Welcome to Part I and II HSA Annual Survey 2010

Constricting Healthcare Costs with HSAs

Find Out Which HSAs Will Work Best for You
With Our Annual Survey

1. What are the primary services you offer as part of your HSA product?
Aetna: Compatible high deductible medical plan, HSA administration, HSA investment services.
Anthem Blue Cross: We offer medical HSA health plans and an option to join an integrated banking system through our contracted partners; BNY/Mellon.
Blue Shield: Blue Shield of California has had a relationship with Wells Fargo since 2004 to administer HSAs for Blue Shield members in HSA-compatible plans. Wells Fargo provides services such as an HSA debit card, dedicated customer service for Blue Shield members with HSAs, online account management for HSAs, and an array of institutional mutual funds for investment of HSA funds. We recently entered into a joint marketing agreement with eflexgroup, Inc, for the administration of HRAs and other consumer directed products, including HSAs. Also, eflexgroup offers a full spectrum of programs and services to members. Blue Shield clients can take advantage of our relationships with both Wells Fargo and eflexgroup, or work with a vendor of their own choosing.
CIGNA: CIGNA Choice Fund HSA, with accounts managed by JPMorgan Chase, is an integrated HSA, combining the plan’s entire healthcare and financial management features into one easy-to-use healthcare product. It includes several features, such as health coaching, integrated medical and HSA claim capabilities, a diverse range of mutual fund choices, employee education, and medical and pharmacy cost transparency tools, hospital quality comparison tools, and online health risk assessments.
First Horizon Msaver: We offer an FDIC insured health savings account that may be matched with any carrier’s qualified high-deductible health plan. Account holders receive a specially branded VISA debit card, tiered interest rates, three investment options, an award-winning CD welcome kit, no-fee ATM transactions, free bill pay online, free banking online, and a healthy lifestyles portal to help save money on prescription drugs and medical services. First Horizon Msaver also offers a dedicated HSA customer call center.
HSA California: HSA California® is the only small-group, fully-integrated HSA program with multiple carriers. Each employee can choose from a menu of HSA-qualified benefits from Health Net, Kaiser Permanente and Western Health Advantage..HSA banking and savings programs are offered through The Bancorp Bank, with accounts FDIC-insured to at least $250,000. Accounts include a free debit card, access to hundreds of investment options, personalized checks, and 24/7 secured online banking access. There are no application or set-up fees to open an HSA with The Bancorp Bank.
HSA California also offers wellness services through wellness360® and prescription discounts through The California Rx Card® Program.
Kaiser Permanente: Kaiser Permanente (KP) offers HSA-qualified deductible HMO plans (available to the individual and family market, small, mid and large employer groups), PPO plans (available to small business, with two to 50 subscribers), EPO plans for individuals and Self Funded EPO plans. We have selected Wells Fargo as our preferred financial administrator to provide HSAs in connection with our HSA-qualified health plans. Wells Fargo offers to all KP customers a competitively discounted monthly administrative fee, an FDIC-insured tiered interest rate account, HSA Visa debit cards, investment options, online account management, and dedicated customer service.
Sterling HSA: Sterling offers education, implementation and account management services through personal sales and service teams, as well as online for brokers, employers, and accountholders. Among our primary services are HSA education, enrollment assistance, a review of the explanation-of-benefits, bill paying, record keeping, scanning and archiving of bills, receipts, and other critical information in case of an IRS audit. We also offer options for self-directing investments and flagging expenses submitted as qualified and non-qualified for HSA distribution. Our online services include online enrollment, banking, account transaction information and the ability to make changes to the HSA account. Our new website with expanded features and functionality launches in Q1 2010.
UnitedHealth Group: UnitedHealthcare is the largest provider of consumer-driven health plans in the country with nearly 3 million members enrolled in consumer-driven health plans that incorporate a health savings account or health reimbursement. Additionally, UnitedHealth Group uses its own financial corporation, OptumHealthBank, for its HSA program administration. OptumHealthBank, an FDIC-insured financial institution focused solely on health care banking, is the nation’s largest HSA administrator. Account holders receive market competitive interest rates on their deposits, online bill payment options, and direct debit card access to their accounts. Additionally, once they get a qualifying account balance, they also can invest in a range of highly regarded no-fee, non-proprietary investment options.

2. Do you offer an HSA-qualifying high
    deductible health insurance plan?
Aetna: Yes.
Anthem Blue Cross: Yes
Blue Shield: Yes, Blue Shield offers HSA-compatible high deductible health plans in the Individual and Family Plans (IFP) and employer group markets.
CIGNA: Yes, CIGNA offers a full suite of account-based medical plan designs that meet the definition of a qualified high deductible plan.
First Horizon Msaver: We do not offer an HSA-qualifying high deductible insurance plan, but our health savings account may be paired with any carrier’s qualified health plan, which allows for greater portability.
HSA California: Yes. HSA California only offers HSA-qualified health plans; our portfolio includes seven different HSA-compatible plan designs.
Kaiser Permanente: Yes, Kaiser Permanente offers an array of HSA--qualified deductible HMO plans for the Individual, Family and Employer group markets, PPO plans for Small business groups with 2-50 subscribers, EPO plans for individuals and Self Funded EPO plans.
Sterling HSA: As an independent HSA administrator, Sterling can work with all HSA compatible plans -- fully insured and self-insured.
UnitedHealth Group: Yes, UnitedHealthcare offers several HSA-qualified HDHPs. In addition to administering the medical plan, UnitedHealthcare offers a wide variety of health care services, tools, and tips for its HSA customers.

