With the rise of GLP-1 drugs like Ozempic, Wegovy, and Mounjaro, conversations surrounding their inclusion in employee benefits programs are expanding in new directions.
Prescriptions & Premiums: How Rising Drug Costs Impact Your Health Insurance
Prescription drug costs in the United States have been rising steadily over the past few decades, and the impact of these rising costs on corporate health insurance plans has been significant. The high cost of drugs and pharmacy services has been a major contributor to the rising cost of healthcare in the United States, and it is a problem that affects everyone, from patients to employers.
According to a recent report by the Kaiser Family Foundation, the cost of prescription drugs has been rising faster than any other component of healthcare spending in the United States. The report found that in 2019, the average cost of a brand-name prescription drug in the United States was $6,798, up from $1,869 in 2006. Generic drugs have also seen price increases, with the average cost of a generic prescription drug rising from $90 in 2010 to $140 in 2019.
These rising costs have had a significant impact on corporate health insurance plans. Employers are finding it increasingly difficult to provide affordable health insurance coverage to their employees, and many are passing on the costs of prescription drugs and pharmacy services to their employees in the form of higher deductibles and co-pays. This, in turn, has made it more difficult for employees to access the medications and treatments they need to manage their health conditions.
According to the AHIP, over 22% of all commercial health plan premiums go towards Prescription Drug costs, while only 11% go towards Doctor Visits and 3.3% towards Emergency Room Costs.
The impact of rising drug costs on corporate health insurance plans has been particularly acute for small and medium-sized businesses. These businesses typically have fewer employees and less bargaining power when negotiating with health insurance providers and pharmacy benefit managers (PBMs). As a result, they often end up paying higher prices for prescription drugs and pharmacy services than larger businesses with more flexibility and options in regards to the group health insurance offerings.
A few of the reasons for our heightened costs of prescription drugs in the United States is increased pressure for expensive R&D, and the lack of price regulation and transparency. Unlike in many other countries, the United States does not have a centralized authority that negotiates drug prices on behalf of the entire population. Instead, drug prices are set by the manufacturers, and insurers and PBMs negotiate prices with the manufacturers on a case-by-case basis.
There are some efforts underway to address the problem of rising drug costs in the United States. For example, several states have passed laws allowing the importation of prescription drugs from Canada and other countries where drug prices are lower. However, these efforts are limited in scope and may not be enough to address the larger problem of rising drug costs.
Larger employer groups and organizations that are “experience rated”, or in an alternative-funded group health arrangement, often have an opportunity to directly impact their prescription drug spend, thus directly impacting their group health insurance costs. As opposed to “fully-insured” health plans that include bundled vendors with little flexibility, many self-funded programs allow for an unbundling of services including Pharmacy Benefit Managers (PBMs), which gives the group more power to negotiate the most favorable contracts, pricing, and rebates. In addition to the PBM flexibility, these groups also have the ability to implement proactive drug advocacy and oversight programs to further control and reduce annual drug spend while still providing optimal care and coverage to their employees. We recommend speaking to your broker or consultant regarding these options, or contact a member of our Capstone Benefits Team for more information: Benefits@CapstoneGrp.com
In conclusion, the rising cost of prescription drugs in the United States continue to negatively impact corporate health insurance plans, and ultimately consumers & patients. While there are some efforts underway to address the problem, more needs to be done to ensure that everyone has access to the medications and treatments they need at a price they can afford. This will require a concerted effort by policymakers, healthcare providers, consultants, and the pharmaceutical industry to find solutions that work for everyone.
Employee Benefits: How will Rising Inflation Affect Healthcare Costs?
From gas stations to grocery stores, you've almost certainly noticed that the costs of goods and services are skyrocketing with no end seemingly in sight. The American Healthcare system is no exception, as the rising costs of inflation coupled with the unrelenting strain of the COVID-19 pandemic on both the workforce and supply chains have led to ongoing challenges. With an unpredictable future ahead, making business decisions about balancing a tighter budget while still offering a competitive employee benefits package is more difficult than ever.
