bjarvis: (Brian Jarvis)
bjarvis ([personal profile] bjarvis) wrote2005-10-31 02:44 pm
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Benefits enrollment

Open enrollment has for 2006 has started at my workplace so I'm looking over the benefits which must be manually renewed, as opposed to those which automatically renew. One of the manual renewals is the amount of money to put into a medical savings account (MSA).



For the uninitiated, an MSA is a sum of pre-tax money shaved off one's paycheck which can then be used for miscellaneous expenses which aren't already covered by one's medical insurance plans (if any). I use mine for, say, co-payments on prescriptions and visits to my doctor. The downside is that any money left over in the MSA at the end of the year is forfeited to the plan provider: you had better have a very good idea of what expenses will be coming in the coming year or the tax benefit is completely lost.

At this point last year, neither my optometrist nor my dentist were participants in my office plans so I paid for them out-of-pocket, was reimbursed partially for using an out-of-network office by my medical plan and used the MSA to pay off the balance. Earlier this year, however, both my dentist and optometrist joined my plans. Instead of requiring $1300 for out-of-pocket expenses, I need only about $700. I'm now looking for places I can spend $600 on medical/dental/optical purchases by December 31 so I don't forfeit the balance.

Looking at the detailed rules of what is and is not a suitable use of my MSA, I'm struck by the inconsistency. Viagara is a legitimate expense, but Rogaine is not. Christian Science practitioners are covered, herbalists are not. Smoking cessation is covered, vitamins are not.

Basically, if it is elective and/or not on a prescription, it isn't covered, but even some items which are prescriptions would be rejected unless carefully worded & documented. Things which either help you reproduce or intentionally prevent reproduction are explicitly covered. Things which merely keep you healthy may or not be covered.

I'm sure there's a pattern in here somewhere, but it evades me still.

In any case, I may be ordering a lot of disposable contact lenses and lens solution in the next while to burn up my remaining funds. I wish I could blow this money on someone else --say, someone else's prescription-- but the rules forbid it and I can't find an elegant interpretation around them (yet).

[identity profile] unzeugmatic.livejournal.com 2005-10-31 08:44 pm (UTC)(link)
A few years ago I had to have the fillings that cover the front of my four front teeth replaced -- there are braces-resultant cavities on those teeth, and the filling material used was at that point over 25 years old and starting to disintegrate. The technology is different now, so to fix the teeth they use porcelain veneers -- a pain-in-the-butt expensive process (at the time $750/tooth), but the best thing to do according to three separate dentists (including my father, who did the first set of fillings).

I had no choice in the matter -- I needed to have the fillings replaced. But this wasn't an emergency, so I put aside the money in my health care expense account for the next year, had the procedure done early in the year, and sat out the whole year while the account built up enough for reimbursement.

And they rejected the reimbursement, because sometimes people get porcelain veneers for cosmetic reasons alone. Now, I'm used to insurance companies second-guessing my own doctors when it comes to things like what drugs I should be taking (which is something I think should be illegal and for which I think the insurance consultants making those choices IN OPPOSITION to your own doctor should be flayed alive while being given an ineffective but cheaper pain medication), since it makes them lots of money to play around with my comfort and health. But the health care money is my money, my own, taken out of my paycheck. I couldn't believe that eyeglass frames are covered while dental surgery is not.

I did eventually get the money -- it took some pretty serious letters from my dentist to do this (and I offered to provide dental xrays from 1969 showing the medical issue) -- but I was sickened by the whole thing.

The other problem I once had with this absolutely absurd mechanism (of not getting the money back if you don't use it): I once had to pay a visit to an emergency room. One of the incidental bills from that visit got lost somewhere, and was issued to me about 16 months late. By which point it was too late for me to get reimbursed from my health care account, which for that one year (and that one year only) I had put away more than I used. I felt as if the money had been stolen from me, twice.

It's a really really stupidly administered program.

[identity profile] bjarvis.livejournal.com 2005-11-01 07:27 pm (UTC)(link)
Agreed, it is a despicable practice to be forced to grovel for your own money, and the burden of documentation & justification definitely guts the utility of the system unless one is an MSA high roller. The rationalization for forfeiture (as opposed to refund or rollover) utterly escapes me.

[identity profile] billeyler.livejournal.com 2005-10-31 10:28 pm (UTC)(link)
I've opted never to use an MSA just in the same way I never escrow my utility payments. Just annoying, ESPECIALLY if you lose the excess.

I just keep $X in my savings account for those sitches.

Although I'm an accountant, the whole MSA thing is way over the top of the complexity beaker here at UNM.

And on another front, it took decades for the university to come up with an equitable short-term disability plan, since third-party insurance plans were way too expensive for that. We just donate one day of vacation a year into a fund for critical illness pay funding. You can opt out of the plan, but if you do, no short-term disability. It's so amazingly simple, and now there's enough funding to cover all the requests, as opposed to the 30% coverage there was before. Because it's so simple, I'm surprised that some entity hasn't found a way to make that illegal.

[identity profile] bjarvis.livejournal.com 2005-11-01 07:29 pm (UTC)(link)
I usually try to low-ball my MSA funds when I do my estimates to avoid the potential of forfeiture; I would have been on target if my dentist and optometrist had stayed out of my health plans. Still, despite the annoyance, the 30% bonus of using pre-tax dollars is tough to pass up.

God as my witness, I will buy enough of something to avoid forfeiting the balance.