Notes
1You're not required to have an HSA simply because you're on an HSA compatible health plan. That said, without the HSA, itself, there's no tax advantage. Talk to your tax advisor, but it may be a good idea to open and contribute funds to an HSA.

2HSA funds can be used to pay for a variety of health care services, including physician visits, dental and vision care services, Medicare premiums, long term care insurance premiums and medical insurance premiums during times of unemployment. For a complete list of qualified medical expenses, please consult the IRS website at irs.gov/publications/p502.

3To be eligible to open or contribute to an HSA, you must 1) be covered only by an HSA compatible, high deductible health plan; 2) not be a dependent on another person's tax return; 3) not have coverage under Medicare Parts A, B, C or D; and 4) not have access to a general purpose health care FSA or HRA through your employer or your spouse's employer.

4Penalties are not assessed for non-qualified medical expenses after you reach age 65, become disabled or die. However, taxes still apply.

5"Members Rate Their HMO" - 4 stars, "Plan Service" - 3 stars, 2012 Health Care Quality Report Card.

6For a complete list of preventive care services covered without cost sharing, consult Appendix A of your Combined Evidence of Coverage and Disclosure Form (EOC/DF) booklet. Your Copayment Summary also lists other, non-preventive services that are not subject to the deductible.
Please note that the visit will be considered preventive care and will not require the payment of any deductible or copayment if and only if the visit is limited to preventive care services. If you schedule an annual physical but, at that visit, your doctor treats you for a cold, the service will incur costs. Similarly, if you schedule a preventive screening but an abnormality is found and treated in the process, that procedure will no longer be considered preventive (for example, if polyps are removed during what begins as a colorectal cancer screening).

7Services covered under optional rider plans, such as infertility, do not contribute to your deductible or OOP maximum.

8On the claim with which you meet your deductible, if a balance remains, you will be assessed the appropriate copayment.


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