Group Eligibility

For Employment-related Groups

Business / Commercial Retirees

Union Retirees

Government Retirees

PEO / Association Retirees

Small Business Active Employees

Beneficiary Eligibility

Medicare dictates the eligibility requirements for beneficiaries. Anyone eligible for the group’s employment-based health coverage (e.g., retirees, active employees, spouses or dependents) must also meet these requirements:

  • Medicare-eligible and enrolled in Medicare A and B

  • Reside in the U.S. for 183 or more days during the calendar year

  • Not having other insurance covering the MSA plan deductible

  • Not currently eligible for Medicaid / not dual eligible

  • Not currently receiving Medicare hospice benefits

Flexible Plan Administration

Joining is Easy

Once the group indicates their interest in offering our Group MSA plans, we work with them to plan and conduct enrollment activities for their beneficiaries. For our initial effective date of 1/1/2024, beneficiary enrollment activities will occur in fall of 2023.

Beyond 1/1/2024, groups can offer our MSA plans at any time during the year, and beneficiaries can enroll at any time of the year.

Medicare uses a calendar year-basis for MSAs. Beneficiaries can enter the plan at any time, and the benefit period will always end 12/31 of the current year.

Enrollment in the Fenyx Health Group MSA plans is “evergreen.” This means beneficiaries will continue to be enrolled in the plan until a) the group no longer offers the plan or b) the beneficiary voluntarily or involuntarily leaves the plan.

If a beneficiary joins the plan after 1/1 or leaves the plan before 12/31, it is considered a partial-year enrollment. Partial-year enrollments are subject to prorated deposit and deductible amounts.

For example, a beneficiary joining in June will receive half of the plan’s deposit amount; their deductible amount is also adjusted for the fact they’re joining midway through the year.

If a beneficiary leaves the plan before 12/31, they owe a prorated portion of the current year’s deposit back to us. We, in turn, provide that back to Medicare. For example, if a beneficiary started the plan on 1/1 but left in June, they owe half of the current year’s deposit amount they initially received in January.