Not sure if a medication is covered? Search your plan’s drug list or call the customer service number on your member ID card.
Your HIA is funded when you earn rewards for taking certain steps to improve your health. Check your Plan Summary for more information about earning rewards.
What type of services may I pay for with my HIA funds?
You can use the money in your HIA to pay for health care services covered by the Lumenos plan, such as doctor’s office visits, prescription drugs, and lab tests. Check your Plan Summary for more information on covered services.
What is traditional health coverage?
Similar to a PPO or HMO plan, after you meet your deductible, you pay coinsurance (a percentage of the provider’s charges) when you visit a network provider. You’ll pay more if you visit an out-of-network provider. Check your Plan Summary for more information on coinsurance amounts.
How do I check my health account balance?
It’s easy. First register then log on at anthem.com. You can keep track of your account activity and balance, and get details on your medical claims. You’ll also receive a monthly statement with your account balance, account activity, medical and prescription claim history and important messages about how you may be able to improve your health or save money.
Can I roll over all the money in my HIA at the end of each plan year?
Yes. Whatever you don’t spend on covered services will roll over to the next year, as long as you remain enrolled in the Lumenos HIA plan. You can use roll-over funds to help pay future out-of-pocket expenses.
If I leave this Lumenos plan, what happens to my HIA funds?
You cannot take your HIA funds with you if you leave the plan or your employer. The funds in your HIA stay with the health plan.
It’s called consumer-driven because it puts you in the driver’s seat of your health and health care spending. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.
It gives you the flexibility of a PPO - you can often go to doctors in and out of your network, though you’ll get better rates with in-network doctors. HSA plans tend to have lower monthly premiums than similar PPOs, and sometimes even HMOs.
It’s sometimes called a consumer-driven health plan (CDHP) because you’re in more control of your care spending at first. With your checkups and preventive care likely covered at 100%, and tools to help you stay healthy and shop around for quality care at more reasonable costs - you might be able to cover all your costs with the money in your account.
If you still have money left in your account, it stays in there for next year and beyond. And you can also take it with you if you change health plans. View IRS rules on paying costs with money in your HSA.
Your employer puts money into your health incentive account (HIA) when you take certain steps to improve your health. You use that money to pay for your share of care costs, like your deductible or coinsurance. If you don’t use all the money, it stays in there next year as long as you’re still at the same job.
Yes. The three main types of FSAs are:
1. Health care FSA for qualified medical, dental, vision or other health care costs, including insurance deductibles, co-payments and co-insurance.
2. Dependent care FSA for child, elder or other dependent care.
3. Limited purpose FSA for qualified dental and vision care costs only when combined with a Health Savings Account (HSA) or a Health Reimbursement Account (HRA).
To be eligible for an FSA, your employer must offer it. You don’t have to participate in your employer’s health plan. You must elect to participate in the FSA during your employer's open enrollment.
For a Dependent Care Flexible Spending Account (DCA), you must have children under the age of 13 (if divorced, you must be the custodial parent) or you must claim an adult dependent on your tax return who’s physically or mentally unable to care for themselves.
Qualified individuals must meet one of the following criteria: children under the age of 13 or any adult you can claim as a dependent on your tax return who is physically or mentally unable to care for themselves.
For more information, view IRS Publication 503.
Typically anyone whose employer offers a DCA can participate. As a rule, your DCA can only cover expenses incurred during work hours. Ask your employer’s benefits team to verify eligibility.
For more information, view IRS Publication.
Qualified medical expenses include medical, dental, vision and prescription expenses. Visit this website for more information:
- Before and after school care programs
- Preschool or nursery school
- Extended day programs and summer day camp
- Babysitter (in or out of your home)
- Nanny and au pair services
- Daycare and eldercare facilities
- Educational expenses (summer school and tutoring)
- Tuition for kindergarten and above
- Overnight camp
- Field trip expenses and fees
- Housekeeping services
- Dependent care expenses incurred if your spouse doesn’t work, unless your spouse is a full-time student or is disabled
The work related expense test is the standard the Internal Revenue Service uses to determine if expenses are work related for a DCA. An expense isn’t considered work related just because you had it while you were working. Expenses are considered work related only if both of the following are true:
- They allow you (and your spouse if filing jointly) to work or look for work
- They’re for a qualifying person’s care
For more information, view IRS Publication 503.
Reimbursements can be requested when a qualified expense is incurred during the plan year and before the end of the FSA run-out period (or grace period if applicable).
- If you are eligible under a federal law known as COBRA, you may have an opportunity to remain covered under your employer's coverage for some period of time, provided you pay the full amount of your premium.
- Your employer may offer retiree coverage.
- You may have the opportunity to convert to an individual policy offered by Anthem.
- You may have the opportunity to continue coverage under your group coverage.
If new coverage is obtained within certain time frames, waiting periods and medical underwriting might not apply. Contact your employer, your Certificate or Customer Care for more information and for any guidelines that apply.
Precertification is a required review of a service, treatment or admission for a benefit coverage determination which is done before the service or treatment begins or admission date. Certain services require precertification in order for you to get benefits. Precertification includes a review to decide whether the service, treatment or admission is considered medically necessary or is experimental/ investigational under the terms of your plan.
In general, the following treatments and services must be pre-certified. This is not a comprehensive list and coverage and/or precertification requirements may vary depending on your plan.
- Advanced Imaging (CT, MRA/MRI, PET)
- Air/Water Ambulance (non-emergency)
- All Potential Cosmetic Surgeries
- Bariatric/Gastric Surgeries
- Cardiology - Cardiovascular Services
- Durable Medical Equipment (DME)
- Enteral/Parenteral Nutrition
- Genetic Testing
- Hearing and Speech Devices
- Home Health Care
- Hyperbaric Oxygen Therapy
- Inpatient Admissions/Services
- Joint Surgeries/Procedures
- Out of Network Referrals/Services
- Outpatient Services
- Pain Management Procedures/Injections
- Physical/Occupational/Speech Therapy
- Private Duty/Skilled Nursing (home setting)
- Radiation Therapy
- Select Mental Health/Substance Abuse Services
- Select Prescription Drugs
- Sleep Studies/Therapy
- Spine Surgeries/Procedures
- Surgical Procedures
You can also check to see what services might require a precertification by calling Member Services at the number listed on the back of your member identification card. To find out more about how to request precertification review you can contact Member Services at the number listed on the back of your member identification card.
Please check your plan for details about covered benefits, copayments, coinsurance, deductibles and exclusions or call member services for help with your questions.
A Consumer-Driven Health Plan (CDHP) is a high-deductible plan that also includes a tax-free Health Savings Account (HSA) or Health Reimbursement Account (HRA). Depending on your plan, you may put tax-free money into your account, or your employer might put money in, for example, as a reward for steps you’ve taken toward better health. Then, you use that money for your share of care costs, such as your deductible or coinsurance.
It’s called “consumer-driven” because it puts you in the driver’s seat of your health and health care spending. With your check-ups and preventive care likely covered at 100 percent by your plan, as well as tools to help you stay healthy and the ability to shop around for quality care at more reasonable costs, you might be able to use your CDHP to cover most if not all your health care costs.