Today, inflation in the United States has reached rates not seen in years. The Consumer Price Index rose by 8.6% year-over-year in May 2022. All indications lead us to believe that it is only a matter of time before healthcare prices catch up to this increase. We've heard from clients that they are surprised that there hasn't been a more immediate substantial increase in healthcare costs currently. These dramatic increases are only being delayed by the unique characteristics of the healthcare industry. While other companies can raise the price of commodities such as food, gasoline, and raw materials immediately, that's not how it works in healthcare, where prices are set by government programs or negotiated with private insurers at an earlier point in time. In healthcare services, prices, reimbursement rates, labor contracts and several other input factors are set two to three years in advance. So, while physicians, hospitals, and other healthcare providers face higher costs—mainly increases in areas with shortages such as nursing and supplies— there will likely be a lag before consumers experience the same pressures.
We see this situation ultimately playing out in two steps. First, providers will demand higher reimbursement rates. Second, payers will pass higher costs to employers and consumers in the form of higher annual premiums and an increase in out-of-pocket expenses such as copays and coinsurance.
As for health insurance premiums, Peterson-KFF Health System Tracker's 23rd annual Employer Health Benefits Survey found that single and family premiums for employer-sponsored health insurance were up 4 percent in 2021. Also, The KFF survey found that the average family premium has risen 22 percent over the last five years and an astounding 47 percent over the past ten years. This burden of higher health insurance costs is shared by employers and employees alike. In 2021, covered employees contributed an average of 17 percent of the premium for single health coverage and 28 percent for family coverage. This means employers covered 83 percent of single premiums and 72 percent of family premiums last year.
Controlling Rising Healthcare Costs
While we can't predict how the inflation rate will fluctuate in the coming years, we can assume that healthcare costs and health insurance premiums will continue to ascend. What can your organization do to mitigate these price increases without sacrificing the quality of your overall employee benefits program?
Because inflation and the increased costs charged by healthcare providers are generally outside of your control, mitigating its effects is the best option for employer groups. Now is the time to be talking to your healthcare advisors and evaluating cost control methods. Evaluating and implementing products and concepts like alternative-funded health plans (self-insurance, level-funding, group captives, and consortiums), reference-based pricing, voluntary benefit offerings, and the utilization of Tax-Advantaged Accounts (HRAs, HSAs, DCAs, FSAs, etc.) are just a few of the strategies that enable employers to better manage healthcare spending. The KFF survey referenced earlier found that 64 percent of covered workers are now enrolled in self-funded plans, and 42 percent of small firms reported using level-funded plans. Both of these numbers are an increase from previous years' surveys, providing further proof that alternative funding models are continuing to gain traction compared to traditional fully-insured health plans.
A small silver lining, the IRS recently announced higher Health Savings Account (HSA) contribution limits for 2023 to help combat the inflation surge. The annual inflation-adjusted limit on HSA contributions for self-only coverage will be $3,850, up from $3,650 in 2022. The HSA contribution limit for family coverage will be $7,750, up from $7,300. The adjustments represent approximately a 5.5 percent increase over 2022 contribution limits, a substantial increase, whereas these limits rose by about 1.4 percent between 2021 and 2022.
Our top priority is to ensure your business is taking advantage of every possible course of action to reverse the trend of annual premium increases that will allow you to reallocate and reinvest those funds into initiatives that will more directly drive business growth. If you are a business owner or decision-maker within your organization struggling with the ever-increasing costs of offering a competitive employee benefits program, please don't hesitate to reach out to me directly or our team at Capstone to start a conversation!
Contact Us:
Joseph Fox
Senior Vice President - Employee Benefits
jtfox@capstonegrp.com
Office: 215-542-8030
2021 MLR Rebate Checks Recently Issued to Fully Insured Plans
As a reminder, insurance carriers are required to satisfy certain medical loss ratio (“MLR”) thresholds. This generally means that for every dollar of premium a carrier collects with respect to a major medical plan; it should spend 85 cents in the large group market (80 cents in the small group market) on medical care and activities to improve health care quality. If these thresholds are not satisfied, rebates are available to employers in the form of a premium credit or check.
If a rebate is available, carriers were required to distribute MLR checks to employers by September 30, 2021.
Importantly, employers must distribute any amounts attributed to employee contributions to employees and handle the tax consequences (if any).
This does not apply to self-funded plans.