3. Are you providing a health spending
    arrangement or a savings vehicle?
Aetna: Yes.
Anthem Blue Cross: We have partnered with BNY/Mellon and their support staff – ASC/Mellon to provide banking and investment options for the financial piece of our HSAs. Our integration allows members to login to http://www.anthem.com/ca/ and be linked to their BNY/Mellon account.
Blue Shield: Blue Shield offers high deductible health plans that are HSA-compatible. Members have the flexibility to choose an HSA trustee or custodian that offers the type of health savings account that best meets their needs.
CIGNA: CIGNA has an extensive offering of consumer funds that include an HSA, HRA, healthcare flexible spending account, dependent care flexible spending account, and incentive health reimbursement accounts (Healthy Awards).
First Horizon Msaver: We provide an FDIC insured savings account with tiered interest rates that can be linked to one of three investment options. More accounts features can be seen at firsthorizonmsaver.com.
HSA California: HSA California and The Bancorp Bank have partnered to create a seamless, online approach for employers and employees to fund an HSA with a wide array of savings and investment options.
Kaiser Permanente: Members who enroll in one of our HSA-qualified deductible HMO plans can open a health savings account through our preferred financial administrator, Wells Fargo. However, members are also free to open a health savings account with a financial institution of their choice. Our HSA-qualified deductible HMO plans are designed to work with HSA administration from any financial institution. In terms of other spending arrangements, Kaiser Permanente also offers different deductible HMO plans paired with health reimbursement arrangements (HRA).
Sterling HSA: Sterling now offers HRAs and POPs, in addition to HSAs.
UnitedHealth Group: Yes, UnitedHealthcare has partnered with OptumHealthBank for HSA administration, savings and investment opportunities.

4. What size employee group is the HSA available for?
Aetna: All sizes of groups.
Anthem Blue Cross: All employee groups are eligible.
Blue Shield: We offer HSA-compatible plans for all markets, including individual and family, small groups (from two to 50 employees), midsize groups (51 to 299 employees), and large groups (300+ employees).
CIGNA: Our HSA product is available for employers with 200 or more eligible employees. We also offer qualified high deductible health plans to groups with 50 or more eligible employees.
First Horizon Msaver: We provide HSA administration for individuals as well as groups of all sizes.
HSA California: HSA California is available for employers with 2-50 employees.
Kaiser Permanente: Kaiser Permanente (KP) offers HSA-qualified deductible HMO plans to any group size. PPO plans are available to groups with 2-50 subscribers, and Self Funded EPO plans are available to groups with 500 subscribers.
Sterling HSA: We work with individuals and groups from small to large group.
UnitedHealth Group: Our consumer-driven health plans are available to individuals and groups of all sizes.

5. Is your management team experienced in
    health insurance, financial services, or both?
Aetna: Health insurance.
Anthem Blue Cross: Anthem has subject matter experts in health insurance and the financial services for our HSA plans. These associates can work with the client and agent/broker to explain all processes.
Blue Shield: Blue Shield is experienced in offering and managing HSA eligible high deductible health plans and other health insurance products
CIGNA: Our HSA product is available for employers with 200 or more eligible employees. We also offer qualified high deductible health plans to groups with 50 or more eligible employees.
First Horizon Msaver: Our management team is experienced in both health insurance and financial services.
HSA California: The HSA California team is comprised of health insurance specialists with extensive experience with both HDHPs and HSAs. Our banking partner, The Bancorp Bank, provides expert financial services support via a team that shares 140-plus years in banking and technology experience.
Kaiser Permanente: Kaiser Permanente’s management team is experienced in health insurance and HMO plans. Our preferred HSA administrator, Wells Fargo, brings the appropriate financial services expertise.
Sterling HSA: Sterling HSA’s executive team has extensive experience in healthcare and insurance management. We have complemented those skills with staff and advisory board members who have experience in financial services to optimize support of our clients during enrollment and to manage their accounts with us long-term.
UnitedHealth Group: Both.

6. Do you provide training for brokers about HSAs?
Anthem Blue Cross: We provide on-going broker communications, newsletters, and product demos as new products are introduced.
Blue Shield: Blue Shield provides a continuing education seminar on HSAs to our IFP brokers periodically. Brokers also have access to educational programs and tutorials through Wells Fargo and eflexgroup,
CIGNA: CIGNA provides consumerism education on products including the HSA to brokers via forums and through highly skilled sales managers.
First Horizon Msaver: We provide CE certified training programs on the subject of HSAs in over 20 states. In addition, First Horizon Msaver regional representatives and the Broker Support Team (1-866-889-8583, Option 3) are available to assist brokers in the field with education as well as the installation and enrollment of the HSA.
HSA California: Yes. HSA California has dedicated HSA experts ready to provide personalized training and HSA education to brokers. We can be reached between 8 a.m. and 5 p.m. Monday-Friday at sales@hsacalifornia.com or toll-free at 866.251.4625. HSA California also provides ongoing seminars to provide brokers with the information and tools they need to explain HSAs to clients.
Kaiser Permanente: Yes, we provide training to our brokers. In addition, our preferred financial administrator for HSAs, Wells Fargo, has a dedicated support line to assist our brokers with questions. Wells Fargo also has an online flash educational presentation for our customers about HSAs online at: wellsfargo.com/investing/hsa/demo
Sterling HSA: Yes, Sterling offers a variety of training options, including CE courses across the nation, lunch and learn meetings for large regional brokerage groups, and individual sessions pairing Sterling account executives with brokers and consultants.
UnitedHealth Group: Yes, we routinely provide training to brokers on all of our products and services, including print materials, online education, and regular webcasts to inform brokers about the HSA.

7. What commissions are paid to brokers and when?
Aetna: Standard commission levels, monthly.
Anthem Blue Cross: Brokers are paid the standard medical commission for the HSA compatible medical plan.
Blue Shield: Blue Shield of California pays commissions to brokers on health plans. Referral fees for HSAs vary by financial institution.
CIGNA: CIGNA pays its standard commissions for HSA sales.
First Horizon Msaver: We pay brokers $.50 per account referred for the life of the account. Referral fees are paid via direct deposit on a quarterly basis. More information about how First Horizon Msaver works with brokers may be found at firsthorizonmsaver.com.
Kaiser Permanente: Brokers are paid the standard medical commissions for all of our HSA-qualified health plans.
Sterling HSA: Commissions for our HSA business are paid quarterly on all new and renewing business.
UnitedHealth Group: UnitedHealthcare’s standard commission schedules and payment processes apply to the CDH products.

