I ran across a cool website today called outofpocket.com; let's call it Oop for short.  Oop is a good thing, not to be confused with Oops, a bad thing.  Oop also rhymes with something that occasionally attaches itself to the bottom of my son's shoes, which he feels compelled to bring into the house, but that's a story for another day.

Outofpocket.com is an exclamation point on consumer directed healthcare, not only because its mission is to bring transparency to the cost of medical treatment and procedures, but because it is largely driven by you and me! 

As luck would have it, the nurse from my son's school called today.  Not to tell me he had stepped in anything but that he had a sore throat.  We were advised to come get him before he spread the plague to the rest of the thousand or so students there at his school or worse, infect the nurse. 

While my wife took him to the Doc, I typed "strep throat" into the Oop website and POOF, it gave me pricing for strep throat testing in my area.  The tests ranged from $10.00 to $55.00.  Unfortunately, the locations listed were really not that near my house, so I couldn't hit the $10.00 strep test store.  But I will have an idea of whether the price of the test was good, bad or ugly.

Here's the thing.  As best I can tell, the Oop website is fairly new, and because the database is being built based on real people receiving real procedures. It is not yet extensive to the point that it has my son's Doc down the street. 

That's where the opportunity is knocking for you and me!  If we go and take a little from Oop, we should also give back a little to Oop.  We should input the pricing of our medical treatments and procedures.

Unfortunately for me, at least for the next few weeks, I can't make a deposit at the Oop bank.  Right now I do not know what the cost of the strep test was.  Even though I have a high deductible health plan (HDHP) and am on the hook for 100% of the charge I will not know what it is until my insurance company sends me a bill.  So, when it shows up I will plug the cost into outofpocket.com and join the movement.

If we all give a little bit, soon we will take a fantastic concept and turn it into a powerful and positive machine, for ourselves, our kids our parents and friends.  For sure, check it out! 

It would appear, as the DNC national convention draws to a close, The New Black Moses has come to lead the American people from their adversity and their bondage of slavery.  From the depths of the heart of darkness.  A great leader to save a people incapable of saving themselves. 

If we believe what we hear from those who create fear for the sole purpose of propagating their solution; our country is in shambles, it sits at the lowest point in our still short history, is rife with injustice and inequity.  It paints a picture of iniquity and calls it a burning Bush.

Can The New Black Moses deliver manna from Heaven?  Can he deliver healthcare like manna?  Can he deliver energy like manna?  Can he deliver jobs like manna?  Can he deliver the safety and security of his people like manna?  The promise would seem to be there.

The delivery of that promise has yet to be seen, but the Israelites had their doubts too.  That said, they were willing to wander for 40 years and you can be darned sure, they had neither high deductible health plans (HDHPs), nor health savings accounts (HSAs).

With all respect, due or not, I prefer the original Black Moses.  He really was a voice of social change at a time of true social and political injustice.  He was a man who rose from poverty to become a voice and a symbol.  A man who wore chains on his back as a symbol of the bondage of his ancestry and the promise of a better life.  A man whose voice and deeds supported human rights of people not only at home but around the world.

To Obama: The New Black Moses, I say, good luck with that. 

Who knows what his legacy will be, but in the meantime, we can enjoy the legacy of the original Black Moses.

Still hot.  Still buttery.

For those folks glued to this blog to learn about the whole ‘Grab Bag' thing, fear not.  For as best we can tell it pretty much goes into perpetuity.  However, it is definitely time for the staff at Gradock to take a break and cover some other ground.

It is hard to believe it's been almost a year since we plunged into the world of high deductible health plans (HDHPs) and health savings accounts (HSAs).  And brothers and sisters have we learned a lot.  If you were around to read this blog a year ago you might recall the Alice and Wonderland-like journey through the land of insurance and specifically HDHPs.  There were (and are) some amusing articles written about that little journey, the highlights of which are found in Hold the Lettuce   and Hold the Pickles (click on either link for your entercational  pleasure) both located on the HSAeducator.com website.

As luck would have it, we ended up not being real happy with our high deductible health plan because it said one thing, it actually did another.  Apparently accountability does not really apply to insurance companies when they seemingly make errors.  But one thing positive I can say is that it had great well care that covered our physicals this year.  Well care is a benefit can be found in a number of HDHP products.

So my wife still thinks I am too stupid to lead the process of finding a new plan.  She has taken this bull(ship) by the horns, sharpened her profanity skills, and thrown both feet and the rest of her body into the process.

Since last year we met this guy, whom we have mentioned in a couple of blogs before, named Scott Borden, a.k.a. "My HSA Guy."   Scott is hugely knowledgeable about health insurance and understands the ins and outs of HSAs, so I suggested that my wife give him a buzz.  Which amazingly, she did.

