Using HSA Funds Overseas

Good to know.

No, but mine seems to be pretty loosely monitored, no where near as strict the FSA. As long as the prescription is charged in dollars I wonder if they would even notice it.

 

It is the IRS. What I'm saying is the HSA isn't tracked near as stringently as the FSA. I have had both. The HSA has never requested an EOB (explanation of benefits). I get it all the time from the FSA.

An HSA requires a high deductible health plan to be able to contribute to it. I think the deductible has to be over $2800.

 

Well there you have it. I knew I could count on you to do the heavy lifting.

 

If the hospital doesn't accept cards (which I think would be pretty common in the Philippines) how does one go about making a payment?
I can't take cash out of my HSA, it only provides me a credit card, so it would have to be out of pocket. You will need to seek reimbursement from HSA by submitting official documentation after the treatment. I assume a prescription would also have to be descriptive like you get in the US. It couldn't be a cash register receipt for $300 php.

Can you pull money out of an ATM to make payments and then hold the receipts in case the IRS has questions?
You wont' deal with the IRS, you will deal with the HSA manager who holds your funds and they will want receipts to substantiate reimbursement request. I can't get a cash advance as far as I know.

Would the receipt issued need to be in a certain format to prove what treatment/medication you purchased?
It should be an itemized list like what you get when you go to a doctor/hospital/drug store in the US. I had food poising in Boracay and the doctor just wrote some stuff on a notepad. They didn't take it even though it was legit. Stay away from witch doctors. It also has to be an approved procedure, so they won't pay for your plastic surgery. I had a kidney stone in BKK, went to BKK hospital and their receipts worked fine.

In the US, I just issue a reimbursement check to myself based on the EOB if I paid out of pocket. I've never tried to issue a check to myself for the heck of it, but I suspect they would ask for supporting documentation. My HSA is closely integrated with my insurance, which may be why my HSA seems much easier than my FSA. When I log into Anthem, it links to my HSA manager so they are talking.
In a foreign country, I would expect it to go something like this. Assuming the hospital doesn't accept your plan, all costs paid out of pocket or HSA credit card. Submit the bills to your insurance company for determination of coverage. If deductible hasn't been met, all out of pocket, you then pull money from HSA to cover using insurance determination. If I met my deductible and assuming a 90/10 plan for fees after the deductible, I would expect 90% reimbursement from the insurance company and 10% coming from my HSA to cover my out of pocket. You might also have to deal with the in network, out of network stuff so your benefit may pay at a lower level like 70/30. If HSA credit card was used you will have to true up the account after insurance determination. Never had the problem with my HSA, but I find my FSA shuts down my account after a couple of transactions without substantiating documentation. I wouldn't worry about the IRS because the HSA/FSA manager seems to be on the hook to keep you on the straight and narrow. If you were committing fraud and creating false documentation.....maybe, but in the big scheme of things you are a small fish.
Whats is covered is determined by your health care plan. You just submit a bill and cross your fingers. It's possible you had an HSA and then you dropped you high deductible plan and no longer have insurance. In that case, I would think just submitting the bill. Essentially you are self-insuring. The IRS determines what procedures can be covered, but the HSA will enforce it.

 

One last thought where there would be IRS involvement. If you wanted to use the funds for something else, like building a house, you would essentially be taking out tax advantaged dollars and not using them for health care, so taxes and a possibly a penalty may need to be paid. Sort of like the situation where you take money out of an traditional IRA or 401K early.