Page 23 - Tacony 2021 Annual Benefits
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Eligibility Chart
Employee Enrolls in Employee Enrolls in Employee
Employee Enrolls in Medical Plan with Medical Plan with Enrolls in
Medical Plan with Family Coverage Family Coverage Employee Medicare
Single Coverage (spouse enrolled as (spouse NOT enrolled Declines (or other
dependent w/HSA) as dependent w/HSA) Medical Plan non-HSA
qualifying
Single Family Single and coverage)
Child(ren)
Spouse Enrolls in You may contribute Spouse and Spouse and employee Spouse may Spouse may
Single up to $3,550 to employee may may contribute a contribute up contribute up
HSA-Qualiied HSA; spouse may contribute a combined total not to $3,550 to to $3,550 to
Coverage—Single contribute up to combined total not to exceed $7,100 spouse’s HSA spouse’s HSA
$3,550 to spouse’s to exceed $7,100 distributed between
HSA distributed between their accounts
their accounts
Spouse Enrolls Spouse and Spouse and Spouse and employee Spouse may Spouse may
in Family HSA- employee may employee may may contribute a total contribute a contribute up
Qualiied contribute a contribute a not to exceed $7,100 total of $7,100 to $7,100 to
Coverage combined total combined total not to distributed between spouse’s HSA
(you are enrolled as not to exceed exceed $7,100 their accounts
dependent)—Family $7,100 as long
as the employee
contributes no more
than $3,550
Spouse Enrolls Spouse and Spouse and Spouse and employee Spouse may Spouse may
in Family HSA- employee may employee may may contribute a total contribute up contribute up
Qualiied contribute a contribute a not to exceed $7,100 to $7,100 to to $7,100 to
Coverage combined total combined total not distributed between spouse’s HSA spouse’s HSA
(you are NOT not to exceed to exceed $7,100 their accounts
enrolled as $7,100 distributed distributed between
dependent)—Single between their their accounts
and Child(ren) accounts as long
as the employee
contributes no more
than $3,550
Spouse Enrolls in Neither may Neither may Neither may contribute Neither may Neither may
General Purpose contribute contribute contribute contribute
Medical FSA Plan*
Spouse Enrolls in You may contribute You may contribute You may contribute up Neither may Neither may
Medicare up to $3,550 to HSA up to $7,100 to HSA to $7,100 to HSA contribute contribute
* Note: typically, a general purpose medical FSA covers all family members (employee, spouse and tax dependents); therefore a spouse enrolled in a
general purpose medical FSA would disqualify the employee from opening and contributing to the HSA. The spouse would need to verify this with
their employer.
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Employee Enrolls in Employee Enrolls in Employee
Employee Enrolls in Medical Plan with Medical Plan with Enrolls in
Medical Plan with Family Coverage Family Coverage Employee Medicare
Single Coverage (spouse enrolled as (spouse NOT enrolled Declines (or other
dependent w/HSA) as dependent w/HSA) Medical Plan non-HSA
qualifying
Single Family Single and coverage)
Child(ren)
Spouse Enrolls in You may contribute Spouse and Spouse and employee Spouse may Spouse may
Single up to $3,550 to employee may may contribute a contribute up contribute up
HSA-Qualiied HSA; spouse may contribute a combined total not to $3,550 to to $3,550 to
Coverage—Single contribute up to combined total not to exceed $7,100 spouse’s HSA spouse’s HSA
$3,550 to spouse’s to exceed $7,100 distributed between
HSA distributed between their accounts
their accounts
Spouse Enrolls Spouse and Spouse and Spouse and employee Spouse may Spouse may
in Family HSA- employee may employee may may contribute a total contribute a contribute up
Qualiied contribute a contribute a not to exceed $7,100 total of $7,100 to $7,100 to
Coverage combined total combined total not to distributed between spouse’s HSA
(you are enrolled as not to exceed exceed $7,100 their accounts
dependent)—Family $7,100 as long
as the employee
contributes no more
than $3,550
Spouse Enrolls Spouse and Spouse and Spouse and employee Spouse may Spouse may
in Family HSA- employee may employee may may contribute a total contribute up contribute up
Qualiied contribute a contribute a not to exceed $7,100 to $7,100 to to $7,100 to
Coverage combined total combined total not distributed between spouse’s HSA spouse’s HSA
(you are NOT not to exceed to exceed $7,100 their accounts
enrolled as $7,100 distributed distributed between
dependent)—Single between their their accounts
and Child(ren) accounts as long
as the employee
contributes no more
than $3,550
Spouse Enrolls in Neither may Neither may Neither may contribute Neither may Neither may
General Purpose contribute contribute contribute contribute
Medical FSA Plan*
Spouse Enrolls in You may contribute You may contribute You may contribute up Neither may Neither may
Medicare up to $3,550 to HSA up to $7,100 to HSA to $7,100 to HSA contribute contribute
* Note: typically, a general purpose medical FSA covers all family members (employee, spouse and tax dependents); therefore a spouse enrolled in a
general purpose medical FSA would disqualify the employee from opening and contributing to the HSA. The spouse would need to verify this with
their employer.
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