Anyway, she and Scott are big ole buds now, and after some consultation he set her down the path of a different HDHP policy from a different insurance carrier.   The new policy, if we are approved, should serve our families needs better than the one we have right now.

We'll do a "The Good, The Bad, and The Ugly" on our current and new plans here in the near future, but I want to offer up a small piece of advice to anyone who is either smart enough to allow their significant other to figure out their insurance, or to anyone who feels like brilliance is their own and wants to do it themselves. 

At such time you get ready to fill out the application, you will likely find it to be a lengthy and formidable form.  If you fill it out online, it is not good enough to merely save it in the in the software that is serving it up (the insurance company's).

My wife, after spending over an hour with the form (maybe more) filling medical history from the past ten years, hit "save" multiple times.  The next day, when she went back to work on it some more, "poof" it was gone.

Hell hath no fury like that of a woman who has filled out an encyclopedia of family medical history only to have it disregarded like a pair of old shoes.

So for goodness sakes print off a hard copy of all your hard work.  Save a copy on your hard drive if you can.  Do whatever it takes to keep from completely losing it.  Sounds ridiculous, I know, but fill out those forms one time, and you'll never want to do it again.

Some of these questions that are addressed in the Grab Bag seem so unlikely, one just has to wonder how many times the question has been asked.  That said, apparently they have been asked and so we'll share the answers.  They just seem very strange as it were.

But first, in the hair department, if you thought previous editions of The Gradock Bulletin focusing on haircuts were strange, check out this video.  Now that is strange! 

With out venturing into politics today, can I just say, we should be grateful for our many blessings.

OK, back to business here.  Say you and your wife are covered under a High Deductible Health Plan that has a family deductible, and for some kooky reason, half way through the year your spouse comes off your plan and is covered under another leaving you with an individual deductible on your HDHP.  

First:  Are you no longer eligible for and HSA?  Answer: The mere changing from Family to Individual does not disqualify you.

Second:  You both had had medical expenses that were applying toward the deductible that in total exceed your new individual deductible.  Can you consider your deductible met?  And if not, how do you apply expenses incurred between the both of you to the new deductible. 

You can come at it one of two ways.  First is to subtract your spouse's medical expenses from the total and whatever is left (your expenses) apply to the deductible.  The other method is to add the two amounts up, divide them by two and apply that to your new deductible.   

If, however, your spouse goes onto COBRA under the HDHP, all bets are off and you must comply with the requirements of Question and Answer #2 of Document 54.4980B-5, which, of course is not included in the ‘Grab Bag'.  We took the liberty of looking up that specific IRS document and not only can you read the full text if you feel so inclined, we'll take a stab at making a sweeping overview of the three-page document that it is.

Please note, this is just a stab.  "Stab" being defined in this instance as a moderately educated guess.  Please, if this sounds like your specific situation, please consult with your benefits department, your insurance agent, your attorney and your palm reader.  Between the four of them, I'm sure it will become just as clear as yesterday.

With the above disclaimer now in place, basically, the general rule of thumb is that whatever your spouse incurred against the deductible prior to COBRA kicking in is what they get credit for against the COBRA deductible for the year. This sounds all well and good, but in reality, your situation will probably just different enough to make you think you are looking to hit a hanging curveball.

Good luck, God bless, and do your homework if you should you find this question applies to you.

And the answer is......maybe.  Sorry, black and whiters, that's just the way it is.

It depends on the type of free or in this case, discounted care you receive.  So as an example if your employer has a clinic where you can go for a flu shot, or say get your allergy shots, or maybe to get an aspirin when you have a headache, or maybe to have a wart looked at or maybe get some antiseptic and a bandaid if you cut yourself opening a box or something you would still be eligible for an HSA.

On the other hand if you work at say, a hospital, and you get your medical care for free or at a deep discount, sorry Charlie (or Charlene) No HSA For You!! 

Sorry, couldn't resist.

So if this is your first exposure to the Gradock Bulletin's  ‘Grab Bag Series' you are kind of jumping into the middle of the game.   No problem with that but you may want to go back and read the first one or two in the series that started this little snowball (and it's still fairly little right now) down the hill.

Also, if you read this on a fairly regularly basis you might be used to a bit more humor (or attempts at it anyway) than has been injected into some of the more recent articles.   That said, we may have to make some detours away from the ‘Grab Bag' along the way.  Otherwise we may go totally insane here at Grab Bag Central.  For what it's worth, we'll do our best at spicing up this latest and highly gripping notice from your IRS and US Treasury.

If you want the full report got to IRS Notice 2008-59 attempt to read it, then come back here for the Cliffs Notes translations.

Ok, now that we've got all that out of the way let's take a look at another goodie from the grab bag.

