Page 9 - 2022 CPI Card Benefits Guide

The HDHP and HSA: How They Work Together

Together, your and the Company’s contributions to your HSA can cover a portion of your deductible
and coinsurance.

Free In-Network Deductible Coinsurance Out-of-Pocket Maximum
Preventive Care

To emphasize the You pay for your Once the deductible The plan limits the
importance of initial medical costs is met, you and the total amount you’ll
wellness, preventive until you meet your Company share any pay each year. Once
care is covered at annual deductible. further health care you meet your
100% if you receive This deductible is costs until you meet out-of-pocket
this care from higher compared to the out-of-pocket maximum, the plan
in-network providers. the other medical maximum. pays 100% of your
plan, but offset by eligible, in-network
HSA contributions expenses for the
you and the Company remainder of the year.
may make.

How the HSA Works Example HSA in Action

Please note: Funds available for reimbursement are Mary enrolls herself only in the HDHP with HSA. She
limited to the balance in your HSA. chooses to use her HSA to pay for covered services.
Mary was enrolled in the Buy-Up PPO previously. She
decides to put the difference between the Buy-Up
Choose the HDHP
during Open Enrollment. PPO bi-weekly pay check deduction and the HDHP
bi-weekly pay check deduction into her HSA. She
keeps for herself $47.00 each pay date in her HSA.
You determine how much to
contribute (tax-free) to your HSA Year 1 Example Year 2 Example
each pay period.
The Company deposits The Company deposits
$500 in Mary’s HSA $500 in Mary’s HSA
The Company opens an HSA for you
and you begin to make deposits into She contributes $1,222
your account. The Company also She contributes $1,222 for a total of $1,722
deposits quarterly contributions to ($47.00 per pay period)
your account. for a total of $1,722 $972 rolls over from
last year for a total
of $2,694
Use money in your HSA for
eligible medical, pharmacy, dental She uses her HSA She uses her HSA
and/or vision expenses. to pay $750 of to pay $1,000 of
eligible expenses eligible expenses

She has $972 in She still has $1,694 in
Money left over at the end of the her HSA to roll over her HSA to roll over
year rolls over for future use. to next year to next year

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