Page 11 - Adreima Enrollment Guide

Adreima

How an HSA Works with the Consumer Driven

Health Plan

How You Use Your HSA
You determine how and when to use your HSA dollars. You can use

your funds to pay for qualiied expenses covered by the Consumer
Driven Health Plan. If you decide to use funds to pay for ineligible
expenses, there will be a 20 percent penalty, plus income tax payment.
You can also pay for health expenses out of pocket and let your HSA
funds grow.

Any funds remaining at the end of the year will remain in your
account for future use. If you leave Adreima, you take your HSA
funds with you.

You are Eligible to Open and Fund an HSA If
„ You are covered by an HSA eligible CDHP option

„ You are not covered by your spouse’s health plan or FSA

„ You are not eligible to be claimed as a dependent on someone
else’s tax return

„ You are not enrolled in Medicare, TRICARE, or TRICARE for
Life

„ You have not received Veterans Administration Beneits

How You Fund Your HSA
You can set aside dollars on a pre-tax basis through payroll deduction

if you open an HSA through Beneit Wallet.

How the Plan Provides Coverage

1. You pay 100 percent for all medical and prescription drug
services up to the plan’s annual deductible
2. After you satisfy the annual deductible, you pay the appropriate
coinsurance until you meet the annual out-of-pocket maximum

3. The plan pays 100 percent of eligible expenses once you meet the
annual out-of-pocket maximum

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