HEALTH SAVINGS ACCOUNT (HSA)

Transcription

1 HEALTH SAVINGS ACCOUNT (HSA)

2 Plan Details Carrier: Alerus Toll Free Phone: (877) Website: Policy or Group Number: HSA 144 Policy or Anniversary Date: January 01 Employee Eligibility: Waiting Period for Enrollment: (Time employee must wait before being eligible to enroll) Initial Enrollment Period: (Time frame after the waiting period during which employee must enroll) Coverage Termination Date upon loss of Eligibility: Percent of Unused Balance that rolls over into the next plan year: If you qualify for and elect the designated High Deductible Health Plan through Lamex Foods, Inc. and are not also enrolled in another health plan that would disqualify an HSA contribution, you are eligible for the HSA Once you qualify for and elect Health Insurance through Lamex Foods, Inc. and are NOT also enrolled in another health plan that would disqualify an HSA contribution, participation can begin 30 days You will continue to have access to any remaining funds in your HSA account until they have been exhausted 100% Employer HSA contribution: Single: Single + Spouse: Single + Child(ren): Family: Plan Year Employee HSA Contribution Maximum: $ ($10.42 per pay period) $ ($15.63 per pay period) $ ($15.63 per pay period) $ ($20.83 per pay period) The maximum that can be contributed to your account by any party is: $ 3,400 for single election for 2017 $ 6,750 for family election for 2017

3 Commonly Asked Questions Which health plans disqualify me from participating in an HSA? If you participate in a health plan that is not a high deductible health plan including a Health Flexible Spending Account that is not limited scope, you cannot participate in an HSA. What are the steps for employee participation in the plan? 1. If you elect to make a contribution to the HSA, pre-tax payroll deductions will be taken from your paycheck. 2. Your employer will begin to make contributions to your HSA account. 3. You incur an expense. 4. You submit a claim for the expense by completing a Health Savings Account Distribution Request form. a. No documentation is required; however you are responsible for maintaining records of your expenses. b. If you elected to be a Spender on your election form, you have the option of using the HSA debit card in lieu of the claim process. 5. Alliance Benefit Group reimburses you 5 to 10 days after receipt of the Health Savings Account Distribution Request form. What is the debit card? If you enroll as a Spender you will receive the Benny debit card by mail at your home address. The debit card can be used at merchants that provide health services or sell health supplies and draws funds directly from your HSA. It is important to know the balance available in your HSA when using the debit card; if your purchase exceeds the balance in your HSA account the transaction will be declined at point of sale. What expenses are eligible? Medical expenses as defined by Section 213(d) of the Internal Revenue Code. How do I submit a claim? Complete a Savings Account Distribution Request form and submit it to Alliance Benefit Group. You are not required to submit documentation of the expense to Alliance Benefit Group. You must, however, retain records of your receipts (for medical expenses) in the event of an audit. When must a claim be incurred in order to be eligible? Claims must be incurred on or after the date you join the plan. Are health insurance premiums qualified medical expenses? In most cases, health insurance premiums are not qualified medical expenses. However, the following are exceptions: Premiums for qualified long-term care insurance Premiums for COBRA health care continuation coverage Premiums for health coverage while an individual is receiving unemployment compensation For individuals over age 65, premiums for Medicare Part A or B, a Medicare HMO and the employee share of premiums for employer-sponsored health insurance, including premiums for employer-sponsored retiree health insurance. Premiums for Medigap policies are not qualified medical expenses What happens to money I do not use by the end of the plan year? If you do not have claims that equal or exceed the balance of your HSA account at the end of the plan year, the remaining funds will roll forward into the next plan year. How do I check my HSA balance? Go to