8. Are electronic enrollment forms accessible through your Website?
Aetna: Yes.
Anthem Blue Cross: Enrollment processes are the same for HSAs as for any other product Anthem offers.
Blue Shield: Members enrolling in HSAs must enroll directly with the HSA trustee or custodian. Many HSA trustees are offering electronic enrollment for group set-up and individual enrollments, but this will vary by institution.
CIGNA: CIGNA provides an online and paper version of the HSA bank enrollment application. Employers can provide online or paper enrollment options for their employees.
First Horizon Msaver: We were first to market with a completely paperless online enrollment form. Brokers and employers are encouraged to call the Broker /Employer Support Center (1-866-889-8583, Option 3) to obtain an enrollment form URL that is exclusive to the group and the broker. Other electronic enrollment methods are available for large groups. A generic online enrollment form may be found at http://www.firsthorizonhsa.com.
HSA California: PDF enrollment forms are available on our Web site at www.hsacalifornia.com. Employers and employees can open and fund an HSA on our Web site through a simple process driven by our partner, The Bancorp Bank. Employers can even maintain employees’ membership information online.
Kaiser Permanente: Individuals and families can apply for Kaiser Permanente health plans online by logging on to: kaiser.healthinsurance-asp.com/expressweb/user/Welcome.HSA Employer and Individual applications can be downloaded at wellsfargo.com/hsa.
Sterling HSA: Yes. We provide online enrollment for individuals who are part of employer groups, individuals seeking a HSA administrator on their own, and for employer groups to manage the HSA enrollment of employees. Sterling account enrollment and management forms are also available on our website at www.sterlinghsa.com to download, print, and email or mail to us.
UnitedHealth Group: Yes, electronic enrollment forms are available through our Website.

9. How do you assist account holders with paying medical bills?
Aetna: We provide cost estimator and quality assessment tools.
Anthem Blue Cross: High deductible health plans engage the members to be knowledgeable about their healthcare treatment and management of funds. Members manage their own bank accounts, pay for their medical and Rx needs with their H.SA account. Members can view online their banking balances and their claim activity.
Blue Shield: As a health plan, Blue Shield determines plan eligibility and payment for services incurred, such as determining plan and member responsibility based on plan agreements. In terms of paying for medical bills from the HSA, the member is responsible for determining what qualified medical expenses they choose to pay out of the HSA. Any HSA financial transactions (movement of money in and out of the HSA regardless of qualified medical expenses status) are managed by the HSA trustee or custodian.
CIGNA: CIGNA helps account holders manage their healthcare expenses with information decision support tools and ready access to HSA funds. CIGNA provides cost and quality information according to the individuals’ plan for more than 200 procedures performed by specialists, in hospitals and in outpatient facilities. The pharmacy price quote tool compares actual real time out-of-pocket costs for brand name, generic and over the counter medications at 57,000 pharmacies nationwide.
First Horizon Msaver: We offer free Online Bill Pay for the convenient electronic payment of medical bills. Tools such as a free medical cost estimator and a patient bill evaluation and negotiation service are also available in the Healthy Lifestyles Portal at www.firsthorizonmsaver.com.
HSA California: Our carrier partners – Kaiser Permanente, Health Net, and Western Health Advantage – have created special units within their organizations to help members enrolled in HSA California.
Kaiser Permanente: Money in the HSA can be used to pay for a variety of healthcare related expenses ranging from routine physicals to prescription drugs. To pay for expenses, the member can simply present their HSA debit card to the provider, and money will be deducted directly from their HSA. However, if the member wants to pay for services out of pocket and submit an HSA reimbursement claim manually, they can. Kaiser Permanente’s Member Service Unit can support our members with any medical bill question or concern.
Sterling HSA: Sterling reviews the explanation of benefits and medical bills for discounts to insure that our accountholders do not spend more for a healthcare service or product than the insurance company would pay. We also alert accountholders when we spot disbursements that do not appear to comply with IRS rules. We help our clients with payment plans to their providers in the event there are insufficient funds to pay a bill.
UnitedHealth Group: Participants can use checks or a debit card to access funds in their HSA to pay providers directly for outstanding expenses or reimburse themselves for out-of-pocket expenses paid to a provider. UnitedHealthcare then gives members monthly health statements that provide personalized cost-saving and health improvement tips, as well as simple charts showing individuals’ claims experience and health care account balances – all in an easy, concise, plain-English sort of way.

10. How does the administrator help the
      accountholder with insurance-related questions?
Aetna: Customer service representatives are available by phone and through our website at www.aetna.com.
Anthem Blue Cross: Anthem provides online resources as well as a customer service support line for all members. Support numbers are listed on the member’s health insurance card.
Blue Shield of California: All insurance-related questions are referred back to Blue Shield.
CIGNA: CIGNA offers integrated customer service via our mycigna.com Website and 24/7/365 toll-free telephone service to respond to questions about the member’s health insurance and the HSA.
First Horizon Msaver: We work with a large number of health plans and will refer the account holder to the health plan for questions related to insurance. However, general HSA questions can be answered by the dedicated HSA call center staff.
HSA California: Both HSA California and The Bancorp Bank have customer support teams with expert knowledge available by phone or e-mail from 8 a.m. to 5 p.m. Monday-Friday.
Kaiser Permanente: Our preferred financial administrator for HSAs, Wells Fargo, refers insurance-related calls back to Kaiser Permanente (KP). KP member service representatives are trained to answer any insurance related questions our members may have. At kp.org, we also have a website for deductible plan members to educate themselves about what to expect pre/during/post visits with our providers, including decision support tools (e.g., preventive services list, sample fee list, interactive treatment fee tool) that may facilitate better understanding of their insurance coverage and optimize the wide range of health related services offered by KP. Visit kp.org/deductibleplans to find out more.
Sterling HSA: Our customer service representatives are available Monday – Friday from 8 am to 6 pm Pacific time. Clients and brokers can reach us toll-free at 800-617-4729 and via e-mail at customer.service@sterlinghsa.com.
UnitedHealth Group: UnitedHealthcare’s Customer Care Professionals are available by phone to respond to all insurance and account-related questions; a number of resources, including calculators and FAQs are also available online at www.myuhc.com.