How about Medicare Part D?  If you are eligible for Medicare part D (or any Medicare benefit for that matter) but not enrolled, fear not, you are still HSA eligible.  That said, if in any month you do enroll (in Medicare), you become ineligible.

Now this next one is a little wacky to me as it outlines a scenario, I would have never contemplated on my own. If an individual has an HDHP/HSA qualifying plan but then has insurance on top of that whereby the deductible exceeds that of the HDHP plan, does the second plan disqualify the first plan in terms of HSA eligibility?

Huh?  Here's the deal. If say you have an HDHP plan with a $ 1 million lifetime limit and then picked up a second plan with a $1 million deductible with a $2 million lifetime maximum benefit, that second plan would not disqualify you from HSA eligibility.

Breathtaking stuff, no?

 It's "T" minus two days and counting; then my kids go back to school.  My son is doing that "I'm sooooooo bored, there's nothing to doooooooooo" routine that I am pretty sure all kids under the age of about 15 perpetrate for the sole purpose of driving their parents nuts.  The "go read a book," recommendation went over about as well as his sister pulling his hair or him twisting his ankle on his way to the pantry for the eighth time today, and the 4,623^rd time this summer to see if there is anything "good" in there for him to graze upon.  Amazingly, there are still no Snickers, Hershey Bars, anything from the Keebler Elves, or from the chocolate fairy, staring out him.  As you might imagine, these really are the only items in the pantry that would meet his needs and qualify as "good."

I kind of know how he feels as honestly, this whole HSA  ‘Grab Bag‘ series has been fairly mind numbing for me too.   And why isn't there a chocolate Fairy?

While seeking inspiration for this article I had my TV on mute with the Olympics on.  I had one eye fixed on the set and the other staring absently at my computer screen when my son landed on the couch next to me.  In a fleeting moment of "inspiration" the following words spouted from my mouth,

"You are welcome to watch the Games with me,

But there's one thing you can not do;

 that's sit here and complain.

‘Cause if you do,

you're going

to drive me

out of my mind insane."

Now I wouldn't go so far as to call that poetry, but I humored myself and seemed a bit less dry than the Health Savings Account Grab Bag.

But alas (is that Shakespearian?), I suppose, a nugget from the Grab Bag is in order so let's grab another.  How about eligibility of individuals receiving benefits from the VA?

No doubt, the burning question on the tip of thousands of readers' tongues, or at least one somewhere.  Otherwise the ‘Grab Bag' folks wouldn't have come up with an answer to the question....or maybe they would have.

Here's the scoop, generally individuals receiving VA benefits in the past three months are not HSA eligible.  However, if the covered individual's medical benefits consisted only of preventative care or disregarded coverage then the individual is in luck.

So if you have an HDHP through work and your employer is paying you back before you meet the deductible, you may NOT be qualified to contribute to a health savings account (HSA). 

Now that pretty much smells like skunk but here's the deal. There are some things that your employer may be able to pay for like preventative care or what is called "disregarded coverage" (things your health plan wouldn't pay for anyway). 

Of course it's ok for your employer to contribute to your HSA and you can pay for those expenses under the deductible with those funds, but when they start reimbursing you outside of the HSA, that's when things get squirrely.

For sure, if you have a high deductible health plan (HDHP), by all means, you want to be sure you are able to have an HSA too.  If you have any questions about things that might disqualify you from being able to open or contribute to an HSA be sure to consult with a good insurance agent or your company's benefits department.

Here's one from the grab bag that if it sounds like something that applies to you, we recommend you go do a little bit of research (talk to your insurance agent).

One pretty smart way to give yourself some added coverage for specific health issues is to look at supplemental plans that will pay for things regardless of if you have hit your HDHP deductible.  One form of these are Mini Med Plans, which can cover a range of things from help with hospital stays, to ambulance rides, to doctor's visits.

For certain types of events, these plans can live harmoniously with HDHPS and HSAs, but there are some plans that could actually disqualify your ability to contribute to your HSA.  That would be a wicked bad day and should be avoided.

If your insurance agent is well informed about Health Savings Accounts, they can steer you toward the good stuff and away from the bad.

This might be a good forum topic for the forum on this site.  Feel free to get some discussion going.  Click here for the shortcut.

 So what if you are covered by an HRA (health reimbursement arrangement) that can be used to pay for dental, vision, and preventative and also pay for or reimburse you for your employer sponsored High Deductible Health Plan (HDHP) premiums.  Does this situation disqualify you from being eligible for an HSA? 

And the answer is.......Nope.

Piece of cake huh?  If this has been the burning question keeping you up at night, note that the qualifications are fairly specific and you should know that the IRS has provided other guidance on HRAs that might apply to your situation you should check out.  (IRS Notice 2008-59)