Family Savings Plan
What is the Family Savings Plan?
The Family Savings Plan (FSP) is a way for you to save money by transitioning from your City health insurance to another employer-sponsored plan (typically your spouse’s plan). The FSP is administered by Network Health. With the Family Savings Plan, you and your family can be reimbursed for eligible out-of-pocket health care expenses (including copayments, coinsurance and deductibles) and, in some cases, premiums.
How does the Family Savings Plan work?
1. You Waive City of West Allis Plan Coverage- Coverage under the West Allis plan is waived (when enrolling in the other employer-sponsored plan).
2. You, Your Spouse, or Your Dependent(s) Enroll in Another Employer-Sponsored Plan- Anyone not enrolled in the other employer-sponsored plan (including you, your spouse, and any dependents) cannot participate in the FSP. The FSP is not available if the other employer-sponsored plan is one of the following:
- High Deductible Health Plan with active contributions to a Health Savings Account
- Medicare, Tricare, Medicaid, and COBRA
- Individual plan purchased on the Health Insurance Exchange (Marketplace)
- A stand-alone Health Reimbursement Account, not paired with a medical plan
- Short-term individual coverage
- Limited Benefit Health Plan under IRS rules
3. Use Network Health or Pro-Health Providers Under the Other Employer-Sponsored Plan - To be eligible for reimbursement under the FSP, medical services must be provided by Network Health or Pro-Health providers. Alternatively, if you live outside the Network Health service area, medical services may be received from in-network providers for the other employer-sponsored plan. Medical services are covered under the other employer’s medical plan first. Any remaining charges are covered through the FSP.
4. Get Reimbursed for Eligible Services from In-Network Providers - If you paid your provider at the time of service (for example, you pay your office visit copayment), obtain a receipt. Send your receipt with the Explanation of Benefits (EOB) to provide documentation of the service and the payment you made. If you didn’t pay at the time of service, send your EOB and the bill from your provider together. See the FSP Claim Reimbursement Form for details.
Family Savings Plan enrollees are reimbursed for all eligible copayments, coinsurance, deductibles and out-of-pocket expenses incurred using Network Health or Pro-Health providers under the other employer-sponsored medical plan, up to the maximum out-of-pocket limits established by the Affordable Care Act (ACA). Reimbursed claims are not taxable income to Family Savings Plan enrollees. The 2021 maximum reimbursement according to the ACA is $8,550 for one person and $17,100 for employee plus one or more dependent.
Frequently Asked Questions
Q: How do I enroll in the Family Savings Plan?
A: Contact Network Health by phone at (262) 825-9660 or email at FSPEnrollment@networkhealth.com to receive application materials and instructions. You will be required to submit proof of health coverage from the other employer-sponsored plan and the cost of that plan.
Q: When can I enroll in the Family Savings Plan?
A: You, your spouse, or dependents may enroll any time they are eligible to enroll in another qualified health plan, as long as each covered individual has been a member of a City health insurance plan for at least 6 months. For example, your dependents can move from a City health plan to the FSP as soon as they enroll in another employer-sponsored plan. Your dependent would receive FSP benefits, and if only you and your spouse remain on the City plan, you would pay a lower premium, as your insurance plan category would change from Family to Couple.
Q: Are there any other benefits?
A: If the other employer-sponsored plan charges a fee for adding you to the plan (such as a spousal surcharge), the City will reimburse you for that fee.
Q: How do I get a premium reimbursement?
A: If the premium on the other employer-sponsored plan is more expensive than the City’s premium, you may be eligible to receive a premium reimbursement as taxable income on your paycheck. The amount of the reimbursement depends on who enrolls in the FSP.
Full Reimbursement: If everyone on the City’s plan enrolls in the FSP (the employee or retiree and their spouse, if any, and dependent children, if any), the City will reimburse you the difference between the two premiums. For example, if the employee was paying $262.32 per month with the City and the premium for the other employer-sponsored plan is $350, the City would reimburse $87.68.
$350 (Other Plan’s Premium) - $262.32 (City’s Premium) = $87.68 Reimbursement
Partial Reimbursement: If an eligible member of your family enrolls in the FSP but you remain on the City’s plan AND you change to a lower coverage tier with the City (i.e. family coverage to couple or single coverage, or couple coverage to single coverage) you may be eligible to receive a partial reimbursement of the premium for the other employer-sponsored plan. For example, if your adult dependent enrolls in the FSP, changing your City coverage from family to couple, you can calculate your reimbursement using the following steps:
1. Calculate your premium savings
(Employee’s Old Premium Share) - (Employee’s New Premium Share) = Employee Premium Savings
Ex) $262.32 Family Premium - $179.04 Couple Premium = $83.28 Savings
2. Determine the reimbursement differential
(New Premium Share for Other Plan) - (Employee Premium Savings) = Reimbursement Differential
Ex) $150 (Adult Dependent’s New Premium) - $83.28 = $66.72
3. Get reimbursed!
In this example, you would be reimbursed $66.72 per month. Note that you cannot receive a partial premium reimbursement if you do not change to a lower coverage tier. See Network Health’s Comparison Worksheet to calculate your total potential savings by enrolling in the FSP.
Q: How do I find a Network Health or Pro-Health provider?
A: To determine if your doctor is a Network Health provider, visit the Network Health website and select “Find a Doctor”. Under “Plan Type” select “HMO/POS/EPO (I get coverage through my employer)”. Use the “Advanced Search” feature to narrow your results, then select “Search”.
You can find a Pro-Health provider by going to prohealthcare.org and selecting “Find a Provider”.
If your provider is not a Network Health or ProHealth provider, you can still choose to see them, but your out-of-pocket expenses will not be reimbursable.
If you are being treated for a complex or chronic health condition, contact the Network Health management department for help transitioning to an in-network provider by calling 800-236-0208.