11. Is the administrator integrated with the health plan?
Aetna: Yes
Anthem Blue Cross: Yes, BNY/ Mellon provides consumers with the following:
• Interest-bearing checking account
• Anthem-branded MasterCard debit card
• Checkbook
• Consumer receives the HSA debit card, checkbook, etc. after completing the activation process
• Monthly HSA Statements (bank statement)
• Annual Tax forms: 1099s (January), 5498s (May)
• Investment opportunities through its subsidiary Dreyfus
Blue Shield: Not at this time.
CIGNA: Yes, the high deductible health plan is fully integrated with the HSA.
First Horizon Msaver: We currently are not integrated with a health plan allowing account holders to move between health plans without the need to disrupt the HSA portion of the program.
HSA California: HSA California is completely integrated with The Bancorp Bank. Eligibility is automatically transferred to The Bancorp Bank so that account set-up is simplified; employers can set-up employee HSAs, fund employee HSAs, and complete other administrative capabilities – all online.
Kaiser Permanente: No, Kaiser Permanente provides the health plan services and Wells Fargo, our preferred financial administrator for HSAs, provides the financial account.
Sterling HSA: We are an independent administrator available to work with all health plans across the nation.
UnitedHealth Group: Yes, in 2002, UnitedHealth Group chartered OptumHealthBank to help advance the growing convergence of healthcare and financial services and to give consumers a more integrated experience.

12. Are investment choices limited by the administrator?
Aetna: The administrator provides a diverse fund selection by asset classes supporting a range of investment objectives.
Anthem Blue Cross: There are over 20 investment opportunities Through BNY/Mellon’s subsidiary Dreyfus.
Blue Shield: Yes.
CIGNA: CIGNA offers a customized slate of diversified HSA investment options through JP Morgan Chase as part of our CIGNA Choice Fund HSA.
First Horizon Msaver: We offer three investment options. Two of the options, self-directed online brokerage and self-directed telephonic brokerage, do not limit the investments that are available. A third option, mutual fund sweep, does limit investment to a set of no-load mutual funds. More details on these investment options can be found at firsthorizonmsaver.com.
HSA California: The Bancorp Bank offers an extensive investment portfolio, from FDIC-insured savings accounts to more than 6,500 investment options. There are no application or set-up fees required to open an HSA with The Bancorp Bank.
Kaiser Permanente: The Wells Fargo HSA offers both an FDIC-insured interest bearing deposit account plus the option to direct funds into pre-selected investments and mutual funds. For more information on Wells Fargo Advantage Funds, visit wellsfargo.com/advantagefunds or call (800) 222-8222.
Sterling HSA: Not at all. Our account holders can choose any IRS qualified investment for their funds, including stocks, bonds, mutual funds, and CDs.
UnitedHealth Group: Optum Health-Bank offers a range of highly regarded no-fee, non-proprietary investment options to HSA accountholders.

13. What forms are needed to submit an HSA case?
Aetna: Aetna’s standard enrollment processes are used. There are separate medical and HSA elections. Eligibility/enrollment options are electronic batch enrollment, paper enrollment, and Web enrollment.
Anthem Blue Cross: An HSA Addendum and Agreement need to be completed. The HSA Addendum captures how the Employer wants to fund their employees’ accounts. The HSA Agreement is stating you will or will not use our integrated banking option.
Blue Shield: Forms (online or paper) vary by HSA custodian or trustee.
CIGNA: CIGNA’s standard processes and forms are used for all CIGNA products including the HSA.
First Horizon Msaver: We recommend that new employer groups complete an Employer Registration Form. These may be obtained at fristhroizonmsaver.com or by contacting the Broker/Employer Support Team at 1-866-889-8583, Option 3. Individuals may enroll online at firsthroizonmsaver.com.
HSA California: Standard application forms are needed to submit an HSA California case. These forms are available at www.hsacalifornia.com.
Kaiser Permanente: We require our standard application and enrollment process plus additional information if Wells Fargo is utilized. Wells Fargo: A broker must complete the “HSA Broker Supplement – Application for Services” form and an “HSA Employer Application.” You can find copies of the applications at wellsfargo.com/hsa
Sterling HSA: All that is required is a completed employer group application (for groups) and an individual accountholder application kit for each accountholder, along with a list bill and employer preferred form of contribution. All forms are available at www.sterlinghsa.com.
UnitedHealth Group: Employers contributing to the HSA account are required to to complete an employer discovery document. Individuals establishing an HSA account.

14. Do you plan to offer an HSA-eligible plan to your own employees?
Aetna: Aetna Inc. offers several HSA-eligible plans to our employees.
Anthem Blue Cross: All Anthem Blue Cross and WellPoint eligible employees have the option
to choose a Lumenos HSA plan.
Blue Shield: Yes, we started offering an HSA-compatible plan to our own employees effective
January 1, 2007.
CIGNA: Yes, CIGNA has offered employees HRA and HSA plan options since January 2005.
First Horizon Msaver: Yes, we have offered an HSA-eligible plan to our employees since 2005.
HSA California: CHOICE Administrators®, the company behind HSA California, CaliforniChoice®, CaliforniaChoice 51+, Kaiser Permanente Choice Solution, Contractor’s Choice®, and Choice Builder, currently offers its employees access to HSA-compatible plans.
Kaiser Permanente: We consider our entire portfolio of health plans for our own employees.
Sterling HSA: We have offered our employees a HSA since Sterling was founded in 2004.
UnitedHealth Group: All UnitedHealth Group employees have the option of enrolling in all an HSA
or HRA.