What to do with MRL Rebate Checks?
What will the Rebate amount be?
Will there be any Communication?
What are the tax consequences?
2021 Benefits Compliance Guide
To prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan. 1, 2021. Employers should review their plan documents to confirm that they include these required changes.
In addition, any changes to a health plan’s benefits for the 2021 plan year should be communicated to plan participants through an updated summary plan description (SPD) or a summary of material modifications (SMM).
Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.
Health Insurance & The COVID-19 Vaccines
As we step closer to the availability of the vaccine to the general population, employer groups will be considering many variables for their employees, including the availability of the vaccine, how their workforce fits into the phased rollout, vaccine costs, and what can be done now to prepare. In an effort to help local organization navigate these topics within the framework of their employer-sponsored medical plans, the Capstone Benefits Team has consolidated the most recent guidance being provided by the largest health insurers in our area:
Independence Blue Cross:
IBX does not specifically address how the plans will cover vaccinations, however the federal government has committed to providing the vaccine itself to the American public at no cost)
Click to Read More: IBX COVID Vaccine Update
Aetna:
Aetna will cover the cost of COVID-19 vaccines and their administration without cost sharing for Aetna members in all plans. Our coverage aligns with requirements in the CARES Act and the recent federal regulation. The requirement also applies to self-insured plans.
COVID-19 vaccinations will be available at pharmacies, including CVS, as well as doctors’ offices at other clinical sites of care. HHS recently announced a federal government partnership with large pharmacy chains and community pharmacies to access and administer COVID-19 vaccines as they become available.
Click to Read More: Aetna Vaccine FAQs
Cigna:
Will the vaccine be considered a preventive service waiving cost share for an employer’s workforce?
Any vaccine that receives FDA approval and is recommended by CDC (in partnership with guidance from ACIP), will be covered as a preventive service.
Will my health plan with Cigna cover the cost of a COVID-19 vaccine?
The vaccine will be covered as a preventive service. Initially, the cost of the vaccine serum will be paid by the government. We expect that providers’ charges for administering the vaccine will be paid under your Cigna medical plan, the same as any other immunization administration charge. We also expect that members enrolled in plans that cover preventive services at 100% will incur no additional cost.
Click to Read More: Cigna - Understanding COVID19 Vaccines
United Healthcare:
When COVID-19 vaccines are authorized by the FDA, members will have $0 cost-share (copayment, coinsurance or deductible), no matter where they get a vaccine, including when two doses are required, as outlined below:
Employer and Individual health plans: Members will have $0 cost-share at both in- and out-of-network providers through the national public health emergency period. This applies to fully insured and self-funded commercial health plans.
Click to Read More: UHC Preparing for COVID-10 Vaccine Authorization
For more information or company-specific questions, please contact Sr. VP of Benefits, Joseph Fox:
Email: jtfox@capstoneinsgroup.com
Capstone Group Welcomes Ed Stefanski, Jr.
For Immediate Release:
PHILADELPHIA (PRWEB) MAY 29, 2019
Capstone Group, a leading provider of risk management, employee benefits, and insurance brokerage services, has announced the hiring of Ed Stefanski, Jr. as a Senior Benefits Consultant.
For the past 15+ years, Ed has held various positions within some of the most respected Employee Benefits and Banking institutions in the country. Ed’s diverse experience in these areas, coupled with his consultative approach to creating and implementing cost-effective employee benefit programs, makes him an invaluable asset to Capstone’s current and prospective corporate clients.
“Our management team has known Ed for a long time, both personally and professionally,” said Kevin Fox, Managing Partner of Capstone Group. “His prior experience in various aspects of our business was certainly appealing, but it’s more our shared client-centric approach and desire to continue improving the insurance and benefits distribution model for employers and employees alike that really makes Ed a tremendous addition to the Capstone team.”
Ed joins Capstone Group to partner with employers on navigating rising healthcare costs and changing regulations. He brings expertise in financial analysis, health and welfare benefits consulting, and negotiation and risk reduction. He also specializes in the integration of new benefit programs and technology platforms to ensure seamless delivery for administrators and employees.
https://www.prweb.com/releases/capstone_group_welcomes_ed_stefanski_jr/prweb16335511.htm
Self-Funded Health Plans and Cross-Plan Offsetting
A recent court decision highlights an administrative process known as cross-plan offsetting. Briefly, cross-plan offsetting is a mechanism used by third-party administrators (“TPAs”) to resolve overpayments to a provider made through one plan by withholding (or reducing) payment to the same provider through another plan.
