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Find the answers to some common employer questions. If you have a question that is not answered below, please call Member Services at 413-787-4004 or 800-310-2835, 8 a.m.-5 p.m., Monday-Friday. We would be happy to help.
High Deductible Health Plans (HDHP) FAQs
Q.: If I have questions, who should I contact?
If you are an employer group interested in obtaining a quote for HNE coverage or would like additional information about our plans contact the Sales Department at 413-233-3535 or Karla Vandal at kvandal@hne.com
If you currently offer HNE coverage to your employees and have questions, please contact Yvonne Diaz at 413-233-3395 or ydiaz@hne.com
Thank you for your interest in HNE.
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Q.: How do I enroll a new employee or terminate coverage for an employee?
You may submit an Enrollment/Add/ Termination form to enroll or cancel employees or their dependents. You may also administer your enrollment and termination activity electronically via HNE Direct, our secure website. You may also terminate employee coverage via telephone by contacting Member Services at 413-787-4004 or
800-310-2835.
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Q.: What is the difference between HMO and PPO plans?
Members enrolled in an HMO product must select a PCP and may see specialists and other providers in the HNE provider network without a referral.
Members enrolled in a PPO do not have to choose a PCP and have the option of using in-network providers for the lowest out-of-pocket cost OR using non-network providers and paying a deductible and coinsurance.
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Q.: How do I change my Primary Care Physician?
It’s simple and convenient. You can:
You may select any PCP, except those who have notified HNE that they no longer accept new patients. Member Services representatives can provide up-to-date information on PCPs in your area. We’ll make sure the change takes effect the next business day after you contact us, and we’ll also send a revised HNE ID card listing the new PCP. You can also call us to change your address and phone number.
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Q.: I received a bill that I didn’t expect. What should I do?
First check to see if the bill lists copayments or charges for non-covered services, which you pay. If you are still unable to determine why you received a bill, call Member Services at 413-787-4004 or 800-310-2835, 8 a.m.-5 p.m., Monday-Friday. A representative will investigate to correct any errors and inform you of the result as soon as possible.
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Q.: Do I need a referral from my PCP for specialty care?
HNE does not require referrals for any in-plan specialty services. Prior Approval is required for certain services and for out-of-plan care.
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Q.: Can I see a specialist who does not participate with Health New England?
Our HMO members may visit an out-of-plan specialist only if HNE approves in advance. If plan providers offer the services, we usually will deny the request. When you use plan providers, you know they have been credentialed by Health New England and that they will work with our medical staff to help ensure you get the care you need.
If you seek medical care from an out-of-plan specialist:
- Before scheduling an appointment, ask your Primary Care Physician or treating doctor to send an Authorization Request form.
- After reviewing the request, we will notify you and your doctor of our decision in writing.
If you are enrolled in a PPO or point of service plan, you have the freedom to visit any provider, although your costs are lower and coverage levels higher when you visit plan providers.
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Q.: What happens if my children attend college? Are they still covered?
Under the MA Healthcare Reform regulations, dependents covered under a fully insured plan will be eligible for coverage for two years after losing dependent status under the IRS rules, or until they reach age 26, whichever occurs first. Thus, if your child was last claimed as a dependent for tax year 2006, that child would still be eligible for coverage under your plan until December 31, 2008, unless the child turns 26 before that date.
Students who attend college outside the HNE service area are covered for urgent or emergency care under an HMO plan. Under a PPO plan, services may be obtained from non-plan providers subject to deductible and coinsurance.
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Q.: Are newborn children automatically enrolled in my plan?
No. To obtain coverage for newborn children, you must enroll them within 31 days of the birth. Depending on your plan, you will enroll your child through your employer or HNE. To learn the enrollment process for your plan, please call Member Services at 413-787-4004 or 800-310-2835, 8 a.m.-5 p.m., Monday-Friday.
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High Deductible Health Plans (HDHP) FAQs
Q: How will the HDHP work?
