Page 16 - CPS Benefits Guide
P. 16
How does an HSA Maximum Contributions for the Plan Year
work? Coverage Level IRS Mandated Maximum Contribution
An HSA works in conjunction Individual (covering just yourself on $3,400
with your health plan coverage. the plan)
Your HSA dollars can be used Family (covering yourself and any $6,750
number of additional dependents)
to help pay the health insurance Age 55 or Older? Add an additional $1,000 to these amounts
deductible and qualiied medical as a catch-up contribution!
expenses, including those not HSA Eligible and Ineligible Expenses
covered by the health insurance,
like dental and vision care. Any Funds you withdraw from your HSA are tax-free when used to pay for
funds you withdraw for non- qualiied medical expenses as described in Section 213(d) of the Internal
qualiied medical expenses will be Revenue Service Tax Code. A list of these expenses is available on the
taxed at your income tax rate, plus IRS website, www.irs.gov in IRS Publication 502, “Medical and Dental
20% if you’re under 65. Expenses.
Once you meet the calendar-year The following list provides examples of eligible and ineligible medical
deductible, you are responsible expenses. This list is not all-inclusive. Remember, the IRS may modify
for a small portion of your its list of eligible expenses from time to time. As always, consult your tax
total expense (coinsurance) and advisor should you require speciic tax advice.
your health insurance pays the
remaining covered expenses in Eligible Examples
accordance with the terms and Medical expenses: copays, coinsurance, and deductibles
conditions of your plan. Once Dental expenses: exams, cleanings, x-rays, and braces
your deductible and coinsurance Vision expenses: exams, contact lenses and supplies, eyeglasses, and
expenses total your out-of-pocket laser eye surgery
maximum, the plan pays 100%
of your eligible expenses for the Professional services: physical therapy, chiropractic, and acupuncture
remainder of the plan year. services
Prescription drugs and insulin
Over-the-counter healthcare items: bandages, pregnancy test kits,
blood pressure monitors, etc.
16 2017 Benefits Enrollment
work? Coverage Level IRS Mandated Maximum Contribution
An HSA works in conjunction Individual (covering just yourself on $3,400
with your health plan coverage. the plan)
Your HSA dollars can be used Family (covering yourself and any $6,750
number of additional dependents)
to help pay the health insurance Age 55 or Older? Add an additional $1,000 to these amounts
deductible and qualiied medical as a catch-up contribution!
expenses, including those not HSA Eligible and Ineligible Expenses
covered by the health insurance,
like dental and vision care. Any Funds you withdraw from your HSA are tax-free when used to pay for
funds you withdraw for non- qualiied medical expenses as described in Section 213(d) of the Internal
qualiied medical expenses will be Revenue Service Tax Code. A list of these expenses is available on the
taxed at your income tax rate, plus IRS website, www.irs.gov in IRS Publication 502, “Medical and Dental
20% if you’re under 65. Expenses.
Once you meet the calendar-year The following list provides examples of eligible and ineligible medical
deductible, you are responsible expenses. This list is not all-inclusive. Remember, the IRS may modify
for a small portion of your its list of eligible expenses from time to time. As always, consult your tax
total expense (coinsurance) and advisor should you require speciic tax advice.
your health insurance pays the
remaining covered expenses in Eligible Examples
accordance with the terms and Medical expenses: copays, coinsurance, and deductibles
conditions of your plan. Once Dental expenses: exams, cleanings, x-rays, and braces
your deductible and coinsurance Vision expenses: exams, contact lenses and supplies, eyeglasses, and
expenses total your out-of-pocket laser eye surgery
maximum, the plan pays 100%
of your eligible expenses for the Professional services: physical therapy, chiropractic, and acupuncture
remainder of the plan year. services
Prescription drugs and insulin
Over-the-counter healthcare items: bandages, pregnancy test kits,
blood pressure monitors, etc.
16 2017 Benefits Enrollment
