Open Enrollment - Health Plan

[Auto-generated.] morning everyone, and welcome today's overview of Cornell's 2026 open enrollment. I'm Melanie Walker. As Amanda said, I am the, Aetna plan sponsor liaison for Cornell University. Today's meeting is intended to provide you with all the necessary information you're going to need to make an informed decision regarding your 2026 benefits. During this meeting, we will review the OIE time period. What's changing for 2026? Highlighting, the endowed plans, new and existing programs and where you can go for help throughout the open enrollment period. Open enrollment this year begins on October 27th and will run through November 14th. If you're happy with your current election, then no action is necessary from you. However, if you would like to make changes, this is of course, the time to do so. During open enrollment, you can enroll in the endowed health plans, change, change plans, add or remove any dependents. And to do that, please visit the website that's on this slide which is the HR cornell.edu backslash enroll. And this is the website that you would use to make any changes. Change plans. Add or drop any dependents. So let's go over the endowed health plans. let's go. over a few of the common insurance terms that you may or may not be familiar with. Claims they are your formal request to pay for the medical services that you received. An explanation of benefits, or more commonly called an EOB, shows a breakdown of how Aetna processes your claims, your plan, year, follows the normal calendar year January through December, and then the accumulators they refer to where we refer to them. This is where your deductible, your coinsurance and your out-of-pocket maximums, are tracked throughout the calendar year. Coordination of benefits, or most commonly called Cob, is the process of determining what insurance carrier pays first. When a member has more than one plan. Common terms regarding payment. Deductible. This is the amount that you pay before the plan begins to pay. Cost sharing. Or sometimes it's called co-insurance. Once you meet your deductible, you share the cost with the plan, either with coinsurance or a copay. Coinsurance is a fixed percentage, and a copay is a fixed dollar amount, and the out-of-pocket maximum is the maximum that you would pay out of year out of your pocket each year. For covered services. Once you hit that value, the plan then covers at 100%. There are three core now plans available. The first one is the Cornell Program for Healthy Living, or more commonly known as the CPR, for the Weill Cornell PPO and the High Deductible Health Plan with an HSA or a health savings account attached. This chart outlines high level in and out of network differences for each plan, for all plans except the high deductible. The deductible maximum out-of-pocket limit. Copayments and prescriptions, and coinsurance are all staying the same, so there are no changes to the, There are no changes to the wild Cornell, and the only change with the high deductible plan is there will be an increase in the deductible amount. All plans include prescription drug coverage through Optumrx, which is covered under a different pharmacy ID card. A few of the differences with the plans. The CP gel program includes an optional fitness discount at your local YMCA, Island Health and Fitness, or at Cornell Wellness CPA membership. The Weill Cornell PPO plan includes an enhanced tier one benefit, which provides access to you while Cornell physicians who otherwise do not participate with Aetna. However, you do still have full access to Aetna's nationwide providers, including those while physicians who accept Aetna and non Aetna participating providers and the HP plan generally, covers preventive care at 100% without needing to meet your deductible. If you enroll in the high deductible plan, please remember if it's you and a dependent on the plan, you pay the full $3,400 deductible. If it's just an individual on the plan, then it's the $1,700 deductible. After you satisfy the deductible on the high deductible plan, you then, will be paying or the plan would be paying. Excuse me, 90% for in-network services. With the Aetna Choice POS two plan. You can access any physician, hospital or other health care provider worldwide that's both in and out of network for covered services and supplies under the plan. You'll pay less when seeking care through an Aetna participating network provider, typically a copayment. Or if you're in the high deductible plan. Again, the deductible is required before reimbursement from the plan. If your current provider is not part of the Aetna network. You may be requested to pay up front and then submit the claim to Aetna for reimbursement. The reimbursement is less than in-network. You can, contact an Aetna Health concierge to review your options, including inviting your out-of-network provider to join our network or using your out-of-network benefits. If you expect to have out-of-pocket expenses after insurance, you could enroll in the health Care Flexible Spending account. Now, during the open enrollment, season and those if you're enrolling in the flex spending for January 1st, that account would be eligible for expenses incurred in in 2026. This slide, is showing you the different plan offerings and savings when you're using a participating wild Cornell provider. These providers are identified on our member website with the blue P. So as all three plans have in network access to Aetna's, nationwide provider network, the wild Cornell PPO plan does have that expanded access to the Weill Cornell Physicians located in New York City. And to find those providers, you would want to log on to, aetna.com and the providers, you'll of course see the at in-network providers, which will show this in-network icon. And then the Weill Cornell providers will show with this blue P the employer preferred network. And it will also tell you it is the maximum savings that this provider provides, maximum savings to you. Those providers are part of the Weill Cornell Expanded Network. When utilizing your Aetna member website, you can find care by selecting Find Care and Pricing from your members, the landing page on your member website. It will automatically default to your home address. For example, Ithaca, New York. But you can change that to a different location in the United States. When searching, you have multiple options of searching by the physician or facility name, by conditions such as diabetes specialty, or the service that you're looking for. The result of your search will provide you with participating providers within your plan.

