Page 6 - NextCare Holdings 2021 Annual Benefits Enrollment
P. 6
Qualified Example Expenses Health Savings Account
Payments toward your deductible (HSA)
Prescriptions If you elect the BCBS High Deductible Health Plan,
Medicare premiums you may open and contribute to a health savings
Orthodontia account (HSA) through MyBlue Savings. This account
Glasses/contacts is not an option with the BCBS PPO plan.
Non-Qualified Example Expenses You elect a certain amount to contribute tax-free from
Food your paycheck and the money is deposited into your
Clothing account through MyBlue Savings. You receive a debit
Household items card from MyBlue Savings which can be used to pay
Visit irs.gov to view a complete list of eligible and for eligible health, dental, and vision care.
ineligible expenses .
For non-provider employees, NextCare matches 10
cents on the dollar to what you contribute to the
HSA Eligibility health savings account for the employee portion
You may open and contribute pretax to an HSA under of the deductible. The chart below highlights the
maximum you can contribute per paycheck to your
the following circumstances: health savings account without exceeding the IRS
Enrolled in an IRS qualiied high deductible health maximum. You may elect to contribute less than
plan (HDHP) the employee portion listed. If you are eligible to
Not enrolled in a traditional PPO plan through contribute more than the per pay period maximum
your spouse or other employer sponsored plan noted below or would like to change your contribution
options amount, send an email to Michelle Geeve.
Not enrolled in a Government sponsored
program (Medicare, Medicaid, Tricare, etc.) Employee HSA Per Pay Period
Have not received VA beneits within the last Maximum Contributions
three months (unless receiving beneits for a Plan Type
service related disability) Non-Providers: Individual Deductible $0 .00–$125 .87
Not claimed as a dependent on someone else’s tax Non-Providers: Family Deductible $0 .00–$264 .34
Providers: Individual Deductible
$0 .00–$138 .46
return Providers: Family Deductible $0 .00–$276 .92
Do not have an HSA and healthcare FSA; your
spouse also cannot have a healthcare FSA through The IRS allows a maximum contribution in 2021 for
his/her own employer individual coverage of $3,600 and $7,200 for family
coverage.
Please note our HSA will now be through
MyBlue Savings . The transition will be simple–you will
have a single sign-on from azblue.com and will be able
to view and ile claims, view account balance, manage
alerts and investments, and submit claims .
6
Payments toward your deductible (HSA)
Prescriptions If you elect the BCBS High Deductible Health Plan,
Medicare premiums you may open and contribute to a health savings
Orthodontia account (HSA) through MyBlue Savings. This account
Glasses/contacts is not an option with the BCBS PPO plan.
Non-Qualified Example Expenses You elect a certain amount to contribute tax-free from
Food your paycheck and the money is deposited into your
Clothing account through MyBlue Savings. You receive a debit
Household items card from MyBlue Savings which can be used to pay
Visit irs.gov to view a complete list of eligible and for eligible health, dental, and vision care.
ineligible expenses .
For non-provider employees, NextCare matches 10
cents on the dollar to what you contribute to the
HSA Eligibility health savings account for the employee portion
You may open and contribute pretax to an HSA under of the deductible. The chart below highlights the
maximum you can contribute per paycheck to your
the following circumstances: health savings account without exceeding the IRS
Enrolled in an IRS qualiied high deductible health maximum. You may elect to contribute less than
plan (HDHP) the employee portion listed. If you are eligible to
Not enrolled in a traditional PPO plan through contribute more than the per pay period maximum
your spouse or other employer sponsored plan noted below or would like to change your contribution
options amount, send an email to Michelle Geeve.
Not enrolled in a Government sponsored
program (Medicare, Medicaid, Tricare, etc.) Employee HSA Per Pay Period
Have not received VA beneits within the last Maximum Contributions
three months (unless receiving beneits for a Plan Type
service related disability) Non-Providers: Individual Deductible $0 .00–$125 .87
Not claimed as a dependent on someone else’s tax Non-Providers: Family Deductible $0 .00–$264 .34
Providers: Individual Deductible
$0 .00–$138 .46
return Providers: Family Deductible $0 .00–$276 .92
Do not have an HSA and healthcare FSA; your
spouse also cannot have a healthcare FSA through The IRS allows a maximum contribution in 2021 for
his/her own employer individual coverage of $3,600 and $7,200 for family
coverage.
Please note our HSA will now be through
MyBlue Savings . The transition will be simple–you will
have a single sign-on from azblue.com and will be able
to view and ile claims, view account balance, manage
alerts and investments, and submit claims .
6