15. Are you using a trustee? If so,
      how long have you been with the trustee?
Aetna: Yes, since May 2004
Anthem Blue Cross: Anthem has partnered with BNY/Mellon FDIC to offer all of your banking
needs for your HSA account.
Blue Shield: Blue Shield has had a relationship in place with Wells Fargo since October 2004,
and recently entered into a joint marketing agreement with eflexgroup, Inc. Members are free to choose Wells Fargo, eflexgroups, or any other qualified trustee or custodian to administer health savings accounts.
CIGNA: JP Morgan Chase has been the trustee for our CIGNA Choice Fund HSA product since January 1, 2005.
Fist Horizon Msaver: First Horizon Bank, a division of First Tennessee Bank National Association, member FDIC, serves as the custodian for our HSAs. This relationship has been in place since 2005.
HSA California: The Bancorp Bank handles the HSAs directly. The HDHP insurance plans are fully-insured products from Health Net, Kaiser Permanente and Western Health Advantage
Kaiser Permanente: We first began selling HSA-qualified deductible HMO plans with an optional HSA through Wells Fargo in our Colorado, Georgia and Northwest regions in 2005, Mid-Atlantic States in 2006, and California and Ohio in 2007.
Sterling HSA: Sterling HSA uses Mechanics Bank as our Trustee and we have been with them since 2005.
UnitedHealth Group: Yes, UnitedHealthcare partners with Optum HealthBank for trustee services. UnitedHealthcare’s parent company, UnitedHealth Group, chartered OptumHealthBank in 2002 to help advance the growing convergence of health care and financial services.

16. What service guarantees do you offer?
Aetna: We do not offer HSA service guarantees.
Anthem Blue Cross: We do not offer performance guarantees in the Small Group market or Individual market.
Blue Shield of California: Our relationship with Wells Fargo provides for a number of service level agreements. One example of a typical service guarantee would be telephone average speed of response.
CIGNA: The standard performance guarantees apply.
First Horizon Msaver: Service-level guarantees vary based on the scope of the relationship with the customer, but generally include commitments around the delivery of debit cards and Welcome Kits as well as Customer Call Center metrics.
HSA California: HSA California guarantees outstanding service. Our customer service team has expert knowledge of the insurance industry and is available between 8:00 a.m. and 5:00 p.m. Monday-Friday for personal assistance.
Kaiser Permanente: We do not offer service guarantees to the Individual, Family or Small group markets.
Sterling HSA: Sterling HSA offers a full money back guarantee for up to 12 months of paid monthly maintenance fees if our accountholders are unhappy with our service for any reason. Sterling was the first HSA administrator to offer such a guarantee and made this commitment when the company was founded in 2004.
UnitedHealth Group: Service guarantees will vary based on the scope of the relationship with the customer, but are typically available with respect to administrative service delivered under the plan.

17. What kinds of depositories are desired?
Aetna: Not applicable.
Anthem Blue Cross: There is no minimum balance requirement.
Blue Shield of California: Guidelines will vary by financial institution.
Our relationship with Wells Fargo provides for the following:
• For IFP members, the minimum HSA deposit is $100
• For employer groups, there is no minimum deposit
• Any deposits after the initial $100 may be directed into investment accounts dictated by the member.
CIGNA: There are no minimum deposit or balance requirements. Contributions to the HSA can be funded through employer facilitated pre-tax payroll contributions (EFT/ACH transactions) or through unscheduled deposits in which participants arrange from an EFT from their personal bank account or send a check and deposit slip to a lockbox for contribution to their HSA.
First Horizon Msaver: No minimum balance requirement and no minimum initial deposit requirement for employer groups.
HSA California provides the following: No minimum balance requirement to open an HSA and no minimum deposit requirement for employer groups
Kaiser Permanente: Our preferred financial administrator for HSAs, Wells Fargo, does not require minimum deposits for employer groups with payroll deduction. The minimum deposit of $100 is required for individual and family plan members not enrolling through an employer group.
Sterling HSA: Sterling accepts cash checks, and electronic fund trans-
fers through www.sterlinghsa.com in a secure, password protected environment. We recommend an initial deposit of $100 and require a minimum balance of $20.

18. Where is your company headquartered?
Aetna: Hartford, Conn.
Anthem Blue Cross: The headquarters building for Anthem Blue
Cross is located at 21555 Oxnard Street, Woodland Hills, CA.
Blue Shield of California: Blue Shield is headquartered in San Francisco, Calif. CIGNA: CIGNA HealthCare is headquartered in Bloomfield, Conn. and CIGNA Corp., the parent company, is headquartered in Philadelphia, Penn.
First Horizon Msaver: Overland Park, KS, with an office in Fresno, CA.
HSA California HSA California is based in Orange, Calif., and does business throughout the state.
Kaiser Permanente: Oakland, California.
Sterling HSA: We are a locally owned company and are headquartered in Oakland, Calif.
UnitedHealth Group: Minnetonka, Minn.

19. Please provide the phone number and e-mail that brokers can use to find out more about your plan.
Aetna: 877-249-2472, prompt 6
Anthem Blue Cross: Please reference our online resources or contact their regional sales manager for individual and small group assistance. Large Group representatives should likewise call their group sales manager at the company.
CIGNA: Please contact your local CIGNA HealthCare sales representative at 888-802-4462.
Blue Shield of California: Brokers can call their Blue Shield sales representative or call Blue Shield Producer Services at (800) 559-5905 or visit Producer Connection at www.blueshieldca.com.
First Horizon Msaver: 1-866-889-8583, Option 3
msaverbroker@firsthorizon.com
HSA California: Brokers can call us at 866.251.4625 between 8 a.m. and 5 p.m. Monday-Friday, or e-mail us anytime at sales@hsacalifornia.com. Brokers can also visit us online at www.hsacalifornia.com, where they will find free sales training and collateral materials, and brochures and forms they can print and share with clients.
Kaiser Permanente: For questions or information about Kaiser Permanente: BrokerNet Website Address: brokernet.kp.org
Individual and Family Broker Sales: 1-800-789-4661, option 6 or 1-800-207-5084 (8:30 a.m. to 5 p.m. PST)
Small Business Broker Sales: 1-800-789-4661
(8:30 a.m. to 5 p.m.PST)
Client Services Unit: 866-752-4737 (8 a.m. to 5 p.m. PST)
For questions about Wells Fargo: 1-866-890-8309 (5 a.m. to 6 p.m.PST)
Wells Fargo Broker Support Line: 866-449-9929
(6:30 a.m. to 4 p.m.PST)
Sterling HSA: Our customer service and broker service number is 800-617-4729 or customer.service@sterlinghsa.com and broker.support@SterlingHSA.com. We have account executives and managers who support our broker and consultant channel as well. Their individual names and contact information is available at www.sterlinghsa.com.
UnitedHealth Group: For more information, please visit www.unitedhealthcare.com.

