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Consumer Choice HSA Plan 2022 HSA Contribution Limits

Individual Coverage Family Coverage
This consumer-driven health plan offers the lowest premiums, includes in and out-of-network coverage and encourages
members to seek out the care that is right for them rather than pay for coverage they do not use. Plymouth Rock contributes $250 $500
How the plan works: Members will pay the full cost for services and prescriptions they receive until they reach the
annual deductible. Once the deductible is met, the plan will pay 100% of the costs for services received from providers You can contribute $3,400 $6,800
and facilities in-network and 80% of the costs for services received outside of the Cigna CareLink network. In-network Catch Up contributions
preventive services are always covered 100% regardless of where you are with your deductible. Generic preventive For employees age 55 or older $1,000 $1,000
medications are only $10 for a 90-day supply and are not subject to the deductible.

How the deductible works: If you enroll in this plan with one or more dependents, the family deductible of $3,000 How do I set up and access my HSA?
applies; medical and prescription costs for employee and dependents work towards one family deductible. If you only
enroll yourself in coverage, the individual deductible of $1,500 applies. An account will automatically be set up at HSA Bank when you enroll in the Consumer Choice HSA Medical Plan. An
To help protect you from an unexpectedly high cost, the plan features an out-of-pocket maximum. This is the most you HSA Bank Debit Card will be mailed to you. You can access your account through mycigna.com or the mycigna app. You
can view your account balance, pay bills, link claims to be paid automatically and even invest your HSA money through
will need to pay in one year. Unlike the other two plans, your medical and prescription costs are put towards a combined
PHYSICAL WELL-BEING You may use a Health Savings Account (HSA) to help you pay for the deductible and other qualified medical, How can I use my HSA funds? PHYSICAL WELL-BEING
the website.
out-of-pocket maximum.
prescription, dental and vision expenses on a tax-free basis.
Spend: Medical, prescription, dental and vision expenses for you, your spouse or any dependent you can claim on your
To help you get started with your health savings,
federal tax return.
Plymouth Rock will contribute up to $500 to your HSA!
Save: Unused money rolls over year over year. Use your savings in retirement!
What is a Health Savings Account (HSA)?
account directly through mycigna.com.
A Health Savings Account is a bank account for you to save pre-tax money through payroll deductions. It may be used
for you and qualified dependents for eligible medical, dental and vision expenses this year, or in the future. Your HSA Invest: Once your balance is $1,000, you can invest in mutual funds, stocks and bonds. You can open your brokerage
money can also be used as a vehicle to save for retirement. Who can I use my HSA funds for?
You can spend your HSA money on qualified expenses for yourself, your spouse and any dependent you can claim on
What are the Benefits of an HSA? your federal tax return.

Tax Advantage: Pre-tax money can be used to pay for out of pocket IRS-qualified medical, prescription, dental and Dependents Under Age 26: You can use your HSA money for a dependent’s qualified expenses only if you claim the
vision expenses. For a list of qualified expenses, visit Cigna.com. dependent on your tax return. If you do not claim a dependent that you cover for medical insurance, their medical

Account Ownership: You own the account. You can use it, invest it, save it and move it as you see fit. and prescription expenses will work towards your deductible, however, you cannot use HSA money to pay for their
expenses.
Portability: Accounts are completely portable. You can keep your HSA even if you change jobs, retire, change medical
coverage, become unemployed, move to another state or change marital status. Domestic Partners: Your partner is not recognized as an IRS qualified tax dependent, therefore you cannot use your
There are no “use it or lose it” rules for HSAs. HSA money for your partner. You can continue to cover your partner on the medical plan. Medical and prescription
expenses incurred by your partner will work towards the deductible.

Who is eligible to contribute to the HSA? How do I use my HSA to pay for expenses?
You must be enrolled in the Consumer Choice HSA Medical Plan and you cannot be claimed as a dependent on someone Invoices for Medical Services: When you go to the doctor or another medical provider, you will not pay anything at the
else’s tax return, be covered by another medical plan including a traditional health care FSA, be enrolled in Medicare or time of your visit. You will receive an explanation of benefit (EOB) from Cigna that summarizes your visit including what
be receiving Social Security benefits. you will owe the doctor; this is not an invoice. You will receive a separate invoice from the medical provider which you
can pay by using your HSA Bank Debit Card or checkbook, the online bill pay feature through mycigna.com or link your
How do I contribute to an HSA? claims to be paid automatically out of your HSA.
You can choose how much you would like to contribute each pay period or choose an annual amount for the year. You Point of Service Charges: Your HSA Bank Debit Card can also be used at point of service, such as at the pharmacy to
can change the amount you want to contribute or even choose to stop contributing throughout the year at anytime. You pay for prescriptions, at a dental office or to pay for glasses/contacts. If you use your own money, you can reimburse
can make HSA contribution elections directly through ADP. yourself by transferring HSA money to your own bank account through mycigna.com.

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