
If you elect the Value HSA and Super Value HSA, you will be automatically enrolled in an account with Fidelity. You will receive additional information from Fidelity about accessing your HSA.
Your online account enables you to:
- View your HSA balance.
- Review your recent distributions.
- Manage how your HSA is invested.
- Manage beneficiary information.
Click here for more details.
Accessing Your Funds
When you take money from your HSA to pay for qualified health care expenses for yourself, your spouse and your dependents, it is tax-free. You can use your Fidelity Debit Card to access your HSA funds.
Who is Eligible to Enroll?
If you are actively employed and you enroll in MAPFRE’s Value HSA or Super Value HSA, you will be automatically enrolled in the HSA.
An employee enrolled in the HSA cannot:
- Be enrolled in Medicare (Part A, B, C or D—though your spouse can be enrolled in Medicare)
- Be covered under another health plan
- Be covered under a health care flexible spending account (FSA), either yours or your spouse’s (even if your spouse does not submit expenses for you)
- Have a carryover balance in a health care FSA
- Be claimed as a tax dependent on another individual’s tax return
- Be a veteran who has received medical treatment from the Veteran’s Administration within the last three months (except for preventive care, dental or vision care)
Other Advantages
- It’s all yours. All contributions are yours to keep year to year. There’s no “use it or lose it” rule, like with the FSAs.
- Choice. You decide whether to use your HSA funds toward qualified health care costs now, or to save these funds for use in the future. It’s your choice!
- Immediate ownership. You’re in control of the money you put in your account, and with MAPFRE’s contribution, you have access to it for health care expenses right away. This account belongs to you.
- Investment options. You can choose to invest in one of Fidelity’s more than 10,000 mutual funds, stocks, bonds or CDs – all monitored by Fidelity’s investment professionals. And don’t forget, it’s still on a tax-free basis.
- Easy withdrawals. It’s your account, so you can use the money when and how you want for qualified health expenses.
- Portability. If you leave MAPFRE for any reason, including retirement, your HSA balance stays with you.
Do You Have Enough Saved?
It Pays to Plan Ahead! Social Security is meant to supplement only 20-40% of your preretirement income. Fidelity estimates that a 65-year old couple enrolled in Medicare and retiring in 2020 will need $295,000 in retirement funds to cover health care expenses in retirement. HSA savings can help!
I enrolled in an HSA plan… now what?
Medical Benefit Summary
The following charts provide an overview of benefits payable under each of the Harvard Pilgrim medical plans. Benefits may be subject to restrictions and limitations. Be sure to refer to your Summary Plan Descriptions for more complete information on plan benefits.
EPO
| Medical Benefits | EPO Plan |
|---|---|
| Deductible In-Network | $750 Ind. / $1,500 Family |
| Out-Of-Pocket Maximum In-Network | Includes deductible, coinsurance and copays $4,000 Ind. / $8,000 Family |
| Coinsurance In-Network | 90% |
| Lifetime Max | Unlimited |
| Preventive Care In-Network | Plan pays 100% |
| TeleHealth/Virtual Visit In-Network | $30 Copay |
| Physician Office Visit In-Network | $30 Copay |
| Specialist Office Visit In-Network | $50 Copay |
| Basic Lab & Radiology In-Network | Plan pays 90%* |
| Emergency Room In-Network | $200 Copay |
| Urgent Care In-Network | $30 Copay |
| Major Lab & Radiology (MRI/CT/PET) In-Network | Prior Authorization Required Plan pays 90%* |
| Inpatient Hospital In-Network | Plan pays 90%* |
| Outpatient Surgery In-Network | Plan pays 90%* |
| Prescriptions Network Retail Pharmacy Network Mail Order (90-day supply) | No Deductible $5/$25/$50/$75/$150 $10/$50/$100/$225/$450 |
| *Plan pays after deductible is met. |
Value HSA
| Medical Benefits | Value HSA Plan |
|---|---|
| Deductible In-Network | $1,500 Ind. / $3,000 Family |
| Out-Of-Pocket Maximum In-Network | Includes deductible, coinsurance and copays $4,000 Ind. / $8,000 Family |
| Coinsurance In-Network | 90% |
| Lifetime Max. | Unlimited |
| Preventive Care In-Network | Plan pays 100% |
| TeleHealth/Virtual Visit In-Network | Plan pays 90%* |
| Physician Office Visit In-Network | Plan pays 90%* |
