Page 8 - Vistra Demo

MYHEALTH HSA PLAN MyHealth HSA Plan
New for 2017: Only the MyHealth HSA plan will be offered in 2017. The plan, with coverage
provided by BlueCross BlueShield, has a company-provided health savings account (HSA) to help
pay for eligible medical expenses. If you participate in this plan, a WageWorks account will be set
up for you. The amount of dollars the company contributes to the account depends on the coverage
level you choose and the program activities you complete:

Only
MyHealth Activities … Employee Employee + Employee + Employee +
Child(ren)
Family
Spouse
Annual Physical Employee $900 $1,800 $900 $900
Spouse N/A N/A $900 $900
Age and Gender Screenings Employee $500 $500 $500 $500
Spouse N/A N/A $500 $500
GetConnected! one-time Employee $125 $125 $125 $125
registration Spouse N/A N/A $125 $125
2017 Potential EFH Funding Total $1,525 $2,425 $3,050 $3,050

The additional amount you can contribute will depend on the program activities you complete:
Your HSA Contributions
You Complete You Complete
All MyHealth activities No MyHealth activities
You only: $1,875 $3,400

You + Child(ren) $4,325 $6,750
All other coverage levels: $3,700 $6,750
If you are age 55-65, you may also contribute up to an additional $1,000 in 2017.
You may use your HSA to pay for any eligible health expenses including covered medical and
prescription drug expenses. Or, you may choose to pay out-of-pocket and let your HSA contributions
grow year-over-year to cover any major medical expenses in the future.
Prescription drug coverage for plan participants is available through CVS Caremark. There is no
separate prescription drug deductible or out-of-pocket maximum – it is included in your medical
deductible. Refer to page 10 for more information.

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