hsa bank is a division of webster bank, n.a.,...

HSA Bank is a division of Webster Bank, N.A., Member FDIC.


Our High Deductible Health Insurance Plan (HDHP)

•Allows you to have a Health Savings Account (HSA)

•Protects you from catastrophic medical claim expense

•Gives incentive to be and stay healthy

•Gives financial reason to shop healthcare services


What is a Health Savings Account (HSA)

•A health savings account (HSA) is a personal, tax-favored account designed to help you save money and pay for eligible medical, dental and vision expenses on a tax-free basis. You can: SAVE by making HSA contributions on a pre-tax basis

through payroll deductions

EARN tax free interest on your HSA account

PAY for eligible expenses with tax-free dollars


HSA advantages

• If you do not use your HSA funds you DO NOT lose the funds, they roll over to the next year

• You can make more informed healthcare decisions

• You own the account. HSA funds stay with you when you change jobs or retire

• Plus, you have the opportunity to invest HSA funds and grow your savings

• If you don’t use your HSA funds for eligible medical expenses it’s one more way to save for retirement


Who is eligible to enroll in a HSA

• You must be enrolled in a HSA-compatible* health plan (HDHP). Additionally, you must NOT be: Covered by any other non HSA-compatible health plan Claimed as a dependent on another person’s tax return

(excluding spouses per Internal Revenue Code) Enrolled in Medicare Receiving health benefits under TRICARE Receiving Veterans Administration (VA) benefits within the past

three months. Covered by a spouse’s general purpose health care flexible

spending account (FSA) or health reimbursement account (HRA).

*An HSA-compatible plan satisfies minimum annual deductible and maximum out-of-pocket costs per Federal guidelines.


2015 Maximum HSA Tax Deductible Deposit

•Single medical coverage allows $3,350 Includes both employer and employee deposits

•Family medical coverage allows $6,650 Includes both employer and employee deposits

• Individuals age 55 or older may deposit an additional $1,000 in their HSA called “Catch-up Contribution”*

* Cannot use payroll deductions for spouse “Catch-up Contribution”


Who puts money in my HSA?

•Your employer and you (if you choose to)

•Your employer will deposit the following tax-free amount $20.00 per month into your HSA for single medical

coverage $40.00 per month into your HSA for family medical

coverage

•You may choose tax deductible contributions that you may change during the year to fit your needs


Eligible medical expenses to use HSA funds

A list of Qualified Medical Expenses can be found in IRS Publication 502, http://www.irs.gov/pub/irs-pdf/p502.pdf. As described in IRS publication 969, http://www.irs.gov/pub/irs-pdf/p969.pdf, over-the- counter medications are

considered Qualified Medical Expenses for HSA purposes.

• Premiums for long-term care insurance*

• Premiums for COBRA* • Premiums for individuals

over age 65 *

• Doctor and hospital visits • Medical equipment • Dental care, braces,

dentures* • Vision care, glasses,

contacts* • Prescription medications (and, over-the-counter

medication when prescribed)

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You can use your HSA to pay for a wide range of eligible medical, dental and vision expenses for yourself, your spouse or tax dependents. Examples:

For a detailed list of eligible expenses double click icon

* These expenses are ineligible for Medica Reimbursements

http://www.irs.gov/pub/irs-pdf/p502.pdf

http://www.irs.gov/pub/irs-pdf/p969.pdf


HSA Bank® account overview • No initial deposit is required

• No minimum balance is required

• Earn interest based on a tiered-interest rate structure

• Receive up to two, FREE initial debit cards

• Order optional checks; unlimited check writing

• HSA is funded with a penny (to meet IRS establishment). That way, you can be reimbursed for eligible medical expenses on day one.

• HSA deposits at HSA Bank are FDIC-insured through Webster Bank, N.A.

• $2.25 monthly fee for balance less than $3,000. No monthly fee when balance is $3,000 or greater.


It’s easy to manage your HSA

•Signup for FREE Internet Banking login: View real-time account balances and transaction history

Access monthly statements and tax documents

Receive year-to-date account information

Transfer funds to or from a linked investment account

Sign up for email confirmations

Pay bills online

Call the Client Assistance Center at HSABank (800) 357-6246

Monday – Friday, 7 a.m. to 9 p.m. CT


HSA and Medicare • If you are on Medicare Part A and/or Part B you will not be

allowed to contribute to your HSABank account. Your employer will not be able to contribute to your account either.

