Page 9 - Rubrik 2022 Benefits Guide

The HDHP and HSA: How They Work Together

Your HSA contributions help to cover a portion of your deductible and coinsurance.

Free In-Network Deductible Coinsurance Out-of-Pocket Maximum
Preventive Care
To emphasize the importance You pay for your initial After your deductible The plan limits the total
of wellness, preventive care medical costs until you meet is met, you’ll pay a portion amount you’ll pay each
is covered at 100%, if you your annual deductible. of the expenses through year. Once you meet
receive this care from This deductible is higher coinsurance or copays for your out-of-pocket
in-network providers. compared to the other prescriptions maximum, the plan pays
medical plans, but offset by until you reach the 100% of your eligible,
HSA contributions. out-of-pocket maximum. in-network expenses
for the remainder
of the year.

How the HSA Works

Please note: Funds available for reimbursement are limited Yolanda enrolls herself only in the HDHP with HSA. She
to the balance in your HSA. chooses to use her HSA to pay for covered services — this
reduces her out-of-pocket amount needed to meet her
Choose the HDHP and HSA during your deductible before her health plan begins to pay.
Benefits Enrollment in Workday.
Year 1 Example Year 2 Example

Elect how much you want to contribute
(tax-free*) to your HSA each pay period.
Rubrik deposits $800 Rubrik deposits $800
in Yolanda’s HSA in Yolanda’s HSA
Rubrik establishes an HSA Bank account on
your behalf so that Rubrik’s HSA contributions and
your own HSA contributions can be deposited. She contributes $2,800 for
a total of $3,600
She contributes $2,800 for
Use money in your HSA for eligible
medical, dental and/or vision expenses. a total of $3,600 $2,900 rolls over
from last year for a
total of $6,500
Money left over at the end of the year
rolls over for future use. She uses her HSA She uses her HSA
to pay $700 of to pay $1,250 of
* Tax-free in all states except CA and NJ. eligible expenses eligible expenses
Please Note: If you are a new hire and contributed to an
HSA at a previous employer, those contributions count She has $2,900 in She has $5,250 in
towards your annual maximum and you might need to her HSA to roll over her HSA to roll over
reduce your contributions at Rubrik. to next year to next year

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