How Intermountain Health drove 80% HSA adoption with strategic employer contributions

Key takeaways: Intermountain Health wanted to boost enrollment in their high-deductible health plans (HDHPs) and help employees save for out-of-pocket costs. But employees were hesitant to start the year with $0 in their Health Savings Accounts (HSAs). Their benefits team identified roadblocks and made plan changes to achieve:

• 80% enrollment in HDHPs
• 99% of HSA members contributing to HSAs
• $10.5M in annual employer healthcare savings

The term “high-deductible health plan” can be intimidating for employees. It might bring to mind high out-of-pocket costs, making it a tough sell for benefits teams. But what if you could change that perception and empower your employees to build a financial safety net?

Intermountain Health, a Salt Lake City-based healthcare system with over 63,000 employees, faced this exact challenge. Dave Adams, VP of Executive Compensation and Benefits at Intermountain Health, understood the potential of HSAs and qualified plans to provide effective, affordable healthcare and help establish a financial safety net for employees.

Why are employees hesitating to enroll in HDHPs?

Like many employers, Intermountain Health struggled with low enrollment in their HDHP and HSA offering. They introduced the benefit in 2006, but by 2010, only 6% of their eligible workforce had opted in, leaving $31 million in potential premium savings on the table.¹

Through employee feedback, they identified several key barriers:

• Confusion between HSAs and FSAs
• Employee misconceptions about HDHPs
• Employee fear of starting the plan year with $0 in their HSA

The benefits team listened to employee feedback and addressed each barrier with targeted solutions such as financial incentives, structural plan changes, and a commitment to overcoming concerns.

They started in 2010 with an HSA match ($300 single/$600 family), then more than doubled it the following year ($750 single/$1500 family) to make the benefit more appealing.

While this helped, the real breakthrough came in 2012 when they addressed the “zero-balance” problem head-on. They partnered with HealthEquity to front-load 50% of their HSA contribution, making funds available to new employees on day one of the plan year. This strategic shift directly countered the “what if I get sick in January?” concern and spurred enrollment to 33%.

How can employers accelerate HSA adoption?

Building on their initial success, Intermountain Health’s benefits team refined their approach. In 2017, they introduced an additional HDHP with an even more powerful incentive: Any new employee who selected the HealthSave medical plan for the first time would be eligible for 100% of the full employer contribution on the first pay period if they made even a single contribution of any amount into their HSA. This demonstrated a deep commitment to the financial security of their employees, and enrollment soared to 67%. This and additional targeted support for lower-income employees propelled enrollment to an incredible 80%.²

“A lot of people will say that HSAs are more beneficial for higher-paid employees, but I don’t think that’s true. We want everyone to be able to save for health expenses while they’re employed or even in retirement.”
Dave Adams, VP Executive Compensation and Benefits, Intermountain Health

Intermountain Health’s thoughtful, multi-year strategy has paid off, driving enrollment far beyond industry benchmarks. By listening to feedback, offering powerful incentives, and removing financial barriers, they empowered caregivers to take control of their health and future—resulting in impressive, measurable results.

As of today, 99% of their HSA members are actively contributing. The average employee contribution is $2,900 annually—more than double the industry median. As a result, their employees have built a strong financial safety net, with an average HSA balance of $5,600.

The impact on employees has been profound. One Intermountain caregiver shared, “For the first time in my life, I am now able to afford to take [my family] to the doctor or the hospital because I have saved enough money in my HSA. This peace of mind is priceless for me.”³

What did Intermountain Health do to build a culture of HSA savings?

Intermountain Health’s journey proves that with a thoughtful, employee-centered strategy, employers can overcome common barriers to HSA adoption. Matching employee contributions, making funds available on day 1, and educating employees on their savings options can help build confidence and drive participation.

Learn more about how Intermountain Health’s success story by reading the full case study here.