My Health Savings Accounts – HSA Take charge of your health care spending with a Health Savings Account (HSA). Contributions to an HSA are tax free and withdrawals for quali昀椀ed medical expenses are tax free. Your HSA can be used for quali昀椀ed expenses, including those of your spouse and/or taxable dependent(s), even Individually Owned Account You own and administer your Health Savings Account. if they are not covered by your plan. If you are not You determine how much you’ll contribute to the account, enrolled in a HDHSA but you have unused HSA funds from a previous account, those funds can still be used when to use the money to pay for quali昀椀ed medical expenses, and when to reimburse yourself. HSAs allow for quali昀椀ed medical expenses. you to save and roll over money if you do not spend it in PayFlex will issue you a debit card, giving you direct the calendar year. The money in this account is portable, access to your account balance. When you have a even if you change plans or jobs. There are no vesting quali昀椀ed medical expense, you can use your debit card requirements or forfeiture provisions. to pay. You must have a balance to use your debit card. There are no receipts to submit for reimbursement. How to Enroll Eligible expenses include doctors’ of昀椀ce visits, eye You must elect the HDHSA plan with FMOLHS. You exams, prescription expenses, laser eye surgery and will need to complete all HSA enrollment materials and more. IRS Publication 502 provides a complete list of designate the amount to contribute on a pre-tax basis. eligible expenses and can be found on www.irs.gov. FMOLHS will establish an HSA account with PayFlex in your name and send in your contribution once bank account information has been provided and veri昀椀ed. Eligibility You are eligible to open and fund an HSA if: » You are enrolled in the HDHSA plan. Maximize Your Tax Savings » You are not covered by your spouse’s HDHSA plan. Contributions to an HSA are tax-free (they can be made » Your spouse does not have a Medical Flexible through payroll deduction on a pre-tax basis when you open an account with PayFlex). The money in this account Spending Account (FSA) or Health Reimbursement (including interest and investment earnings) grows Account (HRA). tax-free. As long as the funds are used to pay for quali昀椀ed » You are not eligible to be claimed as a dependent medical expenses, they are spent tax-free. on someone else’s tax return. Per IRS regulations, if HSA funds are used for purposes » You are not enrolled in Medicare or TRICARE. other than quali昀椀ed medical expenses and you are » You have not received Department of Veterans younger than age 65, you must pay federal income tax on the amount withdrawn, plus a 20% penalty tax. Affairs medical bene昀椀ts in the past 90 days for non-service-related care. (Service-related care will not be taken into consideration.) 39

Team Member Guide to Benefit Enrollment - Page 39 Team Member Guide to Benefit Enrollment Page 38 Page 40