Q4’08 showed slight increases in average High Deductible Health Plan (HDHP) deductibles over Q3’08 both for individual and family HDHPs, coupled with decreases in average monthly employer contributions. However, decreases in employer contributions were offset both in individual and family HDHPs by increases in average monthly employee contributions, with average Health Savings Account (HSA) balances remaining relatively unchanged quarter-over-quarter. Average individual HSA balances were down a modest two percent quarter-over-quarter, while average family HSA balances were unchanged from the previous quarter. Due to continued weakening in the financial markets, average Health Investment Account (HIA) balances realized further sharp declines. On average, individual and family HIA balances decreased from Q3 to Q4 24 percent and 29 percent respectively. Even with continued declines in HIA balances quarter-over-quarter, average transfers into individual and family HIAs were more than double average transfer amounts from HIAs. Individual and family HIA accountholders age 51+ continued to hold the highest average account values, nearly triple individual HIA accountholders age 25-40, and almost fifty percent higher than the value of family HIA accountholders age 25-40. However, in Q4 average overall account values of individual HIA accountholders age 51+ surpassed the average overall account values of family HIA accountholders age 51+, with average account values of $12,010 and $11,684 respectively. In terms of spend, Q4 ’08 again showed card payments lagging behind every other spend category with the majority of spend derived from Reimbursements and Bill Payments, and with Wednesday and Friday being the primary days for sub-deductible account spending (ie. spend incurred before HDHP plan coverage kicks in). In Q4 ’08 the top three spend categories realized by individual HSA accountholders were Hospital, Dental, and Vision related expenditures respectively, whereas the top three spend categories for family HSA accountholders were Hospital, Dental, and Mental Health Services related. Hospital expenditures represented one-fifth, and in the case of family HSAs nearly one-quarter, of total HSA accountholder expenditures for the quarter. Finally, due to end-of-the-year enrollment periods, customer service call durations crept up with more time spent on enrollment type calls, and basic how-to questions of newly enrolled individuals. Looking forward, we anticipate a slight increase again in the first part of Q1’09, as tax forms are generated and account audits become more prevalent.
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