Page 22 - Tacony 2021 Annual Benefits
P. 22
If My Spouse has Coverage in Another HSA-Qualified Plan or I Have Coverage Which Makes
Me Ineligible—Does This Affect the Amount I May Contribute to my HSA?
These charts illustrate some scenarios of how much you or your spouse may contribute on an annual basis based on
other potential coverage. Remember, eligibility for you to open an HSA is based on your circumstances (including
whether you are covered under a spouse’s non-qualiied plan). These scenarios also assume both you and your
spouse will be enrolled in both of your respective health plans for the full calendar year. If you will not be enrolled
the entire year, please review the section “How much may I contribute?”
Assumes for Sample Purposes
Maximum Annual Contribution
Your HSA Plan $3,550 single or $7,100 family
Spouse’s HSA Plan $3,550 single or $7,100 family
Employee and Spouse are Enrolled as of January 1 for the Full Calendar Year
To use the eligibility chart, choose the column which applies to your coverage and the row which applies to your
spouse’s coverage. Please reference IRS Publication 969 for further information with respect to HSA contributions.
Eligibility Chart
Employee Enrolls in Employee Enrolls in
Employee Enrolls in Medical Plan with Medical Plan with Employee Enrolls in
Family Coverage
Medical Plan with Family Coverage (spouse NOT Medicare
Single Coverage (spouse enrolled as enrolled as Employee Declines (Or Other Non-
dependent w/HSA) dependent w/HSA) Medical Plan HSA Qualifying
Single Family Single and Coverage)
Child(ren)
Spouse Enrolls in You may contribute You may contribute You may contribute Neither may Neither may
Single Non-HSA up to $3,550 to HSA up to $7,100 to HSA up to $7,100 to HSA contribute contribute
Coverage
(you are NOT
enrolled as
dependent)—Single
Spouse Enrolls in Neither may Neither may Neither may Neither may Neither may
Family Non-HSA contribute contribute contribute contribute contribute
Coverage
(you are enrolled as
dependent)—Family
Spouse Enrolls in You may contribute You may contribute You may contribute Neither may Neither may
Family Non-HSA up to $3,550 to HSA up to $7,100 to HSA up to $7,100 to HSA contribute contribute
Coverage
(you are NOT
enrolled as
dependent)—Single
and Child(ren)
22 2021 Benefits Enrollment
Me Ineligible—Does This Affect the Amount I May Contribute to my HSA?
These charts illustrate some scenarios of how much you or your spouse may contribute on an annual basis based on
other potential coverage. Remember, eligibility for you to open an HSA is based on your circumstances (including
whether you are covered under a spouse’s non-qualiied plan). These scenarios also assume both you and your
spouse will be enrolled in both of your respective health plans for the full calendar year. If you will not be enrolled
the entire year, please review the section “How much may I contribute?”
Assumes for Sample Purposes
Maximum Annual Contribution
Your HSA Plan $3,550 single or $7,100 family
Spouse’s HSA Plan $3,550 single or $7,100 family
Employee and Spouse are Enrolled as of January 1 for the Full Calendar Year
To use the eligibility chart, choose the column which applies to your coverage and the row which applies to your
spouse’s coverage. Please reference IRS Publication 969 for further information with respect to HSA contributions.
Eligibility Chart
Employee Enrolls in Employee Enrolls in
Employee Enrolls in Medical Plan with Medical Plan with Employee Enrolls in
Family Coverage
Medical Plan with Family Coverage (spouse NOT Medicare
Single Coverage (spouse enrolled as enrolled as Employee Declines (Or Other Non-
dependent w/HSA) dependent w/HSA) Medical Plan HSA Qualifying
Single Family Single and Coverage)
Child(ren)
Spouse Enrolls in You may contribute You may contribute You may contribute Neither may Neither may
Single Non-HSA up to $3,550 to HSA up to $7,100 to HSA up to $7,100 to HSA contribute contribute
Coverage
(you are NOT
enrolled as
dependent)—Single
Spouse Enrolls in Neither may Neither may Neither may Neither may Neither may
Family Non-HSA contribute contribute contribute contribute contribute
Coverage
(you are enrolled as
dependent)—Family
Spouse Enrolls in You may contribute You may contribute You may contribute Neither may Neither may
Family Non-HSA up to $3,550 to HSA up to $7,100 to HSA up to $7,100 to HSA contribute contribute
Coverage
(you are NOT
enrolled as
dependent)—Single
and Child(ren)
22 2021 Benefits Enrollment