20. Which market segment (small/mid/large) do you anticipate these plans will best accommodate?
Aetna: All segments.
Anthem Blue Cross: We are seeing interest and adoption in all market segments.
Blue Shield of California: HSA-eligible plans are generating interest from all market segments, including individual and group markets. To date, Blue Shield’s membership in HSA-eligible plans encompasses all lines of business, from the individual group market to large, major employers.
CIGNA: We believe that HSAs and consumer directed health plans would be appropriate for all markets.
First Horizon Msaver: We successfully service individuals to groups of thousands of employees. Our Implementation and Account Management teams can develop enrollment, funding, and communication programs to fit any size group.
HSA California: We believe HSAs are appealing to all market segments; however, HSA California is designed for employers with 2-50 employees.
Kaiser Permanente: Our HSA-Qualified deductible HMO, PPO and EPO plans appeal to all market segments, including Individual and Family, Small, Mid and Large.
Sterling HSA: HDHP/HSAs accommodate all market segments.
UnitedHealth Group: All segments.

21. What channels have been most effective in selling HSAs?
Aetna: Brokers and general agents, consultants, Aetna sales force.
Anthem Blue Cross: Agents and brokers remain our most effective channel for HSA marketing and sales.
Blue Shield of California: Blue Shield is a broker-driven organization. Our HSA-eligible high-deductible health plans are sold via the broker channel. To assist brokers in selling our HSA-eligible plans, we’ve provided them with educational and marketing collateral to help them sell HSAs during the plan purchase.
CIGNA: We have found that the broker/consultant channel has been the most effective.
First Horizon Msaver: We believe that the most effective channel for selling HSAs is through an informed and empowered broker network.
HSA California: All HSA California sales are through licensed independent insurance brokers and authorized general agencies. To make sure brokers understand the unique selling opportunity behind HSA California – that we’re the only small group, fully integrated HSA program with multiple carriers in California – we produce timely communications and brochures that walk them through the program.
Kaiser Permanente: All channels have been successful in selling HSA programs.
Sterling HSA: We are committed to the broker, agent and consultant channel.
UnitedHealth Group: UnitedHealthcare’s HSA-qualified plans are sold primarily through brokers and consultants, or directly to individuals purchasing insurance policies on their own.

22. Which customer segments have been most receptive to HSAs?
Aetna: All customer segments.
Anthem Blue Cross: All customer segments continue to express interest in and adoption of HSAs.
Blue Shield of California: HSA-eligible plans appeal to all customer segments, from the individual market to small, midsize, and large groups.
CIGNA: Brokers have been very supportive of these plans.
First Horizon Msaver: All segments.
Kaiser Permanente: We have seen strong growth in all customer segments including the Individual and Family, Small, Mid and Large Group segments.
Sterling HSA: Customers who want to contain their healthcare costs and reduce increases are rapidly moving to the HSA market. Areas with high PPO penetration move quickly as well.
UnitedHealth Group: All segments have been receptive to the HSA product.

23. How prone are brokers to support this with reduced commissions on the high deductible health plan side of the equation?
Aetna: We have seen widespread broker support of HSA plans as a viable option for their clients.
Anthem Blue Cross: There is high interest in supporting this product from brokers to date. We continue to believe brokers will promote the appropriate health plans based on their client’s needs, regardless of commission rate.
Blue Shield of California: Blue Shield has been selling high-deductible health plans for many years even prior to the passage of the Medicare legislation that enabled HSAs. High-deductible plans have been an important option for brokers in providing their IFP and group clients plan benefit designs at more affordable price points. HSA-eligible high-deductible health plans are even more attractive because of the possible tax and personal saving advantages. We have received positive broker feedback on our HSA-eligible high-deductible health plans.
CIGNA: Brokers have been very supportive of these plans.
First Horizon Msaver: Brokers most prone to support high-deductible health plans are those who have received education, support, and the tools that allow them to recommend these plans with confidence.
HSA California: In today’s economy, the owners of small businesses are looking to reduce premiums yet still provide quality benefits to employees. HSA California takes HDHPs and HSAs to a new level by not only offering affordable benefits, but packaging three top California health plans in one program – each employee can choose a different health plan – a choice no other program in the state offers. As the market continues to change, we believe brokers will continue to adopt HSAs as an applicable solution for many clients.
Kaiser Permanente: Brokers are very supportive of these programs when they meet their customers’ business needs.
Sterling HSA: Brokers who think this is the right thing to do for their clients place them in an HDHP/HSA. Many brokers use the HSA concept as a marketing advantage to grow business in their book.
UnitedHealth Group: Brokers realize that the CDH plans are experiencing rapid adoption and they are doing their best to offer their customers the product that is right for them.

