Page 7 - 2022 Benefit Guide FNA Combustion

Health Savings Account

If you enroll in the BCBS HDHP 1500 medical option and meet
the eligibility definition you MUST OPEN a Health Savings
Account (HSA) at Fidelity for the Company Contribution to be
provided. Eligibility Requirements — to contribute to an HSA:
• You must be enrolled in a CDHP or HDHP medical
What is an HSA? option.
• You cannot be covered by any other non-CDHP or HDHP
• An individually-owned, tax-free account that you use to pay compatible health plan.
for eligible medical as well as dental and vision expenses.
• You cannot be claimed as a dependent on another
• Contributions can be made by you, the company, or both. person’s tax return.
• You cannot be covered by Medicare A or B, TriCare or
• Money accumulated in an HSA may earn interest or you may have received VA benefits in past 3 months.
invest it. It can be withdrawn to pay for qualified medical
expenses for you, your spouse or eligible dependents – even if • You cannot be covered under a general Medical FSA,
including through your spouse.
they are not covered by the CDHP.
• You must be a U.S. citizen with a U.S. residential
• Unused funds will roll over year to year and will never be address.
forfeited.

• Accumulate funds for the future. After age 65, funds can be Employer Contribution:
used for healthcare expenses in retirement or withdrawn for Each year, Fives will contribute to your HSA as follows:
any purpose without penalty. (May be taxable income.) • Contributions paid ½ in January and ½ in July.
• You may use the HSA funds for your spouse and dependents Employee Only: $500 | All others $1,000
(on your tax return) eligible expenses even if they are not New Hires, paid each quarter following hire date during your first
enrolled in a CDHP. year of employment.
Employee only: $125 | All others $250
What are the Annual Contribution limits?
Bonus HSA Match Contribution Opportunity
• Contributions to the HSA by both employee and employer
cannot exceed the annual limit set by the IRS. New Enrollees: Fives will match employee contributions
made January 1 – June 30, 2022
dollar for dollar up to
2022 Maximum Contribution Limit $250 Employee Only and $500 Other Tiers.

Must be actively employed in July 2022 when the contribution is made
Employee Only $3,650
Employee + Spouse
Employee + Child(ren) $7,300 Using Your HSA:
Family • Debit Card: For instant access to your HSA funds. Just swipe
• The contribution limits go by the enrollment choice you your card to pay for eligible expenses.
selected for your CDHP. • Reimburse Yourself: You can make a withdrawal at any time.
• If you and your spouse both have an HSA the total Family limit The best option is to transfer the funds directly to your own
is $7,300 for the both of you combined. checking or savings account.

• Catch Up Contributions: If you, the accountholder, will reach • Pay Providers: You may pay providers directly from your
age 55 by December 31 , you can make an additional $1,000 account.
st
contribution to your HSA. • Pay expenses out of pocket and Save your funds to use later
or in retirement.
• Employees are responsible for monitoring their account and
verifying they have not exceeded the limits.
Go to Fidelity for more information on using your account, Website: www.netbenefits.com
investments, FAQs, etc. New Enrollee: Click the OPEN Phone: Fidelity Client Service Center: 800-544-3716.
button by Health Savings Account.

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