Page 6 - 2018 Roquette Benefit Guide
P. 6
How Does an HSA Work?
Eligible Examples
X Medical expenses: copays, An HSA works in conjunction with your high deductible health plan
coinsurance, and deductibles coverage. Your HSA dollars can be used to help pay the health insurance
deductible and qualiied medical expenses, including those not covered by
X Dental expenses: exams,
cleanings, x-rays, and braces health insurance such as dental and vision care. Any funds you withdraw
for non-qualiied healthcare expenses will be taxed at your income tax
X Vision expenses: exams, contact rate, plus 20% if you’re under 65.
lenses and supplies, eyeglasses,
and laser eye surgery
Maximum Contributions for the Plan Year
X Professional services: physical Coverage Level IRS Mandated Maximum Contribution
therapy, chiropractic, and
acupuncture services Individual $3,450
Family $6,850
X Prescription drugs and insulin Age 55+ Add an additional $1,000 to these amounts as a catch-up
contribution!
X Over-the-counter healthcare
items: bandages, pregnancy test
kits, blood pressure monitors, etc. HSA Eligible and Ineligible Expenses
X Insurance premiums: COBRA Funds withdrawn from your HSA are tax-free when used to pay for
premiums and Medicare qualiied medical expenses as described in Section 213(d) of the Internal
supplement premiums are Revenue Service Tax Code. A list of these expenses is available on the
eligible for retired or separated IRS website, www.irs.gov in IRS Publication 502, “Medical and Dental
employees
Expenses.”
Ineligible Examples
X Babysitting The list to the left provides examples of eligible and ineligible healthcare
expenses. This list is not all-inclusive. Remember, the IRS may modify
X Cosmetic surgery
its list of eligible expenses from time to time. As always, consult your tax
X Funeral expenses advisor should you require speciic tax advice.
X Hair transplant
Medical Contributions—Monthly
X Health club dues
Low Deductible Plan High Deductible Health
X Teeth whitening Plan
Employee $197.76 $146.26
Employee + Spouse $413.73 $305.06
Employee + Children $382.32 $280.25
Family $599.09 $424.57
6 2018 Benefits Enrollment
Eligible Examples
X Medical expenses: copays, An HSA works in conjunction with your high deductible health plan
coinsurance, and deductibles coverage. Your HSA dollars can be used to help pay the health insurance
deductible and qualiied medical expenses, including those not covered by
X Dental expenses: exams,
cleanings, x-rays, and braces health insurance such as dental and vision care. Any funds you withdraw
for non-qualiied healthcare expenses will be taxed at your income tax
X Vision expenses: exams, contact rate, plus 20% if you’re under 65.
lenses and supplies, eyeglasses,
and laser eye surgery
Maximum Contributions for the Plan Year
X Professional services: physical Coverage Level IRS Mandated Maximum Contribution
therapy, chiropractic, and
acupuncture services Individual $3,450
Family $6,850
X Prescription drugs and insulin Age 55+ Add an additional $1,000 to these amounts as a catch-up
contribution!
X Over-the-counter healthcare
items: bandages, pregnancy test
kits, blood pressure monitors, etc. HSA Eligible and Ineligible Expenses
X Insurance premiums: COBRA Funds withdrawn from your HSA are tax-free when used to pay for
premiums and Medicare qualiied medical expenses as described in Section 213(d) of the Internal
supplement premiums are Revenue Service Tax Code. A list of these expenses is available on the
eligible for retired or separated IRS website, www.irs.gov in IRS Publication 502, “Medical and Dental
employees
Expenses.”
Ineligible Examples
X Babysitting The list to the left provides examples of eligible and ineligible healthcare
expenses. This list is not all-inclusive. Remember, the IRS may modify
X Cosmetic surgery
its list of eligible expenses from time to time. As always, consult your tax
X Funeral expenses advisor should you require speciic tax advice.
X Hair transplant
Medical Contributions—Monthly
X Health club dues
Low Deductible Plan High Deductible Health
X Teeth whitening Plan
Employee $197.76 $146.26
Employee + Spouse $413.73 $305.06
Employee + Children $382.32 $280.25
Family $599.09 $424.57
6 2018 Benefits Enrollment