Based on the court’s ruling, employers should review and understand whether their TPA engages in cross- plan offsetting and whether there is language in the plan documents to support this practice. Further, it is advisable to review whether to continue cross-plan offsetting or “opt-out” of this practice.
The following FAQs are intended to explain cross-plan offsetting and highlight some of the issues identified with this practice.
What is “Cross-Plan Offsetting?”
A TPA may determine that it overpaid a provider when reimbursing a claim for a group health plan. Instead of seeking recoupment for the specific overpayment from the provider, the TPA reduces a future payment made by another group health plan to that provider by the amount owed. This practice is generally applied to out-of-network providers.
What Has Changed?
On January 15, 2019, in Peterson v. UnitedHealth Group, Inc., the court determined that the cross-plan offsetting was impermissible when the written plan terms did not authorize this practice. Because the court determined the plan documents lacked authorization, it did not have to address whether the practice of cross-plan offsetting itself violated ERISA.
Does Cross-Plan Offsetting Violate ERISA?
According to the court, cross-plan offsetting, as a practice, violates ERISA unless the plan documents specifically authorize it. If the documents are silent, vague, or have broad interpretative authority (without express authorization), the practice is not permissible.
The question the court did not answer directly is whether cross-plan offsetting, even with appropriate plan language, violates ERISA. The court expressed concern that cross-plan offsetting is in some tension with the requirements of ERISA.
While not deciding the issue, the court recognized that at the very least, the practice approaches the line of what is permissible.
The Department of Labor is also concerned that this practice raises ERISA issues, both violations of fiduciary duty as well as prohibited transactions (self-dealing) as outlined in their amicus brief. So, while the court did not rule on these issues, the Department may take a harder look at TPA practices and payments when auditing employer-sponsored group health.
Will Removing Cross-Plan Offsetting Affect Plan Costs?
Perhaps. Typical administrative service agreements from TPAs indicate that a TPA will make reasonable efforts to recover any overpayments, but that it is only liable in the case of its gross negligence or willful misconduct. In this case,
an employer will generally be responsible for paying for the overpayment where the TPA does not recover it from the provider using ordinary efforts. This could result in increased costs to the plan.
The plan may be able to engage in “same-plan” offsetting. This means, within the same plan, offsetting overpayments made to an out-of-network provider for one plan participant by reducing a separate payment made to the same provider for a claim of another participant in the same ERISA plan. This practice, which should be disclosed in the plan documents, likely does not trigger similar ERISA issues that cross-plan offsetting does. However, as most plan claims are paid in-network, the potential for the TPA to be able to offset claims with the same out-of-network provider under the same plan may be limited. Further, plans must provide appeal rights to participants in the event they receive a balance bill for offset amounts in dispute.
What Should Self-Funded Plans Do?
Self-funded health plans may receive letters from their TPAs regarding cross-plan offsetting practices. Some TPAs will provide the plan sponsor the opportunity to “opt-out” of cross-plan offsetting practices.
Regardless of whether you received a notification or not, employers with self-funded plans should ask their TPAs whether they engage in cross-plan offsetting.
If the TPA does not use cross-plan offsetting, there is no issue.
If the TPA uses cross-plan offsetting, then the employer (as plan sponsor and plan fiduciary) should consider the following:
• An Opt-Out of cross-plan offsetting is available. If the TPA permits the employer/plan sponsor to opt- out, employers should decide whether they think the potential benefit to cross-plan offsetting is greater than their risk tolerance for a potential ERISA violation.
• Opting out. Opting out of cross-plan offsetting is the most conservative approach considering the court’s ruling and DOL’s interpretation. If choosing to opt-out, keep records of the decision and monitor TPAs to ensure that they are administering the plan consistent with the written plan terms.
