2020 medicare medical savings account - security health plan...msa bank account dollars to pay for...

Want to save money on your health coverage?

Let Security Health Plan show you how.

Medicare Medical Savings Account (MSA)

2020

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Secure Saver MSA

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Make the right choice for your peace of mind.Now you can pair the medical benefi ts of Medicare with the fi nancial savings of a medical savings account when you enroll in the Secure Saver MSA* plan. Coverage is available to Medicare benefi ciaries who are residents of Wisconsin, in both urban and rural locations. It combines the coverage of Medicare parts A and B (Original Medicare) with a savings account fund that you can use to pay for qualified medical expenses, tax-free!

* Plan does not include Medicare Part D for prescription drug coverage – please enroll in a separate Medicare prescription drug plan.

Who can apply for Secure Saver MSA?You may apply for membership in Secure Saver MSA if you have both Medicare Part A and Part B and live in the state of Wisconsin.

Save money on your out-of-pocket costs. Secure Saver MSA offers health care coverage and financial security that saves you money on your yearly deductible or maximum out-of-pocket costs.

Secure Saver MSA is a “high-deductible” health plan with an annual deductible for 2020 of <$5,600> for Medicare-covered services. But you actually pay much less! Medicare, through Security Health Plan, deposits <$2,184> into your MSA account to be used toward the deductible. This leaves you responsible for <$3,416> of Medicare-covered expenses. Once your deductible is satisfied, Security Health Plan pays all your Medicare-covered health costs for the remainder of the year.

Here’s how it works to save you money on your deductible:

1. After enrolling in Secure Saver MSA, you receive a debit card and the option to receive acheckbook to access the funds in your MSA account. You pay the additional costs out of yourown pocket until you reach the <$5,600> annual deductible.

2. You see your doctors for your health care needs. You can use the money in your MSA to pay forall your qualifi ed medical expenses, including those covered by Medicare and not covered byMedicare. Only Medicare-covered Part A (hospital) and Part B (medical) services count towardyour <$5,600> deductible. You will pay Medicare-approved charges for your services.

3. If you use all the money in your MSA, but have not yet reached the deductible, you areresponsible for covering additional expenses until you meet the <$5,600> deductible.

4. After you reach your deductible, you will have no more out-of-pocket expenses for yourMedicare Part A and Part B covered services. Security Health Plan pays these costs forthe rest of the year.

Remember, you must continue to pay your Medicare Part B Premium.

Members will need to retain records on qualifi ed medical expenses paid from their MSA and submit details to the IRS when fi ling taxes. If you use the money in your MSA to pay for medical expenses that are not qualifi ed or to pay for non-medical expenses, these payments will be taxed as part of your income and will be subject to an additional tax penalty.

Secure Saver MSA deductible

$5,600

Security Health Plan

deposit

$2,184

Member’sout-of-pocket

maximum

$3,416

Quality you can trust. And value to count on.Enjoy the freedom to choose your health care providers, plus manage your costs and budget with a <$0> premium Secure Saver MSA.

Compare plans and apply online at www.securityhealth.org/medicare20 Want help? Ask your agent or call our Sales Department – <1-844-679-9733>

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When can I enroll?The Secure Saver MSA plan is generally for the full calendar year, eff ective Jan. 1 through Dec. 31. It is prefunded each year on the fi rst day of the calendar year.

If you join after Jan. 1, Security Health Plan’s deposit and your deductible are prorated to cover just the months remaining in the year.

For example, if you join in July, your coverage period would be for one-half of the year and the Secure Saver MSA plan would refl ect this.

How can I enroll?1. Enroll online at www.securityhealth.org/medicare20 or

2. Complete paper enrollment forms found in the Secure Saver MSA enrollment kit. To get this kit:

• Contact your trusted agent or• Call our Sales Department at <1-844-679-9733> from 8 a.m. to 5 p.m.

Monday through Friday

Please note that MSA enrollment is not available at www.medicare.gov.

Ready to enroll?

