Page 8 - 2022 Penn Engineering Guide

Health Savings Account

Health Savings Account (H S A)
If you elect the Consumer Driven Health Plan (CDHP) High Deductible PPO Plan, you are eligible
Health Savings Accounts
for a Health Savings Account (H S A).
provided by PNC Benefit Plus
A Health Savings Account is a tax- favored account used in conjunction with a qualifying high
PNC Bank Customer Service: 1-
deductible health plan, as defined by the IRS. Deposits into the savings account are insured up
844-356-9993
to a $250,000 maximum. A Health Savings Account can be funded by the Employer and/or
https://participant.pncbenefit
Employee. Contributions are tax free or tax deductible. The interest that is earned on the plus.com
account is tax-free when used for qualifying healthcare expenses.
New participants are required
The Employee can fund the H S A at any time during the Plan year; either through direct to enroll in H S A via MyADP.
deposit; or lump sum deposits. All payroll deposits are considered pre-tax.
If you elect the CDHP High
The account is used to pay for qualified out of pocket expenses that are not covered by the Deductible PPO Plan, you are
health plan, such as the deductibles, co-pays, dental expenses, vision expenses, and certain not eligible for a Health
over the counter medications with a prescription. Save your receipts for your records. Flexible Spending Account
(FSA). You are eligible to enroll
The balance in your Health Savings Account carries over from year to year. No forfeiting of in a Dependent Care Spending
Account.
balances. If you leave the Company, the account still belongs to you.

HEALTH SAVINGS ACCOUNT
After age 65, the account holder may use funds for non-qualified expenses and pay ordinary
WORKSHEET
income tax.

Your expected cost of medical
2022 H S A Plan year
expenses to reach your annual
The Company will deposit monies into your H S A to use towards qualifying medical expenses.
deductible $
This arrangement is only for those employees who elect to participate in the Consumer Driven
Health Plan. (CDHP) Dental and vision
expenses $
If you elect the CDHP option, you will receive an annual deposit from the Company. These
monies will be deposited in your account by the Company in early January 2022. In addition to Health care expenses not
the monies deposited by the Company, you are also eligible to make deposits of your own up to covered by the
Medical or Dental Plan $
the annual maximum amounts defined by the IRS. Like Flexible Spending Accounts, you must

re-elect deposits into your H S A each year. Elections will not roll forward from one year to the
Amount contributed by
next.
PennEngineering $( )

The maximum deposits for H S A’s in 2022 are: Total: Consider contributing
Single tier: $3,650 this annual amount to your
All other tiers: $7,300 account (up to $3,650 or
$7,300 per year) $
*Over age 55 – you are eligible to contribute an additional $1000.
All coverages provided by the
*Age 65 and enrolled in Medicare Part A and or B – you are ineligible to receive H S A Company Company will be reviewed on
Contributions and are ineligible to contribute pre-tax monies into an H S A. an annual basis.

You will receive a PNC Debit card to use with this account to pay only eligible Healthcare
expenses. Debit Card activation is required.

Debit Card activation is a two-step process. Activation is required by accepting the terms and 7
conditions on the PNC Portal, AND calling the number on the front of your debit card.