• If you are on Medicare and covered under Thrifty White Pharmacy group HSA plan with your spouse and any tax dependent children. Your spouse can open an HSA account and make contributions. Their contributions would not be pretax from your paycheck, but you can claim a tax deduction on their contributions every April 15th, however you would still have paid payroll taxes on their contributions that you would not be able to recoup.


When to elect Copay plan NOT HSA plan • You the employee is age 65 or older and covered under

Part A or Part A & Part B Medicare

• You are taking a prescription drug that is categorized by Medica as a Tier 3 prescription drug The Copay plan will pay for Tier 3 drugs, the HSA plan will NOT To find Tier 3 drugs call 1-800-952-3455

• We are not allowed to waive the third month copay on a 90 day supply filled through our central refill pharmacy on the HSA plan


How to Get Funds From Your HSA • What you should know about the HSA VISA:

The VISA can be used as a CREDT CARD or DEBIT CARD.

• We recommend that you always use it as a credit card. Why? There is NO transaction fee when “credit” is used and the maximum limit per day is set at $2000.00. The “debit” should only be used for cash machine withdrawals. For each cash withdrawal transaction

you will be charged $2.00 by HSA Bank plus any additional fees from the financial institution that owns the ATM. When prompted if you would like to withdraw funds from “Checking” or “Savings”, select “Checking”. The maximum limit per day for debit card usage is set at $300.00.

• IT IS YOUR RESPONSIBILITY TO KNOW YOUR CURRENT HSA BALANCE AMOUNT.

There are 4 easy ways to find what your balance is: Statements will reflect all transactions processed, fees/charges to your account, and your current

balance. To speak to a representative, call Client Assistance Center at (800)357-6246 Monday through Friday,

7 a.m. to 9 p.m., CST. For an automated system, call Bankline at (800)565-3512. This is available 24 hours a day. To view your account online, go to www.hsabank.com. Your account can be accessed online 24 hours

a day. To view your account for the first time, you will need to set up your account with the Internet Banking Sign-up Form. You will also need to create your User Name and Password.

http://www.hsabank.com/


How to pay your pharmacy bills with HSABank

• Pharmacy – What to do when paying for prescription medications Show your Medica ID Card to the pharmacist. The pharmacy will process the claim immediately with your medical

insurance company. Pharmacist will present the bill for the cost of the medication

Use your HSA VISA Card to pay for the bill, if funds are available. a) To cover for 100% of the cost, use as a “credit” transaction, NOT “debit”.

Attach the pharmacy receipt and the credit card receipt together in an envelope labeled “HSA Allowable Expenses” for your records.


How to pay your doctor bills with HSABank • Doctor – What to do at a doctor office appointment

Show your Medica ID card to the receptionist. DO NOT PAY THE BILL AT THE TIME OF VISIT! Wait for your insurance company to send you an Explanation of

Benefits (EOB). a) If you have any questions on the EOB, you can call Medica

The doctor bill should reflect the same amount due as the EOB that you received.

To pay your bill, you can call your clinic and pay over the phone by giving them the number of your HSA Bank VISA Card, or wait for the new bill from the doctor’s office and complete the payment stub with your HSA Bank VISA Card information for payment.*

File the EOB and bill in an envelope labeled “HSA Allowable Expenses” for your records.

* In the case that your HSA account does NOT have enough funds to pay the whole cost of the bill, talk to your doctor/hospital to set up a payment plan.


How to pay your hospital bills with HSABank • Hospital – What to do when checking-in or out of the hospital

Show your Medica ID card to the admissions desk. DO NOT PAY THE BILL AT THE TIME OF VISIT! Wait for your insurance company to send you an Explanation of

Benefits (EOB). a) If you have any questions on the EOB, you can call Medica

The hospital bill should reflect the same amount due as the EOB that you received.

To pay your bill, you can call the hospital and pay over the phone by giving them the number of your HSA Bank VISA Card, or wait for the new bill from the doctor’s office and complete the payment stub with your HSA Bank VISA Card information for payment.*

File the EOB and bill in an envelope labeled “HSA Allowable Expenses” for your records.

* In the case that your HSA account does NOT have enough funds to pay the whole cost of the bill, talk to your doctor/hospital to set up a payment plan.


