Members

The deposit

The amount we deposit into your medical savings account is prorated based on when your enrollment begins. If you’re enrolling during the calendar year, the prorated deposit amount(opens in new window) is deposited into your account the first month your coverage begins. Otherwise, the full annual deposit amount is deposited into your medical savings account once at the beginning of the calendar year.

If you leave the plan before the end of the plan year, you will need to pay part of the most recently deposited amount back to us. See more specifics under the Manage Your Savings Account section.

The deductible

A deductible is a specific amount that you must pay before an insurer pays a claim. With the MSA plan, you do not pay a monthly premium to us, but your plan coverage does not begin until you meet your deductible.

It is important that claims are submitted to us, even if you know you haven’t yet reached your deductible, so we can help track your progress toward the deductible.

Each of our plans, or plan benefit packages, has a different deductible amount. Your specific plan benefit package, or PBP, number is located on your Lasso Healthcare MSA Member ID card. PBP 001(Growth MSA) = $5,000. PBP 004 (Growth Plus MSA) = $8,000.

You can use the funds we deposit into your medical savings account to help pay your way to meeting the deductible. As the plan deductible is greater than the amount deposited into your savings account, you will need to pay out-of-pocket before we begin paying for additional Medicare-covered services. The difference between the deductible and the deposit amount is called the “Member Responsibility” amount. PBP 001 (Growth MSA) = $3,000 and PBP 004 (Growth Plus MSA) = $5,000.

Until you meet your plan deductible, you pay up to 100% of the Medicare-approved amount for Medicare-covered services of inpatient hospital coverage, outpatient hospital coverage, primary and specialist doctor visits, preventive care, emergency care, urgent care, diagnostic labs and imaging, hearing services, dental services, vision services, mental health services, skilled nursing facility, physical therapy, ambulance, transportation and Medicare Part B drugs.

Only Medicare-covered healthcare expenses count toward your plan deductible. It doesn’t matter if you paid for those expenses with your MSA funds, out-of-pocket or a combination of both. See the Evidence of Coverage on the Documents tab, for more information on what expenses Medicare covers. You can also find many expenses covered by Medicare in the Medicare and You handbook(opens in new window) or at https://www.medicare.gov/coverage/is-your-test-item-or-service-covered(opens in new window). Neither MSA funds nor out-of-pocket funds spent on non-Medicare-covered expenses count toward your plan deductible.

Once you reach your plan deductible, we will pay 100% of any additional Medicare-covered expense you incur. Any non-Medicare-covered expenses remain your responsibility to pay for, even after you meet the plan deductible.

Enrollment and disenrollment

Enrollment in the MSA is generally for the entire year. Annual Election Period (AEP) and Initial Coverage Election Period (ICEP) are the only two times you can enroll into an MSA plan.

If you qualify for one of the limited special circumstances to disenroll during the year, you will need to pay part of the most recently deposited amount back to us.

Disenrollment is limited to the Annual Election Period (AEP) from October 15 through December 7 each year, if you permanently leave the plan’s service area, or if you no longer meet the qualifications for an MSA plan. Information on rights and responsibilities upon disenrollment can be found on the Documents tab.

Prescription drugs and other non-Medicare-covered expenses

MSA plans are prohibited from offering prescription coverage. You are able to enroll in any stand-alone Medicare Prescription Drug Plan (PDP) offered in your service area. While you cannot use your MSA funds to pay for your PDP premium without incurring tax and penalties, you can use the funds tax and penalty-free to pay for your Part D deductible, copays, and coinsurances. MSA funds used for these types of expenses do not count toward your MSA plan deductible.

CMS regulations prohibit you from obtaining or using other insurance that covers Medicare-covered expenses. However, you can purchase additional limited benefit policies for expenses not covered by Medicare such as vision, dental, long-term care and more. While you cannot use your MSA funds to pay for those supplemental plan premiums (except for long-term care policies) without incurring tax and penalties, you can use the funds tax and penalty-free to pay for any plan deductibles, copays, or coinsurances. MSA funds used for these types of expenses do not count toward your MSA plan deductible.

Prior authorizations and referrals

Prior authorizations and/or physician referrals are not required with the Lasso Healthcare MSA.

Coverage decisions, appeals and grievances

As a member, you have the right to request decisions about your coverage or appeal decisions you disagree with and/or file complaints/grievances. See the Coverage Decisions, Appeals, & Complaints section for further information.