Telehealth. All three plan options offer telehealth coverage for the high deductible health plan, you would need to satisfy the deductible before the plan will start to share in the cost for service. The plans also offer a virtual options through our through Teladoc, which provides 24 seven non-emergency care at the in-network level. Additionally, you can utilize Minuteclinic virtual care for, again, non-emergency care at the in-network level. Both providers, along with telemedicine, allow you to access care that is convenient for your needs. If you're registered, for our Aetna member website and if you're not, we highly recommend that you do register for the Aetna member website. You're able to search for quick care and virtual care, the many options that you have available to you, you can connect with multiple different providers from the website. Or if you're not registered, you can always contact the Aetna Concierge team. And they would be happy to help you, connect with either virtual or in-person care. So what is changing in 2026? Not much. So under the, CPA channel plan, there's no changes for 2026. Your deductible, your co-pays, and your coinsurance is remaining the same for next year. Same with the Weill Cornell PPO plan. No changes. The Aetna high deductible plan with an HSA. Very small change, and that is an increase to both the individual and family deductible. The increase for an individual plan is 1700 from 1650. This year and next year. Under the family plan, it will be 3400, which is an increase from 3300. And these these increases are due to the IRS guidelines changing for next year. In addition to the deductible increasing, this also allows you to add a little extra money to your HSA. The contributions are also increasing for 2026 for an individual plan, you can now, excuse me, you can contribute up to $4,400. And for the family plan, you can contribute up to 8750 for next year, 8750. But the copay, excuse me, coinsurance and your maximum out-of-pocket amounts will stay the same for next year with the Aetna High Deductible Health Plan. hinge health is a great program. It offers access to a virtual support at no additional cost to help you reduce everyday joint and muscle aches. Recovering from an injury or just improving your mobility and strength? You will receive customized exercise programs that address your needs, your specific needs, and to be eligible for the program, you must be an endowed faculty, staff, or a dependent eight age 18 plus and enrolled in the at the medical plan through Cornell University. If you're interested in services through Hinge Health, you can, visit their website, which is Hinge Health, backslash, Cornell University Dash, enroll and fill out the application. From there, you'll get a welcome message with the next steps on how to start your program with Hinge Health.

Where to go when you have questions? Well, we are here for you. You can outreach to your Aetna concierge team by calling the number that's on your ID card. We also have the number up here for you, (877) 371-2007. Or log on to your Aetna member website. When you log on, you can either chat live, chat with a concierge representative, or email our concierge team as well. When you reach out to the Aetna Concierge team, you receive personalized support on how to find providers, what's covered under your plan, how to submit a claim, and all the available services that are available to you. They can also get you connected to the 24 hour nurse line. Should you have any medical questions about upcoming visits, or just questions following a visit. As mentioned, the 24 hour Nurse line, you can reach one of our nurses by calling them directly. You can reach them 24 seven at (800) 556-1555, or you could reach out to our concierge to get you connected with them as well. Additionally, the 24 hour nurse line, their phone number is on your Aetna ID card. The nurse line is there to support you by answering questions you have about your health care decisions. Unfortunately, they are not going to diagnose or treat a condition, but they will offer you the support to navigate the health care system and answer the questions that you need and and address the concerns that you have. our website, you can visit@aetna.com to log in or to register, to create an account specifically for you. You can also access or download our app by texting Aetna to 90156. You can also scan the QR code that is on the screen here for you today. And that will, download the Aetna Health app for you. you can access your digital ID card anytime on the Aetna member website or the health app. You can request a replacement ID card to be mailed to your home address if you track where you can track. Excuse me, you can track where you are with your deductible and your out-of-pocket amount on the website. Can search for in-network providers or facilities. You can request appointments with virtual providers, and on our website, you can file and submit medical claims directly online to Aetna for processing. And first I want to just thank you for joining today. And don't forget the open enrollment period runs from October 27th through November 14th.