Medica Preferred Drug List Below is the link to Medica’s Preferred Drug List (PDL). Type the link below in to your browser: https://www.medica.com/Pharmacy/Group/Pharmacy%20Group%20Prospect?target=myMedicaPharmacyInformation&psnName=link.PharmacyInformation&csId=01072&requestor=/linksAndTools

Chapter 16 of the PDL is the Preventive Drug and Supply List and was developed by the government as part of the Affordable Care Act.

Once you type the above link in to your browser you will see this screen. Click “View Preferred Drug List” and you will get a PDF of the PDL. The HSA Preventive Maintenance Drug List is Chapter 17 in the PDF. To view the HSA Preventative Maintenance List “CTRL F” type in “Chapter 17”

https://www.medica.com/Pharmacy/Group/Pharmacy%20Group%20Prospect?target=myMedicaPharmacyInformation&psnName=link.PharmacyInformation&csId=01072&requestor=/linksAndTools




PARTIAL LISTING OF COVERED SERVICES BUY-UP PLAN BASE PLAN HSA PLAN

Lifetime Maximum Benefit – Per Person Unlimited

Plan Year Deductible – Single/Family $750/$1,500 $6,450/$9,900 $2,600/$5,200

Annual Out of Pocket Maximum – Single/Family Includes copays, deductibles and coinsurance $2,500/$5,000 $6,450/$9,900 $2,600/$5,200

Employer Annual HSA Deposit - Single/Family N/A N/A

$540/$1,080

Net Maximum Out of Pocket – Single/Family $2,500/$5,000 $6,450/$12,900

$2,060/$4,120

When you receive covered services after deductible has been met, you pay:

Preventative Care The deductible does not apply to these services

• Routine Physical & Eye Exams 0% 0% 0% • Immunizations, Well Child Care, Cancer Screenings 0% 0% 0% • Preventative Rx N / A N / A 0%

Office Visits The deductible does apply to these services

• Illness or Injury 0% after $35 copayment 0% after deductible 0% after deductible • Retail Care 0% after $20 copayment 0% after deductible 0% after deductible • Virtuwell 0% after $20 copayment $45 applies to deductible $45 applies to deductible

• Chiropractic Care 0% after $35 copayment 0% after deductible 0% after deductible • Physical, Occupational & Speech Therapy 0% after $35 copayment 0% after deductible 0% after deductible • Mental Health and Substance Abuse 0% after $35 copayment for individual therapy or $30 for group therapy. 0% after deductible Prescription Drugs From a TWP Pharmacy Up to a 31-day supply per prescription • Tier 1 $7 copay $7 copay 0% after deductible • Tier 2 $30 copay $30 copay 0% after deductible • Tier 3 $60 copay $60 copay Not Covered • Preventative Rx N/A N/A 0% no deductible Specialty Prescription Drugs Up to a 31-day supply per prescription for specialty prescription drugs received from a TWP pharmacy. • Tier 1 Member pays 20% up to a maximum

of $200 per prescription unit or refill. 0% after deductible

0% after deductible

• Tier 2 Member pays 40% up to a maximum of $400 per prescription unit or refill

0% after deductible

Not Covered


Inpatient Hospital Services

• Facility 20% after deductible 0% after deductible 0% after deductible

• Physician 20% after deductible 0% after deductible 0% after deductible

• Mental Health and Substance Abuse 20% after deductible 0% after deductible 0% after deductible

Outpatient Hospital Services

• Facility 20% after deductible 0% after deductible 0% after deductible

• Physician 20% after deductible 0% after deductible 0% after deductible

Lab and Pathology 100%

The deductible does not apply. 0% after deductible 0% after deductible

X-Ray and Other Imaging 100%


Urgent or Emergency Care

• Urgent Care Center 100% after $35 copayment


• Hospital Emergency Room 20% after deductible 0% after deductible 0% after deductible

• Emergency Ambulance 20% after deductible 0% after deductible 0% after deductible

Durable Medical Equipment & Prosthetics 20% after deductible 0% after deductible 0% after deductible

Home Health Care 20% after deductible 0% after deductible 0% after deductible

EMPLOYEE COST PER PAYCHECK BUY-UP PLAN BASE PLAN

HSA PLAN

Single $75.00 $41.00 $66.50

Employee & Child $147.00 $128.75 $128.75

Employee & Spouse $134.00 $120.00 $120.00

Family 3-4 $198.00 $178.00 $178.00

Family 5+ $205.00 $187.00 $187.00

hsa bank is a division of webster bank, n.a.,...

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