Life Happens. Get Security.Secure Saver MSA off ers fl exible, high quality benefi ts and services. Here are some more good reasons to choose this plan for your health care coverage:

Use any doctor or hospital you chooseYou can choose any Medicare-certifi ed doctor, hospital or health care provider of your choice in the United States who has not opted out of Medicare. Secure Saver MSA has no provider network, so there are no in-network and out-of-network decisions to make.

Find convenient care with the 24-Hour Nurse Line and Care My Way® Our 24-hour Nurse Line, available 7 days a week including holidays, connects you to a registered nurse who can help answer your health care questions. And for many common health ailments, you can talk to a Care My Way® nurse practitioner without leaving home. You can even use the smart phone app to talk face-to-face with a Care My Way nurse practitioner who can verify your symptoms and, if needed, call in a prescription to the pharmacy of your choice – saving you time, money and hassle.

Get help staying healthyOur team of health professionals will work with you to assess your specifi c needs and then help you and your doctor determine the services and care you need. Plain and simple, we’re here to help you make life a little easier.

• Scheduling medical appointments• Quitting nicotine• Losing weight• Managing your chronic health conditions• Managing your medications

Get your questions answered on the first callAs a member, when you have questions or concerns you get the help you need from our award-winning customer service located in Wisconsin. Our World Class* team welcomes your calls and is recognized as one of the best in health care for resolving issues on the fi rst call.* SQM World Class Customer Service designation, 2016, 2017 and 2018

What happens after I enroll?Once you’ve enrolled in Secure Saver MSA, you will receive a confi rmation letter in the mail. Security Health Plan partners with Optum Bank, member FDIC, to administer the fi nancial and custodial activities.

Optum Bank sets up a dedicated MSA savings account for you. Optum Bank will send you a welcome kit followed by a debit card. You may also request a checkbook if you prefer.

Setting up your online account

Total deductible $2,800 ($5,600 x 1/2 year)

Security Health Plan contribution $1,092 ($2,184 x 1/2 year)

Your out-of-pocket expenditure $1,708 ($3,416 x 1/2 year)

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Besides my annual deductible, are there any banking fees?Secure Saver MSA is a <$0> premium plan. Security Health Plan also does not charge an account setup fee or monthly service charges while you are enrolled in Secure Saver MSA. In short, you will not pay anything to Security Health Plan.

Optum Bank may deduct fees directly from your MSA account for ATM fees, investment fees (if applicable) and check reorders if you use these services. But there are no monthly service fees deducted from your account as long as you are a Secure Saver MSA member.

Here’s what you’ll pay

$

No premium

No setup fee

No monthly service fees

How do I make payments from my Secure Saver MSA?After Security Health Plan sets up your medical savings account, you will be able to pay for qualifi ed medical services, like doctor visits and lab tests, using a debit card or a check from your MSA checkbook, if requested.

What medical expenses count toward my deductible?Secure Saver MSA covers only what is covered by Original Medicare, and these services count toward your annual deductible. These include qualifi ed Medicare Part A and B expenses, hospital stays, doctor visits and lab tests.

How do I use Secure Saver MSA to pay for my annual exam?Medicare Part B covers a Welcome to Medicare preventive visit, available to new Medicare enrollees in the fi rst 12 months, and an annual wellness visit. At either of these visits, your health care provider measures your height, weight, body mass and blood pressure, listens to your heart, discusses your concerns and issues, and establishes or reviews your care plan.

Any expenses will count toward your annual deductible and you may use your MSA bank account dollars to pay for these costs. The expenses are tax-free and applied to the <$5,600> deductible.

Medicare Part B does NOT cover a comprehensive annual physical exam. This exam includes a full-body examination and tests to screen for disease and assess your potential risk factors for future medical problems.

You may use your MSA bank account dollars to pay for costs associated with a physical exam. They will be tax-free, but they will not count toward your annual <$5,600> deductible.

Does the Secure Saver MSA plan include Medicare Part D Prescription Drug coverage?