Except for some in-network preventive care services, the Plan will not pay for any covered services, including prescription
drug coverage, until you meet the annual plan deductible.
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Q: How does the preventive coverage work?
Under the HDHP Plans, certain in-network preventive care services are not subject to the deductible for HDHP
members. These services include:
• Adult routine exams
• Cancer screening
• Child and adult immunizations
• Heart and vascular disease screening
• Infectious disease screening
• Musculoskeletal disorders screening
• Obstetric and gynecologic conditions screening
• Pediatric conditions screening
• Routine annual eye exam
• Routine prenatal and well-child care
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Q: What network does the HDHP use and how can I find network doctors and hospitals?
Under the HDHP HMO options, you must get covered services from the HNE provider network identified for your plan.
With the HDHP PPO option, you may get covered services from in-network and out-of-network providers. In-network
services are available from the HNE provider network. To maximize your benefit, seek care from in-network providers.
You can check the provider network on hne.com or call 800-842-4464.
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Q: Do I have to contribute to an HSA if I elect the HDHP?
No, it’s up to you whether or not to contribute to an HSA.
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Q: What are the benefits of an HSA?
HSAs allow you to put money into an account to save for current or future medical expenses for each month you are
covered under an HDHP. HSAs are portable; you can transfer your HSA contributions from one HSA to another.
Additionally, HSAs carry over from year to year and earn interest. HSAs provide favorable tax treatment, as they have
what’s considered a triple tax advantage:
- Your contributions to an HSA are non-taxable.
- Your HSA interest income is non-taxable.
- Your withdrawals for qualified expenses are non-taxable.
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Q: For what expenses can I use the money in my HSA?
You can use your HSA to pay for:
- Qualified medical expenses. This includes office visit copayments or coinsurance, prescription drug costs, medical
exams, etc. This even includes expenses incurred outside of the United States. However, prescription drugs imported
to the US from another country are not eligible expenses.
- COBRA health premiums.
- Health premiums while unemployed.
- Qualified long-term care insurance (the amount considered a qualified medical expense depends on your age; see IRS Publication 502 for the amounts deductible by age).
- Health premiums once you turn 65, if you are retired (exception: you cannot pay for supplemental health insurance, e.g., “Medigap,” with your HSA).
One of the great advantages of HSAs is that you may withdraw HSA funds to pay for the qualified medical expenses for
yourself, and eligible dependents without tax penalty (as long as your dependents’ expenses are not reimbursable under
another plan.
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Note: Expenses incurred before the date your HSA is established cannot be reimbursed from the account.
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Q: Can I have HSA deductions automatically taken from my pay without enrolling in the HDHP medical option?
No. In order to contribute to the HSA, you must be enrolled in the HDHP.
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Q: What is the annual contribution maximum?
The maximum amount you can contribute during a calendar year is the IRS defined maximum. If you qualify, you also may make “catch-up” contributions (see question 12 for information about “catch-up” contributions).
For this year’s contribution maximums, please go to the IRS website, IRS.gov.
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Q: What is the annual contribution minimum?
There is no minimum calendar year contribution. However, you should familiarize yourself with bank guidelines regarding minimum account balances.
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Q: Can money also be deposited into my HSA by check?
Yes. You may make check contributions to your HSA. However, you cannot exceed the maximum contribution amount
allowed. Remember, contributions to your HSA may include both employer and employee amounts.
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Q: When can I change my HSA contribution?
You can change the HSA contribution amount deducted from your pay at any time.* Your change will be effective as soon
as administratively feasible. Typically, allow two pay periods following notification.
*Note: Your employer may have restrictions.
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Q: How do the “catch-up” contributions for participants age 55 or older work?
If you are or will be 55 or older, you can make additional catch-up contributions to an HSA during the calendar year.
This is true regardless of when your 55th birthday falls during the year. The maximum annual “catch-up” amount changes
each year. To find out the “catch-up” amount, please refer to the IRS website, IRS.gov, or call HNE Member Services at
1-800-842-4464.
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