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Lane
Lane, JD, CFP, MBA, CRPS
Category: Tax
Satisfied Customers: 10109
Experience:  Law Degree, specialization in Tax Law and Corporate Law, CFP and MBA, Providing Financial & Tax advice since 1986
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HSA Accounts, qualification of an HSA Qualified Plan- Can an

Customer Question

HSA Accounts, qualification of an HSA Qualified Plan- Can an HSA qualified health plan have co-payments for visits other than "Wellness" benefit prior to the High Deductible being meet.
Submitted: 10 months ago.
Category: Tax
Expert:  Lane replied 10 months ago.

Hi,

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I'ts POSSIBLE, as long the copays fall within y rdefinitional limits.

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Here's the IRS definition ... (I'll underline the pertinent part)

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A high deductible health plan (HDHP) is a health insurance plan that generally offers lower insurance premiums and higher deductibles than a traditional health plan. Being covered by an HDHP is also a requirement for a health savings account.

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"For calendar year 2015, the IRS defines a high deductible health plan as a health plan with an annual deductible that is not less than $1,300 for self-only coverage or $2,600 for family coverage, and the annual out of-pocket expenses (deductibles, co-payments, and other amounts, but not premiums) do not exceed $6,450 for self-only coverage or $12,900 for family coverage. "

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Note: Do not assume that, since you have a high deductible, you must have a high deductible health plan. For the plan to be a HDHP, you must also participate in a tax-favored health savings account (HSA) or health reimbursement arrangement (HRA).

Customer: replied 10 months ago.
Thank you, ***** ***** the co-pays start before the deductible is satisfied? It is my understanding that an HSA qualified plan can only have "Wellness Benefits" as defined by ACA prior to satisfaction of the deductible. Meaning if an insured member has an ear infection and went to see a physician, they would have to satisfy the deductible before the plan would pay any benefit. If the member has say a $50.00 co-pay for that visit, then it wouldn't be an HSA plan. If that member went for a wellness visit, example, routine physical exam or mammogram, those visits would fall into the "Wellness Benefit" definition. The fisrt dollar co-pay defeats the purpose of having the pre-tax HSA account. Your thoughts?
Expert:  Lane replied 10 months ago.

Only on the case where the only use of the plan is wellness AND you're through in the tax benefit of contributied to the HSA into the mix.

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But taking everything else of the table? that would be a true statement