No, prescription drugs are not covered by Original Medicare. If you join Secure Saver MSA and need drug coverage, you need to join a Medicare prescription drug plan or a prescription drug assistance program such as Wisconsin SeniorCare.

Can I use my Secure Saver MSA to pay for prescription drugs?Yes. You can use Secure Saver MSA for this type of expense. Since this is a qualifi ed medical expense, the money will not be taxed. However, prescription drug expenses do not count toward your deductible.

Managing your Secure Saver MSA costs


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Medical expense examplesMSA funds can beused without penalty?

Count toward MSA deductible?

Medicare-covered doctor visits, lab tests Yes Yes

Excess charges on Medicare-covered services (provider does NOT accept assignment)

Yes Yes

Prescription drugs (copays, deductible) Yes No

Insurance premiums(including Medicare Part B, Part D)

No No

Defi ned by and subject to Internal Revenue Service (IRS) regulations. These may change from year to year.

What about dental and vision care and other qualified medical expenses?Most dental care, dentures, routine eye exams and hearing aids are not covered by Original Medicare and do not count toward your annual deductible. However, you can pay for these expenses using your MSA bank account.

For a full list of qualifi ed medical expenses, contact the IRS at 1-800-829-3679 or visit www.irs.gov for publication 969, “Health Savings Accounts and Other Tax-Favored Health Plans.”

Can I use my Secure Saver MSA to pay insurance premiums, such as Medicare Part B?No. These are considered non-qualifi ed expenses and cannot be paid with tax-free funds. These expenses would be treated as taxable income and may be subject to penalties when fi ling annual taxes. Please contact your tax advisor for additional information.

Can I use my Secure Saver MSA to pay providers who don’t accept Medicare? Providers who do not accept Medicare assignment (non-participating providers) can charge up to 115 percent of approved Medicare Fee for Service (FFS) rates. When you receive covered medical services from these providers, you are responsible for the amount in excess of approved Medicare FFS rates (up to the allowable 15 percent excess charge) until your deductible is met. You can pay this “excess” charge with funds from your Secure Saver MSA and it will count toward the deductible.

Once the annual deductible is reached, Security Health Plan pays the entire cost for Medicare-covered services received from participating or non-participating providers. If you receive services from providers who have opted out of Medicare you may use your MSA funds to pay for these services as long as they are considered qualifi ed medical expenses by the IRS. Payments to these providers do not count toward your deductible.

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Using your dollars - Secure Saver MSA

Can I add funds to my Secure Saver MSA? No, you cannot deposit your own money. Only Security Health Plan can make deposits into your account.

What happens to money left over at the end of the year? If you have money remaining in your MSA savings account at the end of the year, it will carry over to the next year. At the start of a new year, a new allowance is deposited into your account. Your funds will accumulate tax-free.

Can I leave Secure Saver MSA? You may disenroll during the Annual Enrollment Period between Oct. 15 and Dec. 7 and during limited other periods. If you disenroll during the calendar year, you will need to repay a prorated portion of Security Health Plan’s deposit and you will still be responsible for the full deductible amount.

Managing your Secure Saver MSA

Annual contribution paid Jan. 1 $2,184

Member’s eligibility ¾ year - $1,638

3 months of deposited deductible to be repaid $546

Member’s eligible expenses for ¾ year $3,200

Applied annual contribution to deductible - $1,638

Member’s out-of-pocket expenditure $1,562

A member is disenrolling from Secure Saver MSA as of Sept. 30 due to relocation to another state. A move out of state makes the member ineligible for Secure Saver MSA since it is open only to Wisconsin residents.

Security Health Plan deposited <$2,184> in the member’s account for the calendar year on Jan. 1. Since the member is disenrolling after nine months (January to September), <$546> must be repaid to Security Health Plan, leaving <$1,638.>

Since the beginning of the year, the member has incurred <$3,200> in eligible expenses prior to disenrollment. The member has not met the <$5,600> deductible, which remains <$5,600> and is not prorated.

