Sample Benefit Enrollment Guide

2019 Benefit Guide

You are eligible to open and fund an HSA if:

„ „ You are enrolled in an HSA-eligible High Deductible Health Plan, such as the HSA PPO Plan. „ „ You are not covered by your spouse’s health plan (unless it is a qualified HDHP) or flexible spending account (FSA). „ „ You are not eligible to be claimed as a dependent on someone else’s tax return. „ „ You are not enrolled in Medicare, TRICARE, or TRICARE for Life. „ „ You have not received Veterans Administration benefits in the past three months. How Much can be Deposited

On the PayFlex Employee Portal or Mobile App You Can: „ „ Check your balance and view alerts „ „ Make payments, withdrawals, and deposits „ „ View PayFlex debit card transactions „ „ View common eligible expense items and more

into an HSA in 2019? „ „ Under age 55 (and not enrolled in Medicare): z z Up to $3,500 for individual coverage z z Up to $7,000 for family coverage „ „ Age 55 or older (and not enrolled in Medicare): z z Catch-up contribution is an additional $1,000

z z Up to $4,500 for individual coverage z z Up to $8,000 for family coverage Pay the PayFlex Way Once funds are available in your HSA, PayFlex makes it easy to pay for your eligible expenses.

„ „ Use the PayFlex Card®, your account debit card: When you use the PayFlex debit card, your expense is automatically paid from your account. „ „ Pay yourself back: If you paid out-of-pocket for any eligible expense, you can withdraw the funds from your HSA to pay yourself back via direct deposit or check (with a copy of the receipt or invoice).

17