• Opting in. Employers who stick with cross-plan offsetting should ensure that their plan document and summary plan description specifically authorize and outline the cross-plan offsetting process. Consider making the TPA a claims fiduciary with respect to the plan. There is a heightened risk of DOL intervention and/or litigation from providers. We recommend employers continuing cross-plan offsetting review this decision with counsel.
• No Opt-Out Available. If the TPA does not permit the employer to opt-out, the employer should be comfortable with the practice or consider moving to another TPA. We recommend employers choosing to permit cross-plan offsetting review this decision with counsel. Plan documents should include language authorizing the practice.
* This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional. ©2019 Emerson Reid, LLC. All Rights Reserved. CA Insurance License #0C94240. *
2019 PCOR Fee Filing Reminder for Self-Insured Plans
The PCOR fee filing deadline is July 31, 2019 for all self-funded medical plans and HRAs for plan years ending in 2018.
Please note, this is the final filing and payment for some plans. Plans ending in January through September of 2019 will have one more filing on July 31, 2020. We will send a reminder next year for the final filing and payment.
The plan years and associated amounts are as follows:
(Plan Year; Amount of PCOR Fee; Payment and Filing Date):
February 1, 2017 – January 31, 2018; $2.39/covered life/year; July 31, 2019
March 1, 2017 – February 29, 2018; $2.39/covered life/year; July 31, 2019
April 1, 2017 – March 31, 2018; $2.39/covered life/year; July 31, 2019
May 1, 2017 – April 30, 2018; $2.39/covered life/year; July 31, 2019
June 1, 2017 – May 31, 2018; $2.39/covered life/year; July 31, 2019
July 1, 2017 – June 30, 2018; $2.39/covered life/year; July 31, 2019
August 1, 2017 – July 31, 2018; $2.39/covered life/year; July 31, 2019
September 1, 2017 – August 31, 2018; $2.39/covered life/year; July 31, 2019
October 1, 2017 – September 30, 2018; $2.39/covered life/year; July 31, 2019
November 1, 2017 – October 31, 2018*; $2.45/covered life/year; July 31, 2019
December 1, 2017 – November 30, 2018*; $2.45/covered life/year; July 31, 2019
January 1, 2018 – December 31, 2018*; $2.45/covered life/year; July 31, 2019
* Final Due Date/Payment for these Plan Years
For the Form 720 and Instructions, visit: https://www.irs.gov/ forms-pubs/about-form-720
The information is reported in Part II.
Please note that Form 720 is a tax form (not an informational return form such as Form 5500). As such, the employer or an accountant would need to prepare it. Parties other than the plan sponsor, such as third-party administrators, cannot report or pay the fee.
Short Plan Years
The IRS issued FAQs that address how the PCOR fee works with a self-insured health plan on a short plan year.
Does the PCOR fee apply to an applicable self- insured health plan that has a short plan year?
Yes, the PCOR fee applies to a short plan year of an applicable self-insured health plan. A short plan year is a plan year that spans fewer than 12 months and may occur for a number of reasons. For example, a newly established applicable self-insured health plan that operates using a calendar year has a short plan year as its first year if it was established and began operating beginning on a day other than Jan. 1. Similarly, a plan that operates with a fiscal plan year experiences a short plan year when its plan year is changed to a calendar year plan year.
What is the PCOR fee for the short plan year?
The PCOR fee for the short plan year of an applicable self- insured health plan is equal to the average number of lives covered during that plan year multiplied by the applicable dollar amount for that plan year.
Thus, for example, the PCOR fee for an applicable self- insured health plan that has a short plan year that starts on April 1, 2018, and ends on Dec. 31, 2018, is equal to the average number of lives covered for April through Dec. 31, 2018, multiplied by $2.45 (the applicable dollar amount for plan years ending on or after Oct. 1, 2018, but before Oct. 1, 2019).
* This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional. ©2019 Emerson Reid, LLC. All Rights Reserved. CA Insurance License #0C94240. *
Senate Considering Legislation to Improve HSA's
The House of Representatives passed two pieces of legislation that, among other things, purport to improve and “modernize” health savings accounts (“HSAs”). Both pieces of legislation have been sent to the Senate for consideration. Whether the Senate will take up these bills, let alone approve them “as is,” remains uncertain. There appears to be some bi-partisan appetite to loosen the current HSA rules, which means it is possible that we may see changes to these arrangements, which could be effective as early as January 1, 2019.