The member can apply the prorated <$1,638> deposited by Security Health Plan to these expenses. The member is left with <$1,562> to pay out of pocket.

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Notice of NondiscriminationSecurity Health Plan of Wisconsin, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in the administration of the plan, including enrollment and benefi t determinations. Security Health Plan does not exclude people or treat them diff erently because of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status.

Security Health Plan of Wisconsin, Inc.:

• Provides free aids and services to people with disabilities to communicate eff ectively with us,such as:

• Qualifi ed sign language interpreters

• Written information in other formats (large print, audio, accessible electronic formats,other formats)

• Provides free language services to people whose primary language is not English, such as:

• Qualifi ed interpreters

• Information written in other languages

If you need these services, contact Customer Service at 1-877-998-0998 (TTY: 711). If you believe that Security Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status, you can fi le a grievance with:

Security Health PlanAttn: Grievances1515 North Saint Joseph Avenue | Marshfi eld, WI 54449-8000

Phone: 715-221-9596 (TTY: 711) Fax: 715-221-9424 Email: [email protected]

You can fi le a grievance in person or by mail, fax or email. If you need help fi ling a grievance, Security Health Plan can help you. You can also fi le a civil rights complaint with the U.S. Department of Health and Human Services, Offi ce for Civil Rights electronically through the Offi ce for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services200 Independence Avenue SW. | Room 509F, HHH Building | Washington, DC 20201

Phone: 1–800–368–1019 or 800–537–7697 (TDD)Complaint forms are available at http://www.hhs.gov/ocr/offi ce/fi le/index.html.

Language Assistance ServicesATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-998-0998 (TTY: 711).

Español (Spanish) ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al

Hmoob (Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau

1-877-998-0998 (TTY: 711).

1-877-998-0998 (TTY: 711).

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Language assistance services, continued繁體中文 (Chinese)注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電。

Deutsch (German)ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zurVerfügung. Rufnummer: 1-877-998-0998 (TTY: 711).

ةيبرعلا (Arabic)برقم بالمجان. اتصل لك تتوافر اللغویة المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا (رقم ھاتفملحوظة:

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Русский (Russian)ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711).

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Tiếng Việt (Vietnamese)CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số

Deitsch (Pennsylvania Dutch)Wann du Deitsch schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englischSchprooch. Ruf selli Nummer uff: 1-877-998-0998 (TTY: 711).

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(TTY: 711).

Français (French) ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.Appelez le 1-877-998-0998 (ATS : 711).

Polski (Polish)

numer 1-877-998-0998 (TTY: 711).

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Shqip (Albanian) KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-877-998-0998 (TTY: 711).

Tagalog (Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-877-998-0998 (TTY: 711).

Oroomiffa (Oromo/Somalia) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-877-998-0998 (TTY: 711).

Large print – If you require materials in large print, please call1-877-998-0998 (TTY: 711).

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Large print - If you require materials in large print, please call 1-877-998-0998 (TTY: 711).

繁體中文 (Chinese)注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電。

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-877-998-0998 (TTY: 711).

ةيبرعلا (Arabic)(رقم ھاتف ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم

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Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711).




Deitsch (Pennsylvania Dutch) Wann du Deitsch schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: 1-877-998-0998 (TTY: 711).

(Lao): , , , .

(TTY: 711).

Français (French) ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.Appelez le 1-877-998-0998 (ATS : 711).

Polski (Polish)

numer 1-877-998-0998 (TTY: 711).



Shqip (Albanian) KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë.Telefononi në 1-877-998-0998 (TTY: 711).

Tagalog (Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wikanang walang bayad. Tumawag sa 1-877-998-0998 (TTY: 711).

Oroomiffa (Oromo/Somalia)XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama.Bilbilaa 1-877-998-0998 (TTY: 711).