4 Eligible Health HSA Expenses Medical expenses covered under the HSA can include expenses that are not covered under the high deductible health plan such as chiropractic, dental, orthodontia or vision expenses. HEALTH HSA EXPENSES ALLOWED: Dental and Orthodontic Care: Artificial teeth or dentures Braces, orthodontic devices Therapy and Treatments: X-ray treatments Speech therapy Alcoholism treatment Drug therapy treatment Legal sterilization Acupuncture Physical therapy treatment Vaccinations Hair transplant (if medically Electrolysis (if medically The cost of a weight loss program (only to treat obesity as prescribed by a physician) Fees and Services: Physicians fees Hospital services fees Services of chiropractors Christian Science practitioner Services connected with donating an organ Hearing Expenses: Hearing aids and batteries Eye Care: Eyeglasses Contact lenses Contact Solution Lasik surgery Medical Equipment: Wheelchair or autoette (cost of operating/maintaining) Excess cost of orthopedic shoes over cost of ordinary shoes Crutches (purchased or rented) Excess cost of special mattress prescribed to alleviate arthritis Prescribed oxygen equipment and oxygen used to relieve breathing problems Support hose (if medically Artificial limbs Insurance Premiums: Health Insurance (including individual and non-employer sponsored coverage and including continuation premiums Long Term Care Insurance Co-Payments (not premiums): Health insurance out-of-pocket Dental insurance out-of-pocket Prescription medication copayments Assistance for individuals with disabilities: Cost of guide for the visually impaired Special devices, such as tape recorder and typewriter, for the visually impaired Costs of equipping automobile Cost of Braille books and of regular editions Seeing Eye Dog Psychiatric Care: Services of psychotherapists, psychiatrists and psychologists Physical Exams: Prescription & Over-the-counter medications: Prescription co-payments Over-the-counter medications used to treat a medical condition (with doctor s prescription HEALTH HSA EXPENSES NOT ALLOWED: Illegal medication Mechanical exercise device not prescribed Vacuum cleaner purchased by an individual with dust allergy Expenses of divorce when doctor or psychiatrist recommends divorce Sunglass clips Contributions to State disability funds Maternity clothes Insurance against loss of income, life, limb or eyesight Distilled water purchased to avoid drinking fluoridated city water supply Mobile telephone used for personal calls as well as calls to physician Treatments unrelated to a specific problem (for example, massage for general wellbeing) Marriage counseling Nursemaids or practical nurses in charge of healthy infants Cosmetic procedures Over-the-counter supplements/vitamins or other substances related to general good health. THE IRS WILL CHANGE THIS LIST FROM TIME TO TIME. FOR A COMPLETE AND CURRENT LISTING OF HEALTH EXPENSES SEE IRS PUBLICATION 502.

5 Eligible Over-the-Counter Medications OVER-THE-COUNTER EXPENSES ALLOWED: Band-Aids, bandages, gauze Birth control Catheters Cold pack Condoms Contact lens supplies & solutions Denture adhesives Diagnostic tests & monitors Elastic bandages & wraps First aid kits Hot pak Incontinence supplies Insulin & diabetic supplies Ostomy supplies Pedialyte for dehydration Reading glasses Rubbing alcohol Wheelchairs, walkers & canes OVER-THE-COUNTER EXPENSES ALLOWED ONLY WITH A DOCTOR S PRESCRIPTION: Acne Treatments Allergy & sinus medicine Antacids Antibiotic products Anti diarrhea medicine Anti-gas Anti-itch & insect bite Anti-parasitic treatments Aspirin Baby rash ointments & creams Bactine Bee Sting kits Bug bite ointments Calamine lotion Carmex/Blistex/Medicated lip balms Cold medicine Cough drops, lozenges Diaper rash ointments Digestive aids Feminine anti-fungal / anti-itch First aid cream Hemorrhodial preps Lactaid for lactose intolerance Laxatives Menstrual cycle products for pain Motion Sickness pills Muscle pain creams Nasal strips medicated/vapor only Nicotine gum and patches Pain reliever Respiratory treatments Sinus sprays Sleeping aids & sedatives Sunburn ointment Suppositories Visine eye Wart remover OVER-THE-COUNTER EXPENSES ALLOWED ONLY WITH A DOCTORS NOTE: These items would not normally be eligible for reimbursement under your HSA plan, but, could be if used to treat a specific medical condition. The IRS requires a letter from your attending physician stating your medical condition and also stating that the following item is being prescribed for treatment of that condition. Acne Treatments Feminine hygiene products St. John s Wart for depression Weight loss medications Fiber supplements for constipation Glucosamine/Chondroitin for arthritis Hormone therapy for menopause Lactaid for lactose intolerance Orthopedic shoes Sunscreen for cancer Prenatal vitamins OVER-THE-COUNTER EXPENSES NOT ALLOWED: Chapstick Face creams and moisturizers Vitamins* Cosmetics Food, food replacements Toiletries Dietary supplements Medicated shampoos and soaps Toothbrush/toothpaste * Vitamins would not normally be eligible for reimbursement under your HSA plan, but, could be if used to treat a specific medical condition. The IRS requires a letter from your attending physician stating your medical condition and also stating that the vitamin is being prescribed for treatment of that condition. THE IRS WILL CHANGE THIS LIST FROM TIME TO TIME. FOR A COMPLETE AND CURRENT LISTING OF HEALTH EXPENSES SEE IRS PUBLICATION 502.