| Specialist Office Visit In-Network | Plan pays 90%* |
| Basic Lab & Radiology In-Network | Plan pays 90%* |
| Emergency Room In-Network | Plan pays 90%* |
| Urgent Care In-Network | Plan pays 90%* |
| Major Lab & Radiology (MRI/CT/PET) In-Network | Prior Authorization Required Plan pays 90%* |
| Inpatient Hospital In-Network | Plan pays 90%* |
| Outpatient Surgery In-Network | Plan pays 90%* |
| Prescriptions Network Retail Pharmacy Network Mail Order (90-day supply) | Deductible, then: $5/$25/$50/$75/$150 $10/$50/$100/$225/$450 |
| *Plan pays after deductible is met |
Super Value HSA
| Medical Benefits | Super Value HSA Plan |
|---|---|
| Deductible In-Network | $3,000 Ind. / $6,000 Family |
| Out-Of-Pocket Maximum In-Network | Includes deductible, coinsurance and copays $5,000 Ind. / $10,000 Family |
| Coinsurance In-Network | 90% |
| Lifetime Max. | Unlimited |
| Preventive Care In-Network | Plan pays 100% |
| TeleHealth/Virtual Visit In-Network | Plan pays 90%* |
| Physician Office Visit In-Network | Plan pays 90%* |
| Specialist Office Visit In-Network | Plan pays 90%* |
| Basic Lab & Radiology In-Network | Plan pays 90%* |
| Emergency Room In-Network | Plan pays 90%* |
| Urgent Care In-Network | Plan pays 90%* |
| Major Lab & Radiology (MRI/CT/PET) In-Network | Prior Authorization Required Plan pays 90%* |
| Inpatient Hospital In-Network | Plan pays 90%* |
| Outpatient Surgery In-Network | Plan pays 90%* |
| Prescriptions Network Retail Pharmacy Network Mail Order (90-day supply) | Deductible, then: $5/$25/$50/$75/$150 $10/$50/$100/$225/$450 |
| *Plan pays after deductible is met |
Considering Your Options
What benefits work best for you depend on your unique situation. Review the scenarios to see benefits in practice for different employees in different places in their lives.
Medical Plan Resources
Use these resources to maximize your medical benefits.
Find a Network Provider
To find a network provider in your area, log on to www.harvardpilgrim.org.
You can also call Member Services at 888-333-4742.
Doctor on Demand
Access Care from Anywhere
Harvard Pilgrim members have access to the Doctor on Demand telemedicine service and can chat with a doctor from their phone, tablet or computer. When you have a health concern, you can connect with a board-certified and licensed physician in minutes. You pay only your regular PCP office visit copay per video consult.
Doctors can diagnose, treat and write electronic prescriptions for many conditions, including:
- Coughs and colds
- Sore/strep throat
- Flu
- Pediatric issues
- Sinus and allergies
- Nausea and diarrhea
- Rashes and skin issues
- Women’s health: UTIs, yeast infections
- Sports injuries
Convenient and confidential visits with licensed psychologists and psychiatrists to treat non-emergency care related to stress, depression and other behavioral health issues are also available.
Be sure to register at www.doctorondemand.com/harvardpilgrim now so you are ready to use this service when you need it.
Summaries of Benefits and Coverage (SBCs)
MAPFRE’s Summary of Benefits and Coverage (SBCs) are available here. Please refer to these documents for detailed information and a complete list of benefits.
Cost Estimator
Did you know that the cost of a medical procedure or test can vary at different hospitals, even if the same doctor is providing the service?
Harvard Pilgrim’s treatment cost estimator tool helps you plan for the cost of your care…before you visit the doctor.
- Get personalized cost-sharing estimates, based on your specific plan
- Find cost estimates for hundreds of medical services and treatments—from office visits to surgery
- Learn more about specific medical treatments you may need
- Use the filter to narrow or expand your search results
- Compare costs for up to four providers or facilities
- Save and print estimates
- Better understand how your health plan works
Get Started:
- From your computer, tablet or smartphone, log in to your secure member account at www.harvardpilgrim.org (or click on the link to create an account).
- Click on the Tools & Resources tab at the top of the page.
- Click on Estimate my cost
Click here for more details.
Setting Up Online Account
Watch this video to learn more about setting up your account.
ID Cards
Look for your new ID card in the mail the month before your Harvard Pilgrim coverage becomes effective.
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