24. Will high-deductible health plans actually reduce utilization?
Aetna: We see continued positive signs of cost control and consumer engagement in Aetna’s studies of HRA and HSA results.
UnitedHealth Group: A series of studies from UnitedHealthcare in 2006 and 2007 create a solid body of evidence illustrating that CDH plans are delivering positive changes in health care behaviors and costs for both employers and consumers:
• A December 2007 study found that CDH plans constrain costs and utilization over time;
• A September 2008 study found that Health Savings Accounts encourage saving among all consumer segments, including low-income populations as well as white-collar professionals;
• An April 2007 study of preventive and chronic-care services confirms that the above gains do not come at the expense of vulnerable populations or discourage individuals from seeking needed care.
Anthem Blue Cross: When members engage in healthy choices and become active in their medical decisions, utilization is affected.
Blue Shield of California: It is to be determined if HSA-eligible high-deductible health plans reduce utilization. Satisfaction is increased when HSA-eligible plans are offered in tandem with wellness programs and an emphasis on preventive care.
CIGNA: During the past four years, CIGNA has compiled empirical data on literally millions of individuals enrolled in our CDHP, HMO and PPO plans based on claims experience that demonstrates that our consumerism products (HRA and HSA) offered as part of a comprehensive package of communication, member education and access to reliable and actionable information will substantially reduce the overall employer medical trend. Moreover, CIGNA’s multi-year experience studies of CDHP plans provide evidence demonstrate that our consumer-driven health plans both improve costs and health care quality.
First Horizon Msaver: High deductible health plans are designed to engage plan members in health care decisions by making the true cost of health care more transparent. First Horizon Msaver assists in this process by providing its HSA account holders with an online prescription drug cost comparison tool, a free consumer guide to help them determine fair prices for health care services in their area, and a medical bill evaluation and negotiation service.
HSA California: The goal of an HDHP is to allow employees and their families to control what they spend on healthcare. It’s still too early to tell whether utilization will actually be reduced by offering plans with higher deductibles.
Kaiser Permanente: We are evaluating the impact on utilization. Based on some small samples assessed, we have seen a drop in utilization with our members in HSA-qualified health plans. The lower risk factor behind this population segment may be a contributing factor. Additionally, there are also some small studies that indicate a change in behavior from these members as they become more financially engaged and responsible for their health expense. Preliminary information shows that some members have pursued alternative options – e.g., emailing their physician.
Sterling HSA: Our experience suggests that our clients are carefully
evaluating cost/treatment alternatives, thereby reducing unnecessary medical utilization.

25. How can vendors make HSAs more effective and attractive for brokers?
Aetna: Make the sales process as simple as possible and give brokers tools that allow them to present these options to employers and employees effectively.
Anthem Blue Cross: Vendors can make HSAs more effective by streamlining and simplifying the enrollment and communication processes.
Blue Shield of California: From a broker perspective, they would like higher referral fees from the HSA administrator and ease of enrolling their client into an HSA.
CIGNA: Provide information to help brokers understand the consumer advantages of the HSA product, provide products and processes that are easily understood by employers and support the member education at enrollment on an ongoing basis.
First Horizon Msaver: We make HSAs more effective and convenient for brokers by providing education and training as well as local and telephonic broker/employer support to simplify the enrollment and funding processes.
HSA California: Education is the key. It’s important that brokers are comfortable explaining the concept of an HSA and how it can work to completely satisfy the needs of clients, employees and families. HSA California and The Bancorp Bank provide a number of educational resources for brokers to help them better explain HSAs to clients. For more information on these materials, brokers can call us anytime at 866.251.4625.
Kaiser Permanente: Vendors can make HSAs more effective and attractive by keeping the sales process simple, supporting good communications, supporting installations and bringing effective online tools to the employer and members.
Sterling HSA: We support the broker channel with sales directors and account managers who handle their needs personally. We also offer HSA training and education. We have online toolkits for brokers and consultants who have registered with Sterling. These include spreadsheets, PowerPoint presentations, and other sales material. In addition, we support the broker’s employer clients in a similar fashion. This helps our broker partners better satisfy their client’s needs.
UnitedHealth Group: Make quoting, set up, and enrollment as simple as possible for the broker. Provide as much broker training as possible. Provide simple communication materials for HR staff and the enrollees. Leverage the experience and materials of your health plan partner, who can offer communications materials and other tools to provide assistance.

26. Will consumers purchase plans for their traditional health plan features and view the HSA account as a perk to cover short-term medical expenses or will the primary purchase decision focus more on long-term financial planning to cover immediate and long term medical expenses and to reduce tax liability?
Aetna: We see both with the latter being more common.
Anthem Blue Cross: The HSA plans offer choices for all members. The member can choose to save the tax-deferred monies or choose to spend the monies to cover their individual or family medical and pharmacy claims.
Blue Shield of California: Statistics are showing that consumers are using their HSAs for both purposes, though the investment dollars in HSA accounts are growing at a rapid pace
First Horizon Msaver: We recognize that the HSA appeals to both segments and we have designed our HSA offering to benefit both “spenders” and “savers.” For example, our low monthly administration fee and no transaction fees approach appeals to “spenders,” whereas our tiered interest rates and trio of investment options address the needs of those planning for the longer term.
HSA California: It depends on the individual consumer. Having funds available in an HSA for short-term medical expenses is a great feature. However, the long-term advantages are equally important. The ability to save HSA funds and earn interest tax-free year-after-year, provides the unique value inherent in HSAs. An HSA is a perfect savings vehicle to add to a long-term savings portfolio next to a 401(k), IRA or any retirement medium.
Kaiser Permanente: Consumers purchase our HSA-qualified deductible HMO plans and open HSAs to cover both immediate and long-term medical expenses, as well as to reduce tax liability.
Sterling HSA: The latter appears to be the case. This is truly a new way to finance the costs related to healthcare. In today’s economic climate, the HSA is a great way to budget for medical, dental and vision expenses as well.
UnitedHealth Group: Based on research from OptumHealthBank released in April 2007, HSA accountholders typically can be categorized into one of three basic patterns of account usage: Spenders, savers and investors. Roughly half of OptumHealthBank 400,000 accountholders are spenders and most of the remaining are Savers. While less than 5 percent of today’s HSA population are Investors, this may someday be the largest group based on early, accelerating balance trajectories. OptumHealthBank Spenders carry balances that hover between $400 and $600, spend 80 percent of contributions on current medical expenses and contribute an average of $133 per month. OptumHealthBank Savers hold a balance of nearly $1,500 on average and spend less than 10 percent of contributions to their account. OptumHealthBank Investors are the most active contributors with the highest total balances and highest expected tax savings, holding over $2,000 in bank balances and, on average, investing another $3,000 in any combination of OptumHealthBank eight highly regarded non-proprietary mutual funds.