[Auto-generated.] My name is Mike Cruz. I am the strategic account executive with Optima RCS here, and we manage the benefits for, the Cornell University endowed plan. And I'm going to spend, little, a little bit of time with you today talking about pharmacy and, and how it relates to your, your benefit plans.

So on the first page, just, briefly, just wanted to touch on the fact that at Optima, our mission is to, you

know, help people live healthier lives and helping make the health system work for everyone.

As I mentioned before, we are we are the farm pharmacy benefits manager for Cornell University. So if you ever hear that, acronym PBM, that's what the PBM acronym stands for.

It's the pharmacy benefit manager. So Cornell University has a self-insured health care plan. And we manage the pharmacy benefits for that plan.

I want to take just a second and and share with you, the agenda that we've laid out for you today.

And, and essentially this agenda is to help you understand how the pharmacy benefits work. And sometimes that can be, daunting, especially if you're someone who doesn't use your pharmacy benefits a lot. But the most important thing I can tell you at the outset is always, always, always remember your ID card that you receive, will have your pharmacy information on it and that, identification card that you receive, your Optumrx X identification card will have all of the information that your doctor and your pharmacy will need.

And so I'll talk about that throughout the course of the presentation. But I just want to help keep that in mind for you. So what I'll do is for those of you who haven't used the pharmacy benefits a lot, I'll emphasize the fact that, you know, I want you to understand how to use the benefits. And number one, we'll talk about the formulary and what the formulary is.

We'll talk about what your costs are as a Cornell University plan member. I'll also talk to you about how to find a pharmacy, how to use your identification card in finding that pharmacy.

I'll tell you a little bit about our home delivery and customer service, and we'll spend some time in the customer service section talking about our online tools and some of the self-service tools that we have available to you as a plan member.

So first and foremost,

I just wanted to mention, you know, a little bit about formulary and what it means to have a formulary. So,

for prescription benefits, the formulary is basically just a covered list of medications. So when you talk about, formulary, what that means to a plan member is that these are the medications that are covered under the plan.

Both brands and generics are included in that formulary. And so the way the formulary works is each of the medications that are covered under the formulary are assigned what we call a tier. So there's a tier one, there's a tier two and there's a tier three. And all of those tiers associate with your plans copay. And I'll share a little bit more about that with you in just a moment.

But basically the formulary is a covered list of medications that you will use. How do you use the formulary? Well, the formulary can be found um@optumrx.com. And the most are the, the most ideal or the, the, the best way to use the formulary is for you to create an account at Optumrx RCom on the portal, and that will allow you to use the formulary by searching for a prescription drug within the within the portal and as we get further into the presentation this morning, I'll show you how that works.

But you can see on the screen that I'm showing, just a just a snapshot of what it looks like on our mobile app, where you can see how the medications are listed in the formulary.

The next part of the formulary is understanding your cost. So when the when the doctor prescribes a medication that's on the formulary, I mentioned that it's going to fall into one of those drug tiers that you have.

So you can see here on tier one those are your lower cost products. Tier two are mid-range costs. And then tier three are your higher cost. So your particular co-pays are going to associate with each one of those tier levels. So if you take a 30 day supply of a medication at a tier one level, it's going to cost you $5 at the pharmacy.

For tier two, it'll cost you $30 at the pharmacy. And the tier threes will cost you $50. And then if you expand those out and you get, the longer days supply of the medication, your $5 terms and the $10. So the benefit of getting a longer day supply is that you pay only two times the copay. So your $5 terms, the $10, your $30 to $60 for tier two, and then $50 to $90 for tier three.

The one really valuable thing that I'll tell you about your Cornell University benefit plan is that these co-pays have been the same. They're the same this year as they were last year. So there's no change to the co-pays that you pay.

So a few common questions that people will ask when it relates to, formulary and coverage as far as pharmacy benefits go. Number one, will my medication be covered? Well, I'll tell you this. Our formulary covers thousands and thousands of medications and all of those medications are broken down into specific, disease categories. And so for any particular, circumstance that you may be prescribed a medication for, there are medications that will cover, that will cover that will be covered under the formulary.

So the way that you check the formulary is like I said earlier, you can set up your own account on the Optumrx portal, which I'll walk you through, momentarily. Or you can certainly call our our dedicated customer service line as well. That customer service line will be on your identification card. And it's also listed here in the packet that the Cornell University, human resources team will share with you.