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繁體中文 (Chinese)注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電。


ةيبرعلا (Arabic)برقم بالمجان. اتصل لك تتوافر اللغویة المساعدة خدمات فإن اللغة، اذكر تتحدث كنت إذا (رقم ھاتفملحوظة:


Русский (Russian)ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711).




Deitsch (Pennsylvania Dutch)Wann du Deitsch schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englischSchprooch. Ruf selli Nummer uff: 1-877-998-0998 (TTY: 711).

(Lao): , , , .

(TTY: 711).

Français (French) ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-877-998-0998 (ATS : 711).

Polski (Polish)

numer 1-877-998-0998 (TTY: 711).



Shqip (Albanian) KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë.Telefononi në 1-877-998-0998 (TTY: 711).

Tagalog (Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wikanang walang bayad. Tumawag sa 1-877-998-0998 (TTY: 711).



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繁體中文 (Chinese)注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-472-2363 (TTY: 711)。


ةيبرعلا (Arabic)(رقم ھاتف 3632-274-008-1ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم


Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-472-2363 (телетайп: 711).


1-800-472-2363 (TTY: 711)번으로 전화해 주십시오.

Tiếng Việt (Vietnamese)CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-472-2363 (TTY: 711).

Deitsch (Pennsylvania Dutch)Wann du Deitsch schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: 1-800-472-2363 (TTY: 711).

ພາສາລາວ (Lao)ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ ້ າພາສາ ລາວ, ການບໍ ລິ ການຊ່ວຍເຫືຼອດ້ານພາສາ, ໂດຍບໍ່ ເສັຽຄ່າ, ແມ່ນມີ ພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-472-2363 (TTY: 711).

Français (French)ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-472-2363 (ATS : 711).

Polski (Polish)UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń podnumer 1-800-472-2363 (TTY: 711).

�हदं� (Hindi)

ध्यान द�: य�द आप �हदं� बोलते ह� तो आपके िलए मुफ्त म� भाषा सहायता सेवाए ंउपलब्ध ह�। 1-800-472-2363 (TTY:

711) पर कॉल कर�।Shqip (Albanian)KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1-800-472-2363 (TTY: 711).

Tagalog (Filipino)PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-472-2363 (TTY: 711).



1-877-998-0998

10

1515 North Saint Joseph Avenue PO Box 8000Marshfi eld, WI 54449-8000

Sales Department<1-844-679-9733> (TTY: 711) Monday-Friday, 8 a.m. to 5 p.m. www.securityhealth.org/Medicare20

In addition to our Medicare health plans, we off er health

insurance coverage for all stages in life. If you know someone looking for individual and family coverage or small or large business health

insurance, please tell them to call us at <1-800-622-7790.>

(09/19) 18740-002

Security Health Plan of Wisconsin, Inc., is an HMO-POS, MSA and D-SNP plan with a Medicare contract. Enrollment in Security Health Plan depends on contract renewal.

MSA Plans combine a high-deductible Medicare Advantage Plan and a trust or custodial savings account (as defi ned and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally must pay money out of pocket before your coverage begins.

Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate Medicare Prescription Drug Plan. There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact Security Health Plan, 1-877-998-0998 (TTY: 711), for additional information. We are open 7 days a week,8 a.m. to 8 p.m., Oct. 1-March 31; and Monday through Friday, 8 a.m. to 8 p.m., April1-Sept. 30.

About Security Health Plan

Security Health Plan of Wisconsin, Inc., part of the Marshfi eld Clinic Health System, is helping its 230,000 members in Wisconsin and beyond reach their best health. Accredited by the National Committee for Quality Assurance (NCQA), Security Health Plan off ers health insurance coverage for employees of large and small businesses, individuals and families. Security Administrative Services, a wholly-owned subsidiary of Security Health Plan, provides full service third party administration for self-funded employers in <Wisconsin, Indiana, and Michigan.>

©2019 Security Health Plan of Wisconsin, Inc. All rights reserved. Written permission to reproduce or transmit this document in any form or by any means must be obtained from Security Health Plan of Wisconsin, Inc.

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