27. Do you envision interest in an HSA eligible HMO (low-cost) plan?
Aetna: Yes, since January 2006, Aetna has offered an HMO HSA in some markets.
Anthem Blue Cross: Anthem is reviewing market interest and feasibility of offering an HSA HMO.
Blue Shield of California: Statistics are showing that consumers are using their HSAs for both purposes, though the investment dollars in HSA accounts are growing at a rapid pace
CIGNA: We have not seen significant interest at this time.
First Horizon Msaver: Yes, and since our HSA may be paired with any carrier’s eligible plan, the HSA becomes portable making it easy for a member to move between eligible plans without disrupting the saving portion of the program.
HSA California: Yes, we envision interest in an HSA-eligible HMO plan.
Kaiser Permanente: Absolutely. Since 2005, our HSA-Qualified Deductible HMO plans have appealed to all market segments, including Individual and Family, Small, Mid and Large Groups.
Sterling HSA: There has been widespread interest in HMO plans that are HSA compatible. Both Kaiser and Western Health Advantage provide these products.
UnitedHealth Group: Yes.

28. Which geographic areas and consumer demographics are brokers seeing a demand for competitive individual and family plan HSAs?
Aetna: We are not in that market segment, so we cannot respond.
Anthem Blue Cross: Being our HSA plans are consumer centric and come with strong preventive benefits, we are seeing strong demand across all territories and demographics.
Blue Shield of California: Blue Shield experience indicates that the broker interest in IFP HSAs is statewide.
CIGNA: At this time, we do not offer an individual/family plan in California so we do not have information on this market.
First Horizon Msaver: We have seen growing interest throughout the state.
HSA California: We’re seeing growing interest throughout the state.
Kaiser Permanente: We are seeing demand across all geographic areas and demographics.
Sterling HSA: We know that the early baby boomer is very interested in choosing a HDHP/HSA product. Areas with high PPO concentration and lower pricing are high sales areas. The individual market has been a PPO market for some time and was the first to migrate to the HSA. Some individuals already have a HDHP and now have a tax-advantaged way to pay for medical expenses or save for retirement
UnitedHealth Group: All.

29. What problems, if any, have you encountered with HSA eligible plans?
Aetna: None
Anthem Blue Cross: Many health plans in the California market have had challenges pricing the 100% HSA plans. Anthem made pricing adjustment in 2008 and a pharmacy benefit adjustment in 2009 to reflect the actual utilization we were seeing in these 100% plans. Anthem small group also introduced new 80% plans in 2009 and the market continues to show an interest in HSA plans in all market sizes
Blue Shield of California: We have not encountered any specific issues relative to HSA-eligible plans.
CIGNA: We have not encountered problems with the administration of the HSA eligible plans. One of the challenges of introducing these plans is to educate the member on the value of the plan and the tools to become actively engaged in the management and maintenance of their own health care.
First Horizon Msaver: A common problem is the insufficient orientation of employees as to how both parts of the program (HDHP and HSA) work together. To help brokers and employers with this education process, First Horizon Msaver has added to fristhorizonmsaver.com a number of short video clips of real people telling of their first hand experiences with the program. We have also added an interactive HSA tutorial that provides a self-guided tour of HSA basics. These new features compliment existing HSA education located at firsthorizonmsaver.com.
HSA California: We haven’t encountered any problems with our benefit plan designs.
Kaiser Permanente: When there is excellent communication to the employer and employees we do not encounter problems. It is important to provide education on how the deductible plans and the HSA work together. Kaiser Permanente and our preferred financial administrator for HSAs, Wells Fargo, have developed extensive training materials and marketing collateral for brokers, employers, employees and individuals.
Sterling HSA: Some of the carriers have not priced them competitively enough and the prices were dramatically increased in 2009. Employers want to see enough of a differential in cost and deductible limits. Carriers that have priced the products most competitively are finding the greatest opportunity to sell. The carriers that get creative on the first dollar coverage will also be very attractive to people.
UnitedHealth Group: The main challenge with the HSA product is educating the consumer to take financial responsibility when receiving health services. Most consumers are used to dealing with a health insurance company or their bank. The HSA product is more than the sum of its parts; it involves educating the members and encouraging them to ask financial questions when seeking and receiving health services.

30. How has your plan changed from last year?
Anthem Blue Cross: We have enhanced our online support of resources with our banking partners BNY/Mellon (ACS/Mellon), added Rx Copay vs. Coinsurance and a variety of enhanced deductibles for our HSAs.
CIGNA: We have added enhanced decision support tools including the Health Risk Assessment CIGNA HealthCare has entered into a long-term agreement with the University of Michigan providing access to the use of analytics that help consumers and CIGNA identify and address health risks and help employers develop worksite health and wellness programs. New online coaching capability invites immediate, active participation in online behavior change modules, pushing targeted follow-up based on HRA responses.
First Horizon Msaver: Our program has
changed over the last year with the addition of:
• Broker/Employer Support Team
• Healthy Lifestyles Portal: Prescription drug discounts, prescription drug cost comparison tool, a free consumer guide to help them determine fair prices for health care services in their area, and a medical bill evaluation and negotiation service.
• Video Vault
• Interactive HSA education
• Online calculators
HSA California: There have been no changes to our plan this year. Our health plan portfolio still includes Health Net, Kaiser Permanente and Western Health Advantage,
Kaiser Permanente: We have no significant changes planned for 2010, but we are always exploring ways to make improvements to meet our customers’ needs. We have expanded member support activities including proactive outreach activities to assist with employee understanding of these programs.
Sterling HSA: Sterling HSA has seen steady growth despite the economic environment. We anticipate healthcare reform legislation may modify HSAs to some degree, but expect industry growth to continue in 2010 and beyond. Brokers have become much more knowledgeable about HSAs and are presenting it across the board to their clients. We have also seen many clients move from a multiple option program to a total replacement of their program either initially or at renewal.