CLICK HERE TO READ A SUMMARY OF PROPOSED CHANGES
VISIT CAPSTONE'S HEALTHCARE REFORM WEBSITE: WWW.CAPSTONEHEALTHREFORM.COM
Trump Halts Cost-Sharing Reductions
On Thursday, October 12, 2017, the White House indicated that President Trump will end ACA cost-sharing reduction (“CSR”) payments to insurance companies effective immediately. This was followed up by a White House statement indicating that the payments had lacked appropriations and therefore the government could not lawfully continue making them. While the impact to insurance companies and individuals who obtain subsidized coverage in the Marketplace is expected to be significant, the direct impact to employers and employer sponsored health plans is expected to be minimal.
Implications for Employers
The direct impact of this decision is minimal. Applicable large employers (“ALE”) - those with 50 or more full time equivalent employees - are subject to ACA employer shared responsibility “A” or “B” penalties for failure to offer affordable and/or minimal value coverage to fulltime employees, if one or more of those employees obtain a subsidy or CSR in the exchange.
Even if CSRs are eliminated, since a prerequisite to an individual obtaining a CSR subsidy is to qualify for a premium reduction subsidy, there should be no change to an ALE’s “A” or “B” penalty exposure since premium reduction subsidies are not impacted by this White House decision.
Further, since an ALE must make an offer of affordable and minimum value coverage in order to avoid “A” or “B” penalties, we do not anticipate a significant increase in employees forgoing coverage in the Marketplace and enrolling in employer sponsored plans (since those individuals would generally have been ineligible for Marketplace subsidies due to the employer’s offer of affordable and MV coverage in the first place).
Additionally, if carriers exit the Marketplace or otherwise cancel plans in light of this change in policy, employers may see an increase in requests for special enrollment in their group health plans due to the loss of eligibility for Marketplace coverage.
The indirect implications are less clear. Stopping CSR payment will make individual insurance more expensive in the Marketplace. This may lead to carriers dropping out of the Marketplace, or if they remain, pricing plans beyond the reach of those individuals who previously benefited from CSR payments. This will likely result in an increase in the uninsured population. All payers in the health care system are affected by higher costs when there is a high uninsured population receiving uncompensated care.
Read more: http://www.capstonehealthreform.com/
New Executive Order and Insight on the Employer Mandate
President Trump signed an Executive Order (“EO”) on October 12, 2017, directing various federal agencies to take regulatory action that will “increase health care choices for millions of Americans.”
Employers should:
- Be aware that we are likely to see new regulations addressing AHPs, HRAs, and STLDIs in the coming months. While changes to existing AHP and HRA rules are unlikely to affect 2018 plan years, such guidance may create challenges for 2019 and beyond.
- As the Administration signaled its intent to enforce the Employer Mandate: • Plan for compliance with the 2017 ACA reporting. The final Form 1094-C, Form 1095-C and Instructions are available.
- Prepare to address any notices issued by the IRS regarding Employer Mandate assessments for the 2015 and 2016 calendar year.
Read More: http://www.capstonehealthreform.com/
Capstone launches site for real-time healthcare reform updates
Capstone Group is proud to announce the launch of a new webpage dedicated to keeping readers informed of recent compliance and health reform updates. Our Benefits Team is committed to providing the guidance needed to understand and make decisions based on the evolving future of our nation's healthcare legislation.
Benefits of Health Savings Accounts (HSAs)
As the cost of healthcare in general -- and health insurance specifically -- continues to climb, it's refreshing to find a vehicle that is helping save people money. Health savings accounts (HSAs) are one of the best innovations in health benefits to arrive this century.
The concept behind the HSA is simple, really: It's a tax-advantaged account set up with a trustee that holds money you set aside for the purpose of paying for future medical expenses. Consider the following HSA features and think about whether opening an HSA would benefit you:
1. You save money on insurance premiums
2. Contributions are tax free
3. Qualified distributions are tax free
4. You can keep the money
5. The account stays with you
6. You can make money on your contributions
Read more about the benefits of HSAs here