Page 10 - QSC Benefits Guide 7-17 COLORADO

MEDICAL INSURANCE

Health Savings Bank Account: It’s as Easy as 1-2-3!

The opportunity to establish and contribute to a Health Savings Bank Account is available when you elect the HSA PPO
Medical option. It’s like a personal, tax-free savings account for health care expenses that earns interest. Any unused money
rolls-over from year to year.

Here’s an overview of how it works:
B You enroll in the HSA PPO for Medical coverage and establish your Health Savings Bank Account with HSA Bank
online during open enrollment or any time during the year. You will receive a Welcome Packet at your home address
with detailed instructions on how to administer your Health Savings Bank Account.
C If enrolled, QSC will make biweekly HSA contributions of $46.16 per employee and $92.31 per family in 2017. These
contributions can total as much as $1,200 per employee and $2,400 per family for the year. QSC’s contribution
will be deposited in your account whether or not you decide to make your own contributions. In addition to QSC’s
contribution, you may elect to make contributions into your account up to IRS maximums. IRS maximums for 2017
are $3,400 for employee coverage and $6,750 for family coverage (these amounts include employee and employer
contributions). If you are 55 years of age or older in 2017, the IRS also permits you an additional catch-up contribution
of $1,000. The portion of your paycheck that you contribute to your Health Savings Bank Account will be taken out
before you pay federal income taxes, Social Security taxes and most state taxes (excluding state taxes in AL, CA
and NJ). Any contributions you make can be increased or decreased over the course of the year.
D You can decide how to manage your money. The money in your Health Savings Bank Account is yours to save
and spend on eligible health care expenses whenever you need it, whether in 2017 or during a later year. You can
use the funds in your account to pay tax-free for qualifying out-of-pocket Medical, Dental, Vision, and Prescription
Drug expenses such as deductibles, coinsurance and copays. Your account balance earns interest and the unused
balance rolls-over from year to year. The money is yours to keep even if you leave QSC, no longer participate in a
high deductible health plan (like the HSA PPO), or retire. You may continue to make contributions to your Health
Savings Bank Account if you enroll in another qualified high deductible health plan, or elect COBRA continuation
coverage of your HSA PPO coverage if your employment terminates.

PPO HSA
HSA TAX SAVINGS COMPARISON EMPLOYEE FAMILY EMPLOYEE FAMILY
FIRST DOLLAR EXAMPLE
Calendar Year Deductible $500 $1,000 $1,300 $2,600
Annual QSC HSA Contribution* N/A N/A $1,200 $2,400
Adjusted Deductible $500 $1,000 $100 $200
CATASTROPHIC EXAMPLE
Out-of-Pocket Maximum (includes deductible) $3,000 $6,000 $2,600 $5,000
Annual Employee Contribution* $1,690 $5,460 $1,040 $4,550
Annual QSC HSA Contribution* N/A N/A $1,200 $2,400
Total Annual Employee Maximum Cost $4,690 $11,460 $2,440 $7,150
*Dollar amounts reflect the annualized contributions for the 2017-2018 plan year.

About HSA Bank
You must establish your Health Savings Bank Account through HSA Bank during the 30-day enrollment window following your
hire date to be eligible to receive the full company contribution. Also, in order for an expense to be paid through your Health
Savings Bank Account account, it must be opened and funded with at least one cent on the date when the claim occurred.

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