Implementation Worksheet


Please complete the Implementation Worksheet below. Once complete, click Next. You will then be provided with tips and recommendations regarding plan design and communication. If you have any questions concerning the worksheet or the recommendations provided, please contact Business Relations at 866-357-5232, Monday through Friday, 7am to 7pm, Central Time.

1. What is your employer size?
2. How many employees are being offered/eligible for an HSA-compatible health plan?
3. Is the HSA-compatible health plan the only plan being offered?
4. How many health plans are being offered?
5. What are your objectives for offering an HSA-compatible plan?
Lower Premium Costs Lower company-wide medical claims Offer an alternative health plan to employees Increase employee's awareness of overall health Enhance employee benefits Begin transition to replace all current plans with HSA-compatible plans
6. What is your goal for % enrolled in an HSA-compatible plan?

1. Are you paying a portion of premiums?
2. Is there a premium savings to the employee for selecting an HSA-compatible health plan?
3. Is there a premium savings to the employer when an employee selects an HSA-compatible health plan?
4. Will you be making contributions to the HSA?
5. Will you be facilitating employee payroll deductions through a Section 125 Plan?

Please select the communication methods available to communicate to your employees.
Email Communication Intranet site Material provided directly to employees at work Materials mailed to employees at home Employee presentations
Please select the estimated time prior to enrollment that materials will be provided.
Please select the frequency of employee communication prior to enrollment.

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