Why could my medication cost or coverage change? I'll share with you just briefly why that may happen. So within within, the course of a plan year, there are medications that are added to the formulary and there are medications that are taken away. We only make, we only make formulary modifications twice a year as it relates to medications being removed from the from the formulary.

But during the course of the year, at any time a medication is can be added to the formulary. So the most up to date, formulary guide is going to be the one that we'll have online because it's it's fluid, it changes a lot. But the reason why medications may be taken away. So like I said, that only happens twice a year.

We make formulary changes on January 1st or July 1st.

we take it very seriously from a formulary perspective to make sure that, our plan members always have access to what we would consider that are the lowest net cost that's out there for medication. So what what the plan cost is from a formulary perspective is what is the, of the utmost importance to optumrx to make sure that we're always passing along the most affordable product to you.

So the reason why, formulary products may change is because of that very reason. We also, utilize a, a board of professionals who are not associated with Optumrx to make formulary decisions. And they base those decisions solely on, cost and the clinical efficacy of the products, because we want to make sure that you have access to, the most, affordable products that are out there and also the safest products that are out there.

You can see that some of the notes that I, that I have in here, which, which are part of the medication cost or change, medications might move to a different tier. So if the cost of a medication changes or if you know the, the nature of the medication changes, it may move from a tier two to a tier three or a tier one to a tier two. Medications may no longer be covered. I talked about that. And and in some cases you may be required to get a prior authorization for a medication depending upon what that medication covers. Because depending upon what, the nature of the medication is, there may be some requirements that, you have to meet in order to obtain that medication. the last question here mentions if I take a medication routinely, how soon am I eligible to refill? We thought that was an important, point to talk about today. And I just wanted to share with you that there are what we call refill windows that are open to you. So if you take a if you take a medication on a regular basis, once you've once you filled your 30 day supply, after you've had the medication for 23 days, you can go back and get the next fill. So you can, let the pharmacy know that your next refill, can be filled after that 23rd day. And in most cases, the pharmacies will be aware of this and they'll they'll let you know. But I just wanted to make sure that you understood that because that refill window is open after the 23rd day on a 30 day supply, in the case of a 90 day supply, after the 68th day of the fill, you can you can go ahead and work with the pharmacy to fill your prescription. Again. So the opposite is true. If you try to fill those medications before the 23rd day or before the 68th day, in the case of 90 day supply, you will get a denial at the point of sale. And the reason would be because you're not allowed to refill those medications before those time limits are available. So the first section was about formulary and cost. So hopefully that was a good description on how you use the formulary and what the costs are for the plan.

The next thing that you may be thinking about, if you're just taking a prescription for the first time, is what pharmacy can I use? And the great thing about the partnership that Cornell University has with Optumrx is that really, essentially it boils down to the fact that you can basically use any pharmacy that you want. We do have a very large, robust retail network. Our retail network has over 65,000 locations that are that are that are what we would consider, network pharmacies. You can see some of the names here, but I'll share with you on the next page, some of the other, some of the names as well. But Walgreens, Wegmans, Walmart, CVS, tops, Rite Aid, Kinney Drugs, all of these, pharmacies are part of the Optumrx network. But if you have any questions about any particular pharmacy that you want to use that's not mentioned here, you know, feel free to reach out to the Optumrx customer service team or just by going online and to the Optumrx portal, as I mentioned. And you can find out if the pharmacy is a network in most cases it will be because the network is very robust. In addition to that, the Cornell Health Pharmacy, is is a network pharmacy that you can use and take advantage of as a Cornell employee. Optumrx also has two pharmacies that we manage. Those pharmacies are the Optum Home Delivery Pharmacy and the Optum Specialty Pharmacy. I'll talk to you a little bit about specialty pharmacy later on in the presentation. But both of those pharmacies are available for you to use for you to use as well. The Optum Home Delivery Pharmacy is what you would commonly referred to as mail order. And I'll talk to you about the benefits of using mail order. Here you can see a map of, United States with just a list of the medication or the pharmacies that are available to you for you to use and network. And so you can see in those, in those green, in the dark green, and then the light colored green, which are both up in the northeast part of the United States. There is a lot, there's a lot of concentration of network pharmacies in those areas. So as I mentioned before, Kenny Drugs and CVS and Walmart, tops. Pharmacy, Safeway, Walgreens, Hy-Vee, Publix, Wegmans, these are all these are all network pharmacies that you have access to be able to use. So essentially, at the end of the day, you can make the decision as the consumer where you would like to fill your medications. But I will tell you that you do get, a little bit of an advantage by getting a 90 day supply through either Cornell Health Pharmacy or through the Optum Home Delivery pharmacy. the next page mentions that very fact.

So may I pick up a prescription at Cornell Health Pharmacy? Yes. You can get up to a 90 day supply of covered medications at Cornell Health. And you all you have to do is ask your clinician to prescribe your 90 day prescription to the Cornell Health pharmacy. And, once that's been sent there, you can you can pick it up or call the Cornell Health Pharmacy to arrange, that pick up. So next, I'll just tell you briefly about Optum home delivery. I mentioned before that Optum home delivery is also referred to as mail order. Right. So in some cases people really like the option to have medications shipped to their home. And the true benefit that I mentioned earlier as part of your Cornell health plan is that by getting a 90 day supply of medication, you can you can save on a co-pay. So instead of a $5 copay over three months, costing you $15, if you have a tier one medication that will only cost you $10 if you use the the 90 day supply. So, there are several ways that you can sign up for a mail order and that is online at Optum RCom by creating an account there. We also have the mobile app, which I'll share with you as well in a moment. Or you can simply just call the the Cornell dedicated customer service line that we have and talk to our customer service agent. And, you know, of course, when you're at the doctor's office and the doctor ask which pharmacy that you would like to use for your medication, if you just let them know that you'd like to use the optimal home delivery pharmacy, they can prescribe that pharmacy directly to us. one of the true benefits of, home delivery that I mentioned to you is that you're able to get, two times the copay, which basically saves one of the copays on a 90 day supply. The other is that Optumrx, provides free standard shipping, you know, so with any of the medications that are part of that, part of that, delivery process, they will be, shipped free to your home. I already mentioned to you that some of the ways that you can get a prescription ordered to home delivery is ask your provider to send the prescription there. You can go to Optum RCom and set up an account with our home delivery to be able to transfer your prescription. There. And then one of the questions that people will ask is, what's the time frame is it does it take longer for, prescription to come from home delivery? No. What happens is, what happens is you will get an email reminder when it's about ten days away from your medication fill, and then it happens on an automatic basis. So we used to call it hassle free. So it's really hassle free once you establish your medication with home delivery, it happens automatically every month that you get a notification from the home delivery pharmacy that your medications about the ship, and then it arrives to you, within the window that I talked about earlier. Once the medications available.

So one of the things that I also wanted to mention that, in 2026, if you do use our home delivery pharmacy or our specialty pharmacy, you'll have access to a new copay card incentive program for Cornell University members. So, if you do take a medication that, that you're, using home delivery or Optum specialty for when you filled your medication for the first time in 2026. Depending upon if the medication is eligible for the coupon card program, one of the representatives will let you know about that. If you have any questions about that program as well, you can also reach out to the Cornell dedicated customer service line. And I mentioned our optimum specialty pharmacy. This really applies to a lesser number of people, in total on the plan, because specialty medications are prescribed to treat rare and complex health decisions. Should you be in this situation where you are requiring a specialty medication? all that has to happen is for the doctor to send that prescription to the Optum specialty pharmacy. And then one of our patient care coordinators will talk to you about how to use the medication. Those medications will be shipped to you. And, our Optum specialty pharmacy has a fantastic customer service department that's available 24 hours a day, seven days a week.

So I want to take just a couple of minutes and talk to you about customer service. And as part of our customer service section, I also want to walk you through some of the self-service tools that are available to you as a corner. Cornell University Plan member. in general, our customer service unit is available to you 24 hours a day, seven days a week. You have a dedicated phone number. I mentioned to you that dedicated phone number is on your identification card. It is (866) 533-6977. It'll be in these materials that the Cornell Human Resources team will share with you as well. But the best place to find that is on your identification card, because if you use Google and you just, pull up, generic Optima customer service number, you may or may not get into the Cornell dedicated line. So it's important for you to use your dedicated, customer service number for optimum. member portal has a lot of self-service tools. And I mentioned that to you. A moment ago. And so when you think about cost or when you think about network pharmacies or when you think about really just price comparisons in general, a lot of these things can be done right on the Optima portal without having to call customer service. You can do this yourself. So I'm going to walk through some of that with you right off to Ma X.com. And the difference between what I meant, what I refer to as the portal and the app is really the functionality between what you can do, like on your laptop, at home, on the Optima X.com portal, or using a smartphone. You can download the Optima dot com application and within the application, there certainly are a number of things that you can do, but the the service features are a little bit different and you can get a little bit of expanded, a little bit of expanded features within the portal itself. So you can see here on this slide, it just mentions what I was talking to you about before. In the middle of the page, you can see kind of an example of what the Optima mobile app looks like. And then off to the sides you can see what the portal looks like. And I'm going to get into that a little bit more. So this is an example of what the portal ribbon looks like. So when you log in to Optima X.com on on your laptop at home, you'll have a ribbon that comes across the top of the screen. And it will it will give you, quick actions, my prescriptions, order, status, member tools. You can really, take advantage of a lot of things, but some of the top functions that members do on the digital platform is to place a home delivery order, to find and price a medication and to check order status and then to view your claims in history. So a lot of times you may want to look back at to at your claims history and, and that will be available to you on the portal within the mobile app. You'll be able to do some of those things, such as find and price of medication. But all of your claims history will be a little bit easier to find under the portal.

So I'm going to walk to walk through some of the ribbon features here for you. So under your My Prescriptions tab on the Optum portal, you'll be able to see the medications that you've filled in the past. And you can also see if you have any refills available for that medication, or if you can use home delivery for that medication as well. next feature on the ribbon is order status. So if you have an order that's happening with home delivery, as I mentioned before, typically you'll receive an email when it's time for that, medication to fill. But if you ever have any questions about what the timing of that refill is for that medication, all you have to do is go out and check your order status, and all of that information will be there. Under some of the member tools on the ribbon, you see that there's the option for you to the price, price of medication. There's also the prescription drug list, which is the formulary that I talked to you about before. And then the other feature that we talked about was the pharmacy locator or, you know, finding a network pharmacy. under the My Profile section, you can also manage, you know, you can manage, your own access to the portal and just what's available to you. There's also resources out there on the portal, such as videos to kind of walk through, certain questions that you may have on several different subjects as it relates to pharmacy, just a lot of information within the portal. And that kind of gives you a brief, description on how you can use it and what's available to you as a member. with today's technology and the fact that everybody has a smartphone, it's very easy to download the app to our mobile app and to be able to keep track of your medications and your home delivery pending orders, and to even price medications right there on your smartphone. So I wanted to just make sure that you were aware that there was an app, because in many cases, people aren't even aware that they can download the app or to register for, a pharmacy account. And by putting that app on your smartphone, it gives you immediate access two year plan benefits. Another feature there is to be able to track your order on the mobile app. So you can see at the bottom right hand corner of the screen that if you have an apple phone or if you have an Android phone, either way, you can download the app on the Apple Store or through Google Play. So it's always going to be available to you whether, you know, no matter which type of smartphone that you have. And then one of the things that I like to do as, you know, I'm also an optimizer member. So one of the things that I like to use my Optima Mobile app for is, you know, you can compare pricing at different pharmacies. So if you're wondering to yourself where you might see the best price, in most cases the prices are going to be very similar, at different pharmacies. But you may find that CVS, for example, has a better deal on a certain cholesterol medication that you like to take. And because of that, you may you may choose to fill at CVS versus another pharmacy. So, that's one thing to keep in mind as you're talking about, you know, medication pricing and understanding what the cost is going to be to you. As a plan member.

I know that during the course of the next few weeks, you're going to have decisions to make as a, as an employee of Cornell University and your plans for next year. I also know that you've got, open enrollment timeframes coming up, to have those questions answered. So, we're always available to you. I mentioned to you the optimal, dedicated customer service line at (866) 533-6977. And that's also on your identification card. But certainly as you go through the process of making sure that you have your, coverage available, I know that pharmacy is very important to a lot of people, who take medications. And for those people who haven't necessarily had to use a pharmacy benefits in the past, hopefully this information has been helpful to you as you start to make your, decisions for 2026.

[Auto-generated.] welcome everyone. Thank thank you so much for taking an interest to learn about how the health savings account can really help you and your family on your journey to build a health security account. As mentioned, my name is Melanie Bridges, and in an inspired financial, we're guided by our goal to really help account holders thrive today, tomorrow and into retirement.
We are fortunate to be helping over 1.2 million HSA members through our and our employer sponsored health plans. So first, today we're going to go a little bit about what is an HSA. High level overview. Give you a little, more information about the basics, review the contribution limits for 2026 and then get into some more specifics about potentially planning for retirement, some savings strategies, the investment option that you do have through the HSA.
And then just a little bit of information about HSA and Medicare. And then obviously at the end, if there are questions, we can definitely get to that as well. So let's jump right in. So what is an HSA? An HSA is a financial account with a tax free status. So when paying for eligible medical expenses so contributions up to the IRS limit are pretax when contributing through Cornell's payroll.
Some of the benefits include. Payroll contributions reduce the overall gross income. Affordability increases when taxes can be avoided. You can save for the future. And as mentioned, there is an opportunity to invest, which we'll get into a little bit later. So who is eligible? Anyone who enrolls in an HSA eligible health plan, also referred to as a high deductible health plan, is then eligible to be part of the HSA.
So today, you do have a Cornell high deductible HSA medical plan, and the HSA offered to Inspira would be paired with that. Who's not eligible to contribute? Just a couple things to call out. Individuals enrolled in non HSA health plans or in in a health care, FSA or HRA program. Anyone receiving Medicare or Tricare receiving veteran Affairs medical benefits, and or claimed as a dependent on someone else's tax return.
Spouse's spouse contributes to FSA at the same time, is also something where you're not eligible to contribute, and spouses may not be eligible to contribute to their spouses. HSA, as well only to their own.
A little bit about HSA. High level overview at a glance. So an HSA can fund eligible medical expenses for the primary health plan member who is the HSA account holder, as well as, if applicable, for a spouse or a tax dependent child. An HSA is unique in that anyone can contribute to an account holders HSA an HSA is a lifetime account.
So unlike an FSA, an HSA is not a use it or lose it program. You can transfer other HSA funds into your Inspira HSA at any time during the year. And one IRA to HSA transfer is allowed per lifetime, and that does count toward your max contribution for that year. The HSA earns interest, interest tax free, and funds can be invested after a $1,000 minimum cash balance is is reached.
Withdrawals for qualified medical expenses are always tax free, regardless of your age. Again, you must be enrolled in the HSA Qualified Health Plan. The FDP program in order to open and receive the contributions after age 65, you can use withdraws for any expense. However, those would be taxed at your normal rate. And remember, most important, you own your HSA so it stays with you.
Whether you retire or change jobs.
Here's just a little bit of a list of some of the things that can be considered eligible expenses under an HSA. Things like your out-of-pocket medical expenses, prescriptions, dental or vision, as well as some over-the-counter products, that are all described through some of the IRS code that regulates the health savings account.
In addition, for an HSA, there are some insurance premiums like Cobra and Medicare that can also be, eligible through the Health Savings Account. You can also find a complete list under Help and support if you go under explore eligible health care expenses under the Inspira Member website.
So distributions from an HSA, you can receive tax free distributions from your HSA to pay or be reimbursed for qualified medical expenses you incur after you established the HSA.
That's really important. So for illustrative purposes, we put two hypothetical examples of two different reimbursement situations. The first is where you're reimbursed right away. So it's an immediate need to pay an existing medical bill out of pocket. And the second example shows where you could withdraw funds that you built up in your account over the years at a future date.
As long as you have qualified expenses that occurred after you established and opened your HSA, you always want to keep proper receipts documentation as there is no time limit on that withdrawal.
IRS does put yearly contribution limits to these programs. So for 2026, for an individual self coverage it's $4,400. And for family it's $8,750. In addition, anyone that's 55 or over can add an additional thousand dollars each year that you're in. You're eligible to be in the program. You also have an employer contribution through Cornell, where Cornell contributes $1,000 whether you're single or family, each year.
It's important to note that the IRS has one maximum limit per HSA, no matter who contributes. So those employer contributions through Cornell do count against your HSA overall maximum limit. So you definitely want to plan accordingly. Since you are fortunate enough to have those Cornell contributions automatically put into your health savings account. The self family limits are indexed to inflation on an annual basis.
And those updated figures typically are released each May for the following year. The 55 catch up is not indexed, and it's remained $1,000. Over for each year.
a little bit of information about tax advantages of an HSA. When thinking maybe about planning for retirement. So as mentioned, all contributions to your HSA are tax deductible. So they're always free from federal income tax.
States themselves do determine tax rules. And all states except for California and New Jersey today also exclude HSA contributions from taxes.
Withdrawals as mentioned, to pay for qualified medical expenses are tax free as well. So those amounts are treated as eligible expenses under section 213. And again, you are eligible to be reimbursed for those with no tax.
This is very similar or this to the regulation that applies to an FSA. If you've ever been in one of those before, as far as what is an eligible expense. All funds in your account grow tax free, including interest, dividends or capital gain. And as mentioned, HSA funds can be invested and retained for use in retirement.
Some additional strategies.
Savings strategies for a health savings account A couple things. Treat your HSA like an investment account. So don't spend the funds unless you either needed for a medical expense. Max out your investment by making the full annual contribution each year, including the thousand dollars. If you are 55 or over. And again, just reminder that you do want to consider the Cornell employer contribution in that maximum as well.
So you want to take full advantage of the employer HSA contributions, as well as what you can put in yourself. And again, invest your savings wisely through the program.
Couple additional strategies, as you get into your HSA and build up the benefits. So if you have a big bill, maybe think smart and save on taxes. You could contribute to and pay large eligible medical bills using your HSA.
Optimize your tax savings and retirement by including your HSA kind of in your overall portfolio. You can leverage auto investment feature tools, and we'll show you a little bit about that in the future to methodically invest over time. And then one thing to mention, the IRS only allows a family HSA, to be used with tax dependent family members simultaneously.
Health plan law. The Affordable Care Act allows family members to remain on a family health care plan until age 26. So this creates a very likely event that an adult child becomes tax independent prior to leaving the family health plan. If so, the adult child must open and fund their own HSA.
In particular with employer sponsored HSA plans. As you have, it's really critical to understand the HSA fund menu that's offered and part of the program. Inspira recognizes the importance of having an independent investment advisor act as a fiduciary, backing these selections and ongoing monitoring of the Health Savings Account Fund. Menu. In our case, we have been why advisors as registered investment advisors, and we've used them for over ten years.
On the right of this, slide, the diagram shows the different nature of the funds in the menu. And each has a very specific role to play in creating a diversified portfolio.
Once you have $1,000 in your cash balance, you can start investing.
This slide shows a screenshot of the Inspira Financial HSA website, specifically the HSA Investment Dashboard page.
So you can go out here and view and research the fund menu by clicking on the highlighted tile. There's also some guidance and education on what to look for when researching a fund menu.
kind of a busy slide, but the Financial Industry Regulatory Authority requires strict compliance in how investment performance is shown. For purposes of assuring that it is not misleading to you as a member.
This grid, while pretty dense, is in the required format for good reason, which is to show historical performance over long time periods. To show the ticker symbol of each mutual fund and the fund expense ratio or cost each option as well. This data is updated quarterly by the Inspira product team and the sources more is Morningstar Advisor Workstation.
As mentioned before. Once you're in the investment accounts, you could consider setting a plan. So from your investment dashboard, you can do a couple of different things. You can game plan to save and you can, set it up as an automatic investment reoccurring situation. You could invest a percentage of your HSA contributions, or you could do a periodic sweep from HSA to the investment account.
What's great about this is you could set it and then walk away and let the system sort of do what it needs to do from an investment perspective. And you can always change it. So if you want to move back to not having one of these plans, you can absolutely. Just, take it away under your, under your own website access.
I want to bring up a couple of things just to be aware of when it comes to Medicare.
With Medicare, you are not eligible to enroll in or contribute to an HSA. If you are enrolled in Medicare. If you had an existing HSA when you enroll in Medicare, you can still use those HSA funds to pay for eligible expenses for yourself, your spouse, and your tax dependents.
However, you can no longer make or receive contributions to the HSA on or after the date of your enrollment in Medicare. So it's really important to be aware of when you're enrolling in Medicare, especially if you potentially may be delaying it if you wait to sign up for Medicare. And you do want to plan accordingly. So we always want to call this out just for awareness.
As mentioned on the prior slide, there are specific rules around Medicare and the potential non coordination with an HSA plan. While you still can use your HSA funds to pay for eligible expenses, including, as mentioned, some of the premiums associated, you can no longer make contributions. So again, just an awareness to plan accordingly. If a Medicare event is in your, near future.
Just a couple additional tricks or things to be aware of that we suggest using your resources. So if you do have a financial advisor, make sure that they are in the know that you have a health savings account. You may want to consult with that advisor on your HSA on a quarterly or annual basis, and again, loop them in on what your potential investment offerings are.
In the event that you are looking at investing. Develop short term and long term strategies for both your contributions and investments. And really key. You can adjust your contributions and investments as needed. So this is not a one and done during open enrollment. You can go in and make changes throughout the year to your health savings account.
So I want to thank everyone today for the time that, you came here to look to learn a little bit more about your health savings account option through Cornell University.